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We sometimes deal with a tough situation in direct service: a user comes in, and reports having contracted an STI; a user who also isn't a first-time user of our site or services, and who, in a previous conversation with us about pregnancy risks, blew off also talking about STIs and safer sex and turned down help we offered to them to reduce their STI risks, not just pregnancy risks.
When this happens, a person like this will usually be very upset about having contracted an STI, often angry, and even mystified about how this happened to them. Of course, we're rarely mystified and also are not usually surprised this happened, since we already identified risks of STIs when we were talking with them in the past, which is why we brought the importance of safer sex up with them in the first place.
This is one of those things where there's no joy or pride in being right: it stinks to be right about someone getting any kind of illness and being unhappy. Even though the majority of STIs are treatable, many of our users are not contracting HIV, but the other, less deadly STIs, and have access to healthcare and treatment, and even though most feelings of upset with an STI are happening based more on social stigma than from serious, long-term health outcomes, we would greatly prefer our users didn't have to suffer needless distress and fear, and that they avoid any kind of illness that can be avoided.
It's frustrating for us when we know a user had an opportunity they refused to get more information about and help with safer sex; when they could have changed their habits before so they would've most likely avoided an STI entirely, since most of the time with most STIs, safer sex practices are highly effective at preventing STI transmission.
Even more frustrating is that sometimes, some of the users in situations like these still aren't interested in prevention help, and clearly still aren't going to rethink and change their habits. So then we have to know they'll probably transmit or contract the same STI or another in the future. Even with treatment, that really can, and often does, take a toll on our personal health and well-being, and certainly takes a big toll on the public health.
Like most public health organizations and people who work in sexual health and aim to try and improve it for everyone, we really want to change this pattern. We also know this is an ongoing challenge, and something where we all just have to keep talking, keep trying, and keep seeing if we can't come up with new or adjusted approaches in order to help people do better with safer sex. That's what I'm trying to do today. This isn't a finger-wag, a scold or an I-told-you-so, but an attempt to, together with you, I hope, just work on doing this better.
Today, before I suggest some things that might help you improve your safer sex practices, I want to specifically address two of the biggest players I often see in these situations: either when someone has been in a relationship for a while, and/or when condoms, which were often once used as contraception as well as safer sex, are replaced as a contraception method by other methods, like the pill or a Depo shot.
These aren't just issues for our users, by any means. They're two of the biggest challenges when it comes to public health and reducing our personal and global rate of sexually transmitted infections, particularly among younger heterosexuals. The idea that just being in a relationship for a while, somehow all by itself, reduces STI risks (it doesn't, especially if anyone involved came to the relationship with a pre-existing STI they didn't know about or haven't had or can't have treated, as often happens) is a biggie. It's also very common for a person to start use of another contraceptive and then either ditch condoms, or for condom use to become far less consistent about using them.
Ideas like pregnancy being a much bigger risk than STIs, and a far less important one, or that "safer sex" -- a term about behaviors and practices intended to prevent STIs specifically -- is already covered when you're preventing pregnancy are also very prevalent among many people. And unfortunately, as we know from study and observation over time, the people most often at the greatest risk of STIs are both often those who are least likely to continue to use condoms when they have another method of contraception, or are in ongoing relationships which they're serious about, but which are still relatively new, and where one or more partners haven't yet been tested for STIs or aren't really being or staying exclusive.
We know those at the most risk of STIs, period, are often those who think they have the lowest risk: like people in their teens and early twenties, people who don't get tested for STIs or whose partners don't, people who engage in serial monogamy (where they switch partners fairly often, but think of those partnerships as serious, long-term relationships without risk because they are monogamous, even if short-term), people who assume a partner has never had other partners before, or whose previous partners they think didn't pose risks (often because they were "virgins"), people who use condoms sometimes, but not all the time, or use them, but not properly.
We say some of what I'm about to say a lot around here, but I know that it's one of those things -- and not just here, everywhere -- that doesn't really land for a lot of people. So, I figure the best I can do is to just keep saying it, and try saying it as many different ways as we can.
If you are having the kind of sex that presents a possible risk of pregnancy, you are having one of the two kinds of sex (anal intercourse being the other) that presents the biggest STI risks, too. When there is direct genital contact -- including for people with the same kinds of genitals, where there isn't a risk of pregnancy -- there are always risks -- a definite maybe -- of STIs. And those risks are usually not smaller than pregnancy risks for people in the age group we work with most, even though a lot of people think they are.
