FS: Sexuality and Youth in Communities of Color

Sexuality and Youth in Communities of Color Fact Sheet

Young people in communities of color face disproportionate rates of unintended pregnancy and sexually transmitted diseases, including HIV.

The reasons for these disparities are rooted in the complex social, economic, and political landscape of our nation and are difficult to understand completely. Still, the Centers for Disease Control and Prevention (CDC) suggest several important factors including the distribution of poverty, availability and quality of health care, the level of drug use in some communities, multiple sexual partners, and sexual networks with high STD prevalence.

This fact sheet provides information about many issues affecting the health of young people in communities of color including sexual behavior, contraceptive use, STDs, HIV, unintended pregnancy, and knowledge and beliefs about sexual health. Understanding all of these issues can help professionals provide culturally competent sexuality education and prevention programs.

Throughout this fact sheet references to racial/ethnic groups vary. These variations reflect the terms used in the original research.

(Published in the SIECUS Report, Volume 32, Number 1 - Winter 2004)

SEXUAL BEHAVIOR

Data from the Youth Risk Behavior Surveillance System (YRBS)¹

60.8 percent of Black students (68.8 percent of male and 53.4 percent of female); 48.4 percent of Hispanic students (53 percent of male and 44 percent of female); and 43.2 percent of White students (41.1 percent of male and 41.3 percent of female) reported having had sexual intercourse.
16.3 percent of Black students (25.7 percent of male and 7.6 percent of female); 7.6 percent of Hispanic students (11.4 percent of male and 4.1 percent of female); and 4.7 percent of White students (6.2 percent of male and 3.3 percent of female) reported having initiated sexual intercourse before the age of 13.
45.6 of Black students (52.3 percent of male and 39.5 percent of female); 35.9 percent of Hispanic students (37.3 percent of male and 34.5 percent of female); and 31.3 percent of White students (30.0 percent of male and 32.3 percent of female) reported being currently sexually active, defined as having had sexual intercourse in the three months prior to the survey.
26.6 percent of Black students (38.7 percent of male and 15.6 percent of female); 14.9 percent of Hispanic students (20.6 percent of male and 9.5 percent of female); and 12 percent of White students (12.8 percent of male and 11.1 percent of female) reported having had sexual intercourse with four or more partners.
Among currently sexually active students, 17.8 percent of Black students, 24.1 percent of Hispanic students, and 27.8 percent of White students reported using alcohol or drugs during last intercourse.

Data from the National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes, and Experiences²

68 percent of White adolescents and young adults (ages 15 to 24), 69 percent of African-American adolescents and young adults, 67 percent of Latino adolescents and young adults, and 57 percent of Asian adolescents and young adults reported having had sexual intercourse.
61 percent of White adolescents and young adults (ages 15 to 24), 41 percent of African-American adolescents and young adults, 47 percent of Latino adolescents and young adults, and 40 percent of Asian adolescents and young adults reported having engaged in oral sex.
89 percent of White adolescents and young adults (ages 15 to 24), 59 percent of African-American adolescents and young adults, and 75 percent of Latino adolescents and young adults who had engaged in sexual intercourse reported having engaged in oral sex.
14 percent of White adolescents and young adults (ages 15 to 24), 8 percent of African-American adolescents and young adults, and 9 percent of Latino adolescents and young adults who had not engaged in sexual intercourse reported having engaged in oral sex.
77 percent of White adolescents (ages 15 to 24), 76 percent of African-American adolescents, 74 percent of Latino adolescents, and 67 percent of Asian adolescents reported having "been with someone in an intimate or sexual way (including but not limited to intercourse)."

ATTITUDES ABOUT SEXUAL BEHAVIOR

Data from the National Survey of Adolescents and Young Adults³

60 percent of White adolescents (ages 15 to 17), 36 percent of African-American adolescents, and 36 percent of Latino adolescents agree that "once you have had sex it is harder to say no the next time."
60 percent of White adolescents (ages 15 to 17), 59 percent of African-American adolescents, and 56 percent of Latino adolescents agree that "there is pressure to have sex by a certain age."
51 percent of White adolescents (ages 15 to 17), 30 percent of African-American adolescents, and 32 percent of Latino adolescents agree that "oral sex is not as big of a deal as sexual intercourse."
61 percent of White adolescents (ages 15 to 17), 68 percent of African-American adolescents, and 67 percent of Latino adolescents agree that "waiting to have sex is a nice idea but nobody really does."

