Health-promotion experts and historians generally concur that the federal government’s response to HIV/AIDS during the 1980s and early 1990s was inadequate and constrained by moralism. President Ronald Reagan famously refused to publicly address the issue of AIDS until five years after the first reported cases of AIDS (and only after it was clear that HIV was spreading outside so-called “deviant” groups, such as homosexuals and injecting drug users). The U.S. surgeon general, C. Everett Koop, fought a losing battle against Reagan and Secretary of Education William J. Bennett to introduce pragmatic sex education classes into American high schools or even mention the word “condoms” in literature mailed to U.S. households. Congress was reluctant to fund gay-based organizations, such as New York’s Gay Men’s Health Crisis, to devise and deliver HIV prevention programs to their constituencies, despite evidence from countries such as Australia that peer-provided education was more successful and cost-effective than having medical professionals and public health bureaucrats design campaigns and disseminate information. And successive presidents and Republican- and Democrat-controlled Congresses have failed to provide funding for needle-and-syringe exchange programs, even though there is overwhelming evidence that they are effective in preventing HIV transmission among injecting drug users. Federal public health officials claimed (and continue to assert) that there is less incentive for drug users to seek treatment once they are supplied with sterile equipment that reduces the danger of injecting, and fear that young people will experiment with drugs if needles and syringes are readily available. Yet between 1991 and 2001, eight comprehensive federally funded evaluations of the effectiveness of needle-exchange programs (both domestic and foreign-country based) concluded that such schemes reduced the rate of HIV transmission and did not lead to an increase in drug use.
The influence of the religious right and a conservative social agenda remains evident in the federal government’s current approach to AIDS prevention, particularly its vast commitment of funds for “abstinence-only” sex education programs in U.S. schools. These programs aim to reduce the rate of teenage pregnancy and incidence of sexually transmissible disease such as HIV. It is a formidable task. According to the most recent and comprehensive survey (involving 13,917 students from 159 different schools), about 47 percent of U.S. teens have sexual intercourse before leaving high school, and more than 750,000 teenage girls become pregnant each year. Nearly 37 percent of high school students who were sexually active at the time of the survey had not used a condom during their last sexual intercourse. Unsurprisingly, approximately three million teens acquire a sexually transmissible infection each year.
The move toward abstinence-based sex education programs ...
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