Monday, January 19, 2009

Abstinence and Atheistic Religion

I recently read this and, due to a terminal lack of creativity, resolved to exploit this post for a topic of my own, and then promptly died. Fortunately there was another me to take my place, and this – dear imaginary readers – is due to sex.

Human beings, by and large, have a strong desire to engage in sexual activity – it’s one of the things which has allowed our species to flourish and survive as long as we have. In addition to the replacement me, it’s also produced innumerable (well, 106 billion, or 45 – 125 billion, according to the legendary researcher citation needed of U-wiki) human beings over our species’ history. Sex makes babies (a shock, I know), but that desire to procreate has, over these millions of generations, generated a lust for sexual contact more often than is strictly required. This gross unfairness to Dungeons & Dragons fans everywhere has far more dangerous consequences, however, for those unfortunate enough to be attractive. Were there to be studies done on teen pregnancy and STD prevalence among the former populace, I’m certain they’d be an inspiration to Christians everywhere. (Except for the whole Satan worshipping thing they all do.) Sadly however, where abstinence is a choice, it fails about as badly as an Emmental condom. (cheesy joke) {in incredibly bad taste} [dear god, must stop] (please do) {blog post continues}.

Abstinence is a good idea to avoid pregnancy and STD’s. That’s pretty much beyond doubt, and furthermore, it should – ostensibly – be the easiest to implement as it requires no other apparatus than a willing mouth. Excuse me, it’s difficult to put the subject matter firmly out of my mind, I’m trying my breast. Unfortunately, this wonderfully simple Utopian ideal has shown itself to be point of contention, and a remarkably sticky one at that. As Ken Binmore says “Utopians aim at first-best solutions that inevitably fail, leaving us with a third-best solution or worse”, this is clearly illustrated by the effects of abstinence-only (hereafter jauntily referred to as Ayoh) sex education in the USA.

Underhill et al. reviewed 13 trials of Ayoh programmes in the US, surveying some 16 000 youths and concluded that there was no effect on “incidence of unprotected vaginal sex, number of partners, condom usage, or sexual initiation”. Score! Oh wait, no, that’s bad news. There’s more of the same from a 2008 editorial in the AJPH by John Santelli, where it turns out Ayoh programmes tend to be driven by ideology. Who would have thought, (if they’d been allowed to)? Furthermore, those which are most ideologically driven, in the form of Virginity Pledges, have no effect at all on preventing amorous behaviours, are frequently recanted, or opted into post-sexual-intercourse, and are correlated with underestimating the risk of STD infection from sexual activity. Pledges don’t work, Ayoh doesn’t work – and Uganda is not some kind of miracle story, for those about to raise that issue.

ABC – Abstinence, Be Faithful, Condomise.

Sure, abstinence is in there, but the evidence suggests that it’s not enough. Especially (though I am loathe to generalise) considering that customary polygamy is still widespread in many parts of Africa. Fundamentally, one of the issues noted by the Ugandan government is that Abstinence is an imperative that is incredibly difficult to sustain. Anecdotally, we can describe this as familiarity breeding contempt, or familiar contemptuous breeding if you are so inclined, but the issue ranges further than mere saturation of the message. For this kind of insight, we have to examine how we act when we’re aroused versus how we act when we’re not.

Dan Ariely wrote about this in his book Predictably Irrational, taking students from UC Berkeley and having them answer questionnaires in both unaroused states and those of arousal. Students were roughly 25% more likely to engage in some kind of risky sexual behaviour in the aroused state. One example of which was not going to get a condom if it might decrease their chances of completing the sexual act (30% increase). Ariely writes “…’Just say no’ assumes we can turn off passion at will, at any point…”, a notion which is attractive to our conception of free will and responsibility, but totally irresponsible when we consider the data gathered on this subject.

At this point I’m sure you’re asking “But, “I”, how can you possibly have written such a boring article about sex… it’s sex for god’s sake”. Lie back and think of England, dear (imaginary) readers, and I shall impress myself upon you.

