Analysis Sexual Health

If You Give It, They’ll Be Tramps: An Offensive, False, But Oft-Repeated Argument About Reproductive Health Technologies

Martha Kempner

The argument that access to sexual health care or information causes promiscuity is offensive to women and has been proven false time and again. Yet it seems unlikely that it we will end anytime soon.

This week we learned that the HPV vaccine does not cause young women to have sex. A study looked at the medical records of 1,400 women under the age of 16 to determine sexual behavior based on pregnancy tests, contraceptive counseling, and STI screenings and diagnoses. It found no difference in behavior between those who had received the HPV vaccine and those who had not.

As Marianne Møllman points out in her piece, this fear—that their daughters would be become “sluts” —is the number-one reason that parents do not vaccinate their daughters against HPV.  Apparently, this fear is even greater than the fear of cervical cancer, a potentially deadly but completely preventable disease.

You would think that this study would allay such fears. The truth is, we’ve seen this argument made repeatedly—whether it’s about making condoms available in schools, providing sex education, or allowing Emergency Contraception (EC) to be sold over the counter. The idea that access to protection will cause young women to run wild is deeply ingrained in our culture. Think of how fast Rush Limbaugh connected Sandra Fluke’s request for contraceptive coverage to her own clearly “slutty” sexual behavior.  And it doesn’t seem to matter that the notion has been debunked by research time and time again.

Promiscuity Police

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Though the false arguments about women’s barely controlled promiscuity likely began with the introduction of short skirts or bathing suits that showed some knee, they were prominent during the 1960s, as the birth-control pill became a medical and cultural phenomenon. In a 1966 article on birth control and morality, U.S. News and World Report asked: “Is the Pill regarded as a license for promiscuity? Can its availability to all women of childbearing age lead to sexual anarchy?” Two years later, author Pearl Buck warned iin Reader’s Digest:

“Everyone knows what The Pill is. It is a small object—yet its potential effect upon our society may be even more devastating than the nuclear bomb.”

The introduction of the pill did coincide with a change in social values and norms around sexuality, and women’s sexuality in particular. Some believe that by separating sex from procreation and giving women control of their own fertility (thereby allowing them to pursue education and employment), the pill is, in fact, responsible for the sexual revolution. Others believe it was a convenient scapegoat for a societal change that was already in the works. What we know for sure is that 45 years later, we are still debating the impact of contraception on women’s sexual behavior.

During his recent run for the Republican presidential nomination, former Senator Rick Santorum called contraception a problem:

“It’s not okay because it’s a license to do things in the sexual realm that is counter to how things are supposed to be. They’re supposed to be within marriage, they are supposed to be for purposes that are, yes, conjugal, but also [inaudible], but also procreative. “

The idea of a license to have sex came up quite often this summer when the country was debating provisions of the Affordable Care Act that required contraceptive coverage. Sandy Rios, vice president of Family PAC Federal, which describes itself as “the leading pro-family conservative political action committee in Illinois,” said on Fox News:

“Why in the world would you encourage your daughters, and your granddaughters, and whoever else comes behind you to have unrestricted, unlimited sex anytime, anywhere and that, somehow if you prevent pregnancy, that somehow you’ve helped them. I would submit to you that uncontrolled sexual behavior is what is harming our girls, not our lack of birth control—which by the way they don’t seem interested in taking anyway.”

We heard this same idea back in 1998 when the FDA was first considering approval for EC and then over and over as the agency decided whether EC should be available without a prescription. During one of these debates, the Family Research Council (FRC), a conservative not-for-profit organization, said this:

“… one might expect the medical profession to speak out against promiscuity, if only to prevent the disease and destruction it causes. Instead, public health professionals have not only made peace with sexual license (against society’s practical interests), but now virtually advocate it. The campaign for the morning after pill is just one case in point.”

We hear it practically every time a school district considers distributing condoms, and even when condoms are handed out on college campuses. Last year, for example, a state Representative chastised Wisconsin University’s Health Center for giving out condoms along with sunscreen and lip balm as part of a campaign for a safer spring break. According to a spokesperson, the lawmaker objected to the university’s role in “encouraging sexual activity.”

