Photo: WDCpix

An appropriations bill passed by Congress last weekend is being hailed by public health advocates for ending funding for abstinence-until-marriage sex education and eliminating the ban on federal funding for needle exchange programs. Minnesota is one of a three dozen states that allow drug users to have access to unused needles and is one of a few states which has rejected federal abstinence funds.

“This bill marks the first time since 1981 that abstinence-only-until-marriage programs will not receive dedicated federal funding in the coming fiscal year,” Jen Heitel Yakush, assistant director for public policy at SIECUS told RH Reality Check.

In 2007, Minnesota state officials declined to accept abstinence funding, which at one time was bringing in more than $2 million from the federal government to Minnesota.

The bill passed over the weekend also put an end to a ban on the use of federal funds for needle exchange programs. That ban was put into place in 1988.

“After 20 years of work, this historic vote finally signals that the United States now fully accepts the evidence of eight federal studies that syringe exchange reduces the incidence of HIV/AIDS and does not increase substance abuse,” Rebecca Haag, executive director of AIDS Action, a national advocacy group, said in a statement. “AIDS Action calls on the President to sign and implement this legislation in the U.S. and to ensure that the State Department allows funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) to go to syringe exchange in countries that need it. Tens of thousands of infections worldwide could be prevented by ensuring that people who inject drugs use only clean syringes.”

Minnesota has had needle exchange programs for more than a decade, and advocates told the Minnesota Independent this summer that the restriction on funding is a detriment to their work.

President Obama is expected to sign the legislation.

Barack Obama (WDCpix)

President Obama released his budget (pdf) on Thursday that eliminates funding for controversial abstinence-only-until-marriage sex education. The funding, initiated by a Republican Congress and President Clinton in 1996, has been heavily criticized as ineffective. In 2007, Minnesota opted out of federal abstinence money after the Bush administration added new and more conservative mandates to the programs.

Obama is also proposing funding for a new “Teen Pregnancy Prevention Initiative” to “support community-based and faith-based efforts to reduce teen pregnancy using evidence-based and promising models,” according to the budget document.

The abstinence money that Obama proposes to cut comes from the Community-Based Abstinence Education and Title V Abstinence Education programs, parts of the Social Security system.

The two programs are part of 121 areas that Obama is proposing to cut with his new budget.

(Minnesota Historical Society)

Government health officials testified Monday that rates of sexually transmitted diseases are increasing, particularly among urban women, and that a proposed bill to increase funding for testing, treatment and education might stem the steady rise in rates and curb teen pregnancy.

The bill was heard by the Health, Housing and Family Security Committee, where it passed by a voice vote on Monday.

Senate File 273 includes the Comprehensive Family Life and Sexuality Education language that almost made it to Gov. Tim Pawlenty last year. That bill would have mandated a baseline for sex education in Minnesota’s public schools. As part of last year’s negotiations, Pawlenty told legislators they’d need to hash out the details of the bill with the conservative Minnesota Family Council. Needless to say, the bill was withdrawn during conference committee.

This year’s version, coauthored by DFL Sens. John Marty (Roseville) and Sandy Rummel (White Bear Lake), has similar provisions, but contains an addition: funds for testing and treatment for chlamydia and gonorrhea in the form of family planning special project grants similar to those Pawlenty proposes to cut from the state budget.

David Johnson, epidemiologist for the Minneapolis Department of Health and Family Support, said the city’s chlamydia rate is three times higher than elsewhere in Minnesota. If left unchecked, chlamydia can wreak havoc on a woman’s reproductive organs, and infection of a newborn infant through childbirth can lead to blindness.

Because some communities are seeing such high rates, aggressive action in needed, Johnson said. “The amount of disease in the community, the rate is so high that it is virtually sustaining,” he said. “In these communities, we need targeted screening in order to bring rates down.”

Peter Carr, who heads the STD and HIV Program at the Minnesota Department of Health, said the under-served communities need the most targeting. “One of the defining characteristics of STDs in Minnesota is the disparities in communities of color. They have rates 45 times higher than for whites.”

The funding in the bill is aimed to target extra resources to those communities that are most impacted by high STD rates. But that doesn’t mean suburbs are a safe haven.

Said Kathy Wick of the Dakota County Public Health Department, “I am here to dispel any myths that living in the suburbs protects you from STDs.”

