• World Health Organization (WHO)
• Sexually transmitted infections
• Comprehensive Sexuality Education
• infertility

Capobianco J, Flowers NI, Salazar LF (2024) Empowering Racial/Ethnic Minority Youth: Bridging Sexual Health Gaps through Social Media Education. JSM Sexual Med 8(3): 1139.

According to the World Health Organization (WHO), sexual health is defined as “a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity” [1]. Sexual health is considered fundamental to every person’s overall health and well-being, as well as the social and economic development of communities/countries; impacting all levels of society [2]. Comprehensive Sexuality Education (CSE) is a curriculum- based process aiming to equip children and adolescents with knowledge, skills, attitudes, and values that will empower them to understand their health, well-being, and dignity, alongside considering how their decisions affect their own well-being and the well-being of others [3]. Sexually transmitted infections (STIs) have a profound impact on global sexual health and, when left untreated, can lead to serious health complications like increased risk of HIV, cancer, and infertility [4,5]. Similarly, unintended pregnancies also have a significant impact on global sexual health. Each year, approximately 74 million women living in low and middle-income countries have unintended pregnancies, leading to a range of health issues like malnutrition, complications from unsafe abortions, as well as maternal and/ or child death [5]. Even though the United States is considered a high-income country, sexual health problems are comparable to other lower-income countries.

Between 2020 and 2021, STI rates in the U.S. have risen dramatically, with more than 2.5 million reported cases [6]. STIs disproportionately affect younger people and racial, ethnic, and sexual minority groups [7]. Additionally, racial and ethnic minority women face a high risk for unintended pregnancies [8]. According to the National Survey of Family Growth (2006-2010), 50% of pregnancies were unintended, with the highest rates among Black women (63%), Hispanic women (48%), and White women (42%) [8]. Regardless of race or ethnicity, the overall 42% rate for unintended pregnancies remains high [8]. Indeed, the U.S. has one of the highest rates of teen pregnancy and birth among industrialized nations, and with adolescents and young adults aged 15-24 accounting for half of all new STDs [9].

As a part of the WHO’s mission to address the global STI burden, recommendations include increasing the accessibility of quality patient-centered STI care and creating environments that facilitate discussions about STIs, safer sexual practices, and seeking treatment [4]. Despite male condoms being one of the most effective contraceptive methods for STI prevention, only 8.4% of women in the U.S. ages 15-49 used condoms from 2017 to 2019 [10,11]. Among those who did, women aged 15- 19 had the lowest utilization rate (5.1%) [11]. Low condom use contributes to the disproportionately high STI rates seen among young people [7]. In addition, although male condoms are 98% effective at preventing pregnancy, they were only the fourth most commonly used contraceptive method among women ages 15-49 from 2017 to 2019 [10,11].

Increasing accessibility to effective contraceptive methods, sexuality education, and counseling can decrease STI transmission and unintended pregnancy rates [8]. Comprehensive sexuality education (CSE) equips young people with the knowledge, skills, and attitudes necessary to promote positive health outcomes [12]. Many policy makers and public health professionals agree that school-based sexuality education is vital to the sexual health and well-being of young people [7]. However, sexuality education programming varies widely across the U.S., with only 39 states and the District of Columbia mandating some form of sexuality education and/or HIV education [13]. This inconsistency may contribute to the noticeable differences in sexual health outcomes, particularly among minority groups. This commentary will discuss the applicability of a proposed social media-based comprehensive sexuality education intervention called Healthy Bodies and its potential public health and political implications.

Healthy Bodies

Healthy Bodies is a comprehensive sexuality education intervention that targets young racial/ethnic minority females to reduce the disproportionate STI and unintended pregnancy burden this population experiences. The Healthy Bodies intervention is guided by international guidelines on sexuality education, which defines CSE as “an educational approach designed to develop an understanding of the cognitive, emotional, physical, and social facets of sexuality.” Healthy Bodies’ curriculum aims to empower young racial/ethnic minority females with the information and skills necessary to maintain their health, well-being, and dignity. It encourages the development of respectful social and sexual relationships, promotes awareness on the impact of personal choices on oneself and others, and emphasizes the importance of protecting their rights throughout life. The principles of CSE align with broader public health goals, where health advocacy, patient navigation, and education are essential components for improving public health outcomes [14].

An innovative component of Healthy Bodies is its use of social media to overcome barriers to access and gaps in sexual health knowledge experienced by racial and ethnic minority women. Content is aimed at reducing stigma, encouraging safer sex practices, and dismantling myths surrounding STIs and contraceptive methods using culturally specific information. By hosting the intervention on Instagram, a free social media platform, any person with a cell phone can access Healthy Bodies’ sexual health education. Healthy Bodies also incorporates patient navigation (PN) principles to significantly enhance healthcare delivery and access to appropriate care. The PN content comprises information and strategies needed to navigate the healthcare system and develop interpersonal relationships to teach participants appropriate care-seeking skills and how to build rapport with their providers. The PN component works to empower young women with the necessary skills to facilitate quality counseling during their doctor’s visit. To further facilitate access, a customizable module provides information to local health facilities and resources to access affordable care. Utilizing an accessible and free social media platform is an innovative approach to delivering CSE to young racial/ethnic minority females. This is particularly salient as political tensions throughout the U.S. continue to rise and CSE and reproductive rights in school curriculums are under attack. These efforts concentrate on rolling back decades of progress in health education, leaving many individuals vulnerable and without the knowledge and resources needed to advocate for their health. We must recognize the necessity for a standardized sexuality education system that will empower individuals to make informed choices about their bodies and relationships, fostering a culture of safety, respect, and understanding.

