HIV & Sexual Health Education: what is it, and how can we help youth stay safer?

1. HIV & Sexual Health Education: what is it, and how can we help youth stay safer? National Association for the Education of Homeless Children and Youth (NAEHCY) Conference Pittsburgh, PA 11/8/2011 Presenter: Suzanne M. Hidde, M.S. HIV & Sexual Health Program Supervisor Washington State Office of Superintendent of Public Instruction(OSPI) suzanne.hidde@k12.wa.us

2. Group Norms • We all care about young people • Everyone has something to offer • We are enriched if we hear from everyone • This is a safe space to ask questions • We are mindful of diversity

3. Group rights/Ground rules • Step Up, Step Back • One Diva, one mic • NO Dissing • Listen all the way through • ELMO • Move IN the circle • Ouch/Oops • Sit with your discomfort before responding • “I” statements • Don’t Yuck My Yum! • Others?

4. Session Overview Goal – be comfortable and confident identifying risk and protective factors for HIV/STD and teen pregnancy for disenfranchised youth, as well as how to create a safe environment for all students. Topics we will cover today: Statistics - adolescent sexual health &health disparities HIV and Sexual Health Education Laws/Guidelines Risk and Protective factors Best practices for sexual health education

5. Fast Facts • Each year in the U.S., approximately 750,000 to 850,000 teenage women, ages 15 through 19, become pregnant. • In 2009, 46% of U.S. high school students had ever had sexual intercourse; 39% did not use a condom during last sexual intercourse; 80% did not use birth control at last intercourse (YRBS 2009) • More new HIV infections occurred among adolescents and young adults 13 – 29 years old (34%) than any other age group. Most young people with HIV/AIDS were infected by sexual transmission. • Each year, approximately 19 million new STI’s occur, and almost half of them are among youth aged 15 – 24.

6. 2009 national youth risk behavior survey(YRBS) Among U.S. high school students: • 46% ever had sexual intercourse. • 6% had sexual intercourse for the first time before age 13 years. • 14% had sexual intercourse with four or more persons during their lifetime. • 34% had sexual intercourse with at least one person during the 3 months before the survey. • 39% did not use a condom during last sexual intercourse. (among those currently sexually active) • 13% were never taught in school about AIDS or HIV infection. http://www.cdc.gov/HealthyYouth/yrbs/index.htm

7. What is the status? - Health education 2009 YRBS Among U.S. high school students: • 69% required instruction on health topics as part of a specific course. • 28% taught 11 key pregnancy, HIV, or other STD prevention topics in a required health education course. • 87% taught abstinence as the most effective method to avoid pregnancy, HIV and other STDs in a required health education course. • 85% taught how HIV is transmitted in a required health education course. • 39% taught how to correctly use a condom in a required health education course. • 76% taught how to find valid information or services related to HIV or HIV testing in a required health education course.

8. Health services – 2009 yrbs Among U.S. high school students: • 45% provided HIV counseling, testing and referral services at school. • 53% provided HIV prevention services at school in one-on-one or small-group sessions. • 5% made condoms available at school. • 24% provided services for gay, lesbian, or bisexual students. http://www.cdc.gov/healthyyouth/yrbs/factsheets/sexualrisk.htm

9. What are the solutions? • Better & More health education – including sexual health! • More comprehensive health services – or linkages to them • More supportive policies

10. Statistics and health disparities CDC Health Disparities: http://www.cdc.gov/omhd/ CDC HIV/AIDS: http://www.cdc.gov/hiv/topics/surveillance/basic.htm

11. Health disparities • Occurrences of diseases/situations are greater among certain population groups. Differences may occur by gender, race or ethnicity, education, income, disability, geographic location and sexual orientation among others. • Social determinants - poverty, unequal access to health care, lack of education, stigma, and racism are linked to health disparities.

21. Minority communities are disproportionately impacted across each of these areas.

22. MARGINALIZED YOUTH

23. Definitions (nn4y) • Unaccompanied youth – up to 17 not within physical custody of parent or guardian • Runaway youth – under 18 who leave home without permission • Throwaways are youth who were “induced” to leave home against their will and no effort was made to find them • Homeless youth – not more than 21 – not possible to live in a safe environment with relative or other alternative situation • Disconnected youth – runaway or homeless – specifically these youth are separated from societal institutions – family, school – socioeconomic instability • Economically Homeless – youth made homeless by their family’s economic hardships

24. The National Network for Youth NN4Y • p3 Community Action Toolkit for Schools http://www.nn4youth.org/

25. HIV Risk Factors for Runaway and Homeless Youth (RHY) • An estimated 16,859 – 27,600 RHY in the US are currently HIV positive • Factors: • high risk sexual and drug use behavior • survival sex • minimal condom use • injection drug use • needle sharing • having sex while intoxicated or high • RHY tend to be sexually active at early ages (98% of RHY 16-18 reported having had intercourse) with 49% reporting having first intercourse by age 13 • Being on the street also elevates their risk for sexual victimization which elevates their HIV risk

26. Runaway and homeless youth experience rape and assault rates 2 to 3 times higher than the general population of youth.

