Learning to Speak

Frontdesk by David Waggoner

Our cover story interview with actress Lisa Edelstein touches on her club kid days in the New York City of the mid-eighties, a time when the media made her a Page Six celebrity à la Paris Hilton. She capitalized on this attention not for self-promotion but to write, produce, and act in one of the first AIDS musicals, Positive Me, a performance piece couched in the pop idiom and aimed at educating teens and young people about HIV prevention. In an interview, she expresses her frustration about not being able to take the musical into many high schools, which forbade discussion about sex and drugs altogether or without heavy moralizing. This obstacle remains today. References to bodily fluids and genitalia are cleaned up, biology textbook-style. The limit of this approach, some critics point out, is that the audience tunes out or does not fully understand what is being taught when an educator says “receptive oral intercourse” rather than “getting a blow job.” Something is lost in translation, and that something might be the health—even the lives—of our teens.

But how do we explain the same restrictions placed on HIV prevention efforts aimed toward adults? Of course, these restrictions have long been in place but it did seem we were moving toward a more liberal approach to safer sex dialogues, whether verbal or visual—at least until a CDC investigation of prevention efforts targeting gay men by San Francisco’s Stop AIDS Project a few years ago told us otherwise. At issue was whether workshops—“Booty Call” and “Great Sex”—violated federal obscenity standards and promoted sexual activity. Other ASOs across the country that receive federal funding learned to choose their words wisely. The message was clear: What we do with our mouths and tongues was under attack.

The right of free speech, which the U.S. ostensibly wants to defend at home as well as overseas, has suddenly become weighed down by conditions. Organizations and clinics abroad have often now become tongue-tied in their attempts to follow U.S. guidelines and retain American funding. The guidelines, most recently issued by PEPFAR and implemented by the Office of the Global AIDS Coordinator, require a prevention approach based on “Abstain, Be Faithful, and use Condoms,” or ABC. One-third of funding had been recommended (but not required) to be spent on prevention, but this has fallen over the years to twenty percent. Of that twenty percent, one-third of PEPFAR funds must be spent on preventing new HIV cases through sexual transmission; two-thirds of that must be devoted to programs that promote sexual abstinence-until-marriage and faithfulness, but not condom use. “Abstain” is given priority to those who are not sexually active; “Be faithful” is prioritized for those who are sexually active. The third, “use Condoms,” is given a rather mystified status—it doesn’t seem to be an explicit priority in any context, and condom use as a primary prevention method can never be part of a campaign targeting youth.

The U.S. Government Accountability Office has reported that health workers in the field are confused about what they can and cannot say, and to whom they can or cannot say A, B, and especially C. Rather than risk a loss of funding—which of course goes to treatment and palliative care, among other things—health workers are at a loss for words.

To talk about prevention we need to talk about sex. Lisa Edelstein, and many, many other safer sex advocates knew this back in the eighties. Why are our efforts still being burdened by an unproven theory that talking leads to sex? I fear an old slogan is being rewritten—“SILENCE = AMERICA.”

May 2006