Roundups Sexual Health

Sexual Health Roundup: Psychiatrist Apologizes for Study on Reparative Therapy, CDC Wants to Test Boomers for Hep-C

Martha Kempner

Sexual Health Round-up: A renowned psychiatrist who is paradoxically responsible for both the biggest advance in gay rights and one of the studies most often used to deny these rights apologizes to the gay community; CDC recommends that everyone ages 47 to 67 be tested for Hep-C; and a new study warns that young men who abuse Viagra (and its cousins) are less satisfied with their sex lives.

Psychiatrist Responsible for Often-Misrepresented Study of Reparative Therapy Apologizes to the Gay Community

The front page of Saturday’s New York Times includes an in-depth interview with Dr. Robert L. Spitzer, a psychiatrist who is paradoxically responsible for both the biggest advance in gay rights and one of the studies most often used to deny these rights. In the interview the 80-year-old, who is now suffering from severe Parkinson’s disease, says he feels he owes the gay community an apology.

Spitzer was a psychiatrist and professor at Columbia University in 1970 when a group of gay rights activists heckled a meeting he was attending arguing that homosexuality should not be treated as a mental illness. He says their arguments made sense to him and, “I began to think, well, if it is a mental disorder, then what makes it one?” He went on to compare it to other conditions that were also defined as disorders and, according to the article:

“saw immediately that the latter [alcohol dependence and depression] caused marked distress or impairment, while homosexuality often did not.”

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Spitzer was in a position to make change because he was serving as a member of the American Psychiatric Association committee that was charged with rewriting the diagnostics manual. He organized a symposium to discuss homosexuality and led the charge to get it removed from the list of mental disorders. In 1973, he was successful and the revised Diagnostic and Statistical Manual of Mental Disorders (which came out in 1980) did not classify homosexuality itself as a disorder. Instead it included “sexual orientation disturbance” which applied to individuals — gay or straight — who were distressed by their sexual orientation. This was celebrated as a major victory throughout the gay community because until then legitimate psychiatrists and therapists often sought to “cure” homosexuality through therapy.

Some of Spitzer’s colleagues, however, felt this new classification was a mistake and continued to champion therapy to cure homosexuality which came to be known as “reparative” or “conversion” therapy.” Spitzer describes himself as being drawn to controversy and, like the gay rights advocates decades before, some ex-gays (those who believe their sexual orientation was, in fact, changed through therapy) caught his ear and his interest in the nineties. He went on to conduct and publish a study about reparative therapy in which he interviewed 200 patients who had gone through it and asked them how they would classify their sexual orientation before and after. 

The results, which were released at a meeting in 2001 before they were published without peer review in the Archives of Sexual Behavior, found that most participants felt their sexual orientation had changed with treatment. Those involved in the reparative therapy movement — a movement which is politically enmeshed with religious conservatives and others opposed to gay rights — hailed this as a major victory and seized on Spitzer’s reputation and career history as proof that he wasn’t biased. They used it this study to argue for everything from removing GSAs in schools to banning gay marriage and civil unions. 

Many of Spitzer’s colleagues, on the other hand, jumped on this study as bad science noting that it didn’t test any particular method of conversion therapy (some of the participants weren’t even in therapy but had simply done independent bible study) and that it relied on self-reported feelings. They argued that the participants may have been lying not just to Spitzer but to themselves. 

This was the criticism that really got to Spitzer:

“As I read these commentaries, I knew this was a problem, a big problem, and one I couldn’t answer. How do you know someone has really changed?”

But it took over a decade to admit this publicly.  In his letter of apology, Spitzer acknowledges that his study had a fatal flaw: “the simple fact is that there was no way to determine if the subject’s accounts of change were valid.”  He went on to say:

“I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some “highly motivated” individuals.”

Spitzer ended his New York Times interview by pointing out that he didn’t know of any other psychiatrist who had admitted his mistake and apologized for it saying, “that’s something isn’t it?” People seem to be having very different reactions to what exactly it is though. The comment section after the online version of the article is full of people who accept his apology as better late than never and hail him as brave, as well as those who feel the damage is done and his apology is useless at this point. 

Baby Boomers Should Get Tested for Hepatitis C

The Centers for Disease Control and Prevention (CDC) is recommending that all Americans who were born between 1945 and 1965 be tested for Hepatitis C. This strain of Hepatitis is most often spread through sharing infected needles for drug use, needle sticks in health care workers, and from mother-to-child. Other possible means of transmission include snorted cocaine and shared personal care items like razor blades and tooth brushes. Though it can be spread through sexual activity the CDC describes the risk as low and explains:

The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.

Hepatitis C infects the liver and causes a gradual deterioration of the organ leading to cirrhosis and liver cancer. It is the most common reason for liver transplants. And it is most common in baby boomers — 2 million of the 3.2 million cases occur in this age group. The CDC believes that most of these individuals were infected in their twenties before the virus was official discovered (which happened in 1989) and the blood supply was screened. 

