Abstinence-only agenda replaces condom message

Conservative message travels around world

Twenty years into the HIV epidemic, behavioral scientists appear to have a pretty good idea of what type of education works in preventing the spread of HIV, particularly among high-risk populations.

While sexual prevention strategies are varied, sometimes complex, and often use language and visual aides that appeal to one particular type of audience, they could be summed up in one word: condoms.

So it is baffling to some public health officials and others why there has been a backlash against the use of condoms and, by extension, groups that promote comprehensive sexual education for youth.

"I’m a Catholic-educated person, but this is just obscene," says William Smith, director of public policy for Sexuality Info and Counseling in U.S. of Washington, DC. "The abstinence only until marriage education in this country is an ideologically and morally driven agenda, and it’s only under this [Bush] administration that it’s been forced on the public health infrastructure," he says.

Last fall, 12 members of the U.S. House of Representatives wrote to Tommy G. Thompson, secretary of the U.S. Department of Health and Human Services (DHHS), to express concern about a trend in which scientific information that doesn’t fit the Bush administration’s political agenda is being suppressed. They cited an example of how the Centers for Disease Control and Prevention (CDC) removed from its web site a fact sheet titled Condoms and Their Use in Preventing HIV Infection and Other STDs.

The same congressmen and women wrote a second letter to Thompson on Dec. 18, 2002, saying that they were extremely concerned that the CDC had replaced that condom fact sheet with a new one that omits information on how to use condoms effectively, and the new fact sheet has deleted the description of the different types of condoms.

For example, the original condom fact sheet explained that lambskin and novelty condoms should not be used for HIV prevention and that for people allergic to latex there are synthetic alternatives. The new fact sheet says nothing about different types of condoms.

"Finally, the original fact sheet discussed the numerous studies that have shown that HIV education and sex education that included information about condoms either had no effect upon the initiation of intercourse or resulted in delayed onset of intercourse,’" wrote the 12 members of Congress. "This information has been completely expunged from the revised fact sheet," the letter stated. "In fact, according to recent press accounts, the administration is now taking the exact opposite position at an international conference on population, arguing that despite scientific studies to the contrary, providing education about condom use will increase teenage sex."

The major change in the new guidelines about condoms is that the messages about condom effectiveness are more directly tied in to specific STDs, says Ronald O. Valdiserri, MD, MPH, deputy director of the National Center for HIV, STD, and TB Prevention of the CDC. "The scientific information on how well condoms work to prevent HIV infection is very sound, very solid," he says. "There’s very good information around the world showing that when condoms are used effectively and consistently, they can substantially be used to prevent STDs."

The new guidelines are more discerning and do not make global statements about condoms and all STDs, Valdiserri says. "We try to point out where we have information that condoms have proven to be very effective with, for instance, HIV and gonorrhea." But condoms don’t have the same degree of effectiveness, according to research, in preventing the transmission of human papilloma virus (HPV), he says.

The revised condom fact sheet is only one example of how politics are changing the view of condoms from HIV lifeboat to Titanic, critics charge.

In Texas, where abstinence-only sexual education has become the standard for school-age youth, there are programs that tell teen-agers that condoms are ineffective in preventing HIV transmission, according to a Human Rights Watch report.1

"Teachers and administrators in one Texas school district with an abstinence-only program told Human Rights Watch that they don’t discuss condom use, except to say that condoms don’t work,’ and described an activity to teach students about condoms’ ineffectiveness," writes Rebecca Schleifer, JD, MPH, a researcher with the HIV/AIDS and human rights program at Human Rights Watch of New York City, who authored the report. "When I was in Texas, there was a TV ad that told parents not to tell kids lies about condoms and safe sex," Schleifer says. "One woman I know and her daughter heard this ad, and the daughter said, Mom, why did you tell us that condoms are safe when they’re not?’"

In Texas, a "Truth for Youth" advertising campaign teaches adolescents that condoms don’t work, Schleifer notes.

According to the Human Rights Watch report, one such commercial says, "If you are a parent, you could be telling life-threatening lies to your children without even knowing it. That’s because for years you’ve heard about safe sex.’ The truth is that condoms will not protect people from many sexually transmitted diseases. Don’t you think that your son or daughter has a right to know the truth? . . ."1

"These are programs that are promoting a very strong political and ideological agenda that is pushed by religious fundamentalists in the United States," Schleifer says.

The anti-condom agenda already has made its way into international relations and global AIDS funding, says Heather Boonstra, MA, senior public policy associate of the Alan Guttmacher Institute of Washington, DC. For instance, DHHS administrators traveled to Uganda to study the nation’s HIV prevention model, which essentially promotes three messages: abstinence, be faithful, and use condoms, she says.

"Now there are hearings on the House side that infer that abstinence is the reason that Uganda is successful," Boonstra adds. "We’ve found that all three approaches have influenced infection rates, but abstinence less than increased monogamy and condom use."

U.S. funds for AIDS work has traditionally gone to some faith-based organizations, but there has been a new emphasis on funding faith-based initiatives since Bush took office, Boonstra says.

"The Bush administration can make inroads into conservative areas easier on the international front than domestically," Boonstra says.

Exporting the anti-condom message could be especially harmful to less affluent countries where there remain few alternative prevention measures and more obstacles to antiretroviral treatment, AIDS advocates say.

"That the House of Representatives is trying to export this [anti-condom] stuff flies in the face of public health and science," Smith says.

A national survey of superintendents and teachers shows that abstinence-only education has increased dramatically in the past five years, while condom discussion has declined, says David Landry, MS, senior research associate of the Alan Guttmacher Institute.

In 1998, when the survey was first conducted among teachers who teach sex education to grades 7-12, researchers found that 2% of teachers presented abstinence as the only option to avoid pregnancy and STDs, he says. "When we conducted the latest survey, a full 23% of teachers presented abstinence that way. By contrast, there was a pulling back of teaching some types of content, such as the use of condoms as a form of HIV prevention, which declined from 89% in 1998 to 78% in 1999."


1. Schleifer R. Ignorance only: HIV/AIDS, human rights and federally funded abstinence-only programs in the United States; Texas: A case study. Human Rights Watch Publications 2002:14(5-G):1-49.