Running head: COMPREHENSIVE SEX ED

Comprehensive Sex Education effects on the reduction of HIV

Samantha M. Waterman

Instructor: Gregory Falls

Global Studies and World Languages Academy at Tallwood High School

COMPREHENSIVE SEX EDUCATION

Abstract 2

Introduction 3

Limitations 4

Lit Review 5

Sex Education in the U.S 6

History of HIV/AIDS in Africa 9

Sex Education in Africa

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Abstract

This paper focuses on the implementation of comprehensive sexual education as an aid to

the HIV/AIDs epidemic within east and South Africa, while also reviewing the improvement of

women’s health due to comprehensive sex education. This paper also reviews the framework of

comprehensive sexual education and reviews the structure’s effectiveness in different regions

that have adapted the structure.

The first section discussed in this paper will explain the history of sex education and the

HIV/AIDs epidemic that devastated the United States around the 80’s and the early 90’s. The

second section will discuss the history of HIV/AIDs in Africa and the beginning of the epidemic.

The third section will review the significance of sex education and what it would mean in terms

of HIV prevention in Africa. The fourth section will review the implementation attempts in

Africa. Finally, the fifth section will review the state of women’s health in both the United States

and Africa, and the effects that comprehensive sex education has had on women’s health. These

reviews will come together to theorize comprehensive sex education as a solution to the

epidemic within Africa.

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Introduction

Sexual education is a structure that relates to the teaching of human sexuality, human

anatomy, autonomy and reproductive health. Sex education has a purpose in specifically teaching

to students in their adolescence, primarily for preventing unwanted pregnancies and STDs in

their futures. This framework of education holds a significance in a nation's sexual health and

development, thus promoting the general welfare of the citizens in that nation. Generally, the

success of sex education also has an impact on specifically women’s health and the growth of

HIV/AIDs in a nation. These are heavily correlated with the quality of sex education, creating a

need for a more advanced and detailed framework that would accommodate these issues

specifically in a developing country. Comprehensive sexual education is primarily for the youth

of these developing nations. The primary purpose for the development of sex education in the

U.S. is to keep both men and women informed on the practice of safe sex and provide access to

tools that would help them achieve that goal of a healthy sex life. Implementing a strong

foundation of education relating to sexuality, while also granting access to the tools necessary to

practice the act of safer sex, is vital to the growth of a nation. This framework of sex education

can strongly benefit the youth of certain regions of Africa, specifically the young women. The

improvement and implementation of comprehensive sex education within the U.S. and

developing countries in Africa can impact the prevention of HIV and AIDs while also raising

awareness of issues regarding women’s health.

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Limitations

Although STDs are a problem around the world, this paper will focus on the growth of

STDs in East Africa and South Africa. More specifically, Mozambique, Zimbabwe, and

Botswana. The specific diseases discussed in this paper will be HIV/AIDs, due to it being quite

an epidemic in this region. The author has no personal connections to any persons of direct

African descent, nor does the author come from any African country; therefore, the author has no

personal bias towards any of the research found on the region. The research regarding the sexual

education in East African countries is limited, due to the lack of sexual education practiced in

those countries. The form of sexual education that is found is mainly “abstinence-only”

education, eliminating discussions around the practice of sex safe. The author also has very

limited experience with successful and comprehensive sexual education. The author, being a

woman, has a bias around the research based entirely on the effects that sexual education has on

women’s health. The author also has personal experience and bias towards the practices being

researched (birth control, emergency contraceptives, and the practice of safe sex in a

monogamous relationship). The research done by the author is modern and updated from any

previous research done on the subject. This paper will be more focused on the youth of Africa,

the developing knowledge and education within the realm of sexual health, with focus on the

young women as well. This subject has a lot of historical context but due to length, cannot be

discussed in its entirety in this paper. The analysis of the history of HIV/AIDs will be based on

its relevance in affecting Africa’s youth.

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Lit Review

Ringheim & Gribble, Karin & James. (2010). Improving the Reproductive Health of

Sub-Saharan Africa’s Youth. [PDF file].

This article goes into detail about the health problems that sub-Saharan Africa is facing,

and how improved education can help. The young women in Africa face threats of early

marriage, unplanned pregnancies, and the risk of contracting HIV. It describes how boys having

more access to information than girls and rural areas where poverty is present plays a role in

child marriages and poor sexual health.

UNAIDS. (2014). The Gap Report. [PDF file].

This report evaluates the data of minority populations that are being left behind due to

stigma, lack of services, and discrimination. This report brings light to the the problems that

these populations face due to their HIV status. It holds the statistics and the numbers of people

who are left behind of those who don’t have a status of HIV, hence the “Gap” report.

