Commentary Sexual Health

When It Comes to STDs and Relationships, Skip the Website and Talk to Each Other

Martha Kempner

A new website asks members to sign up for frequent STD testing and lets them share their results with other members confidentially. Encouraging STD testing is a good thing, but the site has major flaws. And when it comes to STDs, I can’t help but wonder if we would do best to leave the digital world in our pocket and just talk.

The last time I was single was 1995. It might not sound like that long ago, but from a technology standpoint it was practically the Stone Age; google was still just a number, Mark Zuckerberg was in elementary school, and only birds tweeted. The most advanced technology available to me was a beeper and an answering machine. So I might not know all that much about dating in the era of social networking and smart phones, but nonetheless the newest entry into this market strikes me as inefficient and a little creepy.

Earlier this week, a new site launched that mixes social networking with sexually transmitted disease (STD) testing, with a splash of online dating thrown in for fun. The site is called MyLuhu.com, and the model is a little complicated (as evidence by 31 frequently asked questions on the site). But it boils down to this: A single person can join Luhu for $92 upfront and then $10 a month. The site has partnered with Quest Diagnostic, a nationwide chain of laboratories, which will provide members with quarterly tests for HIV, hepatitis C, and syphilis. Members can choose to be tested for other STDs as well. If the tests come back negative, members receive a badge that proves they are healthy. They can share their test results with other members or put the badge on their Facebook page or other social media sites. If the tests come back positive, they get a call from a counselor; they get no badge and their results are not kept on the site. If members let their testing slip and don’t have current results to share, their badge turns to amber.

The main goal of the site is to give single people a way to confidentially and reliably share test results. The site is HIPPA-compliant and has no paperwork. The results are stored electronically and are locked” so they are only available to the member and anyone the member chooses to share them with. The shared results come with the member’s first name and birth date as a way to verify that the person is being honest, and the FAQs point out that the laboratory requires identification at the time of the test so results can’t be faked. Shared results are only available to the recipient for 24 hours.

There is an element of the site’s underlying philosophy here that I really like. The founders say they want to make STD testing a more regular part of everyone’s lives, take away some of the stigma and awkwardness, and reward those who are invested in their sexual health. In fact, a member can make a profile on Luhu and search for others who have done the same, thus being sure they are finding someone who also values good sexual health. That’s great. I applaud efforts to increase testing and believe making sexual health a point of pride for individuals is a great goal.

Like This Story?

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

Donate Now

Unfortunately, I think the site fails in its execution, and I have real doubts about its widespread appeal.

First, I don’t believe it actually succeeds at its method of proof that someone is disease-free, because it relies on a quarterly check for three STDs, and not even those that are the most common. Members earn a green badge for being free of HIV, syphilis, and hepatitis C; the founders of the site say they chose to focus on these because they are the most life-changing and life-threatening. I am not sure these should be the criteria by which one ranks which STDs to test for, nor am I sure that I agree with the site’s assessment of which diseases are the most life-changing or even most life-threatening.

Syphilis, for example, made their list, but only an estimated 45 people died from syphilis in 2011. Human papillomavirus (HPV) did not make the site’s list, which makes sense in one way because most people who get it don’t even know they have it and clear the infection within one or two years without any intervention. But if you look at it from another angle, HPV causes over 20,000 cases of cancer each year, which can be both life-changing and life-threatening. Herpes, which is far more common than the three STDs that are routinely tested on Luhu, is left off the list in part because “it is a disease that is, overall, not deadly, and can be suppressed with medication.” Again, I take issue with the criteria—at this point few STDs are deadly, and even HIV can be suppressed with medication for decades.

Moreover, I have a sinking suspicion that these criteria were chosen based on ease of testing. In fact, the FAQs note that herpes and HPV are both left off the mandatory list in part because testing is difficult. There is a blood test for herpes, but it returns many false positives. And it is better to diagnose herpes with an exam during an outbreak; this can’t be done quarterly in a lab. Testing for HPV in women involves pap smears and other tests, which take cells from the cervix, something that also cannot be done in a lab. And, as of now, there are no tests for HPV in men.

