EXAMPLE Analysis Paper-1

EXAMPLE Analysis Paper-1 - (-13. Dispmportionate Rates 1...

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Unformatted text preview: (-13. Dispmportionate Rates 1 Running Head: DISPROPORTIONATE RATES OF STls/HIV AMONG ADOLESCENTS Disproportionate Rates of STls/HIV Among Adolescents and the State Abstinence Education Program: A Critical Analysis Caya Schaan In partial fulfillment for the requirements of SCWK 204 Social Policy Analysis Dr. D’Andrade 5/15/07 Disproportionate Rates 2 Disproportionate Rates Of STls/HIV Among Adolescents and the State Abstinence Education Program: A Critical Analysis Introduction This paper wili first outline the social problem of disproportionate rates of sexually transmitted infections and HIV/AIDS among adolescents. It will explore the issue through the two lenses of abstinence—only education supporters as welt as comprehensive sex education proponents. The State Abstinence Education Program will then be examined, as it is the only source of federal fluids that attempts to address lowering the rates of STls/HIV among young people. A critical analysis of abstinenee~only education as federal policy will reveal many deficits in the program. Lastly, a proposal that addresses comprehensive sex education will be it it? Ml“ ‘ offered as an. alternative solution. Social Problem: STIs and HIV/AIDS among Adolescents in the US. Definition og'Problem: While adolescents account for only one quarter of the sexually active population, they make up almost half of the new sexually transmitted infection and HIV/AIDS diagnoses every year. Here 1 will define adolescents as young people ages lyears old. Unfortunately, by the time they are 24, one out of every three adolescents who are sexually active will have contracted at least one STl (Alford, 2003). STls are transmitted by bacterial, viral or parasitic pathogens that are passed through sexual activity. A virus causes HIV. The STls which young people are being diagnosed with are as follows (in order of most frequently diagnosed cases): HPV, Trichomoniasis, Chlamydia, Genital Herpes, Gonorrhea, HIV, Syphilis, and Hepatitis B (Gnttrnacher, 2006). The disproportionate prevalence of STl's and HIV amongst adolescents is a major issue that negatively Disproportionate Rates 3 impacts both the physical and emotional health of young people and affects all segments of the US population. Magnitude of the problem: One of the main issues, when trying to gauge the magnitude of the problem of STls and HIV/AIDS amongst adolescents, is that it is extremely hard to measure exactly how many people are infected. According to the Guttmacher Institute, there are serious challenges when it comes to measuring STis: “Data collection may be incomplete because some STls (such as herpes and HIV) are not part of a national reporting system, because some STls (such as Chlamydia and HPV) can be asymptomatic and go undetected, and because surveys intended to measure the prevalence of STls have not been based on representative samples of the US. population” (Guttmacher, 2006, para 2). I In addition to these challenges, adolescents are less likely to be tested for STls and HIV than older members of the sexually active population. While there are reported figures related to the number of adolescents who have been diagnosed, the numbers of adolescents actually living with an STl or HIV/AIDS are most likely MN), (WWA A it begun; e flattens?) 260px“ xi‘l M) much higher (Deas, 2003). 9.1 million adolescents were diagnosed with an STI in the year 2000, and 15, 000 of those young people were diagnosed with HIV (Guttrnacher, 2006). Chlamydia and gonorrhea rates are consistently highest among young women and men (ages 15-24), when compared to all other age groups. In 2001, young women were diagnosed at a rate of about 6,000 per 100,000, and young men were diagnosed at a rate of about 1,500 per 100,000 (Alford, 2003). Young people from all ethnic groups and from all gender and sexual orientations are being diagnosed with higher rates of STls and HIV than the older population, but young men who have sex with men and young women of color are disproportionately represented among all new cases. L” Young men who have sex with men are diagnosed at. a higher rate than both. young women and Disproportionate Rates 4 young men who identify as heterosexual. However, the rate of STls and HIV infection among young women who have sex with men is growing quickly especially amongst young women of color. By 2001, African Americans and Latinas comprised 82 percent ofnew HIV cases amongst young women ages 13-24. In that same year, young African American women contracted Chlamydia at a rate seven times higher than for young white women. (Augustine, Alfred & Deas, 2004, para 2). in addition to race and gender as factors related to high rates of STl infection, class plays a role as well. Young people from neighborhoods with lower socioeconomic income levels have higher rates of STl/HIV