Category: Sexual Health

Dr. Leana Wen Selected as New President of Planned Parenthood

Last week, it was announced that Dr. Leana Wen, Baltimore City Health Commissioner, will serve as the new president of Planned Parenthood Federation of America, an organization that provides vital sexual and reproductive health care and education to millions of people around the world. Dr. Wen will be the first physician in almost 50 years to serve in this role. She will succeed Cecile Richards, who has served as president of Planned Parenthood for the past 12 years.

Dr. Wen, an emergency medicine physician, has led the Baltimore City Health Department since January 2015. She is a passionate public health leader and active champion for communities and patients. During her tenure as Baltimore City Health Commissioner, Dr. Wen led a lawsuit against the Trump administration after its abrupt decision to cut funding for teen pregnancy prevention programs, resulting in $5 million of funding being restored to two of these programs in Baltimore. Additionally, Dr. Wen has fought to preserve Title X in Baltimore, which funds a variety of health care services for low-income women.

Dr. Wen is no stranger to Planned Parenthood. After she and her family immigrated to the U.S. from China, they depended on Planned Parenthood for their health care. Dr. Wen also volunteered at a Planned Parenthood health center in St. Louis during medical school.

In a recent statement posted on the Baltimore City Health Department website, Dr. Wen wrote:

“A core principle in public health is to go where the need is. The single biggest public health catastrophe of our time is the threat to women’s health and the health of our most vulnerable communities.”

She continues, in referring to Planned Parenthood, writing:

“I have seen firsthand the lifesaving work it does for our most vulnerable communities. As a doctor, I will ensure we continue to provide high-quality health care, including the full range of reproductive care, and will fight to protect the access of millions of patients who rely on Planned Parenthood.”

Dr. Wen’s last day as Baltimore City Health Commissioner will be Friday, October 12th, where she will then begin her new role as President of Planned Parenthood.

References:

Planned Parenthood. (N.d.). Dr. Leana Wen. Retrieved from  https://www.plannedparenthood.org/about-us/our-leadership/dr-leana-wen

Planned Parenthood. (N.d.). Cecile Richards. Retrieved from  https://www.plannedparenthood.org/about-us/our-leadership/cecile-richards

Zernike, Kate. (2018, September 12). Planned Parenthood Names Leana Wen, a Doctor, Its New President. Retrieved from https://www.nytimes.com/2018/09/12/us/politics/planned-parenthood-president-wen.html?rref=collection%2Fsectioncollection%2Fpolitics

Wen, Leana S. (2018, July 6). Trump’s family planning dystopia. Retrieved from http://www.baltimoresun.com/news/opinion/oped/bs-ed-op-0708-wen-dystopia-20180703-story.html

Baltimore City Health Department. (2018, September 12). Statement from Baltimore City Health Commissioner, Dr. Leana Wen. Retrieved from https://health.baltimorecity.gov/news/press-releases/2018-09-12-statement-baltimore-city-health-commissioner-dr-leana-wen

Revised Cervical Cancer Screening Guidelines Offer Women More Options

New recommendation guidelines for cervical cancer screening were published this month in the Journal of the American Medical Association (JAMA). These guidelines are an update to the U.S. Preventive Services Task Force (USPSTF) 2012 recommendations on cervical cancer screening. The new screening guidelines now offer women more options and longer screening intervals when it comes to their preventative care. One of the most notable guideline changes is that women aged 30-65 can now get an HPV test alone every 5 years instead of just a Pap smear alone every 3 years, or in combination with a Pap smear every 5 years.

According to the guidelines:

  • Women aged 21-29 years should get a Pap smear every 3 years
  • Women aged 30-65 years can get:
    • A Pap smear alone every 3 years
    • An HPV test alone every 5 years
    • A combination of a Pap smear and HPV test every 5 years

The USPSTF does not recommend screening for women younger than 21 years as well as women older than 65 years who have received adequate screening before and are not at high-risk for cervical cancer.

Cervical cancer was once a major cause of death among women. However, with the advent of screening tests, such as Pap smears, cervical cancer rates have fallen considerably over the years. Still, the American Cancer Society estimates 13,240 women will be diagnosed with cervical cancer in 2018.

