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Evaluating Existing Sexual Education Methods Based on HIV/AIDS Rates
Ashley M. Dameron
I. Introducing the Debate
a. Types of sexual education methods and why we should evaluate the types of research available for them
II. Current HIV/AIDS status in the United States
a. The Current Stats – related to regional, racial, and education differences
b. The Misinformed State – current misconceptions about transmission
III. Abstinence vs. Comprehensive Sexual Education
a. The Main Prevention Methods
b. The Better Choice
c. Biased Claims
d. Unbiased Resources
IV. Current education policies
a. The Funding Issues
b. Conclusion—what should change
VI. Appendix A
INTRODUCING THE DEBATE
Over the past several years, numerous controversial debates have developed regarding the concept of appropriate, adequate, and effective sexual education methods for American youth attending public schools. Two prevention methods have prevailed as the main education models —abstinence only and comprehensive education. While there has been scores of research seeking to prove which prevention method is actually the most effective, with the current research being financially supported by right wing fundamentalists or extreme liberal pro-choice groups, it is unclear which research studies go beyond vehemently advocating one position and gives true scientific merit to the better of the two prevention methods. Furthermore, there are multiple ways to evaluate the prevention methods depending on what end results one deems important. One can look at the teen pregnancy rates, average sexual encounters, number of sexual partners, and numerous other criteria to determine the education method’s effectiveness. One of the least biased, and thus most telling, scientific data available is the rate and spread of sexually transmitted diseases (STDs), including HIV/AIDS, for the respective sexual education programs. By looking at the HIV transmission rates between teenagers “enrolled” in abstinence only verses comprehensive sexual education, one can adequately decipher which sexual education is the most effective and worthy of national government funding in public schools.
THE CURRENT STATS
Before one begins to evaluate abstinence only and comprehensive education models by HIV transmission rates, it is important to identify the current state of HIV/AIDS in America. The first reported case of HIV was formally documented in the United States in 1981 and since then has spread into the nation’s spotlight as one of the most lethal STD in modern society. Once thought to only be a disease afflicting Caucasian, homosexual males, HIV has quickly infiltrated every race, social, and economic class; and now has the fastest growing rate among African American women. About 40,000 HIV transmission cases are estimated to occur each year in the United States; about 70% of cases are male and 30% are female.1 Furthermore, the United Nations states that over half of the annual 40,000 HIV infectious cases in America occur in individuals under the age of 25 years. At the end of 2003, approximately 1,039,000 to 1,185,000 people in the United States were living with HIV/AIDS and 24-27% of these individuals were undiagnosed and unaware of their HIV infection.2
Obviously the numbers about HIV prevalence and incident rates are concerning statistics, so much so that the American government has expanded and created new HIV/AIDS monitoring methods over the past ten years in order to determine the most appropriate ways to initiate prevention mechanisms. However, one of the existing problems in accurately monitoring the HIV prevalence rates in various states, genders, and transmission encounters is the fact that America’s Center for Disease Control (CDC) currently only uses data from 33 non-biased research sites for the entire United States.3 The researchers claim that from the data collected at these 33 sites they can develop an adequate estimate of the HIV/AIDS rates. (They use several, rather complex statistical analyses to apply the data from the 33 sites to the entire country—a method similar to that used by the United States Census Bureau to calculate America’s current population.) However, once all 50 states are included in this data collection, there will be an even greater confidence in actually determining America’s HIV prevalence rates.
