joreth: (polyamory)

Thanks to some experiences with people who use "agreements" as weapons and who also hide their abusive behaviour behind social justice language, I have become extremely averse to words like "agreements" and the casual use of the term "rules".

I was always pretty anti-rule, but a lot of things are treated as rules while being called other things. And I've discovered that the words we use are important because they subtly and subconsciously influence how we think and view our partners and other people, especially when we use agency-denying language in jest or casually.

So I have written an answer to the common question "what are your relationship agreements" that I'd like to archive on my blog to share every time the question comes up:

I don’t have very many “agreements”. I learned the hard way a long time ago that some people use the word “agreement” as a blunt object with which to beat partners over the head. I don’t do “rules”, which are things that are imposed on other people that dictate their behaviour (and sometimes their emotions and choices). I do “boundaries” which are lines that I draw around myself where I don’t want other people to cross.

Some people treat “agreements” like “rules”. You can usually tell that someone is treating an agreement like a rule when you discover what happens when someone “breaks” the “agreement” or wants to change it. If there are punishments, if breaking or changing the agreement is seen as a “betrayal”, then it’s probably a rule in disguise.

What I do is, I have certain things that I *prefer* to do with my own body, and I tell my partners what those things are so that they know what to expect of me. If I change my behaviour for any reason, then I notify my partners as soon as possible that I’ve done or am planning to do something different, so that they can make informed decisions about their own body (mind, emotions, time, etc.) based on my choices.

The things that I prefer to do is to get tested once a year for HIV, gonorrhea, syphilis, & chlamydia (what I refer to as The Big Four) and also HSV +1&2. If I have not had any new partners in the last 6 months, and my ongoing, regular partners have not had any new partners, then I might skip a testing period. But if I am considering taking a new partner then I will get tested right before so that my tests are the most current possible. Then I also prefer to get tested about 2 weeks after I take on a new sexual partner.

I prefer to see the actual tests results on paper for my partners before we have genital contact or fluid transfer for the first time, and 2 weeks after any ongoing partners take on a new sexual partner. I also prefer to keep an open dialog with all potential partners and ongoing partners about our sexual history, our current STD test results, our interests in potential new partners, etc.

I tend to use condoms only for birth control, and I tend to prefer having sex with men who have had vasectomies so that I don’t have to use condoms for birth control. I don’t consider condoms alone to be sufficient protection in the absence of discussing sexual history, STI testing, and sexual patterns so I don’t generally have even barriered sex with people I’m not comfortable having unbarriered sex with.

I prefer to choose sexual partners who have similar STI risk profiles as me - people who prefer to get tested regularly, only have sex with partners who get tested regularly, who openly and frequently discuss sexual risk and history and behaviour, who tend to have a relatively stable number of partners, who have had vasectomies, and who have paper test results that they are willing to share with me.

We do not make “agreements” to do these things, these are just things that I tend to do and I prefer to date people who also tend to do these things. Should either of us make choices that differ from anything we discussed that our partners can expect from us, then we talk to each other about the different choices we have made (or want to make), and we each evaluate the new situation and make our respective choices based on the new information.

I have found this to be the most statistically likely to prevent me from unwanted consequences for sex and to also be the most respectful of everyone’s agency. This allows everyone to be in charge of themselves, to have complete autonomy over their body, mind, emotions, and choices, and to still respect the risk we might place on our partners through our decisions.

**Added**  I  received a comment on my Facebook post of this article and I like my response to it that I'm adding it here.  The comment was about a person who responds negatively to agreements being broken, not because they're "rules" but because they believe their partners should find them safe enough to come to them and renegotiate any agreements that aren't working instead of just breaking them, because their own personal integrity requires them to keep any agreements they make and so only make agreements that they can keep, and because many times people will break an agreement and then dismiss this person's upset feelings as if they are not responsible for breaking their trust.

Here is my response:

And that's exactly why I don't make agreements. I basically treat them as promises, and I don't make promises that I can't keep. For most things, since I can't tell the future, I can't guarantee that I can keep an agreement or a promise. And, yeah, when trust is broken, it's understandable that someone would be upset and want that broken trust to be acknowledged.

For most reasonable people, things like "we both agree to pay half the rent" and then a few months in, having a conversation that goes "honey, I don't think I can make my share anymore, can we change this agreement?" are conversations that are had and people don't generally flip out about one person "betraying" them if they can't make their share anymore.

Those are expectations and agreements about how two people are going to treat *each other*. You will pay for half our our shared expenses, and I will pay for half our our shared expenses, and that is how we will help each other survive.

But most of the abuse that I see comes from "agreements" between two people about what one person will do *with their own body, mind, emotions, and time*. When someone makes an "agreement" about what they will do with their own body, time, mind, and emotions, and then they change their mind about that, whether it's something talked about before or after the fact, the other person they made that agreement with takes that as a personal betrayal, even though it was the first person's sole property, so to speak, to do with what they will, "agreement" notwithstanding.

The casual way that people mix these two types of "agreements" up under the same label of "agreements" is the danger, and, in my experience, most people are not savvy enough to separate these two things out when discussing their relationship arrangements.

I make "agreements" all the time, where I "agree" to come pick someone up from work because their car is non-operable and they need a ride somewhere, or where I "agree" to call them before I show up at their house to give them some notice, or where I "agree" with them on where to go for dinner so that we find a place that we both want to go.

These are not generally the sorts of "agreements" that get people into trouble. I mean, they *can* ... lots of people do things like agree to pick someone up and then totally flake out on them and leave them hanging. But when it comes to  people asking "what kinds of agreements do you make in your relationships", this is not generally what they're asking about.

Usually, they're asking about having sex with other people, falling in love with other people, spending time with other people, and spending money on other people. These are things that are better handled by discussing *boundaries*, because these are things that only one person can *own* and stake a claim to (excepting money, in states with shared property marriage laws).

I will make agreements with someone on how I will treat *that person* and how I want that person to treat me. This is discussing our boundaries. I say what my boundaries are, they say what their boundaries are, and we agree to respect each other's boundaries. Then, if for some reason, one of us feels that we can not abide by that particular agreement anymore, we discuss it.

But I will not make agreements with someone on how I will treat *my body, time, mind, emotions, or money* with respect to other people. My time away from my partners is my own time and I will not make agreements with my partners on how I will spend that time away from them. My body is my own, and I will not make agreements with my partners on what I will & won't do with my own body, etc.

It is the lack of awareness of that division (or the deliberate blurring of that division) that I see causing problems (and becoming abusive, in many cases).

It's one thing to get angry because a partner had sex with me without telling me that they recently had unprotected sex with a new partner without trading test results - that is a violation of my ability to consent. That is a "betrayal".

It's quite another thing to get angry just because they had sex with someone else, even if it was unprotected and without trading test results, and even if it goes contrary to their preferences. That is not a violation of my ability to consent. That has nothing at all to do with me. That has to do with *their* body, and I am not entitled to control of their body. That is not a "betrayal" of me.

And I will not be punished anymore for things that I do with my body, my time, my mind, my emotions, and my money just because somebody else had an expectation of the things I would or ought to do with my stuff. They are not entitled to those things, even if they have reasonable expectations of what I would do with those things.

What I do with the things that are mine are not a "betrayal" of someone else. But as soon as you say the word "agreement", people take any deviation as one.

So I don't make "agreements". I state the kinds of things I am *likely* to do and try to only date people who are likely to do similar sorts of things.
joreth: (polyamory)

A quick explanation of how I have boundaries regarding safer sex practices that don't turn into "rules" or those insidious type of rules that masquerade as "agreements" from a comment I made literally upon waking and not even out of bed yet:

Q. You say you don't have rules or agreements about what people can do with others, but don't your safer sex agreements cover what your partners can do with others?

A. Nope, they address safer sex boundaries *with me*.

All of my relationships are structured to support everyone in being authentic to themselves and any "agreements" are about what "you" can do to *me*, not what "you" can do with others. And even then, those "agreements" are always subject to negotiation. "That thing you said you needed me to do to you? I don't think I can live up to that, so let's talk about our options".

Boundaries are the lines I draw around *myself* and only myself. They are the edges of where I end and the world begins. They tell you how to treat me, and that's it.

Boundaries are if-then statements. Rules are you-will statements. So, my boundaries are "if you take these kinds of precautions with others, then I will have this kind of sex with you" and "if you do these things, then I will not have this kind of sex with you". I do not say "we agree that you (and I) will not do these things with others."

My partners can make whatever choices they want regarding their own bodies, minds, and feelings with regards to other people. Only when it comes to what they do with me do I get a say in it. Then I choose partners who naturally, of their own volition, *prefer* to do the kinds of things that match my boundaries. Then I never have to police anyone, and there is never any punishment nor "breaking" some agreement (which, btw, is one way you know it's a rule in disguise) because I'm not their mother to dictate and punish their behaviour when they misbehave.

My relationships are a Choose Your Own Adventure story. If we make Choice A, the story goes this way. If we make Choice B, the story goes another way. This respects everyone's autonomy and agency at the same time. They are free to make choices about themselves, I am free to make choices about myself, together our choices create our relationship structure.

joreth: (Purple Mobius)

* I am committed to protecting the safety of myself and my partners through informed consent and risk-benefit analysis of behaviour, prioritizing evidence-based reason above emotional justification.
This is deliberately vague. Most people like to put down in writing (i.e. stone) their safe-sex rules. I've written several times about my safer sex guidelines, from the classifications of sex categories based on STI risk to my preferences in when I decide to take those risks. But I have learned over the years that even prefacing all that with "guidelines" and "agreements" doesn't stop anyone from attempting to prescript behaviour, impose rules, or resist change. Sometimes shit happens. Sometimes Game Changers come along and change the game. Sometimes the risks are lower because of special circumstances. And, as I said at the beginning, this is not a contract between me and my partners. This is what I commit to myself. Which means that my agreements and arrangements may be different between myself and different partners.

I'm tired of trying to nail down every little detail for every possible hypothetical scenario. That's not realistic. This commitment is intended to cover all my partners current and future, which means it has to accommodate for different arrangements and different people. I've cut away all the extraneous details and just gotten to the point - the underlying goal for what all those rules and agreements and boundaries are supposed to be doing: I will protect my safety and my partners' safety by giving the information they need to give informed consent (thereby respecting their agency, autonomy, and personal sovereignty) based on their respective boundaries, we will use that information in an analysis designed to assess risk on a per-case basis, and I will not use sexual safety boundaries to mask emotional concerns or issues. If I am feeling concerned about a partner taking on a new partner, and my concern does not match the actual, evidence-based risk, then I intend to get to the root of the issue without using safer sex boundaries as an excuse or justification or a Motte-And-Bailey Doctrine.

I get it, really I do. I've been there myself. No one wants to look like they're cavalier about safer sex, so pulling out the "I'm worried about STIs so we need to have safe sex boundaries / rules / agreements" card is a great way to make someone toe the line. It's really easy to avoid looking deeper at an insecurity when that insecurity just gave us a perfectly reasonable distraction to focus on - sexual safety. I was once so bothered by a metamour's resistance to polyamory that I said I felt "unsafe" and instituted physical barriers and restrictions between myself and my partner. I now know that was the wrong way to handle it. I should have said that my emotional concerns are affecting my willingness to be physically intimate with him, and I shouldn't have hidden behind "safety". That would have been owning my shit. But I didn't, and I do not wish to make that mistake again. At the same time, though, I want both the freedom to pursue relationships as I see fit and to be the sort of person who feels a responsibility for how her actions affect her partners so that I will be considerate of the risks that I take with regards to how they impact others.

This commitment to myself seeks to find that balance between consideration for others and freedom for myself and honoring their freedom; between maintaining a rational, reason-based, evidence-based skeptical worldview and embracing opportunity, love, sex, relationships, being vulnerable, and other emotion-based actions that bring color and depth to life.
joreth: (Bad Computer!)
I know this will piss some people off, but I firmly believe that everyone has a right to not have sex with anyone they don't want to have sex with, for any reason they have, or no reason at all. Even if that reason is stupid. Even if that reason hurts someone's feelings. Even if I think that reason is so full of shit that I want to physically and literally knock some sense into them. They have a right to say no and they have a right to revoke consent at any time.

What they don't have a right to do is treat that person any differently in a non-sexual context than anyone else, or harm them in any way, or participate in a system that discriminates against them or any of that other bullshit. But that's not the issue. Those are good reasons not to disclose private information to people who are not sex partners and it's a good reason not to take on certain people as sex partners (with the added bonus that you don't have to disclose to them). It is *not* a good reason to manipulate someone into becoming a sex partner who would not consent to that role had they known.

"But we can't read minds to know all the possible things that all the people in the world might possibly make them not want to have sex with me!"

Strawman argument. There are things that we know by virtue of living in our cultures what people are *likely* to object to. Just like I know what Christianity is all about, and what the experience of being a white male out in society is all about, and what mono relationships are all about - even though #NotAllWhateverMajorityDemographic, I know enough about those demographics because I'm steeped in the expression of the experience of those demographics every fucking day of my life. I know that if some guy hits on me while I'm walking down the street, there is a greater-than-average chance that he won't like me *because* of my atheism, my polyamory, my feminism, my job, my independence, and my gender identity even though I'm really not that far away from cis. Those things all go contrary to the cultural narrative, so I'm pretty sure that at least one of them will be deal-breakers for the average guy who thinks it's appropriate to hit on me while walking down the street.

But, on the very off chance that he might like me precisely because of those things, or that maybe he won't mind those things, telling him about it up front will be a bonus. It'll give him even more reason to be interested in me. But that's such a statistically unlikely event that it has never once happened to me in all my years of being hit on by randos on the street.  Excuse me, not minding the atheism thing happened exactly once, but he was not American-born and he was from a country where religion isn't a big thing, so I don't think it's really an exception to my point.

Now, disclosing all that shit to street randos is not what I'm advocating either - that's a personal call regarding safety. But by the time I've decided to accept someone as a sexual partner, and he has accepted the idea of me as a sexual partner, I know there are certain things that he is, by pure numbers, likely to have a problem with and could affect his willingness to consent.  Most of those things are actually related to the act of sex itself and are not unreasonable to want to know, even if their reaction to that information or their beliefs about that information are, in my opinion, unreasonable.

What I absolutely do not want, as a small female person, is to find out *afterwards* that he would not have given consent by *him* finding out afterwards and thinking that I betrayed him. I've actually already had that happen to me and I count myself damn lucky that all I got away with was a hurt pride and some temporary embarrassment at being shoved out the front door without all my clothes on. I know all the excuses - this was just for fun and not some long-term relationship, if that was a deal-breaker for him then it was his responsibility to ask about it, blah blah blah.

I know how mainstream guys (and a lot of poly guys) feel about the idea of putting their dick in somewhere that some other dick has already (recently) been. Telling them up front that their dick isn't the only one is the best way I've found so far of only fucking the guys who won't beat me for it later, and being open about that in general is the best way I've found to locate guys who actually think it's pretty fucking cool that they're not the only ones.

When someone finds out after they have already had sex with someone whom they wouldn't have had sex with had they known what they found out later, it doesn't matter how "wrong" they are for not wanting to have sex. It doesn't matter how unjustified they are for feeling betrayed. It doesn't matter to the people they kill, or beat, or humiliate. Being "right" doesn't save them that beating, that death, that humiliation, that heartache, or that disappointment.  Knowing that the potential partner is that sort of person is the kind of information you want *before* you fuck them and not to find it out the hard way.

It didn't feel great when I had to disclose to people who I liked that I had an STD.  It really hurt my feelings to have people I cared about be so afraid of something based on stigma, and not facts, that they were afraid to even touch me non-sexually even though it wasn't something they could catch that way and it wasn't even something that was likely to harm them.  But it would have hurt them more to have sex with me without the information necessary to give informed consent.  It was more than just physically harming them, because I disclosed my STD long after I needed to, long after it wasn't possible to pass it on, just to make sure they understood sexual safety.  Not giving them that information would have been robbing them of their agency.  It would have been manipulative, and it would have been making decisions for them - deciding what they "needed to know" on their behalf based on what *I* felt about that information.  Sure, *I* knew that the STD wasn't likely to harm them, but that wasn't my call to make.  They have the right to refuse sex with me on any grounds and to make decisions for their own participation based on their own risk analysis, not mine.

If the information that you're hiding (even passively) isn't a big deal, then it shouldn't be a big deal to disclose. This goes along with the Little White Lies defenses & [ profile] tacit's post on truth and virtue- if someone is defending the secret that hard, then it's clearly not "no big deal". Remember, this isn't a situation where one partner is demanding to know something that isn't relevant and is attempting to violate another's privacy. This is something that could *change someone's consent* for having sex with you.

If you can't trust the person you're about to get slippery with to handle the information that you're keeping secret, then this is probably not the safest person for you to be getting slippery with either. If you fear for your safety, then don't take them as a partner. You don't *have* to disclose anything that will make you unsafe, but if you're unsafe with this partner, then choosing them as a partner was your first mistake (assuming you, yourself, weren't coerced or forced into the encounter in the first place - this whole rant is aimed at consensual sexual arrangements, not abuse victims keeping secrets from their abusers to prevent further abuse - again, go back to the truth and virtue post) and keeping the secret is the second in a list of mistakes.