The blog post I linked to above is a trifle confusing. Like an inverted nipple, its point is elusive. What it seems to suggest is that there is an ideological reason for dismissing Ayoh education. The atheists have a problem with anything they perceive as coming from a religious background, and they think Ayoh does. First (base), allow me to offer a potential mantra for these bigoted, disgusting atheists.*kissez*

Second, it’s quite simple that reality dictates this position, not any massively evil posturing. Denying the virtue of a good idea for ideological reasons is utterly shameful, and one of the reasons why Ayoh programmes should be being beaten to death by a condom gloved boxer. The evidence is against these programmes, and we should be placing the emphasis on those areas most likely to affect a change. *squeeze squeeze*

Third, and most closely related to the inspirational post, none of the examples mentioned therein promote abstinence per se, only virginity in women. They’re not rejecting “sex outside of marriage” they’re rejecting the appropriation of their property. A wonderfully ridiculous idea “new and unproven – that people have to have their sex” is just begging to be severely fisted. What exactly is new, or unproven about the hypothesis that sexual desire is a powerful motivating factor in human existence? Furthermore, “abstinence has been around a lot longer than the concept of multiple partners” is an equally risible contention. No, sir, this is not the case, unless you consider the important part of that sentence to be “concept”. Abstinence is a delightful idea provided we are in the situation that modern society finds itself. The survival of the species has for the most part been based on having as many (surviving) offspring as possible, as fast as possible. Holding off from sexual desire is simply not something that humans evolved to do, thus, it’s difficult for us to do so at the drop of a hat (even more so at the drop of a skirt). *schlick/fap*

Sliding into Home, Abstinence is largely an idea foisted onto us by the remnants of patriarchal norms about “purity” and other ideological absurdities. It is a great way to avoid pregnancy and STD’s but doesn’t work at deterring sexual behaviour on its own, and cannot be considered a reliable way to solve the problems created by sex. Some of the evidence even suggests that those exposed to Ayoh programmes have a substandard understanding of the risk of STD’s, and simply define other sex acts as “outside” the realm of abstinence.

Cectic makes the absurdity of Ayoh quite clear, but to be honest, by now I’m just flailing around in the dark (as if the first three bases hadn’t made that clear) because there are no references and no coherent line of argument in the post that provided my inspiration. If we include the comments section as fodder for discussion we can be slightly more fruitful, but not much. The reason abstinence shouldn’t get as much attention in serious anti STD/HIV/Pregnancee programmes is because it’s just not as effective to advocate “just say no” than it is to make sure that when resolve slips, as it invariably does for the vast majority of people, there are alternatives available which can stem the epidemic, lower rates of unwanted pregnancy, and the spread of STD’s and still allow for the kind of sexual contact which so very many people crave. Ayoh? Just say No (oh)! (and thus my contrived reason for using the shorthand).

So, was it good for you?

Some references

Uganda AIDS info:

http://www.aidsuganda.org/npdf/aidsstory.pdf

Virginity pledge retractions:

Janet E. Rosenbaum, Reborn a Virgin: Adolescents’ Retracting of Virginity Pledges and Sexual Histories, American Journal of Public Health 96:6 (2006) pp. 1098 – 1103.

Review of Abstinence Only programmes for HIV/AIDS infection.

Kristin Underhill, Paul Montgomery & Don Operario, Sexual abstinence only programmes to prevent HIV infection in high income countries: systematic review.
doi:10.1136/bmj.39245.446586.BE

Editorial on accuracy of info in Abstinence Only programmes

John S. Santelli, Medical Accuracy in Sexuality Education: Ideology and the Scientific Process, American Journal of Public Health 98:10 (2008) pp. 1786 – 1792.

12 comments:

  1. Thanks for the link to my post. ;)

    Before we start, perhaps I should define what is meant by "abstinence". Abstinence does not mean "no-sex ever". Abstinence generally is used to mean "no sex outside of marriage".

    HOWEVER (sorry to disappoint anyone reading this or my blog with the hope of crucifying ignorance) -- this isn't a post to promote abstinence only. It's to promote balance.

    "Furthermore, “abstinence has been around a lot longer than the concept of multiple partners” is an equally risible contention."


    So, in the context of the above definition, when I say that abstinence has been around for a much longer time, it is correct. Sex has always been societally considered a function of marriage. And marriage has been considered a condition of faithfulness - even in polygamous society.

    An African friend once corrected me when I said, the problem is polygamy (meaning "multiple partners"). He said, no.. because polygamists are generally faithful to their spouses. The problem is in multiple boyfriends/girlfriends.

    "abstinence is largely an idea foisted onto us by the remnants of patriarchal norms about “purity” and other ideological absurdities."


