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Prison is where Heather Bush feels most free to talk to teens about sex.

With Utah schools essentially off limits, youth detention centers are among the few places to reach the teens most at risk for sexually transmitted diseases — minorities, who make up a disproportionate share of the centers' population. The centers are also occasionally home to youth from the west side of Salt Lake City, where the rates of the most widespread sexually transmitted disease, chlamydia, far exceed the national average.

Bush, an STD-prevention specialist for the state health department, tells locked-up teens that abstinence is the best way to avoid disease. But, she adds, having fewer sexual partners and using protection are good choices, too. "I'm trying to empower them to make their own decisions," she says.

As Utah's minority population grows, the state is just beginning to grapple with why their rates are so steep and what to do about it.

"This whole ethnicity thing — we're kind of baffled," said Mary Ann Kirk, the Utah Parent Teacher Association's sex-education specialist. "What's the underlying [cause], and how do we approach that?"

While most of Utah's chlamydia cases are among whites, minorities have a greater risk of becoming infected. That's true nationally, as well.

The infection rate among Utah Latinos is three times higher than the white rate. The rate among blacks is five times higher.

The contrast is even greater looking at rates by neighborhood: Some of Utah's most ethnically diverse ZIP codes, which also happen to be some of the poorest, have the highest rates of chlamydia.

Among teens, Glendale and Rose Park have the highest rates of chlamydia and births in the state. Glendale's STD rate is 32 times higher than the state's lowest rate in Provo, according to data provided by the Utah Department of Health.

"We have such a problem out here on the west side," says Amanda Thorderson, a Rose Park mother of four who represents her neighborhood on the Salt Lake City school board. "Every parent should know what the rate of infection is in Salt Lake and how that infection is growing every year. Parents have no idea."

The dramatic growth is now driving fissures in the conservative hard line against providing more information about contraception to teens.

An environment of risk • Teens in disadvantaged neighborhoods are more likely to have an STD or get pregnant, national research suggests.

In places such as Glendale and Rose Park, where the rates of poverty, violence and substance abuse are higher than average, teens are more likely to begin having sex early, which increases the risk of STDs, according to a 2007 review of 400 U.S. studies on teens' sex lives.

The reason: Poorer neighborhoods are "associated with a breakdown in social relations, with fewer effective sanctions and social controls to regulate behavior," according to a similar 2004 study of teens with STDs.

Once the STD rate is high in an area, teens having sex are likely to do it with someone who is infected, according to another study.

Plus, "To some degree, kids follow what they see," says Annabel Sheinberg, education director at Planned Parenthood of Utah. "There are some communities where risky sexual behavior may seem much more of a norm."

For Lynn Beltran, Salt Lake Valley Health Department's STD and HIV manager, the west side's high rate is connected to poverty. "When people are lacking the skills and the ability to plan for a future, that's when we see things like high rates of sexually transmitted diseases," she said.

Also, research by the National Campaign to Prevent Teen Pregnancy shows there are cultural differences that lead to riskier sexual behavior among Latinos — who make up about 50 percent of Glendale and Rose Park. They are less likely to use contraception, compared with whites, and they're more likely to want to become pregnant. High rates of teen pregnancy can lead younger siblings to become sexually active earlier.

And because Latina teens are more likely to date partners who are four or more years older, they're more likely to have sex and have more partners over time and less likely to use contraception.

Many of the young Latinas who Beltran sees "do not have a lot of say in their sexual well-being in terms of the number of partners their partner has, or whether or not they use protection such as condoms."

The stakes are high.

Undetected, chlamydia can cause infertility and increases the risk of contracting HIV. The disease can also be passed to newborns — five times in Utah in 2009 — potentially causing premature delivery, pneumonia and eye infections.

Communities with low rates of chlamydia cannot assume they don't have a problem, cautions Matthew Mietchen, the state health department's STD epidemiologist. Rates reflect who gets tested; west-side teens may be more likely to be screened. And with every positive case, public health workers contact that person's partner to get tested and treated, so the cluster grows, Bush notes.

Trying blunt talk • The dozen teen boys file into a classroom at Wasatch Youth Center. Wearing white or tan collared shirts, tan pants, black shoes and closely shorn hair, they grab folders, sharpen pencils and sit in faded green couches arranged in a horseshoe. Narrow, barred windows offer a view of a razor-tipped chain-link fence.

The discussion is more riveting. For 13 hours over nine weeks, a healthy-sexuality class from the state health department covers topics from anatomy to STDS. The teens see graphic pictures of anal warts and gonorrheal discharge and hear from a man with HIV.

The boys are knowledgeable — they can name which STDs are caused by viruses or bacteria — and they aren't shy.

"There's nothing worse than waking up and there's a girl in your bed and you're going, 'Who the hell are you?' " one teen tells the group.

The Centers for Disease Control and Prevention says there is insufficient evidence to show that programs that promote abstinence and mention failure rates of condoms prevent STDs and pregnancy. But that is the course taken in Utah public schools, which restrict what health educators can say about preventing disease. State law says they can't encourage condom use and many fear even mentioning contraception.

So Bush rarely goes there. Instead, she educates at college campuses, at community events and in lock-up, where the teens can debate the pros and cons of condoms.

"We can be more honest and open" in the centers, Bush says.

Up to 40 percent of the boys in the South Salt Lake facility, which holds 40 at a time, have had an STD, its screenings show. That doesn't count boys locked up for sex crimes, who are in a separate unit. Virtually all report being sexually active, with an average teen having 10 to 12 partners in a year. When they are released, they're told to use condoms.

