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Friday, Jan. 9, 2009 | Marge Kleinsmith-Hildebrand oversees sex education in San Diego Unified schools and has helped teach local kids about the birds and bees for nearly two decades. She trains ordinary teachers to educate students about sensitive topics and brings in outside clinics and agencies to add more expertise and perspective.

The sex education program relies exclusively on outside funding from the Centers for Disease Control and Prevention, which bankrolls class segments ranging from one hour to two weeks. It gets no funding from the school district, and has only two teachers including Kleinsmith-Hildebrand herself, a gentle educator who just became a grandmother.

Kleinsmith-Hildebrand sat down with us to talk about why condom use is down, how a controversial rule about pregnant teens plays out in schools, and whether same sex marriage changes what children learn about sex.

What are the most persistent misconceptions about sex among San Diego teens?

They don’t really understand that it only takes once to transmit a sexually transmitted disease. They don’t understand that you can’t tell by looking at someone whether or not they have an infection. And so they tend to be very trusting. They forget that young people, and also older people, are not very honest about their sexual history. They think, “I know him,” or “I know her. We’ve been together for a couple of weeks.” And they put a lot of stock in that. “We don’t have to worry about using condoms, I know they don’t have a disease.” You have to be more cautious. Surveys say the two things people lie about most are sex and money.

There has been a lot of media attention to the hookup culture in colleges (people having casual sex with friends and not dating). Do you see frequently that among high schoolers as well? Does that affect the way you teach sex ed?

We’ve always joked about this idea that the kids are in serial monogamy. What happens is they meet someone and are hooking up. In their view, they are together for a few weeks and that seems long term, like they know them and are in love. … Part of that is what youth is about — the experience of being with different people. The unfortunate part is now you add sex into the mix and there is a health danger there. So I think the whole idea of hooking up, dating, experiencing different people — is fine. When you add the high-risk sexual behavior it gets more dangerous.

So the way to change that would not be to tell teens to structure their relationships differently, but to consider at what point you have sex?

Exactly. You know, I went to Catholic schools many years ago and I know there were young people having sex then. And they were in long term relationships and it was more hush hush. It may be a little more open now. Sex doesn’t have the same mystery or the same penalty that it did years ago.

People think that young people are more free with sex today, more promiscuous, but not according to our own data in the school district. … About 20 years ago, 52 percent of kids were having sex by the time they graduated, and now it is 38 percent. It has really gone down. But the attitude towards sex is a little more casual and we see that a lot in the media. … And young people see that and we are surprised that they don’t take sex more seriously.

Though sexual activity is down dramatically, you mentioned that condom use is also down slightly among San Diego Unified students. Do you have a sense why?

You know, I don’t. I have a concern about it because we know that condoms are the best way for young people to protect themselves. … There have been a lot of messages that condoms don’t work, they don’t really protect you, and so sometimes young people think, “Why bother?”

State law says we have to talk very specifically about condoms and what their success and failure rates are, and we know that they don’t protect against all STDs. But sometimes we give these messages, and maybe young people are weighing it and saying, “Well, if it’s not 100 percent, maybe it doesn’t matter.” The other thing is there is a lot of sexual behavior linked to drug and alcohol use, and when you’re using (drugs or alcohol), you’re not necessarily making the best decisions. …

Another thing that some researchers have been looking at is virginity pledges and talking about abstinence only. [San Diego Unified does not teach abstinence-only] but I think young people are still getting a lot of messages about abstinence only. If you only talk to them about abstinence, when the time comes and they want to have sex, they are really not prepared so they don’t think about, “What method am I going to use when that time comes?” … The assumption is that they will just never have sex.

There were a number of campaign ads this year that raised concerns that same sex marriage would in some way change what is being taught to kids about sex and marriage. Did the legalization of gay marriage change anything in San Diego Unified?

It called more attention to our programs and what we were teaching. Some of the ads really got people nervous about the messages we were going to be required to teach about gay marriage. There is a section of the Education Code that says if you are teaching a required health course — which we don’t have and the state doesn’t require — that you do have to talk about marriage. I guess people assumed that meant you would have to talk about all marriage.

