Comprehensive STD/HIV prevention education targeting US adolescents: Review of an ethical dilemma and proposed ethical framework

Adolescents are increasingly at risk for sexually transmitted diseases (STD s) including human immunodeficiency virus (MN) infection. The prolonged lat ency period, sometimes in excess of five years, and the incubation period o f up to 10 years before the manifestation of symptoms, may foster adolescen ts' false sense of invincibility and denial as they often do not see the de vastating effects of the disease in their peers until they are older. In tu rn, their practice of safer sex may be hindered and thereby contribute to t he escalation of this public health crisis among sexually active adolescent s. Prevention-focused recommendations were made in the USA as a result of t his crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% th e proportion of primary care and mental health professionals who provide ag e-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HN education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provisi on of school-based comprehensive STD/HIV education has been difficult to ac hieve owing to certain Limitations and, in some instances, legal action. Th ese limitations include: limited student access; restricted content; and th e implementation of sporadic and/or brief educational programmes. Given the se recommendations and the fact that adolescents are acquiring STDs and HN infections at increasing rates, and despite the limitations and legal actio ns, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical d ilemma wilt be discussed using the ethical decision-making principles of 'a utonomy' and 'beneficence', and a decision-making model proposed by Thompso n and Thompson, and by Chally and Loric.