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Volume 4, Number 2
January 9, 2003
In this edition:
Teens Are Taking Sexual Abstinence More Seriously
Brebeuf social activist Ali McCormick is doing it. Ninth-grade
jazz saxophonist Aaron Trincado is doing it. Hamilton Southeastern
junior class officer Jonathan Zerkle is doing it. Arlington
wide receiver Nic Carothers is doing it. So are New Palestine
varsity cheerleader Carrine Sitler and her boyfriend, Zack
Brown, an Eastern Hancock basketball center.
High school students and young adults all across America
are doing it-- abstaining from premarital sex, that is.
“My first commitment is to God. My second commitment
is fear of sexually transmitted diseases and pregnancy,”
said Jonaya Williams, a Broad Ripple High School graduate
who is studying education at the University of Cincinnati.
“I think it’s important that as young adults we
take a stand. Virginity is something we have that is ours.
As an African-American woman, I want more girls to stop fitting
the stereotype and stop having sex just because their friends
are doing it.”
Williams, 19, tutors at an inner-city high school and talks
openly to students about the consequences of premarital sex.
According to research by the Centers for Disease Control
and Prevention, and The National Campaign to Prevent Teen
Pregnancy during 1991 and 2001, the prevalence of sexual experience
decreased 16 percent among high school students, the prevalence
of multiple sex partners decreased 24 percent, and 40 percent
of college freshmen are less likely to approve of casual sex.
They abstain for moral reasons, religious reasons, health
reasons, fear of pregnancy, and a chance to exercise their
freedom of choice.
Jonathan Zerkle is outspoken about his beliefs. “I’ve
had girlfriends, but basically I let them know, before we
start dating, where I stand. I like to find out a lot about
a person first. I believe kissing is the limit,” said
Zerkle, 16, the youngest of three boys. He made a commitment
before he entered high school to abstain from premarital sex.
He said it’s morally wrong to take a casual relationship
to that limit.
“I think he lives by example,” said his mom,
Carla Zerkle, Fishers. “He’s not afraid to do
what he feels is right. His brothers have set wonderful moral
examples for him to follow.
“It’s a topic that we speak freely about in
our home, because talking about it helps them feel comfortable
at home and helps them feel comfortable when they’re
away from home and faced with making decisions.”
“We tell them that when you get intimately involved
with a female, you’ll get into a position where it’s
difficult to draw the line. You don’t want to push the
limits and find yourself at an unsupervised party in a dark
basement at 1 o’clock in the morning, trying to find
a way to get out,” said Carla Zerkle.
One popular abstinence program, Creating Positive Relationship
(CPR), outlines the stages of affection: holding hands, hugging,
kissing, underwear zone and sexual intercourse. The nonprofit
organization based in Carmel, Indiana reaches about 40,000
young people statewide through public and parochial chools
and church-affiliated organizations. Those committed to remaining
chaste say it’s best to set boundaries that begin by
remaining fully clothed.
“It’s just not necessary. I want to wait until
I’m married,” said Aaron Trincado, 15, who moved
to the United States from Chile five months ago. “I
believe premarital sex is just wrong,” he said.
“I’m so young. I have plenty of time for that,
so why get started on birth control and all the other issues
that go with that?” said Ali McCormick, 17, a junior
at Brebeuf Jesuit Preparatory School. “I’ve had
lots of boyfriends, but when it gets to that point, I’m
just not interested.”
Nic Carothers made his decision, in part, based on childhood
experience. “My father wasn’t a very responsible
man. I want to be a better man, a better father, when the
time is right,” said Carothers, 18, a senior at Arlington
High School. He last saw his father when he was in elementary
school. He now lives with his mother and stepfather. “I
want to be a doctor and work in sports medicine so that when
I do have children, I’ll be ready to support them. I
see sex as an obstacle and a distraction to my future.”
Carothers said sometimes he feels like he stands alone in
his decision. “Guys think it’s the adult thing
to do. They really joke about it and encourage me to have
sex. I let them know that anyone can have sex, but it takes
a strong person to say, ‘No,’” he said.
Zerkle said he spends time with friends who share similar
beliefs so he can avoid negative peer pressure.
