You oughta know

Head about 175 miles south of Duncanville to another class of 9th-grade Texans-this one in Leander, a town northwest of Austin, but also with lots of students dressed in Jnco jeans or cargo pants, tattered hems scraping the floor. The boys in baggy shirts and the girls in tight sweaters slouch into their seats, with cleaner-cut kids up front and slackers in the back. They turn semi-sullen faces toward Kem Haggard, a middle-aged guy in khakis and a Mickey Mouse golf shirt, whose job it is to help students see that they should wait to have sex until marriage.

But those students are in for a surprise because this isn't your mother's old abstinence class. That message is driven home when the students watch a short video, Just Thought You Oughta Know, produced by the Medical Institute for Sexual Health. It's a quick-cut, MTV-style piece that bursts with constantly changing urban images: teens standing around a trash-barrel fire at night, sirens screaming, or a boy and girl against an eerily lit wall, dribbling a basketball, or kids dancing on a set, against the backdrop of giant male and female gender symbols.

In many of the segments five of the teens are giving in short bursts the brutal statistics of sexually transmitted diseases (STDs), with numbers punctuated by the constant refrain, "Just thought you oughta know." In rap style they say, "About a third of infertility in women is caused by STDs. Just thought you oughta know. Every day about 8,000 American kids are infected with a sexually transmitted disease...." The video is insistent on truth-telling: "Don't hide the truth from us, show us the way," the teens chant. "Or get out of the way and we'll show you."

That tough-minded focus on facts has led the liberal Sexuality Information and Education Council of the United States (SIECUS) to attack the Medical Institute as a "fear-based" organization. SIECUS prefers the rosy picture about STDs presented in Planned Parenthood's prophylactic-pushing website, Teenwire: "Prevent. Test. Treat ... it's pretty easy once you get used to it: Use protection, get tested, and if you need to, take your medicine. It's as easy as one, two, three."

The Medical Institute video doesn't pretend that condoms don't exist and that body organs are unmentionables. "This is a condom," a teen in dreadlocks says while opening a condom package. "It could protect your penis," another teen says. "It might protect your vagina," says another. "It won't protect your mind. It can't protect your heart," they all chime in. "Just thought you oughta know."

The video is a direct attack on the prophylactic empire. For years, under the guise of AIDS education, federally funded programs touted the benefits of condoms. Comprehensive "safer-sex" programs, like those promoted by SIECUS in its 1991 guidelines for sexuality education, urged educators to teach students how to properly use them. Schools in Manhattan and other places began to distribute free condoms to students despite parental protests. Abstinence educators, working on a shoestring, objected to the condom approach but had a hard time countering the data about the necessity and effectiveness of condoms that poured forth from reputable academic journals.

But along came one of SIECUS's worst nightmares, the Medical Institute for Sexual Health, based in Rollingwood, Texas, a suburb of Austin. There, in an old cedar and limestone building tucked away down a dead-end street that winds over a low-water crossing, a staff of 14 labors to provide sound scientific resources to abstinence educators, parents, churches, and government leaders.

Dr. Joe S. McIlhaney Jr., a tall, soft-spoken ob-gyn known nationally in pro-life circles, founded the Medical Institute in 1992. He retired from his medical practice in 1995 because he was becoming increasingly aware of the epidemic of sexually transmitted diseases. "As I talked to physicians and others, most of those people did not realize how bad it was," he said. A third of the cases of infertility that he saw were directly attributable to STDs contracted by his patients without their knowledge.

Dressed in a brightly colored sweater on a cold January day, Dr. McIlhaney has the soothing manner of a long-time physician. He labors in a rabbit-warren of offices, where he has to duck his head as he moves through doorways and into small, cluttered offices. He speaks in measured tones, pausing often to make sure he's being understood, and he stresses the importance of his data. He'll acknowledge that condoms can reduce the risk of AIDS-if they are used correctly 100 percent of the time. He knows that only if his data is trustworthy will he and the Institute be able to influence the debate.

