A new report commissioned by the Center for Health and Gender Equity (CHANGE) blames “bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms” for delaying the expansion of U.S.-funded female condom distribution efforts.

But the biggest deterrent — for both male and female condoms — lies within U.S. global policy concerning HIV prevention.

The report, “Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid,” takes to task the U.S. Office of the Global AIDS Coordinator, which prioritizes condom promotion programs under the President’s Emergency Plan for AIDS Relief (PEPFAR) only for “high-risk persons.”

Also damaging is the congressionally mandated requirement that PEPFAR spend 33 percent of all HIV prevention funds on abstinence-until-marriage programs, which funnel money toward programs that only promote abstinence and fidelity as means of preventing HIV.

Congress reauthorized PEPFAR earlier this month. Policy and news updates are available through PEPFAR Watch, also sponsored by CHANGE.

“Saving Lives Now” is available for free at PreventionNow.net (download PDF), a global campaign to expand access to female condoms. CHANGE and its U.S. partners work with existing female condom campaigns in other countries such as Argentina, Ghana, and Zambia.

Female condoms account for just 0.2 percent of total global condom supply. The report found that female condoms are available in 108 countries, but they are not readily accessible in most countries. The United States has supplied female condoms to 30 countries in the past decade and to 16 countries in 2007. Nearly 26 million female condoms were distributed worldwide in 2007, compared to 11 billion male condoms.

“It is distressing that women make up half of those infected by HIV and policy makers are refusing to provide women with the tools they need to negotiate safer sex,” said Serra Sippel, CHANGE executive director. “The U.S. and other donors must increase comprehensive funding for the purchase, distribution and programming of female condoms to ensure that women and men have access to female condoms and know how to use them.”

Based on interviews with health experts and a review of current literature on female condoms, the report’s executive summary (PDF) offers the following findings and common-sense recommendations:

FINDING: U.S. agencies responsible for female condom programming and procurement do not have polices that promote the integration of female condoms into HIV prevention and family planning programs. Whether the U.S. procures female condoms in a given country is highly dependent on the personal biases of USAID mission staff.

RECOMMENDATION: USAID and OGAC should issue policy guidance promoting female condom procurement and programming within U.S.-funded development programs, including PEPFAR. As a signatory of ICPD, the U.S. should promote female condoms as a vital tool to prevent both pregnancy and HIV infection.

FINDING: The U.S. excels at assisting countries in female condom logistics and procurement.

RECOMMENDATION: The U.S. should expand technical assistance for female condom logistics and procurement to additional countries to increase HIV prevention efforts.

FINDING: Sustained product availability and effective programming is limited to a few countries. Accurate estimates for female condom needs do not exist.

RECOMMENDATION: The U.S. should apply intensive programming efforts to an additional three countries for scale-up and replication. These efforts could be used to create a more realistic assessment of global female condom needs for scale-up.

Plus: Here’s a post from last year on efforts to redesign the female condom and problems with raising money in the United States for the clinical trials required for FDA approval.

Alabama’s Response to Pregnant Drug Users: “Two worlds are colliding in this piney woods backcountry in southern Alabama: casual drug use and a local district attorney unsettled that children or fetuses might be affected by it. The result is an unusual burst of prosecutions in which young women using drugs are shocked to find themselves in the cross hairs for harming their children, even before giving birth,” reports The New York Times. The story continues:

Over an 18-month period, at least eight women have been prosecuted for using drugs while pregnant in this rural jurisdiction of barely 37,000, a tally without any recent parallel that women’s advocates have been able to find. The district attorney, Greg L. Gambril, acknowledges the number puts him at the “forefront,” at least among Alabama prosecutors. Similar cases have come up elsewhere, usually with limited success. But Alabama, and in particular this hilly, remote terrain just above the Florida Panhandle, is pursuing these cases with special vigor.

The National Advocates for Pregnant Women has published an excellent, comprehensive response that begins: “We were pleased that it did not use such stigmatizing and scientifically baseless terms as ‘crack’ and ‘meth’ baby. We were disappointed though that the story did not quote any experts in the field.”

Birth Control for Others: In a review of Matthew Connelly’s new book, “Fatal Misconception: The Struggle to Control World Population,” Nicholas Kristof writes that Connelly, an associate professor of history at Columbia University “carefully assembles a century’s worth of mistakes, arrogance, racism, sexism and incompetence in what the jacket copy calls a ‘withering critique’ of ‘a humanitarian movement gone terribly awry.’”

Kristof adds:

Critics of family planning programs will seize gleefully upon this book, and that’s unfortunate, because two propositions are both correct: first, population planners have made grievous mistakes and were inexcusably quiet for too long about forced sterilization in countries like India and China; and second, those same planners have learned from past mistakes and today are fighting poverty and saving vast numbers of lives in developing countries.

