Instead, SIECUS provides lessons like those in the old MCPS video, the one the lawsuit helped to eliminate. Here’s what SIECUS says about anal sex, HIV, and staying safe in their pamphlet for youth, “All About Sex”:35 Putting the penis inside a partner’s anus is called anal sex. Many couples (both opposite sex and same sex) choose to have anal sex. All STDs can be passed during oral, vaginal, or anal sex with an infected partner. HIV is passed from an infected person through blood, semen, vaginal secretions, and breast milk. It is also very important to use a latex condom during oral, vaginal, or anal sex, or a dental dam during oral sex.
When sex educators teach that HIV can be transmitted by “any exchange of body fluids—blood, semen, vaginal secretions, and breast milk,” when they say infection can occur via vaginal, oral, or anal intercourse, and when they claim, “Anyone can get HIV,” their message is technically accurate. The problem is, however, that the various “anyones” have vastly different risks—some would say million-fold differences, depending on their behavior.36 It’s like saying, “Lung cancer can be caused by radon, asbestos, tobacco, and air pollution.” The statement is correct, but 80 percent of lung cancers are due to tobacco,37 and a person smoking four packs a day of unfiltered Camels is at much greater risk than someone living in Los Angeles’s polluted air, and everyone would agree he needs to know that.
It’s as if the smoker is being discriminated against, and, that being unacceptable, all causes of the disease must be portrayed as carrying the same risk. You might call it the equal opportunity approach to epidemiology. It goes like this: All individuals face the same risk of illness, regardless of their genetics, diet, use of nicotine, or drinking habits. It’s only fair.
Like the original MCPS curriculum, SIECUS said nothing in “All About Sex” about the highest risk of transmission during anal sex or the increased likelihood of condoms failing. And surely absent is the recommendation to avoid this high-risk act; to the contrary, unsuspecting kids are told, “Many couples (both opposite and same sex) choose to have anal sex.” gURL.COM, a site recommended to teens when they log on to SIECUS, is better. Their “Anal Sex: Fast Facts”38 warns of the dangers:The tissue inside your anus is very delicate and tender, and tiny tears or scrapes can happen without you even noticing.
But the warning refers only to the condom-less act. With a condom,Both women and men can enjoy giving or receiving anal sex, and both women and men can have orgasms from anal sex. Likewise, people of any sexual orientation may enjoy anal sex.
At Planned Parenthood’s site for teens,39 a reader calling himself “Crazylivedevil” has a question for the experts. He and his girlfriend are going to try anal sex, and she is concerned about safety. What, he asks, are the consequences of anal sex? In their answer, they do not even mention of the 20-fold increased risk to his girlfriend, not him, of HIV transmission, or increased risk of condom failure, compared to vaginal sex:Like unprotected vaginal intercourse, unprotected anal intercourse is high-risk for many sexually transmitted infections . . . .Use condoms during anal sex to decrease the risk of sexually transmitted infections . . . it is important to use an artificial water-based lubricant ....It is also important to stop if anything hurts and communicate with your partner about how you feel—sex play that is painful or uncomfortable should not continue....Most people do not enjoy anal intercourse. They should not be embarrassed and should not force themselves to accept it. Many people however, do enjoy anal sex and, for them, it’s perfectly normal.40
Elizabeth Schroeder, chair of SIECUS Board of Directors, is on the medical advisory board41 that reviews the content of Rutger University’s “Sex, Etc.”42 The award-winning site warns teens about the risk of damage to rectal tissue, explaining that tears can make it easier to transmit STDs, including HIV. It also points out that a condom can rip or tear. So far, so good.
Then they turn to the sanitation issue, with the heading, “But, it’s nasty!” What follows is this astonishing reassurance, based on the insights of one Jennifer Johnston, identified as an educator at Planned Parenthood of Western Washington.
While there is a possibility of coming into contact with feces, Johnston reassures that “the rectum isn’t the main storage area for feces. The colon is. So if a person has had a recent bowel movement and eats healthy food and keeps regular, the rectum can be feces-free, especially if it is washed thoroughly before engaging in anal sex.”
