Sex Education That Works

What is sex education?

HIV and sex education for scouts in the Central African Republic

Sex education ('sex ed'), which is sometimes called sexuality education or sex and relationships education, is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. Sex education is also about developing young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices.It is widely accepted that young people have a right to sex education. This is because it is a means by which they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases and HIV and AIDS. It is also argued that providing sex education helps to meet young people’s rights to information about matters that affect them, their right to have their needs met and to help them enjoy their sexuality and the relationships that they form. 1 2 3 4 5

What are the aims of sex education?

Sex education aims to reduce the risks of potentially negative outcomes from sexual behaviour, such as unwanted or unplanned pregnancies and infection with sexually transmitted diseases including HIV. It also aims to contribute to young people’s positive experience of their sexuality, by enhancing the quality of their relationships and their ability to make informed decisions over their lifetime. Sex education should be more than just puberty and reproductive biology; it should help young people to be safe and enjoy their sexuality. 6

What skills should sex education develop?

If sex education is going to be effective it needs to include opportunities for young people to develop skills, as it can be hard for them to act on the basis of only having information. 7 8 9
The skills young people develop as part of sex education are linked to more general life-skills. Being able to communicate, listen, negotiate with others, ask for and identify sources of help and advice, are useful life-skills which can be applied to sexual relationships. Effective sex education develops young people's skills in negotiation, decision-making, assertion and listening. Other important skills include being able to recognise pressures from other people and to resist them, dealing with and challenging prejudice and being able to seek help from adults - including parents, carers and professionals - through the family, community and health and welfare services.
Sex education that works also helps equip young people with the skills to be able to differentiate between accurate and inaccurate information, and to discuss a range of moral and social issues and perspectives on sex and sexuality, including different cultural attitudes and sensitive issues like sexuality, abortion and contraception. 10 11 12 13

Forming attitudes and beliefs

Young people can be exposed to a wide range of attitudes and beliefs in relation to sex and sexuality. For example, some health messages emphasise the risks and dangers associated with sexual activity and some media coverage promotes the idea that being sexually active makes a person more attractive and mature. Because sex and sexuality are sensitive subjects, young people and sex educators can have strong views on what attitudes people should hold, and what moral framework should govern people's behaviour.
Young people can be very interested in the moral and cultural frameworks that bind sex and sexuality. They often welcome opportunities to talk about issues where people have strong views, like abortion, sex before marriage, lesbian,  gay and contraception and birth control. It is important to remember that talking in a balanced way about differences in opinion does not promote one set of views over another, or mean that one agrees with a particular view. Part of exploring and understanding cultural, religious and moral views is finding out that you can agree to disagree.
People providing sex education have attitudes and beliefs of their own about sex and sexuality and it is important not to let these influence negatively the sex education that they provide. For example, even if a person believes that young people should not have sex until they are married, this does not imply withholding important information about safer sex and contraception. Attempts to impose narrow moralistic views about sex and sexuality on young people through sex education have failed. 14 15 16 Rather than trying to deter or frighten young people away from having sex, effective sex education includes work on attitudes and beliefs that enable young people to choose whether or not to have a sexual relationship, taking into account the potential risks of any sexual activity.

“Attempts to impose narrow moralistic views about sex and sexuality on young people through sex education have failed.”

Effective sex education also provides young people with an opportunity to explore the reasons why people have sex, and to think about how it involves emotions, respect for one self and other people and their feelings, decisions and bodies. Young people should have the chance to explore gender differences and how ethnicity and sexuality can influence people's feelings and options. 17 18 They should be able to decide for themselves what the positive qualities of relationships are. It is important that they understand how bullying, stereotyping, abuse and exploitation can negatively influence relationships.

So what information should be given to young people?

