Roundups Sexual Health

Sexual Health Roundup: Illinois to Improve Sex Ed, Changing HPV Messages, and West Virginia Bans Teen Sexting

Martha Kempner

This week, the Illinois senate took up a bill requiring that sex education be medically accurate, West Virginia took on teen sexting, and a new study suggested we may need to change our HPV messages if we want more women to get the vaccine.

Sexual Health Roundup is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Illinois Lawmakers Look to Expand Sex Education

The Illinois senate is poised to vote on a bill that would require sexuality education courses to be medically accurate and teach about birth control and sexually transmitted diseases (STDs). This is a bit of switch for the state, which has allowed abstinence-only education for over a decade.

In fact, the state’s current law says that schools must “emphasize abstinence as the expected norm” and that any course that teaches about sex must teach “the hazards of sexual intercourse.” Schools in Illinois, however, do have some choice in how they teach sexuality education. They can provide an abstinence-only course, a comprehensive course, or choose not to have sex education at all. All courses must emphasize abstinence.

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If the bill passes, this would change. Schools would still have the option of not providing any sexuality education at all, but if they choose to do so the education must be medically accurate and cover both birth control and STD-prevention. The law includes an opt-out policy that allows parents who object to the content to take their children out of the class without penalty.

The bill passed the state house last month by a vote of 66-52. It now moves to the senate, where it is being sponsored by Sen. Heather Steans (D-Chicago). Steans explained to the Chicago Tribune, “Kids are doing this. We need to give them proper and better tools to inform them. Our goal is we need to limit teenage pregnancy.”

According to the Tribune, a number of Steans’ senate colleagues agree, and feel that simply telling teens to wait for the right person is not enough. During committee hearings on the bill, Sen. Don Harmon (D-Oak Park), for example, compared the proposal to school-based drug awareness programs.

Cancer Messages Don’t Motivate Young Women to Get the HPV Vaccine

As we know from past reports, there are now two vaccines that can prevent the strains of the human papillomavirus (HPV) that are most likely to cause cervical cancer. The HPV vaccine has been a hard sell in this country, as parents seem reluctant to follow the advice of the Centers for Disease Control and Prevention (CDC) and vaccinate their sons and daughters early. Like many of my public health colleagues, I’ve long believed that the best messages—especially for parents—are ones that look past the sexual nature of HPV transmission and focus on the ultimate goal of preventing cancer. However, a new study suggests that college-age women are more motivated by preventing STDs, while their mothers are neutral.

Researchers enrolled college-aged women who had not yet had the vaccine as well as their mothers in a study designed to see which messages motivated them the most. Half of the students and half of the mothers got a packet of information called “Prevent Cervical Cancer,” while the other half got a packet called “Prevent Genital Warts.” The groups were given the same amount of time to read their packets and then answered a questionnaire that asked how they felt about HPV and the vaccine and how interested they were in seeing a doctor about this issue.

The genital warts message clearly resonated more with the college-age women, as this group was not only more likely to say they were interested in seeing a doctor, but were also more likely to say they’d be comfortable talking to the doctor about the HPV vaccine. The researchers believe that this comfort is key, and that scare messages are probably not the right tactic to take. The lead author told Medical News Today, “Our results suggest it is more important to get women to feel comfortable talking to their doctor about the vaccine. Fear doesn’t work. They need to feel it is not difficult or embarrassing to discuss the vaccine with their doctor. That’s the best way to encourage them to be vaccinated.”

The concern that STD messages would not resonate with mothers because it would force them to confront the possibility that their daughters are sexually active turned out to be unfounded in this study. The mothers reacted similarly to the two messages, which led the researchers to conclude, “[if] we focus on the prevention of genital warts in our messages to daughters, it may not mean we have lost the mothers.”

I do wonder if the results among the mothers in the study have anything to do with the age of their daughters. It is relatively expected that college-age women are sexually active. A repeat of this study with younger girls and their moms would be very interesting, as the vaccine is recommended as part of routine care for 11-year-olds to make sure that they have all three doses before they become sexually active.

West Virginia Bans Sexting Among Teenagers

Teenagers in West Virginia should probably set an alarm on their smart phones for July 12 that tells them, well, to put down their smart phones. That’s the day a new law goes into effect in the state making sexting an act of juvenile delinquency.

