sexual health

When Madonna released “Like a Virgin” in 1984 she dedicated the album to “all the virgins of the world.”  At that time, her fans (including me, a reserved high school girl infatuated by Madonna’s commanding sexuality) thought we knew what she was talking about. But if this album were released today, it’s likely that many high schoolers and others would have a more diverse understanding about Madonna’s message.

This is because several forces have been in the works for many years (at least in mainstream American culture) which have allowed people to envision “sex” — and hence, virginity —  as including more than the presence or absence of heteronormative, procreative, penile-vaginal intercourse. (Societies and cultures across time have always had a variety of meanings attached to various sexual acts, so this shifting and broadening perspective on “sex” is actually a global norm). A new study from researchers at The Kinsey Institute provides further empirical support that the idea of “having sex” is not seen as static or universal in contemporary US culture. The following comes from a press release from Indiana University, which houses the Kinsey Institute:

The study involved responses from 486 Indiana residents who took part in a telephone survey conducted by the Center for Survey Research at IU. Participants, mostly heterosexual, were asked, “Would you say you ‘had sex’ with someone if the most intimate behavior you engaged in was …,” followed by 14 behaviorally specific items. Here are some of the results:

  • Responses did not differ significantly overall for men and women. The study involved 204 men and 282 women.
  • 95 percent of respondents would consider penile-vaginal intercourse (PVI) having had sex, but this rate drops to 89 percent if there is no ejaculation.
  • 81 percent considered penile-anal intercourse having had sex, with the rate dropping to 77 percent for men in the youngest age group (18-29), 50 percent for men in the oldest age group (65 and up) and 67 percent for women in the oldest age group.
  • 71 percent and 73 percent considered oral contact with a partner’s genitals (OG), either performing or receiving, as having had sex.
  • Men in the youngest and oldest age groups were less likely to answer “yes” compared with the middle two age groups for when they performed OG.
  • Significantly fewer men in the oldest age group answered “yes” for PVI (77 percent)

…   William L. Yarber, RCAP’s senior director and co-author of the study, said its findings reaffirm the need to be specific about behaviors when talking about sex. 

According to Yarber, because “There’s a vagueness of what sex is in our culture and media,” it is especially important for sexual health workers to be specific about what they mean when they talk about sex:  

“If people don’t consider certain behaviors sex, they might not think sexual health messages about risk pertain to them. The AIDS epidemic has forced us to be much more specific about behaviors, as far as identifying specific behaviors that put people at risk instead of just sex in general. But there’s still room for improvement.”

These study results appear to show that respondents have a broad range of understandings of sex: Men and women across generations are likely to count “sex” as including oral, anal, and vaginal activities. And while many assume that sexual change always starts with youth, this study indicates that the attitudes and behaviors of older men (who were LEAST likely to count penile-vaginal activities as sex) as not what we might expect. 

Given the disconnect between popular culture and people’s lived experiences around sexuality, I have a proposal:

  • To Madonna: I think that you should re-release “Like a Virgin” in 2014, 30 yrs after its original release, and partner with sexual health organizations like SIECUS and the Guttmacher Institute to critically discuss the various meanings and cultural associations attached to being a “virgin” as well as being “like a virgin.”
  • To sexual health workers: By entering into a cultural conversation around the varied meanings that people attach to virginity and sex, you would open up a needed, and much broader conversation about sexuality, health, and the various pathways to living a vibrant life. (Plus, come on, how cool would it be to partner with the goddess herself?!)

—————–

Study citation:

  • Sanders, S., Hill, B., Yarber, W., Graham, C., Crosby, R., Milhausen, R., (2010) “Misclassification bias: diversity in conceptualisations about having ‘had sex,'” Sexual Health. 7(1), 31-34.
  • Thirty-seven years ago today (Jan. 22, 1973), women in the U.S. were granted the right to ask for and receive abortions from trained medical professionals. This decision set off decades of protests by pro-life activists which occasionally have turned violent. (In a strange coincidence, the trial of Scott Roeder, who was arrested for murdering Dr. George Tiller, also begins today.)

    While stalemate debates over abortion ethics continue, a promising series of side movements have emerged in recent years that help to contextualize the issue of abortion within a larger framework of reproductive, sexual, and social justice. An example of how this shift can occur is provided by Asian Communities for Reproductive Justice, a grassroots community organization based in Oakland, California.

    The graph below demonstrates how ACRJ conceptualizes reproductive oppression and reproductive justice, and how to build a reproductive justice movement:

    Click here to download a full-size PDF

    The following two graphs illustrate how ACRJ conceptualizes the connections between social justice and reproductive justice. Note how the lower circle (which shows ACRJ’s work) also includes principles of sexual justice (although this is unnamed, and in my opinion could and should be more clearly articulated):

    We at Sexuality & Society applaud the work of ACRJ;  their leadership in modeling reproduction and sexuality within much larger frameworks of social justice is an inspiration to critical sexuality scholars, practitioners, and activists. Happy anniversary, Roe v. Wade.

    See also:


    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.

    For the women’s G-spot, lack of scientific data is due mostly to a lack of guts or interest in measuring a woman’s vagina while being penetrated (no one has done anything close to this since Kinsey). As a result, tales of the G-spot is to this day are seen by scientists as anecdotal at best.

    In an attempt to study to G-spot empirically yet “safely” (given the testy political climate for sex researchers), a group of British researchers decided to investigate the question by …

    • Observing women having penetrative sex?
    • Asking women to keep detailed sex journals?
    • Giving women physical exams looking for variations in vaginal interiors?
    • Asking women to test for themselves the area known as a G-spot, and report back to researchers?
    • Investigating a possible relationship between women’s level of curiosity and openness to sexual pleasure, and their understanding of their “G-spot”?

    No. The researchers simply created a survey and asked a bunch of female twins if they “believed” they had a “so called G-spot.” Guess what they found?

    They found that 56 percent of respondents answered “yes” and that there was no genetic correlation (CNN).

    To translate: by “genetic correlation” researchers simply mean that identical twins didn’t give the same answer to the question of whether or not they believed in a “so called G-spot.” (Even though this could simply mean that these twins haven’t had exactly the same sexual partners, exactly the same sexual experiences, and exactly the same sexual education).

    Let’s put this into context. What if researchers asked instead if subjects “believed” there is a “so called God”? And what if there was not a statistically significant correlation for twins who both believed in God? Would this mean that scientific researchers could conclude that  a) God is not real, and b) that God (not a belief in God, but that God) is NOT is genetic?  Of course not. The question itself is absurd, as belief systems are not genetically ingrained. They are learned within particular social contexts.

