Journal articles on the topic 'HIV AIDS culture Comprehensive Sexuality Education'

This study aims to assess knowledge, attitude and behavior in sexual and reproductive health (SRH) including comprehensive sexuality education (CSE) among 439 first year students; 213 sciences and 226 arts students from 5 Faculties of University Malaysia Sabah (2016-2017). Exposure of Malaysian students to sexual education is limited to science subjects which are only being taught at upper elementary and secondary high school levels. Arts students are less exposed to sexual education across Malaysia as it is delivered in Basic Science subject only. It was a university-based, cross-sectional, descriptive study. Pretested self- administered questionnaire was anonymously completed by all participants and was conducted from November 2016 to January 2017. Students’ demographic characteristics from Science and Arts streams were same except females, Sabah ethnics and Malays were more in Arts. Awareness of HIV/AIDS, Condom, Wet dream, COC pills and abortion services were more in Science students and statistically significant. 34.3 % and 81.2% of Science students agreed that CSE should be introduced in primary and secondary school but not statistically significant. 22 out of 439 students were sexually active. Science students had more knowledge about SRH and favourable attitude towards sexuality education but less favourable behaviour of watching and reading pornographic materials. It was concluded that there were gaps in knowledge, attitude and behaviour of SRH and need to remedy these by giving appropriate CSE classes to first-year university students in an elective module according to their culture and religious beliefs in accord with International Technical Guidance on Sexuality Education (ITGSE).

PurposeSex education in China has been promoted for many years, but limited data are available regarding the sources from which adolescents receive sex‐related knowledge. The present study was designed to examine the sources from which Chinese adolescents obtain their information on puberty, sexuality and STI/HIV/AIDS, and whether there are any differences in sources of sex knowledge according to adolescents' demographic characteristics and sexual status.Design/methodology/approachThe data were collected in 2001 in Changchun City, China. Unmarried adolescents 15‐19 years of age (322 males and 360 females) were included in a cross‐sectional survey using self‐administered questionnaires.FindingsSchoolteachers and mass media were identified as the two most important sources of sex knowledge. Sources of sex knowledge among adolescents on various topics (puberty, sexuality, and STI/HIV/AIDS) differed by the level of taboo associated with these topics in Chinese culture. The percentage of adolescents obtaining knowledge for puberty, sexuality, and STI/HIV/AIDS from teachers declined by topic (45.4, 30.7 and 18.4 percent, respectively), while the percentage of adolescents obtaining knowledge from television/movie increased by topic (6.7, 12.2 and 27.5 percent, respectively). Adolescents obtained knowledge on topics with less taboo (e.g. puberty) from teachers and obtained knowledge on topics with more taboo (e.g. sexuality, STI/HIV/AIDS) from mass media. However, this differs by having been sexually experienced or not. Parents were the primary source for sex knowledge on less taboo subjects. Doctors were the primary source for STI/HIV/AIDS knowledge. Sexually active adolescents obtained sex knowledge mainly from peers or mass media, while those adolescents who were not sexually experienced identified teachers and parents as the main sources of sex knowledge.Originality/valueThe current study illustrates that it is necessary to improve and enhance current sex education programs in China by recognizing and strengthening the role of parents, teachers, and health care professionals in adolescent sex education.

The Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa (ESA), or the ESA Commitment, was affirmed December 7, 2013, by 21 countries located across this region during the 17th International Conference on AIDS and Sexually Transmitted Infections in Africa. The ESA Commitment speaks to the numerous practices and challenges of school age populations stemming from interplay among education, health, and contextual issues varying by country. Analysis of this policy is approached using methodology drawn from Bartlett and Vavrus (2014, 2017) and using a lens of policy borrowing, particularly focused on incorporating agency, process, impact, and timing (Steiner-Khamsi, 2000, 2010). This analysis seeks to understand the ESA Commitment and national curriculum subsequently implemented in Zambia by situating these actions among broader international, regional, and national discourse in the area of sexual and reproductive health and education for young people between 1994 and 2016. Through analysis considering its effectiveness in terms of implementation, scalability, and sustainability, its ability to enable progress towards improving the lives of young people, especially through increased knowledge of HIV/AIDS prevention, is examined and recommendations are presented.

Teens encounter a barrage of messages about sexuality in popular culture—messages that shape their identities and schooling experiences in profound ways. Meanwhile, teen sexuality, pregnancy, and sexually transmitted diseases (STDs) increasingly arouse public panic. To date, however, schools do little to help teens make sense of their sexualities. In this article, I argue that schooling will grow increasingly irrelevant and ineffective if educators fail to address teen sexuality and popular culture. My argument is twofold. First, I suggest that sex education in particular must attend to popular culture. Second, I contend that we can no longer confine efforts to address teen sexuality and popular culture to sex education; rather, we must extend such efforts across a wide range of classroom and schooling contexts. Doing so is important for accomplishing three educational goals: (1) to make a wide range of curriculum (e.g., literacy, social studies, sex education) more relevant and culturally responsive to diverse youth; (2) to develop critical multicultural curriculum that interrogates social inequities, and (3) to indirectly create conditions that would reduce teen pregnancy, sexually transmitted diseases, and HIV/AIDS. To make this argument, I draw from my 9-month ethnographic study of ESPERANZA, a progressive peer-driven sex education program. In contrast, I then analyze how two popular films deal with issues of sexuality in different ways. I conclude with a discussion of how the insights from these popular texts might inform research and practice in critical multicultural curriculum and in educational efforts to help youth address sexuality.

Comprehensive sexuality education (CSE) is a rights-based approach to comprehensive sexuality education which seeks to equip young people with the knowledge, skills, attitudes and values which they need to determine and enjoy their sexuality physically and emotionally while the primary goal of the school-based sexuality education programme is to build on knowledge, skills and behaviours thus enabling young people to make responsible and safe choices as well as prepare them for sexually healthy adulthood. Learners need to be aware of the different kinds of development and the impact they have on their lives such as globalization, arrival of new population groups with different cultural and religious backgrounds, the rapid spread of new media, particularly the internet, internet pornography and mobile phone technology, the emergence of HIV and AIDS and increasing concerns about STIs. Thus, the purpose of the study was to investigate the effectiveness of comprehensive sexuality education on curbing teenage pregnancies among secondary school girls in Samfya district of Luapula Province. The study employed a mixed method paradigm of an embedded method and descriptive survey design that used purposive and simple random sampling to select 5 Head teachers, 5 Guidance and counselling teachers, 20 teachers, 10 parents and 60 learners. Data was obtained from respondents by means of interviews, questionnaires and classroom observation schedules. Frequency, percentages, tables, graphs and pie-charts were used to analyze the quantitative and qualitative data obtained. Data was then analyzed by use of the Statistical Package for Social Science (SPSS) computer package. The findings revealed poor implementation and teaching of comprehensive sexuality education and lack of qualified guidance and counselling teachers in schools.

The sexual culture of sub-Saharan African peoples is variously utilized as an explanation for the high incidence of HIV in Africa. Thus it has been the target of behaviour change campaigns championed by massive public health education. Based on ethnographic fieldwork (using participant observation, individual interviews, focus group discussions, and a survey) in Masaka District, this article contests a reified, homogeneous and ethnocentric sexualizing of Africans. It engages with how prescribed ritual sex practices are (re)negotiated, contested, affirmed, policed, revised and given meaning within the context of a society living with HIV/AIDS. Among Baganda, sex is customarily a vital component for ‘completing’ individual prosperity, kin-group equilibrium and social cohesion. Various forms of prescribed customary sexual activities range from penetrative sex interaction between penis and vagina, to symbolic performances such as (male) jumping over women's legs or (female) wearing of special belts. Unlike portrayals of customary sex activities in anti-HIV/AIDS discourse, the notion of ‘dangerous sex’ and the fear of contagion are not typical of all ritual sex practices in Masaka. Akin to Christianity, colonialism, colonial medicine and modernizing discourses, anti-HIV/AIDS campaigns are the contemporary social policemen for sex, sexuality and sexual behaviour. In this regard, public health discourse in Uganda is pathologizing the mundane aspects of customary practices. The HIV/AIDS metaphor is variously utilized by Baganda to negotiate whether or not to engage in specific ritual sex activities.

