Sex, Lies and Abstinence
Last December, at the London offices of the sexual and reproductive rights organization International Family Health, employees found a festive musical email in their inboxes. Entitled "The 12 STDs of Christmas," the four-part harmony sing-along began: "On the first day of Christmas my true love gave to me/a bug that made it hard to pee." Stick figures danced at the bottom of the screen, displaying symptoms of each sexually transmitted infection. By the sixth day of Christmas, true love had brought with it "pubic lice, gonorrhea (five golden rings!), genital herpes, syphilis, chlamydia, and the possibility of HIV." Suffice it to say, the state of affairs had not improved by day 12.
"Don't play the sex lottery. Use a condom," was the message following the song, "Worried you've picked up something? Visit www.playingsafely.co.uk."
Who had cooked up this comic little e-card? None other than the UK's National Health Service. Well done, thought activists of their own government.
Meanwhile, across the pond, the US government's strategy for disease prevention was hardly in tune with the philosophy that has taken root around the world -- and so masterfully expressed by the Brits: Give people accurate, comprehensive information and services, and they are more likely to stay healthy. Instead of finding similarly clever ways to disseminate such information to the American public, the Bush administration was actively trying to censor it.
The most blatant attack was the severe gutting of the Centers for Disease Control and Prevention (CDC) fact sheet on condoms, which had been disappeared from the website in July 2001 and replaced, with significant battle scars, in December 2002. Pre-Bush, the fact sheet had encouraged consistent condom use, advice supported by vast bodies of scientific research that show condoms to be 98-100 percent effective in preventing pregnancy and sexually transmitted infections, including HIV. "The primary reason that condoms sometimes fail," read the original fact sheet, "is incorrect or inconsistent use, not failure of the condoms itself." Following that statement was user-friendly guidance on proper use.
Now, according to the once nonpartisan CDC, abstinence is the "surest way to avoid transmission of sexually transmitted diseases." Along with the condom "how to," the CDC removed the "Programs that Work" section, which summarized several large studies of teenagers that found no increase or hastening of sexual activity among those who were taught about condoms.
Revising the CDC website is just one of the many ways the Bush administration has sought to distort and suppress scientific inquiry, not to mention sound public health policy, that contradicts its so-called family values.
"We've been monitoring a deeply unsettling trend where public health science is being supplanted by politics and ideology," says James Wagoner, president of Advocates for Youth, a proponent of comprehensive sexuality education. The Bush administration has stacked scientific advisory panels with ideologues who have scant credentials and conflicts of interest; flooded schools with medically inaccurate "abstinence-only" programs; punished HIV/AIDS prevention groups with audits; and gagged overseas healthcare workers who receive US funds, repeatedly exemplifying its willingness to let ideology trump the very pillars of democracy it claims to be defending.
This agenda is so ruthless that members of several domestic sexual and reproductive rights and health organizations speak of a pervasive "climate of fear" created by the Bush administration; a climate in which entities on various levels, from non-governmental HIV/AIDS prevention groups to high schools and even epidemiologists at the CDC, are being pressured to toe the party line.
"It's really remarkable," says Mariann Wang, an attorney at the American Civil Liberties Union. "They're really doing everything in their power, on every front, to keep people's mouths shut. And that goes from the top research scientists down to basic health care workers on the ground."
Ignorance Until Marriage
In middle and high schools across the country, teachers are being directed to adhere to the Federal Definition of Abstinence-Only Education, which requires that a program teach, among other things, that "a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity" and that any other sexual activity "is likely to have harmful psychological and physical effects." By law, teachers cannot "promote or endorse" condoms or show adolescents how to use them, nor can they recognize any relationship outside of heterosexual marriage. Rebecca Schleifer, an HIV/AIDS researcher at Human Rights Watch, led a study of abstinence-only programs in Texas and calls them nothing less than "censorship."
A pamphlet distributed by the McLennan County (Texas) Collaborative Abstinence Project and obtained by Human Rights Watch cautions that "condoms have a 17 percent failure rate; that's 1 in 6." Another piece of McLennan literature reports that a "meticulous review of condom effectiveness" found that they "appear to reduce the risk of heterosexual transmission of HIV infection by only 69 percent" and that condoms break or slip as much as 25.5 percent of the time.
