Recently, I got a call from my gay friends in New York—they are the adoptive parents of a wonderful 17-year-old young man. They were livid over New York’s new proposed law that would teach sexual health education to kindergarteners. Although very progressive and open about social issues, they are firm believers this is a bad idea. After an hour-long passionate discussion on the topic, we could not agree; there was very little I could say that would change their minds. It was a frustrating example of how difficult it can be to address this topic.
Despite sex being an essential aspect of human nature, sexual health education is a nightmare nationwide. In fact, sexual health is one of the most debated topics within school districts and local, state, and federal governments, not to mention within U.S. households. The reality is that sexual health knowledge is intrinsically tied to the number of HIV and other sexually transmitted infection (STI) cases. The question of who should ultimately bear the responsibility to teach about sex is the impasse to progress in the fight to end the HIV epidemic. This unanswered question consequently perpetuates the unhealthy cycle of sexual ignorance and transmissions.
Let’s say sexual health is solely the parents’ responsibility. More often than not, parents are unequipped to have these conversations because they did not have them either with their parents. Even when the “sex talk” happens, sexual health is complex, dependent on culture, religion, and family dynamics. It also must be an ongoing conversation that is medically accurate, age appropriate, and inclusive of all gender identities and sexual orientations. In my experience, leaving the sex talk to parents usually leaves young people unprepared to face the realities of sex as they grow up. Even well-informed parents can struggle with deciding when and how to deliver comprehensive sexual health education. Meanwhile, the average age when children encounter porn online is 11 years old. When I transitioned from high-school teacher to middle school, I expected to not be surrounded by so many sexual situations, but I was mistaken. In middle school, children were naturally curious, surrounded by sexually explicit media, yet unable to speak about it freely at home.
Should comprehensive sexual health be taught in schools?
School districts determine their approach to sexual health education, often relying on school boards and committees not comprised of sexual health experts, but rather elected officials and committee members who approve sexual health curriculums. Some districts might teach abstinence only, while others might have more comprehensive approaches. In some states, there could be as many sexual health curricula as there are school districts. For example, there are 67 counties in Florida, each one with their own ideas about sexual health—and they vary greatly.
Even if a school district’s sexual health education is great, in many cases, parents must “opt-in” their child to participate in the classes, meaning they must give consent for their child to learn about sex. This places the ultimate decision about sexual health back in the parents’ hands. Administrators tend to shy away from implementation of curriculum to avoid perceived unnecessary attention and issues to the school. In addition, classes are usually within a certain timeframe, and only teachers with “special training” can actually teach it. Similar to administrators, some teachers are resistant or flatly oppose teaching the curriculum.
Although national sexuality education standards (which are devised by an alliance of nonprofit organizations) for kindergarten through 12th grade were updated last year for the first time since 2011, most sexual health curricula still do not address the intricacies of consent or the #metoo movement; no HIV pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), no undetectable equals untransmittable (U=U), and certainly no information about gender identities or sexual orientation is included. This is simply unacceptable, but it is an issue that continues to be ignored at both the state and federal level.
States should have a vested interest in keeping their residents well-informed and healthy. Ultimately, it can decrease transmission of disease, sexual abuse, and unwanted pregnancies. But, as stated by the Centers for Disease Control and Prevention (CDC), people who live in Southern states, which have worse sexual health education standards across the board, are at higher risk of HIV, STIs, and unplanned teenage pregnancies. It would make sense to have the most comprehensive sexual health education where it’s needed the most, but implementation of sexual health in these states often has to contend with conservatives, Republicans, as well as religious ideologies. This can hinder the impact on progress and policy changes in public health that advocates have been fighting for now for decades. It is no coincidence that the Southern United States account for more than half of all new HIV transmissions in the nation.
A Southern state like Mississippi with a Republican trifecta government is a great example. The governor, the deputy governor, and the House speaker are all hostile to the LGBTQ community. The lack of Republican lawmakers of color who can vouch for the impacted communities presents a lack of representation at state level. In addition, a large majority of lawmakers in Mississippi belong to the Baptist Church, which has been traditionally opposed to sex education and LGBTQ equality, making any efforts at inclusion of comprehensive sexual health almost impossible. There is strong opposition to policy changes through legislation from a portion of the general public, religious groups, and lawmakers. Mississippi’s Bill 999 on Sexual Health Education gives school districts two options: abstinence only or abstinence-plus. The Creating Healthy and Responsible Teens (CHART) model, sponsored by the health department, has to be “requested by school districts” as well as having an opt-in option and opposition from the community and school districts.
Condom demonstrations and LGBTQ inclusivity are banned in Mississippi. Similarly, religious-exemption laws and anti-LGBTQ legislation (i.e., Bill 1523, the Religious Liberty Accommodations Act or Protecting Freedom of Conscience from Government Discrimination Act) are highly supported. Finally, Mississippi is a “No Promo Homo” state, which limits LGBTQ exposure and discussion in government settings. This perfect storm allows for high levels of HIV stigma and misinformation, poor access to health care, poor access to sexual health services, and consequently more HIV transmissions.
Not everything is lost, however. One county with high prevalence of HIV—Broward County in South Florida—has the right approach to sexual health education. Since 2014, Broward County Public Schools has implemented a comprehensive sexual health curriculum as part of the CDC’s Division of Adolescent and School Health initiative (DASH). In addition, they have partnered with local community-based organizations to bring HIV and STI testing to middle- and high-school students across priority schools on a monthly basis. There are plans to expand DASH nationwide. Similarly, Advocates for Youth has the 3R’s (Rights, Respect, Responsibility), a comprehensive sexual health curriculum available to schools and parents to download for free.
Until we address the national disaster on sexual health education, we will not be able to end HIV and decrease STI incidence. Right now, the government spends millions on prevention and treatment; it’s time to also invest in teaching basic sexual health knowledge.
[Correction: This article was updated on March 31 to note that national sexuality education standards were most recently updated in 2020, not 2011.]