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Wednesday, December 1, 2010

HIV Prevention: Educating the Next Generation

By Peter Cassels -

Everyone agrees that sex education is the key to protecting teenagers from contracting HIV. What they don’t agree on is what they should be taught.

Most experts say using condoms and other safe-sex techniques is the most effective method of prevention, but social conservatives and some religions say abstinence is the only choice.

Prevention has taken on new urgency as infections rise throughout the world. The problem is particularly acute in large American cities. The Centers for Disease Control and Prevention recently issued an alarming report showing that one in five gay/bi men has HIV -- and many, especially African-Americans and those under 30, are unaware of it.

Pope Benedict XVI recently entered the fray when he said male prostitutes could use condoms to prevent the spread of HIV. A Vatican spokesperson clarified his remarks Nov. 23 by stating that using a condom is a lesser evil than transmitting HIV to a sex partner. Even that mild OK for condoms distressed conservative American Catholics.

The policy reversal came a year after the pope, en route to Africa, contended that condoms worsened the spread of the virus and could be prevented only by abstinence. Abstinence advocates say that is the best -- and only -- appropriate advice to give teens. It’s also the only method that is 100 percent effective, they hasten to point out.

Activists: Sure, Abstain. But Also Educate
Most comprehensive sex-education proponents argue that teens should be encouraged to abstain, but should also get information about how to avoid STDs and HIV.

There’s evidence that the latter approach is working. A recent Indiana University survey of more than 5,000 Americans, including about 800 under 18, showed that nearly 80 percent of teens use condoms during sex, while those 25 and over use them less than 20 percent of the time.

The study is consistent with results from the annual public school Youth Risk Behavior Survey and the National Survey of Family Growth.

Last January, the International Planned Parenthood Federation began distributing Healthy, Happy and Hot, a brochure for youth living with HIV to help them understand their rights.

The introduction states that its purpose is to support "your sexual pleasure and health, and to help you develop strong intimate relationships. It explores how your human rights and sexual well-being are related and suggests strategies to help you make decisions about dating, relationships, sex and parenthood."

Perhaps predictably, social conservatives were outraged.

In November, the right-wing list serve Free Republic linked an article from the conservative Life Site News that included excerpts from the pamphlet. One example: "Some people like to have aggressive sex. There is no right or wrong way to have sex." The report contended that the brochure encourages young people who might have sex after drinking or using drugs to "plan ahead by bringing condoms."

The Girl Scouts Get Involved
The piece further reported that a Mormon mother saw the brochure at a closed-door, girls-only meeting at UN headquarters in New York sponsored by Girl Scouts USA.

As a result, chapters around the nation "have been roiled in a debate about the connections between Girl Scouts and Planned Parenthood," the article continued. "Girl Scouts USA refuses to denounce the brochure and denies the brochure was in the UN room where the young girls met."

The Girl Scouts connection went viral on the Internet.

Free Republic reader reaction was unsurprising. One advocated violence. Another labeled HIV-positive people the "new protected minority" and "homo activists." A third called Planned Parenthood "baby-killing filth."

A comment argued that marriage is only between one man and one woman, then added: "Genital-genital contact only. Anything else is immoral and potentially fatal." One reader wrote haiku about leather, Vaseline, whips and chains. "I suggest that very few people with HIV are healthy or happy or hot (unless they have a fever)," said another.

Reaching about 1.2 million a year through 86 affiliates in every state and the District of Columbia, the Planned Parenthood Federation of America is the nation’s largest provider of teen sex education programs.

"We’re trying to balance abstinence and safe-sex education," Leslie Kanter, its national director of education initiatives, told EDGE in an interview.

She declined to comment on the brochure because the American organization was not involved in its production. Kanter did point out that only about half of 16-to-19-year-olds have had sexual intercourse.

"We have always included abstinence as an option," she reported. "It’s the current choice for a lot of teens. We want to make sure that they have the skills to implement the choice methods available and understand some of the pros and cons of each. There are far too many young people who regret a previous sexual experience. We would like to prevent that.

"We want people to engage in sexual behavior only when they have made a conscious commitment to do that when they and their partners are prepared," Kanter added.

Planned Parenthood’s programs, which reach 700,000 public school students, are LGBT-inclusive. "We don’t assume that everyone is going to have an opposite-sex partner," she explained.

Youths & Condoms
EDGE asked Ralph Vetters, medical director at the Sidney Borum, Jr. Health Center, a drop-in clinic adjacent to the Boston Common, whether the vast majority of youth use condoms during sex.

"It’s a little more nuanced than that," he maintained. "They will make a risk assessment based on whether or not it’s a long term relationship. The first time they will use a condom unless they are drunk or stoned, but over time as they develop a long-term relationship they tend to not use protection."

Vetters went on to explain that teens tend not to use condoms in coteries - small groups that have sex with each other:

"If they bring someone from outside, STDs will spread rather rapidly. That tends to be the model among African-American boys for HIV infection."

The center, part of Fenway Health, serves clients 12 to 29 years old. It conducts outreach services with a variety of Boston LGBT youth organizations and Bridge Over Troubled Waters, a shelter for gay and straight homeless youth.

Some of his clients practice abstinence. The physician is careful to acknowledge that, even though he believes protected sex is more effective.

"I always try to make sure that I’m supportive of abstinence for HIV prevention," he told EDGE. "I don’t want them to feel stupid and want to affirm and support their choice."

The clinic assesses youth involvement with parents and other relatives in discussing sexual practices. "At the same time, we provide sexual health support to minors independent of parental consent," he added. "Public health is better served if they have access."

Sexually Active in Early, Mid-Teens
Teens begin having sex at an early age, Vetters reported. The clinic has seen two 12-year-old patients in last two years.

"Most begin around 15 or 16," he said. "Not the majority, but a large percentage."

New York City’s Ali Forney Center provides shelter and outreach services to homeless LGBT youth.

Steven Gordon, associate director of supportive services, said in an interview that the center houses 58 but has more than 120 on a waiting list. Its outreach program serves an additional 650 clients annually.

Its staff routinely encounters safe-sex issues. Many clients "come to us sexually experienced," he explained. "While they know the points of using a condom, they don’t always think in the moment. When they are having a sexual experience, they forget about it."

Many are sex workers because it’s a way to survive on the streets, according to Gordon. Because they earn more for unprotected sex, some are willing to risk contracting HIV.

The AIDS Action Committee of Massachusetts also works with high-risk youth, including the homeless, through its Cambridge drop-in center. Like the Ali Forney Center, it performs HIV testing and other services.

AIDS Action operates several hotlines and web sites serving Bay State teens. It receives about 650 calls and e-mails a month, according to Katie Boos, multimedia and public information programs manager.

The web sites include Maria Talks ( for people under 25 and STD 411 ( for those 18 to 29.

"A common topic is questioning, exploring and trying to understand what sexuality means," said Boos. "We have young people who are out as well as those who are exploring their own feelings and what it means to them."

"Our approach is to provide as much information that is medically accurate and easy to understand so they can make healthy decisions," she added.

Peter Cassels is a recipient of the National Lesbian and Gay Journalists Association’s Excellence in Journalism award. His e-mail address is

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