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Twin Town High (vol. 8)
The Birds and the Bees and the STDs
Wednesday 17 January @ 16:14:40
by CHARLES DAVIS
Candlelit bedroom, an empty wine bottle, Bobby Womack playing on the phonograph, singing soulfully … "Nobody wants you, when you're down and out ..."
"What is this music?"
"You like it?"
"Yeah, it's real funky."
"…Nobody wants you, now…"
"Do you want to have sex?"
"Do you have a condom?"
"Do you have any STDs?"
Record screeches to a halt.
It wouldn't be going out on a limb to say that sexual encounters don't often begin with questions about sexually transmitted diseases (STDs). There is the general phenomenon of sleeping together first and asking questions later. And first-time sex with a new partner might occur under the influence of alcohol or drugs, when getting it on becomes the overriding and urgent goal.
For many, "dating" can be like navigating with a DSL connection--faster and more furious; the dial-up version still happens, but has mostly become a thing of the past. And the trend of having sex at younger ages, when people may not be educated about the possible risks involved and their critical thinking skills are not fully developed, is a growing health concern.
One guy who is paid to notice such sexual trends is Dave Dolman, the director of Sexual Health Awareness and Disease Education (SHADE). Dolman said this of collegiate dating rituals: "Relationships tend to form very quickly and be very intense, or last for just one night."
And here's a shocker: It seems that Minnesotans are not following much of the leading sexual health advice, as 2005 had the highest number of reported STD cases for a single year in Minnesota. There were 15,785 new cases reported, according to the most recently released data from the Minnesota Department of Health (MDH).
Bottom line, most people do not want to assume the worst about the person they are interested in, but as one nurse spokesperson for the Midwest Health Center for Women put it, "Whomever you sleep with becomes your sexual health history. Once you've slept with one person, you've slept with whomever that person has … and when many couples have been active since they were 18, they might have had over 30 partners." This really should make people think twice before having sex with a stranger.
When it comes to preventing STDs, get this through your head: Condoms are not enough. Condoms are only effective when used to prevent infection from STDs such as chlamydia, gonorrhea and HIV/AIDS that are transmitted through the exchange of bodily fluids. Herpes, syphilis and the human papillomavirus (HPV)/genital warts are all spread through skin contact and are unlikely to be deterred by a condom unless the entire effected area is covered.
And even then condoms are not 100 percent effective, and, as one representative of the STD Hotline (1-800-78FACTS) explained, the only completely effective method is having no sex at all. Having sex exclusively with one partner greatly reduces the risk of infection, as does knowing your partner's sexual health history.
According to Kip Beardsley, the director of the STD and HIV Section at MDH, the high number of reported new cases of STDs "represents an alarming trend that says loudly that too many infected people are going untested and untreated." These new cases include chlamydia, gonorrhea and syphilis, but not HIV/AIDS, HPV/genital warts, herpes or any other STD. Many cases remain undiagnosed or unreported. HIV infection rates have remained fairly consistent over the past decade, with 304 new cases reported in 2005. The good news is that some common STDs such as chlamydia, gonorrhea and syphilis can all be treated medically if they are diagnosed in time.
Some advice before you get started
Most Minnesota health educators interviewed for this article agreed that one of the most important ways to prevent infection from sexual partners is to have open, clear and non-judgmental communication before sex. People normally have to be in a trusting relationship for this to occur, as it can be a touchy subject. At the same time, many are unaware that they have an STD, and so they are spreading it unintentionally, so any amount of open communication will not help. Part of this is due to the fact that so many STDs are difficult to detect and may not have any symptoms at all. "Seventy-five percent of women and 50 percent of men show no symptoms for chlamydia, and 85 percent of women have no symptoms for gonorrhea," explained Minnesota STD hotline spokesperson Maneesha Jain. Most of those who have herpes are not aware of it either, according to the Center for Disease Control (CDC).
The negative effects of diseases and infections that are asymptomatic, or "silent," can often be completely cured without any lasting damage if they are detected in their early stages. That is partly why health care professionals increasingly recommend getting tested if there is any possibility of past exposure. "We don't tell everyone to get tested automatically, because it can be costly," said Peg LaBore of the Family Tree Clinic in St. Paul, but if an infection seems likely, it is better to be safe and get tested. Partners are also beginning to get tested for STDs together before they become involved sexually, a positive trend for the future of sexual health. Many clinics now offer rapid testing, where the results can be received within 20 minutes of the test, before the excitement wears off.
Syphilis on the rise
Syphilis is considered one of the silent STDs, as its symptoms often are overlooked, and its numbers are increasing at alarming rates in Minnesota. The number of people with syphilis in the Twin Cities more than doubled from 2004 to 2005, compared with an 11.1 percent increase nationally. Syphilis can lead to blindness, brain damage, heart disease and even death if it is not treated. The drastic increase of STDs in Minnesota was distressing enough for the MDH to instigate a syphilis elimination campaign, even during a time of severe budget cuts for sexual health and family planning.
