Medical 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
So 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
A Chilean gay man who was brutally beaten in a park in Santiago earlier this month succumbed to his injuries on March 27, 2012. Prosecutors claim that 24-year-old Daniel Zamudio was struck with bottles, rocks and other blunt objects before the attackers cut off part of his ear, carved swastikas into his chest, and burned other parts of his body with cigarettes.
The attack has sparked widespread outrage across Chile and throughout Latin America. A few days after the attack, President Sebastián Piñera and Interior Minister Rodrigo Hinzpeter met with members of Zamudio's family and Movilh, a GLBT human rights advocacy organization. Hinzpeter and the United Nations have urged Chilean lawmakers to pass a law that would ban discrimination based on sexual orientation, gender identity and expression.
Daniel Zamudio has become Latin America's Matthew Shepard.
What is tragic is that after 40 years of gay liberation, we still face homophobic attitudes that discriminate, stigmatize, and demoralize people based upon their sexual orientation. In many countries scientific evidence has led to public policy changes and changes in public opinion, but obviously we have not gone far enough.
Thirty years ago, I wrote my most cited article "Developmental Stages of the Coming Out Process." I wrote it to describe a new model of affirmation therapy as opposed to the outdated "illness model." It showed how individuals could escape from shame and self-destruction through a process of affirming one's own sexual identity and developing meaningful relationships and integrating their sexual identity with their overall identity and integrating into society.
It was a helpful model then. I am often struck by how relevant this article still is today. Today the struggle for self-acceptance and acceptance by others has been made be easier, but true integration is still an issue. Individuals, families, and communities continue to struggle around these issues.
Oh for the day that this article is irrelevant and meaningless.
Meanwhile, we need to continue to strive to make the world a more accepting place for diversity of sexual and gender identity. Everyone's life is enriched by this acceptance.
There is obviously no place for the homophobic attitudes and hatred that apparently led to the death of Daniel Zamudio. I do hope that like Matthew Shepard's death, that this horrible event will lead to greater public awareness, changes in public policy, and new hate crime laws that will help to foster a climate of tolerance, inclusion, and respect for diversity.
In Minnesota, we are struggling with the question of whether individuals who love someone of the same gender can be entitled to the full rights of citizenry - including the right to marry. There is no scientific evidence which shows that this will have adverse effects on society; and in fact there is ample evidence that laws that assure rights to citizenry will result in better health for all.
We need to move to a more enlightened society based upon the best available science and the principles of democracy and justice.
Coleman, E. (1981/82). Developmental stages of the coming out process. Journal of Homosexuality, 7(2/3), 31-43. doi: 10.1300/J082v07n02_06
August 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.
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
The American Psychiatric Association (APA) has concluded a first step in revising the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association by releasing proposed new classifications and criteria for the next revision of the DSM due to be released in 2013. At the same time, the World Health Organization (WHO) is undergoing its own process of revising its International Classifications of Diseases (ICD). The sexual and gender diagnoses are sure to spark intense debate. Sexual and gender disorders can be barriers to sexual health. Access to care for these disorders can lead to improvements in sexual health. At the same time, pathologizing normative sexual behavior and gender expressions can lead to stigma, discrimination, and poor sexual and other health outcomes. What is considered a disorder by these organizations has an enormous impact on all of us.
We know from history that psychiatrists once classified masturbation, oral sex, and homosexuality as perversions. With new knowledge regarding human sexuality, these were removed from the category of "sexual disorders." While the American Psychiatric Association declassified homosexuality in 1973, it was not until 2001 that the Chinese Psychiatric Association did so.
At present, there is quite a bit of concern and disagreement about the existing diagnostic categories and criteria for the sexual and gender diagnoses. Several national health boards have broken from the ICD and have declassified previously classified "disorders." For example, Denmark removed sadomasochism from their classification system in 1995, and as of January 1, 2009, Sweden declassified dual-role transvestism, gender identity disorder of childhood, fetishism, sadomasochism and multiple disorders of sexual preference. They retained transsexualism in order to preserve medical and psychological treatment for this condition (Pink News, 2008).