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Sex Education significance and history in the US

Sex education is a series of teachings of human sexuality, anatomy and development that

is primarily taught in the adolescence stage of life. This form of education is meant for youth to

lead a healthy and stable sex life in their futures. The history of this concept of providing

accurate information regarding sex arose during the 1900s following a social hygiene movement,

“founded in the United States in 1905 by Prince A. Morrow, the social hygiene movement

argued that the problems of sex arose, not from an evil human nature, but from ignorance.

Education was key, and teaching the young was essential” (Huber & Firmin, 2014, p. 27).

Initially, the social hygiene movement was brought about to avoid sexually transmitted diseases,

but then progressed into teachings that would help improve the sexual attitudes and knowledge

of the general public (Huber & Firmin 2014, p. 27). This movement laid down a strong

foundation of education that has progressed over time, constantly adapting to society’s

ever-changing issues regarding sexual health. However, the changes made in this field have also

regressed over time, due to shifting public attitudes towards sexual health.

Over time, America’s attitudes about sex and the way we access knowledge about it, have

changed. In the 1980s, there were widespread debates between more accessible comprehensive

sexual education in schools, and abstinence only programs (Planned Parenthood, 2016). The

main argument against the more comprehensive education was that it would actually increase

risky behavior among adolescents. In fact, it has been proven with significant evidence that this

is not true, and that abstinence only programs have not shown the same success rates as

comprehensive sexual education (Planned Parenthood, 2016). It has been shown that

implementing this framework upon teens in schools has “delayed the initiation of sex, increased

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condom or contraceptive use, or both” (Kirby, 2007). Contrarily, abstinence only programs have

been the favored view of the U.S. government. The U.S has been funding abstinence-only

programs for over a decade to reduce the rates of pregnancy and STDs among teens

(Stanger-Hall & Hall, 2011). The general message that these programs convey to teens is to wait

until marriage, and does not include information on contraception or safe sex practices. “Young

people (aged 13-24) accounted for an estimated 21% of all new HIV diagnoses in the United

States in 2016” (CDC, 2016), these alarming rates are heavily correlated with the attitudes

towards sex that is conveyed through abstinence-only education. Furthermore, there is no strong

evidence to support that abstinence-only programs delays the initiation of sex among teens or

decrease the number of sexual partners among teens (Kirby, 2007). These findings render

abstinence-only programs to be ineffective, thus strengthening the argument for more schools to

adapt comprehensive sexual education.

The push for comprehensive sexual education in schools has been heavily advocated for

throughout history, mainly because schools are the hub of knowledge for adolescents. The social

hygiene movement during the Progressive-era promoted sexual education within schools because

advocates believed that “sexual problems prevailed because there was an unwillingness to

address the problems openly” (Huber & Firmin, 2014, p. 30). The general message that children

needed a space to gain adequate information in order to control their sexual behavior, has been

the main goal of sexual education for decades. Although this message was understood by most

pioneers of the sexual revolution in the 1960s, there were also strong opponents who claimed

that implementing this into schools would damage children’s purity; however, this did not stop

the widespread support of the growing subculture within the sexual revolution from heavily

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influencing the implementation of sex education in schools (Huber & Firmin, 2014, p. 36). The

support for sexual education grew in the 1980s when the AIDs epidemic broke out, an

overwhelming majority of states agreed that teaching sex education to students is crucial (TIME,

Rothman, 2014).

When AIDs broke out in the 1980s, there was a nuance to the decades long debate. There

was a shift in what should be taught in sex education classes. Parents, teachers, and politicians

were now more involved than ever in the conversation of what to include in these courses.

Regarding the stigma of AIDs at the time, it was now a debate on whether or not homosexual

relations should be taught in sex education courses. Surgeon General C. Everett Koop made it

clear in a 1986 interview published in TIME, that these things should indefinitely be taught in

schools. It was clear that “we have to be explicit as necessary to get the message across” (TIME,

Leo, 1986). This sentiment influenced growth of sex education in the 90s, with the publishing of

the Guidelines for Comprehensive Sexuality Education - Kindergarten - 12th grade in 1991

(Planned Parenthood, 2016, p. 2). This publication has inspired the development and

implementation of several sex education programs that have been evaluated to better understand

the different approaches that better help young people achieve the goal of sexual health (Planned

Parenthood, 2016, p. 2).

These events have changed the way that sex education is viewed in society and have

influenced the conversation regarding sexual health. The framework currently implemented in

U.S. schools have progressed throughout history, sparking many different conversations around

sexual health. With the general public’s support and politicians’ funding, the evaluations and

advancements made in the framework of comprehensive sex education has been vital to

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understanding how to prevent HIV among adolescents. There has been a development of “44

evidence-based curricula that are effective at preventing teen pregnancies, reducing sex ually

transmitted infections, or reducing rates of associated sexual risk behaviors — sexual activity

and number of partners — as well as increasing contraceptive use” (Planned Parenthood, 2016 p.

