All together now: combining pregnancy and STI prevention programs.

Okay, so you would like to have me come to your class and teach about contraception and STIs. The classes are 40 minutes long, right? Okay, I can block out 10 days, how does that sound? Oh, just one day? Oh, just one class.

No doubt this phone conversation will sound familiar to many sexuality educators. But educate about both contraception and STIs in a single 40-minute lesson? How is that possible? Even the most creative individual might find that request a little too daunting.

And why would an educator even want to do it? New research is continuing to reinforce what many educators already knew (or at least suspected): a major characteristic of effective sexuality education programs is that they are ongoing, integrated into other curricula, and not limited to one single lesson. (1)

So the educator receiving this program request is left with a dilemma. Turn it down, and maybe someone with incomplete or unreliable information will do the lesson instead. Accept the request and figure out how on earth to meet this impossible challenge.

PERSONAL RISK FOCUS

When sexuality educator Peggy Brick originally developed the "All Together Now" lesson in 1996 for The New Positive Images, the second edition of a popular teaching manual published by Planned Parenthood of Greater Northern New Jersey (PPGNNJ), (2) she acknowledged that having just one session to educate about both contraception and safer sex is truly inadequate. That said, she pointed out that that precious time would be best spent helping young people assess their own risk, rather than detailing facts about each infection and method.

Often, well-intended educators spend time giving endless information about STIs--signs, symptoms, treatment regimen. Some kid themselves into believing that young people will somehow find these details meaningful--as if young people are choosing, "I'll risk getting this infection, but I definitely won't risk getting that." Since the mechanism for transmission is essentially the same for any STI, young people need to know how to avoid all of them.

In addition, limited time is not best spent reviewing endless details about how each method of contraception works. While it is useful for young people to know the advantages and disadvantages of a variety of methods, educators often miss the opportunity to help young people learn how to think about protecting themselves from both pregnancy and infections.

The "All Together Now" lesson addresses the unfortunate reality that many educators have only one opportunity to reach a group of young people. They need to spend that valuable time helping young people examine their own personal risk for unplanned pregnancy or STIs.

LEARNING METHODS

The "All Together Now" lesson incorporates a variety of learning methods described by sexuality educators Evonne Hedgepeth and Joan Helmich in Teaching about Sexuality and HIV, (3) as well as in other ground-breaking sexuality education resources.

Learning methods that are most prominent in this lesson include:

* Sensual (kinesthetic, visual, and aural) learning, in which participants move around the room placing signs correctly to describe relative levels of protection from unplanned pregnancy and STIs and then discussing their placements; and

* Collaborative learning, which requires that group members work together to establish a full, wall-sized picture of the effectiveness of both contraception and safer sex

The "All Together Now" lesson helps students integrate prevention of both pregnancy and STIs into their sexual decision-making process. This is something that is not so easily accomplished if one lesson is exclusively about contraception and another focuses exclusively on safer sex.

Europeans have already learned this and have effectively integrated the dual message about pregnancy prevention and STI prevention into their lessons and their public health campaigns.

In the Netherlands, for example, teens learn to go "Double Dutch," using the pill to prevent pregnancy and the condom to prevent infections. Consequently, 24 percent of Dutch teens use both oral contraception and condoms together at first intercourse, (4) compared with between five and nine percent of teens in the United States. (5)

The difference is also seen in the rates of teen pregnancy and STIs, where the United States lags behind not only the Netherlands but also many other developed nations in the world. (6)

TRAINING EDUCATORS

During the past year, PPGNNJ has trained more than 1,200 sexuality educators in 30 cities to use the lessons in Positive Images, including the "All Together Now" lesson.

As part of the training, we established a list serv of sexuality educators as a way for workshop participants to exchange ideas about uses and adaptations of the lessons. To date, more than 200 educators have signed up.

This list serv also allows workshop participants to network with other Positive Images users long after the workshop. These are some of their comments about "All Together Now":

We use it a lot. I like it most because it allows the facilitator to add whatever level of details about each method is appropriate for the setting and session. I love that it gets students to identify their own personal goal for risk reduction and that all methods have strong points and things we wish were better. This lesson plan has become a real standard for us.

Kathleen Baldwin 

Planned Parenthood of Greater Indiana

I love the All Together Now lesson. I am called to present on STD/HIV and pregnancy prevention by our local high school teachers and I really do have just 50 minutes to cover it all. This lesson allows me to do just that in a manner that:

* Has the kids interacting because I have them decide with a partner where the method falls on each spectrum

* Honors both methods promoted by local faith communities and the ones promoted more by the medical community (especially important because this is a very conservative area of Minnesota)

* Provides a great visual of each method's effectiveness

* Introduces what the methods are for further discussion. After the lesson, there is time to briefly discuss related topics such as where teens can go for birth control counseling and teen parenting

Denise Erti, M. Ed.

McLeod County (MO,) Public Health

I have successfully added a decision tree to the lesson to integrate both pregnancy and safer sex decision-making. The first branch of the tree is the decision to be sexually active. Flowing from that decision is the decision whether or not to have intercourse, and from that, vaginal, anal, or oral intercourse. From vaginal intercourse, there are two decisions -- to protect against pregnancy and to protect against STIs, Franz anal and oral intercourse, there is the decision of whether or not to protect against STIs. If any of these decisions are NO, the tree branches out to possible consequences and additional decisions arising from those consequences (pregnancy options, whether or not to seek early STI treatment,). If the decision for protection is YES, then the tree branches out to list possible methods, and identifies which methods protect against both pregnancy and STIs, and which do not.

Myra Aaronson

PPGNNJ

Contact information: Bill Taverner, director of education, The Center for Family Life Education, PPGNNJ, 196 Speedwell Avenue, Morristown, NJ 07960. Phone: [phone], extension 135. Fax: [phone]. E-mail: [e-mail] Web site: www.ppgnnj.org

References

(1.) D. Kirby, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Washington DC: National Campaign to Prevent Teen Pregnancy, 2001).

(2.) P. Brick, et al., 1996.

(3.) B. Hedgepeth and J. Helmich, Teaching About Sexuality and HIV (New York, NY: New York University Press, 1996).

(4.) L. Berne and B. Huberman, European Approaches to Adolescent Sexual Behavior and Responsibility (Washington DC: Advocates for Youth, 1999).

(5.) M. A. Ott, er al., "The Trade-off between Hormonal Contraceptives and Condoms among Adolescents," Family Planning Perspectives, January/February 2002; The Alan Guttmacher Institute, In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men, 2002.

(6.) M. A. Ott, 2002; Adolescent Sexual Health in Europe and the US--Why the Difference? Advocates for Youth, 1999.