You're Teaching My Child What? (13 page)

Dr. Jacobs was alarmed: this was flat-out wrong. First of all, 98 percent protection refers to avoidance of pregnancy, not infection, and is achievable, according to studies, by adult couples with “perfect use” of condoms. Few individuals manage to use condoms “perfectly”—consistently and correctly. Much more common is “typical use”—the device is not worn for every act, and when worn it's occasionally used incorrectly. With “typical use” by adults, studies show pregnancy prevention falls to 85 percent.
³
Taking into account their immaturity, use of alcohol before sex, and other factors, teens' typical use of condoms could be expected to prevent pregnancy at a much lower rate.

Dr. Jacobs knew that quantifying the degree of protection condoms confer from infection is not a simple matter. Even a panel of 28 experts had a tough time at it. The NIH, CDC, and FDA brought them together in 2001 and asked, “What is the scientific evidence on the effectiveness of latex male condom-use to prevent STD transmission during vaginal intercourse?”
⁴

The answer to that question was—and still is—“It depends.”
⁵
Although latex is essentially impermeable to all sexually transmitted organisms, germs and sperm can escape around the edges. At best, protection against HIV has an estimated 80 percent
⁶
reduction in risk of transmission with perfect use during vaginal intercourse.
⁷
Risk reduction for infections transmitted in secretions ranges from 26 percent (chlamydia) to 62 percent (gonorrhea).
⁸
In one study of sexually active African American teen girls, despite 100 percent condom use, one in five became infected with chlamydia, gonorrhea, or trichomonas within twenty-eight months.
⁹

Protection against infections transmitted skin-to-skin is compromised, because sometimes the condom will not provide coverage of the area. Other research indicates perfect condom use only reduces the risk of genital herpes by 25–50 percent.
¹⁰
Large studies have found little or no effectiveness of condoms in preventing transmission of HPV.
¹¹

Again, these numbers refer to correct condom use for every instance of vaginal intercourse.

Jacobs concluded that the “Protect Yourself” video was dangerously misleading. It would give students a false sense of security, and the consequences could be catastrophic. She had evidence in her own practice that even people who use condoms perfectly can be infected with HIV/AIDS. Two of her most recent cases had been patients infected with HIV who were both shocked at the diagnosis. One was a teenager, the other a mature adult. They had used condoms 100 percent of the time and couldn't understand how it had happened. As she later recalled, “They were so angry, it was as if flames were coming out of their heads.”

“
This scenario always makes me want to cry
,” she wrote in a letter to a Maryland community newspaper in 2005,
“because if they had only known the risks they were taking, maybe this human tragedy would not be playing out in my office.”
¹²

Pivotal to Dr. Jacobs's objection
¹³
to “Protect Yourself” was the absence of warnings about the danger of anal intercourse. Students were being told that HIV and other infections are shared through unprotected vaginal, oral, or anal intercourse, as if each activity carries the same risk. Dr. Jacobs wanted students to hear what she told her patients—that due to anatomy and physiology, anal sex has been
estimated to be at least 20 times riskier than vaginal.
¹⁴
Also missing was the information that condoms are more likely to fail during anal sex
¹⁵
—a danger acknowledged on condom wrappers that warn consumers: “Non-vaginal use can increase potential damage to the condom.”
¹⁶

This is a subject most people would like to ignore. First of all, it has a high “ick factor.” Second, it cannot be discussed honestly in our society without leading to some nasty name-calling. Ruth Jacobs knew that, but she also knew the subject was too important to
not
discuss honestly. So, the fear of being called names didn't stop her. She'd seen too many people fighting these diseases, some of them with AIDS, in their final days, trying to survive another month or week, hoping to see a child graduate or get married. She was not about to sit back and watch as kids were provided dangerously inaccurate information.

If her years of practice had taught her anything, it was that with or without a condom, anal intercourse is high risk behavior, and that kids must be told flat out: Don't do it.

Dr. Jacobs voiced her concerns at a meeting of the school board. She described the anger of her patients who became HIV positive, despite use of condoms 100 percent and following safer sex guidelines. She told the large audience of concerned parents that the video was so misleading it would add new patients to her infectious disease practice.

In a letter to the local newspaper, Dr. Jacobs wrote, “Each sexually transmitted disease is a disaster in the life of the individual,” she wrote. “We must educate [students] to the dangers and to steps they need to take to have full and productive lives and not spend their lives in a physician's office.”
¹⁷

Her concern was for all students, regardless of sexual orientation. A CDC study of over 12,000 people
¹⁸
has indicated that by age 19, 11 percent of girls have had anal intercourse, and by 24, almost 30 percent. The rate of condom use during anal sex for those 11 percent of teen girls was only 25 percent. Many teens do not recognize this as risky sexual behavior; one study on urban minority females indicated 41 percent engaged in anal sex to avoid pregnancy, and 20 thought HIV could not be transmitted through anal sex;
¹⁹
some don't even consider anal sex “sex.”
²⁰
So this is not only about the sexuality of men who are attracted to men. As Dr. Jacobs knew, the hazards of anal intercourse are a matter of anatomy, histology, immunology, and microbiology; and any sex ed program that does not consider what those sciences demonstrate is not medically accurate, let alone comprehensive.

