The ABC Approach—Is It Working in Uganda and What Can Others Learn from It?

By Jennifer, Youth Activist and former Advocates for Youth Board Member

Speech Delivered at The Call to Action on Sexual Health: Science and Belief Seeking Common Ground, a national conference at the Omni ShoreHam Hotel in Washington, DC on May 25th, 2004

Before I start, I would like to thank Doctor David Satcher for having me here. His dedication to the health of all Americans is inspiring. I would also like to thank you all for attending. This is clearly a very important topic in our society and it affects all of us. I would also like to extend gratitude to my fellow panelists. Regardless of our differences (and, believe me, they do exist), I am certain that we have both come here with one goal: to improve the health of Americans.

I offer a different position: my presentation does not involve charts, data, or any substantive statistical information. While I value formal research, my presentation is founded upon my direct experiences with youth from across the United States. The information I offer you today comes directly from the voices of the young people that are personally affected by these issues. Our voices are equally as important, if not more so, than any data that is presented here today.

My experience in sexual health comes from the peer education groups I have been involved with for the past three years. I have worked with women of color in low-income communities in Chicago—women whose misconceptions about the efficacy of contraceptive methods often lead to unintended pregnancy. Online, I have worked with gay, lesbian, bisexual, and transgender (GLBT) youth from across the country—youth who feel alienated and are afraid to talk to adults about sex and who put themselves at great health risk because of it. And for the past year, I have worked with youth activists from all over the nation who are tired of the lack of substantial and credible information about sexual health in school curricula.

I think it is important to establish the difference between children and young people. What may sound like semantics is actually an important distinction, since sexual health policy aimed towards "children" oftentimes overlooks that these "children" quickly become autonomous adults. Young people easily recognize, and just as easily dismiss, paternalistic, condescending approaches. Young people need to feel that they are respected as thinking, competent human beings, primarily because, and Read My Lips: YOUNG PEOPLE ARE CAPABLE OF MAKING EDUCATED DECISIONS ABOUT THEIR SEXUAL HEALTH OF THEIR OWN VOLITION. However, this comes at a price—educated decisions cannot be made on the basis of false information. Accurate, honest facts are necessary, by definition, for responsible, educated decision-making.

It's hardly surprising that America's current scare tactic approaches aren't working. Young people are not stupid. Believe me, I know. They also don't appreciate being manipulated, which in fact they are, when the information they are given is itself manipulated. And most importantly, if people, young or old, feel that they are being manipulated, they lose the ability to trust. This we all know! If we can't trust an information source and, by extension, the information itself, then we're likely to disregard both. By scare tactics, I mean the misinformation incorporated into many sex education curricula—misinformation that is meant to cause paralyzing fear, enforcing abstinence. A girl living in a low-income community area on the south side of Chicago told me that her sex education teacher in her public school told her condoms had holes in them. So we tell young people that condoms have holes in them! This is a gross exaggeration whose effects are far-reaching and unilaterally damaging. What is the purpose of providing this false information? Do we want sexually active youth not to use condoms? I don't think so.

My observations of these realities, both through my experiences working with young people, and, lets face it, I'm not too old myself, have made it very clear to me that it is vitally important that the decisions that we make rest on comprehensive and personal understanding of the complexities of sexual health. In an environment saturated with sex, youth today are bombarded with mixed messages—we are to be sexy and cool, and at the same time healthy and abstinent. A parent's reasoning for sexual abstinence, founded on "because I said so," will not work and isn't likely to suffice when hundreds of other contradictory messages come from multiple sources. I am not saying "lets burn our TVs" or "let's throw condoms from helicopters." What I am saying is, let's support our young people by arming them in a culture that is not always looking out for their benefit or safety. Their best weapon—information. The saying is, "knowledge is power" and though it's trite, it's true. Accurate, comprehensive information empowers by enabling rational decision making. Nobody, especially teenagers, likes to be told what to do. Slogans like "just say no," whether they address drugs or sex, do little to prepare us for real life situations and emotions, which are far more nuanced and complicated than is assumed. These one-dimensional approaches attempt to homogenize an experience that is complex at all stages of life. Youth can arrive at healthy decisions of their own accord, if they are given a broad range of information and are given the opportunity to apply it to their individual situations. While it is easy to see youth as one large group, let us remember that the group is made up of individuals with individual situations and characters. In addition, these types of decisions, the ones derived from personal reasoning based on a sound understanding of the situation, are not only smarter and healthier but are more likely to withstand the powerful pressures that most adolescents face.

