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Minimizing Harm and Maximizing

Pleasure: Considering the Harm
Reduction Paradigm for Sexuality
Education
a

Michal A. Naisteter M.Ed. & Justin A. Sitron Ed.D.

a

Boston Medical Center , Boston, MA, USA

Widener University , Chester, PA, USA

Published online: 14 Jun 2010.

To cite this article: Michal A. Naisteter M.Ed. & Justin A. Sitron Ed.D. (2010) Minimizing Harm and
Maximizing Pleasure: Considering the Harm Reduction Paradigm for Sexuality Education, American
Journal of Sexuality Education, 5:2, 101-115, DOI: 10.1080/10627197.2010.491046
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American Journal of Sexuality Education, 5:101115, 2010

Copyright Taylor & Francis Group, LLC
ISSN: 1554-6128 print / 1554-6136 online
DOI: 10.1080/10627197.2010.491046

ARTICLES
Minimizing Harm and Maximizing Pleasure:
Considering the Harm Reduction Paradigm
for Sexuality Education
MICHAL A. NAISTETER, M.Ed.
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Boston Medical Center, Boston, MA, USA

JUSTIN A. SITRON, Ed.D.

Widener University, Chester, PA, USA

This article explores the potential for introducing harm reduction

into sexuality education. When the goal of sexuality education is
on prevention and focuses on risk and public health concerns, a
discussion of pleasure is rendered problematic, as many pleasurable behaviors are inherently unsafe or risky when considered
using a safe-sex lens. The authors argue that integrating harm
reduction into a national strategy to enhance sexual health will
provide participants in sexuality education programs the agency to
make educated harm-aware choices about their behavior. A harm
reduction paradigm offers an opportunity to negotiate pleasure and
safety in a paradigm that juxtaposes unbound pleasure and restricted sexual safety, rather than one that allows for either unsafe
or safe sexual behavior choices.
KEYWORDS Sexuality education, prevention, pleasure, harm reduction, sefer sex

INTRODUCTION
With the passage of the health care reform bill in March 2010, the Obama Administration renewed $250 million for abstinence-focused education. These
funds will be allocated to participating states for the next five years (Landau,
2010). At the same time, the Presidents budget for fiscal year 2010 also included funding for comprehensive approaches to sexuality education (U.S.
Address correspondence to Michal A. Naisteter, Boston Medical Center, Section of Infectious Diseases, Dowling Room 3317, 850 Harrison Avenue, Boston, MA 02118. E-mail:
michal.naisteter@bmc.org
101

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M. A. Naisteter and J. A. Sitron

Department of Health and Human Services [USDHHS], 2010). As funding

goes to these very different types of sexuality education, educators and curriculum developers will be part of a cultural conversation about what types
of sexuality education are most effective. As a result, it is time for sexuality
educators in the United States to think about future strategic directions for
their work. It should be noted that both approaches, comprehensive and
abstinence-focused, aim at reducing teen pregnancy and have other public health goals, such as reducing participants risk of sexually transmitted
infections (STIs) and HIV transmission.
This article explores the potential for considering a harm reduction philosophy for sexuality education. Doing so would expand the dialogue we
have about education to one that includes an important aspect of sexuality that is often neglected or challenging to incorporatepleasure. While
this article will discuss sexuality education, STI/HIV prevention, and harm
reduction, it does not attempt to be a comprehensive review of the varied approaches and their efficacy. Instead, the article has four goals: (1) to
identify the common goals of comprehensive sexuality education programs
and STI/HIV prevention interventions and consider their limitations; (2) to
consider the neglect of pleasure in both strategies as they are most often
implemented; (3) to establish the value of introducing a harm reduction
paradigm in sexuality education programs; and (4) to offer some specific
suggestions on how to successfully integrate harm reduction into a national
strategy to enhance sexual health.

