What They Don't Know...

Despite national guidelines aimed at improving sexual-health services for teenagers, most sexually active young men -- even those who report high-risk sexual behaviors -- still get too little counseling about HIV and other sexually transmitted diseases during their visits to the doctor, according to a study led by researchers at Johns Hopkins Children's Center. The study, published in the Journal of Adolescent Health, analyzed data from the 1995 National Survey of Adolescent Males and the 2002 National Survey of Family Growth and found that only 26% of teens who reported high-risk behaviors -- such as having sex with a prostitute or an HIV-infected person or having sex while high or drunk -- said they received HIV or STD counseling at their doctor's office in the year preceding the survey. Only 21% of all sexually active young men -- regardless of risk level -- said they discussed HIV and other STIs with their doctors. The study also found no improvement in how well teenage males were screened for STDs and HIV between 1995 and 2002, even though in the early 1990s the American Medical Association and the American Academy of Pediatrics both issued guidelines urging physicians to make sexual-health counseling and related services part of the regular exam for teenagers. The researchers who worked on the study say their findings signal the need for better counseling of young male patients in order to minimize risky behaviors. 'If guidelines alone can't change what is being done at the doctor's office, then the million-dollar question becomes how to get doctors and nurses to talk with their patients about sexual health,' says lead investigator Arik Marcell, MD, MPH, a pediatrician and adolescent medicine specialist at Johns Hopkins Children's Center. Marcell and his colleagues say the first step to better counseling is the use of evidence-based, uniform guidelines to reduce confusion among providers. And, they say, it is critical to understand what prevents providers from counseling and devise ways to eliminate any such barriers. In the meantime, Marcell advises, pediatricians on the front lines should think of the acronym ACT -- for ask, counsel, and test -- when counseling young men about their sexual health. 'Ask the patient if he is sexually active, counsel him about risk, and test accordingly,' he says. ---------- Other Study Highlights >In 1995 less than one fourth of teen men said they had discussed HIV and other STDs with a doctor or a nurse, compared to less than 22% in 2002. >In 2002 less than 18% of young men reported ever discussing birth control with their doctors. The 1995 survey did not include birth control questions.