NEAL CONAN, host: This is TALK OF THE NATION. I'm Neal Conan in Washington. Thirty years ago, after doctors first diagnosed AIDS, the phrase "safe sex" entered the public consciousness. Fear overcame the reluctance to ask prospective partners about their history, to use condoms, and to get tested.
Three decades later, sexually transmitted diseases don't seem to hold the same terror. Fewer people worry about HIV/AIDS. Fewer national media campaigns promote condoms and regular tests, and many older Americans really don't think they're at risk at all.
Do you practice safe sex? Why or why not? Our phone number, 800-989-8255. Email us, email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
As a reminder, this is an adult conversation that may not be appropriate for younger listeners. Later in the program, Rami Khouri with an update on Syria. But first, Vallerie Wagner joins us from the studios at NPR West. She's the director of health and wellness programs for the Education Division at AIDS Project Los Angeles. And Vallerie Wagner, nice to have you with us today.
VALLERIE WAGNER: It's great to be here, Neal, and actually I'm the director of education at AIDS Project Los Angeles.
CONAN: Thanks very much for that correction, and I apologize.
WAGNER: No problem.
CONAN: What are you hearing from the people you work with about HIV infection rates? And what are you hearing about people practicing safe sex?
WAGNER: Well, actually the term that we like to use is safer sex because the only safe sex is no sex. So we actually encourage people to engage in safer sex practices, meaning that they should use condoms every time they have sex, that they should not engage in sexual activity while under the influence of alcohol or drugs.
And one thing that we know about HIV in the country - that the rates are going up, particularly in communities of color. While we've seen a leveling off or a decline since the early '90s, when we were looking at probably about 130,000 new infections every year, in 2006, the CDC adjusted their numbers up to over 56,000 new infections a year from 40,000, which we had seen for about a decade.
CONAN: And 2006 is the last year we have complete numbers for.
WAGNER: Well, 2006 is when they actually introduced a new algorithm for determining the number of new infections that we were seeing every year. So we also have states that are now engaged in names-based reporting. So the CDC has more accurate data in order to provide the numbers that we're seeing, and that we know that we've been experiencing with this epidemic for a number of years.
So as far as what I'm seeing with the people that we work with, we know that particularly in black and brown communities - African-American and Latino communities - that the numbers are rising. These two communities are disproportionately impacted by HIV and AIDS, given their relative numbers against the general population across the country.
Here in L.A. County, we've seen increases in the number of people living with HIV, as well as the new infections per year. So we've gone, here in L.A. County, from about an average of five new infections a day up to eight new infections a day.
CONAN: And is that a reflection that people don't have the same fear anymore?
WAGNER: I don't know if it's a reflection that people don't have the same fear. I mean, I think one of the things that we're dealing with, particularly in communities of color, are the stigma, discrimination, homophobia that is still associated with this disease that has - I don't want to say is overcome in other communities, but these are more - these are some of the factors that have more impact on people that are living in these particular communities.
When families are not engaged in conversations with their children about safer sex practices or even just talking about sex or sexual orientation or sexuality in general, what you have is people sort of feeling invincible, that this disease has gone away. The media attention has certainly lessened over the years from the way we saw things in the early '80s when, you know, diagnosis to death was about six months.
People are living longer lives now. People are living healthier lives. People are looking healthier. And so we're really grateful for the advent of the treatment that has been introduced into the equation. But we still know that people are dying from this disease.
We know that in communities of color, people are testing later, and so people are actually testing both HIV positive and, within a year or less, also receiving an AIDS diagnosis. So in those particular communities, the disease is still - I don't want to say out of control, but we still haven't been able to get a handle on it and deal with it effectively.
I think there is a lot of AIDS fatigue. I think people are - you know, the conversation about use a condom, use a condom, I think there's a lot of condom fatigue that's out there. I think also with the advent of the new medications, there's this sense that, well, if I do get infected or become HIV positive, all I have to do is take a pill, and everything will be fine. And we know that that's not the case.
