Issues Magazine

Who Needs Sex Ed When We Have the Internet?

By Alisa Pedrana

Educators, parents and health promoters must educate young people about sexual health in an engaging and realistic format, rather than leaving them to their own devices.

Youth is a formative stage when individuals mature physically, mentally, socially and intellectually. We need to support and educate them during these changes, not least in sexual health (see box below).

Young people represent a stage in life (usually defined as 16–29 years) that includes both adolescence (teenage years) and young adulthood. Individuals mature, developing a sense of self and identity. Young people learn through self-exploration and they establish social norms and patterns of behaviours that often last throughout adulthood.

Sexual experiences give young people opportunities to build notions of respect, understanding and intimacy towards others and practice building and maintaining relationships. If cognitive, emotional or social skills lag around this time, or if individuals are greatly influenced by negative experiences, unhealthy behaviours and adverse outcomes can result.

It is particularly important that youth begin to understand their own decision-making process and develop their ability to perceive their own risks and take action to minimise potential harm and reduce the chance of negative outcomes.

High-Risk Behaviours

Youth is also a time of risk-taking, usually accompanied by a failure to consider the future consequences of one’s behaviour. Consequently, young people frequently engage in high-risk sexual behaviour.

Having multiple sexual partners is an important part of exploring one’s sexuality and building relationships yet it can result in negative outcomes or unintended consequences, including contracting a sexually transmitted infection (STI) or becoming pregnant. An annual survey of 16–29-year-olds conducted by the Burnet Institute at Melbourne’s Big Day Out festival found that in 2013 around 50% of participants each year reported not always using condoms with casual partners, 19% had had more than 10 partners in their lifetime of which 42% had more than one sexual partner in the past year. Of those who were sexually active, 35% were at risk of an STI because they didn’t always use a condom with new or casual partner(s) or had multiple partners and didn’t always use a condom; 5% of females reported ever having an unplanned pregnancy and only 38% had ever had an STI test.

Similarly, the National Survey of Secondary Students and Sexual Health (2008), conducted by the Australian Research Centre in Sex, Health and Society, found that 48% of those that were sexually active had not always used condoms within the past 12 months. This study also revealed that 38% of young women and 19% of young men reported having unwanted sex, and that this number had increased significantly among woman between the 2002 (28%) and 2008 (38%) surveys. Students cited being too drunk (17%) or pressure from their partner (18%) as the most common reasons for having sex when they did not want to. While the majority of students reported positive feelings after having sex, for young women there is some evidence of a decline in more positive feelings between 2002 and 2008.

These behaviours are of particular concern when considered in conjunction with the increasing rates of STIs and low rate of STI testing among youth. National surveillance data published by the Kirby Institute indicates that young people (15–29 years) are the most affected population in Australia for STIs other than HIV, such a chlamydia and gonorrhoea, and these rates have been rapidly increasing over the past five years. Research has also identified sexual health as one of the issues that young Australians identify as being of most concern to them.

Reaching Young People with Health Promotion Messages

Traditionally, sexual health promotion for young people has been delivered through institution‐based sex education programs, peer education and mass media campaigns. While these approaches have demonstrated utility for sexual health promotion, they are generally resource‐intensive and evidence of their effectiveness to date is mixed.

For example, only 29% of young people surveyed about the National Sexually Transmitted Infection Prevention Programs sexual health campaign – entitled “STIs are spreading fast” – recalled the campaign when shown advertisements, despite a campaign budget of over $9.8 million. The campaign had targeted Australians aged 15–29 years, and was featured nationally in magazines, radio, online, on outdoor advertising such as billboards and public transport, and in community venues.

These approaches may be less effective in reaching young people, who are now spending less time watching and listening to “traditional” media and more time on the internet. A national online survey of more than1200 young people from across all Australian states and territories, conducted by Australian Youth Affairs Coalition and Youth Empowerment Against HIV/AIDS (YEAH), reported that young people obtain or look for sexual heath information on sexual health most commonly from the internet (85%), friends (76%), magazines (72%), school (69%), TV/movies (67%), a parent/guardian (65%), sexual health clinics/community health services (65%) and pornography (64%). It is clear that young people access sexual health information from a variety of sources, and in planned and unplanned ways.