Heather Corinna, of Scarleteen, goes further. She not only provides instructions on how to engage in anal sex in her book for teens,43 she introduces readers to “oral stimulation of the anus or rectum.” This, kids learn, is “something people of all genders and orientations may enjoy.”44
Jennifer and Heather would benefit from Dr. Jacobs’s “swirly talk,” don’t you think? In case you forgot, here are a few of the nasty organisms found in the rectum: salmonella, shigella, amoeba, hepatitis A, B, and C, giardia, and campylobacter, among others.
For Heather, ever the social activist, every subject, even this one, is related to oppression. When “Teenie” wonders why anal sex is “a bad thing,” Heather answers:45 It’s not a bad thing when it isn’t a bad thing for you.... But you’re right: there are a lot of negative attitudes about anal sex and the anus. For certain, some of that comes down to a basic fear of or disgust about feces.... But more of it is often based in homophobia and heteronormativity... [unprotected] anal sex does present big HIV risks... but the same risks exist with vaginal intercourse... you can probably see why homophobia has such a big hand here.
Over at the Columbia’s GoAskAlice, a male reader (“well adjusted . . . with a steady girlfriend”) finds himself drawn toward trying anal intercourse, on the receiving end.46 Is he bisexual, he wonders?
Labels, Alice answers, “act like a ball and chain around our desires.” Don’t feel you need to pigeonhole your sexuality into a comfortable box, she advises. “Alice applauds you for getting in touch with what flies your flag.”
That’s it. No warnings or suggestions for this reader who is poised to try out something a former surgeon general instructed the country “is simply too dangerous to practice.”
With the rapid emergence of the new sexual mores and permissiveness in our society as well as a greater acceptance and understanding of sexual deviation by the general public, the surgeon is now confronted with new problems in diagnosis and treatment of unusual anorectal injuries.
So began a report called “Social Injuries of the Rectum” in the American Journal of Surgery, November 1977.47 The article described two cases—one a rectal tear with profuse bleeding, the other a laceration of the colon requiring emergency surgery. Both were due to what the authors called “fist fornication”—“the practice of introducing the closed or clenched fist into the rectal ampulla, upper rectum, and sigmoid colon to achieve sexual gratification.”
Thirty years later, courtesy of Alice48 and Heather,49 teens can easily find guidance—indeed, books are suggested—on how to engage in this behavior and reduce the risk of “social injuries.” I suppose some people would consider that progress. Colorectal surgeons are probably not among them.
What Kids Must Know
As mentioned earlier, all self-respecting microbes have one goal: to find a home and reproduce. The same is true for HIV. And there is no doubt, the deadly virus has an easier time doing this in the rectum than anywhere else.50
Having receptive anal intercourse with someone who is HIV positive is dangerous; the studies confirming this are voluminous.51 The reason is biology—actually, to be more precise, histology. Histology is the study of cells, what they do, and how they are organized. To fully understand how HIV is transmitted, and why a “generic” notion of intercourse is dangerously false, a comparison of the histology of the vagina with the histology of the rectum is mandatory.
For infection to occur, keep in mind that HIV must either enter the bloodstream or gain access to deeper tissues. This makes it a relatively difficult bug to pass along. Consider for example the
highly contagious viruses that cause conjunctivitis (commonly known as pink eye).52 They are easily transmitted on your finger, when you touch one eye and then the other. They can also live on inanimate surfaces, like towels or pillows, and infect you from there.
In contrast, HIV must reach a group of cells in the immune system called “target cells.” Only here can the virus make a home and reproduce. To reach target cells, the HIV must either bypass or pass through a barrier. For example, the heroin addict sharing a dirty needle infects himself by injecting the virus directly into his bloodstream, bypassing the natural barrier, skin. The same is true for persons infected through blood transfusions. The infant nursed by an HIV positive mother is infected when the virus passes through the lining of the digestive system. So the barrier is important to look at: it is the wall the virus must breach to succeed.