"What's scary about the rise in syphilis is that there are classical authors from the 1700s who were dying from this," said Maneesha Jain from the STD Hotline. It was nearly eradicated in the 1990s, but has been steadily increasing since 2000. Gay and bisexual men have a much higher infection rate than other groups, representing 92 percent of the syphilis cases in Minnesota. The "Stop Syphilis Now!" campaign is directed primarily at gay and bisexual men for this reason, according to Derek Blechinger, who works with the HIM program at the Red Door Clinic in Minneapolis. "Easy to miss, easy to get, easy to cure," is how the program describes syphilis to the groups with which it works. The HIM (Health Interventions for Men) program focuses on health issues related to gay and bisexual men, providing support groups for single and married men, HIV and STD testing, as well as chemical dependency help.
The Most At Risk
New HIV cases have also seen recent increases in the gay and bi-men community. Of the new HIV cases from 2005, 68 percent of them are in the men who have sex with men (MSM) category, a 21 percent increase from 2004.
HIV and STD infection is more common in the gay community. "You could write a thesis paper on all the reasons for that," stated Blechinger. One major reason may be that it is a marginalized group in society that is not taught safe sex practices in the same way as heterosexual groups. "Like in any minority culture, you're not getting the same education and care that other groups are," Blechinger explained. As a marginalized group, gay people may also be more likely to turn to drugs to cope--Blechinger mentioned the recent rise in crystal meth use in relation to syphilis--which would lead them to make poor decisions in their sexual practices. These issues are prevalent in the community as a whole, but within the gay and bi community, they are especially pronounced.
Other marginalized groups, such as African-Americans and the African-born in Minnesota, represent higher percentages in STD rates than would correlate to their overall numbers within the population. In Minnesota, 37 percent of males living with HIV/AIDS are non-white, whereas only 12 percent of the general population is non-white. The MDH reports that of women affected by HIV, 59 percent are either African-American or African-born. MaryJo Meuleners, a community health specialist at the Red Door Clinic in Minneapolis, works specifically with African-American women, who, she said, have higher infections rates for a lot of reasons, including poverty, chemical dependency, homelessness, and sex work involvement.
Amy Weiss, the director of communications at the Minnesota AIDS Project (MAP) said this of HIV rates in Minnesota: "Sixteen percent of the new cases are in the African-born population, which is less than 1 percent of the population in Minnesota."
The Minnesota AIDS Project used to have a program targeting African-born people, but it had to shut down due to funding cuts. "We aren't addressing these issues on the prevention side, which ends up being very short-sighted," Weiss continued, as anti-retroviral medication for HIV is extremely expensive. There also has not been any significant decrease in the number of new infections, so the total number of people living with HIV/AIDS has been steadily increasing over time. "We've become complacent, and it's marginalized communities that are being infected," Weiss said. "Often politicians think they can sweep these issues under the rug."
In 2005, the state cut funding dramatically for sexual health programs. In the last two House sessions, money has been cut, and 48 percent of statewide funding will be cut in July 2007 for the Family Planning and Special Project Grants.
The Minnesota AIDS Project AIDSLINE (1-800-248-2437) currently only has funding through February, and the STD hotline has had to cut back on hours.
Politics plays a key role, and, as Ms. Jain from the Hotline explained, "When there is a conservative political environment, we definitely are scrounging for money. In 2003, we were almost sure we would be shut down, but we managed to regain our funding." Minnesota may be ahead of other states, but there is still a gap in education and awareness. "A lot of community clinics are having problems financially, and access is getting more difficult--especially for youth and undocumented folks," complained one person at the Community University Health Care Center.
Peg LaBore, the director of the Family Tree Clinic in St. Paul, has been working in the area of reproductive and sexual health for 25 years and brings a veteran perspective to the issue. Over the last three decades, LaBore has not seen a whole lot of positive change. "I just wish it could be like Europe, where you buy a condom when you buy the newspaper," she said.
In terms of product development, sexual health has definitely improved. LaBore said that birth control is easier, as well as testing availability and accuracy, but in terms of "culture and acceptance of sexuality, I don't see it has improved at all. Young people are still getting the message that sex is bad." At the same time, LaBore is more optimistic than she has been in the past, especially after the elections in the fall. "The winds of change move very slowly, but at least it seems like they're turning in the right direction."
Are the kids alright?
Last year, the Red Door Clinic lost all funding for the Youth Intervention Project (YIP), a program targeting youth and sexual health, which had been operating since 1989. Youth are a particularly at-risk group because they are the most likely to have sex with multiple partners and be misinformed. Meuleners, the former director of the YIP program, explained that youth are still coming to the Red Door Clinic, but the specific program is not there for them anymore. Most parents are not talking to their kids about sexual health either. "The climate has been that you just don't talk about it," Meuleners said. This is bad news for youth, because the number of places they can turn in Minnesota is decreasing.