“Fatal Misconception” is to population policy what William Easterly’s “White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good” (2006) was to foreign aid: a useful, important but ultimately unbalanced corrective to smug self-satisfaction among humanitarians. Connelly scrupulously displays a hundred years of family planners’ dirty laundry, but without adequately emphasizing that we are far better off for their efforts. One could write a withering history of medicine, focusing on doctors’ infecting patients when they weren’t bleeding them, but doctors are pretty handy people to have around today. And so are family planners.

An Epidemic No One Wants to Talk About: “A much-publicized study from the Centers for Disease Control and Prevention this month highlighted the high rates of sexually transmitted diseases among teenage Americans. But for those of us who work in public health, this ‘news’ is already old,” begins this Washington Post op-ed by three medical experts who argue convincingly for discussions that address race and poverty and other social conditions underpinning high rates of HIV and STIs in some communities.

For one thing, women in poor African American communities who engage in the lowest levels of risk behavior are dramatically more likely to acquire STDs than higher-risk women in communities with low background rates of infection. Where you live and choose sexual partners has an enormous impact on your risk, particularly if it is in a community with high incarceration rates. Imprisonment changes community male-female ratios, and these unbalanced numbers contribute to low marriage rates, a reluctance to negotiate “safe sex,” formation of concurrent partnerships and the maintenance of STDs within the networks in which members choose partners.

Simply put, we will never rid the United States of HIV and other STDs if our only weapon is medical treatment. And if we are unable to engage in a national dialogue about the sexual health of our youths and the social dynamics that drive STDs, this epidemic will go largely ignored, and many more lives will be lost.

The CDC study is covered here. Read the full op-ed at the Washington Post.

HHS Challenges ACOG Ethics Opinion: Daily Women’s Health Policy Report has a nice round-up of information concerning an NPR report on the Bush administration’s criticism of an ethics opinion released last year by the American College of Obstetricians and Gynecologists that calls on physicians to provide referrals for patients seeking abortions, emergency contraception or other procedures if they are opposed to providing the service themselves.

NPR’s “Morning Edition” covered the issue in two parts last week.

Voices from the Sidelines: “To begin with, both those of us who oppose and those who support legal abortion agree that there’s unbearably little nuance in the public conversation on reproductive rights,” writes Anna Clark at RH Reality Check. “But that’s only the beginning of our common ground. While not one national anti-choice organization supports contraception or science-based sexuality education, many individuals who oppose legal abortion are making the connections on their own: birth control and education reduce the rate of unintended pregnancy and abortions.”

Targeting Health Disparities: What’s the connection between living in disadvantaged neighborhoods and early onset breast cancer? University of Chicago researchers are trying to find out. According to a release, “researchers are studying 230 black women with newly diagnosed breast cancers living in predominantly black Chicago neighborhoods to learn about environmental factors, such as neighborhood features that might lead to social isolation.”

Who Wants to Work in an Attractive Field?: “As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive,” reports The New York Times. “The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.”

A Plea for Reading the Original Sources: Or, a manual to ending poorly researched stories about the differences between men and women’s brains. Mark Liberman has the breakdown. Via Feminist Law Professors.

A new federal study suggests that one in four American teenage girls age 14 to 19 has a sexually transmitted infection. Among black teens the number was almost half.

Researchers with the U.S. Centers for Disease Control and Prevention released the results Tuesday at the 2008 National STD Prevention Conference in Chicago. Here’s the abstract and the CDC’s press release.

The Chicago Tribune breaks down some of the details:

The teens were tested for four infections: human papillomavirus, or HPV, which can cause cervical cancer and affected 18 percent of girls studied; chlamydia, which affected 4 percent; trichomoniasis, 2.5 percent; and genital herpes, 2 percent.

Dr. John Douglas, director of the CDC’s division of STD prevention, said the results are the first to examine the combined national prevalence of common sexually transmitted diseases among adolescent girls. He said the data, now a few years old, likely reflect current prevalence rates.

Disease rates were significantly higher among black girls — nearly half had at least one STD, versus 20 percent among both whites and Mexican-Americans.

HPV, the cancer-causing virus, can also cause genital warts but often has no symptoms. A vaccine targeting several HPV strains recently became available, but Douglas said it probably hasn’t yet had much impact on HPV prevalence rates in teen girls.

The study found that among those with an infection, 15 percent had more than one type of infection.

Rachel notes that this study “didn’t even count HIV, gonorrhea, syphilis … Yikes.”

CDC researchers stressed the need for screening, vaccination and prevention strategies. Making sure schools educate boys and girls about the STI prevention, symptoms and treatment would be a good start.

Over at Scarleteen, Nicole writes, “When accurate or trust-worthy sources of information about sex and sexually transmitted infections are drowned out by conflicting and harmful messages about human sexuality, it’s difficult to know that there’s no shame — or should be [no] shame — in having sex and getting tested for STIs and using condoms — that, in fact, by using condoms and getting screened on a regular [basis] is showing that you care about your own health — and the health of your partner.”

Score One for the Patient: A breast cancer patient whose medical coverage was canceled by her insurer was awarded more than $9 million from her for-profit insurer, Health Net Inc., reports the L.A. Times. “The award issued by an arbitration judge was the first of its kind and prompted Health Net to announce it was scrapping its cancellation practices that are under fire from state regulators, patients and the Los Angeles city attorney.”

