Part III: Healthy Adolescent Sexual Development

ALL TOGETHER NOW

An Integrated Approach to Preventing Adolescent Pregnancy and STD/HIV Infection

William A. Fisher, PhD Department of Psychology and Department of Obstetrics and Gynecology The University of Western Ontario, London, Canada

M ost American adolescents have sexual inter- relationships, are particularly likely to fail to use contra- course at some point during their teenage years, yet ception.5,6,7 Moreover, American teenagers, white and most do not consistently utilize contraception or prac- black, have rates of pregnancy that exceed those of al- tice safer sexual behaviors to avoid infection with a most all industrialized nations8 and, although there are sexually transmitted disease CXD) or the human immu- some differences in sexual behaviors and contraceptive nodeficiency virus (HIV). Despite high levels of adoles- use among black and white teenagers,2 many have di- cent pregnancy and STD/HIV risk, most educational in- minished with time and may have less overall signifi- terventions, when they exist at all, contain information cance than popularly supposed.3 In addition, although that is irrelevant to behavioral change, treat pregnancy data are fragmentary, it appears that the American ado- and STD/HIV risk as unrelated phenomena, and most lescent proclivity for risking pregnancy has not changed frequently are based upon a collection of untested and in recent years as a function of the increasing fear of unscientific “best guesses” about the appropriate proc- HIV/AIDS.9~10J1 Beyond the scope of this article are the ess and content for intervention. sequelae of adolescent childbearing, which may be se- This article will review the degree of pregnancy and vere for both mother and child, and may include welfare STlYHIV risk among American adolescents, present a dependence, health complications, and other negative framework for understanding why adolescents continue outcomes (see references 4, 12, 13, 14, 15, 16, and 17 for to practice high-risk sexual behaviors in respect to preg- a discussion of the possible negative outcomes of teen nancy and STD/HIV infection, and close by presenting childbearing and means for ameliorating such out- an integrated model and demonstration project that has comes). been created to reduce adolescent pregnancy and STD/ STD infections, such as gonorrhea, chlamydia, her- HIV risk. pes, and cervical cancer, are occurring at epidemic levels in the United States. Adolescents, unfortunately, are both Pregnancy and STD/HlV Risk Among Adolescents the recipients and transmitters of these infections.18J9J0~ Research suggests that although most American ado- ‘*JZ Moreover, today HIV infection and AIDS present a lescents have sexual intercourse during their teenage very real threat to American adolescents; HIV is heter- years, they do not consistently use reliable methods of osexually transmissible,23*24~25and is present at alarmingly contraception.‘“” It has been estimated that 30% of high levels in the general population.2’~26~27 Given the in- sexually active American adolescents become pregnant cubation period of the virus,28 it is likely that a significant during their teen years and approximately 600,000 preg- number of the more than 109,000 Americans with AIDS nancies annually are the unintended pregnancies of became infected with the virus during their adolescent single female teenagers. 1,2,4Pregnancies often occur in years. The sequelae of STD/HlV in adolescents may in- situations where maturity and/or partner support for clude lifelong infection and infectiousness (herpes); pel- dealing with unplanned pregnancy are lacking; young vic inflammatory disease, tubal scarring, and infertility teenagers, and those who are not in committed (chlamydia, gonorrhea); cervical cancer (human papilloma virus infection); a long period of asympto- time a sexually-active young woman in this country re- matic infectiousness; and, eventually, death (HIV infec- ceives a prescription for oral contraception it is likely tion). that she and her partner will continue to be sexually Notwithstanding the threat of STD and HIV infec- active, will cease any prior use of condoms, and will tion, American adolescents appear to be resistant to elevate their risk of acquiring and transmitting STD/ changing their behavior in order to reduce the risks of HIV infection during their sexual careers of serial mo- STD/HIV.10~29~30Surveys of adolescents in the San Fran- nogamy. Recent data concerning the interdependence cisco AIDS epicenter9 and of adolescents in Massachu- of oral contraception, condom use, and STD exposure setts indicate low levels of STD/HIV preventive behav- have been gathered from a national sample of Cana- iors.2g A multisite study of U.S. high school students also dian college students, and may be informative for emphasizes that a significant number of adolescents Americans as well. As can be seen in Table 1 (opposite continue to engage in sexual intercourse at very early page), as young women have more and more sexual ages and have many partners.M With respect to univer- partners, their use of oral contraceptives increases, sity students - who are presumably older and wiser - their use of condoms declines, and their reports of pre- J. Fisher and S. Miscovichr” report evidence of an in- viously diagnosed STDs increase astronomically. It is creu.se of STD/HIV risk among college students from obvious that adolescents, educators, and health care 1986 to 1988. providers must begin to approach adolescent Overall, adolescents appear to be engaging in many sexual behaviors that pose the risk of STD/HIV infec- tion. To the degree that relevant pathogens are found among adolescents, it would appear that they are pres- Vol.18 No.4 ently infecting one another with dangerous-to-lethal SIECUS Report April/May 1990 sexually transmitted diseases. Sex Information and Education Council of the U.S.

I Executive Director, Debra W. Haffner, MPH The Relationship Between Adolescent Pregnancy Editor, Janet Jamar and SD/HIV Risk Editorial Assistant, Elizabeth Wilber Adolescents’ risk of pregnancy and STD/HIV infec- tion are related behaviorally-produced problems that have related behaviorally-focused solutions. In regard to sexually active adolescents, pregnancy risk and STD/ The SZECffS Report is published bimonthly and distributed to SIECUS members, professionals, organizations, government offi- HIV risk are produced by a number of similar factors. cials, libraries, the media, and the general public. Among them are: the unwillingness to acknowledge in advance sexual activity and preventive needs; the failure Annual membership fees: individual, $60; student (with validation), to seek out relevant preventive knowledge; the unwill- $30; senior citizen, $40; organization, $100 (includes two bimonthly copies of the SZECUS Report); and library, $60. SZECUS Report ingness to engage in public preventive behaviors, such subscription alone, $55 a year. Outside the U.S., add $10 per year as condom purchasing or contraceptive acquisition; the to these fees (except Canada and Mexico, $5). The SZECUS Report failure to engage in discu,ssion and negotiation of pre- is available on microfh from University Microf~ms, 300 North Zeeb vention methods prior to sexual involvemenl; and the Road, Ann Arbor, MI 48106. failure to execute preventive acts and to reinforce one- All article and review submissions, advertising, and publication self and one’s partner for preventive behaviors. Inter- inquiries should be addressed to the editor: ventions that focus on training and motivating sexually active adolescents to engage in the above preventive behaviors have the potential to reduce both pregnancy Janet Jamar and STD/HIV risk among adolescents. Director of Publications Despite the overlap in the causes and potential solu- SIECUS 32 Washington Place tions for pregnancy and STD/HIV risk, health educators New York, New York 10003 and service providers often fail to deal with these prob- 212/673-3850 lems in an integrated fashion. For example, health edu- cation curricula for pregnancy prevention, when they Editorial Board exist, often are separate from curricula for HIV preven- William L. Yarber, HSD, Chair tion, and curricula for HIV prevention, astoundingly, Barbara Beitch, PhD often do not deal with other STDs. Moreover, whether Jane Quinn, ACSW curricula contain material on pregnancy prevention, HIV Rt. Rev. David E. Richards prevention, or STD prevention, the content often in- volves bits of information that are irrelevant to behav- Copyright 0 1990 by the Sex Information and Education Council of ioral change as adolescents are not provided with a pre- the U.S., Inc. No part of the SZECUS Report may be reproduced in cise script for preventive behaviors that they can per- any form without written permission. sonally enact in their particular social settings. In con- Library of Congress catalog card number 72627361. ~ sidering service providers, it is painfully clear that ac- ISSN: 0091-3995 tions that have been suggested to reduce adolescent pregnancy have actually increased STD/E-IIV risk. Each

1 SIECUS Report, April/May 1990 2 Table 1 Sexually Active College Women’s Use of Oral Contraception, Condoms, and STD History as a Function of Number of Sexual Partners*

Number of Sexual Partners 1 2 3-4 5-9 1 O/more

% Regular users of oral contraceptives 65.6 71.9 77.9 82.0 84.5

% Regular users of condom 19.6 17.9 11.0 13.6 7.5

% Reported SZ!l history 3.1 3.9 4.6 11.0 24.2

*Percentages are based on a Canadian national survey of a proximately 2,710 universi women (see reference 11). For further analysis of the risk behavior and condom/contraceptive use of a su f7 set of this sample, see NE %I acdonald, et al. Hish risk STIVHIV behavior 1 among college students, JAMA, (in press). pregnancy and STD/HIV prevention as interrelated to prevent pregnancy and STD/HIV infection. problems with correlated causes and correlated solu- tions. The Preventive Behavior Sequence The sequence of preventive behaviors that may help The Psychology of Adolescent Pregnancy and STD/ to minimize adolescents’ risk of pregnancy and STD/HIV HIV Risk infection is presented in the sidebar on page 4 and will It is clear to all that there are major barriers to re- be explained in more detail here. Each step in the pre- ducing adolescent pregnancy and STD/HIV risk. First, ventive behavior sequence can be taught to teenagers there are structural barrien to adolescent pregnancy and can be rehearsed and refined until the behavioral and S’IWHIV prevention: to avoid pregnancy or STD/ skills required for pregnancy and STD/HIV prevention HIV risk, adolescents need to perform a complicated are firmly in place. series of interrelated preventive behaviors that are al- Step 1: Teenagers must be encouraged to accept most never taught and that may be personally and so- their sexuality. Before a discussion of prevention can cially costly to perform. Second, there are psychological become relevant, adolescents must acknowledge the fact barrier to adolescent pregnancy and SIWHIV preven- that they are sexual beings who are likely in the future to tion: adolescents quite often are socialized with feelings, become sexually involved. Complicating self-acceptance thoughts, and fantasies that promote sexual activity yet of sexual behavior and preventive needs, however, are at the same time inhibit pregnancy and STIYHIV pre- social norms that hold that it is inappropriate and im- ventive behavior. moral for teenagers to be sexually active. Structural Barriers to Prevention Step 2: Teenagers must be encouraged to leam relevant sex-related preventive information. There Adolescents must perform a series of objectively dif- are two categories of sex-related preventive information ficult acts in order to avoid pregnancy and STD/HIV.31~u that are particularly important for teenagers to obtain. Scripts for behaviors that might help teenagers avoid First, teenagers must acquire information that helps them pregnancy and STD/HIV infection are rarely, if ever, to make an objective assessment of their degree of preg- taught, rehearsed, or reinforced. Moreover, the behav- nancy and STD/HIV risk. Second, teenagers must learn ioral acts involved in pregnancy and STD/HIV preven- information about specific preventive behaviors that can tion are often emotionally and socially difficult for teens be readily enacted in their personal social environments. to enact, and pregnancy and STD/HIV preventive be- Among other behavioral topics, teenagers must acquire haviors have immediate costs and only distant and un- information about the preventive behavior options open certain payoffs. Given the behavioral complexity, the to them (including limit-setting short of intercourse, con- lack of relevant teaching, and the costs involved, it be- traceptive behavior, and safer sexual behavior), and comes easier to understand why teenagers at present do about how to bring up and negotiate pregnancy and not consistently practice pregnancy and S’IWHIV S’IWHIV preventive behavior with a partner, reinforce prevention. At the same time, it is clear that it may be their own and their partner’s preventive behaviors, and effective to provide teens with the instruction and en- exit unsafe sexual situations. couragement that will enable them to perform what I Step 3: Teenagers must be encouraged to make call the Preventive Behavior Sequence of acts that help an active decision to engage in preventive

3 SIECUS Report, April/May 1!990 behaviors. To the extent that ado- lescents accept their sexuality, are aware of personal levels of risk, and possess skills for risk reduc- tion, they should make active deci- sions in favor of preventive behav- iors. ‘IHE Step 4: Teenagers must be encouraged to bring up and ne- PREVENTIVE BEHAYIOR gotiate sex-related prevention with their partners. Discussion and negotiation should occur prior SEQUENCE to significant sexual involvement, and could, for example, focus on setting limits short of intercourse, on refusing to use IV drugs or to share needles, and on contracep- Teenagers must be taught the following be- tive and safer sexual practices as means of preventing pregnancy havioral skills and encouraged to practice and STD/HIV infection. Specific them. They must: training on how to bring up and negotiate sex-related prevention is rarely included in educational cur- 1. Accept their sexuality. ricula, but it is possible to teach and reinforce critical skills, such as methods for timing and initiating presex discussions of prevention, 2. Learn relevant sex-related preventive informa- skills for assertiveness and negotia- tion with a partner who may pos- tion. sess greater influence and be un- willing to cooperate with preven- tive efforts, and skills for exiting a relationship in which preventive 3. Make an active decision to engage in preven- behavior cannot be agreed upon. tive behaviors. Step 5: Teenagers must be taught to perform more or less public sex-related preventive acts. If an adolescent elects to 4. Bring up and negotiate sex-related prevention have sexual intercourse, he or she will have to engage in public be- with their partners. haviors, such as purchasing con- doms and spermicidal foam at a pharmacy, visiting a physician to get a prescription for oral contra- 5. Perform more or less public sex-related pre- ceptives, or obtaining an HIV ventive acts (condom purchasing, HIV testing). blood test in a clinical setting. It is possible to teach and rehearse these public preventive acts. (Of course, if teenagers elect to set 6. Consistently practice sex-related preventive be- sexual limits short of intercourse, haviors and reinforce themselves and their such public pregnancy and STD/ HIV preventive behaviors may not partners for practicing prevention. be necessary.) Step 6: Teenagers must be encouraged to consistently practice sex-related preventive 7. Be able to shift preventive scripts. behaviors and reinforce them- selves and their partners for practicing prevention. Adoles- cents must consistently observe either sexual limits short of

SIECUS Report, April/May 1930 4 intercourse or contraceptive and safer sex practices in the other hand, be too uncomfortable to execute critical order to minimize pregnancy and STD/HIV risk. Such stages of the Preventive Behavior Sequence.Highly eroto- consistency could be facilitated by training adolescents phobic teens will be too uncomfortable to engage in ex- to reinforce themselves and their partners for reliably tensive sexual behaviors, and therefore will not need to practicing sex-related prevention methods. Teenagers practice sex-related prevention behaviors at present (al- should be encouraged to feel reassured every time they though they should learn about prevention for the fu- practice sex-related prevention and to imagine how ture). each protected sexual act will help them to avoid gut- More than a decade of research has investigated the wrenching anxiety about pregnancy and STD/HIV and relationship between young peoples’ erotophobia/eroto- to devise appropriate ways of communicating their thanks and affection for having cooperative partners. Step 7: Teenagers must be taught that they can shift preventive scripts. An adolescent who presently sets limits short of intercourse as a means of pregnancy Potential Psychological Obstacles and STD/HIV prevention may wish, at some point, to to Performance of Sex-Related move to protected sexual intercourse; on the other Preventive Behaviors hand, an adolescent who practices contraception and safer sexual behavior may find such practices to be un- rewarding and may wish to initiate, as an alternative form of prevention, a limit-setting pattern in future rela- tionships. To facilitate a shift to an alternate form of sex- I I related prevention, adolescents must learn that they have the option of shifting their preventive scripts and May be so sex-negative that individual avoids must learn to perform behaviors that are effective in im- learning and practicing preventive behaviors. plementing such shifts. For example, teenagers might read, role-play, and observe models in vignettes in which younger teens, who are setting sexual limits, de- velop the maturity to bring up, negotiate, and imple- lCognitions1 ment contraceptive and safer sex practices. Or, they may read, view, and role-play vignettes in which ado- lescent couples or individuals decide that they wish to May be so inaccurate or opposed to prevention move from contraceptive and safer sexual practices to that preventive behaviors do not take place. sexual limit-setting as a strategy within their present or future sexual relationships. Preparing for such shifts in preventive strategy may ensure that they occur con- pLzizy sciously and are implemented effectively. Psychological Bam’e?s to Prevention May include images and scripts that motivate There are strong psychological barriers to teenagers’ sexual, but not preventive behavior. learning and practicing sex-related preventive behaviors. Adolescents’ sexual activities and preventive practices appear to be determined by their feelings, thoughts, and fantasies about sexuality. 33,34However, these all too of- philia and their likelihood of engaging in pregnancy and ten encourage sexual activity and at the same time dis- STD/HIV preventive behaviors. Erotophobia has been courage preventive behavior. The psychological factors found to interfere with the performance of each preg- responsible for adolescents’ prosex/antiprevention ten- nancy and SD/HIV preventive behavior studied. It in- dencies will be the focus of the following discussion. hibits the self admission of upcoming sexual activity and Emotional Barriers to Prevention. Adolescents the need for preventive actioq3’ the learning of informa- possess generalized and stable feelings about sexuality tion relevant to sex-related prevention;36v38”g*40s41commu- which strongly influence their sexual activities and pre- nication with others about sexuality;42 performance of ventive practices. 35,36Some adolescents are highly eroto- public sex-related preventive acts, such as the utilization philic (mostly positive in their feelings about sexuality), of a contraception clinic;35~43and the consistent use of some are highly erotophobic (mostly negative in their contraception by both females and males.42s43 feelings about sexuality), and some fall in between Cognitive Barriers to Prevention. The maturity of these emotional extremes. Highly erotophilic teens adolescents’ cognitive processes and the content of their should be comfortable enough about sexuality to be cog&ions are thought to exert powerful influences on sexually active and should be able to negotiate each of adolescent sex-related preventive behaviors.33s34 the steps in the Preventive Behavior Sequence.Moder- With respect to the maturity of their cognitive proc- ately erotophobic teens may be relaxed enough about esses, it has been found that both age and general level sexuality to participate in sexual behaviors, but may, on of planfulness may determine adolescent contraceptive

