Sexual Health

What Is Known

In the US, 1 in 5 people have an STI, which translates to nearly 68 million infected persons in 2018.² Around half of new STIs were among those 15-24 years old.² In Hawai‘i,

• Gonorrhea rates have doubled over the past 10 years.³ In 2018, the gonorrhea incidence rate was 90.0 per 100,000 population (Hawai‘i State Department of Health [DOH]).
• Syphilis infections have increased 150% over the past 10 years.³ Between 2014-2018, the incidence rate was 6.4 cases per 100,000 population (DOH).
• Chlamydia cases have increased 20% over the past 10 years.³
• 32.4% of all adults and 34.5% of young adults have ever been tested for HIV (BRFSS 2020).
• 43.8% of female and 48.3% of male public school students in grades 9-12 used a condom the last time they had intercourse (YRBS 2019).

Who Is at Risk

Any sexually active person can contract an STI/HIV through condomless vaginal, anal, or oral sex. Some STIs can also be contracted simply through mutual genital contact such as genital herpes and human papillomavirus (HPV). All sexually active people should have an honest and open talk with their healthcare provider and ask whether they should be tested for HIV or other STIs.

Inequalities affect communities differently and have a greater influence on health outcomes than either individual choices or one’s ability to access health care. Certain groups are more impacted by STIs/HIV due to inequities caused by generations-long limited access to healthcare, social, environmental, and economic conditions. Adverse health outcomes have a critical influence on an individual’s health, in addition to personal choice. In Hawaiʻi some of these subgroups include youth aged 15-24, individuals with a previous STI diagnosis, people who use injection drugs (PWID), men who have sex with men (MSM), and transgender women.

Sexual health is often stigmatized – meaning it can be difficult to discuss and can be perceived negatively. Stigma can make it hard for people to have open discussions with their partners, family, and friends, and often increases barriers to accessing care and resources.

How To Reduce Risk

To reduce unintended pregnancies, adolescent births, and HIV/STIs, it is important to encourage responsible sexual behavior and have access to resources and care. This can be accomplished by:

• Condom use – Condoms are 98% effective if used correctly and consistently during every sexual encounter.⁴
• Pre-exposure prophylaxis (PrEP) – PrEP is a biomedical prevention medication for those who have a higher likelihood of acquiring HIV. PrEP reduces the risk of getting HIV through sex by about 99%.⁵
• Postponing/abstinence – Delaying sexual initiation until a person is emotionally and physically prepared, and has more knowledge about sexual activity, can help reduce the risk of contracting an STI/HIV.⁴
• Limiting partners and increasing testing – Limiting the number of sexual partners and getting screened annually, or with a new partner prior to any sexual contact will reduce the risk of contracting STIs/HIV.⁴
• Alternative forms of sexual activity – There are many alternative forms of sexual activity that are lower risk and gratifying that people can engage in such as hugging, holding hands, masturbation, and mutual masturbation.
• Mutual monogamy – Having sex with only one partner, while that partner is also only having sex with you, will limit any other bacteria from entering your genital region potentially resulting in an STI.⁴
• Vaccinations – There are vaccines for both the human papillomavirus (HPV) and Hepatitis B infection.⁴