Sex education should be provided to all. However, our resources are limited. Priority is given to adolescents because:

1. They have a maximum sex drive.
2. They form a high risk group.
3. They are eager to get information because of the physical and physiological changes.
4. Their common sources of information (misinformation) are their friends, blue films and pornographic literature.
5. They are easily influenced and therefore likely to go astray and land in probems of unmarried motherhood, abortions, STD/HIV infections, sexual abuse.
6. They are going to be the responsible citizens of tomorrow.

Adolescents gather information about sexuality from friends and through the print and electronic media. Often this information is wrong and unscientific. They have a great curiocity and concern about the sexuality of their own and of the opposite sex. Adolescents often have neither access to accurate information on the issues related to sexuality and sexual health, nor solutions for their problems, due to socio-cultural barriers.

There is a rising rate of morbidity associated with sexual ignorance, poor decision making and inadequate sexuality education.

The studies on the effects of sex education in schools show that sex and AIDS education often encourages young people to delay sexual activity and to practise safer sex, once they are active. This is contrary to the popular belief that teaching young people about sexuality and contraception encourages sexual experimentation.

In a study of AIDS prevention programme done by UNICEF of selected Municipal Schools in Bombay (Mumbai), it was found that students’ queries ranged from sexual intercourse to marriage and sexual harassment. Many women’s organizations feel that the girls should not be ignorant about basic facts of life and become victims of sexual abuse, unwanted pregnancy and deception.

A survey shows that 50% of the daily clientele of an STD clinic comes from 15 to 25 age group. Children are not less informed but they are malinformed. Ignorance and misinformation provide the ideal environment for all sorts of risky behaviour. It is such behaviour that spreads HIV infection. Aims of Sex Education to adolescents

ITo help children understand that each part of the body and each phase of growth is good and purposeful.
1. To understand the process of reproduction.

2. To prepare children for the changes of developments which come with growing up.

3. To help young people see that sexual conduct involving other persons needs to be based upon a sincere regard for the welfare of the other.

4. To make children proud of their own sex and appreciate attributes and capacities of the other sex.

5. Responsible sex behaviour.

6. Building up of healthy attitudes to sex.

The aim is of prepare the adolescents of today to be productive, to have responsible and positive social-sexual behaviour, and to be caring and healthy adults of tomorrow. The need for this is knowledge, attitudes and skill gained through sequential sexuality education programme. Sex Education is:

1. Information: To provide accurate information about human sexuality, including growth and development, human reproduction, anatomy and physiology of genital organs, pregnancy, child birth, parenthood, contraception, abortion, sexual abuse, HIV/AIDS and sexually transmitted diseases (STD).

2. Attitude, values and insight: Opportunity to question, explore and assess their sexual attitudes in order to develop their own values, increase self-esteem, develop insights concerning relationships with members of both genders, and understand their obligation and responsibilities to others.

3. Relationships and interpersonal skills: Help them develop skills like communication, decision making, assertiveness, peer refusal skills and ability to create satisfactory relationships. Develop capacity for caring, supportive, non-coercive and mutually pleasurable intimate relationships.

4. Responsibility: To help young people exercise responsibility regarding sexual relationships, including abstinence; resist pressure to prematurely involve in sexual intercourse and encourage the use of contraception and other health measures.

There is little value in giving anyone information after the moment when they need it. Girls need to know about menstruation before it happens to them, and boys need to know about mastubation before they are experiencing the desire to masturbate. Boys experience nocturnal emissions from the age of about 14 years and girls attain menarche at the age of about 13 years. Some boys and girls experience these events even a year of two earlier. It is felt that the adolescent sex education should begin before these events take place.

Std. VI (age 11 years) is thought to be the age when sex education for adolescents should begin. Ideally sexuality education for adolescents should be introudced from Class VI (age 11 years) and continued through junior and senior colleges (age-20 years).

Students of Std. X and XII should be spared for their Board examinations. The aim is to provide information and guidance before they become curious, face problems due to physical and psychological changes or become sexually active. How to implement? Sexuality education should be offered as a part of overall comprehensive health education programme. It should include health promotion and disease prevention.

The sexuality education should be taught in a graded manner like mathematics. Secondly, the messages once introduced should be reinforced repeatedly at different levels. Agewise suitable curriculum should be available. Level I – Std. VI to X - Age 11 to 15 years. – to cover basics and essentials. Level II – Junior College and Senior College Age 16 to 20 years – to cover advanced studies and reinforce- ment of education. It is possible to develop more than the above two levels for the age group of 11 to 20, but then it would be difficult to demarcate the borderline between the levels while teaching the subjects.

