Time to grow up - an end to the folly of abstinence only sex ed?

Story

AIDS
Time to grow up
Sep 20th 2007
From The Economist print edition

?Abstinence only? education does not slow the spread of AIDS

THERE can be no surer way of averting a sexually transmitted infection such as AIDS than avoiding sex. That much is obvious. And it is also convenient for religious lobbyists who believe that premarital sex is a sin. But is it realistic? Those lobbyists argue that a popular alternative?known in the jargon as ?abstinence-plus??which recommends chastity but also explains how to use condoms, is likely to make things worse by encouraging earlier intercourse. ?Abstinence-only? teaching, they reckon, should be more effective.

That, of course, is a possibility. But it is a testable possibility. And Kristen Underhill and her colleagues at the University of Oxford have, over the past few months, been testing it. Their conclusion is that it is wrong. Abstinence-only does not work. Abstinence-plus probably does.

Last month Dr Underhill published a review of 13 trials involving 16,000 young people in America. The trials compared the sexual behaviour of those given an abstinence-only education with that of those who were provided with no information at all or with whatever their schools normally taught. Pregnancies were as numerous in both groups. Sexually transmitted diseases were as widespread. The number of sexual partners was equally high and unprotected sex just as common.

Having thus discredited abstinence-only teaching, Dr Underhill and her colleagues decided to evaluate the slightly more complicated message of ?abstinence-plus? using 39 trials that involved 38,000-odd young people from the United States, Canada and the Bahamas. Their results are published in the current issue of Public Library of Science MedicineThis tuition?compared, as before, with whatever biology classes and playgrounds provide?reduced the number of pregnancies in three out of seven trials (the remaining four recorded no difference). Four out of 13 trials found that abstinence-plus-educated teenagers had fewer sexual partners, while the remainder showed no change. Fourteen studies reported that it increased condom use; 12 others reported no difference. Furthermore, in the vast majority of cases, abstinence-plus participants knew more about AIDS and HIV (the virus that causes the disease) than their peers did. And the tuition often reduced the frequency of anal sex (which brings a greater chance of passing on HIV than the vaginal option). In contrast to the fears of the protagonists of abstinence-only education, not one of the trials found that teenagers behaved in a riskier fashion in either the long or the short term after receiving abstinence-plus instruction.

Unfortunately (and surprisingly) only two of the studies addressed the question of disease transmission directly, and the numbers involved were too small to find a statistically significant difference between groups. Nevertheless, Dr Underhill's pair of reviews should make informative reading for policymakers. America's government earmarks money for abstinence-only teaching, which is matched by individual states. It should review that policy?which is clearly no better than the alternatives, and is probably worse. Its generosity to needy foreigners is similarly prescriptive. Of the $15 billion promised over five years by PEPFAR, President George Bush's personal anti-AIDS initiative, $1 billion is reserved for groups that intend to fight AIDS without mentioning condoms. Though Dr Underhill's results apply only to North America, they do suggest a need to investigate what happens elsewhere, in case PEPFAR's policy, too, needs to be reviewed.

A dose of prevention

Teaching people about what they might wear during intercourse is an important way of reducing the chance of them catching HIV. But teaching them, in addition, about what drugs they could take to reduce that risk may be added to the syllabus in the future. A

 

I think it's very optimistic to assume that the people who support abstinence-only sex "education" to be swayed by anything as paltry as facts.

Moreover, it's a particular blind spot of certain kinds of people who refuse to see the forest (the human species as a whole) for the trees (individual humans). They refuse to see human behavior in the large sense as anything other than the aggregate of individual decisions, and reason that larger realities can be altered if you just persuade enough individuals. This, of course, is total poppycock, because humans in the large scale behave in statistically predictable ways, largely dictated by economics, biology, etc., but to admit that would kind of bring down the whole flimsy house of cards of contemporary religious conservatism.

 

Hell yeah social science.

The social scientist's motto: "We can test that."

Also, hell yeah for PLoS. I head a social medicine reading group here at my school, and I get the vast majority of our articles off of PLoS. It's a wonderful resource for persons interested in the social aspect of medicine and biology.

 

Not only are the promoters of abstinence only sex education uninterested in the facts, some of them deliberately promote misleading public health messages that amount to either lies or half-truths, depending on how generous you want to be in characterizing them. Some of this is messaging that equates to "using a condom is about as safe as using nothing at all."

 

I was definately a victim of that mis-information in public high school. It's outrageous.

 

Given the fact that HIV is fatal, despite better treatments, and that cervical cancer can now be prevented, not arming our youth with all the facts is criminal.

Most of the physicians with whom I work, including several who are very religiously conservative, agree with that statement, faith notwithstanding.

Peace,

V-03

 

Abstinence-only folk seem to be under the mistaken impression that people don't want to have sex. Or maybe they just don't.

 

The problem is the situation doesn't meet the principle of double effect. You have one option with major negative consequences, another option with minimal consequences, and an option with no consequences. As long as the no-consequence option remains valid, even if less than likely to succeed, the other two are not permissible. You'd have to argue that abstinence is in fact impossible, which rejects any notions of agency and responsibility.

 

Except, you're washing your hands of responsibility by keeping people ignorant but absolving yourself of any consequences of that ignorance.