5). This has been due to the overwhelming support and advocates for this cause, such as the

contribution made by the Obama administration in 2009, “the Obama administration transferred

funds from the Community-based Abstinence Education Program, and budgeted $190 million in

new funding for two new sex education initiatives: the Teen Pregnancy Prevention Program

(TPPP) and the Personal Responsibility Education Program (PREP)” (Planned Parenthood, 2016

p. 5). With money being put aside to fund education that has proven to promote and sustain

sexual health among teens. The implementation of comprehensive sex education has successful

in the U.S. in promoting and progressing sexual health among teens.

History of HIV/AIDs in Africa

This history of this disease and the epidemic to follow it has an extensive and tragic

history, affecting the population heavily and devastating the continent immensely. The origins of

HIV is believed to be in the Democratic Republic of Congo, when it crossed from chimpanzee to

a human in 1920 (AVERT, 2018). By the 1960s, there’s data to suggest that 2,000 people in

Africa had been inflicted by the HIV virus. The virus was most likely carried throughout East

Africa (Uganda, Rwanda, Burundi, Tanzania, and Kenya), during the 1970s (Thomas, 2015).

Much like the U.S. the first widespread epidemic within Africa happened during the 1980s,

hitting Uganda the hardest (Thomas, 2015).

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Due to the causes of the disease being unknown, stigma around the disease arose, leaving

many confused and misinformed of the disease. The main stigma of this disease was often linked

to homosexual men, a stigma that also reached to medical teams operating on this sudden

outbreak. David Serwadda, a former medical resident at the Uganda Cancer Institute, stated “But

we just could not connect a disease in white, homosexual males in San Francisco to the thing that

we were staring at…” (Thomas, 2015). These stigmas were immensely damaging to people

living with the disease. These stigmas affects the care that these people recieve, especially the

fear of facing these stigmas fuels the epidemic by fueling secrecracy and denial (Brennan, Schell,

Laviwa, Rankin & Rankin, 2005). Due to these stigmas being highly active in these

communities, individuals can be isolated from their own families, lose community support, and

can be hidden away from visitors by their families (Brennan, Schell, Laviwa, Rankin & Rankin,

2005). Women have also been identified as one of the main groups who face stigmatization

within their communities. With already having the traditional expectations of bearing children

and fulfilling the sexual desires of men, the inequality within these roles have predisposed

women to the infection by having a dynamic that only benefits the man (Brennan, Schell,

Laviwa, Rankin & Rankin, 2005).

The HIV/AIDS epidemic continued to grow in Africa, hitting South Africa in 1982. The

epidemic was initially ignored due to the country overcoming apartheid (Cichocki, 2018). The

government ignored a steadily growing disease within the communities in South Africa, with

HIV rates growing by 60%. Although it was eventually acknowledged by the late 90’s by Nelson

Mandela, South Africa had already become one of the largest populations suffering with HIV in

the world (Cichocki, 2018). The majority of those affected by the disease have been those living

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in poverty, with very little resources to help those in need. Women also account for 55% of these

new infections, signaling a call for action.

Sex Education significance in Africa

The framework of sex education within the U.S. has proven strong benefits for the youth

within the country; therefore, the implementation of the framework could strongly benefit the

youth in other nations. Especially the countries in Africa that have high rates of HIV/AIDs,

comprehensive sex education has been offered as a solution to the growth of HIV. There has

been an existing focus on the youth of Sub-Saharan Africa. The push for comprehensive sex

education in Africa has been the topic of discussion for many global health organizations

advocating for the sexual health of countries especially in East Africa.

The most heavily affected countries in Africa are: Mozambique, Zimbabwe, Botswana,

and Swaziland. This countries have a high prevalence of HIV among adults, leaving 17.1 million

people living with the infection in Eastern and Southern Africa (UNAIDS, 2013 p. ii). The

biggest factor in the growth of this infection among adults is unprotected sex. There has also

especially been a significant rise in HIV among the young people in these countries, “an

estimated 2.7 million young people, aged 15–24 years, living with HIV in the eastern and

southern African region” (UNAIDS, 2013 p. 19). There has also been a disproportionate number

of young women being infected by HIV to young men in these countries. Young women have

been proven to be more vulnerable to this infection due to the high number of marriages between

these young women to men much older than them (AVERT, 2018). Child marriages in Africa are

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most likely to happen to young girls in poor and rural areas, and more often than not, they are

less educated than those who are not from those areas (Ringheim & Gibber, 2010). Another

factor in young women being heavily affected by the infection, is domestic violence. In a study

done in South Africa showed that women who experienced domestic violence were “50% more

likely to have acquired HIV than women who had not experienced violence” (UNAIDS, 2014 p.