Young people get information about sex and sexuality from a wide range of sources including each other, through the media including advertising, television and magazines, as well as leaflets, books and websites (such as www.avert.org). Some of this will be accurate and some inaccurate. Providing information through sex education is therefore about finding out what young people already know and adding to their existing knowledge and correcting any misinformation they may have. For example, young people may have heard that condoms are not effective against HIV or that there is a cure for AIDS. It is important to provide information which corrects mistaken beliefs. Without correct information young people can put themselves at greater risk.
Information is also important as the basis on which young people can develop well-informed attitudes and views about sex and sexuality. Young people need to have information on all the following topics:

• Sexual development & reproduction - the physical and emotional changes associated with puberty and sexual reproduction, including fertilisation and conception, as well as sexually transmitted diseases and HIV.
• Contraception & birth control - what contraceptives there are, how they work, how people use them, how they decide what to use or not, how they can be obtained, and abortion.
• Relationships - what kinds of relationships there are, love and commitment, marriage and partnership and the law relating to sexual behaviour and relationships as well as the range of religious and cultural views on sex and sexuality and sexual diversity.
• Sexuality - including all the above for young people that are heterosexual or homosexual.

When should sex education start?

“Providing basic information provides the foundation on which more complex knowledge is built up over time.”

Sex education should start early, before young people reach puberty, and before they have developed established patterns of behaviour. 19 20 21 22 The precise age at which information should be provided depends on the physical, emotional and intellectual development of the young people as well as their level of understanding. What is covered and also how, depends on who is providing the sex education, when they are providing it, and in what context, as well as what the individual young person wants to know about. 23
It is important for sex education to begin at a young age and also that it is sustained. Giving young people basic information from an early age provides the foundation on which more complex knowledge is built up over time. For example, when they are very young, children can be informed about how people grow and change over time, and this provides the basis on which they understand more detailed information about puberty provided in the pre-teenage years. They can also be provided with information about viruses and germs that attack the body. This provides the basis for talking to them later about infections that can be caught through sexual contact.

Does sex education at an early age encourage young people to have sex?

Some people are concerned that providing information about sex and sexuality arouses curiosity and can lead to sexual experimentation. However, in a review of 48 studies of comprehensive sex and STD/HIV education programmes in US schools, there was found to be strong evidence that such programmes did not increase sexual activity. Some of them reduced sexual activity, or increased rates of condom use or other contraceptives, or both. 24 It is important to remember that young people can store up information provided at any time, for a time when they need it later on.

When should parents start talking to young people about sex?

Father and baby

Sometimes it can be difficult for adults to know when to raise issues, but the important thing is to maintain an open relationship with children which provides them with opportunities to ask questions when they have them. Parents and carers can also be proactive and engage young people in discussions about sex, sexuality and relationships. Naturally, many parents and their children feel embarrassed about talking about some aspects of sex and sexuality. The best basis to proceed on is a sound relationship in which a young person feels able to ask a question or raise an issue if they feel they need to. It has been shown that in countries like The Netherlands, where many families regard it as an important responsibility to talk openly with children about sex and sexuality, this contributes to greater cultural openness about sex and sexuality and improved sexual health among young people. 25The role of many parents and carers as sex educators changes as young people get older and are provided with more opportunities to receive formal sex education through schools and community-settings. However, it doesn't get any less important. Because sex education in school tends to take place in blocks of time, it can't always address issues relevant to young people at a particular time, and parents can fulfill a particularly important role in providing information and opportunities to discuss things as they arise. 26

Who should provide sex education?

Sex education can take place in a variety of settings, both in and out of school. In these different contexts, different people have the opportunity and responsibility to provide sex education for young people.

Parents/carers

At home, young people can easily have one-to-one discussions with parents or carers which focus on specific issues, questions or concerns. They can have a dialogue about their attitudes and views. Sex education at home also tends to take place over a long time, and involve lots of short interactions between parents and children. As young people get older, advantage can be taken of opportunities provided by things seen on television for example, as an opportunity to initiate conversation. It is also important not to defer dealing with a question or issue for too long as it can suggest that you are unwilling to talk about it. There is evidence that positive parent-child communication about sexual matters can lead to greater condom use among young men and a lower rate of teenage conception among young women. 27

Young people

In some countries, the involvement of young people themselves in developing and providing sex education has increased as a means of ensuring the relevance and accessibility of provision. Consultation with young people at the point when programmes are designed, helps ensure that they are relevant and the involvement of young people in delivering programmes may reinforce messages as they model attitudes and behaviour to their peers. 28 29 30 As part of their school-based Sex and Relationship Education programme, the UK-based organisation, Apause involves peer-educators to achieve positive behaviour change among students aged 13 and 14, with an aim to reduce the rates of first intercourse before the age of 16. 31

Teachers

In school the interaction between the teacher and young people takes a different form and is often provided in organised blocks of lessons. It is not as well suited to advising the individual as it is to providing information from an impartial point of view. The most effective sex education acknowledges the different contributions each setting can make. School programmes which involve parents, notifying them what is being taught and when, can support the initiation of dialogue at home.

