Tag Archives: education

Sex education: we should teach young people about more than the mechanics

Sex education: too much emphasis on the mechanics, says Doortje Braeken, who argues for more teaching about sexuality. Photograph: David Levene (The Guardian)

Sex education polarises opinion, sets legislators against parents and parents against schools and regularly inflames media opinion. Somewhere in the middle sit young people: ill-served, receiving confused messages and gaining their information from famously unreliable sources, such as peers or the internet.

Sex education, as all too many experience it, is like teaching people how to drive by telling them in detail what’s under the bonnet, how the bits work, how to maintain them safely to avoid accidents, what the controls do and when to go on the road. It’s all about the mechanics. And that’s it.

There’s a growing consensus that young people don’t need sex education, they need comprehensive sexuality education or CSE..  CSE is sex education plus: the mechanics, plus a lots more about sexuality.

That means not just teaching young people about the biology of sex, but also teaching them about the personal, emotional, societal and cultural forces which shape the way in which they choose to conduct their lives. Armed with this understanding, young people can make far more considered decisions.

This approach has the potential to unite the warring factions that bicker over the fundamental rights and wrongs of sex education: CSE equips young people with basic biological knowledge, but at the same time it equips them to question why they act in certain ways, and whether or not it is right, valuable or desirable to do so. CSE imparts information, and promotes responsibility.

CSE contains components which allow learners to explore and discuss gender, and the diverse spectrum of gender identities that exist within and between and beyond simple heterosexuality. It also contains components that examine the dynamics of power in relationships, and individual rights.

These are not taught as theoretical concepts. They have serious practical effects on the way in which young people interact with each other, both in the sexual and the wider social and educational spheres. Studies have shown that addressing such issues can have a marked impact both in school and the expansion of young people’s social networks.

CSE also engages with what some doubtless regard as difficult territory. Sexuality – however, individually, we choose to regard it – is a critical aspect of personal identity. The pleasure that we derive from sexuality, even if that pleasure is the pleasure of feeling that a reproductive duty is being fulfilled, is a vital part of our lives: it’s what makes us human. CSE views sexuality as a positive force.

CSE exploits a variety of teaching and learning techniques that are respectful of age, experience and cultural backgrounds, and which engage young people by enabling them to personalise the information they receive.

What is most telling is that a large number of studies have reached the clear conclusion that CSE does not lead to earlier sexual initiation or an increase in sexual activity. To paraphrase, traditional sex education seems to say: “If you’re going to do it, this is how everything works and you need to protect yourself in these ways to prevent this.” CSE says all that, but it also asks young people to ponder what exactly “it” is, and to deepen their perception of its implications.

In a political environment which is quantitatively driven, we measure the success of sex education in straightforward health behaviour indicators. These are easy to manage: numbers which build on existing health surveillance and measurement systems, and which are simple to understand from an objective point of view.

However, CSE is a far more nuanced discipline, and it will be necessary to include other measures of programme success: qualitative, subjective indicators which relate to gender equity, empowerment and critical thinking skills.

While governments have recognised young people’s right to CSE via various intergovernmental resolutions and conventions, the journey from recognition to delivery will be a long one. Even in the UK, there are notable differences, with England having a bare-bones biological approach “puberty, menstruation, contraception, abortion, safer sex, HIV/Aids and STIs should be covered”, while Wales and Scotland have curriculums which incline far more towards the CSE agenda.

The International Planned Parenthood Federation, the organisation I work for, and its 153 member associations around the world, has been instrumental in pressing for the adoption of international policy commitments to CSE. For many, it may seem like we are pushing 10 steps ahead of the agenda when the basic principle of young people’s right to even the most basic introduction to the biology of sex is still not universally accepted.

Our view is different: it is that CSE is what will secure widespread acceptance of sex education, because it is about more than the mechanics of sex. It is about helping young people, the world over, to become more healthy, more informed, more respectful and more active participants in the life of their community and their nation.

Doortje Braeken is the IPPF’s senior adviser on adolescents and young people, responsible for co-ordinating programmes in 26 countries implementing a rights-based approach to youth friendly services and comprehensive sexuality education. She will be among the panellists for a live discussion on sex and sexuality education, taking place on the SocietyGuardian site from noon to 2pm on Thursday 31 May

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Education for awareness of and attitudes to HIV

Positive? (www.learningpositive.com) is a HIV information service website and the end work of the commitment and hard work of many UK Stakeholders, Partners and key players who in many different ways gave of their time, skills and expertise to help put together this innovative teaching and learning resource.

This highly accessible teaching and learning tool will challenge you, engage you, and empower you. By working through the different sections of the website, on your own, with friends or under the direction of your teacher, you will deepen your understanding of the facts about HIV whilst increasing your awareness of its social impact.

The interactive website is a tool to teach young people about HIV, how it affects people in the UK, how to prevent it spreading and how to reduce the discrimination experienced by those living with HIV. It also provides insights into the global dimension of the epidemic and introduces a series of interactive activities to raise awareness among the new generation and encourage positive, campaigning action to be taken.

