Safer Sex

This is a story about the power of love, as it is understood by a certain 17-year-old San Francisco highschool student. Carmen had sex for the first time when she was 13, with a teenage boy from the neighborhood. She had symptoms of venereal disease-possibly chlamydia-at 14 and was finally treated for it a year after that, when she saw a gynecologist for the first time. Now, when she has sexual relations with her teenage boyfriend, she doesn't use a condom because she thinks she has something better. "Even if he was screwing around nothing would happen because he says he'll never do anything that would mess me up, and I believe him," she explains, changing buses on her way home from her Roman Catholic school. "We don't need no condom because he says he loves me."

Love: next to the mosquito, probably the greatest disseminator of deadly microbes ever devised by the cruel hand of fate. Not only does it draw people into intimate contact, it addles their brains in the process. For the things a condom is intended to prevent, it doesn't matter whether Carmen's boyfriend loves her or not; what counts is whether he has been infected by one of the seven major diseases known to be transmitted through sexual contact. There are 12 million cases of sexually transmitted disease each year, according to the Centers for Disease Control (page 58). Even as the overall rate of new HIV (AIDS) infections appears to be leveling off, the disease is becoming endemic in disadvantaged communities, where syphilis and gonorrhea are also on the increase. Middle-class whites are coming down with herpes, genital warts (which can lead to cancer of the cervix) and chlamydia (which can make women infertile). Three million teenagers contracted one of these diseases last year. How many of them got it from someone who loves them?

And yet STDs are among the easiest of diseases to prevent. Anyone who has mastered washing his hands after using the toilet has the intellectual capacity to avoid most venereal infections. Their prevalence represents an apparent failure of the quintessential liberal solution to social problems, education. For nearly a decade society has been throwing education at AIDS. NEWSWEEK has run 11 cover stories on the subject. Lectures on safe sex now start in the fourth grade in some schools (page 61). Homemade safe-sex programs have sprung up in all sorts of unlikely places, like the Columbia, S.C., salon of beautician DiAna DiAna, who recorded her own instructional videos on her home camcorder. Almost no one is ignorant of AIDS in this country. "You have to sample Mars to find someone who doesn't know the basic facts," says Jeffrey Kelly, a professor of psychiatry at the Medical College of Wisconsin.

Much of this effort has been directed at getting people to use condoms, which are more widely available than ever. Sample packages, along with graphic guidance on their use, are thrust into the hands of passersby on San Francisco streets and New York City subway stations; sober matrons on their way home to Sausalito or Pelham stuff them into their purses as if they were sailors heading for the fleshpots of Bangkok. Last week New York began handing them out to high-school students, no parental approval required. In Chicago, anyone embarrassed to ask a drugstore clerk for condoms can go to a month-old store named Condomplation, where they never give you Tums by mistake instead.

If education alone could affect people's behavior, STDs would be a thing of the past-but then, so would drugs. The one group that has unquestionably changed its behavior is middle-class homosexual men, who had the most incentive, and the example of countless friends who died of AIDS. It would be almost inconceivable now for a man to lead the kind of life described by songwriter and author Michael Callen, who estimates he had more than 3,000 different sexual partners between 1973 and 1982-contracting in the process "hepatitis A, hepatitis B, hepatitis non-A/non-B, herpes, syphilis, gonorrhea, chlamydia, cytomegalovirus ..." and eventually AIDS. Few heterosexuals ever lived like that in the first place, and the changes in their lifestyles have been less pronounced. More typical is someone like Sharon Taylor, 34, a Denver lawyer who hit a rocky patch with her husband last spring when she questioned his fidelity. "We decided to work on our relationship and see a counselor," she says, "but when I insisted we start using a condom he balked. I think I surprised myself by sticking to my guns. He kept saying "don't you trust me?' and I kept saying, "no'." They separated for a while, reconciled, and recently have begun sleeping with each other again. Now that she's not so mad at him anymore, she has relented on the question of condoms. "I figure I'm taking a risk no matter what I do," she says. "Safe sex is an option, but at some point you have to draw the line and leave it in the hands of providence."

If a mature, educated woman like Taylor considers safe sex optional, what can one expect from college students, much less younger teenagers? There were a million teenage pregnancies last year, representing uncounted millions of acts of unprotected copulation. This is not just a problem of minority high-school dropouts. Janice Baldwin and John Baldwin, sociologists at the University of California, Santa Barbara, have done largescale surveys of California college students, the great majority of them white. In one they found that "less than 20 percent of the currently sexually active women and men reported using condoms 75 percent of the time or more..." This was not due to lack of information. They knew enough to be worried about AIDS, especially those who were most sexually active, with three or more sexual partners in three months. It just didn't make them any likelier to use condoms. On the contrary, the Baldwins found, "the people most at risk are taking the least precautions."

