sexual health

Does it matter when popular stories about “sex trafficking” are based on half-truths, junk science, and/or religious beliefs? Given that many people are interested in the issue of human trafficking in general and human trafficking in the sex industry in particular, it is critical that we face the consequences of stories told in the name of rescuing girls and women.

Since the passing of the Trafficking Victims Protection Act of 2000 (TVPA), stories of human trafficking have been well integrated into the American cultural imagination. While there are now many more reliable scholarly resources on human trafficking today then there were at the turn of the 21st century, many individuals still derive most of their knowledge about human trafficking from sensationalistic media stories about so-called “sex trafficking.” [i]

In the United States, mediated stories of human trafficking of sex workers vary around specific contextual details of who, when, and where, but they consistently portray the same messages about why and how. Hollywood action-adventure characterizations of victims and villains are deployed; complex structural problems are squeezed into personal morality tales; and the stories are then used by anti-sex work politicians and activists to justify heightened forms of criminal punishment. While the stories may have popular appeal, evidence suggests that more criminalization actually hurts all sex workers across the continuum of privilege and oppression.

The argument I will make here is organized around the following interrelated points:

1. We must critically interrogate dominant stories told about people in the sex industry. (There are numerous examples, but I will focus here on the content and impact of recent feature length film in particular, The Abduction of Eden);
2. Such stories justify the criminal punishment system via rescue/capture methods as an avenue for social justice (this includes laws being proposed right now in Washington State);
3. Because the criminal punishment system has a long history of destroying the lives of poor people and people of color — including those of sex workers — academics and activists concerned about people in the sex trade need to rethink this entire set of dominant stories and strategies.

1. Demonizing tales
While there are a plethora of sensationalized media stories about coercion, abuse, and trafficking in the sex industry one recent story – Abduction of Eden (AKA Eden, released 2012) – provides a powerful blend of Hollywood and Biblical tropes. This in combination with the promise that Eden is a “true” story makes it a productive one for understanding the relationship between American cultural storytelling and political policies about sex work and human trafficking.

Eden is a feature length film directed by Seattle filmmaker Megan Griffiths derived from the allegedly true story of Chong Kim. The protagonist (actress Jamie Chung) – a naïve 17 year old girl with hard working, Korean immigrant, Christian parents – is kidnapped and brought to a warehouse/jail with dozens of thin, young, feminine, cisgender, and (mostly white) girls who are forced to stand obediently in line wearing identical white underwear-tanktop sets. The protagonist’s (now renamed “Eden”) first assignment is on a BDSM porn set; she sobs as her hands are handcuffed and pulled upward. At her next job Eden attempts a dramatic escape; bloody and screaming she runs into a suburban backyard with white women drinking white wine (they don’t call the police and Eden is recaptured). We learn that Eden’s best friend in the prison/brothel was stolen at age 13, and when her friend gets pregnant and gives birth, her baby is also stolen and sold. A message portrayed in Eden is that when girls disobey or simply grow too old for the work (20+ years of age) they are executed. The film also implies that this sex trafficking operation is part of an international network directed from outside the US. Although the external controller is never named, there are Russian men working for the operation and Dubai is frequently mentioned. This includes a scene where the drug-addicted supervisor (Vaughn/Matt O’Leary) threatens Svletlana (Naama Kates), a blonde Russian woman with being sent back to Dubai, where she “can get dicked by donkeys all day.”

If these themes are not enough to convince the average American viewer that the world of sex work is pure evil (relying on enslaved cisgender girls enacting forced BDSM porn and probably dictated by an international network of men from Russia and the Middle East who have sex with donkeys), the film hits home the message with multiple Biblical references and metaphors.

This includes the obvious metaphor about the Garden of Eden. It also includes a scene where God appears in the body of a tall white deputy named Ron Greer (Tony Doupe). When Greer questions the corrupt, murderous federal marshal Bob Gault (Beau Bridges) about his possible role in a double homicide, Gault/Bridges looks upward with fear in his eyes and says: “Lord. How are your leads coming?” When Greer informs him that his cell phone activity was picked up near the scene of the crime, Gault replies: “I’ll be damned.” Greer responds: “Well I surely hope not.”

What Eden viewers may not be aware of is that there are many counter-narratives to the “truth” claims of such messages. For example:

• While there are certainly degrees of coercion or lack of choice found in all jobs especially unregulated or informal economy labor including the sex industry, the portrayal of a warehouse of dozens of kidnapped teenage girls being forced to be prostitutes is simply not consistent with reliable data about the experiences of contemporary sex workers, especially as practiced in the U.S.
• Individuals representing a spectrum of genders, sexes, races, ages, social classes, sexual orientations, and body types work as sex workers.
• BDSM is a consensual sexual lifestyle choice for many people as is participation in pornography – but both of these activities have long been demonized by conservative feminists and religious groups. The stigma and fear of BDSM and porn can thus be used as an easy tool to invoke shock and horror from people who are morally opposed to both.
• Despite narratives about international “sex trafficking rings,” critical criminologists describe trafficking in the sex industry as better described as “crime that is organized” (rather than “organized crime”).[ii]
• Eden was produced and consumed within a broader U.S. cultural context where fictitious claims about “sex trafficking” are common, ranging from grossly inflated and unreliable global estimates, to debunked claims that the Superbowl creates an uptick in sexual slavery, and statistically untenable assertions that the “average age” of women entering prostitution is 13-14.[iii]
• As it turned out, none of the content of Eden was based in truth. In June of 2014 multiple investigators into Chong Kim’s story found that she lied about the everything.[iv] Kim was investigated and charged for fraud by a variety of anti-trafficking organizations.[v] But Eden still had several years of celebrity adoration before this news broke.

Initial mainstream responses to Eden
Even before its official release, mainstream (non-sex worker and non-allied) audiences and critics went wild over the story of Eden. While many found the performances impressive and the action-adventure storyline gripping, what sealed Eden’s critical success was that people believed that this story was true. Feminist and women’s groups, churches, and film festivals sponsored screenings; awards were given, local anti-sex work/trafficking politicians were featured, people became enraged en masse and were motivated to join the crusade. The text of Eden folded seamlessly into the curriculum of U.S.-based anti-sex trafficking efforts with its images of taped mouths, chained wrists risen toward the heavens, “in our own backyard” and “stolen innocence” messages, and the idea that the average age of sex trafficked girls in the U.S. is age 13. The true story of Eden appeared to be an American anti-sex trafficking activist’s dream come true.

Even mainstream/secular journalists converted to Eden’s cause, infusing their reviews with Judeo-Christian language and imagery. David Schmader of the progressive Seattle based periodical The Stranger called Eden “a miracle.”[vi] James Rocchi of MSN Entertainment described Eden as “a rewarding, righteous example of how fiction can tell the truth.”

Anti-sex work apologists may try to explain away the embarrassment around Eden (as well as other high profile “sex trafficking” stories)[vii] as just an anomaly, or as a few people stretching the truth for a good cause. But Eden is just the visible cultural iceberg of a story that has already become embedded into U.S. policing practices.

