prevention and family planning policy found that only eight states had a written policy on sexuality education for youths in out-of-home care (i.e., family foster care, group homes, and residential care) (Mayden, 1996).
STDs are also a major problem among homeless adults. For example, a study of homeless women in Chicago seeking gynecological care revealed that 26 percent had trichomoniasis, 6 percent had gonorrhea, and 5 percent had pelvic inflammatory disease (Johnstone et al., 1993). Another study of homeless persons in Baltimore found that 8 percent of men and 11 percent of women had positive gonorrhea or syphilis tests and nearly one-third reported a prior STD (Breakey et al., 1989).
Adolescents in detention facilities have higher rates of risky sexual and substance use behaviors than do other adolescents (Shafer et al., 1993; Shafer, 1994). Adolescents in detention facilities may represent "core" transmitters of STDs since they have problems, such as high rates of drug and alcohol use and poor access to health care, that place them at continuing risk for STDs (Shafer, 1994). Compared to other adolescents, those in detention facilities tend to have engaged in sexual intercourse earlier and more frequently; have engaged in unsafe sexual practices more often; and have higher rates of STDs (Bell et al., 1985; DiClemente et al., 1991; Weber et al., 1992; Oh et al., 1994). Of 966 sexually experienced male adolescents examined in an Alabama detention center, 48 percent became sexually active before age 13; age at first intercourse ranged from 5 to 17 years (Oh et al., 1994). In a study of 1,580 male adolescents in juvenile detention in rural Florida, 27 percent were sexually active by age 11 (Weber et al., 1992). Multivariate models show that inconsistent condom use, multiple partners, and frequent alcohol use appear to increase the risk of STDs (Shafer et al., 1993). These same factors are likely to play a role in the larger population as well. Although condom use is low among adolescents in detention, those who communicate with their partners regarding their sexual history and who know someone with AIDS are more likely to use condoms (Rickman et al., 1994).
Both male and female adolescents in detention facilities have high rates of STDs. A 1994 national survey of state and local juvenile detention facilities found that the rate of gonorrhea was, respectively, 152 and 42 times greater among confined male and females adolescents than among their counterparts in the general population (CDC, 1996b). In a study of 414 sexually active male adolescents in a San Francisco detention center, 15 percent were diagnosed with at least one STD and 34 percent reported a history or had current evidence of an STD at the time of entry into the facility (Shafer et al., 1993). Twelve percent of male adolescents tested in an Alabama detention center for gonorrhea, chlamydial infection, and syphilis were positive for at least one of the three STDs (Oh et al., 1994). In addition, almost a third of the female adolescents in a King County,