In a 2014 study, researchers found that Hispanic participants and teenagers were less aware of the contraceptive methods available to them. Only 74% of Hispanic participants and 77% of teenagers had heard of IUDs, compared to 90% of white women and 90% of young adults. They were also less likely to know that women could switch brands of the pill (72% of Hispanics vs 86% of white women, and 76% of teenagers vs 90% of young adults) (Craig, Dehlendorf, Borrero, Harper, & Rocca, 2014). The health issue I will be addressing in this paper is safe sex practices in young adults. There have been hundreds of studies down researching all aspects of this issue, from the insufficiency of high school sexual education to the effect of social media on the use of condoms. This is an important issue because it affects the younger generation today, which is most at risk for things like STIs and unplanned pregnancies. While sexual education has been greatly improved over the past few decades, it is nowhere near the level that it should be at to properly provide students with the information that they need. A 2005 study showed that in females ranging in age from 14 to 22, only 59% had received information from their parents about STDs compared to 94% that had discussed the menstrual cycle. In formal education, though, 91% had received information about STDs and 78% had received information about birth control. After receiving this information, test scores on these topics were high: 14/15 on STD risk knowledge, 8/10 on condom use attitude, and 29/30 on condom use negotiation (Ancheta, Hynes, & Shrier, 2005). When sufficient formal sex education is provided, young adults are more likely to practice safe sex. Sexual education is a necessity. The fact that it is not sufficient at home nor in school indicates that more work needs to be done to promote accurate information to adolescents and young adults, especially those in minority groups.
The Healthysexuals campaign was started in December 2016 by Gilead Sciences, Inc., a biopharmaceutical company that works with organizations in science, academia, business, and local communities to address areas in medicine where research is lacking, including HIV/AIDS. While their main aim is to promote safe sex practices, they do not use the term “safe sex”, saying that the term was coined in a time when “safe” sex was necessary (especially during the AIDS epidemic in the 1980s), but today perpetuates fear and judgement against people based on their sexual activities. Now, they are highlighting the importance of “healthy” sex. Though it seems like an issue over semantics, it is an important one in 2017, as concerns about sex are less about avoiding danger and more about promoting health. The Healthysexuals campaign is designed to promote four aspects of healthy sex practices: preventing STIs, getting tested, understanding available treatments, and discussing sexual health with partners and physicians. In my critique, I will look into the effectiveness of each of these four aspects. To do this, I will be focusing on how well the campaign uses social media to effectively communicate their message.
One of the biggest problems in ensuring young adults practice safe sex is the lack of quality sexual education courses during their adolescent years. A common practice taught to adolescents in many states in the US is abstinence-only, where adolescents are instructed to avoid all sexual acts until marriage. To date, 27 states require abstinence-only as the main focus in their sexual education for public high schools. In abstinence-only education (AOE), where teachings are outlined by the federal government, language is restricted to imply that sexual activity outside of marriage is psychologically and mentally harmful to participants but there is no scientific data that suggests or backs this claim. AOE is especially popular with religious schools and societies. In a 2006 study, abstinence-only program instructors and youth were more likely to define abstinence in term of morality, using phrases like “making a commitment”, “chaste”, “virgin”, and “being responsible”. AOE is dangerous in that it assumes adolescents will have no sexual activity outside of marriage as it encourages them to avoid such acts, leaving adolescents unprepared for when/if they decide to have sex before marriage. According to data from 2002, the median age for first sexual intercourse for women was 17.4 years old while the median age of first marriage for women was 25.3 years old. In this instance, there is an almost 8 year gap between first sexual experience and first marriage. In that time, AOE leaves adolescents and young adults at risk for STIs and unplanned pregnancies. (Santelli, et al., 2006) An updated study on the same subject done by the same researchers in 2017 reports that the age of first marriage has risen, leading to an increase in premarital sexual activity; the gap now stands at 8.7 years for women (Santelli, et al., 2017). Another dangerous issue posed by AOE is the stigmatization of same-sex relationships. Most of what is covered in teachings features heterosexual relationships, which denies inclusivity to and even existence of sexual minority youth (lesbian, gay, bisexual, transgender, asexual, non-binary, and questioning individuals). This can lead to increased feelings of depression, anxiety, isolation, and loneliness in these individuals. Additionally, AOE often reinforces gender roles like female submissiveness and male dominance in sexual situations. This has been linked to risky sexual behaviors like reduced condom and contraceptive use. (Santelli, et al., 2017). Adolescents and young adults are in dire need of sexual education and AOE denies them the information they need.
