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Street smarts and training aid in battle against sexually transmitted diseases

This article first appeared in the St. Louis Beacon, Dec. 6, 2010 - He got his education in the streets, and she got hers at the University of Texas School of Public Health. She left a job at the Centers for Disease Control and Prevention in Atlanta to join the St. Louis Health Department. He also got a job in the department after he decided to turn his life around and focus on encouraging inner city youngsters to go straight and steer clear of at-risk behavior.

In time, this unlikely team of Brandii Mayes and Aaron Morris, both under 30, would become the most visible faces in the city Health Department's fight against sexually transmitted diseases. They are part of the department's first-ever youth component to address STDs and were brought on board when the STD rates in St. Louis were among the nation's highest.

Relying on a combination of academic training and street smarts, the two established the Body and Soul project to educate young people about STD prevention and intervention. At the time that the Body and Soul project began in 2006, nearly 72 percent of chlamydia cases and over 60 percent of gonorrhea cases in St. Louis involved city residents in the 15-24 age group. City health officials said the data showed that nearly 94 percent of chlamydia cases, 96 percent of gonorrhea cases, and 93 percent of syphilis cases involved African Americans.

The CDC says the problems can be traced to larger problems, such as limited access to comprehensive physical and mental health care, the consequences of poverty, ignorance among young people about risks associated with sexual activity and ignorance as well about treatment options.

Stds Affect All of Us

The STD problem may seem like an issue of little consequence to anyone except those who engage in risky sexual behavior. But it's a public health problem that indirectly affects everybody, consuming about $15 billion nationwide in medical expenses each year, the CDC says. It adds that some women victims face related illnesses, such as cervical cancer, infertility and ectopic pregnancy.

Body and Soul is just one city approach to STDs among young people. Another is a drop-in clinic, called the SPOT, or Supporting Positive Opportunities with Teens, part of a collaboration with BJC Health Care. In addition, the city has turned to more aggressive testing and screening at unusual sites, such as jails and juvenile detention facilities, as well as mobile clinics, and free, walk-in STD clinical services at ConnectCare. These proactive attacks seem to be paying off.

For a decade, the city has routinely placed near the top in gonorrhea and chlamydia infections. But new CDC data, released last week, show that St. Louis had lower rates for gonorrhea and syphilis in 2009 than in 2008, and saw an easing in the rise of chlamydia infections as well. The city still ranked second in the nation in chlamydia, but the rate hadn't risen as fast as it did in previous years.

Allowing young adults to take a greater role educating other youngsters about STD issues began when the city set up YEAH, which stands for Youth Empowerment Advocates for Health. Through YEAH, Mayes and Morris created the Body and Soul project.

Music Moves Minds

Their challenge had been to come up with a program that would hold the attention of inner city blacks long enough to get across messages about sexual health.

Mayes says, "We wanted to put together something that teaches black teens that's not only informative but fun, that's exciting with an entertainment component. While we always have a message, we don't just talk bout STDs."

She adds that the written word is losing its impact and that youngsters nowadays are "very into technology. They're into music. They watch a lot of videos. You might give them a piece of paper with information and they might look at it and throw it on the ground. But they're very receptive to music. So we always try to incorporate music in some way. We also give out T-shirts and prizes."

The Body and Soul name came to Morris because he and Mayes wanted to stress that the fight against STDs not only was about protecting the body but using the mind to help make good choices about sex and produce positive outcomes.

Body and Soul quickly organized projects at St. Louis Community College at Forest Park. The youth-oriented events included poetry, rapping, music and other engaging ways to boost awareness about STDs, the need for abstinence and some of the consequences of risky behavior. About 200 people, including 60 parents, turned out for the event, and about 60 young people signed pledges to take the sexual health message to others in the community.

Reaching People 'Where They Are'

Mayes had been content working at the CDC in Atlanta before coming to St. Louis. But two of the city's top health officials -- interim Health Director Pamela Rice Walker and Health Commissioner Melba R. Moore -- offered her a job and a challenge to be part of the first youth component in the city Health Department.

"We've now gone to churches. We've gone to high schools. We've gone to community centers. We've gone to any place we could with an entertaining message," Mayes says.

"You know, when we started working with churches, I was concerned about taking the message about STDs to the churches, but some of the clergy have been really responsive."

Morris adds, "Sometimes, we go in and they'll give us restrictions, asking, for example, that we not bring condoms. We're OK with that."

Mayes adds that "you have to reach people where they are. That's what's important. We always encourage abstinence as the only way to stay STD free. But we encourage protection as a must if you are engaging in sexual activity."

Dealing with Emotion and Ego

The two have learned lessons of their own about how teens and young adults view sex. For girls, Mayes says, "I've learned that it's not just about sex and condoms. It's often about family and loneliness, a desire to be loved. We listen as much as we talk during these sessions. It's not scare tactics that a lot of other people might try to use, and we think our approach is working."

Morris adds that he has had to shatter some egos among the boys. One thing he hears them talk about is needing to use the largest condom they can find.

"They might say, 'Yeah, man, we're Mags,' " Morris says, meaning nothing smaller than a Trojan Magnum condom will fit.

To show them they don't need the size their egos might suggest, Morris slips a less expensive condom onto his hand and part of his wrist. He says some of the young men are surprised by what they see, not realizing that a condom can be stretched that much.

"I tell them, 'You thought you needed a Magnum, but you're really just being charged more for your ego.' You know what I'm saying?"

He says the team comes across a lot of other myths, including one about young men using ear wax to determine if a partner is clean.

"Supposedly you dig some wax out of your ear and place it in her opening and if she jumps, it means she's dirty," Morris says. "We have to remove those kinds of myths and give people the facts. Another one is that brothers can strap up twice (strap on two condoms) for protection. We have to educate them to the fact that using two condoms can lead to friction upon friction, and that can lead to breakage."

Morris worked his way from the streets to participation in the city's old gang abatement program, and he is now supervisor of the YEAH Team. He says he is able to reach a lot of people because he understands youth better than most.

"In the African-American community, it's not just about testing," he says. "Getting tested is one thing, but how to prevent it is another. I've seen a situation, for example, where a young mother who is only 19 years old, addicted to heroin and doesn't have a lot of skills. She has become lazy because of her drug use and is willing to have sex to get another high."

Morris adds, "My reaction to cases like that is always emotional because I'm a former gang member and a former drug dealer. So it's a touchy issue for me. But I have to show people what we can do to help them, you know."

Mayes adds a word of caution. While gratified that Body and Soul seems to be making a difference, she says, "I don't want to make it seem as though, you know, we have come in and saved the day."

Which is her way of saying the city still has a lot of work to do to get STDs under control.

This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.