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Disease and Deceit: How Fear-Based Abstinence-Only-Until-Marriage Programs Continue to Spread Inaccurate, Incomplete, and Biased Information About STDs
 
Though they are billed as sexuality education or pregnancy-and HIV-prevention programs, more often than not fear-based abstinence-only-until-marriage programs fail to provide even the most basic information about topics related to sexuality including anatomy, puberty, reproduction, and sexual health care.   The information that is included in these programs focuses primarily on sexually transmitted diseases (STDs), and seems to be designed to scare rather than inform students.
 
Curricula inflate the number of STD cases, focus on worst case scenarios, and provide incomplete and confusing information about transmission, testing, and treatment. By discouraging testing and suggesting that treatment for STDs rarely works, these programs are harming our young peoples’ health, both now and in the future.   
 
The Numbers Game
  • “Syphilis, which affects about 120,000 Americans each year…”  (Choosing the Best LIFE, Student Workbook , p. 21)(In fact, according to the CDC, in 2002 approximately 32,000 cases of syphilis were reported by health officials in the United States.)
  • “AIDS is currently the leading cause of death for people between the ages of 24 and 44.”(Choosing the Best LIFE, Student Workbook , p. 36) (In fact, according to the National Center for Health Statistics (NCHS) Vital Statistics System, HIV/AIDS is the sixth leading cause of death for people between the ages of 24 and 44.)

  • Ladies, you contract Chlamydia one time in your life, cure it or not, and there is about a 25 percent chance that you will be sterile for the rest of your life.” (In fact, according to the CDC, only 40% of untreated cases of chlamydia lead to Pelvic Inflammatory Disease, and only 10% of acute cases of PID lead to infertility)[1] (Pam Stenzel, Sex Still Has a Price Tag)

STDs are a major public health threat and an epidemic in this country. Young people need to know this. However, it is neither necessary nor appropriate to use inaccurate statistics in order to get this point across. Moreover, using false information—such as the assertion that AIDS is the most common STD among homosexuals—to perpetuate myths and stereotypes is shameful and dangerous. Students, instead, should be told that HIV/AIDS has been and remains a risk for everyone regardless of their sexual orientation and be given accurate information about how they can protect themselves. 

The Worst Will Happen
  • Sexually transmitted diseases affect teenagers’ dating relationships. AIDS can kill. It can kill you. It can kill your date.” (RRTW, Student Workbook, p. 125).
  • “Warts are usually painless, but can become large and block urethra, vagina, anus, or throat…” (Why kNOw?, 8th grade and high school, p. 93)
  • “[Chlamydia] may remain in the area of the cervix for some time, or may spread to the uterus (endometritis) or fallopian tubes (salpingitis). When this spread occurs, the condition is called pelvic inflammatory disease.” (WAIT Training, p. 211)
  • “HPV is the greatest cancer killer” (FACTS Middle School, Student Handbook, p. 45).
  • “HPV—Human Papilloma Virus, better known as genital warts. Once you get this disease you have it for life. It causes cervical cancer.”(Passion & Principles, Leader's Guide, Appendix A) 
  • "...you say marry me, by the way I’ve got genital warts, you’ll get it too, and we’ll both be treated for the rest of our lives in fact you’ll probably end up with a radical hysterectomy, cervical cancer, and possibly death but marry me.” (In fact, the majority of cases of HPV resolve spontaneously without causing genital warts or cervical cancer or requiring medical treatment.) (

Discussions of symptoms in fear-based, abstinence-only-until-marriage curricula rarely focus on the early signs of STDs that may help young people know when they need to seek medical attention. Instead, these curricula focus on long-term side effects of untreated infections. Such discussions typically distort information in an attempt to scare young people. While it is true that, if left untreated, some warts will grow large enough to block the urethra and that some people may need extensive and repeated treatments for genital warts, these cases are rare. In fact, the majority of HPV infections clears up spontaneously and do not lead to any long-term health effects.  Moreover, these discussions fail to adequately explain that proper medical care and treatment can prevent many of these dramatic outcomes. Chlamydia, for example, can be treated and cured before it causes Pelvic Inflammatory Disease and regular pap smears can detect changes to the uterus long before they lead to cancer. This kind of helpful information, however, is omitted from these curricula in favor of dramatic stories and exaggerations.