There's still significant side effects to a lot of the medication. There's lots of medication that a lot of people can't take because it just doesn't work with their system. So we still have a long way to go, unfortunately, in the fight against HIV and AIDS.
CONAN: We're going to talk more about that, but we want to hear from some callers, too. Do you practice safe sex? If not, why not - 800-989-8255; email us, firstname.lastname@example.org. And we'll start with Rachel(ph), and Rachel's on the line from Saginaw, Michigan.
RACHEL: Hey, love your show, by the way.
CONAN: Thank you.
RACHEL: I'm a heterosexual female, and I practiced safe sex when I was having like, casual relations. I'm in a relationship right now where it's a monogamous relationship, and we've been together for a while. But I think because I'm in my mid-40s, I have experience with - two of my friends passed away from AIDS.
And I think now, people - the younger folks - I know it sounds silly - the younger people just don't - it's death is so far away now. And they don't have any friends that have died from it. So they don't understand how serious it is.
RACHEL: And it's - you don't want to see someone pass away from this, and I think it's so far away now that they just don't - it's not, it's not thought of anymore.
CONAN: Vallerie Wagner, some, as you said, think of HIV/AIDS as something you live with and not necessarily something you die from.
WAGNER: And I mean - and it is. So it's both things. It is something that people are able to live with. It's sort of been classified now as a chronic disease. But that doesn't mean that people aren't still dying. And the caller is absolutely right. The younger generation, or younger people, don't remember - or don't have any idea of the AIDS that we saw in the '80s, where, I mean, people were literally dropping dead in the streets from a disease that no one really understood or knew how it was transmitted.
And so she's right. I remember I was talking with a good friend of mine, who was doing some mentoring with a group of young men and just one day, casually asked how many knew someone who was living with HIV. And I think every hand in the room was raised.
Then he asked the question, how many know someone who's died from AIDS? And not a single person raised their hand. So this is a very different disease from the '80s, but it is still a very serious disease, and we've got to do more, and come up with more innovative and creative ways to get people to understand that this disease is not over.
There is no cure. There's no vaccine. And so we've got to continue to promote safer sex, and engage in prevention that allows people that are negative to stay negative and at the same time, increase our testing efforts to find those positive people and get them into treatment and care.
CONAN: Rachel, thanks very much for the call. We're sorry for your losses.
RACHEL: Thank you.
CONAN: Joining us now by phone from Seattle is Pepper Schwartz, a professor of sociology at the University of Washington in Seattle; the sex, love and relationship ambassador for AARP. Nice to have you with us today.
PEPPER SCHWARTZ: Thank you, it's great to be here.
CONAN: And we asked you to come on because we've read that a lot of older Americans don't think they're vulnerable to HIV/AIDS.
SCHWARTZ: I know. It's true, and it's scary. One of the things AARP does is acknowledge the sexuality of people over 50, and try to provide both safety and information at aarp.org and in various ways, to our LGBT community at Pride - www.orgpride, to everyone at The Naked Truth and in the magazine, and in our Hispanic magazine.
And the reason we try all this is because we did a study in 2010. And in the heterosexual community, only 12 percent of the men who were single and out there dating said they used a condoms sometimes; always, usually. And only about a third of the women use it always or usually.
Now, it's true that the disease of HIV is not as present in this community, but it is not absent. And so I think we have stepped up our efforts to say: You are not immune. If you are out there having sex, you need to protect yourself, and we want to give all these resources for people to do it.
CONAN: And do you get a lot of questions from readers about condom use?
SCHWARTZ: At www.aarp.org, Pride has just opened up. It's a new portal looking, in a sense celebrating, the pride month. At my column, The Naked Truth, on our portal, I do get quite a few - not as much as I'd like, actually. I write more columns than I'm asked for about condoms because, you know, most of our people, they either have lost a partner through divorce after very long marriages, or death.
They don't really know what to do in the dating world. We try and help them get tools about how to negotiate sexuality and enjoy it. We have a lot of series going on now - how sex can be great, and how we can make it even better as we get older. We don't want to be sex negative, but we want to be sex safe. And so we forge ahead with information whether or not we get asked.
