During the first 15 months of the Trump administration, HIV advocates have found themselves in a state of perpetual defense, always on guard against the next salvo of attacks on evidence-based and inclusive public health policy from administration officials who are diametrically opposed to the very offices they serve. Being forced to maintain such a position for so extensive a period, the question naturally arises of just how long the center can hold -- at what point the inertia of institutional ignorance will become too much to bear and the hemorrhaging of knowledgeable public health officials and loss of effective, federally funded programs will begin causing irrevocable harm to people living with and affected by HIV.
This question of when exactly the levees will break under the torrent of misinformation and mendacity of the Trump administration and sweep away the health and well-being of vulnerable populations might at first blush seem largely theoretical; however, it is anything but. Take, for instance, the Trump administration's repeated attacks on reproductive and sexual health programs, particularly around family planning and comprehensive sexual education. In a cruel, yet wholly foreseeable irony, our 45th president -- a man who has been accused of sexual assault by more than 20 women, is on his third marriage, and is currently being sued by an adult film actress with whom he likely had an affair shortly after his current wife gave birth to his youngest son -- has appointed a cadre of militant abstinence-only, anti-abortion, anti-contraception crusaders to positions of leadership within the Department of Health and Human Services (HHS).
This group, led by recently appointed acting deputy assistant secretary for population affairs Valerie Huber, has done everything in its power to roll back the objectively successful, evidence-based sexual education and family planning programs implemented by the Obama administration and replace them with programming centered on "sexual risk avoidance," which is essentially a rebranded form of abstinence-only education.
Related: Sex Education Can Help End the Epidemic!
Huber and her pro abstinence-only peers at HHS have already tried -- and fortunately, failed -- to eliminate the Obama-era Teen Pregnancy Prevention Program, which played a significant role in reducing teen pregnancy by 41% between 2010 and 2016. However, they have been successful in instituting major changes to the funding process for the Title X Family Planning Program by emphasizing a preference for organizations that do not "normalize sexual risk behaviors," omitting any mention of birth control, and providing Huber with the final say on who receives the $286 million in family planning funding, a frightening prospect given her background.
Huber has been at the forefront of the movement to resurrect abstinence-only education under the banner of sexual risk avoidance for more than a decade, serving as the president of the abstinence-only professional association Ascend (formerly the National Abstinence Education Association) and running abstinence-only education programs for the state of Ohio in the mid-2000s, which researchers at Case Western Reserve University found, "contain false information" about abortion and contraception, "misrepresent religious convictions as scientific fact," "perpetuate destructive, inaccurate gender stereotypes," and fail to provide information for LGBTQ populations.
As it concerns LGBTQ youth, Huber and other abstinence-only advocates would like the public to believe that their programming is based on "universally transferable principles" that work equally well with lesbian, gay, bisexual, transgender, and questioning teens as with their their heterosexual, cisgender counterparts. However, as recently as June 2016, Huber and Ascend released a report that used student responses to a survey to claim that teens do not want and should not be subjected to sexual education that focuses on "controversial topics," such as "LGBTQ lifestyles," "gender identity," or anything that would "promote sexual activity that causes pregnancy."
With federal sex education policy being driven by a woman who promotes the idea that the mere existence of LGBTQ individuals is controversial and that the only acceptable framing of sex is as a means to pregnancy, LGBTQ Americans are increasingly going to have to look to alternative methods of sex education. Researcher Javontae Lee Williams, M.P.H., and his colleagues at Widener University in Philadelphia have begun working on another way for the LGBT community -- particularly black men who have sex with men (MSM) -- to engage in a continuing sex ed of sorts into their 20s and 30s, covering a whole host of topics that aren't touched on in even the most comprehensive sex ed curriculums, and which can be accessed using a smartphone.
This pilot program, called Making Sex Ed Relevant, is part of the ACCELERATE! Initiative funded by ViiV Healthcare and designed to engage MSM in Baltimore and Jackson, Mississippi, in a way that builds community, reduces HIV transmission, and makes sex ed fun.
"Our approach is to center our conversation [pertaining to] black men and sexuality around pleasure. We want to say that there is joy around sex," Williams told TheBody.
Not being tethered to federal funding or the restrictions that come with working in a middle school or high school has allowed Williams and his fellow researchers to create more expansive and in-depth sex ed information.
"This program isn't designed to be Sex Ed 101", Williams said. "Our target demographic is black men ages 18 and older, particularly between 25 and 35. This is grown men having a grown men conversation that doesn't have to be filtered through the language of academia. These guys are ready for Oral Sex 301, not the basics."
The program will consist of both a more traditional toolkit with lessons to be delivered piecemeal among communities and a smartphone app that will allow users to engage with people across the country around the content that speaks to them and their sexuality, enabling them to go on deep dives with the help of trained facilitators who will be guiding the discussion. With this digital resource, the app's creators are hopeful that they can reach both geographically and ideologically isolated communities, where people may feel there is no one with whom they can be open and honest about their sex lives.
Ultimately, we all must hope that, in the near future, similar privately funded and LGBTQ-focused sex ed programs are developed, particularly with an eye toward positively impacting teens and young adults, Because, under the watchful, bigoted eye of the Trump administration, federal funding probably won't be developing them.