Wick argues for increased education in those areas. “It’s not for lack of health resources, money or insurance that we have an STD problem in Dakota County,” she said. “It’s a lack of knowledge.”

Experts testified that the current sex education programs in schools are a patchwork, with schools dedicating differing amounts of time to the topic and  it from an abstinence-until-marriage model — a model that numerous studies has shown to be ineffective.

Advocates for the bill say that educating young people now will save the state money later. Deb Wilkens-Costello of St. Paul’s Family Tree Clinic predicts that Minnesota will find benefits from a consistent sex ed curriculum that reduces teenage pregnancy.

“The state would feel an immediate impact to Medicare and welfare costs for years to come,” she said. “The state spends $120 million per year for teenage births.”

With a huge budget deficit and a governor with close religious right ties, Sen. John Marty said the bill likely won’t pass. But still he is hopeful.

“We can’t afford not to make the expenditure.”

A boisterous Senate Majority Leader Larry Pogemiller, DFL-Minneapolis, was joined at the podium by House Speaker Margaret Anderson Kelliher, DFL-Minneapolis, and both expressly challenged Republican Gov. Tim Pawlenty to sign a comprehensive sex education bill in this session.

“Most Minnesotans think comprehensive sex education is just common sense,” said Kelliher. “We’re going to support it even if we have to face that little red Flair pen again,” she added, referring to last year’s veto threat by Pawlenty, which scuttled a legislative measure aimed at funding sex education.

“Family planning makes sense whether you’re a conservative, a liberal, or an agnostic,” Pogemiller added. “Sex ed makes sense no matter your political views. You don’t have to be out there on the far right, we don’t have to be on the far left. You just need to do what is common sense, Governor.”

Rev. T. Michael Rock, the minister at Robbinsdale United Church of Christ and a member of the Religious Coalition for Reproductive Choice, told the crowd that abortion rights are essential “for women to have full moral agency.”

“The men in the room should listen, support, and then get out of the way on legislative issues,” he said.

State Sen. Patricia Torres Ray, DFL-Minneapolis, urged those assembled to remember that abortion access is limited for working-class women. “What we’re really talking about is class and access,” she said. “The educated women who have resources to make this choice are making that choice.”

Rep. Ken Tschumper, DFL-La Crescent, credited Republican lawmakers for joining with DFLers to support last year’s comprehensive family planning bill. “Last year we passed comprehensive family planning for the first time in 20 years,” he said. “And the real heroes in that group were the pro-life legislators who stood up to a certain group whose name I won’t mention” — a reference to the anti-abortion advocacy group Minnesota Citizens Concerned for Life.

While 2007 was a year of big news in reproductive health, it wasn’t a year of much progress.

In 2007, we heard good news that sex education can delay sexual activity and worrisome findings that abortions are up in Minnesota and that the teen birth rate is up across the country. But when it comes to action on reproductive health issues this year, we’ve heard almost nothing. The state legislature took a pass on an effort to expand comprehensive sex education, and the U.S. Congress continues to dither about whether to extend or end abstinence-based programs. It will be at least 2008 before the news reflects any policy shifts resulting from the big reproductive health news of 2007.

Still, 2007 did set the table for policy change, and it’s worth taking a look back at the stories we covered throughout the year.Sex Education

In March, there was good news for proponents of comprehensive sex education. The Minnesota Organization of Adolescent Pregnancy, Prevention and Parenting (MOAPPP) released a poll showing that 77 percent of Minnesota parents supported a comprehensive sex education curriculum.  The polling did not wow the state legislature, however, as it eventually dropped a provision that would have mandated comprehensive sex education programs, out of fear of a veto by Gov. Tim Pawlenty, R-Minn.

July brought the National Abstinence Clearinghouse’s (NAC) annual convention to St. Paul.  NAC President Leslee Unruh said that she had chosen St. Paul to “get people back to their roots,” as Minnesota was an early hotbed of the abstinence-based education (ABE) movement.  In a press conference given at the start of the event, the NAC’s brain trust evinced concern about possible funding cuts for ABE, prompting Unruh to declare that “This message is not going away. The message is good — with or without federal dollars.” As of the end of the year, whether Democrats in Congress will cut funding to ABE programs is still an open question.

