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Archive for the ‘Policy’ Category

Government inevitably plays a role in the bedroom

Female condoms on the move

Posted by Condomologist on March 9, 2010

Good to see Washington DC taking the lead on some dicey issues: sexual health types like myself get excited when a big city officially goes gay marriage and female condom on you at the same time. I’ve heard rumblings that the campaign to distribute female condoms — which in more politically correct circles go by a gender-neutral name (such as receptive condom) because they can be used anally by men — is not adequately targeting the gay community, and also that it misrepresents itself as the first city to put forth such an effort. And both those gripes probably have some validity. But no matter. It’s pretty bad ass for an American city to make such a bold move.

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Condoms aren’t the only answer

Posted by Condomologist on March 9, 2010

I respect Serra Sippel and CHANGE, the organization she heads up, and I’m particularly grateful for their bringing me to a wonderful training in DC last year focused on increasing sexual health lobbying efforts. And they do wonderful work around female condoms and promoting them around the world. But let’s not oversimplify the end to the AIDS epidemic: condoms alone won’t solve our problems. A few days with teenagers in the work I do now, or a few days with the (mostly) men I worked with last year in Philly makes it pretty clear that simple condom availability is not the panacea we’ve long been seeking. There’s a whole lot of HIV happening to men and women who have access to free condoms. She briefly mentions stigma — though curiously does not elaborate — and certainly various forms of stigma lead to unsafe sex: asking to use a condom can lead to men accusing their female partners of promiscuity or lack of trust; the stigma and homophobia towards gay men leads to far too much secretive, anonymous, drug-fueled sex — to give two examples. But more than anything, people don’t like to use condoms much because it doesn’t feel good. Also, there is a lot of ignorance about the ill effects of not just HIV and AIDS, but the long-term effects of chlamydia and gonorrhea, for example; we don’t see the devastation it causes until it’s personal, and so we don’t take the precautionary steps we know exist. And then there are just far too many myths to count that lead to people the world over not believing HIV — or even pregnancy, for that matter — can happen to them.

Yes, let’s push for more political support for condoms. But contrary to what Ms. Sippel says, that’s not “it.” It is far more complex than that.

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Condom Use Worldwide

Posted by Condomologist on May 21, 2009

The Guardian takes a look at WHO data reflecting the prevalence of condom use around the globe. China comes in atop the list around 90%, with the UK a good ways behind in second, and the US lagging even farther back at 72.8%, behind Vietnam, Iran and others. Check out the data here. It doesn’t take into account myriad factors — presence of other contraceptive methods, China’s one-child policy, condom availability…the list goes on — but it’s interesting nonetheless.

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Obama’s Budget and Sexual Health Education

Posted by Condomologist on May 8, 2009

There’s no doubt uproar and anger upon reading any President’s proposed annual budget — and make no mistake, the Democrats and Republicans both have a lot of beef this year — but it’s hard to argue with the intentions of this administration when it comes to promoting evidence-based, comprehensive sexuality education — and maybe more importantly, eliminating funding for abstinence-only education. No doubt some are already arguing he’s not allocating enough resources to the struggle to reduce unintended pregnancies and prevent HIV transmission both here and abroad — and maybe they’re right — but at least his heart and mind are in the right place. From the insanely long budget comes this nugget:

“The 2010 Budget proposes a new Teen Pregnancy Prevention Initiative to support community-based and faith-based efforts to reduce teen pregnancy using evidence-based and promising models. In addition, a new Strengthening Communities Fund will help build the capacity of non-profit organizations and State, Local and Tribal entities to better serve low-income and disadvantaged populations. This Budget also proposes funding for (1) a new child welfare initiative, and (2) a human services case management system for Federally-declared disasters. This Budget eliminates funding for Community-Based Abstinence Education, the mandatory Title V Abstinence Education program, the Compassion Capital Fund, and Rural Community Facilities.”