Background : Comprehensive Sexuality Education (CSE) plays an important role in preparing adolescents for safe, productive lives, and understanding about HIV and AIDS, sexually transmitted infections (STIs), unwanted pregnancy, Gender-Based Violence (GBV), and Gender inequality still pose serious risks to their well-being. Study Aim : Determine the method most instrumental in improving adolescents' knowledge about adolescent sex education and teens identify constraints in obtaining information on sex education. Methods : Stage approach to review the literature using framework Arskey and O'Malley. The framework used to manage with PEOS research questions so that the search strategy uses 5 databases, viz. Pubmed, Science Direct, Wiley, Proquest, And Ebsco with the identification of the relevant study according to the inclusion and exclusion criteria. Results: Each method has its contribution in providing information and knowledge about sex education to adolescents, however the source of the greatest role in providing sex education information mostly came from digital sources both internet and TV media. The lack of role of parents and teachers to provide enough information about sex education is reflected in the results and the above discussion. Problems in adolescent sexual behavior that negatively due to inaccurate sources such as peer and the internet and added with minimal information from parents and teachers in which teenagers hoping to get information about sex education from parents and teachers.

Background: Adolescent sexual and reproductive health (SRH) problems remain an important public health issue in many developing countries, such as Indonesia. Therefore, assessing SRH knowledge, attitude, and behavior among adolescents are worth considering for public health intervention purpose in order to reduce their vulnerability to SRH problems. Aims: This study aimed to assess SRH knowledge, attitude, and behavior among adolescent students in Denpasar, Bali, Indonesia.Methods: This was a cross-sectional school-based study conducted in Denpasar, Bali, Indonesia from July to September 2016. This study applied multi-stage random sampling to recruit 1,200 students out of 24 junior, senior, and vocational high schools. Variables in this study consisted of socio-demographic characteristics, knowledge, attitude, and behavior related to SRH. Data were analyzed using descriptive analysis and cross-tabulation to identify proportion differences.Results: Regarding knowledge on SRH, students had less knowledge on a reproductive process (10.1%) and reproductive risk (11.4%), but half of them knew about the sexually transmitted infections (STIs) and HIV&AIDS (55.6%) and almost all had sufficient knowledge on puberty (90.7%). Meanwhile, few students argued that several sexual behaviors can be performed before getting married, such as kissing and hugging (48.9%), petting and oral sex (18.7%) and sexual intercourse (vaginal sex) (13.8%). Out of 1,200 adolescent students, 880 (73.3%) reported for have ever been in dating with someone. Among adolescent dating, few students reported for an experience of petting (14.3%), oral sex (9.8%), vaginal sex (6.5%), and anal sex (2.6%).Conclusion: Adolescent students in Denpasar, Bali, had a low level of sufficient knowledge in some SRH aspects, a few students reported for permissive attitude and performed premarital sexual behaviors. Therefore, providing comprehensive sexuality education (CSE) is worth considering to improve knowledge and appropriate skills in order to prevent risky sexual behavior among adolescents. Keywords: Sexual and reproductive health, adolescents, students, knowledge, attitude, sexual behavior.

Mental health is a state of well-being which allows a better realisation of one's own potentials. With good mental health, individuals are able to cope productively with life situations. According to WHO (2002), hundreds of millions of people worldwide are affected by mental health problems. This led to their defection in terms of behavioural, neurological, physical, emotional, and substance use. It was discovered that about 36 million people worldwide are HIV positive, and about 20 million people have died from AIDS, tobacco, alcohol, amongst others. The use of hard drugs are discovered as potential addictive substance that have led to major health problems like heart diseases, stroke, cancer, liver diseases, fever, amongst others. Mental illness/problem occurs due to careless attitudes towards mental health education. Most middle and low income countries devote less than 1% of their health expenditure to mental health and mental health education thereby worsening the health condition of the citizens. This paper, therefore, sees it as point of urgency to re-orientate Nigerians towards mental health and its counseling implications. For its effectiveness, the roles of counseling cannot be over- emphasised. There is need for counsellors to inculcate into the public mental health skills, self-management skills, and self-descriptive culture through seminars and workshops. The Counsellor should bring to the awareness of the public information about their lifestyles regarding sleeping procedures, eating behaviour, nutrition, exercise, and stress management through enlightenment campaigns and medical programmes. Other recommendations include; the government in collaboration with the counsellors and NGOs should embark on comprehensive mental health problems preventive programmes. Also, mental health policies, legislation, community care giver facilities, and treatments for people with mental illness should be given proper attention.

