Transcript Abstinence education, SRE, HIV prevention and condoms

Abstinence education, SRE,
HIV prevention and
condoms
Simon Forrest
Abstinence v. Comprehensive SRE
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Abstinence education focuses on teaching young people
that abstaining from sex until marriage and being faithful
to their marriage partner thereafter is the best means of
ensuring that they avoid infection with HIV, other sexual
transmitted infections and unintended pregnancy
Comprehensive SRE includes emphasising the potential
benefits of delaying having sex and educating in the use
of contraception to avoid infections and pregnancy.
A Rapprochment?: Abstinence Plus[1].
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Abstinence plus places the main emphasis on
abstaining from sex as the preferred choice of
protection but young people are provided with
information about contraception and disease
prevention so that they can protect themselves
when they do become sexually active .
[2]
[1] Halperin, D. T., Steiner, M. J., Cassell, M. M. et al. (2004) The time has come for
common ground on preventing sexual transmission of HIV, The Lancet 364: 19131915.
[2] The Henry J. Kaiser Family Foundation (2003) Sex Education in the US: Policy and
Politics, http://www.kff.org/youthhivstds/3224-02-index.cfm
Conflict of ideology
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Moral basis for views
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(Condoms)
Theoretical
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(Mixed messages)
Negative or positive attitudes
towards sex and sexuality
Contentions
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Against comprehensive approaches:
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Too positive about effectiveness of condoms;
Sending mixed messages
Against abstinence approaches:
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Understate/misrepresent the effectiveness of
condoms;
Reinforcing negative gender and sexual stereotypes
Representing sex too negatively
Evidence (against comprehensive)
Rector, R. (2002) The Effectiveness of Abstinence Education Programs in Reducing Sexual
Activity Among Youth, The Heritage Foundation Policy Research and Analysis,
http://www.heritage.org/Research/Family/BG1533.cfm
Condoms offers relatively little protection (from "zero" to
"some") for herpes and no protection from the deadly HPV. A
review of the scientific literature reveals that, on average,
condoms failed to prevent the transmission of the HIV virus-which causes the immune deficiency syndrome known as
AIDS--between 15 percent and 31 percent of the time. [3]
[3]
Weller, S. (1993) "A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted
HIV," Social Science and Medicine, 36(12)
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of
Health and Human Services, "Summary," Scientific Evidence on Condom Effectiveness for Sexually
Transmitted Disease (STD) Prevention, July 20, 2001
.
Evidence (against abstinence)
White, C. (2004) Group suggestions for introduction to True Love Waits, Nashville:
Lifeway Press (http://www.lifeway.com/tlw/downloads/pdf_IntroTLWGroup.pdf)
Evidence (against abstinence)
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…. contain factual inaccuracies, such as massively overestimating
the prevalence of HIV and STIs, the failure rates of condoms when
properly use and marginalising the needs of lesbian, gay and
bisexual young people by focusing on marriage[1]. These reviews and
other critical evaluations of abstinence curricula have also shown
that they tend to project stereotypes about gender, repress
information about positive aspects of sexual relationships and
overstate the emotional risks and dangers associated with sex[2]
[1] Batchler, M (2004) Keeping our Youth ‘Scared chaste’ SIECUS Curriculum Review: Choosing
the best life A fear-based abstinence-only-until-marriage program for high school students,
http://www.siecus.org/reviews.html
[2] Blake, S. and Frances, G.(2001) Just say no to abstinence education, National Children's
Bureau, 2001
Evidence (against abstinence)
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The age at which people first marry is around 30 years old
a fifth of marriages end in divorce or separation within five
years[1],[2].
Age at first sexual intercourse is around 16 years old and a
diminishing minority of people report that their first sexual
partner was also their marriage partner[3],[4].
[1] National Centre for Health Statistics (2004) Marriage and Divorce (data for US
2003) http://www.cdc.gov/nchs/fastats/divorce.htm
[2] National Statistics (2005) Marriages, 1846-2002: median age at marriage by sex
and previous marital status,
http://www.statistics.gov.uk/STATBASE/xsdataset.asp?More=Y&vlnk=5277&All=Y&B2
.x=36&B2.y=9
[3] [3] Wellings K, et al. Sexual behaviour in Britain: early heterosexual experience.