COMPREHENSIVE SEXUALITY EDUCATION DEFINED

The Sexuality Information and Education Council of the United States
(SIECUS) stated that the primary goal of sexuality education is to promote
adult sexual health while helping people achieve a positive view of sexuality (2004, p. 17). SIECUS (2009) defined sexuality education as . . . a lifelong
process of acquiring information and forming attitudes, beliefs, and values.
It encompasses sexual development, sexual and reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles
(1). The International Planned Parenthood Federation (IPPF, 2006) named
the following seven topics as important elements of comprehensive sexuality education: gender, sexual and reproductive health, sexual citizenship,
pleasure, violence, diversity, and relationships (p. 1). These comprehensive
approaches to sexuality education are supported by the World Health Organization (WHO, 2002), which offered a description of sexual health as a
state of physical, emotional, mental and social well being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity (8).
This conceptualization of sexual health emerged after a WHO conference
in 1975, which provided guiding principles for the education and treatment

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of STIs and pregnancy (Kelly, 2005). Since then, these concepts of human
rights, mental health, and responsibility have been added to this definition
(Edwards & Coleman, 2004).
What is unique about the WHO definition is that it makes clear a very
important point, that is, that the absence of disease is not the main outcome
or topic of sexuality education but rather one component of sexual health
goals. In considering the SIECUS and IPPF descriptions and this last point,
American sexuality educators are faced with an important question: How
can we develop sexuality education programs, the majority of which are
funded for disease prevention or pregnancy prevention purposes, to reflect
this comprehensive definition of sexual health while employing prevention
strategies at the same time?

Historical Reflection on Prevention-based Sexuality Education

To contextualize contemporary prevention-based sexuality education in the
United States, it is important to consider its history. During the late 1980s, the
dangers of the HIV pandemic caused interest in sexuality education burgeon
(Haffner & de Mauro, 1991). Over the past two decades, sexuality educators, researchers, and advocates have implored schools to implement more
comprehensive approaches to address sexuality by focusing on public health
issues (Bruess & Greenberg, 2009). In the current HIV-aware climate, when
authors write about the need for comprehensive sexuality education, the
language they utilize often has cited goals such as increasing contraceptive
use, reducing adolescent pregnancies, STI incidence, reducing risk behavior, and discouraging commencement of coital activity (Braeken & Cardinal,
2008; Bruess & Greenberg, 2009; Castleman, 2006; Delemater, Wagstaff, &
Havens, 2000; Sabia, 2006; Zabin et al., 1986). As a result, public health concerns have played a major role in shaping the goals of, and the justification
for, sexuality education.
With the increase in funding of abstinence-only sex education during
the 1990s and 2000s, the discourse surrounding comprehensive sexuality education became focused on an approach that incorporates contraception and
safer sex with abstinence (Goldfarb, 2005) in order to reduce the prevalence
of sexually related medical problems including teenage pregnancies, sexually
transmitted infections, including HIV infection, and sexual abuse (Bruess &
Greenberg, 2009, p. 17). Any discussion of broader goals of developing a
more positive and fulfilling sexuality, such as those mentioned above (IPPF,
2006; SIECUS, 2009), have often been ignored (Goldfarb, 2005). In addition to the funding that supports the preventionbased approach, sexuality
educators are also motivated to support it. According to Kelly (2005), many
sexuality educators are content with adopting such a framework that emphasizes sexuality as a health entity because it provides a safe and respectable
context for their work, and a reason to focus on preventative aspects of

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sexual behavior (p. 12). Our concern is that while sexuality educators and
their programming are addressing an important societal public health goal
with prevention-based education, they also are simultaneously compromising valuable and important tenets of comprehensive sexuality education. In
turn, they are forfeiting valuable opportunities to engage participants in truly
comprehensive programming that incorporates a comprehensive approach,
particularly with regards to sexual pleasure.

