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.”

Commentary LGBTQ

You Can’t Go Home Again: North Carolina’s HB 2 Criminalizes Trans Life

Mina Carpenter

On Wednesday, I became illegal in my home state.

On Wednesday, I became illegal in my home state. I can’t go home to see my mother or my sister or my uncle or my friends from high school. I can’t go back to my favorite restaurant. Because the systematic eradication of transgender people from North Carolina is now the law of the land.

That’s not what the headlines said, but it’s the truth. A law that criminalizes trans people using the bathrooms of our actual genders criminalizes trans life.

That might seem like a big leap to you. So let’s break it down.

North Carolina’s HB 2, signed into law last week, overturns local anti-discrimination laws, bans cities or counties from setting a minimum wage for private employers, and dictates that access to restrooms in schools and publicly owned buildings be restricted to the gender on a person’s birth certificate. The law applies to schools and all state- and locally owned public buildings—public universities, rest areas, airports, courts, jails, social services, and the like. The law also defines public accommodations such that private property owners who wish to discriminate against trans people are protected; it just doesn’t force them to do so.

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Using the wrong bathroom as the law demands isn’t a realistic solution for most trans people. Most trans people can’t walk into the bathroom the law says we should use without the risk of someone deciding we’re in the wrong place. A lot of trans people can’t walk into any bathroom without the risk of someone deciding we’re in the wrong place. Complying with the law wouldn’t work out very well, but that’s beside the point. Saying that it’s legal to be trans so long as you use the wrong bathroom is like saying it’s legal to be Christian so long as you don’t set foot inside a church. It makes it illegal to be trans in practice—illegal to live your gender.

If you could make us cis by making it illegal for us to live as who we are, don’t you think it would’ve worked by now? We were illegal when we rioted at Compton’s, we were illegal when we rioted at Stonewall, and we persisted despite being illegal for 100 years before that. A lot of us are still de-facto illegal, and we’re still here. Yes, sometimes trans people have to hide or compromise on who we are in order to survive in a world that wants us dead. Sometimes it means letting the system rob you of your dignity so that it doesn’t rob you of your freedom or your life, just as sometimes it means dying rather than let it rob you of your dignity. That’s the choice that trans people in North Carolina have right now: Dignity or freedom. Choose one—and probably get neither.

So it is absurd to say that what this law does is force trans people to use the restroom corresponding to the gender on our birth certificates. This law gives North Carolinian trans people three choices: risk legal penalties and police harassment for using a gendered bathroom, find a way to do without, or leave the state.

But bathrooms aren’t optional. Having them available is a requirement to access public space and public life. Could you hold down a job if you couldn’t pee at work? Could you go to school if a round trip to the only bathroom you could use took eight minutes, but you only had seven minutes between classes? Could you go on a date if you didn’t know whether you’d be able to pee at the restaurant, at the movie theater, at the bar—at all—until you got home? Could you keep yourself healthy by exercising at the gym without using the locker room or the bathroom? Could you fly home to visit your family if you had to get to the airport, check in, get through securityand board your flight before you had access to the plane’s gender-neutral restroom?

Bathrooms are an essential part of public infrastructure, and if you can’t access them safely and reliably, you can’t leave the house safely or reliably.

It is our duty to fight for our freedom. It is our duty to win.

The reality for transgender people in this situation isn’t that we have to use the wrong bathroom. The reality is that unless we leave and never come back, we either imprison ourselves metaphorically in our homes or risk being imprisoned literally. These are conditions calculated to bring about our destruction as a people. That’s genocide.

North Carolina isn’t alone in what it’s trying to accomplish. Security personnel already harass and arrest trans people for using the bathroom even without any laws to back them up. Because any time we interact with a representative of the state, there’s what the law says they can do, and then there’s what they actually do.

Laws like these justify and expand practices that already exist to eliminate and subjugate transgender people. Airport scanners are designed to deny trans people freedom of movement for the sake of security theater for cis people. A majority of states make trans people’s legal rights and access to accurate documentation dependent on genital surgery—which amounts to coerced sterilization.