incidences. Certain STls such as genital herpes are more prevalent amongst adolescents who live in an area that has large amounts of drug sales and use (Alfred, 2003, para 4). Homeless youth and youth who are incarcerated report higher rates of STE/HIV infection. "5;!th _ Causes and conseguences 02: the problem: As this paper will later examine federally funded abstinence-only education programs, I will first state what proponents of those programs believe are the causes of high rates of STI/ HlV w” incidences in young people._Abstinence—only education advocates believe that young people engaging in premarital sex is the primary cause of high STI/HIV prevalence among that population. A breakdown in “family values” and a lack of a strong religious and moral upbringing can lead I,» young people to have premarital sex. In 2001, 46 percent of all high school. students reported that they had sexual intercourse (Deas, 2003> para 1.). Proponents for these programs promote the idea that early sexual behavior outside of marriage causes young people to contract S-TIs/HIV and bear children out of wedlock (Santelli, Ott, Lyon, Rogers and Summers, 2006). / Proponents of comprehensive sexuality education, which I will explore in my analysis and proposal, have identified several different causative factors. Comprehensive sexuality education. advocates argue that lack of access to contraception and contraceptive education is one of the main w..._...__._ Disproportionate Rates 5 causes of adolescent STl/HIV infection. Another cause they point to is a lack of adequate health care coverage for young people. Over a quarter of adolescents are uninsured, which makes both testing and treatment more difficult. This in turn may increase transmission rates, as young people who are infected cannot get the testing, treatment and education they need to prevent passing the infection onto their partners (Alfred, 2006). Institutional sexism, racism, homophobia and poverty are also regarded as possible causes for the fact that young women, people of color and GLBTQ youth have higher STI/HIV incidences. Deas writes, “While racial-ethnic identity and socioeconomic status do not determine HIV infection, structural racism within the US that leads to greater likelihood of poverty and drug use in minority communities creates an environment of risk for many African American and Latina Women” (Deas, 2003, para 3). In addition, sexual violence against women and children puts them at increased risk for infection. Many homeless youth are forced to trade sex for shelter, food or money and also use drugs, which increases their risk for transrnission. The consequences of the problem are adolescents who have serious health problems at a young age. While some of these infections are treatable, some, if left untreated, can lead to infertility and death. Young women’s anatomy puts them at a higher risk for transmission and STls are more likely to be silent in women, which makes them more likely to go undetected. Untreated STls cause more health problems in women such as pelvic inflammatory disease, cervical cancer and infertility (Alfred, 2006, para 3). There is no cure for herpes or HIV, and though there are drugs that can prolong the life of a person who has HIV/AIDS, it is still considered a fatal disease. If left untreated, syphilis can also be fatal. In addition to causing physical problems, STIs and HIV can also cause substantial emotional health issues. Disproportionate Rates 6 Ideology and values: Proponents of abstinence-only education operate from a strong ideological base which stems from the belief that the underlying cause of the problem are young people who are promiscuous and engage in premarital sex. The behavior of teenage sexual activity is cited as the primary problem and STIs/HW and pregnancy amongst teenagers are regarded as negative consequences to this behavior. Proponents point to a media culture and society that promotes sexuality among adolescents. The official White House Web page cites the “sexual revolution that began in the 1960’s” as a major cause for “. . .the explosion of SIDS” (White House website, 2002). The value inherent in abstinence-only advocates’ identification of the problem is that no young person should be having sex outside of marriage, and adolescents should be protected from their own impulses and a sexually promiscuous society. The advocates for comprehensive sexuality education point to the government for not funding programs, which teach information about contraception. They believe that it is not teenage sexual behavior that causes STls and HIV, but a lack of comprehensive sexuality programs which teach young people to make healthy choices and protect themselves. They might argue that a single payer health care system, which would guarantee health insurance for everyone, would help prevent high transmission rates among young people. The values inherent in their advocacy are that no M. young person should be deprived of contraceptive education or adequate access to health care. Gainers and losers: The losers are obviously the young people who are being infected with STls and HIV. Instead of pursuing dreams that would contribute positively to their lives, they must spend much of their time, energy and resources dealing with health problems. GLBTQ communities and communities of color also lose when many of their future leaders are becoming sick. Our society, in Disproportionate Rates 7 general, also loses both spiritually and financially when many of its young members are grappling with significant diseases and infections. In the US, STIs and HlV, cost up to 13 billion dollars per year (Guttrnacher, 2006, para 7’). The gainers of the problem prove a little harder to identify. Though this is rather insidious, it’s possible that people who promote abstinence-only education gain from. young people being infected, because it helps them to portray negative examples of what can happen if you engage in premarital sex. Other possible gainers are health care providers and pharmaceutical companies that My make money off of providing services and drugs at a cost to either the young person’s family or the state . Social Policy Description: State Abstinence Education Programs Mission, Goals and Objectives: in. 1996, as a component of the Personal Responsibility and Work Opportunity Reconciliation Act, Section 510 of Title V of the Social Security act was added. This Section is titled the State Abstinence Education Program. The mission of this program is to provide federal funds to states that will promote abstinencenonly education in their schools. The title defines abstinenceonly education as having its “. .. exclusive purpose to teach (adolescents) the social, psychological, and health gains to be realized by abstaining from sexual activity” until marriage (Wilson, 2007, para 2). Abstinence is taught as the only certain way to avoid STls, HIV and pregnancy. The objectives for teaching and promoting abstinence~only education are long term: to lower the rates of out~of—wedlock pregnancies as well as sexually transmitted diseases ;;od1er health problems related to teenage sexual activity. Abstinence-only education also teaches young people that engaging in sexual activity before marriage can cause both negative psychological and physical effects. In addition, abstinence—only programs must state that having children out-of— Disproportionate Rates 8 wedlock can harm the child and the child’s parents as well as society as a whole. This type of education teaches young people how to reject sexual advances and how using drugs and alcohol can make them more susceptible to sexual advances. It also stresses the importance of becoming self- sufficient before becoming sexually active (Wilson, 2007). Form of Benefits and Services: The main benefit that the abstinence—only education funds provide comes in the form of a grant for the states who agree to abide by the rules and restrictions of teaching this form of education. This type of benefit federally subsidizes states that pass the funds on to schools and other programs that promise to teach abstinence-only exclusively. States can use these grants to create new programs or add new components to already existing ones. The federal government was mandated to divide $50 million dollars a year to all eligible states that would carry out these programs from 1998« 2003. More funds are used to conduct scientific research on the viabiiiw of these types of programs. The states had a certain amount of leeway in how they could choose to implement these programs. Most states use these funds for a combination of iu—school education programs and media campaigns directed at youth. The schools and programs can train their own staff to teach this curriculum or they can hire a private group to teach abstinence education to the students. States can also choose to implement “private mentoring, counseling and adult supervision ("til :? to promote abstinence from sexual activity/“(Social Security, 2000, para 3). Eli‘gibilirv: The states that are eligible to receive these funds are the states that promise to use the subsidies solely for abstinenceuonly education programs. States cannot accept the money if they intend to use the funding to teach any subject related to contraceptive use. Abstinencemnly educators are prohibited from passing out condoms or promoting the use of birth control.