The Impact of Contextual Factors on Comprehensive Sexuality Education for Learners with Intellectual Disabilities in South Africa

Adolescents and youth with disabilities in South Africa still lack access to sexual and reproductive health and rights services including comprehensive sexuality education, which may increase their vulnerability to SRHR issues such as HIV and sexual violence. This is exacerbated for learners with intellectual disabilities whose educators often lack skills and tools to accommodate these learners in comprehensive sexuality education lessons. The following paper outlines the findings of a formative evaluation of an innovative sexuality training approach for educators of learners with diverse disabilities (Breaking the Silence approach). This approach was developed and piloted with educators across eight schools for learners with intellectual disabilities in KwaZulu-Natal, South Africa. The paper discusses the educators’ understanding and experiences of using this approach. The findings revealed that although educators were able to implement parts of the approach, contextual factors impacted the degree of implementation. These factors were related to perceptions of socio-cultural norms, interpersonal engagement with peers and management, the structural environment of school settings, and the wider community setting. Educators began to address cultural taboos related to talking about sexuality, but were challenged by untrained staff and the larger socio-cultural context, which includes a heighted risk of sexual violence against their learners. The paper concludes with recommendations for a further investigation of the approach within a whole school setting considering the needs of educators to not only acquire skills and knowledge but also to address their larger socio-cultural context in which they have to implement comprehensive sexuality education.     

Sexuality in People with Intellectual Disability: Review of Literature

Sexuality is an important component in people’s lives, however forgotten in people with intellectual disabilities. Faced with this situation, people with intellectual disabilities tend to be in a situation of vulnerability with greater risk of sexual abuse and altered sexual behavior that give them difficulties to have a lasting relationship. A review of the literature was performed in the databases: Medline, Embase, Lilacs and Scielo. Included studies must mention the perception of people with intellectual disabilities about their sexuality in relation to: education, difficulties, strengths, gender identification, the role of the family and their close circle. 898 articles were reviewed by title and abstract. In total, 38 references were selected for full-text review. Being evident the importance of sexuality in people with intellectual disability, this topic should be addressed from a personal level and their close circle (family and support networks) through sex education about: sexuality, anatomy and functioning of the body, sexual abuse, use of contraceptives, and sentimental relationships. Sexuality in people with intellectual disability should be approached in a multidimensional way. An overarching theme is to teach family and educators not to diminish the value that represents sexuality in people and to assist when needed to address the process of sexual development and sexuality.     

Caregiver Perceptions and Implications for Sex Education for Individuals with Intellectual and Developmental Disabilities

Caregivers are important to the educational experiences of individuals with intellectual and developmental disabilities. Sexuality is an area of concern for many caregivers and parents. This study explores the relationship of caregiver perception of sexuality of individuals with intellectual and developmental disabilities, the caregiver perception of agency support for sex education, and their perception of their ability to participate in a sex education program designed specifically for individuals with intellectual and developmental disabilities.     

Protect or Enable? Teachers’ Beliefs and Practices Regarding Provision of Sexuality Education to Learners with Disability in KwaZulu-Natal,South Africa

Literature argues that people with disabilities have heightened risk of exposure to sexually transmitted infections, including HIV due to lack of HIV knowledge, access to health services, and increased risk of sexual abuse and poverty. People with disabilities lack access to sexuality education. Teachers should be at the forefront to address this; however there is little understanding of the knowledge, attitudes, practices and needs of teachers of learners with disabilities in regards to sexuality/HIV education in Africa. A pilot study was conducted in ten special schools (eight urban, two rural) representing four types of disabilities in South Africa. Data was collected from 99 teachers using scales investigating beliefs and practice in teaching sexuality education, perceived subjective norms, self-efficacy, and materials/professional preparation. Frequencies, means, standard deviations and Cronbach’s alphas were calculated for all scales. The data shows that overall teachers have positive attitudes towards teaching all elements of comprehensive sexuality education. However, they find it easier to discuss “soft topics” around relationships and personal skills (e.g., hygiene) than to talk about sexual behavior and functions. Teachers expressed confidence in their ability to teach sexuality education but indicated that their professional preparation and materials are not adequate to provide accessible sexuality education to their learners. The study highlights the need to develop appropriate materials and to build teachers’ capacity to deliver sexuality and HIV education to learners with disabilities.     