Jacobs' efforts and those of the CRC had no impact on the Board of Education. It was only following a lawsuit and restraining order
²¹
that the condom video [and another portion of the program] was dropped. The settlement stipulated that Citizens for a Responsible Curriculum
²²
would have a seat in the new citizens' advisory committee, charged with establishing a new curriculum and a new condom video for MCPS students.

Dr. Jacobs was amazed at what was passing as sex education in Montgomery County, one of the wealthiest and most educated in the country. She assumed the deficiencies were related to the lack of medical knowledge among school administrators and parents. That could be easily remedied by providing them with some basic facts about infectious disease, she thought, and sharing a few of the harrowing stories of patients in her care. Armed with the facts, they'd certainly understand that vast changes needed to be made.

Whenever the Board of Education meetings were open to the public, Dr. Jacobs would attend and make a presentation.
²³
For nine months, she took time away from her practice to speak about the fundamental principles of public health as they related to sexually transmitted
infections and HIV/AIDS. Each time, she had two minutes to cover the material—that was Board of Ed protocol. Her talks covered a wide variety of topics including germ theory, the risks of anal and oral sex, and of multiple partners. She provided graphic descriptions of the blisters, warts, discharges, and other medical problems caused by sexually transmitted bacteria and viruses, and explained the inadequate protection provided by condoms. She emphasized to the Board what she knew from medical literature and professional meetings: the patients being seen by clinicians are the tip of the iceberg—most people carrying genital viruses and bacteria don't seek care. They, along with their unsuspecting partners, are unaware of their infections.
²⁴
That even after two decades, HIV/AIDS was still hitting young people hard—half of all new cases were occurring in the 15–24 age group.
²⁵
What we face now, more than ever, is a vast, silent epidemic.

One of her presentations was prompted by a visit to a friend's home, where the babysitter, a MCPS graduate, had proudly announced a unique way of entertaining the kids with a “swirly”: have a child place his head in a toilet, then flush the water. What fun! What excitement!

Not so much fun, however, when the child came down with a vomiting illness the following week.

As a specialist in infectious disease, the notion of a “swirly” caught Dr. Jacobs' attention. For her next opportunity at the Board, she'd speak about the dangers of exposure to stool—a topic about which every infectious disease expert could write a book. She designed and printed a handout to supplement her talk, with diagrams and electron microscopic photos of the bacteria and parasites that live in the rectum. Dr. Jacobs practiced before the meeting, so she could summarize the points she considered most critical within 120 seconds.

Fearless of the “ick factor,” she explained to the Board and audience of parents that feces are filled with dangerous pathogens: salmonella, shigella, amoeba, hepatitis A, B, and C, giardia, campylobacter, and others. These organisms and others can be transmitted during anal sex
or oral-anal contact,
²⁶
she explained, and the consequences can be much more serious than a few days of vomiting. She reminded the Board of their responsibility to include these warnings in the new curriculum.

The doctor's unique mini-course in microbiology, epidemiology, and public health made some difference, but not enough. With time, it was clear that the new curriculum, while improved, would not adequately address the increased danger of anal sex and multiple partners, or the limited efficacy of condoms.
²⁷
Dr. Jacobs concluded that the Board had an agenda, and it had nothing to do with student health. Their priority, it seemed, was to downplay the hazards of high-risk behaviors, anal sex in particular.

“It may not be politically correct to describe ills related to having multiple sexual partners and anal intercourse,” Dr. Jacobs wrote in the
Washington Times
.
²⁸
However, it is scientifically correct. “Our tax payer dollars should not be used to encourage or normalize risky sexual behavior or to hide the results of such behavior from youth.”

Having hit a wall with the Board, Dr. Jacobs took the issue to her peers—medical doctors. She argued that the new MCPS condom lesson should include these statements:

 

From the National Institutes of Health:

From the Food and Drug Administration:

And from former Surgeon General C. Everett Koop:

She asked physicians who agreed to sign the following petition:

As Jacobs collected signatures, doctors shared their horror stories. A pathologist described the advanced malignant changes in the cervix of a 16-year-old. This was a cancer he would have expected to take six or eight years to develop. Gynecologists reported on anal herpes and warts of the anus—these are due to HPV
³³
—in young women. Doctors
complained that they're tired of performing LEEPS—a procedure to treat cervical tissue infected with HPV—on girls in high school.