HIV in Canada: A primer for service providers

 

School-based education

Key Points

  • There is a high level of sexual risk-taking among Canadian youth.
  • Alarming rates of sexually transmitted infections among youth could be an early warning sign of sexual risk-taking that could lead to an increase in HIV infection.
  • Comprehensive school-based programs can reduce the behaviours that put youth at risk for sexually transmitted infections including HIV.
  • Most Canadian educational jurisdictions have developed “learning outcomes” for sexual health education but very few have developed curricula for school-based sexual health education.
  • School-based education that is age appropriate, evidence-based, and acknowledges differences in sexual orientation and gender diversity is essential.

The majority of Canadians are sexually active during the teenage years. Condom use among sexually active Canadian youth is relatively high. About 80% of sexually active 15 to 17 year olds report using a condom at last intercourse. However, there is also a trend for high rates of condom use among sexually active teens to decline as they get older. A study of Canadian university students found that less than half used a condom at last intercourse. Although HIV prevalence remains relatively low among youth, increases in the prevalence of sexually transmitted infections in recent years show an alarming trend of sexual risk-taking in this population. The prevalence of common sexually transmitted infections such as chlamydia, gonorrhea, and human papillomavirus is highest among youth and young adults. These infections are a marker of risky sexual behaviour, which could lead to an outbreak of HIV within this age group.

There is a large body of strong evidence showing that sexual health education can have a positive impact on sexual health behaviours. In Canada, the Sex Information and Education Council of Canada (SIECCAN) has been a leader in research and advocacy for comprehensive school-based sexual health education. Consistent with international evidence, SIECCAN has also found that comprehensive sexual health education can lead to delayed initiation of sex, a reduced number of sexual partners, increased condom and contraceptive use and reduced frequency of sex. Evidence has also shown that comprehensive HIV programming does not hasten the initiation of sex or increase the frequency of sex. By contrast, abstinence-only programs that intentionally do not teach young people the importance of consistent condom and contraceptive use do not delay the initiation of sex, increase the return to abstinence or reduce the number of sexual partners.

Given that schools are the only formal institutions that have contact with nearly every young person in Canada, they are uniquely positioned to provide youth with comprehensive sexual health education before sexual debut and during the teen years. School-based sexual health education can reach a wide range of potentially at-risk youth and play an important role in the primary prevention of HIV.

Despite the evidence for the efficacy of school-based sexual health education and an overwhelming level of support for the provision of HIV/AIDS education in schools by students, parents and teachers, there is much to be done to improve the availability and quality of sexual health and HIV education in schools. Although most Canadian educational jurisdictions have defined learning outcomes related to sexual health, very few have developed curricula to support teachers in working with their students to meet these outcomes.

In 2018, SIECCAN and a national working group revised the 2008 Canadian Guidelines for Sexual Health Education developed by the Public Health Agency of Canada (PHAC) in 2008.

The guidelines offer a framework for the development and delivery of comprehensive sexual health education and are based on nine core principles. Comprehensive sexual health education for Canadians:

  • Is accessible to all people regardless of age, gender, sexual orientation, STBBI status, geographic region, socio-economic status, cultural or religious background, ability or housing status
  • Promotes human rights including autonomous decision-making and respect for the rights of others
  • Is scientifically accurate and uses evidence-based teaching methods
  • Is broadly-based in scope and depth and addresses a range of topics relevant to sexual health and well-being
  • Is inclusive of the identities and lived experiences of lesbian, gay, bisexual, transgender, queer, intersex, Two Spirit and asexual people
  • Promotes gender equality and the prevention of sexual and gender-based violence
  • Incorporates a balanced approach to sexual health promotion that includes the positive aspects of sexuality and relationships, as well as the prevention of sexual health problems
  • Is responsive to and incorporates emerging issues related to sexual health and well-being
  • Is provided by educators who have the knowledge and skills to deliver comprehensive sexual health education and who receive administrative support

Resources

Sex and U Resource Library – SexandU.ca

Canadian guidelines for sexual health education – Sex Information and Education Council of Canada (SIECCAN)

Sexual health education in the schools: Questions and answers – SIECCAN

Sexual health education in the schools: Questions & Answers (Updated 2015 Ontario Edition)

Questions and answers: Sexual orientation in schools – Public Health Agency of Canada, 2010

Questions & Answers: Gender Identity in Schools – Public Health Agency of Canada, 2010

Questions & Answers: Sexual health education for youth with physical disabilities – Public Health Agency of Canada, 2013

Sources

  1. Rotermann M. Sexual behaviour and condom use of 15-to 24-year-olds in 2003 and 2009/2010. Health Reports. 2012;23(1):1–5. Available from: http://www.statcan.gc.ca/pub/82-003-x/2012001/
  2. Milhausen R, McKay A, Graham C, et al. (2013). Prevalence and predictors of condom use in a national sample of Canadian university students. The Canadian Journal of Human Sexuality, 2013;22 (3):142–151.
  3. Canadian Association for Adolescent Health. Sexual behaviour and lack of knowledge threaten health of Canadian teens. 2006.
  4. Kirby D. Emerging answers 2007: research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007.
  5. Rugg D, Collins J, Sogolow E, et al. Assessing effectiveness of school-based HIV prevention. In Abstracts of the 10th International Conference on AIDS, Yokohama, Japan, 2004. Abstract 371D.