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Focus On Sexual And Reproductive Health
Across the United States, young people are at risk for unintended pregnancy and sexually transmitted infections (STIs) including HIV. Due to structural barriers and policies that do not support young people’s rights to honest, medically accurate information and services, Louisiana’s youth are likelier to experience pregnancy, HIV, AIDS, and other STI diagnoses than most young people in the United States. Comprehensive sexuality education, health equity, and access to contraception are more important than ever to the health of young people in the state.
LOUISIANA’S YOUTH POPULATION: AN OVERVIEW
• According to the 2014 American Communities Survey, Louisiana’s population is 63.4 percent white, 32.5 percent African American, 1.8 percent Asian, 4.8 percent Hispanic or Latino, .8 percent American Indian, and .1 percent Native Hawaiian or Pacific Islander. [1]
• As of 2014, 13.4 percent of Louisiana’s 4,601,049 were between the ages of 15 and 24. [2]
SEXUAL HEALTH OUTCOMES IN LOUISIANA: YOUNG PEOPLE HAVE HIGH RATES OF PREGNANCY, HIV, AND STIS
• In 2013 there were 15.4 HIV diagnoses for every 100,000 young people aged 13-19 in Louisiana, more than double the national rate.3 The rate of AIDS diagnoses among young people 13-19 was 2.2 per 100,000 compared to a national rate of 1.6.4 Rates of HIV and AIDS diagnoses above the national average also exist for young people 20-24 – at 74.1 per 100,000 and 20 per 100,000 – were both more than double nationwide rates. [5]
• In 2013, Louisiana had the second highest rate of chlamydia and gonorrhea among young people age 15-19, and the first highest rate of syphilis. [6]
• In 2010 there were 69 pregnancies per 1,000 Louisiana women age 15-19 – the fifth highest teen pregnancy rate in the United States. There were 10 abortions per 1,000 women age 15-19, the 25th highest rate in the U.S. [7]
SOCIAL AND STRUCTURAL FACTORS PUT YOUTH OF COLOR AND LGBTQ YOUTH IN LOUISIANA AT RISK
Racial disparities in health outcomes for young people in Louisiana are stark: Although African Americans make up 32.5 percent of Louisiana’s population in 2011 54 percent of births to women under 20 were to black women.8 In 2013, over 60 percent of new HIV diagnoses were among Black or African American Louisianians. [9] Disparities in barriers to accessing healthcare services, poverty, structural exclusion, and disadvantage all contribute to young people’s ability to prevent unintended pregnancy, HIV, and STIs. For example, young people under the age of majority rarely may consent to contraceptives or abortion without parental permission, [10] disproportionately burdening youth in the foster care system or who are otherwise not living with their parents. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth in Louisiana are marginalized, increasing their risk of HIV, STIS, and other negative health outcomes: the National Youth Risk Behavior Survey found that 11 percent to 30 percent of gay and lesbian students and 12 percent to 25 percent of bisexual students surveyed did not go to school at least one day during the prior month because of safety concerns. These concerns put LGBTQ youth greater risk for depression, substance use, and sexual behaviors that place them at risk for HIV and STIs. [11] As a result, in Louisiana the HIV epidemic in the state is disproportionately concentrated among men who have sex with men, with over 60 percent of new diagnoses in 2013 related to male to male sexual contact. [12]
SEX EDUCATION IN LOUISIANA VARIES BY DISTRICT, BUT MOST PARENTS WANT COMPREHENSIVE SEX ED
• In Louisiana, schools may offer sex education only after grade 6, or after grade 3 in Orleans Parish. [13]
• When districts do choowse to offer sex education, they must emphasize that abstinence outside of marriage is the expected standard for school age students, and that “each student has the power to control personal behaviors.” [14]
• Recent research on abstinence-only programs found them ineffective, with no impact on reducing teen pregnancy, delaying sexual initiation, or reducing STIs. Recent research on comprehensive sexuality education has shown that young people who receive complete and accurate information about abstinence, condoms, and contraception were not more likely to acquire an STI, but were significantly less likely to be involved in teen pregnancy and were significantly more likely to use condoms once sexually active. [15]
• Although Louisiana youth face significantly higher rates of HIV and AIDS diagnoses than the national average, 26.9 percent of high school students in 2013 had never learned about HIV or AIDS in school, compared with 14.7 percent of high school students nationwide. [16]
• In Fiscal Year 2014 agencies and organizations in Louisiana received a total of $5,151,520 in Teen Pregnancy Prevention Program grants, $58,409 in Department of Adolescent & Sexual Health grants, and $714,141 in Personal Responsibility Education Program grants, to help implement targeted programs that have more comprehensive approaches to sexual health education for certain groups of young people. [17] That year, agencies and organizations in Louisiana also received $848,451 in Title V Abstinence-Only-Until-Marriage funding. [18]
CONCLUSION
Young people in Louisiana are at serious risk for unintended pregnancy, HIV and STIs. Youth of color and LGBT youth are at even higher risk for negative sexual health outcomes. To address these risks, research shows that comprehensive sexuality education and access to contraceptive services can help young people protect their health and well-being.19 In addition to helping young people choose healthier behaviors, we must also dismantle barriers to health equity (including poverty, lack of insurance, and disparities in education) and support structural interventions that help allow all young people to build healthy lives.