The Vale Sonhar Project was inserted in São Paulo´s state curriculum in 2008. Its activities were included in the first grade high school Biology´s program. This article aims to analyze this material´s contribution to the emancipatory practice in basic education from the realization of the educational kit´s workshops with a first grade high school class, during Biology classes. Then, limits were pointed out and changes were proposed as a way to overcome the difficulties encountered and to amplify the formative potential of this didactic action. The Vale Sonhar Project is an important curricular space for the subject; however it presents limitations such as the long time necessary for its execution which impacts on the decrease of the playful aspect and unfeasibility in a context of extensive curricula and few weekly Biology classes. The insertion of the psychological and sociocultural dimensions importance in the workshops was perceived, the absence of Sexually Transmitted Infections mention was questioned and notes were made for some issues in the proposed activities. In this sense, some changes in the workshops were suggested, besides the pregnancy prevention, in order to talk about topics that were not addressed in this material such as life project design, prevention of Sexually Transmitted Infections, diversity and sexual violence. Therefore it is hoped the provision of resources so that Biology teachers include in their classes The Vale Sonhar Project, working sex education with their students in a comprehensive way also achieving psychological and sociocultural aspects and an effective reflection of their life projects.ResumoO Projeto Vale Sonhar foi inserido no Currículo do Estado de São Paulo em 2008 e teve suas atividades incluídas no material didático de Biologia de primeiro ano do ensino médio. Este artigo tem como objetivo analisar a contribuição deste material para a prática de Educação Sexual Emancipatória na Educação Básica, a partir da realização das oficinas do kit educativo, com uma turma de 1º ano do Ensino Médio, durante as aulas de Biologia. Em seguida, pretende-se apontar limites e propor alterações como forma de superar as dificuldades encontradas e ampliar o potencial formativo desta ação didática. O Projeto Vale Sonhar constituía um importante espaço curricular destinado à temática, no entanto, apresenta limitações como o longo tempo necessário para sua execução, que impacta na diminuição do aspecto lúdico e inviabilidade em um contexto de currículos extensos e poucas aulas semanais de Biologia. Percebemos a importância da inserção das dimensões psicológicas e socioculturais nas oficinas, questionamos a ausência de menção às Infecções Sexualmente Transmissíveis (IST) e apontamos para alguns problemas nas atividades propostas. Neste sentido, sugerimos algumas alterações nas oficinas, buscando trabalhar, além da prevenção da gravidez, temas que não eram abordados neste material, como elaboração do projeto de vida, a prevenção de IST, diversidade e violência sexual. Esperamos, assim, oferecer recursos para que os docentes de Biologia incluam em suas aulas o Projeto Vale Sonhar, trabalhando a Educação Sexual com seus alunos de forma integral, contemplando também aspectos psicológicos e socioculturais e a reflexão sobre o projeto de vida.Palavras-chave: Material didático, Educação sexual, Gravidez na adolescência, Projeto de vida.Keywords: Educational Material, Sex education, Teen pregnancy, Life plan.ReferencesBARDIN, L. Análise de conteúdo. Lisboa: Edições 70. 1977, 223 p.BELO, M. A. V.; SILVA, J. P. Conhecimento, atitude e prática sobre métodos anticoncepcionais entre adolescentes gestantes. Revista de Saúde Pública, 38 (4), 479-486. 2004.BONFIM, C. Desnudando a educação sexual. 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In my postgraduate formation during the last years of the 80’s, we had close to thirty hospital beds in a pavilion called “sépticas” (1). In Colombia, where abortion was completely penalized, the pavilion was mostly filled with women with insecure, complicated abortions. The focus we received was technical: management of intensive care; performance of hysterectomies, colostomies, bowel resection, etc. In those times, some nurses were nuns and limited themselves to interrogating the patients to get them to “confess” what they had done to themselves in order to abort. It always disturbed me that the women who left alive, left without any advice or contraceptive method. Having asked a professor of mine, he responded with disdain: “This is a third level hospital, those things are done by nurses of the first level”. Seeing so much pain and death, I decided to talk to patients, and I began to understand their decision. I still remember so many deaths with sadness, but one case in particular pains me: it was a woman close to being fifty who arrived with a uterine perforation in a state of advanced sepsis. Despite the surgery and the intensive care, she passed away. I had talked to her, and she told me she was a widow, had two adult kids and had aborted because of “embarrassment towards them” because they were going to find out that she had an active sexual life. A few days after her passing, the pathology professor called me, surprised, to tell me that the uterus we had sent for pathological examination showed no pregnancy. She was a woman in a perimenopausal state with a pregnancy exam that gave a false positive due to the high levels of FSH/LH typical of her age. SHE WAS NOT PREGNANT!!! She didn’t have menstruation because she was premenopausal and a false positive led her to an unsafe abortion. Of course, the injuries caused in the attempted abortion caused the fatal conclusion, but the real underlying cause was the social taboo in respect to sexuality. I had to watch many adolescents and young women leave the hospital alive, but without a uterus, sometime without ovaries and with colostomies, to be looked down on by a society that blamed them for deciding to not be mothers. I had to see situation of women that arrived with their intestines protruding from their vaginas because of unsafe abortions. I saw women, who in their despair, self-inflicted injuries attempting to abort with elements such as stick, branches, onion wedges, alum bars and clothing hooks among others. Among so many deaths, it was hard not having at least one woman per day in the morgue due to an unsafe abortion. During those time, healthcare was not handled from the biopsychosocial, but only from the technical (2); nonetheless, in the academic evaluations that were performed, when asked about the definition of health, we had to recite the text from the International Organization of Health that included these three aspects. How contradictory! To give response to the health need of women and guarantee their right when I was already a professor, I began an obstetric contraceptive service in that third level hospital. There was resistance from the directors, but fortunately I was able to acquire international donations for the institution, which facilitated its acceptance. I decided to undertake a teaching career with the hope of being able to sensitize health professionals towards an integral focus of health and illness. When the International Conference of Population and Development (ICPD) was held in Cairo in 1994, I had already spent various years in teaching, and when I read their Action Program, I found a name for what I was working on: Sexual and Reproductive Rights. I began to incorporate the tools given by this document into my professional and teaching life. I was able to sensitize people at my countries Health Ministry, and we worked together moving it to an approach of human rights in areas of sexual and reproductive health (SRH). This new viewpoint, in addition to being integral, sought to give answers to old problems like maternal mortality, adolescent pregnancy, low contraceptive prevalence, unplanned or unwanted pregnancy or violence against women. With other sensitized people, we began with these SRH issues to permeate the Colombian Society of Obstetrics and Gynecology, some universities, and university hospitals. We are still fighting in a country that despite many difficulties has improved its indicators of SRH. With the experience of having labored in all sphere of these topics, we manage to create, with a handful of colleagues and friend at the Universidad El Bosque, a Master’s Program in Sexual and Reproductive Health, open to all professions, in which we broke several paradigms. A program was initiated in which the qualitative and quantitative investigation had the same weight, and some alumni of the program are now in positions of leadership in governmental and international institutions, replicating integral models. In the Latin American Federation of Obstetrics and Gynecology (FLASOG, English acronym) and in the International Federation of Obstetrics and Gynecology (FIGO), I was able to apply my experience for many years in the SRH committees of these association to benefit women and girls in the regional and global environments. When I think of who has inspired me in these fights, I should highlight the great feminist who have taught me and been with me in so many fights. I cannot mention them all, but I have admired the story of the life of Margaret Sanger with her persistence and visionary outlook. She fought throughout her whole life to help the women of the 20th century to be able to obtain the right to decide when and whether or not they wanted to have children (3). Of current feminist, I have had the privilege of sharing experiences with Carmen Barroso, Giselle Carino, Debora Diniz and Alejandra Meglioli, leaders of the International Planned Parenthood Federation – Western Hemisphere Region (IPPF-RHO). From my country, I want to mention my countrywoman Florence Thomas, psychologist, columnist, writer and Colombo-French feminist. She is one of the most influential and important voices in the movement for women rights in Colombia and the region. She arrived from France in the 1960’s, in the years of counterculture, the Beatles, hippies, Simone de Beauvoir, and Jean-Paul Sartre, a time in which capitalism and consumer culture began to be criticized (4). It was then when they began to talk about the female body, female sexuality and when the contraceptive pill arrived like a total revolution for women. Upon its arrival in 1967, she experimented a shock because she had just assisted in a revolution and only found a country of mothers, not women (5). That was the only destiny for a woman, to be quiet and submissive. Then she realized that this could not continue, speaking of “revolutionary vanguards” in such a patriarchal environment. In 1986 with the North American and European feminism waves and with her academic team, they created the group “Mujer y Sociedad de la Universidad Nacional de Colombia”, incubator of great initiatives and achievements for the country (6). She has led great changes with her courage, the strength of her arguments, and a simultaneously passionate and agreeable discourse. Among her multiple books, I highlight “Conversaciones con Violeta” (7), motivated by the disdain towards feminism of some young women. She writes it as a dialogue with an imaginary daughter in which, in an intimate manner, she reconstructs the history of women throughout the centuries and gives new light of the fundamental