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Developing Innovative, Computer-Based Sexual Health Education Program » Women's Courage

Developing Innovative, Computer-Based Sexual Health Education Program

March 3rd, 2011 by anna Leave a reply »

TO: Bill & Melinda Gates Foundation

RE: Letter of Inquiry for Innovative Sexual Education Programs for Children and Adolescents

To Whom It May Concern:

Worldwide, there are over 1 billion people between the ages of 10-19.  These individuals, classified as “adolescents” by the United Nations Population Fund, constitute over one-fifth of the world’s population.   If we extend this range to include all those under the age of 25, we include over half of all people alive today.  By numbers alone, young people are astoundingly important to the economic stability, population health, and security of all nations. Further, this developmental period represents a critical period in which to intervene to promote the public’s health.  Scholars consider adolescence a time of both heightened vulnerability to initiating risk behaviors and a crucial time to establish healthy behaviors.  Adolescent girls and young women an especially important because of their relatively lower status and increased vulnerability to a number of health problems across the life course.  Focusing on ensuring good health and promoting health-enhancing behaviors in young people, especially females, should therefore be a top priority for global health leaders today.

Of particular importance to today’s adolescents is sexual and reproductive health.  There are 33 million people living with HIV/AIDS worldwide, the vast majority of whom live in developing countries.  Adolescents constitute the fastest growing group of new infections worldwide.  Sexually Transmitted Infections (STIs) comprise a leading cause of morbidity in women (often second only to domestic violence), and are the primary killer of 200,000 women annually.  An additional 87,000 deaths during pregnancy and childbirth are due to complications of STIs, and 237,000 women die each year of cervical cancer, a highly treatable illness if caught early, and preventable via vaccination of women not yet sexually active.

Worldwide, millions of young women are sexually active. In developing countries, anywhere from 20 to 70% of teen girls aged 15-19 report in surveys having already initiated sex.  In many countries, up to one-third of sexually active adolescent girls report having two or more sexual partners in the past year, an indicator.  More than 14 million adolescent girls give birth each year.  Over 6 million of these pregnancies are unintended, indicating improved access to and understanding of contraception.  Given that most young women will become sexually active during adolescence, and millions will experience an unwanted pregnancy and/or contract HIV or another STI, the public’s health depends on providing comprehensive, effective sexual and reproductive education to these youth.

Yet, it is clear that governments, civil society, and the private sector alike have failed to meet this basic human right.  Nationally representative Demographic and Health Surveys across the globe underscore this failure.  These data show, for example, that in 24 of 30 countries with adequate data, 30 to over 50% of young women do not know that a healthy looking person can carry HIV.  This is true even in some high-HIV-prevalence countries, such as Kenya, Ethiopia, Mozambique, and Nigeria.   Knowledge of modern contraceptive methods is no more encouraging.  As many as one third of teenage girls report they do not know of any modern contraceptive methods.  While more report knowledge of condoms, this appears to be only a general awareness of condoms: most countries show a stunning gap between the proportion of girls who have heard of condoms and the proportion that know where to obtain one.  Clearly, current programs are falling short.  New efforts are needed to ensure that young women receive the knowledge they need to protect themselves from STIs, HIV, unintended pregnancies, and cervical cancers, and to ensure they can develop positive, healthy, and satisfying sexual relationships.

Most current efforts to provide comprehensive sexual and reproductive health information to adolescent girls suffer from important limitations.  School-based education fails to reach the huge numbers of youth who drop out of school or whose attendance is only sporadic.  This is particularly true for girls, who are much less likely to complete primary or secondary school than their male peers.  Teachers frequently lack training and resources to successfully implement sexual education.  Mass-media campaigns are often unidirectional in their communications – youth may not have the opportunity to ask questions or seek clarification.  Mass-media messages are also limited to topics and curricula considered socially acceptable, which is particularly problematic in the case of sexual health education for adolescents, an extremely taboo topic across the globe.  Also, the very poor and those living in rural areas may lack access to many forms of media because of their poverty, remoteness, or high rates of illiteracy.  Internet-based education faces similar limitations.  Some of these challenges are being met with SMS-based hotlines; however, these programs can offer only very brief communication (i.e. messages soften limited to 140 characters) and are considered one-time services to answer specific questions rather than provide comprehensive education.

