Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 37, Number 2, June 2005
FYI


THE MEDIUM MUDDLES THE MESSAGE

Confusion about the relationship between emergency contraception and medical abortion plays a substantial role in debates about emergency contraception. The media, it turns out, are not helping.1 In a review of newspaper coverage that mentioned both emergency contraception and medical abortion between 1992 and 2002, researchers found at least one inaccuracy in 45% of the 1,077 articles sampled: Nearly one-third inaccurately differentiated emergency contraception's and medical abortion's mode of action, and about one in 10 used terms that blurred the distinction. Some articles "were so muddled that they were indecipherable." Half of the articles explicitly compared the two modes of action; of these, 52% contained only inaccurate statements, 32% only accurate statements, and 16% both accurate and inaccurate ones. The bulk of inaccurate statements appeared in letters (64%) or were attributed to activist or religious individuals or groups (78%). The researchers stress that inaccuracies about emergency contraception in the media "should not be underestimated" and that "providing consistent and accurate information should be a priority" in the debate regarding its over-the-counter status.

1. Pruitt SL and Mullen PD, Contraception or abortion? inaccurate descriptions of emergency contraception in newspaper articles, 1992–2002, Contraception, 2005, 71(1):14–21.

ABORTION NOT TAUGHT HERE

Medical students in the United States who wish to receive abortion education may have a hard time finding it.1 Of the 62% of accredited U.S. medical schools represented in a 2003 survey, four in 10 do not offer formal education on abortion during the preclinical years, and one-quarter do not offer it to third-year students doing clinical rotations in obstetrics and gynecology. The most commonly offered type of instruction on abortion for preclinical students is lectures in which abortion is mentioned (reported by 22% of respondents); lectures about abortion come in a close second (19%). For third-year students, clinical experience is the most frequently offered type of abortion education (45%). Half of the schools offer a reproductive health elective for fourth-year students, but few students enroll. The researchers contend that even if physicians do not wish to provide abortions, they should be adequately trained to ensure that they understand the procedures and possible complications.

1. Espey E et al., Abortion education in medical schools: a national survey, American Journal of Obstetrics and Gynecology, 2005, 192(2):640–643.

STD TEST JUST A CLICK AWAY

With the number of early syphilis cases in San Francisco skyrocketing (mainly among men who have sex with men), the city's public health department and a community-based organization have developed an innovative way to offer confidential testing and treatment; pretty much all a person needs is a computer and Internet access.1 The service, launched in June 2003, allows area residents to submit an online request for a syphilis test, which is then ordered by a licensed physician. The individual goes to a participating lab to have blood drawn and receives the test results, which are tagged with an anonymous ID number, online. If the test result is positive, the individual is directed to a Web page containing information about syphilis and its treatment, and is informed that a city public health staff person will be in touch to discuss appropriate care. During the service's first year of operation, 218 tests were performed, and 3% detected syphilis infections. The proportion identifying early syphilis (2%) was similar to that at a municipal STD clinic and at a gay men's health center.

1. Levine DK, Scott KC and Klausner JD, Online syphilis testing—confidential and convenient, Sexually Transmitted Diseases, 2005, 32(2):139–141.

ABORTION SUPPORT SLIPPING

The proportion of Americans who support Roe v. Wade declined from 57% in 1998 to 52% in February of this year, results of an online Harris poll indicate.1 Meanwhile, the proportion who oppose the decision rose from 41% to 47%, its highest level in 20 years. A bare majority—51%—of U.S. adults consider themselves prochoice, while 44% say they are prolife and 5% put themselves in neither category. In 1992, when Harris first asked this question, 58% of respondents identified themselves as prochoice and 35% as prolife. Only 23% favor permitting abortion in all circumstances, 55% think it should be permitted in some situations and 21% believe that it should be banned altogether; these proportions have changed little over the years. Support for tightening restrictions on abortion rose from 34% to 42% between 1992 and 2005, while support for easing restrictions fell from 18% to 13%. As in 1998, about three in five Americans today believe that abortion should be legal during the first three months of pregnancy, one-quarter during the next three months and one in 10 during the last trimester.

1. The Harris Poll, Majority back Roe v. Wade, but U.S. opposition is rising, The Wall Street Journal Online, Mar. 3, 2005, <http://online.wsj.com/article_print?0,,SB11096981145667170,00html>, accessed Mar. 3, 2005.

THE HUMAN COSTS OF SEX

Although most adverse health outcomes of sexual behavior are preventable, sexual activity takes a tremendous toll on the health and lives of Americans.1 In 1998, analysts from the Centers for Disease Control and Prevention estimate, 20 million adverse health events and 30,000 deaths were attributable to sexual behavior. Six percent of disability-adjusted life years (a measure that adds loss of life years caused by premature death and loss of healthy life due to illness and disability) among Americans were related to sexual behavior. Women accounted for the majority of adverse health outcomes (62%) and disability-adjusted life years (57%); curable infections and their effects were the primary factors in sex-related disease and disability among women. Most deaths attributable to sexual activity (66%) were among men; HIV accounted for 90% of sex-related mortality among men. Noting that these estimates "probably reflect the lower bound" of the public health burden of sex-related disease, the analysts stress the need for "greater emphasis on the design and implementation" of risk reduction interventions.

