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Abstinence-only Sex Education and the ACA

I learn something new every day. There has been a lot of news recently about the Patient Protection and Affordable Care Act (ACA) as the nation celebrated its two-year anniversary (or not, in the case of opposition). Also, today the Supreme Court concluded its review of the health care bill. I support many aspects of the ACA. Although many aspects of the ACAwill be enacted at different times, the Act: does not allow health insurance companies to deny someone coverage because of pre-existing health conditions; allows children to be covered under their parent's health insurance until they are 26; requires health insurance companies to cover, free of charge, preventable health services such as vaccines, mammograms and screening for conditions like obesity and Type II diabetes. Also, this March it became mandatory that federal health programs collect racial, ethnic and language data which will perhaps help us better understand health disparities. However, thanks to a CNN article I learned that the Act also renewed $50 million per year for five years, for abstinence-only sexual education.

Abstinence-only sex education was something I heard about long ago. Then I really began to pay attention to the issue while I was a Public Policy Fellow at Gay Men's Health Crsis in 2009. Abstinence-only sex education places a great emphasis on waiting to have sex until after marriage. Such education often minimizes the biological aspects of sex, and often speaks very little about the use of condoms and birth control, if at all. Such education has been linked to increased rates of teen pregnancy and contraction of sexually transmitted infections. One 2011 study at the University of Georgia examined the correlation between abstinence-only sex education and teen pregnancies, births and abortions.

For every state, the investigators examined education laws and other policies regarding sex and/or HIV/AIDS education. Actual education laws were retrieved from the Education Commission on the States, while other related policies were retrieved from the Sexuality Information and Education Council of the US (SIECUS). All but two states (Wyoming and North Dakota) had education laws and/or policies on record. Each state's laws and policies were assigned a number from 0-3 indicating the level of importance each state placed on abstinence from sex; level 0 laws indicated no specific mention of abstinence, while level 3 indicated that abstinence from sex until marriage was the fundamental teaching standard. The policy level for each state was correlated with data on teen pregnancy, and birth and abortion rates. The investigators also accounted for population factors like socioeconomic status, education level, ethnicity and access to Medicare waivers for family planning.

The results? States that were described as Level 3 (abstinence was their fundamental teaching standard) had the highest rates of teen pregnancy and births among teen moms. The investigators also found that richer states tended to have a higher proportion of white teens in their teen populations, and emphasized abstinence less. These richer states also tended to have lower teen pregnancy and birth rates than poorer states. These results support the notion that abstinence-only sex education is ineffective.

Politics often involves compromise between the concerned parties. In June 2009, when I was a Public Policy Fellow, the major source of funding for abstinence-only education expired. A new bill was signed in December 2009 that provided $114 million to more comprehensive and evidence-based sex education (hooray)! Therefore, I was surprised to learn that the ACA provided funding for abstinence-only education which yields questionable outcomes. But like I said-- compromise.

The debate about whether or not abstinence-only sex education works is important; however, it is the unwanted outcomes with which we should be very concerned. The University of Georgia study found that teenage pregnancy was strongly correlated with ethnicity and socioeconomic background. Public health campaigns that target high-risk populations to educate them about teen-pregnancy and provide better access to preventative services will be invaluable moving forward.

Antiquated U.S. Blood Donation Ban Against Gay Men Contributes to Stigma and Blood Shortages

GMHC Report Explores Alternatives to Lifetime MSM Ban

New York, NY — The Food and Drug Administration (FDA) currently bans any man who had sex with another man (MSM), even once, since 1977 from donating blood. The policy does not consider the potential donor’s HIV status, frequency or risk of sexual activity, or if he is in a monogamous relationship. Today, Gay Men’s Health Crisis (GMHC) released a report detailing the history of the policy, efforts towards revision, and analysis of alternative donation criteria.

Advances in HIV screening of blood supplies since the 1980s make the chance of receiving a unit of HIV infected blood one in 1.5 million. Guidance, for most donors, takes into account the “window period,” the short period after HIV infection whereby a HIV screening would not detect infection. Current FDA guidance includes a questionnaire of potential blood donors that asks 48 questions about current health status, medical history, blood donation history, sexual practices, drug use, and other behaviors. But risk factors are not uniformly applied. A heterosexual donor who has had sex with a knowingly HIV-positive partner 366 days ago would be eligible for donation. By contrast, a man who has had sex with another man, regardless of the frequency, safe sex practices involved, or duration since the episode, is denied for life.

“Across the country, we experience critical shortfalls of blood supplies on a consistent basis,” said Janet Weinberg, Chief Operating Officer at GMHC. “Yet only five percent (or less) of Americans that are able to donate blood do so. We call on the FDA to re-examine discriminatory policies that categorically exclude potential blood donors, including gay and bisexual men,” added Weinberg.

The report analyzes alternative recommendations for blood donation by gay and bisexual men using a comprehensive framework to assess actual risk of HIV transmission and increased availability of blood supplies. The framework, called “DONATE,” provides a way to understand how the use of advanced technology and objective screening standards can decrease the risk faced by recipients of blood products, while at the same time reducing the discriminatory impact on MSM, expanding the pool of blood donors (thereby reducing the potential for blood shortages), and raising awareness of HIV/AIDS risk among donors in general, regardless of sexual orientation or gender.

The report also examines how other countries, including Russia, South Africa, and Spain, treat gay and bisexual male blood donors.