5 SIECUS Report, April/May 1990 practices. In one study, females who had first inter- and the content of their cognitions often work against course between ages 15 to 17 were much less likely to the practice of pregnancy and STD/HIV prevention. use contraception than females who had first inter- Fantasy Barriers to Prevention. Adolescents are course at ages 17 to XL5 This finding was interpreted by exposed to a nearly unending stream of imagery that the researchers as an indication that the younger fe- promotes sexual activity yet provides no reference to males did not perceive themselves to be sexually active pregnancy or STD/HIV prevention. Consequently, it is and therefore took no contraceptive precautions. With easy for teens to imagine personal and social rewards for respect to an adolescent’s planfulness and the ability to sexual involvement and to plan in fantasy elaborate adopt a future time perspective, investigators have re- scripts for attaining such sexual intimacy, but they are ported that adolescents who plan for future events are able to imagine few incentives for enacting preventive more reliable users of contraception.**Thus, an behaviors and rarely, if ever, include preventive imagery adolescent’s degree of cognitive maturity may place lim- in their fantasized plans for engaging in sexual activities. its on his or her ability to enact critical sex-related pre- It has been found, for example, that young women can ventive behaviors. produce detailed seduction fantasies concerning how to In regard to the content of their cognitions, concerns achieve sexual intimacy with a desirable partner, and will have been raised that adolescents possessnumerous imagine strategies that involve the use of environmental clusters of information that are antithetical to the prac- signals (e.g., dress, music), verbal strategies (e.g., sexy tice of sex-related prevention.32p45First, adolescents may talk), and nonverbal strategies (e.g., eye contact), but no possessinaccurate information about conception, mention is made of any kind of pregnancy or STD/HIV contraception, limit-setting, and STDLHIV infec- prevention in the fantasies of the women who have been tion.11~31*45,46,47,48For example, in eight different surveys, studied.50 Research has indicated that often adolescent less than half of the teenagers questioned possessedac- males imagine that prior discussion of prevention will curate knowledge of the fertile period of the menstrual result in botched seductions51and that young females cycle.48 imagine health care providers reacting censoriously to re- Second, adolescents may possessirrelevant informa- quests for contraceptive protection.42 tion, in the sense that what they have been taught is ir- Overall, it is clear that both mass media images and relevant to the practice of the specific behaviors re- personal fantasies encourage sexual behaviors and lack quired for sex-related prevention.46 Adolescents may be or actively oppose preventive efforts. aware of the hormonal mechanisms of oral contracep- tives, may be familiar with the notion of retroviruses, The Joint Functioning of Structural and and may have heard theories about the African green Psychological Bam’ers to Pmvention monkey and the origin of AIDS, but such tidbits of in- One can see that many adolescents are too emotion- formation do not comprise the kind of behavioral script ally ambivalent about sexuality to plan for prevention; necessary for the performance of the acts that are in- they are often misinformed or uninformed about the eluded in the Preventive Behavior Sequence.In fact, need for, and nature of, prevention; and they often have when one reviews pregnancy and STlYHlV prevention prosex but antiprevention fantasies. These affective, cog- curricula, one is tempted to deduce that curricula devel- nitive, and fantasy barriers to prevention act to inhibit opers follow the dictum that information that might ac- them from practicing the sequence of pregnancy and tually be translated by teenagers into personal preven- STD/HIV preventive behaviors, which itself may be com- tive behavior may not be taught. plex and intrinsically difficult to execute, is rarely taught, Third, many adolescents possessantiprevention be- and may be met with social disapproval. liefs and act in accordance with these beliefs.43~45~49Ado- It is argued that this combination of psychological lescents may believe that they are too young to get and structural barriers to prevention explains much of pregnant; that having a baby at any age is the highest adolescents’ tendencies to risk pregnancy and STD/HIV achievement for a woman; that withdrawal prevents infection. However, these barriers can be overcome and HIV/AIDS; or they may have clusters of religious beliefs, the sequence of critical preventive acts can be taught, re- fatalistic beliefs, and the like, that work against the prac- hearsed, and refined. tice of sex-related prevention. Fourth, teenagers are regularly exposed to a vast The Solution: An Integrated Approach to Prevention amount of frightening and/or dangerous information Interventions to reduce adolescent pregnancy and with respect to sexuality and prevention. Frightening STD/HIV risk must accomplish two goals. First, it is nec- mass media communication about HIV/AIDS, herpes, essary to weaken emotional, cognitive, and fantasy barri- rape, and the sexual abuse of children may well suc- ers to prevention and replace them with feelings, teed in increasing teenagers’ erotophobia and their re- thoughts, and images that encourage pregnancy and luctance to plan for their own sexual and preventive be- STD/HIV risk reduction. Second, it is critical to train ado- haviors. Dangerous information, which promotes risk lescents to perform skillfully the relatively complex se- behaviors, such as the inaccurate “fact” that most quence of behaviors that is involved in pregnancy and women cannot get HIV/AIDS (as promoted by Cosmo- STD/HIV prevention. politan in January 1988, for example), may also interfere Chan@ng Emotions. Research indicates that many with the development of preventive behaviors. Thus, adolescents feel relaxed enough about sexuality to be both the maturity of adolescents’ cognitive processes sexually active, yet feel too uncomfortable to engage in

SIECLJSReport, April/May 1990 6 necessary preventive behaviors. Interventions, therefore, accept this fact. The course that is best for them is either must seek to relax anxieties about performing the Pre- to bring their behavior into line with their self-concepts ventive Behavior Sequenceso that adolescents may ef- via limit-setting strategies or to change their self-con- fectively set sexual limits and/or negotiate and imple- cepts to include an image of themselves as sexually ac- ment contraceptive and safer sexual practices. tive and in need of pregnancy and STD/HIV prevention. Several strategies for systematically reducing adoles- For teens who are unable to plan for future events, cents’ anxieties about sex-related prevention have been such as the need for sex-related prevention, it is neces- suggested.32s52. sary to highlight the link between present sexual behav- First, educators may wish to conduct a fantasy walk- iors and future important outcomes. These students through of the Preventive Behavior Sequence for stu- might write completions to “What if.. .n vignettes. For dents, exposing them to images of persons, much like example: “What if I impregnated someone or became themselves, who have successfully performed each of pregnant?” or “What if I got a disease that made it im- the sex-related preventive behaviors under discussion. possible for me to have children?” They then could ex- Reading material, videotaped vignettes, guided discus- change these imaginative future-time probes anony- sion, and observation of drama club enactments have mously and discuss the need for the active planning of been used successfully to illustrate that teenagers are ca- prevention. Cairns 53 has produced a very engaging com- pable of managing important preventive behaviors with puter simulation of adolescent life in which teens make positive consequences. decisions about school, work, social life, sexuality, and Second, in vivo walk-thmughs of some steps of the the like, receive accurate feedback about the conse- Preventive Behavior Sequence could follow. Teenagers quences of their decisions, and have to “live” with these could role-play how to bring up and negotiate sexual consequences in future rounds of the game. Efforts to limits, refusal of needle sharing, and/or protected sexual bring sexual self-concepts into line with behaviors, and activities with other teens. They also could visit birth efforts to help teens adopt a future time perspective in control centers or have personnel from these centers respect to their sexual behaviors and their conse- visit their classes, or they could visit pharmacies and quences may ready teens for learning and enacting spe- talk to pharmacists about condom purchasing. cific sex-related preventive behaviors. Third, teaching in this area should strive not only to With respect to the provision of information to ado- reduce anxiety, but to increase positive feelings about lescents, it is absolutely clear that teenagers require rele- prevention. Educators should use humor, and should vant, scriptlike information that informs them as to how connect prevention with sexual arousal, maturity, love, they may execute each step of the preventive behavior an increased likelihood of finding intimate partners, re- sequence in their particular social settings. Such easy-to- assurance, the avoidance of anxiety, and other similar translate-into-behavior information can be presented positive outcomes of prevention. visually - in videotape form for example - or as writ- Teaching, fantasy walk-throughs, and in vivo walk- ten print backup which can be accessed when needed. throughs that connect prevention to desirable positive Presentation of this information could overlap with fan- outcomes should increase teenagers’ knowledge about tasy and in vivo walk&roughs. how to employ prevention behaviors, reinforce teens’ However it is delivered, teenagers should learn, re- feelings that they are capable of prevention, and in- hearse, and refine each of the steps of the preventive crease positive, and decrease negative, expectancies behavior sequence - from self-acceptance of sexuality about personally performing sex-related preventive be- and bringing up and discussing prevention to public haviors. preventive acts and self and partner reinforcement - in Changing Cog&ions. It is apparent that numerous a fashion that will be effective in their own age, ethnic, cognitive obstacles interfere with the learning and per- and socioeconomic environments. The success of such formance of sex-related preventive behaviors. Adoles- a behavioral skills training approach has been empiri- cents may be too cognitively immature to appreciate the cally demonstrated, in respect to pregnancy prevention need for prevention; they may lack scriptlike, easy-to- among adolescents54*55 and college students32 and in re- translate-into-behavior information about prevention; spect to HIV prevention among gay men.56 and they may possess beliefs that work against the prac- With respect to beliefs and belief systems that work tice of preventive behaviors. Interventions must deal against sex-related prevention, interventions must iden- with these cognitive barriers to prevention. tify the beliefs that are present in particular settings, Where cognitive immaturity is concerned, education make teenagers aware of these beliefs and of their must deal with teenagers whose self-concepts do not in- negative effects, and attempt to persuade them that ei- clude the fact that they are sexually active and with ther their antiprevention beliefs or their risky sexual be- teenagers who cannot effectively foresee future events. haviors must change. Antiprevention beliefs vary idio- For teenagers who are not yet sexually active and syncratically, but they often fit into the categories of in- who do not see themselves as such, stress on sexual accurate information, frightening information, dangerous limit-setting strategies may be well received, as such information, and frankly antiprevention beliefs. Once practices are consistent with their self-images. such clusters of beliefs have been identified in a popu- For teenagers who are sexually active but refuse to lation, it is helpful to hold them up to teen scrutiny and see themselves as such, it may prove useful to explain for reflection on the personal costs of antiprevention that some teenagers who are sexually active refuse to beliefs.

7 SIECUS Report, April/May 1990 With respect to the issue of changing teens’ cogni- efficiently be delivered via the public school system sup- tion about prevention, a caveat is in order. Occasionally plemented by other delivery channels directed at more and distressingly, teenagers’ antiprevention beliefs are difficult-to-reach populations. Public school is as close to highly adaptive and, in a sense, appropriate reactions to a universal experience as we have available in our soci- very hostile environments. In such cases, it is necessary ety, and it provides the opportunity for the early intro- to work vigorously to change the teenagers’ environ- duction and continuous reinforcement of age-appropriate ments as well as their antiprevention beliefs. For ex- prevention education as it becomes relevant at succeed- ample, if an adolescent correctly perceives that preg- ing developmental stages. While public schools are be- nancy at age 16 would be his or her comparative “best leaguered and short of resources, the urgency of the ado- bet” because of alcoholism at home, chaos at school, lescent pregnancy and STD/HIV threat justifies claims on and unemployment in the community, it would be most this strained resource. honest to work toward belief change in the teenager Yoking Interventions with Community Re- and toward a change in his or her environment. By the sources. It is crucial to link pregnancy and STD/HIV same token, if the unpredictability and uncontrollability prevention interventions with awareness of existing com- of negative events give rise to a fatalism in teenagers munity resources in order to support preventive behav- that works against prevention, it is once again critical to iors. For example, when an integrated pregnancy and work honestly toward both proprevention belief STD/HIV prevention intervention is delivered, it is neces- changes and toward some measure of environmental sary to identify ‘user friendly” community resources for improvement. Needed interventions, such as job train- adolescents, such as birth control clinics, STD clinics, ing, neighborhood renewal, and improved law enforce- HIV-testing centers, drug treatment centers, needle ex- ment, can produce a social climate that will be more changes, and the like, and to provide practice in utilizing congenial to the prevention message. Moreover, it is ar- such resources. Research has demonstrated that when gued that teenagers who have plans and activities that, behaviorally relevant, sex related, prevention inter- in effect, compete with pregnancy are often best moti- ventions are backed up by effective community re- vated to practice contraception.32 Teenagers who have sources for realizing preventive aims, the interventions plans and activities may be better at STD/HIV preven- can be quite successful (see, for example, Zabin and col- tion as well, which is another reason for working for leagues’ pregnancy prevention program which, backed both environmental and belief changes. up by school-based clinics, has effectively reduced urban Changing Imagery. It is evident that adolescents teenage pregnancy rates56). In contrast, even the most are continually exposed to media and fantasy images relevant prevention interventions cannot be expected to that promote sexual activity but do not promote preven- be highly effective without necessary backup from identi- tion. Interventions must sensitize teenagers to the insidi- fied community resources or without the creation of such ousness of prosex media imagery and help them incor- resources if they do not exist. porate sex-related prevention into their imaginative The Politics of Sex-Related Prevention. It is appar- plans for sexual involvement. To make teens more ent to those in the field that sex-related prevention is as aware of the prosex messages of the commercial media, much a matter of politics as it is a matter of pedagogy.49 “media literacy” teaching - in which teens watch com- Sensitive political issues include the content of preven- mercial movies, prime time TV, soap operas, and com- tion interventions, institutional inertia, and the approach mercials, and plot the incidence of sexual activity, pre- that interveners make to a community. ventive behaviors, and the consequences of prevention- With respect to the content of interventions, it is axi- free sexual behaviors - may help teens become aware omatic that sexuality education that provides relevant in- of media representations of indiscriminate and conse- formation that a teenager might actually translate into quence-free sexuality. Moreover, video material that is preventive behaviors may encounter great political resis- utilized to provide fantasy walk&roughs, and to teach tance, while the more common educational efforts that teens the Preventive Behavior Sequence, should include provide information that is irrelevant to personal behav- images of similar others who have successfully and re- ioral change may encounter less resistance. Some seg- assuringly practiced prevention as well as images of ments of our society see the provision of practical pre- those who have not practiced prevention and have ex- ventive information as an effort to teach teenagers to sin perienced negative outcomes. Such imagery should with impunity, but the intrinsic morality of providing enter teens’ memories as fantasy-based scripts for per- teenagers with life- and health-saving information must sonally practicing preventive behaviors when and if be stressed. Some segments of our society also view such behaviors are necessary. Through media literacy sexuality education as a prime cause of sexual behaviors, teaching and observing models of prevention, teenagers but research findings make it clear that relevant sexuality may come to imagine detailed scripts for the practice of education only guides ongoing sexual behaviors along prevention, may see themselves as capable of practicing more prudent lines and does not encourage such behav- prevention, and may be able to imagine the benefits of iors. The point that sexuality education does not cause prevention as well as the costs of not practicing it. sexual activity must be clearly and repeatedly made (see, for example, references 49 and 56). Some Applied Concerns With respect to institutional inertia, many figures in The Intervention Setting. It is proposed that inte- authority are fearful of change and of the controversy grated pregnancy and STD/HIV interventions may most that preventive interventions might bring. In such in-

SIECUS Report, April/May 1990 8 stances it is necessary to emphasize the fact that the have been placed in campus washrooms as part of the status quo is not safe - at least from the standpoint of intervention. It is directed at illustrating the specific steps teenagers - and that a vote against effective interven- students must enact to practice prevention in their par- tions is a vote in favor of teenage pregnancy, abortion, ticular social environments, and through humor, non- SD/HIV infection, infertility, death, and like outcomes. judgmental models of health care provision, and scenar- With respect to the overtures that interveners make ios in which antiprevention beliefs are debunked, it at- in seeking permission to work in community settings, tempts to alter feelings, thoughts, and fantasies about additional political resistance may occur. In particular, contraception as well. The video annually reaches more sexuality educators often seek broad community sup- than 2,000 students through dormitory lectures, health port for intervention from PTAs, religious leaders, news- fairs, showings in university courses, and the like. papers, and the like. Occasionally, however, such activi- The third phase of the intervention, used in conjunc- ties are perceived as permission-begging efforts by mar- tion with the video, is a pregnancy prevention booklet, ginal forces who are not even sure of their own legiti- Can We Talk?: A Sexual Communication Guide for Stu- macy. Therefore, it may prove more useful to inform the dents @ Students.This booklet, distributed to all incom- community that a legitimate and necessary intervention ing students, reaches some 5,500 per year and is in- is planned, rather than appear to be seeking permission, tended to hnction both independently of, and as print and, in the process, communicating that preventive backup to, the pregnancy prevention video. The Can We sexuality education may be optional. Talk? booklet explicitly lays out each phase of the contraceptive behavior sequence - from how to learn An Intervention Model: Preventing Pregnancy about contraception and discuss it with a partner, to how on a University Campus to acquire and use it - and confronts common obstacles The principles of intervention discussed in this ar- to prevention. Again, the goal of the pregnancy preven- ticle have been effectively utilized in reducing student tion booklet is to provide easy-to-translate-into-behavior pregnancy in a multiyear intervention at a major Cana- information about prevention and to help individuals dian university. 32 The student pregnancy rate at this uni- overcome emotional, cognitive, and fantasy barriers to versity was relatively high and stable from the late 1970s utilizing such information. For further discussion of the onward, and in 1983, a three-component intervention details of this intervention, the interested reader is re- was phased in with the objective of teaching students ferred to Fisher’s chapter on this subject.32 the Preventive Behavior Sequence and altering their feel- To provide at least a crude idea about the effective- ings, thoughts, and fantasies in the direction of preg- ness of this pregnancy prevention intervention, data on nancy prevention. positive pregnancy tests at the Student Health Service The first phase of the pregnancy prevention inter- have been collected over the years before and after the vention involved dormitory-based lectures. Since the introduction of this program. As can be seen in Table 2 initial year of the intervention, the Student Health (see page lo), there is a relatively steady pregnancy rate Service’s personnel have annually given lectures on from about 1978/1979 through 1982/1983. In 1983/1984, birth control and contraceptive services to about one- the dormitory lectures were phased in and the student third of all the dormitory residents. Since the bulk of the pregnancy rate dropped precipitously by 28%. In 1984/ dormitory residents are freshmen, these lectures reach a 1985, the pregnancy prevention video and booklet were dense population of individuals who are at risk of preg- introduced and the pregnancy rate dropped a further nancy by virtue of youth, inexperience, and unpredict- 11% and has remained at this reduced level for some able sexual relationships. The lectures are nonjudgmen- years since. Parallel drops in the pregnancy rate in the tal, legitimize both limit-setting short of intercourse and general population of student-age females did not occur, contraceptively-protected intercourse, and establish the and the changes that occurred may have actually under- on-campus Student Health Service as an approachable estimated the program’s effectiveness. Since the Student address for contraceptive services. Behaviorally-relevant Health Service was represented as a sympathetic venue information is the focus of the lectures, which deal with for dealing with suspected pregnancy, students may how and where students can acquire contraceptive in- have become more willing to get a pregnancy test at the formation and services on campus and explain how to center, which would have minimized the decrease in use various methods of contraception. positive pregnancy tests that was observed. With respect The second phase of the intervention involved the to condom purchasing from campus vending machines, production (in the summer of 1984) of a pregnancy pre- no preintervention data are available, as the resource did vention videotape, Can We TaZk?The videotape, written not exist at that time; but, since the installation and pro- by students and based on the behavioral scripting con- motion of condom vending machines as part of this in- ceptualization under discussion here, utilizes student ac- tervention, some 1,500-2,000 condoms have been sold tors to model a fairly precise behavioral script concern- annually in both men’s and women’s washrooms. Al- ing how to anticipate the need for contraception, dis- though these results are most encouraging, it is impor- cuss it with a partner, and where on the campus and in tant to emphasize that the effects of any uncontrolled in- the surrounding community students can acquire con- tervention must be interpreted cautiously, and further, traception in nonjudgmental settings. The videotape that controlled experimentation with these techniques, in stresses condom use for STD prevention and models the a variety of settings, is necessary. purchase of condoms from the vending machines that

