Inadequate Sexual Health Education for High School Students in the United States

Photo by javier trueba on Unsplash

By McKinley Harwood

Published Winter 2023

Special thanks to Alyssa Augustus for editing and research contributions

Summary+

Sexual health education across the United States is inconsistent and inadequate in providing the information necessary to allow individuals to make informed, healthy decisions about their sexuality and sexual activity. Only about half of states require sex education to be taught, and only a quarter require medically accurate information to be taught. This incomplete and sometimes inaccurate curriculum results from contradicting morals and religious teachings, legislation created by state and national governments, and misconceptions about the effects of comprehensive teachings. This inadequate education leads to high rates of teen pregnancies, STD transmissions, and social stigma for LGBTQ individuals. Organizations have attempted to intervene by creating comprehensive curriculums, providing assistance for implementation into school curriculums, and providing information on websites so that individuals can access them for free. In other countries, this form of intervention has proved successful through outcome and impact evaluations. However, while these organizations working in the United States have completed output and outcome measurements, they have done little to evaluate their impact.

Key Takeaways+

• There is no universal curriculum for sexual health education across the United States.
• Inadequate sexual health education is a result of moral and religious controversies, legislation, and misconceptions about the consequences of teaching safe sex for heterosexual and LGBTQ individuals.
• Because of the lack of adequate sex education, the US has one of the highest rates of teen pregnancy in all developed countries.
• High rates of physical health issues, including HIV, chlamydia, gonorrhea, and other STDs, are a consequence of inadequate sexual health education.
• Social stigma for LGBTQ individuals is a significant consequence of incomplete or lack of sex education.
• Best practices exist, and interventions in the form of comprehensive sex education curriculums demonstrate the most significant outcomes, but the complete implementation of a universal curriculum is the most crucial challenge.

Key Terms+

Sexually Transmitted Disease (STD)—An infection transmitted through sexual contact caused by bacteria, viruses, or parasites.¹

Abstinence-Only—A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.²

Comprehensive Sex Education—A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence.³

Contraceptives—A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴

Teen Pregnancy—A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.⁵

Human Immunodeficiency Virus (HIV)—A virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶

Stigma—Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities.⁷

Heteronormativity—Refers to heterosexuality being the norm and dominating other forms of sexuality.⁸

Sexual Orientation—The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual.⁹

Acquired Immunodeficiency Syndrome (AIDS)—The final stage of infection with HIV; it happens when the body’s immune system is badly damaged because of the virus.¹⁰

Human Rights Approach—Access to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health.¹¹

Context

Q: How are we defining adequate sexual health education in this brief?

A: Adequate sexual health education, through the scope of this brief, is defined as having a comprehensive curriculum, being medically accurate, and being taught by trained teachers. The adequacy of sexual health education programs can be indicated by lower teen pregnancyA pregnancy that occurs for a woman under the age of 20, including girls who are under 12.⁵ and STD rates.¹² Curriculums that are comprehensive in nature address issues such as disease prevention, contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴, relationships, communication, and sexuality.¹³ These programs are more successfully taught when the teachers are trained and qualified to address these different topics.¹⁴ To improve training for teachers, it should include the human rights approachAccess to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health.¹¹: providing complete and accurate information in order to allow teenagers to make an informed decision regarding their sexual health, sexual activity, and how to potentially prevent disease.¹⁵

Q: What inadequacies exist in current sexual health education curriculums in the United States?

A: Sexual health education in American high schools is lacking in curriculum, qualified teachers, and inclusive speech. One of the main inadequacies has to do with incomplete curriculums. In 20 out of 34 states that teach abstinence, the curriculum stresses abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.², which is a type of sex education that presents not having sex outside of marriage as the only safe and effective way to prevent pregnancy and STIs.^{16, 17} These programs often eliminate other topics, including human development, relationships, sexual behavior, and sexual health. This focus means that through current sexual health education programs, students are not guaranteed to receive the necessary information to make informed decisions regarding condom use, consent, and whether or not to participate in sexual behaviors.¹⁸ Because knowing about safe sex practices is necessary for people to make an educated decision regarding their health, access to this information is considered a human right by the American Public Health Association.^{19, 20} Another inadequacy includes improperly trained or unqualified teachers. In a qualitative study including 335 sex education teachers at Illinois middle schools and high schools, half of the teachers lacked confidence in teaching about topics regarding condoms and birth control. This may be due to inadequate training these teachers received, as 30% of them said that they had no special training in teaching sex education.²¹ The last main inadequacy that exists within US sexual health education programs is the lack of or inaccuracy of information related to the LGBTQ community. They are often omitted from current high school sexual health education curriculums or spoken of in a derogatory manner.^22,23,24 This style of teaching may leave those individuals who experience something else, for themselves or in their family, feeling isolated.²⁵ Due to inadequacies in the current sexual health curriculum, many high schoolers lack important knowledge that affects their physical, social, and mental well-being.²⁶