Specifically, the law bars juveniles from making, having, or distributing photos, videos, or other media that portray a minor in an inappropriate sexual manner. Minors found with such material would be guilty of juvenile delinquency. The law, however, also directs the state supreme court to develop an education program that would show offenders the consequences of sexting, including the long-term harm it can do to relationships, school success, and future job opportunities. Minors who are caught sexting can choose this course as an alternative to juvenile charges.

While I agree that sexting, especially when it involves naked or otherwise sexual pictures, can have long-term consequences, I wish states would not rush to punish young people for their sexual behavior. Here’s a radical idea for West Virginia: Put education first. Instead of waiting until you catch kids red-handed to teach them something, develop that course and use it to teach all young people how to think critically before they hit the send button.

Roundups Sexual Health

This Year in Sex: It’s Time to Take Action

Martha Kempner

We have the tools to work against sexually transmitted infections, harmful "conversion therapy" for LGBTQ teens, and sexual assault on college campuses. Now, we just have to use them.

This Year in Sex takes a look back at the news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and other topics that captured our attention in 2015.

STIs Are on the Rise in Every Group

This year, it seemed like every week there was a new headline about a rise in sexually transmitted infections or diseases among a specific group, in a certain geographic area, or even among the general population. When states released their 2014 STI data, we learned that Minnesota’s rates hit a record high and that the rate of gonorrhea nearly doubled in Montana between 2013 and 2014. Counties across the country reported rising rates of chlamydia, gonorrhea, and syphilis. California’s Humboldt County, for example, noted a tenfold increase in gonorrhea since 2010, and Clark County, Nevada—home of Las Vegas—reported a 50 percent increase from 2014 in the number of cases of primary and secondary syphilis.

In fact, many of the headlines this year involved syphilis—a curable disease that the United States was once close to eliminating because rates were so low has continued its resurgence. A Department of Defense report, for example, points to a 41 percent increase in the rate of this disease among men in the military. Another disturbing report showed a dramatic rise in the number of babies born with syphilis; congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. This reflects both an increase in cases of the disease among women and a lack of prenatal testing that could catch and treat syphilis during pregnancy. This year, there was also an outbreak of ocular syphilis on the West Coast that led to blindness in at least one patient.

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While syphilis is on the rise in both men and women, 90 percent of cases are in men, 83 percent of which are those who have sex with men in cases where the gender of the partner is known.

Young people are also disproportionately impacted by STIs, specifically chlamydia and gonorrhea—54 percent of the cases of gonorrhea and 66 percent of cases of chlamydia reported to the CDC occurred in those younger than 25. Though if detected early and treated, those STIs can be cured, they can also cause future health problems, including infertility.

Perhaps the ultimate headline about STIs this year, however, was the one in which we learned that almost everyone has herpes. A report by the World Health Organization estimated that 3.7 billion people worldwide—or about two out of every three adults across the globe—are infected with herpes simplex virus 1.

All of this news should remind us that sexually transmitted diseases and infections are a public health crisis and we have to up a fight. We need to prevent the spread by educating young people and adults and making condoms readily available. We need to invest in testing that can help people detect STIs before they face many potential health consequences and prevent them from spreading further. And, we need, of course, to provide access to treatment and combat stigma-based fear.

We Know How to Prevent HIV (Now We Just Have to Keep Doing It)

There was a lot of good news this year when it comes to preventing HIV, much of which focused on how well pre-exposure prophylaxis (PrEP) can work. PrEP is a combination of two antiretroviral drugs—tenofovir and emtricitabine—used to treat people who have HIV. When taken daily by people who are HIV-negative, these drugs have been shown to prevent transmission of the virus. In fact, a study by Kaiser Permanente found that since the approval of PrEP in 2012, none of the patients who were using it became infected with HIV. This was actually better than the researchers expected given the findings in clinical trials.

Incorporating PrEP into a multifaceted HIV-prevention program can work, and San Francisco—once a hotbed of the national HIV and AIDS epidemic—proved that, with just 302 new HIV diagnoses in 2014. Getting those HIV-negative residents who are at high risk of contracting the virus onto PrEP is one of the strategies the city uses. In addition, the city provides rapid treatment for the newly diagnosed and continued follow-up appointments to make sure that patients stay on their treatment plan. This can not only help them stay healthy but can prevent the further spread of the virus, as people who adhere to an antiretroviral drug protocol can suppress the virus to the point that they cannot transmit it to others. In San Francisco, 82 percent of residents with HIV are in care and 72 percent are suppressed. This is significantly higher than national statistics, which show that 39 percent of those with HIV are in treatment and only 30 are taking their drug regimen regularly enough to be considered suppressed.

