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Archive for the ‘Sexual health’ Category

By Benjamin Castro

Condoms cannot cure Africa. They should not be at the forefront of HIV/AIDS prevention programs, nor should they be considered a top-priority.

These statements stand diametrically opposed to accepted conventional prevention strategies proposed by western nations. Many organizations, UNAids for instance, state that condoms should be at the vanguard of the continental struggle to prevent HIV/AIDS in Africa. Anything contrary to this statement is often labeled as ignorant, misguided, or a product of ultra-right wing radicalism, often religious. In a word, anti-scientific. However, Dr. Edward Green, who served as the director of  the AIDS Prevention Project at Harvard University as well as a member of the Presidential Advisory Council on HIV/AIDS (amongst many other positions), would agree with those statements. He provocatively states that condom use, while managing marginal amounts of risk in preventing HIV/AIDS, does not at all address the risky behavior which ought be the focus of prevention strategies. (more…)

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By Maria Paez

At the beginning of the week I read an article in the New York Time titled HPV Sharply Reduced in Teenage Girls Following Vaccine, Study Says, and was pleasantly surprised. But the statistics lingered in my mind. Yes it was great! But I am sure that lower prevalence rates would be easily attainable if the vaccine achieved higher immunization rates or was mandatory. It is incredible that scientists have gotten so far in cancer research and, although still uncertain, the so desired “cure” might not be impossible.

I find it rather contradictory that we, Americans, hope for a cure for cancer yet we fail to embrace a vaccine that can prevent multiple forms of cancer like cervical. (more…)

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By Arianna Nisonoff

Condoms are the key to an exorbitant number of global health problems. We need to be making more use out of this simple and cost effective innovation. When used correctly, they can be used effectively to stop the transmission of numerous diseases, control population growth (and in turn poverty), and empower women. They are a simple solution that could change the world once people gain better access on top of accepting them culturally.

Normally, when people think of using a condom to prevent disease they think of HIV and AIDS; but as recent discoveries have shown new diseases, such as the Zika virus, can also be sexually transmitted.7 Zika virus is a disease of current epidemic proportions. Largely seen in South America, this disease is transmitted by mosquitos and causes fever, joint pain, red eye and other symptoms.2 Many governments and religious figures are now recommending the use of condoms to prevent the spread of Zika virus. Not only can a male pass on Zika virus to a women when having unprotected sex, but there is also a chance for mother to child transmission to occur, which can lead to birth defects. Birth defects such as microcephaly, which results in abnormal brain growth and potentially impact mental development in children, and impaired vision, due to damage to the retina or optic nerve and could lead to potential blindness, can occur.5, 6 Protected sex could prevent so many of these birth defects and eliminate the sexual transmission of this disease.

Disease prevention is a huge benefit of condoms, but they can also do so much more. Condoms are a major player in family planning. The poorest countries have the highest population growth rate.4 When the average family size in a community is 7 children, there is no future. Making contraception accessible everywhere and decreasing population growth is a major factor in ending poverty.8 Limited family planning is concurrent with low female education rates.4 Not only does implementing greater condom use improve family planning, but this access to contraception is just one step in building female autonomy. Having a large number of children poses a health risk to women, and many of these women in developing countries having these large number of children report having more babies than they want and starting earlier than they want.4 Condoms are a step in empowering women and letting them have the number of children they want, while also giving them more opportunities and freedoms.1 In a lot of low income countries women have very few rights. In an article by Nina Lakhani, women in El Salvador are being imprisoned for 30-50 years on the count of murder for Zika related miscarriages.3 This was mind-boggling and absolutely heart breaking to me. This is a huge injustice to these women and this sort of treatment needs to be stopped. Fighting the legal system in this country needs to be done but would be an extremely difficult task. The least that should be done is promoting condom use so that the Zika virus is not transmitted to these women and they are not wrongfully imprisoned because of a disease related miscarriage.

