Establishing widespread and broadly based sex education curriculums has been a relatively easy task in countries like Australia, where prevention of HIV/AIDS was recognised early on as an urgent public health problem, where there was evidence that demonstrated young people were sexually active, and where relatively liberal attitudes to sexuality existed.
Early HIV prevention strategies were founded on a harm minimisation approach that took a realistic view of young people's behaviours, be they sex- or drug-related, and on education programs designed to reduce the potential for harm associated with these behaviours.
There is no doubt in my mind that these programs, mostly but not entirely school-based, have been successful. There is also much evidence that broadly based sex education - that teaches negotiation skills, conflict resolution, and about gender issues and sexual diversity - improves young people's ability to make informed choices, such as postponing the first sexual intercourse.
But I fear we are entering a dangerous period for the sexual wellbeing of young people in this country. In the early days, we had a government and an opposition who, together, endorsed harm minimisation and who ensured that continuing funds supported these programs. Just how fragile this support is can be shown by what has happened recently in the US.
The US has the highest rate of teen pregnancies in the world and an even higher proportion of sexually active young people than in Australia. Despite this, there have been few, if any, national campaigns targeting young people, HIV and sexual activity. Worse is the steadfast and expensive commitment to abstinence-only education, in spite of a continuing failure to produce evidence about the effectiveness of these programs.
I was interested to read of an attempt to introduce a thoroughly US solution to the "sexual epidemic" affecting Britain's teenagers. The cutely called "Silver Ring Thing" encourages young people to take a pledge of abstinence before marriage. I know that a similar movement is becoming active here.
A recent report showed that 88 per cent of 12,000 teenagers in the US who had pledged to do this reported having sexual intercourse beforehand. Teenagers who had signed pledges were less likely to use condoms when they became sexually active and less likely to seek medical help for symptoms of STIs.
President George Bush has consistently supported the view that sex education should teach abstinence only and not include information on other ways to avoid STIs and pregnancy. Since his election, Congress has appropriated more than $US100 million in grants to organisations that sponsor abstinence-only education. Funding for abstinence-only education increased by nearly 3000 per cent from 1996-2001.
In a rapidly changing world, cultural beliefs and practices are subject to change, so those of us who care about young people's sexual health must be eternally vigilant.
And this is why I am so worried about our federal Health Minister's recent statements about "teenage promiscuity" and abortion being the "easy choice", about his attempt to restrict access to emergency contraception for teenage girls, and about his plan to increase the age when parents can have access to the medical records of their children from 14 to 16. There is no doubt that these last two will have serious consequences for the sexual health of our young.
The past decade has seen a sea change in what we know and understand about young people's sexuality. We need to monitor their sexual practices to ensure that our health promotion messages remain effective. And remember that young people do have agency in the way they express their sexuality.
But this agency is affected by circumstances outside their control. They have little political power and are largely excluded from decisions that will affect their lives, sexual or otherwise. Even today, young people make decisions within environments that are likely to regard their sexuality as worrying at best and deeply disturbing at worst.
Considering the complexity of factors in play allows us to move away from the notion of vulnerable risk-takers and embrace the idea of young people's sexuality as a valid expression of their humanness.
This is an edited extract from a public lecture to the Key Centre for Women's Health in Society at the University of Melbourne on 22 June 2004. It was first published in The Sydney Morning Herald on 23 June 2004.
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