Relationships: What about the guys?

Most weekdays around 3 p.m., timed to the last high school bell of the day, Desmond Grady walks out of the Fremont Community Health Clinic in north Minneapolis and hits the streets. Over his shoulder he carries a plaid vinyl bag, packed with an unusual collection of items.

Three years of experience have taught Grady, 21, how to nail a target within minutes: young men, some barely teenagers, alone or in groups. He wanders over, flashes his disarming smile and delivers his opener: "Want a condom?" Then his work begins -- quickly -- talking about pregnancy prevention, the scourge of sexually transmitted infections (time to pull out pictures of organs afflicted with gonorrhea and chlamydia), and how easy it is to be tested (he also happens to have several spare urine containers).

As Grady works the streets, Lars Hansen takes a similar message indoors. A member of a Planned Parenthood-sponsored Teen Council, Hansen, 18, speaks to classrooms of middle school and high school students about safe sex and abstinence.

Hansen and Grady know their message cannot be shouted too loudly, particularly in light of new findings from the Centers for Disease Control (CDC) that one in four American teenage girls has a sexually transmitted disease. In the black community, it's one in two. But their focus isn't girls. It's guys. And a chorus of health officials and sexuality educators says it's about time.

"We have got to start talking about the males," said Lisa Turnham, director of educational programs for Planned Parenthood Minnesota, North Dakota, South Dakota. "The [CDC] study could easily have tested males and STDs, but it didn't. It's imperative that we start to pay attention to young men."

Barriers aplenty

The CDC study was the first of its kind, focusing on four common STDs in 838 girls ages 14 to 19: human papillomavirus (HPV), chlamydia, genital herpes and trichomoniasis, a parasite. The overall rate of sexually transmitted disease (STD) was 26 percent, which extrapolates to about 3.2 million teenage girls nationwide carrying some kind of infection. Left untreated, HPV can cause cervical cancer. Chlamydia can lead to infertility.

Antibiotics can treat chlamydia and trichomoniasis, and medications can control, if not cure, herpes outbreaks. A vaccine targeting several HPV strains is newly available. But girls must recognize symptoms, such as painful urination or abnormal discharge, and see a health care provider. And this is where the great gender divide begins.

Most girls, from their early teens, view the doctor's office as a routine and necessary checkpoint, a safe and largely feminine place to ask questions about their periods, get an annual physical exam including a Pap test (beginning at age 21 if not sexually active) or a birth control prescription.

Most young men would rather have their wisdom teeth pulled without drugs than sit in a waiting area decorated with Mary Cassatt prints, waiting to get poked, prodded and possibly undressed for a checkup. So, except for the sports physical they get about once every three years, they don't.

"Unless they're burning, leaking or dripping," they don't see a doctor, said Fred Evans, community health coordinator at the Fremont Clinic, where Grady and other young people on the sex-ed fronts earn equal parts ribbing and respect from their peers. "It's a macho image," Evans said. "It's 'I can handle it myself.'"

Generally, though, they can't. Girls aren't getting pregnant or infected by themselves. A recent sexual-intimacy study by the National Campaign to Prevent Teen Pregnancy revealed that high school males are likelier than high school females to have sex (49 vs. 43 percent), boys are likelier than girls to have had four or more sexual partners (17 vs. 11 percent) and 55 percent of males ages 15 to 19 say they either have received or given oral sex, an act that many incorrectly believe is unconnected to disease transmission.

The study offered a few surprises, too. Condom use was highest among 10th-grade males (69 percent) and lowest among 12th-grade males (60 percent). And males age 12 to 19 are slightly more likely than females the same age to report feeling pressured to have sex (82 vs. 79 percent).

Clearly, young men need information. But unlike young women, who raise their hands and ask questions with relative ease, guys typically sit back and fidget, or turn their discomfort into a comedy act.

"All the bone-headed things said [in classrooms] are said by the boys," Hansen said. "That's why I got interested in educating them. The boys weren't serious, and that made me mad."

Grady agrees. It's easy to single out the one guy to approach on his rounds, he said. "You can tell who he is," Grady says: "the loudmouth, the goof-off."

Go where they go

The key to getting young men to listen up, said Evans, is to go to their "hot spots." Alternative schools and youth centers, parks and parking lots, barbershops and basketball courts, even juvenile detention centers.

Evans' clinic is part of a collaborative effort to do just that. Called Seen on da Streets, it's designed to target and educate young Minneapolis men about reproductive health. The five-year Streets program, funded with a $1.4 million grant from the U.S. Department of Health and Human Services, began in 2003 and faced formidable challenges from the start. Nearly every young man contacted was sexually active, and most had multiple sexual partners in the previous six months. Condom use was inconsistent and one-fourth said they had not seen a doctor in the previous year.

As the program wraps up, nearly 9,000 young men have been educated, most of them black and between the ages of 15 and 20. STD tests have increased 43 percent, with treatment administered to nearly every male testing positive for gonorrhea or chlamydia.

Other big ideas

Small changes can also make a big difference in how males approach their overall physical health, say health officials. Waiting rooms offering sports and music magazines and posters, and perhaps most important, male support staff, represent one new push.

Some health providers are getting more aggressive when boys come in for their occasional sports physical, Turnham said. "We have made that [physical] so intense," she said. "This is an opportunity to get them and, with their consent, discuss prevention, testing and treatment."

Male-focused leadership programs also pay dividends. Grady, for example, doesn't just walk the streets using condoms as bait. He also has been trained to process the urine at the clinic himself before it's shipped to Hennepin County Medical Center for testing. Then he's back on the streets to deliver results and assistance. "My friends ask, 'How do you get that job?'" he said proudly.

Hansen, too, is proud of his efforts educating his peers. "They want to learn. They wake up, stop sleeping in class."

Around Minnesota

While Minneapolis leads the way, other communities are also adjusting their focus to young males.

A seven-session program titled "Sex 101" teaches male responsibility at Boys Totem Town, an intervention facility in St. Paul. In Duluth, 17-year-old Emil Green, a senior at Unity High School, serves on a youth-development and leadership council, similar to Hansen's. Still, much of his outreach is done informally.

"People at my school ask me questions all the time," said Green, who said he was appalled by the CDC findings. "They ask, 'How many condoms should I wear to stay safe?' 'Can I get a pregnancy test?' 'What is this STD?' " Sometimes guys come to him seeking relationship advice that has nothing to do with sex. They just want to know how to get along with their girlfriends. He tries to help with that, too.

"At first, I was a little nervous about the whole thing. Now I want them to know. After I tell them a little about how STDs spread, I'm pretty sure by the look on their faces that they hear me."

And in Brainerd, Minn., the Wise Guyz program invites male teens to meet regularly to learn about healthy relationships and reproductive health.

Progress is being made, but it's not coming fast enough for Evans, who is working to create similar outreach to young Latino men. "Ten people in the state get the flu and we call it an epidemic," Evans said. "But this is an epidemic. This is a movement to create a healthier generation of youth."

Gail Rosenblum • 612-673-7350