Another tale of twin cities is encapsulated in twin counties, both nestled on the Tampa Bay. St. Petersburg occupies the southern borders of the bay and Tampa hugs the northern shoreline; Pinellas County and Hillsborough County respectfully.
Like most twin cities, these twin counties are dealing with some of the same civic and social challenges: shared infrastructure or shared natural resources or even shifting residential patterns. Another aspect that these twin counties share is the startling rates of sexually risky behavior among their youth, which manifests itself in high rates of sexual infections and diseases.
High school-age kids are nearing epidemic proportions in regard to sexually transmitted infections (STIs) and HIV/AIDS in these counties – as well as throughout Florida and the United States. If the 13-18 year old identifies him-/herself as LGBT, then those frightening percentages go up. Following a medical model of disease and infection control, a three-tiered approach has proven to be effective. This same model is often assigned to curbing, staving off and preventing the prevalence of STIs and HIV/AIDS among school-aged kids. At present, Florida ranks number one in the country for new HIV/AIDS infections.
Despite the fact that county school boards are officially tasked with sex ed, it’s often external advocacy groups who are filling in where school boards either can’t or fear to tread. Organizations like Healthy Teen Network, Planned Parenthood and Metro Wellness & Community Centers are at the forefront of augmenting “real world” sexual education. All these organizations admit that collaboration is the first hurdle but the execution is the biggest hurdle to effective sex education.
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The medical mantra for attacking epidemics head-on is simply the interconnected concepts of primary care, then secondary care, followed by tertiary care. The Centers for Disease Control (CDC) has a diagnostic research database: The Youth Risk Behavior Surveillance System (YRBSS), which monitors six different health-risk behaviors that contribute to the leading causes of death and disability among youth; primarily students in grades 9-12.
Germane to sexual education is “sexual behaviors related to unintended pregnancy and sexually transmitted diseases, including HIV infection,” the report reads. In the case of sexual education, primary care encompasses the prosaic explanation of what sex is: physiological, emotional and medical.
Next in line is secondary care. This entails a more in-depth foray into the collateral damage of sex: things like STIs, teen pregnancies, unwanted sexual encounters and HIV/AIDS. A basic component of secondary care, as it applies to sexual education, is prevention. At this stage, risky behaviors are evaluated in addition to addressing how teens can protect themselves against these risky behaviors. This is also the point at which either abstinence or the use of prophylactics are taught as methods of mitigating the fallout of risky behavior. Planned Parenthood’s Anna Eskamani, senior director of public affairs in Southwest and Central Florida (including Pinellas and Hillsborough Counties), says sex education in Hillsborough and Pinellas are based on abstinence-plus models. This method teaches abstinence as the preferred strategy of avoiding risky sexual behavior; like HIV/AIDS, STIs and pregnancies.
Finally, tertiary care delves into what can be done to treat the adverse effects of risky sexual behavior. It informs the teens where they can go to seek treatment; how to contact support groups, and in general, how to live with the ramifications of risky sexual behavior.
Is sex education effectively preparing teens to deal with risky sexual behavior, and does sex education address one of the most vulnerable group of teens: the LGBTQ kids?
Florida as a whole isn’t coming to grips with the demographics, specifically among its LGBTQ population, of what sexually transmitted diseases are, experts say. The Florida Health Department doesn’t breakdown the epidemiology fully, leaving only two gender categories: male and female.
“Wholeheartedly we need to include LGBTQ education in the curriculum, not even just sexually but by gender orientation. We need to integrate it in an age appropriate way,” Eskamani says. “We need to insure that no matter who you love, who you are, all of you are valued.”
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The percentages are alarming. For instance, as reported by the Florida Health Department, 75 percent of reported STIs fell within the 15-29 age range. Young Floridians, ranging in age between 15 and 24, made up around 13 percent of the state’s total 2015 population of all new HIV infections in 2014. Yet, this age group amounted to the lion’s share of reported cases of chlamydia at a staggering 64 percent. Roughly 40 percent of teen girls who are sexually active have reported having an STI. It should be noted that not all STIs require Health Department reporting. Gonorrhea, syphilis, chlamydia, viral hepatitis (A, B and C) and HIV/AIDS are the primary sexually transmitted infections which are mandated to be reported to the health department. The statistics don’t include empirically driven data for things like herpes, pubic lice or genital warts.
When you add gender and gender identity to the equation, things don’t get any easier. The CDC estimates that gay and bisexual males were diagnosed with 80 percent of the HIV cases in the age group 13-24 occurring in 2014. In addition, the CDC reported that men who have sex with men (MSM) were the majority of new gonorrhea and syphilis cases. The CDC is, by its charter, a scientific and fact-based institution promoting, protecting and preserving the nation’s public health. CDC guidelines are as clear as their recommendations; namely, “many curricula do not include prevention information that relates to the needs of young gay and bisexual men.”
