"The focus on everything has to be abstinence," said a long-time CDC scientist, who asked not to be identified. "The language has to be very scrutinized and approved at 3,000 levels. The general sense is that propaganda has taken precedence over science."
The government's Mr. Pierce argued that the condom review simply produced results that showed the CDC website was inaccurate: "So they took it down.
"They put up that most recent, up-to-date information -- based on science, the thing, the Holy Grail they keep raising up," he said sarcastically. "What's wrong with that? Nothing. . . . There's just no denying the fact, if you practise abstinence, you're not going to get pregnant and you're not going to get STDs."
Morale has plummeted at the Atlanta-based CDC, one of the world's foremost public-health authorities. "You want an environment of open inquiry, but you see policy driven more by ideology than science," said John Santelli, a former CDC scientist who worked for 13 years in STD prevention.
Now a professor at Columbia University, Dr. Santelli said he left the agency for both personal and professional reasons last summer: "It was becoming increasingly difficult to do good science in the federal system. The CDC wasn't being as bold as it could in looking at issues that should have been explored."
A Washington Post article last month estimated that between retirements and widespread discontent, 40 CDC top managers had left the agency, or were about to do so.
Dr. Stewart argues that it will take federal agencies a long while to recover from the loss of good people. As well, she said, "bright graduate students aren't going to be attracted to public-health areas. . . . They will see the controversy, and say, 'I think I'll go into X-rays.' "
True to his campaign promise to spend as much on abstinence-only programs as on programs that deal with contraception, Mr. Bush has doubled spending on the area since taking office, with $170-million earmarked for the cause this year.
Leslee Unruh, president of the Abstinence Clearinghouse based in Sioux Falls, S.D., has received a $2.7-million grant that will allow her group to police abstinence-only programs to make sure they mention condoms only in reference to their failure rates, with no instruction as to their proper use.
"This is his baby," Mrs. Unruh said admiringly of the President's push for abstinence. "This is what he wants to see."
Ever since her son came home from a Grade 5 sex-ed class "sick to his stomach" in 1984, Mrs. Unruh has argued that telling youths about contraceptives confuses the message. "The problem is we've got two worldviews in America. Some think we should give kids birth control and pay for their abortions, and some don't. Some of us believe you can control yourself -- some believe you can't."
No public-health official opposes teaching abstinence. But they argue that emphasizing it over other prevention ignores the fact that different people require different approaches. The vast majority of the roughly 40,000 new HIV infections in the United States each year, for example, involve gay men. But if sex outside marriage is considered wrong, and gays cannot marry, the implicit and unrealistic message is that gays should never have sex.
"When the morality mandate is driving what are the best interventions, you will undermine prevention efforts," said Dr. Marrazzo at Washington State.
Meanwhile, a report released in December by California representative Henry Waxman, a fierce critic of the government's science record, found some federal abstinence-only programs taught young people that touching a person's genitals could result in pregnancy, that abortion often led to suicide or sterility and that half of gay teens in the United States had AIDS.
A key federal study is under way to evaluate the abstinence-only approach. But researchers argue that evidence to date suggests it doesn't work. Some have found it may even be harmful.
Prof. Bearman, director of Columbia's Institute for Social and Economic Research Policy, discovered that STD rates among 12,000 teens who took virginity pledges were the same as for non-pledgers. While some pledgers delayed sex for 18 months longer, had fewer sexual partners and married earlier, Dr. Bearman found they were unprepared or uneducated when the heat of the moment was unexpectedly upon them. What's more, they were more likely to engage in risky sexual behaviour -- such as unprotected anal sex -- to "technically remain a virgin."
"Kids who take these pledges are less likely to go see a doctor, less likely to be diagnosed with an STD and less likely to think they have an STD. If you actually care about public health, these are programs that are, at best, neutral, and are possibly dangerous."
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