We’ve heard it for decades when it comes to sexuality education. Teaching kids about sex, the argument goes, will give them ideas, encourage experimentation, and undermine any message about abstinence they might have received. In a 1986 newspaper article, conservative activist Phyllis Schlafly derides a sexuality education textbook as far too liberal, saying:

 “It’s no wonder that our country has a high rate of teenage promiscuity and the unhappy consequences it causes, including out-of-wedlock pregnancy, abortion and venereal diseases. Those things are the result of the sexual liberation that students are taught in required courses in ‘health’ and ‘sex education.’”

And, of course, we heard it as soon as the HPV vaccine became a scientific possibility. In 2005, Bridget Maher told the British Magazine, The New Scientist, that: “giving the HPV vaccine to young women could be potentially harmful, because they may see it as a license to engage in premarital sex.” Her warnings were echoed by Reginald Finger, a former medical advisor to Focus on the Family, who told The Hill that: “…if people begin to market the vaccine or tout the vaccine that this makes adolescent sex safer, then that would undermine the abstinence-only message.”

Though sociologists may continue to argue the precise role of the pill in the sexual revolution for at least four more decades, we now have research that directly counters the notion that recent advances in women’s sexual health have paved the way for a generation of tramps.

What the Research Says

For every argument that says a new advance—be it EC or comprehensive sexuality education—will turn women into whores, there is a stack of peer-reviewed research that proves otherwise.

  • Condom Availability Programs: The first major study of condom availability programs was done in 1997 by researchers who compared New York City public high schools that provided condoms to students to similar public high schools in Chicago that did not. The study found that condom availability does not increase rates of sexual activity but does increase the rate at which sexually active young people use condoms. A similar study done a few years later in Massachusetts found that sexually active students in schools that had a condom-availability program were more likely to use contraception at last intercourse than sexually active students in schools without one.
  • Sexuality Education: Numerous evaluations of sexuality-education programs have found the very same thing. These programs do not increase sexual behavior among teens, they do not cause teens to have sex at a younger age, they do not increase the number of partners young people have, and they do not increase the frequency with which young people have sex. In fact, they tend to do just the opposite. Young people who have gone through highly effective sex education and HIV-prevention programs tend to delay sex and have fewer partners. When these young people do become sexually active they are more likely to use condoms and other contraceptive methods.
  • Emergency Contraception:  In 2008, the Bixby Center for Global Reproductive Health at the University of California San Francisco conducted a review of 16 studies on the impact of providing EC to adult and adolescent women. The review found no evidence that access increased sexual risk taking. It found that women did not abandon their regular method of contraception when they had access to EC; did not use EC repeatedly just because it was available; did not engage in increased sexual activity; and did not have increased incidences of STIs. It also found that adolescent women are no more likely than are adults to engage in sexual risk taking when they have access to EC.
  • HPV Vaccine: Research released this week examined the medical records of young women under age 16 for indications of sexual activity and found no difference between those who had been vaccinated and those who had not. This adds to an earlier study of young women ages 15 to 24, which also found no association between the HPV vaccine and risky sexual behavior. A study released in January 2012 also put to rest fears that young girls would consider themselves fully protected once they received the HPV vaccine. It found that “Few adolescents perceived less need for safer sexual behaviors after the first HPV vaccination”

Changing the Conversation 

Still, years of research showing that access to information about sexual health and contraception does not increase sexual activity have not stopped right-wing pundits from warning parents that each new advance is a step toward the death of their daughters’ virtue. hy am I still surprised when science and facts lose in a showdown with judgment and fear? The question becomes, what will convince opponents to stop crying “slut” from the rooftops?

