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Sex Education Can Help End the Epidemic!

January 5, 2017

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Sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

-- World Health Organization

Youth experience negative sexual health outcomes at rates higher than adults. One in four adolescents will contract a viral or bacterial sexually transmitted infection. The number rises to one in two by age 25.

In the field of public health, there has been an important shift away from blaming people for any negative health outcomes they may experience. Instead, the field acknowledges the ways in which different influences (social, political, and economic) contribute to individual and community health.

Sexual health outcomes, including unintended pregnancy, HIV, and other STIs, are very much included in this shift, for many reasons. First, high-quality, comprehensive sexuality education goes beyond helping students learn how to use condoms correctly or gain access to reliable contraception (though these remain critical components of the work). Truly comprehensive sexuality education is sexpositive, includes all gender identities and sexual orientations, and empowers youth to build their knowledge and skills.

The research is clear: youth experience negative sexual health outcomes at rates higher than adults. One in four adolescents will contract a viral or bacterial sexually transmitted infection (STI). The number rises to one in two by age 25. According to the 2011 Youth Risk Behavior Survey (YRBS):

  • 61% of New York State high school students reported they had sexual intercourse by 12th grade. Over 20% had sexual intercourse by 9th grade.
  • 13% of students did not use any method to prevent pregnancy during their last sexual intercourse.
  • Only 11% of sexually active students used both a condom plus another birth control method (recommended to address both pregnancy and STI/HIV prevention) during their last sexual intercourse.
  • Youth with special circumstances, such as youth in foster care, have significantly higher rates of sexual activity and pregnancy. Nearly a third of young women in foster care reported that they had been pregnant at least once by age 17.

Reproductive and sexual health issues are key for adolescents and young adults, and the one-sized-fits-all approach is missing the mark -- especially for those who are most vulnerable, namely youth of color and those who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ). Love Heals, Inc. believes that young people who are provided age-appropriate, medically accurate information will develop the knowledge and skills they need to stay healthy, while learning the advocacy skills they need to tackle the larger systemic issues that contribute to their sexual health.


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Social Drivers, Youth and HIV

Systemic factors are major drivers of the HIV epidemic. When risk-taking behaviors are otherwise equal, factors such as poverty, poor health care, systemic inequality, and location elevate risk for HIV transmission. As a result, youth of color and young men who have sex with men continue to have a higher risk for HIV infection than their peers.

Living in poverty increases the likelihood that a young person has limited or no access to quality health care. As a result, they may delay HIV and STI testing, or not be tested at all, increasing their time without treatment if they are infected. Improving access to youth-friendly clinical care could increase the number of young people who have access to condoms, HIV and STI testing, and treatment. This could help decrease transmission in two ways: through the consistent use of condoms, and by adherence to HIV medications, which reduces viral load.

Systemic inequality perpetuates HIV transmission in numerous ways. First, racist and discriminatory police practices, such as Stop-And-Frisk and increased surveillance in schools (part of the "School-to-Prison Pipeline"), target youth of color and those who identify as LGBTQ. These are the same young people who are more likely to live in unstable housing or poor neighborhoods, to experience homelessness, or to be victims of harassment and bullying. They are more likely to be arrested, subjected to frequent and harsher disciplinary action, and experience overall marginalization at rates much higher than youth who are white and/or heterosexual.

Stop-and-Frisk policies target youth of color and LGBTQ youth, resulting in arrests for prostitution if condoms are found. By criminalizing condom possession, law enforcement actually increases the risk of HIV transmission in those who are trying to prevent it. Youth exposed to the criminal justice system often experience social isolation due to homophobia and transphobia, and often receive little support from adults. This increases their risk for HIV infection by maintaining the status quo of unjust school rules and law enforcement practices.

In order to combat these practices and decrease HIV transmission, larger strides need to be taken so that social systems promote fairness rather than impeding it. Enacting legislation can help spark systemic change. By working to change NYC police leadership and enacting an anti-racial-profiling bill, Mayor Bill de Blasio's administration is attempting to dismantle the School-to-Prison Pipeline, end Stop-and-Frisk, and decriminalize condom possession, which collectively can shift the impact those policies have on HIV transmission.


Bolster HIV Prevention Education in Schools

The National HIV/AIDS Strategy (NHAS) states that everyone needs to be educated about how to prevent HIV. It follows that HIV education should be a part of health education nationwide. Aligned with the NHAS, New York State mandates that HIV prevention be taught in grades K-12. As a result, the NYC Department of Education recommends that young people receive sexual health education for one semester in both middle and high school.

However, this sex ed requirement is neither funded nor enforced during curriculum design and planning for middle and high school students. For those reasons, more could be done to bolster prevention efforts across the state and to help meet the objectives outlined in Governor Cuomo's End the Epidemic (ETE) Blueprint.

Of all age groups, young adults aged 20 to 29 had the most HIV diagnoses (36%) in 2014. The Northeastern U.S. had the second highest HIV rate: 14.2 per 100,000 people. The only region experiencing higher HIV rates was the South, at 18.5 per 100,000 people.

In addition to the steps described in the ETE, Love Heals suggests the following ways to help decrease HIV transmission rates in youth, which will in turn bring HIV diagnoses down to the goal of 750 per year in NYS.

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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication Achieve. Visit ACRIA's website to find out more about their activities, publications and services.
 

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