"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

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

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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

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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."

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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

Decisions

While 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 "is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act" yet "the Church teaches that married people may then take 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."

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.

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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

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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?....

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!

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.

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.

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.

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."

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

Picture via Flickr