Fact Sheets Adolescence and Abstinence Guidelines for Comprehensive Sexuality Education The National Coalition to Support Sexuality Education Sexual Orientation and Identity Sexuality Education in the Schools: Issues and Answers Sexually Transmitted Diseases in the United States Strategies To Build Support For HIV-Prevention and Sexuality Education Programs The Truth About Latex Condoms ---------- Adolescence and Abstinence DATA ON TEENAGE SEXUAL BEHAVIOR1 * Rates of sexual activity among teenagers have risen throughout the last thirty years. * In the mid-1950s, just over a quarter of women under age eighteen were sexually experienced. Between 1962 and 1970, rates of sexual activity for women this age were fairly constant at 30-35 percent. During the 1970s, the proportion of young women having sexual intercourse prior to age eighteen rose from 35 percent to 47 percent. During the 1980s, rates of sexual activity began to level off. Today, the proportion of eighteen-year-old women who have had intercourse at least once is 56 percent. * In 1970, 55 percent of men had intercourse by age eighteen. During the 1970s, this proportion rose to 64 percent; today, it is 73 percent. * A significant proportion of adolescents remain abstinent: nearly 20 percent of young people do not have intercourse during their teenage years. * Almost all adolescents participate in sexual activity of some kind. Overall, 90 percent have kissed, 79 percent have participated in deep kissing, 72 percent have participated in touching "above the waist," and 54 percent have participated in touching "below the waist."2 * Sexual activity is fairly rare among the youngest teenagers, but becomes increasing common with age. The proportion who are sexually active is 9 percent among twelve-year-olds, but rises to 23 percent among fourteen-year-olds, 42 percent among sixteen-year-olds, and 71 percent among eighteen-year-olds. * For women, the interval between puberty and first marriage has lengthened significantly since the turn of the century-from roughly seven to about twelve years. On average, women reach puberty (begin menstruating) at age twelve and one-half, and first marry at age twenty-four. For men, puberty (marked by sperm production) begins at age fourteen, and first marriage occurs at age twenty-six, on average. COMPREHENSIVE SEXUALITY EDUCATION CAN HELP TEENAGERS TO POSTPONE INTERCOURSE * Helping adolescents to postpone sexual intercourse until they are ready for mature relationships is a key goal of comprehensive sexuality education.3 Sexuality educators have always included information about abstinence in sexuality education courses. * Interventions that are effective in encouraging teenagers to postpone sexual intercourse help young people to develop the interpersonal skills they need to resist premature sexual involvement. Effective programs include a strong abstinence message, as well as information about contraception and safer sex. For interventions to be most effective, teenagers need to be exposed to these programs before initiating intercourse.4 * In a 1993 study, SIECUS found that state curricula emphasize abstinence. Abstinence is among the topics most often covered in state curricula and guidelines, along with families, decision making, and sexually transmitted diseases and HIV. The topics least likely to be covered include sexual identity and orientation, shared sexual behavior, sexual response, masturbation, and abortion.5 ABSTINENCE-ONLY PROGRAMS NOT PROVEN EFFECTIVE * Only three studies of school-based abstinence-only programs have been published in the professional literature. These studies did not find any impact of such programs on adolescents' initiation of intercourse.6 * Sexuality education programs that teach only abstinence have not proven effective. The research that exists on these programs tends to have serious methodological flaws, such as not asking students about their sexual behavior before and after their participation in the program. * No available evidence supports the effectiveness of having young people sign pledges that they will not engage in intercourse until marriage. * Nearly two-thirds of teenagers think teaching "Just Say No" is an ineffective deterrent to teenage sexual activity.7 References 1. Data on teenage sexual behavior have been adapted from The Alan Guttmacher Institute, Sex and America's Teenagers (New York, 1994). 2. Roper Starch Worldwide, Teens Talk About Sex: Adolescent Sexuality in the 90's (New York, 1994). 3. National Guidelines Task Force, Guidelines for Comprehensive Sexuality Education: Kindergarten-12th Grade (New York: Sex Information and Education Council of the U.S.,1991). 4. D. Kirby, "School-based Programs to Reduce Sexual Risk Behaviors: A Review of Effectiveness," Public Health Reports, 109 (1994): 339-60. 5. A. E. Gambrell and D. W. Haffner, Unfinished Business: A SIECUS Assessment of State Sexuality Education Programs (New York: Sex Information and Education Council of the U.S., 1993), 18. 6. S. Christopher and M. Roosa, "An Evaluation of an Adolescent Pregnancy Prevention Program: Is æJust Say No' Enough?" Family Relations, 39 (1990): 68-72; M. Roosa and S. Christopher, "Evaluation of an Abstinence-only Adolescent Pregnancy Prevention Program: A Replication," Family Relations, 39 (1990); 363-367; and S. R. Jorgensen, V. Potts, and B. Camp, "Project Taking Charge: Six-month Follow-up of a Pregnancy Prevention Program for Early Adolescents," Family Relations, 42 (1993): 401-06. 7. Roper Starch Worldwide, Teens Talk about Sex. copyright © 1995, SIECUS ---------- Guidelines for Comprehensive Sexuality Education WHAT ARE THE GUIDELINES FOR COMPREHENSIVE SEXUALITY EDUCATION: The Guidelines are a comprehensive model designed to promote and facilitate the development of comprehensive sexuality education programs nationwide. The Guidelines are designed to provide a framework for developing comprehensive sexuality education curricula, textbooks, and programs as well as for evaluating existing programs. WHY WERE THE GUIDELINES DEVELOPED? * Approximately nine out of ten parents want their children to have sexuality education in school.1 * Twenty three states require sexuality education, and 38 require HIV/STD education. 2 * Only one-fifth of sexuality education curricula used by state education departments provide adequate sexuality information. * Eight out of ten sexuality education teachers report a need for more assistance concerning education about prevention and sexually transmitted diseases.1 * A literature search conducted by the SIECUS library revealed a lack of written material detailing standards for providing comprehensive sexuality education. National educational and public interest groups confirmed a need for guidelines for sexuality education. HOW WERE THE GUIDELINES DEVELOPED? In 1990, SIECUS convened the National Guidelines Task Force to develop guidelines as a framework for providing sexuality education. The task force was comprised of 20 professionals in the fields of medicine, education, sexuality and youth services, from prestigious organizations such as the American Medical Association, March of Dimes Birth Defects Foundation, Planned Parenthood Federation of America, National Education Association, American Social Health Association, U.S. Centers for Disease Control, and the National School Boards Association. This Task Force developed the topics, values, life behaviors, and developmental messages which are now presented as the Guidelines For Comprehensive Sexuality Education: Kindergarten-12th Grade, a 52-page booklet. The National Guidelines Task Force authored the SIECUS published Guidelines. WHAT ARE THE PRIMARY GOALS OF THE GUIDELINES? The goal of comprehensive sexuality education is to assist children in understanding a positive view of sexuality, provide them with information and skills about taking care of their sexual health, and help them acquire skills to make decisions now and in the future. The Guidelines define the life behaviors of a sexually health adult. The Guidelines are based on the following four primary goals: 1. INFORMATION: To provide accurate information about human sexuality. 