    One of the points I was making in my blog "Abstinence Isn't A Christian Idea" is that "self-control" has been practiced for thousands of years in non-christian societies. It's not a "purity" issue as you seem to want to make it. (Of course once we make it a purity issue, we can dismiss it - which i find quite convenient)

    "A wonderfully ridiculous idea “new and unproven – that people have to have their sex” is just begging to be severely fisted. What exactly is new, or unproven about the hypothesis that sexual desire is a powerful motivating factor in human existence?"


    Of course we are sexual beings and are created with the passion to reproduce or else we wouldn't survive. However, there seems to be a thought that if you do not have sex on a very regular basis, that your balls will turn blue and you will explode. It is on this basis that I feel that people throw out abstinence all together (I'm speaking in generalities). Is it necessary for a 16 year old to have sex? Will they harm themselves if they do not?

    Again... when i mention the term "non-proven" it is in the context of, societal acceptance of multiple boyfriends/girlfriends, being a new concept. 50 - 60 years ago this was not the case. The way society looks at sexuality today is not the same as a couple generations ago.

    **
    However bad we might want to polarize this issue and make it seem like a Christian vs. Reality one, the truth is that it is not.
    (read my lips)
    * People need to use (and learn to use) condoms
    * People need to learn to be faithful to their sex partner (whether they're married or not)
    * People should not exclude abstinence as a violable solution for non-married individuals.
    * Christians need to realize that the world is going to have sex and we had better find some working solutions
    * Non-Christians need to realize that abstinence can help a 16 year old not contract HIV/AIDS

    My problem is not with people having sex. I like Sex. My problem is with people having sex, contracting HIV/AIDS and dying.

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  2. I wanted to add one more thing (as if i havent already bloated your comment page)

    "...that when resolve slips, as it invariably does for the vast majority of people, there are alternatives available which can stem the epidemic, lower rates of unwanted pregnancy, and the spread of STD’s and still allow for the kind of sexual contact which so very many people crave."

    This is a wise statement (somewhat ;) ). I agree that resolve slips and people had better know some ways to protect themselves. That's reality.

    Your last statement I found interesting .. "the kind of sexual contact which so very many people crave" - which i'm assuming means sleeping with as many people as they desire. This was one of my points - in the face of this worldwide catastrophe, people are blinded to the thought of not-having sex for a time being (as if it would kill them). Unfortunately, promoting agendas/solutions with the intent of maintaining the sexual status quo (which is what is spreading the disease) doesn't seem rational to me.

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  3. non-rational in the same vein as coming up with better liposuction methods to combat obesity

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  4. The evidence suggests that the "wait until marriage" directive doesn't work. That's my primary complaint.

    The institution of marriage is, I'm sorry to tell you, a relatively recent invention in the history of our species. Whether we practiced enforced monogamy before that is a different matter.

    "Sex has always been societally considered a function of marriage. And marriage has been considered a condition of faithfulness"

    No, this is not true. First, because Sex predates the invention of marriage, and second because it is culturally expected of married men in some areas to take a mistress, or many mistresses. I concede polygamy was the wrong word to use to describe this practice, and hope that reading the Ugandan .pdf will describe the practice in question.

    Self-Control is only a virtue AFTER we've decided that having a single sexual partner is a good idea, and even then, the rate of infidelity is massively high. In short, people cannot be trusted to simply "not have sex"

    "...Is it necessary, 16 year old..."

    Is it *necessary* for ANYONE to EVER have sex, except for the purpose of procreation? And the norms 50-60 years ago do not describe the norms 500-600 years ago, nor 5000-6000 years ago, nor 50 000 - 60 000 years ago. I'm sure you get the idea.

    "...which I'm assuming means sleeping with as many people..."

    I wasn't trying to imply "many partners" by saying the "kind of sexual contact which so very many people crave". I was stating that there is no good reason to stop a committed, loving couple from engaging in pre-marital sex when there are methods for making it a largely safe activity. People should be encouraged to behave responsibly, Abstinence is mentioned as an option. We know from the studies that it won't work for the majority of people, whereas condoms will. That's why the push is on those things, it's easier to make the force of nature safer, that it is to quash the force altogether.

