Analysis Sexuality

Sexual Health as a Framework for Addressing Holistic Prevention Efforts: Connecting the Dots Between Movements

Jonathan Yglesias

Sexual education and empowerment leads not only to responsible and respectful sexual behaviors and attitudes but also an increased access to effective preventative, screening, treatment, and support services that promote physical and sexual well-being. But we need integrated approaches and more connection to achieve our goals.

This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness

Sexuality is bigger than sex. It’s an integral part of the human experience with physical, emotional, intellectual, social, and spiritual dimensions. And yet, what comes to mind when you hear the word “sexuality”? Really think about it for a minute.

It’s likely to be some sort of disconnected hodge-podge of awkward memories tracing back to (inadequate) sex-ed classes, sexual acts or personal experiences with sex, and a few Prince or Salt-N-Pepa lyrics sprinkled in, all framed by those not-so-fuzzy feelings of social shaming. The point is, it doesn’t always matter how large your frame of reference is or how much you’ve studied public health and Feminist theory, the result of simply hearing the word (sexuality) is likely to conjure up culturally entrenched, hyper-contextualized messages that have little to do with promotion or a healthy sense of self for that matter.

Our conception of sexuality is, without a doubt, influenced by and connected to things like mood, environment, self-concept, development, and social interaction. And yet, there exists a fundamental disconnect between how we’re expected to interact with and process sexuality and the reality of how we live it. We often get stuck in this place where we wind up experiencing a range of attitudes and emotions dependent on the development and maintenance or our own (fragile) identities as sexual beings – furthermore, we are dependent on the cultural contexts in which those identities exist. It would seem that sexuality, at least in Western culture (and arguably in many parts of the globe), doesn’t really belong to us. Rather, it’s packaged and collectively processed as something that exists but shouldn’t. Something we will experience but won’t be prepared for. We are encouraged to detach from our own sexuality and accompanied with this is a range of (connected) negative health outcomes.

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Unhealthy or otherwise uninformed attitudes and behaviors do not contribute to an individual’s well-being. Seems like a no-brainer, but it isn’t. Over the past 2 to 3 decades in the United States, we’ve sunk millions of dollars into abstinence-only-until-marriage programs and promoted do-it-yourself standards across the nation. While these methods are intended to replace comprehensive sexuality education, in all actuality they deprive people of basic information regarding their bodies, relationships, and basic reproductive and anatomical health – these things arguably being the foundation for fostering empowerment and healthy decision-making with regards to a host of positive health outcomes.

So what do we know about these wide-spread replacements for comprehensive education and empowerment (that’s really what I like to call it)? Research and reviews (using public health and traditional research methodologies) of abstinence-only curricula have consistently revealed ineffective programming. A 2005 review of 21 abstinence-only curricula, published in the Journal for School Health, found major themes and inconsistencies with regards to some of the most widely-used abstinence-only classroom curricula in the country. The study found that the materials and framework for delivering course content in abstinence-only programs have heavily relied on notions of – surprise, surprise – fear and shame, included severe medical inaccuracies, and have been inconsistent in their definitions of abstinence (Wilson et al., 2005). And yet, according to the Guttmacher Institute, 70 percent of teenagers have their first sexual experience by the time they reach their 19th birthday. There’s that problematic disconnect again.

So it’s no wonder most of us spend years beyond our youth trying to pick up the pieces – attempting to understand and value our sexual self as it relates to basic conceptions of identity, social and inter-personal relationships, our community, and our social fabric. In many ways, our culture is one of silence and disenfranchisement for youth – when you throw sexual and identity-related misinformation in the mix, our youth are not empowered to have and be receptive to conversations about who they really are. That’s problematic. That’s also where we begin to understand connections between this process and concrete health outcomes: transmission rates of HIV and other sexually transmitted diseases (STD), unintended teen-pregnancy, coercive sexual behavior, and other adolescent sexual health outcomes that are likely to follow us into adulthood.

A public health approach to fostering healthy sexuality and identity-affirmation among youth (and many of our now scarred adults) can remedy this. We need to address the bigger picture. If we view sexuality and sexual development as inextricably linked to identity development and the way that we experience and relate to the world around us (in terms of relationships, community values, social positioning) then we need to see the benefits in promoting it. A healthy sexuality and promotion paradigm has the potential to connect the dots between public health movements such as STD and violence prevention – which have historically been treated as silo-ed issues, despite the fact that we experience these and other health issues in complex and connected ways.

So let’s talk about those dots, how do we connect them? While sexual and intimate partner violence have nothing to do with sex – but rather, power and control (sexual autonomy is the object of violation in sexual violence) – the healthy sexuality paradigm has the ability to interrupt the process by which harmful notions about sexuality and relationship dynamics are normalized and reinforced, both in our culture at large and throughout an individual’s lifespan. The capacity to understand, enjoy, and control one’s own sexual and reproductive behavior in a voluntary and responsible manner, undoubtedly, enriches our social lives, creating a buffer between us and a host of learning/development processes that might lead to perpetrating sexual or intimate partner violence. Likewise, the ability to understand and feel positively about your sexual identity by extension leads to responsible and mutually-empowering decision-making both in terms of sexual interaction and emotional, spiritual, and physical well-being. The theoretical leap isn’t too difficult to make but research has consistently defined that leap for us: sexual education and empowerment leads not only to responsible and respectful sexual behaviors and attitudes but also an increased access to effective preventative, screening, treatment, and support services that promote physical and sexual well-being.

The violence prevention and disease (STD/HIV) prevention movements have, within the past decade, made monumental strides to connect these issues within a healthy sexuality paradigm, all-the-while connecting public health entities with advocacy and community-mobilization initiatives on the ground. As a result, the movement to make accurate sexual and reproductive health accessible has moved beyond traditional school and community outlets to the digital landscape – online programs promoting advocacy, outreach, awareness, education, etc. are relevant and sometimes, the only way for youth to safely (and in a largely silo-ed-issue/shaming culture, independently) access information that they have control over. While the Centers for Disease Control and Prevention (CDC) makes policy and pushes for increased capacity nationally, non-traditional collaborations such as Virginia’s Healthy Sexuality Workgroup, are creating space and producing resources (like the Healthy Sexuality for Sexual Violence Prevention: A report on promising curriculum based approaches) to advocate for holistic violence and disease prevention reform and capacity-building on the state and local levels.

With medical and productivity costs associated with violence related injuries and deaths totaling $70-billion and immediate and long-term health costs associated with STD transmission totaling $17 billion we really can’t afford to not be making this shift in practice and culture. While operating from within a healthy sexuality and promotion paradigm still might take a while to receive institutional support, the sweeping change, when it finally happens, will have radical (positive) implications for our health.

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