BCA Blasts Approval of Avastin: In a surprise move, the FDA approved the use of Avastin as a treatment for breast cancer. “The big question was whether it was enough for a drug temporarily to stop cancer from worsening — as Avastin had done in a clinical trial — or was it necessary for a drug to enable patients to live longer, which Avastin had failed to do. Oncologists and patient advocates were divided, in part because of the drug’s sometimes severe side effects,” writes Andrew Pollack.

“In the end, the agency found a compromise of sorts. It gave Avastin ‘accelerated’ approval, which allows drugs for life-threatening diseases to reach the market on the basis of less than ideal data, subject to further study.”

Breast Cancer Action blasted the decision. “The FDA has lowered the bar on the approval of breast cancer therapies. At a time when many questions are being raised about how the FDA approves drugs for market, today’s decision is a victory for drug companies, but not for patients,” BCA Executive Director Barbara A. Brenner said a statement posted at Prescription Access Legislation.

Short Maternity Leaves, Long Deployments: The Washington Post reports on the difficulty women in the military face if they want to have children and keep their jobs. Ann Scott Tyson writes:

The wars in Iraq and Afghanistan have placed severe strains on the Army, including longer deployments in which soldiers serve 15 months in the war zone, followed by 12 months at home. Under that system, a woman who wishes to have a child and remain with her unit must conceive soon after returning home so she can give birth, recover and prepare for her next overseas tour.

Female soldiers interviewed over the past year say the tight schedule cuts short precious time for mother and infant to bond and breast-feed, forcing women to choose between their loyalty to their comrades — as well as their careers — and nurturing their families.

Vaccinating Boys for Girls’ Sake?: The New York Times looks at efforts to convince parents to vaccinate boys to prevent the spread of human papillomavirus, or HPV, which can lead to cervical cancer. HPV also causes anal and penile cancers, but these are much more rare. (Read our previous coverage of the HPV vaccine Gardasil here.)

One woman tells the NYT, “You don’t want to say it’s just the girls’ problem … But my sons won’t contract cervical cancer. And genital warts are treatable. I’m very skeptical. What risks will I expose them to?”

Another woman comments, “If there was a vaccine I could take that would get rid of prostate cancer, why wouldn’t I? … If there was a vaccine that sons could get that would get rid of breast cancer, most parents wouldn’t hesitate. But cervical cancer is the ‘sex cancer.’”

Do Cellphones Affect Male Fertility?: Some studies suggest as much, but the data is limited, writes Tara Parker-Pope, adding, “There are some global concerns about declining male fertility in industrialized countries, but issues like pollutants, exposure to chemicals and smoking are likely far more worrisome culprits than cellphones.”

The Studies Surrounding DHEA: The L.A. Times “Healthy Skeptic” column looks at the anti-aging claims of DHEA and finds it’s no fountain of youth.

More on Migraines (and Music): I’ve mentioned the group blog on migraines at The New York Times — be sure to check out Paula Kamen’s latest post on leaving the rabbit hole. Kamen, who suffers from chronic daily headaches, also appeared last week on WBUR’s “The Point”.

Jeff Tweedy hasn’t weighed in yet, but I did see Wilco Tuesday and Wednesday (braving cold and limited views) during the band’s five-night run in Chicago. Yeah, OK, that had nothing to do with women’s health, but I had to boast somewhere.

Debating “Juno”: Will “Juno” win best picture? Stay tuned. In the meantime, young birth mothers discuss what they liked and didn’t like about the film’s portrayal of adoption.

The Big Push for Midwives: Great post by Amy G. about the campaign for the regulation and licensure of certified professional midwives. Amy mentions a number of blog posts on the issue, including ours.

Metabolic Syndrome Is Tied to Diet Soda: “This is interesting,” said Lyn M. Steffen, an associate professor of epidemiology at the University of Minnesota and a co-author of the paper, which was posted online in the journal Circulation on Jan. 22. “Why is it happening? Is it some kind of chemical in the diet soda, or something about the behavior of diet soda drinkers?”

I don’t know, but it makes me see red ….

Feeling Bad?: Those susceptible to Seasonal Affective Disorder, take note: Chicago had 11 — count ‘em — 11 minutes of sunshine during the first eight days of February. Chicago Tribune health columnist Julie Deardorff writes that she is going to try a sauna that that “uses infrared energy to warm the body and release toxins.” Readers, if you have suggestions for coping with a long gray winter, please leave them in the comments.

Why I am an Abortion Doctor: “I can take an anxious woman, who is in the biggest trouble she has ever experiences in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.” — Canadian abortion doctor Garson Romalis, who has survived being shot and stabbed because of his work.

