frank communication and the sharing of information regarding sexuality and STDs are essential to preventing high-risk sexual behavior. In order to change behavior, Americans have to feel comfortable discussing sexual health issues; open communication between parents and children, between sexual partners, between teachers and students, and between health care providers and patients is essential. The secrecy surrounding sexuality impedes sexuality education programs for adolescents, open discussion between parents and their children and between sex partners, balanced messages from mass media, education and counseling activities of health care professionals, and community activism regarding STDs. Opponents of sexuality education programs for adolescents are likely to deny the possibility that their children are sexually active. Unfortunately, denial often eliminates the possibility that parents will communicate with their children regarding STDs, and this encourages high-risk behaviors. Children in these families are likely to get their information, which is often inaccurate, from other sources. Lack of comfort with open discussions of sexuality also makes open communication regarding sexual history and negotiating safer sex difficult. In addition, this discomfort has also resulted in a mass media that has not been involved in promoting healthy sexual behaviors. This industry commonly acquiesces to the public's fascination with sex, yet is generally not willing to incorporate and promote factual information regarding STDs and protective behaviors. Furthermore, discomfort and secrecy among health care providers adversely affects the delivery of health services. As a result, many clinicians do not identify potential problems or are ineffective in counseling their patients regarding healthy sexual behavior. Finally, secrecy hinders community activism for STDs. An effective STD prevention program should focus on overcoming all barriers to open communication.

Despite or because of the secrecy surrounding sexuality, adolescents and young adults are becoming increasingly sexually active. Better research is needed to track the problem of STDs and identify possible solutions; much of the data available in this area are seriously outdated or incomplete. There is a compelling need for further training of clinicians, educators, and researchers in the area of human sexuality. The poor understanding of STDs among Americans strongly supports a coordinated campaign to improve knowledge and awareness.

References

AAP (American Academy of Pediatrics), Committee on Child Abuse and Neglect. Guidelines for the evaluation of sexual abuse of children. Pediatrics 1991;87:254-60.

AMA (American Medical Association), Council on Scientific Affairs. Health care needs of homeless and runaway youths. JAMA 1989;262:1358-61.

AMA, Council on Scientific Affairs. Health care needs of gay men and lesbians in the United States. JAMA 1996;275:1354-9.

Amaro H. Considerations for prevention of HIV infection among Hispanic women. Psychol Women Q 1988; 12:429-43.



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