Health Professionals, Educators Tackle Touchy Subject : Teens Hear Some Plain Talk About AIDS

Times Staff Writer

If you have daughters, put condoms in their purses. I keep a row in my drawer. My son knows I don't want him to need one but I assure you I'd rather have him disagree with my value system and be alive than disagree with my value system and be dead.

--Los Angeles school board member Jackie Goldberg, mother of a 12-year-old son.

With no apparent self-consciousness, the group of seventh through 12th graders, boys and girls, had just watched a no-punches-pulled film on AIDS and had discussed in some detail the risks of anal sex and oral sex. Now, a boy raised his hand and asked, "Can you get AIDS by biting your nails?"

The question seemed symbolic of the confusion with which today's pseudo-sophisticated teen-ager is facing the fact: AIDS kills. And one way you get AIDS is by having sex.

The statistics on teen-agers and AIDS are not in themselves cause for alarm. Although almost 33,000 Americans have contracted acquired immune deficiency syndrome since record-keeping began in mid-1981 at the Centers for Disease Control in Atlanta, and 19,000 have died, there have been only 135 cases in the 13-to 19-year-old group. In Los Angeles County, according to the Health Department, there have been five teen-age victims, four of whom have died.

Long Incubation Period

But health professionals, noting the long incubation period for the AIDS virus--five to seven years or more--point out that one in five victims has been in the 20-29-year-old group. "Subtract that five years from 20," said Wendy Arnold of AIDS Project Los Angeles, a nonprofit community service organization, "and what do you get? Fifteen. We feel teen-agers and adolescents are being exposed."

"It's clear," said Dr. Joseph Church, professor of pediatrics at the USC School of Medicine and Childrens Hospital of Los Angeles, "that there are certain behaviors that put people at risk. One is sexual promiscuity and number two is intravenous drug abuse, and teen-agers who are exploring their own sexuality or experimenting with illegal substances are going to be at risk."

The medical profession does not know when, or how fast, the numbers will increase, Church added, but he mentioned data from U.S. Army studies of recruits indicating that up to 4% of young black male volunteers from New York are infected with the virus.

Childrens Hospital here has seen only one infected teen-ager, a boy who denies either homosexual contact or IV drug use. But he is, by Church's description, "a street kid with home-placed tattoos and pierced ears" who has shared tattoo needles with friends.

Dr. Kenneth Williams, a pediatric hematologist who chairs the County Medical Assn. committee on AIDS, also spoke of the "potential threat." Despite the small number of established cases among teen-agers, Williams said, the fact that 1 million teen-age girls become pregnant each year in the United States means that teen-agers are not using birth control, including condoms, which while not foolproof are considered the best barrier to transmission of the AIDS virus.

(Planned Parenthood estimates that, by age 18, eight in 10 males and seven in 10 females have had intercourse--and that most wait at least nine months after their first intercourse before seeking contraceptive advice while only one-third use birth control regularly and one-third never use it.)

'Immortality Syndrome'

There is an additional obstacle to getting across to teen-agers the message about condoms--the "immortality syndrome." Said Williams, "Youth doesn't feel that they have to deal with death or the threat of dying. But here we're talking about a lethal disease. It's not like herpes or gonorrhea or syphilis."

Medical professionals who work in clinics serving teen-agers report increasing patient concern. "My own vision," Church said, "is that teen behavior will change when significant numbers develop the symptoms and die before their classmates' eyes."

In the past, acknowledged Williams, many physicians "have not felt comfortable talking about sexual issues" with adolescent patients, but he sees it as a doctor's responsibility to counsel those who are sexually active on "safe sex," which means using condoms and spermicides.

Church agrees, adding, "I think it has to be emphasized to them that the best way to avoid getting this disease is abstinence."

The state PTA has endorsed a bill by Sen. Gary K. Hart (D-Santa Barbara) that would mandate showing of an educational film about AIDS in all junior and senior high schools. State PTA president Donetta Spink says parental education is also vital, that there is still "a lot of resistance" to teaching children about sexually transmitted diseases.

