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Letter from the Chair in Sexual Health

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MSM-global-forum-crop-BP.jpgI am writing this letter from the XIX International AIDS Conference in Washington, D.C. It has been 22 years since the International AIDS conference was held in the United States (mainly due to the unwillingness on the part of the United States to grant visas for HIV-infected individuals- only recently lifted).

Here 25,000 scientists, policy makers, health and education ministry officials, advocates, and activists from around the world are gathered with a renewed determination to stem the tide of this epidemic. Medical advances, improved access to care, prevention initiatives, and our nation's revived determination are all good signs, but as a culture we will need to shift our perspective to stop the spread of HIV.

Recent news of pre-exposure and post-exposure prophylaxis treatment has been encouraging. Last week, the Food and Drug Administration (FDA) approved Truvada (emtricitabine and tenofovir disoproxil fumarate) for Pre-Exposure Prophylaxis (PrEP) to prevent the spread of HIV to high-risk, healthy individuals. Other similar preparations are under investigation and HIV therapeutic drugs are being developed for prophylactic use. These drugs are very costly and require individuals to adhere to rigid compliance in order to be effective.

Also, last week, Health and Human Services (HHS) Secretary Kathleen Sebelius announced nearly $80 million in grants to increase access to HIV/AIDS care across the United States. The funding will ensure that low-income people living with HIV/AIDS continue to have access to life-saving health care and medications. This effort stemmed from President Obama's determination to create an AIDS-free generation.

In addition, there is reduced stigma for HIV infected individuals. The CDC just launched "Let's Stop HIV Together" a new campaign that is part of the 5-year initiative started in 2009 to reduce stigma around HIV and advocate for more access to testing and treatment "Act Against AIDS."

The United States, through its National AIDS Strategy, has outlined a "prevention" strategy through early detection and early treatment, focusing on vulnerable populations.

These new strategies are overdue. In the United States, we continue to experience 50,000 new infections a year. And, there are serious health disparities. People of color, youth, and sexual minorities are much more likely to become infected than other groups.

Over the last 30 years, where have we failed? We know that HIV is still mostly spread by sexual behavior. Yet, the disease is rather easily preventable through the use of condoms. Condoms are reasonably inexpensive, potentially readily available, easy to use, and highly effective in preventing HIV and other sexually transmitted infections (and unintended pregnancy). What a bargain! So, why are they not used more?

Behavioral HIV prevention strategies and interventions have tried to get people to reduce risky sexual behavior and promote condom use. While reasonably effective, there needs to be continuous implementation of these interventions, and they are costly. Investment in prevention strategies has always been difficult. With the recently adopted National Prevention Strategy, National AIDS Strategy, and the Affordable Care Act, there is new hope that these investments will be made.

But a fundamental problem remains. We remain a sexually dysfunctional culture. We live in a culture that is still uncomfortable talking about sex and sexuality in a mature and honest fashion. We continue to debate and hold back on providing comprehensive sexuality education. It is very clear that what distinguishes the United States from other developed countries in sexual health indicators is the existence of (or lack thereof) early and sustained comprehensive sexuality education. When kids are educated early they grow up to be more comfortable with talking about sexuality, more likely to be sexually responsible, and have lower rates of sexually transmitted infections and unintended pregnancies. They contribute to a cultural climate that is sexually healthy. That climate then insists on comprehensive sexuality education and thereby creates a cycle of healthiness. In the United States, we are still caught up in a negative and unhealthy vicious cycle. The goal of the Joycelyn Elders Chair in Sexual Health Education is to reverse this negative cycle.

Both Walter Bockting and I, along with over 600 delegates from around the world attended the "Global Forum on Men who Have Sex with Men (MSM) and HIV" as part of the International AIDS Conference. While 60% of new infections around the world are found in gay and bisexual men, only 2% of the global prevention budget is directed at this group. Also, transgender individuals are an overlooked population at major risk for HIV, due in large part to continued stigma and discrimination. This disparity in funding efforts represents the institutionalized stigmatization, heterosexism, and homophobia that exist in our cultures as well as in our public health systems. If we do not attend to this population as well as other marginalized populations such as sex workers and drug users, we will fail in our efforts to stop the spread of infections.

