Roundups Sexual Health

Sexual Health Roundup: HIV-Prevention Drug Wins FDA Panel Approval, Parents Talk About Internet Pornography

Martha Kempner

A New York Times article looks at how parents do (and should) react when their children inevitably see Internet pornography, an FDA advisory panel recommends approving a drug for HIV-prevention, and Massachusetts cuts over $1 million from its HIV-prevention and testing program in county jails. 

How Some Parents Are Handling Internet Pornography

An article in the New York Times gives parents some advice on how to react when their children see internet pornography. As the article notes, it’s not just computers that have access to the Internet — it’s smart phones, i-Pads, i-Pods, gaming systems, and e-readers.  As such, it is pretty much inevitable that children will see pornographic images whether by accident or on purpose — even with the best filtering software. The article interviewed parents who took radically different approaches to this issue and talked to experts for their advice.

One mother of five children felt so strongly that it was her duty to ensure they didn’t see any explicit material that she took back the i-Pod Touches she had given each of them for Christmas when she realized that there was no way to disable or filter the internet on those devices. In fact, she petitioned Apple to put a warning on the boxes so other parents with her concerns would not unknowingly purchase them as she had. (According to the article there is now a new app specifically designed to filter content on mobile devices like the i-Pod Touch and the Kindle.)

In contrast, a father of a 14-year-old boy took a different approach when an i-tunes bill revealed that his son had bought an application called 1,001 breasts. Remembering how much he wanted to look at Playboy when he was that age, he was not shocked and did not get angry. Instead, he used it as an opportunity to discuss pornography with his son and then set up blocking software that allowed one site with naked women (which he described as not much more explicit than the Sports Illustrated swimsuit edition) to get through. 

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Of course, there is also the issue of much younger kids accidentally clicking on a link that brings up pornographic material. One mother interviewed, after realizing what her six-year-old had seen, told her daughter simply that there are some videos that are not appropriate and left it at that.

For an expert opinion, the article turned to Elizabeth Schroeder, executive director of Answer and Rewire contributor, who pointed out that the bigger issue is not necessarily what children see but how parents react. “If we flip out, freak out or go crazy about it, we’re giving a very set message,” she said, one that may prevent children from feeling they can ask their parents questions without being judged or punished.”  Schroeder says it’s important to remain calm and let your child know, he or she can come to you to discuss what they’ve seen. She and other experts agree that it is also important to have the conversation before any internet incident precipitates it and to make it part of ongoing family conversations about sex and sexuality.

FDA Panel Approves New HIV-Prevention Drug; Some Advocates Worry

A few weeks ago, I noted in the Sexual Health Roundup that California was set to try Truvada, a drug previously given to HIV-positive individuals, as a method of prevention for those most at risk of sexual transmission of the virus. While many were excited about this new weapon for prevention, others feared that it would cut back on condom use and that it was too expensive to be worthwhile. This debate is now likely to heat up and go national.

Last week an FDA advisory panel recommended giving Truvada to healthy people who might be exposed to HIV through sexual activity. Studies have found that, when taken daily, this antiviral medicine greatly reduces an individual’s chance of become infected with HIV. The panel, therefore, recommended that the drug be, “prescribed for people at high risk of infection, like gay men who have multiple sex partners, especially those who do not always use condoms, and people in relationships with someone who is H.I.V.-positive.”  Other high-risk populations that might benefit from Truvada include young black men and sex workers.

Some experts believe that the availability of this preventive drug could reduce the number of new HIV infections by 50,000 per year. Still, there are questions about Truvada. Members of the FDA panel voiced concerns that people who become infected with HIV while taking the drug could develop a drug-resistant strain of the virus. Others also worried about the testing requirements. Individuals should be tested for HIV before starting Truvada as a preventive measure because if they are HIV-positive when they start, the virus may quickly become drug resistant. While testing is required before people start the drug, experts say this will be hard to enforce and worry that it could become a barrier to some people taking the drug at all.

The biggest fear, though, is that people who take the drug will stop using other prevention methods like condoms. And, that at the same time they will not adhere properly to the daily dose of the drug leaving them more at risk of HIV infection than they were before. Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles, said:

Among our own patients who are HIV-positive, we have difficulty getting them to adhere, let alone people who don’t have the disease. Counting on adherence is not going to work.

In fact, among those who participated in the trials of Truvada, only 10 percent took the drug every day. In another interview, Weinstein said: “You will definitely have a result that is far worse than what you had in any of the studies.” Other advocates and researchers disagreed; one compared Weinstein’s arguments to those that suggested airbags were dangerous because people would stop wearing seatbelts. 

Truvada is already approved by the FDA for use with HIV-positive patients so doctors are free to prescribe it “off-label” to those who they feel should use it as a prevention method.  Until the FDA approves it for preventative use, however, its manufacturer cannot advertise or label it as a prevention method. The panel approval is a step toward FDA approval of the new usage and will also likely mean that the $14,000 a year price tag will be covered by insurance. 

Massachusetts Cuts Funding for HIV Testing and Education in County Jails

Cuts in CDC funding have forced Massachusetts to reduce its state budget for HIV  prevention by $4.3 million and it looks like programs in county jails will be among the first to go. The state announced more than $1 million dollars of cuts to programs that educate inmates about HIV, test them for HIV, and monitor the health of those who are HIV-positive. These new cuts will mean eliminating jobs of HIV educators as well as ending visits to inmates by infectious disease doctors.  

In the 2011 budget year, 8,211 county inmates were tested statewide and 34 were  HIV-positive. Inmates are frequently at high risk before coming to jail because of unprotected sex and injection drug use, and the risk of unprotected sex within the jails themselves is also high. Jails also have a much higher rate of turnover than state prisons because their inmates serve no more than two years meaning they will be back home soon. Because of that high turnover, jails have often been seen as an important point of prevention and testing so that when inmates return to their communities they are aware of their status and can take preventive measures. 

The federal cuts which will be phased in over five years are part of the CDC’s efforts to move resources out of states like Massachusetts where HIV/AIDS rates are low and into state with increasing rates of infection like those in the South.  “In today’s challenging economic environment, it is more important than ever to ensure that every federal HIV prevention dollar has the greatest possible impact on the national HIV epidemic,’’ CDC spokeswoman Jennifer Ruth Horvath said in an e-mail to the Boston Globe.

The state was then forced to make a similar decision, cut funding where it would do the least damage. And some believe, based on the low rates of HIV revealed by testing in the jails, that officials made the right choice. One public health professional who works for a health center that also lost funding recently said: “They’re being left with a bunch of bad choices. The county jails in this particular case may not be the highest yield for the dollars that are spent. . . . I think it’s the least bad alternative.’’ 

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