May 14, 2005

Abstinence Ed Not Working

Down in the heart of the Bible Belt, all isn't going as planned regarding getting everybody to wait until marriage:

... For example, AIDS cases rose 27 percent for six Southern states - Georgia, North Carolina, South Carolina, Alabama, Mississippi and Louisiana - between 2000 and 2002. Whetten said such cases only rose by 11 percent during the same period in the entire Midwest.

A separate study found that North Carolina AIDS rates increased by 36 percent between 2001 and 2003.

"These six states are in a lot of trouble," Whetten said. "You're better off being born in Costa Rica or some South American countries than in Durham, N.C."

In addition, the nation's highest rates of chlamydia and gonorrhea remain in Southeastern states, many of which are plagued with high poverty levels, poor health care resources and low levels of health insurance coverage. ...

What is working? A program in Philadelphia that has young women practice condom use and roleplay negotiations for safe sex has shown measurable improvements in the rate of STDs in an at risk population:

... One year later, girls in the skills-based program were less likely than their peers to have an STD; about 10 percent tested positive, versus 18 percent in the general-health program and 15 percent in the STD-information program.

They also reported fewer instances of unprotected sex than girls in either of the other groups, and were less likely to say they'd had multiple sexual partners in the past 3 months.

There were, however, no clear differences between the groups at an earlier time point, 3 and 6 months after the classes. The apparent "delayed effect" of the skills-based program, Jemmott and his colleagues note, may indicate that it's hard for girls to start safer-sex practices in their existing relationships. Instead, they may be better able to use what they've learned at the beginning of a new relationship.

Though past studies have found that teenagers in STD-prevention programs report changes in their sexual behavior afterward, this study -- by actually screening for STDs -- helps confirm that the changes are real, according to the researchers. ...

By demonstrating greater efficacy when sex education is given before the start of a new relationship, and promotes less promiscuous behavior, this study blows the claims of hypocritical moralists out of the water. Unless the goal is to punish people who engage in premarital sex (that may be the goal of abstinence cheerleaders it shouldn't be the goal of public health and education officials,) the earlier this education happens the better the likely results.

Though I'd already made up my mind that an exclusive focus on abstinence education is a serious public health threat.

Posted by natasha at May 14, 2005 12:29 AM | Health/Medicine/Health Care | TrackBack(2) | Technorati links |
Comments

Great post. Thanks for the reality-base.

Posted by: Screwy Hoolie at May 16, 2005 05:55 PM

just thought i'd let you know, as a parent of a high schooler in Durham, NC, that we do not have an abstinence based sex-ed program in our district.

That's not to say our kids practice putting condoms on bananas in sex-ed class, but we're not totally backwards. Even some Duke administrators have their kids in the public school system.

Posted by: Barry Ragin at May 16, 2005 06:13 PM

The ignorant let their bogeymen drive them right into the arms of real perils. And it's their children who will pay the price.

The real perils consist of pregnancy, venereal diseases inc. AIDS. The imagined bogeyman consists of the disintegration of our children's moral fibres, whatever those might consist of.

God forbid that children learn about their bodies and how to keep them healthy. And how to plan their families so that they have children when they are ready to provide for them properly emotionally and financially.

I guess that's why we keep losing elections. We just don't understand moral values. ::sigh::

Posted by: Malacandra at May 16, 2005 06:17 PM

Praaaiiiizzzzz Jeeeeeeeeeeeeeezus and where's the penecillin.

Posted by: vinnie at May 16, 2005 06:19 PM

The South: proudly ignorant.

Posted by: gak at May 16, 2005 06:33 PM

What makes you think things aren't going as planned?

The idea isn't to stop sexual behavior, it's to punish sexual behavior.

Things are going just right, as far as the right is concerned.

Posted by: noone at May 16, 2005 06:40 PM

This is ancient history. We've known forever that teaching abstinence doesn't work! When will we take our heads out of the sand?

Posted by: DK at May 16, 2005 06:41 PM

This is and always will be about men in positions of power who are terrified at the thought of women taking charge of their own sexual identity.

Let's put it this way: if men had an extremely high chance of contracting AIDS from women, instead of the other way around, we wouldn't be having this discussion. Maxim would devote whole issues to the new fall line of "designer sheaths," Doctor Phil would conduct therapy sessions on "condom shock," there would be "Condom of the Month Club" advertizement inserts in Parade Magazine, for Pete's sake. Am I wrong?

Posted by: urizon at May 16, 2005 07:04 PM

Abstinence works 100% of the time, until it stops working.

Al Franken.

Posted by: llamajockey at May 16, 2005 08:36 PM

For REAL Abstinence Only Education, go here:

http://www.abstinenceonly.com

Posted by: scarlet p. at May 16, 2005 10:51 PM

In Georgia, do the abstinence-only programs include any information about abstaining from mule-fucking?

Posted by: just horsley-ing around at May 17, 2005 01:04 AM

Given that Costa Rica has a universal national health care, I think most Americans would be better off if they were born there. (Had to respond to the quote.)

Posted by: Sean Hurley at May 17, 2005 04:51 AM

hey natasha! howse it going?

