Youth STIs Are at an All-Time High. A DC Program Shows Community Engagement Is Key to Fighting This Trend.
Although young people make up about 25 percent of the sexually active population, they contract 50 percent of all new sexually transmitted infections (STIs) annually. In 2018, combined cases of chlamydia, gonorrhea, and syphilis reached a record high following a five-year continuous increase. Sex is part of many adolescents’ and young adults’ lives, and evidence suggests access to clinical care and education on safe sex, healthy relationships, and routine screenings should be as well.
To encourage health and wellness among teens, many states and the District of Columbia allow minors to access some sexual and reproductive health services without parental consent. Still, navigating and accessing health care for these sensitive services can be intimidating, especially for young people, meaning they often miss out on vital sexual health information.
Here is how Promoting Adolescent Sexual Health and Safety (PASS)—a partnership between the Benning Terrace DC Housing Authority community, including participating teens, and the Urban Institute—is strengthening young people’s connection to local health resources.
Young people are more likely to seek services when they feel safe
The prevalence of STIs, including HIV, is higher among Black young people, and young people in the DC are diagnosed with HIV at nearly twice the national rate. PASS is unique because it was developed in partnership with teens and adults from a primarily Black community, and it approaches each lesson and activity with an understanding of the ways historic and current racial disparities influence participants (PDF). PASS offers a safe, culturally appropriate environment for adolescents and their caretakers to learn about sexual health, access health services, and challenge norms and behaviors around sex and relationships.
Young people may be uncomfortable seeking sexual and reproductive health services—especially Black young adults, given the exploitative history Black Americans have with health care in relation to STIs. Understanding this context, PASS minimizes potential tension by inviting clinicians and community health providers to Benning Terrace to speak with young people.
Lekeisha Terrell, a doctor from Unity Health Care, and Wayne Laster, from Sasha Bruce Youthwork’s mobile testing clinic, are regular PASS guests. With the program’s facilitators, they colead safe space discussions with the young people, providing resources and answering their questions without the added pressure and time limitations of a typical classroom or doctor’s office. After establishing rapport, they offer the young people a tour of Unity’s teen health clinic and Sasha Bruce’s mobile testing clinic.
Sharing knowledge and lived experiences in an environment where the young people feel comfortable has enabled PASS to build trust and increased the likelihood young people will seek its services. PASS participants demonstrated increased knowledge of where to go to get HIV/STI testing (54 percent before the program versus 61 percent afterwards), nearly all used the mobile testing clinic during its visit, and facilitators reported multiple accounts of previous participants referring their peers to Terrell and the teen clinic. When several young people tested positive for STIs, Laster reached out confidentially through PASS facilitators to ensure they received the necessary health services.
Community engagement and health care can work in tandem to advance well-being
Health researchers and practitioners are increasingly recognizing the value of community engagement and incorporating it into their work. The World Health Organization has even adopted a formal definition for this type of work, calling it “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes.” Research shows community engagement can lead to improved health and health behaviors among people who face geographic barriers to health care access, culturally inappropriate services, and financial barriers.
Urban’s Community Engaged Methods group encourages researchers, service providers, and local governments to incorporate community engaged methods into their work as much as possible to address local needs and goals more effectively. Community engagement can take many forms. Like PASS, efforts should work toward building trust and ensuring services appropriately meet the needs of the people they’re designed to serve. In the long run, community-based approaches like PASS can create more sustainable initiatives, more empowered and resilient communities, and improved outcomes for those involved.
The Urban Institute has the evidence to show what it will take to create a society where everyone has a fair shot at achieving their vision of success.