Table of Contents
The United States Must Confront Its Epidemic of Sexually Transmitted Diseases
The Kaiser Family Foundation is a private philanthropic organization that supports research and public education projects on health-related issues.
Summary: The problem of sexually transmitted diseases (STDs) in the United States is serious and is underestimated by many health care professionals. Such diseases can cause serious complications, including infertility and death. Young people are especially at risk. Not all STDs are curable, but all are preventable. The United States needs a coordinated national system of health services and education campaigns on safe sexual behaviors to prevent the further spread of STDs.
What Are Sexually Transmitted Diseases (STDs) and How Many Different Types Are There? “Sexually transmitted diseases” or “STDs” represent a group of at least 25 infectious organisms that are transmitted through sexual contact, and a number of syndromes that these STDs cause. These include: bacterial vaginosis, chancroid, chlamydia, cytomegalovirus (CMV), gonorrhea, hepatitis- B virus (HBV), herpes simplex virus (HSV) or genital herpes, human papillomavirus (HPV) or genital warts, hepatitis B, human immunodeficiency virus (HIV), pelvic inflammatory disease (PID), pubic lice, scabies, syphilis, and trichomoniasis. And, the number of STDs is growing. Since 1980, eight new sexually transmitted pathogens have been recognized in the United States alone, in part because...
(The entire section is 1883 words.)
Safer Sex Practices Can Be Satisfying and Prevent Sexually Transmitted Infections
Planned Parenthood Federation of America is a national organization of medical clinics that provide medical, counseling, and educational services relating to sexual and reproductive health, including screening and treatment for sexually transmitted diseases.
Summary: Sex is a normal and enjoyable part of life, but it carries with it the risk of contracting sexually transmitted infections (STIs). “Safer sex” refers to various techniques that sexually active people can utilize in order to lower their risks of contracting such diseases. By using condoms and practicing alternatives to intercourse, such as mutual masturbation, people can avoid contact with their sexual partner’s body fluids. Practicing safer sex can actually broaden and enhance a person’s sex life in addition to preventing disease.
“My love life actually improved when I started having safer sex.”
—a 41-year-old Hispanic man.
Enjoying Sex Is a Normal, Natural Part of Life. We are all sexual—from birth to death. When we decide to have sex, we want it to be satisfying—whether we’re women or men, married or single, young or old, straight, lesbian, gay, or bisexual. Most of us have taken risks to have sex—risks that include sexually transmitted infections (STIs). We take so many risks that at least one out of four of us becomes infected some time in our lives.
The risks we...
(The entire section is 2898 words.)
“Safe” Alternatives to Intercourse May Spread Sexually Transmitted Diseases
The Medical Institute for Sexual Health is a medical education organization that provides health information to parents, students, and educators that emphasizes the consequences of irresponsible sexual involvement.
Summary: Some public health leaders and organizations maintain that mutual masturbation and other forms of “outercourse” are safe alternatives to penetrative sex and that young people should be taught about these options as a means of reducing the incidence of sexually transmitted diseases (STDs). However, medical researchers have found that the organisms that cause STDs are present in the sexual secretions of men and women and can be transmitted from one person to another by sexual activity that does not include vaginal or anal intercourse. Educators should not teach adolescents that mutual masturbation and similar activities can protect them from STDs. Instead, they should challenge young people to limit sex to lifelong monogamous relationships.
Former Surgeon General Joycelyn Elders lost her job when she recommended that sexuality education include teaching students about masturbation. On World AIDS Day, December 1, 1994, at a meeting of the Society for the Psychological Study of Social Issues in New York City, Dr. Elders answered a question from Dr. Rob Clark about masturbation education by replying, “As for your specific question about masturbation, I think it is something...
(The entire section is 3162 words.)
Abstinence Education Can Prevent Sexually Transmitted Diseases
Kathleen M. Sullivan is director of Project Reality, an organization that promotes abstinence education.
Summary: The opposition to abstinence-only sex education expressed by organizations such as the Sexuality Information and Education Council of the United States (SIECUS) is misguided and selfserving. Giving young people information about condoms and other information about “safe” sex has helped to create an epidemic of teen pregnancy and sexually transmitted diseases (STDs). Children should be taught that abstinence is the only sure way to stay healthy and to prevent STDs.
Amazingly, some people in this country are vigorously discouraging state participation in the new provision for abstinence-education funding contained in the 1996 Welfare Reform Act. They need to understand that abstinence until marriage is not a moral judgment—it is a prescription for physical and emotional health. Those now so determined to silence the abstinence-centered message should open their minds and hearts and welcome this new opportunity to promote the healthiest lifestyle for our children and teens.
A panic cry is now emanating from mixed-message “safe” sex advocates like SIECUS (Sexuality Information and Education Council of the United States), in conjunction with its bureaucratic partners and some in the media, against abstinence education.
They call for “abstaining” from...
