This film shown to World War II soldiers is already better than any official abstinence-only (a-h criteria compliant) education curriculum. The message is do not have sex, but if you do, use a condom, and it shows a condom and then tells how to put it on, and do not drink so much that you are careless. And then it closes with the typewritten message on the screen, "Do not be so weak as to let some ignorant individual persuade you that you must seek sex relations to be a good sport. If you follow his advice, you are only being a fool."
Short and to the point, and an easy substitute for weeks-long curricula. And this was before there was even effective treatment for either syphilis or gonorrhea. (And before we were aware of chlamydia, herpes, and HPV.) Interestingly, the film was made in 1941, or either in the 24 days after the US declared WW2 or prior to entering WW2. Either way, it's clear that the army clearly anticipated that STIs can be a major problem, and it knew that it had to prevent STIs as much as possible, rather than waiting for them to come up. Unfortunately, there is no such common unifying impetus to prevent STIs today.
Policy proposal: given that some idealize the times before the sexual revolution, states that are reluctant about giving modern comprehensive sex education should limit themselves to material produced by state and federal government bodies prior to the sexual revolution. The vintage government films that I've seen are more practical and factual than the abstinence-only curricula that I've seen.
Showing posts with label STD risk. Show all posts
Showing posts with label STD risk. Show all posts
Friday, May 14, 2010
Monday, April 12, 2010
Sweden has had sex education since 1918
While doing a literature review for a paper about syphilis, I learned that Sweden has had what we would now call comprehensive sex education since 1918 ("Venereal Diseases and Sex Education", Report by a Swedish Government Committee, British Medical Journal, vol 1, no. 3204, May 27, 1922, p.842), as part of their "venereal disease" prevention law.
A 1943 discussion of sex education shows that current discussions are almost identical to past dicussions. The Archbishop of Canterbury noted that "if men and women would abstain from fornication the problem would be reduced greatly and become a purely medical matter. The bulk of the evil is primarily a moral problem." and he suggested that by distributing condoms to the troops "the implication is that many are expected to practice fornication" and thus it increases. One person cited one example in which moral suasion worked to prevent sex among soldiers --- the Black Sea Army in World War I --- and that the forces would respond if chastity were portrayed "in the right way".
On the other side, a medical officer from St. Pancras argued that the Church's teaching was unhelpful and that creating a taboo against premarital sex causes those who break the taboo to become rebels and outcasts. An alderman calls for sex education for those age 13 and up since otherwise they will learn about sex from "street talk", while a doctor calls for sex ed starting at age 11. Meanwhile, a minister in the Church said that he has discussed venereal diseases openly for years, and in a separate report, a psychiatrist noted that "The clergy were more broad-minded than schoolmasters."
A 1943 discussion of sex education shows that current discussions are almost identical to past dicussions. The Archbishop of Canterbury noted that "if men and women would abstain from fornication the problem would be reduced greatly and become a purely medical matter. The bulk of the evil is primarily a moral problem." and he suggested that by distributing condoms to the troops "the implication is that many are expected to practice fornication" and thus it increases. One person cited one example in which moral suasion worked to prevent sex among soldiers --- the Black Sea Army in World War I --- and that the forces would respond if chastity were portrayed "in the right way".
On the other side, a medical officer from St. Pancras argued that the Church's teaching was unhelpful and that creating a taboo against premarital sex causes those who break the taboo to become rebels and outcasts. An alderman calls for sex education for those age 13 and up since otherwise they will learn about sex from "street talk", while a doctor calls for sex ed starting at age 11. Meanwhile, a minister in the Church said that he has discussed venereal diseases openly for years, and in a separate report, a psychiatrist noted that "The clergy were more broad-minded than schoolmasters."
Monday, February 8, 2010
NY Times on the undergraduate sexual economy
Just as Katherine Bogle found: The NY Times reports that women are outnumbering men on campus, and turning to hookups in hopes of hooking a man. Based on both what I've learned anecdotally and also read in Rachel Greenwald's qualitative study of dating among adults, that's counterproductive. As someone told me when explaining why he thought early sex was intrinsically casual sex, "Everyone knows that if you have sex on the first date, you'll never see each other again."
