Healthy sexuality: A guide for advocates, counselors and prevention educators This guide is intended to provide guidance and practical tools around discussing healthy sexuality within the context of sexual violence for advocates, counselors, prevention educators, and activists. Implementation of these tools by local sexual violence programs will depend on the strengths, needs, and resources in each community. This guide works within a framework that views sexuality as an ongoing journey we all take, one that changes with time and experience, and one that contributes to our humanity. What is healthy sexuality? Cultural messages shape individual understandings and experiences of sexuality and can make it difficult to come up with an all- encompassing definition for healthy sexuality. It is important to understand that sexuality is much more than sex. Healthy sexuality is emotional, social, cultural and physical. It is our values, attitudes, feelings, interactions and behaviors. For this guide, healthy sexuality can be understood as having the individual knowledge and sense of empowerment to express sexuality in ways that contribute positively to self esteem and relationships with other people. It includes approaching sexual interactions and relationships from a perspective that is consensual, respectful, and informed. Healthy sexuality is free from coercion and violence. Healthy sexuality and issues of sexual violence Making connections between issues of healthy sexuality and sexual violence can help strengthen prevention efforts. This section will review some of the areas of overlap when looking at health sexuality and sexual violence prevention and intervention. Consent. Consent, by definition, means permission for something to happen or agreement to do something. When sex is consensual, it means everyone involved has communicated their desires, needs, and level of comfort with different sexual interactions. This intimate dialogue allows for more than just a “yes” or “no” – it is consent that represents each person’s complex and unique sexuality. In consensual sexual interactions needs, desires, and boundaries are communicated and respected. Because healthy sexual interactions are rooted in consent and respect, healthy sexuality is an excellent strategy for sexual violence prevention. Providing a healthy model can help give individuals and communities the tools and skills to build healthy relationships and sexual interactions. This can also help victim/ survivors during the healing process – knowledge around consent and empowerment to assert boundaries with current or future partners is central to a trauma-informed approach. Key characteristics of healthy sexuality The following behaviors, adapted from the Sexuality Information and Education Council of the United States’ Life Behaviors of a Sexually Healthy Adult demonstrate healthy sexuality (SIECUS, 2004, p. 16): A sexually healthy adult will … • Be comfortable with their body. • Know that human development includes sexual development, which may or may not include reproduction or sexual experience. • Have access to information and resources to protect and enhance their own sexual health. • Engage in sexual relationships that are consensual, non-exploitative, honest, pleasurable, and safe. • Express their sexuality while respecting the rights of others. • Interact with all genders in respectful and appropriate ways. • Know the difference between life- enhancing sexual behaviors and those that are harmful to self and/or others. • Communicate well with family, peers and romantic partners. • Express their sexuality in ways that are in line with their values. • Enjoy sexual feelings without necessarily acting on them. • Be aware of the impact of family, cultural, media, and societal messages on thoughts, feelings, values, and behaviors related to sexuality. • Accept one’s own sexual orientation and respect the sexual orientations of others. • Accept one’s own gender identities and respect the gender identities of others. Sexuality throughout the life span Sexuality is a part of life at every stage – from birth through adulthood. It is common for children to be curious about their bodies, and it is just as common for individuals in later life to be sexually active. In order to embrace healthy sexuality and its core principles, we must all recognize and support that sexuality exists throughout the life span. Children. Children receive messages about sexuality from a very young age. Sexual behaviors can be ignored, paid attention to, punished, or supported. For example, parents may react in a variety of ways to a child who touches their own genitals while taking a bath. These reactions send messages that stick with individuals and help to shape their view of sexuality as they mature. Empowering children by giving them basic information, such as the proper names for body parts, and understanding that certain parts of their body are private, can help them identify abuse and tell someone they trust. Parents can establish that they are a support when their children have questions and that no topic or question is off-limits. For more information, visit the Vawnet Special collection: Working with children towards a healthy and non-violent future at www.vawnet.org/special- collections/Children. In addition to educating and empowering young children in regard to their sexual development, we must be aware that there are social messages that hyper-sexualize children and how these messages can be damaging to everyone. This process can be seen in advertisements that make women look more like young girls or vice versa. Concepts such as virginity, purity or innocence