This is about two things - 1) respecting your partner's agency enough to give them the information necessary for them to give consent. You can't read their minds to know that they would revoke consent if they found out that you once masturbated to a poster of the New Kids On The Block when you were a kid and they have an irrational fear of cooties from Donny or whatever the fuck one of their names was, but you can know that there are certain kinds of information that is culturally important and likely to affect someone's willingness to fuck you if they knew about it (and if you don't know that person individually well enough to know their specific deal-breakers, you at least know those culturally likely deal-breakers). Your partners are human fucking beings and deserve to be treated with no less dignity and respect than allowing them to consent to sex with you and I can't fucking believe this still has to be said;

And 2) saving yourself either the repercussions of being found out later, or of being a person who is not your best self. Sure, it's possible that person may never find out, especially if it's a one-night stand in a strange town and you didn't exchange names or phone numbers and have no overlapping social circles or interests to ever run into them again, even on the internet. It's probably even likely. But *you* know that you will have acted with the best of intentions and the highest degree of integrity. *You* will have been a person who respects your partner's agency. *You* will have been the sort of person that you ultimately hope your partners would be for you - someone who does not take it upon themselves to decide on your behalf what information is "necessary" when it's actually something that you think is not only important, but reasonable to be informed about.

This isn't about degree of severity.  I have two analogies I often bring out in this debate - murder and jawalking aren't the same thing and don't deserve the same punishment, but both are against the law.  A creek isn't the same as the ocean, but both will get you wet if you step in them.  I'm not talking about whose the baddest, most evilest, most terrible person out there and I'm not talking about stringing people up by their toenails even for minor infractions.  The guy who didn't dislose his HIV and had unprotected sex with a bunch of people, giving them HIV? Yeah, he was a monster, and I'm not putting him in the same category as someone who has a sort-of sexual partner with no arrangement of exclusivity not disclosing that person to a one-night-stand in another country on a business trip.  But both are still examples of not disclosing information that not only could affect one's willingness to consent but is *likely* to.  Both are still examples of not respecting the other person's right to not have sex, one example just has much more dire consequences than the other.

I'm far less likely to make a personal value judgement about someone who says "I've done some things where I wasn't my best self. I know my justifications for them, and I may even slip and not be my best self in the future, but I know that this thing is not living up to my highest ideals of integrity," than someone who tries to justify their actions, digging in their heels and doubling down on preventing informed consent with excuses, selfish justifications of "privacy" and "not my responsibility" and "too much trouble / effort."  Someone who says "yeah, I torrent big blockbuster movies.  I know it's wrong, but I do it," isn't getting the same kind of judgement from me as someone who says "I don't care if you're a starving artist, you OWE the world, and consequently me, the right to use your art without being compensated for it." (That's a real example, btw, not a strawman and not hyperbole).  This isn't about degree.  It's about being your best self and by doing so, treating those around you with the dignity and respect that they deserve, especially those you engage intimately with.

If I want to live in a world where I, as a woman, have the right to say "no" for any reason whatsoever and no reason at all, if I want to live in a world where my body is completely mine and I have ultimate authority over what happens to it, then I have to make that world by defending other people's right to say "no", even if I disagree with their reasons, because it's *not my place* to decide the validity of someone else's reasons for saying "no".  If integrity were easy, everyone would do it all the time.

"Ben, there's a story eating at you ... one you know you gotta tell."

"Not that simple."

"Telling the truth is never simple... or easy. Why only the best of us ever really try."
joreth: (Kitty Eyes)
There hasn't been an HPV update in a really long time, mainly because there hasn't been any HPV news in a really long time.  No real progress on the vaccine or the virus itself, either in curing or in understanding.  We already understood it pretty well and things seemed to reach a plateau.  But today, I have 2 fairly major updates!

1) There is now a vaccine that covers 9 strains of the virus!  The original, Gardasil, covered 4 strains - the two most common strains known to cause cancer (HPV 16 & 18) and the two most common strains known to cause genital warts (HPV 6, & 11), while the main competitor Ceravix covered the two cancer-causing strains.  There are dozens, perhaps hundreds of strains of HPV, but 16 & 19 were known to cause something like 70% of all the hpv-caused cancer cases and a smiliar number of genital warts, so the researchers understandably focused on those strains first.  There has been some evidence that Gardasil was 50% effective against several other strains as well, but it was approved for those 4, for which it's about 90~% effective.

Now, however, there will be a new vaccine, called Gardasil 9 that covers  HPV-31, 33, 45, 52 and 58 in addition to the original 4 strains.  That is estimated to protect against 90% of the cancer-caused-by-HPV cases in vaccine-protected women!  The test shows that there were slightly more side effects after taking the vaccine, but the side effects were completely within the range of expected side effects for any vaccine - namely that if you stick someone with a needle, they might faint or feel sore at the injection site.  Duh!

2) The CDC has compiled a report analyzing adverse reactions to the HPV vaccine.  And, guess what?  It's exactly as predicted - totally safe!  More than 23 million (MILLION!!) doses were administered in the US since it became licensed in 2006.  There were just over 12,000 adverse reactions reported in the 2 years that this study covers.  Out of those 12,000~ adverse reactions, 94% were not serious and the usual sorts of things you'd expect when you get jabbed with a needle - fainting, soreness, redness at the injection site, dizziness, etc.

Out of the 6% that were classified as "serious", 32 were deaths.  I know, 32 dead is an awful number.  But remember, that's 32 out of MILLIONS of doses.  AND, on top of that, not a single one of those deaths can be tied to the vaccine itself.  They had to do with illicit drug use, diabetes, a known heart condition that resulted in heart failure, etc.  Remember, VAERS - the Vaccine Adverse Event Reporting System - collects data about, literally ANYTHING that happens to someone after a vaccine.  I wrote about the Phase III trials in India a bunch of years ago, where 6 girls died after taking the vaccine, but that included several suicides by drowning and a fatal snake bite.  And yet, the system is designed to count anything bad that happens, so they got counted.  Even if all 32 of them could be linked to HPV due to some quirk of genetics or something, that's still only 32 out of millions, and that's still a risk worth taking.  And yes, I do take these risks myself.

After analyzing all the data, the summary concludes that there is no evidence to support the vaccine causing a single one of those serious adverse reactions.  There are, however, several cases that the study recommends further investigation, although I would like to reiterate that it recommends further investigation EVEN THOUGH there is currently no evidence to suggest those reactions were a result of the vaccine.  This is science working - if the evidence doesn't reach a certain level of confidence, they keep looking at it.  There rarely is any black & white, yes / no answers in science.  There is, however, margins of error and robust vs. weak spectrums.  And the evidence for the safety and efficacy of the HPV vaccine has pretty much slammed the needle on the "robust" side supporting the vaccine.

However, even with the safety evidence continuing to mount, the CDC and the FDA both have amended their warning recommendations to better reinforce safety protocols, such as keeping a better watch on patients for 15 minutes after receiving the vaccine to make sure that they don't fall and hit their head if they get dizzy from being stabbed with a sharp pointy object.

So, the bottom line is that the HPV vaccine is as safe as any vaccine out there - which is to say pretty damn safe; pretty much no one has been harmed by it any more than one would expect to be harmed by being poked with a big needle even with no vaccine at all; they continue to watch and evaluate and refine the process; and there will shortly be an even better vaccine available that I heartily recommend to everyone who can afford it.

For more on HPV vaccine safety, I refer you to a previous post that includes a graphic from the Information Is Beautiful site that elegantly explains, using easy-to-grasp graphics, the relative risk vs. safety and efficacy of the vaccine.  I also recommend clicking on the STI tag below to see all my older posts on the subject.
joreth: (Kitty Eyes)
I haven't done an update on local testing options in a few years, so even though that post is still here in my journal, it's time to do a new one.

Local Testing Options Review )
Here's my opinion on necessary testing )

To sum up:

Get tested for everything listed above at least once to establish a baseline. Then get tested for The Big Four approximately once a year and 3 months after new sexual partners.

If you don't have a GP or health insurance for a full STD screening, visit one of the online services like AnyLabTest Now! for a complete workup to set your baseline. Then, if you are in the Orlando area, I recommend using the Orange County Health Department on Center Ave. for the minimum Big Four to maintain your regular testing schedule and AnyLabTest Now! for the HSV test for the most economical options. If you skip any of the steps, get another full workup as soon as possible to reset your baseline known health status. If you test positive for anything, discuss your case with your STD counselor, your clinician, or your GP for the appropriate measures for you.

For more information about HPV, about HPV research, or about other testing posts that I have made, click on my STI tag below.  I focus on HPV research and occasionally I post about local testing options and general testing information to give non-local people enough information to research their own local testing options.


Sep. 16th, 2013 12:09 am
joreth: (Nude Drawing)
Did you know that STD screening only requires a blood & urine test? No invasive procedures, no penis swabbing, just a blood and urine sample. That's it! And did you know that they ONLY test for the specific STDs that you're paying them to test for? Nothing else. No "everything" test, no drug test, no genetic defect test, just the specific STD tests that you request. NOTHING else will show up on these tests.

Which means that you have to request specific STD tests. You can't just ask for "everything". They can't test for "everything". If you ask for "everything", they'll just give you those tests they think you ought to be tested for, which actually leaves out quite a few STDs because most clinics don't think you need to worry your pretty little head about silly things like STDs unless you're showing symptoms.

Also, you can get the most important tests at your local Planned Parenthood (while offices are still open, which won't be for long if the Rethuglicans have their way - PP is my primary health care provider, which means I'm screwed if I move to an area where the offices are getting shut down) or county clinic for fairly low rates. For a little more, you can get even more tests from several online services that will just send you to a local lab for your convenience.

All sexually active adults should get tested regularly, just the way we do other regular maintenance tests. If you're in a long-term monogamous relationship and you're not showing any symptoms, then your maintenance schedule will be different from someone with multiple partners, someone showing symptoms, or someone with shorter-term relationships.

My personal recommendation is to get tested prior to engaging in sexual activity with a new partner, and then again 6 months after first contact with a new partner. I also recommend actually trading test results with your prospective partners. After that, consult with your doctor about what kind of maintenance schedule is right for you. In most cases, women will only need a pap and HPV test about once every 2 or 3 years (guys can take their HPV status from their female partners) and that's it until/unless there's a change of partner or you're showing symptoms.

Speaking of HPV, ask your dentist about oral HPV screening. It's an important first defense in catching throat and mouth cancers caused by HPV.

Speaking of specific STDs, here's the bare minimum that I recommend getting tested for, all of which are available at PP, and the first four (what I call The Big Four) are usually available at your local county clinic:

~HSV 1 & 2 (you have to specifically ask for both 1 & 2 or they won't give you 1)
~HPV for people with a cervix (no test for cismen except orally at the dentist)

If you haven't ever been tested for it, you might want to get tested for Hepatitis just to start out your record keeping with a full baseline set of records, but unless you're showing symptoms or think you've been exposed, this does not need to be done as often as the others.

I also recommend getting the Hep A&B vaccine, as well as the HPV vaccine if you can afford it. You can still get the HPV vaccine even if you're over 30, you just have to pay for it out of pocket and probably will have to go to a private physician instead of a clinic. The only reason the FDA approved it for under 30 is because it loses effectiveness if you've already been exposed, and if you're over 30, then you've probably been exposed. But that doesn't mean it's worthless.

The diseases with the highest mortality rate (i.e. likely to kill you) are also the easiest to avoid by using condoms and not sharing needles. Everything else is manageable, so don't stress out about STDs. Get tested so that you know where to start from and keep records just like your other health maintenance routines. It's nothing to freak out about, but it should still be done, just like going to the dentist or changing the oil in your car. It's better to know what your status is so that you can make appropriate decisions about your personal health practices. Routine maintenance for the responsible, sexually active adult.

To follow-up on the PSA about STI testing, here's a Sexual Health & History Disclosure form that's useful for helping you keep track of your sexual health records: Right-click on the link and save the file to your computer.  From there, you can fill it out and save and/or print it.

Even if you never share this with anyone and just use it to keep your own records, it's important that you know your medical history, and sexual health is just one aspect of your medical history.

This applies even to monogamous people, although if you've been monogamously married for a whole bunch of years, it's probably less important to share this with your partner, as I'm assuming you have already shared this info with them at least at some point over the years. But, as I know people who think "what happened before we met doesn't count", that's probably not a safe assumption for me to make.

It does count - get tested!
joreth: (Purple Mobius)
Atlanta Poly Weekend is coming up in just a couple of weeks and I'm REALLY excited about it this year! This is APW's third year and, if the trend continues, it should be even better than last year, which was better than the first year.

For APW's first year, I gave several presentations, including why poly people should cooperate with the media and how to get into it, and a panel discussion on the intersection between polyamory and skepticism with Kelley Clark. I also debuted my Miss Poly Manners costume for the first time and held a live Miss Poly Manners Q&A.

Last year I was invited back as one of APW's keynote speakers, where I featured a talk on the intersection between poly and skepticism, and also debuted my own interpretation of the Five Love Languages for polyamorous relationships. I reprised my role as Miss Poly Manners (with an improved Victorian gown) and stretched my range of etiquette lessons to include convention etiquette, not poly-specific etiquette.

This year, Miss Poly Manners comes back once again to kick off the convention with some Con Etiquette, and to participate in APW's newest fun track! The folks in Atlanta had so much great content this year that they had to open up a fourth track of programming, not including the kids-specific track! In addition to three panels simultaneously all weekend long, covering such topics as communication tools, creating intimacy, poly case law, the results of a 15-year long study on kids of poly families, kissing classes, dealing with stress, jealousy, STIs, and special poly celebrity panels, APW will also feature a fun and games track.

Just as polyamory is not ALL about the sex, conventions are not all about the serious lectures. To lighten the mood and have some fun, this year's APW will feature some of our favorite campy game shows with a special poly twist. There will be events like Poly Family Feud and APW's Got Talent and Poly-eopardy and ... Miss Poly Manners will be the center square on our own live version of Polywood Squares! You won't want to miss it!

The highlight of every weekend is the evening entertainment and this year will have another dance with DJ Cat Ninetails. Right before the dance, by special request, I will be teaching dance lessons with Sterling! According to the expressed interests of everyone who says they want to learn how to dance but never get around to taking lessons, we've chosen a dance that will look flashy enough to show off, but can be danced to almost any popular music you might hear at a nightclub, a wedding, an office party, a convention, a party, or almost anywhere out in public. You will learn a handful of steps that can have you dancing that night, with plenty of room for growth to continue learning how to dance on your own, plus a list of resources for practice videos online and where to shop for dance shoes and clothes.

I'll be on the poly & skepticism panel again with Kelley Clark & Shaun Philly, and Sterling will be giving his ever-popular workshop on using personality types to improve poly relationships & communication. His workshop fills up to capacity every time he gives it and everyone who takes it wants to attend it again. And, as a special double-feature, I'll be giving my Five Love Languages workshop again!

For those who aren't aware, The Five Love Languages is a self-help theory developed by Dr. Gary Chapman. The basic premise is that everyone expresses their feelings of love and wants to have love expressed to them in certain ways. Those ways can be grouped into what he calls "languages", because they are ways that we all communicate our feelings of love. But the problem is that we don't express or feel loved in the same ways as everyone else. So we can love another person, and do things that we think expresses our love for them, but that person may not hear that they are loved because they speak a different love language than we do.

When people have partners who do not express love in the way they most feel loved, i.e. in their own love language, then it doesn't matter how much the other person loves them, they won't feel loved. And when people don't feel loved, they end up with what Dr. Chapman says is an empty love tank. When people's love tank is empty, they can act out in hurtful, damaging, even unpredictable ways. We have to learn how to communicate our love for each other in ways that the other person most needs to hear, because this acting out is all about how one feels regardless of how the other one thinks he or she is behaving.

Think about a child who is neglected by their parents. You will often see so-called "troubled kids" that have absent or neglectful parental figures. The movie, The Breakfast Club, is pretty much the quintessential story of kids with empty love tanks and the kinds of trouble they get into when they are crying out for love and attention. Adults aren't any different, although they may act out in different ways. Then again, sometimes they don't. People under stress and feeling neglected, unloved, and alone, often do all kinds of strange things in a reaction to that stress, and they often lack the vocabulary to express what it is they're lacking or how to give it to them. And, sometimes, their vocabulary is just fine, but the person listening doesn't have the vocabulary to understand. Or worse, when both are lacking the words to explain and the definitions to understand.

Many times, one person in a relationship will insist that they are doing everything possible to show how much they love their partner, and their partner complains that they still aren't getting what they need, still feel hurt, and still act out. If you've ever tried every way you can think of to show someone that you love them and they still accuse you of not loving them anymore, this is probably what happened - your partner had a different love language and the two of you were talking past each other, not realizing that you were actually speaking different languages. Learning to speak the other person's love language will often take care of many other problems in the relationship, sometimes things you didn't even know were related.

The Five Love Languages is one tool, among many, to give people a set of vocabularly to help explain how they need to feel loved and what they're doing when they are expressing their love. I've taken out the religious justifications and the monogamous intentions and the heteronormative assumptions and adapted the theory to apply to all genders and all relationships. You'll find out what your primary love language is and how to identify your partners' love languages, and concrete suggestions for expressing love in different languages. You'll also get a handout with summaries of each of the different languages & suggestions to take home for future reference.

So I'm really excited to get to do this workshop again, and to dance, and to see all of my old friends from previous years and to meet new friends this year. I'm terrible about out-of-context meetings, so if you see me there, please tell me how we know each other (if you follow me on a particular social networking site, if we've met before somewhere else, etc.) so I can connect the different contexts. Hope to see you there!
joreth: (Bad Computer!)
When calling around in your town to find an affordable clinic that offers all the STD tests that you want, you may come across some clinics with less-than-knowledgeable staff.  It is my opinion that the patients should never have better medical training in the specialty field than the clinic or office the patient would like to patronize.  Here are some tips for weeding out the questionable offices:

1) On the phone, ask what kinds of STDs they test for.  If they say "all of them", repeat the question, emphasizing the word "which".  If they still say "all of them" without giving you a specific list, don't go there.  The receptionist, at least, has no idea what her office handles and will not schedule you for the appointment you want, leaving you to make it all the way up to the doctor herself before discovering that you just wasted your time and now have an office fee or copay for no reason (or will have to have another set of fees for a second office visit somewhere else).