(SOUNDBITE OF LAUGHTER)
CONAN: The stigmas and taboos that Vallerie Wagner was talking about in communities of color, among younger people, those exist amongst older people, too, I suspect.
SCHWARTZ: Oh my goodness, and I think the way they deal with sexuality and some of the inherited taboos about doing it, doing it with someone new, negotiating a condom, is not to do anything, not to deal with it because even though they're older, in some ways they're less experienced.
The baby boom generation did go through a very different generation than people who are over 65. So there are some differences between the people who are between late 40s and 65, and people who are older. But, you know, this is not a sex-positive nation, and we don't teach people how to negotiate for their health and pleasure, either.
I also think that a lot of our older people come from a time when condoms were really a whole lot less pleasant. These days, condoms are thin. You can barely, if even, feel them. They have all kinds of interesting innovations with them. I think that it's not the condom they grew up with.
So between the stigma and the feeling that they're going to lose a lot of sensation - which they are entirely wrong about - they just don't do it. And of course, the idea that you would tell somebody you want a condom, to many people - think you're accusing them of having a disease. Well, we don't know our disease state, and we're trying to de-stigmatize that. So it's just the way you show somebody...
CONAN: All right, I'm afraid we're going to have to cut that off there. This is NPR News.
(SOUNDBITE OF MUSIC)
CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. Thirty years ago this month, the first cases of what came to be called AIDS were diagnosed. Since then, some 1.7 million people in this country have been infected with HIV, including more than 600,000 who died from the disease.
There are more than a million people living with the disease, and many thousands more who don't even know they are infected. Today, we're talking about safe sex. Our guests are Vallerie Wagner of the AIDS Project Los Angeles, and Pepper Schwartz, who writes The Naked Truth column for AARP.
And we're taking your calls. Do you practice safe sex? If not, why not -800-989-8255; email us, email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. Reminder: This is an adult conversation. It might not be suitable for all of our younger listeners.
We also should mention that we have some email, and this from Ruby(ph) in Arizona. On the subject of safe sex, I am in my 30s, white, middle class and notice, that I and others my age do not use safe sex practices with oral sex.
There seems to be a belief that it is safe, and I was horrified to learn that I had contracted an STD from oral sex. I was hoping you would discuss the safety of oral sex, and the stigma of using a condom for oral sex. And Vallerie Wagner, I wonder if that comes up there at the AIDS Project in Los Angeles.
WAGNER: Yes, it does. There's the feeling that, just as the email indicated, that oral sex is not sex because it's not penetrative sex. But you can transmit sexually transmitted diseases through oral sex. I mean, you're - an exchange of bodily fluids. The mouth comes in contact with the genitalia. And so we try to encourage people that, you know, sex has a very broad definition.
There are a lot of young people that I've heard from, that think that anal sex is also not real sex, and so they don't necessarily use condoms in engaging in that particular sexual practice. But we know that anal sex is one of the - given that the disease here in Los Angeles County is mostly driven by men who have sex with men, who engage primarily in anal sex, we know that that is one of the highest transmission rates.
So one of the things that I think is important for people to understand is that if you are sexually active, and that's from oral sex, you know, vaginal sex, anal sex, then you're at risk for HIV. If you can transmit an STD in the activity that you're engaging in, HIV is a sexually transmitted disease, and so you are at risk for HIV.
And the more STDs that you tend to have or encounter, the higher your risk is for exposure to HIV transmission.
CONAN: And Pepper Schwartz, if - talking about, well, what one might call straight sex is difficult for older people, well, here we're entering whole new areas of taboo.
SCHWARTZ: Well, it's true, and as your previous expert is saying, safer sex is kind of how we do want to talk about it because, you know, there's no 100 percent guarantee here. But yes, I mean, it is very hard for people to talk about what they're doing. You know, ironically enough, it seems to be a lot easier to do it than to deal with the issues of health and other kinds of what we can and can't do in a healthy way.