do damage to realistic and complex understandings of sexuality (Valenti, 2009). Advocates, counselors, and educators can work to address this issue by identifying examples of media messages or portrayals that hyper-sexualize children. Having critical media literacy skills, and teaching these skills to others, can help shift norms and encourage communities to engage in a dialogue around what messages are being given to children around sex and sexuality. Examples of commercials, advertisements, local media images, and current events can be used to engage parents, guardians, and community members around ending child sexual abuse and creating safer spaces for children. Adults and young adults. Sexually healthy adults are an invaluable model and support for building healthier communities. In order to prevent sexual violence, it is important to provide diverse examples of healthy sexuality expressed in individuals across the life span. Providing positive examples encourages young people to grow into sexually healthy adults and helps adults to model these behaviors throughout their lives. Not all adults have received comprehensive sexuality education. This can impact knowledge, attitudes and comfort levels around sexuality. The characteristics included in the guide from Life Behaviors of a Sexually Healthy Adult (SIECUS, 2004, p. 16) can foster and strengthened throughout the life span. Providing individuals in early to middle adulthood (ages 17-65) basic information about healthy sexual development, communication skills, and positive behaviors prepares them to deliver messages and model these characteristics. Individuals in later life. Human beings seek out relationships, love, and companionship. Often sexuality in later life is minimized or ignored because of attitudes and beliefs around older individuals and intimate relationships. These attitudes not only reinforce dangerous stereotypes and norms, but also minimize potential health risks. In 2005, 15 percent of all new HIV/AIDS diagnoses were among people over 50 (CDC, 2007). In 2006, the Centers for Disease Control and Prevention changed their recommendations for HIV testing to include routine testing up to the age of 64. Working to end sexual violence and provide services to victim/survivors requires an open-minded and respectful approach. Society sends the message that sexuality and sexual desires end at a certain age – this contributes to discrimination and disempowerment of people in later life. Sexuality in later life A 2007 study found that among participants (Lindau, et al.): • 73 percent of the 57-64 age group reported they were sexually active. • 53 percent of the 65-74 age group reported they were sexually active. • 26 percent of the 75-85 age group reported they were sexually active. • The same study found that most adults ages 57 to 85 said sexuality is an important part of life. Shifting gender norms and preventing discrimination Gender norms are a set of “rules” or ideas created by a culture or society about how each gender should behave. For example, women are not to be as assertive or prone to leadership as men. Children receive messages about what it means to act “female” or “male” in a culture. Too often representations are unrealistic and unhealthy. Strict gender norms contribute to sexual violence because of expectations and beliefs associated with femininity and masculinity (Gallagher & Parrott, 2011). Sexual violence occurs within societal and community ideas about gender — what a woman wears, how men interact with each other, and how people move about their environment. Strict gender norms influence bullying and harassment based on sexual orientation and gender expression. Those who identify as, or are perceived to identify as, lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) are harassed and mistreated for not fitting into the norm. The most common reason students are bullied is because of physical appearance, actual or perceived sexual orientation or how they express their gender identity (GLSEN, 2005). Expanding gender norms to allow individuals to express who they are can help end violence and discrimination and create a more diverse and accepting society. For more information on bullying and sexual harassment, visit the Vawnet publication Addressing the Gendered Dimensions of Harassment and Bullying: What domestic and sexual violence advocates need to know at http://www.vawnet.org/Assoc_Files_VAWnet/ CIB_HarassmentBullying.pdf (image of Two men holding hands) Advocates and counselors: Having discussions around healthy sexuality Because individuals will have different levels of knowledge and comfort around sexuality, self-education and insight is a necessary first step. One of the more challenging parts of incorporating healthy sexuality into work with survivors of sexual violence, as well as the community in general, is finding a place to begin. For sexual assault counselors and advocates, this happens a number of ways – beginning with validating victim/survivor’s as they express interest in sex and sexuality. Educating community collaborators and systems around the importance of healthy sexuality is also important. Working with victim/survivors of sexual violence. For advocates and counselors working with survivors of sexual violence, discussions around sexuality and sex can bring up a myriad of emotions. Here are some strategies for empowering survivors of sexual violence in discussions of sexuality: • Identify and validate feelings about sexual pleasure and the desire for sex. Help the victim/ survivor list positive motivators for wanting to have sex or express sexual desires – this can support her or his individual