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Focus on Reproductive and Sexual Health
Alabama’s youth are likelier to experience negative sexual health outcomes than most U.S. youth–with young people of color and LGBT (lesbian, gay, bisexual, and transgen- der) youth the most at risk. The quality of sex education students receive; the extent of their access to reproductive and sexual health care; and the impediments to health they may face, including socioeconomic dis- parities, homophobia, and racism–all have an impact on sexual and reproductive health. Yet research has shown that when they are given the tools they need, young people can and will protect themselves from negative sexual health outcomes.
Alabama's Youth Population: Overview
- There are approximately 675,000 young people ages 15-24 living in Alabama, comprising 14 percent of the population. 
- According to the 2010 Census, 70.1 percent of Alabamans are white, 26.5 percent are African American/Black, 4 percent are of Hispanic origin and 1.2 percent are Asian. 
- Between 2000 and 2010 the Hispanic/Latino population in Alabama grew by 144.8 per- cent. Only South Carolina saw more rapid growth in this category. 
Sexual Health Outcomes In Alabama
- In 2005, the teen pregnancy rate in Alabama was 73 pregnancies per 1000 persons ages 15 to 19, above the national average of 70 pregnancies per 1000. 
- In 2011, 57.6 percent of high school students in Alabama report having had sexual intercourse compared to 47 percent of all U.S. high school students; and 44.1 percent reported currently being sexually active compared to 33.7 percent of all U.S. high school students. 
- 57 percent of Alabama’s sexually active high school students used a condom at last intercourse, compared to 60 percent of high school students nationwide; 25.8 percent used birth control pills, injectable birth control, rings, implants or any IUD compared to 23.3 percent of students nationwide. 
- Alabama’s young people ages 15-24 experience higher rates of gonorrhea and Chlamydia than the national average. The Chlamydia rate for young people ages 15-24 in Alabama is 3081 cases per 100,000. The gonorrhea rate for young people ages 15-24 in Alabama is 829. In 2010 there were over 5,000 cases of gonorrhea and 20,000 cases of Chlamydia reported among Alabama’s young people. [6, 7]
- In 2011, 29 percent of all new HIV cases in Alabama were diagnosed in young people ages 13-24. 
- Between 2004 and 2011, young people ages 13-24 were the only age group in Alabama to experience an increase in the number of new cases of HIV diagnosed; 2670 young people ages 13-24 are living with HIV in Alabama. 
Social Factors Put Alabama's Racial and Sexuality Minority Youth At Risk
- While white and African American/Black youth account for the most teen pregnancies in Alabama (with approximately 5000 each), Hispanic/Latino youth experience higher rates of teen pregnancy. The pregnancy rate among young Hispanic/Latino women ages 15-19 in Alabama is 228 pregnancies per 1000 women, the highest of any state for this group; among young African American/Black women 95 pregnancies per 1000 women; among young white women, 56 pregnancies per 1000 women. 
- Lesbian, gay, bisexual, and transgender students experience high rates of discrimination and bullying: eight out of ten LGBT students reported being harassed in the last year, three-fifths reported feeling unsafe, and one-third skipped at least one day of school in the past month because of concerns about their safety. 
- Although African American/Black Alabamans constitute only 26.5 percent of the state’s population, in 2011 they experienced 63 percent of all cases of gonorrhea, 50 percent of cases of Chlamydia, and 69 percent of new HIV diagnoses. [9,11,12]
- In 2011, men who have sex with men accounted for 60.2 of all new diagnoses of HIV in Alabama. 
Alabama Law Mandates Failed, Misleading Abstinence-Only-Until Marriage Programs
- Under Alabama law, schools are not required to offer sex education, but any sex ed program must teach that “[a]bstinence from sexual intercourse outside of lawful marriage is the expected social standard for unmarried school-age persons.” 
- Sex education must also emphasize that homosexuality “is not a lifestyle acceptable to the general public” and that homosexual conduct is a criminal offense. 
- The Alabama Department of Public Health has announced that for fiscal year 2012-13, the state has accepted almost $900,000 in Title V funding for abstinence-only programs.
