July 6, 2001
As recent data on HIV infection rates suggest, young people need better access to quality prevention and education services as part of a basic sexual health education program. At the 13th National HIV/AIDS Update conference in San Francisco in March, I talked about this concern, particularly about young men who have sex with men and about youth in foster care. The consequences of ignoring their needs are deadly.
Earlier this year, the Centers for Disease Control and Prevention announced the results of a study it sponsored of gay men from 1998-2000, in which one in every three gay or bisexual African-American men was infected with HIV; 15% of Hispanics, 7% of non-Hispanic whites, and 3% of Asian-Americans were HIV infected. More than 70% of those who tested positive in this study were previously unaware of their infection.
A CDC-sponsored study of young men who have sex with men produced similarly sobering statistics last year. Several thousand men 15 to 22 years old were interviewed in almost 200 different public places in six major cities. Among them, HIV infection was highest among those who were transgendered, and also particularly high among blacks, Latinos, and young men of mixed race. Concluding that the study findings "signal a critical and widespread public health problem," the CDC called for intensified prevention efforts targeting young gay men before they become sexually active.
So is the rest of the government listening? Apparently not. Huge public funding efforts are currently at direct odds with the CDC's recommendations and with other experts, such as the National Academy of Sciences' Institute of Medicine, which supports comprehensive HIV prevention education. From 1997 to 2002, about $300 million in federal funding, and about another $200 million in state dollars, will have been spent on "education" preaching only abstinence until marriage. The federal law (part of the 1996 Welfare Reform Act) that created this funding stream requires that abstinence-only programs, as their exclusive purpose, teach "that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity," and "that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects."
This dogma flies in the face of evidence that comprehensive sexual health education does not accelerate sexual activity and in fact increases the likelihood that kids who become sexually active will use protection against pregnancy and disease. It also ignores the fact that no state yet allows same sex marriage and that the federal government, through the so-called "Defense of Marriage Act," also works to prohibit recognition of our relationships. We are told to abstain from sex until marriage, and then told that some of us cannot marry. And finally, abstinence-only education also grinds in the message that queer youth don't exist or don't matter.
The National Institutes of Health concluded years ago that abstinence-only education and anti-condom messages place "policy in direct conflict with science" and "cannot be justified in the face of effective programs and given the fact that we face an international emergency in the AIDS epidemic." No wonder the American Medical Association and a host of other medical and public health organizations denounce this approach. Yet the number of middle and high school teachers who teach abstinence-only rose to 23% in 1999, from 2% in 1988.
And guess what? Despite the tax dollars and sponsorship of religious organization programs devoted to promoting chastity, lots of adolescents are having sex. Sixty-five percent of teens are sexually active by their last year of high school. More than one-half billion dollars later, as we mark the end of two decades of AIDS, three million adolescents annually contract sexually transmitted diseases. Youth between the ages of 13 and 24 are becoming HIV infected at the rate of two each hour, representing roughly half of all new HIV infections.
Current research shows an alarming number of foster youth are living with HIV; an Albert Einstein College of Medicine survey showed that 60% of the young people it treated for HIV were in the foster care system. With so many HIV-positive youth passing through the foster care system, any effort to address the current tragedy and future devastation of youth through HIV must incorporate a parallel focus on the child welfare system. But that opportunity for prevention also has largely been ignored. Our own research indicates that the reality of current foster care policy does not reflect the need. Few of the states we've surveyed have written policies and programs on sexual health or HIV-prevention education for the children in their custody; none acknowledge the existence of queer youth in their midst with non-discrimination rules, let alone support and protect them through adolescence. Tackling the lack of prevention programming in state-run youth care facilities while challenging politicians' passion for abstinence-only and chastity pledges will be an important part of Lambda's youth advocacy efforts in the coming months.
Anti-gay prejudice and government squeamishness about all things sexual profoundly affected the course of the AIDS epidemic. Today, they continue to hamstring efforts for a real national HIV prevention agenda. To protect lesbian, gay, bisexual, and transgender youth, we need HIV prevention that takes place in a supportive environment on an ongoing basis, and that deals with issues such as coming out, substance abuse, and youths' needs to develop skills and strategies for coping socially -- all anathema to the abstinence-only approach. To earn public funding, HIV programs of any kind should be rooted in medical and scientific fact and be of demonstrated benefit to those in the epidemic's sights.