Built on Tradition: Sexual Health Education for Indigenous Youth
Respecting the Circle of Life incorporates concepts important to Indigenous communities to help young people reduce pregnancy and STI risks.
In December 2021, health educator Barbara Harvey navigated their gray Ford Escape along icy and muddy roads through the rugged high desert of the Navajo Nation, getting lost several times before finally arriving at their destination: the home of several teenage boys.
To address pandemic concerns, the 13-, 14-, and 16-year-olds had built a well-ventilated shack in their side yard, complete with a tarp roof and a crackling fire.
“They put up the plyboards themselves and they even had a Christmas tree in there,” Harvey recalls. “We joked, ‘Should we be wearing hard hats for these lessons?’”
The small group sheltered from the snow and watched intently as Harvey used a wooden model to demonstrate effective condom use. They asked where to find condoms, and what to do if a condom breaks.
The visit was part of Respecting the Circle of Life, a program that focuses on reducing sexual risk for Indigenous young people by teaching them about pregnancy and STIs, building positive peer groups, and promoting condom use. For more than a decade, tribal stakeholders have worked with the Center for Indigenous Health on the course for Native American youth ages 10 to 19.
The program, which emphasizes communication between youth and their parents and caregivers, also addresses striking health inequities among Indigenous communities, where STIs such as chlamydia, gonorrhea, and syphilis take a disproportionate toll. Findings from a randomized control trial of more than 500 Native American youth in 31 tribal communities, published in July in the journal Children and Youth Services Review, suggest it’s working. Participants reported better sexual and reproductive health knowledge as well as increased intentions to use a condom or practice abstinence.
The program is especially important in communities that have a long history of exploitation and cultural oppression, notes Allison Barlow, PhD, MPH ’97, Center for Indigenous Health executive director. Decades of programs that removed Native American children from their families and placed them in federal boarding schools cut off youth from cultural teachings and traditions around reproductive health.
RCL connects with concepts important to Indigenous communities such as respecting one’s body, making empowering choices, and interacting as a positive community member, Barlow adds.
“Facilitators come from the local communities and they, themselves, become change agents,” says Barlow, a senior scientist in International Health. “Facilitators teach in a way that is engaging and not pedantic; there are supportive peer groups and open conversations with a lot of humor.”
RCL has its roots in a Baltimore program designed to reduce HIV risk among urban Black youth. In 2010, tribal and academic partners began creating a culturally adapted version that was piloted with the White Mountain Apache Tribe. In 2020, they launched the program for 140 male and female youth in the Navajo Nation.
While some adjustments were necessary, the White Mountain Apache and Navajo share similar cultural traditions that are referenced in the course, says Jennifer Richards, PhD, MPH, an assistant scientist in International Health and at the Center for Indigenous Health. The commonalities include referencing a rite-of-passage ceremony for a female’s first menstrual cycle as well as a shared hesitancy to discuss sexual health.
“Culturally, these are sensitive topics,” she notes. “Many of us didn’t grow up speaking freely about them.”
Harvey uses Navajo expressions and openly examines this cultural reluctance to discuss certain subjects. “If you say something, you may make it happen,” Harvey says. “That’s why it’s taboo, it’s hush-hush.”
In eight to 12 sessions, participants acknowledge these experiences and then explore why it makes sense to learn more. Often, youth come to the sessions having heard pop culture’s messages about sex but without prior sexual education. They are curious to learn, Harvey says. As the sessions go on, some teenagers have shared their decision to delay childbearing until they’ve finished college or found a good paying job.
Spreading the Knowledge
Parents or a trusted caregiver typically attend the final session to normalize future conversations around sexual and reproductive health. For Roberta John, the program came at just the right time for her three boys. She knew her two older sons, then 19 and 15, were at the right age for “the talk,” yet she feared it would feel awkward coming from her.
After the program, though, her sons appeared more confident and comfortable discussing sexual health. John felt different, too. “As parents, we can be understanding and supportive—it shouldn’t be uncomfortable,” she says.
Felecia Begaye, 19, heard about the program through her aunt, whose children were also participating. With so many activities shut down during the pandemic, she was eager to sign up for anything, she says.
Begaye, a member of the Navajo Nation, was drawn to the practical: what birth control prevention methods work best and why. She scribbled down notes such as what happens if you miss a birth control pill and how long an IUD works. Later, she convinced a close friend to use an IUD to prevent pregnancy.
“It’s always said that our bodies are sacred, our creator’s gift. The program is just about being safe and careful.”
Learning about pregnancy and STI prevention was also the most salient takeaway for LeAndre Frank, a 17-year-old member of the Navajo Nation who attends high school in Flagstaff, about a three-hour drive from his family’s reservation home. He appreciated useful life skills, such as how to put on a condom, as well as how the program’s goals aligned with Navajo values.
“It’s always said that our bodies are sacred, our creator’s gift,” Frank says. “The program is just about being safe and careful.”
At the dormitory for Native Americans attending high school off the reservation, he’s shared his newly acquired knowledge with classmates. Some have even reached out for advice before having sex for the first time.
“I tell them what I learned and how to be safe,” he says.