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We have reached a moment in history with serious global economic challenges and critical and costly sexual health problems. Around the world governments as well as regional and international health agencies are recognizing the importance of having a unified and broad sexual health approach to reduce the burden of disease related to sexual health problems.

There have been several recent, major developments which will certainly have a positive impact on the promotion of sexual health. First, there has been an effort by the Centers for Disease Control and Prevention to consolidate its initiatives in HIV prevention, STI prevention, reproductive health, school-based sexuality education, and sexual violence prevention under a broader and unified effort to promote sexual health as an overarching strategy to deal with the myriad of sexual health problems we face in this country, A Public Health Approach to Advancing Sexual Health in the United States. Second, in July 2010 the White House released a National HIV/AIDS Strategy that acknowledges the importance of addressing sexual health through prevention activities rather than simply more "testing and pills." Third, in March 2011, the Institute of Medicine released its report on The Health of Lesbian, Gay, Bisexual and Transgender People. Finally, in June 2011 the National Prevention, Health Promotion, and Pubic Health Council in the Office of the Surgeon General released a National Prevention Strategy which includes a major section on promoting sexual and reproductive health.

The synergy of these efforts has put sexual health squarely in the center of public health strategies to improve the overall health and wellbeing of all Americans. While PHS has been promoting sexual health for over 40 years, the concept of sexual health has taken root in public policy in a way that represents a revolutionary paradigm shift. It is an exciting time.

We hope that this will translate into improved funding for a strategic approach to change the sexual health climate of this country - using the powerful resources of our government. We hope that this will increase research grants, educational opportunities, and provisions for sexual health care.

During the past decade, it seemed that the leaders in sexual health were in other parts of the world. Now, the US has joined similar international efforts and may be able to assume a leadership role by advancing sexual health through public policy and public health.

PHS is involved in many of these national, regional, and international efforts. Hopefully, through this work, we will truly realize a sexually healthier climate here and around the world. It is an exciting time - a time to "strike while the iron is hot" to consolidate efforts and move the sexual health agenda forward.

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The Program in Human Sexuality exceeded its fundraising goals for the Joycelyn Elders Chair in Sexual Health Education. The Chair is the first of its kind in the nation to focus on sexuality education.

The unique grassroots fundraising efforts for the chair attracted more than 275 donors, from 24 states, the District of Columbia, and 8 countries. Together donors gave $2,008,794 to establish the Joycelyn Elders Chair in Sexual Health Education. In five years, once all of pledged donations have been received, the Program in Human Sexuality will hire one faculty member to hold the endowed faculty position and focus his/her efforts on creating comprehensive life-long sexual education curricula, increasing the number of health care providers and health educators trained in sexual health, and expanding scientific research in sexuality education. These efforts will help to change the direction of sexual health in this country and around the world.

"The Program in Human Sexuality has proven success in educating medical professionals, human sexuality research, providing clinical care, and advocating for science-based public policy. Through the Elders Chair we will build on our strengths to advance sexual health education," said Eli Coleman, PhD, director of the Program in Human Sexuality.

Joycelyn Elders, MD, has always felt a strong connection to the University of Minnesota Medical School where she completed an internship in pediatrics in 1960. "In 1959 the University of Minnesota had the best pediatric internship in the country, they could have had any student that they wanted, and they selected me. I have always been very grateful."

Sexual health has been a primary focus for Elders starting with her service as the Director of the Arkansas Health Department through her time as a US Surgeon General, and in the years that have followed. She continues to travel the country advocating for sexual health to professional organizations and college students. She said, "I have realized the detriment and destruction that can be caused from a lack of sexual health. The most common cause of poverty is children being born to children. Sexuality makes up such a great part of our life, and yet we spend so little time talking about it, teaching about it, and educating our young people about it. We must know that if we want to have a sexually healthy society, it's about education, education, education."

The Joycelyn Elders Chair in Sexual Health Education will be the second endowed Chair at the Program in Human Sexuality. In 2007 the Chair in Sexual Health was established, and the Program's director, Eli Coleman, PhD, holds the position.

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Eli Coleman, PhD, participated in an expert technical consultation for the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) on advancing sexual health in the United States. The project began in April 2010 when the CDC brought together 67 experts with a variety of back grounds and interests in sexual health including individuals from public interest groups, communities of faith, sexual health researchers, professional organizations, media and communications, private sector businesses, and government agencies. In May 2011 the group released a report that highlights the expert consultation proceedings titled A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation. The report is intended to engage future partners and spur continued conversations for the initiative.