2. Context of U.S. policing & criminalizing policies
Part of the reason for the success of Eden is that it was preaching to an American choir that already had the why and the how part of the story in place. It also complemented dominant approaches to end trafficking in the sex industry that feature coercive “law and order” methods where participants are either forced to be rescued/reprogrammed or captured/incarcerated. The rescue side is led predominantly by well-meaning (and mostly white) middle-class women and men (Christians, social workers, feminists) attempting to “save” cisgender girls and women from sex work. The capture side is directed by (predominantly white) men in policing agencies (police, FBI, Homeland Security) who capture girls and women for rescue and men for punishment.

The dynamics between the rescuers/rescued and capturers/captured can also underscore racist power relations. To borrow from Gayatri Spivak’s famous phrase, “white men are saving brown women from brown men”[viii]: Anti-sex trafficking crusaders are often white men and women saving (all cisgender) women from (black and brown) men.

However, we are now in a cultural moment – thanks in part to the Black Lives Matter movement – where many white middle class people are collectively and finally having an epiphany around the reality of police brutality, mass incarceration, and criminalization of everyday life for poor communities and communities of color.[ix] But what many people have not yet made the connection on is how these same principles need to be applied when evaluating the war on trafficking.[x] This war combines many of the same strategies from the “war on drugs” and the “war on terror” (targeting “urban gangs,” people of color and immigrants) to create even more invasive policing and surveillance mechanisms of marginalized people’s everyday lives.

This brings me to the current legislative climate in Washington State: the location where Eden was produced. Washington is currently facing several new state legislature bills intending to create more criminal penalties for clients of sex workers[xi]. The bills are largely generated and coordinated from the desk of Washington State senator Jeanne Kohl-Welles, who is a long time supporter of state level anti-trafficking legislation.

An earlier anti-trafficking bill (also sponsored by Kohl-Welles) resulted in harsh felony punishment for domestic “traffickers” in Washington State. The first individual sentenced under this new law in 2009 was a 19-year-old African American man working as a pimp/manager/boyfriend to a group of young African American women in West Seattle.[xii] He sits now with many other young men of color in prison, many of whom were first incarcerated under the failed and racially discriminatory “war on drugs,” and now also increasingly incarcerated in the name of the war on “sex trafficking.”

With Federal and State punishments now locked in for “traffickers” in Washington State, the new set of proposed state laws are now set on the clients as part of the “end the demand” approach (AKA the “Nordic Model”). The idea is that if men are given harsh enough criminal and social punishments for buying sex, then they will stop trying to buy it. This is a popular idea with contemporary anti-sex work activists despite the fact that:

• there is no reliable empirical evidence to support that this approach is helpful for reducing harms to sex workers,[xiii]
• leading global health experts oppose any form of criminalization in the sex industry due to the health harms it poses for sex workers,[xiv]
• sex worker activists and advocates have consistently documented the harms of criminalization and policing on the well-being and human rights of people in the sex industry,[xv]
• these policies criminalize sexual interactions between consenting adults, and:
• more criminalization ≠ social justice.

Is there a connection between sensationalist “sex trafficking” stories such as Eden and policies that hyper-criminalize the sex industry? I think there is. Not only do these stories serve as a popular master narrative around the sex industry; in this case the critical acclaim for Eden (and its director, Megan Griffiths) is also intertwined with the success of Kohl-Welles’s push for increasingly harsh anti-sex trafficking legislation in Washington State. At a May 2013 screening of Eden, Kohl-Welles was featured as an expert on sex trafficking; Kohl-Welles subsequently supported the Motion Picture Competitiveness Bill in Washington State, which directly benefits filmmakers like Griffiths. In October 2014 Griffiths spoke in support to Kohl-Welles’ re-election.

3. Work with sex workers, not against them
Many progressive individuals and communities aspire to support the war against trafficking, and want to trust that laws that criminalize men actors will help girls and women who are coerced, abused, or trafficked in the sex industry. However, evidence from global health and human rights researchers consistently show that more criminalization hurts all sex workers across the continuum of privilege and oppression.

Because of the harms of criminalization:

• We must insist that the voices of a diverse range of sex workers be included in all panels and policy discussions that impact them.[xvi]
• It is time for class- and race-privileged individuals to examine their own complicity in supporting sensationalistic stories and moralistic rescue/capture policing strategies.
• People concerned about exploitation in the sex industry should join activists working for the labor and human rights of people working in the sex industry. This includes opposition to criminalization of consensual adult sexual exchanges.
• Rather than seek to punish individuals who are already marginalized, and/or punish people for engaging in adult consensual sex, it is time to work with sex workers against systemic punishment, criminalization, and institutional exclusion of women, people of color, poor people, trans* individuals, undocumented people, and homeless youth – many of whom rely on the informal economy including sex work.

If you care about improving the lives of people in the sex trade it is time to advocate for a greater diversity of sex worker stories and perspectives on how to first discuss and then solve coercion and abuse in the sex industry. There may certainly still be space for religious beliefs and metaphors in this wider diversity of stories and plot lines. However, if one truly listens to the bottom line perspectives of sex workers around the world, it will become clear that we need to look beyond the criminal punishment system for solving social justice issues.

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References and further readings:

This essay is an extension of an argument that I made in an earlier publication, which was featured as a dialogue/debate amongst experts on human trafficking: Lerum, K. 2014 (Winter). “Human Wrongs vs. Human Rights.” Contexts.

• [i] Many individuals advocating for sex worker rights, myself included, object to the term “sex trafficking” arguing that the term prioritizes moralistic, limited, and objectifying notions of the product (“sex”) rather than on the people producing that labor (sex workers). Many sex workers’ advocates thus argue for a different way of talking about the issue: e.g. “human trafficking of sex workers” (not “sex” trafficking). Just as people refer to “human trafficking of agricultural workers” (not “food” trafficking) and “human trafficking of domestic workers” (not “house” trafficking).
  [ii] See: M Segrave, S Milivojevic, et al., Sex Trafficking: International context and response, Willan Publishing, Devon, UK, 2009, pp. 9—10.
  [iii]http://traffickingroundtable.org/2011/01/fact-or-fiction-what-do-we-really-know-about-human-trafficking/
  [iv] http://reason.com/blog/2014/06/12/eden-sex-trafficking-fable-falls-apart
• [v] http://slog.thestranger.com/slog/archives/2014/06/04/chong-kim-the-woman-whose-allegedly-true-story-served-as-the-basis-for-megan-griffiths-film-eden-revealed-to-be-a-fraud
• [vi] http://www.thestranger.com/seattle/real-world-horror-film-world-triumph/Content?oid=16638121
• [vii] Two recent examples include the controversy around Somaly Mam http://www.newsweek.com/2014/05/30/somaly-mam-holy-saint-and-sinner-sex-trafficking-251642.html , and the Hollywood film, Taken, starring Liam Neeson http://bitchmagazine.org/article/trade-secrets
  [viii] Gayatri Chakravorty Spivak. 1993. “Can the Subaltern Speak?” In Colonial Discourse and Post-Colonial Theory: A Reader, eds. Patrick Williams and Laura Chrisman. Hemel Hempstead: Harvester, p. 93.
  [ix] Texts such as Michelle Alexander’s (2011) The New Jim Crow have also been helpful for filling in many white middle class people’s consciousness around how the “war on drugs” not only completely failed to reduce drug abuse but in the process also demolished the lives of millions of people of color who were imprisoned for non-violent offenses.
• [x] In contrast, those who have made this connection are social justice activists coming directly out of communities of color, sex worker, and immigrant, undocumented, poor, and queer and trans* communities. E.g, see Queer (in) Justice (2011) by Mogul, Ritchie, and Whitlock.
  [xi] http://swop-seattle.org/resources/summery-of-proposed-end-demand-bills/
• [xii] http://www.seattletimes.com/seattle-news/teenage-pimp-convicted-of-human-trafficking/?cmpid=2308
• [xiii] http://www.seattletimes.com/seattle-news/teenage-pimp-convicted-of-human-trafficking/?cmpid=2308
• [xiv] http://www.thelancet.com/series/HIV-and-sex-workers
• [xv] See, for example: A Crago, Our Lives Matter: Sex workers unite for health and rights, Open Society Institute, 2008, http://www.soros.org/ initiatives/health/focus/sharp/articles_publications/publications/
  ourlivesmatter_20080724/Our%20Lives%20Matter%20%20Sex%20Workers%20Unite%20for%20Health%20and%20Rights.pdf;
  See also: J Huckerby, ‘United States of America’ in Global Alliance Against Traffic in Women (ed.) Collateral Damage: The impact of anti-trafficking measures on human rights around the world, GAATW, 2007, p. 231, http://www.gaatw.org.;
  See also: Sex Workers Project, Use of Raids to Fight Trafficking in Persons, SWP, 2009, http://www.urbanjustice.org/pdf/publications/Kicking_Down_The_Door_Exec_Sum.pdf.
• [xvi] Thus far in Washington State, members of the Sex Worker Outreach Projects (SWOP)-Seattle have been either locked out of – or have had to force themselves into – the recent End the Demand policy discussions. See: http://www.thestranger.com/news/feature/2015/02/11/21689047/meet-the-sex-workers-who-lawmakers-dont-believe-exist

