Mid-Peninsula YWCA

NOTE: This study has ended.

Breakin’ Down Sexual Scripts: Empowering Youth in HIV Prevention Education

by Donnovan Somera and Carolyn Laub, AIDS Prevention Program at the YWCA of the Mid-Peninsula, CA

The AIDS Prevention Program (APP) at the YWCA of the Mid-Peninsula has been providing classroom-based HIV education to young people from East Palo Alto to San Jose since 1987. Today APP has expanded its services to include peer-based street outreach, Outlet–a support group for queer youth, and the Young Women’s Forum–a discussion group for young women. APP is presently working with the Dr. Rafael Diaz of the UCSF Center for AIDS Prevention Studies on an evaluation of our classroom program.

For more information on this Evaluation Project see the Complete Research Protocol

Also see the 1999 evaluation results for this project.

In brief, we believe that empowering youth, in the context of HIV/STD prevention work, is teaching them to analyze and think critically about the “cultural scripts” that regulate their sexual behavior. They must also be able to see how acting out these “scripts” will lead to self-damaging behaviors in the future. The term “cultural scripts” comes from Dr. Rafael Diaz in his work preventing HIV with Latino gay men. “Cultural scripts” are the set of ideas and norms that prescribe ways of thinking and acting in the world and can encompass a range of topics such as body ideals, violence, power, clothing, cars, etc. We will use the term “sexual scripts” to refer to the specific “cultural scripts” which regulate sex and sexuality. In addition, many of these “sexual scripts” are based on a system of rigid gender roles. We will use “sexual scripts” to refer to both gender-based and non-gender-based “cultural scripts” about sex and sexuality.

In order to further explain our definition of empowerment, we must review the theories underlying HIV prevention work over the last 15 years to point out how these theories fall short. We will then explore how a theory that acknowledges “sexual scripts” can build upon the prevention work we are already doing and move us closer to the empowerment of youth. We are drawing from our observations of and experiences with HIV prevention interventions, curricula, films, social marketing campaigns, and other media used in San Francisco, San Mateo, and Santa Clara Counties and around the country.

Simultaneously, we would like to model for you the process of evaluating your own interventions to be able to say explicitly what empowerment means to you. We think it is important for agencies which seek to empower youth to reflect on their activities and interventions by asking the questions: Why are we doing this? What are we trying to do/change? What are the theories underlying our work?

Facts and information: AIDS 101, pamphlets, “Get the facts!”

Underlying Theory: People participate in risky sexual behaviors because they are ignorant of facts and information.

Issues: The simple transfer of facts and information may work with apple juice and Ecoli or tampons and Toxic Shock Syndrome, but information, as necessary as it is, is not nearly sufficient to introduce, change or sustain behavior.

Compassion/Awareness: red ribbons, buttons, fundraisers, art displays, service projects

Underlying Theory: People participate in risky sexual behavior because they are not aware of HIV.

Issues: Activities/messages which teach compassion, spread awareness or raise money, for those affected/infected by HIV are no less useful today than they were in 1981, but we must not make the mistake of substituting them for activities which promote healthy behaviors. Empowering someone to walk in an AIDS Walk does not mean that they are empowered to have protected sex. Ultimately, red ribbons do not prevent the spread of sexually transmitted disease.

Invincibility: “Teenagers think they are immortal.” “It’s not gonna happen to me.”

Underlying Theory: Youth would protect themselves if they realized that they were at risk.

Issues: There are people, both youth and adults, who are ignorant or in denial about their risk for contracting HIV, but this theory does not explain the teenage girl who continues to have unprotected sex with her boyfriend weeks after an abortion or the gay man who has friends all around him who are HIV positive but has unprotected sex anyway. It should also be noted that the “invincibility mantra”: “You can get AIDS/Everybody’s at risk,” repeated over and over borders on scare tactics and can lead to a sense of fatalism (“Why should I protect myself if I’m going to get it anyway?”).

Peer education/culturally appropriate messages: “I did not believe it could happen to me because none of the people on billboards or TV looked like me.” “My Sex Ed. teacher was too old and s/he doesn’t understand teenagers.”

Underlying theory: People are not listening to prevention messages because the people sending the messages aren’t like them.

Issues: This is very important work that has brought us a long way in the art of communicating a prevention message. But, let us not put all of our energy into the “who” of HIV education and think we are done with the “what”. For example, if the message is prescriptive or preachy (Get tested!, Use a Condom!), if the message doesn’t address the reason a person puts themselves at risk in the first place, if the target person is in heavy denial, or if that person knows who sponsored the billboard and doesn’t trust authority, it may not matter that the speaker is culturally similar to the audience. Remember, an ineffective message coming from a culturally appropriate source is a very credible, ineffective message.

