New York City's superintendent of schools proposed last week that condoms would be made available, without parental consent, to the city's 261,000 high-school students. This program, similar to condom distribution policies initiated by health departments in Massachusetts, Michigan, Oregon and Talbot County, Md., is an attempt to arrest the spread of AIDS and other sexually transmitted diseases.
Yet just as quickly as these lifesaving policies can be unveiled, opponents, including the archdioceses of New York City and Boston and fundamentalist groups, have denounced them as sending the message, "Do whatever you want, but do it safely."
But despite objections to the widespread promotion of condoms for slowing the alarming spread of AIDS, the hope of monogamy or prayers for chastity are not the answer. As a physician who treats adolescents in an impoverished urban setting, not a day goes by that I don't prescribe a shot of penicillin or some other "miracle drug" to cure a case of gonorrhea, syphilis or chlamydia -- all sexually transmitted diseases for which patients of the 1990s are fortunate to have an effective treatment.
Occasionally, however, I see patients with newly diagnosed cases of AIDS. For these people, often barely into adulthood, I have nothing to offer in terms of a cure. All I can do is witness their shock of discovery, listen to the cries of anguish and try to provide a gentle, compassionate means of support. The ironic twist to these tragedies is that many could have been prevented, with abstinence, to be sure, but also if these patients had only used a condom during intercourse. And if it's possible to extend this horrifying message, the situation will only become worse as more people are infected with the human immunodeficiency virus.
Not surprisingly, the controversy over the use of condoms to prevent the spread of sexually transmitted diseases is not new. In the 1930s, when no antibiotics existed and gonorrhea and syphilis were rampant in the United States, physicians and public health workers had an equally difficult time providing preventive measures to those who needed them.
In 1934, Thomas Parran Jr., then New York state health commissioner who would soon be U.S. surgeon general, was allowed to broadcast the risks of venereal disease on the CBS radio network provided he did not mention syphilis and gonorrhea by name. Although there is excellent scientific evidence that these diseases could be prevented by using a condom, many public health groups such as the American Social Hygiene Association and the Bureau of Social Hygiene refused to promote its use for fear of creating a double standard of morality.
The result: Millions continued to have unprotected intercourse and millions contracted diseases, which at the time were either incurable or extremely difficult to treat. Then as today, as historian Allen Brandt has observed, the interchangeable messages of fear, disease, stigma and immorality reigned.
And while abstinence outside monogamous marriage is both a worthy and noble attempt at halting AIDS and other sexually transmitted diseases, a little pragmatism is warranted.
It's time to accept the reality that people are ignoring such messages and engaging in sexual activity. Moral judgments, while convenient and comfortable, will do little to stop such activity or a horrible disease that public health officials estimate has already infected about 1 million Americans.
The war on AIDS is an offensive that demands unified support in the crusade to keep people healthy, even if it means promoting and distributing something as embarrassing or objectionable as condoms.
Howard Markel is a clinical fellow in adolescent medicine in the department of pediatrics at Johns Hopkins Hospital.