Resolution 202: Social Vaccination Against STDs

Whereas, The pandemic of STDs consumes a large portion of health care dollars for the treatment of HIV/AIDS, cervical cancer, depression from incurable herpes, sick newborns, sterility, and a myriad of other health care problems; and

Whereas, It is evident that despite years of sex education in Texas public schools, the pandemic of sexually transmitted disease and teen pregnancy continues and, recognizing that "every successful form of prevention requires change in behavior"; therefore be it

RESOLVED, That the Texas Medical Association support the Centers for Disease Control and Prevention goal of seeking to increase the numbers of adolescents in Texas who have never had sexual intercourse or participated in other sexual behaviors that spread disease; and be it further

RESOLVED, That TMA promote a "social vaccine" program that increases education for teens as well as adults that includes abstinence, decreasing the number of sexual partners, delaying sexual debut, monogamous commitment to a lifelong partner, using condoms consistently, and programs similar to the successful ABC program in Uganda (Abstinence, Be faithful, Condoms)1; and be it further

RESOLVED, That TMA promote physician education in abstinence behavior that will help their patients achieve and sustain sexual abstinence outside of a committed relationship2; and be it further

RESOLVED, That a task force be established to determine how to accomplish these goals and the costs involved in such a campaign.

Relevant TMA Policy

55.004  Adolescent Sexual Activity : The TMA adopted the following recommendations of the Adolescent Health Task Force in dealing with adolescent sexual activity:

(1) The role of the physician--Only family physicians, pediatricians, psychiatrists, obstetricians and gynecologists, and other physicians who are willing and prepared to address and feel comfortable with adolescent concerns related to sexual identity and positive self image should deal with adolescents. Comprehensive health care for adolescents must address issues related to reproductive history and sexual activity.

The following general principles should be considered by health care providers in their discussions with adolescents and their families when appropriate.

Sexuality education. Practitioners should help prepare parents to be effective sexuality educators for their children, encouraging them to communicate factual knowledge, family values, and behavioral expectations throughout childhood, especially during the critical transition years into early adolescence.

Confidentiality and consent. Care givers should be familiar with their own state laws, but in general, the adolescent's right to contraception, assessment and treatment for sexually related issues has been upheld consistently in court either through specific statutes or the mature minor doctrine.

Contraceptive choices for sexually active teens. The healthiest and most effective way to prevent pregnancy and sexually transmitted infections in unmarried adolescents is abstinence.  There is no ideal contraceptive method that is 100 percent effective in preventing both pregnancy and infection, is free of side effects, inexpensive, and unencumbered by forethought or planning. However, there are many methods suitable for use by teenagers.

Medical/lifestyle history. It is important to be able to identify adolescents who are at risk for sexually transmitted diseases and unplanned pregnancies. A thorough history including questions concerning sexual behavior is critical to this identification.

Sexual decision making with implications for self-esteem. As teenagers become interested in relationships, they need an opportunity to discuss sexual pressures, values, expectations, options and consequences.

Sexual responsibility. Without being morally judgmental, the practitioner can help adolescents identify their own goals for safe and responsible sexual behavior.

Standards of practice. All primary care physicians should provide counseling and treatment of adolescent patients with respect to sexual development, sexually transmitted disease, birth control and pregnancy.

(2) The role of TMA--TMA can contribute substantially to the promotion of adolescent health by  (a) Sponsoring continuing medical education for physicians and health care providers at annual sessions and preparing reports and facilitating formal presentations concerning adolescent sexual activity; (b) Encouraging medical schools in the state to engage in research and training in all aspects of adolescent health, including adolescent sexuality; (c) Promoting interdisciplinary dialogue and networking on public health and public affairs issues involving the promotion of improved care for adolescents and comprehensive health education; (d) Supporting the health objectives pertaining to adolescents in the Texas Department of State Health Service's Year 2000 Objectives and encourage involvement by various TMA councils and committees to assist in meeting these objectives; (e) Utilizing Texas Medicine and other media as a forum for the promotion and discussion of all adolescent health issues including, but not exclusively concerned with, adolescent sexuality; and (f) Developing educational materials (ie anticipatory guidance/discussion with parents).