Posted by: Hubris Sonic at May 17, 2005 06:21 AM

Thanks to all the assholes outside the region who assume that _all_ the students in the South are in abstinence-based programs. I'd like to know if the study looks at drug use among those surveyed as a contributing factor - drug users are much less likely to practice safe sex, regardless of any education programs they've been exposed to. I know that Durham has a sizable crack problem and has been a significant distribution point for heroin since the 1970s.

Posted by: Michael at May 17, 2005 07:40 AM

Michael - I think abstinence only education is probably a lot more prevalent in the South, if surely not universal, though it fails even when it's tried in blue states. Thing is, the prevailing message that gets heard the loudest down there is an anti-sex message, and not just in the classrooms. Even a good number of the Democratic politicians down there end up sounding more like conservatives on this issue, and the religious movements that make it a prime goal to advocate abstinence for life except in marriage are a lot more prevalent and noisier about it.

More than that, as a life-long blue stater, I've just had it up to here with 'heartland' and Southern politicians and public figures talking about how much more moral they are than the Babylons of the coasts. Imagine the schadenfreude I guiltily enjoy when reading that in statistical analyses of 'morality', such as divorce, teen pregnancy and STDs that there's never been anything but hot air to all these pompous pronouncements.

What you're also saying is that not only are STDs more rampant down there, but that the South has a worse drug problem than places like Detroit, New York, or Los Angeles just on the weight of one city in North Carolina which I think was just tossed out as an example. I don't entirely buy that, though I'm aware that drug and alcohol abuse is a significant problem in rural counties throughout the Midwest where the study indicates lower rates of STD increase.

Posted by: natasha at May 17, 2005 10:19 AM

Michael,

That brings up another good point.

Why are drug use rates so much higher in the South?

Or are they?

Posted by: M. Simon at May 17, 2005 10:38 AM

Nice post!
That was my Epi prof at Duke with the first quote. She has some incredibly compelling data gathered from eastern NC AIDS patients that really merit national attention.

Thanks for shining the spotlight her way.

Posted by: dcdouglas at May 17, 2005 11:06 AM

I know that the Seattle Times already published this letter of mine, but it is germane:

Maybe there is something to this abstinence only approach. If you don't drive and stay out of cars, you don't get into accidents. There is no point in teaching kids to steer into a skid or wear their seatbelts when this only helps 90% of the time. We'd do much better to teach kids how to just say "no". Automobile accidents account for a high percentage of deaths among young people. It is time they are taught to say, "No thanks, I'll walk" or "Thanks, dad, but I don't need the car tonight".

Posted by: Kaleberg at May 17, 2005 12:52 PM

Nice letter, Kaleberg. And great analogy.

Posted by: Mary at May 18, 2005 12:07 AM

To expand on Kaleberg's point, as a trauma nurse I noted that almost everyone who got shot, stabbed, or in a fight had started the evening by drinking in a tavern until 11 or 12 PM. Being home by 10, I believe, significantly reduces your chance of ending up in the hospital.

Posted by: serial catowner at May 18, 2005 05:30 AM

Natasha,

You said "..... as a life-long blue stater, I've just had it up to here with 'heartland' and Southern politicians and public figures talking about how much more moral they are than the Babylons of the coasts."
Please don't forget these politicians do not represent everyone; they just want you to think so. Maybe progessivism will come back in the south ... does anyone remember Luther Hodges, Terry Sanford, or Jim Hunt? There's another aspect to this problem: people in the south very much resent arrogant outsiders telling them how to do everything and talking down to them (basically, ever since the end of the Civil War). Some of the most provincial people I've ever met are life-long citizens of Boston, NYC, Los Angeles, and other large towns that honestly believe the world revolves around them.
You said "What you're also saying is that not only are STDs more rampant down there, but that the South has a worse drug problem than places like Detroit, New York, or Los Angeles just on the weight of one city in North Carolina which I think was just tossed out as an example." That's not what I said; Durham is just one city I have personal experince with. I think any kind of study which looks at STD rates without factoring in drug and alcohol use of survey participants is suspect. People make stupid decisions when they are high or drunk.
People can get drugs about anywhere in this country.

Posted by: Michael at May 18, 2005 07:22 AM

I'd like to know if the study looks at drug use among those surveyed as a contributing factor - drug users are much less likely to practice safe sex, regardless of any education programs they've been exposed to.

I'm not sure that's true; I'd love to see the studies that back up that statement. (In any case, drug use in the South is a bit lower than elsewhere in the U.S., as I understand it, so that couldn't explain the higher unsafe sex and STD rates there even if it is true.) But if you're talking about drug addicts rather than drug users, it's plausible. Addicts often turn to prostitution to get the drugs they're addicted to, and a prostitute doesn't have much bargaining power when it comes to condom use.

Notice this only applies to illegal drugs. Smokers don't have to turn to prostitution for their nicotine, nor do heroin addicts on, say, methadone maintenance.

Cocaine (crack or not) is a tough problem; there's no equivalent to methadone for coke addicts, and the drug is too dangerous to legalize outright. But cocaine could be given to addicts under medical supervision. Britain used that strategy successfully for years until pressure from conservatives forced them to abandon the program.

Posted by: Mathwiz at May 18, 2005 10:47 AM

FWIW, I should add I don't think abstinence-only sex "education" is the sole cause of the South's higher STD rates either. But it's probably a contributing factor.

Posted by: Mathwiz at May 18, 2005 10:49 AM