I've run out of disappointment in conservative think tanks like the Heritage Foundation. In a "webmemo" by Katherine Bradley (what, "blogs" are only for commie-pinkos, Ms. Bradley?), she asserts that the budget included policies that "devalue human life, weaken civil society, and undermine the family".
What draconian policies could be doing this?
- The change in sex education. Bradley WILLFULLY MISREPRESENTS this change, saying that is "defunds the asbstinence-based education program" and puts a "condom-based sex education program" in its place. What is the truth? Peer-reviewed studies have time and time again showed that sex education programs that include a section on condom use are effective. Abstinence-only programs, on the other hand, have only been shown to be effective sometimes- these cases were smaller groups in peer-reviewed studies. With the overwhelming scientific evidence supporting sex education programs, Congress has chosen to mandate that all sex education programs include BOTH abstinence and condom-use components. Abstinence education is still funded and on-going.
- Allowing federal funding to be used for needle exchange. She writes, "Ostensibly to prevent the spread of infection, these programs settle for "harm reduction" rather than overcoming drug addiction." Ostensibly??? It has been PROVEN. Needle exchange programs serve as an important conduit for drug users to access drug addiction treatment programs. A lot of drug users are not ready for treatment services but still have health and social needs that aren't being met otherwise.
- Supporting family planning services domestically and abroad. Use of modern contraceptives improve rates of survival among mothers and their children under 5. Reducing access to family planning services and products would meaningfully contribute to death of mothers and children worldwide and increase the numbers of abortions.
Congress has made an important step to support families with important health and education programs.
Bradley's myopic view and representation of the issues perpetuate rumors and lies that undermine rational discussion. By blindly pushing a political agenda, she devalues the lives of injecting drug users and their families, of American youth, and of mothers and children worldwide. I wish she'd be more Christian, especially during the holiday season.
To read Bradley's article click here
Tuesday, December 22, 2009
Hurrah for Needle Exchange
As a wonderful Christmas/Chanukah/Kwanzaa/Saturnalia present, Congress has finally passed the national budget that also removes the ban on federal funding for needle exchange.
As I've said before needle exchange is an effective tool to improve the lives of people who inject drugs.
Here is more: needle exchange has been thoroughly reviewed for (1) impact on HIV among injecting drug users, (2) uptake by injecting drug users of drug treatment programs, (3) impact on initiation of others to drugs and injecting, (4) impact on the neighborhood where the needle exchange point is placed.
What have the studies shown? Needle and Syringe Exchange Points: (1) reduce HIV incidence among injecting drug users- which also reduces the potential for HIV to be passed on to non-injectors through unprotected sex, (2) increase uptake of drug treatment programs, (3) DO NOT increase initiation among non-injectors and non-users to injecting drugs,(4)DO NOT hurt the neighborhoods around the points.
Needle and Syringe Exchange points are one of the few interventions that have been proven to effectively reduce HIV transmission rates among injecting drug users. There are really not many to choose from for this group. Finally, public health professionals funded by the US federal government can use these effective tools to address HIV among vulnerable groups.
As I've said before needle exchange is an effective tool to improve the lives of people who inject drugs.
Here is more: needle exchange has been thoroughly reviewed for (1) impact on HIV among injecting drug users, (2) uptake by injecting drug users of drug treatment programs, (3) impact on initiation of others to drugs and injecting, (4) impact on the neighborhood where the needle exchange point is placed.
What have the studies shown? Needle and Syringe Exchange Points: (1) reduce HIV incidence among injecting drug users- which also reduces the potential for HIV to be passed on to non-injectors through unprotected sex, (2) increase uptake of drug treatment programs, (3) DO NOT increase initiation among non-injectors and non-users to injecting drugs,(4)DO NOT hurt the neighborhoods around the points.
Needle and Syringe Exchange points are one of the few interventions that have been proven to effectively reduce HIV transmission rates among injecting drug users. There are really not many to choose from for this group. Finally, public health professionals funded by the US federal government can use these effective tools to address HIV among vulnerable groups.
Thursday, May 14, 2009
Dear President Obama, It is Time to Put Out....the Approval for Federal Funding of Needle Exchange
After an outright declaration of support for the needle exchange (based on the overwhelming evidence) and sending out coy signals through the choice of health appointees who are supporters of needle exchange, I feel disappointed in your decision not to go ahead an remove the ban on federal funding for needle exchange for the 2009-2010 budget.
Do you think we just aren't ready for this commitment?
This non-action represents a dangerous uncertainty. The other side of the aisle-- or more precisely, the celebritextreme right pundits on Fox News-- is happy to jump on any hint of doubt. While I understand that polls and some backroom deals may be at play in your decision- this moment of reflection indicates that the OVERWHELMING evidence from IOM and other numerous studies that prove the benefit of needle exchange is not enough.
In fact, the evidence is sufficient for needle exchange to not be controversial in the science and health community.
This is truly unfortunate as in this next year, HIV prevention funding for Russia and Central Asia is due to be in the budget for the upcoming fiscal year. Eastern Europe and Central Asia have the unhappy honor of having the fastest growing HIV epidemic which is largely due to injecting drug risk behavior. Incorporating the intervention with the best track record for injecting drug users (IDUs) would benefit these countries immensely. It may be another 5 YEARS until the next round of USAID funding for these countries comes up--- at the cost of thousands of people newly infected with HIV (as well as Syphilis and Hepatitis C).
This sends the wrong message. Just as you repealed the global gag rule and supported stem cell research, you should let the science do the arguing for you and move ahead with removing the restriction on federally funded needle exchange.
Kaiser Network Update on Obama on Needle Exchange
Do you think we just aren't ready for this commitment?
This non-action represents a dangerous uncertainty. The other side of the aisle-- or more precisely, the celebritextreme right pundits on Fox News-- is happy to jump on any hint of doubt. While I understand that polls and some backroom deals may be at play in your decision- this moment of reflection indicates that the OVERWHELMING evidence from IOM and other numerous studies that prove the benefit of needle exchange is not enough.
In fact, the evidence is sufficient for needle exchange to not be controversial in the science and health community.
This is truly unfortunate as in this next year, HIV prevention funding for Russia and Central Asia is due to be in the budget for the upcoming fiscal year. Eastern Europe and Central Asia have the unhappy honor of having the fastest growing HIV epidemic which is largely due to injecting drug risk behavior. Incorporating the intervention with the best track record for injecting drug users (IDUs) would benefit these countries immensely. It may be another 5 YEARS until the next round of USAID funding for these countries comes up--- at the cost of thousands of people newly infected with HIV (as well as Syphilis and Hepatitis C).
This sends the wrong message. Just as you repealed the global gag rule and supported stem cell research, you should let the science do the arguing for you and move ahead with removing the restriction on federally funded needle exchange.
Kaiser Network Update on Obama on Needle Exchange
HIV and Income
Hans Rosling, of Gapminder, did a great 
presentation of the complicated picture of HIV.
Some key points:
(1) The poorest countries/poorest population quintiles aren't necessarily the ones with the highest HIV prevalence.
(2) Africa is a diverse continent, home to countries with different HIV epidemic stories. We see different epidemiological stories even within those countries.
(3) We need to think about and test other explanations of different HIV/STI epidemic stories e.g. number of partners and concurrency (vs serial monogamy).
Please see the presentation in full at the Hans Rosling TED presentation
presentation of the complicated picture of HIV.
Some key points:
(1) The poorest countries/poorest population quintiles aren't necessarily the ones with the highest HIV prevalence.
(2) Africa is a diverse continent, home to countries with different HIV epidemic stories. We see different epidemiological stories even within those countries.
(3) We need to think about and test other explanations of different HIV/STI epidemic stories e.g. number of partners and concurrency (vs serial monogamy).
Please see the presentation in full at the Hans Rosling TED presentation
Thursday, April 2, 2009
Isabella Rossellini Wins Hearts Talking about Animal Sex
Green Porno has short mini-series online. Imagine Isabella Rossellini in fantastic costumes while she talks about why animals have the parts they do "down there".
It brings a new interpretation of "sex education"
Tuesday, March 31, 2009
"Sexy" Education and The Pleasure Principle
One of my big issues with sex education is that the breadth of information on sexuality and sexual physiology outside of the uterus is quite limited.
Parents, educators, and public health professionals want young people to avoid/reduce sexual risk behavior (delay sexual debut, use birth control, etc) and young people want to know the logistics of sex, what is "normal" or average, and what would make their partner feel good.
So let's help young people learn better by pairing the education we want to give them with the education they want to have.
Here's an example of one of the issues that sex ed courses could address (but don't): The ABC's of Female Ejaculation by "The Doctors" television show via Jezebel.com
The Pleasure Project is a group who is trying to influence sex education to respect the need to incorporate the pleasure aspect.
Picture by me
Friday, March 27, 2009
The Lancet Strikes a Major Blow to the Pope's Flawed Argument Against Condom Use for prevention of HIV transmission
The Lancet, one of the most respected medical journals in the world joins the many public health professionals to call the Pope out for his irresponsible statement on condom use with regard to the HIV epidemic.
The Lancet states in an editorial, "When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record."
AFP "Pope 'publicly distorted' condom science: Lancet"
See my previous posts on the Pope's comments here and here .
