stateofsex

On the Front Lines of the Battle for Better Sex Ed

Maybe the most important lesson — sex itself is just the half of it

Throughout most of the 1990s and 2000s, abstinence-only sex education was the most well-funded sex-ed curriculum in the U.S. — even though this type of sex education has shown no positive impact or increased effectiveness over time. More recently, President Barack Obama did fund sex-ed programming based on science that’s actually proven effective in reducing teen pregnancy. Those programs, however, are in the crosshairs of the Trump administration, which, like with most of the Obama agenda, it’s attempting to overturn. This despite the fact that studies show most Americans support “comprehensive” sex ed in schools.

What is comprehensive sex ed exactly? It’s pretty much as it sounds — sweeping and holistic. Or in the words of Chris White, a sexuality educator in San Francisco who has been teaching sexual health for about 25 years, “We’re talking about sex education that includes medically accurate, age-appropriate information about sexual behaviors, contraceptives, STDs, HIV and AIDS, relationships and dating. Comprehensive sex ed addresses all behaviors and all concerns. It isn’t preaching the idea that the only way to keep from getting pregnant or an STD or HIV is to not have sex. It addresses the reality of young people’s lives in general.”

Yet even in states where such sex-ed policies have been passed — e.g., California’s Healthy Youth Act, which requires comprehensive, LGBTQ-inclusive sex ed be taught in schools — resistance to inclusion has meant school-district disputes that have led to the disappearance or postponement of sex ed all together. Take, for instance, the case of Freemont, California:

That, of course, is a terrible shame. For lots of reasons, but particularly these three:

  1. With the rate of STD transmission at an all-time high, especially among teens, the need for information about sex, not just avoiding it, is a matter of public health.
  2. Lessons in communication skills, values and boundaries — not just being able to put a condom on a banana — will help bring about the end of rape culture, including the rates of sexual assault and misconduct.
  3. Finally, if kids were taught anything about sex from a trusted source, they might have less hang-ups about it and less shame about seeking out the things that they desire the most, leaving them fulfilled instead of guilty.

Moreover, though, like any form of learning, sex ed isn’t meant to stop after high school graduation. It should be something you continue to enrich over your lifetime in response to new physical changes, desires and experiences — one reason why “sex ed for grownups” is on the rise.

Still, you gotta start somewhere, and unfortunately, here in the U.S., that’s with the crap version of sex ed that’s peddled at most schools. White, along with the other experts included below, is at the forefront of trying to change that — or at least attempting to get more educators to adopt some form of comprehensive sex ed.

He began educating college students about sex ed while still a student himself at the University of Texas. In the years since, he’s helped develop and review curricula for new sex-ed classes and has done sex-ed policy and advocacy work with school districts across the country. And while he admits that comprehensive sex ed isn’t without its flaws, he strongly believes it’s much better than the absence of sex ed altogether (or abstinence-only sex ed).

White: California is a very different place because school districts in San Diego, Los Angeles, San Francisco and Oakland have been implementing very progressive sex education for years. We start talking about gender, gender identity, gender expression and sexual orientation as early as fifth grade, so kids actually understand what’s going on as they’re going through the process of development.

Progressive sex ed also goes into more detail about sexual orientation and sexual behaviors. It moves away from assigning anal sex, for example, as a behavior only between gay men. It treats it just as a sexual behavior. That normalizes it as something all types of people — regardless of their gender identity or expression of sexual orientation — engage in. Furthermore, anal sex doesn’t just mean a penis and an anus. It means toys, fingers, hands, fists and everything else we can come up with.

There’s evidence that when we teach young people the ability to talk about their sexuality, sexual desires and sexual behaviors, we’re also empowering them to talk about what things aren’t going the right way. Whether there’s an issue of sexual assault, harassment or abuse, sex ed gives people a way to talk about things they may otherwise hide because of shame and guilt.

The problem right now is that even though it’s mandatory to teach this kind of comprehensive sex ed in California under the Healthy Youth Act  — not to mention, the FAIR Education Act requires schools to teach about LGBTQ people in a positive light — neither of those laws have any kind of funding or mandates for tracking if, and how, this is happening. It’s more like, “You’re supposed to do it.” It’s left up to the teachers, school districts and parents to implement those lessons in the curriculum.