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Prevention Program Goals and Inadvertent Consequences

Prevention programs set goals based on measurable target outcomes and are
often evaluated in terms of risk behavior reduction and an increase in knowledge and skills (Beasley, 2008; CDC, 2007a; Ingham, 2005). These programs
are dominated by an emphasis on rational, scientific means to achieve goals
based on behavioral outcomes (CDC, 2007a). Primary prevention operates
in a paradigm of risk preemption by exclusively focusing on teaching participants to avoid negative health consequences before they transpire (Broom,
2008). Proponents often emphasize evidence-based programs, medicalization, and behavioral risk (Broom, 2008).
According to the CDC (2007b), the main goal of risk reduction prevention programs is to reduce participants risk of becoming infected with HIV
or to reduce the risk of transmitting the virus to others if the participant
is HIV infected. Many prevention programs aim to reduce participants frequency of risk behaviors, including unprotected vaginal and anal intercourse
with partners (Jones et al., 2008; Steward et al., 2008). Catania, Kegeles, and
Coates (1990) introduced the AIDS risk reduction model (ARRM) in 1990,
outlining stages and influences of behavior change efforts in relation to the
sexual transmission of HIV. In their three-level model, Catania et al. (1990)
posited that in order to potentially change peoples sexual behaviors, individuals must have knowledge about the favorable outcomes of safer behavior
and unfavorable outcomes of risk behavior. While this has come to be an
accepted approach, it sets up a dichotomy of sexual behaviors wherein
behaviors are one of two typessafer (leading to favorable outcomes) or
unsafe (leading to unfavorable outcomes). Accordingly, these types of programs are evaluated based on whether or not the sample group increases its
safer behaviors, such as condom use, and decreases its unsafe risky behaviors, such as unprotected sex and multiple sexual partnering (Broom, 2008;
Jones et al., 2008; Steward et al., 2008).
By primarily measuring behavioral outcomes around unprotected sex,
condom use, etc., prevention efforts fail to acknowledge the complexity
of sexual risk behaviors because they do not often account for factors
such as the cultural and social contexts of sexual behavior. Instead, they
focus on providing participants with either/or choices rather than teaching
them about the potential harms inherent in certain behaviors. Engaging
participants in such a discussion would help them learn to navigate some

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of the complex social and cultural contexts in which those behaviors

occur (Beasley, 2008; Broom, 2008). In addition, the dichotomous safe
versus unsafe prevention approach is chiefly negative and focuses on the
dangers and risks in sex rather than portraying sexuality in positive terms
while recognizing potential harm and ways to reduce it. Broom (2008)
argued that while prevention programs have good intentions, they are often
ineffective and come with many inadvertent negative consequences. Such
consequences can include the decontexualization of individuals from their
culture and environment, stigmatization of those who are already infected
(Broom, 2008; Nack, 2007), and resistance to health promotion messages as
a form of asserting individual agency. In response to Brooms (2008) point,
we would like to consider some of these consequences and propose a new
model for framing prevention interventions.

Condom-Focused Education and its Limitations

Despite the demonstrated effectiveness of the male condom, men and
women perceive condoms in a number of negative ways. Many studies
(e.g., Higgins & Hirsch, 2007; Marlatt, 1998; Measor, 2006) have indicated
that aversion to condoms from both men and women is a result from the
fact that they curtail pleasure, along with many other factors. Other factors
influencing noncondom use include: the understanding that condom use interrupts the flow of sex; unfavorable perceived peer norms surrounding safer
sex; issues of trust; discomfort with discussing safer sex; power disparities in
relationships; and the romantic discourse surrounding condomless sex (Higgins & Hirsch, 2007; Marlatt, 1998, Measor, 2006). In addition, some people
may prioritize flesh-to-flesh contact over sexual health (Measor, 2006).
Gay writers (Shernoff, 2006) who challenged the condom-use public
health agenda in the wake of the HIV epidemic have called the message that an individual should always use condoms the condom code
(p. 5). Condom fatigue and prevention fatigue are terms that have been
used to describe the psychological phenomenon of decreased condom use
and weariness of the promotion of safer sex (Adam, Husbands, Murray, &
Maxwell, 2005, p. 238). This cultural context of condoms poses a threat to
programs that solely utilize the safe versus unsafe paradigm for sexual behaviors, because for those participants who are fatigued by condom use the
only alternative left to them is not using a condom at all.
Studies (e.g., Adam et al., 2005; Shernoff, 2006; Wilton, Halkitis, English, & Robertson, 2005) have demonstrated that unprotected sex, including
barebacking, defined as intentional unprotected anal intercourse, arose for a
variety of reasons among MSM populations. Condomless sex involves a complex set of psychological and social factors and it can also hold cultural and
phenomenological meaning for gay men (Adam et al., 2005; Shernoff, 2006;
Wilton et al., 2005). Ridge (2004) found that meanings around the symbolic
importance of masculinity during sex have important implications during

