A hotly debated aspect of the landmark health care reform backed by President Barack Obama related to handling unwanted pregnancies, though the focus then was on whether federal funds would be used to terminate them. Meanwhile, a key provision of the bill went largely unnoticed: More than $375 million in grants toward comprehensive sexual education funding under a program called Personal Responsibility Education Program (PREP). However, the effectiveness of that program to decrease unwanted pregnancies and sexually transmitted diseases is uncertain, especially in the black community.
Despite years of strategizing around the problem, for almost as long, African-American STD rates have remained markedly higher than those of whites and Latinos. Nearly half of black women between ages 14 and 49 have the virus that causes genital herpes. And in Washington, D.C., AIDS rates in the black community rival those of some African nations. Never has it been more important to stem the rising tide of infection in the black community. The question is: How?
In a 2007 Mathematica Policy Research study of four abstinence-only programs, hallmarks of George W. Bush's presidency, researchers discovered that program participants were just as likely to have sex as nonparticipants, and at the same median age. One year later, Johns Hopkins researcher Janet Rosenbaum released a report that found "premarital abstinence pledges" were not only ineffective, the students who took them actually used condoms and contraceptives less frequently than their counterparts when they did have sex.
The answer, it seemed, was clear: end abstinence-only education.
But in February of this year, researchers at the University of Pennsylvania released a federally funded study to the contrary. Using 662 African-American middle-school students, Professor John B. Jemmott III and his team conducted research over a period of three years. Their findings conflicted hugely with that which had come before: Students who were trained in the study's year-long abstinence program were almost 20 percent more likely to refrain from sexual intercourse over the next two years.
Critics of the study say that Jemmott's abstinence classes were unlike most others, as they taught participants to wait until they were "ready" to have sex, excluding moralistic talk of waiting until marriage—a crucial distinction. Nevertheless, the Penn study's conclusions breathed new life into the idea that abstinence programs need not be scrapped entirely.
PREP, which was created with funds from the health care bill, will borrow from both schools of thought on abstinence education. Totaling $75 million a year for five years, the program will provide individual states with grants for "comprehensive" sex-education courses. While grantees will be required to create programs advocating contraception to prevent pregnancy and STDs, they will also have to incorporate in their curricula discussions of abstinence as a means to stay healthy.
Phill Wilson, executive director of the Black AIDS Institute, believes PREP will be a major step in the fight against AIDS and other infections in the black community. "There are countless studies to show that when people have the information that they need to have, and there is support for them to use that information, that's an important backdrop to changing behavior," he says. "Whether or not the resources in the initiative are enough to get the job done, that's a different question altogether." Wilson believes that for too long partisanship has impeded ample sexual health knowledge for our youth. "What young people need is to understand that there is a continuum," he says. "And that no matter where you are along the continuum, there is a strategy for you. And if you're already sexually active and the issue for you is how to use a condom, we have something for you. I would say that abandoning this notion that one size fits all—whether that size is prescribed by the left or the right—is good for our young people."
According to Malebranche, for African Americans to overcome the scourge of STDs and AIDS, the United States' leaning on organizational inequality must be demolished first. "You realize that these racial disparities and these class disparities and the [disparities between the] haves and the have-nots weren't established overnight," he says. "STDs are byproducts of centuries of institutional and structural discrimination …. You can't expect Obama to come in and change all that with comprehensive sex education."
PREP hopes to address at least some of Malebranche's concerns by requiring funded programs to teach at least three "adulthood preparation subjects" alongside sexual health, such as positive self-esteem and relationship dynamics, financial literacy and goal setting. Though they may initially seem tangential, offerings such as interpersonal skills training "contribute to young people making responsible decisions about sex," according to Jennifer Heitel Yakush, director of public policy for the Sexual Information and Education Council of the United States. "All of the comprehensive sexual education programs we know to be most effective, they also include these other pieces. You can't just teach young people how to use a condom in a vacuum. You also have to be discussing negotiation skills."
Despite its breadth of topics, some experts still have reservations, especially because states have the choice of opting out of the PREP grants in favor of abstinence-only funding. In order to obtain federal money for abstinence-only programs, states must contribute $3 for every $4 from the government—PREP money, on the other hand, is free. But as with South Carolina Gov. Mark Sanford rejecting stimulus funds last year, Heitel Yakush says she is anticipating some states to ignore the PREP funds. "But we do think the vast majority will apply for the funding," she adds, "particularly in light of the fact that there's state budget cuts across the country."
If PREP doesn't work, the battle to defeat STDs and AIDS in the black community could be dealt a significant blow. Perhaps then America will be forced to address some of Malebranche's structural concerns. "[Given the PREP money], I'd provide mental health, counseling and coping services to black people who continue to be traumatized by racist institutions," he says. "Because if folks feel good about themselves then the substance abuse doesn't happen, then the searching for love through unprotected sex with multiple partners doesn't happen. I'd go back to the broader things to put them on equal footing, so they can handle the stresses of race and class discrimination when they get out into the real world."
Cord Jefferson is a staff writer at The Root. Follow him on Twitter.