9 SIECUS Report, April/May 1990 Conclusion Family Planning Perspecths, 1987, 19, 46-53. The case has been made that American adolescents 3. Zelnik, M & Kantner, JF. Sexual activity, contraceptive are at continuing high risk for pregnancy and SD/HIV use and pregnancy among metropolitan area teenagers: infection. It also has been argued that these overlapping 1971-1979. Family Pkznning Perspectives~ 1980, 12, 230-232. 4. The Alan Guttmacher Institute. Teenage pregnancy: The problems necessitate an integrated approach to teaching problem that hasn’t gone away. New York: The Alan Guttma- the specific behavioral skills that are involved in preven- cher Institute, 1981. tion and for reducing emotional, cognitive, and fantasy- 5. Cvetkovich, G & Grote, B. Adolescent development and based barriers to prevention. In closing, it should be teenage fertility. In D Byrne & WA Fisher, eds. Adolescents, noted that additional behavioral scripts for the avoid- sex, and contraception. Hillsdale, New Jersey: Erlbaum, 1983, ance of sexual victimization and for the attainment of 108-123. sexual and relationship satisfaction could also be taught, 6. Fisher, WA, et al. Psychological and situation specific corre- lates of contraceptive behavior among university women. Jour- and the psychological barriers to such behavior could MI of Sex Research, 1979, 15, 38-55. be dealt with in a truly integrated program for sexual 7. Zabin, LS, Kantner, JF & Zelnik, M. The risk of adolescent health promotion. Such coordinated interventions re- pregnancy in the first months of intercourse. Family Planning main an important challenge for our future, Perspectives, 1979, 13, 215-222. 8. Jones, EG, et al. Teenage pregnancy in developed countries: A copy of the booklet, Can We Talk?, a a’escription of the die- Determinants and policy implications. FamiIy Planning Perspec- otape, and ordering information can be obtained by writing to tiyes, 1985, 17, 53-62. Ms. A. HiI4 Student HeaItb Services, ‘Ihe University of Western 9. Kegeles,SM, Adler, NE & Irwin, CE. Sexually active adoles- cents and condoms: Changes over one year in knowledge, atti- Ontario, University Community Center, Room II, London, On- tudes and use. American Journal of Public Health, 1988, 78, tario, Canada NGA 3K7. 460-461. 10. Fisher, JD & Miscovich, SJ. Longitudinal assessment of col- References leee students’ AIDS-preventive behavior, AIDS-knowledge, and 1. Coles, R & Stokes, F. Sex and the American teenager. New fe& of AIDS. Manuscript submitted for publication, 1983. York: Harper and Row, 1985. 11. King, AJC, et al. Canada Youth and AIDS Study (2nd ed). 2. Hofferth, SL, Kahn, JR & Baldwin, W. Premarital sexual ac- Ottawa, Ontario: Federal Centre for AIDS, 1988. tivity among U.S. teenage women over the past three decades. 12. Moore, KA & Wertheimer, RF. Teenage childbearing and

Table 2

Unwanted Pregnancy Rates at The University of Western Ontario and Nationally Before and After Pregnancy-Prevention Intervention

Rates of Positiw Pregnancy Percent Change Abortion Rate/l 000 Percent Change Academic Tests/l, 000 Women $za; Preceding All Canadian Women gay Preceding Year Univ. of Western Ontariti Age 20-24=

1978-1979 9.4 - 17.3 -

1979-l!xO 10.2 +8.5% 18.1 +4.6%

1980-2981 10.7 +4.9% 18.2 +o.c% Z!asl-I982 9.9 -7.5% 18.0 -1.1%

IS='-3.983 10.1 +2.0% 18.5 +2.80X1 lP83-1984* 7.3 -27.7% 17.4 -5.9%

lP84-lP8S'* 6.5 -11.0% 17.6 +1.20/b 195198G 6.5 0.0% 17.4 -1.2% IP8G-lP87 6.6 +1.5% - - 197-1988 6.5 -1.5% - -

1. Data supplied by Student Health Services, The Universi of Western Ontario. 2. Data from Statistics Canada Yearbook.; data are availab 7 e only through 1985-1986. ’ Dormitory re nancy prevention lecture intervention phased in. l l * Video and k& let pregnancy prevention interventions phased in.

SIECUS Report, April/May 1930 10 welfare: Preventive and ameliorative strategies. FumiZy Pkzn- 36. Fisher, WA, Byrne, D & White, LA. Erotophobia - eroto- ning Perspectives, 1984, 16, 285-289. philia as a dimension of personality. Journal of Sex Research, 13. Bolton, FJ, Jr. The pregnant adolescent: Problems of pre- 1988, 25, 123-151. mature parenthood. Beverly Hills, California: Sage, 1980. 37. Fisher, WA. Affective, attitudinal, and normative determi- 14. Furstenberg, FF, Jr., Brooks-Gunn, J, & Morgan, SP. Ado- nants of contraceptive behavior among university men. Unpub- lescent mothers and their children in later life. Furnib Plan- lished doctoral dissertation, Purdue University, 1978. ning Perspectives, 1987, 19, 142-151. 38. Goldfarb, L, et al. Attitudes toward sex, arousal, and reten- 15. Zuckerman, BS, et al. Adolescent pregnancy: Biobehav- tion of contraceptive information. Journal of Personality and ioral determinants of outcome. ne Journal of Pediatrics, 105, Social Psychology, 1988, 65, 634-64 1. 1984, 857-863. 39. Fisher, WA, et al. Students’ attitudes towards sex, sexual 16. Nuckolls, KB, Cassel, J & Kaplan, BH. Psychological knowledge, and willingness to treat sexual concerns. Journal of assets, life crisis, and the prognosis of pregnancy. Medical Education, 1988, 63, 379-385. American Journal of Epidemiology, 1972, 95, 431-441. 40. Yarber, WL & McCabe, GP. Teacher characteristics and the 17. Burt, MR. Estimating the public costs of teenage inclusion of sex education topics in grades 6-8 and 9-11. Jour- childbearing. Family Planning Perspectives, 1986, 18, 221-226. nal of SchoolHealth, 1981, 51, 288-291. 18. Faro, S. Sexually transmitted diseases. In RW Hale & JA 41. Yarber, WL & McCabe, GP. Importance of sex education Krieger, eds. Gynecology: A concise textbook. New York: topics: Correlates with teacher characteristics and inclusion of Medical Examination Publishing Company, 1983, 198-214. topics of instruction. Health Education, 1984, 15, 36-41. 19. Bell, TA & Holmes, KK. Age-specific risks of syphilis, gon- 42. Fisher, WA. Predicting contraceptive behavior among uni- orrhea, and hospitalized pelvic inflammatory disease in sexu- versity men: The roles of emotions and behavioral intentions. ally experienced U.S. women. Sexually Transmitted Disease, Journal ofApplied Social Psychology, 1984, 14, 104-123. 1984, 11, 291-295. 43. Fisher, WA, et al. Talking dirty: Respnses to communicating 20. Kroger, F & Wiesner, PJ. STD education: Challenge for the a sexual message as a function of situational and personality 80s. The Journal of School Health, April 1981, 242-246. factors. Basic and Applied So&l Psychology, 1981, 1, 115-126. 21. Burke, DS, et al. Human immunodeficiency virus infec- 44. Oskamp, S & Mindick, B. Personality and attitudinal barriers tions among civilian applicants for United States military serv- to contraceptin. In D Byrne & WA Fisher, eds. Adolescents, ice, October 1985 to March 1986. 7be Nau EnglandJournal of sex, and contraception. Hillsdale, New Jersey: Erlbaum, 1983, Medicine, 1987, 317, 131-136. 76-107. 22. Shafer, M, et al. Chlamydia trachomatis: Important relation- 45. Allgeier, ER. Ideological barriers to contraception. In D ships to race, contraception, lower genital tract infection, and Byrne & WA Fisher, eds. Adolescents, sex, and contraception. Papanicolau smear. Journal of Pediatrics, 1984, 104, 141-146. Hillsdale New Jersey: Erlbaum, 1983, 171-205. 23. Peterman, TA, et al. Risk of human immunodeficiency vi- 46. Allgeier, AR. Informational barriers to contraception. In D rus transmission from heterosexual adults with transfusion-as- Byrne & WA Fisher, eds. Adolescents, sex, and contraception. sociated infections. JAM4, 1988, 259, 55-58. Hillsdale, New Jersey: Erlbaum, 1983, 143-169. 24. Padian, N, et al. Male-to-female transmission of human im- 47. Zelnik, M & Kantner, JF. Reasons for nonuse of contracep- munodeficiency virus. JAMA, 1987, 258, 788-790. tion by sexually active women aged 15-19. FumiZy Planning 25. Fischl, MA, et al. Evaluation of heterosexual partners, chil- Perspectives, 1979, 11, 289-236. dren, and household contacts of adults with AIDS. JAVA, 48. Morrison, DM. Adolescent contraceptive behavior: A 1987, 257, 640-644. review. Psychological Bulktin, 1985, 98, 535-568. 26. Masters, WH, et al. Crisis: Heterosexual behavior in the 49. Fisher, WA. Adolescent contraception: Summary and rec- age of AIDS. New York: Group Press, 1988. ommendations. In D Byrne & WA Fisher, eds. Adolescents, sex, 27. Tempelis, CD, et al. Human immunodeficiency virus infec- and contraception. Hillsdale, New Jersey: Erlbaum, 1983, 272- tion in women in the San Francisco Bay area. JAM& 1987, 300. 258, 474-475. 50. Perper, T & Weis, DL. Proceptive and rejective strategies of 28. Rees, M. The sombre view of AIDS. Nature, 1987, 326, US and Canadian college women. Journal of Sex Research, 343-345. 1987, 23,455-480. 29. Strunin, L & Hingson, R. Acquired immunodeficiency syn- 51. Gross, AE & Bellew-Smith, MA. Social psychological ap- drome and adolescents: Knowledge, beliefs, attitudes, and proach to reducing pregnancy risk in adolescence. In D Byrne behaviors. Pediatrics, 1987, 79, 825-828. & WA Fisher, eds. Adolescents, sex, and contraception. 30. Centers for Disease Control. HIV-related beliefs, knowl- Hillsdale, New Jersey: Erlbaum, 1983, 263-272. edge, and behaviors among high school students [Leads from 52. Wolpe, J. Psychotherapy by reciprocal inhibition. Stanford, the MMWRI. Jm, 1988, 260, 3567-3568. California: Stanford University Press, 1958. 31. Byrne, D. Sex without contraception. In D Byrne & WA 53. Cairns, KA. Computer-assisted learning program for adoles- Fisher, eds. Adolescents, sex, and contraception. Hillsdale, cent sex education. Unpublished manuscript. University of Cal- New Jersey: Erlbaum, 1983, 3-31. gary, Calgary, Alberta, Canada, 1987. 32. Fisher, WA. Understanding and preventing adolescent 54. Schinke, SP. Preventing teenage pregnancy. In M Hersen, pregnancy and sexually transmissible disease/AIDS. In J Ed- RM Eisler, & PM Miller, eds. Progress in behavior modification, wards, et al, eds. Applying social influence processes in pre- Vol. 16. Orlando, Florida: Academic Press, 1984, 31-64. venting social problems. New York: Plenum Press, 1989. 55. Schinke, SP, Blythe, BJ & Gilchrist, LD. Cognitive-behavioral 33. Byrne, D. Social psychology and the study of sexual prevention of adolescent pregnancy. Journal of Counseling behavior. Pwsonality and Social Psychology Bulletin, 1977, 1, Psychology, 1981, 28, 451-454. 3-30. 56. Kelly, JA & St. Lawrence, JS. The AIDS health crisis: Psycho- 34. Fisher, WA. A psychological approach to human sexuality: logical and social interventions. New York: Plenum Press, 1988. The sexual behavior sequence. In D Byrne & K Kelley eds. Al- 56. Zabin, LS, et al. Evaluation of a pregnancy prevention pro- ternative approaches to the study of sexual behavior. gram for urban teenagers. Family Planning Perspectives, 1986, Hillsdale, New Jersey: Erlbaum, 1986. 18, 119-126. 35. Fisher, WA, Byrne, D & White, LA. Emotional barriers to contraception. In D Byrne & WA Fisher, eds. Adolescents, sex, and contraception. Hillsdale, New Jersey: Erlbaum, 1983, 207- 239.

11 SIECUS Report, April/May 1990 From the Executive Director

MOVING TOWARD A HUT~PARADIGM OF TEEN DEVELOPMENT Helping Young People Develop Into Sexually Healthy Adults

Debra W. Haffner, MPH

This issue marks the third in the series of SL!XUS with his views on erotophobia/erotophilia and teenage Reports on healthy adolescent sexual development. We behaviors. American teenagers are moderately erotopho- initiated this series in May 1989 when we realized that bit: they clearly engage in sexual behaviors in large there was little consensus on how to promote healthy numbers, yet much smaller numbers seem to engage in adolescent sexual development. Indeed, although sexu- strategies to prevent health risks. Some conservatives ality, family planning, public health, and education pro- seem to want to encourage greater erotophobia in teens: fessionals know that they are trying to avoid teenage “If we can scare teens about sexuality, perhaps they will pregnancies, teenage sexually transmitted diseasesand be less likely to want to be involved with sexual behav- HIV infection, date rape, exploitation, and so forth, little iors.” The problem is that eventually most people want has been written about what positive sexual attitudes, to be sexually fulfilled; the erotophobic messagesof behaviors, and values should wisely be promoted as de- childhood and adolescence are very difficult to dismiss, sirable for teenagers. even if society is willing finally to condone sexual behav- The government, most religious bodies, many par- ior after a wedding ceremony. Too many of us know ents, and conservative national organizations are now firsthand the damage and violence of early sexually- admonishing teenagers to “just say no,” advice that is negative teachings. discounted or ignored by more than 14 million Ameri- I propose that the first step of Fisher’s model needs can teenagers each year. A more progressive attitude, to be extended to society as well. That is, as a culture, however, has evolved among the many organizations we must begin to accept that teenagers are sexual, that that are concerned with teenage pregnancy prevention: the development of a sexual identity is a critical task of “We prefer teens not to have sexual intercourse, but be- adolescence, and that teenagers have both the right and cause many of them do, they need relevant information the responsibility to make decisions about their own sex- and services.” Nonetheless, neither of these approaches ual values, ethics, and behaviors. The responsibility of and attitudes acknowledge teenagers as sexual persons, caring adults then, whether as parents, teachers, religious nor do they promote healthy adolescent sexual develop- advisors, media professionals, or youth group leaders, is ment. to provide the information, education, and environment Surely, as a culture, almost all of us can agree that that will support that development. adultsshould be sexually healthy and happy. (There are We need to develop new cultural norms around ado- members of the Right that do indeed disagree. For ex- lescent sexuality. Fisher suggests that we help teens be- ample, Joseph Scheidler has stated, “Most people in the come more erotophilic so that they are not only comfort- pro-life movement have a certain morality and believe able enough to engage in sexual behaviors, but also able sex is not for fun and games...1 think contraception is to negotiate and engage in preventive behaviors. We disgusting - people using each other for pleasure.“) I need to help young people develop the skills and the believe, then, that we need to develop a new consensus ability to resist the media and peer pressures that rush about what needs to happen during childhood and ado- them into premature sexual involvement, and to develop lescence to help assure mature, sexually healthy devel- personal criteria, based on their own values, for evaluat- opment. ing relationships. Teens need assistancein knowing how I first read William Fisher’s work on adolescence and to answer the question, “How do I know if I am ready contraceptive behavior several years ago. I then met him for sex?” and, as important, “How do I know if I am in last winter at an invitational conference on AIDS educa- love?” An erotophilic approach would also require talk- tion sponsored by the World Health Organization in ing to teenagers about masturbation and outercourse, Toronto and asked him if he would like to develop and clearly delineating that there are sexual behaviors what has become this month’s cover story to share his that do not place one at risk of pregnancy, sexually approach with SIECUS members. I was most impressed transmitted diseasesor HIV, yet still allow one to give or

