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 (STDs), including human immunodeficiency virus (HIV) infection. The prolonged latency period, sometimes in excess of five years, and the incubation period of up to 10 years before the manifestation of symptoms, may foster adolescents' false sense of invincibility and denial as they often do not see the devastating effects of the disease in their peers until they are older. In turn, their practice of safer sex may be hindered and thereby contribute to the escalation of this public health crisis among sexually active adolescents. Prevention-focused recommendations were made in the USA as a result of this crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% the proportion of primary care and mental health professionals who provide age-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HIV education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provision of school-based comprehensive STD/HIV education has been difficult to achieve owing to certain limitations and, in some instances, legal action. These limitations include: limited student access; restricted content; and the implementation of sporadic and/or brief educational programmes. Given these recommendations and the fact that adolescents are acquiring STDs and HIV infections at increasing rates, and despite the limitations and legal actions, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical dilemma will be discussed using the ethical decision-making principles of 'autonomy' and 'beneficence', and a decision-making model proposed by Thompson and Thompson, and by Chally and Loric.