Despite national guidelines, teen boys still get inadequate HIV/STI counseling

Despite national guidelines aimed at improving sexual health services for teenagers, most sexually active boys - even those who report high-risk sexual behaviors - still get too little counseling about HIV and other sexually transmitted infections (STIs) during their visits to the doctor, according to a study led by researchers at Johns Hopkins Children's Center.

The study, published online ahead of print in the Journal of Adolescent Health, analyzed data from the 1995 National Survey of Adolescent Males and the 2002 National Survey of Family Growth, found that only 26 percent of teens who reported high-risk sex - such as having sex with a prostitute or an HIV-infected person or having sex while high or drunk - said they received HIV/STI counseling at the doctor's office in the year preceding the survey. Twenty-one percent of all sexually active boys, regardless of risk, said they discussed HIV and other STIs with their doctors.

The study also found no improvement in how well teenage males were screened for STIs 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 say their findings signal the need for better STI 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, M.D., M.P.H., a pediatrician and adolescent medicine specialist at Hopkins Children's.

Marcell and 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, pediatricians on the frontlines should ACT: ask, counsel, test. "Ask the patient if he is sexually active, counsel him about risk and test accordingly," Marcell says.

Other findings in the current study:

• In 1995, less than one-fourth of male teens said they had discussed STIs and HIV with a doctor or a nurse, compared to less than 22 percent in 2002.
• In 2002, less than 18 percent of males reported ever discussing birth control with their doctors. The 1995 survey did not include birth control questions.