Low condom and contraceptive use is one of the main problems addressed in safe sex health campaigns. There are many reasons why individuals would choose not to use contraception. One reason is a sense of invulnerability, which is often found in younger generations. A study done in 1994 attempted to address the problem of low condom use following the peak of the HIV/AIDS epidemic in the US by using hypocrisy. Researchers had subjects publicly support using condoms so that the subjects would feel a sense of advocacy and positive feelings of decent and reasonable behaviors. The researchers then reminded the subjects of their own lack of condom use. The researchers hoped that the inconsistency of the subject’s own public and internal image would spurn the subject to change their own behavior (Stone, Aronson, Crain, Winslow, & Fried, 1994). Though this study is now a bit older, it still holds truth. Younger people are more likely to see themselves as immune and invulnerable to all sorts of dangers and illness. Other people get STIs but not me. From this problem stems another problem: lack of communication with sexual partners. As a study done in 1995 shows, young adults have always hit the roadblock of talking with their sexual partner about sexual activity. Sexual encounters feature a low amount of verbal speech, relying more heavily on non-verbal and coded speech to convey meaning (Lear, 1995). There is an unspoken bond of trust that is not broken, due to lack of confidence or inability to address the inconsistency between what one believes of their partner and what one does not wish to know. Psychosocial factors can also affect contraceptive use. By measuring RAA Variables (Reasoned Action Approach), a study done in 2016 was able to research responses from 114 males (mean age of 23.5 years) and 97 females (mean age 22.8 years) to situations like “Intention to Use Condoms “, “Intention to Ask a Sex Partner about His/Her Health Status”, and “Intention to Perform Less Risky Sex Acts”. Their results showed that perceived behavioral control and subjective norms for each of these situations predicted the subject’s intention to enact safe sex practices, by an increase of almost 80% in condom use, 71.4% for asking a partner about their health status, and 57.2% for performing less risky sex acts. (Brüll, Ruiter, Wiers, & Kok, 2016). This research indicates that when people believe that these behaviors are common and socially accepted (whether they actually are or not), they are more likely to adjust their behavior to fit the standard they see. Health campaigns that show regular contraceptive use as the social norm will be more effective.
A person’s culture also plays a large part in how they view sex and how often they use contraception. In more conservative cultures, contraception is stigmatized: it’s seen as dirty, for promiscuous individuals, and irreligious in some cases. This can lead to lowered use of contraceptives in younger generations. In a 2014 study, researchers found that in a group of 335 students that were majority Hispanic females, 30.2% reported that they had never used condoms and only 22.2% reported that they always used condoms. The other 47.6% reported condom use between 20% and 70% of the time. Subjects who were African American had the highest rates of condom use, while subjects who were Asian had the lowest rates of condom use (Thomas, Yarandi, Dalmida, Frados, & Klienert, 2014). While condom use with Hispanic female students was more popular than not, it was inconsistent for the majority of the group. Asian students were the least likely to use condoms and contraception compared to all the students that participated. This could be due to a cultural factor. In more remote places in the world, sexual education is lacking. Schools do not have sexual education classes and, due to the cultural taboo, parents rarely discuss sexual matters with their children. Adolescents in these regions then turn to peers, who might be lacking in knowledge or misinformed altogether on the subject. Researchers in 2017 looked into the attitudes towards sexual activities in 343 high school students and 246 of their families in a small village south of Addis Ababa, Ethiopia. The results showed that 31.5% of the students surveyed were sexually active and 65.7% of these sexually active students had used some form of contraception (including the calendar method) in the past. However, only 20% of parents in the families had reported having any discussion regarding sexual behavior, development, or contraception with their children and 93% of these parents did not approve of sexual activity before marriage. It was noted that as levels of education in parents increased, so did the probability of them having a discussion about sexual behavior with their children (Taffa, Haimanot, Desalegn, Tesfaye, & Mohammed, 2017). Adolescents who receive little or no information about sexual activities are more likely to encounter short and long term challenges than adolescents that received this information. In places where no information is provided, they enter into a cycle of receiving no information and so have no information to share with their peers and, later, with their own children, which starts the cycle again.