    Here’s the point: data about “beliefs” can only be generalized to beliefs and not extended to make absolute truths claims. Despite news headlines now claiming that the “G-spot doesn’t exist,” all this survey tells us is that some women believe in the G-spot, and some don’t. While a sample of identical twins offer researchers the joy of being able to control for biological variation, in my opinion that this study was a waste of the twins’ time.

    These are the kind of sexual research methods that drive critical sexuality researchers CRAZY.

    Thank “god” there are other sexual researchers who can help us interpret these results. These critical researchers include Debby Herbenick (quoted below in an article from CNN):

    The definition of G-spot in the study is too specific and doesn’t take into account that some women perceive their G-spots as bigger or smaller, or higher or lower, said Debby Herbenick, research scientist at Indiana University and author of the book “Because It Feels Good.”

    “It’s not so much that it’s a thing that we can see, but it has been pretty widely accepted that many women find it pleasurable, if not orgasmic, to be stimulated on the front wall of the vagina,” said Herbenick, who was not involved in the study.

    Thank “god” we also have sex-positive sexual health educators to also help interpret these data, such as the folks at Babeland, a women-owned sex toy store. Babeland bloggers immediately hit upon this story yesterday (they were also interviewed for a local TV news show in their Manhattan location). Babeland blogger Dallas had this to say about the British study:

    I have to take serious issue with this research. First, the researchers (or the author of the article) apparently don’t know what the G-spot is. It’s not nerve endings only, but a collection of glands and ducts that surrounds the urethra. Anatomical dissection has already proven that this exists. Defining the G-spot as nerve endings leads me to believe what the research really wanted to know is “do all women experience pleasure from G-spot stimulation?” which is a very different question. Every day when I talk to customers, I have to remind people that everyone is different. What may work for one person won’t work for the next. Thus, I would not be surprised to find that many women didn’t really feel much pleasure when stimulating the G-spot. That’s not the same thing as saying it doesn’t exist.

    That said, the researchers relied on women’s self report of whether or not they felt anything. Although I’m all for listening to what women have to say about their bodies, I’ve also talked to hundreds of women about their G-spots and many of them had misunderstood where their G-spot was or how to stimulate it. They were under the impression that their G-spot did nothing for them when in fact, it may have just needed a different touch. Self report can be a terrific way to do research, but in a world where misconceptions about the G-spot abound, it may not accurately reflect women’s G-spot pleasure potential.

    I’d love to see a study measuring the changes in G-spot sensations after reading a good book about the G-spot or after attending one of our G-spotworkshops.

    gspot-anatomy

    Sounds like a perfectly reasoned challenge to me! Scientific G-spot researchers: I encourage you to collaborate with Babeland educators in your next round of investigations.

    ____

    In his book, Telling Sexual Stories: Power, Change, and Social Worlds (1995, Routledge), Ken Plummer explains that when individuals narrate seemingly internal and personal stories about their sexuality, these aren’t very individual or internal at all. Rather, such narratives emerge in themes that are made possible due to specific cultural and political conditions; sexual stories are thus part of larger sexual storytelling culture, and can be understood and made meaningful and visible only via existing cultural frames.

    In 1995 Plummer documented three kinds of emerging sexual stories: rape stories, coming out stories, and recovery stories. The year of 2009 brought several unique opportunities of its own to tell sexual stories. Some of these stories reaffirmed and revisited familiar plots to “old” sexual stories, while some forged new territory. We have decided to group this year’s stories (which we have selected with a highly subjective and US based lens) into themes; each theme is a compilation of several individual stories, forming what we see as a larger set of cultural stories being told about the pleasures and dangers of sexuality, and the roles of social institutions in regulating and redefining normative sexual boundaries. Thanks to Phil Cohen, Holly Lewandowski, and Amanda Hess for story leads. Also, thanks to RhReality Check’s Amy Newman for her list of top stories from 2009 (from which we borrowed a few).

    #10. “Squeaky-clean”-men-who-cheat stories, starring Tiger Woods!Tiger Woods and Elin Nordegren

    In her recent article on Tiger Woods, Shari Dworkin debunks widespread psychological and “sex addiction” explanations for Tiger Woods’ affairs:

    “Recent media coverage of Tiger Woods’ marital “transgressions” is overflowing. Some argue that Tiger is sex obsessed and has a “sex addiction” given his high sex drive and desire for sex with many women over time. Others argue that any sports star who is on the road and away from home so much has a huge chance of being unfaithful to their wife. (Some media reports argue that it is “rare” to find a faithful male sports star). Still others argue that Tiger Woods’ late father pressed him down under his thumb too much as a youngster and upon his death, Tiger unleashed his “wild side.”  Finally, some news reporters offer that Tiger was “traumatized” as a child when his father cheated on his mother, and that he must just be paradoxically following in dad’s footsteps. But very little media coverage attempts to press beyond an individual level and not many articles offered a much needed broader analysis of masculinity, race, sport, sexuality, and media.”

    • images-3Similar structural and cultural analyses incorporating masculinity and institutional/political power could and should also be applied to the other stars of this story, including: Mark SanfordJohn Ensign, & John Edwards.
    • Additionally, a cross-cultural perspective is needed here as well (e.g. why are these stories so powerful and shaming in the US, but not in European countries?)

    #9. Gay-marriage-success stories, starring: Argentina!

    Argentina Gay Marriage -- first in Latin America
    Latin America's first gay marriage, in Argentina

     

    According to The Guardian: “In Latin America policies and attitudes have mellowed over the past two decades and in most countries it is now illegal to discriminate on the basis of sexual orientation. Buenos Aires, Bogota and Mexico City boast gay pride parades and gay-friendly districts where same-sex couples can kiss and hold hands in public. Yesterday Di Bello, 41, and Freyre, 39, became the continent’s first gay married couple. The pair sidestepped a court ruling blocking their wedding in Buenos Aires by holding the ceremony in Ushuaia, capital of Tierra del Fuego province and the world’s southernmost city. They exchanged rings at a civil ceremony witnessed by state and federal officials, prompting jubilation by gay rights activists and consternation from the Catholic church. “My knees didn’t stop shaking,” said Di Bello. “We are the first gay couple in Latin America to marry” (Guardian.co.uk — Dec. 29, 2009).

    Gay-marriage- success stories from 2009 also starred: Mexico City, Washington DC, New Hampshire, Sweden, Iowa, Vermont, and Norway. These are just the states, countries, and cities adopting gay marriage in 2009 and doesn’t include the longer list of locales which legalized domestic partnership in 2009. [The appendix to this is the Gay-Marriage-doom-&-gloom story: starring the Catholic Church (Maine) & the Mormon Church (California, from 2008)]

    #8. Multiple-birth stories, starring: Angela Suleman (aka Octo-mom!)

    octo-mom

    While more women are having multiple-baby births (thanks to IVF technology), not all multiple-birth mothers are viewed the same. Kathryn Joyce from RhReality Check offers an insightful comparison between the highly demonized Angela Suleman (“octo-mom”) and a “Reality TV” family with 18 children:

    “Suleman’s newborns were delivered, as it were, into a pop cultural moment of preoccupation with large families. Reality TV shows about families with many children abound on TV’s TLC channel, most notably with the chronicles of the 18-child Duggar family. That the Duggars are grounded in and motivated by the pro-patriarchy Quiverfull movement, with its emphasis on female submission and male headship, is breezily dispensed with in favor of dwelling on the sentimental and zany experiences of life in a 20-person family. “Jon and Kate Plus Eight,” another reality TV show about a large family – this one the result of sextuplets born to a mother who, like Suleman, chose not to selectively reduce the number of embryos that “took” during an IVF treatment – is less burdened by the extremist ideology that undergirds the Duggars’ convictions, but still presents a traditional picture of large family life, with married heterosexual parents and a stay-at-home mother. …. While many observers are concerned with her apparent inability to support such a large family, the fact that she is unmarried has alone been cause enough for others to declare her family a situation of de facto child abuse” (for Joyce’s full article click here).

    #7. Homo-hater stories, starring: conservative religious anti-gay activists in Uganda and the US!

    Doug Coe, leader of the arch conservative U.S. group, "The Family"
    Doug Coe (center), leader of "The Family"

     

    In a recent post on Uganda’s “Kill the Gays” bill, Kari Lerum wrote that:

    “…there is an increasing amount of scrutiny and disgust from many regarding the direct connection between the Ugandan anti-homosexual campaign and a conservative U.S. religious group called “The Family” — which some, including The Observer have called a ” cult” due to the requirement for core members to remain secret about their activities. Regardless of what the group is labeled, it is clear that it has been successful in recruiting high level political leaders including some US congressmen and Uganda’s president Museveni to its core values:  “fighting homosexuality and abortion, promoting free-market economics and dictatorship, an idea they once termed ‘totalitarianism for Christ’ ”

    #6. Catholic-priest-cover-up stories, starring: the Irish Catholic Church!

    Irish Justice Minister Dermot Ahern
    Irish Justice Minister Ahern at press conference about decades of Priest abuse

     

    As quoted in the LA Times: “Leaders of the Roman Catholic Church in Dublin engaged in a widespread cover-up of abuses by clergy members for decades, a “scandal on an astonishing scale” that even saw officials taking out insurance policies to protect dioceses against future claims by the victims, a commission reported Thursday after a three-year investigation” (see full article here)

    Ross Douthat, a conservative writer for the New York Times and the National Review, describes how a culture of fear around sexuality is precisely the kind of culture that produces sexual abuse — and especially cover-ups of sexual abuse. Douthat concludes that:

    “…you can see how it could all go bad — how a culture so intensely clerical, so politically high-handed, and so embarrassed (beyond the requirements of Christian doctrine) by human sexuality could magnify the horror of priestly pedophilia, and expand the pool of victims, by producing bishops inclined to strong-arm the problem out of public sight instead of dealing with it as Christian leaders should. (In The Faithful Departed, his account of the scandal, Philip Lawler claims that while less than five percent of priests were involved in actual abuse, over two-thirds of bishops were involved in covering it up.) I suspect it isn’t a coincidence that the worst of the priest-abuse scandals have been concentrated in Ireland and America — and indeed, in Boston, the most Irish of American cities — rather than, say, in Italy or Poland or Latin America or Asia” (see Douthat’s article here).

    # 5. Panic-over-sex/gender/sexuality-fluidity stories, starring: Caster Semenya!

    Castor Semenya
    18 year old Caster Semenya got a makeover

     

    Mississippi girl fighting for her right to wear a tux for her Senior Class photo
    Ceara Sturgis, fighting for her right to wear a tux for her Senior Class photo

     

    articleLarge-150x150
    Click here for Adina Nack's post on "cross-dress" codes

     

    In her post in Sexuality & Society, Shari Dworkin writes, “While Caster Semenya’s recent “news” seems to have shocked the world, the concern about “gender verification” in sport has taken place for quite some time. The tests have changed over time…but the point has not (e.g. when women are “too good,” they must not be women). …” (see also sociologist Philip Cohen’s story about Semenya, and an update on Caster’s status in the NYT). Note that in these stories there are never any calls for parallel sex verification tests to see if men they are “too much of a man,”—a man that no other “normal” man can hope to “fairly” compete with. This is because of the specific role that sport has historically played in terms of making boys into men (when women compete, there have been numerous fears that they are masculinized and are not “normal” women).

    This year’s sex/gender/sexuality-panic stories also starred: Morehouse College‘s dress code, a high school girl wearing a tux, & a 4 yr. old boy kicked out of preschool for having “long” hair.

    # 4. Harsher punishments for-sex-with-minors stories, starring: Roman Polanski!

    Roman Polanski

    Filmmaker Roman Polanski was arrested in 1977 for the sexual assault of a 13 year old girl. He spent 42 days in a California prison and was released. Upon hearing of  a judge’s plan to have him serve more time and possibly deport him, Polanski fled to France. In 1988 Polanski was sued by the girl he assaulted and in 1993 settled with a payment reported at around $500,000. In the  years that have passed Polanski also married (in 1989), had two children, and continued on as a prolific and well regarded film maker.  For reasons that are still murky in terms of timing, Polanski was arrested on Sept. 26, 2009 (32 years after the crime) at the Zurich, Switzerland airport at the request of US authorities. Polanski’s case, spanning decades and continents, offers an insight into how laws and attitudes about sex with minors has changed in the US:

    The LA Times reports that “(s)tatutory rape convictions similar to Roman Polanski’s typically result in sentences at least four times longer today than the 90-day punishment a judge favored before the director fled the United States in 1978, a Times analysis of Los Angeles County court records shows. Polanski’s arrest in Switzerland on an international fugitive warrant — and his pending extradition proceedings — have sparked transatlantic debate about whether the 76-year-old Academy Award winner should serve additional time behind bars for having sex with a 13-year-old girl….The Times analyzed sentencing data to determine how L.A. County courts today handle cases in which men admit to statutory rape — also known as unlawful sex with a minor — in exchange for the dismissal of more serious rape charges, as Polanski did. The findings show that those defendants get more time than Polanski has served — even factoring in his 70-day stint in Swiss detention — but less than his critics may expect. … “Thirty years ago, sexual assault — rape and sex crimes — were treated differently,” said Robin Sax, a former sex crimes prosecutor for the L.A. County district attorney’s office. “Time and education haven’t worked for Polanski’s benefit.”