SIECUS Report, April/May 1990 12 receive sexual pleasure. It would also include helping We need to acknowledge a wide range of sexual devel- teenagers to develop communication and intimacy skills opment for young people, for example: teens who are so that if they choose to be involved in a sexual rela- not yet dating, teens who choose abstinence, teens who tionship, it is not only noncoercive, nonexploitative, and are gay and lesbian, teens who are sexually experienced riskfree, but also mutually pleasurable. - all need our support and respect. I would like to suggest eight approaches that will help young people develop into sexually healthy adults: 4. ONE MUST BE HONEST WITH YOUNG PEOPLE ABOUT SEXUAL ISSUES. I recently met a woman at a 1. SEXUALITY EDUCATION MUST BEGIN AT cocktail party who, after I shared with her what I do for BIRTH. The tendency in homes, as well as schools, is to a living, told me that she would never talk to her six wait until young people reach puberty to provide them year old about sexuality. I asked her what she did when with information about sexuality. Clearly sexually her children asked where babies came from; she told healthy teenagers or adults have received their first sex- me, “I lied.” The conversation ended several minutes ual lessons as infants and toddlers. later. As discussed in-depth in SIECUS’ publication, Sex I am not sure why it is that we are willing to lie to Education 2000: A Call To Action, parents must be sup- our children about sexual issues when we would not ported in their role as sexuality educators of their chil- think to do this with other important issues. Moreover, dren. teachers often report that they are instructed not to an- swer children’s questions about certain sexual issues, but 2. THE DEVELOPMENT OF A HEALTHY SELF- rather to refer them to another source. I am often told by CONCEPT MUST BE PROMOTED. Advertising and school systems that it is impossible for them to talk media give young people, indeed all of us, an un- about masturbation or outercourse with students, al- healthy ideal of sexual attractiveness. My four year old though they can address birth control methods. I believe is currently quite fond of Barbie and Ken. Ken has now that it is imperative that we acknowledge our own dis- joined Barbie in representing an unattainable goal. Not comfort in providing information to children and adoles- only is she perfect, with large breasts and a tiny waist, cents. We also need to develop age-appropriate guide- but he now sports well-defined biceps, triceps, and pec- lines for responding to young people’s questions and torals. In Walt Disney’s charming new movie, “The Little must be willing to offer direct answers. Mermaid,” not only are all the characters white, but the lead characters also look perfect. In recent television 5. YOUNG PEOPLE MUST BE PREPARED FOR RE- specials, both Bugs Bunny and Garfield were on diets. ALISTIC LONG-TlERM RELATIONSHLPS. Almost every Little wonder, then, that one study found that one-half story that I have read to my daughter ends with, I‘. . .and of fourth graders have dieted! We need to help children they lived happily ever after.” I always find myself creat- and adolescents accept their level of attractiveness, de- ing an alternative ending as I have become acutely velop a healthy body image, and understand that media aware of the negative influence of “they lived happily images are unobtainable for most of us, and we need to ever after” on people’s lives. Young people need to un- encourage their acceptance of other people as they are. derstand that healthy relationships require a combination of commitment, intimacy, and passion that necessitates 3. THE WIDE RANGE OF VALUES AND EXPERI- interpersonal skills and hard work. We need to empha- ENCES MUST BE ACKNOWLEDGED. We need to ac- size that sexuality is lifelong, and that sexual education is tively pursue a paradigm that recognizes the diversity of never ending. Teenagers need to understand that sexual- values, experiences, and attitudes, and to encourage tol- ity and love are not necessarily the same, but are joined erance and acceptance among young people. I recently together, in mature love, and they need to learn to dis- spent a day at EPCOT in Walt Disney World. Countless tinguish their emotions. shows and images repeated a single cultural model: characters were white, middle class, and evolved in a 6. YOUNG PEOPLE MUST BE GIVEN HOPE FOR predictable sequence of childhood, dating, high school THFXR FUTURES. Too many young people in our cul- and college graduation, marriage, parenthood, and smil- ture are growing up without basic reading and writing ing retirement. I was struck by the lack of portrayals of skills and decent educational and employment opportu- the lives of the majority of children in America. nities. In addition, many are turning to sexual intimacy In Part I of this series (SZECUS Report, Vol. 17, No. 5) before they have fulfilled their developmental needs of Jay Friedman wrote eloquently on the negative impact identity, connectedness, power, and hope/joy, as identi- of misogyny and homophobia on young men’s sexual fied by Robert Selverstone in his article on adolescent development and Gary Remafedi wrote about the diffi- sexual development, which appeared in Part II of the culty that gay and lesbian youth face in developing Healthy Adolescent Development series (SZECUS Report, positive self-images. Children from conservative or fun- Vol. 18, No. 1). As sexuality professionals, we must be damentalist homes, children of color, and children of concerned with changing the basic living conditions that diverse cultural backgrounds, also face daily challenges too many young people must endure. to their family’s values. As a culture, we need to recog- nize and promote diversity as essentially democratic. 7. WE MUST ACKNOWLEDGE OUR SHARED RE- Children need to be helped to develop tolerance and SPONSIBILITY. One of the conclusions of The Alan compassion for people who are different from them. Guttmacher Institute’s report on the cross-cultural

SIECUS Report, April/May 1990 aspects of teenage pregnancy was that “our children are growing up the most confused in the world.” The same SIECUS adult culture that officially tells teenagers “no” produces books, music, videos, films, and television shows that Recommended show them that every teen is “doing it.” As professionals and parents we need to agree on the messages that we want to give our children and adolescents about sexual- Resources ity, and then we need to be consistent. Parents, churches, youth agencies, schools, health care provid- Abortion ers, television, radio, MTV, and advertisers, for example, all need to be involved in helping young people de- CELEBRATING ROE V. WADE: DRAMATIC IMPROVE- velop a healthy sense of sexuality. We must stop tanta- MENTS IN AhiEFUCAN HEALTH (January 1989, 12 pp., 8x12 lizing our children with exploitive messages while urg- bookkt). Prepared by the National Abortion Federation - ing them to ignore them. which has worked since 1977 to preserve and enhance the quality and accessibility of abortion services - this booklet is 8. WE MUST BE MORE POLITICAL. As sexuality part of a nationwide public education program on the impor- professionals, we must become more active politically. tance of safe, legal abortion and includes accurate, timely, Many of us have experience in fighting local attacks on and unbiased information on abortion. “During a time when sexuality education and in promoting young people’s so much harmful misinformation is being disseminated to the access to contraceptive services. But few of us have public, it is critical that people have access to the facts.” The spoken out publicly on teenagers’ rights to be sexual health benefits of legal abortion are compared with the mor- bidity and mortality rates that result from illegal abortion, the human beings. devastating impact of criminalization on families’ well-being Attacks on teenage sexuality are mounting. Two and the need for greater access to the procedure, and im- cases pending before the U.S. Supreme Court may se- proved medical technology, are emphasized and discussed, verely restrict young women’s access to abortion setv- and a summary of major U.S. Supreme Court Decisions is in- ices. The Department of Health and Human Services’ cluded. NAF has also made free consumer education hotline DraJ Year 2000 Objectives For the Nation stated that counter cards (4x9) available that describe their foll-free Abor- one public health goal for the next decade is to “reduce tion Information Hotline Service (800/772-91OOJ They are sexual activity among unmarried people ages 15 specifically designed for placement in public information dis- through 19 to a prevalence of no more than 35 percent play areas and for easy access by those in need, and are de- [from 47% in 19821.” At a recent speech I attended, Dep- signed so that women and men can get accurate confidential information on abortion, and referrals to safe supportive uty Assistant Secretary for Population Affairs Nabers health care providers. NAF believes this is “an excellent way Cabinis stated that the options for teenagers are absti- to provide information when discussion of this option may nence and mutual monogamy. (She did not answer my require discretion.” Publications Department, NationaIAhr- question during the question-and-answer period about tion Fe&ration, 1436 U Street m Suite 10.3 Washington, DC which behaviors teens were to avoid, and whether the 2ooo3, 202/667-5881, fm 202/667-5890. Price: $2per book- federal government is now advocating’ marriage for let. teenagers, when teen marriages have much highler di- vorce rates than those begun as adults.) Antisexuality FACT!3 ON REPRODUCTIVE RIGHTS: A RESOURCE education forces have taken a new tactic; they state that MANUAL (December 1989, 120 pp., 8’/2x11 munuub. Pre- they are willing to accept sexuality education, just not in pared by NOW Legal Defense and Education Fund, this man- ual is “designed to provide concise, upto-date information the words of a Connecticut antisexuality education ac- and analysis on the most important issues concerning repro- tivist: “the kind Planned Parenthood and SIECUS ductive freedom today.” It features discussions on a broad promote.” Sex Respect, which is now promoted as an range of current topics - including current U.S. Supreme alternative sexuality education curricula, robs young Court abortion cases, public funding for abortion, parental people of any opportunity for decision-making, as those consent and notification laws, fetal viability, the effect of con- of you who are familiar with this curriculum know. The traceptive failure on abortion rates, costs of bearing and rais- need to activate political support for sexuality education ing a child, rape and incest exceptions to abortion bans, for young people is clear. men’s attempts to block wives’ or lovers’ abortions by court SIECUS and its members must become more in- order, Operation Rescue and other antichoice intimidation volved with these issues. All of us need to advocate for tactics, fake abortion clinics, prosecution of women for using drugs or alcohol during pregnancy, the impact of AIDS on teenagers’ rights to be sexually literate, sexually edu- women’s health and medical care, court-imposed medical cated, and sexually protected. We need to advocate for treatment of pregnant women, and the impact of new repro- honesty with young people, not education or public ductive technologies on women’s rights. Background on le- health messagesthat are veiled moralizing sermons. gal, medial, and public Policy considerations and statistics And, we need to advocate for the end of exploitive me- are arranged for easy reference. Contains 16 different fact dia and advertising messagesthat teach children unreal- sheets with references, a summary of the contents, and an in- istic standards and gender-stereotyped behaviors. troduction to law and legal language, designed to provide the I look forward to working with you on these issues. information needed to understand and discuss these issues and offer support for arguments. Reproductive Rights Resource

(Continued on Page 17)

SIECUS Report, April/May 1990 14 EMPOWERING TEENAGERS

The Use of Theater In HIV/AIDS Education

New York Program Models

Carolyn Patierno

SIECUS AIDS Associate

I n times of greatest crisis, the human spirit is often individual can progress to an AIDS diagnosis, it is now resilient and untiring in its search for solutions to prob- assumed that many individuals became infected in their lems that at first appear to be insurmountable. So it has teens. This makes it clear how important it is to effec- been with the HIV/AIDS crisis. The issues that have tively reach adolescents with information and education. been raised because of HIV/AIDS have been far-reach- ing and difficult to deal with - the health care system Obstacles to Education and its policies, medical research and its ethics, sexual- Nonetheless, however clear it may be, there are im- ity and its complications, drug abuse and its treatment, pediments that make this undertaking difficult. discrimination and its ramifications, the blood supply The greatest obstacle is denial. Many parents, teach- and its safety, and education and its implementation. ers, and youth-serving professionals believe that HIV in- fection happens to other people’s children, but not to The Need for Education their own. When adults can so easily deny the reality of However, one of the most difficult problems is to risk, young people are put in a very precarious position. convince the general public of the need for education (It is a sad commentary if a member of one’s own family - everyone’s need for education. Going hand-in-hand must become infected before one will acknowledge that is the need for the general public to understand that the there is a problem and a need for education.) AIDS crisis will affect and, in fact, is affecting all of us Another obstacle encountered in educating young - either indirectly or directly through personal experi- people is that many adolescents do not trust adults as ence with the disease. Among the many ways in which sources of information. To a much greater extent, how- all of us are indirectly affected are through the escalat- ever, trust does exist among peers. Therefore, wherever ing health care costs, shifting policies in the testing of and whenever possible, teens should be considered as investigational new drugs, new discrimination and con- potential educators for other teens. fidentiality laws, and the transformation of health insur- Finally, ongoing, comprehensive, and creative educa- ance procedures. tion is imperative. The practices of handing a young per- HIV/AIDS education confronts a major obstacle son an AIDS pamphlet or teaching an hour-long lesson when people deny that they are indeed affected by the once a year are not sufficient education. The belief that problems created by HIV/AIDS. By nature, people tend these do, in fact, constitute “education” is a delusion. to hold fast to a sense of invulnerability and the belief that “bad things” happen to other people. However, as How the Challenge is Being Met we move along in life and have our own experiences With these and other obstacles to overcome, creative - which may be difficult and even tragic - we begin approaches are imperative. The challenge is to find a to realize that we are those “other people.” This realiza- way to present crucial information on a fear-inspiring tion, however, comes only with age and experience, topic without scaring young people, while also helping And so, the group most entrenched in denial are young teenagers to understand the weight of the problem in and less experienced teenagers. terms of their own lives. Young people have sense of invincibility - a sense Meeting this challenge is a network of 18 theater of invincibility that is sometimes dangerous. As AIDS is groups in New York City who are bringing their message not yet curable, it is important for youth to grasp that to schools, churches, parks, prisons, children’s museums, even they are not immune from potential infection. In and agencies throughout the city. This network, called fact, 21% of the total AIDS cases in the United States are the Adolescent Theatre/Peer Project Committee, was first in the 20 to 29 year old age group. With a latency pe- conceptualized by Cydell Berlin of the Mt. Sinai Adoles- riod of more than 11 years in which an HIV-positive cent Health Clinic and is an offshoot of the Adolescent

15 SIECUS Report, April/May 1990 AIDS Network of New York City. Representatives from mation into the scene, which makes audience input an each of the companies in the network meet informally integral part of the story development. This type of per- once a month to share their experiences and knowledge forming requires a tremendous amount of flexibility, in- and offer each other support as they work to empower genuity, and concentration. Inventiveness is imperative, young people in this crisis. not only in creating fresh material at each of the per- In the spring of 1989, the New York City Depart- formances, but also, in some cases, in attracting an audi- ment of Health requested proposals for programs to do ence. AIDS education through theater and targeted areas As this company frequently performs in parks, gath- within New York City’s five boroughs that most needed ering an audience occasionally entails a “Pied Piper” ap- such education efforts. The outcome was the develop- proach. With their first performance, company members ment of several theater pieces, from various companies, entered a park in the South Bronx, where a group of many of which were developed through improvisation young people were playing softball and were in need of and later scripted. Others have depended solely on im- a few extra players. The theater company struck a deal provisation as a performance mode. Several companies to play three innings of softball if the young people within the Adolescent Theatre/Peer Project Committee would then watch a performance. All agreed, three in- network have been funded through these grants. nings of softball were played, a successful performance The theater groups are telling young people, experience was had by all, and then everyone played through performance and language that the audience is one last inning. The actors lost the game, but met the comfortable with and understands, that it is okay to say challenge of AIDS education. “no” to sexual involvement. But, they are also telling them that if they are going to have sexual intercourse, Sinai Teen Arts Resources protection must be used; that people with AIDS (PWAs) Also meeting the challenge to communicate informa- need compassion and understanding; and that, most im- tion effectively about HIV/AIDS are young performers portantly, anyone who engages in risky behavior is at who are educating their peers through their work. risk of becoming infected. One such company is the Sinai Teen Arts Resources Their vignettes are frank and foster trust among the (STAR) which is directed by Cydell Berlin. The company audience and their characters are recognizable: they are members range in age from 14 to 24 and have been people from the neighborhood, family members, and working together since the spring of 1989. The vignettes friends. Music and comedy also are used to alleviate po- they have developed have come out of improvisation tential fear and facilitate discussion, the audiences are and are now set pieces. A wide variety of situations are not preached at, and the productions are direct and in- presented. For example, two sisters, whose father has volve audience participation at various levels. Because AIDS, try to deal with his illness and drug addiction. the actors portray specific characters, young people are Complicating the situation is the fact that their mother able to relay their thoughts to a “third person,” so to has recently died of the disease. Moreover, they have speak; therefore, no direct confrontation is necessary in chosen to deal with the crisis in opposing ways, which order to obtain information, which provides a unique creates great tension between them. The audience is kind of protection. The effects of the theater perform- able to witness how confronting the problem is the first ances are electrifying to witness and inspirational. step in resolving it. In another scene, a couple contemplates having sex- Teatro Vida/Life Theatre ual intercourse for the first time: the young man does not Ted Welch, artistic director of Teatro Vida/Life The- want to use a condom, but his girlfriend is insistent. atre at the Bronx Council on the Arts, which is working Frustrated, he finally tells her that if she wants to use a in collaboration with the Bronx AIDS Task Force, is no condom then she must go out and purchase them herself stranger to the educational use of theater. He is the and is surprised when she is agrees to do so. founder of Family Life Theater, a company that is dedi- We also meet a young woman who has found out cated to dealing with issues that families face, such as that she is HIV-positive and shares the crushing effect it personal growth, sexuality, alcoholism and drugs, and has had on her “too-young” life. The rest of the cast ral- human relationships. lies around her, singing a song entitled, “You’re Not Teatro Vida/Life Theatre, a bilingual company, is Alone.” In an ideal world, she would not be, but unfor- comprised of adult actors. Performers attend trainings in tunately, ours is not ideal. The reality is that HIV-positive several related subject areas in order to obtain the nec- people and PWAs too often suffer the backlash of dis- essary knowledge base, as their presentations must not crimination and disdain as a result of their status. None- only engage the audience but must be informationally theless, through music and performance, the audience is accurate as well. In addition, this particular company better able to empathize with this young woman and travels with a health educator who fields questions at support is encouraged from those who are well for those the conclusion of the presentations. who are not. The actors create stock characters that come to life At the conclusion of the performance, the audience is through improvisation at each performance. During the given the opportunity to ask questions. The young cast process, Welch acts as a facilitator, stopping the action remains in character and responds to their peers’ com- whenever an audience member has a suggestion or a ments and questions, Ken Hornbeck, the artistic director, comment. The actors then incorporate any new infor- facilitates these discussions.