Effective school-based sex education

School-based sex education can be an important and effective way of enhancing young people's knowledge, attitudes and behaviour. There is widespread agreement that formal education should include sex education. Evidence suggests that effective school programmes will include the following elements:

• A focus on reducing specific risky behaviours
• A basis in theories which explain what influences people's sexual choices and behaviour
• A clear, and continuously reinforced message about sexual behaviour and risk reduction
• Providing accurate information about, the risks associated with sexual activity, about contraception and birth control, and about methods of avoiding or deferring intercourse
• Dealing with peer and other social pressures on young people; providing opportunities to practise communication, negotiation and assertion skills
• Uses a variety of approaches to teaching and learning that involve and engage young people and help them to personalise the information
• Uses approaches to teaching and learning which are appropriate to young people's age, experience and cultural background
• Is provided by people who believe in what they are saying and have access to support in the form of training or consultation with other sex educators
• Focuses on both heterosexual and homosexual relations.

Formal programmes with all these elements have been shown to increase young people's levels of knowledge about sex and sexuality, put back the average age at which they first have sexual intercourse and decrease risk when they do have sex.
In addition to this, effective sex education is supported by links to sexual health services and takes into account the messages about sexual values and behaviour young people get from other sources (such as friends and the media). It is also responsive to the needs of the young people themselves - whether they are girls or boys, on their own or in a single sex or mixed sex group, and what they know already, their age and experiences.

Including sexuality in sex education

In some schools, sex education classes will be covered by a regular school teacher who has volunteered. Other schools have no sex education on their curriculum, and what little information the students receive comes under the umbrella of the biology syllabus.

“The discomfort of teachers and parents has been, for too long, allowed to frustrate the needs of pupils both gay and straight.”

Sexual health education should involve discussion of gay and straight issues. Often, when schools offer practical advice in avoiding HIV infection and STDs, it is aimed at straight pupils, with no mention of prevention methods for gay pupils. This may be because STD and HIV prevention for gay men and lesbians involves discussion of ‘ gay sex’.
Often, teachers are too embarrassed to discuss same-sex relations. However, no sexual health education class can be even remotely adequate without including this type of information. If regular teachers are too uncomfortable dealing with sexual issues, then an external specialist teacher should take some sessions.

Importance of sexuality in sex education

Given that gay men are disproportionately vulnerable to HIV infection and certain STDs, any comprehensive sexual health course should offer information about how gay men can protect themselves from infection. This necessarily involves discussing topics that need to be more explicit, such as safer sex for gay men. It is not possible to teach about safer sex without mention, and ideally discussion, of different sexual practices.
It is also important for young people to receive information about gay sexuality, in addition to just sexual health. Gay pupils need information that will give them an idea of the experience of living as a gay person in the wider world outside the classroom. This also helps to dispel ignorance and prejudice amongst other pupils. Lessons might include topics such as rights of gay spouses and same-sex parents.
Sexual health education, if it exists, offers the opportunity to begin providing education about different sexualities and different lifestyles. This needn’t be restricted to a sexual health class, and should discuss both heterosexual and homosexual relationships. 32

“I told a few other close friends but one day in an AS level history class we ended up discussing HIV/AIDS rather than the German Reformation. Well one person said 'Its all them who spread it- those gays' to which in outrage I shouted ‘WE DON'T SPREAD IT THANK YOU!’" - Tom

Teaching teachers

A UK survey found that less than half of teachers would feel confident in providing pupils with information on lesbian and gay issues. 33 A teacher who isn't trained in sexual health education is likely to feel uncomfortable when asked to teach a safer-sex lesson involving topics such as ‘oral sex’, ‘anal sex’, and ‘sex between women’. This discomfort will be picked up by the pupils, and often leads to important topics being brushed over. A teacher who knows their topic well is much more comfortable in the classroom, and thereby makes pupils much more comfortable with the topic. 34

“An uncomfortable teacher will have a dysfunctional class, with students giggling together behind cupped hands.”