In February 2010, Norway followed suit and declassified these same "disorders" from their national health board. In February 2010, France became the first country in the world to remove transsexualism from its official list of mental disorders but has retained under a special category the ability for individuals with severe gender dysphoria to received appropriate treatment. The French Health Ministry has already agreed to push other countries in the European Union to drop transsexualism from their lists of mental disorders (Time, 2010). As noted in the article below, Cuba has recommended that transsexualism be removed from the ICD as well.
Last revised in 2000, there seems to be a general feeling that revision of ICD is necessary because of advances in knowledge, a deep concern about balancing the restriction of sexual freedoms and pathologizing normal variations in sexual and gender expressions, and the need to define pathological states for research purposes and access to care (and the right to the best possible care).
There is certainly intense concern regarding ridding the ICD of old and pejorative terms such as impotence, frigidity, premature ejaculation, nymphomania and satyriasis and excessive sexual drive.
A fundamental shift has been suggested in classification of sexual dysfunctions according to the traditional Kaplan/Masters and Johnson model of sexual response. This has mostly been driven by research on female sexual functioning and dysfunction that challenges the old assumption of parallelism of sexual response. Many argue that there is a fundamental difference in sexual response and dysfunctions in men and women are fundamentally different and therefore need different diagnostic criteria. Also, as we further understand the interplay between psychogenic and organic factors, many believe that there is a false dichotomy between organic and psychogenic factors in sexual dysfunction and perhaps in the other sexual and gender disorders. Sexual disorders may involve multiple psychological, interpersonal, and biologic/organic causes, and these influences are not always separate entities. They challenge the prevailing notion that organic sexual problems can be separated from psychogenic problems. There have been suggestions to creating a different category for sexual problems, eliminating the "dependence" of psychiatry and the stigma of a mental illness.
The debate over the paraphilias and whether to retain fetishism, transvestic fetishism, sadism and masochism will be contentious. The proposed new category of hypersexual disorder is clearly an attempt to recognize that some "normal" sexual activity can become excessive, driven, compulsive and in some ways "addictive." The potential misuse (and threat of over pathologization) of this category is enormous and there are also still fundamental questions regarding pathophysiology and nomenclature. And the debate over gender identity disorders will loom even larger. Clinicians, physicians, and researchers have made many important recommendations. The APA has responded to some of these recommendations but the stigmatizing nature of the proposed revisions still remains. Changing gender identity disorder to gender incongruence has not seemed to satisfy anyone on either side of the debate. The APA has responded to some of these recommendations but the stigmatizing nature of the proposed revisions still remains. Changing gender identity disorder to gender incongruence has not seemed to be received well by many on either side of the debate.
I am pleased that the faculty of the Program in Human Sexuality have been involved in this debate and that their research has been used to inform the revision process. Having just reviewed and made recommendations to the WHO regarding proposed revisions to the ICD sexual and gender diagnoses, I am very aware of how difficult this task will be. It will be very challenging for the APA and WHO to find the right balance in the revision of the sexual and gender diagnoses in the DSM-V and ICD-11. Both bodies have opened up the revision process to public discussion and debate (DSM and ICD).
In considering the revisions, sexual health and rights need to be taken into consideration. Based on work from the World Association for Sexual Health (WAS), I offer these guiding principles.
1. Recognition and treatment of sexual and gender disorders is a basic sexual and human right.
2. DSM and ICD should take into consideration the sexual rights of individuals as it considers pathologizing sexual behaviors or gender expressions and individuals' right to freedom to express their full sexual potential, as well as to freedom from sexual coercion, exploitation, and abuse. The individual has a right to individual decisions and behaviors as long as they do not intrude on the sexual rights of others.
3. Sexual and gender diagnoses should not be used in any way to support any forms of discrimination regardless of sex, gender, sexual orientation, age, race, social class, religion, or physical and emotional disability.