Almost all cervical cancers are caused by the human papillomavirus (HPV), a common sexually transmitted infection. There are many types of HPV, some low-risk and some high-risk. Low-risk HPV types can cause warts that can be treated. High-risk types, however, can cause cancer. While the body can often fight off HPV infection, this is not always the case. Some HPV infections can become chronic, and chronic infections with high-risk HPV types can lead to cancer in both men and women if left untreated. However, there are vaccines that can prevent cancers, like cervical cancer in women, caused by HPV. The Centers for Disease Control (CDC) recommends that all children get vaccinated against HPV at age 11 or 12. For young women in particular, the CDC recommends they get vaccinated through age 26.

Because it can take years for cancer caused by HPV to develop and for symptoms to appear, the CDC encourages women to regularly screen for cervical cancer. This includes both women who have and have not vaccinated against HPV, as the HPV vaccine does not protect against all types of HPV that can cause cancer.

References

U.S. Preventive Services Task Force. (2018). Cervical Cancer Screening. Retrieved from  https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2

Centers for Disease Control and Prevention. (2017, December 16). The Link Between HPV and Cancer. Retrieved from https://www.cdc.gov/hpv/parents/cancer.html

National Institutes of Health. (2018, June 30). Cervical Cancer. Retrieved from

https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76

American Cancer Society. (2017, November 1). What Are the Risk Factors for Cervical Cancer? Retrieved from

https://www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html

U.S. Preventive Services Task Force. (2012). Archived: Cervical Cancer: Screening. Retrieved from

https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

Centers for Disease Control and Prevention. (2018, August 23). HPV Vaccines: Vaccinating Your Preteen or Teen. Retrieved from

https://www.cdc.gov/hpv/parents/vaccine.html

American Cancer Society. (2015, February 19). HPV and Cancer. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet

American Cancer Society. (2017, October 9). HPV and Cancer. Retrieved from

https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-cancer-info.html

What you need to know about SESTA and the recent seizure of Backpage

Late last week, classified ad website Backpage.com went offline after being seized and disabled due to an “enforcement action by the Federal Bureau of Investigation, the U.S. Postal Inspection Service, and the Internal Revenue Service Criminal Investigation Division”. Backpage.com is known for personal ads, and was considered by many to be the dominant online platform for sex workers to advertise their services.

Various websites have been shutting down their personal ads section in response to the Stop Enabling Sex Trafficking Act (SESTA), which has taken aim at online platforms as a playing a perceived role in sex trafficking and prostitution. While many advocates have been fighting SESTA for a large part of the year, awareness seems to be low of the laws implications among the general population.

Advocates against SESTA argue that the act will do more harm than good in regards to the safety of sex workers. Online platforms for sex work have been viewed as safer than street based sex work, allowing for screening of potential clients. Others have argued that SESTA would limit online free speech, arguing that it would require platforms to put strong restrictions on users’ speech, extending beyond the space of personal ads. If you’re interested in seeing what you can do stop SESTA, check out https://stopsesta.org for more information on how to contact your elected officials.

 

Sources – Buzzfeed News: Backpage Has Been Taken Down By The US Government And Sex Workers Aren’t Happy – https://www.buzzfeed.com/blakemontgomery/backpage-service-disruption?utm_term=.mceyodXp#.bkjAQmNK

App Grindr under scrutiny over privacy concerns

In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.

The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.

Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.

 

Sources:

BuzzFeed News: Grindr Is Sharing The HIV Status Of Its Users With Other Companies –https://www.buzzfeed.com/azeenghorayshi/grindr-hiv-status-privacy?bfsplash&utm_term=.eu9v16ZaQ#.akvOQgNJj

Discrimination and Health Part I: LGBTQ+ Americans

Past research has suggested that discrimination can impact health outcomes – perhaps through vehicles such as stress of daily interactions and negative experiences with the healthcare system. One group whose experiences with discrimination can be linked to negative health outcomes is LGBTQ+ Americans. A study found that over half of LGBTQ people have experience slurs and offensive comments, and over half have been sexually harassed or experienced violence, or had an LGBTQ friend or family member experience such trauma.