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sex without condoms. Ridge (2004) explained that barebacking can be a

mode of letting go, be about muscles grinding, [be] a means of celebrating
masculinity and venturing beyond boundaries or feeling adventurous and
free (p. 275). While much of the literature around condomless sex has focused on this cultural phenomenon among MSM, it certainly does not have
to be limited to that group, but could also be occurring among heterosexuals
and lesbians. The important consideration here is that for some individuals,
sex with a condom is not a goal.
Shernoff (2006) outlined methods of condomless sexual activity that
have become more and more popular in recent years. These include:
(a) negotiated safetyan agreement between two HIV-negative individuals in a relationship who go through a process that will eventually lead to
the cessation of condoms during sex; (b) serosortingthe practice of selecting partners and sexual acts based on the same perceived HIV status;
(c) strategic positioningthe practice of an HIV-infected partner taking the
receptive role during barebacking with an HIV-negative insertive partner;
(d) withdrawalpulling the penis out prior to ejaculation; (e) dippinga
type of withdrawal; the penis is inserted only once or twice before withdrawing; (e) viral load calculatingmaking decisions about whether or not
to ejaculate inside of a partner based on viral load; and (f) oral sexthe
substitution of unprotected oral sex for unprotected nonoral sex.
In addition, Jones, Fennell, Higgins, and Blanchard (2009) suggested
that coitus interruptus is a popular and reliable method for pregnancy prevention. In their qualitative study of 30 heterosexual couples, many respondents mentioned problems with using condoms but viewed withdrawal as
an accessible back-up method (Jones et al., 2009). While the debate continues over the effectiveness of withdrawal with respect to pregnancy and
STI prevention, acknowledging the fact that many people use this method is
critical. Sexuality educators may also be hesitant to incorporate the Fertility
Awareness Method (FAM) into a curriculum, looking over the fact that many
heterosexual couples successfully incorporate this method into their contraceptive repertoire (Weschler, 2002). Despite a significant failure rate for
perfect use, sexuality educators must recognize that this is a valid method of
contraception and that there are reasons individuals seek out nonhormonal
birth control methods despite the risks involved (Jones et al., 2009; Weschler,
2002).
While individuals have been using the behavioral strategies presented
above in recent years, none has been proven to be 100% effective. To date
there is a lack of research documenting the effectiveness of these harmreduction strategies in reducing HIV/STI-infection (Shernoff, 2006) or unwanted pregnancy. With the socio-cultural context and complicated factors
that affect individual choices to use condoms or other prevention methods
such as abstinence, another important dynamic to consider is the role of
pleasure in sexual decision making.