These laws do benefit what happens in the classroom though. For example, if someone is teaching anti-LGBTQ lessons, we can go in and say, “We have a law that says you can’t teach that.” Same thing with sex ed. If you’re teaching abstinence-only education in California, you can get a letter from the state Department of Education telling you to cease-and-desist; if not, you’ll be sued by the ACLU or by the state. That’s usually enough to stop things.

But what shouldn’t stop, according to White, is sex ed itself, that should be a lifelong pursuit.

White: Sex education in high school shouldn’t be the end. Things change over time, including our sexualities, so as an adult, you need to know how to access and ask for this information — from, for instance, your medical providers — and continue learning throughout your lifetime. Now we just have to figure out where this continuing education is going to happen — whether that means sex stores, virtual spaces or in senior centers where we know people are having sex but they don’t talk about it.

Do we even do it in our workplace? Can sex education be included as a benefit, where people can access information about sexuality and sexual health as part of their workplace environment?

Lifelong or not, comprehensive or not, White does feel strongly that sex ed can still be improved as well as made even more progressive.

White: Sexuality education is still very hetero-centric. That means we’re leaving a lot out — like PrEP as a preventative medication for HIV. We’re not educating about that enough; we’re still not doing a good job educating about the importance of HPV vaccines either. We could have more inclusive anatomy models as well, where someone has breasts, a penis and testicles, or a vulva but not breasts — basically, all the different combinations we could come up with to talk about what physical bodies look like.

We’re getting there, but slowly. Really good sex education would be much more based on our lived experiences versus a list of diseases, a list of contraceptives and instructions on how to use a condom.

This is where Tanisha Watkins comes in. As part of her PhD dissertation at Purdue University, she conducted hours of focus groups with Indiana teenagers following what the CDC called “one of the worst HIV outbreaks” ever in 2015. Her mission: to include their real-life experiences in the next generation of sex ed.

Watkins: Teen perspectives are often missing from the conversation about what type of sex education we should provide. I facilitated focus groups simply so that I could sit down and talk with Indiana teens about what they wanted in their sex education. I worked with a rural high school for about a year and was able to sit down one-on-one and have these conversations. Overall, I had about eight different conversations with 47 teens.

The first thing that stuck out to me was that they said sex is something everybody does in high school. They really live in this sexually active culture. Although adults may not want to acknowledge it, the students felt like it’s the norm and that everybody is doing it.

They also stressed that because of this sexually active culture, it wasn’t realistic for schools to teach abstinence-only education. One student in particular said it seemed impractical to her to be teaching abstinence to teens who are probably having sex — or gonna be having sex soon. Essentially, abstinence isn’t teaching them anything useful. That word — useful — was very important to the focus group. They wanted to learn things that were relevant to them and that they could actually use.

One of my participants said it directly: “It’s going to be easier to persuade someone to have safer sex than it is to tell them to not have sex.” We don’t want students to ignore us, because when they ignore us, they don’t hear anything that we’re saying, and we’re missing critical opportunities to provide them with information that they can use immediately to protect themselves. We need to encourage them to come to the table, because we can’t provide them with the information they need unless we know what they’re going through.

To that end, there’s always so much debate between adults about what type of sex education needs to be taught, but it’s not our opinion that matters. It’s the opinion of the students. They have the final say in the type of education that we need to be providing them because they’re the consumers of this information. They’re gonna be the ones who apply it, and this information will have a direct impact on their health, economic mobility and happiness. For all those reasons, we cannot afford to leave them out of the conversation any longer.

As a marriage and family therapist who is also a sex educator at a Christian university in Texas, Lisa Powell trains her students to be marriage therapists, even though they know very little about sex. As a PhD student herself, Powell wasn’t taught about sex in her therapy program either, despite the important role it can play in romantic relationships. Instead, she sought out this information by reaching out to mentors at different schools and attending nationwide conferences. She’s attempting to pay all that forward with her own students, broadening their horizons beyond their abstinence-only backgrounds.

Powell: It’s a unique position to be a sexuality instructor on a Christian campus, because some of these students haven’t heard a lot of this information before. Getting past that is important. In our two-year program, we open up their eyes to the possibilities of what they might see with their clients and the possibilities of what’s out there and what’s normal, which is a wide scope of everything. We have to provide this information for licensure, ethics and all the reasons a good therapist needs sexual information they might not experience in their daily life.

