Sex Education Outside US Cities More Apt to Lack Facts About HIV

By Lisa Rapaport

January 13, 2021

(Reuters Health) - American youth are less likely to receive sexual health education with comprehensive information about HIV/AIDS when they live outside metropolitan areas, a U.S. study suggests.

Researchers examined data from the 2015-2017 National Survey of Family Growth on formal sexual health education and HIV/AIDS testing received by 3,114 youth aged 15 to 24 years. The analysis included 2,668 youth living in metropolitan areas and 446 young people residing in nonmetropolitan areas.

Overall, the majority of participants (85.3%) said they received formal sexual health education on HIV/AIDS, the study found. However, less than half (46.9%) reported receiving HIV testing.

Young people residing in nonmetropolitan areas were less likely to receive sexual health education on HIV/AIDs than their counterparts in urban areas (odds ratio 0.47), but HIV testing rates were similar for both groups, the researchers report in the Journal of Adolescent Health.

"We hypothesize that the disparity here relates to a difference in resources in non-metropolitan areas and perhaps differences in standards of sexual health education," said lead study author Dr. Ashley Ebersole of Nationwide Children's Hospital in Columbus, Ohio.

The results also suggest that even in urban communities, many providers aren't offering HIV screening tests for all patients age 15 years and older, as recommended by the U.S. Preventive Services Task Force, Dr. Ebersole said by email.

"This highlights the need for improvements in HIV testing everywhere," Dr. Ebersole said.

The study looked broadly at sex education, including any formal instruction in schools as well as at church, a community center, or some other place.

Most of the youth in both metropolitan (63.4%) and nonmetropolitan (61.7%) had a history of sexual intercourse. Youth with a history of sexual intercourse were much more likely to get HIV testing (OR 4.06) than those who didn't report any sexual history.

Compared to white individuals, Black young people were more likely get HIV tests (OR 1.51), but there was no significant difference in receipt of sex education on HIV/AIDS.

Those with insurance coverage were more likely to receive sexual health education (OR 1.59) but insurance status didn't appear to impact HIV testing.

One limitation of the study is that outcomes are self-reported and subject to recall bias or misreporting, the study team notes. Researchers also lacked data on any potential barrier to HIV testing or detailed information on the true comprehensiveness of any sexual health education young people in the study may have received.

Sexual education curriculum is largely determined by local school districts and at the state level, and varies widely by state, said Dr. Geoffrey Hart-Cooper, pediatrician and medical director of the Virtual PrEP Program for Adolescents and Young Adults at Stanford University in California.

HIV testing, however, happens at the clinic level and is exempt from such educational policies and regulations, Dr. Hart-Cooper, who wasn't involved in the study, said by email.

The study results underscore that it's essential for clinicians to discuss sexual health in general, and HIV prevention and screening in particular, with all patients, Dr. Hart-Cooper said. These conversations should be open-ended, because even in a state or city where sex education is thorough in public schools there may still be patients who didn't receive this education or didn't attend public school.

"We need to ask what each patient knows about sexual health, and remember that this will depend on state/local sexual health regulations, what school they attend, and whether they participated in any formal sexual health education," Dr. Hart-Cooper said. "And, most importantly, we need to increase HIV testing for adolescents and young adults."

SOURCE: Journal of Adolescent Health, online December 5, 2020.