In 2003, the CDC conducted an extensive evaluation of the HIV/AIDS rates in America and concluded that minority individuals are “disproportionately affected by HIV/AIDS”. African Americans appeared to account for half of the diagnosed HIV/AIDS cases, despite the fact that they only approximate 12% of the US population. 3
Race/ethnicity of persons (including children)
who received a diagnosis of HIV/AIDS, 2003
The CDC also found that the HIV exposure rates differed based on gender—with nearly 80% of females contracting HIV based on hetero-sexual contact compared to less than 20% of males. 3
Exposure categories of adults and adolescents
who received a diagnosis of HIV/AIDS, 2003
Furthermore, the CDC, in collaboration with other non-profit, non-affiliated organizations like the Kaiser Foundation, also found that the HIV exposure incidence rates differed based on regions of the country. While the data these organizations presented only accounts for 33 states and two territories, it is still useful information and can be used in conjunction with current prevention methods and the follow-up incidence rates that are due to be published in December 2005. 4
HIV Infection Cases Reported in 2003
THE CURRENT MISINFORMED STATE
One of the primary concerns of HIV/AIDS epidemiologists and government funding agencies is trying to prevent further transmission of this disease. Besides overcoming cultural stigma of the disease, there is still a major misconception of HIV transmission methods. In 2004, a national survey showed that “99% of Americans knew that having unprotected intercourse and sharing an IV needle might transmit HIV, 38% thought that it could be transmitted by kissing, 25% by sharing a drinking glass, and 18% thought that they could be infected by touching a toilet seat.”1 There are only four bodily fluids that transmit the HIV virus between persons—blood, vaginal secretions, semen, and breast milk—thus, there are only a handful of types of transmissible activities including, but not limited to, vaginal, anal, and oral sex; blood transfusions; needle exchange between two or more individuals; vaginal birth; or breastfeeding. So, over a third of Americans believe, incorrectly, about several HIV/AIDS transmission methods. This misinformation can perpetuate the stigma and, ultimately, HIV transmission. This is why several researchers, governmental organizations, and public health programs believe that the ideal primary prevention method is appropriate, non-stigmatized education that can target youth and populations that are currently most susceptible to the disease. 5
THE MAIN PREVENTION METHODS
The two primary methods of sex education taught in America’s public schools: abstinence only and comprehensive (also known as abstinence plus) education. Abstinence only education programs solely base prevention around “just saying no” to sexual activity until marriage. Comprehensive education still teaches sexual abstinence as the primary method for protecting against unwanted pregnancy, STD or HIV transmission while also educating students about types of contraceptive methods.
Most American public school districts require teachers to use abstinence only or heavily stress abstinence in their sexual education courses. 6
Mandated Sex Education Policies
Also, the preferred sexual education prevention methods seem to exist as regional differences in the United States. 6
Sexual Education by Geography
THE BETTER CHOICE
In 1997, a review of 35 school-based sexual education programs was conducted and published in the Children and Youth Services Review. Of these 35 programs, six were abstinence only, and the rest were a variety of comprehensive education programs that ranged from simply covering abstinence to stressing abstinence. The review revealed that “none of the six studies found both a consistent and a significant impact on delaying the onset of intercourse, and at least one study provided strong evidence that the program did not delay the onset of intercourse.” 7 Furthermore, the study concluded that the HIV education and sexuality programs “strongly support the conclusion that the programs do not increase sexual intercourse, either by hastening the onset of intercourse or by increasing the frequency of intercourse.” 7
In a unique research venture conducted by the American Psychological Association earlier this year, their committee found that:
Both comprehensive sex education and abstinence only programs delay the onset of sexual activity. However, only comprehensive sex education is effective in protecting adolescents from pregnancy and sexually transmitted illnesses at first intercourse and during later sexual activity. In contrast, scientifically sound studies of abstinence only programs show an unintended consequence of unprotected sex at first intercourse and during later sexual activity. In this way, abstinence only programs increase the risk of these adolescents for pregnancy and sexually transmitted illnesses, including HIV/AIDS.
We have found that comprehensive sexuality education programs, those that provide information, encourage abstinence, promote condom use for those who are sexually active, encourage fewer sexual partners, educate about the importance of early identification and treatment of sexually transmitted diseases and teach sexual communication skills are the most effective in keeping sexually active adolescents disease free.
This evidence is striking conformation in favor of comprehensive sex education and HIV prevention programs, particularly since the researchers involved were a collected group from several research institutions, government organizations, public policy consultants, and respected psychologists. 8
Furthermore, the Division of Adolescent and School Health (a branch within the CDC) identified four star sexual education programs that have particularly strong evidence for success in changing sexual risk-taking behaviors, all of which happen to be comprehensive education programs. These programs are Be a Responsible Teen, Be Proud! Be Responsible!, Get Real about AIDS, and Reducing the Risk. 9
Moreover, the American population actually has indicated that they would prefer comprehensive education to be taught in public schools. 10 .
There are several contributing interests vying to defend one prevention method over another, but several of these interests are based on faulty claims or inaccurate research or information. Many of the research that is easily accessible on the internet claiming to be “for or against” one of the prevention methods is often times financially sponsored by a political or religious organization. Obviously, with the secondary interests of these organizations present in the research, it is easily debatable as to if their research is scientifically valid. Therefore, it is necessary for one to thoroughly examine the research articles funding partners as well as claims being made via the research. Also, since several organizations, political lobbyists, religious persons, etc. will use valid research out of context to support their particular claim, it is imperative to look back at original research sources to ensure that the research is being used in an appropriate manner.