(3) Legislative initiatives--(a) Local school districts should provide uniform instruction on family life, human sexuality and comprehensive health education for grades kindergarten through college level. Education should be age appropriate and should be taught by teachers who have received specialized training in family life, human sexuality and comprehensive health education. (b) The State of Texas should adopt in statutory form the "mature minor" doctrine and eliminate other statutory barriers to adolescents accessing health care. (c) TMA should support the following principles regarding adolescent pregnancy when it is the subject of legislation: (1) access to early and accurate diagnosis of pregnancy; (2) professional counseling describing the gestational alternatives; and (3) support of already existing TMA guidelines regarding abortion which base its performance on early and accurate diagnosis of pregnancy; informed and nonjudgmental counseling; prompt referral; skillful and understanding personnel working in a good facility; reasonable cost; and professional follow-up. (d) Funds at the state and local levels should be established for student oriented primary care clinics and/or school linked comprehensive health care for adolescents. (e) A legislative study committee should be established to address barriers to comprehensive health care service delivery, including insurance coverage, specifically addressing adolescent issues, including parental consent, notification and financial eligibility. (f) Funding should be established for STD and AIDS research, treatment and support services for adolescents. (g) The Legislative Appropriations Requests of state agencies that provide services to adolescents should be endorsed. (h) The Texas Comprehensive School Health Initiative, a federally funded program that networks private and public organizations which share the goal of comprehensive health education in schools, should be supported (Council on Public Health, p 76, I-91; amended Res. 304-, 305-, and 306-A-01).

260.021 Sexually Transmitted Diseases : The Texas Medical Association urges increased efforts at local, state, and federal levels to bring sexually transmitted diseases, in particular the newer challenges, such as human papilloma virus and chlamydia, under control through professional and public education, and supports the efforts of the Texas Department of State Health Services, Centers for Disease Control, National Institutes of Health and other appropriate activities (Council on Public Health, p 98, A-93; amended CM-ID Rep. 1-A-03).

260.033 Sexually Transmitted Disease Education : Education about sexually transmitted diseases in Texas schools is an effective tool for the prevention of these diseases. Physicians should support dissemination of medically accurate information to teachers, students, and other members of the public. Physicians who are willing to treat STDs in minors without parental consent are encouraged to submit their names to their county medical societies, health departments, and other agencies involved in providing STD treatment services so that those organizations can provide appropriate referrals when inquiries arise (Substitute Council on Public Health, p 110, I-94; reaffirmed CM-ID Rep. 2-A-04).

260.037  Essential Public Health Services : The Texas Medical Association adopted the Essential Public Health Services Work Group's definition of public health and essential public health services: (1) monitor health status to identify community health problems; (2) diagnose and investigate health problems and health hazards in the community; (3) inform, educate, and empower people about health issues; (4) mobilize community partnerships to identify and solve health problems; (5) develop policies and plans that support individual and community health efforts; (6) enforce laws and regulations that protect health and ensure safety; (7); link people to needed personal health services and assure the provision of health care when otherwise unavailable; (8) assure a competent public health and personal health care workforce; (9) evaluate effectiveness, accessibility, and quality of personal and population-based health services; and (10) research for new insights and innovative solutions to health problems. In addition, in accordance with stated principles, TMA affirms that public health departments should provide accurate information about transmission of sexually transmitted diseases, including HIV, and should provide strategies and tools to the public for disease control  (Council on Public Health, p 80, I-95; reaffirmed CPH Rep. 2-A-05).

¹ "Managing the STD Pandemic: a time for re-evaluation," American Journal of OB-Gyn . (2004) 191, 1103-1112;

² Medical Institute for Sexual Health has a curriculum that helps physicians train patients to change their sexual behavior similar to smoking cessation .

TMA House of Delegates: TexMed 2006