“If I drink Mountain Dew after having sex, will that prevent pregnancy or HIV?” a teenager earnestly asked in one of Thomas Bertrand’s focus groups, this one held at Youth Pride, a social services organization in Providence, RI. Youth Pride is located on Westminster Street, adjacent to the intersection of three of the largest high schools in the Providence School District: Classical High, Central High, and the Providence Career and Technical Academy. The organization has become both a geographical and social cornerstone of the LGBTQ+ community in Providence. Students from all over the city gather to build community with one another, as well as to learn and discuss issues facing the queer community.
As Chief of the Center of HIV, STDs, Viral Hepatitis, and TB at the Rhode Island Department of Health, it is Bertrand’s job to be concerned about sexual health. However, as Bertrand recounted his experiences speaking to several focus groups representative of the various communities at risk for sexually transmitted diseases (STDs), it became evident that his concern was directed specifically at the absence of sexual education among young Rhode Islanders.
“Young people had questions that made me believe that they lacked basic understanding around HIV and STDs,” he said. “A lot of young people thought that if you got tested for an STD, they would also do drug testing at the same time. [They said,] ‘I don’t want to get tested because I’m afraid that they’re gonna find out I do drugs.’” Bertrand found that these misconceptions about sexual health persisted into adulthood. “In one of my focus groups with gay men, they said, ‘Tom, we don’t know that syphilis is a problem. You have to emphasize how serious a problem it is,’” Bertrand said.
Although some communities might be unaware of it, STDs are a persistent and wide-reaching issue in Rhode Island. The state ranks 13th in the nation for rates of infectious syphilis, according to the Center for Disease Control and Prevention. Syphilis cases have also increased 15 percent more than the national average last year, with gonorrhea increasing four percent and chlamydia increasing three percent more than the national rates.
“Every day, it’s probably one of the main calls that we get, people inquiring about STD care,” said Marie Ghazal, Chief Executive Officer of the Rhode Island Free Clinic. Although the Free Clinic’s focus is general care, employees often serve a demographic considered to be at risk for contracting sexually transmitted diseases. “The majority [of calls we receive] are from the inner cities,” she added, “from Providence, Pawtucket, Central Falls.”
The Rhode Island HIV, Sexually Transmitted Diseases, and Hepatitis C Surveillance Report, jointly compiled by the Rhode Island Department of Health and Department of Education, confirms Ghazal’s observations: From 2013 to 2015, the Providence and Pawtucket municipalities had the first and second highest number of cases, respectively, of the “big three” STDs: infectious syphilis, gonorrhea, and chlamydia. The three cities mentioned by Ghazal also rank among the top four poorest cities in the state by per capita income. For every disease, the number of cases in Providence was more than double that of any other municipality. For chlamydia, it was more than triple.
Doctors in Providence are unsure what is causing these numbers to increase, particularly since new cases of both HIV and teen pregnancy have gone down in the past decade. “We’re seeing significant decreases in HIV but significant increases in STDs, which doesn’t make a whole lot of sense,” said Dr. Philip Chan, internal medicine and infectious diseases physician at The Miriam Hospital and director of their STD Clinic.
Dr. Chan raised the possibility that people are exclusively using hormonal birth control or medications designed to prevent HIV, such as Pre-Exposure Prophylaxis (PrEP), and forgoing use of a condom. This conflation of “anti-pregnancy” or “anti-HIV” medication with “anti-STD” contraception would explain how Rhode Islanders might acquire other sexually transmitted diseases without contracting HIV or becoming pregnant.
Although it is well established in the medical and academic fields that condoms are the only form of contraception that also prevent against STDs, an absence of thorough sexual education in Rhode Island public schools may be responsible for the misunderstandings that prevail among teenagers and young adults throughout the state, and for the increase in sexually transmitted diseases in urban RI.
“I’m very apprehensive about talking to you... I’m not sure that I should be,” were the first words that came through the phone. The voice, crackly and difficult to distinguish, belonged to Andrew McIntosh*, one of the four physical education teachers at Dr. Jorge Alvarez High School in the Providence Public School District.
“Excuse me? Could you repeat that, it’s a bit difficult to hear you.” His next words came through crystal clear. “We’re not teaching what we should be teaching, and so we’re very apprehensive about talking to people, letting people come watch us teach.”
McIntosh explained that a few years ago, Providence and Warwick school districts, the two biggest school systems in the state, decided to switch from contraception-based health education to a focus on abstinence. This change has made the job of health educators increasingly difficult, and in McIntosh’s case, increasingly covert. “They’re teenagers,” McIntosh added. “They’re gonna do what they’re gonna do, you know?”
So, despite the school district’s mandate, McIntosh and his colleagues continue to teach contraception to the students at Alvarez High School, promoting condoms and other forms of birth control. As a locally controlled state (one where municipalities have control over the management of public schools), Rhode Island has no mandated state curriculum, instead allowing school districts to design their own curriculum so long as it complies with state guidelines. State law does require discussion about STDs, teen pregnancy, condoms, and contraception, but does not include requirements for the amount of time that should be spent on each topic. The minimum instructional time is 100 minutes per week for health and physical education in general; however, the state does not specify how much time should be spent in gym class as compared to health.
When asked how much time he spent on sexual health in high school, Jacob Jackson responded, “All I remember was a week and a half long project where we all had to research an STD and give a presentation on it.” The former student of Burrillville High School, Class of 2016, said that sexual health wasn’t covered every year, and that when they did cover it, the instruction was comprehensive but brief.