As the Gregorian calendar year officially comes to a close, we offer once again a sampling of the year’s top ten sexual stories. While certainly not a complete, in-depth, or globally representative list, we do think that this list contains snippets that have both disturbing and hopeful implications for sexual justice.

10. Rick Perry steals gay, secular icons to create anti-gay Christmas message

 “​By now, you’ve probably seen Rick Perry’s “Strong” ad, in which he opines, “There’s something wrong in this country when gays can serve openly in the military but our kids can’t openly celebrate Christmas or pray in school.” Not only are gays in our military, they’re also composing music for our campaign ads. As the Harvard Political Reviewpoints out, the music that plays in the background of Perry’s ad is inspired by or directly taken from Aaron Copland, a gay composer.” (Nick Greene, Dec. 10, 2011, Village Voice).

9. Herman Cain tests Mainstream American Media: What’s worse in a political candidate: Assault or Affair?

Presidential hopeful Herman Cain’s campaign abruptly crashed and burned after news media learned of his long time extra-marital lover. But this was after his multiple cases of sexual harrassment and assault against his former employees were also aired. Most news media, including reputable news outlets like the Washington Post, failed to differentiate between Cain’s alleged criminal and consensual acts, using the language of “accusation” to describe both. See for example this story with a headline of “Ginger White accuses Herman Cain of long affair.”

…”Cain denied the accusations. In an interview that aired before White’s allegations were broadcast, Cain told CNN’s Wolf Blitzer that he knows White and that the two had been friends but that there had been no sexual contact and no “affair.” He characterized their relationship as “trying to help a friend” because of her “not having a job etcetera and this sort of thing.””

The story then goes on to simply state that:

“This month, Cain was accused of sexually harassing several women.”

Such lack of differentiation between criminal and consensual sexual scandals is common among contemporary American mainstream media. Gratefully, Amanda Marcotte (Alternet, Nov. 30, 2011) provides a helpful guide for assessing the significance different kinds of sex scandals. See Marcotte’s article here: “6 Kinds of Sex Scandals: What Should be exposed? What should be left private?”

8. Wienergate

… AND speaking of the need to have more sophisticated interpretative filters around why and how some Wieners constitute a “scandal” … see article above, again. … See also our post about Anthony Weiner:

“In contrast to the Dutch, Americans love sex scandals. We love them so much that in a good year we produce and consume not just one of these high-profile scandals, but several. For many of us interested in sexual justice, the juiciest stories are those of the hypocrites: the Elliot Spitzers who lead anti-prostitute campaigns while purchasing sex; the George Rekers who champion the anti-gay movement while hiring “rent boys,” and the Newt Gingrichs who lead impeachment hearings while engaging in their own extra-marital affairs.”

7.  Obama’s Secretary of Health & Human Services overrules the FDA, pulls “morning after” pill 

“In what can only be called an astounding move by an Administration that pledged on inauguration day that medical and health decisions would be based on fact not ideology and for which women are a major constituency, today Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS) overruled a much-awaited decision by the U.S. Food and Drug Administration (FDA) to make emergency contraception (EC) available over-the-counter (OTC) to women of all ages.

According to the New York Times, “no health secretary has ever [overruled an FDA decision] before.”  See Jodi Jacobsen’s full story in RhReality Check here.

6.  The politics of Rape. Rape committed by men against women was frequently in the news during 2011, not because the dynamics of it have changed (it’s always about maintaining/exerting symbolic power), but because some people and institutions have found new tactics of exerting and/or maintaining heterosexism. Here’s a sampling of three such tactics.

• House Republicans try to change definition of Rape (as a way to further erode abortion rights). Note connection to story #5 above.
•  “Corrective rape” campaigns [as discipline for non-heteronormative women in (township/impoverished areas of) South Africa.]
• High school cheerleader raped by athlete and then kicked off squad (for refusing to cheer for her rapist).

5. Penn State & masculinist cultures of sexual abuse.  Rape and sexual abuse committed by men against boys was again in the news this year. While the Catholic Church and the Military managed to avoid serious spotlight time in 2011, another site of masculine privileged culture — American college football –wasn’t as lucky.

“With former Penn State football assistant coach Jerry Sandusky charged with sexually abusing children—and school officials including iconic former football coach Joe Paterno dismissed for purportedly failing to report Sandusky’s alleged crimes to law enforcement—many observers have compared the situation to a series of similar cases that have rocked the Vatican.”

See: What the Catholic Church can teach us about the Penn State Scandal.” (Patrick Hruby, The Atlantic, Nov. 16, 2011.)

After all these dire (and at times ludicrous) sexual stories, we will end with four stories on a slightly more hopeful note …

4.  Mainstreaming of Transgender stories (including both opportunities and misses for gender transformation).

While images of Chaz Bono’s new book and his stint with Dancing with the Stars were ubiquitous, the inclusion of transgender individuals in policies and programs were just as, if not more, influential.  Any sort of mainstreaming can bring missed opportunities for radical transformation (in this case for the institution of gender). But Mara Keisling, executive director of the National Center for Transgender Equality details 14 reasons why 2011 was “a game-changing year for transgender rights.” (See full story in The Advocate, Dec. 28, 2011).

3. Sex workers rights recognized by the UN and US State Department

(Meanwhile the conservative sexual politics of mainstream anti-trafficking rhetoric became increasingly exposed. See: for example, social justice activist Emi Koyama’s brilliant investigative article in Bitch Magazine, American University Human Rights professor Ann Jordan’s series of critical papers exposing the “Hype” of the abolitionist/trafficking movement, as well as of course the Village Voice’s mocking of Ashton Kutcher’s “real men” campaign.)

