LAST SUMMER THE OUTGOING SURGEON GENERAL DAVID SATCHER ISSUED HIS
REPORT ONTHE STATE OF THIS COUNTRY'S SEXUAL HEALTH. PT PUTS A FACE ON THE
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.
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
Psychology Today takes a closer look at the statistics and talks to
some of the people they represent.
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.
BILL AND DWAYNE
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
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
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
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.
HARA ESTROFF MARANO
"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.
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."
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: