Roundups Sexual Health

Weekly Roundup: News on Tennessee’s “Gateway” Law, Parental Consent for HPV Vaccines, and Olympic Sex

Martha Kempner

In this week's sexual health roundup: there is new information on the origin of Tennessee's law that prevents schools from promoting "gateway" behaviors to sex at the same time that anecdotal information suggests teachers are censoring themselves because of it; a new poll shows that adults see the HPV vaccine differently than other STI treatment and prevention efforts and do not want to see parental consent for the vaccine waived; and a new tell-all book suggests that the Olympic village is a hotbed of sex, booze, and drugs.

Tennessee’s Gateway Law Succeeds in Censoring Sex Education

We may all remember the Tennessee law passed back in May–the one that bans the discussion of behaviors that are considered “gateways” to more advanced sexual behaviors–because it seemed like a joke. The law specifically said that school courses could not “promote any gateway sexual activity or health message that encourages students to experiment with non-coital sexual activity.” These behaviors are never exactly defined and left some of us scratching our heads, thinking back to sexual experiences, and wondering if a nice home-cooked meal or a back rub could be considered a dangerous gateway not to be discussed in class.

During his testimony one state legislator assured us that:

“Everybody in this room knows what gateway sexual activity is. Everybody knows there are certain buttons when you push them, certain switches when you turn them on, there’s no stopping, especially for undisciplined, untrained, untaught, and unraised children who just want to feel affection from somebody or anybody.” 

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

There is so much wrong with this backwards, judgmental, and blame-ridden definition that I think I prefer comedian Steven Cobert’s snarky take on it:

“Kissing and hugging are just the last stop before the train pulls into Groin Central Station. We desperately need to intervene earlier to keep kids from engaging in… all the things that lead to the things that lead to sex.”

The most direct definition, however, comes courtesy of the President of the Family Action Council who had a hand in drafting the bill and says “gateway sexual activity” is akin to the definition of “sexual contact” according to the state’s criminal law, which refers to the “intentional touching” of “the primary genital area, groin, inner thigh, buttock or breast of a human being.”  Makes sense—after all, teen sexual behavior is clearly criminal. 

The gateway term—which was in fact modeled on the idea in drug-prevention programs that marijuana is a gateway to the harder stuff like heroin—seems to be designed to directly counter programs that teach young people about “outercourse” as a way to avoid unintended pregnancy and STDs. According to a new article on Bloomberg News the law was a direct reaction to a 2010 presentation in a Nashville school by an educator from a local AIDS organization. The elective course was designed to train students to be peer educators. In a discussion on oral sex, the leader demonstrated how to put on a condom using a penis model and her mouth. The audience for the class included the daughter of Roderick Glover, a Christian and motivational speaker. Though parental permission was required for the course somehow Glover’s daughter managed to attend without a signed slip and reported home on the “pornographic” nature of the class. Glover went immediately to the Family Action Council, Republican lawmakers, and the press. 

Two years later, he and those who joined him seem to have succeeded in censoring sex education teachers in Tennessee. A spokesperson for the Department of Education said that they do not expect this law to change anything as the state has required abstinence-centered education for years. For this reason the state did not issue any guidance on the law. Unfortunately, the end result of this is not that nothing has changed but that teachers are afraid to do anything. The training director at the local Planned Parenthood reported on a recent conference in Nashville during which teachers and counselors, “… said they were less willing to use outside groups and more uncomfortable with sex education and more scared to answer questions.”  This fear is somewhat justified as the law imposes fines on outside groups that violate the new mandate (though teachers themselves are exempt). 

Though the law has been the butt of many jokes, school systems are taking it seriously and proponents clearly see it as a victory. Valerie Huber of the National Abstinence Education Association says: “We have every hope that this will serve as a model for other states.” 

New Poll: Adults Don’t Think Parental Consent Should be Waived for HPV Vaccine

A new national poll by University of Michigan C.S. Mott Children’ Hospital found that while most adults believe that young people should be able to access medical care for Sexually Transmitted Infections (STIs) without parental consent, they do not feel the same way about the HPV vaccine. 

Specifically, 57 percent of those surveyed believed that young people ages 12 to 17 should have access to medical care for prevention of STIs without parental consent and 55 percent believed that these young people should have access to medical care for the treatment of STIs, but only 45 percent supported similar access for the HPV vaccine.  Those who did not support young people’s access without parental consent were asked why; 86 percent said simply they believed vaccines should be the choice of the parents, 43 percent said they had concern about the side effects, and 40 percent said they had moral or ethical concerns about the vaccine. These answers did not differ between those respondents who had kids and those who did not. 

