HIV 101

Because of the research projects I am currently interning for, I have been thinking/reading about HIV-related topics for the past 5 months. I think it would be negligent of me to not make a HIV 101 post. Conducting and listening to interviews of study participants has made me cognizant of how little people still know about HIV, how it is transmitted, how they can protect themselves and what is available (in NYC) to those who become HIV positive. So I am going to start with a basic HIV 101 post and in the future, I will post more in-depth analyses of HIV-related topics.

Note: For this post, I am going to list the links I used at the end instead of sprinkling them throughout the post like I usually do. This is to ensure a more fluid post.

What is HIV and What Does It Do?

HIV stands for Human Immunodeficiency Virus. HIV attacks the CD4 cells aka T-cells in the immune system. These cells usually assist the body in fighting off infections and diseases and without them, the body is defenseless against opportunistic infections. An opportunistic infection is an infection that the body is usually able to fight without a problem, but because HIV has weakened the immune system, the infection seizes this opportunity and attacks the body. At this point, HIV turns into AIDS, which stands for Acquired Immunodeficiency Syndrome. With AIDS, the immune system is seriously damaged and the individual dies from opportunistic infections. For the record, HIV does not have to progress into AIDS. In this day and age, an individual can take medication and live a long and otherwise healthy life with HIV without it progressing into AIDS.

How can HIV Be Transmitted?

The fluids that have a high risk for transmitting HIV are blood, semen (cum), breast milk and vaginal fluid. Pre-seminal fluid (precum) that is released during sexual intercourse can also transmit HIV. To clear things up, HIV CANNOT be transmitting from the following: saliva, tears, sharing food, utensils, cups and bathrooms with a HIV-positive person, hugging, breathing, coughing and sneezing. HIV cannot be transmitted through the air and HIV cannot survive for long outside of the body. HIV is a virus and, like a parasite, desperately needs a living host in order to survive. The only way for HIV to be successfully transmitted is if the infected fluid comes directly in contact with wounds, tears and lesions.

Risky Behaviors

Unprotected Receptive Anal Sex (Bottoming) – The anus is not made for sexual intercourse the way the vagina is. The lining of the anus is very thin and prone to tearing and infected semen can get into the broken skin. Receptive Anal Sex is inherently riskier than insertive anal sex because the bottom is receiving the potentially infected semen from the top.

Unprotected Insertive Anal Sex (Topping) – Infected blood from tears in the bottom’s anus can get into the urethra and into any tears/open sores on the penis.

Unprotected Vaginal Sex – The vaginal wall can also tear and HIV can be absorbed through the mucous membranes of the vagina and cervix. And infected blood and vaginal fluid can get into the urethra and any tears/open sores on the penis.

Unprotected Oral Sex – This is the least common way to transmit HIV. Risk increases if the person has cuts in their mouth. It is recommended that a person does not brush their teeth or floss right before or after unprotected oral sex. Bleeding gums could ease the transmission of HIV.

Having another STI (sexually transmitted infection), like herpes, could increase the risk of HIV transmission because of the possibility of having open sores or the effect that the STI may have on the immune system.

Sharing needles and other injecting drug equipment – Residual blood left on drug paraphernalia can spread HIV.

Prevention

Obviously abstinence is the best prevention of HIV and other STIs, but let’s be realistic. Most people aren’t just going to stop having sex so here are other ways to prevent HIV transmission.

Contraception

Condoms stop the spread of fluids by creating a protective barrier. Dental dams, like condoms, provide a protective barrier when performing oral sex on a vulva and/or rimming (licking someone’s anus). Also latex gloves can be used if a person has cuts on their fingers or long nails and wants to finger another person’s vagina or anus. Lube decreases the likelihood of tears in the vagina and anus, reducing the likelihood of fluid transmission. Proper lube use is also important. DO NOT use oil-based lubes!!! Oil breaks down the latex in condoms and gloves, making them useless and ineffective. Examples of oil-based lubes are: lotion, cooking oils (i.e. Crisco), and baby oil. Again, DO NOT USE THESE!!! Water-based and silicone-based lubes are perfect for sex and do not break down latex. These lubes are usually sold as sex lubes and can be found at your nearest drugstore/pharmacy/sex shop. Two quick notes: If you are susceptible to yeast infections, avoid water-based lubes that contain glycerin. And do not use silicone-based lube with silicone sex toys, it will eat away at your toy, rendering your expensive sex toy useless. Speaking of sex toys, be sure to clean your sex toys after every use, especially if you use your toys on multiple people.