While it will be difficult for many places to adopt a system as expensive as the one in San Francisco, its success shows us that we have the tools we need to prevent HIV. And, in fact, diagnoses of HIV are down in the United States by 19 percent, though the success was not evenly spread: some groups, such as Latino and Black men who have sex with men, are actually seeing increases. It’s time to renew our investment in ending this epidemic for everyone.

Vaccines (Including the HPV Vaccine) Are Not Dangerous, But Skipping Them Is

The year started with a massive outbreak of the measles on the West Coast, so it’s not surprising that there was a lot of conversation about the value of inoculations and what happens when too many people in a certain area are not vaccinated. In the midst of the epidemic and the debate, some schools asked unvaccinated children to stay home, and some states tried to close loopholes that make it easy for parents to opt of required vaccines because of “personal beliefs.”

Unfortunately, many of these personal beliefs are based on false reports and misinformation suggesting that certain vaccines cause autism. A study of anti-vaccine websites found that this misinformation is abundant on the Internet. Of 480 sites dedicated to the anti-vaccine movement, about 65 percent claimed that vaccines are dangerous, about 62 percent claimed vaccines cause autism, and roughly 40 percent claimed vaccines caused “brain injury.” Many of these facts lacked citations, but some were based on misinterpretation of legitimate research.

The scientific truth is that vaccines are safe and have no connection to autism. If there was any doubt, yet another study was released this year confirming it. In fact, the only study that has ever found a connection was proven to be falsified by an unethical researcher who stood to make a profit.

Of course, that didn’t stop the field of Republican presidential hopefuls—which includes two medical doctors—from trying to score political points by suggesting the government may “push” “unnecessary” vaccines.

Though not mentioned by name, they may have been referring to the HPV vaccine, which has always been controversial because of its connection to sex. There seems to be a sense that because HPV is sexually transmitted, vaccinating against it is less important or will give teens permission to have sex. Numerous studies have shown this to be false. One study published this year even found that girls who have gotten the HPV vaccine take fewer sexual risks.

But the fear and misinformation continues, and it turns out doctors might not be helping matters. One study showed doctors may be discouraging the HPV vaccine by not strongly recommending it, not doing so in a timely manner (the CDC advises that vaccinations should start at age 11), and only suggesting it to young people they perceive to be at risk. This could be part of why HPV vaccination rates still lag behind those of other recommended vaccines.

We need to remember that this vaccine prevents cancer. The newest protects against nine strains of the virus and has the potential to prevent 90 percent of cervical, vulvar, vaginal, and anal cancer. And there is reason to believe it will also prevent oral cancer. That’s five cancers prevented by one series of shots.

Of course, like the others, it can only work if our children obtain it. Hopefully, it will not take another outbreak of a preventable disease like measles for us to realize how lucky we are to live in an age in which we know how to stop so many of the diseases that disabled and killed generations before us.

Government Weighs in on ‘Conversion Therapy’

This year saw many positive developments in the struggle for LGBTQ rights, one of which was a willingness of both the White House and many senators to come out against “conversion therapy” for young people. Sometimes called reparative therapy, this is the practice of trying to change a person’s sexual orientation or “cure” their homosexuality. While no legitimate medical organizations sanction such a practice, some young people are subjected to it because their parents or their religion disapprove of same-sex relationships.

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. Research has found not only that it does not work to change an individual’s sexual orientation, but that it can be harmful and lead to depression, shame, and suicidal thoughts.

In April, the White House released a report condemning the practice for teenagers and asking states to ban it for minors. In an accompanying letter President Obama wrote: “Tonight, somewhere in America, a young person, let’s say a young man, will struggle to fall to sleep, wrestling alone with a secret he’s held as long as he can remember. Soon, perhaps, he will decide it’s time to let that secret out. What happens next depends on him, his family, as well as his friends and his teachers and his community. But it also depends on us—on the kind of society we engender, the kind of future we build.” Two Democratic legislators echoed this sentiment when they offered a resolution asking the Senate to condemn the practice as well, and a report from the Substance Abuse and Mental Health Services Administration attempted to offer parents alternatives that can support LGBTQ young people.

