The CDC announced an increase in STD’s and an administration spokesman insisted that it’s all Bush’s fault, because some schools preach abstinence:

“Chlamydia and gonorrhea are stable at unacceptably high levels and syphilis is resurgent after almost being eliminated,” said John Douglas, director of the division of sexually transmitted diseases at the U.S. Centers for Disease Control and Prevention….

The administration of President Barack Obama has signaled a willingness to move away from so-called abstinence-only sex education approaches promoted by his predecessor, George W. Bush, and conservative state and local governments…

“We haven’t been promoting the full battery of messages,” Douglas said. “We have been sending people out with one seatbelt in the whole car.”

The problem with this statement?

Well, for one thing, the “statistics” on abstinence only programs are equivocal…depending on how you read them and the type of community which is using the program.

But that is beside the point.

My point is that Douglas seems to be blaming the high STD rate on Abstinence programs, and the statistics don’t prove that at all.

First of all, only some (not all) school districts offeried the controversial “abstinence only” sex education, and yet the rate of STD’s in the entire country has remained the same.

Second, a closer look at the statistics hint that the problem is not that of ordinary families as much as problems in certain American subcultures.

Let’s look at it from a “non judgmental” public health point of view.
There are:

* 1.2 million cases of chlamydia were reported in 2008, up from 1.1 million in 2007.

* Nearly 337,000 cases of gonorrhea were reported.

* Adolescent girls 15 to 19 years had the most chlamydia and gonorrhea cases of any age group at 409,531.

So adults who are old enough to know better have the majority of cases, even though teenagers are supposed to be the most ignorant.

Working in public health, we have to zero in on the “high risk” groups.

Teenagers are at high risk for sex: But not all teenagers, and even most of them are not promiscuous, but only having sex in a sustained relationship.

In 2003, 47 percent of all high school students and 62 percent of graduating seniors reported ever having had sexual intercourse.In 2003, approximately one-third of students nationwide reported being currently sexually active (that is, having had sexual intercourse in the three months preceding the survey).
• About 20 percent of high school seniors reported having had sex with four or more partners in 200

So if you are going for STD prevention, you don’t do it by shaming the ordinary students to think they are abnormal for not sleeping around, you have to shame those who are doing the risky behavior, those 20% who have had sex with four or more partners.

But isn’t this being judgmental?

The teenagers don’t think so. Again, from the CDC paper:

• Teens express more cautious attitudes about their decision to engage in sex. Many  teens who have already had sex wish they had waited longer. Nearly two thirds of all  teens who have already had sex said they wish they had waited longer before engaging in sex.

Being non judgmental only reinforces the lack of personal worth of young teen-aged girls who give into sex because they are afraid of hurting their boyfriend’s feelings, or because they think they “owe” it to him.

A lot of teen-aged pregnancy is due to low self esteem on the part of the girl, and teaching girls in sex ed classes that giving in to sexual demands is “normal”, without giving them instructions in how and why they should “say no”, especially if they don’t feel like it,  goes against the ideas that we feminists are trying to teach our daughters.

And I have no problem at teaching birth control as part of a health class, as long as it is placed into perspective of the larger issues of health and family.

But exactly who should be the targets of our outreach? Teaching condom use aimed at the average 14 year olds who are mainly at risk from sexual predators is not going to work. Yet we might want to give birth control to  our 17 year olds who have steady boyfriends, and are planning to go to college.

And no one is discussing another  real “problem”: that a lot of teenagers have babies because they think they are “cute”.

The first thing we need to check is what exactly is the “problem”.

Are we seeing an outbreak of STD’s among students, or among drop outs or those out of work? Parents or single? What percentage of them knew about condom use, and did they use condoms, or why not? Was drugs or alcohol involved in the episode? Do the young folk live alone, in dormitories, or in their own apartments? Do they live with a partner?

All of this information is available for researchers, because STD’s are reportable diseases.