Condoms need to be better taken advantage of, and condom education and distribution should be a larger global health intervention. A TED Talk by Mechai Viravaidya (https://www.ted.com/talks/mechai_viravaidya_how_mr_condom_made_thailand_a_better_place?language=en#t-103083), shares a success story of how condoms saved Thailand. With the original intention of population control, condoms were then used to prevent the HIV and AIDS epidemic in that country. The average number of children per family decreased from 7 to 1.5 in 25 years; and incidence of HIV declined by 90%. Viravaidya and his team were able to get these astonishing results by making the condom as accessible as possible, having them at coffee shops and giving them out in various community settings. They received blessings from important religious figures that were widely accepted, which made Thai people more accepting of the condom. Condom education became a major part of education in middle school and in high school, to a point where children where the teachers. These are just a few steps that many current low-income countries should be taking. Condoms have the potential to improve standard of living, and should therefore be better utilized as a tool to combat disease, poverty and to protect women’s rights.

 

Work Cited

 

  1. Center for Disease Control and Prevention. (2015). Family planning/contraception. Retrieved from http://www.who.int/mediacentre/factsheets/fs351/en/

 

  1. Center for Disease Control and Prevention. (2016). Zika virus. Retrieved from http://www.cdc.gov/zika/symptoms/index.html

 

  1. Lakhani, N. (2016, February 12). ‘Zika-linked’ miscarriages pose jail risk for women in El Salvador, activists say. The Guardian. Retrieved from http://www.theguardian.com/global-development/2016/feb/12/zika-linked-miscarriages-pose-jail-risk-women-el-salvador-activists-say

 

  1. Nadakavukaren, A. (2011). Our global environment a health perspective. Long Grove, Illinois: Waveland Press.

 

  1. Saint Luis, C. (2016, February 9). Study in Brazil links Zika virus to eye damage in babies. The New York Times. Retrieved from http://www.nytimes.com/2016/02/10/health/study-in-brazil-links-zika-virus-to-eye-damage-in-babies.html?ref=topics

 

  1. Saint Luis, C. (2016, January 31). Microcephaly, spotlighted by Zika virus, has long afflicted and mystified. The New York Times. Retrieved from http://www.nytimes.com/2016/02/01/health/microcephaly-spotlighted-by-zika-virus-has-long-afflicted-and-mystified.html

 

  1. Tavemise, S. (2016, February 18). W.H.O. recommends contraception in countries with Zika virus. The New York Times. Retrieved from http://www.nytimes.com/2016/02/19/health/zika-virus-birth-control-contraception-who.html?_r=1

 

  1. Viravaidya, M. (2010, September). Mechai Viravaidya: How Mr. condom made Thailand a better place for life and love . Retrieved from https://www.ted.com/talks/mechai_viravaidya_how_mr_condom_made_thailand_a_better_place?language=en#t-103083

 

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By Alicia Van Enoo

Abortion is one of the biggest issues of the 2016 U.S. Presidential Race. The debate centers on the complicated interplay between moral beliefs and legal rights, but rarely focuses on the medical consequences of preventing access to abortions. Recent statistics show that “of the estimated 44 million abortions performed every year worldwide, around half are considered unsafe.”1 This is a specifically important issues in countries where proper medical care and access to birth control is limited or non-existent. In countries where abortions are illegal, and even in countries where they are legal, but inaccessible due to “providers claiming conscientious objection”5, many women resort to extreme and often dangerous methods of terminating pregnancy.