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Obama and Sexual Health

Posted by Condomologist on April 28, 2009

Campus Progress, a wing of the lefty think tank Center for American Progress, takes a look at President Obama’s 2009 appropriations bill and 2010 budget and grades his positions on sexual health, using their nifty condom scale. 1 condoms is a failing grade, 5 condoms equals “awesome beyond recognition.” Their final grade for the President: 18 out of 25 condoms, or 72%. While there is clearly room for improvement, the left must recognize that compromise is necessary for a President to accomplish anything, and a C- grade poorly reflects on a man committed to progressive ideals, yet cognizant of the fact that Washington becomes paralyzed without (at least a modicum of) bi-partisan support.

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Are Foam Condoms for Real?

Posted by Condomologist on April 21, 2009

Sketchy details are emerging from a Chinese bio-medical company suspiciously named Blue Cross and their promotion of foam condom that is sprayed into the vagina. Popsci.com reports on this innovation, made from so-called nanosilver, and warns us to be wary of unknown risks, which I’ll second considering the Blue Cross website itself is rather vague and its faulty English descriptions somewhat alarming. They claim the foam has contraceptive, lubricating and anti-biotic qualities, and if effective and safe would provide a welcome new addition to the world of contraception — especially for women who cannot insist on traditional condom use. Calling this a condom is a bit of a misnomer to begin with — it sounds more like Nonoxynol-9-based contraceptive foam — and I should point out that the EPA has serious questions about nano-particles of silver   and their safety is questioned by many researchers. But if it’s on the market — even the Chinese one — it’s my duty to report on it. Let’s hope it does more good than harm.

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Church with Nerve

Posted by Condomologist on April 10, 2009

President Obama’s United Church of Christ comes out in favor of dispensing condoms at their houses of worship. Read their statement, though, because the Church’s HIV and AIDS Network eloquently articulates its position.

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Is the Pope right? No. And neither is Mr. Harvard.

Posted by Condomologist on April 6, 2009

Ever since Pope Benedict stirred the condom pot and struck up a worldwide controversy with his comments about condoms aggravating the problem of HIV, the rhetoric has been spewing on editorial newspaper pages, from foreign governments, from just about anyone who has an opinion on church doctrine, public health, the merits of the words of the Pope — heck, anyone who heard the news. So I waited a couple of weeks, took a deep breath, listened intently amidst the fracas, to help make sense of the repercussions and validity of the argument. In general, it seems wise to lend an ear to some of the saner, more rational thinkers in the middle of the political spectrum — of which there are a few — but this time the feedback has been fairly black and white. The Pope’s a dangerous, stupid liar who supports the death of innocent people from AIDS, scream the stalwarts on one side. The other side, those defending the Pope with any intellectual seriousness, tell us that, in fact, what the Pope told us — and we know his response was well thought-out, because he chooses the questions beforehand which he later addresses — is backed by science, that condoms do aggravate the problem of HIV/AIDS. Okay, not every argument was clear-cut for or against, but a marked polarity seemed to run through the general sentiments. Through it all, two things remained clear to me: Science is pretty clear that condoms used among two partners, one HIV+ and the other HIV-, will greatly reduce the transmission of HIV; and just about everyone who defended the Pope kept quoting this dude named Dr. Edward Green from Harvard to support his argument. And so it warrants a good look at what Green actually says, what it means, and how that relates to the Pope’s words — but first, let’s clear a few things up.