Level of Knowledge about Sexuality of People with Mental Disabilities

The paper examines the level of knowledge about sexuality of people with mental disabilities. The research also presents differences resulting from sex and the level of mental retardation. The sample included 24 persons with mental disabilities, who the author of this paper knew very well due to the time spent with them during a summer camp at a club in Vjeverica. Data was collected through direct interviews. Two types of questionnaires on sexuality of people with mental disabilities were used during these interviews. Results indicate that the level of knowledge about sexuality is not sufficient. Specifically low knowledge was shown in the area of the protection of sexual health such as sexually transmitted diseases and methods of protection. A relatively good level of knowledge was shown by the respondents in distinguishing between appropriate and inappropriate ways of sexual behaviour and social understanding of certain situational norms. Differences regarding sex and the level of disability were found. The results indicate the need for additional education on sexuality of both people with mental disabilities and their parents, along with support. Despite the fact that the research was conducted on a small occasional sample, it indicates that further research on this subject is needed.     

Capacity to consent to sexual relationships in adults with learning disabilities

People with learning disabilities used to be seen as asexual or promiscuous and were discouraged from expressing their sexuality. However, with the growth of the rights movement, attention has turned to the dilemma of how to both empower and protect people with learning disabilities in relation to their sexuality. A recent research project showed that, on average, adults with learning disabilities knew much less about sex and understood much less about sexual abuse than non-disabled young people aged 16 years. Sex education made a significant difference to their knowledge and understanding however. The implications of the study for services for people with learning disabilities and for definitions of capacity to consent to sexual relationships are discussed.     

Specialists and Sexuality of Individuals with Disability

The article is a research report from a study on selected groups of specialists?? attitudes towards sexuality of people with intellectual and physical disabilities. 98 persons, including special educators, social workers, nurses and physiotherapists, completed semantic differentials of the author??s design. The Author??s own research concerned a broader meaning of sexuality taking into account its physical and psychosocial aspects. Sexual behavior, partnerships, contraception and sex education were among the concepts analyzed on the constructed differential. It was concluded that specialist respondents show more consent (stronger acceptance and more positive evaluation) to most aspects of sexuality of physically but not people with intellectual disabilities. Only sterilization is more accepted by them in relation to individuals with intellectual disability.     

Sexuality and People with Psychiatric Disabilities

This article explores the topic of sexuality and intimacy of people with severe mental illness by addressing a series of questions about the nature of psychiatric disability and its effects on sexual identity and behavior. After describing the characteristics of people with psychiatric disabilities, the paper explores where they fit in the disability rights movement and examines how society treats persons with psychiatric labels. Barriers to full sexual expression are explored, first, from consumer perspectives, and then from the research literature, including a look at impediments to use of contraception and safer sex practices. Finally, the analysis asks a series of questions about issues for women mental health consumers in the expression of their sexuality and access to women's health services, along with sexuality issues for gay, lesbian, bisexual, transgender, and HIV-positive consumers. Finally, the paper concludes with suggestions for ways the disability community and larger society can support mental health consumers' efforts to freely express their sexuality and combat stigmatizing societal representations of it.     