2. Secretary of State Hillary Clinton delivers historic gay rights speech to the United Nations

 GENEVA — The Obama administration announced on Tuesday that the United States would use all the tools of American diplomacy, including the potent enticement of foreign aid, to promote gay rights around the world.

In a memorandum issued by President Obama in Washington and in a speech by Secretary of State Hillary Rodham Clinton here, the administration vowed to actively combat efforts by other nations that criminalize homosexual conduct, abuse gay men, lesbians, bisexuals or transgendered people, or ignore abuse against them. (Myers and Cooper, New York Times, Dec. 8, 2011).

1.  The Sexual Politics of Egypt’s Arab Spring, featuring:

• Aliaa Mahdy (AKA The naked blogger)
• Egyptian women protesting abuse by Military
• “Virginity tests” inflicted upon Egyptian women protestors declared illegal by Egyptian judge.

Happy New Year from Sexuality & Society! Thanks to all the activists and scholars working toward sexual and social justice; may 2012 be filled with your stories!

Warm regards, Kari Lerum and Shari Dworkin

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Related Sexuality & Society stories:

• https://thesocietypages.org/sexuality/2010/12/31/top-10-sexual-stories-of-2010/
• https://thesocietypages.org/sexuality/2009/12/31/top-ten-sexual-stories-of-2009/

In the midst of public health panic over obesity, a parallel concern about “fat” girls and their sexuality exists. In particular, the question that appears to be on many researchers’ minds these days is: “Are “fat” girls at higher risk of sexual dysfunction or STI/pregnancy risk than girls of average BMI (body mass index)?” One way that researchers have attempted to answer this question is by searching for statistical correlations between BMI, sexual behavior and self-esteem.

Indeed, several recent studies have focused on the relationship between body image or body size and sexual health, with a special concern around girls and women. For example, the authors of a recent study (Bajos et al., 2010) found links between obesity and “adverse sexual health outcomes” for both men and women, noting that obese women were less likely to access family planning, more likely to have unplanned pregnancies and less likely to consider sexuality an important part of their “personal life balance.” In a June 2010 interview for HealthDay News,  Bajos went well beyond the reach of his data to make generalized comments about obese women:

“Being obese has a strong influence on people’s sexual life. Because of social pressure or social stigmatization, obese women are less likely to engage in sexual intercourse and more likely to find sexual partners via the Internet. Because of their obesity, they are not comfortable meeting men through friends, through work, through parties.”

In that same interview, Bajos made the assertion (despite any direct evidence from his data) that:

“a lot of these problems are driven by the stigmatization of obese women [because] these women are more likely to have low self-esteem.”

Beyond this particular study, researchers’ focus on female bodies and sexuality even occurs when larger cross-sectional studies survey both men and women about sexuality and sexual pleasure. Typically such studies describe associations between BMI and sexuality factors as measured by sexual attitude or behavior measure (Addofson et al 2004).

While the BMI measure is ubiquitous as an indicator of health, its measurement problems are numerous. For example, BMI does not account for the ratio of muscle and fat in bodies (e.g. why a bodybuilder or elite athlete could be labeled as overweight or obese) nor does it take into account a number of other important factors related to health beyond height and weight including cholesterol levels, blood pressure and family history of diabetes, all things commonly associated with obesity and poorer health (Burkhausera and Cawley, 2008).

Despite concerns over the adequacy of BMI as an indicator of health, BMI continues to be a popular measure in population-based studies of sexuality, sexual health and obesity. Another recent study that garnered press attention was led by Dr. Margaret Villers of Medical University of South Carolina. The study findings (based on data taken from the CDC’s Youth Risk Behavior Surveillance System, a large scale data set that gathers information of youth behaviors ranging from sexual behavior to substance  use to violence) were presented at the 2010 ACOG conference in San Francisco under the title “Sexual Behavior in Obese and Overweight Adolescent Females.” The researchers found that overweight and obese girls were more likely to have sex before the age of 13, have three or more sexual partners during their teen years and were less likely to use contraception. Although the findings have yet to be peer reviewed, or published, the results have been taken up by a number of news outlets and sexual health blogs including the Black AIDS Institute and Kinsey Confidential, a sexual health blog from the Kinsey Institute for Research in Sex, Gender and Reproduction. Eric Grollman, a sociology doctoral student at Indiana University, had this to say about about the Villers study:

Given the link between weight and attractiveness – a societal standard of beauty that favors skinny bodies over fat bodies – some might find the study’s findings surprising: why are heavy girls having more sex with more partners?  [In a press release from Dr. Villers’ university – see Brazell reference below], Dr. Villers and her fellow researchers provide two possible explanations for the difference in sexual behavior among teen girls: development during puberty and self-esteem. The researchers suggest that overweight and obese girls may begin puberty sooner and thus develop faster, which may put them at risk from more pressure from boyfriends and friends to have sex.

Since Villers’ study has yet to be published, reviewing the findings is a bit of a challenge. But the popularity of the initial report of the study by MSNBC reinforces a number of ideas about sexuality and obesity, and especially about the sexuality of girls and women: early puberty means more sexual activity and/or body shame, which leads to sexual pressure from partners. In the press release from her department at the Medical University of South Carolina, Villers points to the need for conversations about sexuality and safer sex regardless of what “daughters” weigh; at the same time Villers’ work presents a clear message about the dangers of not just female teenage sexuality but in particular of obese female sexuality.

Portrayals of overweight girls and women, both in mainstream media and by many health and sexuality researchers, seem to be making several assumptions.  These include perceptions that obese women don’t deserve positive messages about their bodies or that these positive messages can only come from a (male) romantic partner (who is then demonized as pressuring the girl into sex). These messages speak to larger assumptions that obese girls/women are  (and perhaps should be?) disempowered in terms of their sexuality.

These simplistic and fat-phobic assumptions point to how research about sexuality is often more productive when it is not limited to simple associations. Instead, qualitative or mixed methods research (where both statistical/survey and open-ended questions are asked of participants) allow for greater understanding of how social context impacts the meanings that girls and women attach to their bodies and their sexual behavior. For example, what kinds of positive or negative messages do overweight or obese girls receive about their bodies from romantic partners, friends, or family? How did those messages make them think about their sexuality, and how do they resist or incorporate these messages into their lives? For that matter, what messages about sexuality or sexual behavior did they receive, and which had the most salience? How did those messages impact their view of their bodies?

While correlational studies will have a continued and important presence in almost all types of research, especially in public health, when the focus is on sexuality or sexual health, perhaps we need to think beyond numbers. In order to better understand how bodies and emotions relate to each other in the context of human sexuality, research about body size and sexuality warrants a more varied approach.

Natalie Ingraham is a doctoral student in sociology at the University of California, San Francisco. She is interested in fat studies, embodiment and human sexuality.