Q: Who is affected by this?

A: High school students, ages 14–18, are most in need of adequate sexual health education. This demographic has a high rate of STDs as compared to other age groups, and, according to the CDC, 44% of males and 43% of females participate in intercourse by age 17.^{27, 28} Evidence shows that adequate sex education can increase contraceptive use, decreasing STD and pregnancy rates for teenagers.²⁹ Teenagers require this education because they are going through puberty and are subject to new media with implicit or explicit messages about sex and sexuality. Studies show that 1 out of 5 youth ages 9–17 are exposed to unwanted sexual content online.³⁰ This exposure has been linked to risky sexual health behavior, which is why providing necessary information can help them make informed decisions.³¹ Nearly 40% of all high school students in the US report they have had sex, and 9.7% of high school students have had sex with 4 or more partners during their lifetime.³² Through adequate sexual health education, teens can be more informed about consent and better understand their bodily autonomy.^{33, 34}

Q: Who is most negatively affected by inadequate sex education?

A: To be more effective, sexual health education programs can also be inclusive to LGBTQ individuals to support healthy relationships.³⁵ LGBTQ youth are greatly affected by a lack of inclusivity in many current sexual health education programs. For example, a national survey conducted in 2011 found that 4% of LGBTQ students in middle and high school reported experiencing any positive discussion of LGBTQ-related issues in their sexual health classes.³⁶ This demonstrates the level of exclusion the LGBTQ community experiences due to inadequate sexual health education programs and, because of its severity, the effects will be discussed throughout this brief.^{37, 38}

Photo by Sam Balye on Unsplash

Q: Who determines the curriculum?

A: In the United States Constitution, education is placed under the authority of individual states.³⁹ Because of this, no nationwide curriculum can be instituted by the federal government. While the federal government does not play a direct role in determining the curriculum for sexual health education, it still has a large influence through funding.⁴⁰ At the state level, many state governments have certain required parameters for sexual health education if it is taught in schools, but most allow individual districts to determine their own curriculum requirements. These districts allow the school boards and sometimes advisory boards in which the community (parents, students, teachers, religious leaders, and so on) can make their voices heard and implement the curriculum they agree upon.⁴¹ While these school boards essentially determine the subject and scope of sex education and the budget of these programs, they cannot implement any changes contrary to the current state laws unless they work to change the laws.⁴² Thirty states require some form of sexual health education, and 22 states require that if sex or HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶ education is provided, it must be medically accurate.^{43, 44} California Code 3913 defines medically accurate as “verified or supported by research conducted in compliance with scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field.”⁴⁵

Q: How has sexual health education evolved in the US?

A: Sexual health education has both expanded and been reduced throughout its history in US education. After World War I, during which many American soldiers contracted STIs, public schools began teaching sex education in high schools in response to the increased public focus on the prevention of STIs.⁴⁶ The Chamberlain-Kahn Act allocated federal funding to training teachers in STI prevention for high school sex education programs in the 1919–1920 school year.⁴⁷ During WWII, concern for STIs became mainstream due to the significant increase in STI cases, which made sexual health education an important topic of conversation.⁴⁸ Then in 1960, sex education became about more than disease prevention and started to include topics such as sexuality, which largely remained heterosexually focused. The AIDSThe final stage of infection with HIV; it happens when the body’s immune system is badly damaged because of the virus.¹⁰ epidemic, which began in the 1980s, initiated the debate on whether to teach a comprehensive curriculum or an abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² curriculum. The federal government influenced the lean toward abstinence-only education with the Adolescent Family Life Act (AFLA) created in 1981, which subsidized abstinence-only curricula in schools. During the 1990s and early 2000s, abstinence-only-until-marriage curricula were created by conservative organizations. In 2000, a new federal funding source, the Community-Based Abstinence Education program, supported community-based organizations in teaching abstinence-only-until-marriage material. Then, in 2010, The Office of Adolescent Health (OAH) was created and developed the Teen Pregnancy Prevention Program (TPPP) to fund evidence-based initiatives. There continues to be a push and pull between sex education programs that have created unclear standards and inadequate programs.⁴⁹

Q: How do US sexual health education programs compare to other countries?