The debate over the HPV vaccine provides a piece of the answer. Earlier, I quoted a 2005 article in which Bridget Maher of FRC warned that the HPV vaccine was a dangerous license for premarital sex. Here’s what FRC says about the HPV vaccine today:

“FRC believes that Gardasil and other HPV vaccines represent a tremendous advance in preventative medicine. FRC advocates for widespread availability and distribution of the vaccine to both girls and young women. Forms of primary prevention and medical advances in this area hold potential for helping to protect the health of millions of Americans and helping to preserve the lives of thousands of American women who currently die of cervical cancer each year as a result of HPV infection.”

The truth is, many right-wing organizations that rail against school-based sex education or making condoms available to kids have only positive things to say about the HPV vaccine. As early as 2006, Linda Klepacki, an analyst for sexual health at Focus on the Family, told Time magazine:

“This is an awesome vaccine. It could prevent millions of deaths around the world. We support this vaccine. We see it as an extremely important medical breakthrough.”

While reproductive-rights experts expected these groups to opose FDA approval, and folks like Maher seemed to be gearing up to do just that, it never happened. Instead, these groups agreed that the vaccine was a leap forward in health care and reserved their opposition to attempts to make it mandatory for school children. We have not yet had that debate on the national level, though we all watched it play out in Texas under Rick Perry.

This doesn’t mean that there has been no controversy over the HPV vaccine or that we’ve seen widespread acceptance. And it doesn’t mean that no one has bought into the vaccination-will-cause-copulation argument that’s out there in the ethos.

What it does mean is that on some level these organizations—made up of people who hold extremely conservative values on sexuality—realized that they could not oppose the development and distribution of a cancer-prevention vaccine because of their own objections to premarital sex. Whether these decisions were made out of genuine concern for the public health or a superficial concern for their own public image we may never know. The take away? When the stakes are high (cancer and death) the conversation changes—at least a little.

The best way to change the conversation is to continually remind people that the stakes are always high when it comes to reproductive health.

We also have to change the conversation at a more fundamental level by attacking the “logic” that underlies the access-causes-action argument. This argument suggests that women’s sexual behavior is a problem to be controlled and that the only way to do it is to ensure negative consequences at every turn. This argument says that women can’t be trusted to make good decisions unless they’re scared to death of bad ones. I can think of no worse message to send our daughters.

I am very sure that there are no worse message than this one lurking in a package of pills or a vial of vaccine.

Culture & Conversation Media

It Shouldn’t Take a Superhero to Access Abortion Care in Prison, But in ‘Jessica Jones’ It Does

Renee Bracey Sherman

Critics have hailed the show for its realistic feminist-leaning plot lines and discussions of sexual consent, rape, and addiction. But while the show offers a depiction of a confident abortion decision, the reality of the situation is pure fiction.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

The protagonist of Netflix’s Jessica Jones series is a former superhero with extreme strength who is trying to make it as a freelance private investigator in New York City. Played by Krysten Ritter, Jones is a cynical and whip-smart character who self-medicates with alcohol as she attempts to destroy her mind-controlling arch nemesis, Kilgrave (David Tennant).

Critics have hailed the show for its realistic feminist-leaning plot lines and discussions of sexual consent, rape, and addiction. But while the show depicts a confident abortion decision, the reality of the situation is pure fiction.

In the sixth episode, titled “AKA You’re A Winner!” Jones is called to a local jail after hearing that a young woman she rescued from Kilgrave, Hope Schlottman, was beaten by another incarcerated woman. Jones learns Schlottman paid the woman “$50 and a pack of smokes” in hopes of forcing a miscarriage because she was pregnant by Kilgrave. (Viewers learned in earlier episodes Kilgrave had taken Schlottman under his control—along with other women, including Jones—forcing her into sexual acts and to murder her parents, for which she was in jail.)

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“I’m pregnant … still,” she tells Jones. “I can feel it growing in me, like a tumor.” Schlottman says she wants an abortion but a provider cannot see her for at least two months. She tells Jones that she will pay for additional beatings until she terminates the pregnancy.

“Every second it’s there, I get raped again and again,” Schlottman says, adding, “I wanna live. I wanna have children, but I won’t give life to this thing. I won’t do it.”