Walter Bockting and I also attended two important meetings pertaining to transgender health and HIV. The first was called "The Great TRANSformation: Towards a Holistic Approach for Healthier and Happier Trans Communities in Latin America and the Caribbean." Walter Bockting talked about "Avenues for Action for the Provision of Care and the Promotion of Well-Being." This symposium represented some of our ongoing work with the Pan American Health Organization in developing and finalizing a "Blueprint for the Provision of Prevention and Care for Transgender Individuals through Latin American and the Caribbean." We also participated in a second special session on "Addressing Stigma in Transgender & Other HIV-Vulnerable Communities" sponsored by the Human Rights Campaign, the International Association of Physicians in AIDS Care, the International Treatment Preparedness Coalition, and the Pan American Health Organization.
As the current Chair in Sexual Health, I was happy to participate in this conference and push a sexual health agenda in HIV prevention. I was very pleased that the Program in Human Sexuality was a co-sponsor along with the Pan American Health Organization and the Centers for Disease Control and Prevention of a satellite session on "Addressing Sexual Health and Evidence-based Sexual Health Education: Evolving Opportunities." I spoke on "Towards a Broader Vision of Sexual Health in the New Millennium." I emphasized the need for a broad sexual health approach to stem the tide of the HIV epidemic, which emphasizes a positive and respectful approach to sexuality and sexual expression throughout the lifespan and that acknowledges sexuality as a basic and fundamental aspect of our humanness and that the pursuit of sexual pleasure is natural and desirable. A broad sexual health approach combats sexual coercion, shame, discrimination, and violence. But a sexual health approach must go beyond venereology and, on an individual level, promote positive sexual identity and esteem, honest communication and trust between partners, the possibility of having pleasurable, fulfilling and satisfying sexual experiences, taking responsibility of the consequences of one's sexual choices and their impact on others, and optimizing reproductive capacity and choice. At the community level, it is achieved through access to developmentally appropriate, comprehensive and scientifically accurate sexuality education, clinical and preventative sexual health services, and respect for individual differences and diversity and a lack of societal prejudice, stigma, and discrimination.

The Chair in Sexual Health will continue to work with our faculty at PHS and with partners around the world to promote a sexually healthier culture - not only to address the sexual problems in the world -- but to advance the opportunity for everyone to lead sexually healthier lives which are pleasurable and satisfying.

Eli Coleman, PhD
Professor and Director
Academic Chair in Sexual Health

PHOTO: Omar Banos (Impacto at AIDS Project Los Angeles), Rafael Mazin (Pan American Health Organization), and Eli Coleman


"Trans/formation" premiere a success

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Transformation-BP.jpgPHS joined Exposed Brick Theatre to create the new play based on the stories, experiences, and perspectives of transgender and gender non-conforming youth. Nearly 180 people attended the premiere performance of Trans/formation: Addressing Gender Issues in School at the Pillsbury House Theatre. After the production, the audience enjoyed a lively discussion with the cast, writers, and director about the themes of the play and their experience working on the project.

The aims of the project are to validate transgender and gender non-conforming youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender and gender non-conforming youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.

The performance on May 4, 2012, was the first step in a larger process. The next steps will be for the playwrights Anton Jones, Suzy Messerole, and Aamera Siddiqui to make final edits to the script and for PHS psychologists Katie Spencer, PhD, and Dianne Berg, PhD, to finalize the educational materials on the themes of the play. The play script and educational materials will then be made available for high school groups to download and perform at their schools, amplifying the impact of this project.

PHS and Exposed Brick would like to thank Stacey Mills and Sam Heins for their donation that made this project possible. We would also like to thank all of the people that helped to create this piece including the youth we interviewed, the advisory board whose thoughtful and creative feedback lifted the play to a whole new level, the youth who read the early drafts and whose honest feedback led us in the right direction. The youth performers are outstanding and their commitment to the piece has been amazing.