A: When comparing the US to similarly developed countries, the US has a limited and underdeveloped sexual health program. Studies show that introducing sexual health education topics in primary school can decrease child sex abuse, dating, and interpersonal violence and increase healthy relationships and appreciation of sexual diversity.⁵⁰ For example, the Netherlands, France, and Australia have sexual health education programs that begin in primary school.⁵¹ Throughout the program, teachers are required to be qualified, meaning they have the training and are up to date with the current medical information available.⁵² The US, on the other hand, does not require teachers to be qualified or trained to teach sexual health education and begins teaching it at the secondary school level.⁵³ The comparison between the US and other similarly developed countries demonstrates that other countries have more developed and effective programs. This is evident in the birth rates per 1,000 adolescents (children aged 15–17) across the 4 countries.⁵⁴ The US birth rate is approximately 8.5 times greater than the Netherlands, 5.5 times greater than France, and 3 times greater than Australia.⁵⁵ The US also has significantly more HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶ cases in men ages 15–24 than in countries in Europe. This includes the US HIV rate being 5 times that of Germany, 3 times as high as the Netherlands, and 1.5 times higher than France. The difference in these rates can be partially tied to less effective sexual health education systems in the United States.⁵⁶

Contributing Factors

Legislation Funding

Federal funding influences inadequate sexual health education in the US by perpetuating abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² education. An abstinence-only curriculum is not an adequate form of sexual health education because it excludes important information and is not comprehensive. States and districts are more likely to adapt this curriculum in order to receive grants and funding from the federal government for their programs.⁵⁷ This can often lead to less comprehensive sexual health education and more inadequate curriculums. In 2017, one-third of the $299 million in federal funding for teen sexual health education programs was for abstinence education which equates to about $99.7 million.⁵⁸ The federal government has several avenues through which they disseminate funding for sexual health education programs, such as the Title V Abstinence-Only-Until-Marriage (AOUM) law, which was established in 1996.

This law dictates that states must match every $4 from the federal government with $3 from the state, and this money must be used for sexual education programs that omit talk of contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴ and condoms except to emphasize their failure rates.⁵⁹ In 2017, $75 million of the $99.7 million in federal funding given was under Title V, indicating that it is the most influential and abundant source of funding for sexual health programs in the US.⁶⁰ Due to its required parameters, it also indicates that schools in the 44 states and 5 territories that receive this funding are adapting their sexual health education curricula to teach abstinence-only curricula or other restricted curricula that do not adequately teach sexual health.⁶¹ These preconditions for funding lead to the furthering of inadequate sexual health education, specifically by teaching abstinence-only and not including talk about contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴ or condoms.

In 2012, the abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² curriculum was rebranded to be called Sexual-Risk Avoidance Education.⁶² This new legislation provides funds to programs educating youth about how to voluntarily refrain from non-marital sexual activity.^63,64 A downside to teaching sex in this manner is that it can inadvertantly contribute to the 11% of high school students who have experienced sexual assault to feel guilty for situations that were beyond their control.⁶⁵ Despite Sexual-Risk Avoidance Education programs failing to address all the necessary topics of comprehensive sexual health education,⁶⁶ federal funding in the US has increased since 2015, from $55 million to $1.1 billion in 2021.⁶⁷ With current legislation, inadequate curriculums continue to be implemented in schools, contributing to inadequate sexual health education among high schoolers in the US.