The Lancet
The Lancet states in an editorial, "When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record."
AFP "Pope 'publicly distorted' condom science: Lancet"
See my previous posts on the Pope's comments here and here .
The Lancet
Picture via Flickr
Can YOU Save a Rock Star? Naloxone Stops Opiate Overdoses
River Phoenix, John Belushi, Dee Dee Ramone, Jim Morrison, Chris Farley, Janis Joplin all died of drug overdoses that included opiates such as heroin or morphine. Imagine if you were there while they were overdosing and you had something that would very likely save them.
That life saving drug is called Naloxone, usually called by its brand name "Narcan", and it has a very high save rate for those going through opioid overdose. Naloxone works by blocking the receptors in the brain from opioid. It doesn't provide a high and isn't abused- as shown in its success in cities like Chicago and New York.
Remember the scene in Pulp Fiction where Uma Thurman is revived when she is stabbed in the heart with a needle. Administering Narcan is much easier than that- you don't hit the heart. You can just stick the needle in a thigh and there is even a version of the drug that can be given under the tongue. And, just like Uma Thurman's character, the person wakes up pretty quickly.
Here is a great New Haven Independent article on use of the overdose death prevention drug- Naloxone (brand name- Narcan) in the US.
Here is a fabulous video on Naloxone by CRA
That life saving drug is called Naloxone, usually called by its brand name "Narcan", and it has a very high save rate for those going through opioid overdose. Naloxone works by blocking the receptors in the brain from opioid. It doesn't provide a high and isn't abused- as shown in its success in cities like Chicago and New York.
Remember the scene in Pulp Fiction where Uma Thurman is revived when she is stabbed in the heart with a needle. Administering Narcan is much easier than that- you don't hit the heart. You can just stick the needle in a thigh and there is even a version of the drug that can be given under the tongue. And, just like Uma Thurman's character, the person wakes up pretty quickly.
Here is a great New Haven Independent article on use of the overdose death prevention drug- Naloxone (brand name- Narcan) in the US.
Here is a fabulous video on Naloxone by CRA
Picture via Flickr
Wednesday, March 25, 2009
Update on the Alatech Condom Hullabaloo: Political Pork
After seeing many papers take the Kansas City Star article on Alatech condoms, I'm very pleased to see some solid reporting by Celia Dugger.
My favorite parts:
"Behind the scenes, the politicians have ensured that companies in Alabama won federal contracts to make billions of condoms over the years for AIDS prevention and family planning programs overseas, though Asian factories could do the job at less than half the cost.
In recent years, the state's condom manufacturers fell hundreds of millions of condoms behind on orders, and the federal aid agency began buying them from Asia. The use of Asian-made condoms has contributed to layoffs that are coming next month.
But Senator Jeff Sessions, Republican of Alabama, has quietly pressed to maintain the unqualified priority for American-made condoms and is likely to prevail if the past is any guide."
....
"From 2003 to 2005, Alatech and one other company making condoms for Usaid fell behind on their orders, agency officials said. Last year, the other company went bankrupt. "
.....
"Senator Sessions wrote Usaid a letter last year saying it should purchase condoms from foreign producers only after it had bought all the condoms American companies could make, noting it was 'extremely important to jobs in my state'."
Read the full Celia Dugger's International Herald Tribune article
Here's my original post on the Kansas City Star Article on Alatech
And here is Ms. Dugger's article in 2006 about Alatech where my favorite line is:
"Duff Gillespie, a retired senior Usaid official who is now a professor at the Johns Hopkins School of Public Health, said that over the years officials at Usaid raised the prospect of foreign competition to tamp down what he called 'the greed factor' of Alabama condom manufacturers.
But whenever the staff pushed to buy in Asia, Alabama politicians pushed right back."
The Chicago Sun Times adds to the growing reports on Alatech's performance saying, "The U.S. Agency for International Development says Alatech has had problems filling orders, and there were complaints from the field about the quality of its condoms."
My favorite parts:
"Behind the scenes, the politicians have ensured that companies in Alabama won federal contracts to make billions of condoms over the years for AIDS prevention and family planning programs overseas, though Asian factories could do the job at less than half the cost.
In recent years, the state's condom manufacturers fell hundreds of millions of condoms behind on orders, and the federal aid agency began buying them from Asia. The use of Asian-made condoms has contributed to layoffs that are coming next month.
But Senator Jeff Sessions, Republican of Alabama, has quietly pressed to maintain the unqualified priority for American-made condoms and is likely to prevail if the past is any guide."
....
"From 2003 to 2005, Alatech and one other company making condoms for Usaid fell behind on their orders, agency officials said. Last year, the other company went bankrupt. "
.....
"Senator Sessions wrote Usaid a letter last year saying it should purchase condoms from foreign producers only after it had bought all the condoms American companies could make, noting it was 'extremely important to jobs in my state'."
Read the full Celia Dugger's International Herald Tribune article
Here's my original post on the Kansas City Star Article on Alatech
And here is Ms. Dugger's article in 2006 about Alatech where my favorite line is:
"Duff Gillespie, a retired senior Usaid official who is now a professor at the Johns Hopkins School of Public Health, said that over the years officials at Usaid raised the prospect of foreign competition to tamp down what he called 'the greed factor' of Alabama condom manufacturers.
But whenever the staff pushed to buy in Asia, Alabama politicians pushed right back."
The Chicago Sun Times adds to the growing reports on Alatech's performance saying, "The U.S. Agency for International Development says Alatech has had problems filling orders, and there were complaints from the field about the quality of its condoms."
Picture via Flickr
Contraceptives and Catholics: "Sex and Drugs" goes to Divinity School for a Day
To understand some of the Catholic Church's recent stances on condoms (See my previous post )and abortion of a nine-year old incest survivor in Brazil (Source: Huffingtonpost), I thought it would be useful to review a key document that informs some of the Pope's recent decisions and statements. I'm no expert in religion and it shows- I just have more questions!
Documentation that Guides Catholic Church
DecisionsWhile the Old and New Testament address adultery and divorce, there is no Bible-based guidance to Christians on use of contraceptives, which came later. The reference most commonly used in Catholicism is the Humanae Vitae- a document attributed to Pope Paul VI in 1968. (Source: Wikipedia)
The Humane Vitae was written in response to the oral contraception becoming available in 1960 and a Catholic Church Commission Report in 1966 which proposed that, "that artificial birth control was not intrinsically evil and that Catholic couples should be allowed to decide for themselves about the methods to be employed", and a minority report which held that contraception was instrisically evil. (Source: Wikipedia)
The Humanae Vitae prohibits use of artificial contraception, but does not label it as evil and overall is a complicated document which is supposed to reaffirm previous Church positions and embody some of the conflict within the church on contraceptives. (Source: Wikipedia)
Three Catholic Cheers for Sex!
The Humanae Vitae does take a tremendous step and call, "sexual activity, in which husband and wife are intimately and chastely united with one another, through which human life is transmitted, is...noble and worthy.''
Hurrah for the Catholic Church's appreciation of sex!
Asserting an Inseparable Connection and then Severing it?
The Vatican's Humanae Vitae "
Now this point confuses me. The overall point of this document is to say that the benefit the couples gets from sex relating to couple unity and intimacy should never be separate from the other benefit of sex- procreation. Yet then the document goes on to say that it is allowable for couples to time when they have sex to reduce the potential that the sex act will result in a pregnancy.
All is supposed to be "cleared up" when the documents says that "neither the Church nor her doctrine is inconsistent when she considers it lawful for married people to take advantage of the infertile period but condemns as always unlawful the use of means which directly prevent conception".
Oh thanks- all clear now.
My biggest issue with the Humane Vitae is that it states "an act of mutual love which impairs the capacity to transmit life which God the Creator, through specific laws, has built into it, frustrates His design which constitutes the norm of marriage, and contradicts the will of the Author of life. "
This is in conflict with my limited understanding of the Catholic interpretation of the power of God. As I understand, God is all powerful and miracles are possible. Couples who were previously thought to be infertile have been able to conceive and this miracle is attributed to God's will. How can we be so arrogant to belive that these small steps could override God's will?
As the religious right has brought up many times, there is no contraception that is 100%- not condoms, oral contraceptives, even sterilization. "In the United States, most studies of breakage caused by fault in the condom itself have shown breakage rate is less than 2 condoms out of every 100 condoms. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time." Avert.Org Condom Effectiveness If condoms work only 87-97% of the time, there is room for divine action.
The % chance for divine intervention for condoms is not too far off with perfect practice of contraception by following natural cycles. Chances of pregnancy in a typical ovulation calendar varies by day from 0-20%.
Why must a fertile 20-something be held to a higher standard of self-discipline than an infertile peer or the post menopausal generation? Chances of conceiving post menopause are extremely low per "Ask Our Expert" at drspock.com. Why do the baby boomers get to have all of the fun?
Limiting contraception to "infertile methods" puts the moral burden unevenly on the most fertile part of the population. If we were to truly hold ourselves to not separating the procreative and couple-intimacy benefits, wouldn't those populations who were less fertile be expected to abstain from sex full stop?
Understanding Why the Church Accepts Natural Cycle Contraception, but Not Artificial Contraception- Unpacking the Concept
Why is natural cycle contraception considered ok while artificial contraception (oral contraception, injectables, condoms, etc.) is not? I'll paraphrase the HV's section on this using two couple examples- Couple A live within the church rules of maintaining intimacy while avoiding a pregnancy while Couple B are avoiding a pregnancy using artificial birth control.
