Institute of Medicine calls for fundamental change in American attitudes toward sexuality

United Press International (Washington). Tuesday, 19 November 1996.

WASHINGTON, Nov. 19 (UPI) – The Institute of Medicine called Tuesday for a fundamental change in American attitudes toward sexuality as part of a big effort to reduce sexually transmitted diseases.

The United States has the highest rate of curable sexually transmitted diseases (STDs) of any developed country, costing taxpayers at least $10 billion a year, said a new report from the medical arm of the National Research Council. The cost would be even higher if it included incurable diseases like AIDS.

One of the primary obstacles (to reducing the diseases) is this country's reluctance to openly confront issues regarding sexuality and STDs, said the report.

Rates for some of the diseases are 50 to 100 times higher than those in other industrialized nations, commented Dr. Helen Gayle, director for the STD, HIV and TB center at Centers for Disease Control and Prevention. She seconded the concerns described in the report and warned that our future success depends on a willingness to talk directly about conditions that were once only whispered about.

Sexually transmitted diseases were considered dirty diseases, said committee member Dr. Kathleen Toomey, state epidemiologist for Georgia. Public attitudes haven't changed much.

Even her own mother asked her not tell the mother's classmates at a school reunion that Dr. Toomey studied sexually transmitted diseases. If I can make my mother happy about I do, we'll have done a good job, she said.

People may maintain that nice people like them don't get such diseases, but the reality is sexually transmitted diseases are very widespread, Toomey said. One out of two or three Americans will catch a sexually transmitted disease during his or her lifetime, she said. Each year, doctors diagnose 12 million new cases.

Studies in parts of Washington state and California, she said, have found that one out of four female college students had a chlamydial infection. Women often do not know they have the common infection, which raises the risks of pelvic inflammatory disease and ectopic pregnancies. Out of the illnesses that must be reported to the Centers for Disease Control and Prevention in Atlanta, five of the 10 most prevalent are sexually transmitted, said the report.

These diseases are quite prevalent among all sectors of society, Toomey said. She described an affluent community outside Atlanta that has been jolted into awareness of the disease problem by an outbreak of syphilis among 15- and 16-year-old girls.

The United States' high rates of disease do not mean that Americans are more promiscuous than other industrialized countries, Toomey said. That's simplynot the case.

Instead she blames the high rates of U.S. disease on an incredible dichotomy in American society that frowns on personal discussions of sex and its consequences but allows a glorification of sex in the media.

In our country, physicians are very uncomfortable with taking sexual histories, she said. Her own med school education, the finest in the country, did not mention chlamydial infections or techniques to help patients discuss their sexual issues.

To change the attitudes and reduce the disease rate, the committee called for highly visible and strong leadership and support from both the public and private sectors.

The report calls for wider coverage from health plans for disease screening. A number of plans reimburse for diagnostic tests only if someone has symptoms, but in women, sexually transmitted diseases are mostly asymptomatic until there are complications, Toomey said. Letting the diseases wait until complications develop causes unnecessary misery as well as leaving more time for people to spread the disease unwittingly.

She praised a study by Group Health in Seattle that showed screening participants for chlamydia paid for itself in reduced costs for care of complications like pelvic inflammatory disease and ectopic pregnancies. This is not just an insurance issue or a government issue, said Dr. David Satcher, director of the Centers for Disease Control and Prevention. A number of players are going to have to step up to the plate.

Citation:

Institute of Medicine calls for fundamental change in American attitudes toward sexuality. United Press Int (Washington). 1996-11-19

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