In September, Minnesotans got good news about sex education. The University of Minnesota was rated the best school in America at keeping its students informed about sex.  In an interview with Minnesota Monitor, Emily Matson, the student co-chair of the U of M’s Sexual Health Awareness and Disease Education program, said, “There are students who come from an abstinence-only sex education or none at all. We teach these students the skills and base knowledge they need to be able to go out into the world and make better sexual decisions.”

Finally, December brought the news that sex education was helpful in delaying sexual activity.  Sarah Stoesz, the President of Planned Parenthood Minnesota, North Dakota, South Dakota (PPMNS) said, “The CDC’s study backs up what Planned Parenthood has known for decades: When we give teenagers the tools to make responsible decisions about their health, they step up to the challenge.”

But Leslee Unruh, President of the National Abstinence Clearinghouse, disagreed. “The report, due out in January, does not distinguish between teens who were given contraceptive-based education and those who attended abstinence education classes,” she said.  “Sexual activity was delayed, but in response to which message?”

Reproductive Health and Abortion

In February, the Minnesota Family Council came out against a bill in the state legislature that would have mandated vaccination for the human papilloma virus (HPV), a sexually transmitted disease that can be a precursor to cervical cancer in women.  Tom Pritchard, the head of the Minnesota Family Council, objected to the vaccination, saying in an interview with WCCO that it was “targeting very young girls” and could lead to earlier sexual activity. Ultimately, the bill did not pass, not so much because of the Family Council’s objections, but because of concerns about mandating a vaccine that had just received the approval of the Food and Drug Administration.

July brought the sobering news that Minnesota’s abortion rate had risen for the first time in four years.  In an interview with Minnesota Monitor, Sara Stoesz, the President of PPMNS, said that it was too early to determine if the increase represented a trend. “It could be that the decline we saw over the past three years has bottomed out, and it can’t go lower. It could be a statistical blip, or it could be the result of something in the external environment,” she said.

But the Minnesota Citizens Concerned for Life (MCCL) thought they knew the cause of the increase. In a strange statement, MCCL executive director Scott Fischbach said, “Planned Parenthood has learned how to take advantage of teenagers and young women by marketing its brand and building relationships to create future abortion customers.”

“The spike occurred the same year Planned Parenthood of Minnesota, North Dakota and South Dakota opened two suburban ‘express’ mall stores targeting young women with scented oils, candles and referrals to its St. Paul abortion center.”

Stoesz said Fischbach’s statement was nothing but “wild allegations,” and said that whatever the cause of the increase, she “doubt[ed] it indicates an increased preference for abortion.”

July also saw a rare moment of agreement between pro-choice and anti-abortion activists, when the Supreme Court of Minnesota threw out convictions against two anti-abortion activists.  Despite being on the opposite side of the issue, PPMNS media relations director Kathi Di Nicola said that her organization supported the ruling. “We support and fight for First Amendment rights.  This case is about that,” she said. And Joe Scheidler, national director of the Pro-Life Action League, said the ruling was a “big victory for pro-life activists” in a posting on his organization’s website.

In August, Jim Sedlak, head of the anti-abortion group STOPP International, called on group members to “spend time spreading the pro-life message at [Planned Parenthood] express clinics,” including those in Minnesota.  That brought a rare rebuke from the MCCL; in a statement given to Minnesota Monitor, William Poehler, communications associate for the organization, said flatly, “MCCL will not be involved in any protest at Planned Parenthood’s PLAN express clinics.”

A month later, MCCL went on their annual fall tour.  At the start of October, I went to one of their meetings to report what the anti-abortion set was arguing against these days, unfortunately, I was kicked out of the meeting for being a journalist.  According to MCCL staffer Andrea Rau, the meeting was “open to the public, but not to the press.”  How the press differs from the public was not explained.

Later that month, PPMNS President Sarah Stoesz and Steve Sviggum, the commissioner of Labor and Industry and a former Republican leader in the Minnesota legislature, joined together at the Humphrey Institute to discuss the impact of the ongoing effort to prevent South Dakota from banning abortion.  Stoesz credited her organization’s willingness to take their case to South Dakota’s voters with changing minds. “People in that state now see and can publicly talk about abortion in shades of gray, rather than in shades of black and white,” she said. “The conversation was difficult, it was painful, I do not want to go through it again anytime soon, but ultimately, we learned a lot from it.”