Any honest discussion of the Pope’s argument first requires admitting that, at the very least, the Pope owes a more thorough explanation to the world if we’re to believe his comments were simply reflecting the conclusions of Dr. Green. A simple statement would go a long way towards calming the critics — especially the more angry ones — something like, The Catholic church does not support condoms as a means of contraception, and we do not condone any form of homosexual behaviour [implying anal sex for pleasure is not even a topic to be discussed], but if two men or a man and a woman are engaging in sexual intercourse and one partner is HIV+, then condoms will in fact reduce the likelihood that HIV will be transmitted to the uninfected partner. And then he could go on to say that he still felt promoting monogomy and abstinence before marriage — as the Church feels is what’s right and the only sinless choice — is the best way to reduce the spread of HIV in Africa. Until then, as far as I’m concerned, Dr. Green’s argument becomes moot, because we’re arguing about two different things. Even assuming one can amend a quote — as the Vatican chose to do after the Pope’s initial response — something curiously bizarre in and of itself, the Pope still risks doing harm without clarification that condoms do not “risk” aggravating the problem of HIV on an individual level, something Dr. Green (doctorate in  anthropology from Catholic University) acknowledges pretty clearly in his recent Washington Post editorial. For example, some of the more eloquent, toned-down criticisms of the Pope focused on examples where an uninfected woman is married to a man who is HIV+ and the need for them to use condoms if they’re engaging in sexual activity; how can the Pope not side with the use of life-saving protection in such a case, they ask? And what gets lost in these discussions is the fact that the Church must soldier on with an anti-condom stance regarding disease/infection prevention simply to adhere to its long-stated belief that artificial contraception is intrinsically evil and anti-life. So my real question is, Why does Dr. Green have the Pope’s back? Does he really believe that what the Pope said about condoms aggravating the spread of HIV is simply a reflection of Green’s studies and conclusions? I’ll take him seriously, but then let’s take a look at some of what he’s said over the years. (And again, let’s remind ourselves that literally almost every argument made of late in defense of the Pope quotes or paraphrases Dr. Green’s Catholic News Agency interview — with its shoddy quotations and attributions — or his Post editorial.)

First off, Green’s general argument — and the one most often cited and generally accepted — is that in Uganda, HIV/AIDS percentages went down drastically in response to the government working to promote across all public sectors of society — so that the message could be distributed adequately through religious, educational, governmental institutions, etc. —  abstinence, partner reduction and mutual monogomy, but condoms also as the “C” in the “ABC” approach (1. Abstinence, 2. Be faithful, 3. Use condoms if you can’t accomplish the first two.)  His 2003 book Rethinking AIDS Prevention, is seen by some as a landmark publication in the way we view HIV/AIDS prevention in Africa, but on his Harvard website page, in the summary of the book nowhere does it mention anything about condoms aggravating the problem. And in his editorial, he repeatedly talks about the lack of evidence that condoms work as a primary intervention to stem the HIV epidemic in generalized African populations; this is a fair argument to make — that throwing millions of condoms to a culture not accustomed to them will not work alone — but nowhere in his editorial does he dare make the argument that condoms aggravate the problem. This is an important distinction. The closest he comes to making such a case is in a very thoughtful piece he wrote in 2003 called “Culture Clash and AIDS Prevention” in which he writes that “countries with the highest levels of condom availability (Zimbabwe, Botswana, South Africa, Kenya) also have some of the highest HIV prevalence rates in the world.” But there is no exploration as to cause and effect. For example, might there be the most condoms there because the HIV rates are so high? Might there be more condoms available because of their geographical relationship to donor nations? Might the proximity of 3 of those 4 countries — all except Kenya border one another — play a part in their respective exceedingly high HIV rates and thus the attention those nations receive? It’s illogical to imply that more condoms = more HIV, when there are numerous other factors at play, many of which he discusses in the piece. And in fact, at the 2004 International AIDS Conference, Green clears things up a bit: “There may be no causal connection between the availability of condoms and levels of HIV infection, but…there’s little evidence at the national level in Africa that more condoms resulted in less AIDS.”

