Black Sexual Health: Condition Critical
The high STD infection rate among black teens threatens an explosion in the AIDS epidemic
The study is just the latest on a growing list of Centers for Disease Control and Prevention investigations that have found the sexual health of black youth to be in critical condition. You name it, and we're more likely to get it. HIV/AIDS? Yup, we're 69 percent of newly diagnosed cases among teens. Syphilis? While it's holding steady or declining in other racial groups, it's shooting up among black teens, particularly boys. Teen pregnancies? Rates went up for the first time in 14 years in 2006, and black girls saw the highest spike.
But before you start wagging fingers and passing judgment, there's another set of stats about youth sexual health that don't get reported as often. CDC studies have consistently found that black youth—male and female, gay and straight—are not leading terribly risky sex lives compared to their peers, and in many cases they are in fact far more responsible.
Why, then, are they so much more likely to have health troubles? That's the billion-dollar research question, and it remains both hotly debated and largely unanswered.
First, let's run the numbers. This latest study, released March 11 at the CDC's annual conference on STD prevention, was the first of its sort. Researchers culled through 2003-2004 data in an ongoing, annual health survey of American households. As part of that survey, 838 14- to 19-year-old girls were tested for a handful of common sexual transmitted infections—chlamydia, herpes, human papilloma virus, or HPV. Forty-eight percent of black girls had at least one of the STIs, compared to 20 percent of white and Mexican American girls (the only Latino group CDC broke down the numbers on).
HPV was by far the most common infection, and it's worth noting that studies have long shown its wide prevalence among sexually active people of any age. The virus is contracted by simple skin-to-skin contact and, in nine out of 10 cases, the body naturally clears what is an essentially inconsequential infection. There is however a link, in some cases, between HPV and later development of cervical cancer, prompting a heated debate over whether states should mandate—and pay for—a newly developed HPV vaccine for kids.
Conservative activists, meanwhile, have long held up HPV as proof that condoms don't work and that abstinence-until-marriage is the only healthy way to live.
But the politics and economics of HPV aside, the CDC's study raises troubling questions beyond the particular infections it discusses. For one, researchers expect the teen STI and STD rate to be even higher than they actually found, because their study didn't include a number of serious infections, such as syphilis, gonorrhea and, the big one, HIV. Which raises a giant, troubling question. There's much we don't know about HIV, but one thing is clear: If you've got an untreated STI or STD and you have unprotected sex with someone who's HIV positive, the chances of you contracting the virus go up as much as five-fold. If half of black teen girls had an STI in 2004, the potential growth of the black AIDS epidemic is off the charts.
Indeed, undiagnosed STDs have emerged as one of the leading theories explaining why the overall American AIDS epidemic is so racially lopsided—African Americans, who make up 13 percent of the overall U.S. population, represent about half of all new HIV infections every year. Among women, the number is a stunning 60 percent. This week's study suggests those numbers are likely to get worse before they get better.
So what do we do about all of this? What's clearly not the answer is to tar black kids as sexually reckless. In fact, CDC studies show them to be relatively responsible. Federal and state health officials work together every two years to survey high school students about the wide range of risks they take in everyday life, ranging from riding bikes without helmets to snorting coke. And they ask about sex—how often the students do it, under what circumstances, and with what precautions.
It's true that black youth report more active sex lives than their peers. They're more likely to have ever had sex, to start by age 13, and to have multiple sex partners in their lifetime. But among all students who report having sex, black youth are less likely to do so in ways most people would consider risky. They are more likely to use condoms. They are far more likely to be sober when they have sex. And they are far more likely to get HIV tests.
One compelling theory explaining this disconnect between taking risks and getting infections is that blacks have smaller sexual networks than whites—we choose our sex partners from within tight-knit social circles. Thus, once an infection is introduced into the circle, be it HIV or HPV, it spreads more quickly. Another, similar theory is that widespread prevalence spawns wider spread prevalence—as one AIDS activist puts it, the more sharks swimming in my section of the water, the more likely I am to get bitten.
But ultimately, all of these sexual health studies add up to more questions than answers about black youth sexuality. We know far more about the troubling outcomes of sex than we do about the range of inputs. What drives sexual choices? How are they made and under what emotional and mental circumstances? When young people don't choose condoms, why don't they? We've established there's a problem. Let's start having an honest, and urgent, conversation about what's behind the problem.
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