NYT Op-Ed on Same-Sex Marriage Ruling: “In a decision at once common-sensical and profound, a New York State appeals court ruled Friday that same-sex marriages validly performed in other jurisdictions are entitled to recognition in New York. It was common sense because it simply accorded same-sex marriages the same legal status as other marriages. It was profound because of the way it could transform the lives of gay people.” Continue reading …

A Health Law With Holes: “This idea of an individual mandate absent comprehensive reform – how to say this politely? – is nuts. It makes a social failure the problem of the individual,” writes Robert Kuttner in an op-ed published in the Boston Globe about health care in Massachusetts.

Health Cuts Trigger Crisis in Chicago: In a front-page story on Friday, the Chicago Tribune reported on what doctors are calling “an emerging health crisis” in the city, with “hundreds of women with abnormal Pap smears, unusual bleeding, pelvic masses and other worrisome symptoms are waiting for weeks or months to see gynecologists in the Cook County health system.”

“The longer women wait for care, gynecological experts warn, the more likely it is that untreated medical problems could worsen, exposing the women to severe pain, cancers that are harder to treat or even life-threatening emergencies.”

Breastfeeding and HIV-Infected Mothers: “An antiretroviral drug already in widespread use in the developing world to prevent the transmission of HIV from infected mothers to their newborns during childbirth has also been found to substantially cut the risk of subsequent HIV transmission during breast-feeding,” according to this release from the John Hopkins Center for Clinical Global Health Education. Approximately 150,000 infants are infected through breastfeeding each year.

The findings were made public during the 15th Conference on Retroviruses and and Opportunistic Infections held in Boston this past week.

Another study presented at the conference found that the risk of HIV transmission decreased by 90 percent within couples in which one person is HIV-positive and the other is HIV-negative — if the HIV-positive person took antiretrovirals, which drive down the level of HIV in the blood.

“Getting an early diagnosis, and getting treatment to drive down viral load, is going to be good for prevention,” said Dr. Rebecca Bunnell, a researcher for the CDC in Kampala, Uganda, told the San Francisco Chronicle.

SF Chronicle writer Sabin Russel described the study as “one of the few rays of hope” to come out of the conference, “a meeting that has been dominated by discussions of setbacks, such as the failure of a major AIDS vaccine trial that was abruptly ended in September.”

And The New York Times reports on yet another study that was discussed, one that showed that male circumcision did not result in a lower risk of transmission for female partners. “Although the findings did not reach statistical significance, they still underscore the need for more effective education among men who undergo circumcision and their female partners, the authors of the study said,” reports the Times.

So what is it about the female condom that — pardon the pun — creates a barrier to widespread acceptance and use, both in the United States and in other countries?

Scientists and health advocates are trying to figure out the answer to that question.

Part of the problem is that in 15 years, there’s never been a second-generation product produced that improved upon the original version. Michael J. Free, head of technology at PATH, a nonprofit group based in Seattle that has redesigned the female condom, commented on the lack of competition in the development. “There’s no lack of interest, but we’ve been stalled,” he told The New York Times.

PATH is now seeking FDA approval for its version (more info on it here), which is supposed to offer improved ease of use and a more natural feeling sexual experience, but the process could be lengthy:

While the F.D.A. designates male condoms as Class 2 medical devices — meaning that a new maker has to pass tests only for leakage and bursting — it puts female condoms in Class 3, the same category as pacemakers, heart valves and silicone breast implants.

That decision was made in 1999 — after much debate, and well after the condom was in use overseas — because there was no clinical data on the effectiveness of female condoms, and failure could be life-threatening if the woman’s partner had AIDS. An advisory panel suggested not even calling it a “condom” and instead labeled it an “intravaginal pouch,” but the agency rejected that advice.

Names notwithstanding, the Class 3 listing means that any new design must pass clinical trials, which would cost $3 million to $6 million.

“That’s a huge, huge impediment, close to a 100 percent block, because no one’s willing to put up that sort of money,” Dr. Free said.

Design costs and prototype development have been covered by a combination of public and private funds, but no one is putting up money for the clinical trials or factory costs. Some investors cite the smaller-than-predicted American and European markets that never warmed to the original design.

There are some issues that even an abundance of development funds and a redesigned product can’t fix: the female condom can’t be used with discretion.

For that reason, married women, now one of the highest risk groups for AIDS in poor countries, rarely use it.

“I don’t want my husband to know that I am wearing a condom,” said Lois B. Chingandu, the director of SAfaids, an anti-AIDS organization in Zimbabwe.

“Condoms are almost undiscussable within a marriage” in Africa, she added. “It is something associated with casual sex. If a wife uses a condom, the message is that you have been unfaithful. If she even initiates the discussion, it tips the power scale. Men resist quite a lot, and it can result in violence.”

The female condom has developed a following among sex workers, however. And supporters say the condom’s failure in some countries was due more to poor marketing and inconsistent availability.

“People said, ‘Oh, it failed,’” said Mitchell Warren, former director of international affairs for the Female Health Company. “Well, it didn’t fail. It just wasn’t available, or its introduction was a bad program. People need to practice with it before it catches on.”

Plus: In 2005, health experts attended the Global Consultation on the Female Condom in Baltimore to review evidence of the female condom’s effectiveness in preventing pregnancy and sexually transmitted infections and to learn about countries’ program experiences. Slide presentations and panels from that conference are available online.