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References and Recommended Readings

• Adolfsson, Birgitta , Stig Elofsson, Stephan Rössner and Anna-Lena Undén. 2004. Are Sexual Dissatisfaction and Sexual Abuse Associated with Obesity? A Population-Based Study. Obesity Research, 12, 1702–1709.
• Bajos, Nathalie, Kaye Wellings, Caroline Laborde, Caroline Moreau. 2010. Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours. British Medical Journal, 340:c2573. Accessed online at: http://www.bmj.com/cgi/content/abstract/340/jun15_1/c2573
• Brazell, Dawn. 2010. “Obese teens more likely to have unsafe sex.” Press release. Accessed March 12, 2011.  http://www.musc.edu/catalyst/archive/2010/co6-18teens.html
• Burkhausera, Richard V. and John Cawley. 2008. Beyond BMI: The value of more accurate measures of fatness and obesity in social science research. Journal of Health Economics. 27:2, 519-529.
• Grollman, Eric. 2010. Plus-Size Girls Are More Likely To Have Sex Early And Unprotected. Kinsey Confidential blog. Accessed at: http://kinseyconfidential.org/plus-size-girls-unprotected-sex-early/
• Reinberg, Steven . 2010. Obesity Can Take Toll on Sex Life. HealthDay News. ©2011 HealthDay Accessed at: http://www.healthfinder.gov/news/newsstory.aspx?docID=640149
• Rothman, K.J. 2008. “BMI-related errors in the measurement of obesity.” International Journal of Obesity (2008) 32, S56-S59.
• Simopoulos, Artemis P. 1986. “Obesity and Body Weight Standards.”American Review of Public Health, 7, 481-92
• Villers, Margaret S. . 2010. Sexual Behavior in Obese and Overweight Adolescent Females. Presented at the annual meeting of the American Congress of Obstetricians and Gynecologists (ACOG), San Francisco, CA, May 2010.

For the past few months, I have been honored to be part of a team of activists and researchers responding to developments involving the United Nations Human Rights Council, the US State Department, and matters concerning human rights abuses against sex workers. The team of which I am a part is one of many civil society groups invited to engage in dialogue with the State Department in response to the UN’s Universal Periodic Review of the human rights record of the United States. For this blog post, submitted on March 3 – International Sex Workers’ Rights Day – I will briefly share highlights of this unprecedented historic process.

The Universal Periodic Review is a relatively new procedure created by the United Nations Human Rights Council (which itself was only created in 2006). Over the past three years (beginning in 2008 and ending in 2011) the human rights record of all member states of the global community have been and/or will be reviewed by the United Nations Human Rights Council in Geneva, Switzerland. This past November (2010), it was the turn for the current human rights record of the United States (as well as 15 other UN member states) to be reviewed. Upon review of the US record, more than 200 recommendations were made to the Obama administration, including the following by member state Uruguay[i]: “undertake awareness-raising campaigns for combating stereotypes and violence against gays, lesbians, bisexuals and [transgender people], and ensure access to public services paying attention to the special vulnerability of [sex] workers to violence and human rights abuses.”

Since its review in November, the US State Department has engaged in meetings with civil society representatives to help inform its response to the 228 UN recommendations. (The entire list of recommendations to the US can be found here).

Uruguay’s recommendation has generated an exciting and productive dialogue among people concerned with the welfare of sex workers and people in the sex trade. This historic moment has also created a refreshing opportunity to discuss sex work BOTH as a human rights issue AND as an issue that cannot be adequately addressed by responses to sex trafficking alone.

Will the US administration recognize this UPR recommendation, and make concrete steps to improving human rights for all, including sex workers (meaning ALL sex workers, including adult consensual sex workers AND those who are exploited or trafficked)? We are hopeful that it will. Judging by the outpouring of support we have received from leading researchers and organizations — representing sexual and reproductive health, law, and criminal justice — we are far from alone in this hope. Several formal letters of support have been received, including from former Surgeon General Dr. Jocelyn Elders, the Center for Health and Gender Equity (CHANGE), and Change.org. Dozens of other researchers, experts, and organizations have given signatures of support including Human Rights Watch, Sexuality Information and Education Council (SIECUS), and Amnesty for Women.

These letters and signatures, along with other documents including a policy brief discussing violence against sex workers, have been submitted to the State Department for review. Below are segments of this policy brief (see end of post for list of authors and collaborators).

“In November 2010, the current human rights record of the United States was reviewed by the United Nations Human Rights Council. As part of this process, members of the U.N. made a series of recommendations toward improving human rights in the U.S. In recommendation #92.86, member state Uruguay called on the Obama Administration to “undertake awareness-raising campaigns for combating stereotypes and violence against gays, lesbians, bisexuals and [transgender people],[ii] and ensure access to public services paying attention to the special vulnerability of [sex] workers[iii] to violence and human rights abuses.”[iv]

“This recommendation from the global community highlights human rights issues that have gone unnoticed for too long. Sex workers—that is people who engage in sexual commerce for income and subsistence needs—are members of families and communities in all parts of the United States. Because of stigma and criminalization sex workers—and those profiled as such—are subjected to violence and discrimination, and are impeded from accessing critical services, such as healthcare, and the right to equal protection under the law. State agents themselves, specifically police officers, commit physical and sexual violence against sex workers. These abuses are particularly rampant in poor and working class, urban, majority African-American and immigrant communities and also greatly affect lesbian, bisexual and transgender (LGBT) people. Globally, the U.S. federal anti-prostitution policies, such as the “anti-prostitution pledge,” have had dire consequences for international HIV/AIDS efforts.

Our policy brief discusses and critiques three policy areas in need of improvement: 1) Federal policies that conflate sex work and trafficking, 2) Federal approaches to HIV/AIDS, and 3) Criminalization (including state level laws) and Policing. Below is our language on Federal policies that conflate sex work and trafficking:

“Some current federal policies are rooted in the misconception that sex work and human trafficking (a serious human rights abuse acknowledged by the U.S. Government under the Trafficking Victims Protection Act of 2000 and subsequent re-authorizations) are the same issue. This misconception, combined with pressure from some advocates seeking to use concern about human trafficking as a way of diverting resources into anti-prostitution campaigns, has had significant impact on efforts to provide the services and support needed by sex workers both within the United States and globally.

“Globally, the U.S. imposes the Anti-prostitution Loyalty Oath or the “anti-prostitution pledge” on groups funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) to provide services internationally to address HIV/AIDS.[v] In order to receive funds organizations must adopt a policy indicating that they oppose prostitution and “sex trafficking.” This policy runs counter to documented best practices for HIV/AIDS interventions[vi] and have lead some groups to avoid offering any health and safety services for sex workers.[vii] [viii] As a result, the global and public health community has been virtually unanimous in its calls for revoking the anti-prostitution pledge. [ix] [x] [xi] [xii] [xiii] Two lawsuits against the U.S. government were filed on behalf of three U.S.-based NGOs engaged in HIV-prevention, leading to U.S. Court Judgments concluding that the “anti-prostitution pledge” is unconstitutional on the basis of violating the first amendment right to freedom of speech.[xiv] The Department of Justice has appealed both cases; the second case is still in court.[xv]

“Federal policies that conflate sex work and trafficking also impact sex workers’ human rights domestically. Federal funding and other resources intended to protect victims of trafficking have instead been used to arrest and incarcerate adult sex workers based on state laws. For example, ongoing federal taskforces aligned with regional and municipal law enforcement agencies, such as “Operation Cross Country,” use funds that are allocated for services for trafficking victims.[xvi] There is mounting evidence that anti-trafficking brothel raids of this kind place migrant sex workers and trafficked persons at greater risk of incarceration, deportation, and trauma.[xvii]”

After careful consultation with organizations run by and serving sex workers, as well as human rights activists and members of the State Department, we have made a number of recommendations to the US government. These recommendations, in their shortened version are the following:

The U.S. Federal Government can show progress in addressing human rights abuses against sex workers by a) accepting recommendation #92.86, and b) engaging in concrete, politically-feasible steps that can minimize human rights abuses including at a minimum:

1. Building capacity for states to address human rights violations through research and dialogue.
2. Modifying or eliminating existing federal policies that conflate sex work and human trafficking and prevent sex workers from accessing services such as healthcare, HIV prevention and support.
3. Investigating and preventing human rights abuses perpetrated by state agents, such as law enforcement officers.
4. Investigating the impact of criminalization, including state level criminal laws, on sex workers and other groups.