Dr. McIlhaney learned that lesson the hard way. He had assembled a little slide show about STDs, which he used in area high schools. An official from the Texas Department of Health watched one of these presentations and then criticized some of the data because they had come from what Dr. McIlhaney calls "throwaway journals," non-authoritative sources which he had used because they had lively quotes. He asked the official to take the slides back to the Department of Health and critique them, which he did. Then Dr. McIlhaney took the criticism and totally revised his presentation, a process that taught him the importance of "calling everybody to a higher standard of excellence and accuracy."

The Medical Institute has helped to move the abstinence movement toward the use of both fact-based arguments and materials with higher production values that communicate in secular surroundings. Since 1992 it has analyzed the data and published readable reports that have been used by parents and educators, as well as policy-formulating state and federal government leaders. Dr. McIlhaney says, "Sex is like driving. Driving can be good or bad.... Sex is very much the same way. It can be risky.... We want to be honest. What are the stats? What are the data?" And what the data say, according to Dr. McIlhaney, is that "condoms don't make sex safe enough for a single person."

In its Just Thought You Oughta Know video, the Medical Institute shrewdly plays the generation card. "Yeah, we're young, that doesn't mean we're stupid," one teen says. "Just because some of our parents had no self-control doesn't mean we don't. Maybe we're smarter. Maybe we're stronger. Maybe we're wiser than they were." The video stylistically places the abstinence movement among the thoroughly hip and at the same time plays to the idea of being willing to stand against the crowd. After emphasizing the statistic that 8,000 American kids are infected with an STD every day, one teen writes the number 7,999 on a clear marker board and says quietly, "Not today."

According to the Medical Institute, the number of teens who are virgins is increasing for the first time in 20 years; pregnancy rates, birth rates, and the number of abortions are declining. The federal government for once is playing a positive role: As part of welfare reform, Congress amended Title V of the Social Security Act to include funding designed to encourage the development of new abstinence programs. According to the National Center for Abstinence Education (NCAE), an independent group set up to monitor the spending, $437 million in state and federal dollars has become available to fund programs that advocate abstinence until marriage.

The Sex Information and Education Council of the United States, of course, has gone on the attack. SIECUS president Debra Haffner has complained that "the federal abstinence-only program is beginning to change the landscape of sexuality education."

Evidence of the change became stronger last month when two groups that support "safer-sex" programs, the Alan Guttmacher Institute and the Kaiser Family Foundation, released studies showing that many school districts had turned away from their comprehensive sex-ed policies and were now emphasizing abstinence. A third now require abstinence-only programs, but more than 80 percent require that the programs emphasize abstinence. Only 14 percent still require comprehensive safer-sex programs.

Although the trend is encouraging, the larger question is whether students are keeping the pledges they make to remain abstinent until marriage, or if they already have had sex, to commit to "secondary virginity." Last month American Medical Association delegates voted to accept a report that said "little evidence is available to support the effectiveness of an abstinence-only approach in delaying the onset of intercourse among adolescents." The report went on to praise safer-sex programs, saying "safer-sex programs that are comprehensive in nature show promise with respect to changing student attitudes and behaviors."

The Medical Institute criticized the AMA report for saying that abstinence programs had not been subject to rigorous evaluation, and then attacking them for being ineffective. It will take several years for adequate evaluations of the new programs to be done, and Dr. McIlhaney is looking for such a dramatic decrease in teen pregnancy and STDs that even the most biased evaluator or jaded journalist won't be able to ignore the evidence.

"Wise up. These are not the good old days. Grow up. Sex is not a game," the new video proclaims. "Can't change the past. Can decide what I'm going to do today. And tomorrow. And the day after." That forward-looking message has put the Medical Institute in a position where it is setting the agenda rather than just responding. And it is leaving SIECUS's Debra Haffner muttering. Dr. McIlhaney smiles and says gently, "SIECUS is clinging to the old attitudes. She means well."