Glenden BrownSafe Sex: All the Facts, please
Last week, Cameron at Magic Valley Mormon published a post about Safe Sex last week. The core of his argument can be summed up: Condoms don’t make sex 100% safe, therefore sex is never safe and we shouldn’t ever tell anyone it is or can be. Hence he wrote:
We as parents, educators, and society as a whole need to stop pretending that there is such a thing as “safe sex”. This is simply an easy to believe lie, one particularly harmful to the youth with whom we have been entrusted.
Cameron’s post is a good example of how otherwise well intentioned people get it wrong when it is time to talk about sexuality. He focuses on and overmphasizes the risks of sexuality, telling a story of sexuality as dangerous territory filled with landmines. Cameron avoids the usual whackadoodle abstinence only nonsense, which is good, but can’t quite bring himself to talk about comprehensive, life span sexuality education and its value. Instead, what he delivers is a screed against “safe sex” that isn’t accurate:
Simply handing out condoms and preaching safe sex is a harmful lie we tell ourselves and our children.
Even the most basic STI prevention programs consist of far more than handing out condoms. Such programs involve practice with the condoms, practice negotiating condom use and safer sex practices, and, perhaps more important, practicing refusal skills. In addition, safe sex edcuation (at least today) tends toward the harm-reduction model - the goal being to identify and manage the risks of sexuality. Refusing to teach adolescents about harm reduction insults and devalues them. Focusing on the risks of sexuality does the same - adolescents deserve to know that sexuality can and should be tremendously life-enhancing. Our sexuality is fun - talking about the risks alone is a huge mistake.
Effective sexuality education is much more difficult for the adults involved than the adolescents. Most parents have a fairly extensive list of fears about adolescent sexuality that include everything from having sex at all to getting pregnant/fathering a child at 15, to getting AIDS. For many parents, sexuality education scares the holy living shit right out of them because they have to face the potential outcomes. Add to that the normal process of grieving that parents go through as they realize their children are growing up and going to go out into the world and make lives of their own and you have a strong emotional reason to NOT talk about sexuality. (I sometimes wonder if the desire to teach abstinence is about delaying maturity in kids; adults have sex, if adolescents aren’t having sex they’re still “kids”.)
Avoiding the topic by saying “Simply handing out condoms and preaching safe sex is a harmful lie we tell ourselves and our children” avoids the real work of sexuality education. Teaching abstinence only is taking the easy way out and not talking about safe sex is the easy way. FWIW, mainstream thought in the mental health, medical and sexuality educators has shifted to the harm reduction model - the idea that nothing is ever completely safe, so that’s not the goal - the goal is to help individuals identify and manage the risks associated with their sexuality.
Cameron starts with a good point - there is a tremendous amount of ignorance about sexuality, as well, as a tremendous inability on the part of many people to openly discuss sexuality with their lovers, friends, and family. With regard to sexuality, misinformation, lack of information, inaccurate inforamtion, confusion and poor communication are the norm not the exception. In response to this sorry state of affairs, the UCC and UUA churches created Our Whole Lives as lifespan, comprehensive sexuality education (starting in kindergarten all the way up to adult). Our Whole Lives has as one of its primary goals providing accurate, complete information in age appropriate ways. Addressing and correcting those misperceptions is hugely important. The trap that Cameron falls into is the trap of seeing and emphasizing the risks of sexuality - talking about failure rates and emphasizing the problems, most of which can only be addressed by education.
Floating in the background of many discussions of sexuality, but rarely articulated, is the notion that sex today is far more dangerous than the past. A while back on the Salt Lake City channel (channel 17), they featured a public discussion of sexuality education in which a proponent of abstinence-only education boldly asserted that there are more STDs today than in the past. This is false. the belief that we have to contend with greater risks than our ancestors. I checked with the Fred Wyand at the American Social Health Association and was told that with the possible exception of HIV, there are no more STIs today than say fifty years ago (HIV is possible since some evidence suggests there may have been some cases as early as the 1930s but that is highly speculative at this point); the perception that there are more STIs than in the past rests at least partly on our ability to diagnose some today that we could not diagnose in the past.
Focusing on the risks of sexuality, not the rewards, is a one sided message that, however well intentioned, alienates an adolescent audience.
Cameron links to a sight that shows three studies of condom failure rate - one as low as 1.04%, the middle on in 3’s, the high of 4.5%. Cameron focuses on the highest number (which he bumps up to 5%).
