Welcome to the first official post for Bedside Manners. As a sexual health researcher and book author, I receive a lot of emails from women and men who are dealing with sexually transmitted diseases. Yesterday, I replied to Liza, a 25 year-old married, monogamous woman who had just been diagnosed with a serious cervical HPV infection and treated via LEEP. She could not understand how this had happened, since she had been getting pap smears during her annual gynecological exams for the past 10 years, and her husband had never been diagnosed with genital warts. Her doctor told her it was “bad luck,” and now she is worried about the possibility of having an oral HPV infection, wondering whether her cervical infection is cured, and trying to figure out how to this will affect her marriage.

By getting annual pap smear exams, Liza has been doing the right thing. Unfortunately, most medical practitioners don’t explain that pap smears only sample a small area of a woman’s cervix. So, it is possible to receive a “normal” pap smear result when there are HPV-infected/abnormal cell changes in other portions of the cervix.

With Liza’s husband as her only sexual partner, it’s key for him to get thoroughly examined for HPV/genital warts. If HPV-infected cells are found, then he should have them removed via one of several treatment options. Once both of their bodies have healed from treatments, the couple should strongly consider using condoms during sex (note: condoms reduce but do not eliminate the risk of HPV transmission).

Given Liza’s concern about oral HPV, a ‘HPV test’ can determine the specific strain of the virus. HPV 16 has been linked to cervical cancer and to oral/head/neck cancers. So, an important follow-up exam after receiving a genital HPV diagnosis is to see a dentist: I encouraged her to share that she’s been exposed to HPV orally and request a thorough exam.

As I concluded my reply to Liza, I realized that I needed to address the stress that she was clearly experiencing. Medical sociologists have often written about how disease can cause dis-ease, an illness often causes a patient to lose her sense of wellbeing. In the case of socially stigmatizing and medically incurable infections, like HPV, stress is almost unavoidable for newly diagnosed patients. In my book, Damaged Goods?, I detail specific strategies for handling the variety of stressors that come with a genital HPV or herpes infection, but I’ve decided to wrap up today’s post with a general note about stress.

I was fortunate to attend a talk last night by the authors of a new book, The Inner Game of Stress. Tim Gallwey has teamed up with two physicians, who practice a patient-centered approach to integrative medicine, to combine medical research with his executive coaching techniques. The result is a thoughtful self-help approach to stress management that encourages readers to be assertive patients. As a medical sociologist, I have written about the health impacts of practitioner-patient interactions and was familiar with the body of research showing how stress can weaken a person’s immune system.

For people, like Liza, who are battling a virus, it is important to not only empower yourself with knowledge about your particular illness but also to strategize how to strengthen your immune system. In addition to the obvious recommendations of decreasing unhealthy behaviors and increasing healthy ones, I encouraged her to find sources of emotional and social support. Some who are facing a stigmatizing illness may find comfort by talking with trusted friends, while others may prefer the neutrality of a therapist, and many may find empowerment in a book. 

Travels and graduations behind us, we’re back! This month foremost on our minds is the issue of budget cuts. How many times will history have to repeat itself before we get it right?

Question: What do cuts in services for disabled and vulnerable people, shoddy food regulation practices that are making people in some states very sick, the recent rise in crime and simultaneous reductions in police resources, and even Nebraska’s inability to provide adequate services for troubled children and their families have in common?

Answer: These recent phenomena can be traced in some part to the reduction in social services that is common in national, state, and local budgets when trying to prevent the onset of a deep fiscal crisis. While these phenomena are all deeply troubling, even more troubling is the fact that there is historic evidence that such cuts do not work and, in many cases, actually have the opposite effect. That is, when the state no longer pays for things like health care, education, and even local security, there are extremely negative consequences for everyday people, especially for vulnerable groups such as the elderly, the disabled, and children, who depend on such services for daily survival.

In the 1980s, the world saw the effect of these policies writ large in the international arena, with so-called “Structural Adjustment Plans”, or plans put in place by the World Bank and the International Monetary Fund (IMF), which laid out various conditions that had to be met by countries in order to get a loan from both establishments. Most of these conditions involved the opening of markets, “free” trade conditions, and extreme reductions in state provisions of social services like health care and education; it was argued that such services should instead be privatized. In short, the prevailing sentiment was this: let the markets take over and we’ll see what happens.

