Sexuality in Adolescence

National surveys reflect what adults probably already know: Teenagers are engaging in sexual activity. Fortunately, there is some good news in this area. The rates of teen pregnancy are down (from 85.7 per 1,000 women ages 15 to 19 in 1999 to 83.6 in 2000; Guttmacher Institute, 2004). Rates of 9th- through 12thgrade students who report having sexual intercourse are holding steady (46.7% in 2003 compared to 45.6% in 2001), and for those students reporting sexual activity in the past 3 months, use of condoms has increased (63% in 2003 compared to 57.9% in 2001). However, the number of youth who report first sexual intercourse before age 13 is ticking upward (from 6.6% in 2001 to 7.4% in 2003; Youth Risk Behavior Surveillance System, 2004). Teens are also still at high risk for sexually transmitted diseases (STDs) because they are likely to have multiple sexual partners, to have older sexual partners, and to engage in unprotected sex (CDC, 2003). More than half of new HIV infections occur in young people ages 15 to 24 years old. And, increasingly, this disease has a female face. Thirteen-to-19-yearold females worldwide account for a staggering 57% of new HIV infections and 48% of all new AIDS cases (CDC, 2002; UNAIDS, 2004). So despite some declines, these reports indicate that young people are engaging in sexual practices in greater numbers and at earlier ages than generations before them (Nahom et al., 2001). Yet most adolescents do not have accurate information about the risks associated with these practices. This may not be too surprising, given adolescents egocentrism and their sense of invulnerability. A recent study published by the Washington, DC Urban Institute discovered that most teenagers did not believe that oral or anal sex was real sex. Thus, kids concluded, it was safe and had the added benefit of preserving girls virginity (see Gaiter, 2001). Fewer than one quarter of teenagers ages 16 to 24 indicate that they have any knowledge at all about HIV/AIDS, according to an MTV survey of 4,140 U.S., Asian, European, and Latin American youth. Approximately one third of the group believed that only drug users who shared needles could get it; 16% believed that only homosexuals contracted the disease. This ignorance exists within a climate of adult reluctance to discuss sexuality and exaggerated and, some say, degrading sexual saturation in movies, music, TV, and Internet, all of which bombard mediasavvy teenagers (Brown, Steele, & Walsh-Childers, 2002). Caring adults need to address this situation with a combination of information, vigilance, empathy, awareness, and authority. Counselors can establish a trusting, nonpunitive relationship that fosters sharing of information and reduces the anxiety involved in disclosing personal information. With respect to younger adolescents who are particularly dependent upon the support of adults, counselors must work to include a family member or other guardian in treatment. Given the earlier onset of puberty today, experts recommend that efforts to educate about health and sexuality begin at earlier ages, before or at pubertal onset both for boys and for girls (Susman, Dorn, & Schiefelbein, 2003). More research is needed to identify the most effective ways to reduce risky sexual behavior. In general, education about health promotion and disease prevention is an important component. Some research demonstrates that abstinence-only

programs are ineffective in delaying sexual activity, pregnancy, and STDs compared to comprehensive sex education that incorporates discussion of the benefits of abstinence with information about contraception (Starkman & Rajani, 2002). Schools that offer on-site clinic services and health counseling to students have lower rates of pregnancy when compared with schools without these services (Zabin, Hirsch, Smith, Streett, & Hardy, 1986). Education, important as it is, appears to be less effective than the combination of education and appropriate counseling. St. Lawrence and associates (1995) report that youth enrolled in a cognitive-behavioral treatment program that trained them in refusal skills, problem solving, knowledge of contraceptive choices, and coping had lower rates of risky sexual activity than youth given education alone. Based upon their work with HIV prevention in adults, Schreibmen and Freidland (2003) suggest that clinicians should incorporate prevention-focused information in each counseling session when dealing with clients at risk. Their advice might be useful to adapt to at-risk adolescents as well. Counselors focus on prevention need not take the form of didactic messages but rather should be the basis for discussing practical steps toward risk reduction. Because topics of sexuality (or other risky behaviors, for that matter) may be difficult to broach, clinicians may use scripted phrases to introduce these issues sensitively. These are a series of questions that can draw clients into the conversation while minimizing discomfort. For example, Now that weve finished discussing your medications, Id like to ask you some questions about your sex and drug behaviors. What behaviors are you involved in now? Would you feel comfortable discussing them? Can you think of anything you might like to change about these behaviors? . . . How important is reducing risk behavior to you (on a scale of 1 to 10) and how confident are you that you can do this (on a scale of 1 to 10)? (p. 1174)