role of feminism in the life of modern women. Another book that shows her bravery is “Había que decirlo” (8), in which she narrates the experience of her own abortion at age twenty-two in sixty’s France. My work experience in the IPPF-RHO has allowed me to meet leaders of all ages in diverse countries of the region, who with great mysticism and dedication, voluntarily, work to achieve a more equal and just society. I have been particularly impressed by the appropriation of the concept of sexual and reproductive rights by young people, and this has given me great hope for the future of the planet. We continue to have an incomplete agenda of the action plan of the ICPD of Cairo but seeing how the youth bravely confront the challenges motivates me to continue ahead and give my years of experience in an intergenerational work. In their policies and programs, the IPPF-RHO evidences great commitment for the rights and the SRH of adolescent, that are consistent with what the organization promotes, for example, 20% of the places for decision making are in hands of the young. Member organizations, that base their labor on volunteers, are true incubators of youth that will make that unassailable and necessary change of generations. In contrast to what many of us experienced, working in this complicated agenda of sexual and reproductive health without theoretical bases, today we see committed people with a solid formation to replace us. In the college of medicine at the Universidad Nacional de Colombia and the College of Nursing at the Universidad El Bosque, the new generations are more motivated and empowered, with great desire to change the strict underlying structures. Our great worry is the onslaught of the ultra-right, a lot of times better organized than us who do support rights, that supports anti-rights group and are truly pro-life (9). Faced with this scenario, we should organize ourselves better, giving battle to guarantee the rights of women in the local, regional, and global level, aggregating the efforts of all pro-right organizations. We are now committed to the Objectives of Sustainable Development (10), understood as those that satisfy the necessities of the current generation without jeopardizing the capacity of future generations to satisfy their own necessities. This new agenda is based on: - The unfinished work of the Millennium Development Goals - Pending commitments (international environmental conventions) - The emergent topics of the three dimensions of sustainable development: social, economic, and environmental. We now have 17 objectives of sustainable development and 169 goals (11). These goals mention “universal access to reproductive health” many times. In objective 3 of this list is included guaranteeing, before the year 2030, “universal access to sexual and reproductive health services, including those of family planning, information, and education.” Likewise, objective 5, “obtain gender equality and empower all women and girls”, establishes the goal of “assuring the universal access to sexual and reproductive health and reproductive rights in conformity with the action program of the International Conference on Population and Development, the Action Platform of Beijing”. It cannot be forgotten that the term universal access to sexual and reproductive health includes universal access to abortion and contraception. Currently, 830 women die every day through preventable maternal causes; of these deaths, 99% occur in developing countries, more than half in fragile environments and in humanitarian contexts (12). 216 million women cannot access modern contraception methods and the majority live in the nine poorest countries in the world and in a cultural environment proper to the decades of the seventies (13). This number only includes women from 15 to 49 years in any marital state, that is to say, the number that takes all women into account is much greater. Achieving the proposed objectives would entail preventing 67 million unwanted pregnancies and reducing maternal deaths by two thirds. We currently have a high, unsatisfied demand for modern contraceptives, with extremely low use of reversible, long term methods (intrauterine devices and subdermal implants) which are the most effect ones with best adherence (14). There is not a single objective among the 17 Objectives of Sustainable Development where contraception does not have a prominent role: from the first one that refers to ending poverty, going through the fifth one about gender equality, the tenth of inequality reduction among countries and within the same country, until the sixteenth related with peace and justice. If we want to change the world, we should procure universal access to contraception without myths or barriers. We have the moral obligation of achieving the irradiation of extreme poverty and advancing the construction of more equal, just, and happy societies. In emergency contraception (EC), we are very far from reaching expectations. If in reversible, long-term methods we have low prevalence, in EC the situation gets worse. Not all faculties in the region look at this topic, and where it is looked at, there is no homogeneity in content, not even within the same country. There are still myths about their real action mechanisms. There are countries, like Honduras, where it is prohibited and there is no specific medicine, the same case as in Haiti. Where it is available, access is dismal, particularly among girls, adolescents, youth, migrants, afro-descendent, and indigenous. The multiple barriers for the effective use of emergency contraceptives must be knocked down, and to work toward that we have to destroy myths and erroneous perceptions, taboos and cultural norms; achieve changes in laws and restrictive rules within countries, achieve access without barriers to the EC; work in union with other sectors; train health personnel and the community. It is necessary to transform the attitude of health personal to a service above personal opinion. Reflecting on what has occurred after the ICPD in Cairo, their Action Program changed how we look at the dynamics of population from an emphasis on demographics to a focus on the people and human rights. The governments agreed that, in this new focus, success was the empowerment of women and the possibility of choice through expanded access to education, health, services, and employment among others. Nonetheless, there have been unequal advances and inequality persists in our region, all the goals were not met, the sexual and reproductive goals continue beyond the reach of many women (15). There is a long road ahead until women and girls of the world can claim their rights and liberty of deciding. Globally, maternal deaths have been reduced, there is more qualified assistance of births, more contraception prevalence, integral sexuality education, and access to SRH services for adolescents are now recognized rights with great advances, and additionally there have been concrete gains in terms of more favorable legal frameworks, particularly in our region; nonetheless, although it’s true that the access condition have improved, the restrictive laws of the region expose the most vulnerable women to insecure abortions. There are great challenges for governments to recognize SRH and the DSR as integral parts of health systems, there is an ample agenda against women. In that sense, access to SRH is threatened and oppressed, it requires multi-sector mobilization and litigation strategies, investigation and support for the support of women’s rights as a multi-sector agenda. Looking forward, we must make an effort to work more with youth to advance not only the Action Program of the ICPD, but also all social movements. They are one of the most vulnerable groups, and the biggest catalyzers for change. The young population still faces many challenges, especially women and girls; young girls are in particularly high risk due to lack of friendly and confidential services related with sexual and reproductive health, gender violence, and lack of access to services. In addition, access to abortion must be improved; it is the responsibility of states to guarantee the quality and security of this access. In our region there still exist countries with completely restrictive frameworks. New technologies facilitate self-care (16), which will allow expansion of universal access, but governments cannot detach themselves from their responsibility. Self-care is expanding in the world and can be strategic for reaching the most vulnerable populations. There are new challenges for the same problems, that require a re-interpretation of the measures necessary to guaranty the DSR of all people, in particular women, girls, and in general, marginalized and vulnerable populations. It is necessary to take into account migrations, climate change, the impact of digital media, the resurgence of hate discourse, oppression, violence, xenophobia, homo/transphobia, and other emergent problems, as SRH should be seen within a framework of justice, not isolated. We should demand accountability of the 179 governments that participate in the ICPD 25 years ago and the 193 countries that signed the Sustainable Development Objectives. They should reaffirm their commitments and expand their agenda to topics not considered at that time. Our region has given the world an example with the Agreement of Montevideo, that becomes a blueprint for achieving the action plan of the CIPD and we should not allow retreat. This agreement puts people at the center, especially women, and includes the topic of abortion, inviting the state to consider the possibility of legalizing it, which opens the doors for all governments of the world to recognize that women have the right to choose on maternity. This agreement is much more inclusive: Considering that the gaps in health continue to abound in the region and the average statistics hide the high levels of maternal mortality, of sexually transmitted diseases, of infection by HIV/AIDS, and the unsatisfied demand for contraception in the population that lives in poverty and rural areas, among indigenous communities, and afro-descendants and groups in conditions of vulnerability like women, adolescents and incapacitated people, it is agreed: 33- To promote, protect, and guarantee the health and the sexual and reproductive rights that contribute to the complete fulfillment of people and social justice in a society free of any form of discrimination and violence. 37- Guarantee universal access to quality sexual and reproductive health services, taking into consideration the specific needs of men and women, adolescents and young, LGBT people, older people and people with incapacity, paying particular attention to people in a condition of vulnerability and people who live in rural and remote zone, promoting citizen participation in the completing of these commitments. 42- To guarantee, in cases in which abortion is legal or decriminalized in the national legislation, the existence of safe and quality abortion for non-desired or non-accepted pregnancies and instigate the other States to consider the possibility of modifying public laws, norms, strategies, and public policy on the voluntary interruption of pregnancy to save the life and health of pregnant adolescent women, improving their quality of life and decreasing the number of abortions (17).