2. ATTITUDES, VALUES AND INSIGHTS: To provide an opportunity for young people to question, explore and assess their sexual attitudes. A primary goal is to help young people develop their own values, acquire enhanced self-esteem, develop insights into their relationships with members of both genders, and to better understand obligations and responsibilities to themselves and others. 3. RELATIONSHIPS AND INTERPERSONAL SKILLS: To help young people develop interpersonal skills, including communication, decision-making, peer refusal and assertiveness skills which will allow them to create satisfying relationships. 4. RESPONSIBILITY: To help young people develop the ability to exercise responsibility regarding sexual relationships. This will include addressing issues such as abstinence, resisting pressure to become prematurely sexually involved, and using contraception and other measures related to promoting sexual health and well-being. WHAT ARE THE KEY CONCEPTS OF THE GUIDELINES? The Guidelines consist of six key concepts. These concepts encompass the components of a broad definition of sexuality. The key concepts are as follows: Human Development, Relationships, Personal Skills, Sexual Behavior, Sexual Health, and Society and Culture. Each key concept is designed in instructional levels reflecting four stages of development: Level 1: Middle Childhood, (ages 5 through 8); early elementary school Level 2: Preadolescence, (ages 9 through 12); upper elementary school Level 3: Early Adolescence, (ages 12 through 15); middle school/junior high school Level 4: Adolescence, (ages 15 through 18); high school ARE THE GUIDELINES BASED ON VALUES? The Guidelines are based on specific values related to human sexuality. The Task Force that developed these Guidelines did so in order to be consistent with values that reflect the beliefs of most communities in a pluralistic society. These values include: * Sexuality is a natural and healthy part of living; * Sexuality includes physical, ethical, spiritual, psychological, and emotional dimensions; * Sexual relationships should never be coercive or exploitative; * In a pluralistic society like the United States, people should respect and accept the diversity of values and beliefs about sexuality that exist in a community; * Abstaining from sexual intercourse is the most effective method of preventing pregnancy and STD/HIV; * All sexual decisions have effects or consequences; * Individuals and society benefit when children are able to discuss sexuality with their parents and/or other trusted adults. WHAT IS THE PHILOSPHY UNDERLYING THE GUIDELINES? The Guidelines are based on the beliefs that sexuality education should be offered as part of an overall comprehensive health education program; that sexuality education should be taught only by specially trained teachers; that the community must be involved in the development and implementation of the program; that all children and youth will benefit from comprehensive sexuality education; and that all three learning domains--cognitive, affective, and behavioral--should be addressed in sexuality education programs. HOW ARE THE GUIDELINES STRUCTURED? The Guidelines are divided into 36 topics which make up a comprehensive sexuality education program. Each topic is broken down into developmental messages that are age-appropriate according to school level. There are 703 developmental messages for children and youth about sexuality included in the Guidelines. HOW ARE THE GUIDELINES BEING USED? Nearly 20,000 copies of the Guidelines have been distributed. The following are some specific ways in which the Guidelines are being used by individuals, community based organizations, and educational systems. As this guide was created for national distribution, each locality is customizing the material in the Guidelines to suit their needs. * To develop new, and evaluate existing, programs. * For discussion with school policy makers. * For teacher/staff training. * To develop new guidelines and evaluate existing ones. * For peer education training. * For classroom teaching at the college level. * For parent education. * For special education. * For community education WHO HAS ENDORSED THE GUIDELINES? The Guidelines have been endorsed by a number of national youth serving organizations, including: * Advocates for Youth * American Association of Sex Educators Counselors and Therapists * The Association of Reproductive Health Professionals * Girls, Incorporated * Midwest School Social Work Council * National Asian Women's Health Organization * National Coalition of Advocates for Students * National Council of the Churches of Christ * National Education Association * National Lesbian and Gay Health Foundation * National Network for Youth (formerly National Network of Youth Services) * Planned Parenthood Federation of America * Sexuality Information and Education Council of the United States * Society for Behavioral Pediatrics To order the Guidelines, send a check or money order for $5.75 made payable to SIECUS, c/o Publications at SIECUS, 130 West 42nd St., Suite 350, New York, NY 10036-7802. References 1. Donovan, P. Risk and Responsibility: Teaching Sex Education in America's Schools Today. (New York: The Alan Guttmacher Institute, 1989), p. 5-6. 2. de Mauro, D. "Sexuality Education 1990: A review of State Sexuality and AIDS Curricula."SIECUS Report, 18 (2): 1-9, December 1989/January 1990. copyright © 1995, SIECUS ---------- The National Coalition to Support Sexuality Education NCSSE consists of more than 90 national non-profit organizations, many of which are noted role models and initiators in promoting health, education, and social justice for our nation's youth. These organizations represent a broad constituency of social workers, religious officials and lay people, educators, advocates, physicians, health care professionals, and child development specialists, whose combined work reaches more than 30 million young people. The National Coalition to Support Sexuality Education goal is to assure that all children and youth receive comprehensive sexuality education by the year 2000. The members of the coalition: * Advocate for Sexuality Education at the national and state level. * Assist national organizations concerned with youth to establish policies and programs on sexuality education by the year 2000. * Develop strategies for facilitating national and local implementation of sexuality education initiatives and efforts. * Develop pro-active strategies to address the activities of those who oppose providing children with comprehensive sexuality education. * Provide an opportunity for networking, resource sharing, and collaborating on a national level. * Develop joint goals and objectives into the 21st century. * Hold semi-annual meetings to discuss progress made toward achieving its mission. National organizations wishing to join the coalition, should contact SIECUS for more information. To join or request more information about NCCSE, click on the Feedback button and fill out the form provided. copyright © 1995, SIECUS ---------- Sexual Orientation and Identity SIECUS believes that an individual's sexual orientation--whether bisexual, homosexual, or heterosexual--is an essential part of sexual health and personality. SIECUS strongly supports the right of each individual to accept, acknowledge, and live in accordance with his or her orientation. SIECUS advocates laws guaranteeing civil rights and protection to all people, and deplores all forms of prejudice and discrimination against people based on sexual orientation. Recent public debates on homosexuality have been distorted by homophobia, misinformation, and stereotypes about sexual orientation and identity. This fact sheet has been prepared by SIECUS staff to provide current, accurate facts to inform a more intelligent debate. DEFINITIONS OF SEXUALITY * Sexual orientation is one's erotic, romantic, and affectional attraction to the same gender (sex), to the opposite gender (sex), or both. *Sexual identity is an inner-sense of oneself as a sexual being, including how one identifies in terms of gender and sexual orientation. * Sexual preference is a term once used to describe sexual orientation--bisexuality, homosexuality and heterosexuality--which is now outdated