  1b) To really test their knowledge, ask if they have the HPV test for men.  If they say yes, be immediately suspicious and ask to speak directly to the doctor.  The doctor should know that their phone staff is providing bad information and is about to schedule you for a service that doesn't exist, which will cost you time and money.  Then, don't go there.

2) When they list the STDs they test for and leave off "HSV", ask them if they test for HSV.  Be sure to say "HSV" and not "herpes".  If the receptionist doesn't know that HSV is the virus that causes herpes and that the HSV test IS the herpes test, don't go there, for the same reason as point #1.

3) When the receptionist or scheduler does happen to understand that the HSV test is the same thing as the herpes test, ask which test they offer (hint, it should involve letters like PCR or IgG).  If they can't tell you which test, or they are unaware there are multiple tests with different methods and accuracy ratings, don't go there.  Even a receptionist who has no medical training should at least be able to ask a nurse or technician the answer to that question, or to ask her office manager what the lab order code says about which herpes test they would be ordering.

  3b) If, upon asking which test they offer, the receptionist responds with "what do you mean which one?  You either have herpes or you don't!", then don't go there.  First of all, that's not true, there is more than one strain.  Second, that wasn't the question, and even accurate test results don't give you a binary yes/no answer - it's a probability or a yes/no with an error margin for false negatives/false positives.

  3c) If, upon making it clear to the receptionist that there are several different types of HSV tests, and you want to know which one that clinic uses, she STILL doesn't know so she offers to transfer you to the lab, where the lab technician answers and is unable to tell you the name of the test they use, don't go there.  I shouldn't even have to explain why this is a problem.

  3d) If you manage to find out which type of HSV test they offer, get them to state, unambiguously, whether they will be able to distinguish between the types of HSV.  This may not be important to you, but it is important to know if this office knows the limitations of their own tests.

4) When you arrive, if you have the money for the tests you want, and the office offers the tests you want, and the doctor, nurse, or technician tries to talk you out of getting a particular test because "everyone already has it, so don't worry about it" or "if you don't have symptoms, you don't need to be tested for it", be prepared to exaggerate or outright lie about your sexual status and demand the tests that they offer that you are willing to pay for.  When I say "be prepared", this means to have the numbers and situations already in mind, and to also be ready to sit there and be lectured about safer sex practices.

Some clinics do not think that a full battery of regular STD exams should be part of one's regular medical maintenance, while simultaneously believing that multiple sex partners automatically equates one with the crack whores who fuck dozens of strangers a day in exchange for dirty needles to shoot up with.  So you may have to tell them that you have more partners than you do, or that your partners were exposed to all kinds of STDs and just deal with the judgement and the, probably, misinformation based on a skewed sense of morality that places a person's value on their sexuality, or lack thereof.  I once had to break down crying about a cheating boyfriend who tested positive for HSV in order to get an HSV test without symptoms.  I also had to break down crying in order to get the 2nd AND 3rd shot in my hepatitis vaccine schedule, which didn't make any sense at all since they gave me the first shot.

Not all of us have health insurance or the money to afford to shop around for just the right health practitioner who will treat us respectfully.  Some of us have to go for price over comfort.  But we shouldn't also have to sacrifice competence.  In fact, it might turn out to be more expensive if you try going for price alone and discover that you didn't actually get what you wanted and now have to go somewhere else anyway.

*This PSA brought to you from direct conversations I've had in the last 2 days with various clinics around town.  Yes, I actually had to explain to someone that HSV was the virus that causes herpes when I called an STD clinic.*
joreth: (Misty in Box)

As I mentioned in my last post, I had heard there was a clinic who was offering the HPV test for men, but I was waiting for confirmation and more information before I posted about it.  I had looked up online on my own and only found more insistence that no HPV test existed except for that used in research.  One clinic in California was taking it upon themselves to use that research testing method to conduct their own study, thereby giving men who participated an HPV test.

Well, I found out that the clinic I heard of that may have had an HPV test for men does not, in fact, have an HPV test for men.  They seemed to have deliberately misled interested patients, as one particular patient tried to confirm several times, through several levels, that he was scheduling himself for an HPV test, and at each level was either told yes, or given an ambiguous or non-committal answer until he finally saw the physician personally.  That physician was the only person to say, flat out, that there was no HPV test for men and that their answering service gives out the wrong information all the time.  The person on the phone, the receptionist, the nurse or medical technician who prepped him for the appointment - none of them corrected the patient on the belief that he would be receiving an HPV test that day.

Remember, when you go in to be tested for "everything", you are not tested for everything.

Let me repeat that:  
When you go in to be tested for "everything", you are not tested for everything.

You MUST go in with a specific list of tests that you want to purchase and get confirmation from the physician herself that you will be tested for those things.  And, more than just saying "I want a herpes test", you have to say "I want the HSV PCR test" or whatever you're looking for.  Some STDs have different kinds of tests with different levels of accuracy and expense.  Make sure you know exactly which test you want and ask for it by name.  

And then be prepared to argue with them over the necessity of getting tested.  Many clinics and doctors still take the position that certain STDs like herpes and HPV are so prevalent, that there's no point in worrying whether you have it or not if you're asymptomatic, so you don't need to get tested.  They figure that if you don't have herpes or HPV yet, you will soon, so just don't worry about it until you start showing symptoms and need treatment.  If you're OK with that, then fine, but if you want to have test results in your records to show prospective partners, then insist that doctors provide the services that they offer to the patients willing to pay for those services, and if they won't, go elsewhere.

It is true that many people either have or will have HSV or HPV, and it is also true that, for the vast majority of those people, the virus is little more than an "inconvenience".  It is also true that stress about health and medical procedures can, for some health issues, be worse than the health issue itself.  Many people are worse off for worrying about things than they are for having those things, and for a great deal of things, too-often testing does not significantly increase your odds of survival or better health.  People who go looking for health problems will often find them, even when those problems are mild or things that the body can heal on its own.  Many people put themselves through unnecessary procedures and surgeries to take care of things "just in case" that probably won't hurt them and that are so mild that they'd never know they had if they hadn't gone looking for them.

All of that is irrelevant if you have done your research and you just want to have accurate and update medical records for your prospective partners.  I caution people against using test results as a way to justify and entrench their own sex-negative fears.  Some people hold onto their "clean" records as sort of a talisman to justify rejecting and being hurtful towards prospective partners who might have an STI.  I can't tell you how often I've heard statements like "I'm clean and I want to stay that way".  The fact is you won't.  STIs should be treated as any other equivalent illness.  You will get sick, whether it's the flu, strep throat, the measles, or warts and cold sores.  By all means, take precautions, but be consistent.  If you're afraid of getting a life-threatening illness like HIV, use condoms, get your flu shots and pertussis boosters, wash your hands regularly, don't go to work sick and insist that other sick coworkers go home, and get your physicals and preventative exams done on time.  

Being sick sucks, but STIs are no better or worse than any other comparable illness, so don't use your test results as a weapon against people with STIs, or to look down on people with STIs, or to think you're "safe" from life-changing surprises like illnesses.  Get tested so that your partners can make informed decisions, so that you can see patterns in your own health history, and to help you and your physician decide on appropriate medical  procedure schedules.  If you routinely have abnormal pap smears, for example, then you ought to be getting the HPV test regularly & often, like annually or semi-annually.  If you consistently have normal pap smears, have no history of cancer in your family, and your sexual network is fairly static, then you can probably get checked less often, like every other year.  

But, yes, definitely get tested "regularly" (for whatever definition of "regularly" fits your particular health circumstances) and definitely insist that your physician provide you with the proper services.  Just make sure to use those tests in the same way that you'd use any other health test - to evaluate your personal risk assessment and manage your personal health checkup schedules, not to freak out about being "unclean" or to ward off "dirty" partners.

For a list of the STIs that you can and should be tested for, download the Sexual Health & History Disclosure form, which includes spaces for you to add your latest testing dates & a record of your past and current partners, their testing status, & the transmissive activities you shared with them and can be found here, along with some other convenient charts & graphics

joreth: (Kitty Eyes)
It was back in July, 2010 that I last wrote about carrageenan, a component of algae found in nearly every type of commericial food, that looks to have HPV-blocking properties.  All in vitro testing done up until that post seemed very promising.  In July of 2010, a research facility had finally gotten the go-ahead to try a double-blind trial on actual people - testing had only been done in the lab before then.  Well, I haven't heard anything new since then so I haven't made any posts about it.  I did a cursory Google search for the specific product that I wrote about, Carraguard, to see what happened, but I didn't find anything more recent than that same study.  It has apparently concluded and found the gel to be effective, but the conclusion didn't make any headlines that I'm aware of, and no announcements about putting Carraguard into production.

Today I saw that there's another research facility in Canada doing their own double-blind, human study sing a personal lube that is currently available on the market, Divine 9 which also passed all of it's Phase II, in vitro, trials).  They will give a very similar gel/lube with either carrageenan or a placebo to be used during sex and then follow up with the women in a year to check the rates of HPV infection.  Hopefully something will actually come out of this study, so that we can start seeing products made specifically with anti-HPV properties in mind, and so we can offer a more affordable option to those women who can't afford the vaccine.  In the meantime, there are already personal lubes available on the market with high concentrations of carrageenan as a regular ingredient used to thicken products.  Divine 9, Bioglide vegan), and Oceanus Dreambrands Carrageenan are all commercially available lubes that the research suggests may be effective and preventing HPV transmission during sex.

Also, I just heard that there is a test for men now, but I'm still trying to get details on it.  So far, all I've found is this article talking about a clinic in San Diego that decided, on its own, to start swabbing the urethra opening and performing the HPV test in the context of a research study.  According to the CDC, there is still no FDA-approved test for men.  Near as I can figure, individual men can occasionally convince a doctor to do the woman's test on their penis.  But I know someone who claims to have found a doctor to give him the test, so when I get more information on it, I'll post it here.
joreth: (Nude Drawing)

**EDIT**  Apparently I wasn't clear enough so it needs to be repeated.  This post is ONLY about classifications of relationship statuses and does not cover all the variables & details about who gets to go into each category.  These categories are where I START from, not the end-all, be-all of my risk assessment procedures.  I cover those topics elsewhere.**

It has come up recently in conversation several times what the definitions of things like fluid-bonding & HPV boundaries & so forth are. So I decided now was a good time to write it all out.

My approach to poly relationships is that each relationship is its own thing and I do not concern myself with the behaviour of my partners with other people unless that behaviour directly affects me (breaking dates with me to go out with someone else who doesn't like me, for instance). I see no value or benefit to being concerned with which sex acts my partners perform with anyone else on an emotional level, and I do see a lot of harm in doing so. Sex, to me, isn't special just because it's sex. Sex is special if the person I'm having it with is special. So I have no attachment to my partners performing certain things just with me, or avoiding certain acts with other people. Sex with my partner is no less special because he also has sex with his other partners, and it's no more special because he doesn't have sex with, I dunno, the checkout girl. Sex with my partners is special because anything with my partners is special, and because my partners themselves are special.

So when I make fluid-bond agreements, or when I use the term "fluid-bond", I am putting more emphasis on the "fluid" part than on the "bond" part. Remember, the only reason for me to be concerned about my partners' behaviour is when it directly affects me. Bringing home an STD directly affects me. So I have different levels of activity between myself & my various partners based on my risk assesment of my physical safety with that partner.

When I say that I have a "fluid-bond" agreement, I do not mean that my partner and I have agreed to only transfer fluids between us. My agreements are based on boundaries, not rules, and that sort of agreement is an imposition on other people's behaviour. My agreements do not tell my partners who they can or can't transfer fluid with. They lay out the circumstances under which *I* feel safe to transfer fluids with them (and vice versa). They are free to make their own decisions on what they do with whom, and I will modify my own behaviour with that partner based on those decisions. I then tend to seek out partners who have similar levels of risk to my own so that I can enjoy relationships with as few restrictions between us as possible without worry or concern (regular testing helps with that too). If they have similar levels of risk as me, then I don't need a rule telling them how to behave. If they have significantly different sexual values than me, then a rule won't stop them when they feel it is important or "right" for them to do it.

Some people put emphasis on the "bond" part, which is some kind of unique connection between them that is symbolized by the transfer of fluids. Some people are incapable of enjoying sexual activity without a deep, emotional connection to their partners, so a fluid-bond might be a statement of the level of emotional committment between the partners.

There are too many variables for me to say automatically that this is a bad thing, but it has been my observation that the people who tend to choose this method are more likely than not to do so for reasons that [ profile] tacit highlighted in his Whats Wrong With Rules Anyway post. Saying "I am not interested in sex unless I love you, therefore being fluid-bonded says how much I love you" is one thing, but many people do not use terms like "fluid-bond" to describe what they do with each other - they use the terms to describe what they don't do with others.

But I'm explaining what I do with my partners, in terms of how I use relationship categories.

So, what is a fluid-bond, in my relationships then?

Since my reason for being concerned with relationship categories is to explain "how does this directly affect me", and in the area of sex that means STD and sexual safety, I define fluid-bonding exclusively around fluid-transfer activities that can transmit STDs. If it isn't going to transmit STDs to me, then I'm not concerned with categorizing it. Sweat and saliva do not transmit STDs. Certain viruses have been known to be found in the saliva, but those classified as STDs are either not found in the saliva, or not in high enough counts to infect someone under the circumstances of kissing. Those infectious diseases that are transmitted by kissing are either not STDs or are transmitted by contact - cell shedding - or airborne, not fluids.

HSV is transmitted by kissing. But 1) I don't consider something an STD if you can catch it from your grandma and 2) since you can also catch it from sharing drinks and other non-direct-contact ways, and it's also very rare to catch it in such a manner, I consider the attempts to completely avoid HSV to be futile* and a direct downgrade in my quality of life (i.e. the payoff is not worth the sacrifice).

So this means that, to me, a fluid-bond is willing to share any activity that transfers body fluids that can carry STDs. Blood, vaginal fluids, penile/seminal fluids, but not saliva or sweat. If a couple uses condoms and dental dams correctly & without fail every single time, a couple can have penetrative sex (PIV, anal, oral) and not be fluid-bonded. If a couple does not have Penis-In-Vagina sex ever, at all, but does engage in oral sex without barriers, this couple would be fluid-bonded, by my use of the term meaning exchanges body fluids.

Since there are so many ways to catch something that either don't involve fluids, or can be transmitted because of human error even with fluid precautions, I have a tendency to just avoid certain activities unless I'm willing to fluid-bond with that person. I'll kiss, pet, make out with, grind on, etc. with someone without too much concern, but if I'm interested in going down on them, or having intercourse, he's probably someone I am also willing to exchange fluids with. If he's so unsafe that I'm not willing to exchange fluids with him, then I'd just rather avoid those activities completely, than risk either accidental exposure or exposure to something that is contact-borne.

A lot of people are willing to have that intermediary step, where they are interested in penetrative sex of some kind, but prefer to maintain fluid barriers. That's fine. And when my partner is not sterile, I can see the need for that intermediary step in my own relationships too. But as a general guideline, in order for me to take that step closer to exposure, I want to feel confident that the risk of exposure is as minimal as possible, and if it's that minimal, then there isn't any need for the intermediary step without extenuating circumstances (i.e. contraception), for me.

So this brings us to HPV boundaries. HPV and HSV are the easist STDs to catch, and not stopped by avoiding fluid-transfers. If you avoid activities that can transmit either of those, then you will also avoid all the other STDs, and pregnancy, and a few other non-sexual illnesses. Since I've already decided that complete 100% avoidance of HSV is impossible, that leaves HPV as my Gold Standard.

Therefore, HPV boundaries are avoiding any activity that is likely to transmit the HPV virus. This means no direct oral, genital, or manual contact with the partners' genitals. Kissing does not appear to transmit HPV, but oral sex does, even with condom use. General guideline for me is if the clothes below the waist stay on, it's probably safe (allowing for exceptions, but they are exceptions to the "rule").

This allows for a lot of other sexual activities while still maintaining a reasonably safe risk level. If my partner does not have any symptoms of an oral HSV infection (and I'm fairly confident that he knows what they are & is being honest when he says he doesn't have any), then I'm pretty comfortable engaging in activities that include contact above the waist, no-contact sex (phone sex, masturbation-voyeurism, etc.) and/or some BDSM activities. I can have a long-term, emotionally intimate relationship with a partner and maintain HPV boundaries indefinitely if I think there is a good reason to do so. This means that I can actually have a sexual relationship with a partner who has HPV or HSV and not put myself or my other partners in a higher-risk situation.

If I want to explore those activities that are prohibited by my HPV boundaries, then that means that I am confident that these activities will not significantly increase my risk (in much the same way that monogamous people in long-term committed relationships are willing to forgoe condoms and other barriers). And if I deem my partner to be safe enough to not significantly increase my risk, then I'm generally willing to go straight from HPV boundaries to fluid-bonding, with only circumstantial exceptions.

Also generally speaking, one of the main things that makes me feel confident that these activities will not significantly increase my risk is testing. If my partner doesn't have an STD, then he can't give me one. Recent & regular STD tests, combined with an assessment of his behaviour, is a statistically safer way to avoid STDs even than regular condom use with a partner of unknown status. Although there is some trust involved, it is far less trust than any monogamous couple who just takes for granted that their partner is completely sexually fidelitious to them and doesn't have anything from a prior relationship. But if it is reasonable for monogamous people to "trust" their spouses and never get tested, then it shouldn't be any less reasonable for a polyamorous person to trust their partners in a relationship that is transparent, hard to hide secrets (the more people in the group, the harder to keep a secret from all of them), and where all the participants regularly get tested for STDs including prior to becoming partners.