The CDC launched the initiative in recognition that sexual health is an essential component of overall individual health, that individual sexual health has a major impact on the health of communities, and that a national dialogue is critical in improving population health. The group worked to identify initiatives aimed at implementing a public health approach to promote age-appropriate sexual health. One that is consistent with the best available science, including healthy, respectful, and responsible sexual behavior, for all Americans over their lives.

Consultants were challenged to identify actions around six goals including:
1. Increase healthy, responsible, and respectful sexual behaviors and attitudes.
2. Increase the ability and awareness to make healthy and responsible choices, free of coercion.
3. Promote healthy sexuality, healthy sexual functioning, healthy relationships, and respectful sexual rights for all persons throughout the life span.
4. Optimize and educate about reproductive health choices.
5. Increase access to effective preventive, screening, treatment, and support services that promote sexual health.
6. Decrease adverse individual and public health outcomes including HIV/STDs, viral hepatitis, unintended pregnancies, and sexual violence.

In 2001 Surgeon General David Satcher, MD, PhD, released The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. The new CDC report states that, "Over 10 years later, many measures of adverse health outcomes of sexual behaviors have worsened, prompting a need for refocused national attention on sexual health-related issues, especially HIV prevention and adolescent sexual health outcomes (e.g., unplanned pregnancy and STDs.)" The new CDC efforts will help to revitalize the goals and guidelines from the Call to Action while incorporating new research and current perspectives.

Centers for Disease Control and Prevention. A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation, Meeting Report of an External Consultation. Atlanta, Georgia: Centers for Disease Control and Prevention; December, 2010.

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Researchers need to proactively engage lesbian, gay, bisexual, and transgender people in health studies and collect data on these populations to identify and better understand health conditions that affect them, says a new report from the Institute of Medicine (IOM).

The scarcity of research yields an incomplete picture of LGBT health status and needs, which is further fragmented by the tendency to treat sexual and gender minorities as a single homogeneous group, said the committee that wrote the report.

The historic report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, provides a thorough compilation of what is known about the health of each of these groups at different stages of life and outlines an agenda for the research and data collection necessary to form a fuller understanding.

"Based on a thorough review of the science, this report recommends a research agenda to better understand the characteristics of the LGBT population, assess their unique health needs, and to identify the factors that either compromise or promote their health and well-being," said Walter Bockting, PhD, IOM committee member and professor at the Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School. "The report recognizes that the LGBT population is diverse in terms of gender, age, race, and ethnicity, and calls for intervention research that addresses the needs of those with documented health inequities."

LGBT individuals make up a minority of the population, therefore researchers face challenges in recruiting sufficient numbers of these individuals in general population surveys to yield meaningful data. Stigma experienced by gender and sexual minorities can make them reluctant to disclose their orientation, worsening the problem. Moreover, it is difficult to synthesize data about these groups when studies and surveys use a variety of ways to define them.

Demographic data provides the foundation for understanding any population's status and needs, federally funded surveys should proactively collect data on sexual orientation and gender identity, just as they routinely gather information on race and ethnicity, the new report says. Information on patients' sexual orientation and gender identity also should be collected in electronic health records, provided that privacy concerns can be satisfactorily addressed, the committee said.

The National Institutes of Health should support the development of standardized measures of sexual orientation and gender identity for use in federal surveys and other means of data collection.

In addition, the National Institutes of Health should provide training opportunities in conducting research with LGBT populations. Training should engage researchers who are not specifically studying LGBT health issues as well as those who are. The agency also should use its policy on the inclusion of women and racial and ethnic minorities in clinical research as a model to encourage grant applicants to address how their proposed studies will include or exclude sexual and gender minorities.

Throughout his tenure at the University of Minnesota, Bockting has conducted research on the health disparities found among transgender people.

Bockting said, "This Report recognizes that we have much to learn about the health of this subgroup of the LGBT population, and calls for research to improve access to quality, evidence-based transgender care. The acknowledgment of this still largely invisible population and the attention the Report draws to their specific health needs is enormously validating and holds the promise of new initiatives to promote transgender health."

The study was sponsored by the National Institutes of Health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.

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On June 17, 2011, the United Nations Human Rights Council declared that all human beings should be protected by universal human rights regardless of sexual orientation and gender identity. The declaration stated, "Expressing grave concern at acts of violence and discrimination, in all regions of the world, committed against individuals because of their sexual orientation and gender identity."

The resolution went on to request a global study to document discriminatory laws and practices and acts of violence based on sexual orientation and gender identity. The Human Rights Council will then convene a panel to discuss the study findings and advance a constructive, informed, and transparent dialogue on the issue.

