Monday, February 23, 2015

The Pullout Generation? Condoms seem so much easier!

Here is an interesting article from New York Magazine worth reading:


     Gather a group of sexually active hetero women, get a few whiskeys in them, and I guarantee that, within an hour, someone will start complaining about how there are no good birth-control options. Sure, there are the IUD evangelists (“No hormones! I barely notice it except for my lighter periods. I canceled my Amazon subscription to tampons!” one friend told me cheerily), and those who have quietly and happily been on the pill or the NuvaRing since their teenage years. But there’s always at least one or two — often many more — who cannot wait to commiserate about their mood swings, depression, or loss of sex drive when they’re on birth control. Condoms are kind of the worst, they all agree, but even some women in long-term monogamous relationships say they’d rather use them than pop a hormone pill every day. This dissatisfaction is exhaustively chronicled in  a new book, Sweetening the Pill, which is dedicated to “every woman who has suffered physically and emotionally as a result of hormonal birth control.”
     What the book doesn’t mention — and what some of these women are reluctant to admit, even after a few cocktails — is that some of them have given up on conventional birth control and are relying on the pullout method. Yeah, they know it’s got failure rates to rival condom use at its sloppiest. But these are women who are sick of taking hormones, are in a long-term relationship with a man they trust, and rely on a period-tracker app so they know to use a condom when they’re ovulating. The risk is one they all seem pretty comfortable with.
According to some research, this isn’t as crazy as it sounds. A 2009 studyfound that, when you compare typical condom use to typical use of the pullout method (rather than the ideal usage of each), the withdrawal method is only slightly more likely than condoms to result in pregnancy. A recent survey conducted by the delightfully named Dr. Annie Dude, a researcher at Duke University, found that almost a third of women between the ages of 15 and 24 have relied on coitus interruptus as a birth-control method. A slew of disappointed articles followed. “Ladies, I implore you: Get on some real birth control,” wrote Janelle Harris at Clutch magazine. Slate’s Amanda Marcotte called the findings “worrisome.” Venerated sexpert Dr. Ruth Westheimer has compared the pullout method to Russian roulette, and clarified that the research mostly proved how often condoms are misused, not how safe withdrawal is.
     Every single American woman who’s now in her childbearing years came of age in the era of legal birth control. Many were prescribed the pill before they even started having sex. For years, the pullout method was taboo — seen as non–birth control for ignorant risk-takers. Admitting that you trusted a man — granted, a man who was your monogamous partner, but still — to pull out in time? That was ceding too much control.But I know a dozen women in their late twenties and thirties who, after years of jumping from brand to brand and always feeling crazy or depressed, or after years of nagging health concerns about taking hormones, finally said "enough" and told their partners to put on a condom and deal with it. Though we all want safe and accessible and reliable contraceptive options — thanks, Obamacare? — the pill is no longer synonymous with sexual liberation.
    These women describe a deliberate transition from the pill to the pullout. They buy organic kale and all-natural cleaning products, and so can’t quite get down with taking synthetic hormones every day. They are more driven by sexual pleasure — they see orgasms as a right, not a privilege — and hate the feel of condoms. They wouldn’t call themselves porn aficionados or anything, but they don’t think it’s demeaning to have a man come on them. They’re sick of supposedly egalitarian relationships in which they bear the sole responsibility for staying baby-free. They're scared to stick an IUD up there, no matter how many rave reviews the devices get. And despite the fact that non-hormonal contraceptive options remain frustratingly limited, there are new tools at their disposal: With period-tracker apps, charting your menstrual cycle is no longer the domain of hippies and IVF patients. They know when to make him put on a condom. Plus, they can keep a packet of Plan B on hand at all times, ready and waiting should anything go awry. So it makes a certain amount of sense that, for these women, the pullout method is looking more like a legitimate contraception option.
     “I've been on the pill for about six years and stopped after a dinner party last month when I realized that all seven women there were not only not on the pill, but had only good things to say about going off,” says a 31-year-old friend of mine, a recent convert to using a cycle-tracking app, pluscondoms while she’s ovulating. As another 31-year-old friend recently told me of her choice to use pullout-plus-period-tracker, “I kind of struggled with our method for a while. It seemed kind of embarrassing and definitely felt irresponsible. But after six or so years of this style, we have still never been pregnant.”
But when I talked to women in their early twenties who have relied on withdrawal, I realized their decisions were far less deliberate. Younger women tended to say they had condomless sex with no birth-control backup only when they were too drunk or too in-the-moment or too shy to protest. “I feel like it was used by older men who didn't want to use condoms,” one 24-year-old told me, “and because of my inexperience I didn't advocate for a more reliable method. So I kind of had to trust that they would withdraw in time and it was hella stressful.”
When I asked these women whether they would ever rely on the pullout method, some were appalled. “I and at least one friend of mine ask our boyfriends to pull out in addition to using hormonal birth control,” says Sarah, 22. “I feel like the pullout method is maybe one of the dumbest things a lady could possibly do,” adds Allison, 21. “There's just too much risk, to me — especially if you're that young.”

     It’s no coincidence that the pullout advocates I know are women who have been sleeping with the same man for years. More than any other birth-control choice, the pullout method requires women to relinquish control and put a significant amount of trust in their partner. But it also comes with the benefit of sharing the burden of preventing pregnancy. After years of being the ones who had to remember to take a pill or replace the ring, pullout puts the onus on men. A friend of mine, who’s 32, says her current partner has more reservations than she does about using the withdrawal method. “He’s like, ‘I’m nervous. Sometimes I feel like I’m going to fail at my job,’” she says, adding earnestly, “It’s a lot of pressure for them.”