I am far less likely to be "surprised" with an STD in my poly relationships than a monogamous person who has never been tested, whose partner has never been tested, and who does not have the safety net of several pairs of eyes checking in on the relationship participants making it more difficult to "cheat", given that anywhere from 40%-80% (depending on which study & which article you read) of people claim to have cheated on their partners at some point in their lives, that STDs can be asymptomatic and/or can lie dormant for quite some time, and that most people don't bother to get tested for STDs unless they think they already have one or have just been unwillingly exposed to one. While STD tests are not 100% accurate (nothing ever is), they're certainly much more accurate than "well, he would tell me if he had something, right? Since he hasn't, I assume he doesn't."

So, to sum up:

HPV Boundaries Maintaining HPV Boundaries means that I am restricted to activities that are not likely to transmit HPV (and by extension, any other STD except possibly oral HSV). Oral, genital, and manual contact of the genitals is off-limits. All other activities are OK.
Barriered Sex Barriered Sex means that I am restricted from fluid transfer. Condoms, dental dams, and gloves for activities that involve blood, vaginal fluids, and seminal/penile fluids. May be used for contraception rather than STD precautions.
Fluid-Bonding Fluid-Bonding means that I have no restrictions on activities for STD reasons. Willingness to exchange body fluids that can carry STDs. Condom-free intercourse & oral sex, blood play, etc.

Any of these can be modified based on individual details, such as whether a potential partner has a known infection of some kind, whether a potential partner has simliar risk aversion strategies or not, or other personal preference red flags such as a potential partner's willingness to get tested, his willingness to disclose, his understanding of STDs & sexual safety, his willingness to meet my other partners, his willingness to introduce me to his other partners and/or friends, etc. As with most of life, the actual risk calculation is quite complex and many people don't even realize all the variables that go into their risk calculation.

Lots of people also try to predetermine which activities are OK and which are off-limits, and, IMO, if you think you can just list all the activities in the world & guess your reaction to them, you are seriously underestimating the sheer breadth and depth of human sexuality. Rather, I try to come up with classes of activities, with a clear guideline for how each activity gets into that class. Then I can determine the safety of engaging in any given activity based on its class, even if I had never previously thought of that activity before, even if I can't reasonably confer with my other partners first, even if I am caught off-guard by something spontaneous. What kind of STD can the activity transmit, how does it transmit it, and is our relationship within the class that would potentially expose me to that STD?

*By "futile", I mean that it is close enough to impossible to completely avoid all possible forms of HSV transmission as to round down to "impossible". But I do NOT mean that one shouldn't minimize exposure. Taking precautions like avoiding kissing someone while they have a cold sore, using antivirals for those with active infections, etc. can be reasonable. Plenty of people will go their entire lives without ever contracting HSV. But if you think it's actually possible to completely avoid HSV entirely, you're fooling yourself. Minimize the risks, but accept the fact that you will be exposed to it one day. If you're fortunate, you might never actually succumb to it, but plan for it like you do a cold or the flu or a car accident - try to avoid it but don't think there's a 100% way to avoid it, and it's probably not the end of the world if you do get it.

joreth: (being wise),0,1665761.story

A couple of interesting points here, mostly good-to-know news, with a little bit of bad news.

First, oral HPV seems to be spread through oral sex, not kissing or casual contact.  That's good news and good-to-know news.

Second, 7% of teenagers already have oral HPV.  That's bad-ish news (bad because it's more than 0% but "ish" because it's "only" 7%).

Third, among those 7%, only a very small percentage of them will develop oral cancer and, according to another article recently, apparently HPV-caused oral cancers has a higher treatment success rate than cancers caused by other means (like smoking).  That's good news.

Fourth, HPV-caused cancers is on the rise with 70% of all new cases of oral cancer being caused by HPV, surpassing tobacco as the primary cause of oral cancers.  But don't freak out - 80% of the population has or has had or will have HPV at some point in their lives, and the vast majority of them will never develop any cancer.  However, this study shows that 1 in 10 boys (yes, BOYS) currently have an infection that *could* lead to cancer.  This is not a female problem, it's a people problem - get vaccinated.

Fifth, apparently, the more oral sex you've had, the greater your risk of developing throat cancer.  That's actually not new news - we already know that the more exposure you have to the virus, the greater your risk of developing cancer.  That's why they FDA won't OK the vaccine for people over 30 - the older you are, the more sex you've probably had, the more exposure you've had to the virus, the less likely the vaccine is to work because it doesn't do shit if you already have the strain it protects against.

But since no one actually knows which strains they have or have had, it's still beneficial to get the vaccine if you're over 30 and have the money for it.  If you don't have that strain, the vaccine still works.  It's just that, being over 30 means you've had more chances to have caught one of those strains, since they're the most common ones.  That's all it means by "less effective" and why it's not FDA approved.  But it's not banned either, so find a doctor to give you the vaccine off-label.  It's legal and safe, just expensive since your insurance probably won't cover it.

Doctors recommend using protection even during oral sex.  It's not "safer" than PIV sex (penis-in-vagina), you just can't get pregnant from it.  Problem is that most people don't talk about using protection for oral sex.  "It's something people are not comfortable talking about, but it is protective ... If you are going to be intimate with someone, there are some adult conversations you need to have."
joreth: (statement)

First of all, note that this is a preliminary study.  Much more research needs to go into this hypothesis, including replicating this study a couple more times.

Second, there is no indication at this time that HPV causes heart attacks or strokes, the way we know that certain strains cause cancer (to be pedantic, even those strains don't cause cancer each time, and, in fact, the vast majority of HPV cases never cause cancer at all.  This just means that, in those cases of cancer that are linked to HPV, as opposed to other cancers for which HPV is not linked, there is a causal relationship.)

This study suggests that HPV has some role to play in increasing the risk of a heart attack or stroke in women by a significant amount.  So it is very important that 1) everyone get the vaccine if there is any way possible to afford it, and 2) we start pushing for the DNA test before the pap smear, so that we can better evaluate every woman's personal risk factors.

At the moment, we currently have women get a pap smear every year.  Then, if there is abnormal activity, her smear sample is tested for HPV DNA.  Many in the research end of things think that this is backwards.  We should be getting regular DNA tests because those DNA tests will tell us how often we should be getting a pap smear.  If we have no HPV, we might only need the invasive pap every other year (HPV is not the only cause of cervical cancer or other pelvic problems for women, just the main cause).  

Tests have sort of a rise and then plateau, or sometimes a drop off, when it comes to efficacy.  We need to be tested often enough for things like cancer to catch them early, when we can best treat them.  But for all tests there comes a point at which testing more frequently does not have any better chance of catching the problem and all it does is put the individual through unnecessary and sometimes invasive procedures, wastes money, and wastes time and medical resources that could have been spent on others with fewer means.

Every test has a different slope and peak in that efficacy chart, and every individual will have their own gradation to that slope because of personal risk factors.  I, with my family history of no breast cancer, of no cancer ever, and with small breasts, am not considered to be high risk for breast cancer so I do not need a mammogram until I am much older, and I do not need them often - regular self breast exams and an annual check with my routine pap will do fine for quite a while.  A friend of mine with a family history of breast cancer, however, does need to be checked regularly, and has since her early 20s.

The HPV DNA test can help with this more personalized style of healthcare by identifying who is higher risk and increasing their screening schedule to a peak efficient timetable while giving those of lower risk a bit of a break in money, time, and discomfort involved with annual paps.  And, apparently, more than just how often we should get pap smears, knowing that we have active strains of HPV can also help us to adjust other exams like cardiovascular exams and better refine our risk category for heart attacks and strokes as well as cancers.

To remind everyone, the HPV vaccine is currently approved by the FDA for both men and women up to age 26.  Since HPV is also known to cause anal, penile, and several oral cancers, as well as be passed on asymptomatically from males to their partners (both male and female), I strongly encourage both boys and girls to get vaccinated.  The sooner they get vaccinated, the more effective the vaccine is, hence the age limit.

Which means that if you are over 26, you can *still* get the vaccine.  You have to request it "off-label".  This does not mean illegal or black market or anything bad.  It just means that the FDA thinks that the vaccine's efficacy (that is, how well it prevents HPV) drops too low in older people to justify making claims about it or including it on governmental or insurance programs.  

The logic goes like this:  If you have already been exposed to those strains of HPV, the vaccine won't do anything.  The older you are, the more likely it is that you have had sex, so the more likely it is that you have been exposed to HPV, rendering the vaccine ineffective.

And that is all true.  The problem is that most people do not know if they have been exposed to HPV or not, and out of those who have, many don't know which strains they have been exposed to.  The main reason is that for the vast majority of people, HPV doesn't actually do anything - we catch it and it just goes away in a couple of years.  Gardasil prevents the two most common cancer-causing strains and the two most common wart-causing strains, but it also seems to work against a handful of other strains that are closely related to the big four, just not as well as against those four.

So, since we don't know if we have been exposed or not, if you have the cash (or the insurance), get the vaccine which will significantly decrease your risk of genital, pelvic, and oral cancers as well as, apparently, lowering your risk of heart attacks and strokes.  And start pushing for screening for men as well as reversing the order of the testing - DNA test first and then the pap based on your personal risk level.  Talk to your healthcare provider, check with Planned Parenthood, and keep an eye out here for opportunities to sign petitions to politicians and/or policy makers regarding better personalized healthcare.

Notes: - FDA approves automated HPV DNA test. - HPV vaccine does NOT make girls more likely to be sexually active (and girls with the vaccine are more likely to use condoms when they do have sex than girls who don't get the vaccine). - HPV DNA testing is much better than pap smears & researchers recommend reversing the order to HPV test first, paps second.
joreth: (being wise)

One of the podcasts that I only sporadically listen to is called Skeptically Speaking, and is actually a real radio show (yes, they still have those) that is recorded and uploaded to iTunes as a podcast so you can listen to it even if you are out of range. It's a good show, I just didn't discover it until I was already polysaturated, so to speak, with podcasts, so I only download those episodes that have titles I am particularly interested in.

This was one such episode. It is all about HIV and AIDS, but they start the episode out with a short bit on HPV, including a description, questions-and-answers from the audience, and a discussion of the vaccines. I highly recommend you check this out:


I have only a quibble about the episode concerning the HPV section. In that bit, the expert talks about the cost benefit of the vaccine. Now, I don't actually have a problem with a discussion on cost-benefits. I can separate out my emotions from my ethics from the practical considerations. I believe it is the right thing, the safe thing, and the ethical thing to encourage vaccinations in men and women. But I can also see that the cost analysis of the vaccine, from both a personal decision perspective and from a governmental budgetary standpoint, might recommend that HPV vaccination is lower on the priority list than other vaccinations, or even other programs.

No, my quibble is that I think the expert left out a major factor that could affect both an individual person's and a governmental agency's decisions regarding the cost-benefit analysis. He points out that cervical cancer is almost entirely caused by HPV, and that cervical cancer is one of the most common forms of cancer in women. Therefore, it is to the benefit of both an individual and the government agencies concerned with public health issues to ensure that women get vaccinated.

But only a very small percentage of the male population get any sort of genital cancer from HPV - namely anal cancer. According to this expert (and I didn't check his facts, so I'll take it at face value for now), pretty much the only men who get anal cancer are MSM or men who have sex with men (this includes men who are not "gay", as a self-identifier). MSM is a statistically significantly small portion of the population, and of that small portion, only a small number of THEM get anal cancer.

So, from a purely cost-benefit perspective, it may not be the most efficient use of resources to make sure all men get vaccinated, and it may not be the highest priority of men who do not fit into the high risk category to spend their money on a vaccine that probably won't help them out in any way. The reason for men to get vaccinated, according to this expert, is to protect a future female partner (which is, I think, a worthy reason, but I can see why it might take a back seat due to finances).

My quibble is that this expert did not mention anything at all about oral cancers and HPV. The latest statistics (for which I don't have time to cite at the moment) now say that HPV is the leading cause of all oral cancers (mouth, tongue, throat, etc.). Not necessarily because HPV-caused oral cancers are rising (they are, but not much), but because smoking is dropping. But what that means is that now the majority of all oral cancers can be prevented by a vaccine.

It is possible that, if you add up all the numbers of oral cancers in men and women, those cancers caused by HPV, cost of the vaccine, etc., it might still be not cost-effective to encourage mass vaccination of men. I haven't added up the numbers, so that is one possible outcome. I'm disappointed that the expert didn't mention oral cancers at all. Maybe only 1% of all men in the US ever get HPV-caused anal cancer, and we can predict 99% of that 1% based on behaviour, so maybe that isn't worth it to push for mandatory male vaccination, whereas mandatory female vaccination has a much better cost-benefit analysis. But maybe enough men get HPV-caused oral cancers that the number could actually tip the balance in favor of mass male vaccination. I would have liked for him to at least mention it.

But aside for that bit, the episode is informative and fairly easy to understand, so I recommend giving it a listen.

joreth: (Super Tech)
I may have linked or posted this infographic in the past, but it is an ongoing and updated project, so I'm posting it now even if I did post it in the past because it has probably changed.  In fact, the post that the following graphic comes from has a link to the original infographic that I probably posted when *it* came out, which compares HPV vax risk to driving risk, which is pretty cool.

It comes to us from the wonderful Information Is Beautiful website, which posts links to all its sources but makes complicated raw data easy to understand.  This particular graphic is located at  I recommend visiting this link directly, and if you have several hours to spend, checking out some of their other infographics.

So if you are under 30 and have health insurance - go get the vaccine.  If you are over 30 and/or do not have health insurance, save up about $300 and find a provider to give you the vaccine off-label (that means it's legal to but they can't legally claim it works so insurance companies probably won't cover it - and they can't legally claim it works only because the FDA has not given them permission to make that claim yet, not because the science isn't behind it).
joreth: (Super Tech)
I spend most of my energy on the STI tag on HPV, since that's the one I know the most about and the one that had the least amount of information when I started this tag. But I found some information on HSV that I thought I ought to share. The part between the horizontal bars below was not written by me, but I did obtain permission to post it.

First of all, some background:

HSV-1 is a strain of herpes that prefers the oral region, but it can reside in either the oral OR the genital region. It's just more commonly found orally.

HSV-2 is a strain of herpes that prefers the genital region, but it can reside in either the oral OR the genital region. It's just more commonaly found genitally.

When we say "prefers", it means that, if a virus comes in contact with the human body, there are some areas that the virus is more likely to attach itself to and some areas that it is not likely to attach itself to.  HSV does not like, for example, the backs of your knees.   You just don't get HSV on the backs of your knees, even if the backs of your knees are exposed to HSV.  So, if HSV-1 comes in contact with your mouth, you have a pretty good chance of it attaching itself there and taking root.  If HSV-1 comes in contact with your genitals, it can attach itself to you, but it can also not attach itself to you, to put it simply.  The opposite is HSV-2 - it will probably attach itself to your genital region, but there's a good chance it won't attach itself to your oral regions even if it comes in contact - although it can.

You can consider them, for all practical purposes, the same thing, just with different preferences.   Both are transmitted through "shedding", which means that they reside in tissue cells that can be transferred by contact and do not require any fluids.   So condoms are effective if the area that is shedding the virus is covered by a condom, but not if the area is outside the condom coverage or if affected cells get moved to outside the condom coverage, and condoms are pretty useless to prevent oral-to-oral transmission.

HSV is often passed from older family members to children just by giving them goodnight kisses.   As far as I'm concerned, any virus you can catch from your grandma is not an STD.   But the reason it can be passed, besides a parent just being careless, is because this virus can be passed through simple touching even when there are no symptoms.  It's called asymptomatic shedding.

Touching a person with HSV, even if you touch the affected area, does not automatically mean that you will get HSV, even if you touch them with the HSV's preferred site.  In other words, it is possible to kiss someone who has oral HSV-1 and still not get HSV yourself.   Whether you get it or not has to do with whether your partner is actively shedding at the time and how well your own body can fight it off for the amount of exposure you have.  Lack of symptoms reduces (but does not eliminate) chance of transfer, and antiviral medication that suppresses shedding also reduces significantly (but does not eliminate) chance of transfer.   Also, the strength of the viral presence in the infected partner affects how likely you are to catch it, so a partner who has an attenuated viral load is also a much lower chance of transfer.

The following is the results of some research that a layperson did into how likely it was that they would transmit HSV-1 to another partner when the site of their HSV-1 was genital and asymptomatic, meaning they had no symptoms, and whether the antiviral medication used to suppress transmission was effective for asymptomatic genital HSV-1:

You know, I really hate it when doctors just flat out lie to me. It makes me cranky.

I was able to find some of the clinical trials for antivirals used to reduce asymptomatic shedding.  The doctor had suggested the studies
were "weak" because there's no way to tell if the antiviral is working. But he was totally full of shit! They can totally tell by doing PCR!

So, back in 1994, they did PCR tests of pregnant women who had HSV-2 but were asymptomatic, and found that they were shedding the virus between 1% to > 75% of the time.  In other words the researchers could detect HSV DNA in "genital secretions".  That's not to say that the virus would be easily transmissible at this time, but it was present.

Administration of Acyclovir reduced this shedding by a median of 80% as detectable by daily PCR tests.  Not bad!

Now keep in mind, this is HSV-2, so you might wonder, as I did, if there are any studies on HSV-1.  There are!  There was a study for
Famiclovir, which is in the same family as Acyclovir, and as far as I can tell, behaves the same way (they have done studies comparing the two and found no difference). This study is from 2007.

So, there are several interesting bits of information.  First of all, the likelihood of asymptomatic genital shedding is much less in HSV-1 vs. HSV-2 given a history of genital symptoms (something the doctor told me which was actually true!).  Again, this was tested by PCR.  This confirms the common wisdom that HSV-2 "prefers" the genital site.

