A new analysis by Population Council researcher Nicole Haberland provides powerful evidence that sexuality and HIV education programs addressing gender and power in intimate relationships are far more likely to be effective than programs that do not. The research appears in the March 2015 issue of International Perspectives on Sexual and Reproductive Health, published by the Guttmacher Institute.

Adolescents in the United States and around the world face significant reproductive health challenges, including high rates of unintended pregnancy and sexually-transmitted infections (STIs). According to the U.S. Centers for Disease Control and Prevention, young people in the United States aged 15-24 account for half of all new sexually transmitted infections. Globally, young people in this age range account for 40 percent of all new HIV infections, according to UNAIDS.

Sexuality and HIV education has been for decades considered a key strategy for improving adolescent reproductive health. As a result, comprehensive sexuality education is being offered to students around the world in schools, clinics, and other community settings. However, despite extensive investment in these programs, the results remain somewhat disappointing, with limited understanding of how attention to social factors affects program outcomes.

Addressing Social Inequality

Studies have shown that when people hold biased beliefs about appropriate roles and behavior for males and females, or when they report unequal power in their intimate relationships, they are more likely to experience poor reproductive health outcomes. For example, women who report low power in their sexual relationships tend to have higher rates of STIs and HIV infection than women who report more equitable relationships. Thus, some programs and researchers theorized that sexuality education should help young people reflect critically about issues of gender and power in relationships.

"We wanted to know whether programs that take such an empowerment approach perform better than the majority of programs, which do not," said Population Council researcher Nicole Haberland, author of the study. "To do so, I wanted to set a very high bar and look at whether these curricula actually reduced rates of unintended pregnancy and STIs."

Integrating Gender and Power Content into Sexuality Education

Haberland searched electronic databases for evaluations of programs that were assessed by measuring impact on STIs or unintended pregnancy, aimed at adolescents 19 or younger, and evaluated using a rigorous study design. She identified evaluations of 22 sexuality and HIV education programs from developed and developing countries.

She divided the programs into two groups based on whether they addressed--or ignored--issues of gender and power (such as notions of masculinity and femininity, gender inequality in society, unequal power in relationships, and young women's empowerment). Ten programs addressed these issues, while twelve did not.

Haberland found that the impact of including gender or power content was dramatic. "The programs that addressed gender or power were five times more likely to be effective than those that did not," said Haberland. "Fully 80 percent of them were associated with a significantly lower rate of STIs or unintended pregnancy. In contrast, among the programs that did not address gender or power, only 17 percent had such an association. It is striking that the two sets of programs--sexuality education programs that address gender and power and programs that do not--have nearly opposite outcomes."

The effect of gender and power content held true even when considering other variables, such as program duration or whether the program had multiple components versus a single component. Furthermore, all of the programs that included gender or power content and were associated with positive health outcomes were also significantly associated with other beneficial outcomes, such as reported safer sexual behavior or improved knowledge.

Recommendations

Haberland studied the common characteristics of the effective interventions and offered several recommendations for integrating content on gender equality and power dynamics into sexuality and HIV education:

Include explicit content about gender equality and power dynamics

Use methods that encourage participants to reflect in meaningful ways on how gender stereotypes and power inequalities affect their own relationships, sexual and reproductive health, and HIV risk, and

Help participants recognize their potential power in their own lives, relationships or communities.

To enable programs to implement such an approach, the Council has published a resource--It's All One Curriculum--with culturally sensitive content and 54 teaching activities. It's All One is available in several languages at no cost: http://www. itsallone. org .

Haberland's review provides strong evidence for focusing on gender and power content in sexuality and HIV education. Not only will incorporating this material result in more effective programs, it will increase the likelihood that young people's relationships will be more equal and respectful.

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