"Birth control is more pertinent than AIDS" among her peers, said Rebecca Bowers, 17, of Modesto, a student member of the state PTA board. "AIDS isn't what pops into your mind" in making a decision about being sexually active, she added, "it's unwanted pregnancies."

And, despite the AIDS scare, the Pill, not the condom, is the birth control method of choice among teen-agers who use birth control. One reason teen-agers do not protect themselves is ignorance but another, more important one, explained Los Angeles school board member Jackie Goldberg, is that "The ethic on sex has changed from 'Thou shalt not have sex before you get married or you're a slut' to 'Thou shalt have sex before marriage if it's in the heat of passion,' which is the ethic of television. Premeditated sex is still as sinful as it always was."

Planned Parenthood, the national organization that has campaigned extensively for lifting the television networks' ban on contraceptive advertising, based that campaign solely on curbing the teen-age pregnancy rate. Indeed, in a 1986 publication, "How to Talk with Your Child About Sexuality," Planned Parenthood dismissed AIDS with a couple of paragraphs--"It is possible, but infrequent, for a child or teen-ager to get AIDS . . . teen-agers account for less than 1% (of the cases)."

The networks, arguing that the moral or religious sensibilities of viewers would be offended, did not compromise until, in February, Surgeon General C. Everett Koop called on the broadcast industry to lift its self-imposed ban, saying, "AIDS kills . . . and sexually active people have to be told this." The networks now permit network-owned local stations to make their own decisions but still do not accept condom commercials for network programs. They have started running some public service spots.

Dr. J. Hugh Anwyl, executive director of the Los Angeles affiliate of Planned Parenthood, which annually sees about 13,000 clients in the 13-to 19-year-old group, welcomes the current widespread effort to promote condoms as protection against AIDS as a bit of "serendipity."

Although Planned Parenthood makes condoms available free to those who cannot pay, Anwyl says "not too many" teen-agers are requesting them as yet.

He said it will take "six months or so" before public awareness brought into focus by the surgeon general's report will trickle down to teen-agers.

Getting the Point Across

Anwyl believes parents should ask their sons as they leave the house whether they have their condoms as well as their car keys. He suggests, "They ought to be literally chained to a pack of condoms to get the point across."

He would like, too, to see "jazzed up" marketing of condoms, with eye-catching packaging, and condom vending machines in supermarkets, convenience stores and malls. There is an image problem, he said, if they are available only in service station restrooms. "They ought to be on shelves with the health foods, in a much more positive context."

Once condoms are freely advertised, freely accessible and readily accepted by both men and women, Anwyl believes, "that will push us forward to deal with the real question--what kind of sexual behavior reasonable, moderate human beings engage in.

"The old idea was that you only had sexual intercourse for procreative purposes, and some people still think that," he said. "Others think it's primarily recreational. Some teen-agers are saying, 'I want a baby because I want someone who loves me.' We really haven't dealt with those issues."

With teen-agers, Anwyl said, "We don't teach enough of the idea, 'If you really loved me, you wouldn't ask me.' In the light of AIDS, if you don't think through those things, you may be dead."

Church Doctrine

Catholic leaders maintain that promoting the use of condoms for sexual intercourse implies a sanctioning of sex outside of marriage, which the Catholic church views as immoral. Church doctrine also prohibits use of contraceptives. In December, archbishop Roger Mahoney of Los Angeles withdrew support of a Spanish-language AIDS education project designed for presentation to Latino parish members after learning that condoms would be discussed as a method of preventing transmission of the AIDS virus. The way to avoid AIDS, the Catholic leaders contend, is by avoiding sex outside of the traditional marriage relationship.

Dr. Morton Shane, a Westside psychiatrist and psychoanalyst who works with children and adolescents, had a different observation about the issue of teen-agers and fear of AIDS. "Often," he said, "they are feeling guilty about their sexuality and they expect punishment, so AIDS comes to the fore. Children who are phobic latch onto this. Sometimes, if they have that tendency to be self-punishing, they even put themselves in jeopardy. It's readily available as a way of torturing themselves. They might have sex with somebody they feel could possibly have AIDS and then worry about it."

