Sex in America

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.

MANDY OLIVARES

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."

STDs

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.

LAURA ZIMMER

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."

Homosexuality

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.

BILL AND DWAYNE