- They are 5/“ Disproportionate Rates 9 allowed to mention contraceptives only to emphasize the rates of failure. Abstinence until marriage must be stressed as the only acceptable and safe stance that a young personcan take with regards to sexual activity and sexual and gender orientation cannot be addressed (Santelli, Ott, Lyon, Rogers and Summers, 2006). With these strictly enforced restrictions, the type of eligibility for the funding of these programs is administrative rule. l/ If a state can agree to these rules and regulations, they are eligible to receive funding. As of 1/ 2007, 43 states are eligible and are receiving funding for abstinence education. California has never sought eligibility nor has it accepted funds. More recently, Ohio, Wisconsin, Connecticut, Rhode Island, Montana and New Jersey have opted out of abstinence-only funds so they could teach comprehensive sexuality programs in their schools. On a more micro level, the people who are eligible for the services that abstinence-only or funding provides are the young people who are in schools. States usually choose to divert most of the funds to educating middle and high school aged children "who are determined to be at the highest risk of sexual activity, but some funds also go to teaching elementary school—aged children, Administration: When the State Abstinence Education Program first began, the Maternal and Child Health Bureau administered it from l997 until 2004. The MICHB is a part of the Health Resources and Service Administration. Now the programs are centralized and controlled by the Administration for“ Children and Families” Family and Youth Services Bureau. The structure of administration is pyramidal with the FYSB overseeing state funded abstinence—only programs, determining eligibility and making sure the individual programs continue to follow the strict guidelines. The actual abstinenceonly education programs are the services, which are delivered through state and local Disproportionate Rates 10 agencies. While the programs are locally run, they are subject to program audits by the FYSB (Wilson, 2007). Funding: Funding has remained. virtually unchanged since the enactment of the federal program in 1997. The govennnent allots $50 million dollars a year for the programs and grants funding to each state that agrees to adhere to the strict abstinencemonly education guidelines. Section 510 of the Social Security Act of 1996 provides for the State Abstinence Education Program. This type of funding is considered tax revenue appropriation. The amount of money an individual state receives for the program is based on the number of low-income children in that state and how many low» income children there are in all the states receiving this funding. The state is also required to match 75 percent of the Title V funds (Social Security Online). Part 111- A Critical Analysis of State Abstinence-Only Education Programs Critz‘ are a Mission Goals and Ob'ectives: A lack a; clarity in the definition Chambers and Wedel argue that . .goals and objectives can only be clear if terms are well defined. . .In other words, meaning of the terms is not left to the imagination” (Chambers and Wedel, 2005, p. 81). For most of the ten years that State Abstinence Education Programs have been funded, the term “abstinence” itself was ambiguously defined, at best. Cynthia Dailard asserts that as abstinence—only programs proliferated, so too did the definitions for abstinence and the confusion surrounding What it truly rneant (Dailard, 2006). Without a clear definition of abstinence, many young peopie in abstinence~0nly programs “imagined” it meant abstaining from sexual intercourse alone and began engaging in oral and anal sex, which actually put them at increased risk for STls Disproportionate Rates 11 and HIV. In one study that followed college students who “pledged” abstinence and stated that they had kept that pledge, 55 percent of them reported that they had engaged in oral sex (Dailard, 2006). Finaliy, in 2006, the federal government defined abstinence as refraining from any sexual activity that is sexually stimulating until marriage. While somewhat clearer, this new definition of abstinence can still shift in the “imaginations” of young people trying to navigate between very real sexual desires and an abstinence pledge. This lack of a clear definition has already proven to be detrimental to the goals of reducing teenage sexual activity and lowering the risk of STI and HIV is L. infection. A 200?” [it between the mission and the groblem One of the main stated missions of the State Abstinence Education Program is to stress the idea that youth must remain abstinent until marriage if they want to avoid pregnancy and STIs (Wilson, 2007). This mission does not fit very well with the goal of reducing STI and HIV transmission among adolescents as it excludes many young people who are at a higher risk. Young people who already engaging in sexual activity are at once left out as they are already involved in the acts that are supposed to be restricted until marriage (Santelli, Ott, Lyon, Rogers and. Summers, 2006}. As abstinence—only educators are prohibited from talking about contraceptive options, except to emphasize their failure, sexually active young people are left without important contraception information, which could help prevent both pregnancy and STIs/HIV. Another group that is excluded from the mission of “abstinence until marriage,” are GLBTQ youth who are, by federal law, prohibited from marriage