In a press statement, Secretary of State Hillary Clinton said, "All over the world, people face human rights abuses and violations because of their sexual orientation or gender identity, including torture, rape, criminal sanctions, and killing. Today's landmark resolution affirms that human rights are universal. People cannot be excluded from protection simply because of their sexual orientation or gender identity. The United States will continue to stand up for human rights wherever there is inequality and we will seek more commitments from countries to join this important resolution."

The declaration was presented by South African and adopted with the support of 23 countries, 19 countries opposed, 3 countries abstained, and 1 country was absent for the vote.

PHOTO: United Nations General Assembly, UN Photo/Rick Bajornas

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On June 20 - 21, 2011, Eli Coleman, PhD, was one of twenty-two sexual health experts from around the globe gathered in Madrid, Spain, to help solidify an action plan to promote sexual rights and sexual health through comprehensive, science-based sexuality education.

While the European Regional Office World Health Organization recently published standards for sexuality education and a law was passed requiring sexuality education to be integrated throughout the Spanish education system curricula, there has been a backlash against these progressive efforts. In response, this global expert consultation was organized under the auspices of the Spanish Academy of Sexology and Sexual Medicine, the Spanish Association of Specialists in Sexology, the Espill Institute of Psychology, Sexology and Sexual Medicine, the Latin American Federation of Sexology and Sexual Education and the World Association for Sexual Health. The meeting was supported by the Health, Social Policy and Education Ministry of Spain, the Regional Offices for Europe and America of the World Health Organization (WHO), and the German Federal Centre for Sexual Education.

Over the two-day meeting, the group worked to prepare a consensus document regarding the principles that should underlie sexual education programs and to strategize how to build greater public support for comprehensive sexuality education.

Coleman said, "It is frustrating to have to defend over and over again the simple principle of providing basic and comprehensive sexuality education and for this education to be based upon the best available science. Hopefully, the outcome of this meeting will effectively respond to those who are thwarting the efforts to provide citizens with their basic sexual rights."

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Michael Miner, PhD, will be the principal investigator on a new $1 million grant from the National Institutes of Mental Health (NIMH) to study sexual compulsivity. Over the next three years Miner in collaboration with the Kinsey Institute and his team of co-investigators will be working to gather the empirical data needed to clarify the characteristics of sexual compulsivity and how it leads to increased levels of HIV sexual risk behavior. The findings of this study will further a nuanced approach to the development of interventions and allow for targeting the most resource- intensive prevention efforts at those individuals most likely to spread HIV.

Miner said, "This grant provides an exciting opportunity to test the assumptions that have driven our treatment interventions for decades. Further, our timing could not be better, given the recent definition of addiction put forth by the Academy of Addiction Medicine which we can empirically investigate using our methodology."

Sexual compulsivity, or high levels of sexual behavior combined with a perceived lack of control, is strongly associated with unprotected sex and other HIV sexual risk behaviors. This association has been robust across populations, but particularly strong in men who have sex with men (MSM). Miner's new project builds on previous research conducted at PHS which found that sexual compulsivity is associated with sero-discordant unprotected anal intercourse in HIV-positive MSM even after controlling for other known correlates (e.g., condom use self-efficacy, intentions to practice safer sex, etc.). However, while the association between sexual compulsivity and unsafe sex has considerable empirical support, the manner in which sexual compulsivity confers this increased risk, and therefore how to best influence such processes in order to reduce risk, is as yet, unknown.

Sexual compulsivity has been conceptualized as an addictive disorder, an impulsive disorder, and as a compulsive disorder. Others have questioned the existence of sexual compulsivity as a definable disorder and attribute the increased sexual behavior to high sex drive. Common across all conceptualizations are four factors: negative affect, sexual arousal, behavioral inhibition, and cognitive control. These factors influence HIV risk by interfering with the ability to manage one's sexual impulses, which would lead to multiple sexual encounters, and through impairments in the ability to consider multiple reinforcement contingencies and to consider the long-term consequences of pleasurable behavior which interferes with condom use. This study will provide needed empirical data to clarify the characteristics of SC and how it leads to increased levels of HIV sexual risk behavior.

A multi-method strategy will allow the research team to characterize sexual compulsivity and to provide needed empirical data to identify, and therefore help address, the underlying mechanisms that influence unsafe sexual behavior.

The research team includes co-investigators Angus MacDonald, III, PhD (U of M Department of Psychology), Rebecca Swinburne Romine, PhD, Nancy Raymond, MD, Erick Janssen, PhD (Kinsey Institute).

