Zipped Trousers, Crossed Legs, and Magical Thinking Sex Education in the Age of AIDS
Sendziuk, Paul
HEALTH-PROMOTION experts and historians generally concur that the federal government's response to HIV/AIDS during the 1980s and early 1990s was inadequate and constrained by...
...In comparison to nonpledgers, they were less likely to use condoms the first time they had sex (55 percent to 60 percent) and were more likely to engage in forms of sexual activity that they did not define as intercourse, such as oral and anal sex, which placed them at risk of acquiring sexually transmissible diseases (STDs...
...President Ronald Reagan famously refused to publicly address the issue of AIDS until five years after the first reported cases of AIDS (and only after it was clear that HIV was spreading outside so-called "deviant" groups, such as homosexuals and injecting drug users...
...These programs aim to reduce the rate of teenage pregnancy and incidence of sexually transmissible disease such as HIV...
...For adolescents aged fifteen to seventeen years, 77 percent of the decline in pregnancy risk was attributed to improved contraceptive use...
...15, suppl...
...Since George W. Bush came to power, funding for abstinence-based education programs has soared, from about $60 million in 2000 to $176 million in 2008...
...Unsurprisingly, approximately three million teens acquire a sexually transmissible infection each year...
...college undergraduates, which reported that more than 60 percent of those who had pledged sexual abstinence (through programs such as "True Love Waits") had broken their vow...
...4, 2003...
...Critics of this approach point out that in sub-Saharan Africa, where much of the money is directed, the majority of newly infected women contract the virus within marriage from their husbands...
...Congress was reluctant to fund gay-based organizations, such as New York's Gay Men's Health Crisis, to devise and deliver HIV prevention programs to their constituencies, despite evidence from countries such as Australia that peer-provided education was more successful and cost-effective than having medical professionals and public health bureaucrats design campaigns and disseminate information...
...For example, a multicenter study coordinated by Glynn et al., involving sexually active women between fifteen and nineteen years of age in Kenya and Zambia, found that HIV-infection levels were 10 percent higher for married young women than for sexually active unmarried young women (AIDS, vol...
...As Steven Sinding pointed out during a controversial session of the 2004 International AIDS Conference in Bangkok, these women had complied with the prevention messages that they were given and were well practiced in their As and Bs...
...It noted that although a "waiver" system had been implemented whereby selected country teams could be released from the funding formula based on the local epidemiology and specific country needs, the remaining country teams must compensate by spending even more than one-third of their total HIV prevention funds on abstinence and faithfulness programs to meet the statutory requirement at the global level...
...97, no...
...Some 35 percent required that abstinence be taught as the only option for unmarried people and either did not allow discussion of contraceptives or only mentioned them in the context of failure...
...Bishop, and C. Robinson, "Virginity Pledges: Who Takes Them and How Well Do They Work?," presentation at the annual convention of the American Psychological Society, Atlanta, Georgia, May 31, 2003...
...Federal public health officials claimed (and continue to assert) that there is less incentive for drug users to seek treatment once they are supplied with sterile equipment that reduces the danger of injecting, and fear that young people will experiment with drugs if needles and syringes are readily available...
...Global AIDS Coordinator issued a directive that all PEPFAR country teams must reserve half of their HIV prevention funds for nonsexually-related prevention interventions such as blood-safety programs, and that at least two-thirds of the remaining funds for HIV prevention be used to promote abstinence-until-marriage and/or faithfulness in marriage...
...Abstinence- and FaithfulnessinMarriage-focused programs, by their nature, do not have to address these issues...
...Lipsitz, P.D...
...The U.S...
...HERE IS also strong evidence that abstinencebased programs are failing to prevent pregnancies and may actually be counterproductive to the aim of reducing the spread of sexually transmissible diseases...
...A supplementary strategy would be for African and Asian governments to make concerted efforts to destigmatize and normalize condom use (with Australia and Thailand providing the obvious models) and invest in the development of vaginal microbicides...
...Nearly 37 percent of high school students who were sexually active at the time of the survey had not used a condom during their last sexual intercourse...
...4, 2005...
...His current research project asks whether artists who make work that deals with trauma and advocates social change can save lives in an epidemic...
...This pattern is reflected in other parts of Africa and Asia...
...32, no...
...The effectiveness of abstinence as a long-term strategy was also refuted by a study involving 527 U.S...