Jones works with Schlottman’s lawyer to obtain an abortion pill. When presenting Schlottman with the pill, Jones tells her, “Once you take this there’s no do-overs. You’ll be sick as shit for about eight hours so I need you to be 1,000 percent sure.” Schlottman grabs and swallows the pill before Jones can finish her statement to show how sure she is, muttering, “Please work fast. Please work fast.” The show later depicts Schlottman cramping in her hospital bed as the abortion completes.

While the show does depict a young woman who is confident and determined to end her pregnancy, and who is able to access a medication abortion with the assistance of a superhero, for incarcerated people, this is not nearly the case.

One in 25 women at state prisons and one in 33 women in federal prisons are pregnant at the time they are admitted, according to the Sentencing Project. Like Schlottman, some will seek an abortion. While a set of court cases show how the constitutional right to abortion in the United States applies to people incarcerated, that hasn’t ended the barriers to accessing care. Many barriers are similar to the ones people outside prison face when seeking care, such as mandatory delays, financial hurdles, and transportation challenges, especially when multiple trips to a clinic are mandated under state law, Dr. Carolyn Sufrin, an OB-GYN who works with incarcerated women, told Rewire in an email.

But other barriers, she continued, are manufactured by local sheriffs and administrators, including requiring the cost of transportation and security to be paid up front, demanding additional administrative bureaucracy and court orders, and having incarcerated women cover the cost of the procedure due to the Hyde Amendment and the burden of Medicaid health-care costs shifting to the correctional facility. Women in prison also are more likely to experience unexpected delays and costs, as well as an overall loss of privacy during their decision.

Because courts and prison administrators view abortion as an elective medical care, it is subject to stigmatizing rules, which delay access and increase costs. Some incarcerated people call the American Civil Liberties Union to help expedite the legal process, or the National Network of Abortion Funds, where I work, for funding assistance, but only if they know that’s an option.

But back to Jessica Jones: At the end of the first season, the writers elevate one of the many false tropes about women seeking abortions in media when Schlottman dies by suicide.

More than 15 percent of women depicted in abortion story lines die after choosing to terminate, and 11 percent of those die by suicide, according to a study by the University of California, which looked at film and television from 1916 to 2013. Even when the deaths are not explicitly tied to the characters’ abortion decisions, this pattern reinforces the false narrative that people choosing the procedure experience negative mental health outcomes related to those decisions—rather than, for example, negative outcomes because of their circumstances created by unjust systems and anti-choice legislation—and deserve violence.

All of these circumstances make the depiction of abortion on Jessica Jones implausible. In reality, incarcerated people have a very difficult time accessing abortion care, particularly medication abortions.

Dr. Sufrin explained that the experience of a medication abortion in prison wouldn’t be as pleasant in real life as it is depicted in Jessica Jones.

“[I]t is highly unlikely that a prison or jail will have a provider who is certified to dispense mifepristone, which requires a special dispensing agreement with the manufacturer, and even more unlikely that the facility would stock the medications for medical abortion on site,” said Dr. Sufrin. “What’s more, medical abortion requires at least two visits to a clinic, the first to take the medications and the second for follow-up to confirm the pregnancy has passed. Each trip off-site to a clinic involves extra logistics and staff to transport the woman.”

Dr. Sufrin added that many prisons ration pads, tampons, and pain medication an incarcerated person can have, thus the pregnant person might not receive enough for the bleeding and cramping they’d experience during an abortion. Additionally, incarcerated people seeking a medication abortion are often afforded less privacy because there is no space for them to complete the abortion within the prison, unlike in a clinic for a surgical abortion, Dr. Monica McLemore, assistant professor at the University of California San Francisco School of Nursing, told Rewire.

“[M]edication abortion isn’t really offered as an option because of logistical space issues and ability for pain management, comfort care, and sanitary supplies in the jail,” she said.

“Medical abortion is practically just not a great option for incarcerated women,” said Dr. Sufrin.