REFERENCES
1. U.S. Census Bureau, State and County Quick Facts. Louisiana. Available at: http://quickfacts.census.gov/qfd/states/22000.html. Accessed January on 28, 2016.
2. U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates. Louisiana. Available at: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_5YR_S0101&prodType=table Accessed January on 28, 2016.
3. Slide 9: “Rates of Diagnosis of HIV Infection among Adolescents Aged 13–19 Years, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), Available at: www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed on January 21, 2016.
4. Slide 18: “Rates of Stage 3 (AIDS) Classifications among Adolescents Aged 13–19 Years with HIV Infection, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), Available at www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed on January 21, 2016.
5. Slide 10: “Rates of Diagnoses of HIV Infection among Young Adults Aged 20–24 Years, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf.; Slide 19: “Rates of Stage 3 (AIDS) Classifications among Adolescents Aged 20–24 Years with HIV Infection, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed on January 21, 2016.
6. NCHHSTP Atlas, “STD Surveillance Data” (Atlanta, GA: Centers for Disease Control and Prevention), Available at: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html. Accessed on January 21, 2016.
7. Kost, K., and S. Henshaw, U.S. Teenage Pregnancies, Births, and Abortions, 2010: State Trends by Age, Race, and Ethnicity (New York: Guttmacher Institute, 2014), Available at www.guttmacher.org/pubs/USTPtrends10.pdf, Table 3.1. Accessed on January 28, 2016.
8. Office of Adolescent Health, Louisiana Reproductive Health Facts. Available at http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/states/la.html. Accessed on January 28, 2016.
9. Louisiana Department of Health & Hospitals, Office of Public Health, 2013 STD/HIV Surveillance Report. Available at: http://new.dhh.louisiana.gov/assets/oph/HIVSTD/hiv-aids/2015/2013_STD_HIV_Surveillance_Report.pdf. Accessed on January 28, 2016.
10. Guttmacher Institute, State Reproductive Health Profile. Louisiana. Available at: http://www.guttmacher.org/datacenter/profiles/LA.jsp. Accessed January 21, 2016.
11. Cetners for Disease Control and Prevention, LGBT Youth. Available at: http://www.cdc.gov/lgbthealth/youth.htm. Accessed on January 29, 2016.
12. Louisiana Department of Health & Hospitals, Office of Public Health, 2013 STD/HIV Surveillance Report. Available at: http://new.dhh.louisiana.gov/assets/oph/HIVSTD/hiv-aids/2015/2013_STD_HIV_Surveillance_Report.pdf. Accessed on January 28, 2016.
13. Sexuality Education Information Council of the United States. State Profile: Louisiana, 2014. Available at: http://siecus.org/document/docWindow.cfm?fuseaction=document.viewDocument&documentid=526&documentFormatId=607. Accessed on January 29, 2016.
14. Ibid.
15. Kohler et al. “Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health, 42(4): 344-351.
16. Centers for Disease Control & Prevention, Adolescent and School Health: YRBSS Results. Available at: http://www.cdc.gov/healthyyouth/data/yrbs/results.htm. Accessed on January 21, 2016.
17. Sexuality Education Information Council of the United States. State Profile: Louisiana, 2014. Available at: http://siecus.org/document/docWindow.cfm?fuseaction=document.viewDocument&documentid=526&documentFormatId=607. Accessed on January 29, 2016.
18. Ibid.
19. 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.
20. Millet, 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. AND 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.
21. 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.
22. Sexuality Education Information Council of the United States. Fact Sheet: On Our Side: Public Support for Comprehensive Sex Education. Available at http://www.siecus.org/index.cfm?fuseaction=Page.ViewPage&PageID=1197. Accessed on January 21, 2016.