because sexual orientation is no longer commonly considered to be one's conscious individual preference or choice, but is instead thought to be formed by a complicated network of social, cultural, biological, economic, and political factors. * Homophobia is the irrational hatred and fear of lesbian and gay people that is produced by institutionalized biases in a society or culture. * Several studies indicate that exposure to truthful information about lesbians and gay men often leads to a reduction in homophobia.1 * Heterosexism is the institutional and societal reinforcement of heterosexuality as the privileged and powerful norm. * Neither the term heterosexuality nor the term homosexuality existed before 1890. ORIGINS AND CHARACTERISTICS OF SEXUAL ORIENTATION * No single scientific theory about what causes sexual orientation has been suitably substantiated. Studies to associate sexual orientation exclusively with genetic, hormonal, and environmental factors have so far been inconclusive.2 * Many interventions aimed at changing the sexual orientation of lesbians and gay men have succeeded only in reducing sexual behavior and self-esteem rather than in creating or increasing attractions to the other gender .3 * It is considered ethically questionable by the professional psychological community to seek to alter through therapy a trait that is not a disorder and is extremely important to individual identity and sexual health.4 * The American Psychiatric Association removed homosexuality from its list of disorders in 1973. * A common false allegation leveled against many gay men and lesbians is that they are child-molesters. In fact, 95% of all reported incidents of child sexual abuse are committed by heterosexual men.5 CIVIL LIBERTIES & DISCRIMINATION * Only nine states in the U.S. have legislation protecting lesbian and gay people against discrimination based on sexual orientation. * In 1992, Colorado voters approved a constitutional amendment prohibiting civil rights protection on the basis of sexual orientation, a measure which effectively invalidated the laws in several Colorado cities that did extend equal rights to lesbian and gay citizens. * Seven states have laws banning the practice of certain sexual acts between adults of the same gender.6 * Sixteen other states plus the District of Columbia have laws banning the practice of certain sexual acts by homosexual and heterosexual couples.7 * Lesbians and gay men are the most frequent victims of hate crimes and are at least seven times more likely to be crime victims than heterosexual people.8 * At least 75% of crimes against lesbians and gay men are not reported to anyone.9 * In a 1991 study of five metropolitan areas including Boston, Chicago, Minneapolis/St. Paul, New York City, and San Francisco, there were 1,833 incidents of anti-gay and anti-lesbian crimes, which is a 31% increase over the previous year.10 * According to a 1986 survey conducted in Seattle, Washington, 40% of homeless youth identifies as gay, lesbian, or bisexual.11 * Half of all lesbian and gay youth report that their parents reject them due to their sexual orientation.12 * Gay adolescents are two to three times more likely to attempt suicide than male heterosexual adolescents. It is estimated that up to 30% of reported youth suicides each year are committed by lesbian and gay young people.13 LESBIANS AND GAY MEN IN THE MILITARY * The ban against homosexuals in the military was codified into law in 1982 by a directive of the Reagan Administration, which reads: "Homosexuality is incompatible with military service. The presence in the military environment of persons who engage in homosexual conduct or who, by their statements, demonstrate a propensity to engage in homosexual conduct, seriously impairs the accomplishment of the military mission." * The Uniform Code of Military Justice criminalizes private oral and anal sexual acts--both homosexual and heterosexual--among consenting adult members of the U.S. armed forces. * The Pentagon estimates that from 1980 to 1990, it spent $500 million alone replacing discharged gay and lesbian members of the armed forces. The total amount spent--including investigation, out-processing and court costs--has not been released. * The military dismisses approximately 1,500 members each year because they are lesbian or gay.14 * Women are eight times more likely than men to be dismissed from the Marine Corps for being homosexual.15 * A 1989 military study concluded that gay men and lesbians demonstrated "preservice suitability-related adjustment that is as good or better than the average heterosexual."16 * A Gallup survey of a cross section of the American population of adults aged 18 and over showed that 57% of those interviewed felt that homosexuals should be allowed to serve in the armed forces.17 * According to a Los Angeles Times poll, 45% of Americans approve of allowing openly homosexual men and women in the armed forces.18 * According to Yankelovich Partners, Inc. study, 57% of people polled thought that gay men and lesbians should not be banned from the military.19 HETERSOSEXUAL MEN IN THE MILITARY * As many as 50 female Navy and Marine personnel were sexually assaulted in public by a dozen male officers at a convention of the Tailhook Association, an official military gathering. * Two senior Navy admirals were forced into early retirement and one was reassigned when it was discovered that they had deliberately undermined the initial investigation of the Tailhook assaults to protect fellow Navy officers from embarrassment and criminal charges. In addition, the Navy Secretary, H. Lawrence Garrett, resigned his position. * Sexual harassment in the military is prohibited and regulated by codes of conduct. * The Pentagon has not raised efforts to investigate or discharge male sexual harassers. The Pentagon has not made public the number and cost of male military personnel who are yearly discharged for sexual assault or harassment of female military personnel. References 1. Herek, GM "Beyond Homophobia: A Social Psychological perspective on Attitudes Toward Lesbains and Gay Men. Journal of Homosexuality 10 (1/2) 1-21, 1984. 2. Gooren L., Fliers E & Courtney K. "Biological Determinants of Sexual Orientation" Annual Review of Sex Research 1:175-196, 1990; and Bailey, JM., Pillared RC. "A Genetic Study of Male Sexual Orientation" Arch Gen Psychiatry Vol 148, Dec, 1991. 3. Haldman, DC. "Sexual Orientation Conversion Therapy for Gay men and Lesbians: A Scientifiic Esamination." In J.C. Gonsiorek & J.D. Weinrich (Eds.) Homosexuality: Research Implications for Public Policy Newbury Par, CA: Sage Publications, 1991, pp. 49-160; and Martin, AD "Psychotherapeutic Implications of Internalized Homophobia in Gay Men." In J.C. Gonsiorek (Ed.) Homosexuality and Psychotherapy: A Practitioners Handbook of Affirmative Models, New York: Haworth Press, 1984, pp. 59-69. 4. Davidson G. "Constructionism and Morality in Therapy for Homosexuality." In J.C. Gonsiorek &J.D. Weinrisch (Eds.) Homosexuality: Research Implication for Public Policy. Newbury park, CA: Sage Publications, 1991, pp. 137-148; MaylonA. "Psychotherapeutic Implications of Internalized Homophobia in Gay Men." In J. C. Gonsiorek (Ed.) Homosexuality and Psychotherapy: A Practitioners Handbook of Affirmative Model. New York: Haworth Press, 1982, pp. 59-69; and Silverstein C. "Psychological and Medical Treatment of Homosexuality" In J.C. Gonsiorek &J.D. Weinrich (Eds.) Homosexuality Research Implications for Public Policy. Newbury Park, CA: Sage Publications, 1991, pp. 137-148. 5. Russell D. The Secret Trauma: Incest in the Lives of Girls and Women. New York: Basic Books, 1986. 6. Hunter ND et al. Rights of Lesbians and Gay Men 3rd Edition, Southern Illinois University Press, 1992, pp. 149-175. 7. See also Haffner D. "1992 Report Card on that States Sexual Rights in America" SIECUS Report Vol 20. No. 3, February/March 1992. 8. Personal Communication. Gay and Lesbian Anti-Violence Project, February 1993. 