    Sociologist Barry Dank, founding editor of the Journal Sexuality & Culture, has blogged extensively about the Polanski case. Dank writes:

    “There is no question that what Roman Polanski did to a 13 year old girl in the 1977 was wrong, and illegal. But it is also wrong to drag Polanski back to the US 31 years after the crime and have him spend an unspecified amount of time in prison. What possible good would come about by Polanski doing time for the crime? Obviously, it would not function to rehabilitate him or change him in some way. The fact that Polanski has had a stellar film career and apparently lived a law abiding life for 32 years after the crime is indicative that the case for changing Polanski is simply irrelevant.”

    The details of Roman Polanski’s case lies in stark contrast to the case of Phillip Garrido, a registered repeat sex offender who was arrested earlier this year for kidnapping 11 yr old Jacee Dugard, and holding her captive and sexually abusing her for 18 years (from 1991-2009). The young Dugard bore two children out of Garrido’s abuse (now ages 11 and 15).

    Despite today’s more stringent punishments for statutory rape, we hope that US jurors and judges will be able to distinguish the vast differences between the sexual crimes of Polanski and Garrido.

    # 3. No-condoms-for-those-who-need-it-most stories, starring: Pope Benedict XVI!

    pope_benedict_gambia

    While HIV/AIDS rates in sub-saharan Africa continue to soar, and condoms are very effective in fighting HIV/AIDS (when used correctly and consistently) Pope Benedict told Africans that it was wrong to use condoms.

    The Pope’s message was also heard in the US, at least among some US Catholic college students. Amanda Hess, writer for the Washington City Paper highlights how all 3,000 students at Catholic University are now prohibited from having sex that is “disruptive”  (defined as “ANY” sexual expression inconsistent with the Catholic Church including premarital sex and same sex sexuality). These rules are written into the code of student conduct. Hess states that:

    Deference to the catechism spares Catholic administrators from the awkward enterprise of referring to masturbation, condoms, or any other specific of a typical undergraduate’s sex life” … “violations to the student code can’t be absolved in typically Catholic fashion, with forgiveness administered privately after confession to a priest. At the Catholic University of America, your sins are subject to judicial review” (click here for full article).

    Clearly, if the Catholic church cannot discuss sex outside of sex within marriage, they cannot discuss condoms very effectively.

    #2. Backlash-against-sexual-&-reproductive-justice stories, starring: the murderer of  Dr. George Tiller!

    Gosh, this story is soooo last century (the 80s and 90s were full of anti-abortion terrorism stories), but unfortunately it’s still a story in 2009.

    George Tiller

    Dr. George Tiller, a doctor who provided late term abortions in Wichita, Kansas, was shot dead while attending Sunday Church services. Jodi Jacobson, Editor of Rh Reality Check explains the importance of Dr. Tiller’s work, as well as the cultural context for how perceptions of his work are widely inaccurate:

    “In all the extensive coverage of the assassination in his church of Dr. George Tiller by a murderer affiliated with extremist right-wing groups, little has been said to shed light on what late-term abortions are, who has them and why. Instead, much of the media and talking heads pontificating on this subject have constantly focused on Tiller’s being “one of the very few doctors who perform late-term abortions,” without providing any context as to why he did so and under what circumstances. As a result, the dominant narrative is one which perpetuates an assumption that people are electing to have late-term abortions for the sake of convenience.”   (To read Jacobson’s entire analysis, click here).

    And finally, we’d like to end on a positive note, with a list of sexual and reproductive justice stories from 2009:

    1. Sexual-&-reproductive-justice stories, starring Barack Obama!

    Obama signed and/or was involved in the following sexual health and justice developments:

    images-7

    And although this last bill still needs to be signed, we are expecting Obama to:

    • fulfill his promise to fund evidence-based, scientifically based sex education.

    As Kari Lerum noted in a recent post, the movement toward more abstinence-only approaches is driven almost entirely by conservative religious ideology, not scientifically reliable evidence.” Because of the lack of scientific credibility for Abstinence-only sex education, we are hopeful that all funding for abstinence-only sex education will finally be eliminated from the US Federal budget.

    We are intrigued by many of this year’s sexual stories, saddened by some, and encouraged by others. May 2010 be filled with opportunities to reframe old (sexist, racist, homophobic, and sex-negative) stories into sexual stories that involve measured discussion of sexual health, sexual justice, and sexual rights.

     

    Kari Lerum & Shari L. Dworkin, Eds. Sexuality & Society.

    ABC news recently featured a story about “Pure Fashion,” a U.S. faith-based program that leads 14-18 year-old girls “through an eight-month course in which they are encouraged to ‘dress in accordance with their dignity as children of God.'” The eight month course ends with a “‘purity preserving’ fashion show.”

    The obsession with, monitoring of, and handwringing over girls’ (sexualized) appearance is of course not new, but this particular iteration comes from an ironic source: a fashion model and former Miss Georgia, Brenda Sharman. Sharman may be preaching “purity” but she also understands that her message will be considered more hip if she can dissociate from conservative and/or mainstream culture. Hence, Sharman is on a mission to reframe “pure” girls as “radical” girls:

    Brenda Sharman: model, former Miss Georgia, and founder of Pure Fashion.
    Brenda Sharman: model, former Miss Georgia, and founder of Pure Fashion.

     

    “The idea with Pure Fashion is very countercultural,” said Brenda Sharman … “It takes a girl who is brave and gutsy…This is not for the weak and wimpy girl … to say, ‘I’m different, and I’m going to preserve my innocence and virginity,’ that’s a girl who’s radical!”