If their concerns are long term, as many of these women and those in Bogle's study said, the women's decision to eliminate half the men to start with is also counterproductive. The article describes a campus that is 60% female where half the men are undesirable, and half of the desirable are coupled. Take a campus of 1000 students (all straight): 500 available women, 200 "undesirable" men, 100 available "desirable" men, and 100 each coupled "desirable" men and women. Effectively, the women have created a situation where the gender ratio is 5:1 female to desirable male, when it would otherwise be 5:3. Of course all the women expect that they are going to be the lucky 10% in a couple, so it would seem that this situation doesn't hurt them. In fact, since it seems likely that even couples are more unstable in a 5:1 gender ratio than a 5:3 gender ratio, labeling half the men as undesirable hurts even coupled women.
As one woman quoted in the article said, "As for a man’s cheating, “that’s a thing that girls let slide, because you have to. If you don’t let it slide, you don’t have a boyfriend.”" (Obviously counterproductive, no matter what the gender ratio is.)
If their concerns are long term, as many of these women and those in Bogle's study said, the women's decision to eliminate half the men to start with is also counterproductive. The article describes a campus that is 60% female where half the men are undesirable, and half of the desirable are coupled. Take a campus of 1000 students (all straight): 500 available women, 200 "undesirable" men, 100 available "desirable" men, and 100 each coupled "desirable" men and women. Effectively, the women have created a situation where the gender ratio is 5:1 female to desirable male, when it would otherwise be 5:3. Of course all the women expect that they are going to be the lucky 10% in a couple, so it would seem that this situation doesn't hurt them. In fact, since it seems likely that even couples are more unstable in a 5:1 gender ratio than a 5:3 gender ratio, labeling half the men as undesirable hurts even coupled women.
As one woman quoted in the article said, "As for a man’s cheating, “that’s a thing that girls let slide, because you have to. If you don’t let it slide, you don’t have a boyfriend.”" (Obviously counterproductive, no matter what the gender ratio is.)
Monday, July 27, 2009
LA County implements STD tests by mail
Women up to age 25 anywhere in LA County are eligible to receive a free home testing kit so they can test themselves for chlamydia and gonorrhea. The Don't think, know project is modeled on the I want the kit project started by my colleague Charlotte Gaydos at Johns Hopkins.
The testing kit arrives in an unmarked envelope. They swab themselves, mail it back, and get their results back via an 800 number or the internet.
Hopefully the LA project will expand also to men, as the Hopkins project did.
The testing kit arrives in an unmarked envelope. They swab themselves, mail it back, and get their results back via an 800 number or the internet.
Hopefully the LA project will expand also to men, as the Hopkins project did.
Wednesday, June 10, 2009
Parody of the day: STD E-cards
A parody of the CDC's STD ecards.
Kids holding a large piece of paper.
"Giving bad news is sometimes really hard.
So I'm saying I gave you crabs with the help of this card."
A couple holds hands in the sunset on a beach.
"Thanks for the blow job.
Sorry about the herpes!"
Man covering his genitals.
"I've been experiencing some genital burn.
So I got tested and now it's your turn."
Not a bad message since some STDs are more likely to be symptomatic in men than in women.
Kids holding a large piece of paper.
"Giving bad news is sometimes really hard.
So I'm saying I gave you crabs with the help of this card."
A couple holds hands in the sunset on a beach.
"Thanks for the blow job.
Sorry about the herpes!"
Man covering his genitals.
"I've been experiencing some genital burn.
So I got tested and now it's your turn."
Not a bad message since some STDs are more likely to be symptomatic in men than in women.
Monday, February 2, 2009
Girls and casual sex: syphilis epidemic, but no rainbow parties
I've read a few accounts lately about girls and young women in casual sexual relationships, and the same pattern emerges. These women started a behavior for adventure and experimentation, but when they decide they've had enough of the behavior they feel unable to step away from the behavior pattern due to social pressure.