And even when students take precautions, they often take the wrong ones. Jeffrey D. Fisher, a psychologist at the University of Connecticut, has found that undergraduates have taken to heart the advice of the surgeon general to "know your partner." But they know the wrong things about them. Rather than directly ascertain whether their partners have AIDS or another disease, they inquire about their home towns, families and academic majors, and on those irrelevant and useless facts draw a conclusion about how safe it is to sleep with them. Fisher calls this "implicit personality theory," but it's essentially a form of superstition, not unlike Carmen's conviction that her boyfriend won't give her AIDS because he loves her. Of course, it isn't always easy to get real information about sexual histories. This is partly a definitional problem. To teenagers, says Leslie Kantor of Columbia's student health service, "monogamy means you're sleeping with one person at a time. " It is also partly an ethical one. Yet another study of southern California college students found that nearly half the men and two fifths of the women said they would lie about how many other people they had slept with. One man in five said he would lie about having been tested for the AIDS virus. Says one of the authors: "A partner telling you he hasn't done anything doesn't tell you anything."

But outright duplicity between lovers may be a lesser problem than anxiety, embarrassment and simple misunderstanding. "I wouldn't know where to start," says a 19-year-old Berkeley student who gave only the name Patricia. "What if he said no? What if he got mad? I just wouldn't be able to ask that." Some people worry that if they insist on using a condom, their partners will suspect they already have a venereal disease. Or, conversely, their partners will be offended by the implication that they might have a disease. Fisher has found that students don't use condoms because they're afraid of being thought of as unhip, repressed and neurotic. Contrariwise, Alicia Carmona, a 20-year-old "peer sex educator" at Columbia, knows many women who don't like to think or talk about condoms because they are "fundamentally afraid to acknowledge they're being sexual." Kenneth Traum, a junior at Berkeley, doesn't use condoms with his girlfriend because "they're uncomfortable and they take away from the whole experience. Sometimes they can really take away from what making love is." His girlfriend presumably concurs, although she assumes they have a monogamous relationship; Traum admits they don't. Still, Traum knows what he should be doing. He has to; he wants to be a "peer counselor" too.

The situation clearly is far worse in poor minority communities, where the future is already blighted by circumstances beyond anyone's control. In Chicago, and probably other cities as well, the big jump in syphilis cases followed closely the arrival of crack cocaine. Anonymous sex in crack houses is an ideal way to spread the epidemic and a nightmare for public-healthworkers. "People aren't able to tell you who they've had sex with," observed Dr. Jane Schwebke, who runs Chicago's five STD clinics. "They may not know." In Cleveland, Dr. Victoria Cargill, an epidemiologist at University Hospitals, founded a program to bring AIDS information to public schools, although information as such is rarely the problem. "Ninety-five percent know that AIDS is spread by sex and needles...," she says. "Their knowledge is excellent. Their behavior is abysmal. We have questions like,'How many of these diseases can I have at one time?"' Some teenagers actually boast about acquiring a venereal disease; it's proof they've been sexually active, a pathetic badge of manhood.

Poor Hispanic communities face many of the same social problems, compounded by a cultural outlook that winks at male philandering but regards the use of condoms as both immoral and contrary to the principles of machismo. Alex Vasquez, a 29-year-old Houston homosexual man with AIDS, still has arguments with family members who believe that he's committing a mortal sin by using condoms. "We're ripe for an AIDS epidemic in the Hispanic community, a runaway epidemic," says Lucy Reyna, president of Houston's Hispanic AIDS Coalition. Mexican immigrants have imported the custom of the "cantina," something more than a saloon, and the "cantineras," the women who frequent them. Sometimes, when the men can't find a cantinera to go with them they take the next best thing, a transvestite male prostitute. The customers do this without considering themselves homosexuals, a term that in Mexican culture is applied only to the submissive partner in homosexual intercourse. Then they go home to their wives.

Obviously, education has some frontiers to conquer. We need an airdrop of condoms for the cantinas, a video for the woman who showed up at Houston's Thomas Street Clinic testing positive for the AIDS virus but insisted she couldn't possibly infect any men because she'd had a hysterectomy. Let's bring Magic Johnson around to talk to the prostitutes, studied by sociologist Kirk Elifson at Georgia State, who now scrupulously insist on condoms when they are working but not when they're having off-duty sex with their boyfriends. Education is sure to be a major theme when Surgeon General Antonia Novello releases an update of the seminal 1987 AIDS report of her predecessor, C. Everett Koop. Her message will be that "we have to alert the public that the epidemic is changing: more heterosexual spread, more women, children, young people."

