The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior
July 9, 2001
V. Evidence-Based Intervention ModelsSubstantial work has been done in the areas of sexual health and responsible sexual behavior, through public-private partnerships at the national as well as community level, by many researchers and organizations throughout the country. Many of these approaches and programs to improve sexual health have been evaluated and shown to be effective. They include: community-based programs, school-based programs, clinic-based programs, and religion-based programs.
The CDC has identified a number of effective STD and HIV prevention programs that are curriculum-based and presented by peer and health educators in various community settings (CDC, 1999c). Other community interventions have involved changing community norms and the distribution of condoms to reduce unwanted pregnancies and STDs, including HIV. Such interventions have the advantages of reaching large numbers of people at a relatively low cost and engaging the active involvement of community members, including local opinion leaders. They have had considerable success in changing community norms about sexual behavior as evidenced by substantial increases in condom use (Arnold and Cogswell, 1971; Kelly et al., 1991; Grosskurth et al., 1995; Kegeles et al., 1996; Kelly et al., 1997). It is important to point out that although the correct and consistent use of condoms has been shown to be effective in reducing the risk of pregnancy, HIV infection, and some STDs, more research is needed on the level of effectiveness.
To date, there are only a few published evaluations of abstinence-only programs (Christopher and Roosa, 1990; St Pierre et al., 1995; Kirby et al., 1997; Kirby, 2001). Due to this limited number of studies it is too early to draw definite conclusions about this approach. Similarly, the value of these programs for adolescents who have initiated sexual activity is not yet understood. More research is clearly needed.
Programs that typically emphasize abstinence, but also cover condoms and other methods of contraception, have a larger body of evaluation evidence that indicates either no effect on initiation of sexual activity or, in some cases, a delay in the initiation of sexual activity (Kirby, 1999; Kirby, 2001). This evidence gives strong support to the conclusion that providing information about contraception does not increase adolescent sexual activity, either by hastening the onset of sexual intercourse, increasing the frequency of sexual intercourse, or increasing the number of sexual partners. In addition, some of these evaluated programs increased condom use or contraceptive use more generally for adolescents who were sexually active (Kirby et al., 1991; Rotheram-Borus et al., 1991; Jemmott et al., 1992; Walter and Vaughn, 1993; Magura et al., 1994; Main et al., 1994; St Lawrence et al., 1995; Hubbard et al., 1998; Jemmott et al., 1998; Coyle et al., 1999).
Despite the available evidence regarding the effectiveness of school-based sexuality education, it remains a controversial issue for many -- in terms of whether schools are the most appropriate venue for such education, as well as curriculum content. Few would disagree that parents should be the primary sexuality educators of their children or that sexual abstinence until engaged in a committed and mutually monogamous relationship is an important component in any sexuality education program. It does seem clear, however, that providing sexuality education in the schools is a useful mechanism to ensure that this Nation's youth have a basic understanding of sexuality. Traditionally, schools have had a role in ensuring equity of access to information that is perhaps greater than most other institutions. In addition, given that one-half of adolescents in the United States are already sexually active -- and at risk of unintended pregnancy and STD/HIV infection -- it also seems clear that adolescents need accurate information about contraceptive methods so that they can reduce those risks.
Most school clinic-based condom and contraceptive availability programs include some form of abstinence or risk-reduction counseling to address the concern that increased condom availability could lead to increased sexual behavior (Kirby and Brown, 1996). The evidence indicates these programs, while still controversial in some communities, do not increase sexual behavior and that they are generally accepted by adolescents, parents, and school staff (Guttmacher et al., 1995; Wolk and Rosenbaum, 1995).
Because many STDs have no clear symptoms, STD/HIV screening promotes sexual health and responsible sexual behavior by detecting these diseases and preventing their unintentional spread. Routine screening in clinics has also been shown to reduce the incidence of some STDs, particularly chlamydia infection (Hillis et al., 1995; Scholes et al., 1996).
This article was provided by U.S. Department of Health and Human Services.