to a same sex partner. These young people are rendered either invisible or deviant according to the guidelines that prohibit discussion of different gender and sexual orientations. As young men who have sex with men have the highest rates of STls and AIDS among adolescents, denying their existence in abstinence—only Disproportionate Rates 12 education is extremely unethical. in addition, GLB TQ youth are at a high risk for loneliness, isolation and suicide, and being excluded in an educational setting may contribute to those negative x7. outcomes (Santelli, Ott, Lyon, Rogers and Summers, 2006). V F ormsflenefim and services: The benefit is inadeguare The benefit a program offers must adequately deal with the problems that it means to remedy (Chambers and Wedel, 2005), and federally funded abstinence—only programs are proving to be inadequate on many levels. On April 13, 2007, a large government study was quietly released that showed that abstinencemonly programs do not delay teenagers from having sex, nor do the programs lessen the number of sexual partners a teenager has (Stepp, 2007). This study was conducted by Mathematica Policy Research over a period of six years and was commissioned by the US. Department of Health and Human Services. Over 2,000 youth were enrolled in the study with approximately half of the group involved in one of four federally funded abstinence~only programs and the other half not involved in this type of group. The results speak volumes: “Findings indicate that youth in the program group were no more likely than control group youth to have abstained from sex and, among those who reported having had sex, they had similar numbers of sexual partners and had initiated sex at the same mean age (14.9 years old)” (Trenholm, Devaney, Forston, Quay, Wheeler and Clark; 2007, p. xvii). While approximately 83 million dollars a year is being spent on the State Abstinence Education Program, the programs have been proven both inadequate and ineffective at keeping young people from engaging in risky sexual behaviors at young ages. Disproportionate Rates 13 am was not created orsu orled h medical or arts or oth themselves As a program directed at a major health issue impacting adolescents, it needs to be evaluated for the ievels of input and support from both the medical and youth communities. Over the years, many segments of the medical community have become increasingly more vocal about their opposition to federally funded abstinence—only education and their support of comprehensive sexuality education. Among the list of supporters for comprehensive sexuality education are the following: the American Medical Association, the Institute of Medicine, the American Academy of Pediatrics, the Society for Adolescent Medicine, the American College of Obstetricians and Gynecologists and over I00 other medical organizations (Hauser, 2005). One of the main critiques that medical experts have of abstinence-only education is that many programs provide medically inaccurate information regarding contraception. Withholding and stating inaccurate information about contraception and other sexual health issues “. ..may cause teenagers to use ineffective (or no) protection against pregnancy and STls” (Santeili, Ott, Lyon, Rogers and Summers, 2006, p. 86). By choosing to ignore the recommendations of medical experts and continuing to fund abstinencenonly programs, the federal government is engaging in medically unethical behavior while putting young people at risk for STIS and HIV. Many proponents of the youth development model of education believe that when youth play a significant role in the creation of programs, both the youth and the programs themselves are more likely to thrive. For the most part, young people have not been able to contribute their input or ideas into the implementation of abstinencemnly programs. In a survey, 89% of adolescents say that sex education courses need to provide information regarding contraception options (Santelli, Ott, Lyon, Rogers and Summers). Abstinence-only education ignores the near consensus of the young people who are most directly impacted by the education and the problems it is trying to remedy. l/ I Disproportionate Rates 14 In addition, while the Family Youth and Services Bureau make a small claim. on one web page to “help promote culturally sensitive programs,” it’s not a consistent message throughout their literature. This line then can be regarded as a token and not as a true attempt at grappling with the disproportionate representation of S'i‘ls/HIV and pregnancy among youth of color. The voices of young women of color and young men who have sex with meng who are the most affected by the problems, have been virtually silenced. This silencing is proving both dangerous and at times fatal to young people. As one young Latina woman asserted in the documentary “Abstinence Comes To Albuquerque: “When it comes to people making decisions about how or what we should be taught