Monday, February 16, 2015

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Tuesday, February 10, 2015

STD Prevention Online does an excellent job of highlighting current issues and updates. If you have not seen it yet, check out their website! It's really well done. 

Thursday, February 5, 2015

 In Honor of National Black HIV/AIDS Awareness Day tomorrow, we thought we share this awesome piece from the National Minority AIDS Council. Feel Free to check their website out for more information on their organization and all the amazing things they do:


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The infographic below shows the stark reality of HIV in Black America. The statistics are mind numbing. At current rates of infection, 50% of black gay men will have HIV by the time they are 35 (8% of white gay men are infected). I’ve been accused of caring more for the black community then I do for my own people. I love being Asian and I will always be concerned about my community, but the numbers don’t lie. As an Asian gay man, I am fighting for black gay men because it’s the right thing to do. I am fighting for black gay men because like the civil rights movement, it’s going to take a rainbow of people fighting together to make a difference.

February 7 is National Black AIDS/HIV Awareness Day. We come together to once again draw attention to HIV’s devastation of America’s black community. How many more awareness days do we need in order to understand that we’ve failed black gay men? Nowhere in the world are there communities with a 50% infection rate. We have also failed African American women when they are 20 times more likely to be HIV infected then white women.

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In the fight against HIV over the last 30 plus years, the statistics for the black community were always known. The social determinants of health are often sited as the reason for the big difference. According to the CDC, "The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.” America has poor people of all ethnicities, so why aren’t the rates of poverty equivalent by race? The color of your skin should not determine your health outcome, yet all the indicators reveal the opposite.

The HIV community cannot solve all the world’s challenges, so what is our responsibility? A recent Lancet article notes, “33 percent of HIV-positive black MSM were retained in care, compared with 51 percent of white MSM; and only 16 percent of black MSM were virally suppressed, compared with 34 percent of white MSM. If black MSM achieved the same degree of HIV care as white MSM, the racial gap in new infection rates would be reduced by 27 percent. If black MSM with HIV had 95 percent diagnosis, or 95 percent retention in care, or both, the reduction would be 27 percent, 25 percent, and 59 percent, respectively.”

In other words, if we’re able to retain HIV positive African Americans in care, we can significantly move the curve. It’s not enough to link people to care, all PLWH need to be retained in care.

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NMAC challenges health departments and community based organizations to move quickly and aggressively to link/retain all PLWH into care. Since it’s not enough just to link into care, we need implementation research to understand how to retain PLWH in care. AIDS United published an interesting study on the use of smartphone apps to support PLWH in care. A panel from the International Association of Physicians in AIDS Care has 5 recommendations on how to retain PLWH into care. NMAC thinks it may be time to look at incentive programs for either the PLWH or healthcare providers.

NMAC challenges the Centers for Disease Control, health departments, and community to re-examine the use of data. There is too much lag time between collecting the data and reporting on it. As a result, decisions are being made using data sets that can be 4 years old. How helpful is it to make decisions in 2015 based on data from 2010? This year the White House will release an update on the National HIV/AIDS Strategy, yet the data from the report may have been collected years earlier. It’s very difficult to get a good picture of the epidemic if we don’t have good data. NMAC asks health departments to create advisory committees made up of people living with HIV, activists, community based organizations, elected officials, healthcare providers, civil rights attorneys, researchers, and others to discuss the use of data. Policies that were put in place at the beginning of the epidemic may no longer be relevant. Making good decisions depends on good data. Data should be the foundation to determine how to spend limited HIV resources.

Viral suppression and when to begin treatment should be the PLWH’s decision with support from their healthcare provider. Health literacy for all people living with HIV is essential in order for individuals to make informed decisions. NMAC calls for impactful, culturally intelligent health literacy programs to be made available to all PLWH. Differences in viral suppression based on race should be closely monitored with timely transparent reporting. Using viral load data, NMAC recommends that money and resources are prioritize for “hot spots”, communities with a large numbers of PLWH who also have a high viral load. The money needs to follow the epidemic.
The color of your skin should not determine your risk for HIV infection, viral load, or mortality. On this National Black HIV/AIDS Awareness Day, let’s commit to retaining everyone living with HIV into care.
Yours in the struggle,

Paul Kawata
Executive Director
National Minority AIDS Council

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ABOUT NMACThe National Minority AIDS Council (NMAC) builds leadership within communities of color to end the HIV/AIDS epidemic. Since 1987, NMAC has advanced this mission through a variety of programs and services, including: a public policy education program, national and regional training conferences, a treatment and research program, numerous publications and a website:

Wednesday, February 4, 2015

We have expanded our HIV/AIDS educational materials. All on specials including the LINDI model and all our New educational boards. Check out our website for more details

Tuesday, February 3, 2015

National Minority AIDS Council (NMAC) Newsletter today highlighted their new Leadership Pipeline division. Total Access Group applauds NMAC's new initiative. Jacqueline Coleman is  leading this new division and summarized her focus in the NMAC 1-29-15 Newsletter:

I am very excited to return to the National Minority AIDS Council (NMAC), and am particularly honored that they’ve asked me to direct a new division called the Leadership Pipeline (LP). Ending the HIV epidemic in America requires visionary leaders who fight for the rights of all people living with the virus. My charge is to educate, train, and inspire new and existing leaders of color who will fight for racial justice in order to end the HIV epidemic in America

(NMAC newsletter 1-29-15)