TIME: Almanac 1993/TIME Almanac 1993.iso/time/090291/0902130.000

Text File | 1992-08-28 | 9.8 KB | 195 lines

                                                                                HEALTH, Page 60

Teens: The Rising Risk Of AIDS


As the infection rate grows among adolescents, the debate over
how to stem it snags on whether to urge safe sex -- or no sex

By NANCY GIBBS -- Reported by David M. Gross/Boston and Anne E.
West/Washington


    When health department officials in rural Maryland
learned from a Johns Hopkins survey that by the eighth grade,
61% of the boys and 47% of the girls at the local schools had
had sexual intercourse, they approached the school board about
providing condoms on demand. Given the speed at which the AIDS
virus is spreading among teen agers -- the number of cases is
still quite small, but it doubles every 14 months -- it was not
surprising that the board seemed open to the proposal. But when
it came time to decide, the condom measure lost by one vote. In
a way, that was not surprising either. "Personally," declares
Allen Whiteley, who was board vice president at the time, "I
think it would have been encouraging sex rather than
discouraging it."

    That episode, and his comment, captures the fundamental
dispute among parents, educators, health-care workers and
activists over how to stop the spread of AIDS before it becomes
a teenage epidemic. One side says the only safe sex is no sex;
the other counters that chastity has no hold on America's youth,
and that if children as young as 12 are becoming sexually active
they should know how to protect themselves.

    The two sides disagree not only about morality but also
about what approach would be most effective. "We don't say,
`Smoke carefully.' We say, `Don't smoke,' " argues Monsignor
John Woolsey, director of Family Life for the Roman Catholic
Archdiocese of New York City. "A huge campaign could work to
stop kids from having sex. We don't water down principles." The
goal, echoes John Walsh, spokesman of the Archdiocese of Boston,
is to teach children to be good, not just safe. "AIDS was caused
in this country by promiscuity and casual sex. It is not
traditional values that have brought us to where we are."

    But AIDS activists and health-care workers have seen
firsthand the devastation that ignorance can yield. Of the 1
million to 1.5 million HIV-infected Americans, an estimated
one-fifth are teenagers. So far, the cases are clustered in
certain populations: mostly blacks and Hispanics who are gay or
drug users, living in major cities. "We have a teenage client
dying with AIDS right now," says Frances Kunreuther, executive
director of New York City's Hetrick-Martin Institute, a service
center for gay and lesbian young people. "No one told him about
AIDS, condoms or homosexuality. If you deny young people
information based on your morality, you are sentencing them to
death. Nothing is more immoral than that."

    The battleground where the forces meet tends to be the
classroom. As of last year, 31 states and the District of
Columbia had mandated that schools provide some form of AIDS
education, and virtually every state encourages such programs.
But the curriculum varies greatly among schools, even among
teachers. The most ardent proponents argue that health education
should begin in kindergarten and eventually include detailed
instruction about the nature and risks of homosexual and
heterosexual intercourse. Conservatives are appalled. "We've
seen the ACT-UP and Planned Parenthood curriculum proposals,"
says Monsignor Woolsey. "I wouldn't put them in Times Square
bookstores, let alone schools. The average parent would throw
up reading them."

    In many communities the debate has focused on whether the
schools should provide more than information. In a handful of
American cities, school-based clinics have begun to distribute
condoms to students, but not without resistance from community
activists. "These people believe that clinics shouldn't be in
the schools because they are usurping the authority of the
family," explains Jackie Sadler, director of the HIV/AIDS
Education Program in the Washington public schools. "They don't
want us to be doing anything they perceive as condoning sexual
behavior."

    But there is plenty of evidence that teens need no
encouragement. Though there are few sources of reliable
information about teenage sexuality, it is clear that the level
of activity is rising. One sign is that each year the number of
teens infected with a sexually transmitted disease grows, with
3 million cases reported last year. The syphilis rate among
15-to-19-year-olds jumped 50% in the 1980s. "We know that STDs
tend to travel together," says Dr. Edward Hook III, chief of
Sexually Transmitted Disease Control for the Baltimore Health
Department. "People who acquire an STD are at risk to get HIV;
certainly they're not practicing safe sex."