There seem to be two major arguments:
(1) Couple A's abstinence during the most fertile times of the ovulation cycle is self control that demonstrates their true love for each other, so they may have sex during infertile times with the intention of avoiding pregnancy within the rules of the church. Couple B is not practicing a method that is time-restrictive and are therefore not sacrificing anything to demonstrate their true love.
(2) Couple A is taking advantage, "of the natural cycles immanent in the reproductive system and engage in marital intercourse only during those times that are infertile, thus controlling birth in a way which does not in the least offend the moral principles", while Couple B obstructs, "the natural development of the generative process".
Is this the Catholic Church's Feminist Manifesto? If So Can I Get an Upgrade?
This document also asserts that that "a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection."
It is odd to me that the same document which praises self-discipline could expect such a severe swing to depravity with the simple use of contraceptives. Cases of men's lack of reverence of women, unfortunately, predates contraceptive devices. Regulating use of contraceptives will not change this- though perhaps if men were able to become pregnant this would change. The HV is supposed to be a statement with the Church's, "new understanding of the dignity of woman and her place in society"- but to me, limiting a woman's access to birth control seems to impair her ability to have her dignity.
Picture via Flickr
Monday, March 23, 2009
What interventions can reduce HIV among IDUs
Way back when I was working in Central Asia, I served as a "country expert" in a joint WHO-UNODC process to set some sort of global standard targets in HIV prevention with injecting drug users (IDUs).
For those interested in HIV prevention interventions for IDUs, I recommend reading it. Not just because I was a part of this process. You get a basic idea of a comprehensive "package" to reduce incidence of HIV among IDUs and some of the definitions of standards indicators for coverage and quality- down to a definition of who should be considered an IDU. If your site does not include one of the elements of the "package"- perhaps that is the gap you should try to fill.
I found that other "HIV prevention comprehensive packages" are a bit of tripe and bs, but this is something that has potential (if only folks pay attention).
So read it!
WHO and UNODC
Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users
For those interested in HIV prevention interventions for IDUs, I recommend reading it. Not just because I was a part of this process. You get a basic idea of a comprehensive "package" to reduce incidence of HIV among IDUs and some of the definitions of standards indicators for coverage and quality- down to a definition of who should be considered an IDU. If your site does not include one of the elements of the "package"- perhaps that is the gap you should try to fill.
I found that other "HIV prevention comprehensive packages" are a bit of tripe and bs, but this is something that has potential (if only folks pay attention).
So read it!
WHO and UNODC
Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users
Picture via Flickr
Condom production and procurement- Buying American doesn't mean better quality
I read an incendiary piece in the Kansas City Star that pushes buying "American"- even condoms. While my heart goes out to the folks working at Alatech condoms in the US, the company has not necessarily produced condoms superior in quality to those produced in Asia and those problems increase risk of HIV transmission worldwide. Here is my response to the author.
Dear Mr. McGraw,
I believe your article about the condom situation is unfair. Alatech is the sole remaining condom producing company in the US in spite of major investment of the US government to support US-based condom producers. There was another US condom company, but even with major funding from the US gov’t, had to close down. One big issue is that the colloidal latex used in condom production is from latex trees- most of whom grow in Thailand, China, Brazil, and Indonesia. Condom production outside of the global South doesn’t really make sense. Just look at where the Durex and Trojan condoms are produced- in places like India, Thailand, and South Korea- from the same plants USAID gets condoms from.
I bet if you had interviewed someone in procurement at USAID or UNFPA, you would have found out that there have been issues with condoms procured from Alatech- including inconsistent size and thickness and MAJOR delays between ordering and delivery. The US government is not without fault, but I think reducing its use of Alatech condoms was the best decision. Even if these condoms still “worked” to prevent transmission of HIV (not AIDS, as you wrote), the variability in size, shape, and thickness would make the consumer unhappy and may decrease consistency of condom use- a dangerous behavior in these times of HIV. If Alatech had been faster in making changes based on the feedback it was getting- they could have saved those 300 jobs. Perhaps all of this governmental protection from international competition made Alatech lazy. I don’t want condom producers to be lazy- I want them to worry day and night to ensure that they produce the best quality condom they can.
Your use of “cheaper” perhaps should have been “less expensive”- as Unidus and Butterfly plants go through a rigorous pre-procurement vetting and certification procedure. From my experience, Unidus condoms are not only high quality-but are superior to Alatech condoms in their consistency of shape, size, and thickness. There is more than one condom manufacturing plant in China and while some plants have issues with quality- the certified and pre-approved plants have earned going through the quality assurance gauntlet.
I was disappointed that you only interviewed Alatech staff and an Alatech consultant- your readers have only gotten half the story. It is a shame American jobs are in danger- I only wished that the high paid executive staff would have done a better job at defending them.
Read the Kansas City Star article U.S. move to cheaper Chinese condoms threatens American jobs
Update: I've sent another letter with some clarifications and here are some snippets....
It made sense that a greater burden of condom procurement was moving towards Asia because of the ready access to the supply. I'm thinking about what would be more affordable for someone in Africa buying a condom where the latex came from Thailand but the condom was made in the US or buying a condom that was sourced and produced in Thailand and shipped directly to the country. It also sounds like a "greener" system. .....
Government regulations on the acceptability of variation of shape and thickness within an order seems to be a bit more lax than the standard for the commercial companies (ex. Trojan)- so an order may meet gov't needs but still result in some unhappy end-consumers. Thinking about the HIV epidemic, I wouldn't want high risk populations to have any additional reasons (valid or not) to not use a condom. ....
There are issues with quality of different kinds of Chinese products. However, just because there are issues with some plants and some products, this does not mean all Chinese products are poor grade. China has some terrible condom plants, but also have some that meet international standards- they are audited on quality standards regularly to ensure this. The same plants that produce condoms like Durex in places like Thailand and India are held to these same standards. Why are condom companies like Durex, Trojan, or European brands not purchasing from Alatech (to my knowledge, they are not, but I may be mistaken)- is it just price or are there other questions?....
Dear Mr. McGraw,
I believe your article about the condom situation is unfair. Alatech is the sole remaining condom producing company in the US in spite of major investment of the US government to support US-based condom producers. There was another US condom company, but even with major funding from the US gov’t, had to close down. One big issue is that the colloidal latex used in condom production is from latex trees- most of whom grow in Thailand, China, Brazil, and Indonesia. Condom production outside of the global South doesn’t really make sense. Just look at where the Durex and Trojan condoms are produced- in places like India, Thailand, and South Korea- from the same plants USAID gets condoms from.
I bet if you had interviewed someone in procurement at USAID or UNFPA, you would have found out that there have been issues with condoms procured from Alatech- including inconsistent size and thickness and MAJOR delays between ordering and delivery. The US government is not without fault, but I think reducing its use of Alatech condoms was the best decision. Even if these condoms still “worked” to prevent transmission of HIV (not AIDS, as you wrote), the variability in size, shape, and thickness would make the consumer unhappy and may decrease consistency of condom use- a dangerous behavior in these times of HIV. If Alatech had been faster in making changes based on the feedback it was getting- they could have saved those 300 jobs. Perhaps all of this governmental protection from international competition made Alatech lazy. I don’t want condom producers to be lazy- I want them to worry day and night to ensure that they produce the best quality condom they can.
Your use of “cheaper” perhaps should have been “less expensive”- as Unidus and Butterfly plants go through a rigorous pre-procurement vetting and certification procedure. From my experience, Unidus condoms are not only high quality-but are superior to Alatech condoms in their consistency of shape, size, and thickness. There is more than one condom manufacturing plant in China and while some plants have issues with quality- the certified and pre-approved plants have earned going through the quality assurance gauntlet.
I was disappointed that you only interviewed Alatech staff and an Alatech consultant- your readers have only gotten half the story. It is a shame American jobs are in danger- I only wished that the high paid executive staff would have done a better job at defending them.
Read the Kansas City Star article U.S. move to cheaper Chinese condoms threatens American jobs
Update: I've sent another letter with some clarifications and here are some snippets....
It made sense that a greater burden of condom procurement was moving towards Asia because of the ready access to the supply. I'm thinking about what would be more affordable for someone in Africa buying a condom where the latex came from Thailand but the condom was made in the US or buying a condom that was sourced and produced in Thailand and shipped directly to the country. It also sounds like a "greener" system. .....
Government regulations on the acceptability of variation of shape and thickness within an order seems to be a bit more lax than the standard for the commercial companies (ex. Trojan)- so an order may meet gov't needs but still result in some unhappy end-consumers. Thinking about the HIV epidemic, I wouldn't want high risk populations to have any additional reasons (valid or not) to not use a condom. ....
There are issues with quality of different kinds of Chinese products. However, just because there are issues with some plants and some products, this does not mean all Chinese products are poor grade. China has some terrible condom plants, but also have some that meet international standards- they are audited on quality standards regularly to ensure this. The same plants that produce condoms like Durex in places like Thailand and India are held to these same standards. Why are condom companies like Durex, Trojan, or European brands not purchasing from Alatech (to my knowledge, they are not, but I may be mistaken)- is it just price or are there other questions?....