As in the 1994 study, they showed that the antiviral reduced the incident of asymptomatic shedding in HSV-2, and they also showed
results specifically for genital shedding in patients with a history of genital outbreaks of HSV-1:

"and genital HSV-1 shedding also decreased, from 2.0% of days for participants on placebo to no days for those on famciclovir"

So that's 2% to 0%.  Not bad! And note that 2% is very low to begin with.  (2% chance of asymptomatic shedding x low chance of transmission with asymptomatic shedding)

As far as oral shedding goes:

"Oral shedding caused by HSV-1 in participants with a clinical history of genital herpes decreased from 4.5% for those on placebo to 1.1% for those on famciclovir, whereas oral shedding decreased slightly in participants without a history, from 3.9% for those on placebo to 3.5% for those on famciclovir"
So if you buy those statistics, that means that the least safe thing a person with genital HSV-1 can do with an HSV- partner is kiss. Though, we're still talking about small percentages (less than 4%).

Obviously, everyone is different and I'm not sure how big their sample set was, so you can't really take these statistics as law, but they are encouraging - both in the base incidence of asymptomatic shedding for a history of genital symptoms for HSV-1, and in the reduction of asymptomatic shedding with an antiviral.

Here's the 1994 study

2007 study

So, this is obviously not an all-comprehensive summary of HSV. But it is important to note that HSV-1 can be found genitally, and HSV-2 can be found orally, although neither really likes those sites.  It is also important to note that both types can be transmitted even when there are no symptoms, and that certain types of antivirals do reduce certain transmission rates by a significant margin.

Also, DON'T PANIC. HSV, while a virus and something that no one wants to catch, is not the end of the world.  The viruses most likely to kill you are also the ones most easy to avoid, through testing and avoiding fluid transfers.  This doesn't mean that HSV is totally harmless so everyone go out and forget about safety, it just means to keep this in perspective - it's a virus like any other virus, and a lot less harmful than some other viruses.  Treat it with the caution that is proportional to the effects of the virus, not with the panic that comes from a social stigma.
If you have a partner with HSV or are interested in someone with HSV, you do not have to run away screaming.  If you have HSV yourself, you don't have to be afraid that no one will ever want to touch you again, or refrain from all contact out of fear of giving your partner the virus.  There are some circumstances which are low risk all on their own without requiring any assistance, there are things that can be done to reduce the risk, and can reduce it by A LOT, and, unless you're severely immunocompromised, even catching HSV can be manageable and something you can live with.  In many cases, the misunderstanding and reaction to HSV is a worse inconvenience on a person's life than the virus itself.
joreth: (being wise)
I still have no time - unusually busy beginning of summer, but I have a few posts written up from a while ago that I haven't posted yet, so I may post those in the upcoming weeks until I get more free time.

Until then, here's an article reminding us all that HPV causes more than just cervical cancer.  The article focuses on women, and reminds us to insist on full healthcare treatment if we do show a positive HPV test.  Don't stop at the cervix, HPV can, and does, show up in oral tissue and anal tissue.  
Now also remember, cervical cancer is serious, and HPV is more dangerous than we ever knew ... however, only a small percentage of people who get HPV ever develop cancer, thanks to regular pap smears and HPV DNA testing.  Now, if we can just increase the testing rate of oral and anal tissue, we can get those cancer rates down to a manageable level too, because HPV-caused cancer actually has a very high remission rate, compared to non-HPV-caused cancers.
joreth: (statement)

We haven't heard much new about HPV over the last several months. Mostly, it's been minor news about specifically which category of person the FDA has approved to take the various HPV vaccines (girls and boys under 30, but not over 30) or new home test kits that haven't yet made it to market.

Reminder: the vaccine being "approved" for a certain category doesn't mean those not in that category CAN'T take it, it means that the company can't make any claims of successful treatment for those categories, and, consequently, many insurance plans won't cover it for those category.   The current evidence suggests that efficacy is decreased with age (because of likely previous exposure), but not eliminated.  So if you have the cash but are not in the "approved" category, I still recommend you find a doctor to give it to you "off-label" (which is completely legal).

Anyway, while testing an anti-HIV drug, researchers discovered that a drug called Lopinavir actually kills HPV-infected, pre-cancerous cells while leaving uninfected adjoining cells alone.

This could be extremely exciting news if it follows through on its promises and scales up to humans. So far, this drug works in petri dishes on actual human HPV-infected cells that have not yet turned cancerous but are the closest thing to pre-cancerous. In order to work on HPV, the cells require 15 times more drug than the HIV-infected cells, so this will not be available in pill form, but researchers speculate that a topical cream could deliver the appropriate dose.

At the moment, the US has a backwards system, in part because of the awesome work that was done in the past with making female reproductive health care such a priority. Currently, women get a pap smear done, which is collecting cells directly from the cervix and then looking at them under a microscope to see if there are any abnormal ones. Then, if there are, several tests are done to figure out why they are abnormal and if that abnormality is bad, including an HPV DNA test. The research community believe this is the wrong order, but the medical practice community is slow to change (partly because of financial concerns) with the newly available HPV tests.

The research community thinks that we should be having the HPV DNA test done first, to see who is even at risk for cervical cancer, and then when we have determined who actually has HPV, those women would go on a frequent pap smear schedule to watch for changes in the cervix, so they can be treated immediately, while those without HPV can go on a longer pap smear schedule (like HPV-infected women get paps every year or 6 months and women without HPV get them every 2 or 3 years, for example).

Then, with this new drug, should it pan out, instead of bothering with frequent pap smears, women who test positive for HPV DNA could just get the cream, kill all the affected cells, do another DNA test to make sure it's gone, then go back to the more infrequent schedule.

Paps would still be important, however, because HPV is responsible for something like 70% of all cervical cancers and is now the leading cause of oral cancers (thanks to smoking dropping in popularity), but that still leaves 30% of cancers that are not caused by HPV (I may have my percentages wrong, but the point is the same - some cancers are not caused by HPV).  And it is our collective access to pap smears & LEEP procedures that make the mortality rate of cervical cancer so very low in this country (no thanks to the GOP defunding Planned Parenthood).  
Also, do remember that even though HPV is responsible for such a high percentage of cancers, the percentage of people with HPV who *get* those cancers is very low.  In other words, 80% of women will contract HPV in their lifetimes.  But only a sliver of them will actually get cancer from it.  The vast majority of women simply pass the virus through their system with little to no effect.  It is for that sliver of women that these journal posts, and the research and the vaccines and the procedures, are so important.  Being one of those women certainly doesn't make one feel good to know that they're statistically in the minority, but let's also remember that this is important to be concerned about, not to panic about.  Regular checkups go a long way towards reducing and minimizing the likelihood of serious complications, but too-often checkups do not increase your chances and can actually have detrimental effects.  Current recommendations are pap smears & breast exams once every 2 years if you are not in a high-risk category.  I recommend annually if you have multiple partners regardless of your risk status.  More frequently is not necessary unless your physician has recommended it based on your personal risk level or if you have a known exposure to an aggressive strain of HPV.

The articles I have read so far have not been very clear on the specific mechanism involved, only to say that the drug "re-activat[es] known antiviral defence systems" that HPV switch off. So this drug could, potentially, eliminate or reduce all viral infections, but not necessarily be that magical "cure for cancer" that everyone is hoping for.
joreth: (sex)
 No time!

Quick update - the AIM foundation is the organization that provides HIV testing & other sexual health services, primarily for the porn industry, but was open to the public as well.  They were single-handedly responsible for catching 2 HIV scares before it was spread throughout the industry and are the driving force behind the ridiculously high level of safety for the industry.  Their basic strategy is that porn producers opt-in to their testing services, then the actors are required to get tested every 30 days (the HIV test has only a 2-week window, which means it's accurate up until 2 weeks prior to the test), and a recent clean HIV test result must be submitted to the producer before an actor can work.

They also set up the system so that the *producers* get the results directly from AIM, to eliminate the possibility of fraudulent or forged test results from actors.

Then they track their patients.  This allowed them, in the past, to quarantine Patient Zeros, who got infected outside of work, so that the virus did not spread to other actors.  The frequent testing & open sharing of medical information has been shown to be just absurdly effective in maintaining safe working conditions even when condoms are not used (although AIM officially recommends condom use & many porn companies do voluntarily use condoms).
Unfortunately, the county keeps harassing AIM & trying to shut them down because they erroneously believe they should legislate & mandate condom use but not testing.  I have no idea why they keep wanting to shut down a testing facility, although I understand the desire to mandate condom use.  There are 2 big problems with this - first, the gay porn industry had a MUCH higher incidence of HIV when they mandated condom use but did not utilize testing.  I am told they have been making the switch to the testing method and that is proving more successful than mandatory condom use alone.  So we already know that mandatory condom use with no testing does *not* work better than often-but-not-mandatory condoms + testing.
And the second is that legislating the industry puts them under the domain of OSHA (as the current laws are written).  The reason why this is a bad thing, is that OSHA currently forbids companies from discriminating against HIV+ employees.  It is currently against the law for an employer to ask about a potential employee's HIV status or make employment decisions based on that status.  For all jobs where HIV status does not affect their ability to perform their job, I completely agree.  But there is not currently any exemption for industries where fluid-transfer is a regular or likely part of the job.  
This means that a porn producer would no longer be allowed to request an actor's test results or refuse to hire an HIV+ actor.  Apparently, legislators don't see why this is a problem.
So, the latest round of harassment resulted in AIM getting denied licence renewal, which effectively shut them down for about 2 months.  But they're back up, re-organized into a different class of organization (a private corp. regulated by the Medical Association instead of the county government), and offering even more services than ever!
This is a Very Good Thing, and I wish them all the best fortune in their upcoming endeavors in protecting the health and safety of sex workers - and all sexually-active people!

Data Dump

Dec. 15th, 2010 10:24 pm
joreth: (authority)
I've had these tabs open for ages, meaning to write a post about them, and I never seem to get around to it.  So I'm throwing them all in one post: - New Discovery May Offer Cure for Human Papillomavirus (HPV). "Test results confirming two of our lead compounds showed excellent in vitro antiviral activity and no cellular toxicity at dose levels tested for Human Papillomavirus (HPV). Testing was performed using the HPV 11 strain, which along with HPV type 6, is responsible for ninety percent of genital or anal warts." - Marinomed's iota-carrageenan effective against H1N1. "In animal experiments, Carrageenan demonstrated equivalent efficacy when compared to the drug Tamiflu". - Evolutionary history of partible paternity in lowland South America. "Partible paternity, the conception belief that more than one man can contribute to the formation of a fetus, is common in lowland South America and characterized by nonexclusive mating relationships and various institutionalized forms of recognition and investment by multiple cofathers." - "JourneyQuest is a fantasy comedy web series from the creators of "The Gamers" and "The Gamers: Dorkness Rising"." - "The Enemies of Reason is a two-part television documentary, written and presented by evolutionary biologist Richard Dawkins. ... Watch the full documentary now" - " aggregate all the Atheist, Pro-Science and Free-Thinking Songs, under the one roof." (I need to comb through this and add songs to my Atheist Music YouTube Playlist - The Rap Guide to Human Nature by Baba Brinkman "Immediate download of 19-track album in your choice of 320k mp3, FLAC, or just about any other format you could possibly desire. Buy Now name your price" - Rationalist Kids Show Martha Speaks The Truth
joreth: (cool)
In this article I wrote about research studying carrageenan-based products that have anti-HPV properties & possibly anti-HIV properties. I listed 5 specific products that were undergoing this HIV testing and had the most promise.

In this one I announced that one of the products, Carraguard had failed the anti-HIV testing, but it did not indicate a failure for anti-HPV properties. I worried that it would be abandoned entirely & left to the SCAM industry to take over. Fortunately, I was wrong.

I posted about further testing on Carraguard for its anti-HPV properties that showed a significant protection level against HPV.

Well, those studies have now resulted in Carraguard being granted $4 million in funding to test the efficacy of this microbicide.

According to the World Health Organization, approximately 440 million males and females are infected with HPV worldwide. The Centers for Disease Control estimates at least 20 million Americans have HPV. ... While a recent phase 3 trial using [Carraguard] did not demonstrate effectiveness against HIV, it was shown to be safe. Recent laboratory tests indicate that carrageenan, the active ingredient in CarraguardĀ®, is about 1000 times more effective against HPV than against HIV. ... Dr. Einstein's study will be a combined clinical trial and translational research project. Two hundred women will be assigned to use either CarraguardĀ® or a placebo gel. At the end of one year, the participants will be examined to determine if CarraguardĀ® was protective against acquiring HPV infections. In addition, assays will be done in the lab to assess the compound's activity and to develop a predictive test for efficacy.

In addition to this being Good News in general, it is particularly good news for Third World nations. An effective microbicide gives women control over the effects of sex, an activity they often do *not* have any control over. While we still need to work on the social aspects that allow, encourage, or ignore human rights abuses towards women, we can, in the meantime, try to protect them from some of the effects of these abuses, namely pregnancy and STDs. By giving women the ability to protect themselves when their partners are uncooperative, we take a step towards decreasing the imbalance of power and rights between the genders.
joreth: (Dobert Demons of Stupidity)
 This shouldn't take too long.  Someone I know who is way into the woo contracted HPV-caused genital warts a few years ago.  I haven't asked about the details of his infection, such as frequency or duration.  I just know he actually got the warts, most presumably from a partner who also had warts about a year before his first wart showed up.

Anyway, because he's way into the woo, he didn't get them frozen off or burned off, which is the typical method of treatment (which, btw, only removes the wart, not the virus - this can cause relief from the itchy/burning symptoms, and it is currently believed that the virus is less-transmissible when there are no physical symptoms - but it can still be transmitted).  No, he sought out a "natural remedy".  It's called D-lenolate, which sounds all medicine-like, but don't let the name fool you.  

As Dara O'Brian says, "Herbal medicine has been around for thousands of years!  Indeed it has, and then we tested it all, and the stuff that worked became 'medicine'!  And the rest of it is just a nice bowl of soup and some potpourri."

So anyway, he took this stuff and his warts went away.  Therefore, this extract of olive leaf must have cured his HPV.  It couldn't be because warts come and go on their own whims or anything.  Nothing like some confirmation bias, eh?

I found it hard to believe that I wouldn't have heard of this particular remedy if it had been real, so I looked it up.  Turns out, I was right.

Every link that shows up in Google goes to a "natural wellness" store selling this crap, and one link goes to a 2006 cease and desist letter from the FDA saying this one company can't claim this shit cures anything or else it has to be classified as a drug.  And if it's a drug, then it needs to go through proper channels of FDA approval before it makes its claims.  Since it didn't go through proper channels, it can't make the claims.  Basically, it claims to be a "natural antibiotic" (psst! antibiotics kill bacteria, not viruses, and antibiotics are not recommended for treatment of viruses except in very specific cases where opportunistic bacterial colonization is a threat) that "boosts the immune system".

Just as an easy-to-remember rule of thumb, if something claims to 'boost the immune system", that's usually a good sign that these people have no idea how the immune system works and are cashing in on our ignorance with fancy, sciencey-sounding words.  You should automatically be suspicious when you see that red flag.  Legitimate, tested medicine does not claim to 'boost the immune system" because that's not how the immune system works (from the ever-snarky Mark Crislip, infectious disease specialist).

So then I looked it up on PubMed, which is the number one resource to see what tests have been done and filed with legitimate science-based organizations and are up for (or have been) peer reviewed.  Guess what?  Not a single mention of this stuff anywhere.  Not even a failed study.


This doesn't mean that it does NOT do anything helpful.  It means that there is no evidence to suggest that it DOES do something helpful, and also no tests to make sure it's safe for human consumption.

If you have, or have been exposed to, HPV-Genital Warts, do yourself a favor and don't take the advice of "some guy".  Even if that "guy" is wearing a white lab coat.  Ask your doctor about the 3 or 4 freezing and burning methods.  They're uncomfortable, but warts are warts, and those are the only way to get rid of them.

Also, they might come back - it's a virus after all.  But don't take untested, unproven "remedies" - you don't know what that shit'll do.  If you're lucky, it won't do anything at all.
joreth: (::headdesk::)
 Ah ha! I'm stuck awake way too early on a Saturday morning without my external hard drive that has all the files and projects I'm currently working on.  And because it's so fricken early on a Saturday morning, the internet is not sufficiently entertaining me.  What a great time to post about a couple of websites currently cluttering up my browser as open tabs!

First we have - a news story that says that STD rates are higher for swingers than prostitutes.

The reason, they suspect, is because swingers are too afraid to get tested or admit to their doctors who could then advise them on how to maintain proper safety practices for the multi-partnered.

Higher than prostitutes.

As in, prostitutes, who know they're doing something dangerous, and are marginalized, discriminated against, and criminalized, have fewer health problems - prostitutes with their high numbers of anonymous stranger-partners.

(Keep in mind that this study was done in the Netherlands and prostitution is legal, so prostitutes can admit to their doctors that they need medical care for their profession but swingers are still marginalized)

What this says to me is that education, proper safety procedures, and openness and honesty are integral to safer sex. Openness and honesty are the keys to being safe, and lack of such is more dangerous than just the number of partners. This also says to me that society in general has their priorities all fucked up and that monogamy is still more highly valued than practiced.

The number of sexual partners is not the most important factor in a person's health risk profile. Using proper safety procedures, and exchanging accurate medical information between partners and with medical practitioners are more likely to keep you safe than just reducing the number of partners.

