This summer, I am participating in the Chester Community Fellows program and interning at Crozer-Chester Medical Center in the Community Health Education department. During my time as a Chester fellow, I have heard a lot about the sexual health issues facing the city, particularly those regarding STIs, HIV, and teen pregnancy. For example, the year 2007 saw an 80% increase in the number of cases of gonorrhea in Delaware County, from 513 cases in 2006 to 921 cases in 2007. Most of these cases were concentrated in and around Chester, and 55% of the cases occurred in people between the ages of 15 and 24. This spike is troubling because infection can lead to serious, long-term health problems. Gonorrhea can cause many unpleasant and uncomfortable symptoms, but some infected people, especially women, experience no symptoms at all. This can be very dangerous because, when left untreated, gonorrhea can lead to pelvic inflammatory disease and epididymitis. Also, those infected with gonorrhea have an increased susceptibility to HIV and can transmit HIV more easily to other people. This could be a serious problem for the county with the third highest rate of AIDS infection in the state.
Chester also has a very high number of teen pregnancies. According to a Chester high school teacher that I met with, Chester has the second highest rate of unplanned, unmarried pregnancies in the world. During the 2007-2008 school year alone, there were 91 pregnant students in the Chester Upland School District. This high teen pregnancy rate has severely disrupted the education of the many Chester students.

How did this happen?

The easy answer given by health officials is that the youth of Chester have been participating in “high-risk” behaviors. However, this begs the question, “Why Chester?” What situations and experiences have led these youth to be more likely to engage in high-risk behaviors? I believe that many distinct factors have all contributed to Chester’s current sexual health situation.
For starters, the city of Chester does not currently have a health commissioner. The former commissioner, Melanie Ragin, left due to “personal reasons” in November of 2008 after holding the position for little more than a year. Ragin described her work environment as hostile, and it is unclear if she was able to get much work done during her period as health commissioner. Near the end of her time working for the city, Ragin was working from home. Before Ragin took the post in 2007, Chester had been without a health commissioner for several years.
Delaware County is also lacking a health department. It is the largest county in the state of Pennsylvania without its own health department, with over half a million residents living in the area. Without an effective city health commissioner or county health department, it must be very difficult for Chester to implement the appropriate programs and initiatives to keep the city healthy.
Abstinence-only education is also likely to have contributed to the high number of STI infections and teen pregnancies in Chester. Congress has given hundreds of millions of dollars to fund state programs that promote abstinence until marriage as the only appropriate sexual behavior. The requirements for these programs often bar important information about contraception, abortion, STIs, and safe sexual practices from being presented to youth. An evaluation of these programs by Mathematica has found that they have no effect on sexual behavior when compared to a control group. In a University of Pennsylvania memo about abstinence programs in Pennsylvania, youth are described as frustrated with the unrealistic nature of the program and the lack of information given to them. The memo concludes that, “The effects of this type of education are mixed at best, and at worst leave our youth becoming sexually active without fundamental knowledge of contraception and how to protect their health.”
Despite the problems with such programs, the Bureau of Health of the City of Chester has been accepting federal funds to run such programs for many years. The project, called the Sexual Abstinence Education and Resource Project (SABER), is an after-school, abstinence-only program. As far as I know, this is the only sexual education program supported by the Chester City Health Department.
Countless other factors also contributed to this crisis. A nurse practitioner for the AIDS Care Group cites poor local economy, high drug use, and low educational attainment as reasons for the high level of HIV and STI infection in Chester. Also, the conservative political and religious nature of the city could make it difficult for programs to openly talk about safe sexual practices other than abstinence. For all these reasons, the environment in Chester has been labeled as the “perfect storm” for an STI epidemic.

Hope for the Future?

The dramatic increase in gonorrhea cases finally sparked some action in the health care arena. Due to efforts from the State Health Department, Crozer-Keystone Health System, Planned Parenthood, school districts, and other groups, the number of gonorrhea cases in 2008 has decreased to 607, down 34% from 2007*. However, this level is still higher than in 2006. How can we keep decreasing the number of gonorrhea cases and prevent another outbreak from occurring? And how can other issues, such as HIV/AIDS and teen pregnancy, be addressed?
The Chester Upland School District asked themselves the same questions and came up with the “Healthy Students, Healthy Living” policy. According to Chester Upland School District Superintendent Gregory E. Thornton, in order to have great student achievement, you must have healthy students. This policy will use sexual health education and prevention methods to hopefully improve the overall health, quality of life, and futures of the students in the district.

