IRVINE, Calif.Reducing risky sexual behavior among teenagers may never be accomplished if the messages are targeted solely to adolescents. In many cases, adults are responsible for the risk behavior exhibited by teenagers.
The incidence of teen pregnancy and sexually transmitted diseases (STDs), including AIDS, among adolescents is staggering. Although countless programs exist at all levels to discourage risky behaviorssuch as sexual activity and intravenous drug useamong adolescents, the initiatives are apparently having little affect.
A close look at the statistics reveals a disturbing trend. More adolescent girls are diagnosed as HIV-positive than adolescent boys. According to the numbers, the girls cannot be getting infected by their peers, said Mike Males, a doctoral candidate in the School of Social Ecology at the University of California at Irvine.
"Ninety percent of the AIDS cases diagnosed before age 20which means infections are acquired in childhood or early adolescenceare in girls," Males said. "They are not getting infected from peer boys. There are simply not enough infected heterosexual boys."
The same holds true for other STDs, said Margaret Hammerschlag, MD, Professor of Pediatrics and Medicine, State University of New York Health Science Center at Brooklyn. She spoke at the Eighth Annual Infectious Diseases in Children Symposium.
"For a lot of these girls, their partners are not teenage boys; they're men," Hammerschlag said. "It is not uncommon for 16-year-old girls to see guys in their 20s. That is one of the reasons that the rate of [gonorrhea] is higher in younger women than in guys their same age. It is because the girls' sexual partners are older guys. [The girls] are frequently monogamous, but they are sleeping with fellows who are not monogamous and who are not telling them, which actually might be a risk factor for these girls getting pelvic inflammatory disease."
Males' research confirms the role of adults in adolescent sexual activity. A review of California birth records, most of which list the father and his age, revealed that 80% of the fathers of teenage pregnancies were older than 18 years; more than half were older than 20.
"I question whether there is such a thing as teenage sex," Males said. "It seems to be just an adjunct of adult sex."
Teenage sexual patterns mirror those of adults between 20 and 44 years of age. There is a correlation of almost 1:1 between teens and adults for increases and declines in birth statistics.
"If there is such a thing as teenage sex," Males asked, "where are the differences?"
Adult influence on adolescent sexual behavior is not a new concept, although it remains a "taboo" issue, Males said. During the 1950s, for example, gonorrhea and syphilis occurred at higher rates among adolescent girls than could be accounted for by the rates among adolescent boys. Adult involvement in teen pregnancy may be traced back through birth records dating from the turn of the century.
"We have had lots of time to get used to the idea," he said. Unfortunately, many records are incomplete, leaving an opening for critics to refute the theory.
"It throws a monkey wrench into theorizing about adolescent sex," Males said. "We like to think that people who do risky things have bad things happen to them, but with adolescents, most of their risky behavior involves adultsit is also high-risk adult behavior. The actions we abhor in adults are the risky behaviors of adolescents."
Despite the historical data, adult involvement in teenage sexual behavior has been largely overlooked. Studies that have uncovered discrepancies among rates of HIV among adolescent boys and girls stopped short of exploring the reasons behind the inconsistency.
"In AIDS research, they don't ask who infected the person," Males said. "They are interested in partner notification, but they don't ask about the nature of the partnership."
Public health, for the most part, has remained silent on the issue. A report issued by the Centers for Disease Control and Prevention delved into the issue of adolescent sexual behavior and HIV infection, but included only a single sentence on the possibility of adult involvement, Males said.
The only real solution is to address the actions of adults. In the meantime, a fundamental shift in the concept of adolescent risk behavior may be warranted. "Major changes must be made in how teenage sex is portrayed and viewed before the problem can be solved," Males said. "It needs to be studied."
Sex education programs must go beyond advising adolescents on how to behave in relationships with their peers; they must coach adolescents on how to handle encounters with adults who may be forceful or abusive.
"Teenagers do not face only their peers," Males said. "Adolescents enter the adult world of sex without being adequately prepared. They need help dealing with their experiences. Rights are importantadolescents need rights. It is something that must be dealt with at the state level. We give adults rights, but then we close our eyes and look the other way."
For more information, see:
- Males MA. Adult involvement in teenage childbearing and STD. Lancet. 1995;346:64-65.
- Kaul S. Sexual health in teenagers. Lancet. 1995;346:649.
You can express your views on this article, or other relevant themes, in the Infectious Diseases in Children Specialty Forums.