We can make the connection between discrimination and trauma through various factors. One is through microaggressions –  seemingly harmless daily interactions with others who express, in this case, homophobic or transphobic views. These have been found to negatively impact health. Another is through discrimination within the healthcare system that lead LGBTQ Americans to seek healthcare less frequently. 18% of this population has avoided necessary medical care. Various forms of discrimination they face at the hands of medical professionals, police, and community members are much worse for those of color and those who are transgender.

Unfortunately, we can already see the health outcomes of discrimination to this population – they have higher rates of psychiatric disorders, substance dependence (including higher tobacco use), and suicide; lesbian women are less likely to get preventative services for cancer, and gay men are at higher risk for certain STIs.

How can we work to eliminate these gaps, even when interpersonal discrimination may take longer to tackle as our culture continues to evolve? HealthyPeople2020 provides several recommendations. First, healthcare providers should discuss sexual orientation and gender identity (SOGI) respectfully with patients, and collect data on it. Medical students should be trained in LGBTQ culturally-responsive care. In addition, we must be spokespeople against legal discrimination of this population in social services such as employment, housing, and health insurance.

Sources:

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

https://www.npr.org/documents/2017/nov/npr-discrimination-lgbtq-final.pdf

https://www.centerforhealthjournalism.org/2017/11/08/how-racism-and-microaggressions-lead-worse-health

https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race

http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/pdf/nihms134591.pdf

Changes to HIV Criminalization Laws in NC

According to a report updated in August 2017, 34 states in the US had HIV criminalization laws still on the books, written at least twenty years ago at the height of the AIDS epidemic [1]. According to the Human Rights Campaign, 25 states in the US have “laws that criminalize behaviors that carry a low or negligible risk of HIV transmission” [2]. Most of these laws require disclosure of HIV status for those living with HIV, and in some states, failure to disclose or follow other laws could result in a felony.

There are various examples of these laws being put to work, including a man living with HIV being convicted of a felony and sentenced for 35 years for spitting on a police officer because his saliva was considered a deadly weapon though HIV transmission doesn’t occur through saliva [3].

In North Carolina, HIV criminalization laws are contained in the health code, and the North Carolina Commission for Public Health recently voted to update the laws in order to better reflect our current understanding of HIV and the current methods available for HIV treatment and prevention [4].

According to the previous law, any individual living with HIV was required to disclose their HIV status to any sexual partners and to use a condom during sex, and anyone living with HIV was unable to donate organs. With the changes to the law, an HIV positive individual who is virally suppressed for at least 6 months does not have to disclose their HIV status to sexual partners or use a condom during sex, and even if they aren’t virally suppressed, if their partner is taking PrEP, they don’t have to use a condom. Also, an individual living with HIV doesn’t have to use a condom when having sex with another individual living with HIV, and individuals living with HIV can donate organs to other individuals living with HIV [5]

This is an exciting step forward for North Carolina that will hopefully make changes for HIV stigma while also representing current options for HIV treatment and prevention. These changes also recognize that HIV is an ongoing issue, especially with high rates of new diagnoses of HIV in the South.

Nonetheless, some activists are still worried that this is only a step forward for those who are already at an advantage. Many individuals are still unable to access healthcare and the medical system for various reasons, limiting their access to PrEP for HIV treatment to attain viral suppression. Only 50% of individuals living with HIV stay in care. Further, Black and Latinx individuals still receive worse care and have less access to care. This results in a continued disparity. Though the changes to these laws are a step forward in creating evidence-based laws and hopefully decreasing stigma and unjust prosecution, there are still significant barriers for individuals seeking HIV treatment and prevention care [6].

“Chart: State-by-State Criminal Laws Used to Prosecute People with HIV, Center for HIV Law and Policy (2017).” The Center for HIV Law and Policy, 1 Aug. 2017, www.hivlawandpolicy.org/resources/chart-state-state-criminal-laws-used-prosecute-people-hiv-center-hiv-law-and-policy-2012

Jackson, Hope. “A Look At HIV Criminalization Bills Across The Country.” Human Rights Campaign, 26 Feb. 2018, www.hrc.org/blog/a-look-at-hiv-criminalization-bills-across-the-country.