Like many other trans people, I’ve been sexually harassed and assaulted in order to confirm a cis person’s suspicion that I’m trans—and I’ve never heard of anyone being punished for it unless the victim turned out to be cis. While this law doesn’t explicitly provide legal cover to expand the practice of transphobic sexual assault and harassment, it’s hard to imagine that that won’t be the effect. Those most vulnerable will be trans women and femmes—whose demonization has been the justification for the law—and people of color whose bodies are already criminalized and subject to additional scrutiny.

Police departments across the country use relentless profiling for sex work to criminalize condom use. In a climate where rampant discrimination can make sex work the best available survival strategy, that criminalization is an incredibly effective strategy for infecting Black and Latina trans women with HIV. Whether it was planned that way or not, the effect is absolutely genocidal. Years of activism culminated in laws banning the practice in New York and California less than two years ago, but it’s still commonplace elsewhere in the country. And then there’s the blunt instrument of murder, which seems to be gaining in popularity as we gain visibility.

We’re not going away. In the words of queer and trans activists of color protesting the bill Thursday night: This is not over. Cis people have been trying to eliminate us for more than 500 years, so for anyone hoping to get rid of us without getting blood on their hands, too bad. But the fact that this fits into a broader context and a longer history doesn’t make it less terrifying or less awful; it makes it worse. It’s another attack on an already threatened community. It’s a huge expansion of criminalization that makes trans people illegal as a matter of law, not just practice.

But personally? I just want to go home.

Commentary Law and Policy

Is One-Sixth a ‘Large Fraction’ When It Comes to Our Constitutional Rights?

David S. Cohen & Jeffrey B. Bingenheimer

When the Supreme Court hears oral arguments Wednesday in Whole Woman’s Health v. Hellerstedt, the most important abortion case before the Supreme Court in more than two decades, the resolution of the case may just come down to how the justices regard that fraction.

Read more of our coverage of ​Whole Woman’s Health v. Hellerstedt​ here.

This article is based on a new study published in the University of Pennsylvania Law Review Online

If we told you that one-sixth of pregnancies in the United States would result in the death of the pregnant person, would you consider that number a large fraction?

How about if one-sixth of your life savings were wiped away in a banking error? Would you think one-sixth was a large fraction then?

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When the Supreme Court hears oral arguments Wednesday in Whole Woman’s Health v. Hellerstedt, the most important abortion case before the Supreme Court in more than two decades, the resolution of the case may just come down to how the justices regard that fraction.

At issue in the case is a Texas law that, among other provisions, would require doctors who perform abortions to have admitting privileges at local hospitals and require abortion clinics to meet the exacting requirements of ambulatory surgical centers. If the law is allowed to go into effect, advocates say, all but nine or ten of the state’s abortion clinics will close. About 900,000 Texas women of reproductive age would have to travel more than 150 miles each way in order to reach one of those remaining clinics. With about 5.4 million women of reproductive age in the state, that would mean one-sixth of Texas’ women would face a serious obstacle in obtaining an abortion.

Why does it matter what fraction of women are affected? In a line of cases starting with Planned Parenthood v. Casey in 1992, the Supreme Court and other federal courts have ruled that an abortion restriction will be found unconstitutional if it constitutes an “undue burden” on a woman’s right to choose. The Court explained further that an undue burden exists when the law is a substantial obstacle for a “large fraction” of people who are subject to that restriction.

Casey involved a Pennsylvania law that would have required married women to notify their husbands before they got an abortion. The Court reasoned that this provision only really affected women who were not in trusting relationships with their husbands. Based on the evidence before the Court, many of those women were in abusive relationships—so for an unspecified large fraction of them, requiring them to tell their husbands would be a substantial obstacle. Thus, this part of the law was struck down as unconstitutional.

In Whole Woman’s Health, however, the Fifth Circuit Court of Appeals upheld the law, concluding that one-sixth is “nowhere near” a large fraction; in a separate case, the same court ruled that a restriction that does not fall on the “vast majority” of women can never be a large fraction. Whether the Supreme Court agrees with the Fifth Circuit on this issue could very well determine the outcome of Whole Woman’s Health.

So is one-sixth a large fraction? We considered this question in a new study we published in the University of Pennsylvania Law Review. In it, we argue that the Fifth Circuit ignored the common understanding of one-sixth and the concept “large fraction.” The Supreme Court needs to take this study’s findings into consideration.

