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THE ISSUE: AIDS November 25, 2008

Filed under: Health — Ryann Hayman @ 2:23 pm
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Ta-Nehisi Coates on how abstinence-only education is exacerbating the AIDS epidemic. From our December 2008 issue. 


When 16-year-old Maché chase came across a new study noting that one-fourth of all teenage girls, and nearly half of all black girls, have a sexually transmitted disease, she barely took notice. “It wasn’t a shocker to me,” says Chase. “A lot of [teens] out here are having sex, and you can tell a lot of people don’t protect themselves. At my school, we have a lot of girls in the lower grades pregnant.”


Chase lives in Washington, D.C., ground zero in the war against HIV—experts say that one in 20 residents of the city is infected, more than in Port-au-Prince, Haiti. And more than 80 percent of D.C.’s HIV patients are black. But while Chase may be at risk, she’s also more knowledgeable about the facts of life than many adults. And the facts are not good: According to the latest data, the rate of new HIV infections is nearly 50 percent higher than previously believed.


Twelve years after powerful new drug therapies led the media to write about “the end of AIDS,” America has seen a resurgence of new infections, and 70 percent of the estimated 5,000 young people diagnosed with HIV this year will be black teenagers. After school, instead of hanging out in the neighborhood, Chase comes to a small basement office in Southeast Washington with a sign on the front that advertises free HIV testing. This is the home of Metro Teen AIDS (MTA), a community health organization founded in 1988, as the AIDS epidemic began ravaging the country.


Twenty years later, MTA’s mission is the same—equipping young people with enough information to be responsible for their sexuality—but the need is greater than ever. 
MTA’s office space is a shrine to sex education: Baskets of condoms are everywhere. On a cool spring afternoon, Chase joined a group of kids from 14 to 16 years old to discuss the various influences and pressures kids face as they become 
young adults. She and many of her friends were dressed in school uniforms mandated by the charter school they attend.


The girls giggled and talked freely. The boys sat back, trying to look cool, and were less eager to talk. The conversation ranged from attitudes among their peers to the effects of single-parent households to advice they offer to their parents. “I go home and be like, ‘Mommy, are you using condoms?’” Vernice Puryear, 16. “And she’s like, ‘You don’t got the right to ask me that.’ I be like, ‘Mom— dang, it’s my job.’” Though her parents may not like it, Puryear is doing exactly what MTA hopes its kids will do—taking the information they get here and disseminating it. “I guess she’s  okay with it sometimes, depending what I’m talking about,” Puryear continued, laughing.  “If I get too detailed, then she tells me to  calm down.”


Details are exactly what health-care workers say are missing from America’s approach to sex education. From cable TV to the Internet, pop culture is suffused with sex. And yet over the past eight years, the federal government has done all it could to take the sex out of sex education. Visit a health class at your local high school, and if they’re receiving any funding from Washington, you can expect an “abstinence education” curriculum that bars instructors from talking about condoms, birth control, and abortion.


In short, the federal government has four words for kids who ask about sex: Keep your pants on. “We are a sex-saturated and sex-suppressed society—all at once,” says Michael Carrera of New York’s Mount Sinai Medical Center. “Every single force and vector that  affects a young person is saturated with sex, from every show to every magazine to hip hop. But you can’t discuss it in school. You can’t talk about it at church. And worst of all, no grown-up wants to deal with it at home.  When there’s no sexual literacy among young people, and little sexual literacy among adults, you pay the price.”


For public health officials, that price is increasingly evident. Although there are six times more whites than blacks in America, the total number of AIDS deaths among blacks (218,000) is fast approaching the  number of AIDS deaths among whites (240,000), and AIDS is the leading cause of death for black women ages 25-34.


Meanwhile, according to the Centers for Disease Control and Prevention, teen condom use increased from 46 to 63 percent between 1991 and 2005. But for the last two years,  condom usage rate has remained flat.  As December 1, World AIDS Day,  approaches, activists are gearing up to do what educators can’t or won’t. “We think abstinence is important, too,” says Martha Kempner of the Sexuality Information and Education Council of the United States (SIECUS), an advocacy group that promotes comprehensive sex education. “But 63  percent of high school students are sexually active. We can’t just ignore them.”


“Abstinence education” dates back to the early 1980s, when the Christian right, emboldened by Ronald Reagan’s victory, began lobbying for funding to bring “chastity education” to America’s schools. But the just- say-no approach to sex ed was ill-funded until 1996, when Bill Clinton’s welfare reform legislation remixed “chastity education” to become “abstinence education” and set aside $50 million annually for the program. Under George W. Bush, the funding has more than tripled to $176 million. School districts and community organizations looking to qualify for the cash have to do more than tell kids not to have sex.


The law requires that anyone  receiving “abstinence education” funds  adhere to a list of tenets that include telling kids premarital sex could cause “harmful  psychological and physical effects.” “Abstinence education” is a favorite among Christian fundamentalists. Alaska Governor Sarah Palin was a proponent even after her unmarried 17-year-old daughter, Bristol, became pregnant. Like intelligent design, “abstinence education” is mostly built on moralizing and junk science.


A 2004 congressional analysis found that “abstinence education” instructors often pushed forward myths such as: abortion causes sterility and suicide; pregnancy can be caused by simply touching your genitals; and HIV can be spread through sweat. “I don’t think we ought to lie to our children about science,” Representative Henry Waxman (D-Calif.) told the Washington Post. “Something is seriously wrong when federal tax dollars are being used to mislead kids about basic health facts.” Furthermore,  “abstinence education” has been condemned by the American Medical Association, the American Academy of Pediatrics, and the American Public Health Association. “It’s a conservative social agenda masquerading as policy,” says Kempner.


