State Rankings

State Rank
Vermont 1
Maine 2
New Hampshire 3
Hawaii 4
New Jersey 5
Rhode Island 6
West Virginia 7
Washington 8
Idaho 9
Oregon 10
Montana 11
Colorado 12
Wisconsin 13
Iowa 14
Connecticut 15
Wyoming 16
Minnesota 17
Utah 18
Virginia 19
North Dakota 20
Nebraska 21
Massachusetts 22
Kansas 23
New Mexico 24
Delaware 25
Pennsylvania 26
California 27
Illinois 28
Kentucky 29
Michigan 30
Indiana 31
South Dakota 32
Maryland 33
North Carolina 34
New York 35
Missouri 36
Ohio 37
Oklahoma 38
South Carolina 39
Arizona 40
Alabama 41
Alaska 42
Nevada 43
Arkansas 44
Tennessee 45
Texas 46
Florida 47
Mississippi 48
Georgia 49
Louisiana 50

The "State by State Safer Sex Index," sponsored by the makers of Trojan™ Brand Condoms, ranks states on eight indicators of sexual health drawn from the main set of sexual health indicators used in the Third Edition of the Sexual Health Rankings.

States are scored on two measures of safer sex: sexually transmitted diseases (STDs) and contraception. These scores are added to get an overall safer-sex score for each state. The 50 states are ranked from first to last by their overall score, with the No. 1 rank going to the state with the highest score.

The highest-ranking states in the State by State Safer Sex Index have the highest scores for STD prevention and contraception. The lowest-ranking states have lowest scores for both measures. Each measure is made up of four closely associated indicators:

  • HIV diagnoses, rate per 100,000 population
  • Gonorrhea cases, rate per 100,000 population
  • Syphilis cases, rate per 100,000 population
  • Percent of adults reported ever receiving a HIV test
  • State mandates sex education in schools must cover contraception
  • State mandates STD/HIV education in schools must cover contraception
  • Percent of high schools in which teachers taught essential condom use topics
  • Births to mothers aged 15-19, rate per 1,000

More details about the statistical methods used to produce the State by State Safer Sex Index can be found at the Sexual Health Rankings Web site.

A The State by State Safer Sex Index ranks all 50 states based on their scores in two measures for safer sex, STD/HIV rates and contraception. The Trojan™ Sexual Health Report Card is an annual ranking of the sexual health resources and information available to students at major college campuses nationwide.
A The State by State Safer Sex Index, sponsored by the makers of Trojan™ Brand Condoms, used 8 of the 33 indicators from the original rankings to create an index that solely focuses on STDs and contraception. The Sexual Health Rankings rank states based on indicators that influence sexual health, including laws, policies and human rights, education, society and culture, economics and health systems.
A The 8 indicators were separated from the Sexual Health Rankings in order to rank the states based on 2 specific measures, STDs and contraception. Each measure includes 4 indicators that are both thematically and statistically related. STD includes rates of gonorrhea, syphilis, HIV and the percentage of adults that have had HIV testing. Contraception includes the rate of teen births and school sex education policies for teaching contraception, condom use and HIV/STD education.

Indicator STDs Contraception
HIV testing
Teaching condom use
Teen births
Sex ed, contraception
STD/HIV ed, contraception

Each state's Safer Sex score is a combination of the STD measure and Contraception measure.

The STD measure includes the values for HIV, rate of Syphilis cases and rate of Gonorrhea cases that count against a state's score for the STD measure, as higher rates are negatively linked to safer sex. The value for HIV testing indicator is inverted and counts toward the score in the STD measure because more testing is a good thing.

The Contraception measure includes the values for teaching condom use, sex ed, contraception and STD/HIV education. These scores contribute positively to the Contraception measure, while the teen birth indicator counts against the score, as Teen birth rates tend to be lower in states that require schools to teach contraception in sex-ed and STD/HIV prevention programs, and where high schools teach essential information about condom use.

A Using the graph, states can see where they rank on each of the two measures and eight indicators to improve where they have low scores. The highest-ranking states in the State by State Safer Sex Index have the best scores for STD prevention and contraception. The lowest-ranking states have worst scores for both. States that rank in the middle score highly on one measure but not the other or receive an average score for both measures. While there is no hard and fast rule for how a state can improve their ranking, it's important for people to take notice of the issues and begin an open dialogue to bring about positive change at the individual and state level to improve sexual health.
A The correlation between state mandates, teaching condom use topics, and teen birth rates shows that teaching condom use topics is significant. The analysis shows that whether or not a state mandates sex education is not the driver in difference in sexual health, but rather the type of sex education that is mandated drives positive sexual health. The inclusion of contraception information or STD/HIV education as part of sex education in schools is an important driver of differences in sexual health among the states.
A While chlamydia is an important factor in sexual health, the chlamydia data that is reported could produce misleading results. The Center for Disease Control cautions that its chlamydia surveillance data is "more reflective of changes in diagnostic, screening and reporting practices than of actual trends in disease incidence." The chlamydia data are not well suited to making state-by-state comparisons.
A The HIV testing indicator has been "reverse-coded" in the analysis, so that states are not penalized for having higher testing rates and to compensate for the effect of higher rates of HIV diagnoses being attributable to increased testing. It is best to have a higher rate of people tested for HIV combined with a lower rate of HIV diagnoses. It is better to have higher HIV testing rates and higher HIV diagnosis rates than to have low testing rates. If the rate of HIV diagnoses is high, and testing is low, then there are potentially more infected people who don't know their HIV status and are potentially spreading the virus and not receiving life-saving HIV treatment. If the rate of HIV diagnoses is low, and the testing rate is low, then that suggests the low rate of HIV diagnoses may be due to under-testing, and that, potentially, infected people are not aware of their HIV status.
A Although 18 is the age when a person is legally considered an adult in the United States, births to mothers aged 15-19 is the standard statistic commonly referred to as "the teen birth rate." Childbearing in that age range is strongly associated with negative social and health outcomes for the mother and the child. Teen birth rates are the data that is collected and reported and in the public health field these data are commonly taken as a proxy for unplanned teen pregnancies, which is not publicly recorded data.
A Trojan™ and Variance, LLC partnered to provide Americans with a comparison of how their state ranks in the Safer Sex measures of STDs and contraception. Trojan hopes to get people talking about the issues, initiating change and making smart decisions about their sexual health.

TROJAN™ Brand Condoms are America's #1 condom and have been trusted for over 90 years. As the most trusted name in protection, Trojan™ continues to be a leader in the sexual health arena and remains dedicated to mainstreaming the conversation and sharing positive messages on sexual health in this country. By partnering with Variance, LLC for the State by State Safer Sex Index, the brand is continuing its commitment to providing sexually active Americans with accessible information and products that provide protection and enhance pleasure. With nearly 20 million new cases of STDs occurring every year, and only one in three sex acts involving a condom, there’s clearly room for improvement and the time is right for an honest conversation on the state of sexual health in America. By drawing attention to this issue and serving as a catalyst for information and improvement, we hope to influence sexually active Americans to make smart decisions about their sexual health.

Safer Sex Indicators

These Safer Sex indicators make up the two measures of safer sex, STDs and contraception, which the states are ranked against to achieve an overall safer sex score.

© 2015 Variance, LLC