Comprehensive Sexuality Education


I. Definition of the Prevention Area

Young people in many countries have unprotected sexual intercourse with one or more partners, potentially exposing themselves to HIV, other sexually transmitted infections (STIs), or unintentional pregnancy. Comprehensive sexuality education (CSE) programs work to delay initiation of sex, reduce the number of sexual partners, and increase the use of condoms and other forms of contraception. Some programs also seek to increase testing and treatment for HIV and other STIs. They can be implemented both in schools and in other community settings.

II. Epidemiological Justification for the Prevention Area

The global HIV epidemic cannot be reversed without sustained success in reducing new infections. The proportion of new HIV infections attributed to young people varies greatly across countries and by type of epidemic. A recent United Nations Children's Fund report estimates that young people aged 15 to 24 accounted for 41 percent of all new HIV infections in adults in 2009. This represents an estimated 5 million young people. In sub-Saharan Africa, nearly 3.3 million youth are living with HIV. Globally, young women make up more than 60 percent of all young people living with HIV; in sub-Saharan Africa, their share jumps to 72 percent.

Young people can reduce their chances of contracting HIV if they reduce their sexual risk by, for example, delaying sex, reducing the number of partners they have, avoiding sex with older partners and with people having concurrent partners, increasing condom use, and, for uncircumcised men, undergoing voluntary medical circumcision. There is strong evidence that CSE programs with certain core programmatic components can reduce sexual risk by changing some of these behaviors. When these programs are implemented in schools, they can reach very large numbers of young people before and after they begin having sex. They can also reach out-of-school youth in clinics, other youth-serving organizations, and communities more generally.

III. Core Programmatic Components

Some CSE programs have reduced sexual risk-taking, while others have not. Effective programs incorporate 24 core characteristics in their development and implementation. For example, they involve experts in behavior change theory and research, involve young people in the design of the program, use a clear logic model, focus on specific behavioral goals and specific cognitive factors that affect those behaviors (e.g., knowledge, perception of risk, values, attitudes, peer norms, skills, intentions), employ multiple participatory activities that address those cognitive factors, give clear messages about behavior, implement at least 12 sessions (if in schools), and provide training to educators.

IV. Current Status of Implementation Experience

Close to 100 studies have examined the impact of CSE programs around the world. These studies include strong quasi-experimental or experimental designs. Their results support several conclusions about the impact of CSE programs:

If implemented on a large scale, effective CSE programs represent a cost-effective method of changing behavior and thus can serve as an important component within comprehensive initiatives to reduce HIV, other STIs, and unintended pregnancy.

What we know

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Putting it into practice

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Tools and Curricula

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Learn more

Children and AIDS: Fifth Stocktaking Report

United Nations Children's Fund, Joint United Nations Programme on HIV/AIDS, World Health Organization, United Nations Population Fund, & United Nations Educational, Scientific and Cultural Organization. (2010).

This report covers the whole span of HIV and childhood from prevention of mother-to-child transmission, pediatric care and treatment, and HIV prevention among adolescents and young people, as well as protection, care, and support for children affected by HIV and AIDS. The chapter on adolescents describes the progress made on prevention of new HIV infections, discusses the barriers to HIV prevention among this age group, and what factors have made prevention strategies successful.

pdf View Report outside link (PDF, 2.1 MB)

UNAIDS Report on the Global AIDS Epidemic 2010

Joint United Nations Programme on HIV/AIDS. (2010).

This report provides an update of the state of the HIV epidemic, including data and commentary on HIV and young people. It has chapters on HIV prevention and treatment, as well as human rights and gender, and investment in HIV. There are country-specific progress indicators and estimates of HIV and AIDS for 2001 and 2009. It is rich in tables, maps, and illustrations, making it easy to read and use.

pdf View Report outside link (PDF, 4.3 MB)

School Connectedness

U.S. Centers for Disease Control and Prevention. (2009).

This webpage on school connectedness, defined as students' belief that their teachers and peers care about their learning and about them as individuals, has numerous useful links. There is a downloadable pdf strategy guide (PDF, 1.7 MB) on fostering school connectedness, fact sheets, and a staff development program. The pdf facilitator's guide (PDF, 1.1 MB) for the staff program is also available for download, and there are two PowerPoint presentations, one giving an overview of school connectedness and another on action planning for school connectedness.

View Centers for Disease Control and Prevention Website outside link

What Works Best in Sex/HIV Education?

Center for AIDS Prevention Studies, University of California, San Francisco. (2006).

This two-page document lays out the case for sex education, argues that it works, and that effective programs are replicable. It highlights studies of curricula found to bring about significant behavior change and describes the main features of effective curricula. It calls on policymakers to fund and support the implementation of sex and HIV education programs, particularly among subgroups known to be at higher risk of HIV, sexually transmitted infections, and unplanned pregnancy.

pdf View Report outside link (PDF, 73 KB)