But then you come into a statistic that is truly shocking:

* Blacks, who represent 12 percent of the U.S. population, accounted for about 71 percent of reported gonorrhea cases and almost half of all chlamydia and syphilis cases in 2008.

Why is this? Why blacks, and not Hispanics for example? Both groups live in poverty, and both groups tend to be uncircumcised. Are there behavioral characteristics that distinguish the two communities?

But even this number doesn’t tell us which black community has the STD epidemic: Is it higher among immigrants from Africa or from the West Indies? Among Blacks in the South or North? In only the inner city or among those in suburban or small town?

Another missing statistic: How many cases are actually “repeat offenders”?

Would a person treated three times in a year for syphilis be counted as one person, or as three cases of the disease.

Once we have all of this information, then we go on to ask: Why is the black community not using condoms? Or maybe we should rephrase it this way: Why are not black teen-aged girls insisting that their partners use condoms?

Back to self esteem issues again.  A girl whose self esteem is so low she thinks she has to give sex when asked is unlikely to insist on his using a condom. Do we just promote condom use, or do we take the next step and  promote the importance of personal dignity that includes the “right” to say no?

Such discussions are not the same as preaching: often they mean a classroom discussion with someone who is trained to bring out all the subtle points (so that the “smart alecs” don’t mock and cause those who are conservative in these matters to not talk about the social problems they see from irresponsible behavior in the community). There also needs to be research if such classes should be limited to only one sex at a time, so students feel safer to express their real feelings.

Finally, when one works with communities, one has to go to community leaders. On the Indian Reservations, this means teachers and tribal leaders, but in the inner city, that is the black church.

Where is the black church in all of this? Is the “separation of church and state” being used to silence the voices of authority in the community?  Or is it a type of reverse racism, where minorities aren’t expected to work hard, play by the rules, and achieve? (I say this from personal experience with teachers who didn’t expect hard work from my Hispanic sons)… I could change schools, but many inner city parents don’t have that option.

Then we have another problem:

* 63 percent of syphilis cases were among men who have sex with men.

This statistic has nothing to do with “abstinence only” policies in high school.

The increase of syphilis cases among gay communities is worrisome, since the chancre could increase the possibility of HIV transmission.

The big  public health question here is: Would gay marriage cut down the amount of dangerous sex in the male gay community? Would same sex marriage encourage monogamy in the more conservative parts of the gay community, or would it just mean  a tax break and a piece of paper without a change in behavior?

But another troubling fact:

* Syphilis rates among women increased 36 percent from 2007 to 2008.

So it’s not just gay men who don’t tell their partner they  have an STD.

Some of this comes from contact with prostitutes, but a lot of it seems to be spread by a few bisexual men who are promiscuous with women.

Not something that can be blamed on Bush’s abstinence program. Having a public health official blaming the problem on a few years of teaching abstinence in some but not all school districts is politicizing the public health problem in a way that helps no one.

In summary, STD’s have been a problem for thousands of years, but the way to approach STD’s is not to equate the behavior of the subgroups as the behavior of the whole.

In behaviorally related public health problems, you build up the good behavior while trying to eliminate or lower the risk of the “bad” behavior that threatens a person’s health.

The American public has been having the “promiscuity is normal” and “non promiscuous folks are prudes” thrown at them for 40 years by the media, so what ever is taught in schools has to take this into consideration.

But that doesn’t mean to give into teaching sociopath’s promiscuity is normal to our teenagers.

You can’t change sexual behavior,  insist the experts.

Well, actually, you can. Syphilis did so in the 16th century. The sexual revolution did the opposite, in the 1960’s.

Besides, if public health can educate people not to smoke, to limit drinking, and to eat a better diet (all of which lowered the death rates of heart disease over the last 40 years),  they can probably teach girls to be proud enough not to give in to every boy who asks.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes essays at HeyDoc Xanga blog.

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