Some aspects of sex education are gender specific and hence gender relevant. Therefore, separate sessions for boys and girls give opportunity to discuss the concerned topics at length, avoid embarrassment while discussing the subject and overcome shyness and anxiety while listening and enable them to share their doubts and views openly.

Girls feel shy, embarrassed and uncomfortable in the presence of boys and hence non-communicative. Therefore, they do not participate in the open discussion. Girls and boys have different problems. If the sex education programmes are to be made acceptable, girls and boys should be given sex education separately. The general topics of sexuality and health could be discussed in a male-female mixed group, while specific issues related to different sexes should be discussed separately in the respective groups.

The advantages of combined sessions are saving of time and repetition, fostering healthy interpersonal relationship between boys and girls, developing mutual respect and reducing inhibitions and anxiety about the subject in the presence of the opposite sex.

The girls and boys feel more comfortable if the resource person is of the same sex as their's. Girls ask questions related to menstruation and gynaecological disorders. Boys ask questions related to virility, masturbation, wet dreams, size of penis and coitus.

Teachers and students will feel more comfortable if they both are of the same gender. Therefore, it is preferable that the girls are given sex education by female teacher and boys by male teacher. There will be a necessity of having one male and one female educator in the school. These teachers should be trained by social workers, doctors, sexologists and psychologists.

Recommendations:

1. Sex education should be commensed before the onset of puberty.

2. It should be provided in a graded manner and should be spread over a period of 8 to 10 years.

3. It should be optional. This would help overall acceptance of the concept in the long run.

4. Parent's permission should be obtained and their cooperation should be solicited.

5. Sex education may be a part of the curricular or extracurricular activity.

6. An evaluation of the programme should be done, feed- back received, review and analysis done, and the programme should be modified from time to time.

7. Teaching should have a social perspective.

8. Answers be given truthfully.

9. Use correct names for various organs.

10. Parents/teachers should not be panic stricken or shocked if the child asks questions or indulges in sex play. Curiosity is normal. Such situation should be handled without rebuke, punishment or creating guilt feelings.

11. Parents and teachers should inculcate a sound sense of values and ideals. They should help young people capture the vision that sex is not a grimy secret between two ashamed individuals but divine impulse of life and love.

Teaching at school:
(Sex education in the school can best be extension of the sex education provided at home.)

1. Teaching should be scientifically correct.
2. It should be a two way dialogue.

3. The subject being emotionally charged, the language used and the manner of conducting of the programme should be socially acceptable.

4. The groups of students should be homogeneous in age and in cultural background.

5. If the teaching is round the year, 45 minutes to 1 hour session once a week should be adequate. Half a day or full day workship periodically 4 times a year would serve as an alternative.

6. Talks should be supported by audio-visual aids.
7. Group should not be over 50. Otherwise two way communication is difficult to establish.

8. Should begin as a pilot project.
   1. At least one trained teacher

   2. Support of administration

   3. Support of parents and teachers. A talk should be arranged for them so as to give an idea of the contents of the programme. Prior permission of the parents of participating students would be obligatory.

   4. Informal experimental programme should be undertaken on a modest scale and carefully planned to avoid culture-based sensational and needlessly controversial topics.

Implementation of programme:

The method and contents will depend upon: a) Availability of human resources b) Availability of time c) Availability of audio-visual aids d) Age, educational level, sex and cultural background of the group.

Methods: 1) Talks 2) Group discussion 3) Question box 4) Question-Answer sessions 5) Role play 6) Drama 7) Story telling 8) Debates 9) Showing films or slides Though, talks is a conventially used method, the other methods, if used, could bring a variety in the programme and maintain interest of the students.

Several topics could be picked up for the debates and dramas, e.g., STD/AIDS, teenage pregnancy, dowry, premarital counselling, myths and misconceptions, homosexuality, child marriage, sexual abuse, gender discrimination, selection of partner. “Question Box” approach for sex education is found to be effective. This method consists of installing a question box in a central place in the school/college campus. By putting a notice on the Notice Board all the students are informed to write questions (without writing their name) about their health problems or questions relating to their bodies and put them in the box. Once a week the box is opened by the teachers and the questions written therein are answered.

Question box approach to sex education is found to be convenient, easy to implement, takes care of embarrassment and fulfils the needs of the adolescents. Should sex education programme be included in a regular secondary school curriculum? Though, majority of principals and teachers are in favour of including sex education in the secondary school curriculum, some have expressed their reservations for it, the reasons being (1) Some topics are sensitive and may raise controversy, (2) Sex education would raise unnecessary curiosity and lead to misconduct among students. (3) Students are already overburdened with studies, (4) Schools have no extra time to allocate for sex education.

