Academic journal article International Perspectives on Sexual and Reproductive Health

The Case for Addressing Gender and Power in Sexuality and HIV Education: A Comprehensive Review of Evaluation Studies

Academic journal article International Perspectives on Sexual and Reproductive Health

The Case for Addressing Gender and Power in Sexuality and HIV Education: A Comprehensive Review of Evaluation Studies

Article excerpt

Globally, young people are at elevated risk of STIs, HIV and unintended pregnancy. Notable gender and racial disparities exist. In the United States, for example, 2013 chlamydia rates were more than four times as high among 15-19-year-old females as among males of the same age, and the rate among black females was five times the rate among white females in that age-group. (1) Worldwide, in 2013, among adolescents aged 15-19, two-thirds of new HIV infections were among females. (2) In some countries, the disparity is even greater; for example, HIV prevalence among young people aged 15-24 in South Africa is 14% for females and 4% for males. (3) In addition, the consequences of unintended pregnancy, along with the associated risks of childbearing and the responsibilities of child care, fall disproportionately on females.

Along with efforts to deliver clinical services, reduce structural vulnerability (4-6) and foster protective social norms, a key strategy for improving adolescent sexual health outcomes has been group-and curriculum-based sexuality and HIV education. Indeed, in response to the call of international agreements such as the 1994 International Conference on Population and Development (ICPD), (7-10) international agencies continue to prioritize comprehensive HIV and sexuality education, (11-13) and many countries are undertaking national efforts or have adopted policies for education to help prevent adolescent pregnancy and HIV transmission. (14-16)

Sexuality education curricula may be delivered in schools, community settings or clinics as a stand-alone program or as a component of a multifaceted intervention, such as a young women's financial literacy program. These programs go by various names, including "family life education," "AIDS education" or "health education," to name a few. The term "comprehensive sexuality education" has evolved historically and continues to be used elastically. It has often been used to describe curricula of any duration that provide complete, medically accurate content, including information about contraception and condoms, regardless of whether topics such as gender, rights, equality, diversity and power are addressed. In general, the term has been used to distinguish such curricula from abstinence-only approaches. (17-19)

Despite extensive investments in and evaluations of sexuality and HIV education for young people, questions of effectiveness persist. Indeed, many researchers note that significant room for program improvement remains, (20-26) and a number of reviews have sought to tease out characteristics common to effective curriculum-based interventions. (25,27,28) Consensus has been reached about several of such characteristics--i.e., the benefits of comprehensive versus abstinence-only content, and of participatory, skills-building teaching approaches--but overall, the literature raises a number of questions. "What is success?" and "What exactly works?" remain matters of ongoing debate. At least two articles have critiqued some of the reviews on methodological grounds. (26,29) Others noted that whether a program is deemed successful or not may depend on whether an evaluation measures a behavioral outcome or a biological or health variable. Because reported sexual behavior does not always correlate with health outcomes, and because of issues regarding reporting by intervention participants--such as the validity of self-reports of sexual behavior and the potential for social desirability bias--one review concluded that "trials with reported sexual behaviors as their outcome are insufficient." (30) (p. S11) Indeed, many reviews recommend the use of a higher bar, biological outcomes, as a more reliable, objective measure of program efficacy. (20,22,27,30-34) Of course, tracking biological and health outcomes requires large sample sizes and substantial resources. Thus, the use of adolescents' self-reported sexual behavior change remains the only practical option for many studies. …

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