This new effort aims to have all individuals ages 47 to 67 take a one-time blood test. Until now the CDC had only recommended routine testing for people with known risk factors—such as HIV, drug use, or existing liver disease. But this often meant that individuals did not become aware of their infection until symptoms began to emerge. The CDC estimates that the new effort could test 800,000 individuals and save 120,000 lives because once detected Hepatitis C can be treated with anti-viral medications. Up to 75 percent of cases can, in fact, be cured and these odds may improve with the introduction of two new drugs to the market.

Hepatitis C is related to Hepatitis A and Hepatitis B but unlike the other two, there is no vaccine available to prevent infection with this strand.

Young Men who Abuse ED Drugs Are Less Satisfied with Their Sex Lives

I suppose it shouldn’t come as a surprise to hear that college students are taking a prescription drug without a prescription — after all college is a time that many young people experiment with alcohol, marijuana, and other illegal substances — but it’s also the peak of young men’s sexual performance so I admit I was a little surprised to learn just how many of them have tried Viagra and other erectile dysfunction (ED) medications. 

A new study published in the Journal of Sexual Health surveyed 1,200 college-age men from across the country and found that six percent of them had used ED as a recreational drug.  The study asked the young men a variety of questions about their sex lives and compared their answers to those of their peers who had not tried these drugs. The results show that young men who have used ED drugs are more likely to be dissatisfied with and anxious about their sex lives. In fact the more ED drugs they took, the worse they felt.

The study found that the young men who used ED drugs had the same level of functioning as their peers who did not but were less confident about their ability to sustain an erection and less satisfied with their overall sex lives even if they enjoyed intercourse in the moment. Researchers could not determine whether this anxiety was what caused them to use the drugs or if the drugs caused the anxiety but one expert who was not involved in the study suggested that when men take these drugs they spend more time and energy during sex monitoring their erection. This “spectatoring,” as he called it, can interfere with their pleasure not only because it requires attention but because it increases the activity of the sympathetic nervous system which is normally decreased by the body during sexual activity.   

Moreover, the drugs can create an unrealistic expectation for the future and men can become convinced that they can’t have an erection without the drugs. As one urologist (who was also not involved in the study) explained: “We understand how they work, and I don’t think there’s any lasting physical harm for a young man who doesn’t need them, or for an older man who does. But it does sometimes create these psychological problems – and they stick around.” Medical professionals also fear that recreational use of the drugs can mask underlying health issues such as high cholesterol, high blood pressure, or diabetes that are actually causing erectile issues. 

News Sexuality

Government Report Condemns ‘Conversion Therapy’ for Young People

Martha Kempner

The report charges that same-gender sexual orientation and variations in gender identity and expression are “part of the normal spectrum of human diversity and do not constitute a mental disorder.”

A federal government report released Thursday calls for an end to the controversial practice of so-called conversion therapy, which is opposed by all major medical organizations and has been denounced by the Obama administration.

Sometimes referred to as “reparative therapy,” conversion therapy aims to change sexual orientation or gender identity.

The new report, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth, was released by the Substance Abuse and Mental Health Services Administration (SAMHSA), and is based on the consensus statement reached in July by a panel of the American Psychological Association.

The report charges that same-gender sexual orientation and variations in gender identity and expression are “part of the normal spectrum of human diversity and do not constitute a mental disorder.” It goes on to say that “interventions aimed at a fixed outcome, such as gender conformity or heterosexual orientation…are coercive, can be harmful, and should not be part of the behavioral health treatment.”

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Conversion therapy can include anything from Bible study to forced heterosexual dating to aversion therapy, in which patients are shown homosexual erotica and shocked every time they display arousal. It became popular in the late-1970s and ’80s, even as mainstream medical organizations stopped viewing homosexuality as a mental illness and began to, instead, help patients accept their sexual orientation and live in a sometimes hostile world.

In the 1990s and early 2000s, conversion therapy became synonymous with the “ex-gay” movement led by religious ministries that promised men they could “pray away the gay.” Many of these ministries were plagued by scandals in which leaders were either caught or admitted to having gay relationships while they condemned the LGBTQ community, as Rewire has reported.

Many of the movement’s leaders have apologized to the gay community and many of the ministries have shut their doors.

The APA released a report in 2009 that reviewed decades of research and found that conversion therapy was not only ineffective, it was potentially harmful. Patients exposed to this kind of therapy experienced loss of sexual feelings, depression, anxiety, and thoughts of suicide.

Since the report, a number of states, including New Jersey and California, have banned conversion therapy for minors.

The Obama administration in April released a report condemning the practice and urging more states to pass laws protecting young people from conversion therapy. Senators Corey Booker (D-NJ) and Sherrod Brown (D-OH) also took a stand against conversion therapy for young people in the form of a resolution in May that urged their Senate colleagues to condemn the practice.