This year Oregon joined those states—including New Jersey, California, and the District of Columbia—that do ban the practice. Furthermore, a challenge to New Jersey’s ban failed when the U.S. Supreme Court turned the case away.

Doing away with harmful practices is a step in the right direction for LGBTQ adolescents, but there is still much more to do in order to protect and educate all of our young people.

We All Continued Talking About Consent

The problem of sexual assault on college campuses was pervasive in the news in 2015. At the end of last year, California became the first state to pass a law mandating affirmative consent on college campuses, also known as “yes means yes.” This year, New York joined it, and other states are considering doing the same.

Affirmative consent has its critics, who say that the standard is unclear and unrealistic in real-life settings. A poll by the Kaiser Family Foundation found that most college students (83 percent) had heard of affirmative consent and many (69 percent) felt it was very or at least somewhat realistic. But when asked whether different scenarios met the standard, students showed a variety of opinions, proving that putting the standard into practice might be tricky.

Still, I believe the conversations about affirmative consent have been useful. They have given us a platform to talk more about the role of alcohol in sexual behavior and sexual assault, and what happens when one is not passed out but clearly very drunk—and therefore incapable of giving consent. We’ve made college students more clearly establish their own boundaries. And educators have been able to both reiterate and go beyond the “no means no” message to talk about what good, consensual sex might look like.

Affirmative consent is not the end-all solution to sexual assault—it won’t, for example, prevent some perpetrators intent on raping. But if we talk about it enough and start before college—California, for example, mandated affirmative consent message in high school—we might have a generation who can think critically about their own behavior and the behavior of others, a generation that is prepared for healthy sexual relationships and knows that, at the bare minimum, a sexual encounter must include consent.

News Sexual Health

Sex Ed Mandatory in Hawaii Schools After Years of Misinformation

Martha Kempner

After years of controversy, sex education will now be mandatory in Hawaii schools just as data suggests recent efforts to improve sex ed have worked to reduce teen pregnancy and abortion rates.

The Hawaii Board of Education voted on June 16 to make sex education mandatory starting in the 2015–2016 school year. The decision comes after years of efforts by educators to make the state’s sex education program more comprehensive and counter lawmakers’ attempts to make it more restrictive.

It also comes on the heels of data that suggest broadened sex education may have been partially responsible for the reduction of teen pregnancy and abortion in Hawaii.

Until now, Hawaii schools were not required to teach sex education at all. Efforts to improve how schools handle the topic began in 2009 with a state law requiring all sexual health programs in schools to provide medically accurate information. Under this rule, schools that chose to teach sex education were required to stress the benefits of abstinence and encourage sexually active students to become abstinent, but they also had to include education on methods of contraception and disease prevention.

Before 2009, many schools in the state were relying on Catholic charities that provided Try Waitan abstinence-only-until-marriage program. The program, which was supported with federal funding, used the Choosing the Best curricula.

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This popular series contains very little information about contraception and STDs, promotes heterosexual marriage, relies on messages of fear and shame, and includes biases about gender, sexual orientation, and pregnancy options, according to the Sexuality Information and Education Council of the United States. (SIECUS).

Other materials used in Hawaii schools were outdated and culturally inappropriate.

Judith Clark, executive director of Hawaii Youth Services Network, told the Associated Press that schools were using videos from the 1980s and at least one of them featured actors who were ice skating in heavy sweaters. “It was very didactic, very boring and very inappropriate for Hawaii because nothing looked familiar,” Clark said.

Clark explained that the state was awarded a $5 million grant to spend on sex education programs over five years beginning in 2010, which has led to the creation of new, more appropriate resources, and a focus on teen pregnancy prevention both in and out of schools.

Clark’s organization, for example, created new DVDs using local actors on the beach and at a Polynesian tattoo shop. In one video, the actors even speak in the local pidgin dialect throughout the story.

One new program that was designed to be culturally appropriate, however, became controversial. Pono Choices was created by the University of Hawaii for 11- to 13-year-old students. It is described by the university as being “culturally responsive,” and introducing “students to Hawaiian cultural terms, practices and concepts that stress positive character development, including making ‘pono’ or ‘right’ choices.”