We often tell teenagers that the way they know they're healthy enough to have sex is they can talk about it. Well, to tell you the truth, the data on teenagers is they do a better job than the people over 50.
(SOUNDBITE OF LAUGHTER)
SCHWARTZ: Well, it's true. They're much more likely to wear a condom on their first intercourse with someone, and they're more likely to keep using it than older people. So we worry about young people the most because, you know, of pregnancy and their beginning of their lives. We want to keep them safe. But we should not say that they're the irresponsible ones. In this category, they're actually more responsible than not only their parents, but their grandparents.
CONAN: Well, Pepper Schwartz, thank you very much for that contribution. We thank you for your time today.
SCHWARTZ: Oh, you're welcome. Thanks for having me.
CONAN: Pepper Schwartz, professor of sociology at the University of Washington, and the sex, love and relationship ambassador for AARP. She joined us by phone from Seattle.
With us here in Studio 3A is Sarah Brown, to whom we turn often in these discussions. She's the CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy. Nice to have you back on the program.
SARAH BROWN: Thank you very much.
CONAN: And we're talking about teens today. Their perception of the fear of HIV/AIDS - maybe not the same as it was 20, 25 years ago.
BROWN: Well, I think that's right. You know, teens look to their older brothers and sisters, young adults, and sort of model their behavior a little bit after them. And you know, if these somewhat older people are not as worried, then they might not be as worried as well.
But it's also true that an enormous of sex education that's provided in schools does cover these issues. Something like 90 percent of the sex ed in high schools includes teaching about HIV/AIDS. So you know, I think what we're learning is that education is important but clearly, it's not enough.
CONAN: Yet obviously, not enough. And in part, is that because of what we were talking about earlier with Vallerie Wagner, that those public consciousness campaigns, those seem to have diminished. There seems to be less coverage in the media.
BROWN: Well, I think what we've learned over many years, is that many things influence teens - and really, all of us. I mean, just think about how we make decisions about anything. We draw on information, for sure, but we also think: Well, what are our friends doing? What are we reading about? What seems to be in? What's out?
And so if aggregate attention - overall, when you add all the pieces together, aggregate attention sort of declines, which I believe it has in this area of HIV/AIDS, we shouldn't be surprised if we find less knowledge, less concern, and health practices that aren't as safe.
CONAN: Let's see if we can get another caller in on the conversation. Let's turn to Nicholas(ph), Nicholas with us from St. Elmo in California - San Anselmo, excuse me.
CONAN: Yes, you're on the air, go ahead.
NICHOLAS: Hey. I'm a 27-year-old gay man, and I've been in a relationship with my partner for eight years, and it's a monogamous relationship. So we don't practice safe sex. Were we not in the relationship, we certainly would, but because we're committed and with each other, we just don't see the need to.
CONAN: And before you got together, did you?
NICHOLAS: Oh, definitely. I mean, I - you know, I grew up, you know, in like, the '90s, and AIDS was something I was educated about - AIDS and HIV. And I had a really good sex education. And so, you know, safe sex was something that was really important to me and, I think, for my generation.
But I have noticed that people of my generation, like a lot of my heterosexual friends, they don't always use condoms. And they seem to think that HIV is predominately a gay disease. And that's been troublesome to me.
CONAN: Sarah Brown?
BROWN: Well, I think one of the many reasons that might help to explain just what the caller has described is that if you really think about it, whatever sex education is offered by institutions - whether it's a school or community group or a church - that often ends by the time someone's 17 or 18. And of course, some young people don't have much at all in the way of education, or it's not very good.
So now you're 23 or 28, and you're out leading a single life and having sex, maybe, with lots of people - or maybe not. But whatever you might have been taught in 10th grade is a long time ago. And I think a number of us are beginning to understand that we really need continuing sex education for adults.
And apparently, according to Pepper Schwartz, we need it all the way up into, you know, the elderly among us.