Each year, the Centers for Disease Control and Prevention releases a report on rates of sexually transmitted infections. The recently released 2006 report reveals a 5.6% increase in reported chlamydia cases over 2005, with 1,030,911 cases reported to the CDC, the first time that number has gone over one million. Gonorrhea rates also increased for the second consecutive year after a long period of decline, as did rates of syphilis, which hit an all-time low in 2000 and have been increasing ever since. It is unclear how much of the change is due to increased screening for the infections.

The CDC’s report includes numerous tidbits on how these infections affect women, such as:

• “Untreated early syphilis in pregnant women results in perinatal death in up to 40% of cases and, if acquired during the four years preceding pregnancy, may lead to infection of the fetus in 80% of cases.”
  
• “In women, chlamydial infections, which are usually asymptomatic, may result in pelvic inflammatory disease (PID), which is a major cause of infertility, ectopic pregnancy, and chronic pelvic pain.”
  
• Gonorrhea infections, like chlamydia, “are a major cause of PID in the United States… In addition, epidemiologic and biologic studies provide strong evidence that gonococcal infections facilitate the transmission of HIV infection.”

A special section of the report addresses STI concerns in women and children, but focuses primarily on fertility and pregnancy.

Resources for learning more about sexually transmitted infections, including symptoms, transmission, and prevention:

• American Social Health Association
  
• MedlinePlus: Sexually Transmitted Diseases – from the National Library of Medicine
  
• STIs: Common Symptoms & Tips on Prevention – from the American Academy of Family Physicians
  
• STIs/STDs – from Planned Parenthood
  
• Centers for Disease Control and Prevention fact sheets – expect to see abstinence listed as your main prevention tool

Senate Votes to Repeal Global Gag Rule: “Defying a White House veto threat, the Democratic-controlled Senate voted Thursday to overturn a long-standing ban on U.S. funding for overseas family planning groups that support abortion,” reports the L.A. Times. “The vote was 53-41, short of the two-thirds majority needed to override a presidential veto on an issue that has been contentious on Capitol Hill since President Reagan instituted the ban. Even so, the vote was a sign of determination by Democrats to press for substantial changes in federal policies, even though they have only a narrow majority in the Senate.”

Read more about the global gag rule; and here’s more analysis from RH Reality Check.

Ad Nauseum: Shannon Brownlee, author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” talks with Brooke Gladstone of NPR’s “On the Media” about the influence of direct-to-consumer drug marketing. One example given: When the sleep drug Lunesta hit the market, so did an epidemic of sleeplessness.

Stress and Pregnancy: The New York Times has a Q&A interview with Dr. Sarah L. Berga, “one of a handful of physician-scientists exploring how chronic stress may keep some women from ovulating and how relaxation techniques may help.”

Why More Cosmetic Companies Are Going “Paraben-Free”: “For years, parabens (methyl, ethyl, propyl and benzyl) have been considered a cheap and indispensable way to inhibit the growth of bacteria, yeasts and molds in personal-care products such as shampoos, conditioners, deodorants and sunscreens,” writes Chicago Tribune health reporter Julie Deardoff. “But studies have shown that some parabens can mimic the activity of the hormone estrogen in the body’s cells. Estrogenic activity in the body is associated with certain forms of breast cancer. And parabens are turning up in breast tumors.”

Condom Nations: Foreign Policy magazine presents data from the Durex Global Sex Survey, the world’s largest sex survey (317,000 participants in 41 countries). Why is it surprising that people in richer countries have more sexual partners than people in poorer countries?

Treating Men and Women Differently: “Research presented at the annual European Society of Cardiology meeting in Vienna suggested that surgeries which typically save men’s lives can be deadly for women,” reports the AP. “A small study of 184 women conducted by Dr. Eva Swahn of the department of cardiology at University Hospital in Linkoping, Sweden, found that women who had major heart operations like a coronary bypass were more likely than men to die.”

NFL Mirrors Society: From a USA Today editorial: “Even people who aren’t football fans have heard about Michael Vick, the star quarterback whose abuse of pit bulls led to a guilty plea on federal dogfighting charges, drew public vilification and spurred an indefinite suspension from the NFL. Far fewer people have heard of Michael Pittman, another NFL player accused of violence. In May 2003, the Tampa Bay Buccaneers running back was arrested on charges of ramming his Hummer into a car driven by his wife and carrying their 2-year-old child and a babysitter.”

“Well-Behaved Women Seldom Make History”: Laurel Thatcher Ulrich, who wrote that sentence in an article entitled “Virtuous Women Found: New England Ministerial Literature, 1668-1735″ two decades ago, has now written a book exploring the hidden history of women.

“‘Well-Behaved Women Seldom Make History’ is by no means jargon-ridden or academic in tone,” writes Michael Dirda in the Washington Post. “Ulrich’s style is plain and direct, agreeable but without frills, and she moves efficiently right along. The book is a pleasure to read.”