work in reclaiming sexual independence and health. • Work to create a safety checklist to help plan for physical and emotional safety and self-care. Guide the victim/survivor through their feelings, physical environment, and communication process with their current or potential partner to help find any areas for potential trauma or feelings of revictimization. For example: Do you feel as though you could express disinterest in a sexual activity and your partner would listen and respect that boundary? • Assist in finding competent support and resources in regards to healthy sexuality. Because there is so much to know about human sexuality, it might be helpful to both the counselor and the victim/survivor to contact a professional specially trained in the area of sex therapy and/or sexuality education. The therapist and counselor can find balance in expertise and support for an individual victim/ survivor. This collaboration will ensure a trauma-informed approach to all services, and will emphasize the need for different types of support. To locate a professional, visit the American Association of Sexuality Educators, Counselors, and Therapists website: http://www. aasect.org/directory_usa.asp • Seek out information and education on healthy sexuality and the human sexual response cycle. Although there is a vast amount of information available on human sexuality, there are topics that may be of particular interest to sexual assault counselors and advocates. There are also professional sexuality educators who can provide staff training to counselors and advocates on topics related to sexuality. See Staci Haines’ Healing sex: A mind-body approach to healing sexual trauma (2007) or the first edition of the book The survivor’s guide to sex: How to have an empowered sex life after childhood sexual abuse (1999) for more in-depth discussion and practical applications. (image of two women embracing) Working with the community: Being part of a coalition or task force There are other ways to support healthy sexuality and healthy relationships, even when not working directly with survivors of sexual violence. Many advocates are working to change policies and engage community members in issues related to sexual violence. These are opportunities for dialogue to promote principles of healthy sexuality, as well as educating others about the connection between healthy sexuality and sexual violence prevention. For example, advocates belonging to child sexual abuse or child abuse prevention task forces can begin discussions on the importance of teaching parents and guardians about healthy sexuality, and projects that support healthy, age-appropriate dialogue between adults and children regarding healthy sexuality. For more on a community that implemented a similar initiative, visits the Family Life and Sexual Health program: http://www.kingcounty.gov/ healthservices/health/personal/famplan/ educators/flash.aspx (image of Group of teenage students) Healthy sexuality and primary prevention of sexual violence Healthy sexuality is free from violence or coercion. Understanding healthy sexuality can help individuals to know the difference between healthy and unhealthy behaviors. Providing healthy and positive examples of sex and sexuality will help young people grow into sexually healthy adults. Because components of this approach focus on media images, cultural norms, and society’s image of sexual relationships, promoting healthy sexuality addresses multiple levels of the socio-ecology (CDC, 2009). As many in the field of prevention know, messages must be supported and received at multiple levels of the socio-ecological model — promoting healthy sexuality is no different. Below, are some examples of how levels of the socio-ecological model would be if healthy sexuality was a successful part of sexual violence prevention (SIECUS, 2004): • Individuals would know the process of human development includes sexual development, which may or may not include reproduction or sexual experience • Relationships would be based on respect, honest communication, and consensual sexual interactions. Individuals would express their sexuality while respecting the rights of others. • Communities would work to prevent sexual abuse by advocating for legislation that was in line with their values regarding issues of sexuality. • Society would promote access to age- appropriate and accurate information regarding sexuality and work to enhance individuals’ ability to build meaningful and healthy relationships. Share these visions and others when working to engage organization partners and community members — highlight the positive impact this will have. Sharing real-life examples of these approaches in local, state, or national events will help to make them concrete and interrupt unhealthy or sexually violent norms. Many state and local groups have identified the inability and/or unwillingness of society to discuss sex and sexuality as an obstacle in promoting healthy, pro-social norms among youth (Vermont TARG, 2010; VSDVAA, 2011). Many times the term “healthy sexuality” raises concerns for individuals, so using a different approach may help. Finding a common worldview will facilitate conversations around shared goals. Model programs and curricular resources. There are a number of curricula available that holistically and appropriately discuss healthy sexuality in a way well-suited for the work of prevention educators and activists interested in ending sexual violence. The Virginia Sexual and Domestic Violence Action Alliance, with the support of the Virginia Healthy Sexuality Workgroup, provides with a list of curricula recommendations that focus