Enhancing ethical decision making in sexuality and AIDS education

Adolescence, Winter, 1997 by C. Everett Bailey, Fred P. Piercy

Recently a group of high school boys known as the "Spur Posse" received national attention when they were arrested on rape and assault charges. The boys had competed with each other to see who could have sex with the most girls, and kept a running point total of their conquests. They showed little respect for their female partners and did not seem to regret their actions. One member of the Posse said, "Everybody likes sex. . . . I haven't done anything wrong." Another pointed out that his school teaches "safe sex" and gives out condoms, and that he used condoms. "So," he asked, "what did I do wrong?"

This paper makes a case for providing sexuality and AIDS education in a way that helps adolescents explore the ethical meaning of their sexual behavior. Principles from the moral development literature are used to provide an ethical framework. Also offered are several activities that sexuality and AIDS educators and parents can use to facilitate discussions with adolescents about sexual and relationship ethics, in order to help them make responsible decisions.

Sexuality and AIDS Education in Context

A little over a decade ago only two states and the District of Columbia required sex education (Kirby & Scales, 1981). At that time, however, most sexually transmitted diseases (STDs), such as gonorrhea and syphilis, were curable. With the onset of the AIDS epidemic and the increase in teenage pregnancy, there has been renewed interest in teaching sex education in the public schools. Today almost every state mandates some type of sexuality or AIDS education (Engel, Saracino, & Bergen, 1993).

Historically, sex education has emphasized the health and biological aspects of sexuality, especially the health risks (Arizona State Dept. of Education, 1988; Bissell, 1987; Missouri State Dept. of Elementary and Secondary Education, 1989). Topics have included anatomy and physiology, human reproduction, contraception, and venereal disease (Kenney & Orr, 1984; Kirby & Scales, 1981). More recently programs have focused on risk reduction and prevention of teenage pregnancy, STDs, and AIDS (Yarber, 1992). The goal has been to educate adolescents about sexual reproduction, sexually transmitted diseases (including AIDS), and contraceptive use. Such interventions have also included making contraception more readily available to adolescents. Currently, some programs suggest teaching teenagers alternative forms of sexual behavior, such as mutual masturbation, genital stimulation, and oral sex. These interventions stress the avoidance of the negative consequences of sex, and responsible sexual behavior is interpreted as taking precautions to avoid pregnancy and sexually transmitted disease. This is reflected in the comment of the above mentioned member of the Spur Posse who implied that responsible action consists of using a condom. Condom use, however, is not a sufficient ethical yardstick, and more emphasis needs to be placed on the emotional, ethical, spiritual, and psychological dimensions of sexuality (National Guidelines Task Force, 1993).

Impact on sexual behavior. Research on sexuality and AIDS education programs shows that what teenagers know about sex and what they do are two different things. Reviews of school-based sexuality education curricula report that while such programs increase knowledge about sexuality, there is little evidence that they change attitudes or behaviors (Engel, Saracino, & Bergen, 1993; Kirby, 1989; Welbourne-Moglia & Moglia, 1989). Kirby (1989) concludes that sexuality and AIDS education programs "can increase knowledge but, like most educational programs, have little measurable impact on behavior." (p. 170).

In light of the current statistics on AIDS and teenage pregnancy, the interventions that have been used are not sufficient. U.S. teenagers have the highest rate of pregnancy of any industrialized democracy - twice as high as that of England, France, and Canada, and nine times as high as the Netherlands and Japan (Miller & Moore, 1990; Alan Guttmacher Institute, 1994). The rate of births to unmarried teenagers has increased annually from 15.3 per 1,000 females in 1960 to 44.8 in 1991. Each year over one million adolescents become pregnant in the U.S. (Alan Guttmacher Institute, 1994). Despite the potential consequences, adolescent sexual activity continues to rise; 56% of females and 73% of males in the 1990s experienced intercourse before age 18, compared with 35% and 55%, respectively, in the early 1970s (Alan Guttmacher Institute, 1994). Further, adolescents are one of the fastest growing groups contracting HIV; the number of AIDS cases reported for persons under the age of 25 almost tripled from 1992 to 1993 (Centers for Disease Control, 1993). Of all AIDS cases reported in the U.S., one in five was probably contracted during adolescence (Alan Guttmacher Institute, 1994). Finally, three million teenagers contract a sexually transmitted disease annually (Alan Guttmacher Institute, 1994).

Probably the most surprising statistic concerning today's youths is that they are the most educated about sexual reproduction, contraception, and STDs (90% of those between the ages of 12 and 25 know the primary causes of AIDS transmission and 86% are aware that condoms reduce the risk of AIDS), yet the majority have not changed their sexual practices and frequently engage in unprotected sexual behavior (Select Committee on Children, Youth, and Families, 1991). Despite the increased availability of contraception to teenagers, the percentage of girls using contraception rose slightly, from 24% in 1982 to 32% in 1988. Other studies indicated that most pregnant teenagers knew about contraception, how it worked, where to get it, and still did not use it (Zelnik & Kantner, 1979; Landry, Bertrand, Cherry, & Rice, 1986). Although data show an increase in condom use, in 1988 4 in 10 unmarried males aged 17-19 used no contraceptive method or an ineffective one at first intercourse (Miller & Moore, 1990). At the same time, Pleck, Sonenstein, and Ku (1993) report that the degree of worry about AIDS and the perceived likelihood of getting AIDS declined over time for sexually active males aged 15-22.