Chlamydia and gonorrhea, however, can be tested for using a urine analysis, which can be done in a lab, so I’m less sure of why the founders chose not to include these in their badge-earning criteria. After all, these are among the most commonly reported and easily transmitted STDs, and are often asymptomatic, which means testing is the only way individuals will find out they are infected. The Centers for Disease Control and Prevention estimates that there are 2.86 million new cases of chlamydia and 820,000 new cases of gonorrhea each year, compared to 55,400 cases of syphilis and 41,400 cases of HIV. Sure, if they are caught they can be cured with antibiotics without causing any long-term health issues, but if they are left undetected and untreated they can lead to pelvic inflammatory diseases and then infertility. While this might not be deadly, it is certainly life-changing for many couples. To me, these diseases seem like perfect candidates for frequent testing and badges.

The “clean” badge has another problem as well: It’s a snapshot in time. A quarterly test is great, but if I am about to sleep with someone in May, the fact that he was free of three STDs at the end of March doesn’t mean very much if he engaged in a lot of risky behavior in between. I worry that between covering only a few of the STDs out there and showing results that may no longer be relevant, the badges will actually present people with a false sense of security or, worse, an excuse not to use condoms with their new partner.

To be clear, I’m not suggesting more frequent testing. The founders of Luhu claim monthly testing as an ideal, but that seems excessive, unless you are in a very high-risk pool. Instead, I think I like the way we did it in the old days before any of us had an app for that: We talked. We asked each other about our risks. We asked if we’d been tested. We got tested again and shared the results. And, until we knew each other well enough to trust that the other was disease-free and not continuing to engage in any risky behaviors, we took universal precautions and used a condom every time.

I’m all for technology. I check Facebook constantly and can’t believe I ever watched TV without being able to pause it. But when it comes to STDs, I can’t help but wonder if we would do best to leave the digital world in our pocket and just talk.

Commentary Violence

Major League Baseball Has More Work to Do When It Comes to Domestic Violence Charges

Claire Tighe

Major League Baseball's response to charges of domestic violence against Jose Reyes is really just a step in the right direction. The league, its fans, and the media outlets covering it have work to do before there is additional cause to celebrate.

Two weeks ago, the Colorado Rockies Major League Baseball (MLB) team made headlines for designating their shortstop, Jose Reyes, for assignment. The designation for assignment (DFA) means he was removed from their roster, most likely so the Rockies could trade him or release him to the minors.

The decision came after an announcement from MLB in May concluding that Reyes had violated its new Joint Domestic Violence, Sexual Assault, and Child Abuse policy. Reyes was put on leave in February while the league investigated charges that he had allegedly assaulted his wife in a Hawaii hotel the previous October. Though the charges were ultimately dropped, MLB still concluded that he had violated its policy—which allows discipline no matter a case’s legal status—based on the available police reports. Ultimately, Reyes was suspended for 52 games.

Many sports fans and media outlets are celebrating the Rockies’ decision to designate Reyes for assignment, framing it squarely as a moral response to his domestic violence suspension. As a result of the suspension, Reyes ultimately lost a total of $7.02 million for missing 30 percent of the season and is required to donate $100,000 to “charity focused on domestic violence.” Still, the team will owe Reyes $41 million despite the DFA—and that, spectators say, makes the Rockies’ actions worthy of praise. The Denver Post‘s Mark Kiszla, for example, wrote that the Rockies franchise owner, Dick Monfort, deserves a “standing ovation” for taking a “$40M stance against domestic violence” that was “not just financial.” According to Kiszla, “the franchise did right by battered women by showing zero tolerance for physical abuse.”

Yet instead of a purely moral response that deserves “a standing ovation,” the Reyes case is really more of a step in the right direction. If, as Bob Nightengale at USA Today suggested, MLB is setting a precedent by suspending Jose Reyes, the league and the media covering it have work to do before there is additional cause to celebrate.