Ineffective Policies

The current policies, at the national and state level, lead to incomplete and inaccurate sexual health education curriculums across states because the policies do not require principles from adequate sexual health education to be taught. Without a universal sexual health education curriculum for the country, states are left to determine their own parameters for sexual health education programs taught in schools underneath their jurisdiction, causing many programs to be inadequate.⁶⁸ A total of 22 out of the 50 states required some type of sexual health education to be taught; 34 states required that if sex education is taught in schools, abstinence must be covered (of which 20 states require it to be stressed), and 13 required that information on contraception must be taught.⁶⁹ This inconsistency leads to teenagers that are receiving parts of a sexual health education and not being guaranteed the information that will allow them to make informed decisions about relationships and sexual activity.⁷⁰ The absence of national guidelines causes high schoolers throughout the United States to have inconsistent sexual health education that is usually inadequate.

Along with the inconsistencies between states, individual states’ policies contribute to inadequate sexual health education for high schoolers. Under the Utah code 53G-10-402, the state requires that sex education be taught but prohibits the advocacy or encouragement of contraceptive methods or devices.^{71, 72} This policy contributes to inadequate sexual health education by not guaranteeing that high school-aged youth are provided with the information that could prevent the effects of unprotected and unplanned sexual activity. This policy does not provide the information necessary for them to make the most informed decisions for themselves and their body. Other states’ policies are similar to that of Utah and lead to a lack of emphasis on important topics that are part of comprehensive sexual health education programs.⁷³ The Centers for Disease Control and Prevention conducted a survey in 2014 and found that across high schools, sexual health programs spent an average of 6.2 hours on human sexuality and 4 or fewer hours on preventing HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶, STIs, and teen pregnancyA pregnancy that occurs for a woman under the age of 20, including girls who are under 12.⁵.⁷⁴ This study demonstrates the little emphasis that states put on sexual health education, especially the topics covered in more comprehensive programs. Without coverage on topics like contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴, states’ policies can promote inadequate sexual health education.

While examining abstinence curriculum, US congressman Henry Waxman observed that the curricula often taught false information about exaggerated failures of contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴ and risks of abortion and reinforced male and female stereotypes.⁷⁵ These abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² curriculums also fail to address important topics such as healthy relationships.⁷⁶ Communication skills, decision-making skills, violence prevention, and consent are important topics, but all 4 of these topics are only currently being taught in 9 out of the 50 states.⁷⁷ Inconsistencies between states dictating whether or not sexual health education should be taught in schools as well as in the type of information that is taught, leads to incomplete and inadequate sexual health education.

Perceptions of Sexual Health Education

An important contributing factor to the current inadequacies in sexual health education in the United States is the historical beliefs and opinions that originally shaped the curriculums. While these beliefs and opinions no longer represent the majority of the population, their influences remain evident in the current sexual health curriculums. One of the most influential beliefs is that teaching healthy sexual practices to individuals who are part of the LGBTQ community will influence other youth to change their sexuality. A case study in Merrimack, New Hampshire, demonstrated that strong anti-homosexual beliefs led to a policy known as the Prohibition of Alternate Lifestyle Instruction. This case led to the removal of all books and topics from the curriculum that had any connection to homosexuality, including AIDSThe final stage of infection with HIV; it happens when the body’s immune system is badly damaged because of the virus.¹⁰ prevention.⁷⁸ This type of censorship of curricula relating to homosexuality was present across the US and contributed heavily to the specific aspect of inadequate sexual health education of exclusivity. As of April 2022, Mississippi, Oklahoma, and Texas have “no promo homo” laws in place, and more than a dozen other states are proposing “don’t say gay” bills that restrict conversation about homosexuality in the school curricula.^79,80

Another influential historical belief is that teaching safe sex practices, including contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴, will increase sexual behavior among high school students. These beliefs were supported by people such as Judith Reisman in the 1990s, who led many national groups and claimed that sex education in schools was leading children to be more sexual and participate in more sexual behavior.⁸³ These beliefs contributed to the creation of programs that teach abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² until marriage and are incomplete, inaccurate, and not inclusive.⁸⁴ As of 2018, 98% of voters believe that it is important to teach sexual health education in high schools.⁸⁵ Similarly, 73% of parents support federal funding being allocated to sexual health programs that delay sex, improve contraceptive use, and prevent unintended pregnancy.⁸⁶ Public opinion is in favor of comprehensive sexual health education in high schools across the United States, but the curriculums being taught continue to maintain elements that make them inadequate.

