Public Health Implications of New York’s Condom Availability Program
The State of New York’s Condom Availability Program (“CAP”) supplies condoms for distribution to high school students in grades nine and above. Part of required HIV/AIDS instructional programming, the CAP mandates that each New York public high school make condoms available for these students within a designated Health Resource Room run by trained staff (“Condom Availability Program”). According to the New York Sexuality Education Law and Policy’s research, 24.3% of female high school students and 22.8% of male high school students reported being currently sexually active. Additionally, 44.4% of females and 38.8% of males reported not using condoms during their last sexual encounter (“Sexuality Information,” 2015, p. 4). These non-condom using students are therefore at an increased risk of acquiring HIV/AIDS or an unwanted pregnancy. Models of health behavior predict that CAPs will increase condom use among high school students and decrease the related public health risks of sexual activity if they can change student perceptions on condom usage and increase confidence in getting and using them (Kirby et al., 1996). This paper will explain why New York’s CAP directly addresses a public health concern, identify various stakeholders’ in the issue and describe their interests in the CAP, identify which level of government properly maintains control of the CAP, and analyze how the CAP has affected the health of its intended population.
New York’s CAP for public school students directly addresses a public health issue: prevention of the spread of HIV/AIDS and of unwanted teen pregnancy. Research shows the severity of the health issue as, in 2015, the reported rate of diagnoses of HIV infection among New York adolescents (13–19) was 6.1 per 100,000, compared to the national rate of 5.8 per 100,000 (“Sexuality Information,” 2015, p. 9). Thus, consistent with the overall public health goal of ensuring the health and well-being of all individuals (Warner, 2022, 00:06), the CAP is a value-driven and effective solution to the problems associated with unprotected teenage sexual activity. Also consistent with public health goals, its scope is broad, focused on providing unlimited access to condoms for public school students, not any single individual. And, in providing condoms, the CAP directly improves the health of this community. Indeed, research shows that supplying free condoms to sexually active students works. According to the CDC, condom usage within 21 New York City Schools increased by 13% from 2015-2017, thereby decreasing the spread of HIV/AIDS, other diseases, and preventing unwanted pregnancy (“Increasing Condom Use,” 2019). Thus, through its CAP, New York complies with a valid public health goal in providing a needed service to its citizens.
There are many stakeholders for the CAP. Foremost among them are New York’s public high school students, the direct beneficiaries of a program designed to impact their health and well-being. For example, research establishes that 89% of students in the New York City public schools support the CAP and willingly avail themselves of condoms and educational material (Guttmacher, 1997, p. 1428). These students embrace this public health service by recognizing that free condoms offer protection from HIV/AIDS and unwanted pregnancy. There remains a cohort of students who do not support the CAP. These students’ concerns are allayed because participation in the CAP is not required. Thus, New York’s high school students' support of the CAP is clear because the vast majority agree it is a valuable, effective program.
New York’s healthcare professionals are also stakeholders in its CAP. Generally, these individuals and their professional organizations support the CAP and advocate for it as a solid public health program because they recognize it will aid in reducing the transmission of disease and unwanted pregnancy. Notably, the Society for Adolescent Health and Medicine and the American Academy of Pediatrics both support CAPs (Andrzejewski et al., 2018). Likewise, New York’s Department of Health and Mental Hygiene supports the CAP, urging the use of condoms in daily practice and redesigning condom packaging to attract attention and track the effectiveness of the distribution (Santora, 2006). As well, Evergreen Health, an HIV education/condom distribution service across New York, firmly supports the CAP, recognizing its success in reducing the spread of HIV/AIDS and preventing pregnancy. Thus, the majority of New York healthcare workers have a favorable stake in the CAP, supporting its success in protecting the health and well-being of high school students, a goal they share.