Tuesday, March 17, 2009
Malcolm Gladwell: Spaghetti Sauce and Human Variability
This video of Malcolm Gladwell on TED brings up some great points including the need to segment the target population to truly meet their needs and the difference between expressed need and actual need.
And don't forget marketing expert Seth Godin on TED who reminds us that safe is risk and "remarkable" is what we need to give the consumer.
Something for behavior changers to keep in mind!
And don't forget marketing expert Seth Godin on TED who reminds us that safe is risk and "remarkable" is what we need to give the consumer.
Something for behavior changers to keep in mind!
Uptight city boards and the true, sexy spirit of the founding fathers
Just like any proud American, when I came to Washington, D.C. I made it a priority to visit an important site in America's history-- the first sex shop in old town Alexandria, Virginia. It is a three-floor shop that sells toys, outfits, movies, and value added condoms and lubricant. In this period of near-depression, this store has a good number of visitors and is likely contributing important funds to the city of Alexandria's coffers. Yet, some sticks-in-the-mud are all uptight about it because the founding fathers walked around there once.
Old historian-jigga please! The forefathers kept mistresses, some visited ladies of the night, and George Washington grew and promoted farmers to grow marijuana. I think if Ben Franklin were in Alexandria now he'd be proud of a sex shop in old town...and then wonder where he could find the local whores.
The Slate explainer series includes an article that explains a bit about the truths (and myths) of American Colonial Prostitution.
Old historian-jigga please! The forefathers kept mistresses, some visited ladies of the night, and George Washington grew and promoted farmers to grow marijuana. I think if Ben Franklin were in Alexandria now he'd be proud of a sex shop in old town...and then wonder where he could find the local whores.
The Slate explainer series includes an article that explains a bit about the truths (and myths) of American Colonial Prostitution.
Pope Benedict dicts around with human lives in the face of the HIV epidemic, 359 years until the apology comes?
As a child of a lapsed Catholic, I do care about what the Pope says. As an epidemiologist, I am disappointed with the Pope's recent statements in Africa against the utility of condom use in reducing the spread of HIV. "You can't resolve with the distribution of condoms,"... "On the contrary, it increases the problem." Source: Yahoo News article on the Pope's stance.
In doing so, he ignores the immense body of evidence that condoms used effectively and consistently are very effective in preventing the sexual transmission of HIV and other sexually transmitted infections and that promoting condom use and increasing access to condom do not increase frequency of sex or number of sex partners. (Smoak et al, Sexual Risk Reduction Interventions Do Not Inadvertently Increase the Overall Frequency of Sexual Behavior: A Meta-analysis of 174 Studies With 116,735 Participants J Acquir Immune Defic Syndr 2006;41:374Y384).
He also sets back the progress that has been made to increase condom use in Africa and countries with large Catholic populations.
In doing so, he ignores the immense body of evidence that condoms used effectively and consistently are very effective in preventing the sexual transmission of HIV and other sexually transmitted infections and that promoting condom use and increasing access to condom do not increase frequency of sex or number of sex partners. (Smoak et al, Sexual Risk Reduction Interventions Do Not Inadvertently Increase the Overall Frequency of Sexual Behavior: A Meta-analysis of 174 Studies With 116,735 Participants J Acquir Immune Defic Syndr 2006;41:374Y384).
He also sets back the progress that has been made to increase condom use in Africa and countries with large Catholic populations.
This is especially sad because in 2006, the current Pope was considering softening the Catholic Church's stance on condoms. Cardinal Carlo Maria Martini, a moderate in the Vatican said in April 2006, "We need to do everything possible to combat AIDS. Under certain conditions, the use of condoms is necessary. Those who are afflicted have an obligation to protect the other partner," and the Vatican's equivalent of health minister, Cardinal Javier Lozano Barragan, said that the Pope had taken the initiative on taking another look at the condom issue. Source: Deutsche Welle.
It does seem that the Catholic Church does have people who are a bit more sensible on life in the times of HIV. Cardinal Godfried Daneels of Belgium, who was once considered a candidate to suceed John Paul II, had a more sensible position to condom use. In 2004, he stated that someone had HIV could use a condom to protect life. Source: WorldNet Daily.
It took more than 300 years for the Catholic Church to apologize for persecuting Galileo and 60 years to apologize for its inactivity against the Holocaust. Perhaps with another 2 million deaths from AIDS-related complications (annual mortality rate is just over 2 million- source UNAIDS), including sero-negative spouses of people living with HIV, the apology and change from the Catholic Church will come sooner?
He's not gay, he just screws men sometimes
There's a concept that people in the HIV prevention sector work with regularly that seems to mystify people who don't talk about sex workers, anal sex, and condoms everyday. I feel bad for people who are not able to talk about such interesting topics on a regular basis, and I like to share.
The concept I'd like to talk about is "Men who have Sex with Men" (MSM). This term is used to describe all men who at least sometimes have sex with other men, even if they do not self identify as homosexual, gay, or even bisexual. Believe me, at the very least, knowing this will make you a hit at dinner parties as my dad can testify.
Non-gay identified men are different from closeted gay men. Non-gay identified men do not see themselves as homosexual. A man can sometimes have sex with other men, but to identify as heterosexual. They can be married to/in a relationship with women and consider their sexual behavior with men as "playing around" or not consider it sex. Anyone who followed the Lewinsky era politics can understand the fungibility of the definition of what is "sex."
Non-gay identified men who have sex with men (NGI-MSM) includes some truck drivers and their assistants in South Asia where one of the accepted functions of a truck assistant is to fellate and massage the driver, men on the "down low" in the US, or a "gay for pay" male sex worker or pornographic actor.
Also, while transgenders (women who are born male, a portion of whom are transitioning/have transitioned to become women physically) are lumped in with MSM in some programs, they do not really fit the definition. They self identify as women and should therefore be approached as a group separate from MSM.
Self identification of gender and sexual orientation are important issues to understand in HIV prevention. Just as the Facebook male sluts (of all orientations) like to say, "it's complicated"-- but it is essential to have a chance of actually making an impact on the HIV epidemic.
Read more about HIV prevention with this self identification challenge in Wisdom of Whores by Elizabeth Pisani.
I strongly recommend reading the CDC Qualitative Report on Non-gay identified Men who have Sex with Men.
A few story examples by Non-gay identified Men who have Sex with Men.
The concept I'd like to talk about is "Men who have Sex with Men" (MSM). This term is used to describe all men who at least sometimes have sex with other men, even if they do not self identify as homosexual, gay, or even bisexual. Believe me, at the very least, knowing this will make you a hit at dinner parties as my dad can testify.
Non-gay identified men are different from closeted gay men. Non-gay identified men do not see themselves as homosexual. A man can sometimes have sex with other men, but to identify as heterosexual. They can be married to/in a relationship with women and consider their sexual behavior with men as "playing around" or not consider it sex. Anyone who followed the Lewinsky era politics can understand the fungibility of the definition of what is "sex."
Non-gay identified men who have sex with men (NGI-MSM) includes some truck drivers and their assistants in South Asia where one of the accepted functions of a truck assistant is to fellate and massage the driver, men on the "down low" in the US, or a "gay for pay" male sex worker or pornographic actor.
Also, while transgenders (women who are born male, a portion of whom are transitioning/have transitioned to become women physically) are lumped in with MSM in some programs, they do not really fit the definition. They self identify as women and should therefore be approached as a group separate from MSM.
Self identification of gender and sexual orientation are important issues to understand in HIV prevention. Just as the Facebook male sluts (of all orientations) like to say, "it's complicated"-- but it is essential to have a chance of actually making an impact on the HIV epidemic.
Read more about HIV prevention with this self identification challenge in Wisdom of Whores by Elizabeth Pisani.
I strongly recommend reading the CDC Qualitative Report on Non-gay identified Men who have Sex with Men.
A few story examples by Non-gay identified Men who have Sex with Men.
Monday, March 16, 2009
Females and male receivers alike celebrate the new "female" condom
A new version of the female condom (FC) has been approved by the FDA. The FC will now be made of a nitrile polymer instead of polyurethane. The new condom is cheaper, softer, and less noisy which helps address some major barriers to female condom use.
Female condoms are a bit of a misnomer because the user doesn't have to be female; the receiving partner in anal sex can also use FCs to protect her or himself. See my old post (link below) on using the FC for more information on how to put one one.
FCs are a great alternative option (to "male condoms") because the receiving partner can insert the FC herself/himself, which gives them an option to still use condoms when the insertive partner doesn't want to put a condom on himself. It sounds odd, but clients of sex workers (for example) who are unwilling to put a condom on themselves can be less resistent to the FC. "I don't want to put on a condom, but I don't care if you put one on yourself."
Female condoms are a bit of a misnomer because the user doesn't have to be female; the receiving partner in anal sex can also use FCs to protect her or himself. See my old post (link below) on using the FC for more information on how to put one one.
FCs are a great alternative option (to "male condoms") because the receiving partner can insert the FC herself/himself, which gives them an option to still use condoms when the insertive partner doesn't want to put a condom on himself. It sounds odd, but clients of sex workers (for example) who are unwilling to put a condom on themselves can be less resistent to the FC. "I don't want to put on a condom, but I don't care if you put one on yourself."