These recommendations, if approved and implemented, will address the needs of a population that disproportionately impacts low-income women, but will also serve a population that is extremely diverse in terms of sex, gender presentation, sexual orientation, race, class, and nation of origin. In the midst of numerous and devastating political assaults on women’s health care in the US, the movement for a human rights policy approach for sex workers and people engaged in sex trade work in the United States is a breath of hope. Stay tuned: the State Department is scheduled to release its response the the UPR recommendations soon.

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*Policy Brief Authors and collaborators:

• Kari Lerum, Ph.D., Associate Professor, Interdisciplinary Arts & Sciences, University of Washington, Bothell
• Penelope Saunders, Ph.D., Director, Best Practices Policy Project
• Dara Barlin, Board of Directors, Sex Worker Outreach Project USA
• Stephanie Wahab, PhD., Associate Professor, Department of Social Work, Portland State University
• Jayne Swift, M.A. Cultural Studies & Doctoral Candidate

In consultation with representatives from the following organizations:

• Best Practices Policy Project
• Bay Area Sex Worker Advocacy Network
• Desiree Alliance
• Different Avenues
• Helping Individual Prostitutes Survive (HIPS)
• Sex Worker Outreach Project (SWOP)
• Sex Workers Project at the Urban Justice Center
• St. James Infirmary
• Woodhull Freedom Foundation

This year’s top ten sexual stories: an incomplete list from our subjective, North American perspective, containing a mixture of disturbing, entertaining, and hopeful developments.

10. Katie Perry got kicked off Sesame Street

“Thursday morning, the PBS children’s show announced that a scheduled appearance by Perry, queen of the most inappropriate whipped-cream bra ever, had been canceled. On Monday, a clip of Perrywearing a sweetheart-cut dress, singing a G-rated version of her hit “Hot N Cold” and begging to “play” with Elmo, was leaked on the Web. Parents, outraged by Perry’s C-cup-accentuating dress,immediately protested. “You’re going to have to rename [Sesame Street] Cleavage Avenue,” wrote one commenter, while another simply joked, “My kid wants milk now.” (LA Times, Sept. 23, 2010).

9. George Rekers got caught with “rent boy”

“Reached by New Times before a trip to Bermuda, Rekers said he learned Lucien was a prostitute only midway through their vacation. “I had surgery,” Rekers said, “and I can’t lift luggage. That’s why I hired him.” (Medical problems didn’t stop him from pushing the tottering baggage cart through MIA.)” (Bullock, P. and Thorp, B., Miami New Times, May 6, 2010).

8. Constance McMillen barred from her prom, becomes a Glamour Magazine “Women of the Year“

“Constance McMillen has been named one of Glamour Magazine’s ‘Women of the Year’ for 2010.  We came to know Constance through her personal ordeal with Itawamba Agricultural High School in Fulton, Mississippi.  The school board rejected her request to bring her girlfriend to the prom as her date, and even further, didn’t allow Constance to wear a tuxedo as she had planned.” (Sledjeski, J. GLAAD, Nov. 5, 2010).

7. This one is a tie between: a) Republicans got caught at W. Hollywood Strip Club

“The “family values” Republican National Committee spent almost $2,000 last month at an erotic, bondage-themed West Hollywood club, where nearly naked women – and men – simulate sex in nets hung from above.” (Bazinet, K, and Saltonstall, D. Daily News, March 29, 2010).

and b) Strippers protest Ohio church

“For the past four years, Pastor Dunfee and some of his New Beginnings church members have picketed and protested the strip club in their local community; they’ve even videotaped visitors to the club and posted the videos online in an attempt to hold them accountable for their actions. Pastor Dunfee said the regular protests were to avoid “sharing territory with the devil.”

Irritated by the protests, employees of the club have decided to protest the church—they arrived early in the morning Monday wearing swimwear and toting barbeques, picnic food, sunscreen, and lawn chairs, along with signs reading Matthew 7:15: Beware of false prophets who come to you in sheep’s clothing and Revelation 22:11: He that is unjust, let him be unjust still. ” (Aug.16, 2010; ChurchLeaders.com).

6.  European Court of Human Rights Rejects Irish Ban on Abortion

“In December, the European Court of Human Rights ruled that Ireland’s constitutional ban on abortion violates the rights of pregnant women to receive proper medical care in life-threatening cases. Each year, more than 6,000 women travel abroad from Ireland to obtain abortion services, often at costs of over $1,500 per trip. In a statement on the ruling, the Irish Family Planning Association—the IWHC partner that helped bring about this decision—said the court sent “a very strong message that the State can no longer ignore the imperative to legislate for abortion.” (Top Ten Wins, International Women’s Health Coalition, December 23, 2010).

5. Millions searched for their G-spot

“Asking if the “G-spot” exists can be a bit like asking if God (the other G-spot) exists: It depends on who you ask. And in both cases, science is (thus far) ill equipped to adequately measure either G-spot. ”

(Lerum, K. Sexuality & Society, Jan 6, 2010).

4. The Pope OKs condoms in some circumstances

“In a break with his traditional teaching, Pope Benedict XVI has said the use of condoms is acceptable “in certain cases”, in an extended interview to be published this week.”

“After holding firm during his papacy to the Vatican’s blanket ban on the use of contraceptives, Benedict’s surprise comments will shock conservatives in the Catholic church while finding favour with senior Vatican figures who are pushing for a new line on the issue as HIV ravages Africa.” (Kington, T., and Quinn, B. Guardian UK, Nov. 21, 2010).

3. Microbicide Research offers hope for HIV prevention

“More than 20 years ago, the International Women’s Health Coalition (IWHC) convened 44 women from 20 countries who conceived of a substance, like contraceptive foam or jelly, which could be inserted vaginally to prevent HIV infection. We named it a “microbicide,” and set out to find scientists and money to develop it. Until recently, progress has been slow, but in July, results from a clinical trial in South Africa found a new gel to be nearly 40 percent effective in protecting women against HIV during intercourse.” (Top Ten Wins, International Women’s Health Coalition, December 23, 2010).

2. Gay Teen Suicide & Bullying as a Social Problem

“The recent rash of high profile suicides by boys who were bullied for gender and sexual non-conformity has created a wake up call for parents and school administrators in the U.S. To create a broader base of support from heterosexual allies, as well as to reach out to GLBT youth themselves, a number of new educational and activist initiatives have emerged. Dan Savage created the “It Gets Better”video project, directed at GLBT youth in despair over hostile treatment and at risk of killing themselves. The Gay and Lesbian Alliance against Defamation (GLAAD) declared Oct. 20, 2010 Spirit Day to call attention to and memorialize the recent suicides. Secretary of State Hillary Clinton even released her own version of an “It Gets Better” video. ” (Lerum, K. Sexuality & Society, Nov. 18 2010).