SIECUS Report, April/May 1990 16 This is peer education at its best. Young people are SIECUS Recommended Resources helping those young people their own age who are Continued From Page 14 most in need of their perspectives and everyone is win- ning. Manual, NOWLegal Defense and Education Fund, 99 Hudson Street, 12th Floor, New York> NY10013, 212/925- Loisaida, Inc. 6635. R-ice: $14.95, plus $2p/b per manual. Checks should Thea Martinez, through Loisaida, Inc., a youth serv- be made payable to NOW Legal Defense and Education Fund. ice agency serving the Lower East Side of Manhattan, coordinates an AIDS education and theater project. Un- PROCHOICE ACTION KlT (FY/zxll). This kit, preparedby like the company members of STAR and Teatro Vida/ Zero Population Growth, contains a historical overview of Life Theatre who are actually performers and have audi- abortion in America; explains how the SupremeCourt can af- fect reproductive rights; offers prochoice action information tioned for these companies, Loisaida has a youth em- (what to do and how), resources, tells where to go for further ployment service through which young people are re- information, and includes sample letters. Zero PopuIation cruited to perform as a job assignment. These teenagers, Growth, 1400 l&h Street w Washington, DC20036, 202/ therefore, not only have to acquire the same HIV and 332-2200. Price: $5. AIDS knowledge base as the performers of the previ- ously discussed companies, but they must become com- Family Planning fortable and proficient in performing as well. To help them along, Martinez sought the assistanceof profes- CHANGES: YOU & YOUR BODY (4th revision 1988, S1/zx8% sionals in the theater community - one of whom was booklet) prepared by CHOICE, (a member agency of Ted Welch. Additional professionals from various com- Women’s Way) edited by Muriel Keyes and Beth Wilkinson, and printed with funding from the Family Planning Council panies throughout the city have also worked with the of Southeastern Pennsylvania. “Each year more than one mil- young performers on voice, movement, and improvisa- lion teenagers get pregnant. Many more teens risk pregnancy tion. This type of cooperation and generosity is another because they don’t know how pregnancy happens, how birth key element in the success of the program. Like Teatro control works, or because they have the wrong information. Vida/Life Theatre and STAR, the scenes are scripted Sometimes it is hard to talk about sex. Wrong information is from improvisations, which often are based on autobio- passed around a lot. This book makes some facts about sex graphical and/or others’ experiences. and pregnancy clear.” It also answers questions. Sections of Through their work, the performers have expanded the book include: Your Body; Your Health; Sexual Issues; their knowledge base in regard to sexuality, self-esteem, Birth Control; Pregnancy; Sexually Transmitted Diseases; and crucial health issues, they have been exposed to AIDS; and What To Do If. Also included are a glossary and the CHOICE Hotline number X5/592-0550, where questions the kindness and creativity of the theater community, are answered concerning the topics covered by the booklet. and, most important, as a result of such exposure they “We won’t judge you or tell you what to do. Your call is pri- are now more skillful in sharing accurate information vate. We won’t ask your name or tell anyone you called. And with their peers. our help is free.” The booklet does a nice job. It is direct and honest and provides good, clear explanations. It is also heter- Conclusion osexist; the only advice for gay and lesbian teens is that one In and of itself, AIDS education through theater is experience does not mean one is homosexual. What about not an effort intended to effect behavior modification; teens who are? CHOICE, 125 S. 9th StreeC, Suite 603, Phikzdel- no one education endeavor is capable of such results. phia, PA 19107, Hotline: 215/592-0550, to order: 215/592- But, it is an effort to empower young audiences in the 764%price: $3 plus 25% ph. belief that they have options and the right to informa- A STITCH IN TIME: HELPING YOUNG MOTHERS COM- tion. It also offers an opportunity for sharing and discus- PLETE HIGH SCHOOL (1989, 70 pp. 6x3 paperback book) is sion. a product of many months of research by Elizabeth McGee, If effective education in areas such as sexuality, an expert in the area of teenage pregnancy, under the aus- HIV/AIDS, and drug use are provided, young people pices of the Academy for Educational Development’s Support will have more of the knowledge that is needed to Center for Educational Equity for Young Mothers. Through make healthy personal decisions. If, as adults, we resist surveys conducted by the Center, the book reviews the cur- the deceptive safety of denying that our young people rent situation of pregnant and parenting students and how are at-risk, perhaps they, too, will be more apt to ac- schools are responding to them. “A larger proportion of knowledge the problem. And, if we continue to seek today’s adolescent mothers are younger than was the case in and develop creative solutions for this devastating crisis, previous decades, and in comparison to those in other West- ern industrialized countries, many American teenage mothers perhaps it will begin to seem surmountable. Theater can are extremely young” and “increasingly, they are single.” In- be an effective step toward acknowledging that it is just tegrating recent research on strategies to assist this popula- that. tion, it provides recommendations on how educators, youth- More information on AIDS education and theater service providers, and community activists can work together may be obtained by contacting Ted Welch at the Bronx to reduce institutional barriers to school completion by preg- Council on the Arts, 1738 Hone Avenue, Bronx, NY nant and parenting students. Academy for Educational De&- 10461, 212/931-9500. opment, 100 Fftb Avaue, New York, NY 10011, 212/243- 1110. (Continued on Page 231

17 SIECUS Report, April/May 1990 CURRENT BOOKS ON SEXUALITY A SIECUS Annotated Bibliography for the General Public

T he reading public is continually encountering books on they are unable to do this, contact the publisher directly. The all aspects of human sexuality. The SIECUS staff peruse as publisher’s address and phone number is provided after each many of these as possible and from time to time select for listing. comment in annotated bibliographies books that cover a wide Please note that SIECUS does not sell or distribute any of the range of subjects and are deemed most informative, from listed publications other than SIECUS publications. However, medical reference to marital and sexual enrichment. most of the materials listed are available for use at SIECUS’ This annotated bibliography is by no means a complete Mary S. Calderone Library. guide to books on sexuality, but it may help the genera1 Copies of this bibliography can be purchased from SIECUS reader, who is faced with a bewildering array of publications, publications department at the following costs: 1-4 copies/$250 select resources that can answer his or her particular needs each; 5-49 copies/$2 each; 50+ copies/$l.50 each; plus 15% and concerns. All listed resources are not appropriate for all postage and handling (p/h). SIECUS is located at 130 West readers. Annotations are provided to help readers decide 42nd Street, Suite 2500, New York, NY 10036; 212/673-3850. whether the resource will be useful. No publication, neverthe- This bibliography, which replaces Human Sexuality: A Bibli- less, is a substitute for medical and psychological care and ad- ographrfor Everyone, was prepared by SIECUS Librarian Daniel vice. M. Donohue and Library Assistants Arno Karlen and Yvette If the listed resources are not available in your local book- Adams. store, the bookstore may be able to order them for you. If

terms in sexuality, and to discuss basic health and disease, with chapters espe- health and sexuality issues including sexu- cially for men, women, and teenagers. ality and alcohol and safer sex. 1990, 63 1983, 206 pp., $13.95 hc., $5.95 pb. GENERAL pp., $5.95; 1990, 95 pp., $5.95. Simon G Schuster, 1230 Avenue of the Michael Friedman Publishing Group, 15 Americas, Nau York: NY 1002Q 800/223- W. 26th Street, New York, NY 10010; 212/ 2348. CONTRARY TO LOVE: HELPING G85-6510. THE SEXUAL ADDICT LOVE, SEX, AND AGING Patrick Carries THE FAMILY BOOKABOUT SEXUALITY Edward M. Brecher This book provides a framework for Mary S. Calderone G Erik Johnson Reports on the findings of the 1978-79 understanding and treating addictive First published in 1981, this straightfor- Consumers Union study of love and sex sexual behavior, introduces a family- ward, comprehensive guide to human conducted with more than 4,000 volun- oriented process of overcoming sexual sexuality has been expanded and thor- teer male and female respondents, ages addiction, and describes the process oughly updated to incorporate new infor- 50 to 93. Includes both statistics and di- by which the addict is treated. Carnes mation on AIDS, adolescent sexuality and rect quotations from returned question- also addresses the controversies which pregnancy, homosexuality, and the sexual- naires. 1984, 441 pp., $19.95 hc., $12.95 surround the concept of “sexual addic- ity of older adults. Contains a reading list pb. tion,” which is not universally ac- arranged by age groups. 1989 revised edi- Littk, Brown, 34 Beacon Street, Boston, cepted by health professionals in the tion, 288 pp., $18.95. MY 021%; 800/343-9204. field of sexuality. 1989, 280 pp., $9.95. Harper and Row, 10 E. 53rdStreel, New CompCare Publishers, 2415 Annapo- York, NY 10022; 800/242- 7 73 7. MASTFSS AND JOHNSON ON SF.X lis Lane, Minneapolis, MN55442; S&I/ AND HUMAN LOVING 328-3330. 45 -AND SINGLE AGAIN William H. Masters, Virginia E. Johnson Mildred Hope Witkin 6 Burton Lebrenbaum G-Robert C. Kolodny DR. MICHAEL CARRERA’S SEXUAL This book provides a wealth of informa- This revised and reformatted edition of HEALTH FOR MEN: tion on sex, love, and relationships that is the college text, Human Sexuality, by YOUR A TO Z GUIDE useful not only to single people over 45 the same authors, provides information DR. MICHAEL CARRERA’S SEXUAL but also to those in long-term marriages. on all aspects of human sexuality. 1986, HEALTH FOR WOMEN: 1985, 204 pp., $15.95. 598 pp., $24.95 hc., $12.95 pb. YOUR A TO Z GUIDE Dembner Books, 1841 Broadway, New Little, Brown, 34 Beacon Street, Boston, Michael Carrera York, NY 10023; 800/223-294. MA 021%; S&?/343-9204. These books ace designed to pro- vide accurate, understandable informa- HEALTHY SEX AND KEEPING IT MIDLIFE LOVE LIFE tion about issues relating to sexual and THAT WAY Robert Butkr G Myrna Lewis reproductive health, to offer clear and Richard Lumiere G Stephani Cook This updated volume, which includes concise definitions of commonly used A layperson’s handbook on genital most of the information contained in the

SIECUS Report, April/May author’s books, Love and Sex Over GO 32 Washington Place, Sui@ 52, New York, offers a combination of self-help and and Love and Sex OLW 40, focuses on NY 10003; 212/673-3850. medical information and assistance in recognizing and treating sexual prob- deciding when medical attention would lems in the mid-years before they be- be beneficial. Includes a short discus- YOUR COMPLETE GUIDE TO sion of the sexual problems of midlife come problems in the later years, The SEXUALHEALTH book emphasizes the importance of males and an excellent resource guide Elizabeth i%ompson Ortiz T185;her information. 1987, 266 pp., talking about the sexual aspects of A basic family reference book on sexual- physical problems and includes spe- ity and reproductive health for people of cific questions to ask one’s doctor or Facts on Fik Publications, 460 Park all ages, this book addresses the common Avenue South, New York, NY 10016 counselor. 1988, 209 pp., $6.95. concerns about reproductive health, includ- PerennialHarper and Row, 10 E. ing reproduction, birth control, and sexual 8MV322-8755. 53-d Stree& New York, NY 10022; 800/ health problems. Lists additional resources 242-7737. at the end of each section. 1989, 344 pp., THE NEW OUR BODIES, OURSELVES: $17.95. A BOOK BY AND FOR WOMEN SEX AND THE SINGLE PARENT: Prentice HalUSimon G Schusle+, Route Boston Women’s Health Book Collective HOW YOU CAN HAYE HAPPY AND 9 R Engkwocd Cl;@, NJ 0 7632; 201/592- Written to help women better under- HEALTHY KIDS -AND AN 2lwo. stand themselves and their bodies, this ACTIVE SOCIAL LIFE book covers sexuality, contraception, Maty Math relationships, health care, sexual physi- This practical, supportive, and thor- EEMALE ology, and reproduction. I984 revised ough guide for parents who are trying edition, 647 pp., $16.95. to adjust to family life after death, di- SEXUALITY Simon G Schuster, 1230Avenue of vorce, or separation, provides guid- the Americas, New York, NY 1002Q ance for the unique problems encoun- 800/223-2348. tered in raising children alone and dis- FOR EACH OTHER: SHARING cusses how to combine an active so- .5mUAL1NTIMACY SAFE ENCOUNTERS: HOW WOMEN cial life with a supportive home life. Lonnie Barbuch CAN SAY YES TO PLEASURE AND 1986, 316 ppa, $16.95. This book offers women a complete pro- NO TO UNSAFE SEX Henry Holt, 115 W. 18th Street, New gram for dealing with the physical and psy- Beverly Wbippk C Gina Ogden York, NY 10011; 800/247-3912. chological aspects of a relationship that This nonthreatening book, designed affects sexual satisfaction, and includes to make women feel more comfortable SEX CARE: THE COMPLETE GUIDE more than 50 easy-to-follow exercises that and aware in dealing with sexual issues TO SAFE AND HEALTHY SEX show women how to reduce anger, en- in light of the HIV/AIDS epidemic, ex- Timothy R. Covington hance communication, increase vaginal plains that safer sex does not have to This comprehensive guidebook for sensitivity, and break unfulfilllng love pat- be unappealing or forbidding. 1989, men and women on practicing and terns. 1982, 320 pp., $13.95 hc., $8.95 pb. 222 pp., $16.95. maintaining a healthy sex life gives Anchor Press/Doubleday, 501 Franklin McGraw-Hill Book Company, 11 W. facts and advice on birth control meth- Avenue, Garden City, NY 11530; 8OC!!323- 19th Street, New York, NY 10011; 212/ ods, preventing and treating sexually 9872. 512-2000. transmitted diseases, how drugs and illness affect sexual functioning, and FOR YOURSELF: THE FULFILLMENT SAPPHISTRY: THE BOOK OF sexual myths and fallacies. 1987, 402 OF FEMALE SEXUALITY LESBIAN SEXUALITY pp., $8.95. Loran& Garfield Barbach Pat Galifia Pocket Books/Simon G Schuster, Written primarily for women who have For anyone interested in learning 1230 Avenue of the Americas, New difficulty achieving orgasm, this book dis- about women’s sexuality, this primer York, NY 1002@ 800/223-2348. cusses sources of confusion about female on lesbian sexuality discusses commu- sexuality, describes female sexual physiol- nication skills, self-loving, and sexual SEX OVER FORTY ogy, and suggests specific exercises to do techniques, demystifies current lesbian E. Douglas Whitehead G Shiriey at home. 1976, 240 pp., $4.50. myths, and includes information about Zussman, Editors New American Library, 1633 Broadway, lesbians and AIDS. 1988 third edition, This practical monthly newsletter di- New York, NY 10019 800/526-0275. 186 pp., $8.95. rected to the sexual concerns of adults Naiad Press, PO Box 1054, Talkzbas- covers health and disease of the sexual MENOPAUSE, NATURALLY: PREPARING see, FL 32302; 904Z539-9322. and reproductive systems, sexual func- FOR THE SECOND HALF OF LIFE tion and dysfunction, effects of illness Sadja Greenwood SEXUAL EXERCISES FOR WOMEN and medications on sexuality, and re- This book, grounded in the belief that A. Harris lationships in mid- and later life. An- good nutrition and regular exercise can These exercises for women are de- nual subscription: $72. positively affect the physical and psycho- signed to tone and strengthen the body PPA, Inc ,, PO Box 1 COO, Chapel Hill, logical changes that occur during meno- and enhance mental well-being. The NC 2 7515; 919/929-2148. pause, combines prevention and medical introduction offers information on the treatment models of health care. 1988 re- basics of anatomy and hormones, and SEXUAL DYSFUNCTION CLINICS vised edition, 201 pp., $10. on becoming more aware of one’s Daniel M. Donahue C Mark 0. Bigkr Volcano Press, 330 Ellis Sheet, San Fran- body, and the appendices offer infor- This booklet lists more than 60 pro- cisco, ~24 94102; 209?2%-33445. mation on dealing with diet, weight, grams throughout the United States and body types. Does not focus exclu- that treat sexual dysfunctions, para- MIDLIFE HEALTH: EVERY WOMAN’S sively on sexual pleasure. 1988, 145 philias, gender dysphorias, sexual ad- GUIDE TO FEELING GOOD pp., ‘$8.95. - dictions, and survivors of sexual Ada Kahn C Linda Hugbey Halt Carroll G Graf Publishers, 260 Fifth abuse. 1988, 11 pp., $4 plus 15% p/h. Addressing many of the health-related Avenue, New York, NY 10001; 212/924- Publications Department, SIECUS, concerns of women at midlife, this book 3344.

19 SIECUS Report, April/May 1990 SEXUALITY 196 pp., $16.95. This annotated bibliography of more L&a Dawson Scanzoni Contemporary Books, Inc., 180 No& than 25 books, pamphlets, and audio- This book, one of the 12 included in Michigan Avenue, Chicago, IL 60601; 800/ visuals provides a critical selection of the Judeo-Christian series, Choices: 621-1918. important resources for the general Guides for Today’s Woman, discusses public. Prices and ordering information sexual theology, anxieties, the search THE MALE COUPLE: HOW are given for each citation. 1989, 3 pp., for intimacy, ways of expressing sexu- RELATIONSHIPS DEVELOP one copy free with a stamped, self-ad- ality, and sexuality over the lifespan. David P. Mc Whirter G Andrew M. dressed, business-size envelope. 1984, 120 pp., $6.95. Mattison SIECUS, 32 Washington Place, Suite Westminster, 925 Chestnut Street, Based on a study of 156 male couples 52, New York, NY10003; 212673-3850. ;i;y&hia, PA ZPlOz 800/523- involved in relationships of one to 37 years, this book presents a series of six THE CONDOM BOOK: THE ESSEN- ages and stages of pair-bonding. Also valu- TIAL GUIDE FOR MEN AND WOMEN able for those interested in heterosexual Jane Everett C Walter Gkanze relationships. 1985, 341 pp., $9.95. This book offers a comprehensive Prentice-HalVSimon C Schuster, Engle- question-and-answer section on STDs, SEXUALITY wood Cl@s, NJ 0 7632 800/6342863. sexuality, and the correct use of con- doms. It includes a buyer’s guide that BIOPOTENCY: A GUIDE TO MALE SEXUALITY lists the condoms by product name with SEXUAL. SUCCESS Bemie Zilbergeld G John Ullman descriptions and information on each, Richard E. Berger G Deborah Berger This book has been written for the man including how they are packaged and This readable book on sexual po- who wants to get more in touch with his the personal opinions of those who tency provides good, concise descrip- sexuality or for the woman who wants to have used them. 1987, 139 pp., $3.95. tions of the male sexual response better understand male sexuality. 1978, 334 Signet, 1633 Broadway, New York, NY cycle and of the facts and myths of pp., $14.95 hc., $4.95 pb. 10019; 212/397-8000. potency, while it also explains the Hardcow: Lit& Brown, 34 Beacon physical and psychological factors that Street, Bosmn, MA 02106; 800/343-9204. CONTRACEFI’ION: A GUIDE TO contribute to erectile dysfunction. It of- Paperback. Bantam, 666 F@b Avenue, New BIRTH CONTROL METHODS fers medical and psychological strate- Yont, NY 10019; 800/2236834. Vem L. Bullougb C Bonnie Bullougb gies for treating erectile dysfunction This up-to-date, comprehensive and a chapter on how women can sourcebook, which begins with an help their partners and themselves. SEXUAL SOLUTIONS: AN INFORMATIVE GUIDE overview of reproductive physiology Many health professionals will dis- Michael Castkwzan and the history of birth control, offers agree with the authors’ claim that 90% A newly updated, practical guide to clear and detailed information on the of these problems can be reversed by problem-free lovemaking that covers a many birth control options available their methods, but the book in general range of concerns: erection and ejaculation today and those that may be available is sound. 1987, 225 pp., $21.95. difftculties, communication, birth control, in the future. Birth control methods are Rodale Press, dz&-ibuted by St. analyzed in terms of their success rate, Martin’s Press, 175 F$f?b Avenue, New sexual health care, and sex therapy. 1989, 301 pp., $10.95. safety, advantages and disadvantages, York, NY 10010; 800/221-7945. Touchstone/Simon G Schuster, 1230 Ave- and medical consequences. 1990, 175 nue of the Americas, New York> NY 10020; pp., $13.95. HOW TO OVERCOME PREMATURE 800/223-234X?. Prometheus Boo&, 700 East Amherst EJACULATION Street, Buffalo, NY 14215; 800/421- Helen Singer Kaplan STRATEGIES FOR SURVIVAL: A GAY 0351, 716’83 7-24 75. This book, written by a sex thera- MEN’S HEALTH MANUAL FOR pist, describes typical male sexual re- THE AGE OF AIDS MANUAL OF SAFE SEX sponses, the causes of premature Dehney Goldblum G Peter Goldblum DonaM Kil&y ejaculation, and the problems which This book, written by gay men for gay After a a short discussion of sexual premature ejaculators and their part- men, presents a step-by-step approach to anatomy and physiology, this book cov- ners may encounter. The “Stop/Start” overall health maintenance using a work- ers the basics of contraception and method of treatment can be used by book format to help one assess one’s sexually transmitted diseases (STDS). men with or without partners. 1989, health status, to look at ways of evaluating Includes drawings and photographs of 118 pp., $11.95. one’s risk of HIV infection, and to change various birth control methods and Brunner/Mazel Publihers, 19 Union behaviors that conflict with sustaining good STDs, a glossary, and suggested read- Square, New York, NY 10003; 800/365- health. 1987, 320 pp., $10.95. ings at the end of each chapter. The 3453. St. Martin’s Press, 175 Fi&tb Avenue, New tone is stiff and technical, but the con- York, NYlOOl~ 800/221-7345. tent is informative. 1986, 213 pp., MAKING LOVE AGAIN: RENEWING $14.95. INTIMACY AND HELPING YOUR C.V. Mosby Company, 11830 Westline MAN OVERCOME IMPOTENCY Industrial Drive, St. Louis, MO 63146; Terry Mason G VaIerie Greene Norman PREVENTING 800/633-G699. This book, for women whose part- PREGNANCIES AND ners are experiencing erectile dysfunc- SEXUALLY TRANSMITI’ED UNDERSTANDING AND PREVENTING tion, describes the feelings of both AIDS -A BOOK FOR EVERYONE men and women who must cope with DISEASES Chris Jennings the problem and discusses how Written clearly and concisely, this women can help their partners con- AIDS: LOOKING FORWARD/LOOKING book “for everyone” deals with a wide front the difficulty and work toward a BACK. A SIECUS ANNOTATED range of topics. Tables are used effec- solution. The book is primarily aimed BIBLIOGRAPHY OF AIDS-RELATED tively throughout and the detailed chap at enabling partners to relate to each RESOURCES FOR THE GENERAL PUBLIC ter summaries are helpful. 1988, 230 other with increased intimacy. 1988, Carolyn Patierno pp., $24.95.

