Two leaders of the sexual-abstinence movement respond to "Bush's Sex Fantasy," by Michelle Goldberg.

By Salon Staff
Published March 2, 2004 10:27PM (EST)

[Read the story.]

I was interviewed for your recent article on abstinence-and-character-based sex education, because the Medical Institute for Sexual Health has been a leading voice in the study, evaluation and promotion of what we call Integrated Sexuality Education. ISE is the alternative to the Comprehensive Sexuality Education approach promoted by SIECUS, Planned Parenthood and others.

Why is an alternative needed? Because the only thing we know for sure about the dominant paradigm of sexuality education in America is that it is not working! Our "model" is clearly flawed. The HIV rate in the United States has been unacceptably high for two decades and is once again on the rise. There is a hidden epidemic of STDs among sexuality active youth and adults, with the resulting increase of abnormal Pap smears and sterility (along with rampant cervical cancer) among women. The U.S. also still leads the industrialized world in unintended pregnancy among youth. Forgetting politics and even AIDS for a minute, this alone is a health crisis!

The M.I. was started to address this crisis by Joe S. McIlhaney, M.D., whose reputation was impugned by mean-spirited innuendo in the article. McIlhaney is a prominent ob-gyn in Austin, Texas, who simply got tired of treating tearful 33-year-old women for infertility problems caused by asymptomatic STDs. In many cases his patients had gotten them through sexual activity in college years earlier, and most had consistently used condoms! Why, they asked, had they still gotten STDs even when they used condoms? The Medical Institute was a largely unintended byproduct of McIlhaney's attempt to answer that question for his patients. Ten years later, we now know why: condoms provide only about 50 percent risk reduction against most viral STDs (see the "Condom Monograph" in "Products" at Medinstitute.org).

Dr. McIlhaney's "credentials" as an author and board-certified practicing physician are impeccable. He has presented his STD material in hundreds of professional forums including several medical schools and, most recently, at a continuing medical education conference cosponsored by the M.I., Scott and White Medical Center, and the CDC. The so-called critical letter from the Texas Department of Health mentioned in the article (actually an evaluation freely requested by the M.I. from TDH) was nearly 10 years ago in the early infancy of the organization, appropriate corrections were made so that the TDH declared the slides "medically accurate," and today the M.I. is a long-standing contractor for the TDH in these issues. This slide presentation, also available at Medinstitute.org, is still the best medical product on STDs for professionals or laypersons.

Goldberg's article was very tough on abstinence education, which of course, I expected. Indeed, the Medical Institute itself has long called for rigorous evaluation of both Comprehensive and Integrated (some abstinence-and-character-based programs qualify) programs. We welcome scrutiny and public debate of this issue. The $270 million in funding that President Bush has proposed for "abstinence" programs is extremely small compared to the nearly 1 billion in federal dollars that goes to fund Comprehensive programs. The question I ask is: what are our opponents afraid of? Since these epidemics have come about under their watch, and given Uganda's success, we think that it is worth funding, and, of course evaluating, something different.

The article raised the issue of the "politicization of science," which is a serious matter and should indeed be discussed publicly. Since the Medical Institute is often criticized by the "left" and the "right" for our independent and data-driven conclusions, we are painfully aware of the conflict between "ideology and science." We consistently chose science over ideology, which is precisely why we believe that a full public debate of sexuality education in America, and a rethinking of our global AIDS strategy, is imperative at this time.

My views were misrepresented on several occasions in the article. For example, I did not say "educators should focus on preventing the 'event' (sexual debut) from happening before students are legally wed." In fact, I mentioned to Ms. Goldberg the "Best Friends" program, which promotes "abstinence until graduation" for inner-city girls. I also did not say or imply that "I believe that abstinence education can change the mores of an entire society." Unfortunately, those misrepresentations were cleverly used to undermine my quoted remarks. I frankly expected higher journalistic standards from Salon than that.

I also did not say or imply that Uganda is even remotely understandable (reducible) to the silly terms of the narrow and polarized "abstinence vs. condoms" debate in the U.S. It is clear from the research, however, that the A+B (abstinence and faithfulness) portion of the ABC program in Uganda is key to that country's success in reducing AIDS infections rates. Condom social marketers know that (assuming for a moment that their strategy works) there are not enough condoms available in Uganda today -- let alone 10-15 years ago -- to effect this kind of dramatic change!