CONTRACEPTIVE USE

Data from the YRBS⁴

Among currently sexually active* students, 67.1 percent of Black students, 56.8 percent of Hispanic students, and 53.5 percent of White students reported using condoms during last intercourse.
Among currently sexually active* students, 7.9 percent of Black students, 9.6 percent of Hispanic students, and 23.4 percent of White students reported that either they or their partner used birth control pills before last intercourse.

*"Currently sexually active" was defined has having had sexual intercourse in the three months prior to the survey.

Data from the National Survey of Adolescents and Young Adults⁵

62 percent of White adolescents and young adults (ages 15 to 24), 59 percent of African-American adolescents and young adults, 52 percent of Latino adolescents and young adults, and 62 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported using birth control or protection all of the time.*
6 percent of White adolescents and young adults (ages 15 to 24), 4 percent of African-American adolescents and young adults, 10 percent of Latino adolescents and young adults, and 8 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported never using birth control or protection. *
90 percent of White adolescents and young adults (ages 15 to 24), 93 percent of Black adolescents and young adults, 89 percent of Latino adolescents and young adults, and 85 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported ever using condoms.*
58 percent of White adolescents and young adults (ages 15 to 24), 72 percent of Black adolescents and young adults, 55 percent of Latino adolescents and young adults, and 57 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported having used condoms regularly.*
56 percent of White adolescents and young adults (ages 15 to 24), 67 percent of Black adolescents and young adults, 52 percent of Latino adolescents and young adults, and 62 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported having used a condom the last time they had sexual intercourse.*
67 percent of White adolescents and young adults (ages 15 to 24), 53 percent of Black adolescents and young adults, 53 percent of Latino adolescents and young adults, and 46 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported ever using the birth control pill.*
41 percent of White adolescents and young adults (ages 15 to 24), 48 percent of Black adolescents and young adults, 42 percent of Latino adolescents and young adults, and 45 percent of Asian adolescents and young adults, who had engaged in sexual intercourse reported ever using withdrawal or "pulling out."*
6 percent of White adolescents and young adults (ages 15 to 24), 5 percent of Black adolescents and young adults, 11 percent of Latino adolescents and young adults, and 13 percent of Asian adolescents and young adults who had engaged in sexual intercourse reported ever using the rhythm or calendar method. *

*emphasis added

ATTITUDES ABOUT "SAFER-SEX" AND CONTRACEPTION

Data from the National Survey of Adolescents and Young Adults⁶

85 percent of White adolescents (ages 15 to 17), 92 percent of African-American adolescents, and 84 percent of Latino adolescents consider sex with a condom to be a form of safer sex.
77 percent of White adolescents (ages 15 to 17), 58 percent of African-American adolescents, and 62 percent of Latino adolescents consider sex using other kinds of birth control to be a form of safer sex.
18 percent of White adolescents (ages 15 to 17), 32 percent of African-American adolescents, and 27 percent of Latino adolescents consider "pulling out" to be a form of safer sex.
24 percent of White adolescents (ages 15 to 17), 32 percent of African-American adolescents, and 27 percent of Latino adolescents consider "sex during the 'safe' times of the month" to be a form of safer sex.
46 percent of White adolescents (ages 15 to 17), 22 percent of African-American adolescents, and 27 percent of Latino adolescents consider oral sex to be a form of safer sex.
92 percent of White adolescents (ages 15 to 17), 71 percent of African-American adolescents, and 73 percent of Latino adolescents agree that "sex without a condom isn't worth the risk."
34 percent of White adolescents (ages 15 to 17), 28 percent of African-American adolescents, and 39 percent of Latino adolescents agree that "it is hard to bring up the topic of condoms."
59 percent of White adolescents (ages 15 to 17), 60 percent of African-American adolescents, and 65 percent of Latino adolescents agree that "condoms break a lot."
51 percent of White adolescents (ages 15 to 17), 29 percent of African-American adolescents, and 43 percent of Latino adolescents agree that "buying condoms is embarrassing."
85 percent of White adolescents (ages 15 to 17), 89 percent of African-American adolescents, and 89 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "like the person cared about me."
87 percent of White adolescents (ages 15 to 17), 89 percent of African-American adolescents, and 89 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "relieved."
86 percent of White adolescents (ages 15 to 17), 98 percent of African-American adolescents, and 91 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "like the person respected me."
14 percent of White adolescents (ages 15 to 17), 9 percent of African-American adolescents, and 11 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "insulted."
52 percent of White adolescents (ages 15 to 17), 58 percent of African-American adolescents, and 58 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "suspicious or worried about the person's past sexual history."
46 percent of White adolescents (ages 15 to 17), 54 percent of African-American adolescents, and 56 percent of Latino adolescents agree that if a partner suggested using a condom they would feel "like the person was suspicious or worried about my past sexual history."