Peer Pressure: “Just Say No!”‘ “Condom Comebacks,” roleplays, assertiveness

Underlying Theory: People do risky things because other people pressure them to do so.

Issues: The ability to be assertive and resist peer pressure are skills that are absolutely necessary in life, but the effectiveness of these activities ddepends upon how they are taught. Many assume that the source of peer pressure is located entirely outside of the individual (i.e. I was minding my own business when along came the bully…), and that the pressure is manifested in ways that are overt (He said, “Smoke this or else you are a dork.”) This does not acknowledge the internalized component of peer pressure; what is powerful about peer pressure is that it acts upon things that we believe might be true about ourselves (i.e. “I’m the only one at this party who has nothing to say about sex. I haven’t had sex yet. Maybe there really is something wrong with me.”)

Skills: assertiveness, safer sex negotiation, condom demonstrations,”Teenagers need to get condoms in their hands, touch them, get used to them, and practice.”

Underlying Theory: People participate in risky sexual behavior because they lack the skills which are necessary for safer sex.

Issues: Teaching skills is absolutely necessary, but an educator must understand that these skills don’t exist in a vacuum. For example, teaching girls how to use condoms and negotiate safer sex is insufficient in a classroom where deep down the girls believe what the world has told them from birth: “Knowing and talking about sex makes you a slut.” Telling people that they should initiate conversations about safer sex seems simple enough. But, if the culture says taking risks is a way to prove your love, bringing up the topic of safer sex shows a lack of trust, you must get and keep a sexual partner and that your sexual partner is a symbol of your desireability and ultimately your worth as a person, that conversation gets a little more difficult.

Eroticizing Safer Sex:“If sex sells, then let’s use sex to sell safer sex.” Rubberware Parties, live safer-sex demonstrations, “Condoms are cool!”

Underlying Theory: People don’t use condoms and negotiate safer sex because talking about sex interrupts the flow,”latex is so medical,” and “condoms make me think of death.” If we turn safer sex into “hot and sexy” foreplay in people’s minds, then they will protect themselves.

Issues: This is a great idea except when the sexy messages that are used to sell safer sex are full of “sexual scripts.” In this case, you make safer sex more sexy while simultaneously perpetuating the “sexual scripts” which are the reason that (we hypothesize) safer sex is so difficult in the first place. For example, a person who is insecure about their sexual identity and lack of sexual experience is reading a safer sex brochure with sexy photos of “ideal” people. The photos have done their job by making people read it in the first place, but instead of hearing the safer sex message this reader may hear the message: “I am not a “real man/gay man/lesbian/etc. because I have not had (enough) sex yet” or ” My body doesn’t look like that” or “I would do anything to be with a person like that.” The information has been transferred but nothing has been done to deal with the complex “sexual scripts” that keep people from using the skills and information they know they should use.

Self-esteem: “Respect yourself. Protect yourself.”

Underlying Theory: People put themselves in risky situations because they don’t value/love/respect themselves.

Issues: We have no doubt that “low self-esteem” has direct links to risky sexual behaviors but the self-esteem issue is much too vague. There are many issues. (1) There are people with high self-esteem when it comes to jobs, athletics, school, political activism, etc. but when in the bedroom they have no voice. Our sense is that “sexual self-esteem” should be set apart from other parts of our lives. With the theory that “self-esteem” is one self-contained item ported around by humans, many teachers and institutions make the mistake of assuming that leadership training, proficiency in sports, political activism, etc. will generalize to assertive power in sexual situations. This is not necessarily so. (2) Increasing “sexual self-esteem” must not be confused with “sexual liberation.” As Maggie Hadleigh-West wrote in Ms., “I learned how to wake up with strangers. According to the world…I was sexually liberated.” However, a person with high “sexual self-esteem” would be able to assess their desires and the safety of the situation in order to know how and when to say “yes” or “no” and not feel guilty either way. (3) HIV prevention educators know that low self-esteem is a problem, but we don’t know what to do about it. Telling someone, “Respect Yourself!” is hardly empowerment. It is invalidating and sounds more like a threat, “If you have unsafe sex, you must not respect yourself, and so there is something wrong with you.” (4) If a girl will do anything to get/keep her boyfriend (i.e., not use a condom or say “no” to sex), we say that she must have low self-esteem. It never occurs to us that she lives in a culture that tells her that she will get self-esteem by having a boyfriend. Or if a gay man only feels “attractive” due to working out at the gym to achieve a body resembling the cultural ideal, we are misguided if we say his low self-esteem is his own fault because we haven’t acknowledged that the culture he lives in tells him to feel “unsexy and unattractive” if he doesn’t measure up to the cultural standards of beauty. Behaviors that make you feel good about yourself because they help you gain temporary societal approval must not be mistaken for building true self-esteem.

