In November 2009, the Washington D.C. City Council’s Committee on Health released a report that assessed the sexuality education available to the District’s students, the Youth Sexual Health Project: A Framework for Change. The report was the first product of the Youth Sexual Health Project (Project), which was created in early 2009. For the report, Project team members conducted focus groups of students and school nurses, surveyed students, interviewed health professionals, and reviewed the websites students consult for guidance. The report indicates that students agree with the Project team’s assessment that young people need a “comprehensive sexual health system of knowledge, skills, and applications that addresses [their needs] beyond the basics of awareness and testing.”[i]
Sexual health is an extremely important issue in Washington, D.C., as the District leads the nation in rates of sexually transmitted disease (STD) infection[ii] and has the highest HIV rate in the country.[iii] An estimated three percent of residents are HIV-positive or living with AIDS, far beyond the one percent nationwide.[iv] The statistics for teenagers in D.C. are especially sobering: the rates of infection for Chlamydia, gonorrhea, and syphilis are almost four times the national average.[v] In 2008, “13 percent of about 3,000 students tested positive for an STD.”[vi] As a result, D.C. officials now offer STD testing to all high school students. In addition, the teenage pregnancy rate is almost triple the national average, and District teenagers are much more likely to be sexually active than their contemporaries in other areas.[vii]
The Project found that District students are dissatisfied with the sexuality education they receive at school. Health educators were criticized as being judgmental, and this perceived attitude inhibited the students’ ability to “speak freely [about sexual health issues] without being labeled promiscuous or viewed as a bad person.”[viii] The students reported that they receive basic information on reproductive health and STDs in class; however, they feel that their needs would be better served by a more holistic approach. Ideally, tools to increase self-esteem and facilitate building healthy relationships would be integrated into sexuality education, according to the report.[ix]
In addition to expanding the content of the information that students receive, the report noted that students prefer to consult a variety of sources, not just health professionals and educators. They expressed a desire to have classes and discussions led by respected, admired, and well-trained peers.[x] Also, teenagers commonly seek information from the internet; therefore, the report stressed that websites should be well-designed, visually engaging, and interactive. Social networking websites and text messaging also were suggested as effective tools to disseminate information or seek advice.[xi]
The report also identified factors affecting condom use among teenagers. Although they reported having ample knowledge of the importance of condom use in order to prevent disease transmission and unintended pregnancy, some teens admitted that they were lax about using them regularly. Students indicated that the difficulty, likelihood of embarrassment, and expense of purchasing condoms were factors that reduced the likelihood that they would use them. Girls, in particular, were susceptible to a perceived social stigma regarding buying or carrying condoms.[xii] Although free condoms are distributed in the schools, students identified several inadequacies in the program. Some students simply were unaware of either the availability of free condoms or where to go to obtain them. Students who did have that knowledge explained that they were reluctant to request condoms from the school nurse because he or she generally is regarded “as an elder in the community and [they] do not feel comfortable talking to him or her about their sexual activity.”[xiii] Finally, the respondents related that they prefer Trojan brand condoms to the Durex brand condoms that are distributed, citing an erroneous belief that Trojan condoms are more reliable.[xiv]
“While the Project team’s report identifies some areas for improvement, SIECUS would like to note the strong commitment the D.C. Public Schools have to ensuring that District students receive evidence-based, medically accurate, and age-appropriate human sexuality education at every grade level,” said William Smith, vice president for public policy at SIECUS. “The comprehensive program in the schools and the D.C. government’s commitment to facilitating cooperation among agencies that serve young people are vital to improving health outcomes in the city’s teenagers.”
The detailed and thoughtful report produced by the Project gives important insight into teenagers’ opinions, beliefs, and attitudes regarding their sexual health. The findings identified areas of improvement ranging from the students’ desire for a holistic approach to sexuality education, rather than the basic instruction on preventing STDs and unintended pregnancy they currently receive, to the practical issue of considering their preference of a particular brand of condoms. The valuable information in the report will enable educators to develop a comprehensive sexuality education program that will fully equip students to make responsible decisions regarding their sexual health.
[i] Kiana Bess, et al., Youth Sexual Health Project: A Framework for Change, (Washington, DC: Council of the District of Columbia Committee on Health, 2009), accessed 9 December 2009, <http://www.davidcatania.com/files/FINAL%20MERGED%20YSHP%20REPORT.pdf>, Appendix E.
[ii] Sexually Transmitted Disease Surveillance 2008, (Atlanta, GA: Centers for Disease Control and Prevention, November 2009), accessed 10 December 2009, <http://www.cdc.gov/std/stats08/surv2008-Complete.pdf>.
[iii] District of Columbia HIV/AIDS Epidemiology Update 2008 (Washington, DC: Department of Health, February 2009), accessed 14 December 2009, <http://doh.dc.gov/doh/frames.asp?doc=/doh/lib/doh/pdf/dc_hiv-aids_2008_updatereport.pdf>.
[iv] Jose Antonio Vargas and Darryl Fears, “HIV/AIDS Rate Hits 3%: Considered a 'Severe' Epidemic, Every Mode of Transmission Is Increasing, City Study Finds,” Washington Post, 15 March 2009, accessed 10 December 2009, <http://www.washingtonpost.com/wp-dyn/content/article/2009/03/14/AR2009031402176.html?sid=ST2009031402211>.
[v] Anita Chandra, et al., Health and Health Care Among District of Columbia Youth, (Arlington, VA: RAND Corporation, 2009), accessed 11 December 2009, <http://www.rand.org/pubs/technical_reports/2009/RAND_TR751.pdf>, 56.
[vi] Darryl Fears and Nelson Hernandez, “D.C. to Offer STD Tests In Every High School: Expansion of Program Draws Praise,” Washington Post, 5 August 2009, accessed 10 December 2009, <http://www.washingtonpost.com/wp-dyn/content/article/2009/08/04/AR2009080403402.html>.
[vii] Lorrie Gavin, et al., “Sexual and Reproductive Health of Persons Aged 10–24 Years – United States, 2002–2007,” Morbidity and Mortality Weekly Report, vol. 58, number SS-6 (Atlanta, GA: Centers for Disease Control and Prevention, 17 July 2009), accessed 10 December 2009, <http://www.cdc.gov/mmWR/PDF/ss/ss5806.pdf>; Danice K. Eaton, et al., “Youth Risk Behavior Surveillance—United States, 2007,” Morbidity and Mortality Weekly Report, vol. 57, number SS-4 (Atlanta, GA: Centers for Disease Control and Prevention, 6 June 2008), accessed 10 December 2009, <http://www.cdc.gov/mmwr/PDF/ss/ss5704.pdf>.
[viii] Bess, et al., 3.
[x] Ibid., 4.
[xii] Ibid., 5-6.
[xiii] Ibid., 6.