"You're going to talk to people about what??!"
This is the refrain I heard from most people when I told them what I was going to do on The Millennial Trains Project. My project was talking to youth across America about their barriers to contraception and sexual health information.
Despite the perceived hesitancy around asking people about this issue, people wanted to talk to me. I can count on one hand the number of people who turned me down, and those that said yes were well over 70.
My premise was pretty simple. While the teen pregnancy rate in the US is the lowest it's been in decades, it's still one of the highest in the developed world and 15-24 year olds make up nearly half of all new STD cases. (I'm going to use the acronym STDs in this article, because while STI is the correct terminology, STD is still the term used most vernacularly, and is what I used while interviewing people).
So if we're providing so much education, what's going on? What's the reason for the continually high statistics? Are youth not getting access to information? Are they not able to talk to their partners about safe sex? What are their barriers?
I used the Millennial Trains Project (MTP) to find out. Each city we stopped in, San Francisco, Salt Lake City, Denver, Omaha, Chicago and Pittsburgh, I set off on foot, walking up and down the streets, stopping people to ask them questions about how their friends talk about sex, and what they thought the major barriers were to sexual health information and how we could change this.
The number one thing I found out? There's a reason that our teen pregnancy rate is the lowest it's been in decades, youth are extremely concerned about preventing pregnancy, our campaigns and messages have been working! But on the flip side, STDs are barely on their radar.
Almost everyone I talked to when asked if they were more concerned with preventing pregnancy or STDs, they answered pregnancy, hands down. STD's weren't among the common topics of discussion, and as one 18-year-old male in Denver told me "I know teenage moms, but I don't know anyone with an STD."
From a public health perspective, this lack of concern around STDs is troubling. Long and short-term consequences of STDs can be numerous and a lack of drug adherence is leading to even greater issues such as the antibiotic resistant strand of gonorrhea. When multiple exposures to STDs are expected, as an 18-year-old woman in Omaha said, "Teenagers don't question it anymore, pretty much people assume they're going to get a disease," should we expect drug adherence every time?
The only city where STDs were a common topic of discussion was Omaha. Omaha's Department of Health has made a conscious effort to begin talking about this problem, and the health department's efforts to put STDs on the front page have started discussions among people on the ground. "You know it's a problem when the newspaper is talking about it," a 27-year-old male in Omaha told me. Statistics from Omaha show that the STD rate is highest among people ages 15-24, and there are clear racial and ethnic disparities. Omaha has recognized this as a problem, and are encouraging greater discussions and education efforts around them.
Omaha's efforts are contrasted with places like Salt Lake City, where disease isn't talked about because so many people are worried about getting pregnant, and the stigma that comes with it. "A pregnancy wouldn't fit in," a 19-year-old woman told me, "it's easier to hide a disease."
Increasing condom use is perceived as an easy solution to solving both STD and teen pregnancy rates, but as youth are increasingly worried about pregnancy and not STDs, we've entered what's called the "pull out generation."
While pulling out can prevent pregnancy, it must be done correctly, every single time to be effective, and it doesn't protect against STDs. As the New York Magazine article stated, and as I heard from youth across America, "Pulling out is pretty common, it's all anyone talks about because it's free"- 16 year old male, Pittsburgh.
If we're going to decrease the STD rate amongst youth, it needs to become a conversation, like teen pregnancy has. Youth need to have the vocabulary to talk to their partners about testing, and we need to decrease the stigma around STDs.
As Melinda Gates said, contraception is not controversial, so let's not treat it like a controversy. As I continue with my career in family planning programming and advocacy, I'm going to use the data I collected through the MTP to increase the discussion around youth sexual health, and how we can create an environment where prevention and protection can be talked about in a safe and positive manner.
My hope is that on the next MTP journey, someone else will be asking people about their methods of contraception and the common refrain will be: "Awesome, I talk to my friends about that all the time."