Hooking Up by Katherine Bogle is about casual relationships in college. She studied two colleges: one small and religious, and one secular and larger. Freshman young women hook-up initially out of a mixture of curiosity, interest, exercising independence from earlier restrictions, and perhaps because it's what others are doing. By hooking up these college students mean anything from kissing to oral or vaginal sex, with or without alcohol, but according to their reports one time hookups are more likely to be at the less intimate end of the spectrum and alcohol is a good social excuse ("beer goggles"). Hooking up is almost always with an acquaintance or an acquaintance of an acquaintance: the closed atmosphere of a college makes women feel safe being alone with someone they just met. Within a year or two, most of the women report that they stopped being so interested in hooking up: they want a real relationship. The dynamic on campus, though, is still aimed at hooking up. The guys who are unassertive are not part of the hook-up culture at all, and they don't date much either. The guys who are assertive are part of the hook-up culture, and seem to have numbers in their favor: they can almost always find a woman willing to hook up with them, so a woman who wants to have any sexual contact and sees her dating pool as comprising such guys has the choice between hooking up or not hooking up: they do not feel that they have the option of a relationship. Some women hook up and hope for a relationship, and are inevitably disappointed. They don't talk about why they don't go for relationships with the nice guys, though probably for the clicheed reasons.
After college, the women are able to assert themselves: they are meeting people outside their comfort zone, hooking up would be with relative strangers and does not feel safe to anyone, and perhaps the men mature as well. Women can insist on real dates and relationships in this new social environment.
Bogle describes a limited time period in which women get involved in casual sex for a time, get tired of it and want real relationships, but don't feel that they have other options. These women seem to feel coerced into hook-ups: not at a level of sexual contact beyond their comfort level, but in a non-relationship context that is beyond their comfort level. After college, women find more power in the romantic arena and are able to have relationships as they want.
This reminds me of the story of the group sex in Atlanta suburbs hosted by 13-16 year old girls that led to a syphilis outbreak. This interview talks about how the girls say that they started having group sex parties partially out of boredom, and partially for similar motivations as the freshman college women reported for hook-ups: curiosity, interest, independence. After awhile, though, the girls felt that they couldn't control the situation any longer: both within an actual event and over many events. At a single event as activity escalated, girls felt unable to slow or stop the activity, especially when with multiple males simultaneously. After going to a few activities, girls felt unable to turn down future activities. The girls engaged in sexual activity with each other as a means of controlling the activity together. Reading that description, I keep thinking of some generally misogynist contexts --- women trafficked into commercial sex work, perhaps --- and have to remind myself that these are upper middle class girls in the US who are told they can become doctors and lawyers and astronauts.
The girls here clearly seem to have less control than the hook-up case because they feel out-numbered and pressured by other attendees, and are obviously less mature and less confident and below the age of consent. Nonetheless, it's interesting that there is a similar dynamic here as well: becoming involved completely willingly initially, and ending up feeling coerced or forced into sexual contact that they did not want both within a single episode and within their social context.
College graduation and syphilis, respectively, intervened, but what if they hadn't? It seems so easy for an outsider to say that a woman should just walk away from a situation she is so uncomfortable with, and yet clearly they didn't feel able to. What inner resources do women need in order to extricate themselves from an uncomfortable situation filled with social pressures? It looks so easy on Degrassi Junior High: one girl finally gets uncomfortable enough to say "Enough! This is not cool." and then everyone suddenly realizes she is right. If nothing else surely these girls have seen Degrassi Junior High or similar! Clearly it's not that easy, and eventually it sounds like the girls did stand up and stop this, maybe before the syphilis, but not after they'd been well past the point of feeling forced and out of control and like they might be traumatized for their future sexual experiences.
No answers, just questions.
Hooking Up by Katherine Bogle is about casual relationships in college. She studied two colleges: one small and religious, and one secular and larger. Freshman young women hook-up initially out of a mixture of curiosity, interest, exercising independence from earlier restrictions, and perhaps because it's what others are doing. By hooking up these college students mean anything from kissing to oral or vaginal sex, with or without alcohol, but according to their reports one time hookups are more likely to be at the less intimate end of the spectrum and alcohol is a good social excuse ("beer goggles"). Hooking up is almost always with an acquaintance or an acquaintance of an acquaintance: the closed atmosphere of a college makes women feel safe being alone with someone they just met. Within a year or two, most of the women report that they stopped being so interested in hooking up: they want a real relationship. The dynamic on campus, though, is still aimed at hooking up. The guys who are unassertive are not part of the hook-up culture at all, and they don't date much either. The guys who are assertive are part of the hook-up culture, and seem to have numbers in their favor: they can almost always find a woman willing to hook up with them, so a woman who wants to have any sexual contact and sees her dating pool as comprising such guys has the choice between hooking up or not hooking up: they do not feel that they have the option of a relationship. Some women hook up and hope for a relationship, and are inevitably disappointed. They don't talk about why they don't go for relationships with the nice guys, though probably for the clicheed reasons.