I remember first hearing about the female condom when it was first introduced in Europe in 1992. It seemed fate that I'd be in this business because my class was visited by the school nurse to get our annual sex education class. I had questions about how the female condom was supposed to be properly inserted and the school nurse had never heard of that option.
It was only in 1993 when female condoms were approved for use in the US by the FDA. Outside of family planning and other health clinics, I really haven't see the female condom be distributed here. Hopefully with this decrease in price, more commercial outlets will begin carrying the female condom.
Slate Article on the new Female Condom.
The maker of the female condom, the Female Health Company
From my How-to post on safe(r) sex How to use a female condom for vaginal or anal sex
History of the female condom
Population Services International (PSI) on use of female (insertive) condoms for men who have sex with men
Slate Article on the new Female Condom.
The maker of the female condom, the Female Health Company
From my How-to post on safe(r) sex How to use a female condom for vaginal or anal sex
History of the female condom
Population Services International (PSI) on use of female (insertive) condoms for men who have sex with men
Picture via Flickr
Tuesday, February 24, 2009
Cooking Lean in Times of Economic Downturn: Learning Lessons from the Depression
In the spirit of resilency during this (seemingly neverending) period of economic downturn, I'm sharing a great how-to video on a charming 91-year old woman, Clara, making egg drop soup. Inexpensive, easy to do, and looks tasy. I love how Clara says "Depression", she's all cheery until she reaches that word in the script. This soup beats instant ramen anyday.
Here's the video.
Here's the video.
Love by Numbers: Evidence on Relationships
Former staff member of the Guardian newspaper in the UK, Luisa Dillner, gets interviewed by her former former co-workers about her new book, "Love by Numbers"(LbN). LbN distills lengthy research papers into guidance for all of us. Listen to the interview. Dr. Dillner finds that many are incredibly lazy about finding love, but that internet dating has actually been pretty successful.
From the interview, it sounds like she knows what she's talking about. She discusses the weaknesses of study designs used like an Epidemiologist and works for the British Medical Journal (BMJ).
From the interview, it sounds like she knows what she's talking about. She discusses the weaknesses of study designs used like an Epidemiologist and works for the British Medical Journal (BMJ).
Thursday, February 19, 2009
Martha Stewart and Pot
Monday's Episode of Martha Stewart will be completely pot themed....
...pot bellied pig, planting pots, and Jimmy Fallon.
info via Jezebel
...pot bellied pig, planting pots, and Jimmy Fallon.
info via Jezebel
Wednesday, February 18, 2009
The Amazing Dr. Reddy, Condom Genius and Other Grand Condom Inventions
Even in the world of condom distribution, value-added condoms get titters. Value-added condoms include condoms that are studded (also called "dotted), ribbed, there are those which are even packed with Benzocaine (a topical numbing agent and cousin of Novocaine) to help men battle against the old foe, premature ejaculation.
A hero in this field is Dr. Reddy, inventor of some of the more interesting shapes of condoms. Dr. Alla Venkata Krishna Reddy invented:
(1) the Pleasure Plus (with a pouch that is an equivalent of a "waddle" on the lower part of the shaft to create additional sensation)
(2) the Inspiral and (3) the Twisted Pleasure - 2 condoms based on the same principal- a spiral shape for more pleasure.
Salon did an article on Dr. Reddy and the sad legal history of these condoms.
Some organizations even tested some Reddy inventions for use in public health interventions to motivate condom-haters to give protection a try.
While the innovation in India on condoms may have slowed, there is a new young Turk on the scene. Jan Vinzenz Krause in Germany is developing a spray-on condom that can provide a perfect fit with little chance of slip. They are still working on the coverage and vulcanization process, but it has been getting some media coverage-- including from Time Magazine.
Here's a video of the condom and an amusing diagram from the company website (in German).
A hero in this field is Dr. Reddy, inventor of some of the more interesting shapes of condoms. Dr. Alla Venkata Krishna Reddy invented:
(1) the Pleasure Plus (with a pouch that is an equivalent of a "waddle" on the lower part of the shaft to create additional sensation)
(2) the Inspiral and (3) the Twisted Pleasure - 2 condoms based on the same principal- a spiral shape for more pleasure.
Salon did an article on Dr. Reddy and the sad legal history of these condoms.
Some organizations even tested some Reddy inventions for use in public health interventions to motivate condom-haters to give protection a try.
While the innovation in India on condoms may have slowed, there is a new young Turk on the scene. Jan Vinzenz Krause in Germany is developing a spray-on condom that can provide a perfect fit with little chance of slip. They are still working on the coverage and vulcanization process, but it has been getting some media coverage-- including from Time Magazine.
Here's a video of the condom and an amusing diagram from the company website (in German).
Sexual Sabotage among Crickets
NeuroDojo reports on an article which finds that exposure to male cricket seminal fluid has some odd impact on female crickets. First of all, female crickets who were exposed walked forward less and secondly, they have shorter lives. Now the question would be that if the female crickets knew their lives would be shortened by sex, would they still do it?
This research sounds like some sort of warning a mother cricket tells her girls to try to prevent them from becoming slutty or a bad joke one tells in an insect bar.
So here's another: "A praying mantis is angry at his girl friend. He says to her 'Bite Me', so she did."
This research sounds like some sort of warning a mother cricket tells her girls to try to prevent them from becoming slutty or a bad joke one tells in an insect bar.
So here's another: "A praying mantis is angry at his girl friend. He says to her 'Bite Me', so she did."
Tuesday, February 17, 2009
Bonk: Behind the Science on Sex
Mary Roach, ignoring the fatalistic pull of her name to other issues, has written a book called "Bonk", where she looks at how research is done on sex. Her account of sex studies- what is their focus and how they are done- gives us a better sense of the need for a good sense of humility and humor in this sub-discipline.
Listen to her talk on Authors at Google
Listen to her talk on Authors at Google
Thursday, February 12, 2009
In tricking our sweet tooth, we are only cheating ourselves
Frontal Cortex (FC) has an excellent posting on the dynamics of artificial sweetners and the human body. It seems that while our tastebuds may be tricked by diet soda and the sweetness in blue, yellow, and pink packets, this trickery changes how the way we manage our dietary intake.
As FC writes, "Rats fed artificial sweeteners gained more weight than rats fed actual sugar...Animals may use sweet taste to predict the caloric contents of food. Eating sweet noncaloric substances may degrade this predictive relationship."
So in summary, the article cited by FC suggest that:
1. Our brain uses how sweet a food is to estimate the number calories and relatedly, how much we can eat.
2. Artificial sweetners screw up this mechanism so we end up thinking we can get away with eating a lot more sweets.
This reminds me of what a family member once (half jokingly) said to me, "I don't understand why I don't lose any weight, I eat diet crackers all day." The labels "diet","light", or the even more annoying "lite" gives us that comforting feeling that we can get away with eating more of the wrong thing. It makes it so much easier to convince ourselves that drinking that soda is acceptable because we are tired, had a long day, and deserve it.
Read more about this study at Frontal Cortex and Diet Soda
As FC writes, "Rats fed artificial sweeteners gained more weight than rats fed actual sugar...Animals may use sweet taste to predict the caloric contents of food. Eating sweet noncaloric substances may degrade this predictive relationship."
So in summary, the article cited by FC suggest that:
1. Our brain uses how sweet a food is to estimate the number calories and relatedly, how much we can eat.
2. Artificial sweetners screw up this mechanism so we end up thinking we can get away with eating a lot more sweets.
This reminds me of what a family member once (half jokingly) said to me, "I don't understand why I don't lose any weight, I eat diet crackers all day." The labels "diet","light", or the even more annoying "lite" gives us that comforting feeling that we can get away with eating more of the wrong thing. It makes it so much easier to convince ourselves that drinking that soda is acceptable because we are tired, had a long day, and deserve it.
Read more about this study at Frontal Cortex and Diet Soda
Wednesday, February 4, 2009
Radioactive IEC Materials
I've also come across an IEC materials in Vietnamese to warn people against the
dangers of Avian Flu. In it you see a radioactive man with green muck on his face who is being menanced by an angry looking rooster carrying a bloody scythe and a figure who seems to be a mix of the Grim Reaper and the Tuxedo Mask character from Sailor Moon.
This poster is laughably bad. It also serves as a sad memory of the media to build HIV awareness that continues to be produced in developing country with donor funds. I've seen way too many grim reapers/grinning skulls, blood, and other evil looking characters carrying a syringe. This approach simply doesn't work! It translates HIV into some fantastical evil out of a comic book and makes it seem less like a real risk. We all know to avoid roosters with scythes, but how many of us know how we can reduce our risk of Avian flu in areas at risk?
It reminds me also of a forward passed around a few years ago. This is a fake Tajik Airways safety card. It features glowing bad guys hijacking a plane and suggests ways passengers can protect themselves like offering hijackers a cigarette and flirting with them.
Link to the larger picture of Tajik Air's "Safety Card
dangers of Avian Flu. In it you see a radioactive man with green muck on his face who is being menanced by an angry looking rooster carrying a bloody scythe and a figure who seems to be a mix of the Grim Reaper and the Tuxedo Mask character from Sailor Moon.This poster is laughably bad. It also serves as a sad memory of the media to build HIV awareness that continues to be produced in developing country with donor funds. I've seen way too many grim reapers/grinning skulls, blood, and other evil looking characters carrying a syringe. This approach simply doesn't work! It translates HIV into some fantastical evil out of a comic book and makes it seem less like a real risk. We all know to avoid roosters with scythes, but how many of us know how we can reduce our risk of Avian flu in areas at risk?