9. National Gay and Lesbian Task Force Policy Institute Report, 1991: (Copies can be attained by writing to 1734 14th Street, NW, Washington, D.C.) 10. National Gay and Lesbian Task Force Policy Instititute Report, 1991: (Copies can be attained by writing to 1734 14th Street, NW, Washington, D.C.) 11. Orion Center, Survey of Street Youth, 1986 (Copies can be obtained by writing tk Seattle, WA.) 12. Remafedi, G. "Male Homosexuality: The Adolescent's Perspective," Pediatrics, 79:326-330, 1987. 13. Gibson P, LCSW. "Gay Male and Lesbian Youth Suicide," Report of the Secretary's Task Force on Youth Suicide, U.S. Department of Health and Human Services, 1989. 14. United States General Accounting Office Report to Cngressional Requesters. "Defense Force Managment: DOD's Policy on Homosexuality," June 1992. 15. House of Representatives correspondence to Jean Appleby, Defense Advisory Committee on Women in the Service, April 24, 1992. 16. PRESEREC. Preserivce Adjustment of Homosexual and Heterosexual Military Accessions: Implications for Security Clearance Suitability, January 1989. 17. Hugick L. "Public Opinion Divided on Gay Rights." Gallup Poll Monthly, June 1992, p.3. 18. "Opinion Poll Chart." Los Angeles Times, January 28th, 1993. 19. Yankelovich Partners, Inc. [for Time Magazine and CNN] January 14, 1993; (Copies can be obtained by writing to 2033 M Street, NW, Suite 900, Washington, DC 2003) copyright © 1995, SIECUS ---------- Sexuality Education in the Schools: Issues and Answers WHAT IS MEANT BY "SEXUALITY EDUCATION"? Sexuality education is a lifelong process of acquiring information and forming attitudes, beliefs, and values about identity, relationships, and intimacy. It encompasses sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles. Sexuality education addresses the biological, sociocultural, psychological, and spiritual dimensions of sexuality from the cognitive domain, the affective domain, and the behavioral domain (communication and decision-making skills).1 HOW DO PEOPLE LEARN ABOUT SEXUALITY? Parents are -- and ought to be -- the primary sexuality educators of their children. From the moment of birth, children learn about love, touch and relationships. Infants and toddlers receive the beginnings of sexuality education through example when their parents talk to them, dress them, show affection, play with them and teach them the names of the parts of their bodies. As children grow, they continue to receive messages about appropriate behaviors and values as they develop relationships within their family and the social environment. Not only do children learn about sexuality through their observations and relationships with parents and families, but they learn from sources outside their homes. Friends, teachers, and neighbors; television, music, books, advertisements, and toys teach them about sexual issues. The process of sexual learning with parents and families can be supplemented by planned learning opportunities in churches, synagogues and other places of worship, community and youth agencies, and schools. Recent polls indicate that most young people look to their parents as their most important source of information about sexuality. Friends are the second most important source, school courses rank third, and television is fourth. More than two-thirds of young people have talked to their parents about sexuality. Among the adults polled, a much smaller number learned about sexuality from their own parents (21% from the mother, 5% from the father), yet two thirds of these adults have talked with their own children abuot sexual issues. In numberous studies, most parents report that they are uncomfortable discussing sexual issues with their children -- and welcome assistance from more formal programs. WHAT ABOUT SCHOOL-BASED SEXUALITY EDUCATION? School-based sexuality education programs conducted by specially trained educators can add an important dimension to children's ongoing sexual learning. These programs should be developmentally appropriate and include such issues as self-esteem, family relationships, parenting, friendships, values, communication techniques, dating, and decision-making skills. Programs must be carefully planned by each community in order to respect the diversity of values and beliefs present in a classroom. WHAT ARE THE GOALS OF SCHOOL-BASED SEXUALITY EDUCATION? The primary goal of sexuality education is the promotion of adult sexual health. Sexuality education seeks to assist young people in understanding a positive view of sexuality, provide them with information and skills about taking care of their sexual health, and help them acquire skills to make decisions now and in the future. Comprehensive sexuality education programs have four main goals: 1) to provide accurate information about human sexuality; 2) to provide an opportunity for young people to develop and understand their values, attitudes and beliefs abuot sexuality; 3) to help young people develop relationships and interpersonal skills; and 4) to help young people exercise responsibility regarding sexual relationships, including addressing abstinence, how to resist pressures to become prematurely involved in sexual intercourse, and encouraging the use of contraception and other sexual health measures.2 DOES THE FEDERAL GOVERNMENT REQUIRE SEXUALITY OR HIV EDUCATION? There is no federal law or policy requiring sexuality or HIV education. Rather than dictating sexuality education and its content, the federal government has been explicit in its view that it should not control the content. While the statutes were not established solely in regard to sexuality education, four federal statutes preclude the federal government from prescribing state and local curriculum standards; the Department of Education Organization Act, Section 103a, the Elementary and Secondary Education Ace, Section 14512, Goals 2000, Section 319b, and the General Education Provisions Act, Section 438. DO STATES REQUIRE SEXUALITY OR HIV EDUCATION? Twenty-two states and the District of Columbia require schools to provide both sexuality and STD/HIV education (AL, AR, DE, DC, GL, GA, IL, IA, KS, MD, MN, NV, NJ, NM, NC, RI, SC, TN, TX, UT, VT, VA, WV). An additional 15 states require schools to provide STD/HIV education (AZ, CA, CT, ID, IN, MI, MO, NH, NY, OH, OK, OR, PA, WA, WI). Thirteen states do not require schools to provide either sexuality or STD/HIV education (AK, CO, HI, KY, LA, ME, MA, MS, MT, NE, ND, SD, WY).3 WHAT SHOULD BE INCLUDED IN SCHOOL-BASED SEXUALITY EDUCATION? The National Guidelines Task Force, composed of representatives from 15 national organizations, schools and universities, has identified six key concepts that should be part of any comprehensive sexuality education program. These are: human development, relationships, personal skills, sexual behavior, sexual health, and society and culture. The National Guidelines Task Force issued Guidelines for Comprehensive Sexuality Education in October 1991, which include information on teaching 36 sexuality-related topics at age-appropriate levels.4 WHAT IS THE CONTENT OF SEXUALITY EDUCATION PROGRAMS? The content of sexuality education varies greatly depending on the community and age-level of the students in the program. The most commonly and thoroughly covered topis (in order) are body image, reproductive anatomy, puberty, decision-making skills, families, abstinence, STDs and HIV/AIDS, sexual abuse, and gender roles.5 Of the 26 states that require abstinence instruction, only 14 also require the inclusion of ther information on contraception and pregnancy and disease prevention (AR, CA, DE, GA, IL, NC, OK, OR, RI, SC, TN, VT, VA, WA).6 Twenty-seven states and the District of Columbia require that schools provide family life education, such as child development, dating, explanation of family responsibilities and interpersonal relationships (AL, AZ, AR, CA, CT, DE, DC, FL, GA, IL, IN, IA, LA, MD, MN, NV, NJ, NM, NC, OR, RI, SC, TN, TX, UT, VT, VA, WV).7 Thirty-one states and the District of Columbia require or recommend the inclusion of decision-making skills instruction, such as resisting peer pressure, setting limits during dates, teaching that it is wrong to make unwanted sexual advances, and encouraging personal responsibility and respect for others (AL, AZ, AR, CA, CO, DE, DC, FL, GA, IL, IA, LA, MD, MA, MN, MT, NV, NH, NJ, NM, NY, NC, OK, OR, RI, SC, TN, TX,UT, VT, VA, WV).8 Five states prohibit