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Letter from the Chair in Sexual Health

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Eli-Coleman-BP.jpgOn World AIDS Day, it is certainly a poignant time to reflect on our progress and to reinvigorate our determination to halt this epidemic.  We have encouraging news.  The rates of HIV have fallen to the lowest levels since the peak of the epidemic, new HIV infections were reduced by 21% since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005 (UNAIDS, 2011).  

While these are encouraging statistics, there are still parts of the world including our own country in which the epidemic rages on.  The number of new HIV infections continues to rise in Eastern Europe, Central Asia, Oceania, the Middle-East, and North Africa.   Here in the US - we still see rises in certain urban centers (particularly among African Americans and men who have sex with men) and, overall, we see an increase in HIV infections in the South-east (particularly in poorest areas).

Poverty is still a major predictor of risk of HIV infection.  The poor, disenfranchised, stigmatized, and marginalized bear the overall burden of disease and HIV remains a serious threat.  Thus racial and sexual minorities are still very much at risk.  Youth in these groups are particularly vulnerable.   

While we need to address the serious issues of poverty, discrimination, prejudice, and the lack of basic sexual rights, we know that even the disenfranchised can be empowered through comprehensive sexuality education and access to preventative services.  We need to put HIV prevention in the context of a comprehensive sexuality approach.

We can be encouraged by the fact that when youth are educated with comprehensive sexuality education, they are more likely to delay the onset of sexual intercourse and use condoms.  We know that condoms are highly effective in preventing the spread of HIV and other sexually transmitted infections.  While the effects of stigma and discrimination are still a powerful force, comprehensive sexuality education can lead to empowerment.

We need an HIV-prevention approach that is sex-positive recognizing that people have a basic instinct and drive to be sexual and that beyond the reproductive utility of sexual activity, people are motivated to experience pleasure and that sex is a fundamental form of communication and expressing intimacy.  We have spent too much time on de-sexualizing HIV prevention, now it is time to promote what I have termed "sexualized HIV prevention."  Let's bring positive sexuality back into HIV prevention - and let's focus on the marginalized populations and empower them to enjoy a fulfilling and pleasurable sexual life.

Eli Coleman, PhD
Director and Professor
Chair in Sexual Health

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Standards-of-Care-BP.jpgThe World Professional Association for Transgender Health (WPATH) released a newly-revised edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), on September 25, 2011, at the WPATH conference in Atlanta. This is the seventh version of the SOC.  The original SOC were published in 1979.  Previous revisions occurred in 1980, 1981, 1990, 1998 and 2001.

The SOC is considered the standard document of reference on caring for the transsexual, transgender, and gender nonconforming population. The newly-revised SOC will help health professionals better understand how they can offer the most effective care to these individuals.  The SOC focuses on primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services and hormonal and surgical treatment.

"The latest 2011 revisions to the SOC realize that transgender, transsexual, and gender nonconforming people have unique health care needs to promote their overall health and well-being, and that those needs extend beyond hormonal treatment and surgical intervention," said SOC Committee Chair, Eli Coleman, PhD, Professor and Director at Program in Human Sexuality, University of Minnesota. 

"The previous versions of the SOC were always perceived to be about the things that a trans person must do to satisfy clinicians, this version is much more clear about every aspect of what clinicians ought to do in order to properly serve their clients. That is a truly radical reversal . . . one that serves both parties very well," said Christine Burns, SOC International Advisory Committee Member.

More than any other version, 2011 revisions also recognize that gender nonconformity in and of itself is not a disorder and that many people live comfortable lives without having to seek therapy or medical interventions for gender confusion or unhappiness.

This version provides more detailed clinical guidelines to address the health care needs of children, adolescents, and adults with gender dysphoria who need assistance with psychological, hormonal, or surgical care. 

In addition to clearly articulating the collaborative relationship needed between transsexual, transgender, and gender nonconforming individuals and health care providers, the new, 2011 revisions provide for new ways of thinking about cultural relativity and culture competence. 

The document includes a call to advocacy for professionals to promote public policies and legal reforms that promote tolerance and equity for gender and sexual diversity.  This document recognizes that well-being is not obtained through quality health care alone but a social climate that eliminates of prejudice, discrimination, and stigma and promotes a positive and tolerant society that embraces sexual and gender diversity.