4. Sexual and gender diagnoses should not be used in any way to pathologize the derivement of sexual pleasure, including autoeroticism, as a source of physical, psychological, intellectual and spiritual well being.
5. Sexual and gender diagnose should not be used in any way to pathologize those who decide to marry or not, to divorce, and/or to establish other types of responsible sexual associations.
6. Sexual and gender diagnoses should not be used in any way to infringe on the individuals right to make free and responsible reproductive choices. This encompasses the right to decide whether or not to have children, the number and spacing of children, and the right to full access to the means of fertility regulation.
7. The DSM and ICD sexual and gender diagnoses should support the right to sexual health care. Sexual health care should be available for prevention and treatment of all sexual concerns, problems and disorders.
8. There has not been enough research into the understanding or treatment of female sexual dysfunctions and that a gender perspective is needed.
9. A lack of scientifically valid information concerning sexual function within the general population is pervasive and the negative impact of this ignorance is felt around the world.
10. Given the importance of adequate sexual functioning for general sexual health, overall health and well-being, and the health of interpersonal relationships, the updating of the DSM and ICD is welcomed to recognize the distinctions between normal range of sexual and gender expression, and the concerns, problems, and dysfunction and disorders that require intervention. Appropriate sexual health services must be made available throughout the world.
11. Given the concern about "Americanization of mental illness," as an international classification of diseases (Watters, 2010a, b), ICD will need to pay particular attention to the influence of culture and globalization in arriving at a classification system that will meet the needs of the world.
I welcome your comments and encourage you to express your opinions to the APA before April 10, 2010 and to the WHO.
Pink News. Sweden removes transvestism and other 'sexual behaviours' from list of diseases November 19, 2008 Accessed from the Internet on March 14, 2010, http://www.pinknews.co.uk/news/articles/2005-9616.html/
Time. In France, Transsexuals Celebrate a Small Victory. March 1, 2001. Accessed from the Internet on March 14, 2010 at http://www.time.com/time/world/article/0,8599,1968767,00.html?xid=rss-topstories
Watters, E. (2010a)The Americanization of Mental Illness. New York Times Magazine, January 8, 2010. Accessed from the Internet on March 14, 2010 at http://www.nytimes.com:80/2010/01/10/magazine/10psyche-t.html?scp=1&sq=ethan%20water&st=cse
Watters, E. (2010b). Crazy Like Us: The Globalization of the American Psyche. New York: Free Press.
On March 3, 2010, same-sex marriage became legal in Washington DC. The district joins Connecticut, Iowa, Massachusetts, New Hampshire, and Vermont in granting marriage licenses to gay couples.
Many couples have requested licenses, some standing in line at the courthouse for hours. According to the Associated Press the courthouse spokeswoman Leah Gurowitz said that the 466 applications received from both gay and straight couples is much higher than the 50 or so applications normally received in a week.
On March 9, 2010, the Human Rights Campaign headquarter office in DC hosted some of the first wedding ceremonies.
Bean Robinson, PhD, had the rare opportunity to travel to Cuba recently. After a difficult two-year application process, a group of 24 people from Temple Christ Church received approval to travel throughout the country to meet with religious, artistic, cultural, and social services organizations. The group traveled to Havana, Matanzas, Guantanamo, and Santiago.
Appointments that directly related to Robinson's research and clinical work included meetings with the director of the Christian Institute for Gender Studies, a visit to the Women's Settlement House (Casa de Orientacion de la Mujer), and time at the Federation of Cuban Women (Federación de Mujeres Cubanas - FMC). The group also attended a seminar by local specialists treating individuals living with HIV and AIDS and visited a School of Social Work.