or restrict discussion of abortion (CT, IL, MI, SC) and only Vermont and the District of Columbia require that discussions of abortion be included.9 Eight states require or recommend teaching that homosexuality is not an acceptable lifestyle and/or that homosexual conduct is a criminal offense under state law. (AL, AZ, GA, LA, NC, SC, TX, VA), whereas one state (RI) requires that schools teach respect for others regardless of sexual orientation.10 WHO DECIDES THE CONTENT OF SCHOOL-BASED SEXUALITY EDUCATION? Many states have advisory committees. Thirty states have established a state school/community advisory committee to develop, review, or recommend appropriate sexuality education material and concepts taught at various grade levels. These advisory committees reflect the recognition by states that programs are best developed with diverse input from external agencies and representatives. Such input also helps to develop community support for programs and to minimize negative reactions from sectors unfamiliar with programs.11 IS SEXUALITY EDUCATION EFFECTIVE? Comprehensive approaches to sexuality education have been shown to be successful at helping young people postpone intercourse and use contraception and STD prevention. Research shows that effective programs provide modeling and practice in communication and negotiation skills; reinforce clear and appropriate values to strengthen individual values and group norms against unprotected sexual activity; focus on reducing sexual risk-taking behaviors; use social learning theories (that focus on recognizing social influences, bolstering health-positive values, changing group norms and building social skills); employ active learning methods of instruction to provide students with the information they need to assess risks and avoid unprotected intercourse; and include activities that address social and media influence on sexual behavior.12 An international study of sexuality education programs found that the best outcomes were obtained when education is given prior to the onset of sexual activity and when information about both abstinence and contraception and STD prevention were given. The same study also found that sexuality education does not encourage sexual experimentation or increased activity.13 DO ABSTINENCE-ONLY PROGRAMS WORK? Abstinence-only programs have not been found to be effective in helping young people to postpone sexual involvement. Three studies of abstinence-only programs have appeared in the scientific literature. The first study found no significant impact on the initiation of intercourse at the six-month follow-up. The other two studies examined posttest data collected only six weeks after the completion of the program. The posttest found that neither those young who received the abstinence-only program or any members of the control group initiated intercourse during the 6-week period. A review of the existing published literature on sexuality education in Public Health Reports concluded: "There is not sufficient evidence to determine if school-based programs that focus only upon abstinence delay the onset of intercourse or affect other sexual or contraceptive behaviors.14 CAN PARENTS EXCUSE THEIR CHILDREN FROM SEXUALITY AND HIV EDUCATION? Yes. Whether it is for sexuality education or HIV/AIDS education, states specifically provide parents with the option of removing their children from the classes or states defer to local decision makers to provide that option to parents. Nearly all local school districts have provisions for students opting-out of sexuality education classes.15 However, fewer than three percent of parents remove children from these education programs. WHO SUPPORTS SEXUALITY EUDCATION? The vast majority of Americans support sexuality education. In every public opinion poll, more than 8 in 10 parents want sexuality education taught in high schools.16 Support for HIV/AIDS education is even higher. Ninety four percent of parents think public schools should have an HIV/AIDS education program. More than eight out of ten parents want their children to be taught about safer sex as a way of preventing AIDS.17 Moreover, many youth, community and national organizations have adopted policies supportive of sexuality education. More than 90 prominent national organizations have joined together as the National Coalition to Support Sexuality Education, a coalition of national organizations committed to assuring that all youth will receive comprehensive sexuality education by the year 2000. SEXUALITY EDUCATION: POINTS TO KEEP IN MIND * Americans overwhelmingly support sexuality education in the schools. * Parents demonstrate their support for sexuality and HIV/AIDS education. * National organizations concerned about young people's health, education and development support sexuality education. * Most states require some form of sexuality or STD/HIV education. * Abstinence education is a component of comprehensive sexuality education. * The content of sexuality education programs in schools reflects community input and standards. * Parents already have the ability to remove their children from sexuality education programs. * Skill-based sexuality and STD/HIV education programs are effective. * Sexuality education programs do not encourage sexual activity or experimentation. References 1. National Guidelines Task Force, Guidleines for Comprehensive Sexuality Education, Kindergarten - 12th Grade. (New York: SIECUS, 1992). 2. Ibid. 3. The NARAL Foundation, Sexuality Education in America: A State by State Review, (Washington, D.C., NARAL, 1995), p.v. 4. Op. cit. 5. Alan Gambreall and Debra Haffner, Unfinished Business: A SIECUS Assessment of State Sexuality Education Programs, (New York: SIECUS, 1993), p.8. 6. The NARAL Foundation, p. iv. 7. Ibid., p. v. 8. Ibid., p. v. 9. Ibid., p. v. 10. Ibid., p. v. 11. Alan Gambrell and Debra Haffner, p. 14. 12. Douglas Kirby, et al., "School-based programs to reduce sexual risk behaviors: A review of effectiveness," Public Health Reports, 109, 339-360. 13. Anne Grunseit and Susan Kippax, "Effects of Sex Education on Young People's Sexual Behaviour," World Health Organization, 1994. 14. Op. cit. 15. National Association for State Boards of Education, conversations with State Departments of Education, 1995. 16. America Speaks: American's Opinion on Teenage Pregnancy, Sex Education and Birth Control (New York: Planned Parenthood Federation of America, 1988) (poll conducted by Louis Harris and Associates, Inc.), p. 24. 17. Gallup polls, September 1987, 69(1). copyright © 1995, SIECUS ---------- Sexually Transmitted Diseases in the United States Of the top ten most frequently reported diseases in the United States in 1995, half--accounting for 87 percent of all cases--were sexually transmitted diseases (STDs). With approximately 12 million new cases occurring annually, rates of curable STDs in the United States are the highest in the developed world.(1) The public and private costs of STDs are tremendous. A conservative estimate of total costs associated with the most common types is approximately $10 billion. This increases to $17 billion when HIV/AIDS infections are included.(2) Despite these tremendous health and economic burdens, the scope and impact of the STD epidemic are still underappreciated. And, to a large extent, the diseases are largely hidden from public discourse.