A main component of this policy is the opening of a Health Resource Center in Chester High School. The center is staffed with a counselor and offers pregnancy, chlamydia, and gonorrhea tests, as well as free condoms. The center also offers sexual education and counseling services.
Hopefully this new resource will allow the youth of Chester to make more informed and safe sexual decisions. So far, about 10 students a day visit the center, and Shakina McClain, the center’s coordinator and counselor, claims that “the reaction has been really good.” She also emphasizes the importance of having resources like this in community spaces, saying “Once I see them at the clinic, they usually already have the infection. Here, I can talk to them before they have the infection.” The school administration was also very careful to keep the religious and politically conservative values of many Chester residents in mind when implementing the health center by allowing parents to “opt out” of allowing their students to receive free contraceptives.
The early success of the center shows how involving community resources, such as a school, could be a very important method of implementing health education in Chester. While it is unlikely that people will just stop by a hospital or clinic to learn more about STIs, having this information available in multiple community locations may be the most effective way to carry out prevention programs in areas like Chester where health education is most needed. There is only so much doctors and state officials can do on their own; at some point, health care providers must start working with and utilizing the community to really see any sort of sustainable change.
Hopefully, the center will also make people realize that it is best to allow youth to make their own informed decisions instead of withholding important information from them. Abstinence-only programs place a moral judgment on youth by telling them that any sexual practices outside of marriage are not “the expected standard” of behavior. If students do not want to accept this standard, they are not given the tools to make safe and healthy sexual decisions. This means that abstinence programs are not only ineffective, but could cause youth to make uninformed choices that could have a lasting impact on their health. The worst part is that these poor decisions can be prevented through proper sexual health education.
Finally, although it appears the Health Resource Center has managed to succeed in its first months, a full-time city health commissioner is still needed. Every city requires someone to determine what the major health risks are for the residents and how to best create and implement programs to address these issues. It is not wise or safe for a city to keep relying on outside groups and other city officials to do these jobs. Chester needs a health commissioner.

* These are provisional numbers released from the state health department.

Sources

Brisson, Amy. “Chester searching for new health commish.” The Delaware County Daily Times. 8 April. 2009.

Brisson, Amy. “Chester Upland proposes adolescent health center.” The Delaware County Daily Times. 20 Oct. 2008.

Brisson, Amy. “Gonorrhea cases on rise in county.” The Delaware County Daily Times. 5 May 2008.

Brisson, Amy. “Gonorrhea rate drops 34% in county.” The Delaware County Daily Times. 6 Feb. 2009.

Brisson, Amy. “Health center is up and running at Chester High School.” The Delaware County Daily Times. 9 Feb. 2009.

Brisson, Amy. “Healthful resource in Chester.” The Delaware County Daily Times. 9 Feb. 2009.

Chester Upland School District. Chester Upland School District. Accessed 27 July, 2008. [www.chesteruplandsd.org].

Halt, Rosemarie O’Malley. “Make health departments mandatory in Pa.” The Delaware County Daily Times. 29 April 2009.

“Impacts of Four Title V, Section 510 Abstinence Education Programs.” Princeton, NJ: Mathematica Policy Research, Inc., April 2007, Christopher Trenholm, Barbara Devaney, Ken Fortson, Lisa Quay, Justin Wheeler, and Melissa Clark. Document No. PR07-07, 164 Pages.

Reproductive Rights Law Project (2007). Five Years of Abstinence-Only-Until-Marriage. Retrieved April 21, 2009 from http://www.law.upenn.edu/probonoprojects/reproductive-rights/Memo%20on%20state%20of%20abstinence%20ed%20in%20PA.doc

Sexually Transmitted Diseases: Gonorrhea. 20 July 2009. CDC. Accessed 27 July, 2008. [www.cdc.gov/std/gonorrhea].

This post was written by emilia.thurber

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