When the Soviet Union fell in 1990, Cuba lost billions of dollars of direct financial support and trade. Today the country is still suffering from the loss. Robinson noted, "Although the country is extremely poor there are fascinating progressive reforms in place, and some of them are decades old. The work of the Federation of Cuban Women is impressive. Nearly 80% of Cuban women belong to the federation and they have been a strong force for gender equality in education, employment, and society. There is an official family code that states that men are to share equally in house work and child care. It goes to show that solidarity can be powerful."
In addition to the group itinerary, Robinson met with Mariela Castro Espín, director of Cuba's National Center for Sex Education (CENESEX) and president of the Cuban Multidisciplinary Society for Sexuality Studies (SOCUMES). Castro is the daughter of current president Raul Castro and Vilma Lucila Espín Guillois who was a feminist, revolutionary, and the founder of the FMC. Mariela Castro is a tenacious activist for GLBT rights. She was instrumental in improving access to care for transgender individuals including the resolution passed by the Cuban government in June 2008 that provides fully integrated health care for transsexuals including government subsidized chest/breast and genital reconstruction surgery to patients who qualify. Robinson's visit came days after the Cuban Congress of Sexual Education, Orientation, and Therapy where SOCUMES proposed to their General Assembly of Members the adoption of the "Statement on Despathologization of Transsexualism" recommendations that are based on a proposal made by the National Commission for Comprehensive Care of Transsexual People of CENESEX (see statement below).
During the 10-day trip the group had the opportunity to visit various churches throughout the country and to meet leaders from the Cuban Council of Churches, the president of the Latin American and Caribbean Council of Churches, and the Matanzas Seminary's Women Knitters Group. They also visited museums including the Museum of the Revolution, Frank Pais Museum, Guanabacoa Museum of Afro Cuban Religions.
Hernub Roderic Southall and Ernest Bryant of Obsidian Arts were on the trip and made arrangements to meet Cuban artists including painters, sculptors, and musicians. In Santiago the group visited the Luis Diaz Eduardo Cultural Workshop and met artist and center director Isreal Tamayo Zamora, and metal sculptor Julio Carmenate. (See a full list of Cuban artists that the group met below.)
Before they departed the group met with the Haitian Cultural Association to discuss ways to help the Haitian people in the aftermath of the January earthquake. Many members of the group made monetary donations in convertible Cuban pesos (CUC) toward relief efforts.
Watch a video (11:25min) interview from January 1, 2009, with Mariela Castro Espín and Anastasia Haydulina of Russia Today Television in Havana Cuba.
STATEMENT ON DESPATHOLOGIZATION OF TRANSSEXUALISM Cuban Multidisciplinary Society for Sexuality Studies
5th Cuban Congress of Sexual Education, Orientation and Therapy
The Sexual Diversity section of the Cuban Multidisciplinary Society for the Study of Sexuality (SOCUMES) proposed the adoption of the following Declaration in its General Assembly of Members on 18 January 2010 in Havana, based on a proposal made by the National Commission for Comprehensive Care of Transsexual People, of the National Center for Sexual Education (CENESEX).
Recalling the current inclusion of transsexuality as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) published by American Psychiatric Association (APA) and the International Classification of Diseases (ICD-10) of the World Health Organization (WHO);
Recalling also that the Standards of Care adopted in Cuba by the National Commission for Comprehensive Care of Transsexual People rely on those published by the World Professional Association for Transgender Health (WPATH), which also includes the classification of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases E-10;
Considering that the American Psychiatric Association will publish in 2012 the fifth version of the above mentioned manual and that the chief and other specialists of the working group responsible for the review have recently proposed the non-removal of this category, as well as the application of corrective psychological therapy to children, to the sex assigned at birth;
Taking into account the concern expressed by individuals and human rights groups at the international level regarding this issue,
Considering that all transgender people -including transsexuality, transvestites and intersex people- may be vulnerable to marginalization, discrimination and stigma, based on the socially regulated binary approach that recognizes only two gender identities: male and female;
Considering also that the above classifications perpetuate and deepen social discrimination against these groups, causing irreversible physical and psychological damage that can lead these people to commit suicide;
Considering in addition that transsexuality and other transgender expressions are not an option for a lifestyle and that the modifications to their bodies have no cosmetic intentions. It is a right and an inner need to live with the gender identity which the person feels to belong;
Recalling the Yogyakarta Principles on the application of international human rights law in relation to sexual orientation and gender identity, especially Principle 18 on "Protection from Medical Abuses" which, among other things, make States and governments responsible to "ensure that any medical or psychological treatment or counseling does not, explicitly or implicitly, treat sexual orientation and gender identity as medical conditions to be treated, cured or suppressed";
Considering that the right to public health and universal free access to its services are guaranteed by the Cuban government for all, but still requires additional laws to fully protect the rights of transgender people;
Recalling Resolution 126 of Public Health Ministry, of 4 June 2008, which regulates the procedures involved in health care for transsexuals;
Recognizing that multidisciplinary care provided by the National Commission for Comprehensive Care of Transsexual People, since its foundation in 1979 until today, has led to a remarkable improvement in the quality of life of transsexual people and their families.