If I can talk about poly relationships in the classroom and introduce them to the idea by having an author of a book come in and answer all their questions, then I can ask them, “Your client is into this. How are you going to handle it?” As another example, we just finished the life-cycle class, where we talked about sex over the age of 65 and what that’s like. My students headed home for the holidays looking at their relatives like, “Yeah!?!?”

Same for the couples that think they’re not supposed to enjoy sex once they’re parents. These couples had great sex lives before, but then they have all sorts of problems because they think the norm is that parents don’t have sex. Just freeing that up and coming to understand that we were made as sexual beings can solve some of these relationship challenges.

That said, I do preface my teaching with, “Jesus said ‘love.’ We’re Christians, and we’re told to love. This is what we’re doing with these clients, and this is what you’re called to do. It can be eye-opening, but it’s the right way to be.”

God made us sexual beings. God — whether you call God “him” or “they” — created our sexuality and gave us a means to express it. Even couples that follow the biblical norms of abstinence until marriage need to be able to express their sexuality within the bonds of marriage without feeling guilt or shame. And that can be hard to do without sex ed.

It’s also probably true that too much of an emphasis is placed on the “sex” in sex ed. For her part at least, sex and relationships educator Anne Hodder believes that’s just the half of it and that such teachings go far beyond the (naked) flesh.

Hodder: Unbiased, accurate sex ed is so much more than just talking about condoms and genitals; it has everything to do with emotional intelligence, self-esteem, self-worth, how we interact with other people, relationship dynamics and love languages. That’s the real foundational stuff that not only equips people to have healthy sex and relationships, but also to be able to be compassionate, emotionally connected human beings in general.

Age-appropriate sex ed equips younger people with an understanding of their emotions, what it means to feel happy and sad and how to behave accordingly. Things like: What happens when we’re sad? What do we need to feel better? What are things that we often do that might be mean or cause harm to the people around us? How do we appropriately handle ourselves?

A lot of that has to do with consent — understanding consent not from necessarily a sexual perspective, but from a human perspective. If someone doesn’t want to share their lunch, you respect that. It’s not a reflection of you, or a personal thing if they said no. Or if you wanna give your friend a hug goodbye, and they’re like, “No…,” you get to show them that no is not only okay, but important to respect.

I like to think of sex education as building a house. There’s no point in talking about walls, ceilings or paint colors until you’ve got a deep foundation, and you’ve built something to stand on first. I see value systems, personal choices and empowered discussions of your own rights and responsibilities when it comes to being a sexual person as the floor and foundation to start with.

When you don’t know what’s important to you — and you don’t know what your values are — it’s like standing in a house with no floor. You’re not really rooted in anything. And so, it’s harder to make choices, because you end up having to adopt other people’s perceived values, replacing the lack of your own with theirs.

There’s just this intense trickle-down effect. Someone who grew up in the 1950s, 1960s and 1970s had access to very specific, very limited kinds of sex education, and now they’re the ones in charge of putting curricula together or determining what kids have access to. There’s no guarantee then that these people aren’t making decisions based off of their own comfort level. And it’s for no other reason than they’re informed by what they were taught.

Justin Sitron and Javontae Lee Williams are developing new sex-ed materials for black gay and bisexual men in Jackson, Mississippi, and Baltimore, Maryland. The project is part of Widener University’s Interdisciplinary Sexuality Research Collaborative (ISRC), which was recently awarded a third year of funding from ViiV Healthcare, “a pharmaceutical company specializing in the development of therapies for HIV infection.”

As of 2014, both Jackson and Baltimore ranked in the top 10 of U.S. cities with the highest HIV diagnosis rate, and according to the CDC, if current HIV diagnoses persist, approximately 1 in 2 black men who have sex with men will be diagnosed with HIV during their lifetime. Similarly, the CDC reports 1 in 4 Latino men who have sex with men will be diagnosed with HIV during their lifetime. These statistics are particularly striking given that only 1 in 11 white men who have sex with men will be diagnosed with HIV during their lifetime.

For Sitron and Williams, acknowledging the racial disparity here and connecting it to a larger history of health-care inequality is a key part in creating accurate and inclusive sex education.