It reminds me also of a forward passed around a few years ago. This is a fake Tajik Airways safety card. It features glowing bad guys hijacking a plane and suggests ways passengers can protect themselves like offering hijackers a cigarette and flirting with them.
Link to the larger picture of Tajik Air's "Safety Card
Condoms for Kids?
I'm of the mind that all sites and literature promoting safer sex should provide guidance based on real situations.
I'm sick of materials designed for high risk groups such as Men who have sex with Men (MSM), sex workers, and injecting drug users that uses child-like cartoons like little condom-men with smiling faces. I've seen more projects that I'd like to admit that have responded to the challenges of trying to reach a young or low-literate target group by making their communications too childlike. Sex is a very adult issue. Treating your target group with a modicum of respect makes for more effective interventions.
Example from: http://www.thethreeamigos.org/
There is hope. I am a big fan of the work at Hard Cell, a website targeting Men who have Sex with Men who address questions of protection with a heavy dose of sexual content. Only those 18 and over should visit.
Thursday, January 29, 2009
What Could be Cuter than Chlamydia?
Ever wonder what Gonorrhea or Syphilis look like under a microscope? Feel like you want to bond with your Herpes? Now you have the chance to have your own cute sexually transmitted infection for snuggling at Plushie Sexually Transmitted Diseases.
Coolstuffexpress has made some famous microcobes into cute and snuggly stuffed "animals".
I think it is fabulous.
Coolstuffexpress has made some famous microcobes into cute and snuggly stuffed "animals".
I think it is fabulous.
How Condoms are Made
Gotta love those "how they're made" videos. Listen to a soothing British voice while you see condoms spinning around. How Condoms are Made.
Condoms are made of a mix of liquid and solid latex. Colloids were never so great!
Condoms are made of a mix of liquid and solid latex. Colloids were never so great!
Your Love is a Drug and I Just Can't Get Enough
If you're like me, you enjoy seeing the random. I seem to get a lot of random and yet interesting points of view at TED. At TED, you can watch lectures on basically any subject. I recommend taking a look.
The one that stikes me most at the moment is Helen's Fisher's "The Brain in Love". She combines the definition of love through a poet's perspective and through an MRI. People newly in love, in love for 20 years, or going through the pain of a breakup with a loved one all have the same part of their brain light up. Love resides in the reptilian part of the brain, in the part where we want.
Here is something what we've known emotionally, but now we have the scientifically vetted proof. Love lights up the same part of the brain that is lights up when taking cocaine.
Love is truly addictive.
The one that stikes me most at the moment is Helen's Fisher's "The Brain in Love". She combines the definition of love through a poet's perspective and through an MRI. People newly in love, in love for 20 years, or going through the pain of a breakup with a loved one all have the same part of their brain light up. Love resides in the reptilian part of the brain, in the part where we want.
Here is something what we've known emotionally, but now we have the scientifically vetted proof. Love lights up the same part of the brain that is lights up when taking cocaine.
Love is truly addictive.
Wednesday, January 28, 2009
Does Congress have its Economics Twisted?
The House recently cut a provision in its economic stimulus package that would include family planning services for low income populations via Medicaid. This decision House Speaker Nancy Pelosi(D-CA) had argued for including the contraception provision because it will "reduce costs to the states and to the federal government" resulting from unplanned pregnancies. (CBS)
Contraception and Economics
In addition to conservative ire, Pelosi's argument seems to stir up a heady mix of Malthusian theory, issues regarding birth spacing, and the aging population. Thomas Malthus argued that there is the potential for rapid population growth that would create demand that exceeds the existing resources (in his example, food supply). Malthus believed that in addition to natural causes, misery, and vice; moral restraint (such as marrying at a later age) could check population growth. Malthus would have loved modern contraception. In the case addressed in Congress, the limited resource is governmental funds for social programs to assist low income populations. The population in need is growing (more people find themselves in the Medicaid-eligible group due to lost jobs) while the available resource has decreased. The cost of regular birth control for one couple is much lower than the cost of a child born to a couple.
If a couple makes a set income, it follows that they could afford to better meet the needs of their family if they have one child than if they had two. Having the choice to limit unwanted pregnancies through contraception becomes particularly important for low income populations who may not be able to afford the resources needed for that additional child. Can you afford the average $11,000 it takes for the first year of a child's life?
Birth spacing is a concept that takes family planning further, using contraception to ensure a minimum number of years between each child. Studies have shown that having 3-5 years between births increases survival rates and health outcomes for the born child, the older child, and the mother. In addition to the devasting impact a lost child or mother has to a family, it is possible that a family, especially one without health insurance, could never recover financially from the burden of medical and funeral costs.
Freakonomics readers will recall an argument by Donohue and Levitt that attributes the decline in crime to the legalization of abortion. While this argument has been criticized for many angles, it does bring up possible social consequences resulting from changes in access to family planning services and products.
And then there is the elephant in the room- the baby boomer population who is rapidly becoming the retirement age. A young, working population is needed to help the government and employers meet financial obligations to baby boomer retirees on pensions and Medicare. Economists have also pushed that population growth is a source of economic growth (the larger the population, the more purchasers demanding products).
So we must ask ourselves, does the government want us to have babies or to not have babies?
What does the government incentivize: more babies or fewer?
Since it is tax season, a look at the 1040 form list of exemptions gives us a better idea of what the US government has wanted us to do. We get exemptions for the number of dependents (such as children) we have. The exemption does not cover all of the expenses related to raising a child, but it does ease the burden in the balance between demand and resources for families.
We can also look at what health insurance companies cover and not cover. For many, contraception is NOT covered by their insurance carrier, yet the same carrier will cover prescriptions for Viagra. While birth spacing is a PROVEN way families can maintain good health of mothers and children, most families do not have access to the contraception that helps couples better time births. Meanwhile, older men can continue to have an active sex life and perhaps, if their female partners are using fertility treatments or are younger, they can also have children. Governmental bodies have the option of regulating change in what insurance companies cover, yet it does not seem to be a priority. As birth spacing is linked with better health, it is likely in the financial interst of insurance companies to include contraception as part of their preventitive health package. A little governmental kick in the rear here could go a long way.
Ethics
Nancy Pelosi has since taken on criticism based on the group the contraception provision was intended to benefit: low income women. Some have said who is to say that the pregnancies that this provision would prevent would not develop into highly productive children. While they make a good point, offering contraception as an option does not mean that it is mandatory. The answer should be to offer all women access to more affordable birth control. Women who are not Medicaid eligible are still in need of the choice of birth spacing.
Ways the government could better stimulate the economy in both the short term and long term
It made sense that contraception was kicked out of the economic stimulus package. Yet there is a need for some change sooner or later.
1. Just as we provide tax exemptions for dependent children, educator expenses, and student loans provide an exemption for out-of-pocket birth control costs.
2. Act legislatively to get health insurance companies to include birth control in their standard coverage package.
3. Work with pharmaceutical companies to negotiate the price down for birth control options.
4. If having a younger, working population is needed to balance the baby boom retiree population, modify immigration laws to allow more of the young, professional population to immigrate to the US.
Contraception and Economics
In addition to conservative ire, Pelosi's argument seems to stir up a heady mix of Malthusian theory, issues regarding birth spacing, and the aging population. Thomas Malthus argued that there is the potential for rapid population growth that would create demand that exceeds the existing resources (in his example, food supply). Malthus believed that in addition to natural causes, misery, and vice; moral restraint (such as marrying at a later age) could check population growth. Malthus would have loved modern contraception. In the case addressed in Congress, the limited resource is governmental funds for social programs to assist low income populations. The population in need is growing (more people find themselves in the Medicaid-eligible group due to lost jobs) while the available resource has decreased. The cost of regular birth control for one couple is much lower than the cost of a child born to a couple.
If a couple makes a set income, it follows that they could afford to better meet the needs of their family if they have one child than if they had two. Having the choice to limit unwanted pregnancies through contraception becomes particularly important for low income populations who may not be able to afford the resources needed for that additional child. Can you afford the average $11,000 it takes for the first year of a child's life?
Birth spacing is a concept that takes family planning further, using contraception to ensure a minimum number of years between each child. Studies have shown that having 3-5 years between births increases survival rates and health outcomes for the born child, the older child, and the mother. In addition to the devasting impact a lost child or mother has to a family, it is possible that a family, especially one without health insurance, could never recover financially from the burden of medical and funeral costs.
Freakonomics readers will recall an argument by Donohue and Levitt that attributes the decline in crime to the legalization of abortion. While this argument has been criticized for many angles, it does bring up possible social consequences resulting from changes in access to family planning services and products.
And then there is the elephant in the room- the baby boomer population who is rapidly becoming the retirement age. A young, working population is needed to help the government and employers meet financial obligations to baby boomer retirees on pensions and Medicare. Economists have also pushed that population growth is a source of economic growth (the larger the population, the more purchasers demanding products).
