Roundups Sexual Health

Sexual Health Roundup: Mississippi Sex-Ed Deadline Looms and Survey Finds LGBT Teens Are Less Happy

Martha Kempner

Sexual Health Roundup: A Mississippi mandate for sexuality education means that school districts have to choose between and abstinence-only or an abstinence-based approach by the end of the month; a survey by the Human Rights Campaign finds that LGBT teens are less happy than their straight peers; and a new condom company promises that for every condom sold it will donate one condom to women in regions with high HIV rates. 

Mississippi Sex Education Deadline Looms

School districts in Mississippi have a decision to make by the end of this month. A law passed in 2011 mandated that all districts teach sexuality education but allowed them to decide whether they were going to take a strict abstinence-only approach (which discusses contraception only in terms of failure rates) or a broader-based abstinence-plus approach (which addresses additional topics such as HIV and STD prevention). According to the department of education, thus far fewer than one fourth of the state’s 152 school districts have registered their decision. Of those that have, most have chosen the abstinence-only approach.

The two approaches, however, don’t vary that much as all classes start with certain tenets of abstinence-only programs such as teaching young people:

  • “that abstinence from sexual activity before marriage, and fidelity within marriage, is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases and related health problems; and
  • that a mutually faithful monogamous marriage is the only appropriate setting for sexual intercourse.”

Abstinence-plus programs may discuss broader sexual health topics, such as “the nature, causes and effects of sexually transmitted diseases,” and other aspects of STD/HIV-prevention education.

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Regardless of which approach a school districts takes, students cannot be taught that “abortion can be used to prevent the birth of a baby;” all classes must be separated by sex; and students must present a signed permission slip from their parents before they can attend. This referred to as an “opt-in” policy and is in place in very few states.

The superintendent of one district that has already chosen the abstinence-plus approach, argued:

“Abstinence-only is what they preach from the pulpit and that the only way to deal with sex education is no sex. The other approach of abstinence-plus is where you encourage abstinence, but you are more real with the information.”

Others who are advocating for this approach have pointed out that Mississippi has the highest teen birth rates in the country.

A number of school districts are holding school board meetings and public forums to discuss this issue this week.  

National Survey Find GLBT Teens Less Happy

I can’t imagine being a teenager again and I’m not looking forward to my daughters’ teen years—all that angst, self-doubt, and uncertainty is a lot to take and the pressure to “fit in” is overwhelming. So it doesn’t surprise me that despite the progress we’ve made on gay rights in recent years, gay and lesbian teenagers are having an even harder time than their heterosexual peers. The survey, conducted by the Human Rights Campaign included more than 10,000 teens ages 13 to 17 who identified as lesbian, gay, bisexual, or transgender (LGBT), as well as 500 teens who identified as heterosexual and made up the “straight” comparison group. 

The survey found that 92 percent of LGBT teens had heard negative things about being LGBT, fewer than half of LGBT teens believed that their community is supportive of them, and 63 percent believed that they would have to move to another town or another part of the country to find acceptance. 

It also found that about half of all LGBT teens reported being verbally harassed at school compared to a quarter of their straight peers. In addition, 17 percent of LGBT teens reported being shoved, kicked or otherwise assaulted at their schools compared to 10 percent of straight teens. LGBT teens were also twice as likely to have experimented with alcohol or drugs (52 percent compared to 22 percent) than straight teens. And ultimately, just four in 10 LGBT teens reported being happy, compared with nearly seven in 10 of their straight peers.

Given the number of suicides we have seen among gay and lesbian young people in recent years, these finding are very disturbing. As HRC explains: “The deck is stacked against young people growing up lesbian, gay, bisexual or transgender in America. Official government discrimination or indifference along with social ostracism leaves many teens disaffected and disconnected in their own homes and neighborhoods.” The good news, though, is that many LGBT teens can see past these years to a brighter future — three quarters of them believe that it will get better. 

New Condom Company Will Donate One Condom for Every Condom Sold

Fast Company recently profiled a new condom company that was created to sell condoms here and donate them in the areas of the world where HIV rates are the highest and condoms are often not available. L. describes itself a “condom company with a cause; to support women globally by focusing on their sexual empowerment.” The company is the brainchild of Talia Frenkel, a photojournalist who has worked with the American Red Cross in many developing countries.  She became frustrated when she saw how often condoms were simply not available in areas with high HIV prevalence rates: “HIV is a preventable disease, and I believe that access to condoms is a basic human right.”

Frenkel began the L. company by developing and manufacturing a new condom which is made in Malaysia. According to the company the latex is purified to cut down on the smell and the lubricants that are used on the condoms are free of glycerin and parabens. All of the packaging is recyclable.