Sitron: There’s been a national call to action for the sexuality-education community to more broadly address the issue of inclusivity in sex education, because most sex-education programming, even some of the most progressive, isn’t speaking directly to individuals who have sex with people of their same gender or people whose bodies are similar to their own. Even in conversations about inclusive and radical sex ed, the unique experiences of people of color and LGBTQ people of color are often left out.

Williams: The lack of race in sexuality education has left a gaping void in terms of how we talk about the racialized gendered roles among gay men or men who have sex with men. When we get to the root of desire, attraction, relating to one another and sexual positioning, a lot of that has deep roots in the larger racialized context. So for black men, you can’t really talk about sex between them without talking about how society racializes their sexual identity and how that gets internalized.

Sitron: On top of that, if sexuality-education programming doesn’t also include conversations about access to care and the trauma that’s been inflicted upon black communities around sexual and reproductive health, we’re also keeping students and participants of those programs from having conversations in educational spaces about the traumatic realities that their mothers, grandmothers and fathers have suffered at the hands of public-health institutions that have broken down the trust that those folks have for the whole idea of health care.

That’s why it’s important that we don’t just talk about sexual behaviors and sexual health from an individual perspective, but that we also engage in conversations about the systems that are there to support people’s health. In some families, the legacy is one of “Don’t trust your provider.” And stories of negative experiences with doctors from family members are often culturally much more valid and reliable than what we hear from teachers in classrooms.

Providers need to understand their role in helping solve these problems as well. For example, so much of the conversation about PrEP is helping men understand what it is and how to get it and take it. But there isn’t the same kind of conversation happening with providers to get them to understand that simply writing a prescription isn’t the answer. Because of the health-care system’s systemic inequities, a lot of men leave an environment with a prescription, but getting it filled is a completely different battle.

Williams: A lot people can’t answer the question, “What are the health needs of young black men?” because they’re so disease-centered. If you don’t have HIV or we’re not trying to prevent HIV, there’s not a lot of focus on holistic approaches to health. But when we think about the provider-for-care continuum, we have to think about it as a comprehensive way where we’re not only including disease prevention and treatment.

Of course that intersection is going to collide with sex ed, because if the larger system isn’t built to keep people well until they’re at a point of disease, when sex enters the picture, what we have is a lot of keeping people from getting the disease.

Sitron: The program we’re developing looks to people who work in the health-care system. A lot of it is helping them not just understand language and client or patient experience, but also understanding how they shape that experience for clients and patients — helping them think not just about treating sick folk, but also about creating clinics and reception desks for people to come because they want to stay well.

To get there, one of the languages we’ve been trying out is calling them “client experience contributors” instead of providers, which reinforces that it’s the client experience that they should be focused on, not the perdition of their own care.

On the client side, we’re trying to build an understanding that when they go to receive care, they have the power in how that care gets provided to them. To help empower them, we’re telling them, “This is what you should expect when you go. These are the kinds of questions you should ask.”

Williams: Our primary method of reaching men is to go through community agencies. We develop a network of partnerships with clinics, drop-in centers and outreach places where men get tested — all these different types of touch points for gay men in the communities.

We started that engagement about a year and a half ago when we went to the communities and said, “Tell us what you’re doing already.” From there, we got an understanding of the types of interventions that were being employed. Because we didn’t want to recreate anything that was already out there — we wanted to have something that filled in the gaps and that spoke to the needs of what men in the community were telling us that they were either tired of hearing or wanted to hear more of. That’s how we started to build out a curriculum.

In doing it this way, we built community support, because it wasn’t like, “Here, teach this.” It was a co-creative process: “You told us this. From that, we heard this. And we designed this tool for you.”

As we ramp up to collect data, we’re launching a needs assessment for understanding why providers don’t access information education that can make their care better. There are tons of resources out there that talk about medical care to the LGBT community. But for whatever reason, the application isn’t always strong. It’s like, “Another sensitivity training that I went through and got a certificate for.”

That’s not a critique or me bashing anything. I think it’s good that we have trainings like that. But I also think that some people feel it’s enough to go through them and leave it there. You have to take it through to the next step, though, which is application. Because if we started applying everything we know about the community, we would have a revolution.

