July 9, 2001

I am introducing the Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior because we, as a nation, must address the significant public health challenges regarding the sexual health of our citizens. In recognition of these challenges, promoting responsible sexual behavior is included among the Surgeon General's Public Health Priorities and is also one of the Healthy People 2010 Ten Leading Health Indicators for the Nation. While it is important to acknowledge the many positive aspects of sexuality, we also need to understand that there are undesirable consequences as well-alarmingly high levels of sexually transmitted disease (STD) and HIV/AIDS infection, unintended pregnancy, abortion, sexual dysfunction, and sexual violence. In the United States:

• STDs infect approximately 12 million persons each year;
• 774,467AIDS cases, nearly two-thirds of which were sexually transmitted, have been reported since 1981;
• an estimated 800,000 to 900,000 persons are living with HIV;
• an estimated one-third of those living with HIV are aware of their status and are in treatment, one-third are aware but not in treatment, and one-third have not been tested and are not aware;
• an estimated 40,000 new HIV infections occur each year;
• an estimated 1,366,000 induced abortions occurred in 1996;
• nearly one-half of pregnancies are unintended;
• an estimated 22 percent of women and two percent of men have been victims of a forced sexual act; and
• an estimated 104,000 children are victims of sexual abuse each year.

Each of these problems carries with it the potential for lifelong consequences-for individuals, families, communities, and the nation as a whole. As is the case with so many public health problems, there are serious disparities among the populations affected. The economically disadvantaged, racial and ethnic minorities, persons with different sexual identities, disabled persons, and adolescents often bear the heaviest burden. Yet it is important to recognize that persons of all ages and backgrounds are at risk and should have access to the knowledge and services necessary for optimal sexual health.

These challenges can be met but first we must find common ground and reach consensus on some important problems and their possible solutions. It is necessary to appreciate what sexual health is, that it is connected with both physical and mental health, and that it is important throughout the entire lifespan, not just the reproductive years. It is also important to recognize the responsibilities that individuals and communities have in protecting sexual health. The responsibility of well-informed adults as educators and role models for their children cannot be overstated. Issues around sexuality can be difficult to discuss-because they are personal and because there is great diversity in how they are perceived and approached. Yet, they greatly impact public health and, thus, it is time to begin that discussion and, to that end, this Surgeon General's Call to Action is offered as a framework.

It is, however, only a first step-a call to begin a mature and thoughtful discussion about sexuality. We must understand that sexuality encompasses more than sexual behavior, that the many aspects of sexuality include not only the physical, but the mental and spiritual as well, and that sexuality is a core component of personality. Sexuality is a fundamental part of human life. While the problems usually associated with sexual behavior are real and need to be addressed, human sexuality also has significant meaning and value in each individual's life. This call, and the discussion it is meant to generate, is not just intended for health care professionals or policy makers. It is intended for parents, teachers, clergy, social service professionals-all of us.

I would like to add a few words for the many thousands of persons living with HIV/AIDS in this country. We realize that you are not the enemy; that the enemy in this epidemic is the virus, not those who are infected with it. You need our support and encouragement. At the same time, it is also important that you realize you have an opportunity to partner with us in stemming the spread of this illness; to be responsible in your own behavior and to help others become aware of the need for responsible behavior in their sexual lives. Working together, we can make a difference.

This Call to Action has been developed through a collaborative process. It is based on a series of scientific review papers contributed by experts in relevant fields, on recommendations developed at two national conferences, and on extensive review and comment as the document was being prepared-all of which sought the broadest possible input and brought together a wide range of experience, expertise and perspective with representation from the academic, medical and religious communities, policy makers, advocates, teachers, parents and youth. The strategies presented here provide a point of reference for advancing a national dialogue on issues of sexuality, sexual health, and responsible sexual behavior. It can begin among individuals, but must also involve communities, the media, government and non-government agencies, institutions, and foundations.

In developing this Call to Action, we have received a wide range of input, and have identified several areas of common ground. A major responsibility of the Surgeon General is to provide the best available science based information to the American people to assist in protecting and advancing the health and safety of our Nation. This report represents another effort to meet that responsibility.

Finding common ground might not be easy, but it is possible. The process leading to this Call to Action has already shown that persons with very different views can come together and discuss difficult issues and find broad areas of agreement. Approaches and solutions might be complex, but we do have evidence of success. We need to appreciate the diversity of our culture, engage in mature, thoughtful and respectful discussion, be informed by the science that is available to us, and invest in continued research. This is a call to action. We cannot remain complacent. Doing nothing is unacceptable. Our efforts not only will have an impact on the current health status of our citizens, but will lay a foundation for a healthier society in the future.

David Satcher, M.D., Ph.D.
Surgeon General