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On May 12, 2011, Robert Garofalo, MD, MPH, delivered the second annual John Money Lecture in Pediatric Sexology at the University of Minnesota. In his presentation, "Advancing the Health of Lesbian, Gay, Bisexual, and Transgender Youth," Garofallo discussed the process and findings of the recent Institutes of Medicine Committee Report, The Health of Lesbian, Gay, Bisexual, and Transgender People. He summarized and contextualized the state of the science as it exists for LGBT youth and as suggested by the IOM, offered a paradigm for the next generation of academic work for this vulnerable population.

Dr. Garofalo is an associate professor of pediatrics and preventive medicine at Northwestern University Feinberg School of Medicine. He is also an attending physician at Children's Memorial Hospital where he directs the Adolescent/Young Adult HIV Program. Dr. Garofalo is a national authority on LGBT health issues, adolescent sexuality, and HIV clinical care and prevention. He has been the principal investigator on five National Institute of Medicine (NIH) and two Centers for Disease Control and Prevention funded research grants and serves as a co-investigator on three additional NIH-funded projects. He is the past president of the Gay and Lesbian Medical Association. In 2010, Dr. Garofalo served as a committee member for the National Academy of Sciences/Institute of Medicine Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.

Joycelyn Elders, MD, was present as the lecture discussant.

John Money's family established the John W. Money Endowed Fund at the Program in Human Sexuality which provides funding for the John Money Lecture in Pediatric Sexology hosted at the Program in Human Sexuality and the John Money Plenary at the Biennial World Conference of Sexual Health sponsored by the World Association for Sexual Health.

On June 12, 2011, Kevin Fenton, MD, PhD, delivered the second John Money Plenary at the 20th World Congress for Sexual Health in Glasgow, UK. The title of his presentation was "A Public Health Approach to Advancing Sexual Health in the United States: Accomplishments, opportunities, and lessons learned."

Fenton is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). In November 2005, Fenton was named director of the National Center for HIV, STD, and TB Prevention, which was renamed NCHHSTP in March 2007 to reflect the addition of CDC's Viral Hepatitis program. He previously served as chief of CDC's National Syphilis Elimination Effort since January 2005. He has worked in research, epidemiology, and the prevention of HIV and other STDs since 1995 and was previously the Director of the HIV and STI Department at the United Kingdom's Health Protection Agency. Fenton has spearheaded the development of a number of national HIV, STD and behavioral surveillance and research programs in the UK and Western Europe including the National Chlamydia Screening Program in England, the 2nd British National Survey of Sexual Attitudes and Lifestyles and the European Surveillance of STI (ESSTI) Network. He is a Fellow of the Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom.

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We are excited to share a new Human Sexuality Research Portal. The Program in Human Sexuality has built this website in collaboration with the Bio-Medical Library in order to begin to create a new information infrastructure around the sexuality materials currently held at the University of Minnesota. It is also an online research portal connecting other sexuality institutes, libraries, and researchers across the United States and the world with human sexuality and sexual health resources. The site offers helpful research instructions and connects researchers to relevant library catalogues, databases, special collections, e-books, and web-based resources.

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Michael Miner, PhD, is one of five editors on the new book International Perspectives on the Assessment and Treatment of Sex Offenders: Theory, Practice and Research released by Wiley-Blackwell this year.

This book represents a departure from recent works on this subject. It presents a comprehensive overview of current theories and practices relating to the assessment and treatment of sex offenders throughout the world, including the United States, Europe, and Australasia. The chapters cover all the major developments in the areas of risk assessment, treatment, and management, including controversial and rarely addressed issues, such as chemical castration and the ethics of sexual offender treatment and management. Unlike most books on this topic, which tend to represent the perspectives of those in the United States, Canada, and the United Kingdom, this is a truly international and multi-disciplinary volume that integrates the Anglo-American and the European perspectives on sexual offender issues.

The project was supported by the International Association for the Treatment of Sexual Offenders (IATSO).

Boer, D.P., Eher, R., Craig, L.A., Miner, M.H., & Phafflin, F. (Eds., 2011). International Perspectives on the Assessment and Treatment of Sex Offenders: Theory, Practice and Research. West Sussex, U.K.: Wiley.

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Walter Bockting, PhD, and Michelle van Ryn, PhD, MPH, have both been promoted to Professor with tenure at the Department of Family Medicine and Community Health, University of Minnesota Medical School.

