More on the Little Black Book

Dr. Warren Throckmorton

Now that GLSEN and Fenway Community Health has admitted that the Little Black Book was available at their educational conference, the fuss should be over, right?

No, for several reasons, including the fact that GLSEN accused the far right of fabricating the event, only to admit that the protocols they were so confident about obviously did not work or were purposely ignored.

Another problem is the contention of the booklet's author that the LBB is "a very effective public health tool for preventing HIV and AIDS" for people over 18. Well, I don't know how convincing that is when Stephen Boswell, CEO of Fenway Community Health (the group that brought the Little Black Book to the conference) said this about HIV/AIDS in MA: "HIV infections among young people are on the rise in Massachusetts, increasing nearly 40-percent between 1999 and 2002 and one-third of HIV infections in the state are among gay and bisexual men."

The LBB does not give risk factors in terms of number for various sexual behaviors but it does say if you are young, gay and sexually active, you should be tested for STDs every three to six months. But I have to wonder how that recommendation could be considered preventative. Prevention of HIV/AIDS is all about making good choices, not getting tested after the fact. This book takes the approach that you are entitled to all the risky practices you want as long as you minimize your risk somewhat by condom usage. Nothing is discussed regarding cumulative risk, i.e, potential risk increases with multiple partners and over the course of several years of risky behavior. Abstinence is maligned and the reader could easily get a false sense of confidence that following the guidelines in this booklet means safe sex.

In contrast, a public health approach that might actually work is described in
a 2004 American Journal of Obstetrics and Gynecology article by Drs. Genuis and Genuis. Here are there observations:

The serious implications of the sexually transmitted disease (STD) pandemic that currently challenges educators, medical practitioners and governments suggest that prevention strategies, which primarily focus on barrier protection and the management of infection, must be reevaluated and that initiatives focusing on primary prevention of behaviors predisposing individuals to STD risk must be adopted…Human immunodeficiency virus/acquired immunodeficiency syndrome, human papillomavirus, genital herpes, and Chlamydia…illustrate the pervasive presence of STDs and their serious consequences for individuals and national infrastructures. Although risk reduction and treatment of existing infection is critical, the promotion of optimal life-long health can be achieved most effectively through delayed sexual debut, partner reduction, and the avoidance of risky sexual behaviors (from the abstract).*

In light of these recommendations, the Little Black Book is an irresponsible intervention, even for adults. I hope this does not get lost now that the promoters of the LBB hope that the heat is off.

*Genuis, S.J & Genuis, S.K. (2004). Managing the sexually transmitted disease pandemic: A time for reevaluation. American Journal of Obstetrics and Gynecology