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Coleman-Chair-BP-7.jpgMedical advances, improved access to care, prevention initiatives, and our nation's aspiration of an AIDS-free generation are all good signs, but as a culture we will need to shift our perspective to stop the spread of HIV.

 
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.


New strategies are overdue. In the United States, we continue to experience 50,000 new infections a year, with young people aged 13-29 accounting for 39% of all new HIV infections.* And, there are serious health disparities.  People of color, youth, and sexual minorities are much more likely to become infected than other groups. 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.


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.


As the current Chair in Sexual Health, I continue to push a sexual health agenda in HIV prevention. I believe in the need for a broad sexual health approach to stem the tide of the HIV epidemic. I envision an approach that goes beyond venereology and on an individual level

• emphasizes a positive and respectful approach to sexuality and sexual expression throughout the lifespan;

• acknowledges sexuality as a basic and fundamental aspect of our humanness and that the pursuit of sexual pleasure is natural and desirable;

• combats sexual coercion, shame, discrimination, and violence;

• promotes positive sexual identity and esteem;

• encourages honest communication and trust between partners;

• supports the possibility of having pleasurable, fulfilling, and satisfying sexual experiences;

• insists that individuals take responsibility of the consequences of their sexual choices and their impact on others; and

• optimizes 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.

As the Chair in Sexual Health, I will continue to work with our faculty at the Program in Human Sexuality 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
Chair in Sexual Health

 

New HIV Infections in the United States by Centers for Disease Control and Prevention

Letter from the Chair in Sexual Health

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Coleman-Chair-BP-7.jpgSo what does the New Year hold for the future of sexual health? Can we be optimistic? I think so. There are four broad reasons to feel optimistic.

1.  As governments struggle with the complexities of the sexual problems and declining resources to commit to alleviate the myriad of problems, they will have no choice but to create broad strategies to promote sexual health. We have a public health imperative. We have an opportunity to use an evidence-based approach to public policy. Public health policies recognize that there is no choice but to address the barriers and opportunities for all citizens to enjoy the right to sexual health. They also recognize more and more that sexual health is a function of the recognition of basic human rights for all citizens.

2.  Sexual Health has taken root in public health policy and sexual science will be needed to guide it. Now is the time of a unique opportunity in history of which we must take advantage.

3.  The field of sexology has clearly established itself as a key player in the effort to promote a healthier society in the new millennium. The HIV pandemic alone continues to drive home the need to understand human sexuality in its full complexity--from the interdisciplinary perspective of sexology. Now sexologists are being asked to come to the table and help direct public policy by sharing our knowledge, research, and expertise.

4.  Public health officials recognize more than any other time that comprehensive sexuality education is essential. They need to support sexuality research and we see a flourishing of funding that is rooted in sound theory and scientific methodology. We see an increase in research publications which add to our knowledge and legitimacy of our scientific field.

In the United States, we have seen major developments that are guiding lights for the future of sexual health. There have been 5 major developments which will have a major impact in the coming year.

1.  In 2010, the Centers for Disease Control and Prevention (CDC) held a sexual health consultation to develop a broad consensus of how we could develop a strong, comprehensive, broad and integrated approach to sexual health. The meeting report was published in 2011. After another year of further consultation, the CDC is about to publish a white paper outlining the basic and fundamental strategies for the coming decades. The CDC adopted its own sexual health definition that could guide its work in this area.

2.  In 2010, the office of the President of the United States published a National HIV Strategy - the first comprehensive national strategy since the beginning of the epidemic! In this strategy, there was a strong statement that we must move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills, information or prevention programs. Instead, we need to develop, evaluate, and implement effective comprehensive prevention strategies and combination therapies. While obvious, it was stated clearly that all Americans should have access to a shared base of factual information about HIV - a revival of the basic premise that US Surgeon General Koop stood upon in disseminating frank and scientifically accurate information to all households in the mid-1980s. Finally, this new strategy outlined a public health approach to sexual health that includes HIV prevention as one component. This was the first time the term sexual health was used in public policy in the United States. The President and Secretary of State Hillary Clinton have called for a concerted approach to creating an AIDS-free generation.

3.  In 2011, the office of the US Surgeon General released a report that was developed by the National Prevention Council. This report was the first national strategy on prevention that called for us to work together to improve health and quality of life by moving from a focus on sickness and disease to one based on prevention and wellness. Reproductive and sexual health is one of the seven targeted priorities. Many of these recommendations have been incorporated and will be funded by the Affordable Care Act.

4.  In 2011, a report commissioned by the Secretary of Health and Human Services and conducted by the Institute of Medicine, was released on the health of gay, lesbian, and transgendered individuals. This report called upon more understanding and research on these marginalized populations and outlined a broad strategy to promote the health and wellbeing of these American citizens. This report has already had profound positive impact on public policies and public attitudes.

