Inclusivity in Youth Sex-Ed: Review highlights the need to attend to sexual and gender minority youth

Pampati, S., Johns, M. M., Szucs, L. E., Bishop, M. D., Mallory, A. B., Barrios, L. C., & Russell, S. T. (2021). Sexual and gender minority youth and sexual health education: A systematic mapping review of the literature. Journal of Adolescent Health, 68(6), 1040–1052.

Introduction

Disparities in sexual and reproductive health outcomes are alarmingly persistent among Sexual and Gender Minority Youth (SGMY), with elevated risks for HIV, STDs, and unintended pregnancies compared to heterosexual and cisgender peers. These disparities are attributed in part to inadequate sexual health education that fails to represent SGMY experiences or address their unique needs. Current sexual health education often excludes LGBTQ+ topics or frames them within the context of risk, exacerbating feelings of alienation and compromising mental health. Pampati and colleagues (2021) review the state of SGMY-inclusive sexual health education, highlight promising practices, and identify areas requiring further research and intervention.

Methods

The authors conducted a systematic search across five databases, targeting studies published between 2000 and 2017 that included U.S.-based SGMY aged 10–24. A total of 32 articles met the inclusion criteria, spanning qualitative studies on SGMY perspectives, evaluations of interventions tailored to SGMY, and analyses of general programs with outcomes for SGMY subsamples.

Results

SGMY Perspectives on Sexual Health Education

Sixteen qualitative studies revealed widespread dissatisfaction with traditional sexual health education. SGMY consistently reported feeling excluded due to the heteronormative focus of curricula, which emphasized abstinence and risk while neglecting same-sex relationships, sexual orientation, and gender identity. Youth expressed a desire for comprehensive programs addressing communication, relationships, and broader psychosocial topics. Importantly, several studies highlighted the mental health consequences of exclusionary education, including depression and suicidal ideation.

Acceptability and Effectiveness of SGMY-Specific Programs

Thirteen studies evaluated interventions explicitly designed for SGMY, yielding promising results. These programs incorporated relatable content, diverse representation, and interactive delivery methods. Key topics included safe sex practices, healthy relationships, and coping with minority stress. Behavioral outcomes such as increased condom use and HIV testing were frequently observed, alongside gains in self-efficacy and knowledge. However, most interventions targeted sexual minority males, leaving significant gaps for younger adolescents, sexual minority girls, and transgender youth.

Broad Youth Programs with SGMY Outcomes

Only one study evaluated a general youth program with outcomes for SGMY, demonstrating high acceptability among both sexual minority and majority participants. This limited evidence highlights the need to expand inclusive sexual health education within universal settings like schools.

Discussion

The findings illustrate the urgent need for inclusive sexual health education that reflects the diverse experiences of SGMY. Interventions tailored to SGMY demonstrate efficacy but remain limited in scope and representation. Schools, as key venues for youth education, are underutilized in delivering inclusive curricula. Implementation studies are essential to bridge this gap, addressing barriers such as parental consent requirements and resource limitations.

Implications for Mentoring Programs

Mentoring programs play a pivotal role in supporting SGMY by fostering resilience, identity exploration, and social connectedness. Incorporating discussions on sexual health into mentoring can bridge the gaps left by traditional education. Training mentors to deliver affirming and inclusive guidance is critical.

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