But at the same time we are coming up against the limits of mere knowledge to change behavior; the studies of college students show that. To a cultural conservative like Camille Paglia, author of "Sexual Personae," this is no surprise. The "dark, turbulent drama of sexual desire" resists rational criticism, however well-intentioned, she asserts. Historically only the strong sanctions of religion and family have succeeded in reining in this primal force. People have risked marriages, jobs, inheritances and death by stoning to go to bed with someone they liked-can we really expect to conquer passion with the threat of genital warts? Backed up with a subway poster?

The logic of Paglia's position leads to a call not for more information but for moral absolutes. Officially, the administration endorses sexual abstinence, outside of a monogamous relationship, as the best preventive for AIDS. But when asked exactly who might be a candidate for this measure, Fred Kroger, head of CDC's AIDS education unit, mentions "the very young, [people] past 90 and others when abstinence is forced on them--with two broken legs, for instance." Chastity as a policy has been so neglected that Vice President Dan Quayle made headlines last month with a few casual words in its defense. Still, some unexpected voices are now being heard on the subject, like that of Harvard child psychiatrist Robert Coles. Coles regrets that "liberals won't talk about abstinence; it's been left to Catholic bishops and the political right. As psychoanalysts, we know that kids need self-control and discipline. But I don't hear anyone speaking out ...Magic Johnson has been turned into a hero, this man who slept with unnumbered women and now has AIDS. Is that what black kids need?"

Perhaps not. But neither will most young Americans today be moved by everlasting damnation, much less the disapproval of the vice president. What will work is a change in attitudes, in the perceived social norm. Gays accomplished it. Many have not so much given up on sex as redefined it to include a whole range of activities that don't even need a condom. Jim Avila, a 45-year-old San Francisco man who lived through the AIDS epidemic, says he now looks for pleasure in "a heightened awareness of intimacy and sensuality...massage, talking and sharing fantasies with your partner, visually performing together and for one another." Whether this precise formulation will work for the fraternity boys at Berkeley, or high-school students in Cleveland, is beside the point; the fact is that sex, while among the most fundamental of human drives, is also the most malleable. Already there is anecdotal evidence that high-school students in some cities are getting the message that sex is no fun at all when you're dead; when they get to college this attitude may start showing up in the surveys. It took nearly three decades for social attitudes to harden against smoking, but when they did, millions of people who could never quit gave it up rather than be pariahs. A similar shift is occurring with respect to heavy drinking, and even drugs. And it will happen with sex; it has to happen. People want to live.

As a result of Magic Johnson's recent announcement that he is infected with the AIDS virus, are you more likely to:

YES NO Practice "safe sex"? 70% 25% Talk with your children about AIDS? 69% 27% Limit the number of sex partners you have? 60% 52% Contribute to an AIDS charity? 59% 58% Have your blood tested to find out if you have the AIDS virus? 41% 57%

SOURCE: The Gallup Organization, Nov. 14-17,1991

Abstinence may be unrealistic, but it's the only thing that's completely foolproof.

A latex condom should be used during vaginal, anal or oral sex and never reused. If you use a lubricant, make sure it's water based. Oil-based lubricants (like Vaseline) leave condoms vulnerable to breakage. Males receiving oral sex should wear a condom; if the woman is the recipient, she should use a dental dam--a flat latex device handheld over the vagina.

Spermicides can kill sexually transmittable germs when a condom breaks or leaks.

Mutual monogamy is far preferable to having multiple partners, but you're still having sex with everybody your partner has ever slept with. If you intend to have unprotected sex, both partners should be tested for HIV and other STDs, then retested six months later, before proceeding.

It's the riskiest method of intercourse. Blood vessels lining the anus and rectum are easy to rupture, giving HIV a direct passageway to the bloodstream.

Of course, there's no guarantee that your partner will answer your questions truthfully. But it's still important for people to explore each other's sexual history before they get involved. Here's where to start:

Have you been tested for HIV or other STDs?

How many sex partners have you had?

Have you ever been with a prostitute?

(For a woman to ask a man): Have you ever had sex with another man?

Have you or your sex partners ever injected drugs?

Have you ever had a transfusion of blood or blood products (particularly before 1985, when blood wasn't screened for HIV)?