So what kind of decisions will these empowered young people make? You'd be surprised that many will choose abstinence. There are many reasons to remain abstinent, reasons that have nothing to do with sexually transmitted infections or unwanted pregnancy. Yet making such a decision occurs best in a non-threatening environment. I have had many young people I work with come up to me and say, "You know what, sex is a really complicated thing and I am not ready for it right now."

The goal is not to impose a particular lifestyle on a young person. The goal is to empower young people to make healthy decisions of their own accord, not only in the classroom but also in the realities of life. While some young people will decide to abstain from all types of sex, most will not. AND THERE IS NOTHING WRONG WITH THIS. Young people, just like all other people, are sexual beings. I understand that this may a hard concept to be comfortable with. It is difficult. Yet it is essential that our parents, guardians, teachers, doctors and everyone else who cares about our development realize that we are human. And as humans, we are sexual. Adult discomfort with this fact is dangerous—it leads to willful ignorance—ignorance such as thinking that telling a girl that condoms have holes in them will make her never have sex before marriage. It is possible. But it's also possible that she will engage in some type of sexual activity before marriage, and isn't it better for everyone to be honest and realistic—so that real, communication can take place. And she can make responsible decisions.

It is the responsibility of the positive adult role models who are involved in youth's development to feel comfortable with sexuality as normal. Sex does not have to be a problem-oriented subject; there are many aspects of sex and sexuality that have little to do with HIV/AIDS, teen pregnancy, or sexually transmitted infections. SEX IS GOOD! Discussing sex only in the context of danger is psychologically damaging, since we are all sexual beings. Should we always be afraid and feel guilty when we think and talk about sex? No. We should be well informed and, therefore, confident of our decisions. I understand the level of discomfort that is inherent in these conversations, discomfort that reflects a certain shame or embarrassment that our society has around sex; however, it is time to get over it. I have found over and over again that, the more comfortable I am talking about a particular subject, the more comfortable the young people I am talking to become.

We all need to communicate. All of this, all the attempts to create healthy individuals that are educated about their bodies and their options, can only be done in partnerships between young people and the caring adults in their community. WE CANNOT DO IT WITH OUT YOUR HELP. This past winter, I accompanied 15 adolescent girls to a family health clinic. We were there to explore facilities and experiences that accompany such a visit. The doctors and nurses were very accommodating to the girls' questions and concerns about sexual health. The health practitioners spoke candidly about the issues and their non-patronizing tone encouraged discussion. I was astonished by the girls' responses. I could tell that they had never before encountered an adult who spoke frankly about sex in a way that did not scare the girls or threaten them. Most of the young girls I work with are told outright, either by family or teachers, not to have sex. This is the extent, I'd say, of the conversation. While the intentions may be in the right place, this is not effective in reaching young people.

Adults, as authority figures, have a great advantage in having their voices heard by young people. But often this advantage is not realized because either the adults avoid their responsibilities to young people, or they refuse to respect youth's rights as human beings. The nurses and doctors had a degree of influence over the girls that I could not come close to. They did not judge, because that is not what they were there to do. Decisions that concern a person's body are personal. As a peer educator, I can only do so much. I can provide a space for discussion and interaction. But young people also respond to adult role models who respect them and their intelligence.

So, you may ask, aside from attitudinal changes to promote honesty and respect, what, specifically, do I think needs to be done? What should we teach youth? In my opinion, I think the ABC approach that is being taken in Uganda could work well in the United States. However, it can only work if the slogan of Abstinence, Be Faithful and use Condoms is kept in tact. Its integrity is in its comprehensive approach to sexual activity. I particularly like this approach because it does not make value judgments on any of the sub-parts. I also like the ABC approach because, if applied properly, it respects the decision making abilities of young people. Each of the options, whether it be abstinence or faithfulness or condom use, is appropriate for different people at different times in their lives. And this strategy allows room for individuals, all individuals, young or old, to make choices that are appropriate for them. Some might say that the ABC approach or something similar has already been tried in the United States and has not worked. This, I can say from personal experience as a high school student in Virginia and a health educator in the Illinois, is not true. Honest, comprehensive sex education has not been supported in the United States yet.

I say yet because I have hopes that my voice and the voice of hundreds of thousand of young people from across the nation will be heard. This past year, I have been working with a youth-led, grassroots movement—the My Voice Counts Campaign—which has, as its goal, the implementation of honest sex education in all of our schools. Advocates for Youth has been an inspiring organization in my life and the life of many other youth activists who do not want to see one more life put in jeopardy because of ignorance.

I hope some of what I have said to day will shed greater light on the issues that are on the table. While they are complex and often emotionally loaded, I do believe in common ground. I have seen it and heard here today. But more importantly, I have to believe in common ground for the sake of myself, my peers and our future.

Thank you.