What happened was that structural adjustment plans had disastrous effects, particularly in many parts of Latin America (where the period of heavy structural adjustment has led many to refer to the 1980s as the “lost decade”) and Africa (where 34 countries implemented some form of a structural adjustment plan in the 1980s). Further, women were the ones to bear the brunt of many of the negative effects of these policies. According to Dzodzi Tsikata of the Third World Network, this is because such policies “assume the unlimited availability of women’s unpaid labour and time and… have tended to see women as a resource to be tapped to promote the efficiency of free market policies and to deal with the short-fall in access to social services.” In many instances, this leads to an increase in women’s working burdens and social responsibilities. In other words, women are expected to shoulder the majority of the burden of reductions in state provided services. And this phenomenon is not limited to developing countries (and surely not when the developing countries in question are following the economic prescriptions of their Western donors and lenders) – critics in the US have also argued that domestic budget cuts have a disproportionate effect on women and children.

The USA’s neighbor up north hasn’t done much better. Kathleen Lahley, a Law professor at Queen’s University in Canada outlined in her gender analysis of the 2009 budget, key ways in which the Canadian government has missed the mark. Not only does her analysis make for good reading, it also demonstrates how women in Canada will not directly benefit as much as men will from the $64 billion in spending and tax cuts. Gender equity requirements have not been included in the spending programs – the result is a gender-skewed stimulus.

With so much evidence on the negative effects of cuts to social services, one wonders why this model is still pursued in such a fashion and, further, whether there are any movements (policy or otherwise) to reverse the ongoing trend, particularly as global leaders consider changes to international economic frameworks in light of the recent crisis.

As we can see, leaders in North America don’t seem to be the fastest learners, but what about the rest of the world? The World Bank and the IMF? In 2007 Elaine Zuckerman, a former World Bank economist, challenged the Bretton Woods institutions to improve their track record of short-changing women. For all intents and purposes, it seems that World Bank President, Robert Zoellick, is trying to rise to the challenge. At last month’s G20 meeting in London, he spoke of the Bank’s plan to develop a Vulnerability Framework. The fund would provide support infrastructure, agriculture, small- to medium- size businesses and micro-finance. Past lessons may just be paving the way to a more gender-balanced future for the World Bank. This plan would benefit not only men through infrastructure jobs, but also women who are heavily involved in agriculture, are the majority of small business owners, and represent 85% of the poorest 93 million clients of Microfinance Institutions. This effort would require a contribution of 0.7% of more “developed” countries’ stimulus packages. Maybe this is their way of making up for the gaping holes left at home through budget cuts…nice but gender equality should happen at home too.

Who would have thought that the G20 would bring us even more good news?! We were a bit skeptical at first; the official documents that come out of these meetings rarely mention gender equality. Oh, we of little faith! The G20 countries pledged to support the World Bank’s Vulnerability Framework AND addressed the human dimension to the crisis and the pledge to “build a fair and family-friendly labour market for both women and men.” Steps in the right direction. Let’s hope this will manifest itself in thoughtful gender-conscious budget cuts across the board. The entire Official Communique can be seen here.

Finally, Argentine President Cristina Fernández de Kirchner called for a “new starting point” in hemispheric relations at the recent Fifth Summit of the Americas in Trinidad and Tobago (the country that gave you Blogger TAB 🙂 ). While much attention has been given to Presidents Obama, Castro and Chavez, we recommend you take a look at President Fernandez’s speech, which was in our opinion one of the, if not the, best (though we haven’t been able to find any links to it). Further, the Summit’s Declaration of Commitment’s preamble Point 6 is calypso music to our ears: “We recognize the importance of considering the differentiated needs of women and men in promoting and ensuring the integration of the gender perspective as a cross cutting issue in national and hemispheric policies, plans and programmes to be implemented in the political, economic labour, social and cultural spheres…’’

At the very least, countries globally have demonstrated a rhetorical commitment to gender-balanced recovery and development. It remains to be seen how these plans will be put into action. Judging from past experiences, the best way to ensure that these rhetorical commitments are implemented in practice is through the work of gender researchers, advocates and practitioners, who must hold governments and international organizations accountable for the commitments that they make in these international forums. So, please, join us in reminding local, state, and national leaders to stick to their commitments to build a more gender-inclusive world. Let the fiscal crisis be used as an opportunity to strengthen gender equitable programs – not an excuse to cut much-needed services for women, men, and children.