And it’s policy with a real impact. As a  junior high school student in Mesa, Ariz., Max Siegel was given “abstinence education”  instruction in his physical education class.  “We laughed through it, and no one took it seriously,” says Siegel. “The teacher was  visibly uncomfortable. I can’t imagine that anyone saw it as realistic.” 
Reality intruded a few years later when 17- year old Siegel, who is gay, began a relation- ship with a 23-year-old man. “I took out a condom, he ignored me, and I didn’t push the issue,” says Siegel. A few months later, after participating in a local blood drive, he got a call from his mother. “A doctor from the blood bank called,” Siegel says. “He needed to see me immediately.”


Siegel was HIV-positive.  Advocates for “abstinence education” say that the best way to prevent cases like Siegel’s is to raise the bar for sexual mores. “It’s true that a lot of Americans will have sex before marriage,” says Valerie Huber, executive director of the National Abstinence Education Association. “But we would strongly argue that bar should be set at the point where there’s the best public health outcome.” For Huber, citing the risks of pregnancy, that place is marriage.


After going off to college, Siegel slowly transformed from patient into activist. Now 24, he testified before Congress this year on behalf of the AIDS Alliance for Children, Youth & Families. “I went to my first HIV conference when I was 19,” says Siegel, who is white. “I remember going up in the glass elevator in the hotel and looking down at the people attending. Everyone was African-American.” IN THE LATE ‘80S AND EARLY ‘90S, fear of teen pregnancy and HIV held a vice grip on the minds of young people. Boogie Down Productions’ “Jimmy” was the anthem for a generation that saw Magic Johnson’s basket- ball career ended by HIV. But it was the death of Eric “Eazy-E” Wright that truly brought home the threat. Losing his father to AIDS made Eazy’s son, Lil Eazy-E, become an anti- HIV activist. “In ’95 when my father passed away, people had to look at it,” says Eazy.


“My dad was an icon. They saw it wasn’t just the gays and the drug-users. It opened everyone’s eyes.” But today’s teenager is coming of age in a world where pop music can be audio erotica, where B-list celebrities busy themselves making sex tapes, and graphic sexual acts are but a mouse click away. Meanwhile, gossip pubs and best-selling books follow the intimate details of Hollywood starlets and video vixens.


“Right now people’s eyes are closed,” says Lil Eazy. “A lot of people don’t see until it hits home.”


Lil Eazy is part of a contingent of entertainers including Kelly Rowland and Common who are trying to encourage young people to get tested for HIV. Test 1 Million is a multiyear effort to screen a million young African- Americans for HIV by December 1, 2009.


“It’s important to know your status by getting tested because HIV/AIDS is taking a lot of lives in our community and around the world,” Common said recently. He also noted the impact of his own art, adding: “Your lyrics can really have an effect on people’s lives. I’ve seen it happen.”


In interviews, teens reject a direct causal relationship between pop culture and sexual irresponsibility, but most agree that among the least informed, pop culture can do dam- age. “Music doesn’t make me want to go out and have sex. I might listen to it. I might dance to it,” says 18-year-old Erica Scottbey from New Jersey. “I think it’s influential on those who don’t really know.”


Scottbey writes for Sex, Etc., a monthly magazine written, and edited, by teenagers.  Sex, Etc. is sponsored by Answer, a group that helps schools create a comprehensive sex-education program. In the pages of Sex, Etc., kids can find answers to intimate ques- tions about masturbation, homosexuality, and STDs.


One recent Saturday, Scottbey and the rest of her casually dressed staff assembled in front of a dry-erase board and brainstormed ideas for next issue. While the average Sex, Etc. reader may be well informed, Scottbey worries that many of her peers simply aren’t.  “In my school, people walk around like they’re invincible,” says Scottbey.


“They’re like, It’s not going to happen to me.” Healthcare professionals are hoping that kids like Scottbey will carry the lessons that schools are shying away from. The hardest messages to communicate are those beyond the immediate. Teenagers seem to get the threat of pregnancy—but STDs and HIV simply don’t have the same hold.  Teens “know that getting a girl pregnant can be devastating to your goals and your life,” says 18-year-old Mike Schwab, who also writes for Sex, Etc.


“STDs don’t have the same stigma. In pop culture, when Jamie Lynn Spears got pregnant, there was an eruption of publicity. If you wrote about every time a celebrity got an STD, you could fill up an almanac…. I think the reason people aren’t thinking about it is because it’s such an awful thing to happen that people block it out of their mind.” In that respect, teens have something in common with policy-makers in Washington who would rather not think about kids having sex. During a 2007 presidential debate at Howard University, Senator Barack Obama did outline a comprehensive AIDS strategy that included breaking down the shame and homophobia that impedes sex education. 


“One of the things we’ve got to overcome is the stigma that still exists in our communities,” he said. “We don’t talk about this. We don’t talk about it in schools. We don’t talk about it in the churches.” But after that, he didn’t talk about it much on the campaign trail either.


Health professionals who work daily with kids are hoping that the war and the economy won’t be the only things subject to change after the 2008 election. “I’ve been in the game a long time,” says Dr. Carrera. “I have no illusions about politicians. There are a lot of other deals in the background that drive policy. It’s not simply what’s best for the American citizen.”


“We think abstinence is important, too. But 63 percent of high school students are sexually active. We can’t just ignore them.” 


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