According to the World Health Organization, 1 woman dies every 8 minutes due to complications from unsafe abortions, making it “one of the leading causes of maternal mortality (13%).”3 With limited access to contraception and sexual education and the alarmingly high incidence of rape in certain developing countries, unwanted pregnancies are not uncommon. Young girls and mothers who are already struggling are faced with difficult decisions in a healthcare system that does not support them. WHO defines unsafe abortions as “a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.”2 Practically speaking, this can range from ingesting toxic chemicals, placing foreign objects into the uterus, or even blunt force trauma to the abdomen.3 These risky methods often lead to hemorrhage, infection, sepsis, or genital trauma – which without immediate medical attention, can result in death.3 Doctors without Borders run an obstetrical emergency center in Haiti to treat women suffering from pregnancy complications.1 They receive many women who are hemorrhaging and suffering from sepsis due to incomplete abortions. Unfortunately, if the abortion is incomplete, but uncomplicated, they are forced to refer them to another clinic. With the stigma associated with abortion, many women are often either treated disrespectfully, or even withheld treatment and left to die.1

Less restrictive abortion laws do not result in increased abortions, on the contrary, countries with the strictest abortion regulations have the highest rates of abortion.2 Consequently, the majority of unsafe abortions happen in developing nations, where abortions are largely unavailable due to accessibility or legality issues.3 South Africa is a promising case study looking at the effect of policy changes on the rates of unsafe abortions. In 2008, more than 97% of abortions in Africa were considered “unsafe”. However, the rate for South Africa, where abortion was legalized in 1997, was only 58%.2 It is a common misconception in the field of public health that providing access equates encouraging behavior. Evidence shows that increasing accessibility to abortion does not increase rates, but it does significantly reduce the proportion of abortions that are conducted in an unsafe and unregulated manner.2

Although programmatic changes concerning access to abortions are undoubtedly necessary in countries facing high rates of unsafe abortions, the first line of defense should be prevention.4 Access to contraception is a privilege taken for granted by many in developed nations, yet it is only sparingly available to many women around the world. Additionally, sexual education is heavily lacking, even in our own backyard. Preventing unwanted pregnancy could help drastically reduce rates of unsafe abortions, without needing to directly tackle the sensitive problem of pregnancy termination.

I concede that at a time of intense debate concerning individual rights and protection, it is difficult to step away from the legal and moral dimensions of abortion. However, the health implications of unsafe abortions make it first and foremost a medical issue in developing nations. Doctors Without Borders urges us to to recognize that aside from being an issue in the 2016 presidential election “safe abortion care is a medical necessity.”1 As Elizabeth McCguire, from Former president of Ipas, said “there is no perfect contraceptive method, so there will always be abortions, and it’s important that abortions be safe so that women don’t die.”4

 

The following video discusses Kenya’s struggles with unsafe abortions and highlights the extensiveness and severity of the issue

https://www.youtube.com/watch?v=xx06amZfes0

 

  1. Doctors Without Borders / MSF-USA. “The Dangers of Unsafe Abortion.” Online video clip. YouTube. YouTube, 10 Jan 2015. Web. Accessed 22 Feb 2016.
  2. Guttmacher Institute. “Facts on Induced Abortion Worldwide.” Nov 2015. Web. Accessed 22 Feb 2016
  3. Haddad L, Nour N. “Unsafe Abortion: Unnecessary Maternal Mortality.” Rev Obstet Gynecol. 2009;2(2): 122-26.
  4. VOA News. “World Health Organization Targets Unsafe Abortion.” Online video clip. YouTube. Youtube, 24 Jun 2010. Web. Accessed 22 Feb 2016.
  5. Wood S. “A Global class on Abortion. “ The New York Times. 28 Jan 2016. Web. Accessed 22 Feb 2016.

