November 28, 2012

Comprehensive sex ed is hardly comprehensive – Part One

Like many parents, those in the town of Princeton, New Jersey are concerned about the sex education in their schools.

They have reason to be worried. The HiTOPS/Teen PEP curriculum used in their district is seriously flawed.

This isn’t just my opinion – it’s also that of an internationally respected expert on STDs and HIV.

Jon Potterat was the director of STD/AIDS programs in Colorado Springs for almost thirty years, and is the author of 203 scholarly publications. I recently had a chance to show Jon some portions of the HiTops curriculum, and ask for his opinion.

One item we discussed was this Q&A:

HiTops Question: Who is at risk for HIV?

HiTops Answer: Anyone who engages in high risk behaviors: unprotected oral, vaginal, or anal intercourse, as well as sharing any kind of needles. Gender and sexual orientation are irrelevant as they relate to HIV infection. It is the specific behavior that may allow infectious body fluids to gain access to the blood supply that puts a person at risk for HIV infection.

Jon’s Perspective: “This is only half the truth”, Jon said. “Theoretically, yes, anyone can be infected with HIV, just like anyone can get lung cancer. But being a heavy smoker for decades increases the risk exponentially. In the same way, gender and sexual orientation correlate strongly with risk of HIV infection”

“They deliberately leave out the numbers, the different magnitudes of risk,” he explained, “and that’s a serious omission. The idea that everyone has the same risk is epidemiologic communism – it’s simply not true”.

To which numbers is Jon referring?

The rate of new HIV diagnoses among MSM (men who have sex with men) is more than 44 times that of other men. This is not because the virus discriminates based on sexual orientation, but because of risky behaviors that are more common among MSM: anal intercourse, earlier age of sexual debut, higher numbers of sexual partners, higher likelihood of using the internet to recruit sexual partners, concurrent partnerships, and infrequent condom use.

So being MSM does not in and of itself impact one’s risk of infection. But participating in specific sexual behaviors with another person who is a member of that group (and who has been sexually active with others in that group) certainly does.

The importance of this information cannot be overstated, yet “epidemiologic communism” is endemic to so-called comprehensive sex education. The dangers of this approach are discussed at length in my New York City Sexuality Education Report.

To its credit, the HiTops curriculum explains to students that anal sex is the highest risk activity. But it does not quantify: is it twice as dangerous, three times?

According to the New York City Department of Health, HIV is about thirty times more likely to be transmitted during unprotected anal, as compared to vaginal, sex.

Bottom line: parents must find out what their children are being taught about HIV transmission. Are educators telling the whole story, or promoting “epidemiologic communism”? We’re talking about life and death here. Find out what’s happening at your school, and join in the conversation.

1. CDC Analysis Provides New Look at Disproportionate Impact of HIV and Syphilis
Among U.S. Gay and Bisexual Men. Center for Disease Control and Prevention.
10 March 2010 Web 31 May 2011 msmpressrelease.html

2. Levin, EM et al. “Characteristics of Men Who Have Sex With Men and Women and
Women Who Have Sex With Women and Men: Results from the 2003 Seattle Sex
Survey.” Sexually Transmitted Diseases 36.9 (2009): 541-546

3. New York City Department of Health and Mental Hygiene. NYC Vital Signs 9.2. (2010)


  1. Kim - reply

    I am a mother of 3 teen age daughters! I don’t know how I got on the e-mail list, but I love what Dr.Grossman is doing, she says it like it is. We live in a scary world and our kids need to hear this info from someone other than their parents. Who better to give this info to teens than a doctor. I try to teach my girls to not have sex with just any guy, but they think I sound old fashion. I have sent this info to my daughter in college and all my friends with teen age kids.

    Dr. Grossman thank you for all you are doing!!!!!

    • MiriamGrossman - reply

      Hi Kim,

      Thanks so much for your comment. With 3 three daughters,
      it’s important for you to have the information from my pamphlet Sense and Sexuality,
      which you can download for free from the “Learn” or “book” pages on my site.
      Good luck with your daughters, I know what the challenges are these days.
      I hope you’ll spread the word about my site to other parents, especially to those
      whose kids are going to college soon.
      Please come back and visit often!
      Miriam Grossman MD

  2. Colorado Christian - reply

    Below is the ‘whole story’ from your reference.

    By Risk Group

    Gay, Bisexual, and Other Men Who Have Sex with Men (MSM)[1] of all races and ethnicities remain the population most severely affected by HIV.

    You can continue to read this article here:

  3. Jackie Brewton - reply

    Dr. Grossman,

    THANK YOU! THANK YOU! THANK YOU! for all that you do! I have been an abstinence educator for the past 11 years and could share tons of stories with you that I have heard over the years. During the past school year, I received 5 letters from teenagers who are HIV positive (at 4 different high schools) and I’ve got my first one this year about a month ago. My biggest frustration is that the people who make all of the laws about what should/will be taught don’t spend any time actually talking to students. My experience is that they are MUCH more receptive to the abstinence message than adults think they would be. I have a harder time convincing adults that abstinence is realistic than I do high school students. Is your calendar posted anywhere. If you are ever speaking in the metro Atlanta area, I would love to sit down and share stories. Please check out my web site: God bless you!

  4. MiriamGrossman - reply

    Thanks Jackie. I looked through your site and see that you’re doing lots of good work with kids. Your comment about students being more open to delaying sexual activity than adults expect is important. Young people need for us to set high standards in this area, just as we do with other health issues, like diet, exercise and tanning salons. Keep up the good work, Jackie!

  5. Michael Barnett - reply

    Are you teaching proper condom use in your safe-sex education? Abstinence is not so easy to enforce.

