Roundups Sexual Health

Condoms Come to Philly Schools, At-Home HIV Test Hits Shelves, and One-Size-Fits-All Condoms Don’t

Martha Kempner

Twenty-two Philadelphia schools installed condom dispensers as part of a city-wide effort to reduce STDs; a new at-home HIV test hit drug store shelves but some worry if this is the best way for individuals to find out their status; and a new study suggests that public health efforts may be leaving some men unprotected.

Condom Dispensers Added to Philly Schools

Students at 22 high schools in Philadelphia may notice something new if they visit the nurse’s office starting today; clear plastic condom dispensers. This represents about one-third of the high schools in the district and is a move by the city to curb HIV infection among teens, a group that accounts for 25 percent of all new infections in the city. 

City officials are very supportive of the measure.  Mayor Michael Nutter said:  

“I support the policy strongly. This is a serious public health matter.”  

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He went on to say:

“Discussion about whether or not [teens] should be sexually active is an appropriate discussion, but if they are, then we need to make sure they’re engaged in safe sexual practices.”

The decision to include condoms is part of an overall effort to reduce STDs, including HIV, in the city. As part of the effort, the city has distributed over four million condoms since 2011 and STD rates are now falling. In addition, 12 high schools in the city already have health resources centers where they distribute condoms and provide STD testing, and the health department goes into other schools to provide STD testing as well. Statistics reveal that of the 130,000 student who have received testing in the last five years, about 6,500 or five percent of them have tested positive for STDs including HIV.

Though some parents in Philadelphia were reportedly outraged by this new policy because they feared it would encourage sexual activity, a school district spokesperson says they’ve received no “specific calls” from parents objecting to the programs. Parents who do object can “opt out” of the program. 

According to Advocates for Youth, a national non-profit advocacy group, about 418 high schools across the country make condoms available to students. Moreover, studies comparing schools with condom availability programs to those without have found that students have sex at the same rates but students in schools with condoms are more likely to use them when they become sexual active. 

Home HIV Tests Hit the Shelves to Mixed Reaction

The OraQuick In-Home HIV Test hit drug stores shelves at the end of last year. Users swab their cheek, put the swab in a test-tube, and wait approximately 20 minutes for results that are given in the form of pink lines similar to the ones found on a pregnancy test. This is the first all-at-home HIV test approved by the FDA, an earlier test allowed users to collect a blood sample (through a finger prick) at home but the sample then had to be sent to a lab.

AIDS activists are torn about this newly available test: on the one hand anything we can do to remove barriers to testing and ensure more people know their HIV status is good while on the other hand there are fears about what will happen when individuals learn they are HIV-positive on their own without the support of a counselor or other medical provider.  

As Dan Teitz, executive director of the research and advocacy group AIDS Community Research Initiative of America, or ACRIA, said this:

“We generally like this thing. It decreases some of the barriers to testing. It kind of puts HIV in front of people, but there’s a bunch of cautions.”

Tony Martinez, an HIV-positive individual, told ABC News that he took the test at home as an experiment but he thought that he wouldn’t have been able to do it if he didn’t already know his status:

“If I didn’t know I wasn’t HIV positive, the test would be a different ballgame. I put myself back many years ago when I went to a clinic and took the test and was terrified. [The home test] was a lot of steps. I don’t think I would have followed the directions in that [terrified] state. Am I really going to read the manual “What Your Results Mean” if the test is positive? It’s like asking someone to read a drivers’ ed manual after an accident.”

The manufacturer, however, claims that its support center—which is open 24/7 and available in English and Spanish—can fill the counseling gap. Though the representatives are not certified counselors they receive over 160 hours of training on how to answer questions about HIV/AIDS, how the test works, and what the results mean. They are also able to refer callers directly to counseling and care. 

Other concerns about the test include questions about accuracy. Though the test is the same one used by health professionals, research has shown that accuracy drops from 99.3 percent in a health care setting to 92.9 percent when the test is done at home. This can lead to false negative which give test-takers a false sense of security. Moreover, some fear that at-home users will not understand the importance of the “window period,” the time between the actual date of infection and the point at which antibodies in the blood can be detected by a test. Tests taken within this period—which usually lasts 3 months—may result in a false negative.

Ultimately, however, most activists agree that the more options people have for testing the better. The CDC estimates that 20 percent of the 1.2 million individuals living with HIV in the United States don’t know they’re infected. As Dr. Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, put it:

“It’s hard not to be fully enthusiastic about the test. Everything we do to increase testing has to have some degree of benefit. By identifying and treating people early, we preserve normal life span and excellent health and reduce contagion.”

The tests sells for $40 and are only available to people over 17; identification is required.  

New Study Finds Size Matters in Condom Use    

A study set to be published in next month’s Archives of Sexual Behavior suggests that men who have larger than average penises are less likely to use condoms because they cannot find one that fits. The study conducted by Hunter College’s Center for HIV Educational Studies and Training (CHEST) surveyed nearly 500 gay and bisexual men in New York City about their experience using condoms. Less than 40 percent of respondents said they could easily find condoms that fit properly. Some respondents admitted that they were having unprotected sex because they could not find a condom that fit right. 

Though drug store shelves are full of condoms of varying shapes and most manufacturers do make large condoms, these varieties are not the ones typically found in health centers or distributed for free by departments of health across the country. 

The lead researchers says he conducted the study to determine whether the “one-size-fits-all approach to condom distribution might be inadvertently creating a group of men at risk for engaging in unprotected sex due to problems with condom fit.” The findings suggest this is, in fact, a problem. He suggests that “offering a wider assortment of condoms could improve the ease and enjoyment—and thus likelihood—of safer sex practices.”

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