Why the Government Urges Abstinence <i> and </i> Condoms : Health: The public interest in curbing sex-related disease is also served in encouraging moral, or at least more responsible, sex-related behavior.

<i> Dr. James O. Mason is assistant secretary for health in the Department of Health and Human Services and head of the U.S. Public Health Service</i>

A couple I know tells about the funny visits they made to a physician and a minister before they were married: The doctor counseled them about the importance of going to church and saying grace at meals, while the minister recommended a new book he had heard about, “The Joy of Sex.”

I am a physician, and I believe in all of the above--Sunday service, the blessing at meals and the joy of sex, within marriage. Like many faiths, mine teaches that extramarital sex separates us from our important relationships, including our all-important relationship with God.

You may by now be thinking, somewhat like the couple, “What’s this doctor doing preaching at me?” So let me add quickly that I am convinced by my experience in the Public Health Service that certain activities that I would caution young people about on moral grounds are also a clear and serious health risk, causing, for example, about 40,000 to 80,000 deadly new infections with the AIDS virus (HIV) each year.

Of course, physicians in public health must do more than rail against such activities. When we cannot eliminate risky activities, we must attempt to modify and mitigate them and their consequences. This public-health role is what brought a conservative moralist, C. Everett Koop, our former surgeon general, to become an outspoken advocate of condoms.


He didn’t change his moral view, but his public-health view reflected a world in which AIDS is the No. 1 disease killing American youth and a world in which many kids are likely to experiment with their bodies and may start having intercourse between the ages of 13 and 16.

This tension between what some of us would prefer that children and adults do and what they sometimes actually do is why the Public Health Service continues to urge abstinence in some programs and yet promotes condoms in others. To appropriate audiences, the need to meet health needs may also lead us to recommend to gay men certain modifications of sexual practices that, under other circumstances and with other audiences, many of us would blush to describe.

Yet, while we need to reach out in this way to committed and sometimes promiscuous homosexuals, I think we must also point out, again and again, that it is permissiveness that has enabled AIDS and other sexually transmitted diseases to ravage many of our people and society. We must not shrink from telling the truth as we see it: Promiscuity--casual and irresponsible sex, whether between homosexuals or heterosexuals--is a root cause of many of the deaths, disability and anguish of AIDS.

Primo Levi, the Holocaust survivor and chemist, wrote, “When we know how to reduce the torment, but do not do it, then we become the tormentors.” I believe that this is true. I believe that we must care for those with HIV and seek vaccines and cures, but we must also speak out about the destructive behaviors that affect individuals and society. We must do this without fear of whatever ridicule Playboy and other voices of “sophistication” may throw at us.


Casual sex and prostitution are responsible for spreading AIDS, herpes, hepatitis and other painful, crippling and deadly conditions.

Casual sex and permissiveness also foster illegitimacy, teen pregnancy and irresponsible parenthood.

Every pregnant woman should receive early and continual prenatal care, but good doctors and medicine are not enough. Partly because of the irresponsible use of drugs, cigarettes and alcohol during pregnancy, 40,000 babies born in the United States this year will die before their first birthdays. And 250,000 will live but will have been born with or will develop disabling, chronic conditions that will deprive them of true independence, throughout their lives.

These are the crack babies, the low-weight babies (a result primarily of cigarette-smoking mothers) and kids with fetal alcohol syndrome, a devastating and persistent handicap.


We know, too, in this AIDS era, that there is no more lethal abuse of women than prostitution. Do we have the courage to rid our cities of this behavior?

We in the Public Health Service have sent out a loud message to Americans that they should modify some of their habits. We tell folks they need to jog, swim, play tennis and ride bicycles. We’ve advised them to limit their intake of saturated fats and increase the fiber in their diets. We’ve told them to go slow on alcohol and not to use tobacco or drugs. We’ve said that women should get mammograms and that men and women should have their cholesterol and blood pressure checked.

But we have been somewhat shy in speaking out against casual sex, early-teen pregnancy and childbearing out of marriage. Without sufficient protest, we have sometimes allowed the concept of fatherhood to degenerate into “sperm donor.”

I reject the idea that behavior is an entirely individual matter, especially in our present circumstances. It is the public’s business--certainly, at least, a matter requiring public discussion--when one person’s smoking impairs the health of another, when a mother’s alcohol use causes permanent damage to her child and when shared drugs and promiscuity destroy promising young lives.


We, as physicians, immunize when we can and treat the conditions we cannot prevent. We moderate disorders when we can and palliate the hurt when we cannot. But there are times when the best we can do is advise, urge and recommend--and do it we must.

End of sermon.