Friday, November 17, 2006

The Doctors' Petition

See what you think about this one. Ruth Jacobs, the CRC's representiative on the citizens committee, is a physician who works out of Shady Grove Hospital. She circulated a petition among the other doctors there, and got more than 200 of them to sign it. It said:
Health education is important. We the undersigned recognize that anal intercourse is a particularly high risk sexual practice and that it is associated with the highest risk of HIV infection. We further recognize that "although there is strong evidence that condom use generally reduces sexual transmission of HIV, solid data showing the effectiveness of currently available condoms during AI, a particularly high-risk sexual practice, still are lacking."

As physicians, we are concerned for the health of the students and recommend that the new MCPS condom use lesson must use the Surgeon Generals statement and NIH consensus conference statement to warn students of the risk of anal intercourse and of the risk of condom failure during anal intercourse.

There were a couple of numbers for footnotes in the text, but I don't see the notes themselves. Supposedly they reference the sources of some of those statements.

Now, there is just so much going on here, your head spins.

First of all, I don't believe there's any debate about the relative danger of anal and vaginal sex. The membranes of the anus are more absorbing, and tear more easily, than vaginal tissue. There is no lubrication, and it seems likely -- though there really isn't much in the way of data -- that condoms tear or slip off more easily during anal intercourse.

Whatever, everybody agrees on the stuff in the first paragraph. Everybody believes health education is important, and agrees that anal sex is riskier than the other kind. Uh, and everybody knows you can't base an argument on a lack of data ... OK, never mind.

I am imagining a little married couple in their bedroom, considering spicing things up a little, and saying to one another, darling, we really shouldn't, you know the data is lacking on this.

So, you're asking, what is this petition for? What's it against? I mean, doctors taking a stand in favor of health, that's a tough one. The second paragraph asks for inclusion of two statements, it sounds like. First of all, the "Surgeon Generals statement" (and no, there is no apostrophe), seems to refer to a statement made sometime in the 1980s by C. Everett Koop, when he was no longer Surgeon General.

In a statement to the school board last week, Dr. Jacobs explained. "The Surgeon General has said, 'Condoms provide some protection, but anal intercourse is simply too dangerous to practice.'" OK, we've been there already, haven't we?

And then there's that "consensus conference" thing -- what's that? Again, she told the school board, but apparently not the doctors who signed the petition: "The NIH consensus conference reminds us that the highest rate of HIV transmission is through anal intercourse."

You know, the NIH consensus conference report is online HERE. It does say, in one place:
HIV/AIDS can be sexually transmitted by anal, penile-vaginal, and oral intercourse. The highest rate of transmission is through anal exposure.

I'm not saying she's lying. It does say that.

The report also says:
The methodological strength of the studies on condoms to reduce the risk of HIV/AIDS transmission far exceeds that for other STDs. There is demonstrated exposure to HIV/AIDS through sexual intercourse with a regular partner (with an absence of other HIV/AIDS risk factors). Longitudinal studies of HIV- sexual partners of HIV+ infected cases allow for the estimation of HIV/AIDS incidence among condom users and condom non-users. From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV.

So, again, what's the point? The conference she cites says to use a condom, just like the school district's newly recommended curriculum.

Listen, let me say this again, even though I know you followed the link I provided and re-read the post about the Surgeon General's statement. In the 1980s America faced a crisis. There was an epidemic among our gay population, and people needed to do something about it. But first of all, the public needed to admit it existed. You remember, Ronald Reagan refused for the longest time to mention the topic or do anything about it.

It was a big mystery. Where did AIDS come from? How was it spread? Why did gay guys get it more than other people? And within a few years of the discovery of the disease, they figured out how it was often spread: anal sex. So the Surgeon General went out and made a statement.

Koop was quite conservative himself, and probably didn't realize that nearly half the straight people in the country were having anal sex, too, and not catching anything from it. Look through this interesting CDC survey HERE. More than a third of Americans have had anal intercourse with someone of the opposite sex -- and lived to tell about it!

So ... anal sex is relatively more dangerous than vaginal sex, for the reasons I gave above, but it's just ridiculous to tell people that it's "too dangerous to practice." It's silly.

We know what the problem is. Dr. Jacobs, like Dr. Koop, assumed that anal intercourse means "gay people." Except in his case he was trying to save their lives, in her case she's trying to persuade us that people shouldn't be gay. And good luck with that one.

Well, I notice the CRC hasn't said anything about these stupid petitions on their web site or even on their forum. It's nothing, really, doctors reading a few words and signing it. Yes, they support health. Yes anal sex is riskier. Yeah, condoms can break. There's no argument about any of that.

I wonder how many of them thought about the fact that there is no Surgeon General, or realized what statement was referred to in the petition, or that it was a statement made nearly twenty years ago. I wonder how many had read the NIH consensus conference report, and knew that it recommended the use of condoms for preventing HIV -- and how many would have objected to including that advice in the 10th grade condom lesson.

Well ... it's the best they've got.


Anonymous Anonymous said...

It would be interesting if a M.D. or researcher type out there would give us an estimate of the number of folks who have presented themselves at the emergency room or via regular check-ups with a torn rectum caused by anal sex - not tears due to sex toys, etc. (That would have been a fun topic for the curriculum.)

It would be even nicer to know how many of those who did have a torn rectum from anal sex were not using a condom at the time. I bet the number is extremely low.

So, if folks are going to have anal sex and the research suggest they will, let's figure out how to make it less risky -- gee, maybe recommend they use lubricants such as KY, Astroglide, etc. Gee, don't the recommendations to the School Board state this? Gee, who voted against it? Gee, too many gee's.

November 20, 2006 6:08 PM  
Anonymous Anonymous said...

"It would be even nicer to know how many of those who did have a torn rectum from anal sex were not using a condom at the time."

Kind of irrelevant. A rectal tear isn't necessary for the transmission of HIV.

November 20, 2006 8:47 PM  

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