This part wasn't mentioned in the article, but the porn industry (those production companies that comply with the AIM foundation - a self-regulated medical facility for the porn industry) has a lower HIV incidence rate than the general public, in spite of non-mandatory use of condoms. I don't have the link off-hand, but some academic researcher actually did a study in preparation for the upcoming legal battle dealing with mandatory condom use, and found that their practice of regular HIV testing, and open test results resulted in lower incident rates.

If your partner is HIV-free, you can't catch HIV. People who have been tested for HIV, and who have the lab results to prove it, are more likely to be HIV-free than people who have not been tested. Your chances of catching an STD go significantly down with regular testing and open test exchange practices. Having 3 partners who have been tested negative for STDs are less likely to give you something than having a single partner who has not been tested simply because 3 partners who don't have anything can't give you anything while a single partner *can* because he might have something and you wouldn't know it to protect against it. Monogamous partners are less likely to use proper precautions because they believe themselves to be monogamous, but either they are unaware of the presence of other sexual partners, or they are not accounting for past partners. Your chances do not go up with numbers of partners. Your chances go up with shoddy practices, like not using protection and not getting tested regularly.

Even monogamous people should require test results of their partners prior to engaging in sexual activity, and regularly just as a matter of regular health maintenance. Only a small portion of people who catch an STD got it from a cheating partner. The majority caught it from ignorance. Get tested, be honest with your health providers, and exchange test results with potential and current partners.

[ profile] emanix ade a point in the comments below that the title of this article SHOULD have been "Prostitutes have HALF the STDs that straight people have!"  The article focused on how high the STD rate was with swingers, most likely as a scare tactic to reinforce the idea of punishment for immoral behaviour, but they neglected to emphasize that professional sex workers in this study are actually SAFER than either swingers OR regular heterosexual people.

Speaking of STDs, here's the latest on the HPV research front.

"A cluster of carbon nanotubes coated with a thin layer of protein-recognizing polymer form a biosensor capable of using electrochemical signals to detect minute amounts of proteins, which could provide a crucial new diagnostic tool for the detection of a range of illnesses, a team of Boston College researchers report in the journal Nature Nanotechnology.


The detection can be read in real time, instead of after days or weeks of laboratory analysis, meaning the nanotube molecular imprinting technique could pave the way for biosensors capable of detecting human papillomavirus or other viruses weeks sooner than available diagnostic techniques currently allow. As opposed to searching for the HPV antibody or cell-mediated immine responses after initial infection, the nanotube sensor can track the HPV protein directly. In addition, no chemical marker is required by the lebel-free electrochemical detection methods."

That pretty much summed it up. Carbon nanotubes are being used to detect HPV immediately, rather than waitng for the body to develop the antibodies or destroyed cells on the cervix. And soon after reliable early detection methods are developed, early treatments will come. Wouldn't it be nice to be able to detect HPV before it does any damage and eradicate it before it replicates enough to become problematic?
joreth: (being wise)
I've been asked about what the "phase" means in "Phase III Clinical Study", or which phase is the human trials? So I found this nifty little graph that illustrates what a "phase" is:

And MD Anderson Cancer Center does a good job of breaking it all down for you. I think in the past I thought Phase I was the lab testing, Phase II was animal testing, and Phase III was human testing, but that's apparently not the case.

Basically, Preclinical trials are to see if it produces an immune response at all. Phase I is to see if it's safe for human use and will it produce a human immune response. Phase II is to determine the best dose in addition to safety and how much of an immune response. Phase III is where we determine if it works, and if it works better than current or standard treatments. Phase IV is really about post-marketing data. Verifying efficacy and side-effects among the general population occurs during this phase, mostly to see how effective it works over time.  Phase IV is done on treatments that have already received FDA approval and is in use in the general population.

There are about 10 years or more between studying something in the lab and getting it to market. So a lot of the nifty new research I talk about here is almost a decade away from ever being found on the store shelves or prescribed by your doctor.

But if you see something labeled "Phase III Clinical Trial", you can start getting excited!
joreth: (yay!)

Results: ...After adjusting for risk factors, Carraguard was found protective for HPV infection for women who inserted >80% of their returned applicators of test product with >30% confirmed covered sex acts. Within the latter category, Carraguard was almost 50% more efficacious than placebo. Carraguard users were 0.529 as likely to contract HR-HPV [95% CI (0.304, 0.920)] as women who used placebo (P=0.0176).

Conclusions: Carraguard was shown to be effective in protecting against vaginal transmission of HR-HPV. To our knowledge, this is the first report of successful protection against genital infection by a vaginal microbicide.

We haven't seen much lately about the carrageenan studies for use as a topical preventative for HPV. Last I'd heard, they were going to human trials and the results were supposed to be out early last year, but I haven't found anything, one way or the other, until now. This particular brand that this study was testing, was found to have failed its anti-HIV test, and I posted about it at the time that I feared they would not follow up on its anti-HPV properties.

Well, apparently someone did, and it seems to be holding up against HPV. I'm still looking out for BufferGel, which was my favorite of the brands being considered, so when I hear more, I'll let ya'll know!
joreth: (anger)
 Some of you may have seen the news reports about a few deaths in India shortly after being administered the HPV vaccine.  6 young girls have died in a very short time after being given the vaccine, and naturally the authorities wanted to investigate.  But I was waiting until the details came out before I reported on it.

So, here's the scoop.  Both Gardasil and Ceravix were given permission to conduct Phase III trials in India - which is basically the kind of trial that has been deemed safe enough to test on humans directly in large numbers.  In the lab, it passed enough tests to be considered safe, but sometimes there are things that we only find out when we can expose large numbers of humans to find any unusual quirks that might not show up in a nice and tidy lab.  Drugs and vaccines need to be tested as excessively safe before they make it to the Phase III level.  That's just a quick sum-up.

Anyway, so they did this trial and 6 girls who participated in the trial ended up dead.  The vaccines were immediately pulled and investigations started, naturally.  This, of course, was done on their own, not prompted only by special interests groups, because, contrary to the fearmongers, Big Pharma is not some shadowy cloak-and-dagger evil Empire out to kill the humans.  It's a collection of many organizations, for-profit corporations, and government entities, all staffed by people.  Some, naturally, want their corporations to to do well, others are motivated by compassion for other people - a desire to help find cures and make lives better, and others just want to file their papers alphabetically and collect their paycheck.  

Anyway, so they pulled the vaccines and conducted an investigation.  And, surprise, surprise, all 6 of the deaths are conclusively attributed to other causes.  4 of which were stated in this one article:  fever, suicide, drowning, and severe anemia with malaria & a snake bite.  

Seriously?  Two girls died from drowning and a suicide and they got lumped into the body count for Gardasil?  This isn't like some mysterious and unusual heart condition that would take an in-depth autopsy to conclusively determine was a pre-existing condition and not related to the vaccine but that we wouldn't know that at the time it happened and a correlation would be a reasonable suspicion.

I haven't even gotten to the worst part.  

So, they conclusively decided that all 6 of the deaths were not related, and yet India has decided to permanently pull the plug on the HPV vaccine and there is a call to pull the vaccine from all the other States.

So, here's a vaccine that has proven to be harmless (as far as vaccines go, this has some of the fewest side effects, and least dangerous side effects of almost any vaccine), has also proven to significantly decrease the incidence of death by painful and prolonged cancer, and yet, for your "protection", we're going to refuse to allow you to take it because a handful of people who have taken the vaccine have, coincidentally, died of totally unrelated causes.

Because dying of cancer is preferable to taking a vaccine that someone else took who happened to drown later that same year.
joreth: (Silent Bob Headbang)

Last heard, the FDA did not approve Gardasil for women over 26. Men and boys were only recently given FDA approval, but for older women, the FDA wanted more proof that it would do any good. The reasoning behind the FDA's rejection is that, the older a woman is, the more likely she is to have been exposed to HPV, and the less likely the vaccine is to do any good once she already has HPV.

Yes, yes, I already know all the logical fallacies in that argument, I'm not agreeing with them, I'm reporting it.

So Merck, data in hand from all their existing research that says it helps a little, dutifully went back and researched some more.

And they found that the vaccine does, indeed, significantly protect older women and gay men.

" A study showed that women ages 25 to 45 had an 89% effective rate of preventing certain strains of the HPV virus.

Gay men could benefit from Gardasil because the vaccine is shown to be 78% effective in preventing anal intraepithelial neoplasia, a precursor to anal cancer."

Merck submitted their request for approval in January, and it typically takes 6 months to review the data & receive approval or rejection.

HPV Update

Feb. 3rd, 2010 01:42 pm
joreth: (Misty in Box)
 It's been a while since I last made an STD update, because there's not much new going on.  Same ol' same ol' with one side arguing to get vaccinated, the other side arguing it's dangerous, treatments awaiting FDA approval, blah blah blah.

This also isn't exactly new, but it seems we need reinforcements as to why the vaccine is GOOD FOR YOU.  People insist on wanting to call HPV a "woman's disease" (as if that justifies lack of treatments & preventive measures) and they insist on claiming that cervical cancer is easily prevented & easily treated and therefore not worth the effort of better screening techniques, treatments, or vaccines.

Except that it's not either of those things.

Yes, in the Western world, thanks to pap smears, cervical cancer is more easily recognized than in other countries; it is recognized earlier and with better accuracy.  This means that, once a woman HAS cancer, or pre-cancerous lesions, she has a better chance than a woman in a third world country of surviving it.

But that's not the end of the story.  What about those women who, even with early detection, do not survive?  What about those who do survive but have life-long side effects, like sterility?  What about those women who do not have healthcare and cannot go do the doctor often enough to catch the cancer early enough to treat it?  And what about everyone who is not privileged to live in the wonderful US where all women have fabulous healthcare, caring & knowledgeable doctors, and regular checkups (that was sarcasm, in case you couldn't tell)?

And what about those MEN and women who get cancer somewhere other than the cervix?

Because cervical cancer is not the only thing that HPV causes, but cervical cancer is the only thing we regularly screen for.  Well, that and breast cancer, but what does HPV have to do with breast cancer?

HPV Vaccine May Prevent Breast Cancer

A vaccine that prevents cervical cancer in women may also prevent some forms of breast cancer, according to Australian researchers. The team, located at the University of New South Wales, used genetic probes to test cancerous breast cells and found several strains of the human papillomavirus (HPV).

The researchers found the presence of high-risk HPV in 39 percent of the ductal carcinoma in situ cancers and in 21 percent of the invasive ductal carcinoma (IDC) breast cancer specimens examined. Non-invasive or in situ breast cancers are those restricted to the glands that make milk and do not spread. Invasive ductal cancers are more deadly and account for 70 to 80 percent of all breast cancers.

"The finding that high risk HPV is present in a significant number of breast cancers indicates they may have a causal role in many breast cancers," Dr. Noel Whitaker, a co-author of the report, said in a statement.

70% of all breast cancers are invasive ductal cancers and are more deadly than non-invasive cancers.  Out of those, 21% may have been caused by HPV.  Of the remaining 30% of cancers, 39% may have been caused by HPV.

Do you understand that's a SIGNIFICANT NUMBER OF BREAST CANCER CASES THAT MAY BE CAUSED BY HPV?  And we can eliminate those with a vaccine that has been proven to be safe and effective, contrary to opponents' claims?

We can fucking eliminate cancer.  Only a certain type right now, but it can be eradicated.  Right now.  With current medical technology.  And people are refusing because taking the vaccine might make their children "more promiscuous" because the threat of death is supposedly removed as a punishment for sex.  WTF kind of logic is that?  And that a statistically-expected number of cases had totally unrelated illnesses and death coincidentally just after taking the vaccine.  Guess what?  People who don't take the vaccine die of totally unrelated accidents and illnesses too.  But people who don't take the vaccine ALSO die of related illnesses, like CANCER.

Report: 40 percent of cancers are preventable

About 40 percent of cancers could be prevented if people stopped smoking and overeating, limited their alcohol, exercised regularly and got vaccines targeting cancer-causing infections, experts say. ...

According to the World Health Organization, cancer is responsible for one out of every eight deaths worldwide - more than AIDS, tuberculosis and malaria combined. WHO warned that without major changes, global cancer deaths will jump from about 7.6 million this year to 17 million by 2030. ...

[E]xperts said about 21 percent of all cancers are due to infections like the human papillomavirus, or HPV, which causes cervical cancer, and hepatitis infections that cause stomach and liver cancer. ...

"Policymakers around the world have the opportunity and obligation to use these vaccines to save people's lives and educate their communities towards lifestyle choices and control measures that reduce their risk of cancer," Cary Adams, chief executive of the International Union Against Cancer, said in a statement.

(bold emphasis mine)

I'm going to repeat this part:  21% of all cancers are due to infections that can be prevented with the HPV vaccine and the hepatitis vaccine.

21-fucking-percent of ALL CANCERS can be PREVENTED by taking a vaccine.

I watched my father battle cancer. He survived. He was one of the lucky ones. Survival is not the only goal here, but quality of life is too, not to mention the financial burden on both the sick individual and the community that houses him.  I don't know about you, but knowing one has a chance of living through that kind of pain and suffering is small consolation when someone is actually going through it.  And it's only a chance, not a guarantee.

It is utterly absurd that we live in an age and a society that has the knowledge and the ability to prevent certain kinds of death, and there are people out there whose "moral" code, not only prevents them from taking advantage of this, but tells them to prevent others from avoiding a horrible, painful, prolonged, frightening death; whose "moral code" promotes unquestioning faith and belief in the Authority figure, not the stand-alone truth of the message, which results in people believing what someone says because they like him, not because he actually knows what he's talking about; a "moral code" which holds as a virtue roping off a section of one's belief structure as untouchable, unquestionable, so that one cannot be persuaded to change one's mind even in the face of rock-solid evidence, even when that belief causes the PAIN and DEATH of those around him. 

How, exactly, am I the immoral one again?
joreth: (Dobert Demons of Stupidity)
 Or, rather, for failing to disclose an STD.  I hate that this has apparently become necessary, I would rather see people just being responsible people, but frankly, I just can't get too upset at someone who knowingly hides an STD from a lover.

Since I expect to actually see my partners' paperwork, I am unlikely to ever fall victim to something like this, unless he's also good at forging medical documents.  In which case, I'm in deep shit anyway.

I find the deliberate refusal to disclose a KNOWN life-threatening illness combined with a deliberate engagement of an act designed to transmit the illness to be an act of evil.  Even if we're talking about an illness that doesn't actually *kill*, or has a high survival rate, this goes beyond ignorance and beyond misunderstanding.  This is a deliberate, pre-mediated act that threatens the life or the quality of life with long-term repercussions, that robs another human being of his respect and dignity in addition to his life, by using the trust and the intimacy of the act to perpetrate this evilness.

I have a hard time not agreeing to the punishment in the form of legal action, against someone like that.
joreth: (::headdesk::)

A study was released on January 13 of this year with some really interesting results on "cultural cognition".  They wanted to find out who thought the HPV vaccine was risky and who didn't, and why.  The "who" came as no surprise to me, but the "why" was interesting.

Interviews of more than 1,500 U.S. adults reveal that individuals who favor authority and other traditional values and who are likely to see the HPV vaccine as condoning premarital sex perceive the vaccine as risky. Individuals who strongly support gender equality and government involvement in basic health care are more likely to see the vaccine as low risk and high benefit.

See that? It's not just that religious people don't want the vaccine because sex is immoral, it's that people who think sex is immoral ALSO think it's "risky". People's cultural values affect how they perceive risk - not facts, not statistics, but a totally unrelated set of subjective values changes how a person evaluates facts and data that has nothing to do with those values.

I totally get that if someone is opposed to premarital sex for religious reasons, and if a vaccine comes along to reduce or eliminate one of the possible drawbacks to sex, that person might be opposed to the vaccine because he might think people will go off and have sex now that it's "safe". I think it's highly unethical to encourage disease, suffering & death in order to "punish" people for doing an activity that *you* don't like, but I see how one follows from the other - if you think action A is bad, then there should be some punishment for people who do it and I get that logic (the part where I have a problem is when action A is agreed upon by all involved & the person who thinks it's bad isn't participating, that and the whole idea of punishing a natural human need that evolution has seen fit to encourage for the survival of our genes, but that's another rant).

I think to some extent it's true - if sex had fewer complications, *some* people would have more of it with a wider variety of partners.  But what I don't get is "premarital sex is immoral, therefore this vaccine is dangerous and will cause you to have a stroke".  I would have more respect for someone who said "I read the data and the vaccine seems perfectly safe, but I'm opposed to it on moral reasons".  At least that's being honest ... stupid, but honest.

They also discovered that when you give people a well-balanced view on the vaccine, they got MORE OPPOSED to it if they were already opposed to it. This is called "bias assimilation", apparently.

Let me say that again in another way: Giving people information to make up their own minds MAKES THEM MORE RESISTANT TO ACCEPTING THE DATA. Sorry you Libertarians who think there shouldn't be any controls or standards in place and that people should just have all the info they want to make their own choices with no mandates or government agencies to oversee the population, but this just DOES NOT WORK. When it comes to things like vaccines, other people's choices affect everyone around them and people do not make good choices even (and especially) if you present them with the information they need to make those choices.

The joke about sticking fingers in ears and yelling "LALALALA I CAN'T HEAR YOU!" isn't really a joke it would seem.

They also found out that what made people more willing to moderate their positions from their adamant opposition to the vaccine was hearing that someone who they perceived to have similar cultural background, or had "cultural credibility", take the pro-vaccine stance.

In other words, they were only willing to take their fingers out of the ears if the person speaking to them looked like them. This is a complete reliance upon the Argument From Authority - the message is exactly the same, but they were only willing to believe it if the messenger wasn't "too different" from themselves.