L SIECUS Report, April/May 1990 20 Health Alert Press, PO Box 2060, SEXUALAWARENE!% ENHANCING and explore the options available as re- Cambridge, MA 02238; 62 7/497-4419. sEXUALPLEASURE I$a:k;;hips change. 1989, 208 pp., Barry McCarthy C Emily Mccizrtby . . These three books are designed to help Newmarket Press, 18 E. 48th Street, people enhance their sexual communica- New York, NY 10017 800/638-3030. ENRICHING SEXUAL tion, feelings, and functioning. Each in- RELATIONSHIPS cludes a series of exercises that encourage ROMANTIC INTERLUDES: partner communication. 1989, 311 pp., A SENSUOUS LOVERS’ GUIDE A LIFELONG LOVE AFFAIR: f$;.;;; 1988, 294 pp., $9.95; 1984, 243 pp., Kenneth Ray Stubbs KEEPING SEXUAL DESIRE ALIVE . . Designed to help people experience IN YOUR RELATIONSHLP Carroll C Graf Publisbeq 260 F@b Aye- all their senses during lovemaking, this Joseph Nowinski nue, New York, NY lCXW1; 212/3243344. guide explicitly teaches how to inte- Based on the notion that intimacy is grate the sexual, sensual, and intimate the key to lifelong relationships, this HOW TO PUT THE LOVE BACK aspects of lovemaking through a series book examines why bonds between INTO MAKLNG LOVE of exercises. A SIECUS Report reviewer partners sometimes break down. Its Dagmar O%onnor said, “I know of no other book avail- main point is that in a successful rela- This book is a guide for people to keep able that is as clear and well written.” tionship both partners are on an equal love and intimacy flourishing within a sex- 1988, 110 pp., $12.95 plus $3 p/h. footing with one another. Tells how to ual relationship. In the first part of the Secret Garden, PO Box G7-SB, Lark- enhance self-esteem, body image, and book the author examines the problems SPUT, CA 94939#Gz 415/540:5454. trust between partners in order to and myths that keep people from being maintain or rekindle intimacy. 1988, truly intimate. Part two is a series of sen- TERRIFIC SEX IN FEARFUL TIMES 244 pp., $7.95. sual exercizes that help people feel and Brook Peters W. W. Norton C Company, 500 Fifth express love by exploring their sensuality. This well-thought-out book for edu- Ayenue, New York> NY 10110; 800/ 1989, 222 pp., $16.95. cating people on how to eroticize safer 221-7945 Doubleday, 666 Fi@ Avenue, New York, sex, partly written as a response to NY 10103; 800/323-98 72. AIDS, describes the components of “terrific sex” and the techniques to help THE ART OF SENSUAL LOVING: THE JOY OF SEX: A CORDON BLEU achieve this goal, including the use of A NEW APPROACH TO GUIDE TO LOYEMAKING condoms and dental dams, masturba- SEXUAL RELATIONSHIPS tion, an understanding of one’s body, Andrew Stanway MORE JOY: A LOVEMAKING COMPANION TO THE JOY OF SEX and exercises. Though written mainly This illustrated book, designed to Alex Comfort for heterosexuals, it includes tech- show younger and older couples and These finely illustrated, explicit guides to niques that can be used by homosexu- those seeking to practice safer sex the lovemaking Include sections on sexuality als as well. 1988, 205 pp., $14.95. pleasures of the “nonintercourse” as- and aging, sexuality and disability, and (in St. Martin’s Press, 175 Fftb Avenue, pects of sexuality, explains how to en- MoreJoy) less conventional sexual behav- New York, NY lOOl@ 800/221- 7!+l5. hance lovemaking and encourages lei- iors. Recently updated to include informa- surely and sensual ways of attaining tion about AIDS. 1986 revised edition, 253 intimacy. 1989, 159 pp., $15.95. ~~~,“:7.95; 1987 revised edition, 234 pp., FOR MORE Carroll C Graf Publishers, 260 Fifth . . Avenue, New York, NYlOOOl; 212/ Crown Publishers, 225 Park Avenue INFORMATION 924-3344. South, New York, NY 10003; 800/733-3000. Your personal physician or religious EROTIC MASSAGE: THE TOUCH OF MASSAGE AND LOVING advisor can refer you to a therapist, LOVE: AN ILLUSTRATED, STEP-BY- Anne Hooper counselor or specialist for sexual coun- STEP MANUAL FOR COUPLES This illustrated book on using massage seling and therapy. Most hospitals have Kenneth Ray Stubbs throughout one’s life and within one’s fam- medical referrals for specific problems. This finely illustrated book on the ily describes the positive effects of touch For referrals to certified counselors and techniques of massage lists all the nec- and the use of massage to enhance inti- therapists in specific geographic areas essary ingredients for massage, the ba- macy between lovers, family members, and contact: sic rules of massage, and safer sex friends. Provides massage techniques for American Association of Sex Educators guidelines. Features step-by-step illus- specific situations, sexual and nonsexual, Counselors trations of massage strokes for specific and for use as an adjunct to sex therapy. and Therapists areas of the body, including the geni- 1988, 117 pp., $12.95. 435 North Michigan Street, Suite 1717 tals. A two-pan video is also offered to Henry Holt, 115 W. 18th Street, New Chicago, IL 6061 l-4067 help the user visualize the techniques York, NY 10011; 8OC??247-3912. 3X/644-0828 described in the book. Part 1 consists of the standard techniques; Pan 2 THE MONOGAMY MYTH: A NEW American Association of deals with erotic massage. Book: 1989, UNDERSTANDING OF AFFAIRS AND Marriage and Family Therapy 112 pp., $16.95. Video: Part 1, 1989, 30 HOW TO SURVIVE THEM 1717 K Street NW, Suite 407 min., $29.95; Part 2, 1989, 30 min., Peggy Vaughan $49.95; both videos, $65. Washington, DC 20006 This book, which helps people under- 202/429-1825 Secret Garden, PO Box G7-SB, Lark- stand the social and psychological factors spur, CA 949390&z 4ly540-5454. that encourage partners to have affairs, de- For a catalog of mail order books scribes the experiences of affairs, the heal- that deal with sexuality, contact: ing processes, and where and how to get FEMALE SEXUAL AWARENESS: help from professional sources, friends, The Sexuality Library ACHIEVING SEXUAL FULFILLMENT and family. Also offers a program to help 1210 Valencia Street MALE SEXUAL AWARENESS: couples communicate honestly with one San Francisco, CA 34110 ACHIEVING SEXUAL. FULFILLMENT another and encourages people to examine 415/550-7399 (12-6 PST)

21 SIECUS Report, April/May 1990 SIECUS NEWS. l l

SIECUS IS MOVING: As of July 1, 1990, SIECUS will be sociation for the Advancement of Health Education; As- in its new home at 130 West 42nd Street, Suite 2500, sociation of Junior Leagues; Girls Clubs of America; Hu- New York, NY 10036. Members will be notified when man Sexuality Program, University of Pennsylvania we have our new telephone and fax numbers. We Graduate School of Education; March of Dimes Birth De- hope you will come visit us in our new home! fects Foundation; National Education Association; Na- tional School Health Education Coalition; Society for A NEW LQOK FOR SIECUS: Through the generosity of Adolescent Medicine; Society for Public Health Educa- new SIECUS Board Member Steve Rabin, president of tion; and the Society for the Scientific Study of Sex. De- Ogilvy and Mather Public Affairs, SIECUS will soon de- tails on the colloquium will be included in the June/July but a new logo in conjunction with our July move and issue of the SIECVSReport. new address. DEAR ABBY HEARTIT.,Y RECOMMENDS SIECUS’ SIECXJS RECEIVES GRANTS: SIECUS continues to re- “HOW TO TALK TO YOUR CHILDREN ABOUT AIDS” ceive new and renewed foundation grants. We are BOOKLET: On October 11, 1989 in answer to a reader’s grateful to the Compton Foundation, the Hunt Alterna- questions, Dear Abby wrote “I heartily recommend a tives Fund, the Robert Sterling Clark Foundation, and booklet titled ‘How To Talk To Your Children About the Public Welfare Foundation for their grants for FY AIDS.’ It is written in plain, easy-to-understand language 19’5% activities. In addition, we have been notified that and published by SIECUS.. And it’s free.. .Please mention we will again receive funding from the Centers for Dis- it’s the booklet Abby recommended.” Within two weeks, ease Control for SIECUS’ national AIDS education initia- we were deluged with more than 15,000 requests from tive; through their support, we will be able to continue “Dear Abby” readers. To date, we have answered more to develop our AIDS education and information activi- than 22,000 requests for complimentary copies of this ties. pamphlet from this column alone.

SIECUS ELECTS NEW BOARD MEMBERS: The Board SIECUS STAFF TRAVELS: In recent months, SIECUS staff of Directors has elected five new members to the Board have presented workshops in Atlanta, Georgia; Indian- of Directors and has reappointed three members for apolis, Indiana; Billings, Montana; State College, Pennsyl- second-year terms. The new members are James Bow- vania; New York, New York; Sun Valley, Idaho; and man, Steve Rabin, John Robbins, Dr. William Stayton, Washington, DC. SIECUS Executive Director Debra Haff- and Pamela Wilson. Those returning for second-year ner presented workshops and speeches at the annual terms are Dr. Clive Davis, Dr. Ruth Westheimer, and meetings of the American Association of Sex Educators, Dr. William Yarber. A complete list of the 1990 Board of Counselors, and Therapists; the National Family Planning Directors can be found on the opposite page. Reproductive Health Association; Family Health Services of Bellefonte, Pennsylvania; the Eastern Region annual SIECUS ANNUAL REPORT AVAILABLE: SIECUS’ an- meeting of the Society for the Scientific Study of Sex; and nual report for 1989 is now available. Please call or the Young Adult Institute. Ms. Haffner presented the an- write us if you would like to receive a complimentary nual Sarrel Lecture (named in honor of past SIECUS copy. The report details SIECUS’ activities for FY 1989, Board members Lorna Sarrel and Dr. Phillip Sarrel) on provides financial information, and discusses our cur- adolescent sexual development at the annual meeting of rent program plans. the Sex Information and Education Council of Connecti- cut (SIECCONN). SEX EDUCATION 2000 NOW AVAILABLE: Sex Educa- tion 2000: A Call To Action was released on March 27, SIECUS AWARDED HIGHEST AWARD BY THE COALI- 1990. The report was covered in Daily News, USA To- TION ON SEXUALITY AND DISABILITY: On June 7, day, Washington Times,ABC, NBC, CBS, CNN radio, 1990, SIECUS will receive the Pioneer Award from the and wire service stories throughout the country. Copies New York-based Coalition on Sexuality and Disability for are $12, or $10.80 with a SIECUS membership discount. its longstanding commitment to the sexual rights of the Contact the Publications Department. disabled. The award recognizes outstanding contributions in this area. SIECUS is very grateful to the Coalition for SIECUS HOLDS 2ND ANNUAL NATIONAL. COLLO- this recognition. QUIUM ON SEXUALITY EDUCATION IN THE UNITED STATES: On May 21, SIECUS held its 2nd an- SIECUS STAFF NEWS: SIECUS is pleased to welcome nual national colloquium on sexuality education in the Meredith Hallowell as SIECUS’ director of development United States. The colloquium was cosponsored by The and Richard Murphy as SIECUS’ director of finance. We Alan Guttmacher Institute; American Association of Sex wish Christine Sperry - SIECUS’ financial manager since Educators, Counselors, and Therapists; American Medi- 1987 - well, as she leaves to pursue a now fulltime cal Association; American School Health Association; As- singing career.

SIEClJS Report, April/May 1990 22 SIECUS BOARD .OF DIRECYORS 1990

President: Robert Selverstone, PhD Vice President: Peggy Brick Psychologist in Planned Parenthood of Private Practice Greater Northern New Westport, CT Jersey, Hackensack, NJ

Secretary: Marian V. Hamburg, EdD Treasurer: Laura B. Resnikoff Professor Emeritus The Equity Group New York University Chicago, IL New York, NY

Barbara R. Beitch, PhD Clive M. Davis, PhD William R. Stayton, ThD Hamden Hall Country Syracuse University University of Pennsylvania Day School Syracuse, NY Malvern, PA Hamden, CT Robert L. Johnson, MD Ruth Westheimer, EdD Joan S. Benesch New Jersey Medical School Radio and TV Host Sex Education Coalition Newark, NJ New York, NY Washington, DC Sandra Orwitz Ludlow Pamela M. Wilson James W. Bowman ETR Associates Sexuality Education James Bowman Associates Santa Cruz, CA Consultant San Francisco, CA Oxon Hill, MD Steve Rabin Vivian P.J. Clarke, EdD Ogilvy & Mather Public Elizabeth C. Winship New York University Affairs Author, “Ask Beth” New York, NY Washington, DC Boston Globe Boston, MA Richard J. Cross, MD Rt. Rev. David E. Richards Professor Emeritus Retired Bishop William L. Yarber, HSD Robert Wood Johnson Episcopal Church Indiana University Medical School Coral Gables, FL Bloomington, IN Newark, NJ John C. Robbins John Robbins Associates New York, NY

SIECLI.. Recommended Resources sible to all potential users, from high school students to schol- Continuedfrom Page 17 ars. In most cases brief bibliographies are provided at the end of the articles. The editors have attempted to survey the entire Homosexuality field of homosexuality through more than 770 interdisciplinary and, as far as possible, cross-cultural articles; “the vast majority ENCYCLOPEDIA OF HOMOSEXUALITY (1990, two volumes, of them are either thematic, topical, or biographical.” The de- 1484 pp., 10x7% books) edited by Wayne R. Dynes. “This en- cision was made, however, to include no biographies of living cyclopedia is the first attempt to bring together, interrelate, people, many of whom are discussed in the topical articles. summarize, and synthesize this outpouring of controversial The editors “hope for a second, expanded edition sometime in and often contradictory writings and to supplant the pseudo- the future drawing on the assessments of readers and review- scholarship, negative or positive propaganda, and apologetics ers and also on the ever broader and deeper stream of new that are still appearing. As recently as the 19&s, dearth of re- scholarship. Their profoundest wish is that future generations search and the widespread Western taboo on public discus- of scholars will revise, correct, and enlarge the volumes from sion of homosexuality even in the world of academia would decade to decade, so that it may serve as a trusted reference have prevented publication of such a work as this.. . this work for all who seek enlightenment on the topic of homosexual- is the first to treat homosexuality in all its complexity and vari- ity.” Garland Publishing, Inc., 136Madtion Auenue, New York, ety.” The editors have tried to make this encyclopedia acces- NY 10016, 212/686-7492.

23 SIECUS Report, April/May 1990 NEW COUNCIL FORMED

The Boards of Directors of SIECUS, AASECT (the American Association of Sex Educators, Counselors and Therapists) and SSSS (the Society for the Scientific Study of Sex) have approved the following resolution supporting a ‘Council of Associations for Sexual Science, Health and Education (CASSHE).”

COUNCIL OF ASSOCIA’I’IONS FOR SEXUAL SCIENCE, HEALTH AND EDUCA’I‘ION

The Boards of Directors of AASECT, SIECUS, and SSSS agree to the following: 1. Establishment of a cooperative council of national professional organizations in the sexual&’ field.

7Y.?eJournal of Sex Research, the SIECVS Repoti, the Journal of Sex Education and Therapy, and other publications will be offered at a reduced rate to the membership of each group. 5. Commission on Accreditation of Human Sexw&ty Programs.