The Guttmacher report he links talks about both female and male condoms - Cameron’s post makes it sound as if its about male condoms exclusively. The female condom is more difficult to use than the male condom and requires more practice to get right than the male condom - even among sexually experienced women femidoms require practice. The Guttmacher report also shows a precipitous drop in failure and slippage rates as experience with condoms increased. This key piece of information is crucial to understanding why comprehensive sexuality education includes practice with condoms - learning things as simple as opening the package, unrolling the male condom, then slipping it off, and learning to properly insert the female condom in a setting that isn’t romantically charged provides teens with a tremendous advantage.
Abstinence only programs (Cameron doesn’t advocate these explicitly) use a simliar pedagogy that Cameron employs. They spend a huge amount of time and energy talking about contraceptive failure rates, with special attention given to condoms. They portray condom usage as risky, complicated, time consuming and awkward. The outcome isn’t adolescents remaining abstinent it is decreased condom usage among teens when they have sex - increasing the risks of sexual activity. Teens who have been through abstinence only programs have a fatalistic attitude toward sexuality that bad things will happen no matter what so there’s no reason to manage the risks.
We can’t scare people into being chaste. But we can offer a realistic message about sexuality - one that embraces the life ehancing potential of sexuality without exaggerating or minimizing its risks.
August 21st, 2008 at 10:05 am
I think the simplest solution to this problem is the best. Don’t have children.
August 21st, 2008 at 10:14 am
I wonder if Cameron is encouraging his kids to enlist and fight in Bush’s war in Iraq!
August 21st, 2008 at 10:37 am
Cameron’s line of argument is a familiar one - just about everyone uses it.
Nuclear power isn’t 100% safe - so we shouldn’t use it.
An ABM shield isn’t 100% effective - so we shouldn’t fund it.
Alternative energy sources aren’t wholly effective - so we shouldn’t explore them.
The South Beach Diet doesn’t work for everyone - so you shouldn’t do it.
Municipal WiFi won’t reach everyone - so we shouldn’t do it.
etc.
etc.
It’s the easy “all or nothing” or “the perfect is the enemy of the good” and whatever side does it, it’s a rotten argument.
August 21st, 2008 at 11:06 am
JD - I think where the challenge arises in identifying all the options, assessing their effectiveness and associated costs; that’s a lot of work and sometimes we don’t have time to do the work.
August 21st, 2008 at 12:11 pm
Glenden, I appreciate the write up and critique of my post. I’d like to note that the post is not an attack on sexuality or the value of sex education. It has a fairly narrow focus - the fact that too often the message received by kids is that condoms make sex safe. Also of note is that I used as sources exclusively organizations that are about as far away from anti-sex/abstinence-only as you can get - like Planned Parenthood’s teenwire.com. If PP, the CDC, and the Guttmacher Institute are saying it, I thought it would be safe for me to as well.
One problem with your critique is that you focus on education as the means of reducing condom failure rates. The first problem with this is that it completely ignores Planned Parenthood’s warning that you can contract CMV, herpes, HPV, pubic lice, and scabies if you have “sex play without sexual intercourse”, CMV, herpes and syphilis just through kissing, and the fact that “some sexually transmitted infections, like herpes and genital warts, are spread through skin-to-skin contact.”
Second, the Guttmacher Institute’s study included thorough training and education not on teenagers, but on 18-35 year olds, yet they still recorded failure rates as high as 11%. It was not education, but experience that caused the rate to fall as low as 1%.
August 21st, 2008 at 12:58 pm
Of course. The other is so much easier….
On another note - Phelps’s interesting style of freestyle is being taught at various powerhouse universities. At some points in his stroke, he actually has both hands in the water! To tie it in to the OP, here’s an example of how the “good” graduated to the “perfect”.
August 21st, 2008 at 1:19 pm
Cameron - Your sources are good sources (and I did note you didn’t go in for the abstinence only stuff). My argument isn’t that we ignore the warnings, but that we deal with them accurately and honestly - we note the risk but also point out that latex condoms are the most effective means of reducing transmission. By emphasizing and talking primarily about the risks of sexuality we lose credibility with an adolescent audience; my central critique of your post is your narrow focus on failure rates. Effective sexuality education does not overhype either the failures or the effectiveness of condoms.
