The McModerate

Cristina Page

With detractors like Rush Limbaugh, Ann Coulter, Laura Ingraham, Glenn Beck, Sean Hannity, Rick Santorum, Tom Delay and James Dobson, most thinking people might conclude that John McCain comes highly recommended. But just because John McCain is an enemy of some of our most cartoonish villains does not make him a friend.

With detractors like Rush Limbaugh, Ann Coulter, Laura Ingraham, Glenn Beck, Sean Hannity, Rick Santorum, Tom Delay and James Dobson, most thinking people might conclude that John McCain comes highly recommended. But just because John McCain is an enemy of some of our most cartoonish villains does not make him a friend. This is most true on reproductive health issues.

Pro-choice Americans haven't yet pegged McCain as the extreme anti-choice copy of George W. Bush he is. But for close watchers of pro-choice politics, he's John McSame.

In fact, the Straight Talk Express has skidded off the road that most Americans drive. He is more extreme than even some who consider themselves "pro-life." For example, most Americans would be stunned to learn McCain won't – or can't – say whether he even supports the right to use contraception. Last March, McCain fumbled through this exchange about contraception with a reporter aboard his campaign bus;

"Reporter: "Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?"

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Mr. McCain: "Well I think it's a combination. The guy I really respect on this is Dr. Coburn. He believes – and I was just reading the thing he wrote- that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn't succeed, then he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I'm not very wise on it." (Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

Mr. McCain: "I haven't thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don't know if I would use taxpayers' money for it [contraception]."

Q: "What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush's policy, which is just abstinence?"

Mr. McCain: (Long pause) "Ahhh. I think I support the president's policy."

Q: "So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?"

Mr. McCain: (Long pause) "You've stumped me."

Q: "I mean, I think you'd probably agree it probably does help stop it?"

Mr. McCain: (Laughs) "Are we on the Straight Talk express? I'm not informed enough on it. Let me find out. You know, I'm sure I've taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception – I'm sure I'm opposed to government spending on it, I'm sure I support the president's policies on it."

Q: "But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: 'No, we're not going to distribute them,' knowing that?"

Mr. McCain: (Twelve-second pause) "Get me Coburn's thing, ask Weaver to get me Coburn's paper that he just gave me in the last couple of days. I've never gotten into these issues before."

The Coburn that McCain has chosen as his mentor on all things reproductive is Senator Tom Coburn, R-Oklahoma, which is like having the Taliban head up the Office for Women's Initiatives. (Think that's an extreme comparison? Keep in mind Coburn supports the death penalty for abortion providers.)

One story about McCain mentor Coburn is particularly telling. Coburn, in recent years, led a sneaky offensive against the condom. In 1999, Coburn drafted legislation mandating that condom labels state that they cannot prevent the transmission of HPV. In 2000, at Coburn's request, the National Institutes of Health, the FDA, USAID and the CDC (the agencies responsible for condom research, condom regulation, condom-use recommendations, and HIV/AIDS and STD prevention) hosted a meeting of experts to compile and examine 138 peer-reviewed papers on the effectiveness of condoms in preventing transmission of STDs. In its report, the panel explained the difficulty in making definitive conclusions based on available studies. For one, thing, there exist ethical boundaries that prevent ideal studies from being conducted. Researchers cannot ask study subjects to go have sex without a condom and come back and see what they caught. They also cannot ask those with treatable diseases, like HPV, to remain untreated, have sex with others using a condom, and see how likely transmission was.

Thus NIH took the cautious route. It pointed out that given the studies out there, it was not always possible to say with certainty that the condom stopped everything, like, for example, HPV or chlamydia. With regard to HPV, it stated, "The panel stressed that the absence of definitive conclusions reflected inadequacies of the evidence available and should not be interpreted as proof of adequacy or inadequacy of the condom to reduce the risk of STDs." In other words, a definitive answer was not possible either way. Still the panel was able to conclude, " Study results did suggest that condom use might afford some reduction in risk of HPV associated diseases, including genital warts in men and cervical neoplasia [or cancer] in women." With HPV, the diseases are what you care about.

The panelists knew how their careful words might be construed by those with a political agenda and explicitly cautioned anyone against using the report to discourage condom use. On cue, Coburn reacted as if the CDC's careful wording proved his case. Somehow he managed to conclude that the government was covering up for "condom pushers." Coburn issued a press release entitled "Condoms Do Not Prevent Most STDs" and joined anti-condom groups the Physician's Consortium and the Catholic Medical Association to call for the resignation of the director of the CDC.

President Bush rewarded Coburn for his good work by appointing him to co-chair, of all things, the Presidential Advisory Council on HIV/AIDS. When it comes to the preventing the spread of AIDS, Bush clearly prefers Right-thinking anti-condom crusaders to scientists. It would appear McCain does too. And might similarly reward Coburn – to oversee HHS, perhaps.

Sadly, though McCain often appears to be the palatable Sunday talk show conservative, the good-humored, apparently moderate Republican, on reproductive rights he's a lot like Coburn. Down the line, positions will leave even the middle-of-the-road reader wondering if we can really afford more of the same.