After college, the women are able to assert themselves: they are meeting people outside their comfort zone, hooking up would be with relative strangers and does not feel safe to anyone, and perhaps the men mature as well. Women can insist on real dates and relationships in this new social environment.
Bogle describes a limited time period in which women get involved in casual sex for a time, get tired of it and want real relationships, but don't feel that they have other options. These women seem to feel coerced into hook-ups: not at a level of sexual contact beyond their comfort level, but in a non-relationship context that is beyond their comfort level. After college, women find more power in the romantic arena and are able to have relationships as they want.
This reminds me of the story of the group sex in Atlanta suburbs hosted by 13-16 year old girls that led to a syphilis outbreak. This interview talks about how the girls say that they started having group sex parties partially out of boredom, and partially for similar motivations as the freshman college women reported for hook-ups: curiosity, interest, independence. After awhile, though, the girls felt that they couldn't control the situation any longer: both within an actual event and over many events. At a single event as activity escalated, girls felt unable to slow or stop the activity, especially when with multiple males simultaneously. After going to a few activities, girls felt unable to turn down future activities. The girls engaged in sexual activity with each other as a means of controlling the activity together. Reading that description, I keep thinking of some generally misogynist contexts --- women trafficked into commercial sex work, perhaps --- and have to remind myself that these are upper middle class girls in the US who are told they can become doctors and lawyers and astronauts.
The girls here clearly seem to have less control than the hook-up case because they feel out-numbered and pressured by other attendees, and are obviously less mature and less confident and below the age of consent. Nonetheless, it's interesting that there is a similar dynamic here as well: becoming involved completely willingly initially, and ending up feeling coerced or forced into sexual contact that they did not want both within a single episode and within their social context.
College graduation and syphilis, respectively, intervened, but what if they hadn't? It seems so easy for an outsider to say that a woman should just walk away from a situation she is so uncomfortable with, and yet clearly they didn't feel able to. What inner resources do women need in order to extricate themselves from an uncomfortable situation filled with social pressures? It looks so easy on Degrassi Junior High: one girl finally gets uncomfortable enough to say "Enough! This is not cool." and then everyone suddenly realizes she is right. If nothing else surely these girls have seen Degrassi Junior High or similar! Clearly it's not that easy, and eventually it sounds like the girls did stand up and stop this, maybe before the syphilis, but not after they'd been well past the point of feeling forced and out of control and like they might be traumatized for their future sexual experiences.
No answers, just questions.
Monday, November 24, 2008
My favorite safer sex pamphlet
I pick up safer sex pamphlets wherever I find them, and so far my favorite is the Fenway Health Center's pamphlet. It gives a much broader range of sexual activities than any I've seen, and lists exactly which STDs are transmissible by them, and which STDs are transmitted by skin-to-skin contact so cannot be protected against by condoms.
A real problem in sex ed is how to talk about the skin-to-skin contact STDs. Sometimes they don't get mentioned except in an oblique way such as "The safest sex is no sex at all. Condoms cannot make you 100% safe." which can be read by the optimistic as implying 90% protection against all diseases. (In the abstinence-only literature, it's phrased as "Condoms can leave you vulnerable to many horrible diseases." which sounds like condoms are no good at all.) I like that this pamphlet treats STDs as individual entities each with their own transmission risks, rather than over-simplifying them.
They do not mention which STDs are commonly tested for in different clinical settings and which tests may need to be specially requested, which is an unfortunate gap because testing practices vary and many people speak of STDs as something tested for as if there were just one test for all known STDs when some STDs aren't tested for at all (e.g., as far as I know, no one screens men for HPV.)
A real problem in sex ed is how to talk about the skin-to-skin contact STDs. Sometimes they don't get mentioned except in an oblique way such as "The safest sex is no sex at all. Condoms cannot make you 100% safe." which can be read by the optimistic as implying 90% protection against all diseases. (In the abstinence-only literature, it's phrased as "Condoms can leave you vulnerable to many horrible diseases." which sounds like condoms are no good at all.) I like that this pamphlet treats STDs as individual entities each with their own transmission risks, rather than over-simplifying them.
