News - Sex and the CDC

Public health campaigns do work ... really

When social conservatives expressed alarm over the Centers for Disease Control and Prevention's funding of sexually explicit AIDS prevention programs in November, they didn't hold back from venting conspiracy theories. What started as a protest of two silly-sounding safe sex campaigns quickly spiraled into demands to de-fund the entire CDC. Because the agency was using tax dollars to teach gays about sex, the allegations went, it wasn't protecting other (decent) Americans from dangers like anthrax. Therefore, the CDC itself should perish.

You needn't support the programs in question (one called "Booty Call") to long for a different level of debate. Sure, the CDC has been known to waste money. Sure, nonprofit health outreach organizations are magnets for mismanagement. But that doesn't mean they're harboring legions of evil government scientists who long to erode our national character by forcing spermicides on the Teletubbies crowd.

By definition, public health campaigns emphasize weaknesses we'd rather ignore — like drugging, drinking, sexing, smoking and driving too darn fast. To make matters worse, the type of people who work in public health are often the type of people who joined the American Friends Service Committee in high school — earnest do-gooders who themselves don't drug, drink, sex, smoke or drive too fast.

Despite this conundrum, prevention programs actually work. Smoking rates, for example, dropped dramatically when anti-smoking campaigns began. I used to think that forcing disaffected teens to watch filmstrips about car crashes and venereal disease was a waste of tax dollars — and I wasn't merely another disaffected 14-year-old at the time. I was a public health worker driving around Atlanta in a Toyota Tercel stuffed with videos about trusting the police, bottles of bleach for drug addicts, and pamphlets about gonorrhea translated into Vietnamese.

Outwardly, I oozed sincerity. Inwardly, I felt like an idiot. I spent one morning with a group of freshly recovering addicts who kept nodding off and tumbling out of the folding chairs I'd arranged so neatly in their rec room. It's hard to feel anything but despair in a place like that. And it's hard to imagine that anything you might say could stand up to whatever it was that brought those people so close to death that their knees, elbows and skulls stuck out and shone like exoskeletons.

I once spoke about HIV to refugees and immigrants learning English in a Baptist Sunday school classroom, and not only did none of the students understand a word I was saying, but the church volunteer who invited me stood up during my presentation and began quoting Bible passages in a loud voice, as if we were engaging in a not-unfriendly debate. Risk behavior, Revelations; symptom list, Leviticus.

It wasn't hard to think of that experience as the essence of "doing public health." You're standing in a room where nobody comprehends a word you're saying, and you're trying to warn them about a grave danger. Meanwhile, someone in the corner is drowning you out with Leviticus.

But it isn't that simple. As I was leaving, one of the church ladies (as I thought of them) asked me to see one student in private. He needed to talk, she said.

The boy waiting in the parking lot was half-American, half-Vietnamese, and he was one of those teens who make your heart break they're so fragile. Tears were running down over his acne; his hair gel was dripping. The church lady put her arm around him and told him he needed to hear what I had to say, and as the three of us stood in the church parking lot, he told me he had come to the U.S. alone and that the American man he was living with had told him you could only catch AIDS by sleeping with a woman — that sleeping with this man, and the man's friends, was safe.

I'd like to say I changed his life. Instead, I gave him a pamphlet. I told him to tell his boyfriend to use a condom. He looked like one of those exoskeletons in the rehab center. It wasn't clear that any effort would protect his life at that point, but the alternative — doing nothing — wasn't any better.

I won't disagree with the conservatives who say that programs like "Booty Call" go too far. But in the face of complexities and emergencies like the one above, demonizing the CDC and pulling public health troops off the streets seems unbelievably cruel and naive. It isn't better — not morally, not socially, not on any human scale.

Tina Trent wasn't a member of the American Friends Service Committee in high school, but she may as well have been.??

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