Because of the importance of educating young women, particularly those living in developing countries, combined with the clear gaps in current programs, I seek funding for an initiative to develop a comprehensive, interactive, computer-based sexual and reproductive health curricula, based on the HIV/AIDS curriculum used by the internationally renowned organization, TeachAIDS.  TeachAIDS is a 20-25 minute, interactive computer application that teaches adolescents key aspects of HIV/AIDS prevention using proven pedagogical and communication theories and culturally appropriate euphemisms, metaphors, and explanations.  The application was originally developed for use in India as a tool to provide effective heath education on socially taboo topics and has since been adapted for use in countries across the globe.  A large, randomized-controlled trial of the application in India demonstrated its efficacy.  Students who received the computer-based instruction showed significantly greater knowledge of HIV/AIDS as well as positive changes in attitudes compared to students who did not receive the intervention.  These differences were still significant at one-month follow-up.  Importantly, while males performed significantly better on a pretest of their HIV/AIDS knowledge, no gender differences were present following the program, indicating the tool’s powerful ability to close the gender achievement gap.

TeachAIDS shows us that it is indeed possible to educate youth on socially taboo topics with a very brief intervention.  Given the program’s success, I argue for funding to expand this program to cover comprehensive sexual health information.  TeachAIDS was developed using rigorous, research-based iterations to ensure its cultural appropriateness and effectiveness.  This process is resource-intense; funding is therefore needed to develop and test new modules addressing other topics in sexual health.  Based on national recommendations, these topics should include human development (reproductive anatomy and physiology, reproduction, puberty, and sexual orientation and identity), relationships (including with friends, love and dating, and relationship abuse and domestic violence), personal skills (including learning decision making, assertiveness training, and increasing skills in negotiation), sexual behavior (including masturbation, abstinence, and sex response), and sexual health (including contraception, STIs, HIV, and reproductive health).  Material should culturally appropriate and inclusive, and tailored to specific age and education-levels.  Ideally, modules would be created for young children as well as adolescents.  Because so many adolescents begin sexual activity at such young ages, it is important that education reaches them before they establish patterns of risky behavior.

Developing and testing each module will be time and resource intensive.  However, the return-on-investment will likely be unparalleled.  Thus far, little seems to be slowing the HIV/AIDS pandemic, which has ravaged the globe for over 25 years.  Maternal mortality rates have remained high over the past few decades, despite increases in infant and child mortality.  STIs, unwanted pregnancies, and unsafe abortions continue to affect millions of women worldwide.  Providing adolescents, particularly adolescent girls, with access to sexual and reproductive knowledge empowers them to protect themselves, perhaps finally reversing the gloomy trends in sexual and reproductive health worldwide.  Further, such efforts are likely to improve the overall health of girls, thereby conferring extensive positive externalities by keeping girls in school longer, delaying childbearing, increasing child spacing, lower overall fertility, and providing economic opportunities otherwise unavailable due to childbearing or illness.

The health of young people worldwide, as well as our global security and stability, depends on new efforts in sexual education, and I hope you will consider exploring this exciting opportunity to address this need.

Sincerely,

Anna Grummon, Stanford University

References

Agha, S (2003). The impact of a mass media campaign on personal risk perception, perceived self-efficacy and other behavioral predictors.  AIDS Care, 15(6): 749-762.

AVERT.org (2011).  “Sex Education that Works.”  Retrieved from www.avert.org/sex-education.htm.

Bertrand et al. (2006). Systematic review of the effectiveness of mass communication programs to change HIV/AIDS related behaviors in developing countries.  Health Educ Res, 21(4): 567-597.

Dixon-Mueller, R. (2009). Starting young: Sexual initiation and HIV prevention in early adolescence. AIDS and Behavior, 13(1):100-109.

Ferguson, J (2010).  Evidence based approaches to sexuality education for adolescents: Training course in sexual and reproductive health research. World Health Organization: Geneva.

Guttmacher Institute (2010). Facts on the Sexual and Reproductive Health Of Adolescent Women in the Developing World – Brief.

International Center for Research on Women (2001). The critical role of youth in global development.  ICRW Issue Brief, December, 2001.

Murray, AF (2008).  From Outrage to Courage.  Monroe, Maine: Common Courage Press.  See especially pp. 44-46; 65-79; and 103-109.

SEICUS (2004). Guidelines for Comprehensive Sexuality Information: Kindergarten through 12th Grade.  3rd Ed.  New York: SEICUS.

Singh, Bankole and Woog (2005). Evaluating the need for sex education in developing countries: sexual behavior, knowledge of preventing sexually transmitted infections/HIV, and unplanned pregnancy. Sex Education 5(4), 307-331

Socar, P and Nass, C. (2010).  Teaching Taboo Topics Through Technology.  Handbook of Research on Digital Media and Advertising: User Generated Content Consumption.  Eastin, MS, Daugther, T, and Burns, NM (Eds).  IGI Global.

Takura & Zaidi 2010.  Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): The case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions.  International Journal of Gynecology and Obstetrics, 110, p. S3-S6

Takura & Zaidi 2010.  Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): The case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions.  International Journal of Gynecology and Obstetrics, 110, p. S3-S6

Taylor, S.E. (2006). Health Psychology. 6th Ed. New York: McGraw-Hill.

