The Centers for Disease Control and Prevention (CDC) released new findings that show a “dramatic decline” in risky sexual behavior among Black youth since 1991. The data, which cover 1991 to 2011, was presented by Laura Kann, Ph.D., and Kevin Fenton, M.D. at the recently concluded 2012 International AIDS Conference here.
Despite the sobering reality that Blacks currently experience the highest rate of new HIV infections among any racial group in the U.S., the CDC findings are a heartening sign that, among Black high school students at least, efforts at promoting safer sex have borne fruit.
“This is good news, but we still have more work to do,” said Dr. Fenton. “For students as a whole, while significant progress was made throughout the 1990s, this progress has stalled over the last decade.”
The data comes from the CDC’s National Youth Risk Behavior Survey (YRBS), a biennial survey conducted among a representative sample of public and private high school students.
“The findings we’re presenting today are from eleven large, nationally representative surveys conducted among public and private high school students in grades 9-12 every two years since 1991,” said Dr. Kann. “These surveys serve as highly credible gauges of changes in sexual risk behaviors over time.”
According to the study, the overall percentage of U.S. high school students who had ever had sex declined from 54 percent in 1991 to 46 percent in 2001. The percentage has held steady since then (47 percent in 2011).
Among Black students, the decline was especially significant, from 82 percent in 1991 to 60 percent in 2011. This is still higher than the rate for Hispanic students (49 percent in 2011) or White students (44 percent in 2011).
Overall, the proportion of students who had multiple (four or more) sex partners declined between 1991 (19 percent) and 2011 (15 percent). The decline for Black students was from 43 percent in 1991 to 25 percent in 2011. The percentage is still higher than that for Hispanics and Whites (15 and 13 percent, respectively, as of 2011).
Just as significant is what the study appears to indicate about condom use among Black youth. Overall, the proportion of sexually active students who used a condom the last time they had sex increased from 46 percent in 1991 to 63 percent in 2003, and since then has stabilized at 60 percent in 2011. But for Black youth condom use appears to be slightly higher than that for Hispanics or Whites (65 percent in 2011 compared to 58 and 60 percent, respectively, for Hispanics and Whites).
Drs. Kann and Fenton pointed out that, despite the welcome news of less risky sexual behavior among adolescents, most of the decline took place from 1991 to 2001, when awareness of the HIV/AIDS epidemic was especially high among the public at large. As HIV has fallen out of the headlines in the 2000s, the sense of urgency that marked the 90s has also abated.
Despite this evidence of stalled progress, there may be a silver lining for African Americans. “Although the overall plateaus in most of these indicators are troubling,” said Dr. Kann, “we were particularly encouraged by one major finding: The study shows that declines in sexual risk behaviors generally persisted among Black students throughout the entire 20-year period.
“This is especially important because African Americans are so heavily and disproportionately affected by HIV in the U.S.,” Dr. Kann said.
One important limitation of the YRBS is that it collected no data on the social and economic determinants of adolescent sexual behavior. “Given that we are unable to assess the impact of factors such as family income and education that are known to influence risk behaviors, we are not able to state the degree to which these factors may contribute greatly or not to generally higher risk behaviors among African Americans in the study,” said Dr. Kann.
Both presenters expressed confidence in the validity of the YRBS findings. Addressing the possibility of young respondents not reporting truthfully about their sexual behavior, Dr. Kann stressed the consistency of the YRBS findings with other studies of youth sexual behavior.
“We’ve learned over the years that if we put kids in the right environment, protect their privacy, promise them anonymity and follow through on that, that indeed they will tell us the truth–on a wide variety of behaviors, not just sexual ones,” said Dr. Kann. “We are able to determine that we think we are getting something very close to the truth when we look at these data and compare them to other sorts of data, such as teen pregnancy rates, or birth rates, or we look at sub-group differences, and see the types of consistencies that we would expect when we makes those kinds of comparisons.”
The CDC has launched a new public awareness campaign, in partnership with MTV and the Kaiser Foundation, called Get Yourself Tested, which the agency hopes will spark further declines in risky sexual behavior among youth. CDC is also funding community-based organizations in an effort to reach young gay and bisexual men with HIV testing and other services.
“At CDC, preventing HIV infections among young people is a priority, and we’re working with partners across the country to reach school youth in schools through media and through a wide range of community settings,” said Dr. Fenton.
“As these findings show, we have made important progress over time in some key areas, but our job is not done,” said Dr. Fenton. “We need to accelerate progress among African American youth who have made great strides in reducing risk behavior but remain most heavily affected by HIV and other sexually-transmitted diseases.”