The concluding message from this study was that if we want to get our point across about the safety of vaccinations, we have to cultivate a very diverse group of spokespeople, so that no matter what cultural identity our audience has, *someone* will be "good enough" for the audience to listen to.
joreth: (Kitty Eyes)
 Not much *new* happening in the world of STDs at the moment, so I haven't had many updates.  Last time, I believe I mentioned that Merck's request for FDA approval for Gardasil for women over 26 was denied until Merck completed more study.  Well, the length of time for the study has been completed and Merk has re-applied for approval for women over age 26.  Here's hoping they get it this time!
joreth: (Kitty Eyes)

Almost 6 and a half years ago, scientists injected a whole bunch of girls with the HPV vaccine, Ceravix. Now, 6.4 years later, every single one of those girls was 100% protected against HPV.

They also checked to see how many girls got sick. 8% of the girls who got vaccinated had un-related health problems following their vaccination. 10% of the girls who got the placebo had health problems following their placebo injection.

All the data points towards the vaccine's continued efficacy.

Once again, the vaccine is proved safe and effective. If we are to blame the vaccine for those 8% of girls who had unrelated health problems, then we have to blame sugar water for making 10% of the other group sick too.
joreth: (Super Tech)
So you've probably all already heard, but for those who haven't, there have been big news in women's healthcare this week.

Both the Pap Smear guidelines and mammogram guidelines have been adjusted. In both cases, they are now recommending that we don't get screened as often as we used to.

For the pap smear, they are now recommending that you don't need to start getting one until 21, and to get them every other year, not annually. The reasoning is that research suggests that younger women, even if they do get HPV, are pretty able to take care of it themselves. Even if it starts to progress to cervical dysplasia, younger women, apparently, are able to treat themselves without the need for biopsies or surgical procedures. And, women who have had surgical procedures for dysplasia have a higher incidence of premature births later on.

But, doctors and research scientists are very careful to point out that this is not a MANDATORY screening schedule. They recommend discussing with your individual doctor your individual health needs and adjusting your screening schedule accordingly. They also stress that a reduction in pap smears does not mean we should reduce how often we get tested for STDs. I, for instance, as a sexually active adult with multiple partners, who in turn have multiple partners, will continue to get screened annually and/or 3 months after the introduction of any new partners.

Now the mammogram guidelines say that we don't have to get screened until age 50 (it was previously age 40) and we can get it done every 3 years. That's a scary thought, that someone who had cancer at age 40 will now not be getting screened for it. But, once again, the experts have very clearly stated that each individual woman should discuss her own needs with her doctor and plan an INDIVIDUAL screening schedule based on risk factors. Plus, if you're doing a self breast exam, like we're all still supposed to be doing, if you find anything unusual, a doctor won't refuse to screen you just because you're under 50.

I have to admit that my knee-jerk reaction to hearing this news was negative, to put it mildly. I have had it drilled into me from before puberty that I have to be rigorous in my health standards, I have to get tested often, and I have to knock a few medical heads to get it done because the bureaucratic machine doesn't care about us and will try to whisk us through as quickly as possible, even at the expense of adequate medical care.

I'm still not sure how I feel about this. My emotions continue to rage at the idea that doctors are telling me not to worry my pretty little head about something I don't understand. But I really don't think that's what they're doing. Between social awareness of women's health issues, and the recommendation that each woman develop a personalized screening schedule based on her risk factors, I think they are legitimately trying to calm down hysteria and panic.

People are getting all up in arms over the phrase "causes anxiety" as if that was the only reason to stop screening regularly. I know that I was certainly pissed when I had doctors tell me that I didn't need to get screened for HPV or herpes because I probably already had it, so why worry about it until it actually does something? Let ME decide what I'll worry about or not and just give me my damn test, thank you very much. Even receiving a positive result is less worrisome than an unknown!

But it's not just anxiety. It's unnecessary medical procedures that go along with false positives and positives for things that the body will deal with on its own that are the problem here. Not only is it more expensive for no real gain, but it's also invasive and sometimes harmful for the body.

But we need to strike a balance between avoiding unnecessary medical procedures and catching stuff while the survival rate is still high. And as long as the guidelines continue to say, EXPLICITLY, that it does not PROHIBIT more frequent screenings, and that individual risk levels should be considered when developing a screening schedule, I can see the value of avoiding cutting into my body when my body might take care of it on its own.

Bottom line here is that I have mixed feelings about it. I'll probably write more as it plays out in real life and we see how it actually affects women's health.

joreth: (Silent Bob Headbang)

Researchers are working on a vaccine that appears to treat current, active HPV infections!

This is still in the early stages, and this study is rather small. But what it seems to do is, when a woman has vulvar lesions, treatment with this vaccine causes the lesions to stop growing and, in some cases, disappear all-together, with a few of the women showing no signs at all of HPV-16 up to 2 years after the treatment.  Although it didn't slow or get rid of the lesions for every woman, all women showed *some* immune response to the vaccine.

Says the head researcher:

"In principle, this vaccine gives an enormous stimulation of the immune response against the HPV antigens expressed in infected and transformed cells. As such, it should do the same in patients with other types of HPV-16-induced (pre-)malignancies. However, in cancer patients, other forces may work against the efficacy of this vaccine. These need to be tackled, too, in order to make the vaccine do its job,"

Since it didn't work in all cases, the research team is investigating why, so they can improve the vaccine.  This is big news, since vulvar cancer tends to be difficult to treat because it's multi-focal & recurrent (it crops up in multiple places and it keeps coming back), and, theoretically, what works for HPV-16-caused vulvar cancer should work for HPV-16-caused cancer elsewhere.  
joreth: (Kitty Eyes)
the HPV vaccine is so important for both men and women.

This is great news for people who already have tonsil cancer.  They discovered (I wrote about it before) that a significant number of people with tonsil cancer had HPV-16 in their cancer.  Now, they've discovered that cancer caused by HPV-16 responds really well to radiation WITHOUT THE NEED FOR CHEMOTHERAPY.

This greatly improves the quality of life for patients with tonsil cancer.

But if they had the vaccine, they might never have had to go through this at all.

Because smoking rates are declining, HPV as the cause of head and throat cancer is rising.  But it's also rising because of the increase in popularity of oral sex.  Pretty soon, with these two factors, HPV will be the leading cause of oral cancers in the US.

Because oral cancers are not screened as rigorously as cervical cancer is, the mortality rate for oral cancer is much higher due to not catching it as early.  This goes for men and women.

But, with the vaccine, we could reduce the numbers of head and throat cancers, along with a decline in smoking, to a very small number of people.
joreth: (Nude Drawing)
There has been some press lately about how the new screening methods were proven to be equally as effective as the old methods (namely, the pap smear).  This is causing the reconsideration of moving towards the new methods and keeping the old one.

But this study explains a little more.  

Basically, the new test, the ThinPrep, is more expensive, but apparently only equally as effective as pap smears.  But 1) the specimen is easier to scan in the lab.  2) it tests for HPV specifically, not just abnormal cells (remember, abnormal cells and cancer *can* be caused by things other than HPV).  3) It has a better failure rate.  Which means that, when the tests get screwed up less often and have to be redone less often than with pap smear specimens.

So, what this means is that the pap and the ThinPrep accurately identify cervical abnormalities about the same.  But the ThinPrep is easier to work with, checks for HPV in addition to just abnormal cells, and doesn't have to be redone as often.  This is what justifies the cost.

However, thanks to all the work being done to develop better screening processes and preventative measures, if we could just get the medical community to do the HPV test BEFORE the pap smear (instead of afterwards, to verify what the pap says), we could actually reduce our need for pap smears to once every 3 years instead of annually!

Study Examines Efficacy Of Cervical Cancer Screening Methods

29 Oct 2009

According to a study published Wednesday in the Journal of the American Medical Association, conventional Pap tests, which have been used since the 1940s, and ThinPrep, a test approved in 1996 that represents 70% of the U.S. cervical cancer market, are equally effective at detecting precancerous cells, USA Today reports. The main difference in the tests, according to USA Today, is how cells are prepared for evaluation (Rubin, USA Today, 10/28). Cells are smeared on a slide for evaluation in a traditional Pap test, while ThinPrep uses liquid-based cytology, wherein cells are rinsed in a vial of preservation solution (Reinberg, HealthDay/U.S. News & World Report, 10/27).

Study authors noted that FDA has allowed Hologic, the maker of ThinPrep, to say that the product is more effective in finding early and more advanced signs of cervical abnormalities (USA Today, 10/28). To test this assertion, the study authors randomly assigned 89,784 Dutch women to have either a traditional Pap test or a ThinPrep test (HealthDay/U.S. News & World Report, 10/27). George Sawaya, an ob-gyn at the University of California-San Francisco, said the study's findings "should serve as a cautionary tale that just because something is new doesn't mean it's better."

Mark Schiffman and Diana Solomon of the National Cancer Institute wrote in an accompanying editorial in JAMA that although ThinPrep is the more expensive alternative, it "is preferred by most laboratories because the specimen is easier and quicker to scan under the microscope."

Lead study author Albertus Siebers of the Radboud University Nijmegen Medical Centre said other factors, including the ability to use ThinPrep samples to test for human papillomavirus, have reduced the use of traditional Pap tests. In the new study, only one of 300 ThinPrep tests had to be redone, compared with one in 100 conventional Pap tests (USA Today, 10/28).

According to Schiffman, however, all types of routine Pap testing could eventually become obsolete because the ability to prevent and screen for cervical cancer is changing. He said, "We now have vaccines that are going to keep getting better, and we have HPV testing, which is even more sensitive than Pap smears." He forecasted major changes ahead for cervical cancer screening, "with the powerful sensitivity of doing HPV testing plus a Pap smear that is optimally done no more than every three years starting at age 30." However, he noted it remains to be seen whether women would accept a shift to testing every three years (HealthDay/U.S. News & World Report, 10/27).
joreth: (Silent Bob Headbang)

Gardasil OK'd to stop male genital warts
WASHINGTON, Oct. 19 (UPI) -- The U.S. Food and Drug Administration says it has approved the use of the vaccine Gardasil to prevent male genital warts due to the human papillomavirus.

The FDA said it approved Gardasil (condyloma acuminata) to stop warts caused by HPV in boys and men ages 9-26 years. Genital warts are diagnosed annually in approximately 2 of every 1,000 men in the United States, the federal agency said.

The FDA previously approved Gardasil for use in girls and women ages 9-26 for the prevention of cervical, vulvar and vaginal cancer caused by HPV, as well as pre-cancerous lesions and genital warts.

HPV is the most common sexually transmitted infection in the United States and most genital warts are caused by HPV infection.

"This vaccine is the first preventive therapy against genital warts in boys and men ages 9 through 26, and, as a result, fewer men will need to undergo treatment for genital warts," said Dr. Karen Midthun, acting director of the FDA's Center for Biologics Evaluation and Research.

Gardasil is manufactured by Merck and Company Inc. of Whitehouse Station, N.J.
joreth: (Nude Drawing)
Here is a great visual representation of the HPV vaccine, Gardasil, compared to other things, like how many people have gotten sick, what else you could die of, etc. It's not a perfect chart, some of the commenters in the original blog (click the picture to read it) have offered some suggestions on how to improve it, but it's a good snapshot of just how safe the vaccine really is.

Unfortunately, several of the commenters have jumped in with the usual BS about how we don't know anything at all about its longevity potential or how safe it *really* is in the long run, some people have provided anecdotal stories about fainting after getting the shot, and at least one person has thrown in the old line about how we're being "forced" to have unnecessary vaccines like the measels vaccine (look how few kids die of that and they make us take it anyway!), and there's the inevitable "if you just don't have sex with anyone, you won't get sick" fucktard who seems to view STDs as a moral punishment for bad behaviour.

But, aside from that, this is a great visual shorthand way of looking at HPV.  The creator of the chart has indicated that he will be updating the graphic as he is made aware of more data, but I don't know if this graphic itself will update or if we will have to view it on his blog directly, so you might want to take a peek over at he original source.

(oh, and thanks to [profile] may_dryad for the link!)

joreth: (Silent Bob Headbang)
Merk's competitor, GlaxoSmithKline has received approval for their rival HPV vaccine, Cervarix.  This is a good thing.  This is where the "free market" and "capitalism" has a place in medicine - the competition should, hopefully, drive consumer prices down to a more affordable and reasonable rate, for those of us without insurance or beyond the approved age limit for insurance coverage.
joreth: (Spank)

Beware of a new STI on the block

You've probably heard of chlamydia, may know about gonorrhoea and must be aware of HIV, but here is an STI you probably haven't heard of: mycoplasma genitalium.

What is it?

Mycoplasma genitalium (MG) is a bacteria that can be passed between sexual partners.

It was only discovered in 1980 and nobody knows how many people are infected but the bacteria has been linked to symptoms in men and women.

In men

MG is often noticed most in men. It causes inflammation of the urethra (tube through the penis) and results in pain passing urine, penile irritation and discharge.

These symptoms are similar to chlamydia - MG could be the cause when a man has symptoms but his chlamydia test is negative.

In women

It has been found to cause inflammation of the cervix (neck of the womb) and urethra in women.

It's also been found in women with pelvic inflammatory disease and may be another cause of blocked tubes and infertility.

Symptoms include a discharge, abdominal pain and pain having sex.


Little is still known about the extent of MG infection, mainly because there is no widely available test for the bacteria.

However, this is set to change over the next few years as good sensitive tests are developed for clinics to use.

Until then, MG infection has to be high on the list of things to check for men who have persistent symptoms of non-specific urethritis where the chlamydia test is negative.


MG can be successfully treated with antibiotics. If you've been treated for an infection but your symptoms haven't settled then ask your doctor about MG.

Changing your antibiotics could make all the difference.
joreth: (Misty Sleeping)

I've been holding off writing about this until the details came in. So by now, some of you may have already heard.

A 14 year old girl died shortly after receiving the HPV vaccine Cervarix in the UK. Naturally, everyone jumped on the coincidental timing and started accusing the vaccine. Article after article has gone up on the internet reiterating the same old, tired concerns about the vaccine that have been thoroughly debunked before.

Yes, there have been calls to the hotline about side effects and deaths that coincided with the vaccine. These "side effects" include "soreness at the injection site" and other things that are related to having a needle stuck in your arm, regardless of what's in the serum, or even if there is no serum at all. Dizzyness, nausea, etc., are all common side effects of having someone jam a needle into your arm or seeing or thinking about seeing your own blood.  There are a few other legitimate side effects too, but every single complaint was well within the expected (and disclosed) side effects of the HPV vaccine.

Yes, there are some actual allergic reactions to the vaccine, that range from mild to moderate (I do not have the statistics on any severe cases off-hand).  That is to be expected with any vaccine.  It's sad, but the number of cases of allergic reactions, and the response to it, are far outweighed by the number of cases of deaths and sufferers/survivors of cervical, vaginal, anal, penile, and oral cancers each year, not to mention the much larger number of people who don't develop cancer, but do develop pre-cancerous lesions and have to undergo expensive and painful procedures and years of regular follow-up testing..

Yes, there have been a couple of hundred deaths reported after taking the vaccine.  There have also been about a million or so deaths after not taking the vaccine.  Neither of these reports are related to the vaccine.  There are also several million deaths reported after taking a breath of air.

In every single case so far reported, not a single death has been confirmed to be related to the vaccine, and the VAST VAST VAST majority of them are outright proven to be not-related.  

This case, however, is a case of such tragic irony.  What killed this girl was not a cancer vaccine, but cancer.

It turns out that the poor girl had a severe, malignant tumor in her chest and she just happened to collapse a few hours after receiving the vaccine.  The autopsy reports that the vaccine had nothing to do with it.

I'm irritated that the media jumped all over the fact that she just happened to have received the vaccine several hours before her collapse.  Not a single newspaper reported that she collapsed right after eating her school lunch.  I remember school lunches.  I'd be more suspicious of them than the vaccine.

Naturally, though, Ceravix recalled the batch of vaccine that the girl had received, immediately as a precaution.  But rest assured, the vaccine is still safe.  Of course, their precautionary recall only fueled the fears that the vaccine had anything to do with it.  The recall was a perfectly reasonable and responsible reaction, even given the outcome.  But the lack of critical thinking skills of the general public and the media seemed to have prohibited them from understanding that, when you don't know what's wrong, you stop *everything* until you can find the actual problem, and you also aren't supposed to jump to conclusions - wait for the damn autopsy report!

I will say this again.  There have been SEVEN MILLION DOSES of the vaccine given in the US (yes, Gardasil is not the same as Cervarix, but Cervarix apparently has an even higher safety rating than Gardasil does).  Out of those 7 million doses, NOT A SINGLE DEATH has been attributed to the vaccine.

Frankly, I'm surprised.  There should have been at least one severe, bizarre, totally anomalous allergic reaction resulting in death by now, just by random chance.  But there hasn't been.  Not one.
joreth: (Silent Bob Headbang)
I've written about VivaGel before and I'm very excited about it.

Basically, it's a gel whose active ingredient prevents the transmission of all 4 strains of high-risk HPV that Gardasil & Cervarix do, plus another 2 strains not covered by the vaccines AND it seems to protect against HIV and Herpes!  In clinical studies, human vaginal cells were treated with the active ingredient, then introduced to HSV and HIV 1, 3, 12, and 24 hours after being treated.  It showed 100% antiviral activity up to 12 hours, and for 12 and 24 hours it showed 90% antiviral activity in more than half the women tested.  It ALSO shows contraceptive properties in animals.

Well, VivaGel has now concluded its initial human testing studies and has been found to be safe for human use. VivaGel has been awarded US$20.3 million from the US-based National Institutes of Health to develop its HIV indication. The NIH also made an additional award to develop its HSV-2 (genital herpes) indication.