When asked about his position on reproductive rights, McCain talking with the National Review advised, "I think the important thing is you look at people's voting record because sometimes rhetoric can be a little… misleading." And there's no truer statement. McCain's voting record, which NARAL Pro-Choice America scrupulously tracks, is telling. He has consistently voted against the right to a legal abortion and he has also consistently voted against contraception. McCain voted to end the Title X family planning program which is the only way millions of Americans have been able to plan their family. Title X has also been heralded as having prevented more than nine million unwanted pregnancies in the last two decades. Without Title X, the number of teenage pregnancies would have been 20% higher too.

McCain voted against legislation that would have required insurance coverage of prescription birth control and would also have provided more women with prenatal health care. (So, throw in anti-baby too. It's also worth noting that in 2004, McCain ranked among the 25 worst Senators for children, scoring 38%, according to the Children's Defense Fund Congressional Score Card.)

He's an unapologetic proponent of the failed abstinence-only approach as well. He voted against making "abstinence-only" programs medically accurate (the most authoritative study found that more than 80% of abstinence-only curricula, used by more than 2/3 of federal recipients, contains false, misleading, or distorted information.) He also wanted to take $75 million from the Maternal and Child Health Block Grant to launch an abstinence‐until-marriage program that prohibits sexually active teens from learning about birth control. Yet another time he tried to route one‐third of all HIV/AIDS prevention funds to the completely ineffective "just say no to sex" programs.

It's clear; Iraq is not the only unpopular war Bush started that McCain hopes to continue. The war on Americans' sex lives is another and McCain has already proven himself a good, loyal general.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

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Arizona Drops 1,500 Needy Children With First-in-Nation Cash Assistance Cap

Nicole Knight Shine

Critics have called the cap "an aggressive and intentional effort to undermine support for vulnerable families.”

At the beginning of this month, around 1,500 children and 1,000 adults living in poverty in Arizona lost cash assistance and now are permanently barred from the state’s welfare program.

Arizona is the first state in the country to end welfare benefits after one year, meaning that a family—typically a parent or a relative with at least one dependent child—who has already used 12 months of cash assistance will be cut off permanently.

The approximately 2,500 individuals who lost benefits July 1 represent roughly 10 percent of the children and one-quarter of the adults who receive Arizona’s funds from a federal block-grant program known as Temporary Assistance to Needy Families (TANF). They may, however, still qualify for benefits like Supplemental Nutrition Assistance, Medicaid, and other assistance.

Arizona had previously provided two years of cash assistance, but Arizona lawmakers and the state’s Republican governor recently agreed to cut the time limit in half to help plug a projected $534 million budget hole in 2016 and shift the money to state child welfare programs. The state expects to save $3.9 million annually with the 12-month limit, according to a spokesperson from the Arizona Department of Economic Security, which runs TANF.

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Supporters of Arizona’s new one-year limit, such as former state Sen. Kelli Ward (R-Lake Havasu City), who’s challenging incumbent Sen. John McCain (R) in the August primarysaid the cut will “encourage the able-bodied to treat welfare like a safety net rather than a hammock.”

Critics have called it “an aggressive and intentional effort to undermine support for vulnerable families,” as Cynthia Zwick, executive director for the Arizona Community Action Association, put it for the Arizona Republic.

The average Arizona family in the program received $201 in May 2016, according to a state report, an amount that is less than half of the nationwide average monthly benefit of $429. To qualify in Arizona, a family of four generally cannot earn more than $2,584 a month, although that varies and is based on multiple factors.

In May 2016, before the new time limit kicked in, 15,581 children and 4,139 adults in Arizona received cash assistance, totaling $1,841,672.

A federal block-grant program, TANF was enacted under former President Bill Clinton in 1996 with the aim of “end[ing] welfare as we know it.” TANF allows up to five years of benefits, but gives states wide latitude with those benefits, as long as their TANF spending meets at least one of four official goals: providing cash aid to needy families; promoting job training, work, and marriage; reducing out-of-wedlock pregnancies; and increasing the number of two-parent families.

In the 20 years since the program’s enactment, what’s happened is a marked and ongoing plunge in cash assistance to families in poverty, as states, like Arizona, spent TANF money elsewhere.

Arizona, for example, has shifted TANF money to its underfunded child welfare programs, as the Phoenix-based Morrison Institute for Public Policy noted in its 2015 report. Ohio funds faith-based crisis pregnancy centers with TANF dollars, with the ostensible goal of reducing out-of-wedlock pregnancies. Oklahoma, meanwhile, spends TANF dollars on marriage counseling.

Roughly 55 percent of impoverished Arizona families received TANF benefits in 1994-95, a number that plunged to 9 percent in 2013, as the Morrison Institute noted in its 2015 report. Arizona’s latest reduction is the fourth since 2009, as the report noted.

Anticipating the cuts, representatives from the state DES said recently in a statement that state contractors have found jobs for more than 1,500 individuals who were in danger of losing benefits because of the new one-year cap.

Arizona outsources its job training and placement to two private companies, MAXIMUS and Arbor/ResCare Workforce Services. The DES also reported that an additional 245 individuals have gained work experience, and more than 450 have participated in community service activities with employers.

DES Director Tim Jeffries described gainful employment as “the true American dream.”

The agency, he noted, acting as “good stewards of taxpayer’s money, should work to assist individuals in becoming self-sufficient, with the goal that one day they will no longer need benefits.”