People with Intellectual Disabilities Talk About Sexuality: Implications for the Development of Sex Education

Existing sex education programmes have failed in involving people with intellectual disabilities in the development of these programmes. Not involving the target population decreases the likelihood that the sex education programme will be effective. This study was conducted to assess the perspectives of people with intellectual disabilities on several sexuality-related topics. Semi-structured interviews were held with 20 people with intellectual disabilities covering topics such as: sex education, relationships, sex, social media, parenthood and support. The reported frequency of sex education the participants receive is low. Their knowledge regarding sex education is mainly limited to topics such as safe sex, contraception and STI’s and tends to be superficial. Additionally, knowledge on safe sex does not always translate to safe sex behaviour. Finally, relationships are important for most participants; mainly because they don’t want to be alone. Findings from both this study and literature shows that there seems to be a need for high quality sex education. Topics to consider to include are: online relationships, social media and parenthood. It would also be beneficial to focus on sexuality-related skills. Finally, to increase the effectiveness of a sex education programme, it is advisable that a theory-and evidence-based framework, such as Intervention Mapping, is used for its development.     

Sexuality Education in Schools for Learners with Intellectual Disabilities in Kenya: Empowerment or Disempowerment?

This paper reports on the nature of sexuality education offered to learners with intellectual disabilities in Nairobi, Kenya. Data was gathered using focus group interviews with 56 learners with mild intellectual disabilities in the age range of 16–22 years. It was supplemented by group interviews with teachers and individual interviews with two head teachers and three deputy head teachers. Interviews were tape-recorded with participants’ permission and thematically analysed. The findings are presented in three themes: (a) sources of information on sexuality-related issues; (b) sexuality education content; and (c) suggestions for strengthening the current sexuality education programs for the group in question. The paper concludes that sexuality content offered for adolescents with intellectual disabilities is not empowering, it perpetuates their marginalization in society.     

Sexual Health: International Perspectives HIV/AIDS and Disability

Globally, one billion people with disabilities face additional barriers in the society that prevent equal participation in their human rights and fundamental sexual freedom which can impact their overall sexual health and wellbeing. Despite the advances in health services over the decades with a substantial decline of the new HIV infections, the exclusion of people with disabilities from mainstream HIV prevention campaigns can heighten risks of exposure to HIV/AIDS. The paper explores the impact of stigmatization and discrimination of people with disabilities from international perspectives based on the Millennium Development Goals and Sustainable Development Goals specifically on combating HIV/AIDS, through quality education and empowerment.     

Model of Intellectual Disability and the Relationship of Attitudes Towards the Sexuality of Persons with an Intellectual Disability

The following article discusses the relationship between the model of intellectual disability and the attitudes towards sexuality of people with disabilities. This correlation has been verified during the author’s own research conducted on students of several medical faculties such as nursing, public health, emergency medical services and physiotherapy. Tools of the author’s design have been used in the research. Likert-type scale “Perspective of intellectual disability” has been used to determine the model of disability seen from the medical (individual) or social perspective. To examine the attitudes towards sexuality two tools of the author’s own design have been used: a Likert-type scale “The essence of sexuality in persons with an intellectual disability” which has been used to analyze the cognitive aspect of the attitudes, and a semantic differential with notions concerning physical and psychosocial aspects of sexuality including the affective-evaluative aspect. As expected, significant correlations have been found between the model and the attitudes both in the cognitive and the affective-evaluative aspect. Higher scores for the individual model correlated with: (a) lover scores for most aspects of sexuality of people with intellectual disability, (b) perceiving them as asexual, (c) biological determinism in the sexual sphere. The social model concurred with positive values given to sexuality of people with intellectual disability and its normalization in the sphere of its determinants and symptoms.     

The sexual support needs of people with learning disabilities: A profile of those referred for sex education

This paper provides biographical and other data on the 185 people with learning disabilities referred to a specialist sex education service over a five year period. Their diverse range of needs are highlighted. Attention is paid to the different experiences of women and men. Prevalence figures of sexual abuse are given. A strong case is made for the development of further specialist services. Learning disabilities is the preferred term in Britain for what was previously known as mental handicap. In an international context it can be used interchangeably with developmental disability (mental retardation) or intellectual impairment.     