E_S

 

I would argue the matter is there is too much ignorance in safe sex education as they get to hear about about the hows and can't be allowed to talk about the whys (or why nots). There isn't a problem in knowing the basic knowledge per se, the problem is it is a sophomoric knowledge. I know much about the various methods of protection, but neither would I use them.

 

Still, even if abstinence is the best option, the next best alternative is whatever the safe sex concept entails, which the current program seems to omit. If we're leaving out morality arguments and focusing on the most effective way to erradicate AIDS and whatnot, then I'd say both viewpoints should be included. Just because a program includes safe sex as a secondary protectionary measure doesn't mean that abstinence can't still be emphasized.

If we're putting in the morality argument, then it actually becomes even simpler. Abstinence can still be taught as the "right" choice to make, but safe sex would still serve as the last line of defense or "if you decide to do this, we still don't want you to get AIDS". Either way, teaching safe sex as a secondary option will work out.

 

I would go further and say that not teaching safe-sex is an immoral act, given that we can greatly reduce the risk of transmission through barrier protections.

 

Really...

Safe sex education boils down to if you're going to do it, here's not to not get pregnant or transmit diseases.

Abstinence only says, "Children, take a deep breath, and plunge your head in the sand of Jesus' love."

The basic thinking of the latter, aside from the underhanded and frankly transparent motives of religious types who are inserting an "ought not" message in there, is that the safest way not to transmit disease or anything is to not have sex.

Fantastic, in theory.

Not practical, nor honestly desirable, in reality.

Teens are going to have sex, it's perfectly natural and it derives from a natural urge.

Not all will have the fear of God's wrath implanted on their psyche to be strong enough to say no, and yes I am being facetious in making that point.

So why cripple them by under-informing them? Because you can't tell it's happening buried so deep in the sand.

E_S

 

How does that follow? You never let the perfect be the enemy of the good, and public policy is basically an exercise in managing the consequences of undesirable realities.

However, in any case:

On a large scale, it is impossible. You can argue that any given individual could, theoretically, choose to refrain from having sex, but we know for a fact that the overwhelming majority of people will not so choose, and that that's true regardless of what you teach young people. People on the large scale behave in statistically predictable ways.

Your notions of agency and responsibility need a serious re-think.

Agreed, completely.

 

So they think sex is evil, and masterbating is evil..... can you imagine how antsy these Christian kids must be lol. theyd be laying in bed with their eyes open for hours before they get to sleep!

 

Teaching safe sex is not a secondary option it is the most important option. Ths idea that morality determines having sex is right or wrong is medieval thinking at best. Not teaching safe sex, as noted above, is truly what's immoral.

 

This issue has always reminded me of another issue, were the single most effective defense has people trying to ban it.
but lets focus on the issue at hand.

Abstinence only sex ed is an oxymoron.

When I was in High School they gave us the facts
raw percentages, this method has a XX% fail rate
and this other method does not protect from disease
and lets' not forget this which prevents some disease
but still has a fail rate of XX%

People are going to do what they want to do, it is our duty to educate them
about the facts, not try to make their choices for them.

 

It's interesting you would equate the phallic symbolism of arms with sex-education, but I suspect that's similar to people seeing the virgin Mary on a tortilla - the harder you look, the more you find.

I think it's interesting though, and this goes back to a programme I heard on NPR on the topic, that people equate non-AOSE as a tacit encouragment of promiscuity.

Um... how?

E_S

 

Presumably for the same reason groups in the US didn't want girls getting the cervical cacer vaccine Gardasil

 

Some Christians are weird.

 

Incidentally, I think comparing sex education and gun education isn't that bad of an analogy. A firearm saftey class at, say, the NRA teaches a person essential information related to the use of a gun: how it works, how to use it safely, when its use is appropriate, any important related legislation, etc. The very same concepts should be taught in Sex Ed. Only about sex. And without any "time on range."

 

I just wanted to make a phallic joke, RF.



E_S

 

Oh, you know us Americans. Always taking everything so seriously.

 

This is exactly what my grievance is with. It's a lesser of two evils approach when there is no such thing as a lesser evil. Is Scylla better than Charybdis? That is what a lesser of two evils argument claims. Fortunately this is a false dichotomy as there is always the option of abstinence.

Barring that, I prefer Master_SweetPea's approach, as it is simply stating the facts. My concern is that in practice anything involving abstinence will just be addressed quite flippantly by either the teacher, the students, or both, while simultaneously emphasizing putting into practice these methods. Just PLEASE don't make it into "They're just going to have sex anyway, so at least let it be done safely". If people were just given the chance to think rather than be spoon-fed from either side (a dangerous proposition, I know) perhaps they would choose differently.

That the issue can only be comprehended in terms of a religious edict or a "sex is evil" strawman is sadly quite telling of today's society.

 

Except, Overlord, and as you consistently fail to address, there's provisions in AOSE for when a person elects not to abstain to avoid the spread of disease etc.

What's especially telling is your steadfast refusal to acknowledge the findings of key surveys which demonstrate AOSE is ineffectual at promoting abstinence or the spread of disease or pregnancy. How do you address the categoric failure of abstinence only sex ed to actually work?

E_S