(3) INCIDENCE AND PREVALENCE* * At least 1 person in 4 will contract an STD at some point in his or her life. * More than 12 million Americans, 3 million of whom are teenagers, are infected with an STD each year. * As many as 56 million American adults and adolescents may have an incurable viral STD other than HIV. * Chlamydial infection is the most common bacterial STD. More than 4 million cases occur each year. Just 23 percent of American adults under 65 cite chlamydia when asked to name any STDs. * About 200,000 to 500,000 new cases of genital herpes occur each year, and 31 million Americans are already infected with the genital herpes virus (herpes simplex virus, or HSV). * At least 24 million people are infected with human papillomavirus (HPV) or genital warts, and as many as 1 million new infections occur each year. HPV is associated with cervical and other genital and anal cancers. * Trends in viral STD infections are unknown, but initial visits to doctors for genital warts and herpes have increased steadily over the last 30 years, dropping off slightly in the last five years. * Between 1987 and 1991, the number of annually reported cases of syphilis--over 100,000--was at its highest levels in 40 years. * At least 800,000 cases of gonorrhea occur each year. HEALTH CONSEQUENCES* * Millions of women, men and children are affected by long-term complications of STDs, including various cancers, infertility, ectopic pregnancy and spontaneous abortion, and other chronic diseases. * At least 15 percent of all infertile American women are infertile because of tubal damage caused by pelvic inflammatory disease (PID) resulting from an STD. * Viral STDs result in lifelong incurable infection. Seventeen percent of American adults under 65 think all STDs are curable--but a large majority (80 percent) know that not all STDs are curable. * STD infections increase susceptibility to HIV. People with an active syphilis, genital herpes, or chancroid infection, or who have chlamydia, gonorrhea, or trichomoniasis are 3 to 5 times more likely to contract HIV than other people. More than half (54 percent) of American adults under 65 do not know that STDs increase susceptibility to HIV. IMPACT ON WOMEN* * Complications of STDs are more severe and more frequent among women than among men. For example, women are more susceptible to reproductive cancers and infertility once infected. * Women are biologically more susceptible than men to becoming infected if exposed to an STD. For example, a woman=s risk of contracting gonorrhea from one act of unprotected intercourse is as high as 90 percent while the risk to a man is approximately 30 percent. * Among couples with one infected partner, the annual risk of herpes infection is 19 percent when transmitted from a man to a woman and 5 percent when transmitted from a woman to a man. * STDs are less likely to produce symptoms in women and are therefore more difficult to diagnose until serious problems develop. Up to 80 percent of chlamydia infections in women are asymptomatic compared to 40 percent in men. From 30 to 80 percent of women with gonorrhea are asymptomatic while fewer than 5 percent of men are asymptomatic. IMPACT ON TEENAGERS AND YOUNG ADULTS* * Three million teenagers--about 1 in 4 sexually experienced teenagers--acquire an STD every year. By the end of 1995, there were more than 2,300 teenagers diagnosed with AIDS. * Young adults are the age groups at greatest risk of acquiring an STD for a number of reasons: they are more likely to have multiple sexual partners; they may be more likely to engage in unprotected intercourse; and their partners may be at higher risk of being infected. * Compared to older adult women, female teenagers are more susceptible to cervical infections, such as gonorrhea and chlamydial infections, due to their cervical anatomy. * Chlamydia is more common among teenagers than among adult men and women; in some studies, up to 30 percent of sexually active teenage women and 10 percent of sexually active teenage men tested for STDs were infected with chlamydia. REFERENCES 1. The Hidden Epidemic: Confronting Sexually Transmitted Diseases, National Academy Press, Washington, DC, December 1996. 2. Ibid. 3. Ibid. * The statistics in this Fact Sheet are from a briefing paper, Sexually Transmitted Diseases in the United States: Exposing the Epidemic, prepared by the Kaiser Family Foundation, The Alan Guttmacher Institute, and the National Press Foundation and based on: * The Hidden Epidemic: Confronting Sexually Transmitted Diseases, The Institute of Medicine, National Academy Press, 1996. * Survey on Public Knowledge and Attitudes About STDs Other Than AIDS, Kaiser Family Foundation, 1996. * Testing Positive: Sexually Transmitted Disease and the Public Health Response, The Alan Guttmacher Institute, 1993. CRITICAL COMPONENTS OF STD PREVENTION & CONTROL** Communities need critical prevention and control services to help reduce costly complications of STDs. They should include both these patient-based and population-based approaches: * Screening high-risk populations for prevalent STDs. Because the prevalence of STD infections varies from place to place, private sector providers may benefit from consulting with public health professionals on disease prevalence in their community in order to select cost-effective strategies for providing relevant STD screening services. * Treating individuals with diagnosed and presumptive infections. Recommendations of STD experts on treatment regimens for STDs should be readily available to health care providers. Quality assurance programs should be implemented to ensure that * Providing prevention counseling and education. Both public and private sources are needed to provide STD prevention counseling and education to individual patients in order to reach those affected by STDs. Such services are essential to reach sexual partners, to address future infections, as well as to ensure that medication is taken properly and that patients return for followup care. Community education about STD prevention is also important for beginning to change risky behavior before infection occurs, * Notifying, treating, and educating partners of persons diagnosed with STDs. A sexual partner who has been exposed to an STD should be informed of his or her potential infection by the infected person, his or her health care provider, the provider's staff, or public health staff trained in partner notification. In most states, the law protects public health personnel in the notification process but does not protect other persons. Private providers and public health personnel may work together to provide sexual contacts with information on all aspects of needed care. Notification is a key step to prevent reinfection and further spread of STDs. * Reporting STD cases to assist in planning, evaluating, resource allocating, and coordinating efforts. Health departments monitor and analyze reported STDs to identify problems in specific communities, to evaluate the effects of control measures, and to detect changes in trends. Complete and accurate reporting is essential so that the partnership of private providers and public health personnel can appropriately address STD problems. Laws in every state require providers to report some STDs. Most states require reporting of gonorrhea, syphilis, chlamydia, and AIDS. Several require reporting of herpes, HIV infection, or STD complications such as PID. Under-reporting of STDs results in failure to note disease trends and inadequate planning to address STD problems. These approaches are needed because: * Screening and treatment will prevent significant future complications. When left untreated, STDs can result in severe consequences including infertility, tubal pregnancy, chronic pain, cancer, premature births, low birth weight, congenital infections in newborns, and even death. In addition, HIV transmission is much more likely when other STDs are present, making STD treatment an important intervention for prevention of HIV infection. For example: In the United States, chlamydia--which infects approximately 4 million people each year--causes the majority of uterine and fallopian tube infections or PID in women. PID is the leading cause of preventable infertility and tubal pregnancy. Tubal pregnancy, in turn, is the leading cause of first-trimester pregnancy-related death in African-American women. Prospective epidemiological studies have repeatedly demonstrated twofold to fivefold increases of HIV transmission when other STDs are present. In addition, other STDs have been demonstrated to increase HIV susceptibility in women by increasing the cells targeted by HIV CD4 cells in their cervical secretions. Other STDs have also been shown to increase the probability that HIV will be transmitted from an HIV-infected person to another person. A recent study demonstrated that in communities with improved STD treatment, HIV transmission was reduced by 42 percent. * Screening and early treatment are cost-effective. The cost of untreated STDs far exceeds the cost of