Express our support for the removal of transsexuality from the international classification of mental disorder, especially in the DSM-V update to be published in 2010.
Reject the application of psychological therapies for transgender people, in order to reverse their gender identity, as well as sex reassignment surgeries performed to those under 18 years old.
Reaffirm that transsexuality and other transgender identities are expressions of sexual diversity, to which it must be ensured all psychological, medical and surgical treatments required to alleviate alterations to the mental health of these individuals, as a result of stigma and discrimination.
Also reaffirm that the implementation of these procedures respects sexual rights of each person, and are consistent with bio-ethical principles of autonomy, nonmaleficence, beneficence and justice.
Reaffirm in addition that transgender care should be comprehensive, beyond just medical and psychological care, to ensure recognition and respect for their individual rights.
Reiterate the need to consider all necessary legislations to ensure recognition of these rights, especially the Gender Identity Bill, which includes the identity change regardless sex reassignment surgery performance.
Call for a broader implementation of educational strategies regarding sexual orientation and gender identity at all levels of education and to the general population, as stated in the National Program for Sexual Education.
Reaffirm the need to include the attention to transgendered people in comprehensive social policies of the State and Government of Cuba, in correspondence with the "Declaration of the General Assembly of the United Nations, condemning the violation of human rights based on sexual orientation and identity gender ", supported by Cuba on 18 December 2008.
Havana, 22 January 2010
Cuban artists visited by the Temple Christ Church group Agustin Jimenez Chacon Carlos Antonio Para Danis Montero Ortega David Grinan Gonzalez Edgar Yero Eduardo Troche Eira Arrate Escalona Estela Estevez Dieppa Eyder Garbey Rodriguez Franklin Gomez Gonce Gilberto Gutierrez Israel Tomayo Joaquin Bolivar Jorge Luis Chaves Games Jose Luis Berenguer Jose Rene (Bola) Jose Rolando Montero Jose Armando Medina Julio Cesar Carmenate Laugart Justino Reyes Jorge Juan Knight Vera Miguel A. Lobaina Maryenis Lláser Díaz Mauricio Reyes Aranda Orlaide Lopez Pedro M. Vazquez F Vivian Lozano Xiomara Gutiérrez Valera. Mearson Daniel ZaFra Pérez
PHOTO: CENESEX staff with Walter Sawicki (US, third from left), Bean Robinson, PhD (fourth from left), and Mariela Castro Espín (fifth from left), Alberto Roque, MD (sixth from left)
On June 21-25, 2009, The World Association for Sexual Health (WAS) convened its 19th World Congress for Sexual Health titled "Sexual Health and Rights: A Global Challenge" in Göteborg, Sweden. The meeting brought together global sexual health experts including clinicians, researchers, educators, activists, and policy makers, to address the most urgent issues of contemporary sexual health.