Students need to be able to get on with group work, engage with their topic enthusiastically, and indulge their natural interest in learning about issues that ultimately will affect them. In a well-managed class, pupils' own interest will provide the motivation to learn. An uncomfortable teacher will have a dysfunctional class, with students giggling together behind cupped hands, whispering at the back of class, and trying to embarrass the teacher further by asking awkward questions. At the end of this class, students will be no better informed than they were at the beginning of it. 35
Teacher training is one obvious answer to this problem. Appropriate training for teachers can familiarise them with questions that they might have to deal with, and ensure that their knowledge of the subject is complete.
Another solution would be for the school to bring in teachers from outside the school to teach HIV, sexual health and sexuality education topics, or to have one teacher in the school who is designated with responsibility for these topics. Social education such as the awareness of prejudice should be present throughout the curriculum.
There is a serious lack of specific training for teachers in many countries, meaning that the majority of pupils receive extremely limited sexual health education with no information for gay pupils.

Barriers to providing sex education

Some schools have no sex education on their curriculum. This can be a result of the wider political climate and legislation in a country, or the stance of the school itself. Some academic planners fear that pupils who are taught about gay sexuality will want to rush out and try it. This is an argument that is often used by those who oppose comprehensive sex education in schools. On the contrary, an abundance of studies have shown that sex education reduces teenage pregnancies and STD infection rates. 36
Many schools that have a strong religious influence are opposed to comprehensive sex education. This can severely limit a pupil's education, with information only being provided in their biology class under the heading of ‘reproduction’. These classes can be about, literally, the ‘birds and the bees’. They often leave young people confused and ignorant, and communicate that human sexuality is embarrassing and shouldn't be discussed. 37 38 This not only means that homosexuality is unlikely to be adequately discussed (if at all), but furthermore, a teacher who communicates to the class that these topics are uncomfortable, will damage the self-respect of gay class-members, and amplify the prejudice they already experience.
The UK government makes sex and relationships education compulsory at primary and secondary level, and removes parents' right to opt their children out of these lessons until they are 15. 39 However, it is vital that this progress is reflected in the attitudes and capabilities of those who are carrying out sexual health education. Teachers shouldn’t feel uncomfortable about their topic, and certainly shouldn’t, themselves, be prejudiced against gay men and lesbians.
This is a problem that needs to be addressed by society as a whole – parents are often uncomfortable talking to their children about sex, and are little happier about the idea of their teacher providing the necessary information. 40 Parents need to know that sex and HIV education is ‘safe’, and that it won’t encourage any ‘immoral’ behaviour in their offspring, whether gay or straight.

Taking sex education forward

Providing effective sex education can seem daunting because it means tackling potentially sensitive issues and involving a variety of people – parents, schools, community groups and health service providers. However, because sex education comprises many individual activities, which take place across a wide range of settings and periods of time, there are lots of opportunities to contribute.
The nature of a person's contribution depends on their relationship, role and expertise in relation to young people. For example, parents are best placed in relation to young people to provide continuity of individual support and education starting from early in their lives. School-based education programmes are particularly good at providing information and opportunities for skills development and attitude clarification in more formal ways, through lessons within a curriculum. Community-based projects provide opportunities for young people to access advice and information in less formal ways. Sex education through the mass media, often supported by local, regional or national Government and non-governmental agencies and departments, can help to raise public awareness of sex health issues.
There is a need to pay more attention to the needs of specific groups of young people like young parents, young lesbian, gay and bisexual people, as well as those who may be out of touch with services and schools and socially vulnerable, like young refugees and asylum-seekers, young people in care, young people in prisons, and also those living on the street.
The circumstances and context available to parents and other sex educators are different from place to place. Practical or political realities in a particular country may limit people's ability to provide young people with comprehensive sex education. But the basic principles outlined here apply everywhere. By making contributions and valuing that made by others, and by being guided by these principles, more sex education and support for young people can be provided.