Health experts and educators say while many students are
making the choices on their own, most receive guidance through
their parents and widespread school- and church-based abstinence
programs.
In a recent health education class at Hamilton Southeastern
High School, sophomores and juniors were presented a weeklong
CPR program. Similar messages are presented by facilitators
of Willing 2 Wait, a teen pregnancy prevention program through
Clarian Health that reaches more than 3,000 students annually
through both public and private instruction; and religious-based
programs like Promise to Keep and True Love Waits.
Indiana law mandates that accredited schools teach abstinence
outside of marriage for all school-age children, and that
abstinence is the only certain way to avoid pregnancy, sexually
transmitted diseases and other associated health problems.
Program instructors include information about contraceptives
only in response to questions, and emphasize sexual relationships
as part of marriage.
Such programs have become prevalent due to the increase in
sexually transmitted diseases and teen pregnancies. In Indiana,
reported cases of chlamydia, one of the most common STDs,
rose from 10,000 in 1996 to nearly 14,000 in 2000, according
to the latest U.S. Census data.
A large majority of those infected were between the ages
of 15 and 19. The Centers for Disease Control and Prevention
report about 840,000 U.S. teen pregnancies annually; three
out of four are out-of-wedlock.
The Marion County Health Department reported this summer
that the syphilis rate is falling in Indianapolis. As of July
2002, 23 cases had been diagnosed, compared to 400 cases total
for 1999 and 129 cases for 2001. In 1999, Marion County had
the nation’s worst syphilis rate.
“The idea behind abstinence education started out
as a radical one-- that we were giving kids credit for using
their minds rather than their bodies,” said Esther Meier,
CPR executive director. “We expect young people to make
wise decisions in doing their homework and practicing a musical
instrument; why wouldn’t we expect them to make wise
decisions when it comes to practicing abstinence for the sake
of their future and their health?”
Many of the programs, like CPR, began in the late 1980s in
response to teenagers in crisis. The theory was that prevention
was preferred over crisis counseling. The abstinence programs
stress creating a “whole person.”
Hamilton Southeastern introduced the CPR program last spring.
Facilitators talk to students about the consequences of premarital
activity, encourage them to develop an abstinence plan and
review sexually transmitted diseases, dating dilemmas and
the differences between love and infatuation. They open the
presentations for questions and answer them bluntly.
When one student asked whether condoms prevented diseases,
the facilitator answered: “You could have a condom covering
your entire body and if you are exchanging body fluids, there
is always the risk of disease. The only safe way is to stay
out of the ‘underwear zone.’”
Cindy Gemmer, who has taught high school health for 25 years,
isn’t afraid to admit that she initially resisted having
an outside abstinence program become part of her curriculum.
Gemmer is now an advocate for the program. “I’m
seeing more and more kids who aren’t just abstaining,
but they’re taking a stand about abstinence,”
said Gemmer. “This is a message you can’t repeat
often enough.”
The programs emphasize the positive aspects of abstaining.
“Abstinence isn’t a dirty word. Every one of you
is worth waiting for. Don’t you want someone who loves
you for who you are, not for what you can put out?”
CPR facilitator Meg Pickett asked her young audience. At the
conclusion of some of the abstinence programs, students sign
a pledge or make a formal commitment to abstain. Such decisions
are left entirely up to the individual. The programs are designed
to make the teen responsible for his or her actions.
Last February, about 150 middle school and high school students
attended a program sponsored by Old Bethel United Methodist
Church. The evening workshop encouraged parents and teens
to talk about purity. There were some hard-hitting messages
too. Speakers talked graphically to teens about the dangers
of sexually transmitted diseases.
Research and recent surveys have gathered information on
what teens think about sex and abstinence:
- 23 percent of students questioned in seventh through 12th
grade said they’d had oral sex. In 11th and 12th grade,
the number increased to 42 percent.
- 16 percent fewer high school students had had sexual
experiences, and 24 percent fewer teens had multiple sex
partners in 1991-2001.
- 52 percent of high school students had sex in 1999, compared
to 61 percent in 1990. The proportion of high school girls
who reported having sex dipped below half in 1999.
- 58 percent of the teens reported using condoms.
- 25.6 percent of teens reported using alcohol or drugs
at the time of last intercourse.
