Researchers have noted that it is unethical for governments and other public institutions to promote low alcohol intake as a disease prevention measure because of the potential adverse risks at the population level, but they also note that it is similarly unethical to promote abstinence (Holman and English, 1996). In an editorial accompanying publication of a large study by the American Cancer Society, a question was raised about whether alcohol consumption is the method of choice for preventing cardiovascular disease. One important consideration is whether physical activity and diet would be as effective as moderate alcohol consumption-with lower risk of harm—in lowering cardiovascular disease mortality (Potter, 1997). The data on physical activity and some dietary factors would seem to suggest that they are equally effective, and they have the additional benefit of reducing risks of many other diseases.
Sexual relationships and practices are complex to investigate, but their study is important because infectious disease has always been a possible outcome of sexual relationships, as has unwanted pregnancy. Both are crucial public health issues of our time. Recently released figures show that the United States is among the highest in incidence and prevalence of sexually transmitted infection (also called sexually transmitted disease) in the industrialized world (USDHHS, 2000).
Concern about AIDS has been an important motivation for recent studies of sexual behaviors, including a large national survey of sexual behaviors and attitudes (Laumann, 1994). Most of the issues that arise in relating sexual behavior to risk of infection with the human immunodeficiency virus (HIV) pertain to many other, far more common, sexually transmitted infections. But HIV has made unsafe sex a matter of life and death. In 1995, there were more than 43,000 deaths from AIDS in the United States, making it the eighth-leading cause of death in that year, and the leading cause of death among Americans 25–44 years old (Anderson et al., 1997). It is now the second-leading cause of death among all Americans aged 25–44, but it is the leading cause of death for African Americans in this age group (USDHHS, 2000). Other, more common sexually transmitted infections—human papilloma virus, gonorrhea, chlamydia, and genital herpes—vary in the severity of their consequences; but if left untreated, these diseases can compromise health and even become life threatening.