27. Family Risk Factors Youth are expelled from home due to the following: Sexual Orientation Pregnancy/Parenting Status Use of Drugs or Alcohol Normal Adolescent Behavior Family Poverty Family understanding of adult milestones (e.g., turning 18 means leaving home

28. Community Risk Factors Child welfare system shortcomings Abrupt exits from custodial care Housing discrimination Low-wage incomes and inability to afford available housing Medical Risk Factors RHY are medically underserved and don't receive HIV prevention services and interventions offered to most youth because they may miss school-based health promotion and disease prevention opportunities RHY experience barriers to health care due to lack of health insurance and their distrust of ‘adult-serving' institutions

29. Consequences of Youth Homelessness • Poor health, educational, and workforce outcomes • Dependency on public health, social service, homeless assistance, and corrections systems • Prevention Strategies • Prevent youth homelessness by improving housing outcomes for youth exiting public care (i.e. foster care, juvenile corrections, and mental health systems).

30. NN4Y's HIV Prevention Strategies • Increase the capacity of RHY organizations to provide effective HIV prevention services for youth served by their programs. • Increase the capacity of other community based youth-serving organizations to provide effective HIV prevention for RHY they serve.

31. HIV: Protect Yourself • Get the facts — Arm yourself with basic information: Are you at risk? How is HIV spread? How can you protect yourself? • Take control — You have the facts; now protect yourself and your loved ones. Effective strategies for reducing HIV risk include: • Abstinence: The most reliable way to avoid infection is to abstain from sex (i.e., anal, vaginal or oral). • Mutual monogamy: Mutual monogamy means that you agree to be sexually active with only one person, who has agreed to be sexually active only with you. Being in a long-term mutually monogamous relationship with an uninfected partner is one of the most reliable ways to avoid HIV infection. • Reduced number of sex partners: Reducing your number of sex partners can decrease your risk for HIV. It is still important that you get tested for HIV, and share your test results with your partner. • Condoms: Correct and consistent use of the male latex condom is highly effective in reducing HIV transmission. Use a condom every time you have anal, vaginal or oral sex .

32. In my state/school/classroom/community… • HIV and Sexual Health education is……. • Students who are “at-risk” are treated…… • I actively do the following to make my work/classroom/office/school welcoming and safe for everyone by…………..

33. Sexual Health Education

34. Sexual healthis a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence [1]. • http://www.cdc.gov/sexualhealth/docs/SexualHealthReport-2011-508.pdf

35. Comprehensive sexuality education programs have four main goals: • to provide accurate information about human sexuality • to provide an opportunity for young people to develop and understand their values, attitudes, and insights about sexuality • to help young people develop relationships and interpersonal skills, and • to help young people exercise responsibility regarding sexual relationships, which includes addressing abstinence, pressures to become prematurely involved in sexual intercourse, and the use of contraception and other sexual health measures. SIECUS: http://www.siecus.org/index.cfm?fuseaction=page.viewpage&pageid=521&grandparentID=477&parentID=514

36. Evidence suggests that effective school programs will include the following elements: • A focus on reducing specific risky behaviors • A basis in theories which explain what influences people's sexual choices and behavior • A clear, and continuously reinforced message about sexual behavior 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 practice communication, negotiation and assertion skills • Uses a variety of approaches to teaching and learning that involve and engage young people and help them to personalize 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

37. Effective HIV/STD Prevention Education Programs Well designed and well-implemented programs can decrease sexual risk behaviors, including- Key common attributes of effective programs tend to be - • Delaying first sexual intercourse • Reducing the number of sex partners • Decreasing the number of times students have unprotected sex • Increasing condom use • Delivered by trained instructors • Are age-appropriate • Include components on skill-building • Support healthy behaviors in school environments • Involve parents/families, youth serving organizations, and health organizations

38. GUTTMACHER INSTITUTE - STATE POLICIES IN BRIEF – 11/1/11 HIGHLIGHTS: http://www.guttmacher.org/sections/adolescents.php • http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf • General Requirements: Sex Education and HIV Education • 21 states and the District of Columbia mandate sex education. • 20 states and the District of Columbia mandate both sex education and HIV education. • 1 state only mandates sex education. • 33 states and the District of Columbia mandate HIV education; of these states, 13 mandate only HIV education. • 29 states and the District of Columbia mandate that, when provided, sex and HIV education programs meet certain general requirements. • 13 states require that the instruction be medically accurate. • 27 states and the District of Columbia require that the information be appropriate for the students’ age. • 9 states require that the program must provide instruction that is appropriate for a student’s cultural background and not be biased against any race, sex or ethnicity. • 2 states prohibit the program from promoting religion. • 37 states and the District of Columbia require school districts to involve parents in sex education, HIV education or both. • 22 states and the District of Columbia require that parents be notified that sex education or HIV education will be provided. • 3 states require parental consent for students to participate in sex education or HIV education. • 35 states and the District of Columbia allow parents to remove their children from instruction.

