“A cornerstone of the Sexual Health Model is the ability to talk comfortably and explicitly about sexuality, especially one’s own sexual values, preferences, attractions, history and behaviors. We believe that such communication is necessary for one to effectively negotiate safer sex with sexual partners, and is a valuable skill that must be learned and practiced.” –from The Sexual Health Model: application of a sexological approach to HIV prevention, by Beatrice E. Robinson, Walter O. Bockting, B. R. Simon Rosser, Michael Miner and Eli Coleman
In most European nations, sexuality is embraced as a positive, natural part of life. There is open dialogue and positive social norms associated with sexual health and sexuality. In contrast, talking about sex, in everyday life, remains uncomfortable for most Americans, including parents, teens, and other adults.
While American girls often take the lead in starting the conversation, many are concerned that their partners will react negatively, either rejecting them or questioning their sexual history. And the vast majority of young adults report that they would be more likely to postpone sexual activity if they were able to have more open, honest conversations about sexuality with their parents. Meanwhile many parents say they don’t know how to talk to their kids about sex and tend to avoid the subject altogether. Teens are also hesitant to talk to their providers, with 66% of teens aged 15-17 saying they have never had a conversation with their doctor about condoms or birth control.
However, according to an Advocates for Youth study, in countries such as the Netherlands, Germany, and France, many parents accept the reality that adolescents will explore and engage in sexual relationships. In these countries, adults tend to have greater respect for adolescents while expecting them, in turn to act responsibly. Government policy also supports this notion, with strong government support for sexuality education, long-term public education campaigns, and sexual health care services, including contraception. It is easier for European families to engage in open and honest discussions with teens about sexuality and sexual health services. When sexual health and sexuality are positively discussed and addressed, the overall quality of life and health of society is improved.
Unfortunately, the U.S. lags behind most other western nations in achieving optimal sexual health. Rooted in our longstanding, conservative attitudes about sex and sexuality, our approach to sexual health and sexuality is often negative, focused on disease and risks, incomplete and sensationalized. Many Americans also lack access to adequate sexual health education and health services. These factors have contributed to high levels of sexually transmitted infections and chronic illnesses, unintended pregnancies, infertility, discrimination, stigma and partner violence.
Significant progress has been made in the U.S.—the teen pregnancy rate has declined 42% since 1990. However, our teen pregnancy rate is still nearly three times greater than rates in France and Germany. Similarly, the 2008 U.S. teen birth rate was nearly two times greater than United Kingdom and ten times greater than Switzerland. Not surprisingly, European youth are more likely to be well protected during their most recent sex than their U.S. peers, with significantly higher levels of condom and contraceptive pill use. These teenage trends continue into adulthood. The prevalence of HIV among the adult U.S. population is estimated to be 1.5 to 6 times higher than France, Germany and the Netherlands.
Americans across the age spectrum often lack the information and skills they need to make responsible choices relating to sex. Surveys reveal that many are misinformed about the risks of unprotected sex, particularly the risks of oral sex; the availability and effectiveness of different contraceptives, along with how to use them; and their personal level of risk. Large-scale communications campaigns like Bedsider from the National Campaign to Prevent Teen and Unplanned Pregnacy, which focuses on increasing contraceptive usage and consistency, have begun to address this need; however, there is still so much more that needs to be done. We can also learn from models around the world, such as the “Sex Worth Talking About” campaign in the United Kingdom, which aims to transform the prevailing culture of “stigma shame, and embarrassment” into a “new culture: open, positive, supportive, respectful.”
Good health is important to achieve and maintain throughout life, and this includes our sexual health. Here in the United States we must begin to embrace sexual health and sexuality as a natural, normal, and positive part of our lives, looking at it across the lifespan and in a variety of contexts. Beginning to have open and honest communication and dialogue on the subject is one important step in the right direction. We need to make “sexual health” a household term, from the dinner table to the doctor’s office, and the celebration of National Sexual Health Month is a great way to start!
Jaclyn Fontanella, MPH
Partnership for Prevention
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