Image Credit

This review comes to GWP courtesy of Jenny Block, author of Open: Love, Sex and Life in an Open Marriage.  You can read more about Jenny’s work at www.jennyonthepage.com

My Little Red Book
Edited by Rachel Kauder Nalebuff
Twelve (Feb. 2009)

I wanted to like this book. I really did. I love the idea of it, women sharing stories about something that we’re not “supposed to” share stories about. The problem is that without stories from every corner of the globe, every generation, every rung of the socioeconomic ladder, and so on, what you end up with is redundancy.

And that is precisely the problem with Rachel Kauder Nalebuff’s My Little Red Book, I’m afraid. The material would certainly be terrific for an article, preferably written by a remarkable writer gifted with profound insight. And there certainly are a few pieces that were wonderful, like Patty Marx’s curt “Can I Just Skip This Period?” and Ellen Devine’s raw and humorous “Hot Dog on a String.” But for the most part, the pieces were generally the same.

more...

Is this a new day, or what?! Check out these two headlines, both from this morning:

First Embryonic Stem-Cell Trial Gets Approval from the FDA – WSJ

Obama Ends Funding Pan for Abortion Groups Abroad – Yahoo

(Thanks, Virginia, for the heads up!)

What Will Hillary Do? The latest:

Ted Kennedy Asks Hillary Clinton To Head Senate Healthcare Team
11/19/08
LA Times: Sen. Hillary Rodham Clinton (D-N.Y), considered a prominent contender to become secretary of State in the Obama administration, was offered an alternative Tuesday — to be a senior member of the Senate team aiming to overhaul the nation’s healthcare system.

Why Obama Wants Hillary for His ‘Team of Rivals’
11/20/08
Time: As he wrapped up his second week as President-elect, it was clear that Obama was taking the long view in both diplomacy and politics. How else to explain the fact that he had all but offered the most prestigious job in his Cabinet to a woman whose foreign policy experience he once dismissed as consisting of having tea with ambassadors?

And while we’re on the subject of Cabinet appointments:

Will Tom Daschle Be The Secretary Of HHS The Reproductive Rights Community Wants?
11/19/08
RH Reality Check: Former Senate Majority Leader Tom Daschle’s record on reproductive and sexual health and rights is a mixed one.

Yep, that’s right, it’s Health Education Week–and Healthcare Quality Week as well.  If you’re looking for material to blog about, here are some orgs and blogs I’ve recently learned about (thank you, Ejima!).  Just wanting to spread the word:

National Women’s Health Network
National Latina Institute for Reproductive Health
RHReality Check
University Coalitions for Global Health blog
BlogHer Health and Wellness
Women’s Health News
ACLU’s reproductive rights blog

Has anyone heard of any blog actions on health taking place this week? If so, please share in comments!

So check out the new widget (scroll down, right) from the Women’s Media Center! Shiny, no?

Among today’s tidbits from the widget, health research with a twist of gender:

Men, Women and Speed. 2 Words: Got Testosterone?
8/21/08
NY Times: Researchers say there is no one physiological reason for the gender gap in sports, although there is a common biological thread. Testosterone gives men what he calls a bigger and better-fueled engine.

Positive Thinkers ‘Avoid Cancer’
8/22/08
BBC: Women who have a positive outlook may decrease their chances of developing breast cancer, say Israeli researchers. The small study, published in the BioMed Central journal, also found that getting divorced, or being bereaved could increase the risk. But the researchers admitted that women were questioned after their diagnosis, which might significantly change their outlook on life.

Wait. Stop. Rewind. HUH??