Here are two widely cited organizations that either produce research with political or religious affiliations or use valid research out of context in order to “prove” a particular agenda:
Heritage Foundation: www.heritage.org
§ A 106 page article claiming abstinence only education is the most effective prevention method –this article does not use any outside source/reference that is not somehow related to a religious or political affiliation. http://www.heritage.org/Research/Welfare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=67539
Planned Parenthood: www.plannedparenthood.org
§ A research evaluation article sponsored by the Sex & Censorship Committee and National Coalition Against Censorship that uses certain SIECUS facts out of context. http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/teensexualhealth/fact-abstinence-education.xml
It should also be noted that there are a wide array of short opinion essays, commentaries, and newspaper articles that may cite specific research in respect to the author’s argument. These items should be read cautiously because the majority of the time, they are simply an individual’s opinion and not based on scientific fact.
When conducting research on the internet it is imperative to locate valid and reliable sources to ensure data and facts collected are indeed appropriate and legitimate. Here are several dependable sources to find accurate HIV/AIDS and sexual education prevention information:
Center for Disease Control: www.cdc.gov
§ “One of the 13 major operating components of the Department of Health and Human Services (HHS). CDC is globally recognized for conducting research and investigations and for its action oriented approach. CDC applies research and findings to improve people’s daily lives and responds to health emergencies. CDC is committed to achieving true improvements in people’s health. To do this, the agency is defining specific health impact goals to prioritize and focus its work and investments and measure progress.”
UNAIDS—Joint United Nations Programme on HIV/AIDS: www.unaids.org
§ “The Joint United Nations Programme on HIV/AIDS, UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the epidemic. UNAIDS' mission is to lead, strengthen and support an expanded response to HIV and AIDS that includes preventing transmission of HIV, providing care and support to those already living with the virus, reducing the vulnerability of individuals and communities to HIV and alleviating the impact of the epidemic.”
Kaiser Family Foundation: www.kff.org
§ “A non-profit, private operating foundation focusing on the major health care issues facing the nation. The Foundation is an independent voice and source of facts and analysis for policymakers, the media, the health care community, and the general public.”
SIECUS—Sexuality Information and Education Council of the US : www.siecus.org
§ “Has served as the national voice for sexuality education, sexual health, and sexual rights for over 40 years….SIECUS affirms that sexuality is a fundamental part of being human, one that is worthy of dignity and respect. We advocate for the right of all people to accurate information, comprehensive education about sexuality, and sexual health services. SIECUS works to create a world that ensures social justice and sexual rights.”
Alan Guttmacher Institute: www.guttmacher.org
§ “A nonprofit organization focused on sexual and reproductive health research, policy analysis and public education. AGI publishes Perspectives on Sexual and Reproductive Health, International Family Planning Perspectives, The Guttmacher Report on Public Policy and special reports on topics pertaining to sexual and reproductive health and rights. The Institute's mission is to protect the reproductive choices of all women and men in the United States and throughout the world. It is to support their ability to obtain the information and services needed to achieve their full human rights, safeguard their health and exercise their individual responsibilities in regard to sexual behavior and relationships, reproduction and family formation.”
In 1981, under the Reagan term, Congress passed the Adolescent Family Life Act (AFLA), commonly referred to as the “chastity law.” The AFLA was initiated to fund educational programs that promoted “self-discipline and other prudent approaches" to sexual education. In 1996, during Bill Clinton’s first term, Congress attached a “provision to welfare legislation that established a federal program to exclusively fund programs teaching abstinence-only.” This created an enormous debate between the two major political parties over the funding of such programs and whether or not the $135 million annual payment is actively benefiting America’s youth. Despite this debate, abstinence only education is still receiving significant federal funding. In fact, President George W. Bush, congratulated Congress on their decision to devote $167 million to abstinence only education programs in their 2005 fiscal year budget, and proposed $206 million for such programs in the 2006 budget. 11
The overwhelming funding for sexual education programs (both abstinence and comprehensive) also extends beyond federal dollars and is present in the majority of American states. Only about two-thirds of the United States requires HIV education as part of sexual education programs—a mandate that will, as a result, give the state additional federal funding. 12
STD/HIV/AIDS Education Curriculum as of January 2005
In order for states to receive the federal funding earmarked for abstinence only education, the states education must abide by the following prohibitions as stated in the formal document of the Department of Education: 13
SEC. 9526. GENERAL PROHIBITIONS.