Standing at a whiteboard, her blue toenails peeking through her flip-flops, Bush points to a list of the ways STDs are spread. "If you avoided all this, our prevention talk is done. Just don't do this stuff," she says, snapping her fingers and pretending to walk away. Knowing that won't work, she asks them to think of ways to reduce their risk. The teens come up with many, from monogamy to using condoms to not getting drunk or high.

Bush discusses abstinence but doesn't push for waiting for marriage, the emphasis that would be required in schools.

"You wait for the moment that is right for you. Nobody can tell you what that is," she says, as the teens come up with their own reasons to wait: Until they are sober, in a relationship, an important event like prom or Quinceañera, when Latinas turn 15, marking the transition to young womanhood.

Bush asks them to anticipate what might make it difficult to stick to their plans to postpone sex.

"When a girl's hot and she's ready to go," says one boy.

"What would you do?" Bush asks.

"Always have condoms," he responds.

Bush suggests he make sure he's not alone with her. He looks at her quizzically. "Stuff happens at parties."

An unknown: Utah teens and sex • After class, a 17-year-old from Rose Park says he usually had sex when he was drunk or high.

"Some people I didn't even know until I went to the party and we had sex," he said in an interview. "I've never really protected myself ... I would just ... get into the heat of the moment. I might have some kids out there [who] I don't know."

A 16-year-old, in a separate interview, told of joining boys taking turns having sex with a girl at a party.

"Me and my friends call it a train," he said, adding he won't do it again, based on what he learned from the health department. "What if I don't have sex with the girl first and my friend goes first and he has AIDS and the condom slips off?"

The stories can't be chalked up to teenage boasting, says Beltran of the Salt Lake Valley Health Department. She's heard similar stories while investigating STD cases.

Utah educators can only rely on stories because Utah is one of six states that doesn't survey youth about sex. It's not known what percent of Utah teens are sexually active, how many partners they have or if they use protection.

Besides helping to target campaigns and test whether programs work, that data could also "give us a little bit more justification to be able to teach in the schools," says Lynn Meinor, manager of the state's communicable-disease prevention program.

No law bans asking Utah teens about sex. But health officials fear adding such questions to an annual federal survey would lead too many parents to stop their children from participating. That would jeopardize other public health programs, since the survey also asks about smoking, drinking and drug use.

"It is instrumental in developing all of [our] outreach to youth tobacco users," said department spokesman Tom Hudachko.

The Utah PTA believes the data could also help combat risky sexual behaviors. It formed a committee last year to look for solutions to the higher rates of STDs and pregnancies among minorities, and recently passed a resolution encouraging school districts to seek parental permission to question youths about sex.

But PTA health commissioner Liz Zentner isn't hopeful. "There have been small groups of parents that have just put their foot down" and don't want children questioned about sex.

"Afraid to even talk" • Conservative Salt Lake City Councilman Carlton Christensen also wants schools to be more proactive in talking about contraception, although without promoting its use.

"You need to be able to give kids the full range of information," said Christensen, who represents Rose Park and recently gathered parents to warn them about the area's high STD rates. "The teachers need to feel free about discussing it and letting the kids make a choice in conjunction with their parents."

The Utah PTA does not support demonstrating or distributing condoms. But, with permission from parents, it wants schools to be more flexible in how they teach sex education — to give sexually active teens additional information about contraception, along with talking about strategies to return to abstinence — outside the regular school day.

That kind of education is already allowed under state law, but schoolteachers are wary of parents' reactions, says Kirk. "We're trying to get over that hump of being afraid to even talk about contraception."

For 18-year-old Mark Martinez, frank talk at Wasatch Youth changed his sex life.

The Rose Park teen, who is again a resident at the center, said he had never bothered to use a condom. But the window of time he was out of jail last fall was different.

After learning that some STDs are incurable, he said, he decided he didn't want to be "marked for life." So while out buying party supplies, he and his buddies agreed to pitch in for condoms, he said.

His friends have also been locked up and sat through the same health classes, he said.

Now, he said, "They know to protect themselves."

About the project

This article was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication & Journalism. —

More news about the west side

O Visit for related stories on what ails the west side, which is already strained by socioecomonic factors and a heavier toxic-pollution burden. —

The series

Healthy for Whom? Utah is considered one of the healthiest states in the nation — but not everyone benefits. There are wide disparities in health based on residents' education, ethnicity and environment.

Up next, in February: Why asthma hospitalization rates for children on the west side of Salt Lake City are so high. —

For NeighborWorks, sex education part of the job

Utah has one of the country's lower teen birth rates but the 12th highest birth rate among Latinos.

NeighborWorks Salt Lake, a group that works to strengthen the west side's housing, economy and community, sees sex education as part of its job.

Its life skills class for youth teaches about contraception, since the area's high teen pregnancy rate leads to poverty and low education levels.

"Utah is a state that continues to be in a state of denial in terms of the sexual activity of teenagers. It's in my face everyday," says executive director Maria Garciaz, noting that of the 12 male teens in a recent skills class, eight were fathers.

"The young men will joke about, 'Well I had this [STD] and I had that.' We say, 'So how do you feel that you caught this STD from this person?' 'Well, I'm mad because they weren't honest with me.'

"If you can teach young people to have healthy respectful relationships," she says, "that's strengthening community."

— Heather May