The final plenary of NHPC 2015 focused on the issues of sexual health for youth, the need to deliver effective HIV prevention messages, and the role social media can play in public health outreach. The session also featured closing remarks by CDC Director Dr. Thomas Frieden and retiring HHS Deputy Assistant Secretary for Health, Dr. Ronald O. Valdiserri.
Dr. Amy Lansky, Senior Policy Advisor in CDC Division of HIV/AIDS Prevention (DHAP), opened the session by introducing Dr. Stephanie Zaza, Director of CDC’s Division of Adolescent and School Health, who presented data indicating that the proportion of teens who have ever had sex (47%) and those who are currently sexually active (37%) has remained constant since 2001. There has also been little change in the number of teens who have multiple partners or who used drugs/alcohol before their last sexual encounter–but the proportion of teens who used a condom the last time they had sex has been declining since 2003.
Zaza told the crowd that, as teens progress through high school, the data show increases in the proportions of students who are having sex and who have multiple sexual partners. Sexually active students in 12th grade also use condoms at a lower rate than students in 9th grade. Data for 2013 show that, by 12th grade, two-thirds of high school students are sexually experienced; half are currently sexually active and/or have had 4 or more sex partners.
Zaza emphasized that schools have a critical role to play in providing effective sex education to help reduce teens’ risks for sexually transmitted infections (STIs) and HIV. Schools can reduce risk by providing sexual health services or referring students to those services, and by creating safe and supportive environments for sexual- and gender-minority students. Although a number of states require schools to teach sexual health, Zaza said. “Requirements are important, but they may not reflect what is actually being taught in the classroom.”
She also spoke about findings from the newly released 2014 School Health Profiles, which indicate that many high schools are not doing well in teaching 16 critical sex education topics, and the proportion of schools teaching sexual health education is declining. A survey of lead health education teachers found that abstinence and information on HIV/STI transmission are taught more often than other topics (e.g., how to use a condom correctly). On a brighter note, Zaza mentioned that schools are making progress in creating safe environments for LBGT inclusiveness.
Zaza closed her remarks by reiterating that school-based sex education is a key opportunity to teach kids how to protect themselves before they become sexually active. She said, “I know we can help [our teens] be better prepared for their sexual lives.”
Thomas Davis, creator of thepozlife.com, shared his personal perspectives on the need to give young people accurate information about sexual health. He said that not getting enough information about sex from adults only fuels young people’s interest–often with a great sense of shame attached. He said that most youth simply want to be asked how they are doing without judgment and to have adults make a connection with them and meet them where they are. Davis told the audience that these approaches are more likely to encourage young people to evaluate their behaviors and empower them to make good sexual health decisions.
Davis was followed by Dr. David Purcell, Deputy Director for Behavioral and Social Science at DHAP, who presented a short history of HIV prevention messaging, including how that messaging has evolved as the number of prevention options and outreach channels has increased. Messaging that began as person-to-person outreach at bath houses and street fairs in the 1980s moved to Internet chat rooms in the 1990s. Today, state-of-the-art digital communities use social media and dating apps with geosocial networks to promote HIV prevention.
New channels mean new messages, Purcell said, and we are working to adapt in a number of way, including:
- Expanding messages about “protected” and “unprotected” sex to reflect new interventions like PrEP;
- Creating and promoting new campaigns, like Start Talking. Stop HIV., to emphasize the importance of discussions with partners, family, and friends; and
- Developing the newly released HIV Risk Reduction Tool, to give online users the ability to customize their HIV risk assessments.
Purcell closed his presentation by noting that new interventions, channels, and messages make this both an exciting and challenging era in HIV prevention. He also stressed that CDC will continue to update all of its HIV prevention messages and engage external and internal audiences for feedback.
After the presentations, Francisco Ruiz, CDC, moderated a panel on using social and digital media for HIV prevention and outreach. Panelists were: Lisa Hightow-Weidman, University of North Carolina School of Medicine; Jen Hecht, San Francisco AIDS Foundation; Jack Harrison-Quintana, Grindr for Equality; Matthew Rose, The Black AIDS Institute; Dan Wohlfeiler, Building Healthy Communities Online; and Chandi Moore, BLUSH Project.
Panel participants emphasized the need for greater collaboration and sharing of developed technologies to deliver HIV prevention messages to the right populations in the right spaces. They also stressed that a broad range of new technologies can be used to teach youth to make healthy sexual decisions, to reduce stigma, and to change the course of the epidemic. The panel agreed that embracing technology is important, but there is also a need to evaluate technologies to ensure we are using them in the best way possible.
Dr. Eugene McCray, Director of DHAP, introduced the conference’s final two speakers. CDC Director Dr. Thomas Frieden shared his perspectives on using public health principles to end the HIV epidemic. He noted important successes, including more people who know their HIV status, fewer infections, and fewer deaths. But there are also emerging risks, including treatment gaps for key populations and injection drug use (IDU). He discussed the recent outbreak of HIV infection linked to IDU in Indiana, saying that the crisis showed the vulnerability of people who inject drugs to both HIV and Hepatitis C (HCV) infections, and demonstrates the potential for additional HIV/HCV outbreaks in communities with significant amounts of IDU.
Frieden concluded by emphasizing the need for a comprehensive public health approach, with real-time surveillance, partner notification, prompt diagnosis, improved quality of care, and scaled-up primary prevention efforts. He encouraged the audience to stay engaged with their communities, to combat stigma, and to work to address other issues such as housing, addiction, and mental illness, that will help us reach those who are most in need.
Dr. Ronald O. Valdiserri, who is retiring after 27 years of Federal service, closed the conference with a ringing reminder of the bitter lessons of the AIDS epidemic and the need to address social and health inequities to prevent future epidemics. “Science alone will not end this epidemic,” he said, “because AIDS has always been much more than a nasty retrovirus playing hell with the human immune system. AIDS was, and is, a disease that thrives on social inequalities…along with the science, we must continue to cultivate strong leadership, mobilize communities, and promote a shared vision of ending AIDS, and…achieving health equity. These are the lessons we must never forget because our brothers and sisters died to expose these truths.”
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