AASECT and SIECUS will send liaisons from their organizations to sit on the SSSS Commission of Accreditation of Human Sexuality Programs. I 6. Each organization will appropriate $250 annually to support the activities of the Council. March 1990

SIECUS Report, April/May 1990 24 one out of six current users of barrier contraceptives cite health concerns NEWS* l l about their prior method as the reason for choosing a barrier method. “Older women may find that barrier methods of birth control are preferable, Gallup Survey PoInts To ence between percentages of women cur- especially if they have medical reasons rently using a method versus those who for not wanting to use the pill or the Frequent Contraceptive have never used a method. For example, IUD. The pill, for example, is often con- Switching and an 82% of women had used the pill at one sidered to be contraindicated for Apparent Disregard for time in their lives, but current usage is 25%. women over 35 or women over 30 who STD Protection Although 39% of women had previously re- smoke.” said Dr. Stumpf. “Pregnancy lied on a condom, only 16% rely on one protection becomes less of a priority now. The figures are 17% previously and with older women because they may be “Not only do women’s needs 3% currently for both the diaphragm and less sexually active, less fertile, and :hange, but the climate in which spermicides, and 16% previously and 1% more concerned about their health.” women must make contraceptive currently for the IUD. :hoices has changed drastically over Much of the method switching happens SexuuIiy Transmitted Dkease .he last several decades,” stated Paul between the ages of 20 and 30, when Prevention Not a Priority jtumpf, MD, program director of ob- many changes related to sexuality (e.g., stetrics and gynecology at The Jersey marriage and childbearing) often occur. As Although 54% of women, ages 18 to shore Medical Center, Neptune, New a woman matures, she moves away from 27, and 28% of women, ages 28 to 49, iersey. “Several issues factor into a the pill to barrier methods of birth control, expressed concern about contracting a woman’s contraceptive choice: the like the condom, diaphragm, and contra- sexually transmitted disease, only 4% of availability of new contraceptive meth- ceptive sponge. The reasons women women in both age groups actually ods; the important issue of protection change their contraceptive method may changed to a contraceptive method that against sexually transmitted diseases have less to do with their opinion of the offered greater STD protection. “Obvi- :STDs); and conflicting information method than with the usefulness of the ously, younger single women, who about the safety of some contraceptive method for their life stage. “Usually, some- have multiple partners and are at higher methods. These issues, and others, thing happens in a woman’s life that risk, are more concerned about STDs,” demonstrate a strong need for more changes her needs,” explains Dr. Paul said Elizabeth B. Connell, MD, profes- information on birth control.” A recent Stumpf. “It may be a change in her per- sor of gynecology and obstetrics at survey, conducted by the Gallup Or- sonal relationships - marriage, divorce, Emory University School of Medicine, ganization, Inc. for Whitehall Laborato- the birth of a baby - or concerns, justified Atlanta, Georgia. “However, these per- ries, indicates that there is a high de- or not, associated with her contraceptive.” centages are distressing. Not enough gree of switching from one birth con- women are actually doing something to trol method to another by women as Health Issues Increase in protect themselves.” they mature. The reasons are that Importance 0z.w Time women’s contraceptive needs change based on age, health issues, childbear- Forty-eight percent of women selected ing intentions, and changing priorities their first method of birth control for its Knowledge and Attitudes regarding effectiveness. Distressing to level of effectiveness. The overall majority Related to AIDS the experts who reviewed the findings, of women (68%) chose the birth control the survey found that almost all pill, the contraceptive with the highest ef- of Counselors of Lesbian women still disregard protection fectiveness, as their fist method. “The goal and Gay Youth Studied against sexually transmitted diseases of most young women when choosing when choosing a contraceptive. their first method of birth control is to ef- A study of the experiences of school The survey asked 344 women, be- fectively postpone childbearing. They will guidance counselors in working with tween the ages of 18 and 49, about seek a highly effective method, but one lesbian and gay youth, and their knowl- their current and past birth control that poses no risk to future fertility,” said edge and attitudes related to AIDS, has usage and the criteria they typically Dr. Stumpf. been completed. This study, funded by use when choosing a contraceptive As women move to their second and the South Carolina Guidance Counsel- product. It found that most women third methods of contraception, effective- ors Association, the Gay and Lesbian (67%) used at least two birth control ness, while still cited as the most important Research Project (GLARP), and the Col- methods during their reproductive criteria, becomes less of a concern as lege of Education at the University of years, a significant number (36%) re- health issues, such as stroke and weight South Carolina, is part of a larger study ported at least three methods and gain, rise in importance. Only 26% of examining the quality of school life for (10%) used five or more methods. women cite effectiveness as the reason for southern gay and lesbian students. One “Clearly, these findings point to the choosing their second or third methods. hundred and forty-two South Carolinian need for more information about con- Use of barrier contraceptives, such as counselors, working with grades 5 to traceptives,” said Stumpf. “This is espy- the condom, diaphragm, and contraceptive 12, participated in this study. The typi- cially true given the new evidence that sponge, is much more common as women cal respondent was a white, native women are trying as many as five or move to their second, third, and fourth South Carolinian female in her late thir- more different methods during their methods. Sixty percent of women choose a ties, with a master’s degree and 10 reproductive years.” barrier contraceptive as their second years of counseling experience with Further evidence of frequent method, Go% as their third method, and rural adolescents. Less than one in 10 of method switching is the marked differ- 50% as their fourth method. Approximately these counselors reported that students

25 SIECUS Report, April/May 19% in their school are knowledgeable menting these and other findings may be Illinois. Almost one-third of the calls are about AIDS; one in 100 counselors obtained by contacting GLARP, PO Box from people - especially teenagers - thought their students were knowl- 5085, Columbia, SC 29250. These and who need to discuss their sexual orien- edgeable about homosexuality. other data collected in this two-year study tation and have been unaware that The study underscored the need will be published by Haworth Press in a there is an available source of informa- for greater efforts to educate South book entitled Crowing Up Guy in the tion and support. “A growing number of Carolina students about sexuality. Less South: Race,Gender, and the Quality of callers are not gay,” said Julien Maurice, than 10% of the counselors surveyed SchoolLife. coordinator of the Crisisline. “Gay and felt that students in their schools were lesbian people need to know the facts, provided with adequate and accurate and so do their families and friends. information about AIDS. At the time of Toll-Free Number The Crisisline is often the only source the survey, only one in five counselors Added to National available to them.” Among those calling believed that their school was provid- the Crisisline have been: a mother of a ing an adequate sexuality education Gay and Lesbian Crisisline gay man with AIDS, who felt isolated program; no differences were found and frustrated by the task of caring for among counselors working in rural, The National Gay and Lesbian Crisis- him; a young person frorn the Midwest, urban, or suburban schools. line - a six-year-old program of the New who felt confused about his feelings for The vast majority (80%) of counsel- York-based Fund for Human Dignity, has his best friend; a gay teenager in Ver- ors felt themselves to be knowledge- added the only toll-free hotline for gay mont, who, thrown out by her very reli- able about AIDS; those who expressed information, referral, and counseling serv- gious family, was contemplating suicide; the most negative attitudes toward ice in the United States: l-800~SOSGAYS an elderly New Yorker, who was re- homosexuality were the least knowl- or l-800-767-4297. It also simultaneously cently “widowed” by the loss of her edgeable about AIDS. Three-fourths of increased its incoming call capacity by 25% lover of 30 years; a Southern, married, the sample noted a desire to attend a with an additional telephone line. The middle-aged businessman, who fell in special conference on AIDS for school only national hotline for AIDS information love with a man; and the straight counselors. Those who had known a and counseling specifically addressing the brother of a gay youth, who committed gay student, had scored lower on indi- concerns of the gay community, it is a ma- suicide after forced electroshock ther- cators of homophobia, and already jor referral source for U.S. government hot- apy. Many young people also call for considered themselves knowledgeable lines. honest and specific information on about AIDS, were found more likely to The more than 100 male and female AIDS prevention. attend such an event. volunteers who staff the telephones re- These findings, according to the ceive intensive professional training in director of the study, Dr. James Sears, general phone counseling and crisis inter- suggest that “guidance counselors are, vention and can access for referrals a com- Coalition on Sexuality as a whole, a supportive professional prehensive computer database of more and population through which AIDS edu- than 6,000 resources nationwide, which Disability cation materials and information could includes 2,000 entries for AIDS-related Adopts Position Paper be effectively targeted.” He added, “Of services developed especially for the course, those counselors who are less Crisisline. Local referrals are provided for The Coalition on Sexuality and Dis- knowledgeable about the disease and social support and information about ability, Inc., the national organization of who have had little exposure to sexual AIDS, health care, legal, psychological, and professionals, consumers, and other minority students are those who are other services. interested laypersons concerned with least likely to seek such information. More than 30,000 callers are directly promoting the sexual health and adjust- Organizations that wish to enhance the assisted each year; 12% of the calls come ment of persons with disabilities, has impact of AIDS education, should tar- from California, Pennsylvania, and Massa- adopted and authorized an official posi- get both groups of school guidance chusetts, and a significant number from tion paper on “The Sexual Rights of counselors.” A research report docu- Ohio, Texas, Florida, North Carolina, and Persons with Developmental Disabili- ties: Guidelines for Programming with Severely Impaired Persons.” The 37- page position paper reviews the myriad Dr. Harold I. Lief philosophical dilemmas, legal issues, parental and family concerns, staffing Recipient of Award problems, and clinical questions that have for so long abrogated the sexual The Human Sexuality Program at the University of Medicine and Dentistry of New rights of individuals within this popula- Jersey-Robert Wood Johnson Medical School announced the selection of Dr. Harold I. tion. Lief as the fourth annual recipient of the 1990 Richard J. Cross, MD, Award for Distin- According to the Coalition, the pa- guished Contribution to Sexuality Education. Dr. Lief is acknowledged for his pio- per recommends a clinical model for neering efforts in fostering the teaching of human sexuality in medical school educa- programming that, if implemented as tion. At a time when it was unpopular to openly discuss sexual matters, Dr. Lief presented, would provide lawyers and championed the importance of educating physicians about all aspects of human sex- the courts with a professionally-recog- ual behavior so that they could respond competently and comfortably to patients’ nized training format from which the sexual concerns. Dr. Lief has conducted seminal work in a variety of sexually related traditional elements (capacity, informed issues, including but not limited to the underpinnings and facilitation of sexual desire, and voluntary) of the legal principle of the assessment of sexual knowledge and attitudes, and the impact of gonadal “consent” can be redefined, and then hormones on sexual function. Dr. Lief served on the first SIECUS Board of Directors applied to regulate abusive and/or and was president of SIECUS in 1969. Dr. Richard Cross is presently a member of the criminal conduct in relation to sexual SIECUS Board of Directors. activity toward or between adults with

SIECUS Report, April/May 26 more severe developmental disabilities. population. control over the course of their own The recommended model for program- Diana M. Gurieva, president of Planned lives,” 84% of New Yorkers agreed. And ming provides social and rehabilitation Parenthood of New York City, said that 85% agreed that legal abortions have agencies and professionals with an ap “New Yorkers may not all feel comfortable prevented thousands of women from preach - based on considerable clini- with abortion, but they clearly believe that death or illness resulting from illegal cal experience - to training more se- the decision should remain up to the abortions. verely disabled persons in safer, more woman, not the government. And they say The survey also questioned New responsible sexual behavior patterns their views will affect their Votes.” The poll Yorkers on two additional issues: Medi- and to monitoring a more wholesome found that the overwhelming majority of caid funding for abortion for low-in- living environment in group homes New Yorkers, or 80%, agree that a woman come women and teenagers’ access to and community residences. should have the right to decide whether abortion. New Yorkers strongly favor To obtain a copy of the paper, she has an abortion; 92% believe a woman Medicaid funding, and that support has send $5 (check or money order made should decide about having an abortion in increased over time: 70% now favor it out to C.S.D., Inc.) to: The Coalition on consultation with her doctor, not with the as compared with 49% in 1981. Asked Sexuality and Disability, Inc., 122 E. government; and, even if they personally to respond to the statement, “It would 23rd Street, Suite 109, New York, NY disagree with a woman’s reason for choos- be unfair to restrict abortions only to 10010. ing abortion, 82% do not want the govern- women who could afford them,” 73% ment to interfere with their right to decide. agreed. And 63% disagreed with the A similar question, posed in a national sur- statement, “the government should not Poll Finds New Yorkers vey (Los Angeks Times poll, March 1989) be involved in paying for anyone’s found that 72% of Americans agreed. Re- abortion.” On the subject of teenagers are Solidly Prochoice sponding to the statement, “In the past 20 and abortion, 93% believe a pregnant years women have shown that they can teenager should talk to her parents be- The overwhelming majority of New make responsible decision about abortion fore having an abortion. And, by a mar- Yorkers are strongly prochoice on the and the right to decide should be left with gin of 55%-40%, New Yorkers said they issue of abortion according to an inde- them,” 74% of New Yorkers agreed. favor proposals requiring teenagers to pendent public opinion poll commis- Asked whether their views on the abor- obtain parental consent. Another 63% sioned by Planned Parenthood of New tion issue would affect their voting behav- favor parental notification. But upon re- York City. Since 1981, the number that ior, 59% said they would be less likely to flection, many more New Yorkers are favor permitting abortions for “all rea- vote for a candidate for office who op- strongly opposed to government inter- sons” has steadily increased. posed abortion. Of those, 61% said they ference in this decision: 76% say it In addition, New Yorkers solidly would definitely vote against an antiabor- would be wrong for a teenagers’ par- support funding for Medicaid abortions tion candidate. Fifty-eight percent said they ents to force her to bear a child; 87% for low-income women, increased were more likely to vote for a candidate think consent or notification laws funding for family planning, and re- that is seeking to keep abortion legal and would endanger pregnant teenagers quiring sexuality education in public to maintain funding for abortions for poor whose parents are known to be abu- schools. A majority said they are less women. sive; 82% say these laws would cauSe likely to vote for antichoice electoral Only 9% of New Yorkers oppose all teenagers to go out of state for abor- candidates and more likely to vote for abortions, while 46% said they favor allow- tions; 78% say teenagers would turn to candidates seeking to keep abortion ing a woman who decides to have an abor- dangerous illegal abortions; and 77% legal and to maintain Medicaid funding tion to have it “in all circumstances”; an- say teenagers would be forced to delay for abortion. New Yorkers also initially other 47% favor permitting abortions in having abortions, which would increase respond favorably to proposals requir- “some circumstances.” Those favoring “all their health risks. ing teenagers to notify their parents or circumstances” have increased steadily New Yorkers expressed wide sup obtain their consent before an abor- from 35% in 1981, and those favoring port for family planning, with a solid tion, but also believe these laws could “some circumstances” have steadily de- 90% agreeing that the best way to re- have devastating consequences. In clined, form 58% in 1981. Those who favor duce abortions is by increasing informa- general, New Yorkers are more abortions in some circumstances over- tion about birth control and access to strongly supportive of choice than re- whelmingly favor permitting it in the case contraceptives. The vast majority of spondents in recent national public of rape, incest, and where the life of the New Yorkers, or 90%, accurately an- opinion polls. mother is endangered. This was true swered that more than half of all teen- The poll, conducted by Penn and among all New Yorkers, including Republi- agers have had sex by the age of 18. Schoen Associates, Inc. is the first New cans, conservatives, and “religious Catho- And 91% of New Yorkers say teen preg- York statewide opinion poll on abor- lics.” (Ninety percent of “religious Catho- nancy is a serious problem in this state. tion to be conducted since 1985 (simi- lics” favor permitting abortion when the A strong majority, 90%, favor increased lar polls were conducted in 1981, 1982, pregnancy resulted from rape or incest.) funding for family planning clinics that 1984, 1985) and since the U.S. Supreme Also, 34% of all Catholics and 17% of “reli- counsel teenagers and 91% favor requir- Court’s decision in Webs& V. Repro- gious Catholics” favor permitting abortion ing sexuality education in the public ductive Health Services, which allowed in “all circumstances.” schools. Eighty-nine percent say teen- states to pass legislation restricting Among the 900 people surveyed, 62% agers should be able to get birth con- abortion. Penn and Schoen Associates said they know someone who has had an trol, and 76% think it should be free. surveyed MO New Yorkers across the abortion. Of those, 71% think the women “New Yorkers have a long history of state by telephone (28 minute inter- they know, who chose abortion, made the experience with safe, legal abortion, views) in December 1989 and say that right decision, and 70% think that the lives and fair funding,” said Gurieva. “Their the probability is 95% that the survey of those who chose abortion was helped responses are therefore thoughtful, con- results are within 3.26 percentage by the availability of abortion. Asked to re- cerned, and fair. They are saying to points of the results that would be ob- spond to the statement, “Allowing abortion their legislators, ‘If it ain’t broke, don’t tained by interviewing the entire state is a freedom that has given women some fix it.‘”

27 SIECUS Report, April/May 1990 BOOKS l BOOKS l BOOKS l BOOKS

baby and with helping professionals. Sev- tions; and Part III, United We Stand, Di- THE BLACK ADOLESCENT PARENT eral chapters discuss programs designed for vided We Die. This excellently edited Stanley F. Battle, MSW, MPH, PhD, Edi- these parents. One survey rates the book successfully covers all areas of tor. New York: Haworth Press, 160 pp., professional’s respect for the client as the the topic, confirming some truths yet $29.95. number one area of concern for adolescent exposing far more deeply pervading clients. Moreover, interviews reveal that myths. What emerges is a collection of ‘Ihe Black Adolescent Parent, pub- utilization of services depends on consum- writings that challenges our ideas of lished simultaneously in book form and ers identifying their own needs and actu- who those who work in the industry in the journal, Child and Youth Services ally helping with program planning. A de- are and what sex work is, and succeeds (vol. 9(l), 1987), is comprised of eight scription also ls given of a pilot program in catapulting sex work into the arena black authors’ findings which are based which capitalizes on the importance of the of serious feminist consideration. on research studies into various aspects extended family. And, outreach techniques, Frederique Delacoste, one of the edi- of black adolescents as parents. In this including home visits to provide effective tors of the book, states in the introduc- volume, issues specific to this popula- services within a family context, are out- tion: tion are viewed from the black profes- lined. Nonconventional strategies to engage “Our intent at Cleis Press is to publish sional perspective, rather than left to the black male adolescent parent highlight the perceptions of “white scholars” books that document women’s resistance the importance of not viewing males’ fears on issues that have previously been ei- who, the foreward states, “would like to and anxieties as hostility, and of finding ther invisible or distorted by sexist ideol- control the diagnosis and prescription small ways to start providing help to males ogy. We look for women editiors and for black adolescent parents and their through legal, job, and school counseling. writers who are directly affected by offspring.” The editors and contributors The last article in the book deals with these issues. ‘Understanding comes from to the book bring to this subject their the cultural and legal implications of ado- listening to those who know how it own special black understanding and lescent sexuality and emphasizes how feels,’ said a reviewer of one of our insight and then establish constructive courts are indifferent to black cultural is- books.. . .My intent was to provide space for women to write about their lives. I and innovative means for blacks to take sues when they make decisions for teens, control of their particular situations. tended not to trust those who labeled all their parents, and their grandparents. Rights sex workers as victims, but I was open This book was meant to influence and of privacy, including the notification of par- to all points of view as long as they guide those professionals and educators ents regarding abortion and contraception came from working women working with this particular population, are discussed, and brief summaries of Su- themselves.. .We chose articles reflecting who could enhance program services to preme Court decisions on privacy are of- a diversity in the work and experience better meet their clients’ needs. fered. of the working women.. .Sezx Work will Devoted to the particulars of the This book is not as enlightening as its hopefully be a bridge between sex black experience, this book includes an workers and the rest of the women’s black perspective promises it should be. movement.. .For some, it marks the be- overview on pregnancy from concep Although its basic tenets are solid, the tion to birth, with an exploration of the ginning, for others the continuation of a readings for the most part are dry and are potentially mighty alliance between all family and the partner’s influence on heavy with statistics. Most of the reference women. ” contraception, abortion, and adoption sources are outdated (from the 70s) for a decisions. The causes and conse- 1987 publication. The black viewpoint, The first section entitled “In the quences of pregnancy, race, and class, which it espouses, does not shed much Life” gathers writings by all types of sex with implications for practice interven- new light on the various aspects of the is- workers - among them, street prosti- tions are the foci of another chapter, sue of the black adolescent parent. As a tutes, women who work in massage which presses the reader to consider result, this book may be disappointing to parlors, porn stars, nude models, and the importance of adolescent cognitive professionals and educators who are seek- call girls. These women range from col- and psychological development, and ing a source to rely on as a standard help- lege grads and adolescent runaways to their impact on the decisions and ac- ing guide. grandmothers and “kept women.” The tions of the family and societal environ- Reuiewed byJoan Picower Seltzer, com- variety of women who “hook” and their ment, especially their deep sense of munity outreach social worker, Teen outstanding writings throws the covers hopelessness. The solutions to these Choice, Inwmd House, New York. off notions of “whore” as evil, junkie, dilemmas include providing more edu- downtrodden, and oppressed. What cational programs that involve the par- clearly emerges is the image of strong, ents and partners of black adolescent SEX WORK: WRITINGS BY WOMEN IN diverse women who choose to make parents. There is also a dictate that THE SEX INDUSTRY their living this way. Many view their black communities be empowered to Frederique Delacoste & Priscilla Alexander, profession as a medium that expresses develop life, educational, and job op Editors. Pittsburgh: Cleis Press, 1987, 360 their strength and power. Indeed, the portunities - a task broadly stated but pp., $24.95 hc., $10.95 pb. first time many women say they felt not so easily implemented. powerful was the first time they “turned The constraints of racism, oppres- Sex Work, a recent compilation of writ- a trick.” “The money,” many say, “is sion, and poverty on blacks are high- ings by women in the sex industry is an good” and the work is “better than typ- lighted throughout the book. The black important work addressing the “oldest pro- ing in some office.” They pride them- adolescent mother’s lack of appropriate fession in the world.” The collection, which selves on their skills and expect to be role models and her basic lack of trust includes poetry, prose, fiction, and schol- paid as any other professional would. make for difficulties in forming a strong arly articles, is divided into three main sec- “I don’t sell myself short for anybody, and close relationship with her new tions: Part I, In The Life; Part II, Connec- under any circumstance. I know my