Like This Story?

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

Donate Now

The league could have acted faster and given Reyes a longer, more consequential suspension to show its seriousness in responding to his violation of the policy. In fact, the New York Mets’ recent signing of Reyes, which the team explained as giving him a “second chance,” underscores just how much tolerance for reports of domestic violence truly exists in professional baseball as a whole.

The public excitement about the connection between Reyes’ domestic violence record and his sportsmanship is warranted, albeit overstated. As MLB Commissioner Rob Manfred put it, the league has taken “a firm national and international stance” on domestic violence. Reyes was only the second player to receive a suspension under the new policy, which was approved by the league in August 2015 as a result of the ongoing national conversation about intimate partner abuse in professional sports. His case was the first to be negotiated with the MLB Player’s Association; his was the harshest punishment a player had received at the time.

Even so, while the Rockies’ consideration of Reyes’ charges of domestic abuse in their decision should be appreciated, the DFA should be understood for what it really appears to be overall: based on the team’s response, it was a business decision, not an action on behalf of domestic violence survivors.

“Would we be sitting here talking about this if the domestic violence thing hadn’t happened in Hawaii? We wouldn’t. So it’s obviously part of the overall decision,” said Colorado general manager Jeff Bridich told the New York Times. After all, an incident causing a player to miss a third of the season is enough to make any team pause for consideration.But, as the Times pointed out, there are other reasons that the Rockies were ready to move on, including “never really wanting him in the first place,” the great performance of his replacement during the suspension, and the fact that the franchise had already sunk the costs of bringing Reyes onboard. By the terms of their contract, designating him for assignment was no more expensive than keeping him.

Furthermore, the handling of the Reyes case within the league and the franchise has been mostly professional, but there is still a lingering tone of undue apology toward Reyes—suggesting, again, that the treatment he has received may not be the unilateral condemnation of domestic violence that others have implied.

It begins with Reyes himself, who first apologized “to the Rockies organization, my teammates, all the fans, and most of all my family,” before retweeting Mike Cameron, a former MLB player who said that Reyes just had a “bad moment in life” and deserved forgiveness for committing physical violence against his wife.

Commissioner Manfred walked a thin line in a news conference in November just after the Hawaii incident, stating his interest in maintaining Reyes’ privacy despite the charges against him. “There’s a balance there,” he said. “On the one hand, I think our fans want to know that the case has been dealt with appropriately. On the other hand, whoever the player is, the fact that he’s a major league player doesn’t mean he has absolutely no right to privacy and or that everything in the context of a relationship or a marriage has to be public.”

While domestic violence can happen “behind closed doors,” that does not mean it is an issue of one’s personal privacy. As Bethany P. Withers has argued for the New York Times, there may not be public witnesses to abuse occurring between partners, but we should not ignore professional athletes who are charged with committing acts of domestic violence. Manfred’s comments, as well as Cameron’s, minimize Reyes’ Hawaii incident into “a lovers’ quarrel,” rather than a report of an abusive act of behavior that most likely exposes an ongoing pattern.

Rockies Franchise owner Dick Monfort’s comments were better, though not ideal. In April he told the Associated Press, “I’d like to know exactly what happened. It’s easy for us all to speculate on what happened. But really, until you really know, it’s hard. You’re dealing with a guy’s life, too.” Monfort, while expressing understandable concern for this player, sounds apologetic to Reyes, rather than the woman he was charged with abusing.

Sympathizing with Reyes in this matter, while he may be sorry for reportedly committing actions that had visible consequences, centers the experience of an abuser in a culture that silences, blames, shames, and erases survivors of domestic violence and perpetuates abusive behavior.