Experts estimate that almost half of the United States' over 19 million STI infections each year occur in youth ages 15-24. A recent study found that one in four young women ages 15-19 has an STI in the U.S. One in four: we've had that figure for a long time now, it's nothing new. More broadly, people between the ages of 15 and 24 account for 50 percent of all new STIs.
In 2008, the U.S. teen pregnancy rate was 67.8 pregnancies per 1,000 young women ages 15 to 19: in other words, just under 7 pregnancies per every 100 people aged 15-19, or around 7%. And, more broadly, about 30 percent of Americans who have the ability to become pregnant do before the age of 20.
So: One in every four people aged 15-19 acquires an STI each year. But less than one in every ten in that same age group becomes unintentionally pregnant. To put it another way: 25% of teens in the United States has an STI. Only around 7% in that same age group become pregnant in a year. 30% of unintended pregnancies in those under 20, but 50% of all new STIs -- that's all the cases of STIs in a year in the U.S. -- occur in those under 24.
You can perhaps see how you are most often more at risk of STIs than pregnancy if you are a young person engaging in the kind of sex that poses risks of both. More at risk. Not less, and not at equal risk. More.
There are a handful of reasons why STIs are so prevalent among people in this age group, including some that are outside your control, like cervical development and how, socially, y'all tend to be more touchy-feely with each other than older people.
One of the biggest reasons? Because more people are getting with the program when it comes to contraception, but never getting on board with safer sex -- or not doing so consistently or properly -- or, once they get another method of contraception besides condoms or newly enter into an exclusive relationship, are ditching safer sex. One of the real bummers of this is that younger teens who are sexually active tend to often do a much better job than older teens or those in their twenties. Yay on younger teens, for sure, but it's usually those same people who lose that habit later, often due to one or both of those two situations up there. In other words, the reason we suspect younger teens tend to do better lately with condom use is primarily because for most of them, that's their only initial method of birth control, and they're new to sex or relationships. Once those situations change, so, unfortunately, often do those great condom habits.
I know engaging in safer sex as a consistent practice isn't easy for everyone, and some situations -- like a lack of access to healthcare or free condoms and lube, unhealthy relationships, crappy sex education, lack of support from family, friends or partners for safer sex -- make it tougher. If it's not a habit you started your sexual life or a relationship with, it's also challenging to switch gears. And, as with learning anything new, or developing any new habit, it might not be something you do perfectly right from the get-go, but flub up now and then. Today, I'm not talking about getting anything perfect: just about aiming to do better.
Any steps you can take to improve with safer sex are a big deal. As we know when we hear from people who have contracted an STI, most people really don't want one, and feel very upset when they get one. So, we can easily know that doing what can be done to prevent STI transmission has got to be something most folks want, since that's the only way to be most likely to avoid them, which is also what most folks want.
Maybe you can't get all the way there today, or even in a week or month. That's okay. But how about some steps towards better safer sex practices that are within reach? Like:
• Take more time to get to the kinds of sex where you need safer sex. Namely, keep genital sex where there's direct genital contact, or direct contact with genital fluids off the table for longer. Figure the time when it's sound to think about going there is when you also feel totally able to talk about and practice safer sex, and feel assertive and safe enough to set those limits with a partner. If the mere thought of the conversation scares you, or you don't feel confident about it? Then know it's probably moving too fast to go into those kinds of sex, because it's too fast for you to deal with some of the real-deal parts of them, like STIs and safety. Remember, too: not every possible partner for us is a sound choice as a partner. If bringing up safer sex with a given person feels totally impossible, but you can see doing it with someone else, it might be because that partner isn't a goodie. You might feel that way because they made clear to you in some way that they aren't invested in your health or theirs, or aren't really ready to be, or interested in being, a healthy partner for you.
• Keep barriers on hand: don't leave them up to a partner. If you and your partner(s) all are responsible for having condoms and other barriers handy, then no one has to worry about them not being there, and it's a lot harder to have "accidents" where sex happens without barriers. Agree to share responsibility with partners when it comes to safer sex, rather than having only one of you take all the responsibility. Have fun creating your own at-home or portable safer sex kit, while you're at it. Pick condoms, dams, lubes and other tools you actually want to try and that appeal to you.
