Analysis Sexual Health

New York’s Universal Comprehensive Sex Ed Mandate: The Radical Notion Our Kids Might Learn Facts

Andrea Miller

For decades, students’ likelihood of receiving sex ed in NYC public schools has come down to the luck of the draw. New York City’s universal standard for sex education, announced in August, seeks to put an end to the loose patchwork of programs across the city. But the usual suspects are using fear-mongering and falsehoods to push their agenda of ignorance.

See our other reports on New York City’s sex ed program here.

Monica has it good. A junior at Bard High School Early College on the Lower East Side, she has a twice-weekly health class this semester that includes one unit each on sex education and on HIV and AIDS. Two-hundred blocks north at Aerospace High School in the Bronx, eighteen-year-old Tamara has never been taught sex education, and it doesn’t appear on the syllabus for this semester’s health class. Somewhere in between, metaphorically anyway, eighteen-year-old Brandon at New Design High School has the option of choosing sex education as a one-week elective, alongside other options like sports, LGBTQ Alliance, and poetry. “It’s a shame you have to pick it,” Brandon said, because so many students don’t.

New York City’s universal standard for sex education, announced by schools Chancellor Dennis Walcott in a letter to middle school and high school principals on August 9, 2011, seeks to put an end to this loose patchwork of sex ed programs across the city. For decades, students’ likelihood of receiving sex ed has come down to the luck of the draw, depending on whether principals have considered it a priority, teachers have the training to teach it, or parents are informed enough to demand it.

The new policy will ensure that middle schools and high schools teach at least one semester each of sex ed, beginning in the Spring semester of 2012. The Department of Education is encouraging schools to use two vetted, evidence-based, age-appropriate, comprehensive sex ed curricula: HealthSmart and Reducing the Risk. They are providing the curricula for free, and offering training and technical assistance to schools on the implementation process.

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Those of us who care about and have been working for years to improve the health of our youth couldn’t be more excited. But as with any attempt to keep our youth healthy and safe by ensuring their access to comprehensive sex ed, a few detractors are raising their voices in opposition. Most notably, the Catholic Archdiocese has rejected the universal standard, and the vehemently anti-choice Chiaroscuro Foundation has rallied to promote abstinence-only education instead. Last week, an op-ed ran in The New York Times claiming that sex ed will usurp parents’ rights to educate their children as they see fit. And on Monday, New York Congress members Bob Turner and Michael Grimm led an anti-sex education rally outside a Brooklyn public school.

In response to these few but vociferous critics, I want to set the record straight.

First, opponents claim that the decision to set these standards was a sudden one, made solely by school administrators without input from a broad spectrum of constituents across the five boroughs.

In reality, it has been years in the making.

New York State has required general health education for all public schools since 1967, and HIV and AIDS education since 1987, but sex education was not required and was by no means universal. In fact, as of 2004, 75 percent of New York City schools failed to even meet state requirements for basic health education.

The city began to ramp up its commitment to sex education under Mayor Michael Bloomberg. In 2007, based on advisory board recommendations, the DOE began recommending the HealthSmart curriculum, supplemented by the Reducing the Risk curriculum for high schools. Both curricula were made available to schools for free, but without a mandate, fewer than half of all schools offered some form of sex ed. Currently, 43 percent of high schools report having used the high school version of HealthSmart and 38 percent report using Reducing the Risk. Sixty-four percent of middle schools report using HealthSmart.

The DOE first tested the waters for implementing a universal standard by piloting a program of evidence-based sex education in ten South Bronx middle and high schools in 2007-2008, using HealthSmart and Reducing the Risk. The South Bronx was chosen for its high rates of teen sexual activity and teen pregnancy. At the end of the school year, seven of the 10 schools successfully implemented the program. Findings showed that students entering the classroom lacked a basic understanding of reproductive anatomy, but were eager to receive that knowledge. The program was wildly popular, garnering support from students, parents, teachers, and principals. All principals involved said they would use the curricula again, with one reporting, “Sex ed is needed throughout the city – not just in the South Bronx. It should be mandatory.”

Our thoughts exactly.

Second, let me be clear that opponents to sex education represent not the concerns of actual parents of public school students, but first and foremost their own conservative agenda to shame and stigmatize sexual activity and push dangerous, useless abstinence-only education. The chief group opposed to the New York City mandate, the NYC Parents Choice Coalition, is a project of the anti-choice Chiaroscuro Foundation – a conservative anti-choice organization that describes itself as a grant-making organization that funds anti-choice initiatives, religious liberty, Christian evangelization and Catholic formation, and humanitarian efforts.

In reality, the vast majority of New York City parents support their children learning comprehensive sex education in school. When the new standard was piloted in the South Bronx in 2007-2008, parents overwhelmingly supported the new program. Only a few parents (zero to three per school) opted their children out for religious reasons, as was – and should be – their right. Similarly, the city-wide mandate has a provision allowing those few parents who do not want their children to learn about prevention and birth control to opt their children out of those lessons.

But more than merely supporting sex education, parents tend to have a widespread expectation that schools have a responsibility to teach the vital, potentially life-saving information that students need to stay healthy and safe. A 2009 poll showed that 85 percent of New York State voters supported comprehensive sex education, and 77 percent of voters mistakenly assumed that it was already being taught.

Third, opponents of comprehensive sex education would have us think that providing comprehensive, age-appropriate sex education is somehow a radical idea. A consistent pattern of fear-mongering has arisen, complete with unfounded and disproven claims that the recommended curricula will increase teen sexual activity. The anti-sex ed crowd repeatedly trots out red herrings in the curricula that obfuscate the truly comprehensive nature of the recommended curricula.

In reality, HealthSmart is medically accurate and abstinence-based, containing materials such as a worksheet students should complete with a parent about how to abstain from sex. And Reducing the Risk has been found to increase parent-child communication about abstinence and contraception, delay initiation of intercourse; and both reduce the incidence of unprotected sex while increasing use of contraception.

Where opponents of sex education see a radical idea, the rest of us see common sense. In 2009, 35 percent of female high school students and 45 percent of male high school students report having had sex. Teens currently make up more than one in four diagnosed STI cases in New York City. Over the past decade, New York City’s teen pregnancy rate has consistently exceeded the national rate, and in 2005 it was 21 percent higher than the national rate. Teens in under-resourced neighborhoods are three times more likely to become pregnant than teens in more affluent neighborhoods. The disparity in access to sex education has been yet another of the disparities plaguing New York City teens, leading to large gaping inequalities in reproductive health outcomes. And, as if that weren’t enough, parenthood significantly increases the dropout rates for teen mothers and teen fathers – about 51 percent of teen moms have a high school diploma, and the graduation rate for teen fathers is around 64 percent.

Universal, comprehensive sex education is not a radical notion. But for students who have not yet received that knowledge, it just might make a radical difference.

As the largest public school district in the country, serving 1.1 million students, New York City’s universal standard should serve as a catalyst for other localities interested in moving forward with a sex ed policy. First and foremost, it levels the playing field for students in the city by ensuring they have equal access to quality sex education across the board. In modeling not only good policy, but also solid implementation guidelines, this move has the potential to reach beyond New York City to inspire other large school districts, localities or even states to implement similar initiatives. With the New York City universal standard for sex education, we just might be one step closer to ensuring that access to sex education is not an accident of geography.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.