Madeline L’Engle Dies at at 88: L’Engle, a graduate of Smith, wrote the children’s classic “A Wrinkle in Time,” and other wonderful stories — many of which featured a girl as the protagonist. From The New York Times obit:

In the “Dictionary of Literary Biography,” Marygail G. Parker notes “a peculiar splendor” in Ms. L’Engle’s oeuvre, and some of that splendor is sheer literary range. “Wrinkle” is part of her series of children’s books, which includes “A Wind in the Door,” “A Swiftly Tilting Planet,” “Many Waters” and “An Acceptable Time.” The series combines elements of science fiction with insights into love and moral purpose that pervade Ms. L’Engle’s writing.

Guest blogger Rachel Walden of Women’s Health News is posting here this week, while Christine is on vacation.

A new study released in the current issue of JAMA: Journal of the American Medical Association looked at whether the new HPV vaccine (in this case Cervarix, a competitor to Gardasil) could help clear the infection in women who already had it, and found that the vaccine is not effective as treatment.

This really should come as no big surprise – vaccines in general, like flu shots, are intended to help prevent a disease, not to cure it.

The fact that the vaccine doesn’t cure infection raises an important point, however – much of the criticism when Gardasil was released stemmed from the need to vaccinate young girls before they become sexually active, and concerns that the vaccine would encourage them to have sex (despite the lack of evidence to support that fear).

This study adds weight to the idea that vaccination prior to the initiation of sexual activity is most effective in preventing HPV infection and possible cervical cancer, and represents the best use of the vaccine. An editorial in the issue (available with subscription) also makes this point:

The lack of therapeutic efficacy of the quadrivalent HPV vaccine was considered in deliberations by the Advisory Committee on Immunization Practices (ACIP). These data, along with data demonstrating the high likelihood of acquiring HPV infection soon after onset of sexual activity and data on sexual behavior in the United States, all contributed to recommendations for routine immunization at 11 to 12 years of age. Because the vaccine has no therapeutic efficacy, the greatest effect will be realized if the vaccine is administered before sexual debut, prior to exposure to HPV.

The study is freely available online. For more information on the vaccine that is currently available in the United States, see Gardasil: What you need to know about the HPV vaccine.

Ed Silverman at Pharmalot makes my day:

What better way to advertise to other beachgoers that you’re free of a sexually transmitted disease than to wrap yourself in this nicely designed terry velour towel, which measures 30 inches by 60 inches. Catch a wave and then use the towel to make clear to that attractive person nearby that genital warts or HPV won’t be a problem. Truly, this is a new way to advertise the advantages the vaccine has to offer. Frisky teenagers will love them!

Check out a larger image here.

And if this is your idea of a must-have summer item, you’ll be pleased to learn that there are five bidding days left for a lot of six terry velour towels. Looks like someone doesn’t want their swag.

The Popularity of Plan B: “The popularity of the morning-after pill Plan B has surged in the year since the federal government approved the sale of the controversial emergency contraceptive without a prescription,” reports the Washington Post. But advocates for women’s health are quick to note that teenagers under age 18 still do not have access.

“There’s no medical basis for restricting teenagers’ access to emergency contraception,” said Nancy Northup, president of the Center for Reproductive Rights in New York, which is suing the FDA to remove the age restriction. “This not about morality, it’s about public health and cutting America’s alarmingly high teenage pregnancy rates.”

Plus: The teen birth rate hits a record low. Here’s the government study on which the data is based.

Think This Would Fly in U.S. Schools?: The award-winning Romanian film about abortion, “4 Months, 3 Weeks and 2 Days,” will be shown in French schools, “following a u-turn by government officials who had initially vetoed plans to show it,” reports The Guardian. “As well as winning the top prize at Cannes, Cristian Mungiu’s film was the recipient of the National Education Prize, which is awarded to a Cannes-selected film with the relevant artistic, aesthetic and educational values each year. The chosen film then receives government funding to allow a special educational DVD to be produced for upper-secondary schools, which teach children between the ages of 15 and 18.”

OBOB previously covered abortion in movies and “4 Months, 3 Weeks and 2 Days” here.

Going for the Gold: “If hypocrisy were an Olympic event, Senator Vitter would get the gold medal,” writes James Wagoner, president of Advocates for Youth. Sen. David Vitter, a Republican from Louisiana, apologized after his name appeared on the client list of Deborah Jeane Palfrey, the “D.C. Madam.” Vitter is also chief backer of a bill to reauthorize funding for abstinence education.

But Viiter “wouldn’t be the only ‘family values’ champion lining up for the gold,” adds Wagoner, who goes on to name a few other contenders.

Reality Bites: Former Surgeon General Richard Carmona testified before Congress this week that his term was compromised by political pressure to weaken or suppress important public health information. The accusations would seem surreal if we haven’t all been reminded in so many ways how backward this administration has been:

The administration, Dr. Carmona said, would not allow him to speak or issue reports about stem cells, emergency contraception, sex education, or prison, mental and global health issues. Top officials delayed for years and tried to “water down” a landmark report on secondhand smoke, he said. Released last year, the report concluded that even brief exposure to cigarette smoke could cause immediate harm.

