Young people in the Virgin Islands have higher rates of sexually transmitted diseases than in any other part of the U.S., and education is the key to preventing it.
That was the message conveyed by public health officials at Friday’s STD/HIV/TB conference, held at the Marriott Frenchman’s Reef Resort in St. Thomas.
The conference, which brought together several dozen health care professionals from all around the Virgin Islands, was arranged by the V.I. Health Department.
"An ounce of education is worth a pound of knowledge," said Dr. Richard Olans, paraphrasing Benjamin Franklin. Olans, who is the Virgin Islands’ territorial director for infectious diseases, was one of the medical professionals who spoke at the conference about ways to reduce the spread of infection.
Recently released statistics from the Centers for Disease Control show that the 2009 chlamydia rate for girls age 15-24 in the Virgin Islands was 15.5 percent. That was the highest rate in the country in 2009, followed by New Mexico at 14.4 percent. The chlamydia rate for men age 20-24 was an astonishing 21.6 percent the same year.
Chlamydia is a bacterial infection that often does not cause symptoms in those who have it, making it easy to unknowingly pass on. However, if left untreated, it can cause pelvic inflammatory disease, ectopic pregnancy, and infertility in women.
The CDC report also tracked rates of HIV and gonorrhea infection, and revealed equally sobering numbers. The gonorrhea rate among young females in the VI was tied for fifth-highest in the country in 2009, at 2 percent. The VI also has the second-highest number of HIV cases per capita in the U.S., and a total of 976 persons infected between 1983 and 2010. Nurse practitioner Rita Olans, Dr. Olans’s wife, noted that the Caribbean region has the second-highest HIV infection rate in the world.
Though tuberculosis is not a sexually transmitted disease, it is strongly correlated with HIV and thus was a major topic of discussion at the conference. HIV-positive individuals have a rate of TB infection that is 200 to 800 times higher than the general population, since their compromised immune systems make them particularly prone to it. Dr. Olans described this type of co-morbidity as a domino effect that STDs can have on public health.
Dr. Olans said he was not sure exactly why the rate of STDs is higher in the VI than elsewhere. But he stressed that knowledge is key, because any sexually transmitted disease, if left untreated, can increase the risk of HIV infection.
"Whatever is causing it is putting our population at greater risk for HIV," he said. "We need to fight it with resources and education. We need to teach in schools, at the dining room table, at the doctor’s office, everywhere we can."
This sentiment was echoed by many of the conference participants, who came from private practices, public health clinics, schools, and the Department of Health. "The key is bombarding young people with education and information, to help them make the right choices," said one attendee.
The array of health care practitioners present included over 70 experienced healthcare workers such as nurse practitioners, EMTs, and social workers, as well as a number of nursing students from UVI.
Deborah Cestaro-Seifer, assistant professor of nursing at the university, said that it was important for the continuum of knowledge to be transferred from more seasoned professionals to those just starting out.
"We brought in almost half the nursing students so they can learn about the latest issues and techniques for educating young people," said Cestaro-Seifer, who also moderated one of the breakout sessions. "We need to maintain awareness in younger health care workers, as the older workers retire and age out of the system."
Since young people, particularly those in their mid-teens, are the ones most commonly affected by STDs, the breakout sessions centered on strategies how to speak to teenagers in terms they can relate to.
"It’s not until late adolescence that their concept of consequences develops fully," explained Dr. Olans. "The message we try to get to teens is that sex is a high-risk event. Yes it’s fun, but it also carries risk."
Speakers Bruce Armstrong and Dr. Alwyn Cohall, both from the Mailman School of Public Health at Columbia University, gave presentations emphasizing the importance of connecting during counseling, especially considering that clinic visits are usually very brief and teenagers are usually reluctant to open up to adults about sexual health issues.
"Demonstrate that you care about them, and that you’re more similar than different," said Armstrong, who is the director of the Young Men’s Health Initiative at Columbia. "Make the teen feel comfortable: Ensure privacy, make eye contact, stay at eye level, and don’t speak at them or lecture them."
Armstrong added that asking questions without judgment can help teens puzzle out their behavior and start to see the consequences of risky behavior. As an example, he described a male patient he counseled who had been having unprotected sex with men. Instead of lecturing him on the risks of HIV, he personalized the conversation by asking him how his mother would cope if he died of HIV, and was therefore not able to help support her.
During the HIV education session, social worker Tiffany Gillyard displayed alarming statistics about the risk of HIV infection through anal sex, which many teens do not regard as dangerous. For women (or men) who engage in unprotected anal sex, the risk of HIV transmission is 2000 times higher than having protected oral sex (the baseline measure).
One attendee said that she would start telling her teenage clients about these statistics as part of the counseling, because she felt they were probably completely unaware of the huge risk they faced.
"I see a lot of girls who engage in anal intercourse because they want to avoid pregnancy," she said. "They don’t even think about the risk of HIV infection. They don’t read statistics. All they care about is not getting pregnant."
Besides increasing health education, Rita Olans said that several other initiatives have been proposed to help screen for and prevent STD infections in the territory. For example, at the moment all pregnant mothers are screened for HIV in the first trimester, but she said that she wants to see a second test administered in the third trimester.
"If we could test twice during pregnancy, we could catch the cases of HIV that do not develop until later in the pregnancy, and treat accordingly to reduce the baby’s risk of infection," Olans said.
The proposal is currently being reviewed by the Health Commissioner’s office.
All the young boys need to start thinking with their big head instead of their little head.