In educating children to the threat posed by AIDS, he said it is important not to subject them to AIDS "hysteria" to the extent that they equate sex with death--"I think they should be told that with reasonable caution it is extremely unlikely they will catch any illness. They should know sex is pleasurable but has consequences they need to be aware of. We talk about washing your hands before you eat. Well, you put on a condom before you have sex."

It is AIDS Awareness Week at Herzl School, a Jewish secondary school in West Hollywood, and Wendy Arnold of AIDS Project Los Angeles has come to speak and to show a frank and explicit 20-minute film, "Sex, Drugs and AIDS," distributed by New York-based O.D.N. Productions.

The film opens with a kid saying, "I'm scared. I want to have sex but I don't want to die."

Then there are reassuring words from the narrator, actress Rae Dawn Chong: "AIDS is hard to get" and you won't get it from sharing a pizza or from a toilet seat. "The virus has to get in your blood. It doesn't get there by itself. You have to put it there."

Chong talks about how that happens--by "shooting up" with drugs or having sexual intercourse, including "your standard guy-girl form of sex . . . guys gotta wear condoms and girls gotta make sure guys wear them."

Chong continues, "I know you may feel like a jerk buying them" or think they're "icky" but "it's better to feel a little embarrassed than risk getting a disease that can kill you." Deciding to have sex has never been simple, she adds, and "with AIDS around it's even more complicated."

A 'Scary Time'

Arnold feels this particular film treats sex "too casually" and she tells these students, "We know that no sex at all during this scary time is the best way to prevent the virus from going from one person to another."

Condoms are not the total answer, she adds--"Condoms do break, and they do have a shelf life. I have to emphasize, this is not a time to experiment."

Like all of the young audiences to whom Arnold speaks, the students want to know whether they can catch AIDS in a swimming pool (no), by sharing a drink (no), from a mosquito bite (no), from food (no). By kissing? "There are no documented cases," Arnold said, but "if two people were deep French kissing, it's conceivable," if one had blood in the saliva.

Arnold tells them that one can be a carrier of the virus without having symptoms (an estimated 2 million Americans are carriers and can give AIDS to others). When the discussion turns to AIDS symptoms and Arnold mentions the possibility of "little blue dots on the arm," every pair of eyes in the room is diverted downward for an arms inspection.

A boy in the classroom brings up the subject of oral sex, to Arnold's relief--she does not like to be the one to introduce the subject. "Oral sex is a no-no," she said, "until we find a cure for AIDS."

Again, she emphasizes the importance of using a condom. "I know a lot of gals feel being on contraceptives should make you safe. It definitely does not," nor does a diaphragm, nor foam alone.

She leaves them with two big messages: You get AIDS from sex (and not just "gay sex"), shooting drugs, blood transfusions (now rare) or in utero, from an infected mother. And, AIDS is preventable.

School director Sonia Berman was pleased with the presentation. She said, "I felt after hearing the kids talking in the hallway that we needed to dispel the myths and to help prevent spread of the disease." None of the parents, she said, denied permission.

Arnold, who has a master's degree in public health from UCLA, has been doing in-school presentations for a year, an average of 20 each month, before audiences as young as 7. By invitation, she has visited three Catholic schools where she did not mention condoms but suggested, "If you have specific questions call the AIDS hot line (1-800-922-AIDS)."

She has found a "lot of kids are getting their sex education while waiting in supermarket lines reading the National Enquirer." Of junior high audiences, she said, "Maybe they don't know what French kissing is, but they're doing it."

Arnold knows she walks a fine line when talking to teen-agers about sex, AIDS and death. "I want to scare them," she said, "but I don't want to petrify them," to instill a fatalistic outlook that might encourage promiscuity. On the other hand, she said, "If I were to talk about chastity and abstinence, I'd be laughed off the floor."

Her conversations with teen-agers have led her to believe that "they're being more cautious" about sex, talking more openly about risk. But among the myths that persist, she said, is their conviction that "there's a cure right around the corner."

