Adolescents and sexual health are words not often said together unless it’s referring to negative news like teen pregnancy and sexually transmitted disease (STD) rates. And while some negative news may be true, it does not give us the full story of adolescent sexual health. There are many youth who lead sexually responsible lives. These youth have been empowered to be abstinent; practice safer sex; communicate with their parents and their partner; and/or get tested for STDs. How can we combine the negative and positive messages to encourage youth to take control of their sexual health? Here’s one example: school-based STD screening.
My organization, the National Coalition of STD Directors (NCSD), has partnered with American Social Health Association (ASHA) to promote and recognize World Sexual Health Month. World Sexual Health Month is recognized in September and is an opportunity to increase awareness of sexual health and its impact on individuals and society. Sexual health is much more than STDs, pregnancy, and puberty. It is multidimensional – physical, spiritual, emotional, mental, and social. It is a part of each one of us.
But we know teens are disproportionally impacted by sexually transmitted infections. Half of all new STD cases are in youth ages 15-24. One in four youth will contract an STD each year. Many STDs have no signs or symptoms. These statistics alone will not lead youth to get tested or use a condom every time they have sex. However, there are opportunities to provide youth with information and access to testing right at their fingertips and empower them to make healthy decisions.
One such way is through school-based STD screening programs. Schools, health departments, and community-based organizations are joining forces to provide youth with needed access to STD information, testing and treatment where youth spend a larger portion of their day – at school.
Youth face numerous barriers in accessing medical care, especially for sexual health. Partnerships between schools, public health departments and community based organizations can help knock down barriers youth often face. Barriers such as inconvenient hours/locations, no financial means, fear of test, lack of awareness about STDs, and stigma, can be mitigated by providing STD screening programs in school. In addition to eliminating barriers, schools provide an optimal location for STD testing because of the connection between academics and health. A student worried about whether or not they have an STD or a student in pain and discomfort all day, may be less motivated and engaged during the school day. This makes it harder to learn and may lead to absenteeism.
Conducting the school-based STD screening programs takes coordination and cooperation among all interested parties (i.e. schools, medical providers, and community based organizations). In general, a STD screening program targets high-school aged youth. Each student is provided with a short educational session and a testing kit comprised of paper work and a urine specimen cup. All youth are directed to a restroom and enter individual stalls. At this point, youth are able to decide to take the test or not. If they decide to get tested then they provide a urine specimen. If they decide not to, then the directions ask them to fill out the paperwork and wait in the stall for a certain amount of time (for example, come out of stall after singing a certain song in their head). After exiting the stall, students return the brown paper bag to dedicated staff. Because all students go through the same steps, students can choose to be tested without the concern of stigmatization by their peers or others. Following the screening event, the medical provider sends specimens to a lab for testing and results are confidentially shared with students. Often the medical provider returns to the school to provide students who tested positive, treatment.
Many states and cities are already doing school-based STD screening programs. NCSD, through a cooperative agreement with the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC DASH), is currently working with Michigan to develop an RFP to expand their school-based STD program throughout the state and to develop a memorandum of agreement to be used between the state health department, medical provider, and school. In addition, NCSD will be working with other DASH funded sites to increase awareness about school-based STD screening programs and move agencies toward action.
In previous years with the support of CDC DASH, NCSD produced a series of webinars on the replication of school-based STD screening programs. The webinars include programs in a variety of settings such as Louisiana, Michigan, District of Columbia, Miami-Dade County, and Durango, CO. The webinars offered participants strategies for successful implementation of a STD screening program and other comprehensive reproductive health services in a school setting.
In addition, NCSD will be highlighting the Philadelphia High School STD Screening Program in an upcoming publication focusing on how STD programs can bill for services. The Philadelphia program, through a partnership with the Family Planning Council, is able to bill Medicaid for the school-based STD test if students provide their consent. While they are not able to recoup all expenses, Philadelphia is able to off-set program costs.
So what’s the positive side of this story? Youth are getting tested and treated when they may not have otherwise. Youth are connecting with sexual health resources and medical providers. Youth are getting up-to-date, medically accurate information to assist in decision making. NCSD and other non-governmental organizations are supporting and providing technical assistance to state health and education agencies to increase the number of localities conducting school-based STD screenings. National organizations are partnering to increase awareness of sexual health. With this combination of activities, we hope to see the number of sexually healthy adolescents grow. Only time will tell.
Becky Griesse, MPH, CHES
National Coalition of STD Directors
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