and the judgmentalism that often accompanies it, had a detrimental effect on efforts to prevent STDs as early as the nineteenth century. Reflecting on America's efforts around syphilis during the last century, Martensen (1994:269) wrote:

For the predominant voices in the late 19th-century US medicine and society, humans were divided into good (celibate and on the way to being married and monogamous) or not good (the intentionally single and/or unmarried but sexually active). ... Such cultural bifurcations of innocence and evil presented few barriers to T pallidum [the cause of syphilis], and they made it difficult to develop consistent policies for the treatment and containment of venereal contagion.

The portrayal of STDs as symbols of immoral behavior continues today. This phenomenon was especially evident during the early stages of the AIDS epidemic when some in society considered this epidemic to be a symbol of deviant sexual behavior and lapse in societal moral values. In his book on the social history of STDs, Brandt (1985:186) writes:

Medical and social values continue to define venereal disease as a uniquely sinful disease, indeed, to transform the disease into an indication of moral decay. ... Behavior—bad behavior at that—is seen as the cause of venereal disease [STDs]. These assumptions may be powerful psychologically, and in some cases they may influence behavior, but so long as they are dominant—so long as disease is equated with sin—there can be no magic bullet.

Changing sexual behaviors that spread STDs is an important component of prevention. But in order to establish preferred behavior or to change risky behaviors, parents must feel comfortable talking to their children, individuals must be able to discuss sex with their sex partners, and educators and health professionals must be able to communicate with their students and patients. In this section, the committee describes how the constraints on acknowledgment and open discussion of sexuality adversely impact sexuality education programs for adolescents, open communication between parents and their children and between sex partners, balanced messages from the mass media, education and counseling activities of health care professionals, and community activism for STDs.

Impact on Sexuality Education for Adolescents

Traditionally, sexual behavior has been regarded as a personal issue and involvement by schools or health care professionals has been seen as intrusive. Debates regarding access of adolescents to sexuality education in public schools, family planning services, and abortion services have raised questions about who has jurisdiction in matters related to sexual behavior. Although there is widespread agreement that parents should be the major source of information and guidance for their children with regard to sexual behavior, communication does



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