As I drive my 14-year-old son to a movie, the radio talk-show host discusses whether girls as young as 10 or 12 should be prescribed birth-control pills. I focus in, realizing that this is a classic "teachable moment."
"So," I say cautiously, "did you learn about birth control in your human-sexuality course?" He stares out the window, then shrugs, saying, "I don't remember." I persevere, asking about condoms, the pill, safer sex, landing feebly on the big pitch: "Just wait as long as possible. You can't take sex lightly. You have to be prepared."
I have reported about health issues for most of my career, but when having "the talk" with my own kids, I still get tongue-tied. According to a recent study, I'm not alone. Boys suffer from a nationwide sexual-health communication crisis.
A study conducted by researchers at Johns Hopkins Children's Center found that only 21 percent of sexually active males ages 15-19 had received counseling about STDs or HIV from a health-care provider during the previous year; and only 26 percent of young men in this age group who had engaged in high-risk sex — like sleeping with a prostitute or someone with HIV, or having sex while drunk — had received such counseling. "No improvements were found" in STD/HIV counseling during the seven-year study period, despite exam guidelines stating that a teen's regular checkup should include sexual-health counseling. Doctors had spoken to fewer than 18 percent of young men about birth control.
Lead researcher Arik V. Marcell, M.D., M.P.H., an assistant professor of pediatrics and adolescent medicine at the Johns Hopkins Bloomberg School of Public Health, says the report reveals two critical points: "We need to do better as health-care providers to address young men's sexual and reproductive health, and young men need to learn to address these kinds of issues, especially within the context of health care. It's not only an issue for a young woman, which is how teens are socialized. Young women get connected to health services, and young men start to fall out of services."
Some of the consequences are staggering. According to the Centers for Disease Control and Prevention (CDC), Black males and females ages 13-19 account for 68 percent of infections (pdf) among youths, and those ages 13-29 account for 38 percent of the nearly 25,000 infections(pdf) estimated to occur each year among African-Americans. Black men have the highest AIDS rate of any Americans — 77 percent higher than that of Black women.
Loretta Sweet Jemmott, Ph.D., a nursing professor at the University of Pennsylvania and director of the Center for Health Equity Research, is one of the few researchers who have created successful HIV risk-reduction programs for young Black males. She says that our country lacks culturally specific intervention programs designed to protect young Black males: "There's a limited, limited, limited amount of information." Black men and boys are also vulnerable to institutional neglect. American men in general are less likely to have a regular doctor or carry health insurance, and are more likely to delay seeking health care, than American women. In addition, nearly 40 percent of Black men (pdf) lack insurance.
"Young men don't go to the clinic as often as girls do," says Dr. Jemmott. "So girls get information from the clinic, from their parents, from the community. But boys don't go to the clinic for issues around sex unless they're sick."
Dr. Marcell recommends that parents engage in "open and frequent" discussions with their sons. And who holds the conversation may matter. "Moms are not necessarily comfortable talking to their sons about these issues," he observes. "And the quality of these discussions may not be as good as those with their daughters. So do sons get short-changed with sexual-health discussions, especially when sexual-health education in schools is not comprehensive?"
Opening the Door to Dialogue
Mothers can significantly help reduce their sons' risk-taking sexual behavior, however.
Dr. Jemmott studied 600 Philadelphia mothers and sons for two years. Half of the mothers learned how to talk to their sons about safer sex, while the others participated in a program focused on nutrition and fitness.
"For the ones who got the HIV risk-reduction program, their sons' behavior changed — less partners, more condom use, less risky sex," says Dr. Jemmott. "Training mothers how to talk to their children made a difference."
According to Dr. Jemmott, parents must play a key role in ending the HIV epidemic. She encourages finding "door openers" and teachable moments to hold essential sexual-health conversations. Starting around the time your kids turn 11, she suggests, communicate not just about human anatomy and sexuality but also about your values — as well as the emotional complexities and spiritual dimensions of intimate relationships. These discussions cannot be outsourced to a doctor, health teacher or book — not when the facts of life are literally a matter of life or death.
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