36). Within these factors, there is an underlying cause for all of them: lack of education.

There is an alarming rate of adolescents who are not properly educated on HIV, nor sex

in general. A study has shown that seven out of ten adolescents reported to not have the correct

knowledge on HIV, and 82% reported that they don’t believe they’ll get infected (UNAIDS,

2014 p. 34). These reports reflect the current state of sex education in Africa. Regardless of the

stigma around this infection, it is very crucial for adolescents to access to information about how

this infection is transmitted. Although education among adolescents is vital to the prevention of

the spread of HIV, there is a disparaging gap between the access of information among young

men and women. In Mozambique, young girls have high rates of dropping school after only

attending the primary level of education, leaving only 11% of girls going on to complete a

secondary education (Borgen Magazine, 2015). The biggest obstacle in girls’ education has been

due to poverty. Young girls who don’t have the same education opportunities as young men,

gives them less access and exposure to information regarding sex and STDs; therefore, making

them more vulnerable to HIV. Young women in Sub-Saharan Africa are at a dangerously high

risk of contracting the infection than their male counterparts, “women acquire HIV infection at

least 5–7 years earlier than men” (UNAIDS Gap Report, 2014 p. 20). Young women experience

these disparities at high rates in especially Eastern and Southern Africa, with Mozambique’s

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women having “an HIV prevalence of 7%, which doubled to 15% by the time they were 25 years

of age” (UNAIDS Gap Report, 2014 p. 32). The lack of educational opportunities among young

women in these countries can heavily affect their abilities to protect themselves from this

infection.

Investing in education in these regions in Africa for young women has the potential to

significantly reduce the rates of HIV. For a young woman in these regions in Africa, an

education can delay marriage; furthermore, they can prepare for a healthy and stable life. In

Mozambique, 79% of young women before the age of 18 have had sex or have been married as a

child (Ringheim & Gribble, 2010). One of the biggest concerns for these women is their

reproductive health which can be heavily affected by their level of their education. Secondary

schooling has been the main focus for young girls to enroll, because that is where they lack

behind their male peers. Access to media is vital to understanding and learning information. The

limited access in media for young women leads to less information regarding sexual health and

HIV prevention. In East African countries, it has been shown the young men had more of an

understanding on how to prevent HIV than young women, capable of listing multiple methods

(Ringheim & Gribble, 2010). These young women that lag behind their male peers are often

found in poor and rural areas. An implementation of comprehensive sex education should be able

to also reach to young women in these areas (Ringheim & Gribble, 2010). Investing in the

reproductive health education in these countries would also be significantly investing in the

health of these women from those countries.

Implementation Attempts

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There have been many initiatives to implement a more comprehensive educational

system that would not only benefit the adolescents, but also women in these regions. The main

reason for many of these initiatives is to lower the rates of HIV among these groups. Many

programs that seek to implement these systems, use “Millennium Development Goals”,

international goals set by the UN to be completed in 2015; addressing poverty, disease, gender

inequality, and education. These goals were agreed by all United Nations member states (Global

Health Action, 2014). Many of these goals are to help youth around the world. Gender equality

and women’s empowerment is the third goal out of eight, tackling the gender disparities in

education (Kabeer, 2015). Equal access to education for women is vital to HIV prevention.

There are different kind of interventions for the HIV epidemic that tackle different areas

of HIV prevention. Behavioral interventions use information based methods, such as sex

education; addressing the sources of risky behaviors (AVERT, 2017). An example of this

intervention would be the implementation of Zimbabwe’s national behavior programme, with a

framework that recognized that education has the capability of influencing risky behaviors

(HDRC, 2011). Another example of a comprehensive approach using a behavioral intervention is

the multimedia program, loveLife in South Africa. This organization has been aimed at the youth

of South Africa to prevent HIV transmissions. This organization hosts a variety of programs that

provide information to adolescents about condom use and healthy relationships (SANGONeT,

2016). Although these programs have provided to be successful in these areas, it has not been

implemented everywhere, leaving only 36% of young men and 30% of young women being able

to communicate different methods of HIV prevention (AVERT, 2016). These programs need to

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be considered for expansion among these regions in Africa in order to reduce HIV/AIDs within

these groups.

Conclusion

With the rates of the infection rising within these countries that don’t have a stable nor

successful sex education system, implementing a new framework for these countries can greatly

reduce these rates. These countries need more encouragement to execute a more intricate

framework of sex education to not only reduce the growth of HIV/AIDS, but to save the many

women living in rural and poor areas within the continent. Providing a more comprehensive sex

education would also greatly improve the understanding of sex and how to be safe in order to

avoid further spreading within these populations.

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Ringheim & Gribble, Karin & James. (2010). ​Improving the Reproductive Health of

Sub-Saharan Africa’s Youth​. [PDF file].

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