...Another study in rural Uganda, conducted by Kelly et al., found that of HIV-infected women ages fifteen to nineteen years, DISSENT / Summer 2008 n 5 7 SEX EDUCATION 88 percent were married (Journal of Acquired Immune Deficiency Syndrome, vol...
...HEALTH-PROMOTION experts and historians generally concur that the federal government's response to HIV/AIDS during the 1980s and early 1990s was inadequate and constrained by moralism...
...36, no...
...Let me note that the "safe sex" education programs and condom-marketing efforts in Africa and Asia target men as well as women...
...teens have sexual intercourse before leaving high school, and more than 750,000 teenage girls become pregnant each year...
...In 2005, the State Department's Office of the U.S...
...58 n DISSENT / Summer 2008...
...SEX EDUCATION ally had fewer sexual partners and delayed their first experience of vaginal intercourse longer than non-pledgers, they experienced a similar incidence of STDs...
...Accordingly, section 510 of Title V of the Social Security Act (P.L...
...Bush announced the plan in 2003, along with a request for $15 billion to be spent on fighting AIDS in poor countries burdened by high levels of HIV infection...
...Indeed, despite the fact that virginity-pledgers gener*A...
...Indeed, in some places, the primary HIV risk factor for women is being faithful to a husband with previous or current sexual partners...
...Unless other women in similar positions are given access to condoms, information about their use, and training in sexual negotiation (all of which U.S.-funded programs could provide), they are powerless to protect themselves...
...In terms of HIV/AIDS education, twenty-six states demand that abstinence be stressed as a preventative measure while a further eleven require that it be covered...
...Twenty-three states currently demand that abstinence be stressed during sex education classes, while ten states require that it be covered...
...schools...
...The resulting bill was ushered through Congress in record time, but only after conservative Republicans secured a number of provisions in the funding arrangement...
...The funding arrangement stipulates that schools can only claim federal money for sex education programs if classes have as their "exclusive purpose" the promotion of abstinence...
...A fully referenced version of this article is available from editors@dissentmagazine.org...
...4, 2001...
...In contrast, only seventeen states require that HIV/STD programs cover contraception, and none require that it be stressed...
...But such programs are initiating a process that could lead to widespread and long-term behavioral change...
...Learning the ABCs The Bush administration's preference for abstinenceuntil-marriage-based education is reflected in the types of programs it chooses to fund through the much-vaunted President's Emergency Plan for AIDS Relief (PEPFAR...
...The money has been dispensed without conclusive proof that abstinence programs have been successful in reducing HIV transmission anywhere in the world, although there are indications that this approach has been successful in Uganda...
...Yet they remain reluctant to publicly support condommarketing efforts while U.S...
...Yet between 1991 and 2001, eight comprehensive federally funded evaluations of the effectiveness of needle-exchange programs (both domestic and foreign-country based) concluded that such schemes reduced the rate of HIV transmission and did not lead to an increase in drug use...
...Fourteen states and the District of Columbia require that sex education programs cover contraception, but none require that it be stressed...
...Government Accountability Office (the audit, evaluation, and investigative arm of Congress), which issued a report on April 4, 2006 detailing their deleterious effects...
...324, no...
...And as the forthcoming presidential and congressional elections draw near, the President's Emergency Plan for AIDS Relief is likely to be touted as one of the greatest achievements of the current government...
...This means that no more than one-sixth of HIV prevention funds can be used for programs that promote condom use...
...If DISSENT / Summer 2008 n 5 5 SEX EDUCATION contraception is mentioned, it must only be in the context of its fallibility...
...Obviously, entrenched traditions and habits are hard to break, and "safe sex" programs will not change the situation overnight...
...In reality, the funding is even more circumscribed...
...The move toward abstinence-based sex education programs began in the early 1980s and received a boost in 1996, when Congress, under the auspices of a welfare reform bill, committed $50 million per year to support abstinencebased education (to be matched by $38 million contributed by the states...
...surgeon general, C. Everett Koop, fought a losing battle against Reagan and Secretary of Education William J. Bennett to introduce pragmatic sex education classes into American high schools or even mention the word "condoms" in literature mailed to U.S...
...By 2000, twothirds of public school districts had developed a policy on teaching sex education, many of them acting after the additional funding became available to schools that promoted abstinence in their curricula...
