Taking on a sensitive issue, Surgeon General David Satcher issued a report Thursday urging Americans to respect diversity in sexual values and calling on parents, schools and community leaders to engage in honest, mature discussions about sexual issues.
The ranging report says communities must provide lifelong sex education, encouraging sexual abstinence as well as birth control. Americans should rely on scientific evidence to determine what works, Satcher said, and develop greater understanding toward gays and lesbians.
The report, two years in the making, says the nation must get past its nervousness about the subject in order to reduce unwanted pregnancy, sexually transmitted diseases and sexual abuse, while promoting healthy sexual relationships.
"Given the diversity of attitudes, beliefs, values and opinions, finding common ground might not be easy, but it is attainable," the report concludes.
The first step is confronting the issue, Satcher said. "Sex is not an easy topic to discuss and it has never been."
The "call to action" begins by detailing the problem: 12 million Americans infected by sexually transmitted diseases each year, with about 40,000 new HIV infections, and more than 100,000 children victimized by sexual abuse annually.
Each year, there are 1.4 million abortions, more than 20% of all pregnancies. Nearly half of all pregnancies are unwanted, a figure based on abortion and government survey data. And an estimated 800,000 to 900,000 Americans live with HIV.
In the tradition of surgeons general, Satcher does not flinch from reporting even controversial data.
He says there is no valid scientific evidence that one's sexual orientation can be changed and details the consequences of harassment on the mental health of gays and lesbians.
"We're certainly not trying to get anyone in any religious group to change their views," he said. "We're just saying these are people, these are human beings."
Sexuality education must be wide-ranging, begin early and be available throughout one's life, the report says. It recommends that sex education programs discuss the benefits of abstinence from sex but also explain how to prevent unwanted pregnancies and sexually transmitted diseases. It recommends improving access to reproductive health care services for "all persons in all communities."
Abstinence is the only certain way to prevent pregnancy and the spread of disease, the report says, and even properly used condoms do not prevent the spread of all sexually transmitted diseases. But the report finds no evidence that "abstinence-only" programs are effective, saying more research is needed.
These programs, which bar any talk of contraception, enjoy the support of many conservatives, including President Bush, who has pledged to raise federal support for them.
Satcher insisted he was not taking sides in the debate. "Those are political decisions. We try to make very clear what's needed to improve sexual health and what's supported by the science."
The report also encourages abstinence from sex until one is involved in a "committed, enduring and mutually monogamous relationship." Federal abstinence programs call for abstinence until marriage.
"I have to deal with reality," Satcher said when asked about the difference.
Sex education begins with parents, the report says, but schools play an important role because some parents are uncomfortable or unable to give their children all the information they need.
"Parents sometimes need help," Satcher said. "Schools have always been the great equalizers."
The report got a chilly reception among conservatives. Andrea Lafferty of the Traditional Values Coalition said Satcher ignored evidence that homosexuality can be changed. He sent a mixed message about condoms, she said, by admitting they do not provide absolute protection against disease and pregnancy but still encouraging people to use them.
"They're talking out of both sides of their mouths," she said.