Bockting completed his postdoctoral fellowship at the Program in Human Sexuality in 1990 and shortly thereafter joined the faculty at PHS. Bockting is a respected researcher, clinical psychologist, and coordinator of the University of Minnesota Transgender Health Services at the Program in Human Sexuality. He received his doctoral degree in psychology from the Vrije Universiteit, Amsterdam, The Netherlands (drs. in 1988 and PhD in 1998). He is also on the graduate faculty of Gender and Sexuality Studies and a co-founder of the University's Leo Fung Center for CAH and Disorders of Sex Development. His research interests include gender identity development, transgender health, sexuality and the Internet, and HIV prevention, and his work has been supported by grants from the National Institutes of Health, the American Foundation for AIDS Research, and the Minnesota Department of Health. He is currently the Principal Investigator of the NICHD funded project All Gender Health Online. Bockting is the author of many scientific articles and editor of five books: Gender Dysphoria: Interdisciplinary Approaches in Clinical Management (Haworth Press, 1992), Transgender and HIV: Risks, Prevention, and Care (Haworth Press, 2001), Masturbation as a Means of Achieving Sexual Health (Haworth Press, 2002), Transgender Health and HIV Prevention (Haworth Press, 2005), and Guidelines for Transgender Care (The Haworth Press, 2006). He is also Editor-in-Chief of the International Journal of Transgenderism, and serves on the editorial board of Archives of Sexual Behavior, Sexual and Relationship Therapy, Journal of Homosexuality, Psychology and Sexuality, and International Journal of Sexual Health. He is past-president and fellow of the Society for the Scientific Study of Sexuality and president of the World Professional Organization for Transgender Health. Bockting recently completed an appointment by the Institute of Medicine (IOM) of the National Academies to the Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The IOM committee assessed the state of the science on the health status of LGBT populations; identified research gaps and opportunities related to LGBT health; and outlined a research agenda that will assist the National Institutes of Health in enhancing its research efforts in this area. Additionally, the committee considered research training needs to foster the advancement of knowledge about LGBT health and identify impediments to such advancement. The committee report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding was released in March 2011.

Michelle van Ryn, PhD, MPH, is a professor in the Department of Family Medicine and Community Health. She earned a PhD in social psychology and health, and an MPH in health behavior and health education at the University of Michigan, School of Public Health and Institute for Social Research, where she also completed a 2-year fellowship on psychosocial factors and mental health and illness. During this period she won the National Mental Health Association's award for the Best Preventive Intervention, 1990. She recently completed the academic coursework needed for licensure as a marriage and family therapist and is currently seeing patients at the Center for Sexual Health. Over the last 20 years, her research (and now clinical) work has focused on the factors that create effective and empowering helping relationships across settings, circumstances, and diverse patient characteristics. She has a strong clinical interest in relationship, intimacy, and sexual health issues. In addition, she has two areas of special clinical and research interest: the impact of illness, chronic disease, and/or disability on self, relationships and sexual functioning, and methods and approaches for providing accepting and effective therapy to people involved in alternative relationships, alternative sexual lifestyles, and/or non-traditional family arrangements.

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Rosemary Munns, PsyD, was honored with the 2011 Faculty Mentor Award presented by the PHS postdoctoral fellows. Graduating fellows Eric Sprankle, PsyD, and Sheena Hoffman, PhD, presented the award.

Sprankle said of Munns, "I learned more about cognitive therapy from her in the first six months of my fellowship than in the five years of previous clinical training combined. She provided invaluable support and advice for job searching and studying for the EPPP. And most importantly, I am truly fortunate to have had her empathy and warmth when I was experiencing personal distress."

Hoffman added, "Rose has always followed through for me, and she was thorough and attentive every step of the way. Being lucky enough to have her as a supervisor my first semester/rotation here, I felt very safe. She serves as a body guard for the postdocs as needed, since she was a postdoc here herself. I have always appreciated that she is organized, on top of things, attentive, and makes sure that she has answered every question before we move forward. I have a lot of respect for her, and feel honored to have worked with her. She has served as a strong mentor to me."

Munns thanked Sprankle and Hoffman and said, "I am truly honored. Training the postdocs is a very important part of my job that I take very seriously. Thank you."

Munns herself is a graduate of the PHS postdoctoral fellowship. She has mentored postdoctoral fellows since 2001.

Munns received her MA in clinical psychology in 1995 and her PsyD in 1998 from the Minnesota School of Professional Psychology. She had 12 years of experience in the mental health field prior to graduate school. She has extensive clinical experience in assessment and treatment of substance abuse, working in correctional settings with juvenile delinquents and adults, as well as inpatient and outpatient psychiatry. Her primary interest is in providing clinical services to adults with sexuality issues. Her areas of interest are sexual dysfunctions, relationship and sex therapy, transgender issues, assessment and treatment of sex offenders, abuse recovery, compulsive sexual behavior, sexual orientation, and HIV counseling.

PHOTO: Rosemary Munns, PsyD, Eric Sprankle, PsyD, and Sheena Hoffmann, PsyD

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