STI prevention information limited to condoms
By Melinda Young
Young people who are gender diverse lack adequate educational resources in sexual health education, and providers often need to fill in the information gaps.
Transgender and gender-diverse youth face stigma, discrimination, and are at risk of multiple adverse health outcomes, particularly if they also are youth of color, research shows.1
Multifaceted sex education could help them, but few sex education programs are comprehensive enough to address their needs.
Sexual and reproductive education for minors varies dramatically between states and schools in the United States, and this contributes to gaps in knowledge among young people who are gender diverse or more broadly part of the LGBTQ+ community.
“It really is contingent on the place in terms of the policy landscape and priorities of school districts and individual schools, as well,” says Michelle M. Johns, PhD, MPH, a senior research scientist at the National Opinion Research Center (NORC), University of Chicago.
“It’s an inconsistent landscape,” Johns says. “What students are receiving in California looks very different from what they’re receiving in Georgia, and even within those states, it depends on where you are.”
Sexual education programs that present a sexual health positive curriculum are available but underused. In the void, students learn what they can from peers and the internet.
“What adolescents know about sexual health is so dependent on where they go to school and how they learn through conversations with their parents and friends,” Johns says. “It’s so variable; you cannot say any single thing about what teens today are able to access around sexual health education because of that inconsistent landscape.”
Investigators found that most youth interviewed about their experiences with sex education had searched for sexual health information online, with YouTube being their most common source. This was followed by Tumblr and sexual health webpages from Planned Parenthood, Scarleteen, and others.1
They sought queer or trans-specific sexual health information, including medical gender affirmation and information about dating and sexual mechanics.1
One participant said, “Part of finding it [information] online was scary, because instead of being taught in a sexual-ed class an appropriate amount of information, I was seeing … all of this big, heavy stuff. It was being delivered to me by the computer screen, so there was no interaction.”1
Johns and co-investigators wanted to do an analysis of different states and their sex education curricula, including looking at what was available to youth.
“When we focused on trans youth in the southeastern United States, there was a very consistent message that trans youth did not see themselves reflected in sexual health education,” Johns explains. “The education was very focused on disease prevention in the context of cisgender heterosexual relationships, and they didn’t see themselves in the context that was there.”
The trans youth also saw negative messages about what sex was and what it means. “It left out a lot of stuff … they did not even explain what a period was … They were just like, ‘This is how it looks. You can get diseases. Go back to class,’” according to one trans male.1
“These were 33 in-depth interviews with trans youth in the Southeast,” she adds. “Generally, the main themes that came up out of this were the youth in this study expressed they thought the sexual health education they received in schools was irrelevant to them in their lives.”
When trans youth sought scientifically accurate information about sexual health, they went to community resources, including community-based organizations (CBOs) or healthcare studies.
“They also talked about going online to see what was on the internet,” Johns says. “Across all of my LGBTQ research, when this community does not have information that is inclusive, they will find it online. They’re very resilient and will seek out information relevant to their lives where they can find it.”
The participants expressed dissatisfaction with their education on sexual risk behavior. Some even talked about their exclusion in the material being traumatic, Johns says.
“They talked about only hearing the negative things: the only time they heard about gay men was in the context of HIV,” she explains. “They had a sense of feeling excluded and left out.”
Some students wondered if they would be treated better by their classmates if the sexual education curriculum was more diverse and sent the message that being transgender was a normal part of human variation, Johns says.
There were some participants who said they received no sexual health education at all or only education that focused on abstinence.
When sex ed programs talked about prevention of sexually transmitted infections (STIs), it was in the context of condoms being the main way to prevent STIs.
“They were thinking about how they as trans youth could understand this information and how it is relevant to their lives,” Johns says.
Most of the youth reported they did not receive sexual health information from their healthcare providers, and the study has only one quote with the word “doctor.”
A participant mentioned a doctor who runs a YouTube channel called “Sexplanations” that is inclusive, queer friendly, and disability friendly.1
Not having access to someone they could ask questions about sexual health created an atmosphere that some participants described as being lonely.1
“They said they were grateful they could go online and learn what they needed to know,” Johns says. “But if they found information that didn’t make any sense to them, they didn’t have anyone they could talk with and get clarity.”
The research suggests that providers working with gender-diverse youth can do a great deal more to open lines of communication about sexual and reproductive health.
The first step is for providers to learn more about transgender and LGBTQ individuals’ sexual health.
“There are a lot of great resources for physicians and healthcare providers on how to be more culturally competent in working with transgender populations,” Johns says.
“The Fenway Institute has a lot of information, and it’s based in Boston,” she adds. “It has national reach and has an online health education center called the LGBTQ Health Education Center, which is a place that providers can go to for online training and to take continuing education units to understand the transgender population.”
Providers also can place materials in their waiting rooms with information that reflects people of all different genders and backgrounds.
“Maybe they could have rainbow symbols to indicate this is a safe place for LGBTQ folks and to let them know they can authentically be themselves and talk with their providers about their concerns,” Johns says.
“Many trans folks do not bring these concerns to their providers because of previous bad experiences of their not using the pronouns patients go by or not using their names and having incorrect information about what their medical needs are,” she adds.
REFERENCE
- Jayne PE, Szucs LE, Lesesne CA, et al. “I wouldn’t have felt so alone”: The sexual health education experiences of transgender and gender diverse youth living in the Southeastern United States. Perspect Sex Reprod Health 2024;56:158-170. [Online ahead of print].