Like Watkins, a lot of what Williams and Sitron know about the community is from talking to those most affected — in their case, the black gay and bisexual men of Jackson and Baltimore.

Williams: For example, in Jackson, there’s a resource deficit, so if you’re exchanging sex for money or shelter, you don’t have time to put into practice the condom demonstration you saw or to go to the clinic to get your PrEP prescription filled.

Conversely, Baltimore was ready for an abstract-level community conversation. Because it’s a Northeastern city — a metropolitan and urban place — gay folk exist. That’s acknowledged; whereas in the South, it’s taboo and impolite to talk about sexuality. In Baltimore, though, it’s very in-your-face. People aren’t struggling necessarily with issues of coming out. It was more like, “I’m tired of all the constant hookups. I want to have a substantial connection with other men.” It was this desire for a more spiritual and emotional conversation.

The differences were stark. You can imagine that it’s a huge challenge to reconcile both of these things in a single project. So we partnered with experts from across the country to design a comprehensive sexual decision-making toolkit to the best of our ability — one that’s broad in scope but also goes deep enough to address the specific needs that we heard from the community.

Sitron: Our upcoming third year will be focused on rolling out these lesson plans in Baltimore and Jackson. We’re in the process of piloting the lessons themselves to see how they’re working and what needs to be changed. Then, in the second quarter of 2019, we will start to roll them out more broadly and train community leaders, agency employees and people who do community health education on how to use them.

Part of that process will also include assessing what additional training and support they need in order to implement them, because we recognize that a lot of the program’s topics aren’t traditional sex-ed topics. And so, a lot of the folks who do sexuality-education work don’t necessarily have the skills and training in this background, so we want to train them in that as well.

Overall, we’re looking to determine if behaviors that put people at risk go down because their overall wellbeing is supported. Because models say that if people are healthy overall and have relationships they want and higher self-esteem and lower stress, they’ll make healthier decisions and engage in health-care systems more readily.

What is abundantly clear to Sitron and Williams already, though — as with everyone else I talked to — is that what we’re doing now is untenable, and frankly, more dangerous than not.

Sitron: I hear people say, “I know I’m supposed to use a condom. I know I’m supposed to reduce my number of partners. Why are people still telling me those things?” So the sex ed folks are getting isn’t what they need or want, and it isn’t actually making a difference. Because if a young man’s experience is, “I’m doing everything everybody tells me, and I still get HIV,” something’s wrong. Either we’re not telling them the right thing or folks aren’t hearing it in a way that makes sense.

Williams: I can’t remember who said it, but there’s a quote that goes, “The universe abhors a vacuum.” When there’s space, something will rush in to fill it. If you schedule your day and you leave a gap, something will fill it. If you clean out a room and you don’t put anything in there, clothes will slowly reappear. If we don’t teach people about sex and sexuality, something else will rush in to fill that space.

I think that’s what we’ve seen with disease rates across the board in terms of STIs in the last few years. As a society we’ve decidedly not valued teaching people about sex like we teach people about money or career paths. We’re not giving them the tools to take care of themselves mentally, emotionally, spiritually and physically. More commonly than not then, inaccurate information has filled that void — information that’s built around a desire to control people’s behavior and not necessarily advance their health.

When I think of radically inclusive sex ed from a lifespan perspective, I think about accurate information that comes in all different bite-size forms over your entire life. I’d love to see pre-K have age-appropriate information about sexuality, so that when those kids graduate from high school, they’re not learning about STIs from being treated for an STI.

Sitron: Years and years ago, when you’d look for sex-ed programming, it was called family life education or population control. Then the movement in the 1980s and 1990s was to focus on sex education and sexuality education, to say that you don’t have to be in a family and it’s not about that — it’s about the sex and sexuality.

But what we’ve lost in this focus on the behavior is the part about complex human relationships. We’ve almost over-emphasized the genital and behavioral aspect of sex, which makes it hard for a lot of people to access other parts of it — the parts about communication and relationships that research says parents want their kids to learn. In other words, how can we de-stigmatize sex, dismantling some of the taboo, but also remembering that it still happens in this bigger context?

Because among some of the radical sex-ed movement, there’s such a focus on “sex is good” that sometimes it can be a hard for people to understand more broadly that sex is contextual.