    Scene from the Pure Fashion catwalk
    Scene from the Pure Fashion catwalk

     

    The problem is, radical, counter-cultural movements are supposed to challenge and pave new ground. In contrast, the leaders and proponents of Pure Fashion look to conservative established models for their inspiration. They are mothers, fathers, and church leaders who are deeply disturbed by the sexual displays (assumed to be impure) of their unmarried daughters. This may be a radical backlash to signifiers of sexuality or the de-coupling of sexuality and reproduction, but it’s not radical.

    Concerns about sexually expressive girls and women is common amongst groups whose cultural and religious norms privilege men and/or believe that men and women have naturally different physical capabilites and personalities. As Shari Dworkin and I argued in a recent article,

    “(c)ultural and religious traditions that privilege men always require intense regulation and surveillance of girls’ and women’s sexuality. In these contexts, the moral and social ‘worth’ of girls and women is based on their sexual availability, creating a good virgin-bad whore dichotomy. This tradition is thriving in many aspects of U.S.  culture, including the movement for abstinence-only education, virginity pledges, purity ball, and so on” (Lerum and Dworkin, 2009b).

    It is clear that “Pure Fashion” can be added to the list of cultural institutions that support a hierarchical segregation between “virgins” and “whores.” For example, one mom who sent her daughter to “Pure Fashion” expressed her desire for men to look at her daughter in the same way that she looks at her daughter, as “pure and beautiful and innocent”:

    “I don’t want her to be distracted by men. So I kind of don’t want men to look at her at all, not notice her,” Tina said. “But I recognize that they will, so I just want to make sure they look at her in the way that I see her, which is pure and beautiful and innocent.”

    But conservative religious parents aren’t the only one sounding the alarm horns; many feminist and feminist-leaning academics and professionals are also concerned about sexy and sexual girls. This is because mainstream media appears to create the opposite problem of conservative religion: that is, rather than telling girls and women that their worth is based on their lack of sexual availability, the media appears to “tell” girls and women that their worth is based on their widespread sexual appeal and availability. They may leave God and purity talk out of it and they may not send their daughters to Sharman’s fashion reeducation program, but secular, feminist, and academic critics are still dismayed by girls who dress “sexy.” Indeed, it has become common for people across lines of politics, religion, and profession — at least in the US — to shake their heads in dismay over the increasing “sexualization” of girls, women, and of culture. This perceived shift in mainstream US culture is almost uniformly seen as harmful, something to critique and work against. It is in this cultural context that the American Psychological Association formed a task force on the Sexualization of Girls and wrote a highly publicized report (APA Task Force report on the Sexualization of Girls 2007).  (See below for the APA’s definition of “sexualization”).

    In contrast to the APA task force and conservative religious groups, we think it is a mistake for scholars and activists to automatically assume that sexualized images and appearances are harmful to girls and women. We critique the methodological, empirical, and epistemological foundations of this argument in great depth in a recent article (Lerum & Dworkin, 2009a), but here I focus on just one point: how the concern about “sexualization” misses the boat on sexual health. While the APA task force briefly discusses what they consider to constitute “healthy sexuality,” we argue that the term “sexual health” is much more useful for social justice, feminist, and public health scholars/activists:

    … we suspect that an ideological gulf may exist between the APA’s (2007) concept of healthy sexuality and the more widely recognized concept of sexual health. For one, the APA’s version of healthy sexuality seems to rely on the existence of a sexual partner: (‘‘intimacy, bonding . . . shared pleasure . . . mutual respect between consenting partners,’’ p. 2). In contrast, the concept of sexual health is often explicitly tied to a rubric of individual sexual rights (some of which may apply to both children and adults). Originally developed by the World Association for Sexual Health and now widely recognized (and modified) by other organizations including the World Health Organization, the concept of sexual rights may include the right to sexual pleasure (not necessarily with another person), the right to emotional sexual expression (including self-sexualization), and the right to sexually associate freely (Lerum & Dworkin, 2009, p. 259).

    We further argue that “(s)ounding the alarms on sexualization without providing space for sexual rights results in a setback for girls and women and for feminist theory, and is also at odds with the growing consensus of global health scholars (Lerum & Dworkin, 2009, p. 260).

    While the APA task force report virtually ignores sexual health, statistics about sexually transmitted infections (STIs) are widely embraced and utilized by conservative religious groups. The following quote comes from Brenda Sharman, director of “Pure Fashion”:

    “If you are too steamy in your bikini, you will become a part of a statistic,” Sharman told a roomful of 40 girls at the Atlanta conference. “By the age of fifteen, 76 percent of teens are involved in a sexual relationship. What do we expect, really, when so many girls have displayed their bodies to the world? … For the first time teen girls have the highest gonorrhea rate in the nation, teen boys have the second. Approximately 400,000 teens have abortions every year. And according to UNICEF, half of all new HIV infections occur in young people 15-24.”

    Of course, Sharman’s use of these statistics is alarmist and conflated (e.g., the UNICEF statistics are GLOBAL, reflecting more about conditions of access to contraception, early marriage, and/or extreme poverty than whether or not a girl has access to a bikini!), but it is also clear that conservatives are using them to shore up a particular theory of sexuality (i.e. bad things happen when girls get sexy). For critical scholars of sexuality, justice, health, and inequality, these statistics illustrate points and questions around a very different set of assumptions. We leave these interpretations to the conservatives at our own peril.

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    The APA task force defines sexualization as a condition that occurs when a person is subjected to at least one of the following four conditions:

    • 1) a person’s value comes only from his or her sexual appeal or behavior, to the exclusion of other characteristics,
    • 2) a person is held to a standard that equates physical attractiveness (narrowly defined) with being sexy
    • 3) a person is sexually objectified – that is, made into a thing for others’ sexual use, rather than seen as a person with the capacity for independent action and decision making, and/or
    • 4) sexuality is inappropriately imposed upon a person          (APA Task Force, 2007, p. 2)

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    Bibliography/Recommended Reading:

     

    worldaidsday400_558On December 1, 1988, the World Health Organization declared its first observance of World AIDS Day. Since that day 21 years ago, every December 1st has been used to raise awareness about the global HIV/AIDS pandemic.  In 2006, the Political Declaration on AIDS set a goal to have “universal access to comprehensive prevention programmes, treatment, care and support by 2010.” While progress has been made, we are very far away from being able to trumpet that successes have been fully reached. For the year 2009, the theme of World AIDS Day is Universal Access and Human Rights.