PrEP

PrEP stands for Pre-Exposure Prophylaxis. It is another form of HIV prevention in which HIV negative people, who are at high risk for contracting the virus, take a low dose of antiretroviral medication (A type of HIV medicine.) every day in order to try to decrease their chances of becoming infected. According to the CDC, PrEP has been shown to be effective with men who have sex with men (MSM) and heterosexual men and women.

Statistics From the Center for Disease Control  (Who Is Most At Risk?)

In future blog posts, I will go into why these populations are more susceptible than others, but this is a HIV 101 post so I want to give basic information.

MSM

“Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the US population, yet are the population most severely affected by HIV and are the only risk group in which new HIV infections have been increasing steadily since the early 1990s. In 2006, MSM accounted for more than half (53%) of all new HIV infections in the United States, and MSM with a history of injection drug use (MSM-IDU) accounted for an additional 4% of new infections. ”

Women

“In 2009, there were an estimated 11,200 new HIV infections among women in the United States. That year, women comprised 51% of the US population and 23% of those newly infected with HIV.”

“For women living with a diagnosis of HIV infection, the most common methods of transmission were high-risk heterosexual contact and injection drug use.”

“In 2009, the rate of new HIV infections among black women was 15 times that of white women, and over 3 times the rate among Hispanic/Latina women.”

African-Americans

“By race/ethnicity, African Americans face the most severe burden of HIV in the United States (US). At the end of 2007, blacks accounted for almost half (46%) of people living with a diagnosis of HIV infection in the 37 states”

Hispanics

“While Hispanics/ Latinos represented approximately 15% of the United States (US) population in 2006, they accounted for 17% of new HIV infections in the 50 states and the District of Columbia during that same year.”

Youth

“An estimated 8,300 young people aged 13–24 years in the 40 states reporting to CDC had HIV infection in 2009.”

“Nearly half of the 19 million new STDs each year are among young people aged 15–24 years.”

I Just Seroconverted. Now What?

To seroconvert is to become HIV positive. With the introduction of better HIV medications and a greater understanding of the virus, individuals who are HIV positive are now able to live full relatively healthy lives. There’s no cure for HIV, but there are treatments to decrease likelihood of transmission and to deal with complications resulting from opportunistic infections. There are public health services that cater to HIV positive individuals, like ADAP (AIDS drug assistance program that provides health insurance), psychological therapy, housing assistance, and substance abuse services. New York State, especially, is well known for its services. Two NYC centers that I have personally heard amazing things about are GMHC and Harlem United. Also check the Department of Health for more information. You are not alone.

Important Phone Numbers:

• NYS HIV/AIDS Hotline - 1-800-541-AIDS
• NYS TTY/TTD HIV/AIDS Information Hotline - 1-212-925-9560
• NYS HIV/AIDS Counseling Hotline - 1-800-872-2777
• NYCDOHMH HIV/AIDS Hotline - 1-800-TALK-HIV
• Confidentiality - 1-800-926-5065
• Legal Action Center - 1-212-243-1313; 1-800-223-4044
• NYS Division of Human Rights - 1-800-523-2437; 1-212-306-7500

Reference Links:

What is HIV? 

HIV Transmission 

Statistics for Women

Statistics for Youth

Statistics for MSM

Statistics for Hispanics

Statistics for African-Americans

The Medicalization of Sexuality

What is medicalization? It is both a process and a viewpoint. It is the idea that every aspect of the life should be observed and defined from a medical perspective. All negative or uncertain phenomena become labeled as diseases or disorders that fall under the jurisdiction of doctors and must be treated with medication. Medicalization falls under the Western biomedical view of health, which defines health as a lack of disease. Human phenomena falls under only two categories: health and illness. As you may know, I’m not a fan of binaries. Binaries oversimplify reality and leads to oppression as some groups are cast to the side because they do not fit in. The biomedical perspective also focuses only on individual health and how to solve an individual problem. My problems with the biomedical perspective and medicalization as a whole are the unwillingness to look beyond the individual into interpersonal and societal factors, disease-mongering in order to make a profit with short-term medications that do not fix long-term societal or psychological issues, the mislabeling of phenomena as disorders or problems and the downplaying of cognitive-behavioral therapy in favor of pills.