Furthermore, the Youth Risk Behavior Surveillance System (YRBSS), states; “Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact with both sexes, are more likely to engage in health-risk behaviors than other students.” So what are Hillsborough and Pinellas county schools doing to remedy this “lapsus curricula?” Not much, unless it’s being done quietly.
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At the state level Florida has mandated a program, based on minimum requirements, which make up the foundation of sexual education delivered in schools. The law requires students who intend on graduating high school to have completed a health course which has a component of sexual education. Although the school boards are to make the curriculum “evidence-based” and “medically accurate,” among other things. The mandate doesn’t seem to be rooted in pragmatism.
Florida’s sex-ed statute reads: “The School Board shall provide an evidence-based, medically-accurate comprehensive health education curriculum that addresses concepts of community health; consumer health; environmental health; family life, including an awareness of the benefits of sexual abstinence as the expected standard and the consequences of teenage pregnancy for one’s life, health, and development; mental and emotional health; injury prevention and safety; nutrition; personal health; prevention and control of disease; substance use and abuse; and teen dating violence and abuse.”
Abstinence isn’t working. But more than that, it doesn’t address anywhere in the requirements LGBTQ sensitivity and inclusion. This is important, because sexual education is taught from the vantage point of the dominant heterosexual sex role. Sexual education still falls under the broad rubric of health education, because historically it was meant to teach about family formation.
But sexual education “is bigger than that,” according to Alexandra Eisler of Healthy Teen Network. This a nationally based advocacy group with ties to Florida. The group is instrumental in assisting schools develop of comprehensive sexual education programs. Eisler is the manager of capacity building and evaluation of the organization, which means she coordinates the understanding of the evidence-based data in order for it to be implemented.
Eisler maintains that if students identify with the curriculum, they will better retain what is being taught. This is essential for LGBTQ youth, she says. One simple way of garnering identification with the curriculum is to employ what Eiser calls “ungendering” terminology: omitting language that is gender exclusive. For example, when talking about intercourse between two people, don’t say, “the man puts his penis into the woman’s vagina.” Say instead, “The penis is inserted into the vagina.” Of course, this is just the bare bones of what experts and advocates agree should be the model: comprehensive sexual education.
Several bills have been proposed at the Florida legislative level as well as broad reaching bills at the federal level in Washington, D.C. These were intended to augment and bolster existing laws to make certain that sex education become more inclusive and objective in giving teens the tools, both intellectually and physically, to protect themselves against risky sexual behaviors; in other words, to make them comprehensive. At the federal level bills were drafted, sponsors found and then ultimately sent to committees for review. Since the 113th Congress (2013), these measures have stalled and gone nowhere. Both State bills HB 859 and SB 1056 would have required schools to have given teens the existing requirements plus family planning and STI prevention, which includes HIV/AIDS prevention. Anna Eskamani explains why she and her colleagues at Planned Parenthood supported the state bill, the Healthy Adolescence Act: “It would set a new standard. That if you were providing any kind of sex ed in your school that
it [would] be comprehensive.” She stressed that, in the past, schools whose budgets were narrow couldn’t provide comprehensive sex education, because of federal grants tied to abstinence-only curriculum. Eskamani said they could now qualify. “[Planned Parenthood] has seen a lot of great comprehensive programs be available for funding compared to (the) past.”
Both bills would have dropped abstinence as the default preventative method. Both bills failed.
“The academic argument is that Florida is number one for HIV transmission, so clearly something has to be done,” state Rep Carlos Guillermo Smith, D-Orlando, says. “And the fact that a substantial number of school boards are not allowing anything but abstinence-only education is wrong. We need age-appropriate, comprehensive sex ed in our schools. That, and making sure that women have free birth control, that students have access to PrEP, and even needle exchanges – that is the way that we are going to slow the spread of HIV among our younger population.”
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Taking a closer look at what the respective school boards in Pinellas and Hillsborough counties are doing to prepare these at-risk kids to avoid becoming another harrowing statistic: One county has one of the two LGBTQ welcome centers in Florida, as well as one of the biggest Pride parades in the state. This same county denied (refused) to comment on the hot button issue of sex education in its schools. Despite multiple calls and emails, county staff sent only a terse reply – after over 30-plus days of inquiry for a statement – that it was unable to be interviewed. The other county doesn’t have the same lofty accolades. But this county does have a new and more inclusive vision and focus for sex education. The former is Pinellas County, and the latter is Hillsborough County. Saint Petersburg Mayor Rick Kriseman and Tampa mayor Bob Buckhorn didn’t return repeated phone calls or emails to comment on sexual education in their cities.