There are two aspects of condom usage - consistency and correctness. In sexuality education, students learn the basic skills of how to use condoms; they should also begin aquiring the consistency component which includes learning to negotiate condom usage with partners. Very often, in the real world, individuals struggle with the consistency aspect (and overreporting usage is a common problem) since partners can often be resistant or even hostile to using condoms. Learning to negotiate consistent usage requires practice - just as learning correct usage requires practice. In my class, students get an opportunity to practice with condoms on medical demonstration models. They get to handle them and learn the challenges of putting on a condom when you’ve got lubriant on your hands or you don’t have perfect visibility. That practice goes a long way toward cutting failure rates.
The Guttmacher report differentiates between FEMALES condoms which had an 11% initial failure rate and MALE condoms which had an initial 7% failure rate. In talking about condoms, differentiating between the two is important (male condoms are much cheaper and easier to use than female condoms; the lack of familiarity with them female condoms is consistent across the board, even among sexually experienced adults). I have two problems with the study Guttmacher reported on - one it’s ten years old and two the sample population is highly specific and all female.
As with any skill, the classroom provides the introduction and basics, but it is real world experience that improves skill and effectiveness. A good corollary is learning to drive; in driver’s ed we can watch movies, use simulators, talk about the skills but it is the real world experience that matures a person as a driver. Sex is much the same - in the classroom students can learn the concepts, they can practice the dialog, but until they use and apply those skills in the real world, they don’t master the skills.
August 21st, 2008 at 1:20 pm
JD - I hadn’t heard that about Phelps’ stroke. I know I’m old school where swimming is concerned but I like the classical, balanced freestyle. Although Phelps butterfly is freaking textbook perfect.
August 21st, 2008 at 1:56 pm
Which is what I was doing.
You see, I think we actually agree here, we’ve just come to this point from opposite ends. I bristle at the notion that using condoms means there’s no risk, and you bristle at abstinence education.
There’s a certain amount of distrust evident in your post - you begrudgingly admit my facts are correct, and that I did not advocate abstinence only programs, but you don’t really trust my intentions. Which is understandable; the commenters to my post reacted the same way. But what I wrote is exactly what you have just advocated - dealing with the dangers and warnings accurately and honestly.
In that same vein, some of my point of view is influenced by a sense that the “accurately and honestly” part of sex education doesn’t always include these warnings.
Now, the common ground that we’ve found is important. It isn’t just education that makes sex safer, it’s “real world experience that improves skill and effectiveness.” However, I think most reasonable people would agree that teenage sexual activity is quite a bit different, and more complicated, than is teenage driving. And we have all sorts of rules and laws concerning driving. With driving, you can spend hours and hours in a parking lot perfecting your skills. You can drive in traffic with a trained teacher in the passenger seat. All of these things are designed to give the driver real world experience to go with the education. There is no such way to prevent inexperienced sexual activity from leading to accidents that can permanently change a teen’s life.
August 21st, 2008 at 2:59 pm
Cameron - I think people do get real world lessons in relationships - watching their parents, siblings, cousins, neighbors, etc. As they see the people in their lives actually live out their relationships, they learn all kinds of lessons. They also get to practice - lots of young kids will announce (a’la South Park) “We’re boyfriend and girlfriend,” and equally, “I break up with you.” Such behaviors are practice for adulthood, are ways of checking out the process and figuring out what it means to “date” someone, what it means to be in a relationship with someone. Many kids - even those whose strict parents tell them “No dating until you’re sixteen” - manage to have boy or girl friends at school. (And before you ask about this, I have yet to meet a kid who did not know how to fool his/her parents about romantic relationships and I’ve met more than a few who were carrying on active sex lives while their parents believed they were utterly celibate.)
These relationships are part of the process of adolescence, of figuring out what kind of person attracts you, what you like and don’t like, how much intimacy you like and how much is too much. The romantic entanglements tweens and early adolescents experience are part and parcel of the process of growing into adult relationships. As we mature, we (hopefully) learn to see sexual intercourse as one way in which to express intimacy with another person. I disagree that we can’t prevent teenage sexual activity from harming lives - our European cousins are far more successful at preventing unintended pregnancy and STIs than we are and Europeans and Americans are all but indistinguishable from one another in terms of sexual activity.
August 22nd, 2008 at 10:56 pm
Yeesh. As the mother of a pre-teen, I fancied myself pretty enlightened because my kids even know that there IS barrier protection. I must confess that my vision of future “special talks” between us pretty much stopped there. Can’t say as I took into account the possibility that the mechanics of that whole business might have a learning curve. Or that the current technology might be inadequate. Or that despite best efforts, there might be some life-changing consequences. This whole idea of it being like driver’s ed — that it might be on you as the parent or the educator to bust out the bananas and lube and do a test-run — this is going to take some getting used to.