- 40 percent of college freshmen are less likely to approve
of casual sex.
- 58 percent of the students said sexual activity for high
school-age teens is not acceptable, even if precautions
are taken against pregnancy and sexually transmitted diseases.
- 58 percent of those interviewed did not think it was
embarrassing to say they are virgins.
- 90 percent said society should promote abstinence.
[The Indianapolis Star, 1/5/03]
Detailed Review of San Diego Needle Exchange
Program Expected Soon
San Diego’s City Council approved its pilot needle
exchange program by a one-vote margin in November 2001 over
the objections of Mayor Dick Murphy. But under state law,
the council every two weeks must vote to declare a state of
emergency to allow the needle exchange to continue. Murphy
said a needle exchange program runs counter to his goal of
making San Diego America’s safest city. The council,
which favors the needle exchange program 6-3, is set to make
its first detailed review of the pilot program.
So far, the number of dirty needles collected exceeds the
number of clean ones given out, said Fran Butler Cohen, executive
director of Family Health Centers of San Diego, which operates
the needle exchange under a contract with the Alliance Healthcare
Foundation. An AHF grant covers the needle exchange’s
$334,000 cost. Nearly 18,000 dirty needles have been turned
in since the program’s July start. As of mid-December,
about 13,000 clean needles had been given out, Cohen said.
More importantly, Cohen said, 37 people who came to exchange
needles have been referred to drug treatment programs, and
75 have been sent for detoxification. In addition, Cohen said
14 people have been referred to mental health programs, 135
people to primary medical care, and 244 to a variety of other
programs, such as those that screen for hepatitis and STDs.
When the council approved the pilot program, the plan was
to have it running by now in North Park and City Heights as
well as downtown, but community opposition has made it difficult
to find sites.
Councilmember Toni Atkins, whose district includes City Heights
and North Park, said she hopes to have sites chosen in those
communities within a month. The problem is that with 171 people
enrolled as repeat users at the downtown site and a shortage
of space at drug treatment centers, the downtown exchange
has reached capacity, Cohen said.
Roland Foster, an aide with the U.S. House of Representatives
Subcommittee on Criminal Justice, Drug Policy and Human Resources
noted that “The primary intent of needle exchange is
to prevent injection drug addicts from becoming infected with
HIV, hepatitis and other infectious diseases. Yet there is
no data to demonstrate that the San Diego program has indeed
decreased new infections. Advocates provide only the number
of needles handed out and returned as evidence of success.”
“Tragically, 3,000 of the 18,000 needles returned
to the NEP-nearly one in five-were turned in by the mother
of an addict that died from AIDS. Not even 3,000 needles could
save one person from HIV or from his own addiction,”
Foster said.
Foster further noted that “needle exchange is also
touted as a link between addicts and drug treatment. But according
to the San Diego report, only 37 out of the hundreds of addicts
participating in the program were actually referred to treatment.
And being referred to treatment should not be confused with
actually being treated. Ironically while San Diego provides
a countless supply of free needles to addicts, the City has
a shortage of space for drug treatment. The City should rethink
its priorities that at this time are enabling addicts to continue
their self-destructive behavior at the expense of treating
and prevention addiction,” Foster concluded.
[San Diego Union-Tribune, 1/5/03; Foster statement,
1/6/03]
South Leads U.S. in HIV, AIDS But Not in Funding
The South leads the U.S. in new HIV infections and overall
AIDS cases, yet lags in the amount of federal funding when
compared with other regions, officials at a regional AIDS
conference say.
More than 130,000 people in southern states have AIDS, compared
to just over 100,000 in the Northeast, 36,000 in the Midwest
and nearly 62,000 in the West, according to U.S. Centers for
Disease Control and Prevention numbers cited in a “Southern
States Manifesto” written by AIDS directors from the
various states.
As an example, Florida receives roughly 5 percent of the
nation’s prevention funds but has approximately 12 percent
of the nation’s AIDS cases, said Dr. A. Gene Copello,
executive director of Florida AIDS Action. Complete statistics
on the full disparities in funding for Florida and the other
states are still being developed, according to Florida AIDS
Action.