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By Evelyn Hitt

Even if you were lucky enough to go to a school that offered comprehensive sex
education as opposed to an abstinence only platform, you probably never heard about anything other than heterosexual sex. Most likely you were taught that sex is between two consenting adults (one male and one female) who were married or at least in a monogamous relationship. But what about all the people who have sex who don’t fit into those neat definitions of sexuality? What about students who identity as lesbian, gay, bisexual, or queer/questioning? Even further, what if you are a student who doesn’t conform to the gender binary? In the current American curriculum, if you fall into one of the categories I mentioned, you are denied a legitimate sexual identity.
Let’s start with a quick definition of heteronormativity. According to Merriam-Wesbster,
heteronormative means something “of, relating to, or based on the attitude that heterosexuality is the only normal and natural expression of sexuality.” Schools today perpetuate heteronormativity through sexual education that solely concentrates on heterosexual sex without considering the sexual practices of anyone else along the spectrum of gender and sexuality. Here you might pause and protest that none of your instructors ever directly told you that heterosexuality was the only normal kind of sexual expression; perhaps that is the case. However, by omitting the discussion of the sexual practices and possible protective measures of sex outside of the traditional male-female relationship, schools enforce heteronormativity with deleterious results for LGBTQ+ youth.
Without sexual education students who identity as LGBTQ+ are taught that their sexual
practices are alien and illegitimate. The effects of heteronormative sex education include feelings of exclusion, increased stigma and prejudice at LGBTQ+ students, a denial of the existence of transgender individuals, and a lack of accurate information that can lead to adverse health outcomes for students who engage in sexual behavior outside of the planned curriculum.  Though the emotional stress and social anxiety that this lack of sexual education causes is nothing to be scoffed at, more frightening still is the fact that many students don’t receive the sex education they need to prevent them from contracting Sexually Transmitted Infections and other venereal diseases. Studies have shown that youth use condoms more infrequently when they are
depressed or anxious. Thus, LGBTQ+ students who may be targeted by their peers and thus moreprone to depression in a non-inclusive environment are more likely to develop an STI. A study completed by the Williams Institute found that an estimated 3.5% of all adults
identify as lesbian, gay, or bisexual with an additional 0.3% of adults identifying as transgender. As we continue to fail LGBTQ+ students by refusing to acknowledge and validate their sexuality, as a society we run the risk of perpetuating stigma and alienating our youth subjecting them to violence and exclusion by their peers. It’s clear that something must be done without delay to modify high school curricula to break free of heteronormative standards to protect our population and empower them in their sexuality.
Where can we turn? Maybe we should look to our neighbors to the north because the
Canadian curriculum introduces youth to homosexual couples in Grade 3 and gender identity in Grade 9. The opposition may be strong as conservative groups from all denominations could come together to prevent an education which they suggest is too sex positive. But I believe there is an equally large group of parents, students, and activists who will demand that youth are taught to respect and take care of their bodies and each other safely no matter what their sexual identity may be. Curriculum changes take time and are inherently political and emotional. In the meantime, you can work on stimulating conversation about the issue of heteronormative sexual education and promoting the use of language that isn’t alienating for LGBTQ+ individuals. For
example, don’t assume that everyone fits neatly on a gender binary so consider asking a person their preferred gender pronouns when you meet them. If you have kids, raise them in an environment that encourages them to be open-minded, critical thinkers with the understanding that not everyone is going to want to get down with people of the opposite gender—and that’s just fine by you.
Works Consulted:
Boskey, Elizabeth. “Heternormative” January 3, 2016. Accessed February 24, 2016. http://std.about.com/od/glossary/g/Heteronormative.htm
Gates, Gary J. “How many people are lesbian, gay, bisexual, and transgender?” The Williams Institute. April 2011. Accessed February 24, 2016. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
Hune-Brown, Nicholas. “The Sex Ed Revolution: A Portrait of the Powerful Political Bloc that’s Waging War on Queen’s Park.” Toronto Life, September 3, 2015. Accessed February 25, 2016. http://torontolife.com/city/ontario-sex-ed-revolution/
Merriam-Webster Dictionary, s.v. “heteronormative”. Accessed February 25, 2016. http://www.merriam-webster.com/dictionary/heteronormative
Smith, Cara. “Texas sex education leaves LGBT students in the dark” The Cougar, October 8, 2014. Accessed February 25, 2016. http://thedailycougar.com/2014/10/08/texas-sex-education-leaves-lgbt-students-dark/