VivaGel was granted Fast Track status by the US FDA in 2006 as a product for prevention of HIV infection. This designation will accelerate the clinical and regulatory development path. Their microbicide program has received further support in other areas including a US$5.4 million grant from the NIH to develop combination microbicides in collaboration with ReProtect Inc.

The human papillomavirus (HPV) will become the third disease area under investigation for VivaGel® following encouraging pre-clinical data.

Oh, and they are looking at marketing it both as a topical microbe (i.e. a lubricant and/or vaginal insert) AND as a condom coating to replace Nonoxynol 9 (N-9), which has spermicidal properties. Because of its detergent nature, N-9 has been shown to increase the risk of infection with HIV and other viruses such as HSV-2, which is why I won't use it. The company researching and manufacturing VivaGel has signed agreements with two leading condom companies to develop VivaGel as a condom coating. For regulatory reasons, the approval process for VivaGel® in this application may offer a faster route to market than the stand-alone gel.

So be on the lookout in a couple of years for products with VivaGel!
joreth: (Super Tech)
Joseph Albietz said it best in an article debunking the anti-vaxxers claim against the swine flu vaccine. His statement stands for all vaccines:

" discussing only the children who die, Dr. Mercola implies that the only benefit of vaccination is the prevention of death in the person vaccinated. People aren’t either healthy or dead. Those who survive an infection are still subject to its inherent suffering and complications. Furthermore, survivors [and/or carriers] run a high risk of spreading it to others who then share in the risk and misery. ... We do not vaccinate “to prevent perhaps 100 deaths,” we vaccinate to prevent a disease altogether, and to help the entire population avoid all of these risks."

He also says later on:

"I’ll take the opportunity to point out that pharmaceutical companies, doctors, and hospitals stand to make a lot more money from an uncontrolled pandemic than from its prevention. The money spent on antivirals, antibiotics, sedation and pain medications, physician and hospital billing for the 200,000 people hospitalized in the US during a normal flu season would compensate them far better than profits from vaccine sales. It’s almost as though, against our financial interest, all of our efforts are designed to keep people from getting sick…"

All of my journaling and ranting doesn't say it any better, any more concisely, or any clearer, than this.


Aug. 21st, 2009 08:49 pm
joreth: (Bad Computer!)

So a new study has come out studying the effects of Gardasil now that 7 million girls have had it. It turns out that out of 7 million people, only 20 have died. Out of those 20, not a single one can be conclusively connected to Gardasil and the majority of them *can* be conclusively connected to something else.

This year, 4,070 women will have died from cervical cancer.

Let me repeat that.

Over four thousand women will have died THIS YEAR of cervical cancer.

Regular pap smears keep that number as low as it is. But not everyone has access to regular health care, even with Planned Parenthood and low-income clinics. And even with screening, some cancers just can't be treated.

So let's say that Gardasil really was responsible for every single one of those deaths. You have a .0000002 chance of dying from taking the vaccine.

And yet, people are pointing towards this study and saying such stupid things as:

"no level of risk is acceptable when inoculating a healthy population against a disease that can be prevented through screening."

"I wouldn’t accept much risk of side effects at all in an 11-year-old girl, because if she gets screened when she’s older, she’ll never get cervical cancer,"

"You don’t have to die from cervical cancer if you have access to health care."

This is absolutely infuriating!  And this was from a doctor!  You ought to hear the stupid things the laypeople say about vaccines!

First of all, you are *supposed* to innoculate a healthy population.  It's what keeps them healthy.

Second, although regular screening does significantly reduce the chances of dying from cancer, and even from having pre-cancerous cells live long enough to turn into cancer, it does not, automatically, mean that you will not get cancer.  That's what vaccines do.  Screening just looks for it after you've already started developing it, hopefully in enough time to treat it.

On top of that, HPV is the cause of anal cancers, throat and mouth cancers, and has even been found in relation to skin and other cancers - none of which get screened with the regularity that pap smears are recommended.  So my number of 4 thousand women dying?  That doesn't count the numbers of people dying or suffering & surviving, from these other cancers.  

Farrah Fawcet, you know, died of HPV-related anal cancer.  I realize her death was completely overshadowed by the much more important news of Micheal Jackson's death on the same day, but that doesn't absolve this idiot doctor from making such ludicrous statements like "you don't have to die from cancer if you have access to health care".

Do you want an early-warning system that tells you when the perimeter has been breeched hopefully early enough to do something about the invaders?  Or do you want an impenetrable shield that prevents intruders from getting in at all?  Screening does not confer immunity.  Vaccines do.

Third, there is absolutely no way to predict who will have access to healthcare and regular screening services in the future.  I was raised middle-class.  I went to private school.  I grew up in the suburbs.  I lived in the 3rd most expensive city in the world to live in.  I had medical coverage under both my parent's employer-provided plans.  I had regular checkups and extensive dental work.

I am currently uninsured and unemployed.

If I want to be screened annually, I have to pay out of pocket, or I can wait, week after week, at the free clinic and hope that this week, maybe, I'll get there early enough to be seen.

Or, I could have gotten a vaccine when I had my parents' healthcare coverage (yes, I know they didn't have it when I was a kid, but this applies to kids today) and I could now spend my money on food and rent because that portion of my health has been cared for.

The US does not have the fabulous healthcare system these people want to think it does.  I don't understand why people are so opposed to giving children the opportunity to avoid, not just death by cancer, but also expensive, painful inconvenience by LEEP procedures, regular and expensive screenings, and humiliating experiences.

Even if the US *does* have fabulous healthcare, compared to other nations, not every individual has equal access to that fabulous healthcare, and there is no way to predict which children will have access to that fabulous healthcare when they need it in order to screen for the cancer that they will have to be exposed to since they weren't allowed to take a shot that gives them immunity from it.

ALL vaccines carry some risk, as do ALL treatments for ALL ailments.  Even asprin has side effects (and that was developed from a "natural" cure, let's not forget).  The reason why we continue to use any of these options is because the benefit outweighs the risk.  In some cases, the risk isn't even all that minimal, like with the case of vaccines.  Some of these treatements have SERIOUS and highly probable health risks.  Chemotherapy is no walk in the park, but the alternative is a certain death, while the therapy is a less-certain death and more certain damned-uncomfortable time.  And we continue to choose them because the benefits outweigh the risks.

The side effects from Gardasil are known, disclosed, and no different from any other vaccine.

The death toll associated with Gardasil is not only inconclusively related, but in many cases it *is* conclusively related TO OTHER THINGS.

It is utterly absurd that people continue to stand here, shouting and hand-waving and wringing their hands in fear of something that has absolutely no scientific basis in reality and, even if it were true, would STILL be far outweighed by the benefits.

Please, get vaccinated whenever possible, get educated, get screened, and get tested.

joreth: (Silent Bob Headbang)

"SALT LAKE CITY, Aug. 10, 2009 – University of Utah scientists developed a new kind of "molecular condom" to protect women from AIDS in Africa and other impoverished areas. Before sex, women would insert a vaginal gel that turns semisolid in the presence of semen, trapping AIDS virus particles in a microscopic mesh so they can't infect vaginal cells."

Dude!  I SO hope this passes the human clinical trials!

Basically, it's a gel that's inserted prior to sex that, when the pH balance of the vagina increases (this happens when semen is introduced to the vagina), a reaction happens between the polymeres in the gel that cause them to form a tight mesh that traps semen, HIV and possibly other viruses!  This then prevents the HIV from attaching itself to vaginal tissue, which prevents a woman from acquiring HIV even if she's been exposed to it.  Even at lower pH levels, the gel slows down the movement of HIV.

"After sex, the vagina gradually becomes acidic again, and any residual HIV particles would be inactivated both by acidity and an antiviral drug within the remaining gel, which still impedes HIV to some extent at normal vaginal acidity."

These findings will be published in a peer-reviewed journal later this week and will hopefully begin human clinical trials in 3 to 5 years, with marketing the gel for public use (pending favorable outcome of human testing) just a few years after that.

This will be first marketed towards women in Africa and other impoverished areas because women have so little power in their own reproductive and sexual functions.  Not surprisingly, it's awfully hard to stop the spread of HIV when your male partner refuses to wear a condom and you have no ability to refuse him sex.  So, although HIV is a big deal here in the US, the most important step is to stop the spread at its source.  

So I really hope the human trials go well.  In the past, microbials have had a hard time making it through the human stage because, as this article says, either it doesn't work inside actual humans, or the humans don't bother to use it (or use it properly) so accurate data is not available.

Someday we'll eradicate this and other plagues and today we are one step closer to that goal.
joreth: (Silent Bob Headbang)
First, the obviously-good article:

HPV Vaccine Success - 8 Years and Counting
by Angela Bowen

A lot of controversy exists over the Gardasil® vaccine for human papilloma virus (HPV) approved for women 9-26 to prevent cancer causing HPV strains 16 and 18, and genital wart causing strains 6 and 11. In 2002, at age 19, I myself received the vaccine as part of the human clinical trial for approval by the FDA.

Studies are now available after presentation at the 25th International Papilomavirus Conference in Sweden with more than 8 years of data collection highlighting very encouraging results. Not only have the majority of women vaccinated remained protected, but the number of procedures for abnormal Pap tests have been greatly reduced. Data of a subset of over 9,500 women were analyzed in the results presented. The original combined studies for approval of the vaccine were participated in by over 17,000 women.

There is great controversy on how and when to use the vaccine in young women. Here are some links for facts concerning HPV and recommendations for use.

The vaccine is recommended for girls aged 11-13 but approved for use in girls as young as 9 and as old as 26. For some, this seems like a very young age to vaccinate for a primarily sexually transmitted disease, and hopefully, this is correct. However, by the age of 15, 26% of girls in the United States have had sexual intercourse and by age 18 that number has increased to 70%. An additional 11% have had oral or non penetrative sexual contact. HPV does not require sexual penetration to be passed, nor are condoms entirely effective in preventing HPV.

The Good News for the Vaccine

HPV 16 Follow-up

No vaccinated women were infected with HPV 16 or HPV 16 related cervical lesions.
6 unvaccinated women had HPV 16 infection and 3 developed related cervical lesions.
The combined treatment length (1998-2004) and follow up (2006-2008) yielded similar tracked results.
1 vaccinated woman developed HPV 16 infection but did not develop related cervical lesions.
21 unvaccinated women developed HPV 16 infection and 8 developed related cervical lesions.

Breaking down these numbers into simple percents based on the women participating:

0.3% developed HPV 16 infection.
0.0% developed HPV 16 related cervical lesions

7.2% developed HPV 16 infection
2.8% developed HPV 16 related cervical lesions

Strain 16 of the HPV virus is regarded as the most virulent strain and accounts for the greatest number of illnesses and abnormalities. Additional information is now available indicating a reduction in the number of medical interventions resulting from HPV illnesses and pre-cancerous lesions in women who have been vaccinated.

And second, an article that might sound like bad news on the face, but is actually good news:

Does HPV Cause Lung Cancer as Well as Cervical Cancer
Tuesday July 21, 2009

Does HPV (human papilloma virus) – the virus we know to be responsible for most cases of cervical cancer – cause lung cancer?
Human Papilloma Virus (HPV), National Cancer Institute

The answer is – it may.

As many of us grow weary of the controversy over the HPV vaccine, we now have another variable thrown into the expanding equation. According to the authors of a study published in the journal Lung Cancer, HPV may even be the 2nd most important cause of lung cancer after smoking.
How did they come to that conclusion?

As the link between HPV and cervical cancer was discovered by finding HPV in cervical cancer cells, HPV has been found in roughly 20-25% of lung cancers in the United States. Whether this frames HPV as a cause of lung cancer, however, is another question. People with lung cancer are more likely to use oxygen than the general public, yet nobody would theorize that oxygen causes lung cancer. But it is a question we need to look at very closely.

According to current thought, HPV most likely works as a cofactor in the development of lung cancer, that is, something that works together with another risk factor such as smoking or radon to cause cancer. If this turns out to be the case, learning about HPV prevention might be something we need to add to our efforts to prevent lung cancer in the future.

Read more about HPV and lung cancer:

Now, before anyone freaks out, remember, this article is GOOD NEWS.  First, we don't know that HPV *causes* lung cancer, just that it's been found in lung cancer cells.  This is not the first article I've read on the subject, and I've also seen other articles about a discovery of HPV found in skin cancer cells.  What seems to be the more popular theory is that the presence of HPV might encourage the development of a cancer that is already present or lower the body's ability to fight a cancer caused by another factor.

Second, the rate of lung cancer has not gone up with this discovery.  The chances of lung cancer are the same as they've always been, and the overwhelming cause is still smoking.  Roughly 80% of lung cancer cases still don't have any HPV, so not smoking is still the best way to avoid getting lung cancer.

And third, the real reason why this is Good News is that this is yet one more bit of information that will be used to combat cancer.  Now that we know there is a portion of lung cancer cases that have HPV present, we can learn what the HPV has to do with it and that might give us additional tools for combating it.  If it turns out that the HPV encourages the cancer growth, for instance, then knowing to look for HPV, and then finding it, means we can treat the HPV in order to prevent a relapse or to enable treatments to work that might otherwise have not worked and we had no idea why a treatment wouldn't work on some patients and not others.

So, remember, this is not cause for panic.  Smoking is still the number one cause of lung cancer, and the cases of lung cancer have not increased with this discovery.  This discovery means we have a better chance when treating lung cancer in the future, and this is GOOD NEWS!

So start encouraging your personal physicians to do the HPV DNA test when they give you a pap smear, get checked regularly, and pay attention to your diet and excercize routine.  If you have the money for it, ask for the vaccine, off-label if necessary, and keep up with your metamours' health records.

As to that, I re-recommend Google Health, a resource that allows you to organize all your medical records into one place, that allows your doctors to access all your records even if you change doctors or health plans so you don't have to re-take tests when your doctor can't get your records from your old doctor, allows your pharmacy to keep track of your prescriptions, keeps up with your medications to automatically detect possible conflicts, AND lets you share your profile with other individuals, such as partners, metamours, and Emergency Contact people.

joreth: (Nude Drawing)
Here is a hip hop song about safe sex that doesn't fall into the abstinence-only / promiscuity dichotomy. It's refreshing to see popular media take the stance that sex is good and fun and enjoyable, but we should be responsible at the same time.

joreth: (Super Tech)
With billboards and commercials aimed at low-income populations to try and correct some of their low-income problems, it surprises me how few people know that vasectomies are available for a reasonable price.

One of the many, many problems contributing to poverty is the difficulty in regulating the size of the family. When people don't have money for healthcare, people don't know how to control the size of their families, and in a post-agricultural society, children are no longer assets, but liabilities.

So it benefits both the individual family and the governmental agencies aimed at providing assistance (and therefore the taxpayers who contribute) to offer low-cost options to help limit procreation. This is why Planned Parenthood just gives out condoms for free (preventing disease follows the same benefits).

But female sterilization is complicated and expensive because of the intrusive nature of the surgery.

Male sterilization is much more simple, easier on the patient and the doctor, and cheaper. Plus, a single male can produce more offspring than a single female. So it should be obvious that it is in the government's best interest to offer low-cost/free vasectomies.

And, coincidentally, the government health agencies and other socially-conscious agencies agree!

So I'm posting a few links to a few resources here in the Orlando area for low-cost vasectomy options, much like I have posted in the past for low-cost STD testing options. For people who are not in the Orlando area, hopefully this will at least make people aware of the option and do some research in their own areas. - $490 no-needle, no-scalpel - $350 - $1000 depending on local Planned Parenthood office, plus many offer cost on a sliding-scale. - I can't find cost info at the website, but I did send an email asking for more information.  However, the county also offers vasectomy services and they're typically low-cost because that's their target audience.  I'll update that when I get a response.

So, there ya go men, it's cheaper, simpler, and safer for men to get vasectomies and there are low-cost options available everywhere.  And if $500 is a steep price to pay, I'm going to suggest that the cost of an abortion or raising an unplanned kid isn't any cheaper (for the record, an abortion in Orlando costs roughly $450 or more and is only available at 2 locations).

Of course, vasectomies are not the answer for everyone.  Most people want to have children someday, just not today, and there are lots of temporary preventative measures available that I'll be happy to talk about elsewhere. 

But, for the men who are done having children or who never want to have children, a vasectomy is a pretty reliable method that a person only has to do once and he never has to worry about it breaking or whether his female partner is keeping up with her method of birth control.

**Some of you may have noticed that I tagged this with my STI tag.  Of course, pregnancy isn't an infection, but I'm pretty firmly on the position that an unwanted parasite could fall under the umbrella of sexually-transmitted illnesses for the practical purposes of Things To Avoid That Are Caused By Sex and is usually included in safe-sex agreements, the likes of which include things like "don't bring anything home that you can't take back"**
joreth: (Misty in Box)
I have some Constant Readers out there who share their lives with animals, hence today's postings about dogs and horses.

Apparently, horses can catch HPV. It's known as aural plaques and is spread to them through biting flies and affects their ears (the link has a picture). It is extremely resistent to treatment and causes some horses to become very head-shy and difficult to bridle.

But in a recent study, doctors used 5% strength imiquimod cream (marketed as Aldera) to treat aural plaques (which is typically used on humans to treat HPV warts) on 16 horses and the lesions cleared up on all 16 horses.  They were treated 3 times a week on alternate weeks for 6 weeks to 8 months and the lesions only returned on 2 horses after 12 months.

Unfortunately, it's expensive.  A 2-month supply costs $250.  The horses ears became sensitive during treatment and they didn't like the crusties scraped off, and the cream caused an inflamatory response.  However, after treatment, the horses' whose ears were bothering them before treatment all improved, got less head-shy, less ear-sensitive, and easier to bridle.  

Says one doctor, "Luckily they seem to forgive us!"


April 2019



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