The biggest call group for the STD hotline are between 18 and 24 years old, and most of the calls are from people who think they might already have an STD--not just looking how to prevent getting one. Though prevention methods are assumed to be common knowledge, most people with STDs remain undiagnosed and unaware of what they might have before it becomes noticeable and dangerous. This may also be partly because there is no standardized sex education in the state of Minnesota. "A lot of people assume one exists in Minnesota, but it actually doesn't," says Amy Brugh, public policy director at the Minnesota AIDS Project.
The Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting (MOAPP), a coalition Brugh works with, has introduced legislation for the past eight years to require comprehensive sexual education in the public schools for grades 7–12. It would require teaching sexual education that would provide "medically accurate, developmentally appropriate sexuality information and resources." The program would promote abstinence, and include information on contraception, STDs, relationships and dating.
Legislation has continued to fail due to conservative votes in the Legislature, despite an MOAPP survey results indicating that 9 out of 10 Minnesota adults support comprehensive sexuality education. Comprehensive sexual education is also supported by numerous national health organizations such as the American Medical Association, the Institute of Medicine and the American Public Health Association.
Public schools are currently required to talk about HIV/AIDS transmission, but the degree to which a class addresses STDs and safe sex depends on the school, the teacher and parent groups.
Part of the problem may be parents themselves. Over two-thirds of teenagers said "it would be much easier to postpone sexual activity and avoid pregnancy if they were able to have more open, honest conversations about these topics with their parents," according to an MOAPP report. One of the many problems is that parents' beliefs may conflict with their children's, and many parents are not educated in issues of sexual health themselves. As Meulener from the Red Door Clinic put it: "There's a lot of misinformation out there, and it's not just the youth." (Older people, even senior citizens, often lack information on how to stay safe beneath the sheets, even as products like Viagra and other erectile dysfunction drugs enable older men to enjoy sex way past middle age.)
Despite the fact that 46 percent of high schoolers have had sex by the time they graduate in Minnesota, many do not receive comprehensive sexual health education until college. The University of Minnesota has a better health program than many public universities, and its Boynton Health Center provides free testing for STDs and STIs for all University students, as well as sexual health information sessions in dorms, fraternities and sororities. They also distribute over 100,000 free condoms a year, according to Dave Dolman, the director of SHADE. SHADE was created in 1992, around the height of the HIV/AIDS epidemic in the country. It provides a good example of the kind of project that is needed on a state level.
Dolman stated that people are coming to the U of M with less remedial sex education than they should have. In order to combat this, SHADE uses peer education, training specific students in sexual health issues so they can educate their fellow students. It can be a difficult subject to address tactfully. "We prefer to use the term sexually transmitted infection, STI, instead of STD. An infection doesn't have all the negative connotations of a disease," Dolman said.
Emily Matson, a student coordinator for SHADE, said that the use of comedy is also a part of the information sessions they give. "At our information sessions we show a video--a cartoon from the early '90s from Denmark that's translated into English--it's really humorous. A lot of people come to the session because they heard about the video." Matson also described a false rumor about a strain of HPV/genital warts that were specific to the U of M, called "Gopher warts." Fighting false rumors can often be a problem in all topics sexual. The most recent study produced by SHADE shows the most common STD at the U of M as being genital herpes.
The future of STDs
Arguably the most important medical breakthrough of 2006 was the approval for the first vaccine to prevent HPV, the most common STD in the United States. There is no cure for HPV, and it can cause cervical cancer and genital warts, leading to an average of 3,700 deaths per year in the U.S. and 233,000 deaths worldwide. The Center for Disease Control estimates that over half of all sexually active men and women in the U.S. become infected with HPV at some time in their lives, although sometimes the body clears the disease naturally. The vaccine, Gardasil, was approved by the Food and Drug Administration to be distributed to women ages 9–26. The vaccine has been controversial in this country because doctors recommend receiving the three-shot series at an early age to prevent infection, and some parents view it as promoting premarital sex.
Research continues in the field of sexual health, but even for diseases that are curable, the symptoms are going unnoticed. Along with improvement in education about safe sex practices, there needs to be recognition of the existence of these issues in the local community. People think of the HIV/AIDS epidemic and think of Africa, not Minnesota, to paraphrase a Minnesota AIDS Project representative. Molly Snuggerud, a public health nurse at the West Suburban Teen Clinic, put it this way: "It's not a lack of knowledge, it's understanding how prevalent it is."
The election of a Democratic majority to the Minnesota Legislature this fall has led many sexual health care providers to be more optimistic about future funding. The state may be closer to adopting its first comprehensive sexual health education legislation, after nine years of attempts. That would be like putting a giant condom on the state of Minnesota--not fail-proof, but a good first step.
For more information about STDs, STIs and general sexual health, visit these websites:
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