Because of high rates in the community in general, an individual African American/Black youth, especially one living in the regional South, has a higher risk of acquiring HIV or STIs even when they have the same or fewer risk behaviors than white youth. [13,14]
In 2003 the Supreme Court of the United States struck down all state laws criminalizing consensual homosexual acts. 
Young people who receive complete, accurate, and culturally sensitive information about abstinence, condoms, and contraception are significantly less likely to be involved in teen pregnancy and significantly more likely to use condoms once sexually active. 
Alabama’s youth are at serious risk for pregnancy, HIV and STIs; youth of color and LGBT youth are at disproportionate risk for negative sexual health outcomes. Research shows that comprehensive sex education and access to contraceptive services can help young people protect their health and well-being.  But in addition to helping youth choose healthier behaviors, protecting these young people will also require the dismantling of barriers to health equity (including poverty, lack of insurance, and disparities in education) and support of structural interventions that help make the entire population healthier. [20,21]
Written by Eric Garbe, Intern, State Strategies
Advocates for Youth © October 2012
- U.S. Census Bureau. 2010 Census Summary File 1, Age Groups and Sex: 2010. Alabama. Available at: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_5YR_DP05. Accessed July 10, 2012
- U.S. Census Bureau. State & County Quick Facts. Ala- bama. Available at: http://quickfacts.census.gov/qfd/states/01000.html. Accessed July 10, 2012.
- U.S. Census Bureau. The Hispanic Population: 2010. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf. Accessed July 10, 2012.
- Guttmacher Institute. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity. Available at: http://www.guttmacher.org/pubs/USTPtrends.pdf. Accessed July 10, 2012
- Eaton, DK et al. Youth Risk Behavior Surveillance – United States, 2011. MMWR. 2012, 61(SS04): 1-162.
- Centers for Disease Control. STDs in Adolescents and Young Adults, 2010. Available at http://www.cdc.gov/std/stats10/adol.htm. Accessed July 13, 2012.
- Centers for Disease Control. Rates of Reportable STDs among Young People 15 - 24 Years of Age. Alabama, 2010. Available at http://www.cdc.gov/std/stats/by-age/15-24-all-STDs/state/2010/AL10.pdf. Accessed July 13, 2012.
- Alabama Department of Public Health. HIV and AIDS Cases by Demographic Group and Exposure Category, Alabama. Available at http://www.adph.org/aids/assets/HIV2ndQuarter2012(Demo).pdf. Accessed July 13, 2012.
- Alabama Department of Public Health. HIV Integrated Epidemiological Profile, December 2011. Available at http://www.adph.org/aids/assets/HIVEpiProfil2011.pdf. Accessed July 13, 2012.
- National Campaign to Prevent Teen & Unplanned Pregnancy. State Profile: Alabama. Available at http://www.thenationalcampaign.org/state-data/state-profile.aspx?state=alabama. Accessed July 13, 2012.
- Alabama Department of Public Health. Gonorrhea In- fections: 2011. Available at: http://adph.org/STD/assets/Go2011.pdf. Accessed July 16, 2012.
- Alabama Department of Public Health. Chlamydia Infec- tions: 2011. Available at: http://adph.org/STD/assets/Chlamydia2011.pdf. Accessed July 16, 2012.
- Millett GA. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 21 (15) 2083-2091.
- Hallfors DD. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. American Journal of Public Health 2007; 97(1): 125-132.
- GLSEN. The 2011 National School Climate Survey. New York: Gay, Lesbian, and Straight Education Network; 2012. Available from: http://www.glsen.org/binary-data/GLSEN_ ATTACHMENTS/file/000/002/2106-1.pdf.
- Ala. Code §§ 16-40A-2(a)(2)
- Ala. Code §§ 16-40A-2(a)(8)
- Lawrence v. Texas, 539 U.S. 558 (2003)
- Alford S. Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.
- Isbell MT. HIV Prevention for Gay Men and Men who have Sex with Men: Development of a Comprehensive Policy Agenda. amfAR and Trust for America’s Health, 2010.
- 21. DiClemente RJ, Salazar LF, Crosby RA. A Review of STD/ HIV Preventive Interventions for Adolescents: Sustaining Effects Using an Ecological Approach. Journal of Pediatric Psychology 2007; 32(8): 888-906.