Looking SHARP? Impact Data Still Elusive for Navy & Marine Sexual Health Program
By Emily Ike, SIECUS Program Research Intern

Source:
Michael R. MacDonald, “Sexual Health and Responsibility Program (SHARP): Preventing HIV, STIs, and Unplanned Pregnancies in the Navy and Marine Corps,” Public Health Reports (2013).

Description:
The author analyzes the Sexual Health and Responsibility Program (SHARP), developed by the U.S. Navy and Marine Corps Public Health Center (NMCPHC) in 1999. SHARP is part of an effort to expand an existing HIV train-the-trainer program into a more comprehensive approach to prevent STIs, HIV, and unplanned pregnancy. Given high rates of unplanned pregnancy and sexual risk behaviors in the Navy and Marines, program planners aimed to encourage sexual responsibility and safety. SHARP was developed through partnerships of key stakeholders including Navy and Marine Corp leaders, researchers, public health advocates, health-care providers, and others. Beginning in 2000, program planners identified sets of evolving sexual health goals and objectives in order to evaluate SHARP’s effectiveness.

Key Findings:

• Rates of unplanned pregnancy in the Navy and Marines have remained steady over the past two decades and have yet to meet the target rate.
• HIV seroconversion rates in the Navy and Marines have declined each year from 2008 to 2011 after nine years of steady increases, but have yet to meet the target rate.
• Gonorrhea infection rates for male and female sailors and marines are low, and now meet or are better than target rates.
• Syphilis cases, while rare, have been rising since 2009.
• There is still a lack of sufficient data to determine whether the SHARP program has directly impacted rates of STDs, HIV, or unplanned pregnancy.

Analysis:
Sexuality education in the U.S. military is understudied, and civilian sexuality educators are often unfamiliar with programs designed to serve learners in uniform. Despite more than a decade of experience implementing SHARP, the U.S. Navy and Marine Corps lack sufficient data to demonstrate the program’s effectiveness at preventing unplanned pregnancies, STDs, and HIV. From the very start, program planners at NMCPHC identified those elements necessary for a successful prevention program involving sexuality education:  “(1) multidisciplinary involvement of many stakeholders, (2) written policies, and (3) measurable outcomes that are valued by leaders and funders.”[1] Because the role of the NMCPHC was strictly advisory, planners lacked direct control over several other elements necessary to ensure measurable, positive outcomes: training curricula, research, data collection, surveillance tools, and relevant policies and practices within the Navy and Marines.

Despite these limitations, the SHARP program increased the visibility of sexual health issues within the Navy and Marine Corps. Stakeholders advocated for better policies on access to condoms and emergency contraception, sexual risk assessment in primary care, HPV vaccination, Chlamydia screening, and partner referral services for HIV and other STDs. The program spurred development of new sexual health education, training, and information products, and integrated sexual health into a workplace-wellness award program sponsored by the Navy Surgeon General.

Sexuality education in the armed services is inconsistent, and in some cases programs are developed only as a response to unflattering news headlines in the wake of sexual assaults or harassment. As demonstrated with SHARP, promising programs still need to be rigorously evaluated to determine whether they are truly meeting the needs of sexually active people in the military. Although the true impact of SHARP remains unknown, the author makes a strong case for the rationale underlying the program:

 “The mere existence of a central sexual health program normalizes integrated and comprehensive sexual health messages, enables efficiencies (such as training product development), promotes program and policy uniformity, and provides a forum for cross-organizational collaboration and continuous improvement.”[2]

Sexuality educators working within the armed services can look to SHARP for promising program elements, while advocating for systematic, high-quality evaluation to ensure that their work is making a difference.