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The following excerpt is taken from Peter Lewis Allen's recent book "The Wages of Sin: Sex And Disease, Past and Present" (U. Chicago 2000). "The Wages of Sin" tells the story of how ancient views of sex and sin have shaped, and continue to shape, religious life, medical practice and private habits -- causing society often to treat sickness as if it were a punishment for sin. In the course of the book, Mr. Allen analyzes society's responses to diseases ranging from leprosy to syphilis to AIDS. The following excerpt explains how, in 1987, a single brief but graphic AIDS pamphlet triggered a devastating legislative response.
-- The Editors

One hugely important battle over AIDS prevention materials was started by a single pamphlet published by the Gay Men's Health Crisis of New York.

The Pamphlet And The President

Most GMHC brochures were targeted at adult gay and lesbian readers, and followed the approved public strategy of portraying safer sex in as positive, upbeat and erotic a light as possible. Any activity, more or less, was fine as long as it did not transmit HIV.

Knowing that this approach was controversial, GMHC carefully segregated its funding: public money went to activities acceptable to government agencies, while more controversial projects were paid for by money from private sources. Within the gay community, GMHC's safer-sex campaigns were generally well-regarded. Elsewhere, however, this was not always the case.

One day in October 1987, Senator Jesse Helms marched into the Oval Office with a small brochure in his hand. The pamphlet in question was "After the Gym," part of GMHC's Safer Sex Comix series; in it, two muscular male characters named Julio and Ed safely but unabashedly worked off, through sex, the excitement produced by working out. One of the captions read: "What happens when Ed, all-star jock stud, meets dark pumpboy, Julio? After the gym, the real workout starts."

"Mr. President," declared the senator, "I don't want to ruin your day; but I feel obliged to hand you this and let you look at what is being distributed under the pretense of AIDS education material." Even more shocking than the comic book itself, Helms proclaimed to Reagan, was the fact that GMHC had "received over $600,000 in federal funds from your administration." (Senator Helms failed, however, to mention the fact that GMHC had restricted the use of public funding to projects that met federal guidelines.)

As more than one newspaper would soon report, the president "opened the book, looked at a couple of pages, closed it, shook his head and hit his desk with his first," and this thud was soon echoed around the nation. "After the Gym" was just what the nation's conservatives had been looking for: proof that the fight against AIDS was just another way gays and lesbians had found to advance the "homosexual agenda."

Not one to restrict himself to words alone, Helms turned his indignation into action. "Every Christian ethic," he proclaimed on the Senate floor, "cries out for me to do something." To an enormous spending bill -- a liberal-proof behemoth -- Helms attached a small but highly strategic amendment designed to prevent the federal government from paying for any AIDS education or prevention materials that would "promote or encourage, directly or indirectly, homosexual sexual activities."

What American politician could refuse such an amendment? It rolled through the Senate with a a 94-2 majority, carried the House 358-47, and became the law of the land.

This small piece of legislative verbiage had an enormous impact on the American AIDS scene. The Department of Health and Human Services not only published a great deal of AIDS prevention literature itself, but also funded much of what came from state and local health departments. The Helms amendment effectively censored the large majority of publicly funded AIDS prevention literature throughout the United States, and its language was so broad that it was not just homoerotic pieces like "After the Gym" that were banned: even a mention of anal intercourse, for example, could be seen as violating the federal mandate, despite the fact that anal intercourse was one of the primary routes of transmission for HIV.

The Centers For Disease Control Set Up Boards of Censors

Fearful of biting the congressional hand that fed it, the CDC immediately adopted strict guidelines that applied to every pamphlet, flier, and poster it printed or paid for. The agency said "no," for example, to any picture of the genital organs, the anus, and either safe or unsafe sex. In addition, all prevention materials had to warn about the dangers of promiscuity and IV drug use and propound the benefits of abstinence.

To enforce its rules the CDC set up program review panels -- groups of ordinary citizens empowered to ensure that AIDS prevention materials did not violate community norms of decency or taste. The panels followed their mandate scrupulously. In North Carolina, for example, a panel prohibited as "offensive" any reference to sexual orientation; a panel in Los Angeles turned down a poster showing a black man simply sitting next to a white man.

The Helms Amendment flew in the face of AIDS prevention principles endorsed by leading public health authorities. The National Academy of Sciences, for example, directed that AIDS prevention materials should contain "explicit, practical, and perhaps graphic advice targeted at specific audiences." Failure to follow these principles carried grave risks, authorities warned: the highly prestigious Institute of Medicine cautioned that "efforts to stifle candid materials may take a toll on human lives."

The Gay Men's Health Crisis Goes To Court

GMHC took HHS to court. Limiting public funds for AIDS prevention, GMHC argued, guaranteed that the underprivileged would fail to get the information they needed to protect themselves; unlike wealthier people who could pay private doctors, they had to depend on government information. Thus, GMHC argued that the case, ostensibly about sex, was really about the morality of life and death. Part of the reason the argument was so bitter was that each side was convinced it had the truly moral position: one side saw safe sex as the route to health; the other, as the road to hell.

the CDC, the court decided, had exceeded its legal authority, and its restrictions on pamphlets' content were unconstitutionally vague, in violation of the First Amendment. GMHC had won the rights for AIDS prevention to take priority over parochial views -- but only after years of effort. As another court held, the offensiveness standard was "one of the greatest single handicaps imposed on professional educators who must depend on government funding for their AIDS-related education efforts."

There is no way to know precisely how many Americans died as a result of the Helms amendment and the CDC's content restrictions, but the numbers are likely to have been substantial. Hundred of thousands of Americans were probably infected with HIV between 1988 and 1992. Could effective education have prevented ten percent of those infections? Five percent? Even if only one infection in a hundred could have been averted, the cost of sparing the country's moral sensibilities ranked in the thousands of lives.

Peter Lewis Allen, a management consultant in New York, has an M.B.A. from the Wharton School and a Ph.D. in comparative literature from the University of Chicago. Formerly, Mr. Allen was a public policy associate at the Gay Men's Health Crisis and scholar in residence at the College of Physicians of Philadelphia. He has been a member of the faculty of Princeton University, USC, and Pomona College.

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