• Choose something besides ditching condoms to demonstrate commitment, trust or love. We often hear from users that they or their partners are obtaining a new method of birth control, instead of condoms, and plan to ditch condoms once it's started as a way of showing affection, love or commitment. Or, who never use condoms with a partner, and only another method, and present this as entering into a relationship with trust on the table. We know this is a common occurrence among people, period. Not only is ditching condoms not the only way to demonstrate these things, it's a very risky way to do so: there are ways to do this where no one has to put their health at risk. How about agreeing to become exclusive instead? Or to giving each other one day a week as a dedicated time to be together? What about building sexual trust by sharing more about your sexuality or sexual feelings with a partner than you have yet? Heck, what about going to get tested together? Now there's a real-deal, healthy way to demonstrate commitment to a shared sexual life that values everyone's well-being. And on that note....
• Don't set up ditching condoms as something you're going to do as a given in your sexual life, especially early in a relationship. Putting your sexual health at a needless risk for someone isn't a smart carrot to dangle, nor one that sets a precedent for a relationship where people take good care of each other. Instead, present condom and other barrier use as something you are committed to doing with a partner, in the interest of showing care for the health of both of you, and committed to doing for the long-term. Sure, six months, a year or more down the road, if you are still together, exclusive, and that's something you want to talk about, you can make clear you'd be open to that discussion. But particularly when a relationship is newer -- when you've been in it for less than a year -- and STI risks are highest -- rather than committing to NOT using condoms, commit to using them. When they're presented as a given, without wavering, people tend to generally just fall in step and cooperate much more easily with safer sex practices. And don't forget: feeling like a relationship will last forever, or like you want it to, doesn't mean it will. In fact, with younger people, sexual relationships lasting more than a year is pretty uncommon. And ditching condoms can't magic a relationship longer: it just makes it riskier for your health.
• Think of and present a new contraceptive not as a replacement for condoms, but as a bonus addition. Dual contraception is not only THE most effective way to prevent pregnancy (and a great way to save yourself the stress of pregnancy scares if and when you make a flub with one method), but pairing condoms with another method is the best way there is to cover all your sexual safety bases when you're having sex that presents high risks of both STIs and pregnancy, like penis-in-vagina intercourse. Adding a contraceptive to condom use is just as big a boon as ditching condoms, if not a bigger one: it means you and your partner get to pretty much not worry about pregnancy at all, you get to keep being able to relax more during sex knowing you're doing what you can to reduce your STI risks, it means you're probably getting to now share responsibility for both of these things, rather than having just one person take it all on, which is likely to make you both feel a lot closer and a lot more like a real partnernship.
• Change the channel in your head if it says that how long you have been with someone means you're safe from STIs. It doesn't. Being with someone where you are practicing safer sex, both are also sexually exclusive AND have been so for a minimum of six months AND have ended that six month-period with BOTH of you getting tested for all the STIs you can? If you both get negative results after that, and stay exclusive, then for sure: that's what makes things safer. But time alone doesn't make pre-existing infections go away or make things safer. It's only what happens during that time, and a substantial period of time, that can.
• Already rock safer sex like nobody's business? If so, make sure your friends know that. You already do a great job taking care of yourself in this regard. Whoohoo for you! If you want to take that a step further and benefit the public health with your righteous sexual health habits, see if you can't be someone in your circle of friends who normalizes safer sex. one biggie we hear a lot from people having a tough time getting with the program is that they feel certain no one else in the whole wide world, or no one they know, does things like using condoms for anal intercourse or oral sex, uses dental dams, washes their hands or uses gloves with manual sex, or keeps using safer sex with long-term partners. When we can tell people around us that those of us who practice safer sex are for-real people with for-real sex lives that include sexual safety, we can actually make a pretty big difference in helping others to do the same.
Hopefully, one or more of these tips can help get you started on doing better, whether you've contracted an infection in your life at this point already or not. Again, remember: steps matter, and they're usually what we need to take to get all the way there. Setting yourself up to try and do something new perfectly, and figuring to hell with the whole thing when you don't is a recipe for not doing it at all, feeling like crap about it, yourself and your sex life, and being more likely to pick up an illness, on top of that. If you're having a hard time with safer sex, just commit to one step or thing to try first: get that down, then choose another, adding more until you'll find that, as it turns out, you've got this down and your life and health are looking up.