SIECUS Report, April/May 1990 28 value, I know my worth.” the main thesis is only weakly defended by to sex work in fiction. Surely the con- Of course, not all contributors to a sea of often conflicting statistics. tents of Sex Work: will propel interested this collection share these sentiments. Part of III of the book, “United We readers to delve deeper into this sub- In a particularly cold and real piece, Stand, Divided We Die: Sex Workers Or- ject. “She Hated the Rain,” Sapphire writes ganked” is a perfect conclusion to the first One might think the book would of a prostitute who returns home on a two sections. After reading Parts I & II, I end there, for it surely is an appropriate cold and rainy night only to be turned found myself sympathizing with the place. At that point, it has informed, out to the street once more by her women workers, and outraged at the injus- educated, and inspired the reader and pimp/lover. In another, a woman tells tices they face and the myths that surround has directed the reader to additional repeated stories of police destroying this field. Part III offers solutions for chan- sources of information and inspiration. large quantities of recently purchased neling the energies and anger that a reader, But it does not end there; it returns to condoms, telling her to have “happy such as myself, might feel. The major sex the women, the writers, the incredible hunting.” The book addresses the dan- worker rights collectives each describe voices in Part I of the book, and pro- gers that prostitutes face from clients, their organizations’ philosophies, missions vides brief biographies on each: where pimps, the police and society. Sex and affiliations. COYOTE (Call Off Your she was born, what she is doing now, workers, often raped, beaten, and Old Tired Ethics) and its parent organiza- how many children she has, and so murdered, generally can expect no as- tions, NTFP (National Task Force on Prosti- forth. This simple touch is a reminder sistance or immunity from the police. tution) and ICPR (International Committee to those who have read the book, that Nonetheless, the writings are unapolo- for Prostitutes Rights) works from the per- after all the theory, statistics, and indig- getic The women, aware of the dan- spective that women have the right to de- nation, these people - these sex work- gers and risks, talk about the support termine for themselves how to use their ers - are just women, like all women, of other workers and the devices they bodies. They also hold that most of the who are struggling to get by. Some create to protect themselves, such as problems related to prostitution are rooted are having a hard time of it and some fantasy, carefully inspecting clients for in society’s stigmas about sex itself and es- are “making it,” but all of them are STDs, and trusting in their sixth sense. pecially sex work. In their article, they offer proudly speaking out and certainly not Sex WorJz exposes a number of a step-by-step section on what can be done for the last time. For an enlightening myths. Among them is the myth that to help bring the movement toward the de- picture of sex work, I highly recom- all sex workers do the same things. criminalization of prostitution and include mend the reading of this book. Just as there may be a range of sexual the addresses for COYOTE, NTFP affiliates, Reviewed by Ekna Deutsch, SIECUS behaviors performed in any sexual re- and a few shelters for sex workers. U.S. executive assistant. lationship, there may be a range of PROS (U.S. Prostitute’s Collective) and its sexual behaviors performed for pay. related organization, the English Collective Not all sex workers, for example, have of Prostitutes, see prostitution primarily as vaginal intercourse with their clients; a class issue and feel that poverty forces many set the terms of what they will poor women to work in the sex industry. do and keep to their strict limits. If a WHISPER (Women Hurt in Systems of client wants more than a woman has Prostitution Engaged in Revolt) believes agreed to do, he will either have to that all prostitutes are victims, that no pay for it or go elsewhere. Not all sex woman ever chooses to work as a prosti- workers walk the street either. “Street tute, and that it is a patriarchal institution prostitution,” the most familiar form of created to control and abuse women. All sex work for most people, is actually three organizations agree on one thing - engaged in by only 10 to 20 percent of they want the law against prostitution pe’ sex workers in the United States. This se repealed. In addition to these organita- is where one most frequently finds the tions, the Dutch groups, the Red Thread traditional pimp/sex worker relation- and the Pink Thread, contribute articles in , pelvic anatomy ship, although 40% of street sex work- which they discuss their work to see that ers work independently. Other catego- prostitute’s working conditions are im- ries of sex work include massage par- proved and a bridge is formed between used b! professionals since 1972 lors, brothels, bar and cafe sex work members of the women’s movement and (more common in Europe and South- sex workers. east Asia) and outcall, which includes This informative section ends with the escort services and “call girls.” World Charter & World Whores’ Congress The above breakdown and other statement. This document, drafted at the thought provoking points open Part II second World Whores’ Congress in I986 of the book - aptly entitled “Connec- G& for a uniform decriminalization of tions” - which begins with Priscilla prostitution, a guarantee of civil liberties, Alexander’s article, “Prostitution: A Dif- and the creation of a self-governing regu- simplify sexual ficult Issue for Feminists,” This section lating committee, in addition to the revalu- anatomy instruction contains a number of important ar- ation of sex work in light of feminism, sex- ticles that tie together the individual ual self-determination, and the rights of sex voices heard in Part I - articles such workers under the basic premise of human as “Lesbians & Prostitutes: A Historical rights. write for free brochure: Sisterhood” and “Prostitutes are Being An extenSiVe and comprehensive bibli- Scapegoated for Heterosexual AIDS,” ography completes the book, covering a jim jackson and company which are well-researched and range of subjects from the global history of 33 nchdalr wenuc cambrbdgc. mawchusrtts0214 strongly written. The latter article prostitution (from the ancient to the mod- makes a number of marked points, but ern era) and feminist analyses of sex work

SIECUS Report, April/May 1970 ccmference and Seminar Calendar

NEW YORK CITY DEPAI WMENT OF HEALTH AIDS TRAIN- quaint participants with current theories, strategies, and tech- ING INSTITUTE’S JUNE 1990 TRAINING SCHEDULE. “AIDS niques in the field of sex therapy. Kansas City, Missouri. Con- 101: An Introduction to HIV Infection,“June 6, II, 14; tact: Brenda Viik, Conference Coordinator, Division of Continu- “Social Dimensions of AIDS/HIV Infection,” June 1; “A ing Education, The Menninger Clinic, Box 829, Topeka, KS Comprehensive Overview of AIDS/HIV Infection,” June 4 66601-0829, X)0/288-7377, X5991. 5;- .,--upportumsuc . . . wlmecuons I- -..- ~- ana- * Lurrem-- -.-.----A----A 1 reatmenu 3: An Overview,” June 12; “Effective Strateeies--.------for ---HIV/AID , -- S LIFECYCLE IEARNING WORKSHOPS. “RecIaiming Lost Prevent&-in the &in0 Community,” June 13; “Training childhood: FeeIings, Affirmations, and Challenges in of Trainers,” June 18-22 “Negotiating Safer Sex,” June 18- Recovery,* June 4(White Plains, New York), June 7(Boston, Massacht&t;s): “From Shame to Self-Empowerment: Ori- 12 “The Haitian Community’s Respon.? ,- *n- ‘YYY,*ma * J”‘Ifilflp 20 “Adolescents and AIDS/HIV Infectic__ -ML,,” June 21-22; gins, HeaIing and Treatment Issues,” J&e 27oJvhite Plains, “Women and AIDS/HIV Iflfectic- MI.~I J--‘-‘Tune 25-26 “Under- New York), June 28 (Boston, Massachusetts); ‘Sound Mind - standing Chemical Dependency; Gain% ng Access and Pre Sound Body: Bridging SpirituaIity, Health and viding Outreach to Drug Users,” June 2 7. Sponsored by the Effectiveness,” July 12 (Washington, DC), July 13 (White New York City Department of Health, Div ision of AIDS Pro- Plains, New York). Contact: LifeCycle Learning, 1320 Centre gram Services, “to help participants becorr re more effective in Street, Newton, MA 02159, 617/%4-5050. promoting risk reduction among clients at risk for HIV infec- tion, and to dispel myths about AIDS and HIV infection by SUMMER INSTITUIE IN SEX EDUCATION AND SEX nroviding current information and a forurr I for discussion of THERAPY, July 16-27, 1990. Designed for practitioners and graduate students who want to apply knowledge, principles, Issuesn P;erequisites reauired1 for some co,,,-.,I*?-= To*. be held at 346 Broadway, Roon 1702, New York, New York. Contact:- _~~_ and techniaues of sex education and sex theranv to their work. Registrar, AIDS Train ing Institute, Department of Health, 125 University of Pennsylvania, Philadelphia, Penn&lvania. Contact: Worth Street, Box A/ ‘1, New York, NY 10013, 212/566-7105. Dr. Kenneth D. George, Summer Institute in Sex Education and Sex Therapy, University of Pennsylvania, Graduate School of

1I.I WM .TAlilll” 1EE F~TT,-A--CI,3W Education. ,-. 3700~~ Walnut Street. Philadelnhia. PA 19104-6216. ETR ASSOCIATES’ 7 , rNI4AA.I L&rA2 C”“L.r%I1”,. L , INSTITUTE, “Adolescent Life Sk IlIs In The 1990s: Training 215/898-5195. From Experts For A Positive Approacn- --*-Tn(~ne II-ISCAt- lanta, Georgia); June 2529(Dallas, Texas); /u~yI y-13e--h/T”, (wasn- I AIDS IN ASIA AND THE PACIFIC, Au.wst 5-8, 2990. Canberra, P... ^-,^* . -4s. . \ ~ . H _^,^ Australia. Contact: Oraanisincr Committee. PO BOX 660, Woden, ington, DC$, July .a-~/ (Cntcago, nuno~s); Augusr o-1(/ (San ACT 2606 Australia. ” v Diego, California); August 20-24 (Boston, Massachusetts). Edu- caters will present a series of professional develop lment. . .train- _ F0UR’l-H INTERNATIONAL CONFERENCE ON AIDS EDUCA- ings designed for teachers, comml unity educators and all social TION, ‘Challenges And Choices For The 9Os," August 6-8, service and youth-serving professionals, to “achieve a break- lm.- Sponsored by the International Society for AIDS Educa- through with strategies from experts that can make a differ- tion. Will focus on approaches to prevention and control of ence in the lives of teens.” Among the sessions are :: -Peer -Fres- AIDS. El Juan Hotel, San Juan, Puerto Rico. Contact: Donna L. sure Reversal: Saying No and Saving Face, Positive Images: Richter, International Conference on AIDS Education, University Educating Teens for Sexual Health, and Teen Stress & Esteem: of South Carolina, School of Public Health, Columbia, . SC, Techniques to Empower Young People. C ontact: ETR Associ- 29208, SO3/777-4845. ates, Training Department, PO Box 1830, ballraL.-+^ ~,ru+PA...‘.. bfiPI 95071-1830, @O/321-4407. AIDS: THE EPIDEMIC, August G-IO, 1990. Boston, Massachu- setts. Contact: Office of Continuing Education, Dept. B, Harvard JOHNS HOPIUNS’ EIGHTH ANNUAL GRADUAm E SUMMER------School of Public Health, 677 Huntington Avenue, Boston, MA PROGRAM IN EPIDEMIOLOGY, June l8-Jdy G, I,,“.too/-J UtN,s-c-n- ^^--- /--,, ..^ 11-.

sored by the Department of Epidemiology -CT&n“1 1 L,L J”““”r-h*= Hopkins Universitv School of Hvgiene and Public Health. In FOURTH NATIONAL CONFERENCE ON AIDS, Au~urt 8-21, order to develop an understandzg of basic and advanced prin- 1330 Contact: AFAO, GPO Box 229, Canberra, ACT2601 Aus- ciples of epidemiologic research, courses will present epidemi- tralia, 062-47-3411. ologic methods and their application to the natural history and etiology of disease. Among the offerings are: Nutritional Epi- INTERNATIONAL PHARMA CISTS SYMPOSIUM ON AIDS/ demiology, Epidemiologic Methods for Evaluating Health Serv- STD - INFORMATION AND EDUCATION, September 1-3, ices, Cancer Risk and Prevention, and Epidemiology of AIDS. lm. Sponsored by Pharmacists Planning Services, Inc., Con- Baltimore, Maryland. Contact: Helen D. Walters, Program Co- dom Resource Center, and American Association of Public ordinator, Graduate Summer Program in Epidemiology, The Health Pharmacy. Istanbul, Turkey. Contact: Frederick Mayer, Johns Hopkins School of Hygiene and Public Health, 615 Pharmacists Planning Services, Inc., PO Box 1336, 200 Gate North Wolfe Street, Baltimore, MD, 21205, 301/955-7158 or Five Road, Sausalito, CA 94966, 415/332-4066. 955-3462. CENTER FOR POPUIATION OPTIONS’ 1OTH ANNIVERSARY TREATING SEX RELATED CONCERNS: CURRENT STRATEr CONFERENCE, “Remembering Youth: Building Healthy GIES AND TECHNIQUES, June Z-23, 1990. Sponsored by Options For Our Future,” September 24-26, 199. Will focus the Division of Continuing Education and the Center for Sex- on issues vital to adolescents such as HIV/AIDS, teenage preg- ual Health, The Menninger Clinic, and cosponsored by the nancy, access to family planning services, and availability of American Association of Sex Educators, Counselors and Thera- accurate information on reproductive health care for adoles- pists. This conference, designed for experienced sex therapists cents. Crystal City Hyatt Regency, near Washington, DC. Con- as well as other clinicians whose practice includes treating tact Lita Curtis or Cathie Sullivan, CPO, 1012 14th Street NW, individuals, couples, and families for whom sexual concerns Suite 1200, Washington, DC 20005, 202/347-5700, fax 202/347- are a component of their psychosocial difficulties, will ac- 2263.

SIECUS Report, April/May 1990 30 !il@a Bellybuttons Are Navels by Mark Schoen, Ph.D. Illustrated by M. J. Quay Introduction by ContraceptionSexual/EroticLoV-ps Health and Pathology, Mary Steichen Calderone A Guide to Paraphilia, and Gender Transposition in This engagingly told and beauti- Birth Control Methods Childhood, Adolescence, and Maturity fully illustrated story demonstrates by John Money by Vem L. Bullough that boys and girls have some of the same body parts as well as and Bonnie Bullough Pioneering sexologist John Money coined the word “lovemap” to describe the mental template every individual has for an idealized some very different features-and This up-to-date sourcebook offers lover and an idealized romantic, erotic, and sexual relationship. that all have accurate names. The clear, factual, and detailed infor- This book delineates new principles regarding the development book is designed primarily to il- mation on the many birth control of human sexuality and eroticism in health and pathology, from lustrate honest adult-child discus- options available today or planned fetal life through adulthood. sion, but also to help chi!dren for the future. The book begins 33, pages. Paper $,695 develop a healthy acceptance of with an overview of reproductive the body; to provide a basic vo- anatomy and the history of birth cabulary for introducing the topics control, followed by an in-depth Vandalized Lovemaps of human sexuality, reproduction, analysis of such current and forth- Paraphilic Outcome of Seven Cases and sexual abuse awareness; and coming methods as the pill, con- in Pediatric Sexology to model sex-positive roles for doms, natural family planning, by John Money and Margaret Lamacz children and adults. Although the sterilization (vasectomy/tubal li- book will be a favorite with chil- John Money and Margaret Lamacz study lovemaps gone awry: seven cases gation), diaphragms, cervical caps, dren, it is also designed for use in which the outcome has been a lovemap that is paraphilic. The authors spermicidal foams and jellies, ab- in parent, teacher, and child-care examine the principle of lovemap formation and synthesize these principles stention, hormonal injections and into a theory of biographical determinism. worker education groups. Adapted implants, RU 486 (the moming- from the award-winning film, after pill), and more. Employing 224 PcWs l =loth $24.95 Bellybuttons Are Navels offers simple, nontechnical language and wholesome, well-thought-out clear illustrations, each method is answers to very common ques- evaluated in terms of its success Venuses Penuses Sexology, Sexosophy, and Exigency Theory tions. rate, safety, advantages and dis- 44 pages (Full-Color Illustrations) advantages, medical and psycho- by John Money Cloth $14.95 l Ages 3-8 logical consequences, and relevant This volume of John Money’s professional papers constitutes a record legal concerns. of his major theoretical contributions to 20th.century scientific sexology and philosophical sexosophy. 175 pages (Illustrated) l Paper $13.95

659 pages (Illustrations) l Clom $31.95

The Destroying Angel Fitnessand Food in the Legacy of Degeneracy Theory, Graham Crackers, Kellogg’s Corn Flakes, and American Health History by John Money

A fascinating study of the historical genesis and present-day persistence of anti-sexualism in American health care and social/legal policy.

213 pages l clam $22.95

31 SIECUS Report, April/May 1990