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By Anita Brakman, MS, Senior Director of Education, Research and Training, Physicians for Reproductive Health, New York City
Taylor Rose Ellsworth, MPH, Director, Education, Research and Training, Physicians for Reproductive Health, New York City
Melanie Gold, DO, DABMA, MQT, FAAP, FACOP, Medical Director, School-Based Health Centers, New York-Presbyterian Hospital, Columbia University Medical Center, New York City
A recent editorial in the Journal of Adolescent Health discusses young men and reproductive health services, and asks the question, “Are we there yet?”1 When it comes to reaching young men with the sexual and reproductive healthcare they need, the answer may be no.
Adolescent and young adult men experience a variety of negative sexual and reproductive health (SRH) outcomes. For example, annually 21% of new HIV infections in the United States are diagnosed among youth ages 13-24, and 81% of these newly infected individuals are young gay and bisexual men.2 In addition, rates of other sexually transmitted infections (STIs) are rising among young men. Between 2012 and 2016, rates of chlamydia increased by 6% among men ages 15-19 and by 17.8% among men ages 20-24. Rates of gonorrhea in this population increased 15.8% among men ages 15-19 and 36% among men ages 20-24. Young men ages 20-24 had the second highest rate of reported syphilis (37.9 cases per 100,000) compared with any other age group among men and women. The rate of reported syphilis infections among young men has increased steadily each year since 2006.3
Despite these outcomes, many young men are not receiving the sexual and reproductive health services they need. A recent study reported in the Journal of Adolescent Health highlights significant gaps in SRH service provision to young men, especially in communities of color.4 The authors surveyed 427 young men ages 15-24 presenting to urban primary care and STD clinics. Participants were questioned about which SRH services they received across four domains: sexual health screenings, lab testing related to STDs/HIV, receipt of condoms, and counseling related to family planning, condom use, and reducing STD/HIV risk. Among those who were sexually active (90% of the study population), only one in 10 had received services in all four areas. At least half were asked about sexual health, were tested for STDs or HIV, or reported receiving counseling about condom use. However, only 32% were provided condoms, and 23% were counseled about family planning.4
How to work with young men effectively to lower their risk of fathering an unintended pregnancy has not been studied extensively; to date, initiatives to help prevent unintended adolescent pregnancy have focused primarily on young women. Bell and colleagues have adapted a computer-assisted motivational interviewing (CAMI) intervention that originally was designed and tested with young women for use with young men ages 15 to 24 to reduce their risk of fathering an unintended pregnancy. They are piloting a randomized controlled trial, recruiting sexually active young men from urban health centers in New York City, and randomly assigning participants to one of two study arms: one focused on decreasing involvement in unintended pregnancy (CAMI-Teen Pregnancy Prevention) and the other focused on improving fitness (CAMI-Fitness). The two interventions are identical except for the topic, with participants in both intervention arms receiving four sessions of motivational interviewing coaching and using a smartphone app to track SRH and fitness behaviors and set health goals.5
Many major medical and public health organizations have guidelines and recommendations for providing SRH services to young men and for increasing the provision of care that could decrease STI and HIV infections and promote healthy relationships and positive sexuality. Among many recommendations for promoting health and well-being of young men, the American Academy of Pediatrics Committee on Adolescence recommends pediatricians and other healthcare providers caring for young men screen for sexual activity, screen appropriately for STIs, promote condom use, educate young men about emergency contraception, and provide information about dual method use to prevent unintended pregnancy and STIs.6 The federal Healthy People 2020 campaign has set a goal to increase the proportion of sexually experienced young men who received reproductive health services by 10%.7 The U.S. Preventive Services Task Force recommends counseling for sexually active adolescents and adults of all genders at risk for sexually transmitted infections.8
In 2013, The Partnership for Male Youth was founded, with the mission of advancing the health and well-being of adolescent and young adult (AYA) males. One of the partnership’s first efforts was to create a toolkit for healthcare providers. This toolkit includes guidance on a variety of health topics, including SRH. Within each health topic, the toolkit includes a provider checklist, suggested patient interview questions, a video library, and additional supporting material and references. The toolkit is available at . Teaching modules and case videos focused on caring for adolescent and young adult men also are available through Physicians for Reproductive Health at .
Such resources, along with recommendations from professional and global health organizations, can guide providers toward offering care that young men need to have healthy sexual lives, but it is up to healthcare providers to offer this care to patients. Opportunities to discuss sexual and reproductive health exist outside of visits dedicated to such services. Sports physicals, work physicals, immunization visits, acute care, or chronic care visits — any health-related visit — can be an opportunity to start or continue the discussion about sexual health.
Financial Disclosure: Consulting Editor Robert A. Hatcher, MD, MPH, Nurse Planner Melanie Deal, MS, WHNP-BC, FNP-BC, Author Rebecca Bowers, Author Anita Brakman, Author Taylor Rose Ellsworth, Executive Editor Shelly Morrow Mark, Copy Editor Savannah Zeches, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Author Melania Gold, DO, serves on the advisory board for Afaxys Inc. and is a Consultant for Bayer.