    Currently, approximately 33 million people are living with HIV/AIDS (for a full set of global epidemiology slides, click here). Women constitute one half of the people living with HIV/AIDS, and this percentage has risen rapidly from 35% in 1985 (for a slide on the percentage of women in the epidemic around the world, see the UNAIDS epidemiology slides above). Shockingly, young people constitute one half of the new infections each year. While there is no cure for HIV/AIDS, anti-retrovirals have offered hope, newfound possibilities for health and well-being, and added years of life to millions of individuals, households, and communities around the globe. In the case of treatment, while many (but certainly not all) in the United States have access to life saving anti retroviral therapies, the availability of treatment is widely variable around the world. Unfortunately, only a small proportion of those with HIV/AIDS have access to anti-retro viral therapy. (For more details on the prevention, treatment, and care dynamics of the epidemic around the globe, see the UNAIDS 2008 Report on the Epidemic.)

    Universal access as a theme is pointing to the need to ensure that populations have access to HIV/AIDS prevention, treatment, and care.  This is easier said than done—in 2007 only 31% of people who needed treatment received it—and the rate of infection is far outpacing the increases in the number of people who are receiving treatment. Economic retractions around the globe threaten the progress that has been made and there are some reports that treatment programs are being halted or scaled back substantially given economic constraints (UNAIDS 2008 Report).

    Because of the way that the number of infections is far outpacing those who have access to treatment, and because the epidemic is largely spread through drug use and sexual contact, the importance of prevention cannot be overstated. Prevention is well recognized as a key factor in slowing the pace of the epidemic—and this is not simply a matter of getting people much needed information and skills about condoms. Prevention is also about tending to the root causes of the epidemic, which involves issues related to social inequalities, homophobia, poverty, gender inequality, the criminalization of drug use and sex work, violations of human rights, and lack of health care access and infrastructure. And, then of course there are the complexities of culture and human behavior, and the fact that many prevention programs work for a short time, even up to a year, but these behavior changes are not often maintained in the long run. There is a great deal of promise in structural, interpersonal, cultural, and group level behavioral prevention interventions. However, the promise of these prevention interventions will not be fully realized without attention to social inequalities and human rights issues.

    WAD09-Logo1-web1

    This brings us to the second aspect of the theme of World AIDS Day 2009: human rights. While it may not be obvious to many, violations of human rights shape HIV/AIDS risks and access to prevention, treatment, and care around the world.  Men who have sex with men, sex workers, and drug users experience stigma and discrimination throughout the world. Many countries attempt to make HIV/AIDS a public health issue, but far too often, it is treated as a moral issue where populations are blamed for their fate (particularly sex workers, drug users, and men who have sex with men). Some countries do not even count “men who have sex with men” as a category in their surveillance systems and men who have sex with men have the lowest coverage of HIV prevention services of any category (UNAIDS, 2008). In numerous countries, women who are known to be HIV positive are thrown out of their homes  when they test positive for HIV/AIDS and do not have adequate access to education, property rights, or income generation to help them to survive (and these factors shape their risks to begin with)—this is the case even when their partners may have infected them. In my own travels and research in South Africa and Kenya, it is clear that many women will not bring their children back to health care centers or clinics to be treated with ARVs for fear of being thrown out of their households and families by their male partners, relatives, or community members. Many men do not come to clinics to be tested because of HIV/AIDS stigma and because of perceptions that clinics are women’s spaces. Men also do not test because of ideals of masculinity which teach men to avoid signs of “weakness” or need. In many countries HIV positive women and men are subject to forced sterilization. Sex workers and drug users are often arrested and viewed as criminals, and prisons do not have adequate access to drug rehabilitation, condoms, or ARV’s, exacerbating the epidemic among “high risk” populations. And the U.S. has been known to stop funding prevention programs that take comprehensive sex education and condom use into account, arguing (against a very strong evidence-base) that abstinence and be faithful approaches work best (for studies that show that comprehensive sexual education and condoms work better than abstinence only programming, there are too many to list, but see this for one). The list of the links between social inequalities, rights, and HIV/AIDS risks goes on and on.

    There have been gains, and there have been many of them. The number of people on anti-retroviral therapy has increased 10 fold in the past 6 years alone (UNAIDS, 2009). Recognition of the role of gender inequality and homophobia in shaping HIV/AIDS risks is increasing, as has prevention programming which is increasingly gender-specific and transformative for both women and men. Defining ‘human rights’ and implementing changes in rights has newfound momentum and if this continues, may provide marginalized populations with increased protections, resources, legal recourse, and access to prevention, treatment, and care. The US has a centralized dissemination program to diffuse evidence based successes to community based organizations. There is global mobilization to eradicate mother-to-child transmission. The economic contributions to prevention and a global scale ups in treatment have been a stunning testament to the fact that the global community can rally much needed support.

    Still, there is much work to be done both domestically (U.S.) and globally. The incidence rate of HIV/AIDS in Washington DC is similar to that found in Western Kenya. The age distribution in some countries on the African continent has shifted life expectancy downward by several decades in several countries due to the epidemic. AIDS is the leading cause of death right now among African American women aged 25-34 in the United States and African-American women are 21 times more likely to die of HIV/AIDS than Caucasian women. There are millions of orphans due to HIV/AIDS. Sub-saharan Africa constitutes 10 percent of the world’s population and over 65% of the cases of HIV/AIDS. Anti-poverty efforts and food security efforts have been slow to link up with HIV/AIDS prevention, treatment, and care and are much needed. National policies have been hampered in their implementation by a lack of coordination, technical skill, and competing economic and health needs. Young people need prevention efforts more than ever before and prevention efforts reach adults the most. To achieve universal access and human rights within the HIV/AIDS epidemic is a goal that all social sectors and countries must all strive for. At the same time, all must be mindful that recalcitrant issues such as social inequalities and social justice shape the epidemic profoundly and must be dealt with head on in action and not in rhetoric.

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    For more information on the AIDS pandemic and how you can get involved in advocacy, research, or activism see the following links:

    If you are reading this blog from a computer or phone within the United States, you are well aware that health care reform debates are coming to a head. The latest controversy over just how, and for whom, health care reform will become institutionalized comes in the form of the Stupak amendment, which the The Wall Street Journal describes as “a last-minute amendment toughening abortion restriction in the House health-care bill….” backed by “(t)he U.S. Conference of Catholic Bishops, a powerful force behind the strong abortion language in the House.”  Meanwhile, The Wall Street Journal also reports that “Planned Parenthood …. has started a petition drive that has been promoted by Cosmopolitan magazine,” and that  “(a)ctivists hope to flood Washington to rally and lobby on Dec. 2, during the week that Senate floor debate begins.”