prevention services. For example, evidence indicates that chlamydia screening and treatment decreases the incidence of costly complications, such as PID. A random trial of chlamydia screening demonstrated a 60 percent reduction in the incidence of PID in the screened group in the 12 months following testing. Treatment of the consequences of chlamydia (e.g., PID, infertility, ectopic pregnancy) is estimated to be 12 times greater than the cost of screening and treatment. * These approaches would result in a healthier population. STDs are strongly linked to long-term health complications. For example, the association between human papillomavirus and cervical cancer is well documented. STDs are one of the most important preventable causes of adverse outcomes of pregnancy, including low birth weight/prematurity, congenital infection, stillbirth, and postpartum infection. The two leading causes of preventable infertility are chlamydia and gonorrhea. Women, adolescents, and people of color are disproportionately affected by STDs and their consequences. STD prevention services could dramatically lower the incidence of STDs, their long-term consequences, and their significant cost. The overall health of Americans would improve with the routine availability of these components of STD prevention. RESOURCES For more information about STDs, contact: American Social Health Association (ASHA) P.O. Box 13827 Research Triangle Park, NC 27709 202/543-9129 http://sunsite.unc.edu/ASHA/ National AIDS Hotline 800/342-AIDS (English) 800/344-7432 (Spanish) 800/243-7889 TTY Service for the Deaf National Herpes Hotline 919/361-8488 National STD Hotline 800/227-8922 ASHA Resource Center Publications about Herpes and HPV 800/230-6039 ASHA Healthline Publications about sexual health communication 800/972-8500 SIECUS 130 West 42nd Street Suite 350 New York, NY 10036-7802 http://siecus@siecus.org ** Critical Components of STD Prevention & Control is a document published by the STD Prevention Partnership, a group of national organizations with shared concern about the continuing spread of STDs, including HIV, and with a mission to support and encourage partnerships among the private, voluntary, and public sectors in developing and implementing strategies to reduce the incidence and impact of STDs. Detailed references for Critical Components of STD Prevention & Control are available from the Division of STD Prevention of the U.S. Centers for Disease Control and Prevention, 404/639-8260 or by E-mail at jel6@cpsstd1.em.cdc.gov copyright © 1995, SIECUS ---------- Strategies To Build Support For HIV-Prevention and Sexuality Education Programs There are many strategies individuals can use to build broad-based support for HIV-prevention and sexuality education programs. This list--the result of a SIECUS needs assessment of over 150 education and health leaders--offers sound advice from professionals in the United States involved in such programs. Each person was asked: "Are there successful strategies that your agency has employed?" The list shows that, with a little creativity, everyone has a role to play in supporting HIV-prevention and sexuality education programs for young people. WORK WITH OTHER GROUPS * Form a coalition and invite representatives from throughout the community, including colleague organizations, parents, faith communities, and business leaders. Work together on common messages and policy recommendations to key decision-makers. This will result in a strong, unified message and will decrease the likelihood of challenges. (One such coalition scheduled time at meetings to write letters to the editor on different issues of concern to coalition members.) * Seek opportunities to facilitate meetings with other local, state, or national organizations. (Cosponsor meetings when possible.) Groups like the American Cancer Society sometimes cosponsor health programs such as a statewide health education summit or a community health fair. * Form a committee when reevaluating health, HIV-prevention, or sexuality education curricula. Include people that reflect a diversity of viewpoints: school staff, administrators, business people, parents, and religious leaders. Invite teachers and staff to explain what students are learning. * Avoid duplicating efforts. Whenever possible, coordinate activities such as educational programs. * Actively involve the state Parent Teacher Association (PTA). Consider offering HIV/AIDS workshops at its convention. Publish newsletters or brochures for its local presidents and school principals. (The National PTA publishes an HIV/AIDS Education Kit available from state chapters.) * Seek the involvement of local and state public health agencies. Ask for representatives to make classroom presentations to provide support to HIV-positive students, to conduct inservice training for teachers, and to work with peer educators. DEVELOP MODELS * Develop model comprehensive school health education sites within your state that include HIV-prevention and sexuality education components. Staff at these sites can provide teacher training to other communities on how to implement a comprehensive program. * Focus on providing a model of technical assistance and support for schools. Balance public policy efforts with support for those who are trying to provide HIV-prevention and sexuality education within the current environment. * Clearly define the terms that refer to curricula (i.e. "abstinence-based," "abstinence- only," "fear-based," or "comprehensive"). Be consistent. * Emphasize the big picture when referring to specific components of a comprehensive program. Talk in terms of comprehensive health programs that include HIV- prevention and sexuality education instead of just the HIV-prevention or sexuality education components. * Seek out culturally competent programs. Use models (and educators) that work within specific cultures. PROVIDE UP-TO-DATE INFORMATION * Develop policies and written guidelines for guest speakers. Make certain they understand district/agency policy regarding the discussion of topics and understand the parameters of their presentation and how to handle questions from students that go beyond these parameters. If speakers are not experienced in working with students, make certain a staff person helps them develop age-appropriate material. Arrange for a staff person to attend the presentation. * Develop a resource library for health educators. Include curricula, audiovisuals, and the latest data and research. * Send packets of information on comprehensive health education, including HIV- prevention and sexuality education, to all libraries. Include materials for students, teachers, other school staff, and parents. * Help improve a teacher's knowledge, skill, and comfort level by teaching her/him how to build parental understanding and support for HIV-prevention and sexuality education. Whenever possible, collaborate with other agencies and local colleges/universities to provide training. Consider offering continuing education credits as incentives. * Invite medical students or doctors to talk to teachers and older students about their experiences working with people living with HIV or AIDS. ENGAGE THE MEDIA * Work proactively with the media. Mail press releases, try to place articles in newspapers, and respond to an editorial if a constructive debate seems possible. * Appoint a staff person to handle media requests if your agency does not have a public relations department. Make certain all staff keeps this person informed to better anticipate hot spots and respond quickly to media requests. * Arrange for the media to contact your public relations department staff for assistance. (This staff can help prepare responses before you go to the media.) * Make certain that the local media is acquainted with health education programs and issues. If specific materials are contested in the community, acknowledge that challenges are inevitable. Remind the media that good curricula are developmentally appropriate and based on sound research. BUILD COMMUNITY SUPPORT * Help community-based organizations understand the intricacies of working with schools so the programs they develop are responsible and realistic. * Work with