The Lancet 2001; 358 1843-1850
[4] Hubert, M., Bajos, N., and Sandfort, T. (1998) Sexual behaviour and HIV/Aids in
Europe, London: University College London Press
Effects and effectiveness
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Comprehensive sex education works:
Collins, C., Alagiri, P. and Summers, T. (2002) Abstinence only vs. comprehensive sex education:
What are the arguments? What is the evidence? University of California, San Francisco: AIDS
Research Institute
Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard M et al. (1994) School-based
programmes to decrease sexual risk behaviours: a review of effectiveness, Public Health Report
109 pp.336-360
Dickson, R., Fullerton, D., Eastwood, A., Sheldon, T., Sharp, F et al. (1997) Effective Health Care:
Preventing and reducing the adverse effects of unintended teenage pregnancies, National Health
Service Centre for Reviews and Dissemination University of York
Dicenso A, Guyatt G, Willan A et al. (2002) Interventions to reduce unintended pregnancies
among adolescents: systematic review of randomised controlled trials. British Medical Journal,
324 1426-1435
Dennison, C. (2004) Teenage Pregnancy: An overview of the research evidence. London: Health
Development Agency
Swann, C., McCormick, G. and Kosmin, M. (2003) Teenage Pregnancy and Parenthood: A Review
of Reviews. London: Health Development Agency
Effects and effectiveness
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There is no evidence that abstinence education works
(although a trial is underway)[1]
Pledges may lead to later first sexual intercourse (but only for
young people who already have strong faith beliefs and who
form a select group)
Others tend to have more risky sex and use condoms less.[3]
[2]
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[1]Mathematica Policy Research Inc. (2005) The Evaluation of Abstinence Education
Programs Funded Under Title V, Section 510, http://www.mathematicampr.com/welfare/abstinence.asp
[2] Bearman, P. and Bruckner, H. (2001) Promising the Future: Virginity pledges and
first intercourse, American Journal of Sociology 106(4): 859-912.
[3] Bruckner, H. and Bearman, P. (2005) After the promise: the STD consequences of
adolescent virginity pledges, Journal of Adolescent Health 36: 271-278
USA
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$170 million is being granted by Congress to abstinence
education in 2005 and the President seeking to increase
this to $206 million in 2006[1]
Matched funding for programmes which
[2]
…
[1] Sexuality Information and Education Council of the United States (2005) SIECUS State Profile: A Profile of
sexuality education and abstinence-only-until-marriage programs in the States,
http://www.siecus.org/policy/states/index.html.
[2] Maternal and Child Health Bureau,
US Department of Heath and Human Service: Health Resources and Services Administration.
http://mchb.hrsa.gov/programs/adolescents/abstinence.htm
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has as its exclusive purpose, teaching the social, psychological,
and health gains to be realized by abstaining from sexual activity;
teaches abstinence from sexual activity outside marriage as the
expected standard for all school age children;
teaches that abstinence from sexual activity is the only certain
way to avoid out-of-wedlock pregnancy, sexually transmitted
diseases, and other associated health problems;
teaches that a mutually faithful monogamous relationship in the
context of marriage is the expected standard of human sexual
activity;
teaches that sexual activity outside of the context of marriage is
likely to have harmful psychological and physical effects;
teaches that bearing children out of wedlock is likely to have
harmful consequences for the child, the child’s parents, and
society;
teaches young people how to reject sexual advances and how
alcohol and drug use increases vulnerability to sexual advances;
and
teaches the importance of attaining self-sufficiency before
engaging in sexual activity.
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School districts with a sex education policy universally require that
abstinence be taught and around 4 in 5 require that it be promoted as the
best option for young people.
About 35% not only require abstinence to be covered but either do not
allow discussion of contraceptives or allow discussion only of their failure
rates.
The other 51% require that abstinence be taught as the preferred option,
but also allow discussion of contraception as an effective means of
protection.
Only 14% have a policy of teaching abstinence as part of comprehensive
programme[1].
46% of parents prefer an abstinence-plus approach,36% a comprehensive
approach and 15% abstinence only[2].
In the UK an even greater proportion of parents and young people support
comprehensive approaches to sex education[3].
[1] Landry, D.J., Kaeser, L. and Richards, C.L. (1999) Abstinence promotion and the provision of
information about contraception in public school district sexuality education policies, Family
Planning Perspectives, 31(6):280-286.
[2] National Public Radio/Kaiser Family Foundation/John F Kennedy School of Government
Harvard University (2004) Sex Education in America, Kaiser Family Foundation.
http://www.kff.org/kaiserpolls/pomr012904oth.cfm
[3] BMRB International (2001) Evaluation of the Teenage Pregnancy Strategy. Tracking Survey.
Report of results of benchmark wave, January 2001. www.teenagepregnancyunit.gov.uk
PEPFAR (President’s Emergency
Plan For AIDS Relief )
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$15 billion to worst affected countries in Africa
and Caribbean ;
20% for HIV/AIDS prevention
(of which at least 33% is to be spent on
abstinence until marriage programs);
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Learning from Uganda (ABC)
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[1]
[1] Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria,
Rwanda, South Africa, Tanzania, Uganda and Zambia.