Kovach, Gretel C. “Prison for Man With H.I.V. Who Spit on a Police Officer.” The New York Times, The New York Times, 16 May 2008, www.nytimes.com/2008/05/16/us/16spit.html.

Adeleke, Christina. “Choose Science over Fear.” QNotes, 24 Feb. 2018, goqnotes.com/58326/choose-science-over-fear/.

“HIV Criminalization Laws Change in North Carolina.” WNCAP, 20 Feb. 2018, wncap.org/2018/02/20/hiv-criminalization-laws-change-north-carolina/

Salzman, Sony. “Updated HIV Laws May Only Protect the Privileged.” Tonic, 20 Mar. 2018, tonic.vice.com/en_us/article/wj7e9z/updated-hiv-laws-may-only-protect-privileged.

What’s going on with the HPV vaccine?

HPV is the most common STI, and 9 of every 10 people will have an infection at some point in their lives (1).  This virus can cause cancers in the cervix, penis, mouth, and oropharynx (2), and it also causes genital warts (3).  Even though a vaccine exists against HPV, less than half of teens are up to date on all of their doses of these shots (2).

Part of the reason behind these low vaccination rates are due to parents concerns regarding vaccine safety and fear that vaccination will encourage sexual activity (4).  Though all vaccines, including this one, have potential side effects, the HPV vaccine is considered safe (4). Additionally, studies have shown that the HPV vaccine does not make teens more likely to start having sex (4).

The way providers approach talking about the HPV has also influenced vaccine rates, and strong provider endorsement seems to improve vaccinations (5).  On Monday, March 19, Chris Noronha spoke with the Interdisciplinary Health Communications Class about the work he is doing with Noel Brewer on provider communication regarding the HPV vaccine.  They have found that when providers mention the HPV vaccine in the same list as other vaccines that are due at age 11, vaccination rates increase.

If you’re interested in the HPV vaccine, it may not be too late.  You can receive the series through age 26 (1).  Contact your provider if you’re interested.

 

Works Cited
  1. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine Safety. Centers for Disease Control and Prevention. [Online] January 30, 2018. https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html.
  2. Aubrey, Allison. This Vaccine Can Prevent Cancer, But Many Teenagers Still Don’t Get It. National Public Radio. [Online] February 19, 2018. https://www.npr.org/sections/health-shots/2018/02/19/586494027/this-vaccine-can-prevent-cancer-but-many-teenagers-still-dont-get-it.
  3. Centers for Disease Control and Prevention. What is HPV. Centers for Disease Control and Prevention. [Online] December 20, 2016. https://www.cdc.gov/hpv/parents/whatishpv.html.
  4. —. Talking to Parents About HPV vaccine. Centers for Disease Control and Prevention. [Online] December 2016. https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf.
  5. Narula, Tara. HPV vaccine: Why aren’t children getting it? CBS News. [Online] July 23, 2017. https://www.cbsnews.com/news/hpv-vaccination-cancer-prevention-dr-tara-narula/.

 

 

How many teens are sexting?

When we go on the internet and listen to stories, we often hear comments about sexting among teens.  With all of this talk, it may sound like this is something that all teens are doing.  However, according to a study published this week by JAMA Pediatrics, only about 14.8% of teens have sent these messages, and approximately 27.4% of teens have received a sext [1].  This means that roughly 17 out of 20 teens have never sent sexually explicit images, videos, or messages.

Though this rate is lower than we may have expected, sexting is becoming more commonplace, and that is cause for concern. Many teens, view sexting as private and therefore safe.  However, approximately 12%, are forwarding sexts without consent of the sender [1]. Additionally, many teens don’t realize that even though some messaging apps that allow video and image sharing appear private, they may not be [2].

Often times, sexting is a normal by-product of teens trying to establish their identities and wanting to explore their sexuality [2].  However, many teens just are not aware of the dangers that can come with sexting.  Along with these concerns, teens just need to be reminded that it’s not OK for them to be pressured to share more of their bodies than they’re comfortable, and that consent is theirs to give.