    A protester in Los Angeles last Friday

    To better understand this issue from the perspective of reproductive and sexual justice activists, I turned to a former student of mine, Courtney Bell. Courtney received her M.A. in Public Policy from the University of Washington, Bothell in 2008 and is currently working as a Public Affairs Field Organizer for Planned Parenthood of the Great Northwest.

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    Message Number Three

    by Courtney Bell

    As a community organizer for Planned Parenthood of the Great Northwest, I have had the privilege of joining our supporters on the front lines of the debate over health care reform these past few months. Together, we have generated thousands of contacts into the offices of our members of Congress, expressing support for reproductive health care and advocating for its inclusion as part of any basic health care package.

    And it’s been a bumpy ride. When Planned Parenthood Federation of America kicked off our organizing campaign for Health Care Reform early last summer, we had three primary messages to convey:

    1. Reproductive health care must be included in any health care reform package. Reproductive health care is basic health care and real reform includes women’s health.
    2. Essential community providers must be included in health plan networks so that patients can access health care from the trusted providers in their communities.
    3. Women must not be worse off after health care reform than they are today.

    When I first heard Message #3, I thought to myself, “Duh! Isn’t that kind of a no-brainer of a goal to be working toward? Surely, if health care reform is passed, this is the only outcome to be expected.” I knew that health care reform was all about expanded access to care for millions of people, and currently there are more than 17 million women in the United States who are uninsured.

    But now, having participated in three chaotic and infuriating (read: teabagger) Health Care Reform town halls in Western Washington, countless nationwide phone banks, and two advocacy days on the Hill in Washington DC over the past few months, I see that clearly, Message #3 has become our paramount concern. On November 8th, the House passed its version of Health Care Reform with the inclusion of the Stupak-Pitts Amendment. Under this amendment, millions of women will lose access to private insurance coverage for abortion care. And as reported in a study by the George Washington University School of Public Health and Health Services, “the treatment exclusions required under the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange.”

    It has been a founding principle of Health Care Reform, as articulated by President Obama, that no one will lose the benefits they currently have. Make no mistake: this is exactly what will happen if the Stupak-Pitts Amendment makes it into the final version of the bill.

    Fortunately, the Senate version of Health Care Reform currently excludes this disastrous language. We must do all that we can to ensure that when the final bill comes before our President for a signature, it is one that respects our fundamental rights.

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    If you are interested in joining Planned Parenthood in this fight to ensure that women will not be worse off after health care reform than they are today, Courtney offers three action plans:

    1. Sign the petition to President Obama, Majority Leader Reid, and Speaker Pelosi. It’s the first step to stopping the Stupak ban and protecting women’s access to abortion coverage.

    2. Join Planned Parenthood in DC on December 2 for a National Lobby Day, when Planned Parenthood and allies will be taking this message straight to Congress.

    3. Read the Issue Brief: Impact of Stupak Amendment on Access to Abortion Coverage and Care and share with others.

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    Additional readings from reproductive health and justice experts on the Stupak amendment:

    Debates about Gardasil (aka the “cervical cancer vaccine”) have up until this point focused on girls and young women. By focusing on cervical cancer,  rather than on HPV (what the vaccine is really for) — debates on this issue have completely sidestepped around the issue that, of course, boys and men get HPV too. Shouldn’t they also get vaccinated? What will happen now that the debate isn’t just about girls’ sexuality?

    I came across this story through sister sociologist/Huffington post blogger, Abby Ferber. In her post, entitled “Cervix Not Required,”  Ferber interviews Adina Nack, professor of medical sociology and sexuality studies at California Lutheran University and author of the the book, Damaged Goods? Women Living with incurable Sexually Transmited Diseases (Temple U. Press, 2008). I quote from Ferber’s interview with Nack below:

    headshotFerber: Last Friday, the FDA approved the Gardasil vaccine for use in boys and men ages 9 to 26 years old. When I heard this news, I was surprised. My daughter received the vaccine from her physician, and I had always thought of this as a “cervical cancer vaccine.” The reality, however, is that this is a HPV vaccine, to guard against the sexually transmitted Human Papillomavirus. Why, however, is it only now being approved for males, when it was approved three years ago for females? … Why do you think Merck first sought FDA approval of Gardasil only for women?

    Adina Nack, Ph.D._11-08C1-1Nack: Only going through the FDA testing and approval process for women allowed Merck to brand Gardasil as a ‘cervical cancer’ vaccine. Prior to the recent FDA approval of Gardasil for use on male patients, most Gardasil ads have claimed to empower girls and young women with a new tool to protect against cervical cancer. But, it is not clear how many Americans have understood that they were being sold a vaccine designed to protect against a STI.

    Ferber: In your book and blog posts, you talk about the stigma connected with sexually transmitted infections (STIs) being gender-based. How are attitudes about STIs reflected in the initial branding and marketing of Gardasil as a cervical cancer vaccine?

    Nack: As early as 2005, some organizations have been outing Gardasil as a STI vaccine and arguing that inoculating young adolescents against HPV would encourage teenage sexual promiscuity. The heads of various “family values” groups publicly declared that they would not vaccinate their own children. So, some have questioned whether Merck’s decisions to only seek initial FDA approval for female use and to brand it a ‘cervical cancer’ vaccine may have been motivated by a desire to distance the vaccine (and those who receive it) from the negative stereotypes we have about STIs and the types of people who contract them. On one hand, it is reasonable to assume that most U.S. parents would not be eager to have their daughters, as young as 9 years old, vaccinated against 4 strains of a virus that is primarily transmitted by sexual contact. After all, studies have shown that we’re more likely to assign negative traits – like promiscuity, irresponsibility, naivety, and unintelligence – to girls and women who contract STIs than to boys and men who contract the same infections. The Council on Contemporary Families has a forthcoming study showing that, while equality has increased in many areas, sexual-behavior double standards persist. In the U.S. and many other countries, a female patient who seeks out a STI vaccine often has reason to worry that others will label her a ‘bad girl’ or ‘fallen woman.’ We are more likely to see a ‘cervical cancer’ vaccine as something that good girls and chaste women are justified in seeking out (emphasis mine).

    Ferber: If this strategy might have increased the numbers of girls/women receiving the vaccine, then what is the problem?

