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Across the United States, young people are at risk for unintended pregnancy and sexually transmitted infections (STIs) including HIV. In many areas Hawaii has better statistics than most of the country – its HIV epidemic is much less severe, its birth rate is lower, and a lower percentage of youth in Hawai`i have had sex compared to youth nationwide. However, Hawaii's teen pregnancy rate is higher than the national average, and young minority women living in the state have disproportionately high birth rates, while sexually transmitted infections (STIs) are a serious problem, especially among young women.
Because the risk for negative sexual health outcomes is a reality, comprehensive sexuality education and access to contraceptives and other sexual health services are more important than ever to the health of Hawaii's youth.
A Diverse State with Thousands of Youth In Need of Reproductive Health Care
- There are over 176,000 young people ages 15-24 in Hawai`i – just under 14 percent of the population.
- Hawaii is among the most racially diverse states – 26 percent of its youth are white; 30 percent are Asian/Pacific Islander (API); 11 percent are Native Hawaiian; and three percent are black. The remaining 33 percent identify as “other” or as being more than one race.
- Thirty-six percent of Hawaii's high school students report ever having had sex, compared to 48 percent of students nationwide. Twenty-four percent are currently sexually active, compared to 35 percent nationwide.
- Fifty-four percent of Hawaii's high school students reported using condoms at last intercourse – the lowest percentage of any state in the nation.
- Hawaii's teen pregnancy rate of 93 pregnancies per 1000 young women ages 15-19 is higher than the national rate of 84, and only 9 states have higher rates of teen pregnancy. However, Hawaii's birth rate of 36 births per 1000 young women ages 15-19 is lower than the national rate of 41.
- Hawaii's HIV epidemic is less severe than the national one and concentrated among people over 40, with fewer than 20 cases occurring in youth ages 15-24.
- Hawaii's STI epidemic is most severe among young people, especially young women.
- Hawaii has the 6th worst Chlamydia rate in the nation. Young people ages 15-24 experienced 63 percent of Hawaii's Chlamydia cases in 2004.
- Young people ages 15-24 experienced 50 percent of Hawaii's gonorrhea cases in 2004.
- Among those ages 15-24, young women experienced 78 percent of reported Chlamydia and Gonorrhea cases.[6,9]
- GLBTQ students are at risk for discrimination and harassment in Hawaii - the Gay Lesbian Straight Educators Network (GLSEN) gives Hawaii a grade of F in creating policies which protect the safety of GLBTQ youth.
Hawaii's Racial and Sexual Minorities Bear the Burden of Teen Pregnancy and STIs
- Hawaii's teen pregnancy rate is higher than the national average among all racial/ethnic groups with reporting, but African American and Hispanic/Latino youth in Hawai`i are at much higher risk for pregnancy than are their white peers. The teen pregnancy rate is 56 for young white women, while rates are more than 2.5 times as high for African Americans (143) and Hispanics/Latinos (146).
- In addition, while Hawaii's teen birth rate is lower than the national rate (41), Asian/Pacific Islander (APIs) and Hispanic/Latina youth in Hawaii give birth at greater rates than their white and African American peers. The teen birth rate is 23 for whites and 19 for African Americans, while it is almost twice as high for APIs (39) and four times as high for Hispanics/Latinas (96).
- APIs suffered 54 percent of Chlamydia infections and 49 percent of gonorrhea infections among patients reporting their race in 2004.[6,9] Among APIs, Native Hawaiians suffered 28 percent of Chlamydia infections and 37 percent of Gonorrhea infections.
- Whites experience most of the HIV cases in Hawaii (59 percent). However, APIs are affected - 15 percent of those infected with HIV in Hawaii are Asian, while 13 percent are Hawaiian/Pacific Islander.
- Men who have sex with men are at the highest risk for HIV – in 2007, they made up 84 percent of those living with HIV who reported a mode of transmission.
Hawaii's Abstinence-Only Programs Are At Odds With The Values Expressed In Its Sexuality Education Law
- Hawaii has among the most progressive sexuality education policies in the country. The state requires sexuality education for students which emphasizes abstinence but provides students with information on condoms and contraception. It is one of very few states that require or even permit skill development on the use of contraception and condoms.
- Research on comprehensive sexuality education programs, like those Hawaii requires students to receive, has consistently shown that young people who receive complete and accurate information about abstinence, condoms, and contraception were not more likely to have sex or acquire an STI.[10,11]
- However, Hawaii received over $1.7 million in funds for abstinence-only programs in 2006, including Title V funding and Community Based Abstinence Education (CBAE) funding. Federally funded abstinence-only programs cannot include information about the health benefits of contraception and condoms for sexually active youth and must teach that sex outside of marriage is likely to have harmful physical and psychological effects.
