Sex in America


PUBLIC POLICY ON SEXUAL HEALTH HAS A TROUBLED history. Competing agendas, dismissed administrators and shrill representatives often obscure the facts rather than inform the public.

Surgeon General David Satcher, M.D., Ph.D., sought to change this contentious tone by bringing together health professionals representing diverse disciplines and points of view. These meetings produced the surgeon general's report on sex in America, Coil to Action to Promote Sexual Health and Responsible Sexual Behavior.

Without scientific debate, says Satcher, discussion would continue to be fueled by special interests, salacious media and schoolyard mythology. Coil to Action emphasizes that our first task is to encourage honest discussion about sexuality. We then need to find realistic responses to increased rates of sexually transmitted diseases (STD) and HIV, sexual violence, unintended pregnancies and abortions.

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Satcher recognizes that different communities may have different values and approaches as well as different answers. Thus, Call to Action is a starting point, not an end point, from which to develop solutions.

Psychology Today takes a closer look at the statistics and talks to some of the people they represent.

Unintended pregnancies

Nearly half of all pregnancies in the U.S. are unintended. While women of all ages, incomes and ethnic backgrounds have unintended pregnancies, numbers are highest among adolescents, low-income women and women of African-American descent. Unintended pregnancies are also medically costly. They can, for example, increase risk for low birth weight and infant mortality. Aside from higher medical expenses, the cost to society is palpable. Intended pregnancies affect education rates, welfare dependency and even subsequent child abuse and neglect.


It hasn't been an easy life for Mandy and John Olivares. When the young couple found out she was pregnant last year, they were worried. They hadn't intended to have children so soon. Mandy, however, doesn't believe in abortion. So at age 20, she is the mother of a three-month-old infant and a three-year-old boy. She was 16 when she had her first child. Receiving an eviction notice-their apartment building was converted into a cooperative--added to the couple's stress.

To cover their expenses, Mandy returned to work as a sales clerk. John, who already holds down a day job as a clerical worker, plans to take on a night job to help make ends meet. Still, the couple has never relied on welfare. "I got myself into this situation," says Mandy. "I'd rather do it on my own and work with my husband than depend on others." She even has ambitions to return to college and major in interior design and business. "I had two jobs before I got pregnant with my second-child I can do that again She says she's not worried: "I have faith."


An estimated 45 million people in the U.S. are infected with genital herpes, and 1 million new cases occur every year. Sexually transmitted disease (STD) rates in the U.S. are the highest in the developed world. Chlamydia and gonorrhea are approaching epidemic proportions among some adolescent populations, and one in five sexually active adults may be infected with genital herpes. Education is critical, as is breaking the chains of transmission through abstinence, condom use or screening and treatment. Silence is unacceptable.


Barely 18 years old and a freshman in college, Laura Zimmer was just beginning to explore her sexuality when she contracted genital herpes. "I was a naive little Catholic girl," Zimmer admits. When she confronted her boyfriend, he denied knowing he carried the disease. But rather than face possible rejection by other, noninfected men, she stayed with and eventually married him.

Ten years later, Zimmer realized that she and her husband weren't compatible and they divorced. Soon she found herself facing the same challenge she had avoided as a teenager. "I'd date someone until I had to reveal that I had herpes," she says. "Then I'd sabotage it-let my very worst traits come out-so if he rejected me it wasn't because I had shared something personal." But Zimmer couldn't continue living with her fear of rejection. She wanted people to know her story; so she wrote it and then e-mailed it to nearly everyone she knew. "It's the best thing I ever did," says Zimmer, who's now in a healthy, honest relationship. "Everyone responded with such love and respect. This is part of me that won't change, and I'm not going to reject myself."


Some 80 percent of gay men and women have experienced verbal or physical harassment, 45 percent have been threatened with violence and 17 percent have been physically attacked. Strengthening families--whatever their structure--and encouraging stable, enduring adult relationships is important to sexual health. The stigma of this sexual orientation can lead to harassment, depression and suicide.


When Bill told his mother he was gay, she was less than understanding. "She made comments that I would go to hell," he recalls. That winter his mother didn't invite Bill's partner Dwayne to celebrate Christmas with the family. Consequently, Bill didn't see her either. Her reaction has made it hard for Bill to disclose his life to others: "I'm very guarded. I don't feel like explaining myself." At his former place of employment, one coworker compared gay people with child molesters. Although Bill, a 31-year-old cardiac sonographer, wanted to tell his co-worker to relax, he didn't: "I prefer not to have the confrontation."