Sviggum agreed that it was important to come together, but his proposed middle ground — “come together to say reasonably, come together for life of the mother, health of the mother, but not partial-birth or for birth control” — did not persuade Stoesz.

The year closed on another discouraging note, this time on the national front, with the revelation that the national teen birth rate had increased for the first time since 1991.  Di Nicola, speaking for PPMNS, said teens “need the right information to make responsible, healthy decisions. We have a preventable public health problem in this country — at last count an estimated 750,000 American teens will become pregnant this year, and nearly four million will contract a sexually transmitted infection. Honest, accurate sexuality education is part of a common-sense solution to a serious issue.”

But Leslee Unruh of the National Abstinence Clearinghouse said, “The CDC, big Pharma and others should take responsibility [for] the teen pregnancy numbers.”  She added, “The CDC has promoted and aligned themselves with the contraceptive-only message; wrapping teen pregnancies in latex has failed and is unscientific. America’s teens are failing at the contraceptive message; condoms don’t work.”

Trisha Mueller, M.D., an epidemiologist with the CDC who spearheaded the study, said the study showed the efficacy of sex education.

“Sex education seems to be working,” she said in a statement. “It seems to be especially effective for populations that are usually at high risk.”

The study showed marked decreases in sexual behavior among both young men and young women. Teenage boys who received sex education were 71 percent less likely to become sexually active before age 15, and teenage girls were 59 percent less likely to become sexually active.

Teen boys who received sex education were also three times more likely to use contraceptive measures when they did engage in sexual activity. The study did not show a significant difference in contraceptive use among teen girls.

Some of the most significant delays in sexual activities came among disadvantaged populations. Urban African-American teen girls were 88 percent less likely to engage in sexual activity before age 15 if they received sex education, the study showed. And African-American teen boys were 91 percent less likely to do the same.

Planned Parenthood Minnesota, North Dakota, South Dakota President Sarah Stoesz praised the findings. In a statement, Stoesz said, “The CDC’s study backs up what Planned Parenthood has known for decades: When we give teenagers the tools to make responsible decisions about their health, they step up to the challenge.” Stoesz added that teaching teens about sex “starts with honest communication between young people and parents, open and accurate sex educationand access to affordable birth control.”

The Abstinence Clearinghouse did not respond to a request for comment.

The study did not differentiate between students receiving abstinence-based and comprehensive sex education, asking only if they had received any formal sex education in a school- or church-based setting. The study examined data collected in the 2002 National Survey of Family Growth.

The study could strengthen the hand of DFLers in the upcoming legislative session.  In 2007, Democrats pushed for statewide comprehensive sex education classes in public schools.

The campaign, which kicks off this week, is focused on helping parents “talk with their children, from toddlers to teens, about birth, babies, bodies, families and healthy sexuality,” according to a press release from Planned Parenthood.

“Parents are so important in imparting information about sexual health and sexuality to their children.  If we can equip parents to do that job, we think long-term we’ll have more sexually healthy adults,” said Brigid Riley, the executive director of MOAPPP, in an interview with Minnesota Monitor.  Riley said that parents educating their children about sexual health will help “reduce the incidence of sexually-transmitted diseases, as well as helping to prevent unplanned pregnancy.”

Read moreKathi Di Nicola, spokesperson for Planned Parenthood Minnesota, North Dakota, South Dakota, agreed.

“Parents and caregivers have an important role teaching their children about sexuality, shaping their values and helping them develop into sexually healthy young adults,” she said in an interview with Minnesota Monitor.  “This event is about empowering parents to comfortably have these important conversations with their children.”

Riley added that it’s important that parents educate their children about reproductive health.

“Everything from naming body parts correctly when they’re toddlers to making sure they understand your family’s values and expectations as they grow older” is important for children to know, she said.

The campaign, which runs through the end of October, will kick off with an event featuring Robie H. Harris, the author of  It’s Perfectly Normal, Changing Bodies, Growing Up, Sex, and Sexual Health and It’s Not the Stork! A Book About Girls, Boys, Babies, Bodies, Families, and Friends.  Harris will speak this Thursday October 4, at 7 p.m. at Ridgedale Library, 12601 Ridgedale Drive, in Minnetonka.