WPATH, formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity disorders.  As an international multidisciplinary professional Association the mission of WPATH is to promote evidence based care, education, research, advocacy, public policy and respect in transgender health.

The World Professional Association for Transgender Health. (2011). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version.  Retrieved from

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med-class-crop-2.jpgA study conducted at the Stanford School of Medicine confirms that a majority of American medical schools are lacking LGBT-related health curriculum in the classroom and in clinical training. The study findings were published on September 7, 2011, in the Journal of the American Medical Association.

The Stanford research team surveyed deans of medical schools in Canada and the United States.  Of the complete responses the group received (132 = 75%) they found that of the entire medical school curricula the median reported time dedicated to LGBT-related content was 5 hours.  Some schools reported dedicating no time to LGBT-related content in the classroom or the clinic.

At this time, most schools (128) teach student that when taking a patient's sexual history students should ask the question, "Do you have sex with men, women, or both?"  However, on a list of 16 LGBT-specific topics,* only 11 schools reported covering all 16 topics in their curricula.  The topics covered most frequently by schools are sexual orientation, HIV, and gender identity, and the topics covered least often by schools are genital reconstruction surgery, body image, and transitioning.

*LGBT specific curricula topics:  barriers to Care, body image, chronic disease risk, coming out, DSD/intersex, gender identity, HIV, LGBT, adolescents, mental health issues, safer sex, sexual orientation, SRS, STI, substance use, transitioning, unhealthy, and relationships/IPV

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., . . . Lunn, M. R. (2011). Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education. JAMA, 306(9), 971-977. doi: 10.1001/jama.2011.1255

Photo: PHS faculty teaching the human sexuality course at University of Minnesota Medical School

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Capitol-BP.jpgOn November 2, 2011, Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA) introduced the Real Education for Healthy Youth Act (HR 3324), a new bill that lays out a comprehensive, age-appropriate, and holistic vision for sex education policy in the United States.

The bill currently has 31 cosponsors. It has been referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and the Workforce.

Overview of Real Education for Healthy Youth Act (HR 3324)

To provide for the reduction of unintended pregnancy and sexually transmitted infections, including HIV, and the promotion of healthy relationships, and for other purposes

(a) Purpose- The purposes of this Act are--

(1) to provide young people with comprehensive sex education that--

(A) provides the information and skills young people need to make informed, responsible, and healthy decisions in order to become sexually healthy adults and have healthy relationships;

(B) provides information about the prevention of unintended pregnancy, sexually transmitted infections, including HIV, sexual assault, dating violence, bullying, and harassment; and

(C) promotes and upholds the rights of young people to information in order to make healthy and responsible decisions about their sexual health; and

(2) in order to provide the comprehensive sex education described in paragraph (1), to provide increased resources for sex education programs that--

(A) are evidence-based, having been proven through rigorous evaluation to change sexual behavior or incorporate characteristics of effective programs;

(B) cover a broad range of topics, including medically accurate, complete, age and developmentally appropriate information about all the aspects of sex needed for a complete sex education program, including--

(i) anatomy and physiology;
(ii) growth and development;
(iii) healthy relationships;
(iv) the prevention of unintended pregnancy and sexually transmitted infections, including HIV, through abstinence and contraception;
(v) gender, gender identity, and sexual orientation; and
(vi) protection from dating violence, sexual assault, bullying, and harassment;

(C) are gender- and gender identity-sensitive, emphasizing the importance of equality and the social environment for achieving sexual and reproductive health and overall well-being;

(D) promote educational achievement, critical thinking, decisionmaking, self-esteem, and self-efficacy;

(E) help develop healthy attitudes and insights necessary for understanding relationships between oneself and others and society;

(F) foster leadership skills and community engagement by--

(i) promoting principles of fairness, human dignity, and respect; and
(ii) engaging young people as partners in their communities; and

(G) are culturally and linguistically appropriate, reflecting the diverse circumstances and realities of young people.

The entire bill can be read at the Library of Congress website

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Bockting-in-Salzburg-BP.jpgWalter Bockting, PhD, participated in International Partnership for Advancing Transgender Health seminar in Salzburg, Austria, on October 2 - 8, 2011.

The meeting launched a multi-year partnership with international organizations including TIG (lead organization) and Labrys (supporting partner) in Kyrgyzstan, RED TRANS in Peru, Gender DynamiX in South Africa, and The Open Society Public Health Program and the Center of Excellence for Transgender Health at the University of California.