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By Melanie Kirsh

HIV is often thought of as a global health issue that disproportionately affects people of color, regardless of income. This may be a result of inaccessibility to HIV education and effective interventions, or of the negative social factors that contribute to higher likelihood of unsafe sexual practices within the population. ABC programs (abstinence, being faithful, and condom use) were rolled out in sub-Saharan Africa in the 1990s; in Uganda, these programs resulted in significant declines in HIV prevalence. Despite this success, other sub-Saharan African countries’ HIV continues to affect women at disproportionate rates. In her book, Love, Money, & HIV: Becoming a Modern African Women in the Age of AIDS (2014) Sanyu A. Mojola illuminates the socioeconomic and environmental factors that may explain why her home province of Nyanza, Kenya demonstrates rates of HIV/AIDS that are much greater among young, wealthier women in comparison to men of the same age group and poorer women. She argues that the engagement in modern consumption and their perceived need to consume items like makeup, clothing, and feminine hygiene products contribute to their increased vulnerability to contracting the virus. In order to purchase these items, they need money, but since they are much less likely to be employed or receive substantial financial support from their families, they rely on relationships with men (Mojola 2014). Intimate heterosexual relations become complicated with social norms in regards to condom use: even though youth are taught about condom use, their behaviors do not reflect this education. Mojola’s male subjects believe that condoms may be uncomfortable or may (falsely) indicate that the woman is sleeping with other people (2014). This stigma, in combination with concurrency that men practice around the Lake Victoria region, results in the women’s increased risk of contracting HIV. Due to the quotidian nature of female hygiene product consumption, and the implicit need to aspire to European beauty standards with makeup and clothing that impresses their peers, women engage in transactional relationships that expose them to HIV/AIDS. In short, modernity is killing them.

I had the pleasure of meeting Mojola recently, as her book was assigned for a seminar of mine called Contemporary Debates on Sexualities Research. The professor pooled questions from the class prior to Mojola’s arrival, and one of my questions regarded my intrigue with her book’s lack of discussion on Pre-Exposure Prophylaxis (PrEP) as an alternative preventative measure for the young women. Mojola expressed skepticism about the effectiveness of such an initiative, because PrEP requires the person at-risk to follow a diligent schedule, with 100% compliancy, and this is extremely difficult to achieve –especially in a setting like sub-Saharan Africa where resources are already limited and sexual education programs are insufficient. A PrEP study conducted in Kenya, South Africa, and Tanzania from 2009-2011 confirms this, as the study was halted due to female participants’ weak adherence and the poor efficacy that resulted (Damme et al. 2012). Mojola explains that in order for women to be compliant, they need to perceive themselves as ‘at-risk’ in the first place. However, these women do not think they are at risk of contracting HIV because of the perception that sex without a condom signifies the man is not having sex with other women. So, the cycle begins again and preventative measures are tainted with the conflation of trust = love = sex without a condom.

Evidently, the typical ABC programming that advocates for seemingly practical behavior changes has failed the young women of Mojola’s native country. Not all young people abstain from sexual activity, faithfulness is challenged by the concurrency and polygamy in which men and women engage, and condoms increases false suspicion that one’s partner is not faithful or trusting. Given Mojola’s findings and skepticism of alternative preventative initiatives, it is clear that eliminating the HIV epidemic among young women (particularly those in Nyanza, Kenya) would involve a complicated untangling of modern Westernized feminine beauty ideals, deconstruction of gendered economies that disadvantage young women and girls, and increasing access to menstrual products (this would keep girls in school and encourage economic autonomy). It is time to introduce and implement a redefined ABC programming that goes beyond education. It looks like this:

HIV Poster

Of course, this involves a major overhaul of the socioeconomic structures in Kenya and other sub-Saharan African countries. But, Mojola’s work provides us with the understanding that women’s current economic position in conjunction with the initial results of ABC campaigns is killing them. Such an economic overhaul is long overdue.