The biennial meeting was designed to reflects the eight priorities of the WAS Declaration for the Millennium and echoes the urgent need for action to ensure sexual health and rights for all. Lars-Gösta Dahlöf, President of the Congress encouraged participation by saying, "It is more than ever necessary to pool international resources to fight fear, prejudice, ignorance and violence, and to meet the challenge of safeguarding the core values of human sexuality, as we respect life itself, love, intimacy, pleasure and self-acknowledgement."
The conference was attended by a broad spectrum of medical experts from all parts of the world. A grant from the Swedish Government sponsored attendees from many developing countries where the AIDS crisis severely impacts sexual health, and where basic sexual rights in areas such as education, healthcare, and individual choice are largely unrecognized. In his welcome, WAS president, Eusebio Rubio-Aurioles, MD, PhD, said, "Sexual health is a prerequisite for wellness and the fulfillment of human potential. Human development cannot be achieved without sexual health: this is true for the individual, as it is for the couple, the community and for societies everywhere. Today, sexual health and the attainment of sexual rights for all need the urgent attention of the world's professionals and policymakers, as well as that of society at large. Actions to increase the respect and promotion of sexual rights and to improve sexual health are global priorities."
PHS poster presentations included "Homophobia and Internalized Homophobia Among Men Who Have Sex with Men" Bean Robinson, PhD
"Conducting Sexuality Research Online with Hard-to-Reach Populations" Iantaffi Alessandra, PhD
Eli Coleman, PhD, participated in two symposiums "WAS: 30 years of work" and "Advocating for Sexual Health for the Millennium"
Eight principles from the Declaration for the Millennium 1. Recognize, promote, ensure and protect sexual rights for all 2. Advance toward gender equality and equity 3. Condemn, combat, and reduce all forms of sexuality related violence 4. Provide universal access to comprehensive sexuality education and information 5. Ensure that reproductive health programs recognize the centrality of sexual health 6. Halt and reverse the spread of HIV/AIDS and other sexually transmitted infections 7. Identify, address and treat sexual concerns, dysfunctions and disorders 8. Achieve recognition of sexual pleasure as a component of holistic health and wellbeing
The Department of Justice under the Obama administration did not appeal the Schroer v Library of Congress ruling by the deadline of June 30, 2009. Last September Diane Schroer won her discrimination suit after a job offer was rescinded when she revealed her intentions to transition from male to female before her first day of work.
Schroer is a retired Army Special Forces colonel that worked at the Pentagon as the head of a classified anti-terrorism group; she was an ideal candidate for the Library's position of international terrorism analyst. Schroer interviewed for the job as David Schroer, before she began the process of transitioning. However, after she met with her new supervisor and revealed her intentions to transition the job offer was rescinded.
The Library of Congress was explicit that they fired Schroer because she is transgender, and the Bush administration argued that transgender individuals did not have protection against discrimination under federal law. Now, the uncontested Schroer victory will help to make legal headway for transgender individuals. In a statement from the ACLU, Schroer is quoted as saying, "I am grateful that the court took the time to examine the case in detail and come to a fair and unbiased decision. In that same light, I am gratified that the current administration saw this for what it was, a case of sex discrimination focused against transgender people, and recognized that it must end in this country. The important signal that the administration's decision sends to all LGBT individuals gives me renewed hope and restores some of my shaken faith in what our country stands for."
To read more about the case including legal documents, news, and to hear Schroer tell her story visit the ACLU
On July 2, 2009, India's High Court decriminalized homosexuality by removing Section 377 of the Indian Penal Code. The historic judgment reverses a nearly 150-year old law which brought about sentences ranging from fines to a 10-year term in jail. In his conclusion, Chief Justice Dr. S Muralidhar wrote, "Where society can display inclusiveness and understanding, such persons can be assured of a life of dignity and nondiscrimination. . . . It cannot be forgotten that discrimination is antithesis of equality and that it is the recognition of equality which will foster the dignity of every individual." August marked gay pride celebrations in India, and this year they celebrated legally.