The M.I. is interested in ALL of the factors (including, for example, the cultural empowerment of women in sexual decision making) that lead to the AIDS rate reduction we all seek. Could it be that the success of Uganda, the ONE country where the AIDS rates have been successfully reduced without widespread condom social marketing, is so counter to the "biases" and "ideological commitments" of the Comprehensive Sexuality Establishment that they are either unable to see it, or even a bit embarrassed by it?

I hope not. Perhaps we can even find some common ground in attacking these health crises, and work together to replicate Uganda's success in other places. The stakes in this debate are indeed large in human lives.

-- Joe B. Webb, CEO, The Medical Institute

I noted your article, "Bush's Sex Fantasy." If you had read "As Jesus Cared for Women," you would know that I do not recommend prayer as the cure for PMS. If you had knowledge of my large gynecologic practice, you would know that I do prescribe oral contraceptives to non-married women. My scientific credentials as professor, researcher and author speak for themselves. You are correct that I believe that abstinence is the only way to absolutely prevent nonmarital pregnancy and sexually transmitted infections among those not involved in a mutually monogamous, long-term relationship.

-- W. David Hager, Member, The Medical Institute Advisory Board

(Dictated by and sent on Dr. Hager's behalf while Dr. Hager was in the Medical Institute's offices.)

Michelle Goldberg replies:

Webb asserts that "condoms provide only about 50 percent risk reduction against most viral STDs," a figure he attributes to a study by his own think tank. His formulation tells only part of the story and seems designed to downplay condom effectiveness. "Viral STDs" excludes common bacterial STDs like gonorrhea, syphilis and chlamydia, which condoms do defend against. The vast majority of research shows that condoms also offer an excellent defense against the most deadly of viral STDs, the HIV virus. According to the Centers for Disease Control, "The body of research on the effectiveness of latex condoms in preventing sexual transmission of HIV is both comprehensive and conclusive. In fact, the ability of latex condoms to prevent transmission of HIV has been scientifically established in 'real life' studies of sexually active couples as well as in laboratory studies."

That leaves human papillomavirus (HPV), herpes and hepatitis B. There is a vaccine for hepatitis B. As for HPV and herpes, both potentially serious health issues for which there is no cure, studies are inconclusive about the protection condoms offer, but the CDC says condoms do reduce the risk of transmission. HPV is especially controversial -- it's incredibly common and often harmless, but has been linked to cervical cancer and other maladies. As Damien Cave wrote in Salon in 2002: "There are more than a hundred strains of the virus, and an estimated 75 percent of sexually active people contract one of them at some point; about 20 million people in the United States have genital HPV infections at any given moment; and every year, about 5.5 million people become infected, according a 2000 Centers for Disease Control report." When abstinence educators talk about condoms not working, they're often talking about HPV.

That's not to say that HPV doesn't pose a health threat. Thus comprehensive sex educators, like abstinence educators, teach that abstinence outside a monogamous relationship is the only 100 percent foolproof protection against STDs. But comprehensive sex educators believe that those who choose not to remain abstinent need tools to protect themselves from unwanted pregnancy and life-threatening diseases. Most believe that exaggerating condoms' failure rates and ignoring their success rates will discourage condom use more than it discourages extramarital sex.

Dr. Hager writes: "If you had read 'As Jesus Cared for Women,' you would know that I do not recommend prayer as the cure for PMS." My article, while identifying Hager as the author of "As Jesus Cared for Women," doesn't say that he recommends prayer as a cure for PMS in that book. The recommendation the article refers to comes from Hager's 1996 book, "Stress and Women's Body," which he co-wrote with his wife, Linda Carruth Hager, and which, according to the New York Times, suggests that women suffering from premenstrual syndrome turn to a passage from Romans in the New Testament.

Similarly, my article didn't say that Hager has never prescribed contraceptives for unmarried women, only that he has refused to prescribe them. It was based on several news reports, including a Time magazine article from Oct. 5, 2002, that said, "In his private practice, two sources familiar with it say, Hager refuses to prescribe contraceptives to unmarried women."

Perhaps what those sources interpreted as a refusal Hager simply meant as discouragement. In transcript of a roundtable discussion hosted by the right-wing group Focus on the Family and posted on the group's Web site, Hager is quoted saying, "Young women come to my office with many different agendas; some are sexually active and desire some form of contraception. Others haven't yet made a decision. Either way, the door is open for lots of individual patient counsel. My first option for them is abstinence ... From receptionists to nurses, my office is geared to steer patients toward the choice of abstaining."

Salon Staff

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