In our study, we distributed an online questionnaire (which you can take at the link) to potential respondents through Amazon’s Mechanical Turk system. The questionnaire included a few questions about respondents’ demographic characteristics and political orientation. Of primary interest, however, were 12 scenarios that we asked respondents to read. Each scenario featured the fraction one-sixth, and after each, we asked respondents, “In this scenario, do you consider one-sixth to be a large fraction?” Respondents could answer “yes” or “no.” We randomized the order in which the scenarios were presented.

We ended up with a sample of 504 individuals. The sample was heterogeneous: 76 percent of participants self-identified as white, 9 percent Asian or Pacific Islander, 7 percent African-American, 3 percent Hispanic or Latino, and 5 percent mixed-race or other. Fifty-seven percent of respondents were male. They ranged in age from 18 to 76 years, with almost 70 percent being between 25 and 44 years old. What did we find?

First, it is easy to invent hypothetical scenarios in which the vast majority of people will describe one-sixth as a large fraction. When presented with a scenario in which one-sixth of tablets in a bottle of Tylenol were laced with the poison cyanide, 91 percent of respondents reported that one-sixth was a large fraction. When the scenario involved your boss requiring you to donate one-sixth of your take-home pay to her daughter’s elite private school, 93.5 percent of respondents did so.

Second, we found that changing key elements of otherwise similar scenarios can result in large differences in the proportion of respondents who described one-sixth as a large fraction. For example, we presented two scenarios, each of which involved a local business with 100 employees working at its main office. In one scenario, we said that the employees normally arrive on time, but that one day, one-sixth of them arrived to work late. In the alternate scenario, we said that one-sixth of employees of that business were killed one day in separate individual car accidents. When the scenario involved employees being late, only 28 percent of respondents described one-sixth as a large fraction; when it involved employees being killed in car accidents, fully 92 percent did so. Clearly, whether one-sixth is a large fraction depends heavily upon the baseline expectation in the scenario in which it is presented.

We also presented two politically charged scenarios, and examined how respondents’ tendency to describe one-sixth as a large fraction in these scenarios depended upon their own political orientation. One scenario mirrored closely the law at issue in Whole Woman’s Health: A state enacts a law that forces abortion clinics to close, and as a result, one-sixth of women of reproductive age would have to travel 150 miles or more to get to a clinic that remained open. A companion scenario involved a state law that forced gun stores to close, leaving one-sixth of the state’s adult residents 150 miles or more away from a gun store that remained open. Overall, 76 percent of respondents agreed that one-sixth was a large fraction in the abortion clinic scenario, whereas 52 percent did so in the gun store scenario.

What was most interesting, however, was how these responses varied according to respondents’ political orientation. We asked respondents to place themselves along a five-point scale, from very conservative to very liberal. In the abortion clinic scenario, 88 percent of people who described themselves as very liberal, compared to 48 percent of people who described themselves as very conservative, agreed that one-sixth was a large fraction. The pattern was reversed in the gun store example: 38 percent of people who said they were very liberal, versus 62 percent who said they were very conservative, described one-sixth as a large fraction in that scenario. 

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These results would not be surprising to a linguist. The adjective “large” has no absolute meaning, and becomes meaningful only in relation to a comparison group or baseline set of expectations. The basketball player Manute Bol is a large person, compared to other people, or even other NBA players. But a redwood tree of the same size would be considered small, and a planet the size of Manute Bol would be … not a planet at all.

What does all of this mean for Whole Woman’s Health? The Court has never specified what exactly a “large fraction” is under the Casey test, so the everyday English understanding of the phrase matters. With that in mind, the Fifth Circuit’s claims—that only a “vast majority” can count as a “large fraction” and that one-sixth “nowhere near” qualifies—is clearly at odds with common usage.

As our questions about political orientation indicate, the Supreme Court justices should be particularly careful to not to use superficial arguments to provide intellectual cover for their own moral beliefs or political views about abortion.

In its consideration of the case, the Court must provide a more sophisticated analysis that recognizes not only that one-sixth clearly can be a large fraction in some scenarios, but also that the determination has much to do with assumed expectations and values. In particular, if the justices value a woman’s constitutional right to choose to have an abortion, then one-sixth should be seen as a large fraction—because our baseline expectation should be that few people have their constitutional rights denied.