Reviewing the Utilization of New Media in Sexual Health Promotion

Google Hangouts are increasingly becoming a communications channel for groups to present conversations with people in disparate locations to a wide audience. So it was exciting to be sitting front and center—so to speak—at last week’s YTH Live Google Hangout being hosted by one of my favorite organizations, ISIS (Internet Sexuality Information Services – if you don’t know them, check them out!), in preparation for the April YTH Live Conference, focusing on new and social media use and technology in the sexual health promotion space for teens.

The topic was using mobile technology, specifically text messaging, in the sexual health context. As someone who utilizes new media in all my projects, I was excited to hear what the panelists had to say, and see if my experiences were borne out in their work as well. The lineup was great, featuring Tom Subak from Planned Parenthood Federation of America, Dr. Pamela Johnson from Voxiva (developer of the great mobile maternal and newborn health program Text4Baby), Sam McKelvie from Mobile Commons, and Eric Leven from RipRoad. It was hosted by ISIS’s Executive Director and Founder, Deb Levine (who, dear readers, incidentally was instrumental as the launcher of Go Ask Alice!, and as a former Alice! Health Promotion Office employee for a couple of years, I wanted to make sure to plug that).

The first question broached by Deb was around the key trends around people seeking out health information. Tom mentioned that young people are constantly and consistently surrounded by media and information sources—literally at the tip of their fingers, so finding the answers they need is way easier than it was before the advent of new media. In this vein—and luckily, I might add—it is pretty easy to ask what were historically difficult questions. Thoughts and questions about sexually transmitted infections, pregnancy and abortion don’t require the same mustering of public courage required in asking another person face-to-face about a pressing health issue.

Tom also noted something that I have definitely seen as a sexual health educator—people are usually seeking this information in moments of crisis and anxiety. It’s in these crisis moments that text messaging can play an important role. Waiting for an email response or waiting for someone to answer a question on Tumblr or Facebook—while still far quicker than waiting for an appointment with a healthcare professional—is not as quick as being able to text a worried query and getting an immediate response. One of the most fascinating things I heard in the entire Hangout was when Eric discussed his team’s Know HIV campaign, an integrated new media campaign encouraging people to get tested for HIV. He said that the busiest time for people accessing information about HIV was in the early morning hours—either it’s the time when people are mulling over the issue, or it’s the time right after they’ve had sex or potential exposure to HIV and are seeking out information immediately. Having that information easily accessible in those moments can be crucial, and can also help people plan their next steps.

The YTH Live Conference is in April, hosted by ISIS.

The YTH Live Conference is in April, hosted by ISIS. Click for details!

My favorite part of the Hangout was when the speakers were addressing two-way communication. In my own work as well as the projects on which I have advised digital strategy, I try to emphasize two major tenets: One, interactivity is key. New media truly embodies the idea of call and response, and for the conversation to be kept going you need to answer questions as well pose them, and engage followers in creative ways. I’ve done this with polls, questions, trivia that awards responders, and the solicitation of input from my most vocal network members.

Sam underscored how to address that issue, noting that two-way communication doesn’t necessarily mean organizations need someone dedicated to personal responses—great news for folks with small budgets and for people working on a consultant basis. The example given was if you text a client “Did you get a flu shot?” you can have a few answers set depending on the person’s response. If their text back is “Yes,” you can have automatic answers setup to push to the client saying, “Great, don’t forget to remind your friends!” If their text back is no, then automatic messages can be sent saying, “Here is where you can get a shot close to you,” sending a link to a nearby clinic based on their location or directing them to a site giving them more details.

The second point I generally emphasize is that you need to treat your social and new media networks similar to the way you treat your in-person networks—essentially, it’s just relationship building in another context. This is partly accomplished by the first tenet, interactivity, but it’s also accomplished by paying attention to the work of your followers and supporting it, as well as reaching out to build collaborations and coalitions with other like-minded groups, increasing the internet-based safe spaces. (The collaborations are not solely web-based, of course. Pamela emphasized that the public health departments and medical professionals who supported Text4Baby and encouraged their patients to sign up were key, and it’s always a good idea to increase the number of sources of information about sexual and reproductive health.)

There are few organizations who can thrive in new media spaces by just blasting their own content—the New York Times is the only one I can think of. For my work implementing HIV and sexual health programs on Facebook and Tumblr, paying attention to the work of my followers and voicing my appreciation and admiration of their own work made significant headway in how trusting my audience was. In terms of sexual health specifically, this is also meeting teens where they’re at—Sam mentioned this as being essential from a programmatic perspective, but it’s also essential in terms of a behavior change perspective. When I worked with teens and young adults on risk behavior change around sex and substance, the greatest indicator of their success was my ability to assess where they were in terms of thinking about changing their behavior, and help them dissect some of their ambivalence and tease out their true questions (motivational interviewing, for all you health behavior professionals!). New media is a great space in which to do this, because the conversation feels sustained and continuous, and it’s easy to see one’s progression over the course of time. And paying attention to where those conversations are happening is also key—Tumblr has been the busiest platform for my sexual health interventions, which speaks to its popularity among teens, followed by Facebook and Twitter, the latter of which people seem to use as reminders and the former being a good platform for asking questions.