school administrators. Make them aware of the support in your community for school-based comprehensive health education programming, including HIV- prevention and sexuality education. Encourage them to support the work their teachers are doing in these areas. * Conduct community-wide polls and focus groups to see what information community members want in the local school-based health education curriculum. * Arrange for PTA and community representatives to attend teacher and administrator training sessions if appropriate. ORGANIZE PUBLIC MEETINGS * Arrange to have an experienced meeting facilitator--ideally someone perceived as neutral, with no stake in the outcome of the meeting. * When planning the agenda, consider the audience. Meeting planners should closely assess the program and prepare to address issues of concern. * Anticipate differences of opinion. Make certain the facilitator respectfully involves people with all viewpoints. Let people with children in the public schools speak first, followed by taxpayers living in the community, and finally, people from outside the district, if there is time. * Set time limits for speakers. Ask for testimony in advance. PREPARE FOR CHALLENGES * Take inventory of the materials distributed by your organization. Know the content and how people interpret it. * Do not make assumptions about who will support your efforts. Many do not reach out to religious organizations because they do not expect support. In reality, many "institutional" positions do not always play out on the local level. * Meet with those who are resistant to comprehensive programs to find areas of common ground. Whenever possible, work on these areas and agree to disagree on others. * Learn as much as you can about those who challenge comprehensive programs in your community--get on mailing lists, attend meetings/trainings, ask questions. * Learn and practice conflict resolution skills. Role-play situations involving development of a consensus. INVOLVE PARENTS * Build parental understanding and support for health, HIV-prevention, and sexuality education programs. Inform parents in advance of classes. Schedule a parent preview night. Encourage parental involvement. * Serve as a resource for parents. Help them acquire skills to become involved in their children's education. * Schedule an evening parent education series. Include diverse topics related to health issues, including "Talking to Your Children about Sexuality." Widely publicize the series, including mailing announcements to the homes of parents. * Schedule a one-day retreat for middle-school students and their parents. Focus on communication skills between students and parents, including the discussion of sexuality issues. Encourage their involvement in the planning process. * Publish a monthly newsletter for parents on child and adolescent health. Include book reviews and resources. Encourage parental involvement in the newsletter. * Create "health knapsacks" for young students to take home to their parents. These are especially useful for parents who can't attend all school functions. Include reading materials and suggestions for parent-child activities. copyright © 1995, SIECUS ---------- The Truth About Latex Condoms Sexually-involved individuals owe it to themselves to get accurate, unbiased information about condoms and the part they play in preventing unwanted pregnancies and sexually-transmitted diseases. SIECUS has prepared this Fact Sheet -- The Truth about Latex Condoms -- for this purpose. It includes information on both their reliability and their effective use. It also includes resources used in compiling the Fact Sheet so that people will know where to look for more information. EFEECTIVENESS * Using a condom is more than 10,000 times safer than not using a condom during intercourse.1 * Condoms are 98 percent effective2 when used correctly -- with some reports indicating they are 100 percent effective3. * The average failure rate for condoms is 12 percent: reflective of people who do not use them properly or do not use them every time they have intercourse.4 * Laboratory tests show that neither sperm, which has a diameter of 3 microns (.003 mm), nor STD-causing organisms, which are a quarter to a ninth the size of sperm, can penetrate an intact latex condom.5 * Contraceptive effectiveness is determined by the number of women who use a certain method and become pregnant over a one-year period. * Effectiveness rates for STD prevention (including HIV) must be calculated in separate studies from pregnancy prevention. REGULATIONS AND TESTS *Condoms are manufactured according to national standards based on regulations of the Food and Drug Administration (FDA).6 * If there is a leak in more than four per 1,000 condoms, the entire lot (approximately 5,000) is discarded.7 * Condoms are tested electronically to determine their resistance to breakage, elasticity and pore size.8 * The U.S. Centers for Disease Control and Prevention (CDC) has conducted laboratory studies showing that sperm and disease-causing organisms (including HIV) cannot pass through intact latex condoms.9 Information indicating that condoms have holes as large as five microns (.005) was based on tests of latex gloves which had less stringent standards. (Note: they are now more stringent.) HIV TRANSMISSION * Condom use substantially reduces the risk of HIV transmission. * A study published in The New England Journal of Medicine observed partners for 20 months where one was HIV-positive and the other was HIV-negative. * Findings included: (1) HIV-negative partners did not become infected when condoms were used consistently and correctly; (2) 10 percent of the HIV-negative partners (12 of 122) couples became infected when condoms were used inconsistently.10 * A study published in The Journal of Acquired Immune Deficiency Syndromes observed sero-discordant heterosexual couples and showed that only three percent (two out of 171) who consistently and correctly used condoms became HIV-infected and that 15 percent (eight out of 55) who used condoms inconsistently became HIV-infected.11 * A study published in the American Journal of Epidemiology observed female partners of sero-positive men and showed that inconsistent (or no) condom use during vaginal and anal intercourse was associated with HIV infection.12 ABSTINENCE * Abstinence from sexual intercourse is the only 100 percent effective prevention against sexually transmitted diseases. However, it must be correctly and consistently practiced. * Of those who report abstinence as their contraception method, 26 percent become pregnant each year.13 *Eighty percent of all people have intercourse at least once by the age of 20.14 RESOURCES 1. Ronald Carey et al. "Effectiveness of Latex Condoms As a Barrier to Human Immunodeficiency Virus-Sized Particles under the Conditions of Simulated Use," Sexually Transmitted Diseases, 19 (2): 230-34, 1992. 2. J. Trussel et al. "Contraceptive Failure in the United States: An Update," Studies of Family Planning, 21(1), 1990. 3. I.A. Vincenzi, "A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners," The New England Journal of Medicine, 331(6): 431-46, 1994. 4. Hatcher et al. Contraceptive Technology (New York: Irvington Publishers, 1990). 5. C. Rietmeijer et al. "Condoms As Physical and Chemical Barriers against HIV," Journal of American Medical Association, 259(13): 1706, 1986. 6. "How Reliable Are Condoms?" Consumer Reports, May 1995, pp. 1-6. 7. Ibid., 1995. 8. Ibid., 1995. 9. Facts about Condoms and Their Use in Preventing HIV and Other STDs (Centers for Disease Control and Prevention, July 1993). 10. I.A. DeVincenze, Op cit., 1994. 11. A. Saracco et al. "Man-toWoman Sexual Transmission of HIV: Longitudinal Study of 343 Steady Partners of Infected Men," Journal of Acquired Immune Deficiency Syndromes, 6:497-502, 1993. 12. Mark Guimaraes et al. "HIV Infection: Female Partners of Seropositive Men in Brazil," American Journal of Epidemiology, 142 (5): 538-47, 1995. 13. E. Jones and J. Forrest, "Contraceptive Failure Rates Based on the 1988 NSFG," Family Planning Perspectives, 24:21-9, 1992. 14. Sex and America's Teenagers (New York: The Alan Guttmacher Institute, 1994), 19. copyright © 1995, SIECU