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THE PLEASURE PRINCIPLE

In 1994, the Declaration of Sexual Rights was adopted at the 14th World
Congress of Sexology (World Association of Sexual Health [WAS], 1999). In
this document, WAS outlined pleasure as a fundamental sexual right, citing
pleasure as a source of physical, psychological, intellectual, and spiritual
well being (1999, 9). Sadly, both preventative health and sexuality education have often framed sexual health as management of risk and issues of
pleasure are often marginalized (Beasley, 2008; Broom, 2008). This use of
fear and risk in an attempt to motivate people to practice safer sex has been
noted as a great limitation of sexuality education and prevention programs
(Higgins & Hirsch, 2007; Philpott, Knerr, & Boydell, 2006).
Using prevention and risk messages as the motivating philosophy of
sexuality education results in making the discussion of pleasure highly problematic. Sexuality educators are often uncomfortable discussing pleasure in
the classroom setting (Ingham, 2005; Kelly, 2005). One reason this discomfort
may arise in a safe versus unsafe behavior paradigm is because acknowledging sex as pleasurable might be perceived as sending the message that unsafe, pleasurable behaviors are encouraged, thereby promoting risky sexual
practices (Kelly, 2005). However, young people have argued that prevention messages fail to provide them with information they need on pleasure
(Allen, 2007; Measor, Tiffin, & Miller, 2000). In a study among undergraduate
students enrolled in a sexuality education class, Goldfarb (2005) found that
the concept of pleasure was integral to what students perceived as a benefit
of the overall course. Some researchers have suggested that acknowledging
pleasure in sexual health education results in increased negotiation of sexual
practices and increased condom use (Beasley, 2008; Philpott et al., 2006).
One example is the Pleasure Project, a nonprofit organization in the United
Kingdom that aims to combine pleasure and safety into HIV prevention and
sexual health promotion (Philpott et al., 2006).
While these efforts have demonstrated that educators can present the
idea that safer sex and pleasurable sex are not mutually exclusive, prevention approaches to sexuality education have avoided comprehensive and
complex conversations about the relationship among sexuality, desire, pleasure, and danger while making the assumption that everyone wants to avoid
sexual risks. It is often assumed that the student is merely lacking safersex knowledge, but such a perspective does not acknowledge a participant
agency to make choices about engaging in risky sexual practices (Allen,
2007). As mentioned before, some people actively reject safer sex information
for a variety of reasons. In a safe versus unsafe paradigm no space is provided
for these students to consider other options. Instead, they are left out and
may feel as though they are portrayed as ignorant, negligent, or dangerous.
When safer sex and unsafe sex are polarized, a person who actively
risks sexual infection, gains pleasure from sexual risk, or wants to have a

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pregnancy is either ignored or disallowed. Furthermore, polarization may

alienate or marginalize individuals who have already participated in an unprotected sexual behavior while sending them negative messages about their
sexual selves (Allen, 2007). Research on barebacking and other forms of
unprotected sex has demonstrated that these behaviors hold meaning for
people that overshadow the risks (Adam et al., 2005; Ridge, 2004; Shernoff,
2006; Wilton et al., 2005). Prevention-based sexuality education can also
ignore and further stigmatize people who have STIs, including HIV, and
those who are considered part of high-risk groups, including sex workers
and injection-drug users (IDU). Research shows that individuals living with
STIs undergo emotionally difficult processes due to the intense stigma associated with being infected (Nack, 2007). This stigma can be reinforced in a
classroom when the focus is simply prevention. Defining any group or individual as deviant will minimize the capacity for a prevention-based sexuality
education program to positively influence them (Marlatt, 1998).

RETHINKING SEXUALITY EDUCATION: INTRODUCING A HARM

REDUCTION PARADIGM
Researchers have shown us that many people engage in unprotected sex,
but ignorance and irresponsibility are not sufficient explanations for peoples
choices. Adam et al. (2005) found that many men who bareback are well
informed, sophisticated calculators of risk, and any prevention message that
fails to respect the knowledge levels widespread in the community will surely
fall on deaf ears (p. 247). Sexuality educators must think more strategically
about options for effective sexuality education programs that aim to reduce
participants risk of HIV, STIs, or unwanted pregnancy. Given the realities of
life in the 21st century, Kelly (2005) called for the need to have a national
debate among sexuality educators to ascertain where the field is and where
it should be. Developing a grounded, theoretical approach could help sexuality educators find comfort, purpose, and direction for their work while
setting goals, developing curricula, and evaluating programs based on an
agreed-upon standard (Kelly, 2005, p. 15). We would like to engage sexuality educators, particularly those doing prevention-based education, in a
more comprehensive sexuality education approach that recognizes pleasure
as a part of their programs.
We propose a new taxonomy for sexual behaviors that includes a discussion of safety and risk but also incorporates pleasure and harm-awareness
rather than the threat of imminent danger. We propose a continuum in between two dichotomous poles for framing sexuality education programs that
have public health outcomes as their goals; but the strategy we propose
would also equip participants with the knowledge and skills they need to