So what do I mean when I say “the medicalization of sexuality”? Sexuality has always been defined in terms of normal or abnormal, permissible or inexcusable. And sexuality has even been seen as something that can be cured, whether it was through prayer or electroshock therapy. However, something that is new and unique to the past few decades is the idea that aspects of sexuality and sexual phenomena can be studied and treated as if they were medical diseases and disorders. The idea that popping a pill or undergoing a medical procedure can solve all one’s sexual problems is a very new concept. The DSM-IV-TR, the Diagnostic and Statistical Manual, Edition Four, Text Revision, is the current edition of the book used by psychiatrists, psychologists and other health and mental health professionals to diagnosis psychological disorders. It is very controversial, yet it was created to standardize diagnostic methodologies to avoid a situation where two psychologists diagnose a patient with two completely different disorders. One of the reasons why the DSM is controversial is the section on sexual dysfunctions. In the DSM, certain sexual phenomena are listed and declared abnormal. This should make any critical thinker wonder: “What ideal is the phenomena being compared to? What is “normal”?” “Who decides what is normal and, in particular, what is sexually normal?” Society does. The social sciences in this society are well known for using college-aged Caucasian males as the subject of research studies. This small segment of society, that is in no way representative of this society, is set up as the standard for all other members of society. Obviously, that’s ridiculous.

Step two of medicalization: Now, that we have the disease, it’s time to treat it with medical miracles. I can’t watch TV for longer than five minutes before an advertisement for some pill pops up. Did you know those ads are illegal in most industrialized countries? Heather Hartley and Leonore Tiefer, in their article, “Taking a Biological Turn: The Push for a "Female Viagra" and the Medicalization of Women's Sexual Problems,” state, “Direct-to-consumer (DTC) advertising of prescription-only drugs, a phenomenon prohibited in most of the industrialized world, was newly permitted by the FDA in 1997 and plays an important role in the current trends (P. 43).” These commercials are funded by the drug companies who produce the drugs being advertised. They declare that these drugs can fix your current problem and even problems you didn’t even know you had while whispering very quickly all the nasty side effects. These side effects and complications can lead to the individual taking more and more drugs to make up for it, keeping the person trapped in a medicated web. Now, people, seduced by these commercials, run to their doctors and demand these drugs. Medicine is supposed to be about healing people, not about disease-mongering and scaring people for profit. Another thing to think about, that the commercials never tell you, is that studies have shown that, in many cases, medication alone is not nearly as effective as therapy or therapy along with short-term medication. Therapy is needed in order to learn how to live in the long-term without drugs (or with lower doses). One learns techniques to manage and/or solve their problems without the side effects. And therapy can include other people in the person’s life to provide support and to assuage any shame and stigma associated with the issue the person is facing. It is even more insidious and, in my opinion, disgusting when medicalization creeps into sexuality.

Two examples of the medicalization of sexuality that I will be focusing on are Viagra and Female Sexual Dysfunction (FSD). Everyone knows about Viagra. It blasted into mainstream culture and men pretty much paraded in the streets. However, I want to argue that the creation of Viagra has actually had negative effects and has perpetuated a negative and unrealistic standard that affects everyone. Female Sexual Dysfunction is an umbrella term used to describe difficulties in having/maintaining sexual desire (i.e. wanting to have sex), arousal (the vagina becoming lubricated) and orgasm. It is implied that FSD is a purely individual and medical problem that can be solved with a pill or a medical procedure. The trouble begins when one thinks about how a sexual phenomenon is labeled as a dysfunction (Think about what I said earlier: Who gets to determine what is normal?) and, because it is seen as a medical problem, societal and interpersonal factors are ignored.

The pharmaceutical industry, through the creation of Viagra and FSD, perpetuate ideals that continue to have a strong grip on individuals and on society. Barry A. Bass, in his article, “The Sexual Performance Perfection Industry and the Medicalization of Male Sexuality,” states, “The definition of sex, put forth by an industry in which sildenafil (Viagra) is held out to the world as nothing less than the miracle medical breakthrough of the century, represents a phallocentric, sexist, homophobic, and iatrogenic orientation to human sexuality” (P. 338). Ok so let’s unpack this in terms of both Viagra and FSD:

• Phallocentric – The great sex that Viagra promises to men is a kind of sex that focuses solely on the function of the genitals and nothing else. According to the pharmaceutical industry, all you need for sex is a hard penis. Your relationships or the lack of them are not important. Neither are any emotions you might feel or what your situation in life is like. Basically none of the things that might be the underlying causes of your problem matter. Just take this pill, get hard and give me your money. Viagra turns sex from an awesome interaction between two or more people into a performance. Since, according to their outlook, one cannot have sex until a hard penis is present, it puts a lot of pressure on the man to get hard immediately and every single time. As one gets older, this just is not possible and there’s nothing wrong with that. As situations change with age so should people and their sexual experiences/techniques. However, the pharmaceutical industry is promising an 18-year-old ideal to an older reality. This kind of sexual pressure takes the focus away from “intimacy and pleasure” (Bass P. 337) to “achievement and performance” (Bass P. 337). Bass declares, “In short, it is my assertion that whatever it is we mean by good sex is more likely to occur if it takes place in the context of a safe, noncompetitive, and non-performance-oriented setting” (Bass P. 337). However, the pharmaceutical industry does not want men to know this. They would rather men feel insecure and not worthy so that they can become dependent on the drugs and line the pockets of “Big Pharma”.