PHOTO: credit David Hannigan




Momentum against reparative therapy

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Spitzer-BP.jpgIn recent months public momentum has been building against reparative therapy for individuals who are gay, lesbian, and bisexual. For more two decades organizations and associations that work with mental health professionals have been advising that sexual orientation change efforts are not likely to work and that these efforts may be harmful to patients.

Recently several incidents have brought this issue into the headlines. First, two leaders of organizations that have promoted reparative therapy have publically stated that sexual orientation change does not work, and they have apologized for the harm that their work may have caused to individuals: John Smid, former director of Love in Action,* October 2011 on Hardball with Chris Matthews and Alan Chambers, director of Exodus International, January 2012 at the Gay Christian Network conference. Since then Exodus International has shifted its stance on reparative therapy. In a blog post dated June 19, 2012, Chambers states that Exodus International is "no longer an organization that associates with or promotes therapeutic practices that focus on changing one's attraction." The organization states that they will now focus on helping individuals to reconcile their faith and same-sex attractions by not acting on those attractions.

In May 2012, the Archives of Sexual Behavior published a letter to the editor from Robert Spitzer, MD, retracting his study about the effectiveness of reparative therapy published by the journal in 2003.** In his letter Spitzer concluded, "I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some 'highly motivated' individuals." Since 2003 Spitzer's study has been held up by organizations and even international governments as scientific proof that sexual orientation change is possible. Ironically, in 1973 Spitzer lead the efforts to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. Gabriel Arana, a writer for The American Prospect broke this story in April 2012 in his article "My So-Called Ex-Gay Life."

Currently the California Legislature is considering a bill that would make reparative therapy for individuals under the age of 18 illegal and require adults seeking conversion therapy to sign informed consent forms indicating that they understand the potential dangers, including depression and suicide, and that reparative therapy has no medical basis. The bill SB 1172 passed the House on May 30, 2012, and is now under active consideration in the Assembly. The bill states that

• Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.

• Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider.

The bill's author Senator Ted Lieu said, "Under the guise of a California license, some therapists are taking advantage of vulnerable people by pushing dangerous sexual orientation-change efforts. These bogus efforts have led in some cases to patients later committing suicide, as well as severe mental and physical anguish. This is junk science and it must stop." Lieu went on to say, "Being lesbian or gay is not a disease or mental disorder for the same reason that being a heterosexual is not a disease or a mental disorder. The medical community is unanimous in stating that homosexuality is not a medical condition."

On May 17, 2012, the International Day Against Homophobia and Transphobia, the Pan American Health Organization released a statement outlining the dangers or reparative therapy, psychopathologization, and homophobia. The statement concludes, "A therapist who classifies non-heterosexual patients as 'deviant' not only offends them but also contributes to the aggravation of their problems. 'Reparative' or 'conversion therapies' have no medical indication and represent a severe threat to the health and human rights of the affected persons. They constitute unjustifiable practices that should be denounced and subject to adequate sanctions and penalties." The document makes recommendations of how homophobia and ill-treatment can be overcome through the efforts of governments, academic institutions, professional associations, media, and civil society organizations.

In 2009 the American Psychological Association issued a report based on two years of work that stated that sexual orientation change efforts can pose critical health risks to gay, lesbian, and bi-sexual patients and advised patients to avoid such treatments (see PHS Newsletter articles "APA warns against telling clients their sexual orientation can be changed," and Eli Coleman's "Letter from the Chair in Sexual Health September 2009").

*As of March 15, 2012, the organization Love in Action changed its name to Restoration Path.