The manifesto, produced on November 4, 2002, was studied
during the 2-day Southern AIDS Conference aimed at developing
a strong lobbying effort at local, state and federal levels
for fair funding of AIDS and HIV battles in the southern states.
“We intend to be very loud about it and very forceful,
because our people are dying all over the South,” Copello
said at news conference on the last day of the meeting attended
by representatives from groups in Washington, DC, and 13 southern
states. Besides Florida, states represented at the conference
were Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi,
North Carolina, South Carolina, Tennessee, Texas, Virginia
and West Virginia.
Copello said that they were in the process of organizing
a twofold approach, pushing for fair funding for the southern
states and for a core set of services that can be offered
to anyone with HIV/AIDS.
In Florida, 32 people a day are diagnosed with AIDS or HIV,
and women are one of the fastest growing groups among people
diagnosed with AIDS, said David Poole, with the Bureau of
HIV/AIDS and Hepatitis at the Florida Department of Health.
Poole said that Florida receives about $230 million a year
in federal and matching state dollars for HIV and AIDS care
for indigent people and those who aren’t eligible for
Medicaid, but that the state needs a $10 million more to keep
up with rising drug costs. Drugs for HIV/AIDS patients can
cost up to $15,000 a year. “We’re the safety net
for these folks,” Poole said.
[Medical Letter on the CDC & FDA, 1/12/03]
Hepatitis C Presents Risk for Liver Cancer
for AIDS Patients
Government researchers have established a connection between
hepatitis C virus (HCV) infection and liver cancer but not
HCV infection and non-Hodgkin lymphoma (NHL) in people with
AIDS.
“HCV is linked to hepatocellular carcinoma (HCC) and
possibly NHL, but the impact of AIDS on these associations
is uncertain,” said Eric A. Engels of the Viral Epidemiology
Branch at the National Cancer Institute in Rockville, Maryland.
Engels and NCI colleagues reviewed information from a U.S.
database to assess the etiology of HCC and NHL in more than
300,000 adults with AIDS. “The ratio of observed to
expected cancer cases (standardized incidence ratio SIR )
measured risk relative to the general population,” said
Engels and coauthors.
There was a higher risk for HCC among groups of AIDS patients
where HCV infection rates were higher, such as those with
hemophilia or who used injection drugs, than among groups
with lower rates of HCV, including homosexual men and heterosexual
men. Although HCC was higher among patients with high risk
for HCV, the incidence of NHL was lower.
“These data suggest an effect of HCV infection on
HCC risk among adults with AIDS. On the other hand, NHL risk
was not higher for groups in whom HCV infection was prevalent,”
Engels and colleagues stated.
[AIDS Weekly, 1/6/03]
HIV Makes Hepatitis B Significantly More Lethal
Men infected with a combination of hepatitis B virus and
HIV are 17 times more likely to die from liver disease than
men infected with hepatitis B alone, according to a study
by researchers at Johns Hopkins.
“These results underscore the importance of prevention,
treatment and comprehensive management of hepatitis B in people
infected with HIV,” said Chloe Thio, MD, assistant professor
of medicine in the division of infectious diseases at Johns
Hopkins and lead author of the study.
The low rate of liver disease-related deaths in those with
hepatitis B alone is consistent with the 20-30 years typically
needed for complications from hepatitis B to develop, explained
Thio in the December 14, 2002, issue of the Lancet. However,
because HIV and hepatitis B are transmitted in the same way,
co-infection is common and up to 10 percent of HIV-infected
individuals also have ongoing hepatitis B infection.
“Our results suggest that HIV increases the severity
of hepatitis B infections, and that physicians may see an
increase of hepatitis B-related liver disease in the 1 million
people living with HIV in the United States,” said Thio.
Thio and colleagues analyzed clinical data and blood and
tissue samples collected from 1994 to 2000 from 5,293 men
who participated in the Multi-center AIDS Cohort Study.
The researchers compared death rates from liver disease in
four patient groups: HIV-infected individuals, hepatitis B-infected
individuals, individuals infected with both viruses, and virus-free
individuals.They found that 326 men (6 percent) had hepatitis
B, of whom 213 (65 percent) also had HIV. Of the 4,987 men
without hepatitis B, 2346 (47 percent) were infected with
HIV.