    While reported adult AIDS cases occur predominantly among
males -- there are seven infected men for every infected woman
-- the profile of the disease among urban teens is more mixed,
much like AIDS in Africa. There are three teenage males to
every female with the virus, according to Dr. Karen Hein of
Montefiore Medical Center in the Bronx, who founded the nation's
first adolescent AIDS clinic. "We are seeing more younger girls,
sometimes 14-year-olds," says Hein. "Among teens, a far greater
number of cases are spread by heterosexual sex."

    Those who favor a values-based approach to AIDS prevention
urge some variant of Just Say No. Their argument is bolstered
by several studies showing that even well-informed,
well-equipped teenagers engage in high-risk sexual activity.
"The strategic mistake we're making is to assume that more
knowledge and greater access to condoms are going to change
high-risk behavior," says Stan Weed, 48, director of the
Institute for Research and Evaluation, a nonprofit laboratory
in Salt Lake City. "Teens approach sex in neither a logical nor
a rational way."

    This gap between knowledge and behavior is a major
challenge facing AIDS educators, says Richard P. Keeling, chair
of the American College Health Association's Task Force on AIDS
in Charlottesville, Va. "I suspect any parent or teacher would
point to peer pressure, or teens' sense of invulnerability," he
says. But there are other important factors. A teenage girl may
be too embarrassed to ask her partner to wear a condom. Or a
youth might not want to buy condoms because it makes him feel
guilty for having sex. Many prefer not to question their
partners' sex practices, as a sign of trust. And finally,
Keeling says, the mixed messages that teenagers receive can be
deeply confusing. "Kids do what they see, not what they know.
We tell kids not to have sex and then we use sex to sell
everything."

    All too often, logic and good judgment are clouded by
alcohol and drugs, so that disease prevention becomes far more
difficult. "Most of the time I had sex with guys I was drunk,"
says a 23-year-old San Francisco woman who contracted HIV as a
teenager. "I never thought a guy would care for me unless I
slept with him. I was so uncomfortable with myself I had to be
drunk."

    Some researchers suggest that teenagers cannot imagine
themselves at risk because they never meet infected teens. This
view, in a sense, is an extension of the idea that gay men only
started taking precautions after seeing their friends die. But
teenagers are unlikely to meet many ailing peers since the
incubation for HIV averages 10 years. Jennifer Andre, 21, who
was infected by a dirty needle three years ago, regularly speaks
to youths in Massachusetts in order to bring home the point that
everybody is at risk. "A few months ago, I was at a Boston
inner-city school, and there was a kid who wouldn't believe I
was infected," she recalls. "He kept saying that I was a paid
actress and that I was just saying I had AIDS."

    While the debate unfolds, both the traditional and
progressive approaches are likely to roll along side by side --
and rightly so, since teaching about sexual behavior in a moral
vacuum would not serve young people well, any more than ignoring
the practical pressures to experiment with sex and drugs that
they confront each day. Any AIDS education should be coupled
with programs about drug and alcohol abuse, in order to address
all the risk factors that intertwine. School is by no means the
only, or even always the best, place for this to happen. In
Columbia, S.C., a beauty-shop owner named, memorably, DiAna
DiAna began her own crusade six years ago. Impatient with skimpy
newspaper accounts of the spread of AIDS, she wrote away for
pamphlets and photocopied them for her clients. "I read that you
had to have condoms," she says, "so I ordered 5,000." And she
talks to the local teenagers as bluntly as possible. "You cannot
shock or embarrass me," she tells them. The most effective part
of her programs, she says, is that they "get people to talk and
communicate -- to make sex not such a big mystery."

    Judging which approaches to AIDS prevention are most
effective will be impossible without more complete knowledge of
the attitudes and behavior of young people. But that information
may be hard to come by. Last month the Bush Administration
blocked a comprehensive survey of adolescent sexual practices
after critics charged that its questions about oral and anal sex
were too explicit for children. Others greeted the cancellation
with outrage. "We have a terrible deficit of knowledge about
sexual behavior as a whole in this country," says Dr. Hook. "We
don't know if youngsters in low-risk areas are just not having
sex or if the virus hasn't got there yet." Without better
information, researchers might find out only when more people
start dying. That is not a scientific method that any country
can afford.