Abstract Background Although 25% of the Ethiopian population is young, Sexual and Reproductive Health (SRH) Services have not been adequately researched and intervened, leaving adolescents with many reproductive health challenges. Assessment of the uptake of each element of SRH service and its determinants among those age groups is essential to improving service uptake and reducing the burden of illness and disability in adolescents. Thus, this study aimed at assessing the uptake of key elements of SRH services and its determinants among adolescents residing in rural districts of Guraghe zone, Southern Ethiopia. Methods A community-based cross-sectional study was carried out from May 1 to 30, 2020, and a multi-stage sampling technique was employed to randomly select 1028 adolescents. The data were collected by using a pre-tested interviewer-administered questionnaire. The data were coded and entered into Epi-Data version 3.1 and exported into SPSS version 23 for analysis. Independent t-tests and analysis of variance (ANOVA) were run to determine whether there were statistically significant differences in the mean number of SRH services used across each categorical variable. A multivariable generalized linear regression (GLM) model with a Poisson link was used to determine the effect of each variable on the mean number of SRH services used. Adjusted odds ratios with their corresponding 95% confidence interval were used to declare the statistical significance of the independent variables. Results The study included 1,009 adolescents, yielding a response rate of 98.1%. The use of the SRH service was assessed using eight elements, and the mean (± SD) score of service uptake was 4.05 (± 1.94), with only 6.8% of adolescents receiving all key elements. Comprehensive sexuality education (55.1%) and voluntary HIV/AIDS counseling and testing (51.0%) were the commonest service items used by adolescents, while the provision of contraceptives was the lowest service item received (25.9%). Educational level (AOR: 1.28, 95% CI: 1.03–1.56), having a parental discussion (AOR: 1.31, 95% CI: 1.13–1.51), lack of youth clubs (AOR: 0.71, 95% CI: 0.66–0.87), and knowledge on SRH issues (AOR: 0.79, 95% CI: 0.73–0.85) were identified as significant predictors of the uptake of key elements of SRH services. Conclusion The overall uptake of SRH services was found to be low in the study area. Schools should be an excellent means of educating adolescents to increase their knowledge of key elements of SRH services. Furthermore, stakeholders must work together to improve the culture of parental discussion with adolescents and establish and strengthen youth clubs, as measures for encouraging the use of SRH services.

Background: Many countries face several sexual and reproductive health (SRH) challenges, with HIV/ AIDS being one of them, and young people have been greatly affected by HIV [1,2]. It has been suggested that participation in “life skills” education can help reduce HIV related risk behaviours [3]. There have been increased calls for including life skills as a key component of HIV and AIDS education for children and young people [2]. There is a need to ensure that young people develop the life skills relevant to reducing their vulnerability to HIV infection [4,5]. Literature tends to present life skills as a possible solution to several social, gender and general behavioural problems; for example, it is stated that life skills can help trigger political, social and economic participation and help reduce gender inequalities [2]. In addition, life skills are also believed to positively impact deviant social behaviour, crime, and reduction of substance use [6,7].Specifically for HIV, the literature suggests that life skills may positively contribute towards reducing contracting of HIV by, for example, enhancing negotiation and communication skills which may help the young people negotiate for safer sex by making them openly talk about risky sexual behaviours and how they can be prevented [8,9]. Life skills in HIV programming include reproductive and sexual health such as HIV and AIDS, condoms, communication skills, and information on addressing gender-based violence [4,2]. Positive outcomes from these studies included increased communication skills, improved risk perception, reduced stigmatisation of people living with HIV, decreased gender-based violence and improved positive living attitude [2].