The type of correctional facility in which an incarcerated person is held also makes a difference in the care they are able to receive, said Dr. McLemore. She explained that in California, access to an abortion while incarcerated is dependent on whether someone is housed in a public facility where the health services are run by the state health department, or a private facility where the services are privately contracted out.

“In our experience, getting women second-trimester abortions is very difficult at Santa Rita [a private prison] because of delays related to dealing with Corizon [the company with whom the health-care services are contracted],” said Dr. McLemore.

She recently supported a patient who wanted to terminate her pregnancy when she was around 18 weeks, Dr. McLemore said, but was forced to wait until her release over a month later to actually have her abortion.

Being forced to carry an unwanted pregnancy longer than one wants, or to term, can have negative impacts on mental health for anyone, especially an incarcerated person without adequate access to health care and mental health services. Unsurprisingly, a recently released report, called Who Pays? The True Cost of Incarceration on Families, found a majority of the incarcerated people surveyed experienced negative health impacts associated with being in prison. This can be compounded by the experience of not receiving urgent medical care there. Even in cases where the incarcerated person wants to carry the pregnancy to term, they are often denied basic prenatal care to ensure a healthy pregnancy and child.

Serious changes are needed to ensure all incarcerated people receive comprehensive and compassionate health care while in prison, including abortion care. Dr. McLemore said she’d like to see more sheriffs trained on reproductive and gynecological care and the role staff plays in patients receiving it while in custody. Health care should not be dependent on whether a correctional facility’s health system is privately contracted or not, she added.

Similarly, Dr. Sufrin would like to challenge the notion of “elective” and “medically indicated” abortions within the prison system. “An elective procedure is one that can be delayed indefinitely without a significant impact on someone’s life or healthwhich is clearly not the case for pregnancy,” she said. “And when you have women who are not able to access abortions by virtue of being incarcerated, then they are forced to carry unwanted pregnancies as part of their punishment.”

Simply put: It shouldn’t take a superhero to get an abortion in prison.

CORRECTION: A previous version of this article incorrectly stated the U.S. Supreme Court has taken up this issue. In fact, a set of lower court cases show the constitutional right to abortion in the United States applies to people incarcerated. We regret the error.

Commentary Sexual Health

Charlie Sheen Deserves Your Scorn, But Not Because He Has HIV

Becky Allen

HIV is not a punishment for bad behavior. It's an illness. And it's not OK to act like it is a punishment for some crime, even when the "criminal" is a public jackass like Sheen, because that just reinforces the HIV stigma our culture is already swimming in.

Cross-posted with permission from TheBody.com.

I usually work behind the scenes here at TheBody.com, but after spending eight years quietly immersed in the HIV community, it turns out I can no longer see HIV in the news without having some pretty strong reactions.

Since Charlie Sheen confirmed this week he is HIV-positive, oh man, has the news coverage been making me cringe—and that was before I made the number-one Internet mistake of reading the comments on some mainstream coverage.

I started to rant about it to my coworkers, and they encouraged me to actually write those rants down, so here you go: my five initial reactions to the conversation around Charlie Sheen’s HIV status.

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1. Charlie Sheen Has Done Terrible Things, But HIV Is Not a Punishment for Being Terrible

I am not going to defend Charlie Sheen. Sheen has a long history of domestic violence. He has frequently behaved like a total jackass (and a borderline anti-Semitic one at that)He’s also anti-vaccination. Charlie Sheen is not a guy I want to know or spend time with. I avoid his television shows and movies.

I get that it’s tempting, when bad things happen to a bad person, to revel in the schadenfreude—especially given that Sheen has always seemed to be very proud of his sex-and-drugs lifestyle. But this isn’t comeuppance or just desserts—and sorry folks, the jokes about contracting HIV from tiger blood aren’t funny.

HIV is not a punishment for bad behavior. It’s an illness. And it’s not OK to act like it is a punishment for some crime, even when the “criminal” is a public jackass like Sheen, because that just reinforces the HIV stigma our culture is already swimming in. HIV stigma makes it less likely that people will get tested for HIV, and makes it dangerous for people living with HIV to disclose their status and lowers the chances they’ll get health care.