**Spitzer, R. (2012). Spitzer Reassesses His 2003 Study of Reparative Therapy of Homosexuality. Archives of Sexual Behavior, 41 (4), 757. doi: 10.1007/s10508-012-9966-y

PHOTO:  Robert Spitzer, MD, Courtesy of Truth Wins Out, from Spitzer's video apology





AIDS2012-BP.jpgThe international AIDS conference has returned to the US for the first time since 1990. More than 25,000 scientists, practitioners, government officials, activists, and individuals living with HIV from around the world will gather in Washington, DC, on July 22 - 27, 2012. The theme this year is "Turning the Tide Together."

Eli Coleman, PhD, and Walter Bockting, PhD, will both be presenting at the conference this year. The conference objective is to bring together leaders that can directly impact the future of HIV in the United States and around the world, "By acting decisively on recent scientific advances in HIV treatment and biomedical prevention, the momentum for a cure, and the continuing evidence of the ability to scale-up key interventions in the most-needed settings, we now have the potential to end the HIV epidemic."

If you are not attending the conference, you can view videos online featuring conference highlights and interviews with key speakers and delegates on the conference YouTube channel

The selection of Washington DC is significant because HIV rates in the district have reached epidemic levels and in 2009 President Barack Obama overturned the US entry and immigration ban for individuals living with HIV. The US had been ruled out as a possible venue for the international AIDS conference because of the ban.

In addition to the conference, the AIDS Memorial Quilt will be on display in Washington DC across 50 locations. Today the quilt has 48,000 panels and takes up 1.3 million square feet, in DC 35,200 panels will be on display, 8,800 different panels each day.





Together-BP.jpg"Let's Stop HIV Together" is a new initiative launched by the Center for Disease Control and Prevention (CDC) on July 16, 2012. The campaign is a new phase of Act Against AIDS effort launched in 2009 to fight the complacency about HIV/AIDS in the United States and to reduce the risk of infection for the hardest-hit populations. The new campaign shares personal stories of individuals who are living with HIV and asks you to and your community to "Get the facts. Get tested. Get involved."

Based on 2009 statistics, the CDC estimates that in the United States each year 50,000 individuals become infected with HIV. At the end of 2008, an estimated 1,178,350 persons aged 13 and older were living with HIV infection in the United States. Of those, it is estimated that 20% had undiagnosed HIV infections.

If you are interested in promoting "Let's Stop HIV Together" or contributing your story to the campaign visit their website.



New sexuality and aging research

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older-couple-BP.jpgPHS researchers will soon begin working on sexuality, mindfulness, and the body in "women of a certain age."

There is a paucity of research designed to explore the impact of mindfulness and body oriented approaches to the treatment of sexual concerns in older individuals. The goal of this new pilot project is to gather baseline qualitative and quantitative data on women's sexual functioning, sexual satisfaction, mindfulness skills, interest in mindfulness, and general quality of life. The project will include a literature review, focus groups, and an online- survey of women over the age of 50. Researchers Sara Mize, PhD, and Alex Iantaffi, PhD, (Epidemiology) will begin their work in August.

Mize said, "We believe that this formative data could provide the foundation for larger grants to further develop this important area of study, in particular, constructing mindfulness and body-based interventions for individuals and couples with sexual issues or for those without sexual issues who desire to enhance and deepen their sexual lives."

Through a strategic visioning process faculty identified a research priority in the area of sexuality and aging. We are grateful to the donors who also identified this as an area of interest and made this pilot project possibly through their gifts.

Pilot projects are the first step for faculty to secure University support for new clinical and educational programs or acquire larger research grants.






Coleman-JMA-BP.jpgThe John Money Award for 2012 was presented to Eli Coleman, PhD, for his work on sexual health, sexual compulsivity, gender identity, and effective clinical practice for sexual disorders.

On May 19, 2012, Coleman received The John Money Award from the Eastern Region of the Society for the Scientific Study of Sexuality (SSSS) at their annual meeting in Bloomington, IN. The award recognizes scholars who have made outstanding contributions to our understanding of human sexuality. The award is named for John Money, PhD, whose landmark research and theorizing deepened our understanding of gender and sexuality.

As the award winner, Coleman presented the annual meeting opening night plenary, "Defining Sexual Health: History, Challenges and Opportunities."

