A study published online in the journal Alcoholism: Clinical & Experimental Research found that the sexual aggression women often experience in bars isn't a matter of boundaries being blurred. Instead, the types of unwanted sexual contact and sexual aggression seen in adult venues appear to be intentional on the part of the (generally male) perpetrators. One of the things that made this most clear to the researchers was the way in which the men involved were sexually aggressive regardless of their state of inebriation, while tending to target women who had been drinking and therefore might be less able to fully and clearly defend themselves. Such aggression was also likely made easier by the fact that men are less likely to know their victims in such venues, and so it was easier for them to shamelessly take advantage of their targets for the amusement of themselves and their friends.
While only a minority of men behave in such an abhorrent way in adult venues, many more have been socialized that it is perfectly reasonable be as sexually aggressive as they want up until the point where they hear a clear no. There is no expectation of enthusiastic consent for sexual encounters. For that matter, there is rarely even an expectation that both parties need to say yes. Instead, the current standard, at least in many people's minds, seems to be that it's okay if sex happens as long as no one has raised an unmistakable objection. There also seems to be an unfortunate assumption that anyone who is too drunk to easily and firmly object to sex deserves what they get - even when what they get is sexually assaulted.
What's the solution? I think it's people learning that it's not alright to pressure someone into having sex, particularly when they're vulnerable. I also think it's bars and dance clubs keeping an eye out for problematic patrons and kicking them out when they see inappropriate behavior, rather than waiting for someone to complain. I think it's encouraging women to feel comfortable telling men to back off, and giving them safe spaces in which they can do so. Finally, I think it's changing the standards so that people wait to get touchy until their partners have said yes, rather than getting touchy up and until the point where their partner says no. No one deserves to be sexually assaulted or pressured into sex in a way that makes a mockery of the notion of consent. It may happen every day, but that doesn't make it acceptable
Newly released data from the PARTNERS study includes some very promising data about treatment as prevention(TasP). The study, which recruited serodiscordant heterosexual and gay couples where one partner had HIV, examined how effective maintaining an undetectable viral load was at preventing HIV transmission. What they found was that, in the first 16,000 or so episodes of gay sex and 14,000 episodes of heterosexual sex, there were NO virus transmissions when the HIV positive partner had an undetectable viral load. Although the research and analysis remain ongoing, this preliminary data suggests that the rate of HIV transmission during unprotected anal sex is probably less than four percent, and possibly even close to zero, when the infected partner has maintained viral suppression. That's pretty exciting news, particular for gay men -- who are known to generally be at higher risk of virus transmission. It's good news for heterosexual couples as well, although there was already some pretty good evidence about how effective TasP is for them. Unfortunately, the previous iteration of the study simply hadn't enrolled enough gay couples to get a clear picture of the effects on their risk.
According to a local news site, state senators in Tennessee have just filed a bill condemning the state university's sex week and saying that the school should warn parents that some of their student activity fee money may be going to "controversial" programming so that they can opt out. I'd like to say that I have no idea how sex education for college students can still be controversial, but that's not true. The voices of those who would like to police sexual behavior by denying young (and not so young) people information about responsible sexual behavior are loud, particularly in election years. This remains true despite extensive research suggesting that sex education doesn't encourage sex or any other outcomes that are feared by its vocal opponents.
The main thing that quality sex education encourages is thinking - about when people want to have sex, how they want to have it, and who they want to have it with. It may also encourage students to question blind, evidence-free proclamations by authority... which likely explains another reason why it's so unpopular with those politicians who are more motivated by personal beliefs and biases than research. Anything that teaches young people to look for evidence and consider their decisions has a decent risk of putting them out of a job.
Although modern fairy tales about reproductive coercion mostly talk about women who trap men into marriage by pretending to use birth control and getting pregnant, or lying about a pregnancy in order to keep them around, most reproductive coercion in the real world is coming from the other side. Men threaten to hurt women, or abandon them, if they don't get pregnant on demand. Or, alternatively, they hide women's birth control pills or promise to use a condom... and then break them or commit other acts of condom sabotage. A study recently published in the American Journal of Obstetrics and Gynecology found that 16 percent of women receiving routine obstetrics care at a large Rhode Island hospital had experienced at least one of those forms of reproductive coercion at some point in their lives - one third of them in the context of other intimate partner violence.
It's that type of coercion, the one that's less talked about, which may be the real social concern. If men are worried about their partners getting pregnant to manipulate them, there's something they can do about it -- wear a condom every time they have vaginal intercourse. As long as a man is being responsible about his own sexual health, it's extraordinarily difficult for a woman to "trick" him into impregnating her, at least it is difficult for her to do so without committing sexual assault. However, while women can certainly also commit emotional blackmail over a pregnancy, men often have more of the physical, emotional, and social power in sexual relationships. Women may attempt to take advantage of them for financial or other reasons, but when it comes to risking an unwanted pregnancy, they have a much clearer way out. Unlike birth control pills, condoms are cheap (or even free), easy to access, and have no health risks. Anyone choosing to have sex can choose to use them, and by doing so choose to prevent not only pregnancy but other unfortunate outcomes.
Chlamydia is a wily organism. It can lurk, asymptomatic, for years, while the body causes damage to itself trying to stop the silent infection. Long-term infections can lead to pelvic inflammatory disease and even infertility, while an infected person has no idea that anything is wrong. It seems difficult to imagine that chlamydia could have any other ways to be sneaky, and yet a new study published in the journal Infection and Immunity suggests that it may.