But even as the law stands now, while teaching sex ed or about HIV you have to talk about respect for long term relationships and marriage. So the law already stands that we talk about respectful relationships (outside of marriage). We know that young people have different sexual orientations, they come from families where there are two moms, two dads, a mom and a dad, different combinations. And I feel very strongly that all kids and their families need to be respected in our programs. So the law was not going to change anything that we did — I think we already have things built in to be respectful to everybody in the public schools. But we did hear from more parents than usual.

How many parents, in general, pull their kids out of sex ed?

The number is very, very low and we usually see it in 6th grade because parents are uncomfortable. It is the first time their kids are getting sex ed, or maybe parents want to talk with their kids about it at home. We encourage parents to stay in the program and maybe exempt their kids for a couple lessons. But it is pretty low — I would even say that many schools have no exemptions.

We did have one elementary school that had a more religious school within a school, and that was a place where many parents exempted their children. They didn’t want them getting the program. (The school was Carver Elementary, which had absorbed a charter school that predominantly served Muslim families, and all of the girls’ parents asked to exempt them from a class taught by a male teacher.) This year we had more inquiries and parents concerned by what they were seeing on TV, that we were going to be teaching about gay marriage, or doing something extreme that they were worried about. I find that a lot of parents, once we talk with them and explain and let them see the curriculum, they’re usually pretty comfortable. …

At the same time, the Centers for Disease Control and Prevention are asking sex educators to focus more on high-risk youth, including gay, lesbian, bisexual and transgender youth. What are their unique needs, and how are they being addressed in San Diego Unified without raising those parents’ fears?

Our sex ed program is funded through a grant from the Centers for Disease Control and Prevention, and over the past years, because dollars have shrunk, they have really pushed us to look at the youth who are highest risk, to spend the money most efficiently and where the biggest need is. California is also focusing a lot of its state dollars on gay and lesbian young adults, specifically men who have sex with men.

What they are finding is that the disease is really high in both the African American and the Latino population, and the thought is that these are populations that have not been as open to gay and lesbian youth as others, some of it for cultural reasons, some of it for religious reasons. So these young people try to fly below the radar. … Because they may not be part of the mainstream to begin with, they feel kind of alienated, and since nobody is talking to them about these issues, they do face greater risks. They may feel like our messages aren’t for them. So we have made some changes. When we train teachers, we really emphasize to them that they need to focus on behaviors. Instead of talking about girlfriends or boyfriends, you say that if you engage in this behavior, you are at risk.

So what you are saying is that the whole curriculum is gender neutral — not that you have a part of the curriculum where you talk about gays and lesbians.

Exactly. … We work with teachers on their own values, to make sure they understand that their messages have to be for all students in the classroom. And we really encourage teachers to know who at their school is open and friendly to gay and lesbian youth. … We have also done a project with the American Psychological Association and we have trained about 60 agency partners and district personnel on the health risks of gay and lesbian youth. … In our last survey 12 percent of students said they had been harassed because they were perceived to be gay or lesbian, and it was because of that that we undertook these partnerships to get some training for staff, in the hopes that they can make school safer for young people.

How has sex education changed over the time that you have been involved? What do sex educators talk about today that they might not have 10 or 15 years ago?

Our program is over 60 years old and we have always had the same topics, but obviously the messages have changed. We focus more on skill-building rather than just giving kids facts. (She doesn’t mean putting a condom on a banana. Skills include learning how to refuse someone and to ask questions to gauge risks.) Research shows that facts alone do not change behavior.

We also do more training with educators to be more comfortable having conversations with young people. … They can interact with students and allow students to discuss their own values and what is on their minds. And we have one topic that I guess we didn’t talk about years ago — oral sex. In our district we found 31 percent of students said that they have participated in oral sex. The number actually surprised me. I didn’t think it would be that high. … We do talk much more about adolescent rights now and (STD) testing, and that is something I don’t remember including in our curriculum 10 or 15 years ago.