UNAIDS (2011).  Report on the Global AIDS Pandemic: 2010.  Accessed 1 March 2011 from http://www.unaids.org/globalreport/

United Nations Educational, Scientific, and Cultural Organization (2007). Asia Regional Training Workshop For UNESCO Staff On Regional And Country-Level Resource Mobilization For HIV And AIDS. Bangkok, Thailand.

United Nations Population Fund (2004a). State of the World Population 2004.  New York: UNFPA, 2004.

United Nations Population Fund (2004b). Adolescent realities in a changing world. New York: UNFPA, 2004.

United Nations Population Fund (UNFPA), State of World Population 2003—Making 1 Billion Count: Investing In Adolescents’ Health And Rights, New York: UNFPA, 2003.

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5 comments

  1. ktwebb says:

    Anna,

    I sincerely hope you go forward with your letter, because it is well-reasoned, it highlights an enormous issue that should be easy to address but absolutely is not, and it presents a clear, doable solution. I would consider including some additional information about cost–one of TeachAIDS’ strengths is that it is so completely cost effective. Each culture they convert the program into costs around $100,000, with a cost to reach 95% of all cultures at about $13 million.

    One thing you might have to address is that the need for the education may seem less pressing (I agree that it is) when compared to AIDS, which is fatal and poorly understood. Things like premarital sex or even masturbation clearly happen, but they may be more culturally difficult to bring up as subjects without the justification of directly preventing deadly disease. This I’m sure you would cover in the extensive research phase, which is a big part of what makes TeachAIDS so wildly successful.

    My central point, though, is that your presentation was fantastic, and I hope you do consider moving forward with it.

  2. aherrera says:

    What a great memo. The TeachAIDS model is really impressive in that it is both extremely culturally accessible AND is proven highly effective through rigorous research and testing. In most HIV intervention programs you do not see both of these elements. I think that it is excellent to suggest that it cover more sexual health based material, and it definitely would be beneficial to many countries. I think AIDS is such a well-publicized issue in many countries (with good reason), that other sexual health related issues are often overlooked. And while it is a more severe disease than other STIs, that does not mean that other STIs aren’t damaging both physically and emotionally. Overall sexual health can have a huge impact on the life of a woman, and is something that needs to be promoted on a wider scale.

  3. klstaves says:

    I agree that providing a computer-based teaching tool for sex education could be a very useful strategy for improving reproductive. I like the idea of investing in culturally appropriate, well tested curriculum that can be broadly distributed. I still worry, however, that a truly comprehensive curriculum (one including information that explicitly deals with sexual behavior and pregnancy prevention for example) may be rejected in a large number of societies. The TeachAIDS model demonstrated that it is possible to talk about sexually transmitted diseases in a manner that avoids making people uncomfortable. While I have no doubt that this model can apply to other areas of sex education, I wonder if it is possible to really tackle the full spectrum of sex education topics without provoking discomfort among students and/or their teachers. Might we be better off limiting the scope of the curriculum in order to make it more broadly accepted?

  4. sbyron says:

    Anna this is incredible! What a well and powerfully written policy brief! Your introduction was solid and you effectively touched on all the key elements of TeachAIDS and I particularly liked the way you highlighted TeachAIDS’ research-based approach. In thinking about ways to make you memo stronger, I would suggest attaching a link of the TeachAIDS website.

    I’ve been so luck to be a part of TeachAIDS and I’m really excited for its future. We’ve just recently become a 501©non-profit which means that we can apply for grants from funding organizations. Our animations and mission have received a lot of publicity – recently we were covered by the Huffington Post and we were featured on the Yahoo website for World’s AIDS Day. Despite the increase in publicity, funding remains an enormous issue. We’ve been contacted by various governments (last week we were contacted by the Indonesian government), thus we are currently looking for new funding opportunities.

    You’ll be interested to know that we plan to write to the Bill and Melinda Gates Foundation. Fingers crossed.

  5. ritam1 says:

    Anna, great memo! I definitely agree that the need for developing innovative programs that deliver sex ed and reproductive health information is unparalleled. Young people are going to continue to have engage in sexual activity, and abstinence-based approaches are no longer going to cut it. I think that you bring up a great point about high ROI coming from a program such as this. More and more, entrepreneurs are working to overcome present barriers to quality education, and so a program that overcomes the common public discomfort with delivering sex education would truly be beneficial for society. The public needs to understand that young people are very impressionable and therefore vulnerable to misinformation that could have serious health implications. By advocating for an interactive program like this we can work to ensure that they receive critical information in an engaging and culturally competent way. Not only can we expect to see more young people taking an active role regarding their reproductive health needs, but we will shift from a culture that silences conversations about sex to one that is more open to this dialogue, thereby promoting healthy sexual lifestyles.

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