They do not mention which STDs are commonly tested for in different clinical settings and which tests may need to be specially requested, which is an unfortunate gap because testing practices vary and many people speak of STDs as something tested for as if there were just one test for all known STDs when some STDs aren't tested for at all (e.g., as far as I know, no one screens men for HPV.)
Monday, June 23, 2008
The other pledge
A condom company has created a condom pledge program. They'll give a free sample to anyone who takes the following pledge:
Already they have over 100,000 condom pledgers and have created a map of the pledgers' locations, a number which took the virginity pledge about 4 months to reach. Amusingly, the first minute of the video on their site could have been a video for an abstinence program.
Of course I support the message of the pledge, but somehow I don't see any reason to think this pledge would be any more effective than virginity pledges. Nice marketing idea, though! It looks like public service and piggybacks onto a well-known political issue at a time of high awareness.
"I pledge to embrace and advocate for the use of condoms, as a proven way to reduce the risk of unintended pregnancy and sexually transmitted infections and as an essential part of living a sexually healthy lifestyle."
Already they have over 100,000 condom pledgers and have created a map of the pledgers' locations, a number which took the virginity pledge about 4 months to reach. Amusingly, the first minute of the video on their site could have been a video for an abstinence program.
Of course I support the message of the pledge, but somehow I don't see any reason to think this pledge would be any more effective than virginity pledges. Nice marketing idea, though! It looks like public service and piggybacks onto a well-known political issue at a time of high awareness.
Monday, June 2, 2008
"More sex is safer sex"
"More sex is safer sex" is the title of Freakonomics author Steven Landsburg's latest book. The title idea is taken from Landsburg's 10 year old Slate column, based on a paper by Michael Kremer, but the book was published last year. The argument seems to be that the most promiscuous spread disease, so if people with few sex partners each added a sex partner, those with many sex partners would have to have fewer partners, and there would overall be less disease transmission. In other words, abstinence messages appeal to those with few lifetime sexual partners, increases the variance in the number of sex partners, and spreads more disease.
Gil Kalai covers the idea briefly in his review of the book in the AMS bulletin, and phrases it in terms of graph theory: if people are nodes in a graph, and each sexual encounter is an edge, then "if we fix the number of edges (sexual encounters), then the epidemic will spread more rapidly when the variance in the degrees of the vertices is larger."
That assumption that the number of sexual encounters in a population is fixed would be interesting to test. Population-level properties are usually not investigated when studying interventions: people tend to look at individual-level outcomes. Since the goal of abstinence education is to decrease the total number of sexual encounters in a group, or in wonky jargon "decrease the size of the sexual pie", it would be interesting to see if that were true. To extend the idea even farther, we could go from micro-level behavior to the macro, and look at the elasticity of demand for sexual encounters in a population, using macro-level data and standard (flawed) macro demand equations.
Another way of saying "More sex is safer sex" is "If sex is made deviant, only deviants will have sex." Logically, I can't help but think of, "If guns are outlawed, only criminals will have guns," but, oddly, the overlap between the gun control and sex control lobbies is very small.
Gil Kalai covers the idea briefly in his review of the book in the AMS bulletin, and phrases it in terms of graph theory: if people are nodes in a graph, and each sexual encounter is an edge, then "if we fix the number of edges (sexual encounters), then the epidemic will spread more rapidly when the variance in the degrees of the vertices is larger."
That assumption that the number of sexual encounters in a population is fixed would be interesting to test. Population-level properties are usually not investigated when studying interventions: people tend to look at individual-level outcomes. Since the goal of abstinence education is to decrease the total number of sexual encounters in a group, or in wonky jargon "decrease the size of the sexual pie", it would be interesting to see if that were true. To extend the idea even farther, we could go from micro-level behavior to the macro, and look at the elasticity of demand for sexual encounters in a population, using macro-level data and standard (flawed) macro demand equations.
Another way of saying "More sex is safer sex" is "If sex is made deviant, only deviants will have sex." Logically, I can't help but think of, "If guns are outlawed, only criminals will have guns," but, oddly, the overlap between the gun control and sex control lobbies is very small.
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