The Association of AIDS Education and Sex Education with Sexual Behavior And Condom Use Among Teenage Men. (Articles).

According to a 1988 nationally representative survey, most 15-19-year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.

Between 1986 and 1988, AIDS moved from the seventh to the sixth leading cause of death among 15-24-year-olds in the United States. (1) From 1981 to 1988, the rate of gonorrhea infection increased or remained constant among 15-19-6-year-olds, although it decreased among adults. (2) Starting in 1988, the birthrate among teenage women reversed a decade-long decline and began to rise again. (3) These statistics on the incidence of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) and on adolescent pregnancy underscore the multiple health effects of adolescent sexual and contraceptive behavior. The U.S. Public Health Service's health objectives for the year 2000 have stressed HIV, STDs and adolescent pregnancy as areas of national concern. (4)

The past decade has witnessed the development and dissemination of HIV and AIDS education in schools and in other settings. Recent surveys indicate that the great majority of U.S. schools now offer AIDS education as a standard, though sometimes controversial, part of their curricula. Some schools combine AIDS education with other sex education topics; others provide it separately. (5)

How can we assess whether progress is being made in fostering safer behavior among American teenagers? A 1988 report by the Office of Technology Assessment observed that while evidence indicates that AIDS education affects students' knowledge, its effects on their behavior remain unknown. (6) One approach to assessing such effects is to examine trends in behavior over tune. For example, national surveys indicate that condom use at last intercourse increased greatly among adolescent men between 1979 and 1988, (7) and among adolescent women between 1982 and 1988. (8) However, trends also indicate that more teenagers were sexually active in the late 1980s. While trend data are important for purposes of general surveillance, they do not tell us whether AIDS education, as opposed to other secular factors, is responsible for behavioral changes.

A second approach to assessing progress uses experiments or demonstration projects that test the effects of intervention programs by comparing experimental and control groups. Many projects have noted changes in attitudes or increases in AIDS-related knowledge, but they did not examine or identify behavioral changes. (9) However, two recent studies in San Francisco indicated that certain interventions are associated with behavioral change. (10) In addition, Marvin Eisen and colleagues recently reported that a comprehensive, school-based sex education program led to safer behaviors. (11) While demonstration projects have many methodological strengths, local interventions cannot always be generalized, nor can they help us determine whether instruction as it is usually practiced is associated with safer behaviors. Further, some interventions may have no detectable effect if both experimental and control groups received instruction prior to the intervention and had thus already modified their behavior.

This article uses a third approach, based on analyses of cross-sectional data comparing the receipt of AIDS education and sex education with levels of sexual activity and condom use. As a cross-sectional analysis, it is not as rigorous a demonstration of causality as an experimental project, but it does examine the association of AIDS education and sex education as they are taught with preventive or risk behaviors among American teenagers.

While the article's main focus is AIDS education, other sex education topics are considered to compare the effectiveness of different topics of instruction. One possible comparison was the difference in effectiveness between AIDS education and pregnancy prevention education; another was the difference between the effects of education about reducing sexual activity and education about prophylaxis during sexual activity.