HIV, Sexual & Reproductive Health Position Statements

ETR was established in 1981 as a training organization for teachers implementing sexuality education in California. Since then, our work in the area of HIV/AIDS and sexual and reproductive health has expanded to include research, program development and evaluation, organizational and individual capacity building, and dissemination on a national scale.

ETR's Sexual and Reproductive Health Charter—an internal, multidisciplinary team—adopted five focal areas that aim to promote the sexual health and well-being of communities and youth and to reduce disparities in HIV/AIDS, unintended pregnancy and sexually transmitted infection (STI). ETR’s position statements describe our agency values and beliefs in the area of sexual and reproductive health, organized around these five focal areas that align with our Health Equity Framework.

Community & School Context | Relationships & Connectedness | Education, Treatment & Prevention |
Developmental Neuroscience | Implementation Science

 

Community and School Context

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ETR believes that everyone deserves to live in a community that is economically, socially and physically healthy, where individuals and families have access to quality, affordable sexual and reproductive health care and education across the lifespan.

Community and School Context is concerned with how place—where a person lives, works and/or goes to school—influences sexual and reproductive health. We know that educational and employment opportunities, access to health and social services, and local policies shape the choices people make about their health and relationships. For example:

• Opportunities to finish high school and go to college improve the health of individuals and the future health and well-being of their children and families.^[1],[2]
• When people have better access to sexual and reproductive health care, there are fewer unintended and teen pregnancies.^[3]
• The presence of caring and trusting relationships and opportunities for meaningful engagement in the school and community are known to influence sexual behavior choices and outcomes.^{[4], [5]} These factors also impact other outcomes, such as substance use, mental health and academic achievement.^{[6], [7], [8]}

 

Relationships & Connectedness

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ETR believes that creating positive and safe relationships is essential to improving health outcomes. Sexual and reproductive health programs should address consent and communication within partnerships, and cultivate child/youth connectedness with parents and other trusted adults.

Relationships & Connectedness focuses on how relationships with partners, peers and parents—healthy or unhealthy—impact sexual and reproductive outcomes. Sexual behavior most often occurs within the context of a relationship and is influenced by connectedness to families and peers. For example:

• Relationship patterns learned in adolescence can impact future relationships.^[9] Individuals bring forth a history of sexual and relationship experiences that can impact successive relationships, ^[10] highlighting the importance of addressing unhealthy patterns and promoting healthy ones early on. 
• Dating violence or intimate partner violence victimization is associated with increased risk for low self-esteem. ^[11] Young people who experience victimization are more likely to report poor emotional well-being, suicidal thoughts and attempts, risky sexual behaviors, pregnancy, cigarette smoking and disordered eating.^[12],[13] Teaching strategies that promote healthy relationships during adolescence are key to preventing dating violence patterns that can carry into adulthood.
• While peers are important, young people say their parents most influence their decisions about sex.^[14] Connectedness between parents/caregivers and young people is protective of a range of risk behaviors.^[15]

 

Education, Treatment & Prevention

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ETR believes that education, treatment and prevention strategies should be inclusive of all communities, including “invisible” populations, such as LGBT, homeless and system-involved youth. Health education and services should be designed and implemented with the acknowledgment of the social and structural factors that create inequities in our workplaces, health and school systems.

Education, Treatment & Prevention concerns the direct role of health education and services in modifying knowledge, attitudes, skills and behaviors related to preventing unintended and teen pregnancy, STIs and HIV/AIDS. Communities, families and individuals, including young people, are healthier when they have accurate information about their sexual health and rights, and have access to reliable and inclusive services. For example:

• Evidence shows that prevention programs are effective at reducing sexual risk behaviors among youth.^{[16], [17]}
• Education plays a critical role in reducing the incidence of HIV, as well as advancing linkage to and retention in care. [18]
• Major reductions in unintended pregnancy are possible when health services are affordable, universally available and accessible.^{[19], [20]}
• Positive behaviors and outcomes are more likely to be sustained if health education and services address social and structural factors affecting sexual decision making.^{[1], [21]}

 

Developmental Neuroscience

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ETR believes that using developmental neuroscience literature provides an opportunity to strengthen sexual and reproductive health programs and practices, leading to greater impact and reduced disparities. ETR frames its study of neuroscience and sexual health in the context of how environmental factors—such as trauma—influence decision making and behaviors.

Developmental Neuroscience relates to how brain development and functioning influence decision making and behavior, specifically in adolescents. Due to the complexity in sexual decision making for adolescents and young people, the sexual and reproductive health field can learn from this emerging area of research. For example:

• Adolescence is a time of increased neuroplasticity, meaning that there is potential for the brain to change and adapt based on experience. This makes adolescence a critical period for helping young people develop important life skills and healthy behaviors.^[22]
• Developmental changes in social and emotional brain structures are associated with increased risk taking from childhood to adolescence.^{[23], [24]}
• Risk taking declines from adolescence to adulthood with the maturation of cognitive control systems in the brain that help to regulate impulsive behavior.^{[23], [24]}
• Experiences of chronic stress or trauma can inhibit the growth of brain structures that are important for self-regulation and decision making.^[25]
• There is a need to create social contexts that provide the appropriate support to adolescents in order to develop their skills of self-control.^[26]

 

Implementation Science

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ETR believes that empowering people to use programs in their community is critical for increasing the scale, sustainability and impact of programs. As the only organization in the sexual health field who develops, trains on, evaluates and disseminates interventions to scale, we aim to bridge the gap between research environments and the context of practice.

Implementation Science concerns not just what outcomes are achieved by an intervention but how interventions achieved that change. Numerous program evaluations have reported changes in sexual risk behaviors, unintended pregnancy, STIs, and HIV/AIDS. Implementation research allows us to identify the components, messages and factors that are most effective in modifying attitudes, skills and behaviors that lead to positive health outcomes. Through implementation science, we can also examine the influence of other factors in program implementation, such as facilitator characteristics, training and support, implementation schedules, and organizational readiness.

• Fidelity to core components is fundamental for outcomes, and adaptations are both a practical reality and important factor for increasing contextual fit and acceptance.^[27]
• Organizational readiness, facilitator training and implementation support are critical for achieving behavior and health outcomes.^{[27], [28], [29]}
• Evaluation and the development of more sensitive measures contribute to the understanding of when, how and in what context interventions are effective, accepted and cost efficient. Ongoing efficacy, effectiveness, process and replication evaluations are essential to this body of knowledge.^[31]

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Notes