The purpose of this study was to investigate how clergy are dealing with HIV prevention and sexuality education of young people in their congregations. An electronic questionnaire was filled in by 142 clergy from white Afrikaans-speaking churches in the Reformed tradition. Results showed that 77% clergy believed that unmarried young people in their congregations are sexually active. More than 85% clergy agreed that it is the task of the church to provide sexuality and HIV prevention education to young congregants. However, not many clergy (13%) offered HIV prevention programmes for young people in their own congregations. The main HIV prevention message 85% of clergy were prepared to share with young congregants was ‘abstinence only’ or ‘your body is the temple of God’. Only 15% clergy (significantly more female clergy) were prepared to offer comprehensive sexuality education (abstinence PLUS) programmes. The HIV prevention message of the church should at least be in line with the lived experiences and reality of its youth in today’s society. The church can no longer afford to alienate young people through moralism only. She needs an approach that satisfies both morality and reality.Intradisciplinary and/or interdisciplinary implications: This article has implications for the fields of psychology, HIV and AIDS research and pastoral care. It challenges the way the church prepares young people to cope with HIV in a modern society and suggests change in terms of a greater participation in the sexuality education of young people.

Abstract Introduction This article examines recent moral panics over sex education in Uganda from historical perspectives. Public outcry over comprehensive sexuality education erupted in 2016 over claims that children were being taught “homosexuality” by international NGOs. Subsequent debates over sex education revolved around defending what public figures claimed were national, religious, and cultural values from foreign infiltration. Methods This paper is grounded in a survey of Uganda’s two English-print national newspapers (2016–2018), archival research of newspapers held at Uganda’s Vision Group media company (1985–2005), analyses of public rhetoric as reported in internationally and nationally circulating media, textual analysis of Uganda’s National Sexuality Education Framework (2018), formal interviews with Ugandan NGO officers (3), and semi-structured interviews with Ugandan educators (3). Results Uganda’s current panic over sex education reignited longstanding anxieties over foreign interventions into the sexual health and rights of Ugandans. We argue that in the wake of a 35-year battle with HIV/AIDS and more recent controversies over LGBT rights, both of which brought international donor resources and governance, the issue of where and how to teach young people about sex became a new battleground over the state’s authority to govern the health and economic prosperity of its citizens. Conclusions Ethno- and religio-nationalist rhetoric used to oppose the state’s new sexuality education policy was also used to justify sex education as a tool for economic development. Policy Implications Analyzing rhetoric mobilized by both supporters and detractors of sex education reveals the contested political terrain policy advocates must navigate in Uganda and other postcolonial contexts.

ABSTRACT Teenagers face challenges due to the lack of information about sex, sexuality, body changes, puberty, teenage pregnancy, early childbearing, HIV/AIDS in most developing countries, and Bangladesh is no exception. However, the study aims to explore the contributing factors of inadequate sex education at schools in Bangladesh. The study reviewed a variety of secondary sources and literatures to understand the contributing factors of inadequate sex education and analyzes those data and literatures. Therefore, the study found that there is a lack of a comprehensive sex education policy and formal sex education is very limited in Bangladesh. Moreover, it also found that there are very few chapters about sex education in the biological book, but teachers feel uncomfortable teaching about these topics. Furthermore, the parents are not confident to talk with their children as they have insufficient knowledge about sex education topics. In addition, the cultural and religious barriers are also responsible for inadequate sex education due to the orthodox thoughts of the family and society. The paper recommends that there should have a comprehensive sex education policy, and curriculum. Moreover, the focus should be on the implementation of interventions for the teachers' training, parent’s session, & community engagement programs. Keywords: Adolescent, Sex education, Parent’s attitude, Teachers’ perception, Bangladesh

Abstract Background Responding to adolescents’ educational needs in sexual and reproductive health and rights (SRHR) is central to their sexual health and achieved through school-based comprehensive sexuality education (CSE). In 2016, Rwanda introduced CSE through the competence-based curriculum in schools to enhance learners’ knowledge about sexuality, gender, and reproductive health issues, including HIV/AIDS. However, globally, the content of CSE is sometimes dissimilar, and little evidence surrounds its scope in many settings, including Rwanda. In addition, the extent to which CSE aligns with international guidelines has yet to be well known. This study assesses major areas of CSE for early adolescents in Rwanda, analyses how CSE correlates with international guidelines and makes recommendations accordingly. Methods We reviewed the Rwandan competence-based curriculum to map CSE competences for early adolescents and conducted semi-structured interviews with key informants (N = 16). Eleven of the 23 curriculum documents met the selection criteria and were included in the final review. We manually extracted data using a standard form in Microsoft Excel and analysed data using frequency tables and charts. Interviews were thematically analysed in NVivo 11 for Windows. Findings We found 58 CSE competences for early adolescents across various subjects, increasing with school grades. All recommended CSE areas were addressed but to a variable extent. Most competences fall under four recommended areas: sexual and reproductive health; human body and development; values, rights, and sexuality; and understanding gender. The least represented area is violence and staying safe. Of the 27 expected topics, there are two to six CSE competences for 13 topics, one CSE competence for each of the six others, and none for the eight remaining ones. Qualitative findings support these findings and suggest additional content on locally controversial but recommended areas of sexual pleasure, orientation, desire and modern contraceptive methods. Conclusion This study explores the CSE content for early adolescents in Rwanda and how they align with sexuality education standards. Ensuring equal coverage of CSE areas and addressing missing topics may improve CSE content for this age group and foster their SRHR.

AbstractSub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths and HIV-infected people in the world. Even though considerable effort has been made over the years to study HIV transmission risk behaviours of different population groups in SSA, there is little evidence of studies that have looked at pooled effects of associated HIV risk factors among men, particularly in Southern Africa. Thus, this study sought to fill this gap in knowledge by investigating the variations in HIV risk behaviours among men in the region. The study analysed cross-sectional data based on the most recent country Demographic and Health Survey (DHS) for six countries, namely Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. The study employed multivariate logistic regression models on a pooled dataset and individual country data to examine the relative risk of education and other factors on HIV risk behaviour indicators. It considered: (i) condom use during high risk-sex, (ii) multiple sexual partnerships, and (iii) HIV testing among men aged 15–59 years. Findings show that the proportion of men who engaged in HIV transmission risk behaviour was high in Southern Africa. Two-thirds of men reported non-use of a condom during last sex with most recent partners while 22% engaged in multiple sexual partnerships. The percentage of men who used condoms during sex with most recent partners ranged from 18% in Mozambique to 58% in Namibia. Age, residence, marital status and household wealth status were associated with HIV risk factors in the region. The study has established country variations in terms of how individual factors influence HIV transmission risk behaviour among men. Results show that the level of education was associated with increased use of condoms, only in Zambia and Mozambique. Delay in starting a sexual debut was associated with reduced odds of having multiple sexual partnerships in the region. Suggesting the need to strengthen comprehensive sexuality education among young men in school, to promote social behaviour change during adolescence age. The study presents important results to inform direct health policy, programme and government action to address HIV prevalence in the Southern region of Africa.

