James F. Keenan

When I was about six years old, I went to my dad and asked him, “Where do babies come from?” He told me to take a look at the guppies in our fish tank. My mom says I stood transfixed in front of the fish tank for several hours each day for a week.

Seven years later I tried asking my dad the same question. “Here, son,” he said as he gave me a copy of a book on human reproduction. “If you have any questions, you can ask me.” I didn’t.

My dad was a commanding officer in Manhattan South Homicide Squad (the very same position that Kojak had). He was not known for fear or squeamishness, and he and I talked about many things, but not about sex.

These memories came to me often over the past few years as I sat at meetings discussing responsible sexual health. This began when I and several other Christian and Jewish ethicists were invited to a three-day meeting in Newport, R.I., in December 1999 with 100 national experts on sexual behavior. At that meeting, we became convinced that many Americans are not able to talk with their children about sexual health and responsible sexual behavior because many adults do not converse with anyone about sexuality.

As a people, we are not well versed in sexuality, nor are we familiar with the skills to develop such conversations with anyone, even our own contemporaries. In a word, then, we do not talk to our children about sex because we do not talk to one another about sex. But while we remain quiet on the topic, the media bombard us and our children with sexual stimuli that leave us breathless and dumbfounded. Yet efforts to promote such a discussion can become in themselves dangerous, as Dr. Joycelyn Elders learned some years ago.

Subsequent to the Newport initiative, 25 of us went to Washington, D.C., to report to the surgeon general, David Satcher, M.D. We asked him to take action to promote national conversations about sexual health and responsible sexual conduct. We asked him this, not only for the benefit of our children, but of all people. Among the dozens of questions discussed, the surgeon general asked at one point: “What about the clergy? Don’t they know about sexual health?” A Jewish ethicist, a rabbi, answered, “No. They don’t. There is very little training, and like many Americans, they also do not know where to go to get that information.”

When the rabbi spoke, I thought of all the generations of young (in many instances adolescent) men and women who, upon entering seminary and religious life, were told to leave their sexuality behind as they entered. I thought, for instance, of the essay by Jon Fuller, S.J., “Priests With AIDS” (Am., 3/18/00), in which he recounted the same directive: leave your sexuality outside the door. I thought sadly of these priests and all the other religious and seminarians who were given these same orders and of all the pain, embarrassment, awkwardness and shame that these otherwise generous people inevitably experienced when they found that they could not leave their sexuality outside the door. “Don’t the clergy know about sexual health?” I thought, “The surgeon general has asked a valid question.”

At the surgeon general’s direction, a steering committee was convened to plan and carry out another conference to develop recommendations for a call to action on sexuality by the surgeon general. In July 2000 we met in Warrenton, Va.—more than 130 persons representing 90 organizations, collaborating over three days to develop the conceptual framework for the document. Then came the drafting committee, then the national elections, then Florida, then the inauguration. Finally, in July 2001 the surgeon general released his Call to Action to Promote Sexual Health and Responsible Sexual Behavior.

The nation’s major newspapers covered it, and most editorials hailed it as balanced, courageous and wise. Likewise, the heads of the American Academy of Family Physicians and the Kaiser Family Foundation both praised the report. The Bush administration, however, distanced itself from it and from Dr. Satcher, a Clinton appointee whose tenure concludes next year. The Christian Coalition of America issued a brief comment: “Regrettably, the report devalues the merits of remaining abstinent until marriage, ignores the soundness of abstinence education, and criticizes any kind of moral or cultural disapproval of homosexuality. It is an affront to the values of people of faith.”

The report is roughly 20 pages long, with an extended set of studies in the bibliography to substantiate its claims. (It can be found online at www.surgeongeneral.gov/library/sexualhealth/call.htm.) Let us examine three among its many noteworthy points.

First, we have enormous problems related to sexual health. Consider, for instance, these indicators from the surgeon general’s report:

• Five of the 10 most commonly reported infectious diseases in the U.S. are sexually transmitted diseases; S.T.D.’s infect approximately 12 million persons each year.

• An estimated 800,000 to 900,000 persons are living with H.I.V. An estimated one-third of those are aware of their status and are in treatment; one-third are aware but not in treatment, and one-third have not been tested and are not aware. An estimated 40,000 new H.I.V. infections occur each year.

• The AIDS epidemic is shifting toward women. While women account for 28 percent of H.I.V. cases reported since 1981, they account for 32 percent of those reported between July 1999 and June 2000.

• Nearly half of all pregnancies are unintended; an estimated 1,366,000 induced abortions occurred in 1996.

• While only a relatively small proportion of rapes are reported, 22 percent of women and approximately 2 percent of men had been victims of a forced sexual act. The proportion of women in current relationships who are subject to sexual violence is estimated at 8 percent; the number of child victims of sexual abuse is estimated to be 104,000 per year.

• Averaged over two dozen studies, 80 percent of gay men and lesbians had experienced verbal or physical harassment because of their orientation.

• An estimated 45 million persons in the United States are infected with genital herpes, and one million new cases occur per year; chlamydia and gonorrhea infections account for 15 percent of the cases of infertility among U.S. women. Four subtypes of Human Papillomavirus (HPV)—a sexually transmissible virus that causes genital warts—are responsible for an estimated 93 percent of cervical cancer.

Second, the Call to Action is informative not only about sexual health, but also about effective methods of advising. Here’s an example:

A shared culture, based either on heritage or on beliefs and practices, is another form of community. Each of these communities possesses norms and values about sexuality and these norms and values can influence the sexual health and sexual behavior of community members. For example, strong prohibitions against sex outside of marriage can have protective effects with respect to STD/HIV infection and adolescent pregnancy. On the other hand, undue emphasis on sexual restraint and modesty can inhibit family discussion about sexuality and perhaps contribute to reluctance to seek sexual and reproductive health care. Gender roles that accord higher status and more permissiveness for males and passivity for females can have a negative impact on the sexual health of women if they are unable to protect themselves against unintended pregnancy or STD/HIV infection.

Finally, I believe that Americans are interested in building a common ground on responsible sexual health. Many reading the Call to Action will find morally disturbing presuppositions on abortion, contraception or some other issue. But the report has many, many more instances of consensus than of debate: people across the public health sector want to reduce abortions, unwanted pregnancies, rape, sexual abuse, homonegativity, S.T.D.’s and H.I.V. infections. They want to delay the average age of first intercourse, to influence the media to communicate better and more responsible information and to engage everyone in the discourse on sexual health and responsible sexual conduct. Indeed, the last point is critical. The surgeon general writes:

It is, however, only a first step—a call to begin a mature and thoughtful discussion about sexuality. We must understand that sexuality encompasses more than sexual behavior, that the many aspects of sexuality include not only the physical, but the mental and spiritual as well, and that sexuality is a core component of personality. Sexuality is a fundamental part of human life. While the problems usually associated with sexual behavior are real and need to be addressed, human sexuality also has significant meaning and value in each individual’s life. This call, and the discussion it is meant to generate, is not just intended for health care professionals or policy makers. It is intended for parents, teachers, clergy, social service professionals—all of us.

As a priest, I continue to consider the surgeon general’s question about the clergy. Priests, religious and lay ministers need to read this report. And so do parents and educators, media workers and health care personnel. In a word, this is a report for all readers of America. For by being informed, we can learn to speak about sex, for our sake and for the sake of our children.

James F. Keenan, S.J., is a professor of moral theology at Weston Jesuit School of Theology in Cambridge, Mass.