 
Transmitting Misinformation
  • “Any kind of sexual activity can spread STDs from one person to another.” (Navigator, Guide Book, p. 40)
  • “Of all these people who transmit or catch STDs probably none of them will be virgins.” (Sex Respect, Student Workbook, p. 52)
  • The causative agent [for AIDS], I-UV, is transmitted by body fluids such as blood and semen.” (Passion & Principles, Leader's Guide, Appendix A) (In fact, AIDS is caused by human immunodeficiency virus, HIV.)
  • The appendix states that Chlamydia is “contracted only by intercourse,” whereas a card used for an STD activity discusses “skin to skin transmittal.” (Passions & Principles, Leader's Guide, Appendix A and STD Cards) (In fact, Chlamydia is spread through contact with infected secretions—vaginal, cervical, or semen.)
  • “[Chlamydia’s] primary site of infection is a woman’s uterus, tubes and ovaries.” (Passion & Principles, Leader's Guide, Appendix A) (In fact, Chlamydia primarily infects the cervix or urethra in women and the urethra in men.)
  • The curriculum states that Chlamydia is transmitted through vaginal and anal sex and that HPV is transmitted through vaginal, oral, and anal sex.  (Why kNOw?, 8th grade and high school, p. 94) (In fact, Chlamydia infections of the throat transmitted through oral sex are well-documented and HPV can be transmitted through any contact between infected skin and non-infected skin, no intercourse is required.)
  • A handout on HIV/AIDS lists the words “tears,” “sweat,” and “saliva” in the column labeled “at risk.” (WAIT Training, p. 219) (In fact, the CDC states that contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.)
  • Homosexual activity involves an especially high risk for HIV transmission.” (Sex Respect, Teacher Manual, p.68)
There is little debate in the scientific community about how STDs are and are not transmitted, yet abstinence-only-until-marriage curricula are riddled with inaccuracies. Moreover, they rely on vague information like the assertion that virgins don’t get STDs (it is certainly possible to “catch” an STD during one’s first sexual encounter even if that takes place on one’s wedding night) or that any kind of sexual activity can cause STDs (given that such a broad definition could easily encompass masturbation in front of a partner, petting with clothes on, or a particularly good foot massage, this statement is neither accurate nor informative). Perhaps even more disturbing, however, are statements such as “homosexual activity involves an especially high risk of HIV transmission” that are inaccurate (women who have sex with women are at lower risk of HIV transmission) and seem to be designed to perpetuate stigma rather than inform young people.  Young people cannot protect themselves without basic knowledge of how STDs are spread, but fear abstinence-only-until-marriage programs refuse to give it to them.
 
No Need to Know
  • “Chlamydia can be diagnosed through a simple blood test.” (Choosing the Best PATH, Leader Guide, p. 11)  (In fact, Chlamydia is a bacterial infection that cannot be detected in blood.) 
  •  “Some STDs such as gonorrhea and chlamydia are more difficult to detect in girls than in boys.” (Game Plan, p. 33)
  • “That means the virus [HIV] may be in your body a long time (from a few months to as long as 10 years or more) before it can be detected, either by a test or by physical symptoms.” (Sex Respect, Student Workbook, p. 60) (In fact, HIV can usually be detected within 6 months of infection, and, according to the CDC, cannot remain “invisible” to a test for as long as 10 years.)
  • “Patients with symptoms are usually diagnosed when the clinician finds characteristic physical findings and identifies evidence of the Chlamydia organism in genital fluids or urine.” (WAIT Training, p. 211)
  • “When some of my teammates went in for testing of HIV, I didn’t go. I knew I was disease free. The way I’ve chosen is the best way.” (Game Plan, p. 30)
Public health professionals agree that early testing and diagnosis of STDs is one of the most important steps we can take to combat this growing epidemic. To this end, young people need accurate, easy-to-understand information about how and where to get tested, and they need to be encouraged to do so on a regular basis. Discussions about testing in fear-based, abstinence-only-until-marriage programs, however, are riddled with inaccurate and confusing information that sometimes seems to be written for health care providers rather than eighth grade students, and often contains underlying biases. A.C. Green’s quote, for example, suggests that instead of being proud of their decision to take charge of their health and get tested, his teammates should be ashamed of their behavior. Such discussions may ultimately discourage young people from getting tested.
  
Guilty and Ashamed
  • Emotional consequence of premarital sex: “Your partner finds out that you’ve had an STD; he or she feels uncomfortable with that and breaks up with you.” (FACTS Middle School, Teacher’s Edition, Appendix, p. 98) 
  • “Persons with herpes often feel ‘dirty’ and their overall enjoyment of sex decreases.” (Why kNOw?, 8th grade and high school, p. 93) 
  • “Janice said that Lisa said that Kim said that she got crabs from her boyfriend, James. Kim knows that James is probably still sleeping with that dirty girl he was going with before he met her.” (Diary entry, Why kNOw?, 8 th grade and high school, p. 136)
Messages of fear and shame are present throughout abstinence-only-until-marriage curricula and discussions of STDs are no different. Students are told that people who have STDs are “dirty” and should be ashamed. Such assertions do nothing to explain how STDs are actually transmitted and can only further discourage young people from seeking testing and treatment should they suspect they may have an STD. Young people need to know that STDs are the result of a person’s behavior not his or her hygiene or moral character, and they should understand that health care providers are there to help, not judge, them.
 
 Curricula Referenced:

Speakers Referenced:

  • Pam Stenzel, Sex Still Has a Price Tag, A Fear-Based Abstinence-Only-Until-Marriage Presentation for High School Students, 2006. For more information see SIECUS's review of Pam Stenzel at <www.communityactionkit.org/index.cfm>

 

 

[1] Enlighten Communications Speakers, Enlighten Communications (2004), accessed 19 September 2007, <http://www.enlightencom.com/main.asp?page=3>.