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CounterPunch
October
22, 2002
Just Say "Not
Until We're Married":
Legislating Morality and Understanding HIV/AIDS Prevention
by JOANNE MARINER
The influence of the hard-line religious right
on Bush Administration decisions and policies is everywhere apparent.
(One need only think of the choice of John Ashcroft for attorney
general, the nomination of anti-abortion judges to the federal
courts, or the Administration's uncritical sponsorship of Israel.)
But nowhere is it more damaging than in federally-funded "abstinence-only"
programs. These programs, meant to convince teenagers to abstain
from sex until marriage, also censor basic information about
how to protect against HIV/AIDS.
Federal health agencies and other expert
bodies uniformly recognize that condoms, when used correctly,
are a highly effective method of preventing the transmission
of HIV. Yet, by law, "abstinence-only-until-marriage"
education programs cannot "promote or endorse" condoms
or provide any instruction regarding their use.
In Texas, one of the epicenters of the
abstinence-only movement, program administrators not only censor
information about condoms, they actually promote misinformation.
"We don't discuss condom use," a Texas school official
acknowledged in an interview with Human Rights Watch, "except
to say that condoms don't work."
Federal funding for abstinence-only education
runs to over $100 million per year. The Bush Administration is
currently pressing Congress to authorize an increase of many
millions more. As it did with regulations that forbade federally-funded
clinics from discussing abortion--another pet cause of the religious
right--the Administration has also been trying to promote its
abstinence-only agenda internationally.
Adolescents,
Condoms, and HIV/AIDS
Every year, hundreds of American adolescents
contract HIV, the virus that causes AIDS. The disease has a relatively
high incidence among young adults, with the median age of HIV
infection having dropped steadily over the years.
Experts note that even though the overall
incidence of AIDS declined during the 1990s, its prevalence among
American youth did not. According to one authoritative estimate,
at least half of all new HIV cases occur among people under age
twenty-five, with most of them being infected via sexual activity.
Because of condoms' effectiveness, when
used correctly, in preventing the transmission of HIV, federal
health agencies such as the Centers for Disease Control and Prevention
all agree that adolescents should be provided information about
the proper use of condoms. Like the American Medical Association
and other professional organizations, they recommend reliance
on comprehensive sex education programs, ones that include information
on how sexually active young people can protect themselves.
Abstinence-Only
But sex education has never fit comfortably
within the American moral agenda. To the Christian right, it
is a frightful hobgoblin, one of the root causes of adolescent
sexual "irresponsibility."
The moral alternative to knowledge (both
carnal and intellectual) is apparently ignorance. In 1981, just
predating public awareness of the HIV/AIDS crisis, federal funding
of abstinence-only programs began. The Adolescent Family Life
Act (AFLA), passed under the Reagan Administration's auspices,
provides financial assistance to programs to "promote self
discipline and other prudent approaches to the problem of adolescent
premarital sexual relations."
Congress greatly increased funding for
abstinence-only programs in 1996, under Clinton, when it passed
the Welfare Reform Act. To qualify for funding under the law,
programs must portray abstention from sexual activity until marriage
as the only acceptable behavior for youth.
With a presumably unintended nod to Gandhi,
the law defines abstinence education programs as those whose
"exclusive purpose" is to teach "the social, psychological,
and health gains to be realized by abstaining from sexual activity."
This narrow focus on abstinence means, according to the director
of the federal agency charged with administering the law, that
such programs cannot "promote or endorse" condoms,
or otherwise discuss them--except to provide "factual information,
such as failure rates."
A third federal program, established
in 2000, is even more restrictive. Its grantees cannot even use
their own separate funds to provide "other education regarding
sexual conduct"--including, of course, education regarding
condom use--to teenagers who are receiving abstinence-only services.
Notably, the continued expansion in abstinence-only
programs has taken place despite a singular absence of evidence
that such programs are effective. A study commissioned by Congress,
whose interim findings were issued this year, found no proof
that these programs worked to reduce the incidence of teen sex,
pregnancy, or the transmission of disease.
Case Study
in Abstinence: Texas
Human Rights Watch recently examined
the impact of abstinence-only programs in Texas, a state that
receives a substantial share of federal abstinence-only funding.
It found that such programs either "omit any discussion
of condoms and contraception," or "provide inaccurate
or misleading information about condoms as a method of HIV/AIDS
prevention."
Nor can it be said, in defense of such
programs, that they simply provide one perspective that is supplemented
by others. To the contrary, Human Rights Watch found that Texas'
abstinence-only programs were crowding out other sources of HIV/AIDS
prevention information. In Laredo, for example, HIV/AIDS experts
from the local health department were barred from city schools
because they were not teaching abstinence but prevention.
Challenging
the Censorship of HIV/AIDS Prevention Information
In restricting students' access to important
HIV/AIDS prevention information, these programs implement a potentially
lethal form of censorship. Yet, notwithstanding their pernicious
impact, the viewpoint-based restrictions on speech imposed by
federal abstinence-only legislation would likely survive a legal
challenge on First Amendment grounds.
Defenders of these laws would rely on
the Supreme Court's regrettable opinion in the 1991 case of Rust
v. Sullivan, which upheld the abortion "gag rule."
In Rust, the Court ruled that federal regulations denying funding
to organizations that counseled people about abortion, engaged
in pro-choice lobbying, or provided abortion referrals, even
if those activities were paid for out of entirely separate sources
of financing.
From Texas
to the World
As it previously did with the abortion
gag rule, the Bush Administration has taken recent steps toward
imposing its restrictive abstinence-only views on a global audience.
(In January 2001, during his very first week in office, President
Bush issued an executive order barring U.S. financial assistance
to international nongovernmental organizations that, using separate
funds, engage in such activities as talking with clients about
abortion, disseminating information about abortion, or advocating
for the repeal of laws that restrict abortion.)
Last May, at the U.N. General Assembly
Special Session on Children, the U.S. delegation joined with
Iran, Libya, Pakistan, Sudan and the Holy See (the axis of fundamentalism?)
to press summit participants to endorse sexual abstinence "both
before and during marriage" as the only way to prevent HIV/AIDS
transmission.
The Child Rights Caucus, a coalition
of hundreds of nongovernmental organizations from around the
world, condemned the U.S. emphasis on abstinence as "both
naive and inappropriate." As the caucus pointed out, "for
the millions of girls who marry before age 18 or who are forced
into sexual relationships, abstinence is not an option, and lack
of access to appropriate education and services can be life-threatening."
The Price of
Ignorance
The Bush Administration is currently
seeking to expand reliance on abstinence-only education programs,
which are already found in all fifty states. From the current
$100 million annually that goes to support such programs, the
Administration is pressing Congress to increase federal funding
to $135 million.
But the true cost of abstinence-only
programs is not measurable in dollars. The ignorance purveyed
by these programs puts young people at risk of HIV infection
and premature death.
Joanne Mariner
is a human rights attorney.
Mariner directs readers seeking more
information on this topic to Human Rights Watch's just-released
report, Ignorance Only: HIV/AIDS,
Human Rights, and Federally Funded Abstinence-Only Programs in
the United States, which was researched and written by
Rebecca Schleifer.
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