(The entire section is 710 words.)
Abstinence-Only Sex Education Is Not Effective in Preventing Sexually Transmitted Diseases
The Center for AIDS Prevention Studies (CAPS), based at the University of California at San Francisco, conducts research and public outreach programs focusing on the prevention of AIDS.
Summary: The “abstinence only” approach to sex education—in which students are taught to abstain from sex and all discussion of condoms or safer sex is avoided—is inappropriate for the significant numbers of adolescents who choose to have sex. Sexually active young people need information on how to prevent pregnancies and sexually transmitted diseases (STDs). Religious and political agendas, rather than public health needs, are driving government funding of abstinence education programs whose effectiveness has not been demonstrated in studies. Students should be encouraged to remain abstinent, but they should also be taught comprehensive information about sexuality, including condom usage and other methods of STD prevention.
Schools have become a battleground in the nation’s culture wars. In the fight over the hearts, minds—and libidos—of our nation’s teenagers, the latest skirmish involves sex education. The question is not whether education about sexuality belongs in the schools (there is well nigh universal accord on this score),1 but rather, how to approach the topic. “Just say no” is the answer, at least according to a growing number of champions of “abstinence only”...
(The entire section is 1533 words.)
Teenagers Should Be Taught About and Provided with Condoms
M. Joycelyn Elders, U.S. Surgeon General from 1993 to 1994, is a pediatric endocrinologist and author.
Summary: America’s children are being placed at risk for AIDS and other sexually transmitted diseases (STDs) because parents and teachers are reluctant to discuss the use of condoms. Promoting abstinence as the only means of STD prevention is not appropriate for all youth, many of whom reach puberty—and become aware of sexual feelings— at a relatively young age. Classroom abstinence education is also of little use to teen females who are sexually abused by older men. The United States must follow the example of other nations and provide young people with both comprehensive sex education and condoms to protect them from STDs.
These days we confuse ignorance with innocence. Many adults believe (wrongly) that children are asexual, have no sexual thoughts, feelings or desires and shouldn’t become aware of sex in any way before puberty. But in fact, sexual expression is coming earlier to teens, not because of loose morals or lack of values, but because children reach menses and puberty at an increasingly younger age. Yet by leaving them in the lurch rather than helping them understand the changes in their bodies, we punish our youth for what is literally beyond their control.
Few children today receive accurate, comprehensive health education at home; their mostly uninformed and...
(The entire section is 969 words.)
Condoms Do Not Protect Teenagers from Sexually Transmitted Diseases
John D. Hartigan is a corporate lawyer who has done volunteer legal work in the fields of public health and public education.
Summary: Studies have shown that school-based condom distribution programs have failed to achieve their goals of protecting youth from HIV infection and other sexually transmitted diseases and preventing teen pregnancies. Young people lack the necessary discipline to use condoms carefully and correctly. In addition, supplying teenagers with condoms encourages greater sexual activity. Educators must find another approach to protect America’s young people from sexually transmitted diseases.
The theory generally advanced to justify distributing condoms to teenagers is that this will protect them against pregnancy and HIV infection if they choose to be sexually active. However, study after study shows that this policy just doesn’t work in practice. In real life, handing out condoms to teenagers is a prescription for disaster.
The main reason for this is that teenagers are simply too impulsive and undisciplined to use condoms with the rigorous care needed to avoid failure. A 1988 survey conducted in the United States revealed that more than 27 percent of all never-married, low-income teenage girls who depend on condoms for birth control become pregnant in their first year of condom use.1
To make matters worse, supplying teenagers with...
(The entire section is 1000 words.)
Bias and Discrimination Against Women Impede Efforts to Prevent Sexually Transmitted Diseases
Hilary Hinds Kitasei is a freelance writer who reports frequently on health issues.
Summary: The American public health approach to sexually transmitted diseases (STDs) is based on the outmoded assumption that men are the primary victims. But STDs are also a serious health problem for women. Women are at a higher risk than men for being infected in any single sexual encounter and are more likely than men to suffer long-term complications. Many cases of STDs among women go undiagnosed and untreated because the women show no immediate symptoms and because doctors fail to detect their condition. Public funding for STD treatment and prevention must be increased and targeted toward women, and doctors and patients must be educated about the need for regular STD testing for sexually active women.
When the doors of the public clinic for sexually transmitted diseases (STDs) in southeast Washington, D.C., open at 8:00 in the morning, a throng of men and a few women are waiting outside. Often they are there because painful symptoms have alerted them to the fact that they may have a sexually transmitted infection. Because the clinic sees a limited number of patients, those who arrive early enough will be treated; the rest will go away, unseen and still infected.
Meanwhile, at a private gynecologist’s office nearby, a woman has a routine exam. The doctor questions her about her choice of...
(The entire section is 2041 words.)