The study found that the reason chlamydia treatment may sometimes be ineffective at getting rid of an infection is that the organism doesn't only infect the reproductive tract. It also hangs out, but does not cause symptoms, in the gut. The research, which was done in mice, may suggest an alternate explanation for why reinfection with chlamydia is so common. It may not just be that people are getting reinfected through untreated partners. They may also be getting reinfected by their own bodies, as gut infections were difficult to eradicate with standard antibiotics, at least in mice. Whether similar gut infections exist in humans is not yet known, but if they are, it could suggest that we need a whole new way to think about chlamydial disease.
Lesbian, gay, bisexual, and transgender (LGBT) youth are at increased risk of a number of negative health outcomes, including depression and suicide. According to an article recently published in the American Journal of Public Health, they are also at increased risk for engaging in a number of behaviors that may predispose them to a variety of cancers later in life. The study, which examined data from the Youth Risk Behavior Survey (YRBS), found that LGBT youth were significantly more likely to smoke, drink, engage in early sex, have multiple sex partners, and have a higher body mass index (BMI) when compared to heterosexual youth. They were also less likely to exercise. These factors are all associated with an increased risk of a variety of cancers.
Why are sexual and gender minority youth more likely to engage in such behaviors? In all likelihood, it's because they are far more likely to be exposed to stigma, harassment, and stress related to their identity than heterosexual youth from similar backgrounds. In other words, if we want to encourage LGBT youth to live healthier lives, we have to encourage the people around them to treat them in a healthier manner.
A study recently published in the highly competitive journal JAMA took advantage of the detailed medical information available in a Swedish health registry to demonstrate the importance of following through with all three doses of the HPV vaccine. Their data clearly showed that while getting two doses of the vaccine can reduce the incidence of genital warts, getting all three doses is better -- much better.
If there's a reason to stop after two shots, it's not the end of the world. For that matter, even one shot is better than none. However, it's far better for people getting the vaccine to follow through. Not only does vaccination protect against genital warts, it also protects against a number of HPV related cancers. That's why parents should consider it for both their sons and daughters, as soon as is practical and long before they're starting to think about having sex.
A fascinating study published online in the Journal of Adolescent Health looked at how the perceived availability of "the perfect man" affected young African American women's choices in dating partners. Specifically, researchers asked the women to describe their ideal partner, describe their current partner (if they had one), and then rate how easy it was to find a "good single man" in the neighborhoods where they lived. What they found was fascinating. First off, women tended to date men who were more physically attractive and more economically stable than they described as their ideal. However, the level of fidelity they received from their partners was lower than they desired. Furthermore, and not surprisingly, women whose partners gave them less emotional support than their ideal were more likely to either be sleeping with multiple partners at the same time or report that their main partner had someone else on the side. Having concurrent sex partners is a major risk factor for STD transmission, unless people are in certain types of negotiated non-monogamous relationships.
What I found most interesting about this study was that women who thought that good men were available in their neighborhoods tended to be right... They were more likely to be able to find sexual partners who were faithful to them. To some extent, this could be a self fulfilling prophecy - women who have found good men tend to see them as available - but some of those women found partners after rating them as available in their neighborhoods. That said, the perception might be accurate, but it also could have an effect in another, very important way. Women who think that a good man is out there may be less likely to settle for one who isn't.
An article recently published online in the Journal of Adolescent Health reviewed 20 years of research on the effectiveness of various sex education programs. What it found was that, by and large, we do a terrible job of researching sex education programs. Although many programs are tested by their developers, and often found to be effective in the settings for which they were created, very few programs are ever tested again. That means it's difficult to tell whether the programs will work outside of the population in which they were designed, and represents a significant limit on generalizability. In addition, most programs are tested on only white and African American youth. Sexually transmitted disease and pregnancy risk reduction programs for young Latinos and Latinas have only rarely been investigated, even though these youth have significant sexual health risks.
Although it's tempting for researchers and educators to design new education programs every time they want to do research in the area, it would be a lot more helpful if they tested and reviewed pre-existing programs in new populations. Having several hundred programs that have been tested and found to be effective in isolated communities isn't nearly as useful as having 10 or 20 that have been shown to be effective on a wider scale. Teachers need to be able to identify programs that work, and which they can easily deploy.
A study recently posted online in the American Journal of Public Health looked at how people with HIV fare upon release from prison. A significant fraction of the HIV positive population will cycle through the American prison system at one point or another in their lives, which means that it is incredibly important to understand what happens once they're free. This study made the disturbing finding that the outcomes are heavily related to gender. After release from prison, women did significantly worse than men on all measurements of effective therapy. They were less likely to be maintained in treatment, less likely started on antiretroviral therapy, and less likely to be adherent to their medication regimen. They were also less than half as likely to achieve viral suppression, something which has significant potential to affect not just their health, but the health of everyone they engage with.
The fact that women, in general, usually have better engagement with treatment than men suggests that women exiting the criminal justice system are a special population with unique needs that need to be addressed. Unfortunately, far too few interventions have addressed their needs to date. Hopefully this publication will increase awareness of the problem and encourage more programs to focus on the mental and physical health needs of HIV positive female prisoners upon release.