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make informed harm-aware choices about their behaviors. Our proposed

continuum includes the vast variety of sexual behaviors in which individuals
engage and frames them with regards to pleasure and potential harm. On
one end of the continuum is unbound/restricted pleasure, where individuals
engage in sexual behaviors for pleasure without recognizing their limitations.
At this end of the continuum, pleasure, rather than caution, is the priority.
On the opposing end of the continuum is restricted sexual safety, in which
safety preempts sexual pleasure and choices are made with safety a priority.
Such an approach would include individuals of all sexual lifestyles and equip
them equally to make decisions that are best for their lives, circumstances,
social contexts, and family interests. It provides a new alternative to ruling
out behaviors that may alienate or marginalize individuals and exclude them
entirely from what is an important component of their development. The
definitions of sexual pleasure (WAS) and comprehensive sexuality education (IPPF, 2006; SIECUS, 2009) presented above do not refer to a specific
group of people but rather to all people.

Defining Harm Reduction

The harm-reduction literature offers philosophical approaches that we can
adapt for use in sexuality education programming. Harm reduction is a public
health-based approach that relies on multiple strategies to minimize health
and social consequences associated with risk behaviors (MacCoun, 1998;
Marlatt, 1998). The principles motivating the harm-reduction movement recognize that certain behaviors will always exist in society, and it is in the
best interest of everyone to reduce the harms of these behaviors. Driven
by the concerns of an individual as opposed to social morality and social
control, harm-reduction strategies are valued over insisting on the cessation
of a high-risk behavior, which is viewed as an unrealistic goal (Carlson,
1992; Ditmore, 2006). Harm-reduction dialogue is able to occur because services meet individuals where theyre at and enable them to make safer
choices (Ditmore, 2006, p. 202). As described previously, prevention approaches in sexuality education often fail to incorporate the message of
maximizing pleasure because, in a safe/unsafe paradigm, there is no room
to simply discuss reducing harms. Utilizing the harm-reduction philosophy
in prevention-based sexuality education would allow educators to acknowledge any positive harm-reducing behavioral changes that participants make
in their sexual lives. These changes can be used as a measure of the programs success without asking participants to compromise their personal
agency and integrity.
The term harm reduction was coined in the Netherlands in the early
1980s when the government made sterile syringes available to IDUs in order
to reduce the spread of Hepatitis B (Ditmore, 2006, p. 201). Currently, a large

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body of evidence demonstrates that the needle distribution strategy is an

effective method of HIV prevention (MacCoun, 1998; Marlatt, 1998; Nodine,
2006). Driven by the HIV pandemic, the harm-reduction philosophy was
applied to many other public health matters and high-risk groups (Nodine,
2006). Harm-reduction initiatives have been effective in curbing the spread
of blood-borne viruses among IDUs, their sexual partners, and their children,
without increasing drug use (Leslie, 2008).
The lessons learned from applying the harm-reduction model and principles to high-risk groups are compelling. Some studies (Marlatt, 1998; Tolson
& Stanborough, 1996) have shown that individuals more easily accept educational materials and workshops that accurately reflect the social context
and risk environment of individuals as opposed to only focusing on personal
failure. However, many harm reduction approaches remain controversial in
the United States because they clash with the sexual abstinence message
and the just say no to drug use policy (Marlatt, 1998; Rassmussen, 2000,
p. 137). Opponents of harm reduction have argued that it will communicate messages that tacitly condone or promote risky behaviors because of
the absence of strong disapproval (Marlatt, 1998; MacCoun, 1998). However,
without proper research on how harm-reduction messages are viewed by
individuals, this is only speculative (MacCoun, 1998). Some may worry that
making these behaviors safer will lead them to become more socially acceptable and commonplace, but there is no evidence to substantiate that
fear (Card et al., 2007).

