Category Archives: prevention

Dec ’09 Milestone: Abstinence-Only Education

December 2009 was a landmark month in the US for the public health and harm reduction field. I wanted to highlighted one coup: End of years of abstinence only education.

pretty clever though

Obama allocated no money (zero) towards abstinence-only programs in his FY2010 budget request. No money. Nada. Zero. The history of federally-sponsored abstinence-only education is quite long, spanning as back as 1981. This is a dramatic and important move for the Obama Administration. In 2008 & 2009, the Bush Administration put almost a whopping $340million towards various abstinence-only-until-marriage educational programs and initiatives. Given the heaps and heaps and heaps and *even more heaps of evidence demonstrating that comprehensive education (including those that integrate abstinence into their curriculum) is more effective in decreasing unwanted pregnancy, STI, and HIV/AIDS rates among youth than abstinence only programs, this is quite a coup for public health and the future of healthy sex and sexuality education for youth.
*=pdf document

Many abstinence-only programs have not sufficiently tracked or compiled reliable and verifiable data since the 1980s about the usefulness of their interventions. This administration appears to be leaning more heavily towards science informing their policy decisions, so the suggestion for anti-comprehensive-sex-ed organizations would be: demonstrate that your position is effective in the short and longterm and it’ll be funded as well as in the past.

I’d be interested to read the reports.

Personally I am not opposed to abstinence being integrated into comprehensive sex ed. I’m impressed by people who do not engage in sexual activity either indefinitely or until marriage. Not because I believe that abstaining from sex is a virtue or especially more healthy than not engaging, but it is difficult to define yourself against what you’re being told to be. Sex is alluring and controversial, it is difficult to avoid it if one is tapped into any form of media or social interaction. It must be difficult to find acceptance and community as someone who either have no desire or interest in having sex or are actively resisting the temptation to have sex either indefinitely or until marriage. These interests and difficulties should be discussed in sex education curricula, to both create a safety net for the few who consistently choose not to engage but also to prevent the fairly high STI diagnoses among adolescents who take virginity pledges among the many for whom virginity pledges are a short term or a coerced commitment. Additionally, marriage is not the beginning and end of sexuality: people experience unintended pregnancies, unexpected STIs, and non-monogamy (either consensually or non).

In elementary school I decided to not have sex until marriage. I believed in this very seriously and believed my decision was sanctioned by God. Unfortunately, my decision was guided by how I defined sex, and my definition was limited exclusively to the knowledge I had access to. As I went to a privately-funded abstinence-only school, how sex was had and how babies are produced was a pretty vague concept to me, but I knew somehow nakedness was involved. My goal then became not to have a child out of wedlock. Technically, by my 10 year old standards, I have not violated this pledge as I am mostly likely infertile and still celebrate God, however I doubt I expected nearly two decades later to be teaching ‘so-called’ comprehensive sex-education to America’s children.

I am tempted to put America’s Children in italics. Let’s try it:

America’s Children!

More seriously, as a sex educator, my goals and the goals of many who receive family planning funding or work independently as sexuality activists and educators mirror that of ParentsForTruth, a major abstinence-only lobbying organization, who define abstinence-only education as:

  • Avoiding or getting out of dangerous, unhealthy, or abusive relationships
  • Developing skills to make good decisions
  • Setting goals for the future and taking realistic steps to reach them
  • Understanding and avoiding STDs
  • Information about contraceptives and their effectiveness against pregnancy and STDs

No brainer, these goals are admirable and difficult to argue against. I would add reducing the stigma of STDS/STIs and providing accessible treatment and support for those diagnosed or affected, but hey, close enough.

What is the difference between abstinence-only and comprehensive sex education then? The goals of comprehensive sex education is to provide the youth with an opportunity towards health through updated and reliable research. It seeks to give those seeking out sex education the answers to their questions and concerns as thoroughly as possible. Additionally, many who teach sex ed want to know what youth want to know and most youth want a broad range of information. Many youth bypass adultist barriers to information and teach comprehensive sex ed to their own peers.

Abstinence-only education does not allow this. My personal experience of abstinence-only education does not allow this. It instilled a terror of my own body, the bodies of others, and that my own moral and spiritual integrity was irreversibly linked to any type of sexual curiosity – and that any result that deviated from abstinence would lead to [insert various horrible things]. How is this healthy? Or effective?

Obama’s move is an awesome milestone in public health history.

Unfortunately, this big leap forward has not been met without resistance. A team of 10 senators, led by Orrin Hatch (R-UT),  included an amendment to the (now passed) Baucas health care reform bill that supports abstinence-only education (aka Title V funding). We’ll see how this pans out, I’m remaining blindly idealistic. Three tentative cheers: hip hip…. hip hip… hip-hip?

if I had a cartoon with Orrin Hatch it would be here!

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Prevention that works – Syringe Exchanges in the news

Thanks to NYTimes magazine those of us in the prevention and education field of public health are getting good press. It has been a rough few months , and I’ll include ACORN in that rough patch as one of the mantras in Prevention is: “Housing IS prevention”.

Since that article launched last week, there has been more buzz about the valuable and difficult work that needle exchanges offer. I wanted to highlight a few of them, particularly as there are far too few needle exchanges across the US and the ones that do exist often face police harassment, community reprisal, staff burnout, funding cuts, and other threats to their existence. Or, more importantly, bills that are moving in the legislature to ban them

1. Physician’s for Human Rights: Tell Obama to end the Syringe Exchange Ban
2. Harm Reduction Coalition features a guest author who talks about how a needle exchange saved [their] life
3. Center for Global Health Policy on how needle programs curb the spread of HIV/AIDS across the globe.
4. Hume Leader: ‘Syringes: A Life saver, a study’
5. The Australian Drug Blog evaluates Australian government data on cost-effectiveness, return on investment and prevention in needle exchange programs
6. A TED talk by Marc Kosha has a more global focus on the re-use of syringes in low-resourced clinics. His proposal? Create a single-use low-cost syringe. This is important to include in this list as needle exchanges and syringe access not only impacts the people who public health/epidemiologists call IDUs (intravenous drug users). They’re an important target group in the public health field, but ‘syringe access’ is a very broad category.
7. Change.org: On Needle Exchanges: Another 1,000 foot mistake

There are many more, if you know of others, please post them in the comments.

If you’re in New England or can get to New York City, Harm Reduction Coalition is hosting a training on Syringe Access Services & Law Enforcement on Dec 3rd from 10am-5PM.

I’m impressed by the needle exchanges that admist all of the political turmoil and controversy over their existence are somehow able to find the time to set up wound care and narcan workshops for their clients. These educational workshops are usually in addition to providing their usual services. Thanks for the work that all of you do.