Changing the Face of Sexual Health Education

by Kelly Gluckman

How can we get college students to make healthier decisions in their sex lives? Can personal storytelling change attitudes and behaviors? How do we measure the influence of performance art? These are the questions I am addressing with my research. I contracted HIV seven years ago while in a committed relationship that I thought to be monogamous. Part of my coping process was to share with my friends what I was going through, and to my surprise, they would run to get tested after our conversation. I felt strongly that this was my call to become a sexual health educator and HIV/AIDS advocate, so I went public. I share my story with audiences through vulnerable personal narrative and poetry in a performance grounded in theater methodology. My goals are to diminish stigma, influence others to make healthy decisions in their sex lives, and empower people in breaking through the obstacles in their own lives. I’ve been public for five years, and since becoming a student at UCLA, I’ve fallen in love with academia. I want to put my performance to the test.

College students are notorious for risky sexual behavior. According to the CDC, 2015 had the highest number of diagnosed STIs in history, with 20-24 being the age group carrying the brunt.¹ HIV prevalence is showing no signs of improvement either. CDC surveillance reports show that new HIV diagnoses spiked 233% to ~7000 in 2010 and haven’t come down since.² So why is this? A 2010 study found that undergraduate students avoid getting tested either because they don’t think the risk is real for them, they fear the stigma associated with a positive test result, or they have inadequate knowledge of risk factors.³ Simply put, the sexual health education in this country is not working, and stigma is still a huge issue. Only twenty states require that if provided, sex and/or HIV education must be medically, factually or technically accurate, and state definitions of “medically accurate” vary.⁴ The majority of schools that do provide sex-ed to youth are using a fear based, loss and disease emphasizing model (think: graphic photos of severely symptomatic genitalia) that only serves to exacerbate stigma.

My proposed solution is to provide sex-positive, personal narrative driven, edutainment style sex-ed. Wellness- and benefit-emphasizing sex-ed has been linked with increases in STI testing and reductions in the prevalence of HIV, STIs and unintended pregnancies.⁵ An example of the effectiveness of this approach exists right on the UCLA campus. The UCLA Sex Squad is a group of undergrads who perform humorous and heartfelt sexual health theatre, inspired by the performers’ lived experiences, at LAUSD high schools. The performance is part of an initiative called AMP! (Arts-based Multiple-intervention Peer-education) and serves as a complement to the didactic lessons given by health teachers. Edutainment-style initiatives are unique in that they “purposely seek to explain, demonstrate, define, and/or compare consequences of different life choices”.⁶They present the issues in a complex way that mirrors real life. A pilot study was conducted to evaluate the efficacy of the AMP! program with ninth graders, and the result, through entrance and exit surveys, was significant and lasting positive changes in students’ attitudes towards condoms, testing, STIs, and HIV.⁷ I have been a member of the Sex Squad for three years and I’ve seen the effects first hand, so I use this approach in my performances as well.

Professor David Gere has given me the opportunity to perform for 250 students in his Arts & Architecture lecture course in winter quarter next year, and I will be designing my study around this event. My performance will begin with my personal story; a cautionary tale about the importance of using protection and getting tested. I touch on issues of intimate partner communication, overcoming obstacles, developing self-love, and identifying an unhealthy relationship and navigating through it. I also talk frankly about the fact that my boyfriend was sleeping with men and was scared to tell me for fear that I wouldn’t be attracted to him or love him anymore. I’m very careful to talk about this in a way that disseminates stigma towards men who have sex with men, instead of exacerbating it. To me, my ex-boyfriend’s struggle for self-acceptance is a symptom of a deeper societal issue. My story is not unique, and I believe that as a culture, we would be healthier if we stop repressing sexual expression that doesn’t fit within heteronormativity. After I tell my story, I will more formally explain what STIs and HIV are, how they are and are not contracted, how they are treated/managed, how to protect oneself from contracting them (referencing the fact that abstinence is the only real way to be 100% sure, recommending a healthy amount of masturbation, and performing an external and internal condom demonstration), followed by an overview of contraceptive options. I end my program with reciting two pieces of poetry and opening the floor for Q&A. Each part of my performance will be accompanied by a curated set of slides with photos, images, and charts to visually guide the audience through my story, illustrate my points, and educate.