Sexually Transmitted Diseases

Data from the Sexually Transmitted Disease Surveillance 2003⁷

In 2002, African American women ages 15 to 19 years had a gonorrhea rate of 3,307.7 cases per 100,000 females. This rate was 17 times greater than the rate among white females of the same age (196.1). In 2002, African American men ages 15 to 19 had a gonorrhea rate of 1680.1 cases per 100,000 males. This rate was 45 times greater than the rate among white males of the same age (37.7).
In 2002, the gonorrhea rate among White, non-Hispanic adolescents ages 15 to 19 was 115.0 per 100,000 compared to 2,484.9 among Black, non-Hispanic adolescents, 214.7 among Hispanic adolescents, 66.8 among Asian or Pacific Islander adolescents, and 393.1 among American Indian/Alaska Native adolescents.
In 2002, the chlamydia rate among White, non-Hispanic adolescents ages 15 to 19 was 713.2 per 100,000 compared to 5,032.2 among Black, non-Hispanic adolescents, 1,578.6 among Hispanic, 507.6 among Asian or Pacific Islander adolescents, and 2,659.6 American Indian/Alaska Native adolescents.
In 2002, the syphilis rate among White, non-Hispanic adolescents 15 to 19 was 0.3 per 100,000 compared to 8.6 among Black, non-Hispanic adolescents, 1.9 among Hispanic, 0.2 among Asian or Pacific Islander adolescents, and 0.5 American Indian/Alaska Native adolescents.

Data from the Division of HIV/AIDS Prevention⁸

2,825 cases of HIV infection among male adolescents ages 13 to 19 were reported to the Centers for Disease Control and Prevention through December 2001. Of these, 872 were White, non-Hispanic; 1,654 Black, non-Hispanic; 249 Hispanic; 8 Asian/Pacific Islander; and 20 American Indian/Alaska Native.
3,762 cases of HIV infection among female adolescents ages 13 to 19 were reported to Centers for Disease Control and Prevention through December 2001. Of these 739 were White, non-Hispanic; 2,716 Black, non-Hispanic; 256 Hispanic; 9 Asian/Pacific Islander; and 23 American Indian/Alaska Native.

Unprotected Sex and Associated Risk Factors among Young Asian and Pacific Islander Men Who Have Sex with Men

AIDS Education and Prevention featured a study that focused on young Asian and Pacific Islander men who have sex with men (API MSMs). Researchers recruited 253 young API MSMs (ages 15-25) who reported having same-gender sexual intercourse* within the 12 months preceding the study. Participants were selected from gay-identified venues in Seattle and San Diego. The study found:

Sexual Partners

88 percent of participants reported having at least one sexual partner in the three months preceding the study.
Of these, 41 percent reported having only one sexual partner; 23 percent reported having two sexual partners; and 24 percent reported having three or more sexual partners in the three months preceding the study.

Patterns of Sexual Behavior

60 percent of the participants who reported having sexual intercourse* in the three months preceding the study specified having anal intercourse.
Of these, 48 percent reported having used condoms every time they had anal intercourse; 44 percent reported having anal intercourse without condoms with at least one man; and 8 percent reported having anal intercourse without condoms with two or more men.

* Sexual intercourse was defined as oral and anal intercourse, as well as any physical contact leading to orgasm.

Main Partner Versus Non-Main Partner

Participants were also asked to categorize their experiences with "main" or "non-main" partners. Researchers defined a main partner as a "steady boyfriend or lover."
60 percent of participants reported having anal intercourse with a main partner, and 43 percent of participants reported having anal intercourse with a non-main partner in the three months preceding the study.
49 percent of participants reported having unprotected anal intercourse with a main partner, and 25 percent of participants reported having unprotected anal intercourse with a non-main partner in the three months preceding the study.

