Talbot County school board members are struggling to decide whether nurses at the county's two public high schools should dispense condoms to sexually active students.
A vote on the proposal, made last month by the county health officer and the subject of two emotional public hearings, is scheduled Wednesday.
The outcome is "too close to call," said Dr. John M. Ryan, the health officer, and several board members agreed.
Talbot, a largely prosperous Eastern Shore county of 30,330, would be the first Maryland jurisdiction outside Baltimore to dispense condoms in schools. Baltimore's Health Department began dispensing condoms and birth control pills at seven school-based clinics last month.
Only two of Talbot's appointed board's seven members have taken positions on Dr. Ryan's proposal: President Laura S. Harrison, a nurse, is against it, and Susan C. Dillon, a private school teacher, is in favor.
"You go either with it's a moral issue or it's a health issue," Mrs. Harrison said.
"I think it's a moral issue. We're an educational institution. We should be teaching children that safe sex is abstinence."
Mrs. Dillon also favors educating children in the value of abstinence from sex.
But, as a health issue, she says, youngsters at risk of getting acquired immune deficiency syndrome and other diseases need to be protected. Dr. Ryan has presented condom distribution as a health issue -- and an increasingly urgent one in Talbot County.
Forty-five percent of Talbot County eighth-graders reported having had sexual intercourse, according to a 1987-1989 Johns Hopkins University survey sponsored by the National Institutes of Health. Nearly 21 percent reported having sex at least once a month.
By the 10th grade, 65 percent of the students said they were sexually experienced, and 36 percent reported having sex at least once a month.
But only 11 percent of the 10th graders said they used contraceptives.
The survey results dovetailed with disturbing trends at Dr. Ryan's county health clinic: Nearly half the county's gonorrhea cases so far this year involve teen-agers, well above the state average of 28 percent, according to state figures.
And Dr. Ryan said the clinic was "beginning to see young adults showing up HIV [human immunodeficiency virus]-positive," a precursor of AIDS.
The health officer said that his duty was to try to protect county youngsters against sexually transmitted disease and that Easton and St. Michael's high schools were the most effective places to do that.
"It's not our job to either condone or condemn people," Dr. Ryan said. "We meet people where they are, provide them information about risk and be a resource to reduce that risk.
"Adolescents don't come to the health department seeking prior authorization to be sexually active. It's a decision they make on their own," he said.
School board members said they were shocked by Dr. Ryan's depiction of county youngsters' sexual activity and their risk of disease.
"The extent of the problem almost knocked me off the chair," said A. E. Pete Corbin Sr., a board member and business forms broker. "I think the entire board just sat there and looked at one another."
Dr. Ryan's treatment plan -- dispensing condoms at school -- surprised the public as much as his diagnosis had the board.
"I've got 14 letters today alone," undecided board member G. Allen Whiteley, an accountant and real estate broker, said Friday. "This is my sixth year on the board, and this has got more attention than anything else so far."
Opinion has been sharply divided but not always predictable. Nurses, stewards of public health, have spoken both pro and con, as have ministers, keepers of public morality.
"It's a hard issue for old duffs like me to deal with because times have changed so much," said F. Hooper Bond, a 62-year-old board member. "It's hard to believe how far down it reaches -- 13- and 14-year-olds. It's scary as the dickens. It's a horrible thing to vote on."
Mr. Bond, an Easton lawyer, says he is undecided on the issue, but he thinks any dispensing of condoms should be linked to education that promotes sexual abstinence.
"I think the health officer's suggestion is the best he can do, but it's just a Band-Aid. We should only do what he wants to do if we have a strong program to teach morality and the results of all this promiscuous behavior that goes on," he said.
Mr. Corbin said: "It's an extremely tough situation to be faced with. I could argue either side, and I think I've heard just about all the reasons for and against. I am really in a quandary over it."
But he said: "If I had to vote right now I would be leaning for it. If we could save one child from maybe HIV or AIDS or prevent one unfortunate situation, I think a vote for it would be well worthwhile."
Mrs. Harrison said she would be more inclined to accept Dr. Ryan's proposal if parents' consent was required for their children to obtain condoms.
But Maryland law gives minors the right to seek treatment for or advice about venereal disease, pregnancy and contraception without parental permission. In fact, parents may not be informed of such treatment without the consent of the youngster.
"I don't think this is what we should be dealing with as part of the school system. Their bodies are important to them. They shouldn't be giving it away like that," Mrs. Harrison said.
"I think we're sending a message that it's OK to do this, and I don't want to be part of sending that message," she said.
Cheryl S. Alexander, the Johns Hopkins associate professor who conducted the survey of Talbot County youngsters, said no scientific evidence suggests that making condoms available leads youngsters to become sexually active. She said teen-agers usually seek out contraceptives months after their first sexual experience, often because of a pregnancy scare.
Dr. Alexander, who supports Dr. Ryan's proposal, urged that condom distribution be evaluated to see whether it cuts rates of sexually transmitted disease and pregnancy.
Dr. Ryan has also won the support of the Easton High School student government and the Governor's Council on Adolescent Pregnancy, among others.
Diana Callaway, principal of St. Michael's High School, which will host Wednesday's school board meeting, said: "I think our primary concern is to educate students. But given the current climate, with AIDS' increasing prevalence in our communities, naturally we have the concern that we be able to keep students alive in order to educate them."