The theories underlying the HIV prevention strategies discussed above fall short because they only consider HIV risk as an individual phenomenon. Psychologically-based theories of behavior and behavior change posit that the power to change one’s own behavior lies within the individual and is a matter of having the information and intention to change behavior. While some theories have tried to deal with the role of peers as they affect an individual’s behavior, no HIV prevention theories have examined how an individual person is limited by the culturally-constructed set of “sexual scripts” that shape the environment in which a young person’s sexuality develops. Ultimately, none of the aforementioned prevention strategies will succeed in empowering youth if they do not acknowledge that it is disempowering for your sexual behavior to be regulated by a set of culturally-constructed sexual scripts of which you are unaware and that you don’t realize you can change. If we do not acknowledge and address the power of cultural scripts in our sexual health curricula, then our attempts to empower youth will fail. They may be “empowered” with facts, awareness, and skills, but we will have only transferred information not transformed behavior.

So what’s missing?

Sexual Scripts: We begin the process of unlearning the scripts in the classroom with an activity that we call “The Game.” It begins with a discussion of the names that males and females get called depending upon whether they are sexually active or not. The names come in four categories: “stud” and “fag” for the males, “virgin” and “slut” for the females. These names are the most overt manifestation of the system of rules that prescribe very limiting gender roles and standards for “sexiness” and “attractiveness” as well as construct what sex “should” be like. Through storytelling and interactive discussion, the educator helps the students understand how these “sexual scripts” limit our freedom to behave in non-scripted ways which will not lead to risky sexual behaviors.

While we call this “The Game” in our classroom work with youth, Rafael Diaz is also exploring “cultural scripts” with Latino gay men of all ages around the country. Drew Feraios of the AIDS Project of the East Bay calls it the “looksist hierarchy” and Michelangelo Signorile uses the term “body fascism” to describe the ways in which gay men are playing “The Game” of narrow ideals of beauty and heavily scripted sexual acts.

Underlying Theory: People participate in risky sexual behavior because their sexual behavior is being regulated by “sexual scripts” that are much more powerful than the facts and skills they know they “should” use. Empowerment is teaching people to identify and become critical of “sexual scripts.” “Sexual scripts” are not just a set of external forces (name calling or peer pressure) but a way of thinking, seeing the world, and seeing your role in that world that is socially constructed and then, internalized. The scripts are based in the heterosexist and gender-dividing culture that (regardless of what community we claim now) we all grew up in. As the name suggests, we have learned the script and we act out our role everyday.

One of the first breakthroughs that a person must make is that gender roles and the sexual act, including the activities, rules and rituals that surround it, are socially constructed and thus they can be changed. This requires a huge shift in paradigms because like the fish that can’t describe the water it swims in, people accept “sexual scripts” because they assume them to be normal and natural. Empowering people to be aware of and critical of “sexual scripts” occurs through characterizing these cultural norms as unnatural, abnormal, and dysfunctional. “Sexual scripts” enforce a system of oppression where people do not feel free to act in non-scripted ways. Lacking the freedom to make sexual choices keeps us from protecting ourselves and thus, leads us to risky behaviors and situations.

One of the basic premises of this theory is that if we were informed and truly free to make choices, then we would not (or at least be much less likely to) hurt ourselves or allow ourselves to be hurt. Using other behavior change theories to guide our prevention strategies results in us pathologizing the individual who gets infected with HIV. “He slipped up.” “She made a mistake.” “He didn’t know better.” However, prevention theories that understand the role of “sexual scripts” in the regulation of our sexual behavior do not consider people with HIV as people with an individual “problem” or “sickness.” Rather, people with HIV are unlucky manifestations of a sick culture. Living in this culture, we are all vulnerable; we have all been affected. Until we change our culture, we will all continue to have the sickness even if not all of us have gotten the virus yet.

In closing, we would first like to acknowledge the tireless work of HIV prevention educators who have persevered with few rewards for the last 15 years. Second, we must acknowledge that empowerment is a long process that takes a lot of time. As prevention educators, we are successful if we can help youth to take one step towards empowering themselves. Third, we are not saying that all of the prevention theories we have critiqued are useless, because many of them are absolutely necessary. In fact, we utilize many of them in our own HIV prevention curriculum. However, any of these theories, alone, are insufficient to empower youth to prevent HIV infection. While there is still much work to be done, we are hopeful that by addressing “sexual scripts” in our HIV prevention education we can strengthen and deepen our efforts to prevent HIV as well as our understanding of theories of empowerment and behavior change. Whether or not you agree with the conclusions that we have drawn here, it is imperative that, 15 years into the HIV epidemic, HIV prevention educators make their implicit theories explicit.

Last modified: October 22, 2012