on preventing unhealthy behaviors before they occur (VSDVAA, 2011): • Our Whole Lives Lifespan Sexuality Curricula: Created by the Universalist Unitarian Association to not only provide accurate information on human sexuality, but also incorporate the spiritual, emotional, and social aspects of relationships and sexuality. The curriculum is a series of six booklets for specific age groups: Kindergarten through first grade, fourth through sixth grade, seventh through ninth grade, 10th through 12th grade, young adults ages 18-35, and adults and parents. Information about the curriculum and ordering can be found at: http://www.uua.org/ eligiouseducation/curricula/ourwhole/index.shtml • Life Planning Education: A Youth evelopment Program: Developed as a omprehensive program for youth with chapters bout healthy relationship skills and sexuality nformation. The program is available online for ownload through Advocates for Youth at their ebsite: http://www.advocatesforyouth.org/ ublications/555?task=view • Care for Kids: A Canadian program eveloped by the Leeds, Grenville, and Lanark istricts, this program’s goal is twofold: upporting and strengthening communities o be sexually healthy within the context of ecognizing, responding, and preventing child exual abuse. For more information, visit: http:// ww.healthunit.org/carekids/default.htm (image of African-American family at laptop) • The Family Life and Sexual Health Resources (FLASH) Curriculum: From the King County Office of Public Health in Washington, FLASH is broken into developmental stages according to grade level (fourth through 11th and College), as well as having components for Special Education units and parent/guardian materials. FLASH uses an abstinence-based strategy while talking about healthy sexuality throughout the life span and prevention of HIV/AIDS, sexually- transmitted infections (STIs), and pregnancy. For more information, visit: http://www.kingcounty. gov/healthservices/health/personal/famplan/ educators/flash.aspx Concluding thoughts If we want to change something as culturally pervasive as sexual violence, we need many voices delivering the message. Many faith- based organizations, schools, community organizations, etc., are working to help promote healthy sexuality in their communities. Building partnerships to address healthy sexuality and sexual violence prevention helps to ensure greater impact. Advocates, counselors, and prevention educators within the anti-sexual violence movement have a unique set of skills and expertise that will help inform healthy sexuality educators and practitioners. Victims/survivors of sexual violence, communities, and those working in the field of sexual violence prevention will be better served by incorporating healthy sexuality into existing practice. Resources • Advocates for Youth www.advocatesforyouth.org •Answer answer.rutgers.edu •National Sexuality Resource Center (NSRC) http://nsrc.sfsu.edu • National Sexual Violence Resource Center (NSVRC) www.nsvrc.org •Planned Parenthood Federation of America www.plannedparenthood.org • Sexuality Information and Education Council of the United States (SIECUS) www.siecus.org • Veto Violence www.vetoviolence.org • World Association for Sexual Health www.worldsexology.org References Centers for Disease control and Prevention. (2009). The social-Ecological Model: A framework for prevention. Retrieved from http:// www.cdc.gov/violenceprevention/overview/ social-ecologicalmodel.html Gallagher, K.E., & Parrott, D.J. (2011). What accounts for men's hostile attitudes toward women? the influence of hegemonic male role norms and masculine gender role stress. Violence Against Women, 17, 568-583. doi:10.1177/1077801211407296 Gay, Lesbian and Straight Educator's Network [GLSEN]. (2005) From Teasing to Torment: School Climate in America, A Survey of Teachers and Students. Retrieved from http://www.glsen.org/ binary-data/GLSEN_ATTACHMENTS/file/499-1.pdf Haines, S. (1999). The survivor's guide to sex: how to have an empowered sex life after childhood sexual abuse. F. newman (Ed.). San Francisco, CA: Cleis Press Inc. Lindau, S., Schumm, L., Laumann, E., Levinson, W., O’Muircheartaigh, C., & Waite, L. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, Vol. 357 No. (8): 762–774. Sexuality Information and Education Council of the United States [SIECUS]. (2004). Guidelines for Comprehensive Sexuality Education: Kindergarten through 12th grade, 3rd edition. New York: SIECUS. Retrieved from: http://www. siecus.org/_data/global/images/guidelines.pdf U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention [CDC] (2007). HIV/AIDS Surveillance Report, 2005. Vol. 17, revised ed. Atlanta, GA. Retrieved from http://www.cdc.gov/hiv/topics/ surveillance/resources/reports/2007report/ pdf/2007SurveillanceReport.pdf Valenti, J. (2009). The purity myth: How America’s obsession with virginity Is hurting young women. Berkeley, CA: Seal Press. Vermont Sexual Violence Prevention Task Force. (2010). Vermont’s sexual violence prevention technical assistance resource guide (TARG): For school communities K-12 incorporating sexual violence prevention into the health education curriculum. Vermont: Vermont Sexual Violence Prevention Task Force. Retrieved from: http:// education.vermont.gov/new/pdfdoc/pgm_health_ed/ publications_resources/educ_health_ed_TARG.pdf Virginia Sexual and Domestic Violence Action Alliance. (2011). Healthy sexuality for sexual violence prevention: A report on promising curriculum-based approaches. Richmond, VA: VSDVAA. Retrieved from: http://www. vsdvalliance.org/primary_prevention/ partners/vsdvaaStatewide/tools/Healthy%20 Sexuality%20Curriculum%20Report_FINAL.pdf