The group aims to establish and implement culturally appropriate guidelines on transgender health care. Ultimately, groups plan to cultivate trained networks of medical care providers who can offer high quality transgender health care and who will participate in the dissemination of best practices regionally.

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FEMESS-BP.jpgOctober 20 - 22, 2011, Eli Coleman, PhD, and Joycelyn Elders, MD, presented at the VIII Congreso Nacional de Educación Sexual y Sexología organized by the Federación Mexicana de Educación Sexual y Sexología, A.C. (FEMESS) in Chiapas, Mexico.

More than 800 individuals attended the conference, including 150 people form the academic sector and health organization and 54 civil servants from the Ambulatory Centers of Prevention and Attention in AIDS and STI (Centros Ambulatorios de Prevención y Atención en SIDA e ITS or CAPACITS).

In a post-conference statement made by FEMESS, the organization thanked the government and university of the state of Chiapas for supporting the conference.  The organization also commended the government for its commitment to reach the United Nations Millennium Development Goals.  The organization also reiterated its support of the 2008 Inter-ministerial Declaration which was adopted by all health and education ministries in Latin American and the Caribbean which advocated for comprehensive sexuality education starting in pre-school to stem the tide of the HIV pandemic.  

FEMESS restated its goal to depathologize transsexualism as a mental disorder.  The organization reaffirms the need for gender expression to be recognized as a fundamental human right of free expression.  Further the group called on mental health professionals to support this position and join in the goal.

Videos from the conference:

Eli Coleman & Youth's Sexual Health in the 21st Century: Get involved!

Joycelyn Elders & Youth's Sexual Health in the 21st Century: Education, Empowerment & Resources

Photo: Joycelyn Elders, MD, Eli Coleman, PhD, with FEMESS conference organizers

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Researcher Jae Sevelius, PhD, visits PHS

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SEVELIUS-BP.jpgAugust 1 - 5, 2011, Jae Sevelius, PhD, visited PHS to meet with one of her project advisors, Walter Bockting, PhD, and to learn about our transgender research and transgender health clinic.

Bockting is working with Sevelius on her NIH/NIMH-funded K-Award project to assess HIV risk behaviors and protective factors among transgender women of color to develop a culturally specific HIV prevention intervention for this high-risk, underserved population. 

The current focus of her K research is examining how the need for gender affirmation (a psychosocial dimension that refers to transgender women's desire for validation and support of their gender identity and expression) interacts with access to gender affirmation (their access to this type of validation and support) to promote or protect against risky health behaviors.  Sevelius is in year 3 of a 5-year grant.

Sevelius presented her research project to PHS faculty and staff.  She said, "I am passionate about promoting health and wellness within transgender communities. That certainly includes addressing health disparities, such as the egregious rates of HIV among transgender women of color, but also includes bringing resources to trans communities to support overall sexual health, mental health, holistic well-being, and spirituality."

She added, "One of the most rewarding aspects of my work so far has been witnessing the direct impact of the sexual health promotion intervention that I am developing for transgender women of color." Sevelius and two research assistants, Danielle Castro and Angel Ventura, conducted a pilot study of the intervention this year.  Sevelius said that she was, "astounded by the intensity of the positive response we got from participants. It is a peer-led intervention so I was just an observer, but there were many moments that I was brought to tears by what I witnessed during the course of these small-group sessions. The participants shared so much of themselves, supported one another through difficult disclosures, and struggled together to find connection and love through the traumas they have faced and continue to face in an ongoing way, even in a place that is as reputedly liberal as San Francisco. The participants were so grateful for the opportunity to come together in that way and learn from each other and the wonderful facilitators."

Sevelius is an advocate for systematic change for the wellness of the transgender community. She is hopeful that an increased visibility for the community will lead to an increased commitment to address the severe inequities and systemic transphobia that are pervasive. Sevelius said, "Unfortunately, I think we still have a long way to go here in the US in that we still do not collect trans-inclusive data that provides us with the essential big picture perspective that would allow us to really frame the issues accurately.  Health care providers are not adequately educated about the needs of trans people, and violence and discrimination are absolutely rampant. We need to start by acknowledging the existence of trans people on a national level by capturing their unique circumstances and needs in a systematic way."