Who should give Sex Education?
Sexuality education should be taught by specially trained teachers or professionals or by trained peer groups. The community must be involved in the development and implementation of the programme. The programme must be carefully developed to respect the diversity of the values and beliefs represented by the community. Parents, teachers, administrators should be involved in developing a programme. In fact, briefing them about the developed programme prior to its implementation to students is quite essential. Preferably, the curriculum and the audiovisuals should be pretested.

Who Should train?
Sexologists, doctors, nurses, psychologists, social workers, teachers, volunteers, NGOs, media persons, peer groups etc. They should be trained in the subjects. Since the subject of sex education is multidisciplinary, more than one resource persons may be required. Government, municipality, NGOs, can render help. Not only the knowledge of sexuality but the methodology should also be included in the training. The Trainers/Teachers should Have acquired accurate knowledge Have a good communication skill Have a good listening skill Be able to establish good rapport with students and teachers Be non judgemental Be comfortable with his/her own sexuality.

Maintain confidentiality Selection of teachers:
It has been indicated by the adolescents in a survey that they would prefer to get such information from their teachers. Teachers are also best judges about the level of understanding of school child and they would be the best persons to screen or filter the socially unacceptable portions of such training. However, not all teachers would volunteer to participate in the project.

Teachers have their own inhibitions, misconceptions and confusions. Therefore, those teachers who volunteer for teaching sex education should be selected for training. It requires a gifted prudent and morally upright teacher to stand up before a group of young people and impress upon them that sex is precious and dignified. Therefore, not every teacher may be willing to undertake sex education and not every teacher who is willing to give sex education has the ability to do so.

Sometimes the most enthusiastic teacher may be the least suitable. The teachers should be selected only after thorough knowledge of their personality, attitudes and behaviour. Students should be encouraged to act as peer educators, and to share important information with those who don’t have access to it in the way they do.

Organizational Chart\
When the sex education programme is to be implemented on a large scale, the following organizational chart will be of help.

Planners : Core Committee: Govt. representatives Civic body representatives Experts in Human Sexuality Representatives from NGOs Representatives from Principals of schools/colleges Master Trainers : Sexologists Psychologists Trained social workers Doctors Key Trainers : Teachers Volunteers Beneficiaries : Students Parents Audio-visual Aids and Resource Material 1. Chalk-Blackboard 2. Charts/Pictures 3. Models 4. Slides and slide projector 5. Overhead projector 6. Video cassettes 7. Films 8. Books 9. Newspaper cuttings. At present many types of audio-visuals are not easily available. It is better to prepare one’s own audio-visuals that will meet the needs of the group.

Cultural differences in customs, dress, language and behaviour becomes so important that materials judged to be suitable in one region or culture may be totally unacceptable in another. Therefore, each cultural group should develop its own appropriate teaching aids. In order to achieve the best possible outcome from any programmes, it is necessary to invest in the development of competence of people who will be involved. Pretesting Pretesting inolves getting feedback on communication materials prior to their widespread diffusion by measuring the reaction of a group of individuals in the target audience. Pretesting is a cost effective means of avoiding a communications disaster. If materials are inappropriate, misunderstood or unappealing, they will not be worth and should be changed. Pretesting finds out whether the curriculum and the audio-visual materials are acceptable to the culture, whether the message is clearly understood and whether the materials are relevant.

Outcome:
The entire exercise of sex education is directed towards certain desired outcome. After getting sexuality education, the adolescent is expected to demonstrate certain life behaviours such as: – Appreciation of one’s own body – Interaction with both genders respectfully and in appropriate ways – Expression of love and intimacy in appropriate ways – Development and mainteinance of meaningful relationship – Living according to one’s values – Taking responsibility for one’s own behaviour – Practising effective decision making – Communicating effectively with family and peers – Enjoying one’s sexuality throughout life – Enjoying sexual feeling without guilt, shame and fear – Discrimination between life enhancing sexual behaviours and those that are harmful to self and for others. – Expression of one’s sexuality while respecting the rights of others. – Sexual relationship that are characterised by honesty, equality and responsibility. – Prevention of sexual abuse/rape. – Avoidance of unintended pregnancy. – Avoidance of contracting or transmitting STD/HIV – Use of contraception as and when necessary. – Early prenatal care – Health promoting behaviour like regular check up. – Awareness about sex scandals – Awareness about child marriage and population explosion. – Freedom from sexual inhibition/overactivity. – Avoidance of premarital and extramarital relationship. – Freedom from sexual dysfunctions. – Happy married life and responsible parenthood. – Refrain from quackery in the matters of sexuality. – Tolerance for people with different sexual values and life styles. – Responsibility to abide by legislation dealing with sexual issues. – Assessment of impact of cultural, religious, social meassages and media on one’s thoughts, feeling, values and behaviour related to sexuality. – Awareness about social evils like dowry deaths, female infanticide, gender discrimination, premarital pregnancy, child marriage, exploitation of females, sexual abuse and prostitution.

