of HIV infection because condoms are not 100% effective.58 Dr. Lloyd Kolbe, Director of the Division of Adolescent and School Health of the CDC, responded to these concerns. In collaboration with the Division of STD/HIV Prevention at CDC, Dr. Kolbe summarized the extensive body of research about condom effectiveness. His response included the following points:59 • When latex condoms are used consistently and correctly, they are extremely effective in preventing sexually transmitted diseases (STDs), including HIV. • Although latex condoms have reduced the risk of contracting STDs in both laboratory and clinical studies, effectiveness has varied. Several studies show 100% effectiveness for latex condoms. The individual user, not the condom, is more likely to be responsible for any failure in protection from sexually transmitted infection or unwanted pregnancy. While the "typical" failure rate of condoms as contraceptives is approximately 10-20%, condom effectiveness as a contraceptive increases with experience, and failure rates as low as 0.6% have been documented. • Manufacturing defects are quite uncommon. Each domestically manufactured condom is individually electronically tested for pinholes and areas of thinning, and imported batches are subject to testing by the Food and Drug Administration. See Appendix C for materials submitted by Kolbe in response to concerns about condom effectiveness. 60 Between 1982 and 1988, the percent of teenage females practicing contraception rose significantly, from 24% to 32%, reflecting primarily an increase in condom use by this population. In fact, the percent of females ages 15-19 who reported reliance on condoms for contraception increased from 21% in 1982 to 33% in 1988. During the same years, the percent of females relying on the pill for contraception decreased from 64% to 59%.61 The proportion of females ages 15-19 who reported contraceptive use at first intercourse also increased during the 1980s, from 48% in 1982 to 65% in 1988.62 This increase was due principally to increased condom use reported by females of all races/ethnicities, and socioeconomic status. (See Table 8) 63 Table 8: Percent of Sexually-Experienced Females Ages 15-19 Who Despite these improvements, it is important to note that more than one-third of females ages 15-19 do not use any method of contraception at first intercourse and that many young people, particularly females, delay contraceptive use for up to a year after first intercourse.64 Condom use among males has also increased significantly in the past decade. In 1979, 21% of sexually-active males ages 1719 who were surveyed reported that they had used a condom at last intercourse. This figure rose to 58% in 1988.65 As mentioned previously, condom use at first intercourse is especially important for HIV prevention, because younger teens tend to delay contraceptive use, including use of condoms, for many months or even years. Table 9 summarizes data reported by the 1988 National Survey of Adolescent Males. (0) Reprinted with the permission of The Alan Guttmacher Institute from Method and Age at First Intercourse Table 9: Percent of Never-Married, Sexually-Active Males Ages 15-19, By Contraceptive Method Used At First Intercourse, According to Age at First Intercourse and Race/Ethnicity, 1988(P) African All Races White American Hispanic Homosexual Behavior May Be More Common in Teens than Previously Thought As mentioned previously, although male homosexual behavior is implicated in a large number of AIDS cases among youth, a lack of reliable data has prevented accurate assessment of the prevalence of homosexual activity and risk-taking among (p) Reprinted with the permission of The Alan Guttmacher Institute from Freya In this table, effective methods of contraception include oral contraceptives, diaphragm, IUD, sponge, foam, jelly or suppository. adolescents who identify themselves as gay or lesbian. 66 Since the Kinsey studies were conducted during the 1940s and 1950s, only one study using data from a national probability sample has estimated the prevalence of same-gender sex. This 1970 survey found that at least 20% of American men have had same-gender sexual contact to the point of orgasm, with the majority reporting that the first contact of this type occurred during their teenage years or earlier.67 Other smaller studies have confirmed that homosexual experimentation is more frequent among adolescents than commonly believed. One study of high school students in the Bronx found that 10% of female students and 9% of male students reported same-gender sex,68 and four other surveys of young American men found that the incidence of homosexual activity resulting in orgasm on at least one occasion ranged from 17% to 37%.69 Homosexual activity during adolescence does not necessarily confirm a gay or lesbian sexual orientation, but it is important to note that many adolescents who may not consider themselves to be homosexual or bisexual, nevertheless participate in samegender sexual behaviors that place them at risk of HIV infection.70 (See Chapter III for further discussion of homosexual behavior among youth.) Anal Intercourse Practiced by Heterosexual Adolescent Partners Anal intercourse is particularly risky for HIV transmission because it may cause small tears in the rectal lining, which can allow infected semen to enter the bloodstream.7 71 National estimates of the prevalence of this behavior are unavailable. However, one study found that more than one-fourth (25.2%) of teenage females attending an adolescent outpatient clinic in New 72 and York City reported having engaged in anal intercourse, another study found that of more than 100 females ages 15-21 interviewed at a family planning clinic, 12% reported that they had engaged in anal intercourse." 73 Nearly One Million Teens Exchange Sex for Food, Shelter. Money, or Drugs An estimated 150,000 adolescents become involved in prostitution each year,74 and according to one study by the American Medical Association, an estimated 900,000 teens have exchanged sex for food, shelter, money, or drugs. Of these youth, two-thirds are female.75 Drug Use Prevalent Among Teens, Associated with Risky Sexual Behavior Millions of young adults experiment with alcohol and other drug use each year. Although intravenous drug use is particularly risky in terms of HIV infection, other drugs can play a less direct role in HIV transmission because they can impair a user's judgment, leading the user to engage in higher risk sexual behaviors. 76 Data from the 1991 National Household Survey and the 1990 National High School Senior Survey indicate that over four million young people ages 12-17 (20.1% of this population) have used an illicit drug at least one time during their lives; over 2.9 million (14.8%) have used an illicit drug within the past year, and nearly 1.4 million (6.8%) of young people ages 12-17 had used illicit drugs in the month prior to the interview. (See Table 10) |