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Politics rather than scientific evidence is driving the debate over abstinence-only vs. comprehensive sexuality education programs. It is an approach to making policy that may satisfy the needs of some adults, but does nothing to address the crucial needs of young people. In health promotion, as in medical care, the informed practitioner usually chooses a proven effective strategy over one for which there is no indication of effectiveness. Anything else is malpractice. If policy makers were physicians, they would prescribe what the current sexuality education research indicates actually works: tested comprehensive sexuality education programs. They would not be willing to take a chance on an unproven therapy (i.e., abstinence-only sexuality education), outside of limited studies designed specifically to test the intervention’s effectiveness. The U.S. Congress recently approved one quarter billion dollars in new sexuality education funding. But the money comes with strict restrictions on program content. The mandated “abstinence-only” approach dictated by Congress has not been proven effective in scientific studies, runs counter to the sexuality education approaches of most states, and is based on assumptions inconsistent with the behavior of the majority of the youth in this country. The costs of unprotected adolescent sex are clear. American teens have the highest rates of unplanned pregnancies and sexually transmitted diseases in the industrialized world. One in four sexually active adolescents acquires a sexually transmitted disease (STD) in any given year. This adds up to three million adolescent STD cases annually. Every 30 minutes another person under 20 becomes newly infected with HIV. Nearly one in ten high school seniors reports becoming pregnant or getting someone else pregnant. About 406,000 teens have abortions annually, 134,000 miscarry, and 313,000 unmarried teens give birth to a child. In order to address these problems more effectively, it is not necessary to settle any of the political debates that whirl around the issue of sexuality education. What is needed is a commitment to results. Elected officials, teachers, school boards and parents need to choose: is the function of sexuality education in public schools primarily to prevent disease and unplanned pregnancy or to promote traditional ideology? We need to use the information currently available to set responsible sexuality education policy focused on improved outcomes for youth. Quality research on program effectiveness, along with a close analysis of the needs of young people at especially high risk, provides important guidance. Comprehensive sexuality education programs discourage teens from having sex before they are ready, and encourage condom and contraceptive use for teens who choose to have sex. The substantial body of current behavioral research indicates that some of these programs have been effective at delaying the onset of sexual intercourse, decreasing the number of sexual partners, and increasing condom and contraceptive use among young people. To date, no published, peer reviewed research has been able to demonstrate positive outcomes for abstinence-only sexuality education programs like those recently funded by Congress. It makes scientific sense that the more comprehensive programs would demonstrate promising results. Even the most effective behavioral interventions succeed with only a portion of their intended audience. And given that two thirds of high school seniors report having had intercourse, it is fanciful to expect that abstinence-only programs will be able to bring an absolute end to adolescent sexual activity. Given that a large percentage of young people are destined to be sexually active, it follows that they will need to know how to protect themselves in sexual situations, and have access to condoms and other contraceptives. Abstinence-only programs fail to deliver these protections. They ignore the complexity of risk factors relating to youth STD and pregnancy rates. And abstinence-only programs are typically silent or condemning on subjects that are critical to many of the young people at highest risk, including gay sex, dynamics with older sexual partners, and abortion.

Since 1991, the Center for AIDS Prevention Studies (CAPS) has conducted collaborative research with local community-based HIV prevention organizations within a consortium model. Community-based research (CBR) refers to research that is conducted by or with the participation of community members. As conducted by CAPS, CBR was a full partnership, with the CBO partner taking the lead on developing the research question, delivering the intervention, and collecting the data. The academic researcher took the lead on developing the instrument, consent procedures, data collection protocol, and data analysis. Together, the academic/CBO team trained intervention and evaluation staff, interpreted the data, crosstrained on service and research issues, and disseminated the findings. We developed a model which supported joint work and negotiation of research activities, as opposed to a model where the academic researcher conducts a study on the CBO’s clients, with the CBO mainly providing access to clients.

Background: In 1997, the National Institutes of Health (NIH) reviewed evidence of the effectiveness of HIV prevention programs for injection drug users (IDUs) and recommended that three types of interventions be implemented to prevent transmission of HIV among IDUs: 1) community-based outreach, 2) expanded syringe access (including needle exchange programs [NEP] and pharmacy sales), and 3) drug treatment. Progress on increasing the acceptance and feasibility of implementing these programs has been made at the national level, but their implementation has been varied at the local level. Objective: To study the acceptance and implementation of the three interventions by communities and to identify the factors that contributed to the success or failure of communities to implement these programs on the local level. 81: Forty-three in-depth qualitative interviews were conducted with key informants in six U.S. cities. Informants included AIDS prevention providers, political leaders, activists, substance abuse and AIDS researchers, health department directors, and law enforcement officials. Cities were classified according to when they initiated interventions as 1) early adopters, 2) middle adopters, and 3) late or never adopters. Results: Conditions that facilitated or deterred the adoption of interventions were identified. Coalition building and community consultation were key to the acceptance and sustainability of new interventions. Leadership from politicians, public health officials, and program directors provided necessary authority, legitimacy, and access to resources. Grassroots activists took initiative and risks in the face of opposition, but often lacked the resources to sustain their efforts. Researchers played an important role in initiating interventions and legitimizing them by providing access to the scientific information supporting their safety and effectiveness. Successful implementers worked with or avoided the opposition rather than creating polarized positions. Changes in funding and structure of publicly supported drug treatment programs have limited the implementation of new programs. Lack of leadership in the political and public health sectors, and, indeed, fear of adopting or even discussing needle exchange because of perceived political opposition, were the biggest barriers to implementation of syringe exchange programs. Conclusion: Understanding the conditions under which communities accept and implement interventions can help guide effective strategies to foster the implementation of these interventions in areas where programs do not currently exist.