"We don't talk about contraception or condoms," a master teacher in Laredo, Texas, told Schleifer, "because that would be crossing the line that the state or federal guidelines have set. We don't mention the word 'condoms' at all." A curriculum director in Bell County expressed similar fear of losing federal funding: "We don't discuss condom use, except to say that condoms don't work." Schleifer found that when a sexually active student confronted a teacher, the response was often, "Well, that's something you did in the past; now you can renew your virginity."
"We call this programming," says Adrienne Verilli of the Sexuality Information and Education Council of the US (SIECUS), "Not only are they censoring information from young people, teachers feel that their jobs are in jeopardy if they say anything besides 'you should stop having sex'."
Another facet of the McLennan program is television commercials. One shows a dad telling his son to use condoms followed by a voiceover warning, "Condoms will not protect people from many sexually transmitted diseases, and you could be spreading lies to your children." Schleifer spoke to counselors and teachers who heard from teens, including one who was an active intravenous drug user, who said they no longer bothered using condoms because they'd heard on TV they didn't work.
A total of $117 million will go toward abstinence-only programs like McLennan's in 2003, funding that every state but California has accepted, though 38 states -- not Texas -- still mandate that public schools also teach about HIV and other STDs.
Prevention Under Fire
Abstinence-only as disease prevention doesn't stop in high school. All CDC-funded HIV/AIDS prevention spending is currently under review, and comprehensive programs are screeching in their tracks. For instance, an Advocates for Youth parent-child education curriculum, two years in the works for the CDC, was abruptly terminated last summer. "They gave no reason," says James Wagoner, who later heard a Department of Health and Human Services (HHS) spokesman tell National Public Radio that the project's videos were too graphic. "Young people used the correct terminology for male and female anatomy," he says. "It's absurd, what is the president going to do? Issue an executive order that henceforth every man, woman and child should refer to the penis as a dingaling?"
Advocates for Youth wasn't the only organization to feel the heat; Planned Parenthood and SIECUS were also fielding threats of audits -- probably because all three launched the "No New Money" campaign (www.nonewmoney.org) which opposes the taxpayer cash flow toward abstinence-only programs. Sixteen HIV/AIDS prevention groups also came under scrutiny in what activists called a witch-hunt after some of them had signed onto a flyer protesting Tommy Thompson's speech at the XIV International Conference on AIDS in Barcelona in July 2002.
Even before Barcelona, however, the Stop AIDS project in San Francisco went through back-to-back federal audits after Mark Souder, a Republican representative from Indiana, accused the group of "promoting sex" and demanded an investigation.
"We spent the better part of 14 months responding to a series of federal inquiries," says Shana Krochmal of Stop AIDS, which not only took hundreds of staff hours, but a psychological toll as well. "This is a staff working with a community that continues to have a lot of reason to think that the government doesn't particularly care whether they live or die," says Krochmal. And as per a recent memo from HHS, Stop AIDS and other prevention groups must now post disclaimers on their website that warn the content "may not be appropriate for all audiences."
"Front line prevention providers are having to divert some of their energy into rearguard action against harassment by the federal public health apparatus," says Mark McLaurin, associate director for prevention policy at Gay Men's Health Crisis in New York. "And the truth of the matter is that the federal public health apparatus and prevention providers ought to be natural allies. We share the same goals. It doesn't make sense, if the CDC and this administration want to reach its stated goal of halving new infections by 2005."
There's new evidence that these tactics are spilling overseas as well to any foreign organization receiving USAID. A Jan. 9, 2003, cable to local fund managers (based all over the world) regarding AIDS prevention emphasizes abstinence and directs that, "All operating units should review their own websites and any websites fully or partially funded by USAID to ensure the appropriateness of the material."
Even the scientific community -- a group that usually hovers above the political fray -- began shoring up its own defenses as it came to light last fall that the Department of Health and Human Services was purging scientific advisory committees of scientists whose research might undermine the Bush administration's political goals, and replacing them with thinly credentialed ideologues, who, for instance, agree with raising permissible levels of lead in drinking water and oppose workplace ergonomic standards.