1. Ebrahim SH, McKenna MT and Marks JS, Sexual behaviour: related adverse health burden in the United States, Sexually Transmitted Infections, 2005, 81(1):38–40.

PARENTS SAY YES TO VACCINE

Parents surveyed in a clinic-based study generally said that if an STD vaccine were available, they would be willing to have their child vaccinated, regardless of the child's age or sex.1 The 278 participants, who were parents of 12–17-year-olds, were asked to indicate, on a scale of 0–100, the likelihood that they would let their child receive nine hypothetical vaccinations. Each vaccination was defined by the infection's mode of transmission (sexual or other) and potential severity (chronic, curable or fatal), the vaccine's efficacy (50–90%) and the availability of behavioral methods of prevention. Mean acceptance scores ranged from 75 to 89, averaging 81, and did not differ between STD and other vaccines. Parents expressed a "clear and strong preference" for vaccines that prevented potentially fatal infections and that were 90% effective; they also had a slight preference for vaccines targeting infections that could not be prevented by behavioral interventions. The researchers observe that adolescent health care providers may underestimate parents' willingness to have teenagers vaccinated; if these findings are confirmed in larger studies, they conclude, it will be necessary to inform these providers of parents' openness to STD vaccination.

1. Zimet GD et al., Parental attitudes about sexually transmitted infection vaccination for their adolescent children, Archives of Pediatrics and Adolescent Medicine, 2005, 159(2):132–137.

MORE PREVENTION LATITUDE

In late January, the federal government approved the use of antiretroviral drugs to prevent HIV infection in people who have been exposed to the virus in nonoccupational settings.1 Prophylactic use of such drugs has been recommended since 1996 for health care workers exposed to HIV on the job; however, until a recent, extensive review of the literature, the government was not persuaded that the benefits outweigh the risks for individuals exposed through situations such as sexual assault, a nonoccupational needlestick or an occasional failure to practice safer sex. Guidelines available on the Web site of the Centers for Disease Control and Prevention (CDC) provide an algorithm for clinicians to use to determine if an individual's risk is sufficient to warrant treatment; they also suggest specific drugs to prescribe for a 28-day regimen beginning within 72 hours after exposure. The CDC emphasizes that prophylactic antiretroviral treatment should be reserved for individuals who have been exposed to substantial risk and is "not meant to be a substitute for primary prevention practices."

1. Voelker R, Preventive antiretroviral use expands: approved for HIV exposure outside of work settings, Journal of the American Medical Association, 2005, 293(10):1177–1178.

PRESUMED KNOWLEDGEIS NOT POWER

Male teenagers who think that they know more about condoms than they do are at risk of not using them.1 In a sample of 404 males aged 15–17 participating in the National Longitudinal Study of Adolescent Health, the proportions correctly answering five questions about condoms ranged from only 53% to 82%. The proportions who were moderately or very confident that their answers were correct, however, ranged from 66% to 86%. Respondents expressed the greatest level of confidence in their answers to a question regarding the need to leave space at the tip of the condom—the one that the smallest proportion got right. In multivariate analyses, teenagers whose actual knowledge was poor but who perceived it to be good had significantly reduced odds of having used a condom at first intercourse (odds ratio, 0.4); the same was not true for adolescents who underestimated their condom knowledge. The analysts conclude that "programs that target perceived knowledge, in addition to objective knowledge, may produce more successful outcomes" than those focusing exclusively on the acquisition of knowledge.

1. Rock EM et al., A rose by any other name? objective knowledge, perceived knowledge, and adolescent male condom use, Pediatrics, 2005, 115(3):667– 672.

THE CHURCH'S HOLY WAR

A new society of Catholic priests has been established for the purpose of aggressively fighting to end abortion.1 Beginning this fall, the society will train priests and seminarians to use a variety of strategies to advance its cause, including voter registration drives, political lobbying and demonstrating outside facilities that provide services. Members of the society also will "bring healing and forgiveness" to women who have had abortions and will counsel those who are considering terminating a pregnancy. Although the Texas-based society will be privately funded, it has the Vatican's blessing. The society's founder believes that its mission will draw men to the priesthood because eliminating abortion is so important a cause to so many people. While focusing primarily on abortion, the society also will address euthanasia, the death penalty and other aspects of what it views as today's "culture of death."

1. Gold S, New order of Catholic priests is forming to fight abortions, Los Angeles Times, Mar. 31, 2005, <http://www.latimes.com/news/printedition/la-na-abortion31mar31,1, 4552206.story?ctrack=1&cset=true>, accessed Apr. 1, 2005.