Bill lives with Dwayne, a 33-year-old hotel worker, and their three dogs and two cats in Long Island, New York. They bought an abandoned house in a culturally diverse community and renovated it to the delight of their neighbors. But they realize that living in New York is much different than living in the South. "People here have more experience with gays who are out," says Bill. While the couple feels comfortable in their neighborhood, Bill and Dwayne still keep a low profile. "We don't walk around holding hands-not that we don't want to," says Dwayne.


The AIDS epidemic is shifting toward women. While women accounted for 28 percent of HIV cases reported between 1981 and 1999, they accounted for 32 percent of reported cases between June 1999 and July 2000. We need to observe that the enemy is the virus--not those infected. We need to team up with those infected to stem the spread of HIV. With their help, we can increase awareness of the need for responsible sexual behavior.

MICHELLE LOPEZ turned tricks on the streets of New York in the mid-1980s, soon after she arrived from her native Trinidad. But when she became infected with HIV in 1988, it was through sexual intercourse with her husband. Their daughter, Raven, was born HIV-positive two years later and was diagnosed in 1992. Everything changed. Lopez kicked drugs and compulsively researched the disease: "I saw what the gay white male population did I saw what worked for the ones who wanted to live: learning about research and drug side effects and developing relationships with drug companies." Lopez has had full-blown AIDS since 1996, She takes a cocktail of five drugs a day as well as Zoloft far depression.

Today, Lopez is an AIDS educator at the health clinic where she first sought treatment nine years ago, Some 75 percent of the patients are women and, like Lopez, many emigrated from the Caribbean Raven is now 12 and speaks publicly about being HIV-positive. Lopez feels that she herself has come full circle: "I want to help people live. A lot of people did that for me. When Raven and I were diagnosed, I was on a mission to live. Now I'm on a mission to save my child's life."


An estimated 1.37 million women underwent abortions in the U.S. in 1996. Of that figure, nearly 45 percent had already received at least one abortion. Teenage pregnancy has become a focus, but abortion rates are, in fact, higher for women in their early twenties. There is general agreement that rates should be lower. One way to achieve this is by providing information on, access to and use of contraception.


"I have had two abortions," says Hara Estroff Marano. At the time of her first, in the early 1960s, abortion was illegal. Marano ended up on a dining-room table with a coat hanger and a little Italian woman standing over her. The then 21-year-old college student "was oddly confident." Yet two nights later she was bleeding to death, so a friend whisked her to a Boston hospital for an emergency D and C. She woke up at three in the morning inside an oxygen tank, scared and without the emotional support of her family. "I felt l had screwed up and I wasn't going to get any sympathy from my family."

Years later, in her midthirties, Marano faced an impending divorce and another unwanted pregnancy. Already the mother of two young children, she chose to have an abortion. This time, the procedure was professional and not in the least traumatic. "Being a mother is the most important job we have. To be a parent we need resources-emotional, financial and social," says Marano, PT's editor at large and editor of the magazine's Blues Buster newsletter.

PT Staff

The Opposition

Surgeon General David Satcher isn't exactly a popular public figure in many circles. The Family Research Council, for one, has demanded his resignation. So it is no surprise that Satcher's Call has met with a chorus of controversy. The Bush administration and numerous other groups, including the American Family Association, Focus on the Family and the Family Research Council have denounced the report.

These various organizations disagree with several points in the report. For example, the surgeon general advises schools to teach abstinence, while also recommending that students be educated about birth control. This approach, known as "abstinence plus," has drawn the most fire. "The safe-sex campaign has been a disaster," says Ed Vitagliano, of the American Family Association.

The report also concludes that there is no valid scientific evidence that sexual orientation can be changed-another point of contention. "The conclusion was basically down the line with that promoted by homosexuality advocacy groups," says Vitagliano, who objects to the view that "sexual orientation is determined at an early age and that there is no valid evidence that orientation can be changed."

--PT Staff

Michael W. Ross, Ph.D., is professor of public health at the University of Texas and a scientific editor of the surgeon general's Call to Action. For information see:

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