I’m torn, because I want to support Green, because it doesn’t even require factual evidence to support the idea that condoms alone don’t solve any problems. And like he says, there’s nothing in the fidelity and abstinence message that infringes on anyone’s rights — as he implies some might see as an obstacle to behavioural change interventions — and the lefty liberal folk need to do a far better job in learning how to promote these messages in order to be most effective. He’s right that the sexual health people are too damn scared of the word abstinence — even in the context of abstinence-plus, meaning comprehensive sex ed, but abstinence if possible — and he’s correct that we in the sexual health world are suspicious of the religious right and their talk of behaviour change. With good reason: their track record in the States simply isn’t that good, and there’s no proof that abstinence-only-until-marriage programs — something very different than abstinence-plus-condom education — are more effective than the alternatives by any measure. But again, he makes the valid point that we must be culturally sensitive, and approaching the African HIV epidemic with the same risk reduction mindset we may take here in the states — for example, use mutual masturbation or oral sex instead of anal sex to reduce the risk of contracting or transmitting HIV — can miss the point entirely. It makes sense for those on the left to seriously consider that behaviour change is possible, and personally I know I don’t do a good enough job of exploring this possibility. It’s not wrong or condescending or moralizing to bluntly, honestly state that reducing one’s number of sexual partners or staying faithful (even within a polygamous marriage) reduces your chances of contracting HIV. It’s the truth. But the truth has some grey areas in this case, something the Church is not known for (though one can make a strong argument that the Catholic Church should be commended for its absolute anti-condom stance,  for sticking to its guns no matter the facts on the ground), and so what I can’t wrap my mind around is why Dr. Green chooses to defend the Pope. All I can conclude is this is best reaction (to get attention?) to the reactionaries vehemently criticizing (his?) Pope Benedict, while he must know his statements will be distorted by conservatives to call liberals stupid for denying the facts. His argument simply doesn’t follow given what the Pope did and didn’t say.

The BBC has a very good analysis of the issue (which I linked to already) much of which echoes some of  my points above and makes clear the need to accompany any condom promotion with culturally and geographically sensitive education and marketing . Thomas Reese of Georgetown, while sadly and dismissively exculpating the Pope of any culpability — because who listens to the out-of-touch Pope anyway? — at least argues the Vatican would wisely step up to the plate and advocate for condoms on an anti-killing platform. The World Health Organization makes clear that there are many complex gender and cultural factors to overcome, but that condoms have played a decisive role in HIV prevention efforts across the world, including in Uganda, so often cited by Green. The counter-argument to Green as it relates to Uganda (and the one cited by the WHO) is a Guttmacher Institute report from 2003  that pretty unequivocally points to increased condom use across unmarried male and female populations in Uganda, and I could not find anywhere Green disputes this study; he would simply argue that the HIV rates had largely declined before the large-scale condom promotion began in the mid-90s.  But then it’s not a counter-argument at all, because Green never makes an anti-condom argument anywhere. He just oddly chooses to support the Pope with his misguided logic. Or does he? He very ominously continues to point out that condoms lead to “risk compensation,” meaning when people believe they’re safer by using condoms some of the time, they’ll actually engage in riskier sex. It is this last point, one he seems to have little evidence for, that is pounced on by the conservative wing of the debate, and that’s unfortunate given the lack of any real data. One thing he’s very clear to point out is that condom use as a targeted HIV prevention very clearly works, in particular for sex workers in Thailand and Cambodia; but since HIV is largely transmitted through casual heterosexual sex in Africa, condom promotion can’t be the primary message. Fine, but let’s look one last time at what Green says as part of a panel at the  2004 International AIDS Conference: “I feel that condoms have a role to play as a means of protection, especially in couples who are HIV-positive, but it cannot be the main means of stemming the tide of AIDS.”  And he goes on to tell us that while the A and B were far more prevalent in the general population than condom use at last sexual intercourse, “…condom use has become quite high among those who need the most, namely those relatively few who are still having multiple partners. As a matter of fact those going to sex workers, although not many Ugandan men reported paying for sex, but condom use was very high among them and 95% or so.” I’m no expert on this stuff, no advanced degree, haven’t even read Green’s book…but it’s a fairly evident study in contrasts to find him telling us one sentence that condoms aren’t that much of a factor in decreasing the spread of HIV…but wait, they have a role to play…and oh yeah, condom promotion really does work in targeted populations…but last thing, the Pope is right when he says condoms aggravate the problem. Maybe it is relevant that his doctorate is in anthropology and not public health, because one thing we learn in the HIV/AIDS world is that while it’s important to identify as many positives as possible — so folks know their status and hopefully won’t put others at risk — the real key is reaching that one person who is having sex with many partners and thus spreading around town. So it seems rather relevant that condom use was so high among those with multiple partners and those paying for sex — not just something to be discounted. All this said, it’s kinda hard not to question this Harvard doctor’s conclusion and motives.