Sevelius is an Assistant Professor with the Center for AIDS Prevention Studies (CAPS) in the Department of Medicine at the University of California San Francisco, and Co-Principal Investigator of the Center of Excellence for Transgender Health, which promotes increased access to culturally competent health care for transgender people through research, training, and advocacy. With funding from the California HIV/AIDS Research Program, building on work of the Transitions Project and in collaboration with API Wellness' TRANS:THRIVE program, Sevelius is also working to adapt and evaluate the evidence-based HIV prevention intervention SISTA (Sisters Informing Sisters about Topics on AIDS) for transgender women of color.  Another CHRP-funded project of Sevelius' is a qualitative investigation of the barriers to HIV treatment engagement and adherence among transgender women living with HIV. 

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Tobing-&-Coleman-BP.jpgIn September Naek Tobing, PhD, returned to Minnesota and the Program in Human Sexuality from his home in Jakarta, Indonesia. 

Tobing trained as a sex therapist at PHS in 1983. Since returning to Indonesia he has built a private practice in sexual health and marital counseling where he sees patients, provides education to the public and medical professionals, conducts research, and publically advocates for sexual health. In February, Tobing worked with Indonesian Psychiatric Association to hold a three day seminar and workshop on sexual health which hosted 115 participants.

Tobing is grateful for the training he received at PHS.  He said, "I learned how to handle patients, individually and mostly in group therapy. I also learned about many kinds of sexual and marital problems."

Tobing writes about sexuality and relationships in a column for the women's magazine Kartini (since 1984), and he also writes for the most popular tabloid Nyata.  Until it was banned, Tobing had a popular weekly television program about sexual health.

During his visit to the United States Tobing visited family including his granddaughter who is in her second year of studying economics at the University of Minnesota.

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Bean Robinson, PhD, named SSSS president

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B-Robinson-BP.jpgOn November 6, 2011, Bean Robinson, PhD, was named the national president of the Society for the Scientific Study of Sexuality (SSSS).  Robinson will serve a one-year term as president.

SSSS is an international organization with more than 700 members from a variety of professions including anthropology, biology, education, and health care.  The non-profit was founded in 1957 to encourage the rigorous systematic study of sexuality.

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Welcome new PHS staff

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PHS welcomes the newest additions to our team:  Jordan Rullo, PhD, and Cathy Strobel

J-Rullo-BP.jpgJordan Rullo, PhD, received her BA in psychology from Indiana University-Bloomington and her MS and PhD in clinical psychology from the University of Utah in Salt Lake City, Utah. Her training has included completion of a psychology Honors Thesis at the Kinsey Institute for Sex, Gender, and Reproduction, as well as completing an APA-accredited internship at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, with a specialization in the sexual behaviors and forensic track. She received an APA Division 44 Scholarship Award to conduct her dissertation research on the subjective and objective sexual arousal/interest of bisexually-identified men and women. Rullo's clinical interests include: compulsive sexual behavior/hypersexuality, gender identity and sexual orientation development, relationships and sexual functioning, and paraphilias. She employs interpersonal reconstructive and cognitive-behavioral treatment modalities in her clinical work in order to help clients learn to recognize their patterns and where they came from, as well as make a decision about which patterns to change and how to develop new and more adaptive patterns.

C-Strobel-BP.jpgCathy Strobel is the new project coordinator for the Compulsive Sexual Behavior and HIV risk study. She earned her Bachelor's degree from Winona State University and has taken MBA coursework including completion of the Mini MBA for Nonprofit Organizations from St. Thomas University. Strobel worked for the Minnesota AIDS Project for the past 10 years as the program manager for the agency's three HIV prevention programs that targeted gay and bisexual men and injecting drug users. Her programs routinely referred program participants to PHS counseling services and the Man2Man program. She also served on a community advisory committee for the Community PROMISE project where she met Bean Robinson, PhD. Before entering the HIV field, Strobel worked for nine years at the Minnesota State Legislature and was a steering committee member of the It's Time Minnesota, the statewide grassroots coalition that organized to add sexual orientation to the state Human Rights Act in 1993.

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About this Archive

This page is an archive of recent entries in the Fall 2011 Volume 3 Issue 2 category.

Fall 2009 Volume 2 Issue 2 is the previous category.

Spring 2010 Volume 2 Issue 4 is the next category.

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