So look: I’m not defending Sheen. But he deserves your scorn for the crappy things he’s done and said, not because he has HIV.

2. Charlie Sheen Has Access to Better Care Than Most People Living With HIV

Hey, did you know HIV medications are super expensive? They are! Do you know who has a lot of money? Charlie Sheen, the former highest-paid man on television! But do you know who isn’t that wealthy? Most people living with HIV.

The super awesome thing is that with effective medication and care, people living with HIV can expect to live roughly as long and healthy a life as their HIV-negative peers. But HIV disproportionately impacts marginalized communities, which means that a high percentage of people living with HIV can’t get the care they need, let alone pay for the meds that literally save their lives—especially if they live in one of the states that has refused federal money to expand Medicaid, the biggest payer for care to people with HIV in the United States.

Living with HIV won’t be a walk in the park for Sheen, but he has access to resources that the majority of people living with HIV just don’t.

3. Because Sheen Is Getting Proper Care and Treatment, He’s Less Likely to Transmit HIV

Now that Sheen’s interview with Matt Lauer on Today has aired, we know that Sheen is on HIV treatment, that he has alerted his sexual partners to his status, and that, yes, he has had unprotected sex since his diagnosis. He said it’s “impossible” that he transmitted HIV to them. For outsiders to the HIV community, that might not sound true, but actually? It pretty much is. Yes, even when the sex was unprotected.

Basically, when people are on effective HIV treatment, the amount of actual virus in their bloodstream goes way down—and if the virus isn’t there, they can’t pass it on to other people. (Here, have a video.)

So while I would hope that no one wants to have sex with Sheen, that’s because of the aforementioned domestic violence stuff, not out of fear of acquiring HIV. And yes, right now there are a lot of rumors that he has actually passed HIV on to others, but:

4. HIV Criminalization Might Sound Good on the Surface, But It Increases HIV Transmission

There’s been a lot of speculation of the legal trouble Sheen might land in if he did knowingly pass HIV to anyone else. And on some level, it might feel good to say: “Yeah! He’s ruined people’s lives, he should pay for it!”

Except that first, the idea that HIV is a life-ruiner is, again, stigmatizing, and second, criminalizing HIV doesn’t help anything—in fact, it actively does harm. In order for transmitting HIV to be a criminal offense, the transmitters have to know their HIV status. That … really just gives people a pretty good reason not to get tested. It can seem counterintuitive, but is incredibly important to understand, so here are some more really good points about why criminalization doesn’t work.

And oh yeah, let’s also keep in mind, it’s stigma that made it possible for Sheen to be blackmailed over his status. If we removed the idea that HIV is something awful and shameful—something worth literally sending people to jail for—then you also remove the reason even celebrities like Sheen feel a need to keep their status silent.

5. Adult Film Stars Have Relatively Low Rates of HIV

And finally, there’s this: Sheen has been open about the fact that he’s dated and slept with porn stars. People are citing that as if it means of course he was going to acquire HIV. But in reality, porn stars are tested really frequently for HIV. It’s big news when a production is shut down due to possible HIV transmission—but it’s big news because it’s rare.

When adult film performers test positive, they find it out much more quickly than most people. Again, I don’t know the lives of the people Sheen has slept with—but the porn stars probably knew their HIV statuses. Which, considering that one in eight people living with HIV in the U.S. don’t know it, is pretty impressive.

So while we’re working to avoid stigmatizing HIV, let’s try not to stigmatize sex workers, either, OK? (And that goes for you, too, Matt Lauer, for referring to sex workers as “unsavory persons” throughout the interview.)

There is a lot more to say about this, especially about the intersection of mental health, drug addiction, and HIV. But if nothing else, please keep this in mind: The jokes you make about Charlie Sheen won’t hurt him. He’s a super wealthy celebrity in a culture that worships those. But most people living with HIV don’t have those advantages, and the stigmatizing jokes and misinformation can and do hurt them.