Original Article

Sex Education and Sexual Risk Behavior among Adolescents and Youth in the Deep South: Implications for Youth HIV Prevention

Authors: Paul A. Burns, PhD, MS, Fei Teng, MPH, PhD Candidate, Angela A. Omondi, PhD, E. Thomaseo Burton, PhD, MPH, Lori Ward PhD, MS

Abstract

Objectives: Adolescents and young adults represent the largest group of new human immunodeficiency virus (HIV) infections in the United States, especially in the South. We wanted to determine whether abstinence only until marriage (AOUM) sex education programs were effective in reducing HIV vulnerability among youth in Mississippi.

Methods: Using the 2015 Mississippi Youth Risk Behavior Surveillance System, we examined the effect of AOUM sex education among a sample of youth ages 12 to 18 years on 4 HIV-related sexual risk behaviors.

Results: Compared with youth not enrolled in AOUM sex education, we found no statistically significant differences on sexual risk behaviors. Race, age, and gender were significant risk factors in predicting sexual risk behavior.

Conclusions: AOUM sex education programs are ineffective in reducing HIV vulnerability among youth in Mississippi. There is an urgent need to implement comprehensive sex education if we are to reduce the numbers of new HIV infections among youth and achieve our goals of ending the HIV epidemic by 2030.
Posted in: Infectious Disease80 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection9

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References

1. The Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS statistics—2019 fact sheet. https://www.unaids.org/en/resources/fact-sheet. Published 2019. Accessed February 20, 2022.
 
2. Centers for Disease Control and Prevention. Diagnoses of HIV infection among adolescents and young adults in the United States and 6 dependent areas, 2011–2016. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-3.pdf. Published 2018. Accessed February 20, 2022.
 
3. Centers for Disease Control and Prevention. Teen birth rate by state. https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm. Accessed February 20, 2022.
 
4. Centers for Disease Control and Prevention. HIV surveillance - adolescents and young adults, 2018 (preliminary). https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-adolescents-young-adults-2018.pdf. Accessed February 20, 2022.
 
5. Singhal A, Rogers EM. Combating AIDS: Communication Strategies in Action. Thousand Oaks, CA: Sage; 2003.
 
6. Hall KS, Sales JM, Komro KA, et al. The state of sex education in the United States. J Adolesc Health 2016;58:595–597.
 
7. US House of Representatives Committee on Government Reform— Minority Staff Special Investigations Division. The content of federally funded abstinence-only education programs. Prepared for Rep. Henry A. Waxman. https://spot.colorado.edu/~tooley/HenryWaxman.pdf. Published 2004. Accessed February 20, 2022.
 
8. Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. J Adolesc Health 2007;40:206–217.
 
9. Santelli J, Ott MA, Lyon M, et al. Abstinence and abstinence-only education: a review of US policies and programs. J Adolesc Health 2006;38:72–81.
 
10. National Conference of State Legislatures. State policies on sex education in schools. https://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx. Published October 1, 2020. Accessed February 20, 2022.
 
11. Borawski EA, Tufts KA, Trapl ES, et al. Effectiveness of health education teachers and school nurses teaching sexually transmitted infections/human immunodeficiency virus prevention knowledge and skills in high school. J School Health 2015;85:189–196.
 
12. Lord AM. Condom Nation: The US Government's Sex Education Campaign from World War I to the Internet. Baltimore, MD: Johns Hopkins University Press; 2009.
 
13. Luker K. When Sex Goes to School: Warring Views on Sex—and Sex Education—Since the Sixties. New York: WW Norton; 2007.
 
14. Leung H, Shek DT, Leung E, et al. Development of contextually-relevant sexuality education: lessons from a comprehensive review of adolescent sexuality education across cultures. Int J Environ Res Public Health 2019;16:621.
 
15. McKee C, Ragsdale K, Southward LH. What do parents in Mississippi really think about sex education in school?: results of a state-level survey. J Health Dispar Res Pract 2014;7:97–119.
 
16. Markham CM, Tortolero SR, Peskin MF, et al. Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial. J Adolesc Health 2012;50:279–288.
 
17. Tortolero SR, Markham CM, Peskin MF, et al. It's your game: keep it real. Delaying sexual behavior with an effective middle school program. J Adolesc Health 2010;46:169–179.
 
18. Wingood GM, DiClemente RJ, Robinson-Simpson L, et al. Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women: a randomized-controlled trial. J Acquir Immune Defic Syndr 2013; 63(suppl 1):S36–S43.
 
19. Sexuality Information and Education Council of the United States. State laws and policies across the United States. https://siecus.org/wp-content/uploads/2019/03/FY18-State-Law-and-Policy-Chart-Final-1.pdf. Published 2018. Accessed February 20, 2022.
 
20. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance— United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:1–174.
 
21. Mississippi State Department of Health. 2015 Mississippi youth risk behavior survey. https://msdh.ms.gov/msdhsite/_static/resources/7429.pdf. Published 2017. Accessed February 20, 2022.
 
22. Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health 2008;42:344–351.
 
23. Santelli JS, Kantor LM, Grilo SA, et al. Abstinence-only-until-marriage: an updated review of US policies and programs and their impact. J Adolesc Health 2017;61:273–280.
 
24. Kempner ME. Toward a sexually healthy America: abstinence-only-until-marriage programs that try to keep our youth "scared chaste". https://siecus.org/wp-content/uploads/2015/07/TASHA_scared-chaste.pdf. Published 2001. Accessed February 20, 2022.
 
25. Fisher CM. Queer youth experiences with abstinence-only-until-marriage sexuality education: “I can't get married so where does that leave me?” J LGBT Youth 2009;6:61–79.
 
26. Elia JP, Eliason MJ. Dangerous omissions: abstinence-only-until-marriage-school-based sexuality education and the betrayal of LGBTQ youth. Am J Sex Educ 2010;5:17–35.
 
27. Zaza S, Kann L, Barrios LC. Lesbian, gay, and bisexual adolescents: population estimate and prevalence of health behaviors. JAMA 2016;316: 2355–2356.
 
28. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health 2011;49:115–123.
 
29. Marshal MP, Friedman MS, Stall R, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction 2008; 103:546–556.
 
30. Russell ST, Ryan C, Toomey RB, et al. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J School Health 2011;81:223–230.
 
31. Kosciw JG, Greytak EA, Bartkiewicz MJ, et al. The 2011 National School Climate Survey: the experiences of lesbian, gay, bisexual and transgender youth in our nation's schools. https://www.glsen.org/sites/default/files/2020-04/2011%20GLSEN%20National%20School%20Climate%20Survey.pdf. Published 2012. Accessed February 20, 2022.