The "national silence" on issues such as sexual behavior, race and poverty has contributed to the high rate of HIV and other sexually transmitted infections among teenagers in the U.S., Robert Fullilove, associate dean at Columbia University's Mailman School of Public Health, Adaora Adimora, associate professor of medicine at the University of North Carolina-Chapel Hill, and Peter Leone of the North Carolina Division of Public Health write in a Washington Post opinion piece.

According to the authors, a CDC study released earlier this month that found that about 25% of U.S. girls and young women ages 14 to 19 have at least one of four common STIs is "already old" news for people who work in public health. They add that public health workers "fear this latest study will have its 15 minutes in the spotlight and also fade from view," just like a similar study released 10 years ago by the Institute of Medicine did. The "taboo" of talking about sexual behavior, poverty and race is one "obvious reason" that rates of STIs remain high, the authors write, adding, another is "that the incidence of [STIs], particularly HIV, is concentrated in poor, segregated neighborhoods that are characterized by high rates of incarceration." The "shift" in marriage and courtship patterns that results from men being incarcerated, as well as an increase in the number of "multiple concurrent sexual partnerships," also are contributing to the problem, according to the authors.

HIV/AIDS and other STIs cost the U.S. "tens of billions of dollars" annually, "but with the exception of HIV infection, [STIs] remain the elephant in the room when it comes to the national conversation about health and health care," the authors write. They add, "We can no longer have effective [STI] prevention campaigns in poor communities of color if they treat one person at a time or ignore social conditions underpinning high rates of HIV and other" STIs. "Simply put, we will never rid the U.S. of HIV and other [STIs] if our only weapon is medical treatment," the authors write, concluding, "And if we are unable to engage in a national dialogue about the sexual health of our youths and the social dynamics that drive [STIs], this epidemic will go largely ignored, and many more lives will be lost" (Fullilove et al., Washington Post, 3/21).