    Nack: It can be argued that the success of branding Gardasil as a cervical cancer vaccine has come with serious public health costs. How can we account for the boys and men who have been unable to legally access this for the last 3 years, a time period in which many of them (and their sexual partners) could have been protected against HPV-related diseases and cancers? Prevention and early detection is especially important for HPV infections because we do not yet have a true ‘HPV test’ or medical cure. By not seeking FDA approval for both male and female patients at the same time, this vaccine’s potential benefit to the public was limited. The FDA’s recent decision to approve male Gardasil has confirmed that Merck sold us a STI vaccine disguised as a cancer vaccine. Despite the messages in Merck’s successful female Gardasil campaign, cervical cancer has never been the only reason to care about the HPV pandemic: medical studies have connected HPV to oral cancers and anogenital cancers in both female and male patients (emphasis mine).

    Ferber: You have made the point that the Gardasil ad campaign was a primary source of HPV information for many who had not previously been educated about this STI – what do you see as the downsides to this?

    Nack: By obscuring the fact that HPV is a STI in its marketing of Gardasil, Merck missed a chance to educate us about this highly contagious family of viruses: one can contract HPV from the types of skin-to-skin contact that can take place even when sexual partners are using barrier methods, like condoms or dental dams. Given the current trends in U.S. teen sexual attitudes and behaviors, I’m also concerned about how many young people are at risk for contracting HPV because they are engaging in oral sex or anal sex to remain a ‘virgin.’ There has yet to be a large-scale public health campaign to educate the U.S. public about the truth of HPV, so Merck’s Gardasil marketing materials may have been the first (and sometimes only) ‘education’ about HPV for many Americans. For teens and young adults whose primary source of HPV information came from Gardasil ads, then what is the public health damage of not clearly understanding that HPV is sexually transmitted? What about not realizing that HPV can infect and have serious health consequences for boys/men? (emphasis mine).

    Ferber: Why do you see de-stigmatizing STIs as key to improving sexual health in the U.S.?

    Nack: With Gardasil now fully unmasked as the HPV vaccine it has always been, I’m hopeful that we will stop believing the myths that HPV is only a concern for females and that only promiscuous people get STIs. The availability of safe and effective STI vaccines is something to celebrate. Gardasil’s new approval for use by boys/men is an important opportunity to destroy longstanding myths. To de-stigmatize HPV is to stop viewing it – or any other STI – as a sign of immorality. Through my website, I receive emails every week from those whose genital HPV and herpes infections have damaged not only their health but also their self esteem, their relationships, and their social reputations. Eliminating the shameful stigma of STIs could free millions of infected women and men from social and psychological traumas and harm public health. Viewing these kinds of infections as medical conditions would allow STI patients to focus on pursuing treatment options that not only allow them to manage their own symptoms but also make them less likely to infect others. Destigmatizing STIs may also increase the odds that a newly diagnosed person will disclose their sexual health status to their sexual partner. New social attitudes and better public health education about STIs can prepare Americans to support future STI/HIV vaccination programs.

    Ferber: As a result of marketing Gardasil as a cervical cancer drug for girls and women only, scores of males and their partners have unnecessarily contracted HPV over the past three years; the full range of health consequences of HPV have been ignored, and stereotypes and stigmas around STIs remain entrenched. Astoundingly, the American Social Health Association reports that “about 5.5 million new genital HPV cases occur each year — this is about 1/3 of all new STD infections.” Clearly, what we need is open and honest education about HPV and other STIs. We have allowed our stereotypes about women’s sexuality and STIs to put our public health at greater risk.

    During the first week of October (National Sex Education week, and the beginning of Sex Education month) I posted a story about Orrin Hatch’s proposal to restore $50 million a year in federal funding to abstinence-only sex education. Now that we are in the last week of Sex Education month, it is oddly fitting that some of our STI education has been taken over by private industry (in this case, Merck’s marketing campaign about the Gardasil vaccine.) Let’s hope and lobby so that kids are not reliant solely upon on commercial advertisements for their sexual health information.

    On August 24th, 2009, CDC representatives at the National HIV Conference in Atlanta, Georgia reported that gay men and other MSM (men who have sex with men) are 50 times more likely to have HIV than heterosexual women or straight men. The report is not yet available at the CDC website and interestingly, only the “gay” newspapers have picked it up as a worthy news story (thus far).

    This statistic is reported as confirming, in emphatic terms, the disproportionate impact of HIV/AIDS on gay and bisexual men of all races and ethnicities. It also recognizes that the highest impact is on African-American men. This announcement is crucial in a few key ways:

    First, while there is no cure for HIV or AIDS (and a partially effective vaccine–soon to be another post), many in the US have had access to anti retroviral medications (ARVs) for decades. Many people therefore assume that HIV prevalence has leveled off and that there are very few NEW HIV cases in the US. This is simply not the case. We have a truly problematic epidemic here in the US, and the numbers clearly show us that certain populations are even more at risk than we knew.

    This leads me to my second point: Our resources should be aligned to reflect where the risk is. It is not clear that this is happening, particularly in communities of color.

    This new announcement tells us, in a convincing and unrelenting way that there is a disproportionate impact on MSM.

    So, it’s clear that there’s a huge problem here. Still, I have some critical questions about this report.

    1)  First, is there a differential risk between gay men, bi men, and MSM who may not identify as “gay” or “bi” ? Why not report the difference in risk between gay men, bi men, and MSM?

    2)  Second, what is the difference between:

    a) the risk among gay men, bi men, and MSM (as a category and separately, since they lumped them all together) compared to risk among heterosexual women and b) the risk among gay men, bi men, and MSM (as a category and separately) compared to risk among heterosexual men?

    If there is a difference there, shouldn’t we also report that? If we don’t separate out analyses (a) and (b), don’t we unnecessarily set up a “heterosexual” and “minority sexuality” binary?

    3)  Further, given that (a) and (b) were not analyzed and presented and given that heterosexual women are experiencing rapid increases in risk in some populations, how can we assure that resources aren’t needlessly pulled from them due to the way the data is being presented?

    I have more thoughts, but I’ll stop there for now. There are many interesting framings of data that we can offer that rely on categories of gender or sexuality. We should do both at once. I am proud of my Centers for Disease Control for coming out, so to speak, with these newest figures, and as usual, I look forward to even more figures if these are also bravely revealed. Nuance, not simplicity helps—just as we find in media sound bites.