(SOUNDBITE OF LAUGHTER)
BROWN: But, you know, the notion that we would learn something in eighth grade and maybe a little refresher course in 10th and 11th, however good it was, the notion that that would sustain us and be current in our mind - all the details, all the risks - for decades strikes me as rather unreasonable.
CONAN: Thanks very much for the call, Nicholas.
NICHOLAS: Yeah, thank you so much.
CONAN: Here is an email from Tonya(ph) in Minneapolis: When dealing with casual sex, I always say: I don't know where you've been, you don't know where I've been, please use the condom.
This from Andrew(ph) in San Francisco: I'm a 25-year-old homosexual male. I get tested every six months, no exceptions. Though we've come a long way in treating this disease, it's still my biggest fear. Most of my peers also get tested at least once a year.
However, it's my belief that HIV/AIDS education has backfired in a lot of ways. Though most of the gay, educated males I know get tested, they also don't always have safe sex. They know the facts of how HIV is spread, and they think they can beat the numbers. And Vallerie Wagner, thinking they can beat the numbers somehow.
WAGNER: Invincibility. You know, it's not going to happen to me. It's going to happen to someone else and think - you know, again, if you're sexually active, you're at risk for HIV. I think it's important to get tested, to know your status. And I think even sort of testing, while it's great, it is not the end-all, be-all.
So just because you get tested doesn't mean that you then are alleviated of having to - you know, of using safer sex in your sex practices. So I think you're right. I think some of the education has fallen off. I think there is still, in some communities, the prevailing thought that AIDS is a gay disease and not a human disease or a sexually transmitted disease. And human beings are engaging in sex. So I think we've got to do better about getting those messages out.
I think, you know, again, if we look at the people that are probably the ones that are out driving the disease, the ones that are infecting people, are the people that don't know their status. So 25 percent of people in this country don't know their HIV status. They do not know that they're HIV-positive. So we've got to increase testing efforts, to get those people tested - and if they test, and when they test positive, to get them into treatment and care.
And then on the other side, for those people that test negative, we've got to make sure that we have messages to them, or activities that they can engage in, to keep them negative. You know, it's great to get people into treatment and care who are HIV positive, but the cost of preventing one HIV infection is about $600,000 over the lifetime of that person for HIV drugs. So if we can prevent one infection with a 10-cent condom, we've saved $600,000 over the lifetime of that person if they were to test positive and have to get into care.
CONAN: I don't know where you shop. Ten-cent condoms are not...
(SOUNDBITE OF LAUGHTER)
CONAN: ...the price of - I know what you're saying but...
WAGNER: Well, we actually provide free condoms...
WAGNER: So, you know, people don't have to buy them. There are organizations throughout L.A. County - and, I'm sure, throughout cities in states across the nation - where individuals can go and get free condoms.
CONAN: And I wanted to ask Sarah Brown. We do now have better information on new rates of infection, new numbers of infected. Do we have any numbers on how many people are tested?
BROWN: Well, Vallerie actually may know those numbers better than I. But let me just make one comment about the data. One of the problems of trying to understand which direction all these rates are going - not only HIV-AIDS but also chlamydia and gonorrhea and this whole cocktail - is that when we see increased numbers, we don't know if that's actually an increase, or if it reflects more people going to get tested.
So it's very important, obviously, to get as many people tested for these infections as possible. But we can't, then, leap to the conclusion when we see a rise in numbers of diagnosed cases that the underlined rates are going up. For - in the area I work in more, for example, in pregnancy and childbearing, we have numbers that are a little clear because on a birth, for example, we get a birth certificate. So when we see changes in rates, we don't say, well, that's because people are counting more births. It's because there are more.
CONAN: We're talking with Sarah Brown, CEO of the National Campaign To Prevent Teen and Unplanned Pregnancy. Also with us is Vallerie Wagner, who's director of education of health and wellness programs for the division of the AIDS project in Los Angeles. And you're listening to TALK OF THE NATION from NPR News. And let's see if we can get Greg(ph) on the line. Greg with us from Goshen in Indiana.