And this poses one of the biggest challenges. It is a fine line, balancing the rights of minors and the rights of their parents. Our role, really, as educators, is to empower young people to take control of their lives, to have healthy bodies and make good decisions. And that means letting them know where they can access health care, what they can and cannot have access to, and sometimes parents feel that this is not something we should be telling their young people. It is a challenge to stay in the middle and be respectful of everybody.

That raises a really interesting issue. More than a year ago, there was a big discussion in San Diego Unified about this rule on the books saying that educators must notify parents if their children are pregnant. There were questions raised about whether that conflicted with privacy laws. Despite all that, it is still on the books. How do educators handle that today and what is the impact of being in legal limbo?

It has been a major frustration, I have to admit, and part of that … is the change in leadership at San Diego Unified. It takes a very long time to change district policies and procedures. You get the ball rolling and then new people come in — a new superintendent or legal counsel — and things come to a halt and you have to go back to square one.

I often feel caught in the middle with this because I work a lot with agencies and teen clinics and they are very, very adamant from a medical point of view that teens have many rights to confidentiality and access to medical care. Then you come to the schools and they have rules that tend to favor parental rights more, under the assumption that you are protecting the minor, of course. So we get caught in a bind.

I try to refer to the California laws, and I do encourage students and clinics and agencies, if they have concerns that minors’ rights are being violated, they need to pursue it. A lot of times change happens more from the outside than from the inside. The school is in a precarious position. It is their job to protect minors, and parents have a huge role in that. They want to be respectful. So sometimes they feel caught. There is also the issue that there are laws that are very specific to medical providers but not necessarily to a classroom teacher. We know that counselors can extend privacy to students. School nurses are bound by medical confidentiality. But teachers and principals are a whole other legal realm. …

At the school site we try to refer young people to counselors or nurses and hope they can use their confidentiality, their medical and counseling training to guide them to where they need to go. … My hope is that they do get it resolved this year. It is not just a matter of having a clear policy, but having a procedure in place so that everyone knows who to call.

In the meantime, what would you advise teachers to do?

What we usually tell people is, our priority is the safety of the minor. … If a student brings something up and they think they might have a disease or they’re worried they might have a pregnancy, we can discuss things about that without knowing for sure that a student is pregnant or that they do have a disease. … There are ways to have conversations and not violate a student’s privacy. It is usually unlikely that a student would come in and say, “I know I’m pregnant, here is the sheet from the doctor that says I’m pregnant,” and it is only if we have a case like that that we are bound to report.

In such a large, diverse school district, how do you tailor your messages to kids with different cultures, different religions, different backgrounds, and possibly very different background knowledge?

We go into classrooms where some kids are very knowledgeable and sexually experienced and some classrooms where kids are not even thinking about sex. You see that around 8th and 9th grade a lot. … The classroom teacher is trained to implement our sex ed programs, which is valuable because the teachers know their students and they know how to adjust to them. We try to build our lessons to be interactive for the student, where kids will break into small groups and do focus questions or talk about a scenario. We are tapping into where they are and what they are thinking, and I think it is valuable for them to hear what other people are thinking too.

What would be a question you would use to start that?

A good example is a case study about a young couple at a party. It is a younger woman, maybe a high school senior, and a college freshman. Everyone is kind of pairing up and they find themselves alone, and it ends up with a sexual encounter, and the female really wasn’t expecting it and the male thought, “OK, we’re alone, this is what I was expecting.” And we have some guided questions for them and they talk about it.

It gives them a chance to say, “Well, she should have known because she went there and they were alone.” And somebody else might say, “No, she really liked him and didn’t know what to say,” or “She was intimidated by him.” You hear the students’ own experiences coming out. It isn’t a time when you say, “Yes, that’s right” or “No, that’s wrong” — unless obviously, if it was a case where a sexual assault occurred, the instructor would definitely say, “This was a case of sexual assault” and why. But you get to see how young people have these misconceptions about relationships and when sex is OK or when it’s not OK.

— Interview by EMILY ALPERT

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