To get across to a teen-ager that the AIDS virus has a years-long incubation period is almost impossible, she added--"They can't think beyond spring vacation."

Arnold does not minimize the risk of AIDS within this age group. She speaks of the possibility of boys visiting prostitutes and then introducing the virus into a school, of children who have been sexually abused and of teen-age girls "who are prostitutes to support their drug habits."

Some time after the presentation at Herzl a young man told Arnold, "It was real real. I walk down the hall now and the girls don't even look at the guys."

The bill by State Sen. Gary K. Hart, which has passed the Senate and comes before the Assembly Education Committee Tuesday, would mandate that the State Department of Education purchase and distribute one or more AIDS prevention videotapes to every junior and senior high school in the state and require the schools to show the tape each year to seventh through 12th graders. The department would select films from which districts would choose.

"We're hopeful it will start at the beginning of the next school year," said Hart aide Joe Caves. The bill, which encourages school districts to provide a more expansive program at local discretion, provides that students may be excused from such sessions by parental request.

Organized opposition has come from the Sacramento-based Committee on Moral Concerns, headed by W. B. Timberlake, a Southern Baptist minister. Timberlake said the organization, which claims a mailing list of 20,000-plus, condemns it as a "condom consciousness bill."

Timberlake said, "We want to point out there is no safe sex, only safe prevention, which is total abstinence." The committee objects to a mandatory curriculum, as well, he said, because all school districts, "even a little community up in the hills that never heard of AIDS except in the paper" would have to teach AIDS education.

He charges that the Department of Education wants to "teach all about homosexuality without condoning it or condemning it . . . and that's where you get AIDS. Even some conservative areas around Los Angeles would not want this apology for homosexuality."

Nor does Timberlake believe that AIDS presents a serious threat to teen-agers. He downplayed AIDS as the media "story of the month" and said, "I think we're jumping too quick." As for Surgeon General Koop's suggestion that age-appropriate education begin in kindergarten, Timberlake said, "They're not emotionally equipped for that sort of stuff. Even when they get in on their parents' sex act, they go into orbit. It isn't a spectator sport."

California's Roman Catholic bishops have endorsed "the intent" of the bill but have criticized it as lacking a "wider moral context." The bishops' statement said, "We do not support those portions of this bill which present the use of condoms on the same level as abstinence and marital fidelity, the avoidance of promiscuous sexual practices or the rejection of the illicit use of drugs."

In recent weeks, the state Board of Education for the first time adopted a broad set of guidelines for family life education in grades kindergarten through 12, including a section on AIDS. The guidelines suggest appropriate subject matter but do not mandate curriculum.

The state board suggests that sex education not be introduced prior to fourth grade. The guidelines do not specify in what year information on sexually transmitted diseases should be introduced, but specify that the section on homosexuality not be introduced before seventh grade. The guidelines will be distributed to all school districts within a few weeks so local boards may decide whether, and how, to adopt them.

Los Angeles Unified School District board president Rita Walters is one who endorses sex education before the junior high level for "this new generation of sexually active youngsters." (For the past year, all district students in grades seven through 12 have been getting AIDS education and family planning has been incorporated into state-mandated seventh and 10th grade health education classes.)

"The time to get to kids and make them understand is when they're 8, 9, 10," said school board member Roberta Weintraub. "After they're teen-agers, they don't think you know anything. Yet parents are putting their heads in the sand about it. They'll say, 'well, when I went to school. . . .' I wish I could turn back the clock, but I can't."

A family life education curriculum is now being worked out by a blue ribbon committee for LAUSD. It would begin in kindergarten with discussions about differences between boys and girls and it would place heavy emphasis on maintaining loving relationships in a turbulent society. After community input, it could be in place as early as fall, 1988.

Emphasizing that "the preferred answer is abstinence," Walters said, "it's critical that we get young people involved in learning about this terrible disease.

"Young women are still getting pregnant in record numbers. If that kind of behavior translates to AIDS, just a whole generation is going to be wiped out."

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