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Just Say "Not Until We're Married": Legislating Morality and Understanding HIV/AIDS Prevention

Just Say

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.