So we must ask ourselves, does the government want us to have babies or to not have babies?
What does the government incentivize: more babies or fewer?
Since it is tax season, a look at the 1040 form list of exemptions gives us a better idea of what the US government has wanted us to do. We get exemptions for the number of dependents (such as children) we have. The exemption does not cover all of the expenses related to raising a child, but it does ease the burden in the balance between demand and resources for families.
We can also look at what health insurance companies cover and not cover. For many, contraception is NOT covered by their insurance carrier, yet the same carrier will cover prescriptions for Viagra. While birth spacing is a PROVEN way families can maintain good health of mothers and children, most families do not have access to the contraception that helps couples better time births. Meanwhile, older men can continue to have an active sex life and perhaps, if their female partners are using fertility treatments or are younger, they can also have children. Governmental bodies have the option of regulating change in what insurance companies cover, yet it does not seem to be a priority. As birth spacing is linked with better health, it is likely in the financial interst of insurance companies to include contraception as part of their preventitive health package. A little governmental kick in the rear here could go a long way.
Ethics
Nancy Pelosi has since taken on criticism based on the group the contraception provision was intended to benefit: low income women. Some have said who is to say that the pregnancies that this provision would prevent would not develop into highly productive children. While they make a good point, offering contraception as an option does not mean that it is mandatory. The answer should be to offer all women access to more affordable birth control. Women who are not Medicaid eligible are still in need of the choice of birth spacing.
Ways the government could better stimulate the economy in both the short term and long term
It made sense that contraception was kicked out of the economic stimulus package. Yet there is a need for some change sooner or later.
1. Just as we provide tax exemptions for dependent children, educator expenses, and student loans provide an exemption for out-of-pocket birth control costs.
2. Act legislatively to get health insurance companies to include birth control in their standard coverage package.
3. Work with pharmaceutical companies to negotiate the price down for birth control options.
4. If having a younger, working population is needed to balance the baby boom retiree population, modify immigration laws to allow more of the young, professional population to immigrate to the US.
Monday, January 26, 2009
Flight of the Conchords take on Sex Work
I am a huge fan of Flight of the Conchords and recommend watching the show.
In a recent epidsode, faced with debt, Jermaine considers sex work as an option to earn money. While not all sex work initiation scenes include a dedicated theme song, the industry is much more complicated that those who would depict it wholly as sexual slavery. Here's the short video of Jermaine's Sugar Lump video thanks to Jezebel and of course, Flight of the Conchords. (Eat your heart out, Black Eyed Peas!)
In a recent epidsode, faced with debt, Jermaine considers sex work as an option to earn money. While not all sex work initiation scenes include a dedicated theme song, the industry is much more complicated that those who would depict it wholly as sexual slavery. Here's the short video of Jermaine's Sugar Lump video thanks to Jezebel and of course, Flight of the Conchords. (Eat your heart out, Black Eyed Peas!)
How Marketing Does Birth Control
I'd like to say that for-profit companies that market products seem to know a lot more than governments and not-for-profit organizations about what gets people to do something new (like purchase a product).
But what is all of that marketing research being used for? If you put it all together in one loop and add in the hysterical commentary of Sarah Haskins, all of this careful targeting and messaging all seems...silly. Target Women takes on Birth Control.
But what is all of that marketing research being used for? If you put it all together in one loop and add in the hysterical commentary of Sarah Haskins, all of this careful targeting and messaging all seems...silly. Target Women takes on Birth Control.
If you were a smoker, would this get you to quit?
The Centers for Disease Control (CDC) has a series of e-Cards where well-meaning friends and family can send not so subtle notes to push healthy behavior such as quitting smoking. What if you were a smoker? Does a woman jumping in a field make you want to stop smoking? Perhaps not, but perhaps knowing (as the inside of the card says) that half of ALL adult smokers in the US have already quit may give you pause. If so many people have been able to quit, it is possible to successfully quit if you try.
Scores:
Picture: C. The Photo looks like an ad for a feminine product. Message: B- If people perceive that the norm is to quit, they are more likely to take serious steps to quitting.
Global Gag Rule Lifted for US-funded operations
In quick, yet historical move, President Obama has lifted the "global gag rule".
Family planning groups can now discuss the full range of a woman's options with her for her reproductive health, even if US government funds pay for a portion of the (non-abortion) services provided at that clinic.
Perhaps the Year of the Ox is also the Year of Common Sense Healthy Policy.
Family planning groups can now discuss the full range of a woman's options with her for her reproductive health, even if US government funds pay for a portion of the (non-abortion) services provided at that clinic.
Perhaps the Year of the Ox is also the Year of Common Sense Healthy Policy.
Sunday, January 25, 2009
Simply Safer: Basic Sex Ed
I would be remiss if I did not include at least a bare minimum of basic education on how folks can better protect themselves during all of this sexual behavior I'm talking about.
How to Correctly Put on a Male Condom
1. Make sure the condom has not expired and check the condom package & condom for tears
2. Carefully tear open the pack, making sure not to tear the condom (teeth, scissors, and knives are forbidden here!)
3. The shiny, lubricated side of the condom should be on the outside, so the condom can easily be rolled down the penis. If the penis touches the wrong side, throw condom away and use a new condom.
4. Pinching the top of the condom, roll the condom all the way down the erect penis to the base. The entire penis should be covered by condom. Do not skip the PINCH step, this is very important to prevent breakage.
5. If the condom breaks or slips off, stop sex. You should use a new condom.
6. After ejaculation and while the penis is still erect, withdraw the penis, holding the condom by the base so no semen spills on your partner.
7. Holding the base of the condom, pull down. The condom should come off. If you wish, tie it in a knot.
8. Dispose of condoms in a trash can. Do not try to flush condoms!
For advanced male condom tips, I'd also suggest looking up a post by Eric Amaranth on the Dodson and Ross site site. Dr. Betty Dodson is a fabulous resource for any of your questions on sex and your body (not me).
How to Correctly Use Lubricant
1. Use water or silicone-based lubricant, if the lubricant is flavored, make sure it is sugar-free or you'll risk infectiony revenge (hello yeast!). Do NOT use oil-based lubricants like whipped cream, butter, oil, conditioner, or vaseline. They will break the condom. Do not use spermicides, they also increase the change of infection transmission.
2. Use a male or female condom (lubricant does not replace a condom). For male condom instructions, see above.
3. Liberally apply outside the condom-covered penis and in and around the the rectum/vaginal canal.
4. If drying or friction occurs during sex, apply more lubricant.
How to use a female condom
The "female condom" is a misnomer. More properly named the "insertive condom" it can also be used by the receptive partner during anal sex. Here is some guidance for both uses.
For Vaginal Sex
1. Carefully tear open the packet along the edge and remove the female condom. Inspect to ensure there is no damage to the condom.
2. Hold the condom with the open end hanging down, pinching it the ring with your thumb, index finger and middle finger.
3. Find a comfortable position so you may easily insert the condom (squat, sit with your knees apart or stand with one foot on a chair.)
4. The condom has a smaller inner ring (closed end) and a larger outer ring (open end). Squeezing the inner ring with your three fingers, insert it into your vagina.
5. Put your index finger inside the condom until you can feel the inner ring. Use your finger to push the ring up inside the vagina. You can tell that the condom is in place when the inner ring moves into position behind the pubic bone.
6. The outer ring should lie flat around the outside of your vagina.
7. Use your hand to guide your partner’s penis into the condom. Use your fingers to make sure the outer ring continues to lie flat against the vagina opening during sex. Make sure the penis is not inserted between condom and vagina wall.
8. After sex, remove the female condom by twisting the outer ring and pulling it out gently.
9. Wrap the condom with a paper or plastic bag and throw it into the garbage. Do not flush it.
For anal sex
1. Remove the inner ring from the condom.
2. Apply lubricant in the inside of the rectum and on the penis.
3. Place the erect penis inside the condom. The penis will help you guide the condom inside the rectum just as the inner ring would for vaginal insertion.
4. The outer ring should lie flat around the outside of your anus.
5. Use your fingers to make sure the outer ring lies flat against the anal opening during sex. Make sure the penis is not inserted between the condom and rectum.
8. After sex, remove the condom by twisting the outer ring and pulling it out gently.
9. Wrap the condom with a paper or plastic bag and throw it into the garbage bin or dustbin. Do not flush it.
How to Have Safer Anal Sex that Isn't Painful
1. Use the toilet and empty your bowels
2. Gently clean the anal area with soap and water
3. Put on a latex or polyurethane condom - condoms protect from sexually transmitted infection (STI) & HIV transmission and also protects the insertive partner from bacteria in the rectum (see above)
4. Liberally apply water-based or silicone-based lubricant in the rectum and around the anus and also put it on the outside of the (condom covered) penis
5. Gently insert 1-2 lubricated fingers to loosen your anus (or your partner can do it if his fingers are in a condom)
6. Relax the anus as the (condom covered) penis is inserted
7. If it hurts when the penis is first in, remove the penis and wait about 20 seconds before reinserting
8. If drying or friction occurs during sex, apply more lubricant
9. After intercourse, before the penis become soft, withdraw the penis and the condom together from the anus.
There is no reason anal sex should hurt!
How to Have Safer Oral Sex
Some sexually transmitted infections (STIs) CAN be transmitted through oral sex. Think about the skin on your palms versus the inside of your mouth- which one is more vulnerable to cuts and scratches?
