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Infectious Debate 

Infection rates for common sexually transmitted infections are up, and both sides of the abstinence-education debate claim the uptick shows the virtue in their way of looking at things.

Proponents of comprehensive education that includes safer-sex techniques say the increase highlights the failure of abstinence-only education, and those on the pro-abstinence side say the higher infection rates point to a need for more pervasive abstinence education.

The Centers for Disease Control and Prevention (CDC) recently released data tracking infection rates nationally, broken down by metropolitan area and county, of chlamydia and gonorrhea. The 2007 infection rates are the highest and second-highest, respectively, of any infectious diseases ever reported to the CDC. In the Pittsburgh Metropolitan Statistical Area, chlamydia infections rose from 5,499 -- or 228.1 of every 100,000 people -- in 2003, to 6,616, or 279.1 per 100,000. Gonorrhea rose from 2,035 infections in 2003 -- or 84.4 per 100,000 -- to 2,599, or 109.6 per 100,000, in 2007.

While those embroiled in the abstinence debate seem eager to point to the new data as supporting their viewpoint, the CDC itself doesn't assess what effect, if any, abstinence-based versus comprehensive sex education in schools has on infection rates. It does, however, point to the much higher infection rates among black and Hispanic citizens across the country. "Socioeconomic barriers to quality health care and STD prevention and treatment services have likely contributed to a higher prevalence and incidence of STDs among racial and ethnic minorities," it reads.

Guillermo Cole, public information officer for the Allegheny County Health Department, acknowledges that both chlamydia and gonorrhea infections rose in the county between '06 and '07, at drastic rates: about 25 percent for chlamydia and 20 percent for gonorrhea. But the county also has more recent numbers than the CDC -- in '08, gonorrhea went down and chlamydia rose but at a lower rate. Infection rates for both diseases, Cole notes, are cyclical and have jumped and dived in the past.

Could abstinence-only or comprehensive education in schools be one factor in the differences?

"It's difficult to say, absent some study that looks at these different interventions," he says. "I don't know that there have been. We haven't done any here in the Health Department to determine the relative impacts of abstinence-only versus comprehensive STD educations." Cole points out that increased testing certainly contributes to the higher numbers.

The Health Department's position, Cole says, has always been for comprehensive education, in the context of acknowledging that the only certain means of preventing the spread of STIs is abstinence.

"You need to present all information to people, recognizing that there are those who will not abstain. But short of abstinence, there are other things you can do to reduce your risk. We point out that you're reducing risk, you're not eliminating it."

He says each school district in the county makes its own decisions about what curriculum to use, and the county doesn't track those data.

Valerie Huber, executive director of the Washington, D.C.-based National Abstinence Education Association, says the increase is evidence that abstinence-only education needs to be shored up.

"Only an abstinence-centered approach gives teens the skills and real information they need to avoid the risks of casual sex," Huber writes in an e-mail. "The condom-centered message is not good enough and we're seeing that teens are continuing to be victimized by the message that tells them that sexual experimentation plus a condom equals 'safe sex.' It's scientifically unsound and out of touch with the best health message."

In a press release about the CDC report, Huber states that "abstinence-centered education provides teens with the skills to eliminate all risk of STDs. ... Let's not censor vital information that has the potential of removing all risk of STDs among youth. Diagnosis and treatment are vital, but a serious focus on primary prevention is critical."

Kim Evert of Planned Parenthood of Western Pennsylvania calls the increases a clear indication of the failure of school education that only tells teens not to have sex at all.

"What we're looking at is the fact that this is an abstinence-only generation," Evert says. "The education that's out there for young people focuses on abstinence and does not provide them adequate information about how to protect themselves. We have to have a message other than abstinence and 'just say no.' Young people are deciding to be sexually active -- not to give them info about how to protect themselves is a huge disservice to them and to their health."

To that end, PPWP does outreach programming on local college and university campuses, distributing condoms and fact sheets. In the spring, there will be a week of free STI testing at Planned Parenthood sites.

The Pittsburgh Public School District, which is included in the Pittsburgh MSA, uses an abstinence-only curriculum. Last spring, two parents began circulating a petition to force the district to overhaul the system. A task force has been meeting on the subject since summer, which includes PPWP's Sue Steele, vice president for education.

Ebony Pugh, communications and marketing director for the district, did not return several calls seeking comment, but Dr. Jerri Lippert, executive director of the office of curriculum, instruction and professional development said in an e-mail that "We are presenting the committee's work and recommendations on sexuality education policy and instructional materials to support a comprehensive 6-12 health curriculum." Those findings will be made public Feb. 3.

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