As well as learning about HIV for yourself, you will also use your knowledge and understanding to develop an original campaign to advocate for people with HIV. As you work through the various activities, remember to think about which information would work well in raising awareness about key issues related to HIV.

The site helps to educate issues such as prejudice and stigma, discrimination, criminalisation and human rights and many more.  Check it out, it’s very useful for yourself and to pass to others.

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PrEP acceptable to UK gay men, studies find

Pre-exposure prophylaxis (PrEP) would be an acceptable HIV prevention strategy for large numbers of gay, bisexual and other men who have sex with men in major UK cities, according to two studies presented to the British HIV Association (BHIVA) conference in Birmingham this week.

The conference also heard details of a small pilot PrEP study, likely to start recruiting later this year.

A cross-sectional survey of 842 HIV-negative gay and bisexual men, recruited at bars, clubs and saunas in London, suggested that half the respondents would be interested in taking PrEP.

Respondents were given information about pre-exposure prophylaxis and asked: “If PrEP were available, how likely is it that you would take a pill (oral dose) on a daily basis to prevent HIV infection?”.

Half said yes, with 16% saying they were likely to take PrEP and 34% saying they were very likely to. Men interested in PrEP were slightly more likely to be under the age of 35 (AOR adjusted odds ratio 1.58), have attended a sexual health clinic in the past year (AOR 1.59) and to have previously taken post-exposure prophylaxis (PEP) (AOR 1.96). After statistical adjustment, various measures of risky sex were no longer associated with interest in PrEP.

In this survey, 17 men (2.1% of those answering the question) said that they had previously taken antiretroviral drugs to reduce their risk of HIV infection.

Secondly, clinicians at the Manchester Centre for Sexual Health surveyed HIV-negative men attending their service who reported unprotected receptive anal intercourse. Of the 121 men who responded, 36% said they would be “very willing” to take PrEP while only 14% said they would not take the treatment. Daily dosing was perceived as a better option by four fifths of respondents – just one fifth would prefer taking a dose before sexual activity.

These data confirm and reinforce findings from a study reported in November 2011, which found that half the gay men surveyed would consider taking PrEP. Once again, daily dosing was preferred to taking a dose before sex. In the qualitative data, men commented that sex is often spontaneous and that they felt daily dosing would facilitate adherence.

However these data are all based on giving men a few key facts about PrEP and presenting it as a hypothetical option. In real-life circumstances, where men think more seriously about PrEP as an option and hear friends’ experience of taking it, actual uptake and sustainability may be very different.

While the Manchester respondents largely assured the researchers that they would take all their doses of PrEP and wouldn’t have more risky sex, real-life experience needs to be tested in research.

To this end, the Medical Research Council are seeking funding for a 5000-participant, two-year study which would randomise HIV-negative gay men who report unprotected anal intercourse to either take PrEP (Truvada) and attend motivational interviewing (intervention group) or to be put on a one-year waiting list for PrEP and to have motivational interviewing in the meantime (control group).

For the researchers, it is crucial that this is an open label but randomised study, in which participants know whether they are receiving the actual drug. This unusual research design would, they argue, tell us more about the real-world effectiveness of PrEP than a blinded study as it would take into account the possible impact of participants taking more sexual risks because they felt that PrEP afforded some protection. (Researchers call this ‘risk compensation’ or ‘behavioural disinhibition’).

Rather than test efficacy in artificial conditions, the study would therefore test effectiveness in more realistic UK conditions.

So far, however, the potential funders of this costly study have not been persuaded by this argument and it is unclear whether the study will be able to go ahead.

What will, however, start recruiting later this year is a pilot version of the same study, aiming to include 500 men who attend one of around twelve sexual health clinics.

As well as allowing the researchers to have a dry run of the main trial and identify teething problems with its strategy, it should also provide valuable information on the number of men who actually follow through on a clinician’s offer of PrEP. Data on the characteristics of men who seek PrEP, drop-out rates and risk compensation will also be collected.

The researchers intend to take some of these data back to the main study’s potential funders, in order to support a revised application.

Acceptability of taking HIV treatment for prevention purposes

As well as asking people hypothetical questions about PrEP, researchers have also been asking people waiting for an HIV test result hypothetical questions about treatment as prevention.

Individuals from high-risk groups attending the Jefferiss Wing at St Mary’s Hospital for HIV testing were given an explanatory paragraph about treatment, infectiousness and safer sex. They were then asked: “If you were diagnosed with HIV would you consider taking treatment to reduce the risk of passing on infection (even if you did not need to take treatment for your own health)?”.

Four out of five respondents said ‘yes’. Encouragingly, gay men who reported unprotected anal intercourse in the past three months were more likely than others to be interested in the idea. Less encouragingly, people who had had a sexually transmitted infection or who had previously taken PEP were slightly less likely to say that they would take treatment for prevention.

The researchers suggested that the latter factor may be associated with PEP users’ experience of side-effects. It contrasts with the findings of the London PrEP attitudes study described above which found people who had previously taken PEP more likely to be interested in PrEP.

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