Consequences

Teen Pregnancy

The most prevalent and pervasive negative consequence of inadequate sexual education is teen pregnancyA pregnancy that occurs for a woman under the age of 20, including girls who are under 12.⁵. Abstinence-onlyA form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.² education programs have proven ineffective at decreasing teen pregnancy and, in some cases, have shown a correlation with an increase in pregnancies of girls under 20 years old, not due to increased sexual activity but due to a lack of contraceptive use.⁸⁷ In 2017, 194,377 babies were born to girls ages 15–19 in the United States, which constituted a birth rate of 18.8 per 1,000 girls.⁸⁸ When compared to 2006 numbers of 72.2 pregnancies per 1,000 girls with 41.9 births per 1,000 girls, teen pregnancy rates have decreased.⁸⁹ However, the United States still has one of the highest teen pregnancy rates in developed countries. It also has the most limited sexual health education curriculum out of the developed countries.⁹⁰ In a study done on the effectiveness of abstinence education, the youth who received education and the control group who did not were equally as likely to remain abstinent, indicating that abstinence-only curriculums do not decrease sexual activity. Overall, 52% of those who participated in the program participated in sexual intercourse anyway, as opposed to 51% of the control group who participated in sexual intercourse.⁹¹ There was no effect on the level of sexual activity of teenagers because of abstinence education. Studies analyzing comprehensive sex educationA form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence.³ programs showed that 47% of the programs increased condom use, 44% increased the use of contraceptivesA device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.⁴, and 63% reduced sexual risk behavior or unprotected sex. Studies also show that comprehensive programs reduce birth rates.⁹² Comprehensive education teaches teenagers about contraceptives, which would decrease the number of teen pregnanciesA pregnancy that occurs for a woman under the age of 20, including girls who are under 12.⁵ as well as the number of abortions, which are positively correlated with teen pregnancies.⁹³ Between 1991 and 2004 US teen birth rate fell from 62 to 41 births per 1,000 female teens. Although the influence of sex education programs taught during this time is inconclusive, experts attribute decreased pregnancy rates to increased contraceptive use and the delaying of the initiation of sex.⁹⁴ Both of these principles are taught to individuals in comprehensive sex education curriculums, and learning protective information can only encourage teens to take precautionary measures.^{95, 96} Inadequate sexual health education programs do not properly teach teenagers about contraceptives, which increases pregnancy rates.

Sexually Transmitted Diseases

A major consequence of inadequate sexual health education is higher levels of unprotected sex which leads to sexually transmitted diseasesAn infection transmitted through sexual contact caused by bacteria, viruses, or parasites.¹. According to the CDC, in 2019, there were 1.8 million cases of chlamydia and 616,392 cases of gonorrhea. These numbers are 19% and 56% higher than in 2015, respectively.⁹⁷ This increase in sexually transmitted diseases reflects the continuance of inadequate sexual health education in the US since comprehensive education programs have shown that they decrease sexually transmitted diseases.⁹⁸ A report analyzing 56 studies analyzed the effectiveness of abstinence programs compared with comprehensive programs and found that 15 of the 24 comprehensive programs reduced sexual risk-taking while none of the abstinence programs had any effect on risky behaviors.⁹⁹ HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶ is another sexually transmitted disease affected by sexual health education. Young people are the most at risk for not knowing they have HIV because they participate in unprotected sex, which leads to HIV.¹⁰⁰ An estimated 44.9% of young people ages 13–24 who had HIV in 2018 were unaware.

Photo by Reproductive Health Supplies Coalition on Unsplash

The Youth Risk Behavior Surveillance system lists sexual behavior contributing to pregnancy and sexually transmitted diseasesAn infection transmitted through sexual contact caused by bacteria, viruses, or parasites.¹ as one of the six major risk factors for youth, as HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶ is also the sixth leading cause of death for young people.^{101, 102} Lack of education about how STDs are contracted and how to avoid them also leads to an increase in risky behavior. A major consequence of the lack of inclusivity in sexual health programs in high schools is that LGBTQ youth are not provided with information about sexually transmitted diseases. Gay and bisexual men are disproportionately at risk for HIV, and in 2019 they accounted for 70% of the 34,800 new HIV diagnoses in the US.^{103, 104} When compared with white heterosexual women, who had 900 cases in 2014 and 910 cases in 2018, gay men are at a much higher risk of contracting HIV.¹⁰⁵ The exclusion they experience from inadequate sexual health education programs further exacerbates this problem because they are not provided with information about how to protect themselves against HIV and therefore continue to experience a disproportionately high rate of HIV. Programs that do not discuss condom usage increase rates of unprotected sex, which increase the spread of STDs.¹⁰⁶