I really really wanted to give the Pope the benefit of the doubt on this one. I wanted to believe there was a silver lining — and maybe there is in the debate he stirred up — but it’s proven hard to find one. I wonder what the conservative talking heads would’ve found to back up the Pope’s indefensible anti-condom stance if not for one rogue  self-described liberal Harvard researcher who seems only to have mastered the art of duping us all into thinking Catholic craziness has some merit this time. Nope, sorry. I call your bluff. Condoms aren’t the only answer. Far from it. But you all need better data to make your argument come anywhere close to sticking this time.

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“Sex sells everything — except safe sex itself”

Posted by Condomologist on March 31, 2009

Joan Smith makes the case in The Independent in favour of condom advertisements on television, per the British government’s advertising regulatory agency’s recommendation, noting the backwards rationale for what is and isn’t allowed on the telly: “This is an important public health issue, and it’s absurd in a culture where sex is used to sell just about everything that accurate advice on contraception and abortion is treated so gingerly. Visitors from another planet would scratch their heads on discovering that lap-dancing clubs and sex shops are allowed to operate on high streets, but products and agencies that aim to protect people from the unwanted effects of sex are subject to these regulations.”

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Condom Labeling

Posted by Condomologist on March 30, 2009

News out of Canada has prominent researchers advocating for stricter and more accurate labeling on condom packaging to better convey the effectiveness/failure rates of condoms. They make a fair point in that condoms do break and their effectiveness varies according to many different factors, including correct usage, damaged latex, consistency of use, and — if their assumptions are correct, which is entirely possible — the quality of the particular brand or style being used. They also make the fair point that effectiveness/failure rates are typically based on studies done involving pregnancy, meaning how many women of out of 100 will get pregnant over the course of one year, and not STDs and HIV. And further complicating matters is the fact that some STDs are transmitted via fluids and other by skin-to-skin contact, so condoms’ effectiveness in preventing, say, herpes (skin-to-skin) differs from HIV (fluids).

But I’m curious what exact figures they would choose to put on the packaging, and how in the world would they make sense of the many contradictory studies which vary wildly in their conclusions about how effective condoms are. And the larger problem is that percentages and figures are not easily deduced from studies, because this research cannot be done in a laboratory. Pretty much all figures are based on self-reporting, which complicates things greatly. It’s incredibly difficult to decipher the numbers. If one partner is HIV+ and other HIV- and a study shows, as one of the researchers notes, 20% of those uninfected will contract HIV even when using condoms (I’m not sure which study she’s referring to, but I assure you other studies will question those numbers), we would have to know which condoms were used, if they were used correctly and every time, if lubricant was also used, if the sex they had was anal or vaginal intercourse, if the previously uninfected partner had another STD which may have made HIV transmission more likely, if the couple used condoms only upon ejaculation, etc. etc. The variables are too many to count. What kind of labeling would they consider important and how would they agree on the data?

The point is that condoms are highly effective in reducing the risk of pregnancy and STD transmission, which is what most condom labeling — at least in the States — already states, although some of my condoms at home do leave out the “highly” and “reducing risk” and simply say they’re “effective against pregnacy and STDs and HIV” — which, to be fair, is a bit misleading. I’m all for being as honest as possible, giving people the information and letting them make an informed decision. But if we get into details about whether a condom is 85% effective or 97% effective, we’re creating a whole new set of questions and concerns and debates that don’t seem to do anyone much good.

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