Previous John Money Award winners include Jeff Parsons (2011), Mark Padilla (2009), Theo Sandfort (2008), Vern Bullough (2005), and Charlene Muehlenhard (2004). 

PHOTO: Eli Coleman, PhD, and Juline Koken, PhD 



Congratulations fellowship graduates

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Grad-2012-BP.jpgThe Program in Human Sexuality graduated two postdoctoral fellows at the Family Medicine and Community Health commencement this spring. On June 7, 2012, Brad Nederostek, PsyD, and Aimee Tubbs, PsyD, were recognized for completing two years of intensive clinical and research training at PHS.

Nederostek will be completing his fellowship at the end of August and has plans on integrating his knowledge in the areas acceptance-based therapeutic models and human sexuality within the Veterans Affairs Health Care System (VA). He hopes on pursuing these endeavors within the VA System.

Tubbs completed her fellowship at the end of May. She has been enjoying some time off while pursuing a full-time clinical psychologist position. Clinical interests include continuing emphasis on sexual health issues, with a specific interest in addressing compulsive sexual behavior.

PHOTO: credit Libby Frost






Cesar Gonzalez, PhD, and Katie Spencer, PhD, have been promoted to Assistant Professors at the Department of Family Medicine and Community Health, University of Minnesota Medical School.
Cesar-Gonzalez-BP-7.jpgGonzalez completed his postdoctoral fellowship at PHS in 2010, and joined PHS as a clinical psychologist and researcher on the All Gender Health Online research project where he helped develop an interactive web-based intervention for sexual health. Since then he has been promoted to a Research Associate and now to Assistant Professor (research-track).
In June 2012, Gonzalez completed his board certification in clinical psychology by the American Board of Professional Psychology. He is currently receiving his Advanced Certification in Schema Therapy (by the International Society of Schema Therapy through the Cognitive Therapy Center of NY/NJ), an innovative and evidence-based approach for treating complex psychological conditions and personality disorders. Gonzalez received his BA in psychology from the University of Arizona and received his PhD in clinical psychology from Alliant International University, Los Angeles. His clinical training includes behavioral medicine, severe mental illness, child and family therapy, and the assessment of learning differences. He served as director of evaluation and research at Bienestar Human Services, Inc., a non-profit organization serving Latino, HIV-infected/affected, GLBT individuals, where he evaluated HIV prevention programs and conducted community research on HIV/AIDS. Gonzalez is an editorial board member of the International Journal of Transgenderism and is a fellow of the American Academy of Clinical Psychology. He is also recipient of National Institute of Health's Loan Repayment Program award. His research interests include: gender dysphoria; gender non-conformity; depression and suicidality; resilience; early maladaptive cognitive schemas; and multicultural community psychology. Gonzalez is bicultural, and is bilingual in English and Spanish.

Katie-Spencer-BP-7.jpgSpencer completed her postdoctoral fellowship at PHS in 2009, and joined PHS as a clinical psychologist. She has now been promoted to Assistant Professor (clinical scholar track).

In addition to her clinical work, Spencer works with multiple community organizations working to educate about LGBT healthcare issues and primarily transgender healthcare. She works with the Minnesota Trans Youth Support Network on the Community Hormone Access Project, partnering with community advocates and trans youth to develop community based hormone protocols for transgender care, in hopes to increase access to competent care and hormone provision for trans youth. She recently participated in the development of a theatre educational project for high schools on transgender youth issues. Spencer provides training education, and consultation on sexual health and transgender issues, and has worked with the Family Tree Clinic, Face to Face Health and Counseling Services, Fairview Clinics, the University of North Dakota, and the Veterans Administration. Spencer often speaks about the intersections of LGBT rights and impact on well-being, and will be presenting a First Friday Forum for the Minnesota Psychological Association on the psychological research on same sex marriage in October 2012.