(a) PROHIBITION- None of the funds authorized under this Act shall be used
(1) to develop or distribute materials, or operate programs or courses of instruction directed at youth, that are designed to promote or encourage sexual activity, whether homosexual or heterosexual;
(2) to distribute or to aid in the distribution by any organization of legally obscene materials to minors on school grounds;
(3) to provide sex education or HIV-prevention education in schools unless that instruction is age appropriate and includes the health benefits of abstinence; or
(4) to operate a program of contraceptive distribution in schools.
The debate over which sex education prevention method—abstinence only verses comprehensive—is most appropriate and effective is still ongoing despite valid and reliable research supporting comprehensive sex education models as the only method that effectively reduces the rate of HIV, STD and teen pregnancy. Perhaps this is due to the unwarranted federal funding being applied solely to abstinence only programs. In order for tax dollars to provide the most effective sex education method possible, the federal government needs to collaborate its fiscal efforts with the existing scientific research to only support comprehensive sex education.
1 HIV and AIDS in America. http://www.avert.org/aids-america.htm
2 Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 2005; Atlanta. Abstract 595.
3 Fact Sheet—A Glance at the HIV/AIDS Epidemic.
4 Kaiser State Health Facts—50 State Comparison. http://www.statehealthfacts.org/cgi-
5 Guidelines for Effective School Health Education to Prevent the Spread of HIV/AIDS
6 Landry DJ, Kaeser L, and Richards CL, Abstinence promotion and the provision of
information about contraception in public school district sexuality education polices. Family Planning Perspectives, 1999, 31(6):280-286.
7 AEI—American Enterprise Institute for Public Policy Research. School-Based
Programs to Reduce Sexual Risk-taking Behavior. http://www.aei.org/publications/pubID.17761/pub_detail.asp
8 APA—American Psychological Association. In Favor of Empirically Supported Sex
Educationand HIV Prevention Programs for Adolescents. http://www.apa.org/releases/sexed_resolution.pdf
9 (Education Development Center, 1996): Be a Responsible Teen (St. Lawrence, 1994);
Be Proud! Be Responsible! (Jemmott, Jemmott & McCaffree, 1994); Get Real about AIDS (Comprehensive Health Education Foundation, 1994); and Reducing the Risk (Barth, 1996).
10 The Henry J. Kaiser Family Foundation/ABC Television, Sex in the 90s: 1998 National
Survey of Americans on Sex and Sexual Health, Sept. 1998.
11 PBS—Public Broadcasting System.
12 Kaiser State Health Facts—50 State Comparison. http://www.statehealthfacts.org/cgi- bin/healthfacts.cgi?action=compare&category=HIV%2fAIDS&subcategory=Other+HIV%2fAIDS%2dRelated+Policies&topic=STD%2fHIV%2fAIDS+Education+Curriculum
13 US Department of Education. http://www.ed.gov/policy/elsec/leg/esea02/pg112.html
Sex Education in America. NPR/Kaiser/Kennedy School Poll. http://www.kff.org/newsmedia/upload/Sex-Education-in-America-Summary.pdf
In 1989, the National Association of State Boards of Education presented a proposal for all sexual education courses be mandated to contain HIV education. NASBE continued to modify their recommended HIV education requirements until the last evaluation in 2001. The following list is the goals of the proposed HIV education:
§ Be taught at every level, kindergarten through grade twelve;
§ Use methods demonstrated by sound research to be effective;
§ Be consistent with community standards;
§ Follow content guidelines prepared by the Centers for Disease Control and Prevention (CDC);
§ Be appropriate to students' developmental levels, behaviors, and cultural backgrounds;
§ Build knowledge and skills from year to year;
§ Stress the benefits of abstinence from sexual activity, alcohol, and other drug use;
§ Include accurate information on reducing risk of HIV infection;
§ Address students' own concerns;
§ Include means for evaluation;
§ Be an integral part of a coordinated school health program;
§ Be taught by well-prepared instructors with adequate support; and
§ Involve parents and families as partners in education.
1 Someone at School has AIDS. NASBE.
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