Social Stigma Towards the LGBTQ Community

Inadequate sexual health education programs in the US have excluded the LGBTQ community, which has led to increased social stigmaOccurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities.⁷. Within these sexual health programs, LGBTQ youth are often left out of sexual education by being left out of the conversation or are talked about negatively by their peers and teachers.¹⁰⁷ Although recent data is limited, according to a study done in 2017, only 13 states required discussion of sexual orientationThe identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual.⁹ in sexual education classes, 9 of which required the discussion to be inclusive, while the 4 others required only negative information about sexual orientation to be taught.^108,109 The lack of sexual education in a majority of schools in the United States can leave LGBTQ individuals feeling unrepresented and uninformed.

On average, 1 in 3 LGBTQ students have skipped class because of feeling unsafe, and they attempt suicide at a rate 4 times that of other youth. In contrast, LGBTQ youth who go to schools that offer inclusive sexual health education report experiencing lower levels of victimization related to their sexual orientationThe identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual.⁹ and gender expression.¹¹⁰ Over 58% of LGBTQ youth who went to schools without inclusive sexual health programs reported hearing homophobic remarks such as “fag” or “dyke.” This proportion was reduced to 38.6% in schools that did offer inclusive sexual health education.¹¹¹ In addition, a study published in 2019 found that a 10% increase in schools teaching LGBTQ-inclusive sex education led to a significant decrease in the amount of gay and lesbian youth experiencing bullying at school.¹¹² This social stigmaOccurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities.⁷ created by exclusive sexual health education programs led to many mental health issues for LGBTQ youth. Specifically, LGBTQ individuals had lower self-esteem and feel that they must hide longer for fear of rejection.¹¹³ They also had an increased likelihood of attempting suicide. The rates of suicide attempts by LGBTQ students are 2 to 7 times higher than the rates for individuals that identify as heterosexual.¹¹⁴ Other mental health issues include feeling victimized and depression.¹¹⁵ Another negative effect of exclusive sex education programs is that LGBTQ individuals are led to seek information from outside sources, including websites, chatrooms, LGBTQ-specific groups, and pornography.^{116, 117, 118} While some of these sources can be beneficial and provide needed information, they can also be extremely harmful and inaccurate. Porn, especially, is associated with increased anxiety, body-image issues, poor self-image, relationship problems, insecurity, and depression.¹¹⁹ Including LGBTQ youth in sexual health education will improve many of the negative mental health issues and will lead to more inclusive environments within high schools.¹²⁰

Practices

Long Live Love

Long Live Love is a sexual health education curriculum incorporated into the Netherlands biology curriculum. This program was designed to provide students with communication and negotiation skills to enable safe sex practices. Developed 24 years ago and regularly updated to include the most up-to-date information, Long Live Love is a 6-lesson, 26-activity program. The main objective of these activities is to prevent STDs, HIVA virus that attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.⁶, and unplanned pregnancies.

The program is designed to be taught in the 2nd, 4th, and 5th year of the vocational schools, and each has an age-appropriate curriculum that builds on the student’s previous education. The themes taught throughout the curriculum include puberty, falling in love, relationships, homosexuality, what you want, drawing the line and assertiveness, the internet, groomers, the first time, problems with sex, getting help, safe sex, condoms, and contraception. As a comprehensive sex educationA form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence.³ program, Long Live Love not only teaches about safe sex practices but how to have and develop healthy relationships and how to be clear on what you want. One of the most important aspects of the program is its implementation in schools. Long Live Love recognizes that a curriculum is of no use to the youth if it is not implemented fully and properly in the classrooms and therefore focuses on this as part of their intervention.

Photo by RODNAE Productions

The Long Live Love program has few measurements available to the public. More measurements regarding the number of people entering their program and how it has affected them will be necessary to see the true impact of the program.

Preferred Citation: Harwood, McKinley. “Inadequate Sexual Health Education for High School Students in the United States.” Ballard Brief. April 2023. www.ballardbrief.byu.edu.

Viewpoints published by Ballard Brief are not necessarily endorsed by BYU or The Church of Jesus Christ of Latter-day Saints