The challenge for health promoters and educators is keeping up with this changing trend of how young people access information and ensuring that wherever young people are looking for information and answers, we are providing it. Innovative methods of sexual health promotion are needed to reach and actively engage young people in conversations about sexual health.

The ICT Revolution: What Are the Consequences for Youth?

In recent years the evolution of Web 2.0 applications, such as social networking sites, blogs and wikis, has seen a shift from one-way static content delivery to two-way interactive content. Mobile devices allow us to access the internet from almost anywhere in the world, at anytime. In Australia, data from the International Telecommunication Union and the Australian Bureau of Statistics shows that internet access has grown by 158% from 2000 to 2010, and that 83–88% of the population access the internet. Young people are typically early adopters and the greatest users of new technologies. Research from the Pew Research Centre in the US indicates that internet use is near-ubiquitous among teens and young adults.

Data presented at the 2013 Australasian Sexual Health Conference suggested that access to new technologies is giving young people information about sex and exposing them to sexualised content at a younger age than previous generations. Young people are increasingly turning to the internet for sex education and are being met with pornography and other problematic sources of information about sex. While the effects of such exposure are already being seen in various forms, including the rise of “sexting” and the growing popularity of “hook-up” sites such as Grindr and Tindr, the longer-term impacts on young people’s sexual health or sexual well‐being are still unknown.

However, research projects are currently being conducted by the Australian Institute of Family Studies and the Ian Potter Foundation to explore the impact that the normalisation of pornography, especially violence towards women, has on shaping young people’s perceptions of sex and relationships. Data suggest that more than 90% of pornographic scenes contain aggression, of which females are the main target of aggression in 94% of scenes. The documentary Love and Sex in an Age of Pornography, recently screened on SBS 1 and 2, explores these issues through interviews with young Australians and porn industry representatives, including Larry Flynt.

Innovative and Engaging Health Promotion Interventions

We should be embracing the internet and related technologies, taking advantage of their utility, functionality and popularity to reach more young people with health promotion messages.

Effective communication is vital to engaging young people – regardless of their sexuality – in sexual health promotion. Ideally, health promotion should be conducted in a location where young people are already engaged. Mobile phone text messages (SMS), mobile internet and social networking could be exploited for health promotion purposes. They can reach large numbers of young people and, given the time young people spend on them, could play an important role in sexual health education. Their importance as a health promotion and education tool is increasingly being recognised in the published literature – they present an exciting opportunity to engage with audiences in a way not possible with many traditional approaches to health promotion.

Over the past six years, the Centre for the Population Health at the Burnet Institute has explored the use of communication technologies – primarily SMS and social networking sites – to deliver sexual health promotion to young people and other key at-risk groups. We have conducted three key projects examining the use of SMS to deliver sexual health promotion to young people, where we have strived to develop messages that are entertaining yet informative (e.g. “Roses are red, daisies are white, use a condom if you get lucky tonight. Happy Valentines Day! Love the Burnet Institute”). These studies showed significant improvements in sexual health knowledge and increases in health-seeking behaviours among message recipients, and we have begun adapting such models overseas.

In 2009 and 2010 we developed and delivered two interventions using social networking sites – The FaceSpace Project, targeting young people, and Queer As F**k (now known as Being Brendo), targeting gay men. Both interventions used fictional characters to deliver health promotion messages in online videos (webisodes) on Facebook and YouTube. These interventions successfully delivered more than 70 webisodes on Facebook and YouTube, and have attracted more than 7000 fans from 15 countries, accumulating over 450,000 post views and 90,000 video views.

During its peak, Queer as F**k reached almost 5000 people each week, with around 200 unique users engaging online on a weekly basis. Evaluation findings suggested that this project was successful at delivering health promotion messages to the target audience in an information and engaging manner:

Such an amazing web series! Helped me come to terms with my own sexuality, so this is a thank-you!

I have absolutely loved this series and as a gay man with HIV, I think it has showed everyone what we go through and what we all need to think about. Most of all it reminds me that we ALL need to love each other no matter who we are!

The innovative work of these projects resulted in one of the largest and most successful examples internationally of how to exploit the reach and engagement potential of social networking, and provided a model for delivering and evaluating health promotion interventions on social networking.

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