- Abstinence-only programs also must emphasize marriage as the only appropriate context for sex. Thus, at their worst, these programs promote homophobia and at their best they totally ignore the needs of GLBTQ youth.
- Recent research on abstinence-only programs has found them ineffective, with no impact on reducing teen pregnancy, delaying sexual initiation, or reducing STIs.[14,15]
- Recent research on comprehensive sexuality education of the sort offered in Hawai`i found that youth who received it were significantly more likely to use condoms if sexually active, and were significantly less likely to be involved in pregnancy.[11,15]
Young People In Hawaii Need Better Access to Condoms, Contraception, and Services
- Hawaii law prohibits condoms and contraception from being distributed on school campuses or at any school event.
- Among the states, Hawaii ranks lowest in public funding for reproductive and contraceptive services.
- Hawaii ranks 47th in availability for reproductive and sexual health care services.
- In a nationwide survey of high school students, Hawaiian youth were least likely to report using condoms at last intercourse.
Hawaii's progressive sexuality education law means more students in Hawaii get the information they need than in most states. Yet there is work to be done: Hawaii's youth are at risk for pregnancy, HIV, and STIs; youth of color and GLBTQ youth are at disproportionate risk for negative sexual health outcomes. Research shows that comprehensive sexuality education and access to contraceptive services can help young people protect their health and well-being. Further, there are a number of culturally relevant science-based programs than can successfully assist youth of color to reduce sexual risk taking.[10,11]
- U.S. Census Bureau Public Information Office. “Census 2000 Data for the State of Hawaii.” Accessed from http://www.census.gov/census2000/states/hi.html on May 12, 2008.
- Eaton et al. Youth risk behavior surveillance, United States 2007. Morbidity & Mortality Weekly Report, Surveillance Summaries 2008; 57(SS-4):1-136.
- National Campaign to End Teen and Unplanned Pregnancy. “State Profile: Hawaii.” Accessed from http://www.thenationalcampaign.org/state-data/state-profile.aspx?state=hawaii on August 15, 2008.
- “Kaiser State Facts: Hawaii – HIV/AIDS.” Kaiser Family Foundation. Accessed from http://www.statehealthfacts.org/profilecat.jsp?rgn=13&cat=11 on August 15, 2008.
- Hawai`i Department of Health. “HIV-AIDS Surveillance Semi-Annual Report.” Accessed from http://hawaii.gov/health/healthy-lifestyles/std-aids/aboutus/prg-aids/aids_rep/2h2007.pdf on August 15, 2008.
- Hawaii Department of Health. “Case Rate of Reported Cases of Chlamydia, Hawai`i and US, 1986-2004.” Accessed from http://hawaii.gov/health/healthy-lifestyles/std-aids/data-statistics/figures/stats-chlamydia.pps on August 15, 2008.
- Centers for Disease Control. “STD Surveillance 2006: Table 2: Chlamydia – Reported Cases and rates by state, ranked by states, United States 2006.” Accessed from http://www.cdc.gov/std/stats/tables/table2.htm on August 15, 2008.
- Gay Lesbian Straight Education Network. State of the States: Hawaii. Accessed from http://www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/374-1.pdf on August 15, 2008.
- Hawaii Department of Health. “Case Rate of Reported Cases of Gonorrhea, Hawai`i and US, 1980-2004.” Accessed from http://hawaii.gov/health/healthy-lifestyles/std-aids/data-statistics/figures/stats-gonorrhea.pps on August 15, 2008.
- Kirby D. Emerging Answers 2007. Washington, DC: The National Campaign, 2007 to Prevent Teen and Unplanned Pregnancy. Accessed from http://www.thenationalcampaign.org/EA2007/EA2007_sum.pdf on March 1, 2008.
- Alford S. Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.
- SIECUS Public Policy Office. “State Profile: Hawaii.” Sexuality Education and Information Council of the United States, 2007. Accessed from http://www.siecus.org/index.cfm?fuseaction=Page.viewPage&parentID=487&grandparentID=478&
pageId=830 on August 15, 2008.
- Society for Adolescent Medicine. Abstinence-only education policies and programs: a position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2006; 38(1):83-87.
- Trenholm et al. Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton: Mathematica Policy Research, 2007. Accessed from http://www.mathematica-mpr.com/publications/PDFs/impactabstinence.pdf on April 15, 2008.
- Kohler et al. “Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health, 42(4): 344-351.
- Guttmacher Institute. “Contraception Counts: Hawaii” Accessed from http://www.guttmacher.org/pubs/state_data/states/Hawaii.html on August 15, 2008.
Written by Emily Bridges, MLS
2008 © Advocates for Youth