“There is not just one important thing,” said Weisel, when asked what the most important lesson parents can impart would be.  “Sexuality is a natural, healthy, life-long part of being human.  That said, the music of the message is important:  be askable and welcoming of questions from the beginning; be willing to talk about uncomfortable subjects (it honors your child & the importance of their desire to understand; it’s okay to acknowledge your discomfort – kids are usually tuned into it anyway); help clarify misconceptions; be curious together.  No parent can know every answer and every parent gets to keep returning to fine-tune their message for their child.”

Riley said that the ultimate goal is to improve the overall health of society.

“We’re really trying to promote the idea that sexuality is a part of being human, and that it’s a healthy part of being human,” she said.  “Parents are so important in imparting information about sexual health and sexuality to their children.  If we can equip parents to do that job, we think long-term we’ll have more sexually healthy adults.”

A calendar of other Minnesota events planned for Let’s Talk Month is available at the MOAPPP website.

Researchers surveyed schools in 11 categories, including availability of HIV testing, student health center hours of operation, student peer groups and sexual assault programs. The researchers assigned letter grades based on performance.  The U received an overall grade-point-average of 3.91, slightly ahead of the University of Wyoming.  Minnesota significantly improved its showing from 2006, when it was ranked 54th overall.

Read more“We were quite surprised and gratified by our findings,” said Bert Sperling, whose company conducted the survey, in a statement. “The top-ranking schools made significant improvements to their programming — due in part, we hope, to last year’s study results — and they deserve to be commended.”

The Big 10 conference fared well overall, with two schools in the top five and four in the top 20.  Purdue University ranked fifth overall, Wisconsin 14th, and Penn State 19th.  The Ivy League had the best overall grade point average of any conference surveyed.

“The fact is, college students are at serious risk for STIs and unplanned pregnancies,” said Jim Daniels, vice president of marketing, Trojan brand condoms, in a statement. “It’s time to evolve the way we address the realities of sexual health and provide students with the practical resources they need to protect themselves. The Trojan Sexual Health Report Card helps students and their schools celebrate areas of excellence and focus on opportunities to improve.”

The survey covered 139 colleges across the country.

‘Every young person deserves to know they have the choice to be abstinent.’

Luis Galdamez, sharply dressed in a black suit and white shirt that seems to reflect the conference’s “Black and White” theme, goes next.

“As a Hispanic living in this country, I’m grateful for the abstinence community,” he says.  “I came to America and got the wrong American Dream — I thought it was all sex, drugs and rock ‘n’ roll.  I guess I bought the lie.”

Like many abstinence advocates, Galdamez is a late convert to the movement. He has children, and though he doesn’t say it directly, it’s implied that at least some of his offspring resulted from his youthful days of sex, drugs and rock ‘n’ roll.  His spiel smacks a little of the “sex for me, but not for thee” ethos: “Sure, I had lots of sex when I was a kid, but if you do it you’ll destroy your life!”

Not that I think for a second that Galdamez is insincere in his belief that abstinence is the way forward.  He’s eloquent when he says, “My crusade is simple: I want to help my people.”  But he adds, “Bold new vision is what we need in this country, and that means to go back to the basics.”  And the basics, he makes clear, means no sex before marriage and marriage for life, come what may.

After noting that his son is studying to be a pilot at college, just like Galdamez claims he once wanted to do, he concludes, “My kids will get married one time, and they will have kids, and they will not have multiple homes.”  It sounds lovely.  But who plans for divorce?

Julie Laipply, another motivational speaker and ex-beauty queen, chimes in, “Every young person deserves to know they have the choice to be abstinent.”  Later, she adds darkly, “I find that for me it’s not the young people who have the problem with this program [abstinence].”  Thus, I’m forced to wonder: Who is it who’s standing in the door, shouting at kids that they must have sex, and right quick?  Who, exactly, is opposed to people choosing for themselves whether or not to have sex?

More Inside*  *  *

“I think it’s widely recognized that abstinence and delaying the sex act is a good thing,” said Heather Boonstra, a senior policy associate with the Guttmacher Institute in an interview with Minnesota Monitor.  “Part of the challenge is that adolescence is a time of change.  At [age] 15, you might not be sexually active, but in a few short years, you may be.  And part of the challenge is to get students ready for that.”

Writer Amanda Marcotte agreed.  “If you go to any sex education website of any major organization you’ll see abstinence listed as an option for birth control, for STD prevention, in all those various ways.  Planned Parenthood has a list of failure rates for contraception, and abstinence is always on it.”