39. HIGHLIGHTS: • Content Requirements When Sex Education is Taught •  18 states and the District of Columbia require that information on contraception be provided. •  37 states require that information on abstinence be provided. •  26 states require that abstinence be stressed. •  11 states require that abstinence be covered. •  18 states require that instruction on the importance of engaging in sexual activity only within marriage be provided. •  12 states require discussion of sexual orientation. •  9 states require that discussion of sexual orientation be inclusive. •  3 states require only negative information on sexual orientation. •  13 states require the inclusion of information on the negative outcomes of teen sex and pregnancy. •  26 states and the District of Columbia require the provision of information about skills for healthy sexuality (including avoiding coerced sex), healthy decision making and family communication when. •  20 states and the District of Columbia require that sex education include information about skills for avoiding coerced sex. •  20 states require that sex education include information on making healthy decisions around sexuality. •  11 states require that sex education include instruction on how to talk to family members, especially parents, about sex. • Content Requirements When HIV Education is Taught •  20 states require information on condoms or contraception. •  39 states require that abstinence be included. • 28 states require that abstinence be stressed. • 11 states require that abstinence be covered. • http://www.guttmacher.org/pubs/FB-Teen-Sex-Ed.html

40. Risk and Protective Factors for HIV, STD, and Teen Pregnancy Risk Factors • Pressure to have sex • Forced sex • Unprotected sex Protective Factors ***ACCESS to………skills to…… • Health Education • Sexual abstinence • Consistent and correct contraceptive and condom* use • Abstinence from AOD** STD HIV Pregnancy * Male and female condoms ** Alcohol and other drugs

41. What Works?

42. Maslow’s Hierarchy – What do we all need/want?

43. SCHOOL CONNECTEDNESS …..is the belief held by students that the adults and peers in their school care about their learning as well as about them as individuals.

44. School Connectedness Is Especially Important for At-Risk Youth “School connectedness is particularly important for young people who are at increased risk for feeling alienated or isolated from others. Any student who is “different” from the social norm may have difficulty connecting with other students and adults in the school, and may be more likely to feel unsafe. Those at greater risk for feeling disconnected include students with disabilities, students who are lesbian, gay, bisexual, transgender, or question their sexual orientation, students who are homeless, or any student who is chronically truant due to a variety of circumstances. Strong family involvement and supportive school personnel, inclusive school environments, and curricula that reflect the realities of a diverse student body can help students become more connected to their school.” • http://www.cdc.gov/healthyYouth/AdolescentHealth/pdf/connectedness_administrators.pdf

45. The ABCs—Factors that can increase school connectedness • Adult Support • Belonging to a Positive Peer Group • Commitment to Education • School Environment How do we make this happen? http://www.cdc.gov/healthyyouth/adolescenthealth/pdf/connectedness_administrators.pdf

46. http://thekidsarelistening.org/>

47. *The need to respect and protect queer students is extra-difficult for some administrators and teachers to understand—especially when religious values conflict. But when teachers are uncomfortable with these issues, they may misuse their positions of power over students. Some actively contribute to verbal bullying and even to sexual harassment of LGBT students. *Teachers set the climate and ambiance for their classrooms. Their attitudes can either prevent or increase problems. Education about LGBT issues is the first step toward comfort for teachers unfamiliar with the topic. *Smart schools should provide training on anti-bullying and LGBT student issues for every single adult they employ—from the janitor to the coach to the principal. All staff members need to know the rules for protecting student safety, and to apply them consistently. http://www.nyacyouth.org/resources/resource.php?id=299

48. GLSEN Safe Space Kits: http://www.glsen.org/cgi-bin/iowa/all/home/index.html http://www.safeschoolscoalition.org/safe.html

49. http://www.crimethinc.com/tools/posters.html

50. Sample policy - PROHIBITION OF HARASSMENT, INTIMIDATION, AND BULLYING “The district is committed to a safe and civil educational environment for all students, employees, parents/legal guardians, volunteers, and patrons that is free from harassment, intimidation, or bullying. ‘Harassment, intimidation, or bullying’ means any intentionally written message or image—including those that are electronically transmitted—verbal, or physical act, including but not limited to one shown to be motivated by race, color, religion, ancestry, national origin, gender, sexual orientation, including gender expression or identity, mental or physical disability or other distinguishing characteristics.” (Excerpted from Washington State’s Model Anti-Bullying Policy 2010.) http://www.k12.wa.us/SafetyCenter/BullyingHarassment/default.aspx