Originally introduced as a pilot program in 12 schools across the state, the program was pulled twice in large part due to the efforts of Rep. Bob McDermott (R-Kapolei, Makakilo).

The state Department of Education first pulled the program in late November 2013 to review it after McDermott and a few other legislators complained, along with some parents. But after just two weeks, the department not only reinstated the sex ed program, but expanded it to other schools.

McDermott wasn’t satisfied and continued efforts to get the program changed or canceled.

He released a 21-page report in February 2014 charging that the program was too explicit, not medically accurate, and did not adequately explain the risk of homosexual sex.

“The program normalizes a homosexual lifestyle and anal sex, while failing to warn students of the extreme dangers of anal sex; it references multiple sex partners, while failing to inform students about the health benefits of monogamy; it fails to warn students about the ineffectiveness of condoms against HPV, herpes, and anal sex; and fails to educate students on the stages of human reproduction,”McDermott told WatchDog.org.

McDermott seemed very concerned that the curriculum referred to the anus as part of the genitals.

The GOP legislator introduced an amendment in 2014 that would have prevented the education department from describing the anus as a sexual organ in the program. Though the amendment failed with just seven of 51 members voting for it, the floor debate apparently got so heated that vice speaker John Mizuno had to call for a recess twice to resolve personal disputes between members.

Though the amendment was unsuccessful, continued controversy caused the state education department to temporarily suspend the program again in June 2014 while the University of Hawaii made some changes. Ten changes were made to the curriculum before it was reinstated in September. Changes included no longer calling the anus part of genitals, emphasizing the dangers of unprotected anal sex, and rewriting language on condom efficacy rates.

The other change made at the time: a switch to an opt-in system of parental permission for sex education programs. Previously, students were automatically enrolled in sex ed, but parents could choose to take their child out of the course by sending a form to the school. Under the opt-in policy, which was in place for the 2014–2015 school year, no student would be allowed to participate in the program unless their parent signed a permission slip.

Educators often worry that opt-in requirements will prevent some students from receiving sex education for administrative reasons, such as a permission slip that never made it out of a kid’s backpack.

McDermott called the changes to the curriculum and the policy a partial victory, but others worried that the stricter rules indicated a step backward in the progress made toward providing better sex education in Hawaii’s schools. These advocates noted that improved sex education deserved at least partial credit for the lower rates of abortion and teen pregnancy in the state.

Recently released data show that the Hawaii had the steepest abortion rate decline of any state, with the number of terminated pregnancies falling almost 30 percent from 2010 to 2014. The state’s historically high teen pregnancy rate has also been on the decline.

The Hawaii Youth Services Network’s Judith Clark told the Associated Press she believes the increased focus on sex ed has made a marked impact on teen pregnancies in Hawaii.

“I would certainly hope those efforts reduced the incidents of abortions by reducing the rate of pregnancies,” Clark said.

Dr. Donald Hayes, epidemiologist with the Hawaii Department of Health, agreed sex education could be one reason for the decline, but also pointed to high use of long-acting reversible contraception methods such as intrauterine devices (IUDs) or hormonal implants.

McDermott credited something else entirely. “It’s the availability of the morning-after pill,” he told the Associated Press. “The need for surgical abortions is diminished.”

Those who feel sex education is part of the teen pregnancy solution were concerned that controversy over the past few years would diminish that success. Hayes said, “All these gains could be lost if the education in the schools was a big portion of the reductions here.”

But the June 16 decision may allay these fears because the state Board of Education not only voted to mandate sex education in all schools, it denied the Hawaii Department of Education’s request to keep the opt-in policy. Sex education will once again be operating under an opt-out policy when the 2015-2016 school year begins.

Sex education advocates across the country are pleased with the decision. “Kudos to the Hawaii Board of Education for stepping up to ensure the health of Hawaii’s young people by requiring that their schools provide them with age appropriate and medically accurate sexuality education,” Monica Rodriguez, president of SIECUS, told Rewire. “Now begins the hard work of implementing that policy in schools across the state and making sure that schools and teachers have the resources and training they need to deliver high quality lessons.”

Of course, not everyone is pleased. McDermott called the implementation of fact-based sex education “a travesty.”