Advocacy in Healthcare

Generally speaking, PN is an evidence-based healthcare intervention designed to enhance patient-centered care, providing individuals with tools for effective patient-provider communication, and promote health-seeking behaviors [15]. PN is a critical component of effective healthcare delivery that aids an individual’s understanding of complex healthcare systems. The principles of PN are particularly salient for minority groups who face barriers to accessing quality healthcare and who may lack the efficacy to discuss their healthcare needs and concerns with their providers. These are particularly important issues when discussing and advocating for personal sexual health needs with a healthcare provider. Sexual health is a sensitive and often stigmatized topic, particularly for minoritized populations who may face cultural, social, and systemic barriers to open communication. PN plays a pivotal role in bridging these gaps by providing individualized support and guidance. Equipping individuals with communication skills can empower them to take an active role in managing their health. These tools are particularly important in the context of sexual health, where patients need to feel confident and open to discussing issues like contraception, sexual orientation, and STIs without fear of judgment or discrimination. The Healthy Bodies program incorporates PN principles to promote health seeking behaviors and healthy interpersonal relationships with healthcare providers. Healthy Bodies follow Sexuality Information and Education Council of the United States (SIECUS) guidelines to provide quality sexuality education to allow young people to practice the communication, negotiation, decision-making, and assertiveness skills to navigate healthy relationships [16].

Culturally Competent Sexuality Education

Culturally competent sexuality education is vital to facilitate understanding and communication. Furthermore, sexuality education programs that are planned and operated with high respect for and sensitivity to collective group identities are more effective [17,18]. Cultural competency in sexuality education can foster an understanding of important content that CSE highlights, such as consent, recognizing abuse, family planning, and decreasing risky sexual behaviors [15]. Programs tailored to the cultural contexts of communities can empower young people with the knowledge and skills essential to navigate healthy relationships [17,18].

In the Netherlands, sexuality education begins as early as age four. Children receive lessons on relationships, good vs. bad touch, and intimacy [19]. The curriculum expands to include age and culturally-appropriate topics and concepts. Data suggest that the Dutch approach to sexuality education is effective [19,20]. On average, teens in the Netherlands do not have sex at an earlier age and tend to report positive first sexual experiences. Additionally, Dutch teens are among the top users of birth control, and nine out of ten adolescents used contraceptives the first time they had sexual intercourse, contributing to the lowest rate of teen pregnancy in the world, as well as low rates of HIV and STIs [21]. The Dutch center love, empowerment, and respect throughout their CSE curriculum as opposed to the U.S., which emphasizes fear, shame, and stigma associated with sexuality education. The Healthy Bodies program is for young racial/ethnic minority females and is designed with cultural competency and accessibility in mind. Competency is continuously assessed through focus groups to tailor a more culturally appropriate program that adequately addresses the target population’s  specific needs. By incorporating these intersectional and culturally sensitive approaches, sexuality education can be more inclusive and effective, addressing the unique needs and experiences of diverse populations.

Political Implications

The innovation of utilizing Instagram as a platform to deliver Healthy Bodies is important as the U.S. lives in an era of rapid technological advances where internet access and access to smart devices are easily accessible. The ability to access appropriate, informative, accurate, and safe content on social media is vital for sexual health. This is even more salient when understanding the implications of laws passed in states to ban CSE and/or any discussion of sexuality and gender in schools. In 2022 Florida passed the “Don’t Say Gay” law, HB 1557 and prohibited any instruction related to sexual orientation or gender identity in grades K-3 [22]. In 2023, the legislature expanded this law to all grade levels [21,22]. Similarly, states such as North Carolina, Iowa, Indiana, and Arkansas passed similar laws in March, 2023. These laws are particularly harmful for adolescents who identify as a sexual and/or gender minority who are disproportionately affected by STIs [23]. As these laws are passed many adolescents’ primary or only form of sexuality education and health could come from social media. Following SIECUS guidelines, the Healthy Bodies curriculum incorporates teachings of sexual orientation and gender identity as fluid concepts, emphasizing acceptance and increasing engagement in an environment that affirms and promotes sexual health.

Despite being an industrialized and high-income country, the U.S. continues to face substantial sexual health challenges, with rising rates of STIs and unintended pregnancies, particularly impacting racial/ethnic, sexual, and gender minority groups [5,7]. Healthy Bodies is a curriculum that utilizes SIECUS guidelines to curate an interactive social media platform to deliver sexuality education. The modules are currently tailored to racial/ethnic minority females. The Healthy Bodies intervention aims to address disparities by providing culturally appropriate sexuality education delivered through social media to improve accessibility and reduce stigma; aiming to foster an inclusive and safer environment for all participants. Future goals include expanding this model to other minority groups, advocating for comprehensive and inclusive sexuality education policies, and promoting broader use of digital platforms to reach and educate diverse populations.

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