Ethics in Sex Education:
No body contacts No slang language No vulgar jokes No use of naked photographs/pornography No late hours No individual training Non judgemental No religious, cultural criticism No sharing of and asking for personal experiences No emotional involvement No advertisement or promotion of any commercial product. Confidentiality about the communication on sexual and personal matters. Be honest and answer truthfully all the questions posed by children.

Evaluation:
It is essential to receive the feedback, evaluate and analyse and modify the programme from time to time. Evaluation helps in knowing the effectivenss and shortcomings of the programme conducted. Suitable modifications can be made in the next programme to make them more effective. The data collected can be useful for research. The evaluation form should contain personal details (name may be optional so as to hide the identity) and the comments about the contents of the programme, the speakers, the audio-visuals, the duration and other details.

Evaluation can also be based on stated objectives of the course and cover attitudinal, behavioural and cognitive changes. Questionnaire or interviews in small groups intended to identify the needs of participants will determine how far these are being met. On the basis of information gained from these sources the curriculum will require continuing modification and restructuring.

Research
There are several methods of sex research. Each method has strengths and weaknesses. The selection of the method will depend upon the nature of the subject to be studied and the resources available. The methods are: Surveys, Observational research, Case studies, Clinical research, Experimental research.

Survey
Research Surveys are used for gathering information about a sample of population either by interviewing people or asking them to fill a questionnaire. Surveys are economical and permit flexibility in sampling. Surveys are affected by the accuracy of information provided by the subjects in answering questionnaires or interviewer’s questions. Reliability of surveys depend upon obtaining a proper sample.

Observational Research
It involves the use of human observer or an instrument to record the events being studied. The study of sexual response done by Masters and Johnson was a landmark. The accuracy in observational research does not depend upon subject’s self-reports. Volunteer bias may pose uncertainties in this method.

Case Studies
Case studies are in-depth examinations of one or more people having a particular condition. Generalization can- not be done in this method. The biases of researcher can also put limitations.

Clinical Research
It involves studies that test a type of treatment given for specific problem. The reliability will be maximum when done in comparison with a control group.

Experimental Research
It permits scientists to isolate specific variables that affect a condition or a behaviour and may allow them to draw a conclusion about cause and effect. Experimental research is expensive and difficult to perform. Volunteer bias, artificiality of situation may limit the validity of such studies. At present surveys seem to be the only possible method of research in our country. In evaluating the quality of research study it is necessary to look at such issues as the size and nature of the sample, the means by which data was collected, the type of data analysis that was done and the researcher’s discussion about the limitations of the study. It is necessary to see whether the study has been replicated elsewhere. Independent verification or research is most powerful tool for confirming the validity of a study.

Planning a Curriculum
There are no published countrywide accepted national guidelines for comprehensive adolescent sexuality education. Sex educators and teachers create their own curriculum for sexuality education. Some include anatomy and physiology of sex organs, physical, emotional changes at puberty, STD and AIDS, nutrition and hygiene and family planning; while some include family life issues such as relationship between family members, gender role, socialization and child development; few provide information about cultural and social aspects of human sexuality, sexual values and attitudes, beliefs, sexual activities and functioning. Very few include information on sexual behaviour.

Every expert has been dealing with it from one’s own perspective and experience. Therefore, there is a need for a comprehensive course in sexuality education. There can be no ideal curriculum that will meet the needs of every community. However, there can be a document containing guidelines on topics that may be presented to the adolescents in a developmentally appropriate manner, and to suit their needs. These guidelines are given in the next chapter. The characteristic of local situation should determine the exact contents of the local programme.

Community attitudes, developmental differences in children, local socioeconomic influence, parents’ expectations, students’ needs and expectations and religious and other perspectives should be paramount in designing the local sexuality education programme.

The suggestions given in the agewise guidelines should also be flexible. It is important to allow as much autonomy as possible at local level to develop contents and methods which are suitable to local circumstances and preferences. In early years of life, the focus of student-interest is his own developmental adjustment with reference to sexual behaviour. At the later stage, when he has accepted his own sexuality and established his values, he is ready to concentrate on assimilation of knowledge, especially of those aspects of sexuality that seem most relevant to his special areas of interest.

Sex relationships are most sensitive of all human relationships. A programme will not be effective if there is no understanding of moral, ethical, aesthetic and religious sensibilities of the people for whom the curriculum is designed. Apart from accepting a few basic principles on which general agreement is reached, planners would be wise to adopt a flexible approach and avoid stereotypes. The programme will require modification from time to time depending upon the feedback, the need, the acceptance and the changing circumstances.