PERSPECTIVE ON AIDS : Get Aggressive About Safer Sex : Magic Johnson has opened a new door. Why not tax R- and X-rated films to pay for a safety crusade?
Magic Johnson’s announcement that he is infected with the HIV virus underscores the findings of researchers across the country that only modest changes in the sexual behavior of Americans have occurred over the past decade. Unless a more aggressive approach to increasing the practice of safer sex is taken quickly, the AIDS epidemic may devastate America in the same manner as it has done in several African countries including Uganda, where one in five citizens in urban areas is infected. America’s current social climate does not support or reinforce the consistent practice of safer sexual behavior. Even among those who have adopted safer sexual behavior, a considerable number relapse and engage in unprotected intercourse with casual sex partners.
AIDS cases continue to increase among heterosexuals. The rate of infection in child-bearing women has increased by 40% in the past year. Teen-age deliveries are up sharply, an indicator of the increase in unprotected teen-age sexual activity. In addition, there were 54,404 cases of gonorrhea and 10,457 cases of early syphilis in 1990, indicating continued widespread high-risk sexual behavior.
Safer sex means intercourse while using a barrier contraceptive with no exchange of body fluids. Or it can mean intimate relations, such as hugging, massage and kissing, without intercourse. Latex condoms (rubbers) are the best method of protection for vaginal, anal or oral intercourse because they prevent contact with semen, cervical secretions and blood. Many believe spermicides with nonoxynol-9 (it’s listed on the label) enhance protection in case condoms break, because nonoxynol-9 has been shown to kill the HIV virus on contact and is associated with reduced incidence of other sexually transmitted diseases. Its effects on HIV transmission in human volunteers have not been evaluated.
No one likes to use condoms and spermicides. Barrier contraceptives are complicated, uncomfortable, require planning and some motor skills. They may decrease sensation, interfere with spontaneity, may be messy and may create suspicion and anxiety if introduced into existing steady relationships. Even though condoms and spermicides are the only alternative to abstinence for persons who may not be in mutually monogamous relationships, it is an enormous challenge to persuade millions of Americans at risk of contracting AIDS, other sexually transmitted diseases and pregnancy to use them during sex.
However, research has shown that people will use barrier contraceptives when they are familiar with them and have experience using them, in spite of all the drawbacks.
One of the best ways to influence large numbers of people to change their behavior in a relatively short period of time is through social marketing--advertising whose goal is to promote public health. Social marketing is currently being funded by the state of California to prevent and decrease the use of tobacco. When anti-smoking commercials were aired on television during the 1970s, the consumption of cigarettes decreased considerably. California now collects 25 cents on every package of cigarettes sold and dedicates this money to smoking prevention and research.
Social marketing requires funding. Because unsafe sex is very commonly suggested and/or depicted in R- and X-rated films, these films may justifiably serve as a source of revenue for social marketing of safer sex. Love-making scenes rarely raise concerns about pregnancy, venereal disease or HIV infection, and they often promote the sense that unsafe sex (without condoms and spermicides) is the norm in our society. A tax on films that depict unsafe sex, without an emphasis on the use of barrier contraceptives, could collect about $18 million a year, even if films that depict couples using condoms when making love were exempted. The funds collected could be used for safer-sex marketing campaigns that would serve as a constant reminder that the fantasy of the screen is just that--and that unprotected sex in the real world can have serious, even fatal, consequences.
A social marketing campaign should be as explicit and powerful as the films that depict unsafe sex. Widespread advertising and increased availability of, and familiarity with, barrier contraceptives would help people adopt and consistently practice safer sexual behavior. The benefits would be measured in reduced teen pregnancies, fewer cases of venereal disease and decreased rates of HIV transmission. We challenge the Legislature and citizens to help Magic Johnson get his message across.