It’s actually heartening to see that in general adults think young people should have access to prevention and treatment of STDs without parental permission and the survey had other good news; 74 percent of adults surveyed agreed that getting the vaccine is a good way to protect adolescents from HPV. Still, they clearly see the vaccine differently than other prevention options, even though it is the best method for sexually active young people to prevent HPV which causes genital warts, cervical cancer, penile cancer, and cancers of the neck and throat. This may be a result of the CDC recommendation that young people receive the vaccine at 11 or 12—long before adults see them as sexual beings. It may also have a lot to do with the nature of vaccines most of which are given to infants and very young children, and therefore parental involvement is naturally assumed. The results may also have to do with the backlash against all vaccines that has been popular in the last decade or so. Anti-vaccine sentiment continues despite the fact that the original data which began the movement was found to be completely falsified.

This poll is just the latest proof that the HPV vaccine has a public relations problem and that educators and health care providers have to continue to hammer home the important points: HPV is very common; this vaccine is the best prevention available; it prevents cancer; young people need to get the vaccine early in order to ensure that they are fully protected by the time they become sexually active; and there is no reason to believe that the vaccine will make young people more likely to have sex or more promiscuous.

Olympic Village: A Hotbed of Sex, Booze, and Drugs

The Olympic Games kick off in London on Friday and according to a new book written anonymously by a former athlete what we see is only a small portion of what the athletes do while in hanging out in the host city. According to The Secret Olympian, “no matter the host country, it’s always a struggle keeping booze and condoms in strong supply.” The author who attended the 2000 Games in Sydney claims that the Australians’ supply of 70,000 condoms ran out within the first week. 

Olympic villages are stand-alone complexes where everything is private and free. The United States complex has a 24-hour McDonald’s and two beer halls sponsored by Budweiser and Heineken. Condoms are also free. The book includes numerous stories of drunken athletes including tales of a disturbing tradition in which U.S. athletes deliberately get very drunk for their meeting with the President and Vice President after the games are over.

Though some say these stories are exaggerated, others acknowledge that alcohol and sex are rampant among the athletes. The book has this to say about sex:  

“No matter what your type, the Olympic Village can cater [to] it, providing the best physical examples on earth . . . Having completed competition, the athletes need to do something else to burn off their boundless energy. Like thoroughbred horses which haven’t had a run for a while, they get frisky.”

Todd Lodwick, a five-time Olympic Nordic combined athlete and a two-time gold medalist, admits that there is more sex at the Olympics than in day-to-day life: “How could you not?” he says. “If the opportunity is there and it presents itself…” As for the massive number of condoms that the athletes go through, however, he claims that this is just an old-fashioned prank. Athletes are told to take as many as they can so that organizers have to replace them and the athletes get a reputation: “It’s a myth: ‘Oh, look at all the sex these Olympians are having!’ ”

Being at the Olympics must be pretty heady stuff and between the adrenaline, the perks, and the close quarters away from home it would not surprise me if the athletes are having more sex than usual. It kind of reminds me of the first few weeks in Freshman college dorms—lots of freedom and new people. Still if the stories of binge drinking are true (also reminds me of Freshman college dorms), I do worry that athletes may not be making wise decisions. I guess we can only hope that some of those 70,000 condoms given out in the first week get used and that organizers keep refilling that bowl.

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.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

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.

Roundups Sexual Health

This Week in Sex: News From the HIV Epidemic

Martha Kempner

This week in sex: Scientists report the first case of HIV transmission to a patient adhering to PrEP protocols, two studies show a new vaginal ring can help women prevent HIV, and young people still aren't getting tested for the virus.

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

With the death of Nancy Reagan, the 1980s AIDS crisis is back in the national spotlight. But, of course, HIV and AIDS are still ongoing problems that affect millions of people. This week in sex, we review scientists reporting the first case of HIV transmission to a patient adhering to PrEP protocols, two studies showing a new vaginal ring can help women prevent HIV, and evidence that young people still aren’t getting tested for the virus.

