On most college campuses, the latter group appears to be winning. More than ever, student health groups are working to spread awareness about STIs and HIV, and more health centers are providing information and resources. Yet STIs persist on campus: 20 percent to 25 percent of college students either have STIs or have transmitted them, and a large number of students remain underinformed about their risks.
Most college freshmen have a basic knowledge of sexually transmitted infections, according to George Gianakakos, who volunteers with the group Sexual Health and Assault Peer Education (SHAPE) on Northwestern University's campus. "I think if people were questioned regarding STI and HIV prevention, they would give pretty standard answers -- wear a condom, don't have sex, etc.," Gianakakos says. However, freshmen tend to be in the dark about such preventative measures as female condoms and dental dams. Students' main concern is pregnancy, he says; they often assume that despite the prevalence of STIs, they are not personally at risk.
Students at other campuses expressed similar sentiments. Since sexual education is usually taught in middle school or early high school, when most kids aren't having sex, they associate STIs with "other people," and that mentality sticks, creating a pervasive stigma. It's a kind of sexual-health Catch-22, according to Katie Guilfoyle, Northwestern's health education department coordinator. "The students that are affected by STIs are silent, and so the myth that only certain people are affected gets perpetuated," she says.
Guilfoyle adds that bacterial STIs are seen as more acceptable than viral STIs; students with chlamydia know they can clear up the infections with antibiotics, but herpes hangs on for life. This notion makes it even more likely that students won't inform their partners of a viral infection.
The silence surrounding STIs goes beyond stigmatization, however, says Mark Dlugash, a sexual health counselor (SHC) at Swarthmore College in Pennsylvania. Despite the culture of openness on many college campuses, they don't escape the larger society's general dynamic of secrecy surrounding the not-so-pleasant aspects of sex.
"The problem runs deeper," Dlugash says. "Basically, lots of people have sex or hook up, and don't really talk beforehand about boundaries or STI status or anything -- people are embarrassed to communicate about sex, and then they don't." According to a recent SHC survey, just 38.3 percent of Swarthmore students always know their partners' sexual histories, and over three-quarters of students have never had an STI test, though most are sexually active.
Sexual health advocates emphasize that, since the majority of students won't take the initiative to educate themselves, colleges need to take extra steps to spread awareness and encourage students to take preventative measures. But according to a survey by Sperling's Best Places and Trojan Condoms, most schools are falling short. Only 24 percent of a representative sample of universities offer free STI testing, and most don't provide free condoms. Trojan's bias may have impacted the survey results -- there's no doubt that the company would benefit from an increase in school-purchased condoms -- but regardless of specific numbers, it's clear that most schools aren't making STI-prevention resources readily available.
The students and staff with whom I spoke also described less visible deficiencies. While Swarthmore offers free STI testing, the tests don't cover all STIs. And according to the SHC survey, students avoid the health center for myriad reasons -- misdiagnoses, brusque treatment and unnecessarily painful exams -- missing out on the care they need. Nurses on campus tend to assume students are heterosexual, posing questions like, "What does your boyfriend say?" Students at other campuses note similar heterosexist bias, except, predictably, in the case of HIV testing.
The good news is, Dlugash and others say that most students on their campuses are quite informed about HIV, possibly because it's the STI that's most emphasized in precollege sex ed programs. Most campuses offer options for HIV testing on campus. Students who are diagnosed with HIV, however, may have trouble finding on-campus support. Guilfoyle notes that Northwestern students are lucky to live in a metropolitan area with many outside options for HIV treatment. Sexual health volunteers at other schools point to the lack of HIV care on their campuses but say that health centers are generally knowledgeable about off-campus resources.
Clearly, most campuses have a plethora of STI and HIV resources: sexual health-based student groups, access to STI protection and testing and options for sexual health education. So, how to combat the remaining inadequacies in STI education and treatment?
The glaring hole on most campuses seems to be the optional nature of sexual health awareness programs. Most of the peer educators I spoke with were frustrated that, despite their efforts, most students at their schools did not reap the benefits of their programming. Swarthmore is one of very few colleges at which STI and HIV information sessions are mandatory for all incoming freshmen.
Beyond that, as Dlugash notes, campus health centers must work to keep up with the times in matters of sexual health, offering comprehensive testing and treatment. Student groups can't shoulder the STI-awareness load alone.
Of course, no matter how active student groups become or how much support health centers offer, there are limits to the measures colleges can take to combat STIs and HIV. A school can't mandate STI testing or insist that students interview sex partners before hooking up. How can a school program change the societywide fear and stigmatization of STIs and HIV? As most of the folks I talked to pointed out, this isn't just a campus dilemma -- it's a prevailing culture attitude. Yet by improving sexual health education, testing, awareness building and resources, universities could provide the impetus for a widespread change in mindset.
Maya Schenwar is an editor at Publications International and served as contributing editor for the recently deceased Punk Planet magazine. She has written for Punk Planet, In These Times, Common Dreams, Alternet, Conscious Choice and NewCity Chicago. Maya can be reached at mschenwar [at] pubint [dot] com.