Teens and adolescents 'may improvise using plastic wrap or bags' to prevent unintended pregnancy, STIs: Report
Sexually transmitted infections (STIs), including new HIV infections, and unintended pregnancies among adolescents remain significant public health problems in the US. Barrier protection is key to solving these problems, say experts. This includes external condoms (commonly known as a male condom), internal condoms (commonly known as a female condom), and dental dams, according to a policy statement on “barrier protection use by adolescents during sexual activity” by the American Academy of Pediatrics (AAP). While not evidence-based or advised, adolescents “may also improvise using plastic wrap or plastic bags to act as a barrier” to protect themselves from pregnancy and sexually transmitted infections, says the statement.
“Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and STIs. When used consistently and correctly, latex and synthetic barrier methods reduce the risk of many STIs, including HIV, and pregnancy. This update of the 2013 policy statement is intended to assist pediatricians in understanding and supporting the use of barrier methods by their patients to prevent unintended pregnancies and STIs and address obstacles to their use,” says the report. It adds, “For this statement, the age range for adolescent visits, as defined in the AAP’s Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, fourth edition, is 11 to 21 years of age.”
While sexually transmitted diseases (STDs) affect individuals of all ages, STDs take a particularly heavy toll on young people. CDC estimates that youth aged 15-24 make up just over one-quarter of the sexually active population, but account for half of the 20 million new sexually transmitted infections that occur in the US each year. Further, young people aged 13 to 24 are especially affected by HIV, says the agency. Of the 37,832 new HIV diagnoses in the US and dependent areas in 2018, 21% were among youth in 13 to 24 age-group.
In the new statement, the experts recommend discussing abstaining from sex as the most effective way to prevent genital STIs, as well as HIV infection, and unintended pregnancy. “Although abstinence from sexual activity is the most effective way to reduce pregnancy and STIs, it is important for young people to be prepared for the time when they will become sexually active. The prevention of STIs in adolescents involves abstinence or safer sexual practices by those who are not abstinent,” write authors.
The experts suggest that pediatricians should support and encourage the consistent and correct use of barrier methods as well as other reliable contraception as part of anticipatory guidance during visits with adolescents who are sexually active or contemplating sexual activity, including the emphasis on the responsibility of all genders in preventing unintended pregnancies and STIs. “Remove restrictions and obstacles to barrier method availability to encourage and promote barrier method use among adolescents. Beyond the retail distribution of barrier methods, the provision of free or low-cost barrier methods is a priority for adolescent-friendly health services. Pediatricians and other clinicians are encouraged to provide barrier methods within their offices and support availability within their communities,” advocate guidelines.
The researchers recommend supporting school barrier method educational programs, especially because these programs reach large adolescent populations and may potentially provide a comprehensive array of related educational and healthcare resources. Multiple studies reviewed by the authors suggest increased efforts are needed by pediatricians, educators, and those in public health to encourage parents to talk about these issues.
The implication for pediatricians is that providing parents with accurate information about adolescent sexual behavior, risks, and use and effectiveness of barrier methods can improve communication with their adolescents, says the team. Accordingly, actively communicating to parents and communities that making barrier methods available to adolescents does not increase the onset or frequency of adolescent sexual activity and that use of barrier methods can help decrease rates of unintended pregnancy and STIs is another suggestion.
The policy statement also suggests that pediatricians can advocate for engagement and support of additional research regarding barrier use (and safer sex practices) for higher-risk youth and those living in areas with a lack of access to barrier methods.
In a separate report, the American Academy of Pediatrics says that long-acting reversible contraceptives (LARC) are the most effective methods to prevent pregnancy. These are reversible birth control methods that include intrauterine devices (IUDs) and implants. Experts say while the availability of effective contraception has been associated with declines in unplanned pregnancy, yet the rates of LARC use among sexually active adolescents remain low at 2% to 3%. “The safety and efficacy of long-acting reversible contraception are well established for adolescents, but the rate of use remains low for this population. The pediatrician can play a key role in increasing access to long-acting reversible contraception for adolescents by providing accurate patient-centered contraception counseling and by understanding and addressing the barriers to use,” the AAP recommends.