Although many of the severe health consequences of STDs manifest themselves among adults, these complications usually result from infections acquired or health behaviors initiated during adolescence. By the twelfth grade, nearly 70 percent of adolescents have had sexual intercourse, and approximately one-quarter of all students have had sex with four or more partners. Therefore, a national strategy to prevent STDs needs to focus on adolescents. The committee believes that adolescents should be strongly encouraged to delay sexual intercourse until they are emotionally mature enough to take responsibility for this activity. However, most individuals will initiate sexual intercourse during adolescence, and they should have access to information and instruction regarding STDs (including HIV infection) and unintended pregnancy and methods for preventing them.
Many school-based programs and mass media campaigns are effective in improving knowledge regarding STDs and in promoting healthy sexual behaviors, and these two interventions should be major components of an STD prevention strategy. The committee believes that there is strong scientific evidence in support of school-based programs for STD prevention, that adolescence is the critical period for adopting healthy behaviors, and that schools are one of the few venues available to reach adolescents. Given the high rates of sexual intercourse among adolescents and the significant barriers that hinder the ability of adolescents to purchase and use condoms, condoms should be available in schools as part of a comprehensive STD prevention program. There is no evidence that condom availability or school-based programs for sexuality or STD education promote sexual activity.
STD-related clinical services for adolescents, including hepatitis B immunization, should be expanded through school and student health clinics, because adolescents are less likely than adults to have health insurance and they infrequently use regular health care facilities. Adolescents who are not enrolled in school also need access to clinical services. Because confidentiality is a major concern for adolescents, they should be able to consent to STD-related services without parental knowledge.
With respect to the above issues, the committee makes the following recommendations: