Mandating Tests for Sex Workers Doesn't Get a Passing Grade

Often when I engage in conversations with folks about sex work and public policy, I'm asked how I feel about mandatory testing of sex workers for sexually transmitted infections (STIs). And, when I answer that I don't support such measures, they're frequently astonished. "I thought you said that you support harm reduction methods! So why not this? Wouldn't requiring sex workers to be regularly tested reduce the spread of HIV and other STIs?"

No. Testing doesn't "prevent" anything. It provides information towards that end, and only if it's done right.

Let's take the argument for mandatory testing to its logical extreme. Sex workers are a relatively small segment of the total number of sexually active people out there, and according to the best studies out there, contribute very little to STIs overall, and virtually none of HIV transmissions. So if we were to mandate STI testing, then it makes sense to do that for all sexually active adults and adolescents, not just sex workers. Of course, it's reasonable to assume that a significant number of people would lie about being sexually active, in order to avoid being tested. The answer then would be to test everyone from the age of thirteen up.

This would, of course, be met with a number of objections, from cost to loss of freedom to invasions of privacy. And yet, some would still argue that, since STIs constitute an "occupational hazard" for sex workers, then mandatory testing therefore qualifies as an occupational health and safety measure.

But again, this doesn't make sense when applied to comparable circumstances. Hospital workers, for example, are exposed to far more diseases, some of them far more dangerous, and far more often. Yet hospitals do not regularly test every employee for every disease they might have been exposed to. Instead, they find it more effective to implement preventative measures, much as full-service sex workers use condoms and other safer sex measures to reduce the risk of contracting HIV or other infections.

There's also the question of how such measures are best mandated and enforced. More often, they are mandated as a condition of employment rather than by legal regulation; even when laws or government regulations are put in place, it is usually left to employers to maintain and enforce, with government agencies making spot checks or responding to employee complaints. Also, the most effective systems are when lawmakers institute a general mandate to assure health and safety, while leaving specifics to another body which may adapt more quickly to changes in evidence as to the best means of assuring this.

An example of which I'm personally aware is cardiopulmonary resuscitation (CPR). I've been trained and recertified many times over the years, and have noticed how the protocols change as new evidence comes in, most significantly the use of an automated external defibrillator (AED). While there are laws determining who may train and certify people, those laws do not specify the protocols for performing CPR; instead, the groups that train and certify pay attention to new scientific data, and update protocols accordingly.

Compare that system to how Nevada mandates STI testing for sex workers in their legal brothels. The Centers for Disease Control and Prevention recommend that people with multiple sexual partners should be screened every three to six months, based on the best available medical studies; more frequent tests do not produce more reliable results. Nevada's legal requirements, relatively unchanged since 1937, are that women working in brothels are required to weekly medical exams, and at their own expense. With consistent condom usage, and STI rates reported at zero, where is the sense in having sex workers required to be tested at thirteen times the rate recommended by public health officials?

There is no good reason to impose such a requirement on sex workers when other people in similar circumstances are not similarly required. To impose such a burden is nothing more than discrimination, rooted in stigma and unnecessarily perpetuating it. Sex workers have long known how to minimize these risks, as proven by empirical studies. They need neither bureaucrats nor moralists to require anything further. If anything, the rest of us would benefit from listening to their collective experience.

Catholics, Condoms and Confusion

So Pope Benedict XVI has said - finally - that he could see some cases where condom use to prevent the spread of HIV as being morally permissible. A small step, but in the minds of many folks (including many Catholics) definitely a step in the right direction.

Here's where the confusion comes in: The Vatican is insisting that this does not represent a change in Catholic teaching on condom use.

Uno momento. For decades now, popes have been saying "no" to condoms. Even if you're married and preventing the spread of HIV. Absolute rule, no exceptions. Then the current pope says he can see where, in certain cases, it's a good thing. That's not a change?

Well, according to the Associated Press report...

The Holy See's chief spokesman, the Rev. Federico Lombardi, stressed that Benedict was not "morally justifying" the unbridled exercise of sexuality and the church's main advice in the fight against AIDS remains the same: promoting sexual abstinence and fidelity among married couples.

The logic, apparently, is that since the Vatican is still stressing abstinence and monogamy, then its fundamental teaching hasn't changed. Except for one thing: An even more fundamental aspect of the church's moral philosophy has changed.

Originally, the leadership of the Catholic church adhered to absolutism - there is only one morally correct answer, and no deviation is allowed. And that's been the Vatican's problem in terms of being able to adapt to new facts and realities: absolutism allows no exceptions. As soon as you allow an exception, for whatever reason, you're no longer absolutist.

As soon as the Pope said that condoms can be used in certain circumstances, even very narrow ones, then he crossed the line from absolutism to contextualism. So, in a sense, this is representing a shift in Catholic teaching. Maybe Benedict and the other Cardinals are just too stubborn to admit it.

Well, it should be obvious to anyone who reads this blog that I consider it a welcome change. If the Catholic church is indeed going to stand for life, then they need to take the realities of life into account. And if this small step helps them to do that, we should applaud and support it.

The Dangers of Erotic Choking

It started with an email from a mother, frantically worried about her daughter. Since then, in the past few weeks I’ve been contacted by several people on the subject. Yesterday, I met with a group of teens and young adults, worried and wanting more information about one of the riskiest forms of sex play.

The technical term is erotic asphyxiation – the practice of restricting either breathing or blood flow to the brain to enhance sexual pleasure, either alone or with another. The very idea scares people, even to the point of silence. Unfortunately, silence can also be deadly.

I had not intended to address this topic, as many others had done so before (such as Jay Wiseman's well-known article) especially after the recent death of actor David Carradine (as Gloria Brame has done). But given the requests of the past few weeks, and the amount of myths and misconceptions I've heard, it's clear we need more people speaking out and informing people about the real risks involved.

First, we need to understand the attraction of erotic choking. When oxygen levels to the brain are reduced (hypoxia) it can lead to a momentary feeling of euphoria. Combine that with the powerful pleasure of orgasm, and you can see why some would find it addictive. But there’s much more to it. There’s the thrill of risk, and the connection of trusting another with your very life. As one young woman tried to explain to me: “It’s so intense, so on the edge, it feels beyond being in love.”

The problem, of course, is the risk inherent in the practice. Whether restricting breathing or applying pressure to blood vessels, robbing the brain of oxygen can lead to severe consequences. Even if the person doesn’t pass out, a relative lack of oxygen can cause some neurological damage, which can accumulate with repetition. It also changes blood chemistry in a way which can lead to a heart attack. Pressure or even a sudden grab on the throat can trigger the vagus nerve to send signals to the heart, causing it to slow down or even stop. And, worst of all, there is no way to predict when any of this might happen. There have even been cases of individuals who initially seemed to have no ill effects from being “playfully” choked, only to suffer cardiac arrest hours later.

We all desire pleasure and connection, and I can understand when some feel compelled to pursue forms “so intense, so on the edge.” Unfortunately with breath play, there’s no real way to keep from falling over the edge completely. So, if you’re thinking of doing this, please think again. And if you know someone who might be doing so, don’t be afraid to share your concerns with them.

O, Canada: Sex Toys Can (and Should) be Healthy

When it comes to sexuality issues, our neighbors to the north are often much more pragmatic and far-sighted than many here in the States. Not uniformly or across the board, mind you, but there's a lot to be said for a country where same-sex marriage became legal not only much sooner but with much less brouhaha.

Let's hope the same can be said about healthy sex toys.

That's right. According to this article, two Toronto sisters who co-own an eco-friendly erotic boutique (talk about a niche market) decided to contact a member of the Canadian Parliament about the presence of high-risk chemicals in certain vibrators, dildoes and other sexy insertables. And Dr. Carolyn Bennett, the Liberal MP and a medical doctor, not only listened but composed her own letter to Leona Aglukkaq, Canada's Minister of Health, about "the urgent need for responsible regulation in the adult toy industry."

And keep in mind, we're not talking about making it illegal to sell a dildo or vibrator, or own more than a certain number. We're talking about making sure the materials they're made from don't have adverse effects on your health.

Many "jelly" toys, for example, have incredibly high levels of phthalates -- chemical compounds used to soften plastics, and which have been linked to both cancers and hormonal disruption. While governments consider six parts per billion as "safe" levels for phthalates in the majority of consumer items, a German chemist in 2000 found jelly sex toys with levels as high as 243,000 parts per million. Do the math.

If you're Canadian, please write to Ms. Aglukkaq and urge her to act on Dr. Bennett's recommendation. Her address:

The Honourable Leona Aglukkaq, P.C., M.P.
Health Canada
Brooke Claxton Building, Tunney's Pasture
Postal Locator: 0906C
Ottawa, Ontario K1A 0K9

For us down here in the US, it's a lot more tricky. But there are some things you can do:

* Become an educated sex toy consumer, and share your knowledge with others.
* Shop at retailers that stress healthy and eco-friendly products.
* Write to public officials about the need for health and safety regulations for sex toys.
* Raise the issue with women's health and environmental organizations.

We consider it sensible to make sure all sorts of commercial goods are safe to use. It's time erotic goods fit the same expectations.

The Last Abortion on Earth

Recently on an online discussion, someone brought up the following for discussion...

Practitioners who counsel women seeking abortions do an exercise called "the last abortion." The participants choose one woman among six who will be allowed to receive the last abortion on earth. It is an exercise in individual ethics and forces one to confront her own prejudices. There is an orphaned teenager, a victim of rape, a woman carrying a medically deformed fetus, a 46-year-old woman with HIV, a 12-year-old, and a graduate student who wants to finish her Ph.D. They all have good reasons, because all the reasons are theirs. And in the end, that is the answer: All the reasons are theirs.

If you were the chooser -- what would be your choice?

The fellow who put this on the table proceeded to state why his particular choice was the "right" one. But in my mind, that misses the whole point of the exercise -- and what makes it so difficult.

The issue is not simply which woman is more deserving, or which fetus is less viable. It is who makes the choice -- and that is what governed my answer.

I would rather have the women meet in a room, explain what needs to be done, provide them all of the information they would need and want, from medical data to possible future outcome, and let them discuss and decide for themselves. And while I'd prefer it to be by consensus, such a decision should also be made by the women themselves, not me or anyone else.

Yes, it would be difficult to have these women look into their hearts and decide whether or not a given pregnancy will come to term, and what to do afterwards. But, then again, that's the difficulty which each and every woman with a crisis pregnancy faces every day.

Something we should strive to remember whenever this debate comes around yet again.

A Minister of Sexuality? Yes!

I was reading Debra Haffner's latest post from her excellent blog* when something caught my eye. Among the progressive faith leaders joining her in a meeting with White House officials, the United Church of Christ sent Ann Hanson, Minister of Sexuality Education and Justice.

A minister of sexuality?

Absolutely! It's not just that sexuality is an integral part of our lives, with an important spiritual connection. It is that so many religious leaders have either neglected it, or even downright sabotaged it.

Liberals included. So many of us have presumed that being religious liberals means not having hangups about sex, so we don't really need to talk about it. Well, as the Gershwin song says: "It ain't necessarily so." To wit: In response to the Sacred Eros program at Arlington Street Church, I get a lot of contacts from people at other UU congregations because they don't feel comfortable bringing up sexuality with their own ministers.

So yes, we Unitarian Universalists need a minister of sexuality. We need someone who can educate, support, persuade and even cajole other ministers and leaders to address this vital part of our lives.

So if you're a fellow UU reading this post, please consider writing to UUA president Reverend Peter Morales, and putting this proposal to him. With the damage done by "abstinence-only" programs, pervasive homophobia and anti-choice rhetoric and violence, our denomination needs someone who can speak truth to power on these issues, both to the outside world and within our faith movement.

What better way for us to stand on the side of love.

* = If you have not subscribed to Debra's blog, "Sexuality and Religion: What's the Connection?", join me in doing so. She provides great information and insight on these important issues.

Abortion and the Health Care Debate

I was listening to a news program interview on health care, and the host asked both guests (one from the Obama administration, another from the GOP) whether a Federally funded health care scheme should use taxpayer money for abortion.

I have a simple answer: Yes.

Abortion is a legal medical procedure. If we're going to refuse coverage for it, what other legal procedures should we also refuse to fund? And on what grounds?

Many people have religious objections to abortion, and that they should not have their taxes used to fund something which goes against their beliefs. Should we also oppose funding blood transfusions, out of respect for Jehovah's Witnesses? Should we oppose funding psychiatric treatment because it goes against Scientology?

The main argument is that abortion involves the taking of a human life, and therefore should not be financed with taxpayer money. I'd love it if our government never paid to have a life taken -- but we already do. Every casualty of war, every suspect shot by police, and every murderer executed, is paid for by tax dollars. Should we give people the option to check off on their income tax forms that they don't want their share of the tax pool to go to these activities?

My question for those who oppose funding abortion: What is your alternative? So many who oppose funding abortion are also opposed to funding contraception, comprehensive sex education, child care for single mothers and so forth, one has to wonder what practical policies they would favor -- or even if they do.

In the end, the more important question is making sure that every American can get the health care they need. The choice of which procedures to have should be left to patients, in consultation with their health care providers. And if those opposed to abortion do not want it chosen, then they should be willing to make as many alternatives as possible available to all, and especially those options which would prevent unwanted pregnancy and abortion to begin with.

I can't think of anything more ethical -- or more American -- than giving every person the power to choose how best to deal with their family's health, even if the choices they make may not be mine, or my choices theirs.

Vexed About Viagra

Every time I see a commercial for Viagra (sildenafil citrate) or other "erectile dysfunction" medications, I grumble. It's not just the side effects and drug interactions, but how the "quick fix" promised by these medications have set back men's sexual health.

Before Pfizer put Viagra on the market, doctors began treatment for erectile dysfunction by determining the cause -- psychological, physiological, or a mix of the two. Often the most common causes are (a) performance anxiety, (b) substance abuse including nicotine, (b) other lifestyle issues such as diet or stress, or (c) diseases affecting blood flow or the nervous system. Since most of these cause being treatable, that means that lots of cases of erectile dysfunction can be successfully treated, and even cured, without the need for special medications. One physician I'm acquainted with informed me that the top three prescriptions he'd give for erectile dysfunction were aerobic exercise, cut back on booze, and quit smoking.

Viagra originally was being developed as a possible treatment for high blood pressure and angina. Wasn't successful for that, but it was found to help men obtain and maintain erections where other treatments had not worked, due to irreversible nerve or blood vessel damage. Prior to that, there weren't many options for such cases. So, given the choice between having an implant put in surgically, or simply taking a pill ... well, you get the idea.

Problem is that Viagra became so successful -- especially with Pfizer's marketing campaign -- that pretty soon it became the treatment of choice. But what about the other treatment options? Well, why bother with changing your lifestyle or treating other underlying causes, when all you have to do is pop a pill? And with the Internet providing Viagra from overseas, without a prescription, why bother even seeing a doctor?

So you can see why I grumble. Too many men are getting these medications, without regard for what's causing their problems in the first place -- kind of like treating every overweight person with diet pills. A good parallel, hm?

The more I read about erectile dysfunction, the more I see it as a symptom more than as a disease unto itself. Likewise it seems this rush to treat so many of our problems with a quick fix -- whether in pill form or some other manifestation -- is part of a larger spiritual problem. We live in a consumer culture which tells us in so many ways that all our troubles can be solved by just buying the right kind of stuff.

Even religious leaders have fallen prey to this idolatry. How many ministries offer "free gifts" in exchange for a donation -- essentially selling stuff to raise money? How many "abstinence-only" programs have been packaged and marketed to schools nationwide, promising a quick fix to the problems of teen pregnancy and STDs? How many congregations focus on "growth plans" like they were a business needing to recruit new customers?

And how strange that both sexuality and spirituality are linked to something priceless which our world needs so much: Love. Think of the world we could create if we closed our wallets and purses, and opened our hearts and minds.