Dr. Carmona said he was ordered to mention President Bush three times on every page of his speeches. He also said he was asked to make speeches to support Republican political candidates and to attend political briefings.

Trading Shots Over a Vaccine: The Philadelphia Inquirer reports on the competition between Merck and GlaxoSmithKline to develop the world’s top cervical-cancer immunization.

That Pew Survey on Mothers And Work: Good analysis from Echidne of the Snakes on Pew’s latest survey.

Bridal Media Send “I-Do” Message on Overspending: “Where once a bride could design a memorable day using an etiquette guide and a good caterer, the specialized wedding media of today feed a $161 billion per year industry enriched at the expense of many of the people it purports to serve,” writes Sheila Gibbons at Women’s eNews.

Is Soap Clean?: This was an ongoing debate one year in my college dorm … The New York Times answers the burning question about sharing individual bars of soap.

From Rachel at Women’s Health News:

If you’re going to oppose HPV vaccination, you can do it for any number of evidence-based reasons. Let’s not use “it’ll turn the girls into sluts!” Reefer Madness-style propaganda, given the number of holes in that particular argument. If you’ll excuse me, I’m off to stick myself with rusty nails and roll around in a blood spill, because I’ve been vaccinated against tetanus and hepatitis.

Now start from the beginning …

Writing in The Nation, Karen Houppert provides the most comprehensive overview I’ve seen of the controversy surrounding making Gardasil mandatory for middle-school age girls.

Gardasil, as we’ve discussed before, is is the only FDA-approved HPV vaccine. Houppert outlines who’s for it, who’s against it and all the reasons why it’s become such a huge issue.

Today, as thirty-one state legislatures consider mandating the vaccine for middle school girls, skepticism about the wisdom of embarking on this swift and widespread inoculation program has bubbled up from critics who span the political spectrum. These strange bedfellows include Christian conservatives and their abstinence-only ilk, who have long argued that safe sex encourages profligate sex; a slew of Big Pharma critics, who see how Merck (which stands to make $4 billion a year on the vaccine by most estimates) is angling to corner this huge new vaccine market; the growing antivaccine movement, which objects to all such school-entry requirements; the parental-rights folks with a libertarian strain, who bridle at any mandates regarding their children’s health; and a smattering of women’s health advocates, who worry that the pace of the vaccine’s introduction is jeopardizing its ultimate success.

What’s all the noise about?

Read on.

What a week it’s been for advocates — and critics — of the HPV vaccine.

Acknowledging that its lobbying efforts have only hurt its cause, Merck this week announced it would stop campaigning to get states to mandate the use of its new vaccine against the human papillomavirus, which can cause cervical cancer. But the announcement did little to quash debate surrounding Merck’s influence and the general safety of the vaccine.

On Thursday, Texas Gov. Rick Perry, who already signed an executive order making the vaccine mandatory for sixth-grade girls — though the Texas legislature is anxious to overturn it — had to defend his order in light of reports that his chief of staff had met with aides about the vaccine on the same day that Perry’s campaign received $5,000 from Merck’s political action committee. Perry’s relationship with Merck was already questioned since the governor’s former chief of staff is now a Merck lobbyist.

Also on Thursday, a group of Texas families filed a lawsuit to block the executive order.

Merck, which manufactures Gardasil, currently the only FDA-approved vaccine, has been working to promote widespread vaccination with the support of state lawmakers — including Women in Government, a national association of state legislators. Critics note that an executive from Merck’s vaccine division sat on Women In Government’s business council last year, and the group receives funding from Merck (along with other phamaceutical companies).

NPR’s “Morning Edition” on Thursday covered the resentment against Merck’s “steamroller effort,” with medical experts raising concerns about setting up distribution protocols and long-term safety. (Listen here.)

More than 20 states have drafted bills calling for mandatory inoculation (with the usual opt-out provisions) of pre-teen girls. The vaccine was approved for girls and women age 9 to 26. It is most effective if given before females become sexually active and have not acquired any of the four HPV types covered by the vaccine.

Some states are re-thinking legislative efforts to mandate the vaccine, reported NPR. But other states, like Vermont, are not changing course.

GlaxoSmithKline is also working on a vaccine and, according to this story published in The New York Times Feb. 17, “Analysts see a potential $5 billion a year market for H.P.V. vaccines, and some say that Merck is intent on inoculating as many girls as possible before the introduction of Glaxo’s product, which could become available this year.”

Indeed, with the billions Merck stands to reap from the vaccine — a series of three shots that cost a total of $360 per person — some cynics have called the HPV vaccine the “Help Pay for Vioxx” program, referring to the arthritis drug Merck withdrew from the market after studies linked to it a higher risk of heart attacks and strokes.

Merck’s president for vaccines, Margaret McGlynn, insists Merck is motivated by the potential for eradicating the disease. “Each and every day that a female delays getting the vaccine there is a chance she is exposed to human papilloma virus,” McGlynn told the New York Times.

