County’s sexual health problem lacks diagnosis

County’s high rate of STDs, teen pregnancies alarming

By Nick Tabor, New Era Staff Writer

In ninth-grade health classes at Christian County High School, students draw cards from a deck to help them understand the risks of unprotected sex. A sixth of the cards represent pregnancy, and a smaller minority represent sexually-transmitted disease.

Leigh Ellen Malone, one of the school’s health and physical education teachers, can sometimes see the lessons taking hold when she watches the students’ reactions.

It’s part of a curriculum that also involves role-playing, to help students imagine the consequences of teen pregnancy, and lessons about prevention, treatment and symptoms of STDs.

Outside the classroom, students and adults can pick up condoms for free in the bathrooms at Christian County Health Department. Anyone can get other methods of contraception there as well, even if they can’t pay a dime.

The health department offers teaching sessions to local groups that request them.

Nevertheless, in 2009, the most recent year for which public data is available, Christian County reported more than five times as many sexually-transmitted infections as the national benchmark.

Since Kentucky’s average was about 3.7 times the national benchmark, Christian County was an outlier even for its state.

Its teen birth rate was about 59 percent higher than the state average and nearly 300 percent higher than the national benchmark.

Mark Pyle, director of the Christian County Health Department, said the county’s rates have been this high for years.

In response to the New Era’s queries over the last two weeks, local health officials could not explain why the county scored so high in these areas.

Jennie Stuart Medical Center deferred comment to the health department.

Health department nurses pointed to demographics. For instance, the county has a higher ratio of black residents than any other Kentucky county, and the federal government reports a Chlamydia rate among blacks eight times higher than the rate among whites and a gonorrhea rate 19 times that among whites.

Neither the health department nor the state government could provide data on how many STDs and teen pregnancies in Christian County occurred among various racial groups.

Fort Campbell’s numbers also factor into Christian County’s total. A 2006 report from the Borden Institute, the U.S. Army’s center for medical research, stated that the military consistently reported higher rates of sexually-transmitted infections than the private sector.

The nurses also said many parents don’t talk to their kids enough about sex.

Pyle said the health department’s role is to provide education and services. He attributes the county’s problem to residents not using these services.

“Maybe socio-economic status has something to do with it, but personally I think at some point people have to make good choices,” Pyle wrote in an email. “It’s hard to diagnose why our pregnancy and STD rates are higher. For now all we can do is advocate, educate, screen and treat.”

But neither explanation — demographics and the ubiquity of poor sexual habits — reaches the heart of the matter. They beg the question: Why are so many residents practicing unsafe sex?

Pyle agreed that if Christian County were to wage a campaign to reduce these rates, perhaps local government, private businesses, religious organizations and health-care providers could all play a role, as they have in their support of a public smoking ban.

However, to begin treating the large-scale problem, officials would first need to diagnose it in a way no one has yet done.

Data reporting

Between 2002 and 2008, Christian County reported about 6,718 births by girls aged 15 to 19, according to data from the Center for Disease Control and Prevention. This is a rate of 83 per 1,000 girls: much higher than the state average of 52 and the national benchmark of 22.

The county reported about 421 cases of Chlamydia in 2009, according to CDC data. In their rankings of each county’s healthiness, the University of Wisconsin and the Robert Wood Johnson foundation use this number to calculate sexual health.

It does not account for other sexually-transmitted infections, such as Trichomoniasis, herpes, syphilis, gonorrhea or HIV/AIDS.

State law requires private doctors to notify public health departments when they test patients positive for STDs, said Ashley Workman, another health department nurse. This way every diagnosis gets counted in the data.

Anita Simmons, who was director of the Christian County Health Department for nearly 20 years, said residents from other counties often sought treatment in Christian County during her tenure.

In counties like Trigg and Todd, many residents know people who work at the health departments, and this might motivate some to seek testing in Christian County instead, Simmons said.

This would artificially inflate Christian County’s rates.

Treatments, testing

The Christian County Health Department offers a wide array of education and treatment services related to sexual health.

It provides funding to Alpha Alternative, which teaches high school students about the dangers of unsafe sex and encourages abstinence. In certain classes, such as parenting and “life skills,” students can learn about contraceptives. But Malone said these classes are electives.

Students know they can pick up condoms and get other contraceptives at the health department, Malone said.

The department provides contraceptives to anyone who comes in seeking them. As the New Era reported in March, the department spent $289,063 on contraceptives and counseling related to family planning during the last fiscal year. This included $50,441 from local taxes.

The department offers screenings and treatment for STDs. Whenever a patient tests positive, health department personnel ask the person for a list of their recent sexual partners. The staff then tries three times to reach each person on the list to schedule a screening.

They want to stop the infections from spreading further.

Why the gap?

But the high rates of teen pregnancies and STDs make it clear many people are not using the health department’s services. Several people proffered explanations for the gap.

Dr. Tanya Franklin, an assistant professor at the University of Louisville, teaches obstetrics and gynecology and directs the Ryan Residency Program in Family Planning.

Residents of Kentucky’s rural areas often go to Franklin for treatment. They tell her they never went to their local health departments for contraceptives because they knew everyone in town would find out.

“People who work at these places are people they know or people who know their family,” Franklin said. “So they basically just avoid it altogether and just pray that they don’t get pregnant.”

Education about sexual health could make the matter less taboo, she said. But often rural communities don’t make strong enough educational efforts, sometimes because rural areas have so few doctors and nurses. They often focus on issues like diabetes and cancer that affect both men and women, Franklin said.

Rev. John Banks, president of the local chapter of the National Association for the Advancement of Colored People, sees race as a central part of the problem — along with socioeconomic status.

The lack of equal opportunities for blacks through the Civil Rights movement and beyond has promoted generational cycles of poverty, Banks said. Many young black people practice unsafe sex because they’re imitating models in their environments, he said. The health department, with its free contraception, can seem like part of a different world.

To compound the problem, neither churches nor schools commonly educate kids on safe sex practices, Banks said.

“You talk to them about crime,” he said. “You talk to them about alcohol. Talk to them about sex.”

Rev. Buddy Slaughter, pastor of Means Avenue Baptist Church, agreed poor socioeconomic conditions often affect people’s decisions about sexual practices. But they shouldn’t, he said.

Slaughter attributes the problem to people not understanding their value in God’s eyes. Young women sometimes tell him they got pregnant because they were seeking love or affirmation, he said.

Toward a solution

Franklin considers education the key component for improving the statistics.

Through community education, even women in rural areas can eventually feel comfortable seeking contraceptives, she said. Rural health departments might not be able to work around the privacy issue, but they can reduce the stigma.

Increasing the number of nurse practitioners, physician assistants and doctors can also help, she said. More doctors can mean more education.

Banks suspects the health department’s educators don’t reach some of the groups that need most to hear their messages.

A county-wide campaign to improve sexual health could address racial disparities head-on, Banks said. Black ministers could work together with health officials.

“We’ve got to look at this as a homogeneous community and not a separate-but-equal community.”

As rates of unintended pregnancies and STDs go down, overall health, education and income level tend to rise, Franklin said.

However, these proposals are based on fairly loose speculation about the causes for Christian County’s poor sexual health. A comprehensive effort to improve the situation would likely start with a more comprehensive evaluation.