To stop STDs, US-backed clinics prescribe abstinence

This is Kaiser Health News story.

Inside Obria Medical Clinics, conviction — not condoms — is summoned to stop the spread of chlamydia.

The Christian medical chain, awarded $1.7 million in federal family planning funds for the first time this year, does not offer hormonal birth control or condoms; instead, its doctors and nurses teach patients when they’re likely to be fertile and counsel them in restraint.

Reproductive health care providers have bristled over Obria’s inclusion in a federal program, known as Title X, established to help poor women avoid unwanted pregnancies. But clinics receiving money also are expected to detect, treat and prevent sexually transmitted diseases and HIV, and Obria’s prohibition against condoms means its prevention efforts — whether for single millennials or aging married couples — rest on abstinence.

In its application for federal funding, Obria pledged to follow the Centers for Disease Control and Prevention guidelines and recognized medical standards for preventing STDs. Used correctly and consistently, condoms are highly effective at preventing transmission of STDs, according to the CDC, a finding echoed by the American College of Obstetricians and Gynecologists and other major medical associations.

But Obria will not advocate or provide condoms. Instead, its staff will “emphasize that avoiding sex is the only 100-percent method to prevent pregnancy and STDs” and teach patients about “high-risk behaviors” and the “risks of using ‘safe-sex’ methods,” according to the group’s application.

Obria representatives declined a request to be interviewed for this article. But in a 2018 interview, Kathleen Bravo, CEO of the Obria Group, described the organization’s approach.

“By reducing sexual risk, you would have less women getting sick with STDs and cancer and pregnancies,” said Bravo, a devout Catholic. “In other words, teach them to not even go down that path.”

Sexual health educators, tasked with reversing four straight years of record levels of gonorrhea, chlamydia and syphilis across the nation, regard Obria’s prohibition against condoms as reckless and dismiss its focus on abstinence as wishful thinking.

“It’s hard to fathom how a health care provider could test someone for an STI [sexually transmitted infection], have the results either be negative or positive and not provide them with information about the efficacy of condoms in STI protection,” said Philip Yaeger, executive director of Radiant Health Centers, a community provider in Irvine that receives Title X funds.

From 2013 to 2017, the number of gonorrhea cases across the country increased 67%; syphilis rose by 76%. The number of cases of gonorrhea, syphilis and chlamydia reached 2.3 million in 2017. About 30,000 people are newly infected with HIV each year.

Left untreated, sexually transmitted diseases can lead to infertility, cervical cancer, blindness and dementia. The number of cases of pregnant women who pass along syphilis to their babies more than doubled from 2013 to 2017 in the U.S., resulting in scores of newborn deaths and hundreds of children with severe health complications.

In Orange County, among the wide boulevards and gleaming office towers where Obria maintains its headquarters, sexually transmitted diseases are an unrelenting force: From 2013 to 2017, gonorrhea cases rose by 129%, chlamydia by 65% and syphilis by 99%.

To confront the epidemic, health educators from Radiant Health Centers set up tables with sound machines and pulsing lights in nightclub parking lots on most weekends. Over the past year, they’ve handed out 25,000 condoms and oodles of lubricant.

Tiffany Hendrix, Radiant’s director of Health Education and Prevention — who takes an unsentimental view of sexuality after becoming a teenage mother — travels from high school to high school with a model penis and vagina instructing students on how to properly use condoms.

“It doesn’t matter what our beliefs are,” Hendrix said. “It’s our job to educate a person so they can make informed decisions, like with diabetes or cholesterol.”

But the conservative Christians helping fuel the growth in religion-based medical care in the U.S. say doctrinal beliefs rightfully determine the services offered in their hospitals and clinics, even when it involves virulent sexually transmitted diseases.

“Contraception is seen as harming the gifts God gave us,” said Theresa Notare, assistant director of the Natural Family Planning Program at the United States Conference of Catholic Bishops. “You can’t put in physical barriers like condoms or chemical substances that are going to obstruct the natural design of the ovaries.”

“There are no exceptions,” Notare said, even for STDs and HIV.

If a spouse is HIV infected, she said, withholding sex becomes a gesture of love. “The very difficult question has to be asked: Do we never have sex again? Quite frankly, because of a life-threatening disease, I would interpret it as yes.”

Catholic and evangelical Christian advocates herald President Donald Trump as an unlikely champion who, after decades of wobbly promises from Republican lawmakers and presidents, is delivering on their agenda.

The administration has worked methodically to appoint judges who oppose abortion rights; stamp out Planned Parenthood and other abortion providers; reverse Obama-era mandates on employers to include birth control in insurance coverage; and give primacy to abstinence sexual education in schools.

In loosening long-standing requirements that clinics provide the full suite of birth control options, including condoms, the Trump administration has allowed what were once makeshift anti-abortion crisis pregnancy centers — which typically offered pregnancy tests and, at most, operated an ultrasound machine — to become certified medical clinics.

Over the next three years, Obria could receive $5.1 million in federal family planning funds for its California clinics. But Bravo, who operates 38 clinics in six states, has grander visions: She wants Obria to become a nationwide alternative to Planned Parenthood, launching a $240 million capital campaign to open more sites.

“We put huge amounts of money into marketing our medical clinics to make sure that women know that we’re here in their city and these are the services that we provide,” Bravo said.

But Obria’s main website and the Obria Direct app for patients do not clearly indicate the organization’s religious convictions or how its religious beliefs limit its medical offerings.

The organization’s homepage portrays a prosaic medical practice “devoted to taking care of you holistically” and providing “the support and answers you need in regards to your sexual health.” The list of services includes STD testing and treatment, HIV testing, well-woman care and health education. Embedded in a lengthy description of the failure rates and possible complications of intrauterine devices, birth control pills, condoms and patches on Obria’s “Birth Control” page are notes that “Obria Medical Clinics does not prescribe birth control” and that natural family planning “is ineffective at preventing STDs.”

Medical facilities are not required to inform patients of religious affiliations or the limits of health care options.

The number of Catholic-affiliated hospitals across the country has grown rapidly in recent years, especially as hospital systems have consolidated. Five of the top 10 hospital systems by net patient revenue are associated with the Roman Catholic Church. But more than a third of women who visit a Catholic hospital for reproductive care are unaware of the religious affiliation, according to researchers from the University of Chicago and the University of California-San Francisco.

David Magnus, director of the Stanford Center for Biomedical Ethics, said clinics such as Obria are essentially pulling a “bait and switch” and raised the specter of potential liability for religiously oriented clinics, funded with public dollars, should a patient be given incomplete advice and then contract an STD.

“Pretending that you’ve given adequate advice is misleading and lying,” he said.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.