Kyung-Hee Choi, et al., "Unprotected Sex and Associated Risk Factors among Young Asian and Pacific Islander Men Who Have Sex with Men," AIDS Education and Prevention, 14, no. 6, December 2002, 472-81.

HIV/STD Knowledge, Attitudes, and Risk Behaviors Among Hmong-American Adolescents

A study in the Journal of Sex Education and Therapy examined self-reported HIV/STD knowledge, attitudes, and risk behaviors among Hmong-American adolescents.

The Hmong are native to southern China and Southeast Asia. It is estimated that 150,000 Hmong now live in the United States. Much of the information available about HIV/STD groups all Asians, including the Hmong, together despite differences in language, religion, and customs. Therefore, little information is available on HIV/STD knowledge, attitudes, and risk factors specific to the Hmong community.

For this study, researchers surveyed 299 Hmong-American students, ages 12-21, who took part in a culturally specific HIV/STD prevention program offered by public junior and senior high schools in St. Paul, MN, during the 1993-94 and 1994-95 school years. Approximately 20 percent of the Hmong-American students in these schools chose to participate in these programs. The study found:

87 percent of participants responded correctly when asked if "people can get a sexually transmitted disease by having sex."
80 percent of participants responded correctly when asked if "you can get AIDS if you use the same toilet seat or phone as someone who has AIDS."
48 percent of participants responded correctly when asked if "one way to prevent the spread of HIV is to have sex with only one partner."
71 percent of participants responded correctly when asked if "Hmong people don't have to practice safer sex because it is very difficult for them to get HIV."
50 percent of participants responded correctly when asked if "you eat a lot of hot peppers, you will not get AIDS."
30 percent of participants responded correctly when asked if "in Laos, there is a tree that can keep you from catching the AIDS virus if you make tea from the leaves and drink the tea."

Attitudes Toward HIV/STD

87 percent of participants expressed the desired attitude in response to the statement "It is smart to use a condom when having sex."
67 percent of participants expressed the desired attitude in response to the statement "It's okay for teenagers to refuse to have sex."
62 percent of participants expressed the desired attitude in response to the statement "It's okay for teenagers to have sex without a condom if they both say they're virgins."
54 percent of participants expressed the desired attitude in response to the statement "I do not want to get tested for HIV because the Hmong community would find out."
47 percent of participants expressed the desired attitude in response to the statement "Condoms are quite disgusting and I wouldn't want to touch one."
44 percent of participants expressed the desired attitude in response to the statement "Hmong people whose ancestors were 'bad' are in great danger of getting AIDS."

AIDS Risk Behaviors

7 percent of participants reported having engaged in sexual intercourse. Of these, 63 percent reported always using a condom during sexual intercourse and 75 percent reported having had only one sexual partner.
77 percent of participants reported knowing how to use a condom.

B. E. Robinson, et al., "HIV/STD Knowledge, Attitudes, and Risk Behaviors in Hmong-American Adolescents: An Unstudied Population," Journal of Sex Education and Therapy, 24, nos. 1&2, 1999, 37-46.

ATTITUDES ABOUT SEXUALLY TRANSMITTED DISEASES

Data from the National Survey of Adolescents and Young Adults⁹

12 percent of White adolescents (ages 15 to 17), 11 percent of African-American adolescents, and 12 percent of Latino adolescents agree that "unless you have sex with a lot of people STDs are not something you have to worry about."
17 percent of White adolescents (ages 15 to 17), 30 percent of African-American adolescents, and 22 percent of Latino adolescents agree that "STDs can only be spread when symptoms are present."
27 percent of White adolescents (ages 15 to 17), 16 percent of African-American adolescents, and 28 percent of Latino adolescents agree that "if someone I was dating had an STD, I would know it."
9 percent of White adolescents (ages 15 to 17), 11 percent of African-American adolescents, and 18 percent of Latino adolescents agree that "STDs are a nuisance but they do not have any serious health effects."
55 percent of White adolescents (ages 15 to 17), 41 percent of African-American adolescents, and 45 percent of Latino adolescents agree that "it is hard to bring up the topic of STDs with a partner."

ADOLESCENT PREGNANCY

Data from the YRBS¹⁰

Among currently sexually active students, 11.4 percent of Black students, 5.7 percent of Hispanic students, and 3.3 percent of White students reported having been pregnant or having gotten someone pregnant.
Among currently sexually active students, 11.9 percent of Black female students, 4 percent of Hispanic female students, and 6.2 percent of White female students reported having been pregnant.

