Column: STD testing: Too costly for Duke?

How many of us have free condoms in our dressers from the Healthy Devil Peer Education Program? Peer educators, in addition to passing out free condoms, educate the campus about issues of sexual health. The coordinator, Ray Rodriguez, gives an informative, humorous and rather famous presentation on safer sex and STD testing to classes, greek groups and other student organizations. Rodriguez encourages students to seek STD testing if students are concerned with their sexual behaviors. In fact, Healthy Devil Online promotes screening for HIV and chlamydia for "sexually active people who have had more than one partner, or whose partner has had more than one partner..."

Unfortunately, the promotion of STD testing at Duke does not correlate to the experiences some students have had with Duke Student Health Services. Several students I know have been turned away from STD testing after providing their sexual history. Essentially, students are going to the Health Clinic to ask for HIV and other STD testing, but are not deemed at high enough risk to be tested. These white, heterosexual students with whom I've spoken are effectively told, "Duke is a pretty safe place. Even though you participate in drunken hook-ups and may not always use condoms, you shouldn't worry about STDs." This message is outrageous, especially considering the information students receive on campus about STDs and safer sex

In response to this message, some students leave the clinic in disbelief or resort to grand tales of sexual exploits to "convince" a doctor or nurse that they need to be tested. Students should not have to convince anyone to receive this service. One student I spoke with who was turned away from the clinic reported that he no longer believes he should be tested for STDs, even though he has participated in unsafe sex. The doctor unfortunately confirmed the student's erroneous belief that he is not at risk for STDs. Frankly, any sexually active student who enters the Health Clinic for an STD test clearly feels that he or she has need for one. High risk or low risk is irrelevant, considering the difficulty of measuring students' honesty and actual risk level. Any sexually active person is at risk for STDs, including HIV.

One of the goals of safer sex education is to encourage students to be tested. The clinic should expect an increased number of students for testing as a result of improved education. Students getting STD tests for peace of mind after one sexual encounter should receive the same treatment as students getting tested after a weeklong spate of bacchanalian orgies. The only justification for testing should be walking in the front door of the Health Clinic. Students who take this step should not be turned away.

I should note that these deplorable practices have occurred within clinic examination rooms, and not in the separate office for HIV testing. Rodriguez, an HIV test counselor, does not turn away students seeking an HIV test in his office. Students encounter a discouraging climate when they see doctors or nurses about getting tested for STDs besides HIV. After some investigation, I have discovered that doctors are implicitly told to limit the number of STD referrals due to financial constraints, i.e., our student health fee was "only" $496 this academic year.

Some doctors have reportedly had to justify STD referrals for particular students. Doctors become hesitant in testing students out of fear of reprimand by the administration of Duke Student Health. These practices are directly antithetical to the message students receive on campus about the importance of STD testing. In fact, these practices violate Student Health's own decree that: "Sexually active people who have had more than one partner, or whose partner has had more than one partner, should be screened for sexually transmitted diseases." Even though this edict fallaciously implies that "monogamous" couples need not be tested, it still encourages a large number of Duke students to be tested for STDs. This climate of putting money before students' health is absolutely appalling.

According to the Kaiser Family Foundation's 1998 report, one in three sexually active people will contract an STD by the age of 24. Many health professionals are calling the rampant spread of STDs an epidemic, caused by the asymptomatic nature of many STDs and the stigma of acquiring knowledge about STDs and testing. As part of one of the leading health care systems in the country, Duke Student Health Services cannot contribute to this culture of silence.

Students requesting STD testing, often after exposure to sexual health programming on campus, must not face difficulty in obtaining testing and counseling. If Duke truly wants to educate this campus about sexual health, it cannot continue this inexcusable practice of turning students away from services they require.