First Case of HIV Transmission While on Truvada

Last week, Canadian scientists reported on what they believe to be the first HIV infection in a patient who was following a PreP (Pre-Exposure Prophylaxis) regimen.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

PrEP is a method of HIV prevention. By taking a daily pill that contains two HIV medicines, sold under the name Truvada, individuals who are HIV-negative but considered to be at high risk of contracting the virus can prevent infection. Studies have found that PrEP is very effective—the Centers for Disease Control and Prevention estimates that people who take the medication every day can reduce their risk of infection by more than 90 percent from sex and by more than 70 percent from injection drug use. One study of men taking PrEP found no infections over a two-and-a-half-year period.

PrEP is less effective when not taken regularly, but the new case of reported PrEP failure involves a 43-year-old man who said that he took his medication daily. His pharmacy records back up that assertion. The man’s partner has HIV, but is on a drug regimen and has an undetectable viral load. The man did report other sexual encounters without condoms with casual partners in the weeks leading up to his diagnosis.

Dr. David Knox, the lead author of this case study, notes that it is difficult to know if a patient really did adhere to the drug regimen, but the evidence in this case suggests that he did. He concluded, “Failure of PrEP in this case was likely due to the transmission of a PrEP-resistant, multi-class resistant strain of HIV 1.”

Experts say, however, that they never expected PrEP to be infallible. As Richard Harrigan of the British Columbia Center for Excellence in HIV/AIDS told Pink News, “I certainly don’t think that this is a situation which calls for panic …. It is an example that demonstrates that PrEP can sometimes be ineffective in the face of drug resistant virus, in the same way that treatment itself can sometimes be ineffective in the face of drug resistant virus.”

Still, some fear that the new study will add to the ongoing debate and apathy that seem to surround PrEP. While some experts see it as a must-have prevention tool, others worry that it will encourage men who have sex with men to forgo using condoms and perhaps increase their risk for other sexually transmitted infections. Still, only 30,000 people in the United States are taking the drug—an estimated one-twentieth of those who could benefit from it.

A New Vaginal Ring Could Help Women Prevent HIV Infection

Researchers have announced promising results from two studies looking at new technology that could help women prevent HIV. The dapivirine ring, named after the drug it contains, was developed by the International Partnership for Microbicides. It looks like the contraceptive ring, Nuvaring, and is similarly inserted high up into the vagina for a month at a time. Instead of releasing hormones to prevent ovulation, however, this ring releases an antiretroviral drug to prevent HIV from reproducing in healthy cells. (A ring that could prevent both pregnancy and HIV is being developed.)

The two studies of the ring are being conducted in Africa. One study recruited about 2,600 women in Malawi, South Africa, Uganda, and Zimbabwe. It found that the ring reduced HIV infection by 27 percent overall and 61 percent for women over age 25. The other study, which is still underway, involves just under 2,000 women in seven sites in South Africa and Uganda. Early results suggest that the ring reduced infection by 31 percent overall when compared to the placebo.

Both studies found that the ring provided little protection to women ages 18-to-21. Researchers are now working to determine how adherence and other biological factors may have impacted such an outcome.

Young People Not Getting Tested for HIV

A study in the February issue of Pediatrics found that HIV testing rates among young people have not increased in the last decade. The researchers looked at data from the Youth Risk Behavior Survey (YRBS), which asks current high school students about sexual behaviors in addition to questions about drugs and alcohol, violence, nutrition, and personal safety (such as using bike helmets and seat belts). Specifically, the YRBS asks students if they’ve ever been tested for HIV.

Using YRBS data collected between 2005 and 2013, the researchers estimated that 22 percent of teens who had ever had sex had been tested for HIV. The percent who had received HIV tests was higher (34 percent) among those who reported four or more lifetime partners. Overall, male teens (17 percent) were less likely than their female peers (27 percent) to have been tested.

Researchers also looked at data from the Behavioral Risk Factor Surveillance System, which asks similar questions to young adults ages 18 to 24. Among people in this age group, between the years of 2011 to 2013, an average of 33 percent had ever been tested. This review of data also found that the percentage of young women who get tested for HIV has been decreasing in recent years—from 42.4 percent in 2011 to 39.5 percent in 2013.

The authors simply conclude, “HIV testing programs do not appear to be successfully reaching high school students and young adults.” They go on to suggest, “Multipronged testing strategies, including provider education, system-level interventions in clinical settings, adolescent-friendly testing services, and sexual health education will likely be needed to increase testing and reduce the percentage of adolescents and young adults living with HIV infection.”