On a penis
1. A male condom can be used starting when the penis is erect. Before then, make use of your hands. It would be even safer to use a pair of unused, sterile latex gloves with lubricant, but your hands are still a better choice than your mouth on an uncovered penis.
2. Put the condom on the penis as above.
3. Now it is mouth ready. Use SUGARLESS, flavored water-based or silicone based lubricant on the outside to address any latex taste.
4. After ejaculation, dispose of the condom in the trash (again, do not flush).
On a female and/or for Rimming
1. Use a dental dam as the barrier between mouth and genital area.
2. Use SUGARLESS, flavored water-based or silicone based lubricant on the outside to address any latex taste.
If you do not have a dental dam, take your scissors to an (empty, new) male condom.
1. Unroll a new condom
2. Cut the tip off of the condom.
3. Cut lengthwise down the condom.
And now you have your own dental dam!
Why I Hate the Durex Balloon Animal Ad
The Durex Balloon Animal ad has been blazing through social circles faster than Herpes through Derek Jeter's little black book. (at least, that is what some gossip blogs have been saying).
The ad is cute and a fun little thing to pass on to friends for a joke, but does it make people more likely to USE condoms when they have sex?
Yes and no. Like with most marketing campaigns, you have to imagine the target group they are trying to reach and imagine how they would process seeing the same video.
Yes- What we have seen in condom use research is that consistent condom-users are more likely to report they bought condoms than non-condom users. This may overwhelm you with obviousness, but simple sense dictates is that if you have condoms with you, you are more likely to use them than if you didn't have them. If someone already uses condoms quite often, but not always, this ad may remind him or her to stop by to pick some up before a date.
No- think about people you know who do not use condoms (ever or only rarely). I've give you a picture that comes into my head: a semi-religious young woman who feels uncomfortable carrying or buying condoms because she associates having condoms with "sluts". This playful video may actually reinforce her association between condoms and being slutty and she'll be even more reticent to purchase (and therefore use) condoms.
I must admit that I am also annoyed by the rubbery-squeaking sound. If only they used water-based or silicone-based lubricant, they could have gone to town and protect themselves further from the latex breaking and reduce that annoying sound.
I'd advise people who click on this to see the Durex video (and outtakes) be 18 and older.
The ad is cute and a fun little thing to pass on to friends for a joke, but does it make people more likely to USE condoms when they have sex?
Yes and no. Like with most marketing campaigns, you have to imagine the target group they are trying to reach and imagine how they would process seeing the same video.
Yes- What we have seen in condom use research is that consistent condom-users are more likely to report they bought condoms than non-condom users. This may overwhelm you with obviousness, but simple sense dictates is that if you have condoms with you, you are more likely to use them than if you didn't have them. If someone already uses condoms quite often, but not always, this ad may remind him or her to stop by to pick some up before a date.
No- think about people you know who do not use condoms (ever or only rarely). I've give you a picture that comes into my head: a semi-religious young woman who feels uncomfortable carrying or buying condoms because she associates having condoms with "sluts". This playful video may actually reinforce her association between condoms and being slutty and she'll be even more reticent to purchase (and therefore use) condoms.
I must admit that I am also annoyed by the rubbery-squeaking sound. If only they used water-based or silicone-based lubricant, they could have gone to town and protect themselves further from the latex breaking and reduce that annoying sound.
I'd advise people who click on this to see the Durex video (and outtakes) be 18 and older.
Introduction to Sex, Drugs, and Behavior Change
Note: This blog seeks to find ways to better understand complicated issues of behavior change related to sexual and drug-risk related behavior. Some of the issues brought up in this blog are of a sexual nature or relate to drug use and may include notes that are (intended to be) humorous. If you think any of this may offend you, please do not read.
---
Sex. We talk about it, we joke about it, we dish about it, we brag about it. Sex has many faces, it can be (re)productive, playful, or risky in more ways than one. We like it because it feels good or, in some cases (as John Mellencamp says) it "hurts so good." Yet why do some not use condoms when they know they should?
Hurts so Good by John Mellencamp
Sex is the perfect example of learning about behavior, why we do what we do, and why it changes. There are hundreds of professionals who have spent their careers working on how to change sexual behavior and yet we all still have a lot to learn.
What have we learned from more than 30 years of behavior change activites? Actually, a good amount. We just need to pay attention to what we already "know" and try to figure out what's left.
As an example, reducing sexual risk requires a focus first on condom use and talking to partners. Avoiding or downplaying condoms only hurts us in the end.
Let's think about the abstinence-focused curriculum promoted by well-intentioned but almost willfully ignorant policy makers and misled parents. The resulting change from this strategy in youth sexual behavior has been largely contrary to goals. While some young people are delaying their sexual debut (i.e. when they first have sex), they are NOT waiting until marriage, and many are not using condoms.
We have also learned that education and awareness-building alone do not change everyone's behavior.
Drug (licit and illicit) use also gives us a great example.
In 1950, Richard Doll and A. Bradford Hill conducted a case control study that first gave the world the idea that smoking and lung cancer were linked*. From 1951-2001, Doll, Hill, et al ran a prospective cohort study that followed up doctors over fifty years to see if those who were smokers had higher rates of cancer than those who were non-smokers**. Starting in 1954, articles were published on their findings to date which showed a strong causal relationship between smoking and cancer.**
In the US, an American study with similar results was described in the Reader's Digest article "Cancer by the Carton" in 1952. While there was a decline in smoking after the buzz from this article, many continued smoke and non-users continued to initiate.
While awareness of the dangers of smoking did spur some to quit, other factors were at play. There is, of course, addiction, but that is not the whole story. But what of the numbers who initiated? Cigarette advertising a la "Mad Men" could explain some of this. We live in the era where increasing cigarette taxes and city-wide smoking bans are increasingly used and have seen a measureable decrease in smoking as a result, so that must be part of the answer. As before, the answer is composed of multiple factors, some which we know, some we guess, and others we have yet to find out.
Welcome to Sex, Drugs, and Behavior Change
* Doll R Hill AB "Smoking and Carcinoma of the Lung" British Medical Journal 1950 (2) 739-748
** Doll R, Hill AB "The Mortality of Doctors in Relation to their Smoking Habits" British Medical Journal 1954 (1) 1451-1455
** Doll R, Peto R Boreham J Sutherland I "Mortality in Relation to Smoking: 50 Years' Observation on Male British Doctors" British Medical Journal 2004 328 (7455) 1519
---
Sex. We talk about it, we joke about it, we dish about it, we brag about it. Sex has many faces, it can be (re)productive, playful, or risky in more ways than one. We like it because it feels good or, in some cases (as John Mellencamp says) it "hurts so good." Yet why do some not use condoms when they know they should?
Hurts so Good by John Mellencamp
Sex is the perfect example of learning about behavior, why we do what we do, and why it changes. There are hundreds of professionals who have spent their careers working on how to change sexual behavior and yet we all still have a lot to learn.
What have we learned from more than 30 years of behavior change activites? Actually, a good amount. We just need to pay attention to what we already "know" and try to figure out what's left.
As an example, reducing sexual risk requires a focus first on condom use and talking to partners. Avoiding or downplaying condoms only hurts us in the end.
Let's think about the abstinence-focused curriculum promoted by well-intentioned but almost willfully ignorant policy makers and misled parents. The resulting change from this strategy in youth sexual behavior has been largely contrary to goals. While some young people are delaying their sexual debut (i.e. when they first have sex), they are NOT waiting until marriage, and many are not using condoms.
We have also learned that education and awareness-building alone do not change everyone's behavior.
Drug (licit and illicit) use also gives us a great example.
In 1950, Richard Doll and A. Bradford Hill conducted a case control study that first gave the world the idea that smoking and lung cancer were linked*. From 1951-2001, Doll, Hill, et al ran a prospective cohort study that followed up doctors over fifty years to see if those who were smokers had higher rates of cancer than those who were non-smokers**. Starting in 1954, articles were published on their findings to date which showed a strong causal relationship between smoking and cancer.**
In the US, an American study with similar results was described in the Reader's Digest article "Cancer by the Carton" in 1952. While there was a decline in smoking after the buzz from this article, many continued smoke and non-users continued to initiate.
While awareness of the dangers of smoking did spur some to quit, other factors were at play. There is, of course, addiction, but that is not the whole story. But what of the numbers who initiated? Cigarette advertising a la "Mad Men" could explain some of this. We live in the era where increasing cigarette taxes and city-wide smoking bans are increasingly used and have seen a measureable decrease in smoking as a result, so that must be part of the answer. As before, the answer is composed of multiple factors, some which we know, some we guess, and others we have yet to find out.
Welcome to Sex, Drugs, and Behavior Change
* Doll R Hill AB "Smoking and Carcinoma of the Lung" British Medical Journal 1950 (2) 739-748
** Doll R, Hill AB "The Mortality of Doctors in Relation to their Smoking Habits" British Medical Journal 1954 (1) 1451-1455
** Doll R, Peto R Boreham J Sutherland I "Mortality in Relation to Smoking: 50 Years' Observation on Male British Doctors" British Medical Journal 2004 328 (7455) 1519
Subscribe to:
Posts (Atom)
