ABSTRACT
The United States has undergone a dramatic shift in the legal recognition of same-sex marriage, yet the majority of school sex education programs continue to focus almost exclusively on heterosexual relationships and marriage. These programs do not portray same-sex couples in vignettes and hypothetical dilemmas or discuss variations in sexual orientation and gender identity. While health disparities among sexual minority youth are well documented, policymakers continue to promote school sex education programs that are not inclusive or responsive to their needs. This article begins with a brief discussion of health disparities among sexual minority youth followed by an overview of sex education programs and policies in the United States. It then examines the effects of non-inclusive sex education programs and concludes with recommendations for policymakers to ensure that sexual minority youth receive relevant and complete sexual health information.
INTRODUCTION
In 2013, the Supreme Court ruled Section 3 of the Defense of Marriage Act (DOMA) unconstitutional, requiring the federal government to recognize same-sex marriages performed legally in the states. Since that time, the number of states recognizing same-sex marriages has increased dramatically, with over one-third of the U.S. population now living in a state that either has marriage equality or honors out-of-state marriages of same-sex couples. Additionally, according to a 2014 Washington Post-ABC News poll, 59 percent of Americans now support allowing gays and lesbians to marry legally. Despite the increasing acceptance of same-sex marriage, however, the majority of school sex education programs in the U.S. continue to focus exclusively on heterosexual relationships and marriage. These programs do not include same-sex couples in vignettes and hypothetical dilemmas or use language that would be inclusive of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. The relative absence of inclusive school sex education programs in the U.S. suggests that recent advancements for same-sex couples have done little to benefit those most in need – sexual minority youth.
HEALTH DISPARTIES AMONG SEXUAL MINORITY YOUTH
Sexual minority youth are in urgent need of relevant and complete sexual health information. When compared to their exclusively heterosexual peers, sexual minority youth experience significant health disparities including higher rates of unintended pregnancy and sexually transmitted infections (STIs). Gay, bisexual, and other young men who have sex with men, for example, are among the populations most at risk for human immunodeficiency virus (HIV). In 2011, approximately 93 percent of all diagnosed HIV infections among young men aged thirteen to nineteen were contracted through male-to-male sexual contact. Elevated risk for HIV among gay and bisexual young men has been attributed to multiple factors including higher rates of substance use, poor mental health, and ineffective prevention programs.
Similar health disparities have been documented among transgender youth. Many transgender youth experience family rejection and receive little social support, leading some to engage in substance use and risky sexual behaviors as a way to cope with these challenges. Transgender youth are at extreme risk of acquiring HIV and recent studies have found that they have limited knowledge regarding HIV transmission.
Although HIV is less common among lesbian and bisexual young women, they experience their own unique challenges. A recent study found that when compared with their exclusively heterosexual peers, sexual minority young women are less likely to use contraception and they are at significantly increased risk for unintended pregnancy. The reasons for these disparities are unclear, although the authors note that “factors associated with teen pregnancy in the general population such as earlier sexual initiation, more sexual partners, and ineffective contraception are more common in sexual minorities.” Some researchers suggest that lesbian and bisexual young women may engage in risky sexual behaviors because of homelessness, as a way to cope with stigma about their sexual orientation, or because they lack adequate sexual health information.
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