[1]  Madigan, S., Ly, A., & Rash, C. L. (2018, February 26). Prevalence of Multiple Forms of Sexting Behavior Among Youth. Journal of the American Medical Association Pediatrics. doi:10.1001/jamapediatrics.2017.5314

[2]  Gabriel, E. (2018, February 26). 1 in 4 young people has been sexted, study finds. Retrieved from CNN: https://www.cnn.com/2018/02/26/health/youth-sexting-prevalence-study/index.html

Achieving Health Equity and Justice through the Reproductive Justice Framework: keynote by Monica Raye Simpson

This past Friday marked the 39th annual Minority Health Conference, which is the largest and longest run student-led health conference in the world. This year’s 20th annual William T. Small Jr. keynote speaker was Monica Raye Simpson, who is the executive director of SisterSong Women of Color Reproductive Justice Collective, gave a keynote address titled: “Achieving Health Equity and Justice through the Reproductive Justice Framework”. In the talk, Simpson gave an energetic and powerful where she gave a history of the Reproductive Justice framework, and how her own life experiences shaped how she approaches her work. One of her main points was how the Reproductive Justice Framework’s focus on centering those who are the most marginalized is critical for the field of Public Health, in order to overcome health inequities. In case you were not able to attend the event in person, the keynote speech is available for broadcast in the link below, moderated by yours truly.

Sources: https://sph.unc.edu/sph-webcast/2018-02-23_mhc/

HIV Medication Adherence Apps: Challenges Faced

By Chunyan Li

The success of HIV medications has changed HIV from a fatal disease to a chronic illness. However, like other chronic diseases that require lifetime medication (at least for now), maintaining good adherence to antiretroviral therapy is not easy for HIV-positive people for reasons such as the complex drug regimens, strict requirements on the time of daily medication, and sometimes intolerable side effects. Having a mobile phone-based application to remind patients of daily medication is a good way out, but the effectiveness of such medication adherence apps remains less studied.

One significant challenge that such apps often face is a lack of behavioral science in design. Some experts described the development of many healthcare apps as a “black box”[1], blaming that app developers often focus too much on technology while neglecting behavior change theories or research evidence. One 2016 research study [2] reviewed all health apps on Google Play, Apple App Store and Windows Phone Store, and found that the reviewed 28 eligible health apps only used 5.6 out of the total 37 behavioral change principles on average. Among the four categories of behavior change principles proposed by the researchers (task support, dialogue support, system credibility and social support), the most used principles were about “system credibility” and “task support”, including features like surface credibility, expertise, authority, and providing general information and function of self-monitoring.  The two categories “dialogue support” and “social support”, which require higher user-provider interactivity and more constructive design based on behavioral science, are somehow neglected.

In another systematic review [3] that reviewed all eHealth-based HIV intervention studies (including smartphone-, Web- and general Internet-based interventions), 10 out of the 14 studies that had a component of adherence improvement were smartphone-based. As HIV patients are usually required to take medicines on quite a strict daily schedule, and sometimes even to be in private if HIV/AIDS is heavily stigmatized, smartphone-based apps are better for portability and privacy protection. However, it could also be challenged when people feel unsafe to disclose HIV status or worry about leaving digital footprints on such apps. In lower-income settings where cell phones are shared with family members, using apps to keep track of medication adherence might not be an ideal option for HIV-positive people.

In a qualitative research study about the HIV treatment continuum that I’m recently working on, a frequently-mentioned desired feature of app-based interventions by HIV-positive people is having communication with human counselors. Many adherence apps may have functions of knowledge education, tracking medications and pushing reminders, but lack an emotional support. Living with HIV is a chronic and multidimensional (physical, psychological and cultural) stress, and a successful coping with such a stress requires consistent support from families, friends and health professionals. Though the advantages of health apps include its mass-reach to users and increasing access to care in limited-resource settings, we should never ignore the needs for human caring and support. How to incorporate human support into HIV medication adherence apps could be one of the future research directions.

 

[1] Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2). https://doi.org/10.1371/journal.pmed.1001382

[2] Geuens, J., Swinnen, T. W., Westhovens, R., de Vlam, K., Geurts, L., & Vanden Abeele, V. (2016). A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement. JMIR mHealth and uHealth, 4(4), e118. https://doi.org/10.2196/mhealth.6286

[3] Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care. Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-014-0239-3