Concerns About Civil Rights Have Hobbled Efforts to Control AIDS
Chandler Burr is a journalist and contributing editor to U.S. News & World Report. He is the author of the book A Separate Creation: The Search for the Biological Origins of Sexual Orientation.
Summary: Traditional public health measures—which include routine testing for disease, reporting the names of those infected to public health authorities, and tracing and notifying people who may have been exposed to the disease—could have saved thousands of lives if used against AIDS. However, U.S. public health officials did not take such actions because they feared violating people’s rights to privacy and freedom from discrimination and because gay organizations strongly opposed these measures. A comparison of the United States with Cuba—a country that did follow standard epidemiological measures—reveals how badly the United States has failed in controlling the AIDS epidemic.
Dr. Tom Coburn, a low-key 50-year-old family GP who practices obstetrics, mostly for Medicaid patients, in Muskogee, Oklahoma, is the front-runner for the title of Gay Activists’ Public Enemy Number One. It is a designation he is happy to contend for.
In his other job as a Republican congressman (“not my profession, I’m a doctor”), Coburn is the author and primary sponsor of HR-1062, The AIDS Prevention Act of 1997. All the major liberal, civil-liberties, gay, and AIDS...
(The entire section is 3772 words.)
Civil Rights Must Be Protected in the Fight Against AIDS
The American Civil Liberties Union is a national organization that works to defend civil rights and liberties guaranteed by law and the U.S. Constitution.
Summary: Some people have proposed that public health authorities should be given the names of all people who test positive for HIV, the virus that causes AIDS. Such a change to the present system of voluntary and anonymous AIDS testing would endanger privacy rights and would do little to end the AIDS epidemic. People fearing social prejudice will be reluctant to get tested for HIV/AIDS, preventing them from getting treated and hampering efforts to track the spread of the disease. An alternative approach would be to use a system of special codes called unique identifiers to track the epidemic while preserving the privacy of individuals. Such a formula would prevent any conflict between civil liberties and public health.
Recently, there have been renewed calls for HIV surveillance, and specifically for reporting the names of all those who test positive for HIV to public health authorities. Proponents of HIV surveillance and name reporting frequently suggest that there is a conflict between the privacy rights of individuals who have or may have HIV and the public health needs of the country, and that individual civil liberties must take a back seat in order to effectively battle the spread of HIV and AIDS.
In the public debate...
(The entire section is 5510 words.)
Gay Sexual Promiscuity Contributed to the AIDS Epidemic
Journalist and gay activist Gabriel Rotello is a former columnist for New York Newsday and author of Sexual Ecology: AIDS and the Destiny of Gay Men.
Summary: AIDS became an epidemic for American gay men in the 1980s because of the collective sexual behavior of that group, which included practices such as multiple concurrent partners, versatile anal sex, and widespread promiscuity centered in commercial sex establishments. The gay community must rethink its position on what gay liberation means in terms of sexual behavior.
Experts argue that the spread of the human immunodeficiency virus (HIV) among sexually active gay men in the early eighties resulted from a fatal confluence of the biology of HIV and the collective behavior of gay men. While the invention of safer sex in the form of the condom code is based on the simple idea that HIV is transmitted by infected body fluids, the reality is considerably more complex. HIV is indeed spread through body fluids, but virtually all sexually active people transmit body fluids, and very few produce rates of HIV transmission remotely approaching those of gay men. To understand why gay sexual ecology interacted with HIV in such a disastrous way, we need to look at the range of factors that influenced HIV transmission in the gay world.
Multipartner anal sex
Many people, including many gay men, presume that anal sex itself was...
(The entire section is 6373 words.)
Gay Men Can Have Safe Sex and Avoid AIDS
Joseph Sonnabend is a physician who treats victims of HIV/AIDS. Richard Berkowitz is an AIDS activist who cowrote the 1983 pamphlet “How to Have Sex in an Epidemic,” one of the first published articles to advocate safe sex and condom use to prevent AIDS.
Summary: In his controversial 1997 book Sexual Ecology: AIDS and the Destiny of Gay Men, Gabriel Rotello wrote that promiscuous sexual practices of gay men in the 1970s and 1980s furthered the spread of AIDS. Rotello concluded that gay men cannot use condoms and practice safe sex with enough consistency to prevent a “second wave” of AIDS, and he called for gay men to embrace sexual restraint and monogamy. However, a closer examination of the health data indicates that the rate of infection of HIV and other sexually transmitted diseases is falling—indicating that safe sex works to prevent disease. Moreover, stressing sexual restraint as the solution risks a return to the days when all gay sex was condemned by society and repressed within the gay population. Society should respect diversity in sexual expression and should redouble its efforts to teach methods of safe sex to prevent AIDS.
Sexual Ecology must be commended for its accurate analysis of how widespread changes in sexual behavior among gay men in the ’70s propelled the spread of AIDS. Hopefully, [the book’s author] Gabriel Rotello won’t be maligned for...
(The entire section is 1020 words.)