5.  In 2011, the Department of Health and Human Services set broad health goals for the coming decade entitled --Healthy People 2020. In this broad health strategy "Reproductive and Sexual Health" was clearly identified as a leading health indicator. The outcomes of the recent national elections have ensured that these broad strategies to promote sexual health will go forward with commitment, leadership, and essential funding.

So, I think we can look forward to 2013 with a sense of optimism. We cannot be complacent, but we can ride this wave of renewed commitment to the promotion of sexual health for all Americans.

The Program in Human Sexuality will do its part - but it will be made easier by this social and political climate that shares our ideals of creating a sexually healthier climate and overcoming barriers to sexual health.

Thank you all for your support of the Program's activities and we wish you the very best in the coming year!

Eli Coleman, PhD
Director and Professor
Chair in Sexual Health

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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

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PAHO-22-BP.jpgEli Coleman, PhD, and Walter Bockting, PhD, joined a meeting convened by the Pan American Health Organization / World Health Organization (PAHO / WHO) from December 19 to 21, 2011.  PAHO gathered representatives of the health sector, academia, and civil society organizations to discuss a series of recommendations for health services on how to address the needs and demands of transgender people in the region of the Americas.

The conclusions of this meeting will become part of a reference document addressing the main problems affecting access to and utilization of health services for and by transgender people. In addition, a plan for the development of a comprehensive strategy for health care provision for this population throughout the region will be designed. Both documents will subsequently form the basis for sub-regional consultations to be held in 2012.

The participants of the meeting, which was held at the headquarters of PAHO/WHO in Washington D.C., decided to adopt the term "trans" to refer to a population whose members are characterized by a variety of gender identities and expressions that differ from their sex assigned at birth. This population faces a number of problems in accessing health services in the countries of the region, many of which are a result of stigma, a lack of appropriate medical protocols and a lack of information on how to deal with certain social situations.

"Trans people have traditionally been stigmatized, marginalized, abused, discriminated against, and even subject to physical and emotional violence. These and other expressions of transphobia have to be considered factors that negatively impact health," said Dr. Gina Tambini, Area Manager of Family and Community Health. "In order for the health sector to be able to adequately respond to the needs of trans persons, we must create and implement policies of non-discrimination, rely on qualified personnel, and ensure that there are environments of respect and quality of care. The presence and active participation of trans persons was a fundamental and indispensable contribution to the success of the meeting.

Trans people as a group have greater vulnerability and exposure to such health problems as HIV, syphilis, gonorrhea, hepatitis, and genital herpes, which create special demands on health services. But in addition, health care providers need to be sensitive to issues of gender identity related to this group.

"The needs, problems, and demands of trans people cannot be defined externally, but must be expressed by them themselves," said Dr. Tambini.

At the PAHO meeting, participants discussed terminology, definitions, and descriptions of this population, as well as epidemiological profiles and health initiatives that have been carried out in the Americas. In addition to reviewing and discussing the content of the reference document, the meeting was intended to promote a multisectoral and multidisciplinary vision on the provision of services, including prevention.

PAHO was established in 1902 and is the world's oldest public health organization. PAHO works with all countries in the Americas to improve the health and quality of life of people of the Americas and serves as the Regional Office for the Americas of WHO.

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Feminist Perspectives on the Psychology of Same Sex Marriages
Thursday, April 19, 2012
7:00 PM - 9:00 PM
Room 3-100 Mayo Memorial Building

Free and open to the public
Gender neutral restrooms will be available.

Lisa Diamond, Beverly Green, and Glenda Russell will discuss their research and clinical perspectives on marriage equality and the marriage amendment. All three speakers are nationally renowned researchers, authors, psychologists, and teachers. Their specialties are in GLBT concerns and they will speak about women's issues, sexual orientation, ethnic and cultural diversity, and feminism and marriage. Greene will focus on marriage equality as a wedge issue used to divide African Americans and LGBT people. Diamond will discuss areas of caution in the fight for marriage equality, specifically regarding the movement to position same sex couples as indistinguishable from heterosexual couples. Russell will discuss feminist views of marriage from the second wave in the 1970s to the present time. This event is being organized by the Minnesota Psychological Association, Minnesota Women in Psychology, GLBTA Programs Office, Program in Human Sexuality, and the Women's Center.

Beverly Greene, Ph.D., ABPP, St. John's University is Editor of "Education, Research, and Practice in Lesbian, Gay, Bisexual, and Transgendered Psychology" and "Ethnic and Cultural Diversity among Lesbian and Gay Men." Lisa Diamond, Ph.D. is Associate Professor of Psychology and Gender Studies, University of Utah and author of "Sexual Fluidity." Glenda Russell, Ph.D. is a psychologist practicing at the University of Colorado at Boulder.

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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 http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf

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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

SEC. 2. PURPOSES; SENSE OF CONGRESS
(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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Letter from the Chair

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Eli-Coleman-BP.jpgWe 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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CDC-report-BP.jpgEli 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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LGBT-report-BP.jpgResearchers 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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UN-General-Assembly-BP.jpgOn 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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Madrid-BP.jpgOn 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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