• Sexist – The focus on the genitals, more specifically the penis, implies that the only sexual act worth thinking about and performing is penile-vaginal intercourse. This excludes all other forms of sexual expression to the detriment of the average person’s sexual enjoyment. If the only normal sex act is penile-vaginal intercourse and a woman cannot orgasm from just that (and most can’t), then there must be something wrong with her. She must have an orgasm disorder. In February 1999, the Journal of the American Medical Association (JAMA) published a study with this statistic: "Sexual dysfunction is more prevalent for women (43%) than men (31%)." Hartley and Tiefer point out that this statistic has been used over and over again to prove that there is “a virtual epidemic of sexual problems among women” (P. 47). Women have been culturally trained to not be completely comfortable talking about their sexuality and are more likely to do less research and rely on the popular media and commercials for their sexual information. These are the same commercials that are funded by the drug companies. Oh and by the way, a not as widely publicized fact: the study this statistic originates from was written and funded by Pfizer, the drug company that manufactures Viagra. What a lovely coincidence, right? In this modern world, women are getting mixed signals, they are supposed to be sexual to attract men (because obviously wanting women in a romantic and/or sexual way that isn’t for the entertainment of heterosexual men is impossible), but not slutty so men will respect them. Women are now told they should have orgasms and as many as possible, but then they are told that only penile-vaginal intercourse counts as sex (everything else is foreplay and therefore is optional) and if they can’t have an orgasm just from this, they have a disorder.

• Homophobic – The focus on the “importance” of a hard penis and a wet vagina as completely necessary for optimal sex negates those who sexualities and sexual experiences do not fall in line, e.g.  Gay and Lesbian individuals. These individuals are treated as if they do not count and are systematically ignored.

• Iatrogenic – Meaning causing or worsening a problem that it claims to be fixing. As I stated before, medicalization individualizes sexual phenomena, meaning that if a man cannot get an erection, this is a physical problem lies within this individual man, which requires a pill to fix it. It ignores the existence of any other factors. For example, what if he cannot get an erection because he is having relationship problems, feels pressured during sex for some reason or is depressed. Popping a pill does not fix any of these issues. All it does is make his penis hard. Another example would be a woman who does not orgasm from sex with her male partner. The problem could be she can’t orgasm from sexual intercourse and needs to explore other sexual acts or maybe they are having relationship issues and she no longer feels comfortable in the relationship. None of this can be solved by popping a pill. To sum it up, sexual problems can occur because of general ignorance of various aspects of sexuality, sexual anxiety and a lack of open and honest communication among partners (Bass P. 338). These issues require communication among partners and/or therapy, not a quick fix pill. Also this perspective renders invisible other aspects related to having sex. Peggy J. Kleinplatz in her article, “New Directions in Sex Therapy: Innovations and Alternatives,” states “…the amount of time devoted to getting the penis hard and the vagina wet vastly outweighs the attention devoted to motives, scripts [i.e. gender/sexual scripts], pleasure, power, emotionality, sensuality, communication or connectedness” (P. 39). Most people would agree that these aspects are essential to good sex and without them, all that is left is an artificially hard penis and a wet vagina, which loses its appeal after awhile. So it is no surprise when the sex turns sour. The pharmaceutical industry wants people to think that something is wrong with them. According to Bass, “It is the message of fear and inadequacy. It tells us that we do not measure up and that we will never measure up unless we become regular customers of the industry’s products” (P. 338). It is unethical and disgusting, but it makes them a profit.

In conclusion, the medicalization of sexuality is a new method of social control that sets up ideals and standards that oversimplify the diversity and variety of human sexuality. It oppresses those who do not fit into its schema for the “perfect” sex and it brainwashes others into believing they are flawed in order to make a profit for drug companies. That being said, there are benefits to medicalization. Klienplatz states that medicalization has made it possible to “[Identify] difficulties with orgasm, erection, and arousal as appropriate sources of treatment specialization and mental health insurance reimbursement. This inclusion meant legitimacy for sex therapy clinics, organizations, conferences and some research” (P. 37). Without medicalization, sex research, therapy, treatment and outreach would be even harder to conduct. However, at least in my opinion, the negatives outweigh the positives. My moral for today: If you think you may have a sexual dysfunction, don’t just pop a pill. Talk openly with your partners and explore other options. Try to think about it critically from many perspectives: interpersonal, societal and otherwise. Go see a therapist who does not fall in line with the biomedical perspective. Take control of your sexuality. If you don’t, someone else will.