Much of the media, meanwhile, has taken action either to diminish Reyes’ alleged crimes or dismiss them completely. The Post‘s Kiszla, for example, was plain encouraging of Reyes, for whom he “hoped nothing but the best, if his wife had forgiven him.” His uninformed commentary shows utter lack of understanding of domestic violence and what Katherine Reyes might be experiencing in deciding to “not cooperate with the prosecutors” on the case. Fox News was similarly insensitive. At the very least, the media can provide a short explanation as to what domestic violence is and why victims may be reluctant to work with police and the criminal justice system in the first place. The “inaction, hostility, and bias” they might face, as the American Civil Liberties Union put it, is real. And their personal fear of consequences are legitimate.

Nightengale of USA Today had a particularly awful response, explicitly sympathizing with Reyes, saying “that one ugly night in Hawaii cost Reyes his pride and his job.” Except that domestic violence, a cycle of power and control, is hardly ever just “one ugly night.”

Furthermore, incidents of reported domestic violence need to be named as such. In the coverage of Reyes’ charges in Hawaii, the media failed to do so. Though ESPN reported Reyes had been arrested on abuse charges, it still said Reyes had “an argument with his wife [that] turned physical.” The Chicago Tribune labeled it as “an altercation.” The Tribune was also inaccurate in reporting that Reyes ‘choked’ his wife, when the it was actually strangulation. Technically, choking by definition is when the airway is blocked internally. Strangulation, however, is the act of blocking the passage of air through the external use of force. While the difference is subtle—in fact, the police report itself logged the action as “choking”—the ramifications are large. Describing the act as an expression of dominance signals to the public that acts of violence have perpetrators. It also gives detailed meaning to “domestic violence,” an all-encompassing phrase whose intricacies are not widely understood.

While it may seem petty to be picking over semantics, accurate framing is the difference between two partners having a disagreement and one partner committing threatening acts of violence against another in a cyclical power dynamic. It’s the difference between public acceptance of horrific behavior and public recognition of unhealthy, unacceptable relationship dynamics.

The focus on costs to Reyes and the Rockies should also be reframed. If we really want to talk big money, we should consider the exorbitant shared cost of domestic violence on all of our systems, both public and private. Domestic violence is “a serious, preventable public health problem.” The epidemic is estimated to cost $8.3 billion annually to the economy due to its effect on survivors’ physical and emotional health, as well as their workplace productivity. Because domestic violence is so widely underreported, this estimate is even a conservative one. It also does not encompass the cost to child survivors and the trauma inherited by future generations. Understanding the ridiculously high costs of domestic violence centers the long-lasting effects of an epidemic on survivors and our society as a whole, rather than the cost to a singular MLB player or team.

Wholly shifting the narrative is vital in Reyes’ case and in the cases of other players disciplined under MLB’s new policy. It is up to the public to connect the dots between all of the players and teams to understand the wide scale and scope of MLB’s domestic violence problem. The Mets’ quick re-signing of Reyes as a “second chance” to the player is a reminder of many teams’ true priorities.

Though the new MLB policy appears to be comprehensive and informed by experts, the league, the teams, and the media haven’t quite perfected their responses. With regard to MLB’s process and ultimate decision, critics are saying the league should act faster and make longer, more consequential suspensions in the future. If Commissioner Manfred is really going to give weight to charges of domestic violence, a quicker, more punitive response to charges like Reyes’ is a good way to start. There is also significant work to be done in the public relations and media responses to domestic violence in the League overall.

Five years ago, there was very little talk about domestic violence in professional sports, let alone in Major League Baseball. Almost ten years ago, it was a big joke. Until 2016, MLB had never suspended a player for domestic violence. It’s becoming clearer and clearer to the public that domestic violence pervades every arena, from professional sports to entertainment. There has been an explosion of coverage on the topic in relation to the National Football League, college campusesHollywood, theater, and the music industry. Domestic violence in Major League Baseball, in professional sports, and in our culture is a much larger problem than one suspension can solve. It’s up to us to see that domestic violence is not just the concern of a singular player, team, sport, or profession. We all have a domestic violence problem. Together we can solve it.

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?

Like This Story?

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

Donate Now

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. 

Screen Shot 2016-02-29 at 9.58.52 AM

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.