GREG: Hi, how are you doing?
CONAN: Good, thanks.
GREG: Well, I had, actually, been given sex education when I was in sixth grade, and I also had a course when I was in eighth. And it was very intense. But talked to all my friends and their kids now in schools, all they're getting for sex education is either the pamphlet someone telling them no or they're giving those ah, to use an example: the opal ring contract.
GREG: And it seems to me that that might be what's causing more of the spread than anything else, the lack of education.
CONAN: The lack of education. Sarah Brown?
BROWN: Well, actually, although I hear similar things like that as well, the national data show that the vast majority of teens report that they have had some sex education. Now, it may not have been in the school. It could have been in a community center or a youth group or a religious institution. But I think the picture in schools, if we just focus on school-based sex education, I think that's likely not to get much better, and I think the reason for that is that schools that are reporting two things now.
One is that they are very - feeling very underfunded, and they're very stretched, and they must use every ounce of their time to meet academic standards for the No Child Left Behind and, you know, are focused on educational achievement - which, I think, all of us understand and support. But one of the first things to go when you're looking for more hours for math or English, or whatever, is arts, physical education and often health education along with it. And that is where sex education is typically lodged.
So sex education based in schools, especially if it's evidence-based - there are curricula now that are known to be effective both on HIV-AIDS, STDs, as well as the pregnancy risk. When those curricula are used, they help a lot. But this whole conversation in this show, I think, underscores the fact that education alone is not the only driving force in behavior - necessary, but probably not sufficient.
CONAN: Gregg, thanks very much.
GREGG: Not a problem.
CONAN: Let's see - we go next to - this is Janet. Janet with us from Boston.
JANET: Hi. Thank you for having me. I appreciate your comments. And I'm a 55-year-old woman, and my last relationship was with a wealthy man in his 60s, and he convinced me that we did not need to use a condom. We were committed. We were going to be living together. And eventually, I find out that he gave me an STD. So I'd like to caution all the women out there that even though the man has a good background and a lovely lifestyle, just to be aware of that.
CONAN: I'm sorry. Are you doing OK, Janet?
JANET: Oh, yes. Oh, yes, yes. It was cleared up just with a prescription...
CONAN: All right.
JANET: ...within a day or two, so it was fine.
JANET: But just to be cautious out there, and not believe someone from face value.
CONAN: OK. Thanks very much for the call.
JANET: Sure. Thank you for your show.
WAGNER: And I think Janet is absolutely right. You know, AIDS has no respect to person, level of income, education, race, gender. It's crucial to engage in conversations, have honest dialogue with your partner about sexual behavior and sexual practices - and insist on a condom. You know, it's - I recognize it can be a difficult conversation, and one of the things that we realize that particularly, putting women in the position of having to negotiate safer sex with their male partners, because I think one of the teenagers in the top of the show, he talked about it implies that a person is dirty, or that you think that there is something wrong with them. And we try to actually educate, you know, people, young people, older people that it's really about taking care of yourself.
You know, if you're invested in yourself, if you believe in yourself, if you love yourself, if you value yourself, you will protect yourself. And by protecting yourself, you then, you know, you protect your partner, you protect your community so - but it's really about having that self-awareness, and believing that you are a valuable person. And that, you know, asking your partner to use a condom, and if they refuse, then, you know, they're not worthy of you in that regard anyway. And so if you can't use a condom, then we're not going to engage in sex. It's simple as that.
CONAN: Leave the last word to Jen in Minneapolis. I'm female, white, just turned 27 a couple of weeks ago. Everyone I know practices safe sex. I know amongst my peer group, we actually discuss safe sex. And if there's someone who refuses to use condoms, they're typically noted and find their potential partners essentially, dry up. I know we also discuss amongst each other how we often get tested, whatnot. All of us have been tested at least once. As a note, when I last went to a physical, my doctor said chlamydia is exploding among the under-25 crowd. Sarah Brown, thank you, and also our thanks to Vallerie Wagner. This is NPR News.