Liver disease-related death was highest among those with
advanced HIV disease, as measured by CD4 cell count, and was
twice as high after 1996, when highly effective HIV therapies
were introduced.
“Determining possible adverse effects of long-term
use of HIV therapies and assessing the possible interaction
with hepatitis infections are central questions that our ongoing
studies will address,” said Alvaro Mu, PhD, professor
of epidemiology at the Johns Hopkins Bloomberg School of Public
Health.
[Hepatitis Weekly, 1/6/03]
Flu Surpasses AIDS As Killer in U.S.
Influenza has surpassed AIDS as a lethal killer and contributes
to an average 36,000 annual U.S. deaths, largely because of
a vulnerable aging population for whom the vaccine is often
ineffective, government research shows.
The U.S. flu-related death toll surged fourfold from 16,263
in 1976-77 to 64,684 in 1998-99, the Centers for Disease Control
and Prevention reported in Wednesday’s Journal of the
American Medical Association. Those numbers average out to
16,000 more deaths yearly than the previous estimate of 20,000.
Health and Human Services Secretary Tommy Thompson said the
news “that influenza may be taking an even larger toll
than we have realized” underscores the importance of
flu shots, especially for older people.
Drug breakthroughs in the mid-1990s helped reduce U.S. AIDS
deaths from 51,000 in 1995 to about 15,000 in 2001. But the
main weapon doctors have against flu-– a vaccine-–
has proven disappointingly ineffective in the most susceptible
population: people 65 and older.
Older people are more prone to flu complications yet only
about 65 percent of them get vaccinated. The annual shots
do not protect aging immune systems as well as they do younger
ones.
Annual flu shots have been recommended for people 65 and
older since the 1960s and for those 50 and older since 2000.
The flu death toll pales in comparison to that of the worldwide
influenza epidemic of 1918, which killed more than 20 million
people, including 500,000 Americans.
But the new numbers frustrate public health experts who had
hoped the development of flu vaccine about 40 years ago would
have had a greater effect.
[Associated Press, 1/8/03]
Doctor Recommends Screening High-Risk Women
Three Times for Syphilis During Pregnancy
Clinicians with high-risk patients in areas with a high prevalence
of syphilis should screen women three times during pregnancy
to decrease the risk of congenital syphilis, Dr. Virginia
Caine recommended recently at the annual meeting of District
V of the American College of Obstetricians and Gynecologists.
“They should do the first screen at the women’s
initial prenatal visit,” she said, “but then they
should do two more in the third trimester, one at 28 weeks’
gestation and then another one at the time of delivery,”
said Caine, who is with the division of infectious diseases
at Indiana University-Indianapolis.
Most physicians are not aware of the need for a third screen.
“They generally know they should do a screen in the
third trimester, but they generally do one at delivery instead
of doing it at 28 weeks,” Caine noted in an interview.
“Or they do it at 28 weeks but are not aware that they
should do another one at delivery. Both are necessary.”
Pregnant women with untreated syphilis run a 22 percent risk
of delivering a stillborn; a 33 percent risk of having an
infected infant; and a 33 percent chance of delivering an
uninfected baby. Neonatal death occurs in 12 percent of babies
born to infected, untreated mothers.
Caine said that adequate treatment of an infected pregnant
woman before 16 weeks’ gestation should prevent transmitting
the infection to the infant. However, regardless of when the
mother’s infection is first detected and treated, doctors
should consider a sonographic evaluation of the fetus in the
second half of pregnancy to check for hepatomegaly, ascites,
and hydrops, all of which could indicate a greater risk of
fetal infection.
[OB GYN News, 1215/02]
The HIV Update is a weekly report of articles, studies and
other information related to HIV/AIDS, sexually transmitted
diseases and related risk behaviors compiled from various
news sources by the Children’s AIDS Fund.
The Children’s AIDS Fund is a non-profit, non-partisan
organization dedicated to helping limit the suffering of HIV-impacted
children through direct assistance and resources, as well
as through technical assistance for their parents and care-givers.
For additional information, call (703) 471-7350.
Previous editions of the HIV Update are available on-line
at http://www.childrensaidsfund.org/news.asp.
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