    If, as you say:

    “HIV is about thirty times more likely to be transmitted during unprotected anal, as compared to vaginal, sex.”

    then the obvious response to reducing this risk is to use protection.

  6. Thomas Coy - reply

    Converting CDC statistics on HIV infection rates for MSM to a times comparison shows that MSM are about 150 times more at risk of HIV than heterosexual men. In addition their risk of syphilis is 46 times greater. In comparison, male smokers are 23 times more at risk of lung cancer than male non smokers. This comparison can be found at

  7. Miriam Grossman MD - reply

    Hi Michael. You bring up something that I didn’t address in this blog entry, because the point was to demonstrate how, as the title says, comprehensive sex ed is not at all comprehensive.

    The truth is that even “protected’ anal sex is dangerous. Please check out what the FDA, responsible for the safety of medical devices, says on this subject. They quote a former surgeon general who stated:

    “Condoms provide some protection, but anal intercourse is simply too dangerous to practice.”

    A few years ago, 270 physicians in Maryland signed a petition against the condom-based sex ed in their schools. It said, in part, “…solid data showing the effectiveness of currently available condoms during anal intercourse, a particularly high-risk sexual practice, still are lacking.”

    So to return to your comment, I believe the “obvious response” is to advise people to refrain from this very high risk behavior altogether – with or without “protection”. I took an oath to prevent disease whenever possible, not to reduce the risk whenever possible.

    Of course, not everyone will listen – I am certainly aware of that. Still, if there’s a possibility of just one person heeding this warning, and therefore eliminating the risk of losing his life to this deadly virus, it’s worthwhile for me to continue discussing this difficult issue.

  8. MiriamGrossman - reply

    Hi Patricia, it’s true that HPV is much more infectious than HIV.
    But it’s important for you to know that HPV is a virus not a bacteria, that the genital types of HPV are found only on skin near the genitals, and that the virus
    does not live on clothes.

    We don’t want to make people more frightened than they need to be!

  9. Patricia Baker - reply

    Continue to emphaize that HPV is even more infectious thatn even HIV the bacteria lives on skin, clothes and girls as young as 24 are being diagnosed with Cancer cells that causes cervical cancer.

    Keep promoting ABSTINTENCE is the safest.

  10. Miriam Grossman MD - reply

    Patricia, sorry for the delay. Thanks for your comment, but it’s important that I correct you – there’s no evidence that HPV lives on clothes. Where did you hear that? There’s lots of misinformation out there, so you need to be careful. Also, HPV is a virus, not a bacterium. But you ARE right about one thing — delaying sexual behavior until adulthood, and ideally until marriage, is the healthiest choice!

  11. P. Grossman - reply

    Everything you have said validates my own experience as an RN who worked both in a state hospital’s gyn clinic and on their gyn floor, where part of my responsibility included caring for abortion and STD patients. This was actually 20 years ago – how much worse things have gotten now, and they were mind-bogglingly bad back then. I can wholeheartedly affirm that contraceptive education and “safe sex” talks DO NOT WORK. Even mature, otherwise responsible adults can make wrong decisions in “hot” moments, and teens are far less capable. I saw many repeat abortion patients and upon review of their charts, I would often find my very own chart notes from their last procedure, when I was their nurse. I knew that I myself had given them the talk, a three month supply of free birth control pill packs, and a prescription for refills, none of which were used. It was extremely frustrating to me as a young, new nurse, but it did teach me an important lesson. The underlying issues are so much larger than access to contraception can address. Thanks for telling it like it is.

  12. P. Grossman - reply

    And don’t even get me started on my more recent experience in the surgery unit with sex change operation patients! It was a factor in my leaving the profession – obviously not the entire factor, but it played a role.

  13. Taren - reply

    I’m gone to convey my little brother, that he should also pay a quick visit this webpage on regular basis to take updated from most up-to-date news update.

  14. Rosie Boneham - reply

    I’m really appreciating all the information Dr Grossman is distributing. I would like to encourage parents to take the lead in their own children about sex and love. If we get in early, get in with all the information, not just the mechanics, but the whole issue of real love and self respect, our kids will use that information to protect themselves. And the other thing of course is, if we don’t train our kids in self control in all areas of their lives, things like food, leisure, relaxation, training them to be strong willed, we can forget about them having the willpower to say no when something as powerful as the sexual urge makes itself felt. If they can’t say no to more fries, how will they say no to sex? Humans aren’t perfect and nothing can absolutely prevent them from doing dumb things, but education and strengthening their wills will make a huge difference to their lives.

  15. Edward Vivian M.D., B.S.N. - reply

    Dear Dr. Grossman.
    I am humbled by your courage and honesty. You are a true physician in the most,Hippocratic sense. Than you for speaking your heart and mind.

    • MiriamGrossman - reply

      Thank you, Dr Vivian, for your kind words. They mean a lot to me.

  16. Cella White - reply

    Hi Dr. Grossman,
    I’m quoting you in my testimony this weekend, but the trouble is, your material is so informative I don’t know where to start. Keep up the good work!
    I’ve been forced to make a stand here in Australia. I pulled my kids out of their former government school and spoke to the media – a very daunting experience. Our kids are exposed to breast binding, penis tucking, cross-dressing, normalising anal sex, reckless STI advice, a positive narrative regarding hormone treatment for transitioning and the list goes on. As a registered nurse I just cannot understand where the voice of reason, responsibility and truth has gone. Safe School Coalition in conjunction with Minus18 is now at over 500 schools here. There’s been no input from any medical/health professionals, just university academics interested in so-called social justice.
    Love your work!

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