By Reporter
NBC News
updated 4/20/2005 3:30:46 PM ET 2005-04-20T19:30:46

Growing up in North Carolina, Charles Smith was the all-American guy. Being built, good-looking, and a good athlete, he caught the eye of many women in town.

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Now, nearly 10 years after being diagnosed with full-blown AIDS, you can still hear shades of disbelief in his voice as he admits, “I never used condoms. I used to look at myself and say, ‘I am built, I am stocky, and I am indispensable.'”

The diagnosis shocked both Smith (not his real surname) and his wife, since he never thought he could be at risk.

“All I knew about HIV was it’s a gay man's disease and I definitely ain’t gay.”

Since Smith’s diagnosis, he has gone on to become a leading speaker on HIV/AIDS and drug awareness with AIDS in Minorities, a nonprofit group based in Alabama. 

Although he once thought he was not at risk, Smith says the demographics of HIV/AIDS have grown to become an inclusive disease, crossing socioeconomic backgrounds, age, race and sexual orientation.

STDs on the rise
The Centers for Disease Control and Prevention reports there are more than 65 million people living with incurable STDs in the United States, and at least one in four Americans will contract an STD at some point in their lives.

Most alarmingly, there are nearly 1 million Americans currently infected with HIV/AIDS, and nearly 20 percent of them are unaware of their diagnosis. Now, African-American women are the fastest growing group of people infected with the virus in the United States.

Recent reports show that nearly one-fourth of all STD infections occur among teenagers, with female teens having the highest rates of chlamydia and gonorrhea. And, while the  diagnoses rates for gonorrhea and syphilis have remained steady, chlamydia infections have nearly tripled since 1990.

Treatment of STDs annually costs the United States $17 billion, and experts predict STD rates will continue to rise as long as Americans underestimate their risk levels.

Is abstinence education the answer?
In his 2006 budget, President Bush proposed a $39 million increase in federal funding for “abstinence-only-until-marriage education,” bringing its total funding to nearly $193 million annually.

Often run by faith-based organizations, abstinence-only-until-marriage education is frequently criticized for excluding information about condom usage, abortion, masturbation and sexual orientation.

“What is born out by scientific evidence is that comprehensive sexual health programs are more effective than abstinence programs. Safer sex programs delay the onset of sex behavior, reduce pregnancy rates and increase likelihood of condom use,” says Dr. Michael Carey, who runs The Center for Health and Behavior at Syracuse University. 

“Safer sex programs not only include the message that abstinence is the more effective strategy, but also talks about self-management strategies and personal skills. In contrast, a sexual abstinence program does not cover these issues,” he said.

Dismay over funding
While abstinence-only-until-marriage education programs have received a boost in federal funding, the CDC’s funding for HIV/AIDS related research and programs has received a $4 million cut, much to the dismay of many researchers on sexual health.

But not all experts shun abstinence programs. Borris Powell, program director of Gay Men of African Descent, says he favors abstinence programs. However, he believes that faith-based initiatives fail when abstinence is not presented as a choice but as the only option. Like other experts, Powell’s main criticism of both programs is their failure to address existing issues and how these factors may impact sexual behavior.

We need to focus on  behavior and how to persuade someone to change their behaviors,” says Tony Morris, a licensed therapist and director of AIDS in Minorities in Alabama. “And we can talk about abstinence, but did everybody stop using drugs just because Nancy Reagan said,  ‘Just say no?’”

Social issues, such as emotional wellness and substance abuse, can make long-term safer sex practices challenging, says Morris. Morris says focusing on these factors is the only way to change behavior and reduce STD transmission rates.

“I think HIV (and other STDs) are diseases of convenience,” says Morris. “And by focusing on the disease and not the behaviors, it does not address the issues that face many Americans.” 

Underestimating sexual risk
The rising rates of STDs are a combination of people underestimating their personal risk and being misinformed, according to Carey. 

Carey points out that in lasting relationships, individuals often underestimate their personal vulnerability by assuming that both they and their partners are invulnerable to STDs. “People see being in love with their partner as making sex less risky, but microorganisms don’t respect love.”

Trust and the length of a relationship are the primary predictors of risky behavior and condom use, says Dr. Peter Vanable, whose research on HIV/AIDS at Syracuse University is funded by the National Institutes of Health.

Vanable says that individuals normally practice safe sex at the onset of a relationship, but, “once you get past the first couple of weeks, the condoms usually go out the window.”

“As trust develops, the likelihood of perceiving someone as having HIV goes down rapidly, and after a relatively short time,” Vanable said. “That is not because people have gotten tests. It is because of social psychological processes, not based on knowledge about what they know about their partner, but based on personal feelings and trust.”

For some, even a lack of trust does not prevent risky behavior. Tracey Pope, a 26-year-old single female, admits that she has not always used condoms in the past, despite having multiple partners and not discussing STDs and HIV with them. 

Feelings and trust lead many to engage in risky behavior because sex is often easier to perform than to discuss, researchers say.

Pope admits that she enjoys sex but is too uncomfortable to discuss it with her partners. “I think with me it’s an uncomfortable question and topic. Just talking about diseases and all the negative aspects puts a downer on the whole act. Even though I know it is something that should be discussed.”

Drug use linked to spread of STDs
Substance abuse is another issue believed to have an important impact on risk perception and STDs. The association comes primarily because misuse of substances often leads to unwise decisions regarding health consequences, sexual risk and long-term health care, says Morris.

Substances are also used as a way to escape the realities of STDs and other risky behavior.  Dr. Paul Chambliss, a general practitioner and HIV/AIDS expert in New York, says some new theories suggest that substances such as crystal meth are purposely taken to impair one’s judgment and to subvert the guilt often associated with unprotected sex. “There’s an interesting theory that … you take the drug that will allow you to do the things you want to do.”

Vanable agrees saying, “social circumstances or baseline level of function makes long-term safer sex practices more challenging.” Vanable adds that when individuals are depressed or vulnerable to various social difficulties, their health often becomes a distant concern in light of their needs for a sense happiness, love and affection, or validation.

“Sometimes people mistakenly equate sex with love,” says Morris. “And sometimes people from dysfunctional families may have a void they feel they can only fill through sex.”          

Chambliss says studies and programs that simply pass out condoms are ignoring crucial issues and should pay more attention to these underlying factors.

Social issues and behavioral change
“The way we talk about sex in this country reflects our history. It is often used politically as a wedge issue,” Carey says. “We have a societal reluctance to discuss sex. And when we do talk about it, we talk about it in a moral way versus as a health issue.” 

Referring to people such as Pope and Smith, Carey says that when individuals do not think of sex as a health risk, it opens them up to behaviors that may have a significant negative impact down the road.

These behaviors compounded with social problems significantly impact sexual behaviors and can determine whether people will protect themselves now, Morris says. “You have to understand how all of these issues work together.”

As people cope with drug addiction, poverty and emotional well-being, they do not always focus on their health and the negative consequences of their actions. This is where the government has failed and will continue to lose the battle against STDS, says Morris.

“Without addressing the social issues associated with risky behavior, individuals will continue to act irresponsibly.”

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