Data from the National Vital Statistics Report¹¹

In 2002, 39.4 per 1,000 White adolescents (ages 15 to 19) gave birth, compared to 66.6 per 1,000 Black adolescents, 53.8 per 1,000 American-Indian adolescents, and 18.3 per 1,000 Asian or Pacific Islander adolescents.
In 2002, 83.4 per 1,000 Hispanic adolescents (ages 15 to 19) gave birth, compared to 63.0 per 1,000 "other Hispanic" adolescents, and 35.5 per 1,000 "non-Hispanic" adolescents.

BIRTH RATES DECLINE

Data from the National Vital Statistics Report¹²

In 2002, 83.4 per 1,000 Hispanic adolescents (ages 15 to 19) gave birth compared to 104.6 per 1,000 in 1991.
In 2002, 68.3 per 1,000 non-Hispanic Black adolescents (ages 15 to 19) gave birth compared to 118.2 per 1,000 in 1991.
In 2002, 53.8 per 1,000 American-Indian adolescents (ages 15 to 19) gave birth compared to 84.1 per 1,000 in 1991.
In 2002, 28.5 per 1,000 non-Hispanic White adolescents (ages 15 to 19) gave birth compared to 43.4 per 1,000 in 1991.
In 2002, 18.3 per 1,000 Asian or Pacific Islander adolescents (ages 15 to 19) gave birth compared to 27.3 per 1,000 in 1991.

WHERE YOUNG PEOPLE LEARN ABOUT SEXUALITY

Data from The YRBS¹³

91.1 percent of White students, 86.1 percent of Black students, and 80.5 percent of Hispanic students reported having received education about AIDS or HIV infection in school.

Data from the National Survey of Adolescents and Young Adults¹⁴

37 percent of White adolescents (ages 15 to 17), 60 percent of African-American adolescents, and 42 percent of Latino adolescents reported learning "a lot" about sexual health issues from their parents.
47 percent of White adolescents (ages 15 to 17), 33 percent of African-American adolescents and 42 percent of Latino adolescents reported learning "a lot" about sexual health issues from their friends.
25 percent of White adolescents (ages 15 to 17), 45 percent of African-American adolescents, and 30 percent of Latino adolescents reported learning "a lot" about sexual health issues from doctors or other healthcare providers.
29 percent of White adolescents (ages 15 to 17), 47 percent of African-American adolescents, and 45 percent of Latino adolescents reported learning "a lot" about sexual health issues from TV, movies, magazines, or the Internet.
51 percent of White adolescents (ages 15 to 17), 70 percent of African-American adolescents, and 66 percent of Latino adolescents reported learning "a lot" about sexual health issues from sex education classes.

References

J. Grunbaum, et al., "Youth Risk Behavior Surveillance (YRBS)-United States, 2001." In: Surveillance Summaries June 28, 2002, Morbidity and Mortality Weekly Report 51, no. SS-4 (2002): 1-64.
T. Hoff, et al., National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes, and Experiences (Menlo Park, CA: Henry Kaiser Family Foundation, 2003), 14.
Ibid., 64.
Grunbaum, et al., "Youth Risk Behavior Surveillance (YRBS)-United States, 2001," Morbidity and Mortality Weekly Report.
Hoff, et al., National Survey of Adolescents and Young Adults, 30.
Ibid., 60-61; 65.
Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance 2002 (Atlanta, GA: U.S. Department of Human Services, Centers for Disease Control and Prevention, 2002), pp. 59, 92, 104, 119.
Centers for Disease Control and Prevention, HIV AIDS Surveillance Report 13, no. 2 (2002). Accessed on 2/6/2004 at http://www.cdc.gov/hiv/stats/hasr1302/table8.htm.
Hoff, et al., National Survey of Adolescents and Young Adults, 68.
Grunbaum, et al., "Youth Risk Behavior Surveillance (YRBS)-United States, 2001," Morbidity and Mortality Weekly Report.
J. Martin et al., "Births Final Data for 2002," National Vital Statistics Reports 52, no. 10 (2003), p. 32, table 3.
Ibid., pp. 41-42, table 8.
Grunbaum, et al., "Youth Risk Behavior Surveillance (YRBS)-United States, 2001," Morbidity and Mortality Weekly Report.
Hoff, et al., National Survey of Adolescents and Young Adults, 55.