1. The Repeal of “Don’t Ask Don’t Tell”

WASHINGTON — “The military’s longstanding ban on service by gays and lesbians came to a historic and symbolic end on Wednesday, asPresident Obama signed legislation repealing “don’t ask, don’t tell,” the contentious 17-year old Clinton-era law that sought to allow gays to serve under the terms of an uneasy compromise that required them to keep their sexuality a secret.” (New York Times, Dec. 22, 2010).

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Related Story:  Top Ten Sexual Stories of 2009

On World AIDS Day (December 1), it is crucial to recognize the progress that has been made concerning prevention, treatment, and care efforts and all of the urgent work that still needs to be done. Worldwide, 33 million people are living with HIV. In the United States alone, 1.1 million people are living with HIV (CDC, 2010). Within the US, 20% of people are not aware that they are living with the virus. In the richest nation in the world, 3 decades into the epidemic, 56,000 people per year are infected, HIV is the leading cause of death for African-American women age 25-34, the epidemic has an alarming impact on communities of color, particularly young MSM of color, and there are vast disparities in access to prevention, treatment, and care (El-Sadr, Mayer, & Adimora, 2010).

Despite the fact that I normally discuss the state of the HIV pandemic globally, I am going to focus my comments on the epidemic in the United States. This is because in July of 2010, President Obama put into place the FIRST National HIV/AIDS Strategy in history of the United States. The goals of the policy (White House, 2010, p. vii) are to:

1. Reduce the number of people who become infected with HIV,
2. Increase access to care and health outcomes for people living with HIV; and,
3. Reduce HIV-related health disparities.

In order to meet goal #1, the policy proposes that the US:

“intensifies HIV prevention efforts in communities where HIV is most heavily concentrated, expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches, and educate all Americans about the threat of HIV and how to prevent it” (p. vii).

In order to meet goal #2 (increasing access to care and improving health outcomes for people living with HIV), the policy calls for: 

“establishing a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV, take deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV, and to support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing” (p. ix).

Finally, in order to reduce HIV related health disparities, the public and private sector are called upon to:

“reduce HIV-related mortality in communities at high risk for HIV infection, adopt community-level approaches to reduce HIV infection in high-risk communities, and reduce stigma and discrimination against people living with HIV” (p. ix).

The US National HIV/AIDS Strategy can be found here.

Meeting these goals is an enormous task and will require efforts well beyond the federal government, academia, media, health care institutions and practitioners, policy-makers, community mobilization and community based groups to include each and every sector of society. In December of 2010, a special issue of JAIDS was released that assessed the state of the epidemic in the US and made suggestions to ensure that the goals of the National Policy are realized. In it, Chris Collins and Dazon Dixon Diallo praised the National Policy and argue that for prevention efforts to truly succeed, it will be important to advance prevention funding alignment (ensure funding matches epidemic conditions and priorities) and accountability (improve transparency of prevention funding), go to scale with effective prevention efforts in communities at elevated risk, foster synergies between evidence-based prevention and community-based efforts for home-grown and locally developed interventions, and to go “beyond individual behavior change programming by putting a greater emphasis on structural, network, and policy interventions” (Collins & Diallo, 2010, p. S. 148).

Colleagues Ada Adimora and Judith Auerbach agree with this last point in particular, underscoring that “social determinants — the conditions in which people are born, live, work, and age — are critical influences on health and that these determinants, which are shaped by the distribution of money, power, and resources can be influenced in positive ways” (Adimora & Auerbach, 2010, p. S. 132). They detail how social determinants both influence HIV risk and the course of the epidemic and reveal how several structural interventions (such as comprehensive sex education with access to male and female condoms, syringe exchange programs, health care availability, and housing) help to reduce risk behaviors and increase access to care.

Indeed, the National HIV/AIDS policy and its implementers hope to reduce the number of people who become infected with HIV, increase access to care and health outcomes for people living with HIV and reduce HIV-related health disparities. To do so, it will be necessary to support work that intervenes on social and structural determinants of HIV, including poverty reduction, incarceration, homelessness, and food insecurity, along with the numerous other strategies that are discussed and planned as a result of the National policy.

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Related links:

• White House Press Release: Presidential Proclamation on World AIDS Day 201o
• Dworkin, S. Dec. 1 2009. “December 1 is World AIDS Day  — theme is “Universal Access and Human Rights.”
• Dworkin, S. Sept. 30, 2009. “Alarming new rates of HIV among MSM in the US Reported: Now What?”

References:

• Adimora, A.A. & Auerbach, J. (2010). Structural interventions for HIV prevention. JAIDS, 55 (S2),  S132-135.
• Collins, C. & Diallo, D.D. (2010). A prevention response that fits America’s epidemic: Community Perspectives on the status of HIV prevention in the United States. JAIDS, 55 (S2), S148-S150.
• El-Sadr, W., Mayer, K., Adimora, A.A. (2010). The HIV Epidemic in the United States: A time for action. JAIDS, 55 (S2), S63.

I recently attended the massive American Public Health Association meetings in Denver, where there were a number of scientific sessions on topics related to reproductive and sexual health. One of the more exciting sessions for me was a session on “Sexual Health Issues of Youth,” where Professor Lisa Lindley (Global & Community Health, George Mason University) discussed the philosophy and impact of a creative sex education program called “Project Condom.” This program combines the concept of “Project Runway” with condom couture for the intended impact of promoting safer sex.

“Project Condom” is the creative brainchild of Ryan Wilson, who works in Student Health Services at University of South Carolina. Together with Lindley (who was then a professor at USC) and a team of USC faculty, staff, and students, Wilson has now seen Project Condom through its third season. (In addition to being inspired by Project Runway, Wilson’s team was also extending the work of Adriana Bertini, a designer/activist credited for creating the idea of condom couture.)

Student groups participating in Project Condom are provided with 1,000 condoms in assorted colors. Each group develops a PG-13 theme for their design (e.g. pregnancy prevention, STI/HIV protection, abstinence). The judges (most recently including Santino Rice from Project Runway) rate the designs on 5 criteria: Overall concept and theme, use of condoms or abstinence symbol, creativity, stage presence, and interview justification. To see video footage of Project Condom click here: Project Condom, Season 3

Besides offering a forum for artistic expression, there is evidence that Project Condom is increasing both awareness of sexual health and propensity for using condoms amongst USC students. (Evidence based on surveys of audience members of Project Condom as well as increased volume of free condoms being taken on campus).

Project Condom is now being replicated at George Mason University as well:

We at Sexuality & Society applaud Wilson, Lindley, and the Project Condom team for this promising Sexual Health approach!

Two weeks ago, Indiana University researchers at the Center for Sexual Health Promotion debuted the results of their mammoth National Survey of Sexual Health and Behavior. The study, released Oct. 4, 2010 in the Journal of Sexual Medicine, reported that adults in the U.S. have substantial variety in their sexual lives and that American teens are far more likely than adults to use condoms. 