As a former teacher and current researcher, I have personally heard as well as read about many different reasons why homosexuality, bisexuality, and, more generally, sexuality other than heterosexuality should not be discussed in the classroom. There is the argument that sexuality is the domain of the parent, not the teacher, and about the numerous religions that do not condone homo/bisexuality. I have read about teachers’ sense of discomfort with discussing sexuality and sexual orientation. Most frequently, I have come up against the argument that students are not certain of their sexual orientation until adulthood, that teaching about the range of sexualities might confuse ‘impressionable’ adolescents and that there are ‘no gay students in my class’ so such education is unnecessary. Contrary to this last point, research with same-sex attracted (SSA) adolescents has shown that they are first aware of their attractions to members of the same sex as early as 10 years of age (D’Augelli, Pilkington, and Hershberger) and begin to feel concrete about their sexual orientation between the ages of 14 and 16 years old (Rosario, et al.). As far as numbers of young people who are attracted to members of the same sex, recent research using random samples of secondary-school aged students has placed percentages between 2.5% (Garofalo, et al.) and 6.3% (Smith, Lindsay, and Rosenthal). However, as Savin-Williams points out, ‘the vast majority of youths who will eventually identify themselves as lesbian, bisexual or gay seldom embrace this socially ostracized label during adolescence…’, leading to speculation that reported percentages of SSA young people are actually conservative estimates rather than true figures (Savin-Williams 262). To date, no research has shown that adolescents have become homosexual because they were exposed to homosexuality as a topic within the school curriculum. In fact, it is quite the opposite, with many SSA students coming to terms with their homo/bisexuality despite it being pathologised within the curriculum and punishable by sanctioned victimisation within the school environment. The fact that heterosexuality is ‘policed’ and reinforced with the school context is not surprising. In his History of Sexuality, Volume 1, Foucault writes about sexuality as a locus of social control and points out that throughout history individual’s sexual thoughts, beliefs, and, ultimately, actions have been impacted by socially constructed sexual norms. Educational sociologists have taken this idea into the classroom, viewing heterosexuality as a part of the ‘hidden curriculum’, the social norms that students learn without them being part of the formal lesson (Plummer). In this sense, heterosexuality becomes part of students’ unspoken and assumed identity in the classroom and, because of socially sanctioned homophobia/heterosexism, being heterosexual becomes a form of cultural and social capital. In line with some teachers’ reluctance to discuss homo/bisexuality in the classroom are their attitudes toward homosexuality. A number of studies have highlighted the homophobic attitudes of pre-service teachers, primary and secondary school teachers, and counsellor trainees as well as their reluctance and discomfort with discussing homo/bisexuality in the classroom (Sears; Warwick, Aggleton, and Douglas; Barrett and McWhirter; Cahill and Adams). These negative attitudes can manifest themselves in a variety of ways detrimental to SSA students, from simply avoiding homosexual topics or issues to discussing these issues or topics in a negative manner. Recent research with same-sex attracted secondary school students spoke to this trend. When asked about ways in which homosexuality was discussed in the classroom, three main points were consistently raised: sexuality which is not heterosexuality is presented in a reduced form (i.e., male homosexuality); homosexuality is pathologised as either a mental illness or a precursor to infection; and, teachers exhibited prejudice against non-heterosexual sexualities that would not be tolerated in the instance of a racial or gender issue (Ellis and High, 221-2). Research in this area has also investigated the attitudes of secondary school students toward homosexuality, with results showing high levels of homophobia and strict gender role beliefs (Van de Ven; Price; Smith; Hillier; Thurlow); however, recent research has shown some improvement in students’ attitudes (Smith, et al.). Knowing what we know about the ways in which homosexuality is presented within the school setting (or in many cases simply not presented), coupled with the attitudes of the school community members toward homosexuality and gender roles, as reflective of societal norms, it is not surprising these sentiments manifest themselves in the form of victimisation for SSA students and students who are perceived to be SSA. While the ‘hidden curriculum’ reinforces heterosexuality as a covert form of victimisation, overt forms of victimisation of SSA students occur with alarming regularity. Research has highlighted stories of SSA students’ experiences of verbal and physical abuse, property damage, and social isolation within the school setting with a common theme being a lack of intervention on the part of the adult school staff (Jordan, Vaughan, and Woodworth; Flowers and Buston; Kosciw and Cullen). A good deal of research has positioned SSA young people as ‘at-risk’, using data which places heterosexual-identifying adolescents as a ‘control group’ and citing elevated drug and alcohol use, suicide attempts/ideation, and risky sexual practices among the population of SSA young people. This type of research problematises the SSA young people themselves, rather than the environments which they are subject to and the harassment they may be experiencing therein. A far smaller body of research has examined correlates of victimisation for SSA students, the results being exactly what one would expect. At-school victimisation of SSA students has been positively correlated with general risk outcomes such as negative mental health effects (D’Augelli, Pilkington and Hershberger; Rivers), drug and alcohol abuse, and suicide attempts (Bontempo and D’Augelli). Smaller still is the body of research that examines school-related outcomes for SSA students. Victimisation of these students has been positively correlated with their frequency of missed school days as a result of personal safety fears (Bontempo and D’Augelli) as well as their reported academic outcomes and educational aspirations (Kosciw). In light of the body of literature on how SSA students experience the school environment, a logical path seems to emerge. Societal norms surrounding sexuality contribute to adult school staff members’ attitudes toward homosexuality. These norms, coupled with the palpable attitudes of staff, effect the overall tenor of the school environment toward homosexuality which, in turn, contributes to students’ attitudes toward homosexuality. The sentiments of students and staff undoubtedly have a significant impact on how or if sexuality is discussed within the classroom, victimisation of SSA students, and whether or not this victimisation is punished or ignored by staff members. Consequently, victimisation of SSA students has been found to be correlated with both general risk outcomes as well as decreased academic outcomes. Clearly there is cause for concern. If SSA students are more likely to report decreased school outcomes and higher risk behaviours the more they report being victimised within the school setting, then the solution seems rather obvious – protect SSA students from incidences of at-school victimisation. Without doing so, schools are allowing an inequitable school experience for SSA students and students who are perceived to be SSA as well as breaching their classroom duty of care. That said, adolescents cannot be told simply to stop ‘teasing gay kids’. Instead, a school culture must be created wherein homophobia is not tolerated, and heterosexism is recognised as such and the power it has over individual’s thoughts and actions is brought to light. Towards that end, lesbian, gay, bisexual, and transgender topics, issues, and historical/prominent figures must be discussed in the classroom and the historical discrimination of SSA persons should be taught in the same way that racial/ethnic histories of discrimination are part of the curriculum. Through education, homophobia can begin to be viewed in the same way as racism and religious discrimination are viewed – as ignorant and entirely unacceptable. Perhaps this sounds like some gay utopian dream, but I believe that at a future date society will progress to this level and that education is fundamental to the process. By silencing sexualities, educators are marginalising and disenfranching a definite population of their SSA students, not to mention the effects this has on students who have SSA family members or friends. Teachers are uncomfortable discussing homosexuality in the classroom? I am uncomfortable with SSA students missing school because they are afraid, leaving school early because they do not feel that they belong, and reporting decreased marks and lowered aspirations for tertiary education. Silencing (homo)sexualities is a bad idea, not only for SSA persons but for any society which has illusions of being civilised, modernised, or unified. References Barrett, Kathleen, and Benedict McWhirter. “Counselor Trainees Perceptions of Clients Based on Client Sexual Orientation.” Counselor Education and Supervision 41.3 (2002): 219-30. Bontempo, Daniel, and Anthony D’Augelli. “Effects of at-School Vicitimization and Sexual Orientation on Lesbian, Gay, or Bisexual Youths’ Health Risk Behavior.” Journal of Adolescent Health 30 (2002): 364-74. Cahill, Betsy, and Eve Adams. “An Exploratory Study of Early Childhood Teachers’ Attitudes toward Gender Roles.” Sex Roles 36.7/8 (1997): 517-29. D’Augelli, Anthony, Neil Pilkington, and Scott Hershberger. “Incidence and Mental Health Impact of Sexual Orientation Victimization of Lesbian, Gay, and Bisexual Youths in High School.” School Psychology Quarterly 17.2 (2002): 148-160. Ellis, Viv, and Sue High. “Something More to Tell You: Gay, Lesbian or Bisexual Young People’s Experiences of Secondary Schooling.” British Educational Research Journal 30.2 (2004): 213-25. Flowers, Paul, and Kate Buston. “‘I Was Terrified of Being Different’: Exploring Gay Men’s Accounts of Growing Up in a Heterosexist Society.” Journal of Adolescence 24 (2001): 51-65. Foucault, Michel. The History of Sexuality, Volume 1: An Introduction. New York: Pantheon Books, 1978. Garofalo, Robert, et al. “The Association between Health Risk Behaviors and Sexual Orientation among a School-Based Sample of Adolescents.” Pediatrics 101.5 (1998): 895-903. Hillier, Lynne. “Lesbian, Gay, Bisexual, Unsure: The Rural Eleven Percent.” Health in Difference: Proceedings of the First National Lesbian, Gay, Transgender and Bisexual Health Conference, 3-5 October 1996. Ed. Anthony Smith. Sydney: Australian Centre for Lesbian and Gay Research, 1997. 90-94. Jordan, K, J Vaughan, and K Woodworth. “I Will Survive: Lesbian, Gay, and Bisexual Youths’ Experience of High School.” School Experiences of Gay and Lesbian Youth: The Invisible Minority. Ed. M Harris. Binghamton: The Harrington Park Press, 1997. Kosciw, J. The 2003 National School Climate Survey: The School-Related Experiences of Our Nation’s Lesbian, Gay, Bisexual and Transgender Youth. New York: GLSEN, 2004. Kosciw, J, and M Cullen. The 2001 National School Climate Survey: The School-Related Experiences of Our Nation’s, Lesbian, Gay, Bisexual and Transgender Youth. New York: GLSEN, 2002. Plummer, Ken. “Lesbian and Gay Youth in England.” Gay and Lesbian Youth. Ed. G Herdt. New York: Harrington Park Press, 1989. 195-216. Price, James. “High School Students’ Attitudes toward Homosexuality.” Journal of School Health 52 (1982): 469-74. Rivers, Ian. “Long-Term Consequences of Bullying.” Issues in Therapy with Lesbian, Gay, Bisexual and Transgender Clients. Ed. Dominic Davies. Vol. 3. Pink Therapy. Buckingham: Open UP, 2000. 146-59. Rosario, Margaret, et al. “The Psychosexual Development of Urban Lesbian, Gay, and Bisexual Youths.” Journal of Sex Research 33.2 (1996): 113-26. Savin-Williams, Ritch. “Verbal and Physical Abuse as Stressors in the Lives of Lesbian, Gay Male, and Bisexual Youths: Associations with School Problems, Running Away, Substance Abuse, Prostitution and Suicide.” Journal of Counseling and Clinical Psychology 62.2 (1994): 261-9. Sears, James. “Educators, Homosexuality and Homosexual Students: Are Personal Feelings Related to Professional Beliefs?” Coming out of the Classroom Closet. Ed. K Harbeck. New York: Harrington Park Press, 1992. Smith, Anthony, Jo Lindsay, and Doreen A. Rosenthal. “Same-Sex Attraction, Drug Injection and Binge Drinking among Australian Adolescents.” Australian and New Zealand Journal of Public Health 23.6 (1999): 643-46. Smith, Anthony, Jo Lindsay, and Doreen A. Rosenthal. Secondary Students and Sexual Health 2002: Results of the 3rd National Survey of Australian Secondary Students, Hiv/Aids and Sexual Health. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University, 2003. Smith, George. “”The Ideology of ‘Fag’: The School Experience of Gay Students.” The Sociological Quarterly 39.2 (1998): 309-35. Thurlow, Crispin. “Naming the ‘Outsider Within’: Homophobic Pejoratives and the Verbal Abuse of Lesbian, Gay and Bisexual High-School Pupils.” Journal of Adolescence 24 (2001): 25-38. Van de Ven, Paul. “Comparisons among Homophobic Reactions of Undergraduates, High School Students, and Young Offenders.” Journal of Sex Research 31.2 (1994): 117-135. Warwick, Ian, Peter Aggleton, and Nicola Douglas. “Playing It Safe: Addressing the Emotional and Physical Health of Lesbian and Gay Pupils in the U.K.” Journal of Adolescence 24 (2001): 129-40. Citation reference for this article MLA Style Mikulsky, Jacqueline. "Silencing (Homo)Sexualities in School ... A Very Bad Idea." M/C Journal 8.1 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0502/06-mikulsky.php>. APA Style Mikulsky, J. (Feb. 2005) "Silencing (Homo)Sexualities in School ... A Very Bad Idea," M/C Journal, 8(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0502/06-mikulsky.php>.