Sexuality Education Curriculum Content for Malaysian Students with Learning Disabilities

Sexuality education for students with learning disabilities has not been formally established in Malaysia. This study aimed to identify special education teachers’ acceptance of sexuality education content for secondary school students with learning disabilities. A nation-wide survey was conducted with 314 heads of the integrated program for students with learning disabilities. They rated the appropriateness of 42 sexuality education topics for students with learning disabilities. A principal component analysis revealed three distinct dimensions: human development and interpersonal skills; sexual behavior; and, social-sexual health, society and culture. Topics in the human development and interpersonal skills as well as the sexual health, society and culture dimensions were rated higher than topics in the sexual behavior dimension. This empirical finding was reflective of typical beliefs about sexuality in a conservative society. The practitioners perceived sexuality education for students with learning disabilities from a socialized biological perspective, with medical and social-based topics clustered under similar dimensions. Results also did not differ across gender. In conclusion, cultural context contributed to the acceptability of sexuality education content. We advocate that teachers be provided with more exposure and support to teach topics deemed more sensitive in a conservative society.     

Training in Sexuality and Relationships: An Australian Model

This article examines some of the dominant discourses which impacted on the process of developing a curriculum for staff working with people with an intellectual disability in the area of relationships and sexuality within a medium sized Government bureaucracy providing services to people with a disability. Constructions of sexuality as being solely a biological function, sex as dangerous and sex as penetration are challenged as are some of the dominant discourses of learning.     

Unprepared: An Appeal for Sex Education Training for Support Workers of Adults with Developmental Disabilities

The sexuality of adults with developmental disabilities (DDs) is a topic seldom addressed, even by those who are charged with their care. The importance of acknowledging that these individuals have the right to express sexual desires and be given comprehensive sex education is paramount for both their physical and mental health. This qualitative study involved presenting a series of open-ended questions to individuals currently or previously employed as support workers. These questions concerned the training and knowledge of these support workers regarding the sexuality of adults with DDs, and the policies relating to such issues in the institutions in which they work. Results reflect the lack of experience that support workers have as well as their lack of confidence in dealing with their clients when issues concerning sexuality arise.     

Peer Educators in the Facilitation of Sexuality and Respectful Relationship Education for People with an Intellectual Disability: A Scoping Review and Narrative Synthesis

A scoping review was conducted to identify how peer-education models are being used in sexuality and respectful relationship education for people with a disability. The search was conducted in August 2021 using the Joanna Briggs framework to scope and map the literature and research activity. Using strict criteria, 7 online databases, grey literature and reference lists were searched for resources written or published in the last 15 years (2006–2021). Relevant sources were shortlisted and assessed by the two authors. Six sources met the criteria for inclusion in this review. In total, four educational programs are described and discussed. The results identify four sexuality and respectful relationship programs that met screening criteria: (1) “Telling it like it is!”, (2) “Sexual Lives and Respectful Relationships”, (3) “Talking about sex and relationships: the views of young people with learning disabilities”, and (4) “Health, Safety & Sexuality Training for You & Me”. Peer-educators experienced increased confidence and feelings of empowerment, while people without an intellectual disability reported a greater understanding of the challenges and experiences of people with a disability. The use of peer educators to deliver sexuality and respectful relationship education for people with intellectual disability is a promising education model with multiple potential benefits for participants. However, more research is needed to understand the consequences and limitations of such programs.

     

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV(+)) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV(+) youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV(+) women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category-cultured to take responsibility-illuminates the informants' double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV(+) youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. 'Switch off lust', 'balancing lust, fear and obedience' and 'switch off the disease' are strategies that describe how the informants manage sexuality and disclosure. Young HIV(+) people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV(+) youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care.     

Gender and class differences in young people's sexuality and HIV/AIDS risk-taking behaviours in Thailand

This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk-taking behaviours in Thailand. Sixty young people aged 15-19, divided equally by gender and socioeconomic background, participated in focus groups and in-depth interviews. Four topics were explored: the differences between 'good' and 'bad' girls/boys; young people's perceptions of sexuality; social class variations in young people's knowledge of HIV/AIDS and perceptions of risk; and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of 'good girls/boys' as potential HIV/AIDS-free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in-depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at-risk group, nor considered their sexual behaviours to be at-risk behaviours. Finally, family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.