...The "devil in the detail" of the programs that provide sex education and HIV prevention initiatives in the United States and overseas will likely continue to go unnoticed by many, but may come to haunt the current generation of young Americans and young Africans and Asians whose opportunities to gain access to, and learn about, barrier contraceptives are curtailed...
...Funding is allocated through three channels: education grants to the states, the Adolescent Family Life Act, and Community Based Abstinence Education...
...preferences lie elsewhere...
...The model of HIV prevention that underpins the President's Emergency Plan for AIDS Relief is known as ABC ("Abstain, Be faithful, use Condoms"), where the promotion of abstinence-until-marriage and faithfulness-inmarriage is favored over programs that encourage condom use...
...According to the most recent and comprehensive survey (involving 13,917 students from 159 different schools), about 47 percent of U.S...
...The Cambodia Working Group on HIV/AIDS Projection, for instance, found that 50 percent of all married women who contracted HIV in 2002 were infected by their husbands...
...In addition to providing condoms and instruction about their correct use, some also address the issues of gender roles and consent (often downplayed in "safe sex" programs in the United States...
...One of the most significant is that onethird of the total funds allocated for HIV prevention must be reserved for programs with the objective of promoting "abstinence-untilmarriage...
...But they had no control over the sexual histories, or fidelity, of their husbands...
...households...
...THE PRESIDENT'S request for increased funding of abstinence-based sex and AIDS education programs in the United States is expected to be granted by Congress this year...
...Of equal concern was the finding that 55 percent of "pledgers" who reported retaining their virginity admitted to engaging in risky forms of non-vaginal sex.* A more comprehensive study published in 2005, involving 11,471 young adults between the ages of eighteen and twenty-four, found that 88 percent of virginity-pledgers had sex before marriage (Journal of Adolescent Health, vol...
...Despite findings such as these, the level of funding for "abstinence only" education programs continues to rise each year ($204 million has been requested for FY 2009), and the states and schools, desperate for funds to provide some form of sex- and AIDS/STDeducation, are compelled to chase the money and comply with the funding rules...
...And successive presidents and Republicanand Democrat-controlled Congresses have failed to provide funding for needle-and-syringe exchange programs, even though there is overwhelming evidence that they are effective in preventing HIV transmission among injecting drug users...
...As they are taught to simply zip their pants and cross their legs when gripped by sexual desire, we have little option but to cross our fingers and hope...
...1, 2007) concluded that approximately 86 percent of the decline can be explained by correct use of contraceptives and only 14 percent can be attributed to the delay of sexual activity...
...School districts with a sex education policy universally required that abstinence be taught, and 86 percent required that abstinence be promoted over other options for teenagers...
...A recent review of abstinence programs in the United States by Di Censo et al...
...104-193) states that such programs must teach "that a mutually faithful monogamous relationship in [the] context of marriage is the expected standard of human sexual activity" and "that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects...
...Such restrictions, it concluded, have forced some PEPFAR country teams to reduce funding to key programs, including those targeting high-risk sexually active youth...
...The influence of the religious right and a conservative social agenda remains evident in the federal government's current approach to AIDS prevention, particularly its vast commitment of funds for "abstinence-only" sex education programs in U.S...
...About one-third of states have either not mandated sex education in their school curricula or have yet to develop a policy on abstinence...
...He is the author of Learning to Trust: Australian Responses to AIDS (2004...
...Indeed, an exhaustive exami5 6 n DISSENT / Summer 2008 nation of behavioral and pregnancy data published in the American Journal of Public Health (vol...
...Given that the rate of teenage sexual activity has remained relatively stable—kids are still having sex—the reduced incidence of pregnancy has likely been the result of improved and consistent use of contraceptives...
...PAUL SENDZIUK teaches history at the University of Adelaide, Australia, and was a Visiting Scholar at New York University and Columbia University in 2008...
...While the incidence of teenage pregnancy in the United States has fallen substantially over this period, the downward trend was evident well before 1996, when specific funds became available for abstinence-based education and it became the norm...
...British Medical Journal, vol...
...7351, 2002) found that pregnancy rates among partners of young male abstinence-program participants were no lower than those among the partners of nonparticipants...
...It is a formidable task...
...These funding restrictions have been criticized, most recently by the U.S...
...And despite the large injection of funding for abstinence-based sex education programs in the United States, large-scale national surveys suggest that the rate of teenage sexual activity has remained stable for the past two decades...
Vol. 55 • July 2008 • No. 3