Assuming a girl is healthy—without any STIs or conditions that would weaken her immunity—her vagina has some built-in conditions 53 that are protective from the get-go. In fact, one of the functions of the vaginal lining is protection from infection.54 The pH is low, which inactivates HIV.55 Its mucus has anti-HIV proteins.56 Langerhans cells in the cervix can destroy the virus.57 The vaginal wall is 20 to 45 cells thick,58 increasing the distance to be traversed by the virus. Under the wall is a layer in which target cells are found; this area is rich in elastic fibers. Next is a layer of muscle, then more elastic fibers. This architecture allows for significant stretching of the vagina without tears or abrasions. Some researchers believe that HIV is unable to reach target cells in the human vagina under normal circumstances;59 others disagree.60
The rectum has a different structure. As part of the gastrointestinal system, it has a lining whose primary function is absorption, bringing in molecules of food and water. The pH is higher. Most important, the rectal lining—the barrier to be breached—is only one cell thick. Below that delicate lining are blood vessels and target cells. Elastic fibers are absent.
Early in the epidemic, it was assumed that fragility of the rectal barrier accounted for the more common male-to-male transmission. But later in the eighties came a discovery: infection could occur without disruption of the barrier. Specialized cells on the surface “swallow” the virus and deliver it unchanged to target cells.61
Microfold cells (“M cells”) are abundant in a healthy human rectum. 62 Like Langerhans cells in the cervix, M cells are watchdogs that identify foreign particles and shuttle them over to HQ for management by the body’s defense system. An M cell wants to attract microbes, so its surface is sticky.63 When observed with electron microscopy, M cells appear to reach out, engulf a pathogen, and bring it into the cell in a pocket.64 The pocket moves to the other end of the M cell, to immune cells that process the microbe and determine the appropriate response: ignore it or rally against it.
Along comes HIV. It subverts the system, turning M cells into an express lane for invasion. The virus is packaged, transported, and handed over to immune cells that are one and the same as the target cells the virus must reach to cause disease. So M cells facilitate the virus’s job; they Fed Ex HIV directly to a lymphocyte—delivery takes ten minutes.65, 66
Remember Dr. Jacobs’s talk to the Board of Education: feces are packed with organisms that can cause disease. The normal gastrointestinal tract, in fact, has the highest recorded bacterial cell density of any microbial ecosystem.67 So a host of other bugs, not only HIV, can gain entry to the body via the M cell shuttle: cholera, shigella, salmonella, and E. coli.68 No wonder the cell has been called “a potential Achilles heel” in the GI system’s barrier to infection.69
There are no M cells in the vagina. This is not to say transmission of HIV cannot happen there—it can. But for infection to occur, there must be some weakening of the system—an infection like HPV or herpes, an open sore, trauma, cancerous cells.
As former Surgeon General Koop told the nation, “Condoms provide some protection, but anal intercourse is simply too dangerous to practice.” That’s also the message my friend John Potterat told his two sons, his daughter, and their friends.
John has been called “one of the country’s leading epidemiologists”; 70 he was Director of STD/AIDS Programs in Colorado Springs, CO, for almost thirty years, and has authored, as of this writing, 177 scholarly publications about STDs and HIV/AIDS. Before his kids became sexually active, he told them: The anus is an exit, not an entrance.71 This is not the Bible, he said; this is science. The anal lining is only one cell thick, there are M cells everywhere, there is no lubrication, so tissue microtears are common, and access to the blood stream is easy. Unlike the vagina, nature put a tight sphincter at the entrance of the anus. It’s there for a reason: Keep out!
Few parents are STD experts like John P., but your kids deserve the same insider wisdom as his. Go ahead, tell them: The rectum is an exit, not an entrance. Because you can be sure they won’t be hearing that in sex ed class.