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By Michelle Leon

Although many may argue that women’s rights have made significant improvements and has led to a more equal society, I think people often ignore populations across the globe that are still behind in women equality. And when specifically looking at populations at risk for HIV, women are at higher risk than men. And I think the most important factor for women’s HIV risk across the globe is women subordination to men that is still seen today. And it doesn’t just occur when contracting HIV but subordination also affects women’s chance to treat HIV.

I came across a NY Times article speaking about a new vaginal ring that will reduce HIV rates in African Women. According to Denise Grady, this new vaginal ring slowly releases an antiviral drug (dapivirine) thus protecting women from HIV sexual transmission 1. Studies on African women and this vaginal ring resulted in a 27% reduction in infection rates 1. The ring can stay in the vagina for a month and it is cheap. But while I read these results I could only help but wonder why such a device is needed. In the United States, contraceptives and condoms are so prevalent and accessible that I couldn’t understand why such a device was necessary. And then I thought… women in parts of the world don’t have access to contraceptives and can’t protect themselves from sexual transmission of HIV.

Of the 37 million people who are infected with HIV, half of them are women, and most are from the sub-Saharan region of Africa 1. The reason this vaginal ring is important is because men don’t have to find out that women are using it. With this ring, women do not need to ask for permission or ask their partners to wear a condom and even when men deny women the ability to take contraceptive pills, the ring helps protect them from HIV transmission. Additionally, once placed inside, neither she nor her partner will feel it, preventing the possibility it might disturb the sexual experience 1. But such a ring would be irrelevant in a world where women were equal to men in various aspects of life. But the reality is that, women suppression is still common today and I think it is the driving force for why women are at higher risk for HIV. There are various reasons why women subordination leads to higher rates of HIV infection and decreases their rates of survival for those living with the disease.

First off, marital violence and gender-based violence prevent women from protecting themselves from sexual transmission 2. In a study conducted in South Africa, women who experienced partner violence were 50% more likely to get infected with HIV than those who do not experience such violence 3. Secondly, women in countries with high rates of HIV (e.g. sub-Sahara Africa) have less access to healthcare services or have none 2. Lack of access to sexual health services indicates that women have less ability to look out for their health and even when women have access to some services, stigma against women can result in refusal. Consequently, when pregnant, women infected with HIV may not receive the appropriate care to reduce transmission to her child. And lastly, girls’ lack of access to education also drives their higher rates of HIV infection. According to UN’s 2004 publication on women and HIV/AIDS, one study of 32 countries found that women who had some secondary education were five times more likely than illiterate women to have knowledge of HIV 4. Additionally, illiterate women were four times more likely to believe that HIV could not be prevented.

So as you can tell by now, most of these factors that increase women’s risk for HIV infection, are intertwined with women suppression. And I think that is what needs to be addressed and be top priority in developing countries and regions of the world that continue to have high rates of HIV. Women suppression needs to be dealt with through education and spread of knowledge. Women in countries known to have women subordination need better HIV testing, better antiretroviral treatment for pregnant women, better school-based interventions to reduce stigma against women and help change cultural norms about the role of women.

 

 

 

References

 

1 Grady, D. (2016, February 22). Vaginal Ring With Drug Lowers H.I.V. Rates in African Women. Retrieved February 26, 2016, from http://www.nytimes.com/2016/02/23/health/vaginal-ring-hiv-aids-drug-dapivirine.html

 

2 Women and HIV/AIDS | AVERT. (n.d.). Retrieved February 26, 2016, from http://www.avert.org/professionals/hiv-social-issues/key-affected-populations/women

 

3 Jewkes, R. et al (2010) ‘Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study‘ The Lancet 376(9734):41-48

 

4 United Nations Population Fund (UNFPA) (2004) ‘Women and HIV/AIDS: Confronting the Crisis

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