News Sexual Health

New Device to Protect Against Pregnancy, Herpes, and HIV Is Possible

Martha Kempner

A new vaginal ring just entering human trials would release both levonorgestrel, a hormonal contraceptive, and tenofovir, an antiretroviral that has been shown to inhibit the replication of HIV and herpes simplex virus-2.

New technology debuted at the American Association of Pharmaceutical Scientists’ annual meeting last week will combine contraception and disease prevention into a vaginal ring. The small, flexible piece of plastic would be inserted high up in the vagina and could be left in place for 90 days. It would release both levonorgestrel, a hormonal contraceptive, and tenofovir, an antiretroviral that has been shown to inhibit the replication of HIV and herpes simplex virus-2 (HSV-2), one of the two strains of the virus that causes genital infections.

There is already a vaginal ring, called NuvaRing, on the market that can prevent pregnancy. Women insert the ring into their vagina and wear it continually for three weeks. They then remove it for one week, during which time they menstruate, and put a new ring in to start the cycle again. Similar to all hormonal methods of contraception, NuvaRing releases a combination of estrogen and progesterone to inhibit ovulation. NuvaRing does not provide any protection from sexually transmitted diseases.

Tenofovir is the first microbicide that has been proven to be effective in humans. In clinical trials, women who used a tenofovir gel before and after sex reduced their risk of HIV infection by 39 to 54 percent. The gel also reduced HSV-2 transmission by 51 percent.

The combination ring has thus far only been tested in animals but is moving into the human trial phase and has potential to be an important new tool for women. Women are more susceptible than men to both HIV and HSV-2 transmission during penile-vaginal sex, and researchers have been trying to develop products that women can control and use without needing their partner’s help or even consent. If it proves to be effective, this ring could be that method.

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In addition to the combination ring, the drug company is also developing a tenofovir-only ring, and a one-size diaphragm (which will fit most women) that can be used with the tenofovir gel.

As it is just entering the trial phase, these products will not hit pharmacies for quite a while. In the meantime, it is important for both women and men to remember that currently only condoms can provide protection against both pregnancy and sexually transmitted diseases.

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

New Study Has Hopeful Findings for HIV Prevention

Martha Kempner

A new study found that no one taking pre-exposure prophylaxis to prevent HIV became infected over the course of three years. But the rates of other STIs were still high.

A study published online in the journal Clinical Infectious Diseases reviewed the medical records of patients in the Kaiser Permanente system in San Francisco who had been referred for a pre-exposure prophylaxis (PrEP) evaluation between 2012 (when the drug became available) and early 2015. The majority of these patients (82 percent) decided to start taking PrEP to prevent HIV and in the almost three years of the study, not one of them contracted HIV.

These results are better than what would have been expected given clinical trials, and experts are excited that this new prevention method is working so well. But some are worried because condom use among these patients has dropped, and more than half of them were diagnosed with at least one sexually transmitted infection (STI) during the course of the study.

PrEP is a combination of two antiretroviral drugs—tenofovir and emtricitabine—used to treat people who have HIV, as Rewire has reported. When used daily by people who are HIV-negative, these drugs have been shown to prevent transmission of the virus. In May 2014, the Centers for Disease Control and Prevention (CDC) released guidelines that recommended HIV-negative individuals who are at “substantial risk for HIV infection” consider taking the drug.

The agency defined those at substantial risk as: anyone in an ongoing relationship with an HIV-infected partner; gay or bisexual men who are not in a mutually monogamous relationship with an HIV-negative partner and who have had sex without a condom or been diagnosed with a sexually transmitted infection within the past six months; heterosexual men or women who are not in a mutually monogamous relationship with an HIV-negative partner and do not regularly use condoms when having sex with partners known to be at risk for HIV (such as injecting drug users or bisexual male partners of unknown HIV status); or anyone who has injected illicit drugs and shared equipment or been in a treatment program for injection drug use within the past six months.

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The majority of the patients in the Kaiser Permanente study were men who had sex with men, though the study included three heterosexual women and one transgender man who was having sex with men.

The results were better than expected. The researchers followed 657 patients who took PrEP for a period of time that amounted to 388 person years. None of the patients contracted HIV.

“This is very reassuring data. It tells us the PrEP works even in high risk populations,” the study’s lead author, Dr. John Volk, told the New York Times.

Anthony Fauci, the director of the National Institute for Allergies and Infectious Diseases, agreed. “This shows the effectiveness of PrEP is really strikingly high,” he told the Times. “And this study takes it out of the realm of clinical trials and into the real world.”

The researchers noted that the study should allay fears that PrEP use would lead to less condom use and therefore more HIV. In the article, they write: “Our data suggest that fears about risk compensation resulting in increased HIV acquisition among PrEP users may be unfounded.”

Some public health experts are still concerned because while none of these patients contracted HIV, many of them contracted other STIs. A year after starting PrEP, 50 percent of patients had been diagnosed with an STI.

One-third of those patients had contracted chlamydia, 28 percent of patients had gonorrhea, and 5.5 percent had syphilis. Many of these infections were rectal.

Since there was no control group in this study, it is impossible to know whether these rates of STIs are higher than they would have been if the patients had not taken PrEP. Patients on PrEP are required to have frequent screenings for STIs. The high rates of STIs among this group, therefore, may reflect better testing rather than any real increase in the number of infections.

Still, there seems to be some behavior changes among patients on PrEP. Researchers surveyed 143 of the patients about their behavior. Seventy-four percent said the number of sexual partners they had did not change while on the drug, 15 percent said they had fewer partners, and 11 percent said they had more. Fifty-six percent said they did not change their condom use habits, 41 percent said they used condoms less often, and 3 percent said they used them more.

Though the patients enrolled in the study were engaging in high risk behaviors to begin with and some did not change their behavior because of PrEP, the STI rates among them are very concerning to some public health experts.

“We’re thrilled that there were no cases of HIV in the Kaiser PrEP study,” Deborah Arrindell, vice president of health policy at the American Sexual Health Association, told Rewire. “We’ve all been waiting for a study with these positive results. But there are thorns on the rose. Some participants did not follow the FDA guidelines to continue condom use. About half of those in the study contracted a sexually transmitted infection and that is worrisome.”

“More than one in four got gonorrhea—an infection for which we’re running out of treatment options,” Arrindell added. “That is cause for concern, even as we celebrate.​”