Integrating Harm Reduction into Comprehensive Sexuality Education

Sexuality educators should consider applying the harm-reduction framework
in order to shift their work from a prevention-based approach to a comprehensive sexuality education approach. Re-imagining the public health philosophy supporting comprehensive sexuality education is not just a theoretical
issue but also one that has practical implications. This means that sexuality
educators should work to teach participants to minimize the harm that accompanies some sexual behaviors to work within the limits and context of
their audience and focus on attainable goals.
The harm-reduction model is more adaptable to the issues individuals
face compared with the prevention-based sexuality education model that is
rooted in abstinence or is limited to condom use. Sexuality educators must
recognize that an open discussion of unsafe sex is an important part of the
prevention process rather than a model which dichotomizes behaviors as either safe or unsafe. The sexual harm-reduction strategies that do not involve
condoms may still reduce HIV risk, even though they do not fully eliminate
that risk. A harm-reduction approach toward condomless sex would require
that sexuality educators acknowledge the behavior without condemning or

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condoning it (Shernoff, 2006). This educational strategy can still allow for
concerns of safety to enter the discussion. For example, the discussion of
contraception in a classroom operating under harm reduction would acknowledge withdrawal as a legitimate form of birth control and review the
positive and negative aspects of this method.
Contextualizing prevention techniques in terms of pleasure requires that
sexuality educators need to work through ideas surrounding abstinence and
harm reduction. Unfortunately, there is little training for sexuality education
from the harm-reduction perspective. Currently, one program incorporates
harm reduction into their sexuality training. Staff members at the Harm Reduction Coalition in New York City run a one-day program called Sexy
Harm Reduction. However, this program is geared toward clinicians and
focuses on substance use.
While it is true that pure value-neutrality may not be achievable, harmreduction training for sexuality educators needs to be available. A program
that focuses on teaching educators how to discuss harm-reduction methods would require that educators employ compassion and pragmatism while
acknowledging that people engage in risky behaviors. In this training, educators can examine how their public health philosophies influence their
educational content and what their students learn as a consequence. The
reluctance to candidly discuss unsafe sex needs to be examined so that
educators can be given tools to have an honest, rational discussion.

CONCLUSION
Harm-reduction messages will resonate with some audiences and will not
work for others; however, major leaders in our field consider that pleasure
is an undeniable characteristic of healthy sexuality. Ignoring its presence
risks undermining efforts designed to reduce sexual risk behaviors, fails to
recognize the experience and agency of educational participants, and may
even inadvertently intensify the pleasures associated with risky practices. The
philosophies underlying harm-reduction complement sex-positive comprehensive sexuality education. If we want individuals to develop the agency
needed to make empowered decisions, avoiding risk and only practicing
sex with condoms disallows them that agency. Harm-reduction models of
prevention allow for more nuanced messages, but the elimination of risk is
still an option. Still, it is important to note that endorsing harm reduction
might mean that sexuality educators will face a certain degree of opposition.
However, using this philosophy to guide sexuality education will not only
allow sexuality educators to emphasize abstinence and safer sex as important options but also provide information on harm-reduction strategies for
people who do not see this as a realistic goal.

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The potential impact of a program is greatly influenced by what the

participants bring to the educational experience. In an educational setting
that utilizes harm-reduction dialogue, teachers and students are able to coconstruct knowledge while engaging in frank, meaningful dialogue. By meeting people where theyre at, sexuality educators can empower their students to make harm-aware educated choices based on complete information
and set the foundation for further behavioral change.

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