As a sexuality researcher I was (and am) impressed by the depth and breadth of the study as well as the vast amount of media coverage it received. News headlines around the globe proclaimed that people in the US are getting “friskier,” and “branching out sexually.” The Colbort Report and Saturday Night Live both mentioned the report in friendly comedic skits.

(By the way, since Kinsey’s studies in the mid-twentieth century we’ve known about enormous sexual variety in the U.S.  Without systematic historical data it’s unclear whether or not all Americans are actually getting “friskier,” but this new study does a fantastic job of systematically documenting what people across many generations are doing today).

My main surprise around this study? The virtual non-response by conservative religious bloggers and organizations, who are usually quick to offer their critique on cultural trends which indicate approval of (or even a neutral stance on) sexuality outside of adult heteronormative marriage.

This study certainly indicates such a cultural trend, both in its survey design and in its results. Below is a summary of findings, borrowed from the National Survey of Sexual Health and Behavior’s website:

“Many surveys of adolescent sexual behavior create an impression that adolescents are becoming sexually active at younger ages, and that most teens are sexually active,” said Dr. Fortenberry (one of the study’s authors). “Our data show that partnered sexual behaviors are important but by no means pervasive aspects of adolescents’ lives. In fact, many contemporary adolescents are being responsible by abstaining or by using condoms when having sex.”

The graph below illustrates the striking inverse linear correlation between age and condom use (contradicting common patronizing assumptions about “our youth” being sexually irresponsible):

The following bullet points are also taken from the study’s website: 

• There is enormous variability in the sexual repertoires of U.S. adults, with more than 40 combinations of sexual activity described at adults’ most recent sexual event.
• Many older adults continue to have active pleasurable sex lives, reporting a range of different behaviors and partner types, however adults over the age of 40 have the lowest rates of condom use. Although these individuals may not be as concerned about pregnancy, this suggests the need to enhance education efforts for older individuals regarding STI risks and prevention.
• About 85% of men report that their partner had an orgasm at the most recent sexual event; this compares to the 64% of women who report having had an orgasm at their most recent sexual event. (A difference that is too large to be accounted for by some of the men having had male partners at their most recent event.)
• Men are more likely to orgasm when sex includes vaginal intercourse; women are more likely to orgasm when they engage in a variety of sex acts and when oral sex or vaginal intercourse is included.
• While about 7% of adult women and 8% of men identify as gay, lesbian or bisexual, the proportion of individuals in the U.S. who have had same-gender sexual interactions at some point in their lives is higher.
• At any given point in time, most U.S. adolescents are not engaging in partnered sexual behavior. While 40% of 17 year-old males reported vaginal intercourse in the past year, only 27% reported the same in the past 90 days.
• Adults using a condom for intercourse were just as likely to rate the sexual extent positively in terms of arousal, pleasure and orgasm than when having intercourse without one.

These findings provide important information for many, including parents, partners, and sexual health workers. As a way to avoid erroneous advice and policy it’s important for all of us to update our assumptions about who does what sexually.

But why the lack of moral uproar? Perhaps this silence is the true sign of a cultural shift — a striking contrast to the conservative backlash to the Kinsey reports. Then again, the scientific magnitude of this study does make it relatively impenetrable — just like a good condom when used correctly.

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Also recommended (for a brief overview of the Kinsey studies, an important historical precursor): Jim Burroway. Jan. 3, 2008. “According to the Kinsey Reports: A Noisy revolution in social science and popular culture.” Box Turtle Bulletin. 

Gonorrhea and syphillis get sporadic attention from the press–and now is one of those times because rates of STIs in the US are increasing. In recognition of STD Awareness month, William Smith of the National Coalition of STD Directors provides an overview of these and other contemporary STD/STI and sexual health trends. As noted below by Smith, gonorrhea rates are particularly acute in the African-American population, while syphillis is making a come-back among MSM (men who have sex with men). Smith warns that “we are on the verge of a highly untreatable gonorrhea epidemic:”

Gonorrhea is a bacterial infection and bacteria have a funny way of developing resistance to treatments – their own built-in evolutionary survival mode. This is what has happened with gonorrhea, the second most commonly reported notifiable disease in the United States with more than 336,000 cases reported in 2008.

It is also among one of the most racially- and age-disparate diseases. For example, according to the CDC, though blacks make up only 12 percent of the U.S. population, more than 70 percent of reported cases of gonorrhea in 2008 were among blacks. It also affects young people disproportionately, with the majority of new cases being consistently reported among 15 to 24 year olds. In early 2007, after much reporting of resistance to the class of antibiotics known as quinolones, the CDC stopped recommending them for use in treating gonorrhea. We now have just a single class of antibiotics left to treat gonorrhea but resistance is also developing with this class and the pipeline of new drugs is nearly empty. Future treatment might require multiple drug combinations or multiple doses over a longer period of time and even then, we are not sure what the future holds.

Gonorrhea leads to all sorts of adverse sexual health outcomes including infertility and likely exacerbates susceptibility to HIV. Something called Disseminated Gonococcal Infection that can cause crippling arthritis could become commonplace, and toxic blood and outright organ failure are likely prospects for infected persons if we do not get ahead of this situation with new treatments. I hate to sound alarmist, but the prospects of this situation are frightening.

Over the past several years, Advocates for Youth have also voiced alarm over gonorrhea rates in the US, especially in comparison to the Netherlands and other European countries. The following graph from Advocates for Youth illustrates a cross-national comparison of teens in both countries (but no distinctions by race, sex, class, etc):

In addition to the escalating rates of gonorrhea, syphillis is back in business in the US. William Smith of the National Coalition of STD Directors also warns that “we are about to grasp defeat from the jaws of victory in the battle against syphillis”:

Once on the verge of a major public health success story, the nation’s efforts to combat syphilis – still optimistically termed as an effort to eliminate it – have virtually collapsed. In 2008, we had the highest number of reported syphilis cases since 1995 at 13,500 (these are primary and secondary syphilis cases which is when the disease is most infectious). There were another 431 cases of congenital syphilis in 2008 – cases where mother to child transmission occurs. In Chicago last year, one colleague told me that two babies died of congenital syphilis. Yes – in the 21^stcentury United States of America, children die of syphilis. Where is the outcry? And the disease is now increasingly shifting to men who have sex with men, where syphilis infection in a sexual network can have devastating results both on its own and in increasing susceptibility to HIV infection. NCSD has called for a renewed discussion on our nation’s approach to syphilis control and sexual health and we will be convening a meeting later this year to help pave a new way forward.

The graph below from Advocates for Youth also shows a gap in syphillis rates between the US and the Netherlands:

The reasons for these and other sexual health distinctions between the US and the Netherlands are a complex, involving a mixture of social, institutional, and cultural factors. And, race and class relations–and their intersection look very different in the US and the Netherlands. Regardless, much work is needed in the US to offset these and other negative sexual health trends, and raising the visibility of these trends is at least one step toward this goal.

Bibliography and Related links:

Adolescent Sexual Health in Europe and the U.S.: Why the Difference? Advocates for Youth.

William Smith. (4/15/2010). “What I didn’t know about sexual health: Reflections from a new perch. Rh Reality Check.

GYT (Get Yourself Tested)

National Coalition of STD Directors