A Wake-Up Call

The recent revelation that reported cases of chlamydia on campus have increased dramatically should serve as a wake-up call to Harvard students. We may do well academically, but it takes more than intelligence to change behavior. In the delicate realm of sexual activity, Harvard students seem to be on a dismal par with their peers, mirroring a national trend of increases in the number of reported cases of chlamydia. The trend underlying the reported increase in chlamydia cases is disturbing, for it indicates that there are still too many people having unprotected sex. Sex without protection puts people at risk not only for diseases like chlamydia, but also for such life-threatening illnesses as HIV.

According to CNN, "The United States has an estimated 10 million to 12 million new cases of STDs annually--the highest rate among industrialized countries worldwide." Of the top 10 diseases reported each year by the Centers for Disease Control, five are STDs: chlamydia, gonorrhea, AIDS, syphilis and hepatitis B. Their rapid spread in the U.S. reveals that STDs are not just a by-product of biological realities, but of social and cultural ones as well. This week's announcement is an indicator that a set of problems once considered private is so widespread that it has become public--as a threat to the health of entire communities. As such, it must be addressed by the entire community.

So far, the health efforts on campus have been laudable, and should be well-publicized: AIDS Education and Outreach has recently received a grant from the Undergraduate Council and is currently looking into the feasibility of increasing its coverage to other STDs, in addition to AIDS. Its webpage (www.hcs.harvard.edu/~aeo/) already has a list of all the locations on campus where students can get free condoms, still the most effective recommended method of preventing the spread of STDs, after abstinence. In addition, University Health Services' anonymous information services are available by phone (495-9629) or walk-in appointment at the Center for Wellness and Health Communication, open Monday through Friday, 9-5. The Center tracks the kinds of information requests it receives, but not the names of individual students.

In addition, students can get both male and female condoms at the UHS pharmacy and can even get the charges added to their termbills, where they appear as non-traceable, generic "pharmacy" charges--identical to the charges which appear for refills on contact lens solution or cold medicine, for those concerned about confidentiality. In addition, the Center for Wellness recommends that sexually active students have periodic consultations with their physicians--at least once a year for women and variably for men, depending on their behavior.

The good news is that chlamydia can be detected using a culture and completely eradicated with a short course of antibiotics. However, it is also a particularly problematic disease because it may have no visible signs or symptoms and can lie dormant for long periods of time, all the while doing extensive damage to the reproductive system. According to the Centers for Disease Control (www.cdc.gov/nchstp/dstd/chlamydia_facts.htm) "Untreated, chlamydia can cause severe costly reproductive and other health problems.... Up to 40 percent of women with untreated chlamydia will develop PID [pelvic inflammatory disease]. ... Of those with PID, 20 percent will become infertile; 18 percent will experience debilitating chronic pelvic pain; and 9 percent will have a life-threatening tubal pregnancy [which] is the leading cause of first-trimester, pregnancy-related deaths in American women.... In addition, recent research has shown that women infected with chlamydia have a three-to five-fold increased risk of acquiring HIV, if exposed.... "It is particularly troubling for our age group, as the CDC notes: "teenage girls have the highest rates of chlamydial infection. ...15- to 19-year-old girls represent 46 percent of infections and 20- to 24-year-old women represent another 33 percent."

The alarming STD-related issues facing students are as much a public problem as a private one, because the behavior that helps to propagate STDs--both sexual activity and lack of helpful discourse about real health dangers--is a product of the larger society we share. Sexual activity is among the most emotionally-charged of human activities and for that reason many people often have difficulty talking about it and finding answers to their most basic health questions.

The blitz of commercials and middle-school health classes offers information passively; to be effective, that information must be taken up actively and incorporated into people's daily lives. Real change will occur when students can discuss human sexuality maturely and comfortably with their peers, in lunchtime discussions, phone conversations, and all of the other modes in which people provide cues that set the behavioral norms of their own age cohort.

As a society, we have not yet reached the point where this is possible. While our public culture exposes politically correct views of tolerance, all too often, people still privately harbor archaic ideas about sexual norms which restrict the opportunity for necessary communication about life-and-death health issues. If we are effectively to confront the danger to our community posed by these problems, we must begin with an open and honest discussion.