Spencer received her MA and PhD in counseling psychology from the University of Missouri-Columbia. She received her BA in women's studies and psychology from the University of Wisconsin-Madison. Her internship was completed at the University of Illinois-Chicago Counseling Center. She has a strong interest in education and training of therapists and medical providers in sexual health and transgender health care competency. Her primary clinical practice is working with transgender and gender non-conforming children, adolescents, and adults, women's sexual health, and LGBT sexual health and well-being. She co-facilitates several groups, including the gender exploration group for youth and their families, the women's sexual health group, and transgender adult interpersonal groups. She has experience working with compulsive sexual behavior and general sexual dysfunction concerns. Her research and clinical interests focus on cultural competency in working with LGB and transgender populations, LGBT sexual health, sex therapy with LGBT couples, trans youth, and feminist embodied approaches to sexual health. 






Dianne-Berg-BP-7.jpgThe PHS postdoctoral fellows honored Dianne Berg, PhD, with the 2012 Faculty Mentor Award. Graduating fellows Aimee Tubbs, PsyD, and Brad Nederostek, PsyD, presented the award on June 13.

The fellows selected Berg because she is "someone who has gone above and beyond the call of duty, is an outstanding leader, teacher, and mentor, and is supportive of our learning and development as professionals." Tubbs added that her, "clinical skills are top notch, her enthusiasm is contagious, she has the very important ability to instill hope, she seizes opportunities for teachable moments, she is compassionate, kind, approachable, down to earth, and she is ALWAYS open to the 'random door knock' to field fellow's questions. Berg provides balanced feedback, she gives constructive criticism and celebrates successes. She includes the fellows as colleagues and helps us see ourselves as part of the profession."

Berg herself is a graduate of the PHS postdoctoral fellowship. She has mentored postdoctoral fellows since 2000.

Dianne Berg, PhD, is an assistant professor involved in providing clinical services to adults, adolescents and children with sexuality concerns. Her areas of interest are compulsive sexual behavior, transgender issues (including gender identity disorder and intersex issues in children), women's sexual dysfunction including relationship and sex therapy, abuse recovery, and the treatment of sex offenders (including children with sexual behavior problems). She recently developed a time-limited psychoeducational/support group for partners of people with compulsive sexual behavior and has been instrumental in the development and implementation of a new community health seminar for the GLBT community called Our Sexual Health. While at the University of Illinois, Berg helped to develop, implement, and research the impact of a campus-wide acquaintance rape education program. She also was active in the establishment of lesbian support groups. For several years prior to coming to PHS, Berg focused on the psychological assessment and treatment of children, adolescents, and families in a variety of settings including residential treatment and a community mental health outpatient clinic. She continues to be a community faculty member of Metropolitan State University, where she teaches a course on the prevention, assessment, and treatment of child abuse and neglect.






Michael-Miner-BP-7.jpgThe faculty of the Program in Human Sexuality invite you to explore the latest in sexual health research. PHS faculty, postdoctoral fellows, and research collaborators will present their work at our monthly faculty research presentations.

Join us: Noon-1 pm at PHS, 1300 South 2nd Street, Room 142, Minneapolis, MN 55454.

Reserve your seat today--email

August 8, 2012
Michael Miner, PhD
Professor and Coordinator of Forensic Assessments

"How SMART? Comparing Existing State Systems of Identifying High Risk Sex Offenders with the Adam Walsh Act Tiering System"

The Adam Walsh Child Protection Act mandated the standardization of sex offender registries and community notification procedures. One central component of this standardization was an offense based tiering system that was to determine how long an individual needed to register (10 years, 25 years, life) and how often they needed to report, in person, to law enforcement to update their registration information (annually, biannually, quarterly). Implicit in the tiering system is that the higher the tier level (1-3) the more dangerous the individual. This presentation will discuss this assumption and present data that compares the predictive validity of the proposed tiering system with existing systems in Minnesota, New Jersey, and Florida, and with a well-established and accepted actuarial risk prediction tool, STATIC-99R. The implications of these findings will be discussed from the perspective of public policy and the stated goal of the Adam Walsh Act.



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