At other schools in the state, information about sexual health is not so transparent. When the College Hill Independent asked a secretary at William E. Tolman Senior High School in Pawtucket, about sexual health instructors at the school, she responded, “I don’t even know who to have you talk to... it’s a very small component of the education, it’s not even a class.”
This statement is not surprising given that health and sexual education in Rhode Island are often taught by gym teachers in combination with physical education classes. Assistant Superintendent of the Pawtucket School Department Cheryl McWilliams initially gave permission to the Independent to observe health instruction in the district in an email on November 16. However, on November 17, she changed her mind, stating, “We are not able to accommodate your request... it seems you are not an education student seeking to learn about teaching practices. Our Health classes incorporate the state requirements for health education.” Of the two high schools in the district, only Tolman High School had available information on health curriculum, which did not include sexual health.
Although the State Department of Education emphasizes tolerance and awareness of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) identities in its guidelines, little education is provided about the unique sexual health issues that members of the queer community face. While some information reaches queer students through workshops and conversations like the one held at Youth Pride, sufficient LGBTQ-oriented sexual education is woefully lacking in many public schools across Rhode Island.
“There was a unit [in health class] about LGBTQ terminology and how to respect people’s identities, but it was detached from sexual health,” confirmed Jackson, Burrillville Class of ‘16. “We were never taught about how these issues relate to LGBTQ people.”
According to the Rhode Island Adolescent Sexual Health Profile for the period 2016-2020, it is estimated that LGBTQ+ students comprise at least 10 percent of the high school population in Rhode Island. The absence of thorough and contextualized information provided by the state is likely a major cause of the misconceptions that queer youth in Rhode Island often have about safe sexual practices. The profile reported that the rate of condom use is much lower among the lesbian, gay, and bisexual (LGB) population than the general high school population. Specifically, almost half (49 percent) of LGB students reported not using a condom in their recent sexual experiences, as compared to 37 percent of heterosexual students. Data is not available for students identifying as transgender, nonbinary, questioning, or queer.
Additionally, there is no guarantee that available information even reaches students. Many high schools in Rhode Island have a large percentage of students that immigrated from Latin American countries, whom McIntosh termed “newcomers.” It is not only these students’ first time in the United States, but their first time attending school. As a result, he said, very few of them can read above a thirdor fourth-grade level, making it very difficult for them to understand the material, even when it is presented in Spanish.
Alvarez High School, with a 77 percent Hispanic population according to the Department of Education, is among these schools with a high number of “newcomers.” An assessment of the school by the Department of Education in 2017 confirmed this: only 2.3 percent of all students and 1.1 percent of Hispanic students at Alvarez High School are deemed by the state to be proficient in reading.
Parents can also choose to opt their children out of sexual health education, according to Anthony Ficocelli, Director of Athletics and Physical Education at Central Falls High School, RI. If a parent refuses to sign and return the permission slip sent home at the beginning of the year, the student receives alternative classwork during the units when sexual health is being covered.
Ficocelli said that fewer than five percent of students at Central Falls High School opt out each year; however, 35 percent of Rhode Island high schoolers either had not been taught, or were unsure of being taught, about methods of birth control, according to information provided by the state. At Alvarez High School, no permission slip is sent home at all, according to McIntosh, because, “we’re not teaching sexual education; we’re teaching abstinence, wink-wink.”
Rhode Island Department of Education Representative Rosemary Reilly-Chammat stated that she was unaware of the legal liberties being taken with state law by school districts.“[The decision not to teach sexual health] would be unacceptable,” she said. “Schools have to teach these concepts.”
The question of ending sexually transmitted diseases in Rhode Island is daunting, but medical professionals throughout the state are optimistic. According to gynecologist Dr. Vigliani, public health officials are already making attempts to improve the sexual education system statewide.
“I think there’s been a lot of training by the health department in response to the increases in STDs. They have created, out of what was a patchwork quilt of health care, an integrated system for screening for STDs,” she said. “I’m really impressed.”
Department of Health representative Bertrand confirmed Vigliani’s observation. While Betrand himself works with Youth Pride and similar organizations to spread information about sexual health, he added that several nurses working with the Department of Health have been “actively visiting urgent care sites to educate healthcare providers on conducting screenings for STDs.”
Athletic director Ficocelli added that in Central Falls School District, school nurses and medical aids make an effort to provide access to the resources that their teachers do not offer. Among these is the Central Falls High School Clinic, a branch of Blackstone Valley Community Health Care that is located directly inside the high school. Although the clinic does not specialize in sexual health, it does offer basic services such as condoms.
When asked for his thoughts on strategies to reduce the rate of STDs, Dr. Chan repositioned the problem altogether: “We should be talking about how to achieve zero. Zero new diagnoses.” Chan hopes foremost that increased screening and access to better health care will reduce the problem, but he highlighted the importance of education in spotlighting the issue.
“I just think there’s room for improvement in how we talk to people, including our students, about sexual health,” he said. “It’s a very sensitive topic—highly politicized, which is understandable, but I think that we have to be realistic. We have to be open to talking about it, we have to be open to acknowledging that it is a problem, and we have to not just sweep it under the carpet.”
*Names have been changed to maintain confidentiality and to preserve the personal or professional safety of the individual.
IVY SCOTT B’21 likes contraception that glows in the dark.