or not taught about sex, i wish people would come to us and ask us what’s going on in our lives and what we want and need to learn about. We are the ones living it” (Stuart, 2005). Clearly, the creators and supporters of the State Abstinence Education Program are not heeding her message and I the opinions and ideas of young people like her, and this is a major critical flaw. W Proposal: Toward Comprehensive Sex Education Programs 6 As mounting evidence shows, abstinence~only education is not working to keep adolescents from engaging in sexual behavior that puts them at risk for both STIs/HIV and pregnancy. California, which has never accepted abstinence—only money, and supports a comprehensive sex education model, is ranked number one for lowering teen birth rates over the last ten years (Wind, 2006). Comprehensive sex education is supported by a growing majority of medical experts, youth as well as adults. Perrin and Deloy cite a study which states: “83% of adults believe that teenagers should receive information about protecting themselves from pregnancy and STls even if they are not yet sexually active” (Perrin and DeJoy, 2004). Even with this negative evidence against abstinence—only education and positive support for comprehensive Disproportionate Rates ‘ 15 sex education, the government has spent over a half billion dollars on abstinence—only programs in the last ten years and not put any funding toward comprehensive sex education. To conclude, I propose that we move federal funding away from abstinence—only education and toward the creation and implementation of comprehensive sex education programs. These programs would have strong input from the medical community and be scientifically accurate. They would be culturally sensitive with active participation from leaders, educators, parents and youth of color as well as members of the GLBTQ community. Young women and men would be an integral part of the creation and implementation of the programs including the use of peer education whenever possible. The curricula would include information regarding youth empowerment, body ignege, reproductive anatomy, sexual/ gender orientation, dating violence, contraception, STl/HIV prevention, as well as abstinence. Proponents of comprehensive sex education would never leave an abstinence component out of any program for adolescents, but when it comes to reducing the risk. of STIs/HIV and pregnancy, it simply cannot be the only subject taught. WM!”ij )‘0 [d (it __ Vito ant-tut, on ma m ti a, no M ii " L" _. 7 S ) bike, Mam 4%»- l/Jon law/L in «and m I? ll " Critter? on in arms lair at Um {fl/v65 on , .. .. _ , _ . ‘ f f " t I it we. 35%? lead , tiling,th DiSproportionate Rates 16 References Alford, S. (2003). Adolescents—At Riskfor Sexually Transmitted Infections. Retrieved March 3, 2007, “from wwwadvoeatesfogouthorg. Augustine, J ., Alford, 8., & Deas, N. (2004). Youth ofColorwAt Disproportionate Rile of Negative Sexual Health Outcomes. Retrieved March 4, 2007, from. Chambers, DE, & Wedel, KR. (2005). Social Policy and Social Programs. Boston: Pearson Education Inc. Dailard, C. (2006). Legislating Against Arousal: The Growing Divide Between Federal Policy and Teenage Sexual Behavior. Retrieved May 4, 2007 from Dees, N. (2003). Adolescents and HIV/AIDS. Retrieved March 4, 2007, from Guttmacher Institute. (2006). Facts on. Sexually Transmitted Infections in the United States. Retrieved March 4, 2007 from _ Hanger, D. (2005). Op—Ea’: Teens Deserve More Than AbstinencefiOnly Education. Retrieved May 4, 2007 from -- Perrin, K. & Deloy, SB. (2004). Abstinence—Only Education: How We Got Here and Where We’re Going. Journal ofPublic Health Policy, 24, 445-459. Santelli, J., Ott, M., Lyon, M., Rogers, J., & Summers, D. (2006). Abstinence—only policies and programs: A position paper of the Society for Adolescent Medicine. Journal oj‘Aa’olesceni Medicine, 38, 83-82. Social Security Online. (2003). Separate Program for Abstinence Education. Retrieved April 15, 2007 from DiSproponionate Rates i7 Stepp, L. {2007) Study Casts Doubt on Absiinence—Oniy Programs. Retrieved April 15, 2007 from Stuart, M. (Producer/Writer/Director). (2005). Abstinence Comes to Albuquerque [Documentary] United States: Stuart Television Productions. Trenholm, (3., Devaney. B., Forston, K, Quay, Wheeler, 1, & Clark, M. (2007). Impacts ofF our Title VSect‘ion 510 Abstinence Education ProgramsMFinal Report. Princeton: Mathematical Policy Research, Inc. The White House. (2002). Working Toward IndependenceeEncourage Abstinence and Prevent Teen Pregnancy. Retrieved on April 15, 2007 from Wilson, H. (2006). Family Youth and Services Bureau— Fact Sheet: Secz‘ion 510 State Abstinence Education Program. Retrieved on April 15, 2007 from Wind, R. (2006). States as Diverse as California antir 80th Carolina Get Top Ranking For Efloris To Prevent Unintended Teen Pregnancy. Retrieved on May 13, 2007 from wwwguttmacherorg. ...
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