The Fight Rages On
Dr. Jacobs is trying to keep the oath she took upon graduating from medical school: to prevent disease whenever she can. But her politically incorrect message isn’t welcome, and she’s worked, on her own dime, to get life-saving facts to students. If their priority was disease prevention, the Board of Education wouldn’t limit Dr. Jacobs’ talk to two minutes—they’d give her an entire day. Instead of being ignored, she’d be given her own national radio show, to share her wisdom and experience with the entire country. Instead of legal battles, she’d be publicly honored. It’s a sad state of affairs when, due to political correctness and social agendas, a professional with wisdom, experience, and passion must wage war to be heard.
Why promote the untruth that anal and vaginal intercourse are alike? What’s behind the notion of “generic” intercourse? It’s the preposterous belief that males and females are the same, and their unions are equivalent. It’s another example of the indoctrination of children with radical social agendas.
Parents must grasp what’s happening in the classroom. The truth of biology—anal sex is too dangerous—is squelched, because it contradicts the ideology of “anything goes—no judgments allowed.” As always, when it’s health versus sexual freedom, freedom prevails. Kids are encouraged to explore their sexuality, and told precisely how; with the experts’ blessings, they go out and play in traffic. Instead of straight talk and hard science, there’s a lesson like “Protect Yourself” and discussion of homophobia. All’s well, goes this thinking, if kids use latex and there’s no name-calling in the halls.
And then we wonder why, after twenty-five years, HIV is still going strong.
Chapter Five
Whitewashing a Plague
IMAGINE THIS: You’ve been faithfully married for years, you have two kids, and your wife’s expecting. One day, you discover a bunch of reddish bumps in your groin. No big deal, you think—it’s some sort of rash. But in a while, they really itch and sting. It hurts just to walk or sit down. You miss a day of work, wondering, what the heck is this? When the doctor says herpes, you explain that that’s simply impossible. But in a few days the email arrives: your blood test is positive. Yes, you have genital herpes—a sexually transmitted disease. What are you thinking?
No need to imagine—you can hear about the entire ordeal from the unfortunate fellow who lived thru it. Check out the herpes support site racoon.com, his handle is learn2luv, and his first post is “New/Confused/Angry/Lied.”
Learn2luv can cope with the blisters, even though they are awful. It’s his fury and confusion that got him unglued. All these years his wife kept her infection a secret—and that really burns. For that pain, the doctor didn’t have any pills. Whom can he talk to? Learn2luv went online, and spilled his heart out.
I’m confused, I’m angry, I’m depressed....She tells me her reasons for lying were a fear of losing me....I was hoping that someone could help me understand why she would lie, why she would take no regard for my health or the health of our children . . . . Please help me deal with this
news . . . deal with the lies... deal with the pain . . . .1
He had come to the right place. Members of the site replied within hours, and the online discussion about his situation—a small part of the 52,000 posts here—continued for days.
“It is hard to think straight when in the middle of an OB [outbreak of blisters],” he was advised.
The Majority of Sexually Active Teens (Age 12–19) Wish They Had Waited Longer Before Beginning Sexual Activity
Source: National Campaign to Prevent Teen and Unplanned Pregnancy 2007
“If you stick around here at [racoon.com]... you will witness firsthand the anxiety people go through at the thought of having the herpes discussion with a partner; all tied to the possibility of losing that person....There are many people who choose to be celibate and alone because they can’t face telling someone. People let this virus do terrible things to them emotionally and yes, people lie about having it or at least withhold the truth . . . we have all been in her shoes, we certainly understand how this can happen.”
Learn2luv was also reminded that his wife may have been misled by her doctor: she could have been told the virus is transmitted only during outbreaks:Your wife might not have lied to you intentionally. Many doctors as far back as 10 years ago and even today are not very educated on this virus and your wife may have been misinformed.
Their input was helpful, but learn2luv felt terribly betrayed. He began to question his wife’s fidelity in other matters. His marriage was in crisis.
I thank you all for your supportive responses . . . . [I] still am not at ease with lying about an issue that can impact the health of someone you love. It makes me feel second fiddle that her shame and image is more important than our relationship.
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