Thursday’s report echoes these condemnations and tries to help parents find a better option. “When dealing with a sensitive topic such as gender identity or sexual orientation in young people, it is essential that families, educators, caregivers, and providers seek the best available information and advice,” SAMHSA Acting Administrator Kana Enomoto, said in a statement. “SAMHSA’s report provides this information, as well as resources young people, families and others can use to promote healthy development for all youth.”

News Sexual Health

New Study Has Hopeful Findings for HIV Prevention

Martha Kempner

A new study found that no one taking pre-exposure prophylaxis to prevent HIV became infected over the course of three years. But the rates of other STIs were still high.

A study published online in the journal Clinical Infectious Diseases reviewed the medical records of patients in the Kaiser Permanente system in San Francisco who had been referred for a pre-exposure prophylaxis (PrEP) evaluation between 2012 (when the drug became available) and early 2015. The majority of these patients (82 percent) decided to start taking PrEP to prevent HIV and in the almost three years of the study, not one of them contracted HIV.

These results are better than what would have been expected given clinical trials, and experts are excited that this new prevention method is working so well. But some are worried because condom use among these patients has dropped, and more than half of them were diagnosed with at least one sexually transmitted infection (STI) during the course of the study.

PrEP is a combination of two antiretroviral drugs—tenofovir and emtricitabine—used to treat people who have HIV, as Rewire has reported. When used daily by people who are HIV-negative, these drugs have been shown to prevent transmission of the virus. In May 2014, the Centers for Disease Control and Prevention (CDC) released guidelines that recommended HIV-negative individuals who are at “substantial risk for HIV infection” consider taking the drug.

The agency defined those at substantial risk as: anyone in an ongoing relationship with an HIV-infected partner; gay or bisexual men who are not in a mutually monogamous relationship with an HIV-negative partner and who have had sex without a condom or been diagnosed with a sexually transmitted infection within the past six months; heterosexual men or women who are not in a mutually monogamous relationship with an HIV-negative partner and do not regularly use condoms when having sex with partners known to be at risk for HIV (such as injecting drug users or bisexual male partners of unknown HIV status); or anyone who has injected illicit drugs and shared equipment or been in a treatment program for injection drug use within the past six months.

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The majority of the patients in the Kaiser Permanente study were men who had sex with men, though the study included three heterosexual women and one transgender man who was having sex with men.

The results were better than expected. The researchers followed 657 patients who took PrEP for a period of time that amounted to 388 person years. None of the patients contracted HIV.

“This is very reassuring data. It tells us the PrEP works even in high risk populations,” the study’s lead author, Dr. John Volk, told the New York Times.

Anthony Fauci, the director of the National Institute for Allergies and Infectious Diseases, agreed. “This shows the effectiveness of PrEP is really strikingly high,” he told the Times. “And this study takes it out of the realm of clinical trials and into the real world.”

The researchers noted that the study should allay fears that PrEP use would lead to less condom use and therefore more HIV. In the article, they write: “Our data suggest that fears about risk compensation resulting in increased HIV acquisition among PrEP users may be unfounded.”

Some public health experts are still concerned because while none of these patients contracted HIV, many of them contracted other STIs. A year after starting PrEP, 50 percent of patients had been diagnosed with an STI.

One-third of those patients had contracted chlamydia, 28 percent of patients had gonorrhea, and 5.5 percent had syphilis. Many of these infections were rectal.

Since there was no control group in this study, it is impossible to know whether these rates of STIs are higher than they would have been if the patients had not taken PrEP. Patients on PrEP are required to have frequent screenings for STIs. The high rates of STIs among this group, therefore, may reflect better testing rather than any real increase in the number of infections.

Still, there seems to be some behavior changes among patients on PrEP. Researchers surveyed 143 of the patients about their behavior. Seventy-four percent said the number of sexual partners they had did not change while on the drug, 15 percent said they had fewer partners, and 11 percent said they had more. Fifty-six percent said they did not change their condom use habits, 41 percent said they used condoms less often, and 3 percent said they used them more.

Though the patients enrolled in the study were engaging in high risk behaviors to begin with and some did not change their behavior because of PrEP, the STI rates among them are very concerning to some public health experts.

“We’re thrilled that there were no cases of HIV in the Kaiser PrEP study,” Deborah Arrindell, vice president of health policy at the American Sexual Health Association, told Rewire. “We’ve all been waiting for a study with these positive results. But there are thorns on the rose. Some participants did not follow the FDA guidelines to continue condom use. About half of those in the study contracted a sexually transmitted infection and that is worrisome.”

“More than one in four got gonorrhea—an infection for which we’re running out of treatment options,” Arrindell added. “That is cause for concern, even as we celebrate.​”