    I really can't comment on the "people think not having sex will kill them, etc. etc." because I don't think I've ever encountered this idea before. Most people want to have some sex, they'll feel that desire regardless of whether they have been told not to, and that desire manifests itself as a strong feeling that can easily be compared to a "hunger" or "craving". Self control is fantastic for those who can manage it, but the emphasis needs to be on the majority who can't.

    Your definitional changes don't seem to do much to support the argument you try to make, and you've failed to engage with the thrust (har har) of this piece in that - for the vast majority of people - telling them to abstain JUST DOESN'T WORK.

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  5. Yes, it was good for me! :)

    As with most things, education seems to be key. And also self-respect and self-confidence. A teenager may know everything there is to know about sex and its risks, but may still engage in risky business if he/she does not respect his/her body or does not have the confidence to insist on safe sex.


    Great post! Can't wait for the next one.

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  6. Hey. Thanks for the comments Heidi.

    I agree that education is important, it's quite interesting to look at the stats on how even educated people make stupid decisions though. The biological mechanisms of desire make it a tough battle to win. That book by Dan Ariely really is great, I encourage you to take a look at the "arousal" experiment specificially.

    Oh, and also to spread the word about this blog. My populace of dear imaginary readers needs enlarging. (I get e-mails about this all the time)

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  7. Excellent stuff boytjie... See, I was right about you and blogging...

    The cheese thing was... painful. (Painfully funny? Funnily painful?).

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  8. I know it's been a long time since this blog was typed - but finally getting back to commenting on a few things:

    While not disagreeing with the importance of condoms I need to point out the illogic (bias?) in your statement that abstinence does not work:

    You point out that after 5 years (or however long) that the rates of HIV/AIDS infection in Uganda is rising - so of course the abstinence program must not be working and thus abstinence doesn't work.

    However, the very fact that you had 5 years of HIV rates dropping proves that abstinence DOES work (proved by the fact that rates dropped during those years). The real question is why after 5 years did the rates start to rise again.

    Now as a scientist/skeptic/whatever, you need to look at the results , recognize that you might be onto something and isolate the stray variable to try and find complete success (in this situation, after success, why did it start to rise again?). Much like the scientist in the generic sci-fi movie ("At stages 1 and 2 the enzyme stays together, but then falls apart in the late 3rd stage. We need to figure out how to stabilize it in the 3rd stage"). In other words, scientific success comes in steps of progress.

    So why so quick to toss out anything having to do with abstinence?

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  9. No problem on the age of the post, but I'm concerned you may be hallucinating, in that I don't mention what you say I do.

    Go ahead, read it again, I'll wait. If you find something like that, feel free to cite it.

    That aside, I think you may be confused as to how we can attribute a causal relationship between two things:

    If the rate of infection was dropping with an abstinence ONLY programme, then perhaps we could claim that it was the ABSTINENCE that was causing any reductions, but as we can see from the other studies I listed, when we are talking about Abstinence ONLY programmes, they just don't work.

    If we have data that suggests that Ayoh programmes don't improve things, and that combination programmes do, it is logical to assume that the improvement comes from the other factors in the combination, although I agree that in theory there may be some kind of emergant property of the combinations themselves.

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  10. "The evidence suggests that the 'wait until marriage' directive doesn't work. That's my primary complaint." -- comment #4

    "...Abstinence is mentioned as an option. We know from the studies that it won't work for the majority of people, whereas condoms will" -- comment #4

    I would say that the programs you are mentioning are ones that are based in countries or areas where other non-abstinence programs are also being ran at the same time.

    The thing which was so unusual about Uganda was the governments running with the program on all levels - something which cannot be compared, say with the USA or RSA, where there are plethora of other programs working as well.

    However, I'm not fighting for abstinence only programs (i'm actually not fighting at all) but just pointing out an interesting piece of data of which I'm curious as to why it is so disregarded.

    Thank you for your agreement in the end of your last reply.

    Cheers

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  11. If you would be so kind as to point out the actual data of which you speak, and reference it. Then I could address your claim. At the moment, you just aren't being particularly coherent - with no offense intended.

    What evidence do you have that abstinence works?

    I'm concerned you may be misunderstanding me. My "agreement" accepts the *possibilty* of Abstinence WITH other efforts may work better than JUST other efforts on their own. However, looking at Abstinence ONLY efforts - they are virtually useless.

    If you can provide any data to the contrary, go for it. If not, explain your own "bias" for believing that calls for abstinence are effective?

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  12. Jesus. What a pile of tl;dr.

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