From free love to safe sex

In hindsight, the news reported on June 5, 1981, was the first cold slap of a new reality. The Centers for Disease Control announced that five homosexual men in Los Angeles had been stricken with Pneumocystis carinii, a rare form of pneumonia. Within a month, 26 cases of Kaposi’s sarcoma, another rare disease that was soon to be known as “gay men’s cancer,” were reported in New York and California.

No one yet had put the name AIDS to these puzzling cases, no one knew the diseases were caused by HIV, and no one could stop the quick progression from disease to death that made the next 15 years look, in some communities, like a massacre.

What followed those early reports was a roller coaster of fear and apathy, as the epidemic first ravaged gay men, IV drug users and -- until testing made the blood supply safe -- hemophiliacs and transfusion recipients. The epidemic made its way increasingly to heterosexuals, particularly in poor and rural communities. It now afflicts 1 million Americans, and 40,000 new cases of HIV infection are expected this year, according to the CDC.

For a quarter of a century, Americans have had to face the uncomfortable knowledge that, with one false sexual move, AIDS could happen to anyone.

Lovers now know that they are sleeping not only with their partners, but with the entire cast of characters making up their partners’ sexual histories. That reality is perhaps most ingrained in the generations that have come to sexual maturity during the age of AIDS.

The epidemic, by infusing careless sexual encounters with the penalty of death, has added a heavy dose of fear to the joy of sex.

Those CDC reports were the first step in bringing to a close an era that some would recall as a sexual playground of free love and others would condemn as a moral free-fall. AIDS emerged a scant 21 years after approval of the birth control pill sexually liberated a generation. Less than a decade after the Pill, the Summer of Love and then Woodstock tested the limits of the sexual revolution, and the Stonewall riots of June 27, 1969, in Greenwich Village launched the gay rights movement.

Sex, so recently seen as natural and liberating, began to get a bad rap.

Today, adolescents have known about AIDS from the first conversation about the birds and the bees. “If you can find me a 15-year-old who doesn’t know that AIDS is a deadly disease, I’d be shocked,” says Julie Downs, director of the Center for Risk Perception and Communication at Carnegie Mellon University. “They know this.”

The information has no doubt contributed to what has been a bit of a cold shower. The percentage of students who say they’ve had intercourse declined to 46.7% in 2003 from 54.1% in 1991, according to the CDC. And the number of both boys and girls who have had sex before the age of 13 has dropped to 7.4% in 2003 from 10.2% in 1991.

Health class lectures, once just an embarrassing source of giggles and red faces, have fueled this attitude change with information that can only be called urgent.

At the age of 12, in the mid-1980s, sex education was sobering for Martha Kempner, 34, vice president for communication for the Sexuality Information and Education Council of the U.S. She was a seventh grader then, and sex education class remains a crystal clear memory. “It was straightforward and honest,” she says. “The message was that this was something we could prevent. It wasn’t meant to make us scared. But it made us scared because it was straightforward and honest.”

Despite a dose of fear, teens are still a bundle of raging hormones, developing bodies and immature minds. And they still do what they’ve always done, if just a bit later.

“If you thought [AIDS] was affecting their attitudes about sex, you’d expect a rapid decline in the number of 17- and 18-year-olds having intercourse,” says Jeanne Brooks-Gunn, professor of child development at Columbia University. “We’re not seeing that.” Today, the median age for first intercourse is 16.9 years for boys and 17.4 years for girls -- not much different from 1979, when boys started having sex at 15.7 years old and girls at 16.2 years old. By high school graduation, 46.7% of students have had sex.

But teens and young adults have incorporated a measured dose of safety. “Worrying about sex, and using condoms as a way to protect themselves -- that’s what young people have known from the beginning,” Downs says. In 1970, only 22% of women had their partner use a condom the first time they had sex; by 2002, that number was up to 67%, according to the CDC.

There seems to be a generational divide on condom use, Kempner says. “We were the generation where condom use was the norm,” she says. “For people even just a few years older, condom use was something that had to be negotiated.”

Monica Rodriguez is just four years older than Kempner -- a crucial difference, because her sex education classes hardly mentioned the new epidemic. “AIDS was not something we learned about in school. We thought that, unless you were gay or hemophiliac, you didn’t have to worry about AIDS,” she says.

By the time she hit college, the first report of HIV prevalence among college students came out. Though the numbers were small, suddenly everyone knew that the virus was among them -- gay and straight students alike.

“Then it was, AIDS, AIDS, AIDS. Use condoms,” she says. “It was like college campuses were this incubator for sexually transmitted diseases.”

Today, students hear about AIDS in school, but education can be more down to earth when informed teens talk openly to their classmates.

“In school, you only learn the basics, and they focus on abstinence,” says Graciela Ortiz, 17, a recent graduate of Roosevelt High School in Los Angeles.

She spent her senior year giving information to fellow students as a certified family health planner, trained by Planned Parenthood. “They’ll tell you that condoms are more than 90% effective if used correctly, but they don’t tell you how to use them correctly.”

Ortiz believes information can change behavior. And Andrew Francis, a doctoral candidate in economics at the University of Chicago, set out to prove that with an economic model.

Francis put a dollar figure to the risk equation in arguing that the economics of AIDS translates into changing who has sex with whom. He assumes a value to a human life of $2 million. The way HIV is transmitted makes it 3,500 times more likely that a man on the receiving end of anal sex will contract the virus than if he had vaginal sex with a woman.

That translates into this economic bottom line: The cost for a man of having unprotected sex once with a man is $1,924, whereas the cost of having unprotected sex once with a woman who is not menstruating at the time is 55 cents.

Using an economic model, he found that sex, like any other commodity, has trade-offs of risk and benefit, and as the cost increases -- serious illness or death -- people will engage in less-costly behaviors. So bisexual men, who claim an attraction to both sexes, will more often choose women as partners, he says.

Indeed, the percentage of men who said they had a male partner in the last year fell through the late 1980s and early 1990s, then rose again after drug therapy to successfully treat AIDS as a chronic disease became available in 1996, according to the General Social Survey of the National Opinion Research Center.

The cost of risky sex is high enough to become part of an equation once ruled by less deadly considerations such as pregnancy, shame and treatable sexually transmitted diseases.

“Now we have this huge penalty,” says Carol Tremblay, professor of economics at Oregon State University, who has studied teen sexual behavior. “I think kids are taking that into account.”

The economic model also predicts that as the health cost of vaginal sex increases, people will engage in more oral sex. In 2002, 13% of boys and 11% of girls ages 15 to 17 had had oral sex with the opposite sex, but not intercourse, according to the CDC. And many of those teens believe the practice is safe.

The Kaiser Family Foundation found troubling results in adolescent attitudes toward the practice. Some 26% of teens believed, falsely, that a person cannot become infected with HIV through oral sex, and an additional 15% said they didn’t know whether it was possible.

“Is fear of sex a good thing or a bad thing?” says Thomas J. Coates, a professor in the division of infectious diseases at UCLA. “The answer is probably ‘yes.’ ”

Fear, it seems, has taken up residence in the bedroom, the clandestine motel room and the back seat of the family car -- right alongside romance and desire.