Is The Sky Falling? New CDC Guidelines For HIV Prevention
No fewer than four of my regular readers have written recently to ask
me about the CDC's proposed guidelines for the content of HIV
prevention literature, prompted by this terrifying Doug Ireland column
in last week's L.A. Weekly:
Lethal new regulations from President Bush's Centers for Disease
Control and Prevention (CDC) in Atlanta, quietly issued with no
fanfare last week, complete the right-wing Republicans' goal of
gutting HIV-prevention education in the United States. In place of
effective, disease-preventing safe-sex education, little will soon
remain except failed programs that denounce condom use, while
teaching abstinence as the only way to prevent the spread of AIDS.
I've read the proposed new guidelines, and re-read the old 1992
guidelines the new ones are meant to replace. Here are the main points
where they differ:
(1) The content-review process established in the old guidelines is
now extended to information posted on the web.
(2) The new guidelines require "medically accurate information
regarding the effectiveness or lack of effectiveness of condoms in
preventing the sexually transmitted disease the materials are designed
to address."
(3) The new guidelines clarify that program materials need to be
judged acceptable by a community advisory board which reflects the
demographics of the group being served, not just the demographics of
the general population, and require that the advisory board be
selected by the health department.
(4) The new guidelines specify that public health officials need to
certify that the average person would not find the content of HIV
prevention curricula "obscene" according to the Miller standard.
Items 2 and 4, obviously, are the ones that have Doug Ireland up in
arms. Let's look at them one at a time.
Condoms: Ireland says, "they demand that all such materials include
information on the 'lack of effectiveness of condom use' in preventing
the spread of HIV and other STDs -- in other words, the Bush
administration wants AIDS fighters to tell people: Condoms don't
work." But Ireland's tightly edited quote is a substantial distortion
of the actual proposed guidelines, as you can see by comparing it to
my item (2) above. Prevention materials are actually required to
provide medically accurate information about condoms, whether that
information focuses on their effectiveness (for example, in preventing
HIV) or their lack of effectiveness (for example, in preventing
herpes).
Here's what the CDC considers to be medically accurate information
about condoms and HIV, taken from their own factsheet:
HIV, the virus that causes AIDS: Latex condoms, when used
consistently and correctly, are highly effective in preventing the
sexual transmission of HIV, the virus that causes AIDS.
AIDS is, by far, the most deadly sexually transmitted disease, and
considerably more scientific evidence exists regarding condom
effectiveness for prevention of HIV infection than for other STDs.
The body of research on the effectiveness of latex condoms in
preventing sexual transmission of HIV is both comprehensive and
conclusive. In fact, the ability of latex condoms to prevent
transmission of HIV has been scientifically established in
"real-life" studies of sexually active couples as well as in
laboratory studies.
So the CDC is going to require that HIV prevention literature
explicitly state that "condoms are highly effective in preventing the
sexual transmission of HIV," that being the "comprehensive and
conclusive" medical opinion. I'm okay with that. Nothing in the
proposed guidelines for community organizations requires an
"abstinence only" approach or devalues condoms as HIV prevention.
Nothing. Ireland's extrapolating from the Bush Administration's
preferred approach to high school sex-ed programs to interventions for
high-risk communities, and that extrapolation is unwarranted.
Obscenity: Here's Ireland: "These new regs require the censoring of
any 'content' [...] They require all such 'content' to eliminate
anything even vaguely 'sexually suggestive' or 'obscene' -- like
teaching how to use a condom correctly by putting it on a dildo, or
even a cucumber." With all due respect, that's simply nonsense.
The only place the phrase "sexually suggestive" appears in the new
guidelines is the requirement that "educational sessions should not
include activities in which attendees participate in sexually
suggestive physical contact or actual sexual practices." And the
guidelines specify that, although prevention materials are not
supposed to directly promote either heterosexual or homosexual sex,
that requirement "may not be construed to restrict the ability of an
educational program [...] to provide accurate information about
various means to reduce an individual's risk of exposure to, or to
transmission of, the etiologic agent for acquired immune deficiency
syndrome." In other words, it's perfectly allowable to teach people
how to put on a condom.
The Miller standard for obscenity requires that an average member of
the community would find the material "prurient" and "patently
offensive," and that a reasonable person would find that the material
has no scientific value (or artistic value, et cetera, but that's not
important right now). It is by no means the case that all sexually
explicit material is obscene according to the Miller test, yet Ireland
writes about the proposed guidelines as if they prohibit any sexual
explicitness in HIV prevention literature. Just as the "how to insert
a tampon" line drawings inside every box of Tampax aren't considered
prurient, and illustrated urology textbooks aren't considered patently
offensive, "how to put on a condom" illustrations will certainly pass
the Miller test.
Finally, Ireland complains that "the CDC will now take the decisions
on which AIDS-fighting educational materials actually work away from
those on the frontlines of the combat against the epidemic, and hand
them over to political appointees," by which he means public health
departments. As someone who does consulting work for a public health
department, I'm insulted on behalf of my colleagues. Who the hell does
Ireland think is "on the frontlines" if not the people who staff STD
clinics and counseling and testing services?
At any rate, the guidelines specify that only one member of the review
panel should be an employee of the health department, and that the
rest should be representative members of the community being served.
(Which means, for example, that you can't have a review panel made up
of old white men deciding what information is appropriate for young
black women.) Again, Ireland is extrapolating well beyond what the
guidelines actually say.
There's plenty of outrage to be found in the Bush Administration's
approach to HIV prevention - say, in their relentless pushing of
abstinence-only sex ed programs for teenagers and their political
scrutiny of NIH grants. It's not surprising that people immediately
leap to think the worst of anything associated with the present
government. But in this particular case, I think that Doug Ireland is
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