Social media has played a big part in health campaigns today. It can be very helpful, giving researchers access to subjects in a time and cost efficient manner. It can use new media and technology to appeal to a younger audience. YouTube is an excellent source for educational content; it can also be a good source of sexual education content. A study done in 2016 looked into the effects of YouTube videos that gave instructions on how to put on condoms. Participants were 16-18 year old students, the majority of whom were male aged 17. The results indicated that students that viewed the video with a more utilitarian purpose (as compared to a hedonistic view) were more likely to use further use videos on YouTube to learn about safe sex practices (Hong, Tsai, Fan-Chiang, & Hwang, 2016). There is an audience for this information, and they are actively looking for it. A report from the ACT for Youth Center for Excellence researched new media including SMS texting messaging, SNS (social networking sites) like Facebook and MySpace, apps, video sharing sites, and podcasts. It found that 55% of teens between the ages of 12 and 17 that regularly use the internet have a profile on a SNS. 57% watch videos on video sharing sites, including YouTube (Levine, 2009). The report itself is geared towards to parents and provides resources for each of these media where sex positive educational can be found and explored. In 2016, researchers Cornelius and Appiah conducted a literature review of examining connections between mobile technologies and promoting sexual health in teens. They selected 295 abstracts and 17 articles, based on if they dealt with sexual health in adolescents, used a quantitative or qualitative research design, and were published within the past 5 years in a peer reviewed journal. Several of these studies helped to identify challenges with this developing field. In one study, the abbreviations used in some of the messaging lead to confusion in participants. In another study, participants found the first texts stigmatized the African-American community and needed to be changed to appeal to a young black generation. Privacy, lack of anonymity, technical errors, and lack of access were also challenges in these studies (Cornelius & Appiah, 2016). Research today should take advancing technology into account when planning studies on adolescents and young adults, as they can be excellent ways to quickly convey information.
The target audience for safe sex practice health campaigns is adolescents and young adults. Including some of the reasons stated in previous paragraphs, these age groups are the most likely to engage in sexual activities without the knowledge they need to make good choices. Many young adults are sexually active, despite AOE and social stigma, making them the most at risk for STIs. One study in 2014 found that young adults (ages 16-24) from minority groups are the most at risk for STIs and HIV, at rates of 8 to 21 times more than white people (Thomas, Yarandi, Dalmida, Frados, & Klienert, 2014). The main sources of sexual health information for adolescents and young adults are sexual education classes in school, health campaigns on social media, and medical professionals, especially their primary care physicians. Comprehensive sexual education courses in high school provide valuable information that sexually active young adults need to protect themselves from STIs and unwanted pregnancies and improve their sexual health. According to 2016 Pew Research Center survey data, 78% of teens have a cell phone and 93% have a computer or access to one at home. Safe sex health campaigns that create and maintain an online presence have a higher chance of being seen by a young adult, especially one who is actively searching for information. A study in 2016 found that only 60% of pediatricians reported having a discussion about STIs, abstinence, and contraception with their adolescent patients, with only 22% distributing condoms to their patients (Clifton, Trinh, & Woods, 2016). Young adults are actively seeking this information. As technology advances, it has become easier for them to access the information they need but it is also up to their schools to provide the information they need.
The secondary audience that should be targeted in safe sex health campaigns is parents and peers. Parents are one of the most trusted sources for young adults seeking information. Young adults depend on their parents for a variety of things already and see their parents as a trustworthy source of information. If parents have incorrect information, their children will have to deal with the consequences on their own. Providing parents with dependable sources for sexual health information will be beneficial towards young adults. Peers are also a trustworthy source of information for young adults. It is common for people to turn to close friends for advice, especially when it comes to sexual topics like relationships and contraception. Peers are trickier to target because they are most likely the same age and, as such, have access to the same information. If one adolescent asks their adolescent peer for information but they have both received the same lacking sexual education, both adolescents are at risk. Making sexual education easily accessible both online and in school will allow young adults and their peers to make informed choices.
The two theories that are most exemplified in what I have covered so far are the Health Belief Model and the Theory of Planned Behavior. The Health Belief Model (HBM) was developed in the 1950s by social psychologists. It says people will perform health improving behaviors when they believe (1) the condition/illness will affect them, (2) the condition/illness is severe, (3) the behaviors recommended to them will work, and (4) the benefits of adopted the recommended behaviors will outweigh the barriers of the behaviors. Health campaigns that use this model must convey to people that the behavior that they should be performing is in response to a danger that is severe enough to require action. For example, a health campaign that focused on safe sex practices would first need to identify what specific aspect of safe sex they wished to focus on. Let’s say they choose talking with a new sexual partner about STIs, HIV/AIDS status, and recent testing for both before engaging in sexual activities. The campaign would first have to convey that this topic would affect the person if they had a new sexual partner. There would have to be stress on overcoming reasons found in research like “I’ve known them since high school and they didn’t have a significant other,” “They’ve always been really quiet”, “It’ll ruin the mood”, etc. These are things people tell themselves to quiet any cognitive inconsistencies. The campaign should state that these reasons put people at risk for possible STIs, and that clarifying with the partner is the solution to this risk. Providing scripts for people to follow in this situation would reduce awkwardness in the conversation. Finally, showing that this conversation can be quick and provide mental relief for the asker will fulfill the fourth part.
The second theory I have chosen for this is the Theory of Planned Behavior. This theory states that individual motivational factors determine likelihood of performing specific behaviors. Additionally, intention is the best predictor of behavior, which is determined by attitudes towards the behavior, subjective norms, and perceived behavioral control. Staying with the discussion with a new sexual partner example, if a person can be convinced that having this conversation with their partner is worth the potential awkwardness or embarrassment it might cause, they are more likely to have the conversation. A health campaign looking to promote this behavior could include statistics about how relieved people felt once they had a conversation with a new sexual partner, indicating the behavior is worthwhile, or provide information on how to talk to partners to show how easy the conversation can be.
In the second half of this paper, I will be critiquing the Healthysexuals health campaign. This campaign targets an audience of young adults and is LGBT+ inclusive. As mentioned in a previous paragraph, the Healthysexuals campaign focuses on four aspects: preventing STIs, getting tested, understanding available treatments, and discussing sexual health with partners and physicians. To examine how effectively the campaign addresses and accomplishes these four aspects, I am posing the following research questions:
- How does the Healthysexuals campaign web page present information concerning STI prevention, testing, and treatment?
- How does the Healthysexuals campaign use their social media to promote safer sex practices?
- What resources does the Healthysexuals campaign provide for talking to one’s partner or physician about safe sex practices?
To answer these research questions, I will be looking at the resources listed on their webpage (https://www.healthysexuals.com) as well as their social media sites. For the rest of this paper, I will be focusing on and critiquing the Healthysexuals health campaign: its mission, resources, PSAs, social media posts, and goals. Additionally, I will recommending any improvements I think would be beneficial for the campaign.