Encountering difficulties contacting governmental agencies isn’t the sole purview of journalists.
Metro Wellness & Community Centers are situated in both Hillsborough and Pinellas Counties and have experienced similar challenges. For the past 23 years they have been providing health, wellness and community based programming in areas such as medical case management, direct HIV medical care, primary care, prevention programs, and LGBTQ youth programming, to name a few. They also are equipped to supplement sexual education to school-age kids. They are the proverbial “boots on the ground.” Tiffanie Gray, lead provision specialist between Tampa and Saint Petersburg, has been with the organization for about 18 months.
Gray says that, based on the organization’s experience, it is easier for the programming to get into Hillsborough schools than Pinellas schools. Chief program officer at Metro Wellness, Priya Rajkumar, explains that both counties present a challenge to external groups wanting to educate students on sex education.
“In order to be able navigate the bureaucracies of the system, the actual school boards, that’s been next to impossible in both counties,” she says.
Metro Wellness has been active in Hillsborough County Schools, but recently got green-lighted by the school board in Pinellas County to be included on a list of approved sex-education speakers. Rajkumar says the whole organization is “super excited” about the progress.
She went on to say that, in her eight years at Metro Wellness and 17 years in HIV/AIDS programs, she has witnessed a shift from one county to the other in regard to each county’s implicit focus on sexual health education. Through their experience and evaluations, Metro Wellness stressed the need for open dialogue during Q&A portions of the sexual education teaching they provide. Gray chuckled during her response that it’s often the case that teachers have more questions than students. Metro Wellness has collaborated in LGBTQ sensitivity training with governmental entities, like the Pinellas County Sheriff’s Department. Rajkumar and Gray both echoed that neither Pinellas nor Hillsborough school boards have taken them up on such an offer.
When all was thought to be for naught, Hillsborough school board member April Griffin came through and candidly responded. She enthusiastically spelled out a new and progressive direction the school board is taking to be more responsive to pragmatic needs in regard to sexual education. She has spent the last 10 years crusading for the “plus part,” the real-world pragmatic portion, to be the core component of the Hillsborough County sex education curriculum. In the year 2015, there was a paradigm shift in the Hillsborough County school board’s approach to providing sex ed.
It started with hiring a new superintendent, Jeff Eakins. Working with Eakins’ chief of staff has opened the floodgates to extraneous partners that have been clamoring to get involved in supplementing a more comprehensive sex education program in Hillsborough County, Griffin says. She points out that these groups, like the county’s health department and the University of South Florida, had been pushed out years ago.
According to Griffin, Hillsborough will begin to fully utilize the YRBSS reports from the CDC to craft its sexual education curriculum. Many of the questions had been removed from previous surveys, she stated. The theory is that LGBTQ questions will be weighed and policy distilled out of the findings. Implicitly, by adding these questions the county can then qualify for more grant money. Although there is not a launch date set for implementation, Griffin cautions, “Every single year that passes that we don’t have a comprehensive sexual-health curriculum in place…(then) we are losing kids to STDs and STIs.”
Hillsborough seems to be inching toward a more progressive outlook which will entail more inclusion and understanding. Griffin emphasized that the three-tiered approach (primary, secondary, tertiary care) to comprehensive sex education is separate from an overall ethos of emotional health.
As a result of the nationwide kerfuffle over transgender usage of public restrooms, Hillsborough County schools organized a series of continued education trainings for its principals, social workers and teachers. This was an opportunity to educate the staff on informational resources, the laws in place and methodologies for conflict resolution all pertaining to LGBTQ issues. During the session, Griffin says, some people weren’t even clear what it meant to be transgender or transsexual. A heartwarming success story emanated directly from this new tactic of sensitivity and inclusion. Two transgender students in the Hillsborough County school district were “held up and lauded for their bravery,” Griffin says. One of those two students was honored at a Tampa Bay Lightning hockey game as a hero. The team rolled out the red carpet. She was able to invite her teachers, staff and a school board member to private boxed seating.
Hillsborough is edging closer to other counties in Florida – Broward and Palm Beach – which are going beyond abstinence, providing more comprehensive sex education. Although Pinellas remains an informational black hole on sexual education, it certainly has the scaffolding in place to follow Hillsborough’s lead. Unfortunately, we just don’t know what the zeitgeist in Pinellas looks like. That is where the crux of the dilemma facing the twin counties of Hillsborough and Pinellas has nestled. Anna Eskamani of Planned Parenthood is critical of this kind of disparity. Her bureau covers 22 counties throughout Southwest and Central Florida. She offers a warning to the twin counties: “Different zip codes mean different access to critical knowledge.”