Here today is Adina Nack with a fantastic guest post on how STD stereotypes have led to the mismarketing of the HPV vaccine as a cervical cancer vaccine. An associate professor of sociology, who has directed California Lutheran University’s Center for Equality and Justice and their Gender and Women’s Studies Program, and author of Damaged Goods?, Adina asks some provocative questions about the consequences this gendered mislabeling will have for public health awareness. –Kristen

The “Cervical Cancer” Vaccine, STD Stigma & the Truth about HPVby Adina Nack

You’ve probably seen one of Merck‘s ads which promote GARDASIL as the first cervical cancer vaccine. Last year, their commercials featured teenage girls telling us they want to be “one less” woman with cervical cancer. GARDASIL’s website features new TV spots which say the vaccine helps prevent “other HPV diseases,” too, and end with, “You have the power to choose,” but do you, the viewer, know what you are choosing?

A clue that this is a STD vaccine appears briefly at the bottom of the screen: “HPV is Human Papillomavirus.” Merck’s goal may have been to appeal to parents who are squeamish about vaccinating their daughters against 4 types of virus which are almost always sexually transmitted. This marketing strategy means that the U.S. public, currently undereducated about HPV, is none the wiser about this family of viruses which infect millions in the U.S. and worldwide each year. When the ads briefly mention “other HPV diseases,” how many realize they’re talking about genital/anal warts and that recent studies link HPV with oral/throat cancers? [You don’t need to have a cervix (or even a vagina) to contract any of these “other” HPV diseases.] Why don’t they want us to know the whole truth about the vaccine?

Branding GARDASIL as a cervical cancer vaccine was aimed at winning public support. But, what are the consequences of a campaign built on half-truths? Today, only females, ages 9-26, can be protected against strains of a virus that may have serious consequences for boys/men and women past their mid-20s. If public health is the goal, then let’s question how our STD attitudes shaped a marketing plan which has, in turn, influenced drug policy.

Marketing a “cervical cancer” vaccine may have appeased some social conservatives who don’t want their daughters vaccinated against any STD, fearing it might promote premarital sex. But, the vaccine will likely soon be available to males, and their anatomy does not include a cervix — will girls get a “cervical cancer” vaccine and boys get a HPV vaccine? The current gender-biased policy supports a centuries old double-standard of sexual morality. Most view STD infections as more damaging to women than to men. Many believe that STDs result from promiscuity — girls/women deserve what they get. So, are we ready to embrace any STD vaccine (including a future HIV vaccine) as a preventive health measure?

Having studied women with HPV, I know that a person can contract the virus from nonconsensual sex or from their first sexual partner — you could still be a ‘technical’ virgin since skin-to-skin contact, not penetration, is the route of transmission. In my new book, Damaged Goods?, I take readers inside the lives of 43 women who have struggled to negotiate the stigma of having a chronic STD. One chapter delves into stereotypes about the types of people who get STDs: these beliefs not only skew our perceptions of STD risk (bad things only happen to bad people) but also can psychologically scar us if we contract one of those diseases. Merck’s branding of GARDASIL makes sense: a typical U.S. teenage girl or young woman has good reason to fear others’ judgments of her — thinking her to be promiscuous, dirty, naïve, and irresponsible — if they knew she’d sought out a STD vaccine. Whereas, getting a “cervical cancer” vaccine feels more like something that a responsible girl/woman would do.

Unfortunately, with GARDASIL taking the easy way out, the U.S. public misses a prime opportunity to learn about this prevalent, easily transmitted disease that is unfortunately difficult to test for. We’ve also lost a chance to take on STD stigma and challenge the population to view sexually transmitted infections as medical problems rather than as blemishes of moral character.

No vaccine is 100% effective and neither are the treatment options for HPV infections. STD stereotypes (particularly negative about infected women) come back to haunt those of us who become infected with diseases like HPV and herpes, which are treatable but not curable. Until there’s a ‘magic bullet’ cure, we should educate ourselves not only about medical facts but also about STD stigma — the anxiety, fear, shame and guilt — that often proves more damaging to the lives of those infected than the viruses, themselves.