The Presidential Advisory Council on HIV/AIDS is another major battleground. Its co-chair, Tom Coburn, has accused the director of the CDC of "lying" about condom safety and asked that he be fired. These actions prompted scathing editorials in prestigious journals and sharp statements from groups like the American Public Health Association. According to the Federal Advisory Committee Act of 1972, committees must be "fairly balanced" and "not inappropriately influenced by the appointing authority." Donald Kennedy, editor of Science, referenced this law in rebuking the administration: "It would be a good idea for HHS Secretary Tommy Thompson and the White House Personnel Office to read the law, and then follow it."
Scientists were also incensed by the manipulation of the National Cancer Institute, which was prompted to revise its stance on a rumored link between abortion and breast cancer (a rumor that traces back to anti-choice groups). While the original web fact sheet maintained that there was no scientific evidence that abortion increases a woman's risk of breast cancer, the revised version called the available research "inconclusive." It took a weekend-long conference, convened in February 2003 with taxpayer dollars, to confirm, again, that there is no compelling evidence to support the anti-choice claims.
"There is a drive for ideology to be the guiding force in all sorts of programs," says Louise Melling, director of the American Civil Liberties Union Reproductive Freedom Project. "You see the government using its resources to prohibit dissemination of certain information and in some cases information that's needed to protect people's lives. You sort of want to pull out 1984."
Gagged From Day One
Bush's censorious activities seem to be gaining momentum, but the strategy was evident on his very first day in office, when he reinstated the "global gag rule" (or Mexico City Policy), which literally gags any foreign recipient of US family planning funds from so much as uttering the word "abortion," even where it is legal and even if they use their own funds to do so. The Center for Reproductive Rights (formerly the Center for Reproductive Law and Policy) is suing the Bush administration for violating the first amendment rights of its American attorneys working overseas and calls the policy "government sanctioned censorship -- plain and simple."
"The gag rule is the most overt, blatant example of disregard for freedom of inquiry and scientific freedom," says Catholics for a Free Choice president, Frances Kissling. "It is highly violative of common medical ethics." For example, a diabetic woman for whom a pregnancy could be life threatening would not be entitled to receive appropriate medical advice to abort. And on the macro level, the gag rule is "censorious and violative of national sovereignty," Kissling points out, because it actually prohibits health care workers from actively participating in the political process -- they can't lobby, attend a rally, go on a march or sign a petition relating to abortion rights. "Here's an administration that wants to spread democracy around the world," says Kissling, "and they want to prevent people from participating in policy?"
"There's a very conservative element in the Department of Health and Human Services that is behind this whole movement," says Barbara Crane of Ipas, an international abortion rights group that turned down $2 million in US funds to protest the gag rule. "What we're seeing on the international side and coming on the domestic front is a tightening vice grip on programs, activities and speech that are involved in reproductive health in any way."
Bush tried to tighten that grip even more with his Emergency Plan for AIDS Relief, a surprise announcement during his State of the Union speech that promised $15 billion in funds over the next five years. It took little time for activists to figure out that the package was a triumph of "Arthur Andersen-style accounting," as Africa Action director Salih Booker told the Nation, and by mid-February it looked like it was really just an excuse to extend the gag rule to HIV/AIDS money. At press time there was a bipartisan effort in Congress against that move, but its ultimate fate remained unclear.
Activists see the "family planning wars" as threatening 20 years of increasingly "client-centered," culturally sensitive care, effective public health policy, and tremendous gains in women's sexual and reproductive rights. And the cumulative effect is government-sponsored fear, intimidation, repression and regression. Shana Krochmal at Stop AIDS argues "We're back to fighting for the very basic ability to talk honestly and openly with people about their lives." Says James Wagoner: "It is unconscionable to promote ignorance in the age of AIDS, and yet that is what's happening."
Jennifer Block lives in New York and has written for the Nation, the Village Voice and Ms., where she was an associate editor.