Other public health advocates have noted that while Gardasil may well be a life-saving vaccine, the timing of the vaccination push and the speed by which it is being promoted has produced a daunting backlash. “The decision to make this mandatory this early has created a significant controversy over things that have nothing to do with the vaccine,” said Dr. Joseph A. Bocchini, chairman of the committee on infectious diseases of the American Academy of Pediatrics.

The CDC estimates that about 15 percent of the population is infected with HPV. Most women with HPV, however, will not develop cervical cancer and most will find that they test negative for the virus a year after a diagnosed infection. Around 10 percent of women with HPV stay infected, and it is these women with persistent infections who are at highest risk for developing cervical cancer.

Regular screening and follow-up treatment of cancerous and/or pre-cancerous tissue is highly successful, so even those women with persistent infections rarely get cervical cancer. The periodic screening and follow-up care are absolutely necessary, however. The U.S. rate of infection is 7.2 per 100,000 nationally — higher among black and Hispanic women — and there were 3,700 deaths from cervical cancer in 2006.

Of concern is whether public funding that is now allocated to cervical cancer screening and follow-up care will be diverted to the provision of the HPV vaccine. Some public health experts have cautioned that any HPV vaccine mandate should be tied to a guarantee that cervical cancer screening will be made accessible to all women at the same time. Others have argued that money would be better spent providing expanded healthcare for women.

“It is important to note that low income women and women who do not have health insurance are most at risk because they are less likely to get regular Pap smears,” writes Lucinda Marshall in Dissident Voice. “Since the vaccine does not eliminate the need for regular Pap smears, it would appear that a far more appropriate and cost effective first step would be to make regular gynecological healthcare available for all women regardless of income and medical insurance, particularly since this step by itself would go a long way in reducing the few cases of cervical cancer that still occur in this country.”

As the HPV vaccine receives more scrutiny, it remains imperative that we continue to critique those whose objections are rooted in misguided attempts to connect the vaccine with promoting sexual activity. Skim any discussion board on this issue and you’ll come across commenters who argue that promiscuous women bring the virus on themselves, or that it’s inappropriate to mandate the vaccine for women who intend to remain virgins until marriage.

In Illinois, State Sen. Debbie Halvorson, the Democratic majority leader, is in favor of a bill calling for 11- and 12-year-old girls to be vaccinated. She also said publicly that she had the virus, prompting a contributor to the conservative blog Illinois Review to question whether the state senator’s time would be better spent discussing her sexual history than advocating for a bill to prevent cancer.

The post defies logic. But Halvorson shows she’s got moxie, telling The New York Times: “I’m offended by their ignorance, but if I have to take a hit to educate people, I’m willing to do it.”

The New York Times yesterday published this story about a sex education class for men and women for whom understanding how diabetes and medication can contribute to erectile dysfunction is as important as knowing how to correctly put on a condom.

The sex educators had news for this class of 40 people in their 70s and 80s, just in time for Valentine’s Day: Older folks are friskier than ever, and it’s never too late to learn about safe sex.

Sexually speaking, said Norm Sherman, who organized the presentation, “It ain’t over till it’s over.”

The class last Wednesday, for residents of what is known as a “naturally occurring retirement community” at the Queensview and North Queensview co-op complexes in Long Island City, was run by Selfhelp Community Services, a nonprofit agency that provides services for the elderly across New York City.

The group’s leaders said they started sex-education courses in January after noticing an increase in sexual activity among their elderly clients, something they attribute to the popularity of Viagra and testosterone supplements as well as women shedding the idea that sex is shameful. Along with the increase in sexual activity at senior residences, nursing homes and assisted living facilities, there are increased complications because of lack of knowledge, said Becky Bigio, another of the educators.

A recent survey of people 45 and older, conducted by AARP, reported a sharp increase over the past several years of men using sex-enhancing drugs, and observed a corresponding “re-awakening” among women, who said their own sexual satisfaction had been enhanced. The study concluded that health care providers and patients were in need of sex education.

The instructors seemed to do a good job of not only providing the necessary clinical information, but also making sex fun, as they discussed flavored lubricants and achieving orgasm through masturbation.

Warning of the danger of taking Viagra with some heart medications, Ms. Binford recommended “cheap man’s Viagra” — a metal ring that slides onto the penis to maintain the erection. “You can get them at the Eighth Avenue sex shops,” she said. “It’s a good field trip. Put your dark glasses and hat on.”

She recommended similar outings to stock up on condoms and exhorted the women to build sexual confidence and self-esteem by undressing in front of the mirror.

“You’ve got to love you,” she said.

Good advice at any age.

One quibble I have with the story is the comment by an 89-year-old woman who said, “The kids today are having more fun than I had, but they’re also having abortions and all kinds of diseases.” As if abortions never took place before Roe v. Wade!

Plus: Looking for a hip, crafty place to carry condoms (at any age)? Get inspired by the condum amulet Naomi designs and promotes in connection with safe sex advocacy.