L. company is partnering with grassroots non-profits around the world to ensure that for every condom that is purchased from the company another will be donated. Frenkel explains:

“We’re starting with the high-impact areas where condoms are needed immediately, because there’s a high HIV rate and little or no access to condoms. In many places, women sell sex for less than the price of a condom. So there we’re just distributing them freely, with peer-to-peer education.”

In other the places the company will make condoms available for women to sell at affordable rates in order to further empower women. 

The condoms are now available for pre-orders on-line and the company hopes to begin shipping over the summer

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.

Commentary Sexual Health

California Abstinence-Only Sex Ed Ruling Underscores Need to Connect Policy to Practice

Nicole Cushman

Although strong policies provide important backing for schools’ decisions about curricula, they do not automatically translate into implementation at the classroom level.

My first trip to the principal’s office happened not as an erstwhile student, but as a sex educator working in a range of public schools in California’s Bay Area. The mother of one of my students had requested a meeting over concerns about the “explicit” nature of the curriculum. After listening to her concerns, I patiently explained the goals and objectives of the program and walked her through the lessons I would cover in her daughter’s freshman health class. Then I sat dumbfounded as the principal assured her the curriculum emphasized abstinence above all else and, while it included information on condoms and birth control, the main message would be it is always best to wait to have sex. The approach described by this well-intentioned principal, sometimes termed “abstinence-based” or “abstinence-plus” education, was, in fact, against California law.

This meeting took place in 2005, two years after California passed the Comprehensive Sexual Health & HIV/AIDS Prevention Act. The law requires sex education in the state’s public middle and high schools to be comprehensive, providing unbiased instruction about both abstinence and the full range of FDA-approved contraceptive methods, without giving preference to any one option. This approach is in alignment with decades of research demonstrating the effectiveness of comprehensive sex education. Abstinence-only programs, on the other hand, have failed to achieve their stated goal of helping teens wait to have sex.

Another ten years would pass before a judge affirmed the law, ruling just last week that “access to medically and socially appropriate sexual education is an important public right.” In the intervening period, I witnessed myriad examples of spotty implementation, such that I was no longer shocked by schools’ misinterpretations and failures to comply with the law.

In addition to requiring comprehensive and medically accurate education, the Comprehensive Sexual Health & HIV/AIDS Prevention Act also aims to reduce barriers to students accessing such education by allowing parents to opt their children out of the classes if they object, rather than requiring them to proactively opt into the instruction. However, nearly every school in which I taught simply ignored this piece of the statute, sending home opt-in permission slips in an attempt to avoid perceived controversy. (In reality, research suggests the vast majority of parents support comprehensive sexuality education; even the parent who requested the meeting with the principal kept her daughter in the class.)

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What concerned me even more were frequent requests from schools where I taught to omit lessons on sexual orientation and gender identity, despite the expressed intent of the law to “encourage a pupil to develop healthy attitudes concerning … sexual orientation.” School administrators assured me that those topics were covered elsewhere in the curriculum, but my students told a different story. For example, one school held an annual assembly with a theater troupe performing skits about HIV and AIDS that featured one gay character. Students reported that this was the only time sexual orientation was specifically addressed in a formalized way at the school. While such programs offer an important opportunity to normalize depictions of LGBT individuals, deeper discussions in classroom environments are necessary to help students develop a more thorough understanding of sexual orientation and gender identity than what is possible in a large assembly. This understanding is essential in creating inclusive and safe school environments for all students. (LGBT students in schools with LGBT-inclusive curricula hear fewer homophobic and transphobic remarks, are less likely to miss school, and feel more connected to their school community.)

Last week’s ruling, while an important victory, was also a stark reminder of the limitations of public policy as a tool for achieving social change. Although strong policies provide important backing for schools’ decisions about curricula, they do not automatically translate into implementation at the classroom level. Sex education policies rarely have any teeth; enforcement mechanisms are usually slim or lacking entirely, and there are limited resources to support implementation. In the case of California, one state employee is charged with monitoring implementation for the state’s roughly 1,000 school districts. It’s no wonder it took a lawsuit brought by outraged parents, with the assistance of the ACLU, to force the Clovis Unified School District to comply with the law.

I do not discount the essential role of public policy in creating the enabling environment for the implementation of sexuality education. Indeed, without the Comprehensive Sexual Health & HIV/AIDS Prevention Act, Judge Donald S. Black would have had no legal grounds for his ruling. Rather, I believe this case underscores the need to better connect policy to practice by providing funding for implementation; creating systems for enforcement; and encouraging parents, young people, and advocates to be ever vigilant in their activism. If we agree with Judge Black that sex education is a public right, it will take all of these efforts to ensure that right is protected and fulfilled.