To evaluate, I will create a series of three surveys: the first will be given a few minutes before I perform, the second, just after I get off stage, and the third, six weeks later. I will be following the lead of the pilot study conducted for AMP! and base my surveys off of the CDC’s Youth Risk Behavior Surveillance System, the World Health Organization’s knowledge, attitudes and practices survey instrument for adolescents, and the Towards a Healthy Tomorrow survey. These surveys are reliable and valid for adolescents⁸, so I intend to consult a public health professional on campus in order to adjust for age appropriateness. Like the AMP! study, my surveys will gather data about the students’ level and quality of knowledge about STI’s and HIV/AIDS, attitudes towards engaging in high-risk behaviors associated with transmission, attitudes towards seeking sexual health testing and counseling, and attitudes towards people living with HIV. I will also ask about individual behaviors related to sexuality, sexual practice, sexual and reproductive health, and risk behaviors associated with acquiring HIV (8). An analysis of the surveys will reveal how attitudes changed and if the change is sustained over time. In exploring other ways to measure results, I intend to advertise the Ashe Center on stage as the best and most convenient place to get tested. My idea is to give students a simple phrase to say at the front desk, and ask the Ashe Center to track how many students come in and cite that phrase in the ten weeks following my performance. Ideally, I would also like to have focus groups with students, although I cannot be the one to conduct those. My presence, having been the performer, might influence answers, so element of the project is still tentative.

Fall quarter and winter break will be devoted to working with my Professor Gere, who is one of the founders of the AMP! program, in further developing my slides and didactic presentation, working with a collaborator to design my surveys, working with the Ashe Center to help fine tune my evaluation methods, and earning IRB approval. The first two surveys and my performance will occur within the first four weeks of winter so that the final survey can be administered in class before the quarter ends, with a possibility of recorded focus groups in between. Spring quarter will be devoted to data analysis and writing my report.

This past February 22, 2017, I performed for Professor Gere’s 250 student lecture course, the same course where I will be conducting my research study next year. After my performance, the students wrote reflections, in which they were asked to give a word of praise, write a question my performance left in their mind, and give a piece of constructive critique. Professor Gere then sent me the students’ papers, and after reading these responses, I have a good idea of what to expect as far as results for my study. Overwhelmingly, students said that they resonated with my vulnerability, were entertained by my humor, and felt inspired, motivated, and encouraged by my story. Many had questions about HIV itself and about my life, and I received some stage direction. There was little structure to the reflection prompt, so I was excited to see that 20 students said they wanted to get tested, 8 said they were more likely to use condoms, and 47 said that they learned something or that their views of HIV have changed. These results are an exciting precedent, and I hope to be able to publish my findings from this more academic approach, and to continue my research into graduate school by earning my Masters of Public Health. Looking to the future, my ultimate goal is to train others to speak, build an agency, and gather concrete, convincing data along the way that I will use for influencing policy on sex-ed in the US. I want to change the face of sexual health education in this country and create a more compassionate world in the process.

Kelly Gluckman is majoring in World Arts and Cultures at UCLA. After becoming HIV positive, she became a sexual health educator and HIV/AIDS advocate. She tells her story in order to eradicate stigma and prevent others from contracting the virus. She has been featured in a national ad campaign by the Centers for Disease Control and Prevention, a documentary special on MTV, written for online publications, spoken at colleges and high schools, volunteered for AIDS service organizations, advocated for the rights of people living with HIV on Capitol Hill, and is an ambassador for the Elizabeth Taylor AIDS Foundation. She plans to pursue a Masters degree at the UCLA Fielding School of Public Health. Kelly was the recipient of CSW’s Constance Coiner Undergraduate Prize in 2017.

Footnotes

1. “STDs in Adolescents and Young Adults.” Centers for Disease Control and Prevention, 18 Oct. 2016. Web. 19 Mar. 2017; and “2015 STD Surveillance Report Press Release.” Centers for Disease Control and Prevention, 19 Oct. 2016. Web. 19 Mar. 2017.
2. “HIV Surveillance Report, 2015.” Centers for Disease Control and Prevention, November 2016. Web. Accessed 19 Mar. 2017.
3. Karen R. Barth, Robert L. Cook et al. Social Stigma and Negative Consequences: Factors That Influence College Students’ Decisions to Seek Testing for Sexually Transmitted Infections, Journal of American College Health, 50:4 (2002), 153-159.
4. Kate Blackman, Samantha Scotti, and Emily Heller. “State Policies on Sex Education in Schools.” National Conference of State Legislatures, 21 Dec. 2016. Web. 19 Mar. 2017
5. Jessie V. Ford, Rheta Barnes, Anne Rompalo, and Edward W. Hook. “Sexual Health Training and Education in the U.S.” Public Health Reports. Association of Schools of Public Health, Mar.-Apr. 2013. Web. 19 Mar. 2017.
6. Deborah Glik, Glen Nowak, Thomas Valente, Karena Sapsis, and Chad Martin. “Youth Performing Arts Entertainment-Education for HIV/AIDS Prevention and Health Promotion: Practice and Research.” Journal of Health Communication 7:1 (2002): 39-57.
7. A. F. Lightfoot, A. Taboada, T. Taggart, T. Tran, and A. Burtaine. “I Learned to Be Okay with Talking about Sex and Safety’: Assessing the Efficacy of a Theatre-based HIV Prevention Approach for Adolescents in North Carolina.” Sex Education 15:4 (2015): 348–363.
8. Ibid.