Boonstra was not complimentary about the programs pushed by the NAC.  “They follow a very rigid definition of abstinence,” she said.

She’s right.  Unruh has been quoted by Planned Parenthood as saying masturbation is “the first step to sexual addiction.”

Boonstra lamented what she says is a $1 billion cumulative federal price tag for recently-added abstinence programs.

“They didn’t have the evidence for that kind of scale-up.”

*  *  *

Libby Gray Macke speaks next on why programs like her ProjectReality.org are completely based on scientific evidence.

“Our programs have been evaluated by the Northwestern University School of Medicine,” she says, adding sardonically, “I think they’re a real university.”  Indeed, Northwestern University has evaluated the program.  And it gets reasonably good marks for teaching students that abstinence is a good thing, at least in surveys taken immediately post-course.

But as the evaluation itself says, “There are limitations to this evaluation. The absence of a control group makes it difficult to know whether these changes would have occurred over the same period of time (two to six weeks) without intervention. However, this seems rather unlikely in that generally, if any changes occur naturally, teens tend to become more permissive in their attitudes about sexual activity over time. All the changes in survey responses were consistent with the design of the program. Secondly, the question may arise that youth are merely reporting what they believe the program teachers want to hear. However, all surveys were anonymous and done within the context of a normal classroom environment thus reducing the demand characteristics on youth responses. And, even if youth were merely reporting back what they had heard, that would be evidence that they clearly had heard the Game Plan message.”

And hearing the message is all well and good — but the other major limitation to the evaluation is this: Outside of the post-test survey, there’s no measurement of whether there’s any follow-through in the lives of students. Given that 95 percent of Americans engage in premarital sex, there’s plenty of reason to question whether the 67 percent of students who said in the study they plan to be abstinent are being honest, either with themselves or with others.  Indeed, given that 55 percent of the students said they already had planned to be abstinent, there’s plenty of reason to question the study, period.

As Boonstra said, adolescence is a time of change, and what a teenager believes at 2:12 in the afternoon on Thursday can change by the time she’s out on a date on Friday.

But the pro-abstinence forces don’t really seem to be in the mood to be questioned.

“I’m angry,” says Keith Deltano of VirginityRocks.com, a pro-abstinence comic.  “If you in the media want to break a story, here’s one to break.  Because I keep telling people these [statistics], and they don’t get reported.  This really works.”  Noting that Georgia initiated abstinence-based education in Georgia in the mid-1990s, he says, “in the past 11 years…the teen pregnancy rate in 1996 was 68 per 1,000, and in 2005 it was 36.8 per 1,000.  These are facts, you can look them up.”

We’ll leave aside that that’s a nine-year window, because Deltano’s larger point stands: Teen pregnancy rates are down in Georgia, but not nearly as much as he claims.  Teen pregnancy rates in Georgia were already going down under the bad old system he decries — from 126 per 1,000 in 1992 to 107 per 1,000 in 1996, according to the Guttmacher Institute.  And they dropped to 95 per 1,000 in 2004, according to the National Campaign to End Teen Pregnancy.  If anything, the rate of decline appears to be slowing significantly since abstinence-based education began in Georgia.

And this is the statistic Deltano quotes as breaking news.

It’s understandable, of course, because other statistics are worse.  Talking of a study by Mathematica Policy Research commissioned by the U.S. Department of Health and Human Services, Boonstra says, “The Mathematica report looked at what were thought to be the most promising programs in the country.  They didn’t find any positive outcome in terms of delaying sex.”

Indeed, the similarities between students being taught abstinence-only sex education and those who weren’t are stunning.  Forty-nine percent of abstinence-only students in the study remained “always abstinent,” exactly the same as the control group.  Abstinence-only students were slightly more likely to be abstinent over the past year — 56 percent to 55 percent — but that’s not enough to be statistically significant.  It’s not necessarily an indictment of the abstinence-only movement.  But given the millions to billions of dollars spent on it, it’s not exactly a ringing endorsement, either.  No wonder Deltano chooses to address teen pregnancy rates in Georgia instead.

Part One: ‘There Are a Lot of Fallacies That Need to Be Undressed’

Part Three: ‘The message is good with or without federal dollars.’