Photo by Sébastien Goldberg on Unsplash ABSTRACT Rohingya women face challenges that ought to be acknowledged and addressed to ensure that when they seek health care, they can act autonomously and decide freely among available options. Self-determination theory offers valuable insight into supporting these women within their unique situations. INTRODUCTION In August of 2017, military and paramilitary forces in Myanmar began purging the Rohingya Muslim population from the country, motivated by anti-Muslim prejudice of the Buddhist political and social majority. Mass murder, property destruction, kidnapping, torture, and sexual violence still affect Rohingya communities. As a result, more than a million individuals have fled Myanmar.[1] As of February 2021, approximately 880,000 Rohingya Muslims have taken refuge in Cox’s Bazar, Bangladesh, the site of the largest refugee camps in the world.[2] The public health focus in these camps is on treatment of physical ailments and infectious diseases.[3] While women of reproductive age and adolescent girls experience the highest level of violence among Rohingya communities in both Myanmar and Bangladesh, they have consistently lacked access to sufficient sexual and reproductive care. In 1994, the Women’s Commission for Refugee Women and Children exposed issues surrounding the sexual and reproductive health of displaced populations and propelled the recognition of SRH as a human right.[4] Human rights interventionists and public health officials have made progress in the integration of sexual and reproductive health education, facilities, and resources into refugee camps in Cox’s Bazar. This includes the introduction of menstrual cleanliness facilities and educational conversations. However, Rohingya women and male cultural leaders, or gatekeepers, remain reluctant to accept these resources and education.[5] The prevalence of gender-based violence against women and restrictive policies enforced by the Bangladesh government heighten the barriers to the effective introduction of sexual and reproductive health resources and services.[6] A wealth of literature has pushed for the extension of clinical duties of beneficence and non-maleficence in the diagnosis and treatment of refugee and asylum-seeking communities.[7] Additionally, extensive research on Rohingya refugee communities has searched for ways to work around the complex social history and to accommodate power structures by integrating gatekeepers into SRH discussions.[8] However, as interventions have sought to overcome cultural and religious barriers, they have largely overlooked the protection of autonomy of sexual and reproductive health patients in Cox’s Bazar. This paper argues two points. First, attempts at improving outcomes in Cox’s Bazar ought to lead to Rohingya women’s autonomy and self-determination, both in mitigating control of male leaders over sexual and reproductive decisions and in ensuring the understanding and informed consent between patients and providers. Second, policy decisions ought to ensure post-treatment comprehensive care to shield Rohingya women from retribution by male community members. Self-determination theory offers guidance for state leaders and healthcare providers in pursuing these goals. l. Barriers to Sexual and Reproductive Health Services for Rohingya Women As part of its anti-Muslim narrative, the Buddhist majority has painted Rohingya women as hyper-reproductive. False narratives “of a Rohingya plan to spread Islam by driving demographic shifts” and accusations against Rohingya women for having “unusually large families” have motivated violent behavior and discriminatory regulations against Rohingya communities.[9] In reality, demographic data shows that “the Rohingya population has remained stable at 4% since 1980.”[10] In 2013, the government of Myanmar imposed regulations on Rohingya families in the Rakhine state, the region with the highest population of Rohingya Muslims, enforcing a two-child limit and requiring that Rohingya women obtain government authorization to marry and take a pregnancy test before receiving such permission. The majority has also subjected Rohingya females to acts of sexual violence to ostracize them and “dilute” Rohingya identity.[11] As a result, Rohingya women in Cox’s Bazar experience unique illnesses and vulnerabilities requiring imminent treatment. Due to national policies in Bangladesh, “Rohingya [women] cannot receive HIV/AIDS testing and treatment in camps; birth control implants delivered by midwives; and comprehensive abortion care.”[12] Additionally, in accordance with patriarchal Rohingya community structure, male gatekeepers hold high authority over sexual and reproductive decisions of women, evidenced by the persistence of gender-based violence within refugee camps and traditional practices such as the marriage of minor girls to older Rohingya men.[13] Surveys of community members reveal that cultural and religious stigma against sexual and reproductive health care exists among these male gatekeepers as well as Rohingya women.[14] Due to their cultural and political position, Rohingya women are subject to unique power relations. This paper analyzes the ethical dilemmas that arise from two of those power relations: Rohingya women’s relationships with male gatekeepers and their relationships with interventionist healthcare providers. ll. Ethics of Including Male Community Members in Decisions Affecting Women’s Healthcare Autonomy A November 2019 survey of Rohingya women in Cox’s Bazar that had married or given birth within the past two years found that “around one half of the female Rohingya refugees do not use contraceptives, mainly because of their husbands’ disapproval and their religious beliefs.”[15] There are widespread misconceptions such as the belief that Islam does not permit the use of contraceptives.[16] The existence of such misconceptions and the power husbands and male leaders hold over the delivery of treatment creates dilemmas for healthcare practitioners in conforming to ethical principles of care. lll. Beneficence in Providing Care to Refugees While public health scholars and government officials hold divided opinions on the level of treatment required to fulfill refugees’ right to sexual and reproductive health care, most support enough care to ensure physical and psychological well-being.[17] Beneficence requires that healthcare providers and states “protect the rights of others[,] prevent harm from occurring to others[, and] remove conditions that will cause harm to others.”[18] Under the principle of beneficence, there is a duty to provide sexual and reproductive treatment to Rohingya women in Cox’s Bazar that is comparable to that received by citizens of the host state. In addition, the ethical principle of nonmaleficence may call for the creation of specialized care facilities for refugee communities, because a lack of response to refugees’ vulnerability and psychological trauma has the potential to generate additional harm.[19] In response to gendered power relations among the Rohingya community, husbands and male leaders are included in decisions surrounding maternal health and sexual and reproductive care for women. For example, healthcare professionals “have been found to impose conditions on SRH [sexual reproductive health] care that are not stated in the national… [menstrual regulation] guidelines, such as having a husband’s permission.”[20] The refugee healthcare community could do more to mitigate the potential of retribution taken by male community members against women that accept care by dispelling common misconceptions and precluding male community members from influencing female reproductive choices.[21] However, some current practices allow the infiltration of male community leaders and husbands into the diagnosis, decision-making, and treatment spaces. Deferring decisions to male leaders for the sake of expediency risks conditioning women’s access to care on male buy-in and diminishes Rohingya women’s autonomy over their sexual and reproductive health. lV. Male Influence and Female Autonomy Ensuring patients control their own treatment decisions is an essential component of the ethical obligation of healthcare professionals to respect patients’ autonomy. While patients can exercise their autonomy to accept the direction of the community, their autonomy is undermined when “external sources or internal states… rob [such persons]… of self-directedness.”[22] Sexual and reproductive health research on Rohingya women revealed that the presence of male family members during conversations “made female respondents uncomfortable to speak openly about their SRH [sexual and reproductive health]related experiences.”[23] The same study found that when male family members were absent, Rohingya women were more transparent and willing to discuss such topics.[24] These findings indicate that the mere presence of male family members exerts control over Rohingya women in conversations with practitioners. Male involvement also stalls conversations between providers and Rohingya women which may harm the achievement of understanding and informed consent in diagnosis and treatment spaces.[25] Women do have the option of bringing their male community leaders and family members into sexual health discussions. Yet healthcare providers ought to monitor patients individually and avoid programmatic decision making regarding male involvement in the treatment space. While it is the ethical imperative of health interventionists and the state of Bangladesh to fulfill the duties of care required by the principles of beneficence and non-maleficence, the sole prioritization of expanding sexual and reproductive health care in Cox’s Bazar risks ignoring autonomy. V. Ethics of Paternalism in Provide-Patient Relations Rohingya women’s negative beliefs about contraceptives, such as the belief that they cause irreversible sterilization, are the second largest factor inhibiting their use.[26] To an extent, the Rohingya are justified in their skepticism. Prior to the 1990’s, Bangladesh used nonconsensual sterilization as a mechanism of population control to attain access to international aid. Though the international conversation surrounding reproduction shifted its focus towards reproductive rights following the 1994 UN International Conference on Population and Development, delivery of reproductive care in the global South is frequently characterized by lack of transparency and insufficient patient understanding of the risks and consequences of treatment. Additionally, women’s lack of control impacts follow-up care and long-term contraception. For example, when women seek the removal of implantable contraceptives, healthcare professionals often refuse to perform the requisite operation.[27] Patients must understand the risks of treatment in their own culture and circumstances where societal views, misconceptions, or fears may influence healthcare practices. Healthcare providers need to recognize the coercive potential they hold in their relations with patients and guard against breaches of patient autonomy in the delivery of treatment. In accordance with the principle of beneficence, healthcare providers treating refugees or individuals seeking asylum ought to abide by the same fiduciary responsibilities they hold toward citizens of the host state.[28] When patients show hesitancy or refusal toward treatment, healthcare providers ought to avoid achieving treatment by paternalistic practice such as “deception, lying, manipulation of information, nondisclosure of information, or coercion.”[29] Although well-intentioned, this practice undermines the providers’ obligation to respect patients’ autonomy.[30] The hesitancy of Rohingya women to accept some sexual or reproductive health care does not justify intentional lack of transparency, even when that treatment furthers their best health interests. However, paternalistic actions may be permissible and justified during medical emergencies.[31] Vl. Informed Consent Respecting Rohingya women’s autonomy also places affirmative duties on healthcare providers to satisfy understanding and informed consent. However, language barriers and healthcare providers’ misconceptions about Rohingya religion and culture impede the achievement of these core conditions of autonomy for Rohingya women.[32] In an interview, a paramedic in Cox’s Bazar described the types of conversations healthcare providers have with Rohingya women in convincing them to accept menstrual regulation treatment, a method to ensure that someone is not pregnant after a missed period: “We tell them [menstrual regulation] is not a sin… If you have another baby now, you will get bad impact on your health. You cannot give your children enough care. So, take MR [menstrual regulation] and care for your family.”[33] This message, like others conveyed to Rohingya women in counseling settings, carries unvalidated assumptions regarding the beliefs, needs, and desires of clients without making a proper attempt to confirm the truth of those assumptions. Healthcare providers’ lack of cultural competence and limited understanding of Bangladesh’s national reproductive health policy complicates communication with Rohingya women. Additionally, the use of simple language, though recommended by the WHO’s guideline on Bangladesh’s policy, is inadequate to sufficiently convey the risks and benefits of menstrual regulation and other treatments to Rohingya women.[34] For informed consent to be achieved, “the patient must have the capacity to be able to understand and assess the information given, communicate their choices and understand the consequences of their decision.”[35] Healthcare providers must convey sufficient information regarding the risks, benefits, and alternatives of treatment as well as the risks and benefits of forgoing treatment.[36] Sexual and reproductive health policies and practices must aim to simultaneously mitigate paternalism, promote voluntary and informed choice among Rohingya women, and foster cultural and political competency among healthcare providers. Vll. Self-Determination Theory Self-determination theory is a psychological model that focuses on types of natural motivation and argues for the fulfillment of three conditions shown to enhance self-motivation and well-being: autonomy, competence, and relatedness.[37] According to the theory, autonomy is “the perception of being the origin of one’s own behavior and experiencing volition in action;” competence is “the feeling of being effective in producing desired outcomes and exercising one’s capacities;” and, relatedness is “the feeling of being respected, understood, and cared for by others.”[38] Bioethicists have applied self-determination theory to health care to align the promotion of patient autonomy with traditional goals of enhancing patient well-being. Studies on the satisfaction of these conditions in healthcare contexts indicate that their fulfillment promotes better health outcomes in patients.[39] Like principlism, self-determination theory in Cox’s Bazar could allow for increased autonomy while maximizing the well-being of Rohingya women and behaving with beneficence Fostering self-determination requires that healthcare professionals provide patients with the opportunity and means of voicing their goals and concerns, convey all relevant information regarding treatment, and mitigate external sources of control where possible.[40] In Cox’s Bazar, health care organizations in the region and the international community can act to ensure women seeking health care are respected and able to act independently. A patient-centered care model would provide guidelines for the refugee setting.[41] Providers can maximize autonomy by utilizing language services to give SRH patients the opportunity and means to voice their goals and concerns, disclose sufficient information about risks, benefits, and alternatives to each procedure, and give rationales for each potential decision rather than prescribe a decision. They can promote the feeling of competence among patients by expressly notifying them of the level of reversibility of each treatment, introducing measures for health improvement, and outlining patients’ progress in their SRH health. Finally, they can promote relatedness by providing active listening cues and adopting an empathetic, rather than condescending, stance.[42] Healthcare organizations ought to provide training to promote cultural competency and ensure that practitioners are well-versed on national regulations regarding sexual reproductive health care in Bangladesh to avoid the presumption of patients’ desires and the addition of unnecessary barriers to care. Increased treatment options would make autonomy more valuable as women would have more care choices. Given the historical deference to international organizations like the UN and World Bank, multilateral and organizational intervention would likely bolster the expansion of treatment options. International organizations and donors ought to work with the government of Bangladesh to offer post-treatment comprehensive care and protection of women who choose treatment against the wishes of male community members to avoid continued backlash and foster relatedness.[43] CONCLUSION Rohingya women in Cox’s Bazar, Bangladesh face unique power relations that ought to be acknowledged and addressed to ensure that when they seek health care, they are able to act autonomously and decide freely among available options. While providers have duties under the principles of beneficence and non-maleficence, patient well-being is hindered when these duties are used to trump the obligation to respect patient autonomy. Current approaches to achieving sexual and reproductive health risk the imposition of provider and communal control. Self-determination theory offers avenues for global organizations, Bangladesh, donors, and healthcare providers to protect Rohingya women’s autonomous choices, while maximizing their well-being and minimizing harm. DISCLAIMER: As a male educated and brought up in a Western setting, I acknowledge my limitations in judgement about Rohingya women’s reproductive care. Their vulnerability and health risks can never be completely understood. To some extent, those limitations informed my theoretical approach and evaluation of Rohingya women's SRH care. Self-determination theory places the patients’ experiences and judgement at the center of decision-making. 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