Former New York State Chairman of the Conservative Party, Michael Long, who opposes the CAP and views it as a waste to government spending and funds, is another stakeholder acting on behalf of his constituents. Long believes that having condoms widely available promotes “a certain lifestyle” (Santora, 2006). He also disagrees with both the Department of Health and Mental Hygiene’s plan to redesign condom packaging based on cost. Long argues that school systems should keep their focus on learning and allow parents to teach the birds and the bees (Saul et al., 2011). Likewise, he believes that providing condoms to students will promote teenage sexual activity and lead to an increase in negative consequences. Thus, Long is a stakeholder in the CAP, opposed to its provisions on conservative grounds, believing they are not in the best interests of his constituents.
Finally, the New York Roman Catholic Archdiocese is a stakeholder in the CAP that is opposed to it because it objects to condoms as birth control. The Archdiocese fought to block the CAP and supported a lawsuit challenging its validity arguing that the program violated religious freedom or parental rights. The New York Supreme Court dismissed the case, arguing that no rights were violated because participation was not mandatory (Singer, 2018). As well, Archbishop of New York John Cardinal O'Connor lobbied against the CAP by encouraging parents to challenge it in court and argue that it violates parental rights, offering to pay for all legal costs (Goldman, 1991). Finally, the Roman Catholic Church worked to prevent the use of the CAP in some public schools via its role as landlord. New York City rents Church facilities to use as schools. A lease condition precludes these buildings from providing condoms and must promote abstinence only (Singer, 2018). Thus, New York’s Archdiocese is a stakeholder actively opposed to the CAP based on religious convictions.
State governments are granted the power to regulate public school education programs and curriculum pursuant to the Tenth Amendment of the U.S. Constitution and the State of New York’s Constitution. The Tenth Amendment grants state governments the authority to establish and regulate their public schools systems because that authority is not specifically granted to the federal government (Borycz, 2022, Slide 9). Therefore, the state of New York controls its public school system and is responsible for its maintenance and operations through oversight of local districts. Likewise, the New York Constitution states (article 11, section 1) that the Legislature “Shall provide for the maintenance and support of a system of free common schools, wherein all the children of this state may be educated” (“Structure of The…”, p. 2). Thus, these mandates charge New York’s government with creating and regulating curriculum including teaching methods, student materials, with setting graduation requirements (“The Roles of…,” 2018) and with providing a variety of services securing the safety, health, and well-being of students (“Structure of The…”, p. 8). Therefore, New York is entitled to create public health and safety programs, including the CAP.
The New York CAP has affected public health within the affected student community by increasing condom usage and thereby reducing the transmission of HIV/AIDS, other diseases, and preventing unwanted pregnancy within the public schools. As the CDC statistic noted above establishes, the CAP increased condom usage by 13% in 2015-2017 (“Increasing Condom Use,” 2019). A cross-sectional survey examining the effect of CAPs confirms this statistic is attributable to New York’s CAP. The survey compared the incidence of condom usage by New York City students with a CAP in place to Chicago students without a CAP. The results showed that, with similar rates of sexual activity at 60%, 60.8% of New York students used a condom while 55.5% of Chicago students did so. The results prove that New York’s CAP successfully increases condom usages, thereby lowering the risk of sexually transmitted diseases and pregnancy (Guttmacher et al., 1997, p. 1430). Thus, by providing condoms and support staff through its CAP, New York protects the health of its teenage citizens, as intended.
Though statistically successful in achieving its goals, the CAP has its share of detractors, most notably those who object to its advocacy of birth control, those who believe it encourages sex among teens, and those who object to its taxpayer funding. As well, a statistical analysis of New Yorkers generally shows they are divided in their support or rejection of the CAP based upon their class, race, sexual orientation, socioeconomic status, and religious beliefs. For example, lower/middle class New Yorkers show increased concern for HIV/AIDS and prevention programs like the CAP than upper class counterparts. Similarly, LGBTQ+ communities show more concern than straight communities (Berger, 1990).
In creating and implementing its CAP, New York has addressed a significant public health issue. Its creation and existence is well within New York’s authority to establish programs to protect the health and safety of New Yorkers, particularly those within the public school system. Ultimately, the CAP impacts the public health of its intended beneficiaries and other stakeholders by decreasing the incidence of HIV/AIDS transmission and unwanted pregnancies among teenage public high school students.
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