Lastly, the question of how to select the right mobile media tool to implement your public health message was brought up. Eric’s response was that text message was king, since you can access people who are otherwise difficult to reach on other platforms. I tend to agree with this, since other platforms tend to require more initiation on the part of the individual, and populations have to do some seeking out on their own. Text message pushes allow your message to be sent to larger numbers of people across greater demographics, and with more frequency. Sam noted that teens of color and teens in lower-income communities who may not have full web access actually text the most, and information being sent via text can be even more helpful for these teens. That being said, I fully believe the integration of multiple new media platforms tends to ensure greatest success.

You can watch the whole Google Hangout here on the YTH Live page.

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Filed under Health Behavior, Health Education, Media, Reproductive and Sexual Health, Technology

The Impact and Importance of AIDS Activism

A few weeks ago I was lucky enough to interview David France, a journalist and filmmaker who most recently wrote and directed the movie How to Survive a Plague, which has been nominated for Best Documentary at this year’s Academy Awards. The film details the work of the AIDS Coalition to Unleash Power (ACT UP), an activist organization that started in NYC’s Greenwich Village in 1987 in response to the rapidly growing and lethal AIDS epidemic among the gay population. Through political action like protests, public funeral ceremonies, and storming the buildings of the National Institutes of Health, ACT UP initiated ‘treatment activism,’ accelerating the development and distribution of AIDS treatment drugs and changing the pharmaceutical industry’s closed door research and development process to one that incorporated the insight and research of activists themselves. I wanted to learn more about what compelled him to create a film focused on this specific strain of activism, and how he saw the work of ACT UP being relevant to movements today.

My favorite of his responses was when I asked him if there were things that he wished had made it into the film but had to be cut because of the evolving narrative, and what those omissions were. I thought his answer was particularly moving:

“You know what? What broke my heart was leaving out people. People that did amazing things. Even in this very small line of inquiry that I brought to it, which is treatment activism. Other people were working on housing and prevention and pediatric issues, IV drug use issues. Even in just treatment activism I left out a huge number of players, many of whom died, whose lives in the last years were dedicated to this altruistic struggle to change the world of science and medicine. And they ultimately succeeded.”

The full transcript of the interview was published this morning over at The 2×2 Project, so head on over to read everything he had to say. Also check out Mr. France’s website, which has the archives of his incredible journalistic career, which he spent covering HIV and AIDS for years. And of course, I encourage everyone to see the film to witness just how far these grassroots activists got in advocating for and ensuring access to life-saving treatments and the disbursement of research that literally helped save millions of lives.

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Fostering Social Entrepreneurship in Rwanda

This post also appears on the Spark blog. It serves as a profile of one of Spark’s most recent grantees, an organization I happily support, The Komera Project.

It’s not every day that you get to see the foundations of graduate school flourish into a burgeoning non-profit organization halfway across the globe. So, when one of my close friends from graduate school told me in 2008 that she was starting an organization in Rwanda where she had been living, I was of course eager to support her. And the more I learned about Rwanda and the work her organization was undertaking, I became invested in seeing its success grow.

Named The Komera Project (in Rwanda the word “Komera” means “be strong, have courage”), Margaret Butler developed the idea to start the group over the course of her many runs through the Rwandan countryside. She noticed that sometimes girls from the local villages would jump in and join her on these runs until she realized that her behavior wasn’t going to be considered socially acceptable. Combined with the fact that Margaret was seeing first hand how most girls did not make it to secondary school, she decided to host a girls-only ‘fun run’ one day to promote the education and rights of these girls. As they started off, supporters shouted “Komera!” to the girls, and the group was born.

Image

Working with the local government, schools, and some on the ground staff from Partners in Health based in Rwanda, Margaret steered the first of Komera’s 10 girls onto their fully funded secondary education path. Komera has since grown to over 60 scholars, and has expanded their reach beyond just funding the girls’ schooling. They now also provide mentorship, a leadership program, and now a social entrepreneurship program.

Some context and understanding of Rwanda is essential to underscore how significant this is. Only 17% of girls in Rwanda go to upper secondary school (high school). 87% of the country lives in rural areas. All Komera scholars are from these rural areas and live on about $1 a day from families working as subsistence farmers or tin miners – so these girls would be farming, mining, and/or working in their households if not in school. Komera focuses on supporting the girls in grades 10-12, since the majority of girls begin dropping from school in grade 10. Komera never takes on a scholar unless they have the cash to fully fund them for those three years – this cost is $500 a year for tuition, uniforms, boarding, all school supplies, and personal supplies like hygiene products.

By 2010, the focus at the Komera Project had shifted from primarily scholarship to figuring out how to keep the girls in school and create a real Komera community, and that’s when the themes of mentorship and leadership came into play.

The transition into boarding at school can be really difficult for the girls, especially since they are spread between 13 different schools. In Rwanda, once you have the funds to pay, the local government decides what school you will go to, so while Komera would prefer all the girls to be in the same 4-5 schools, that isn’t possible. However, they are all in the same district (there are 30 districts in the country total).

To help combat some of the difficulties around these transitions, Komera provides school-based volunteer mentors for all the girls – female staff or teachers who meet one-on-one with the scholars every week. They actually use curriculum to cover topics like health education, financial literacy, what their rights are as women in Rwanda, to any personal concerns they may be having. The girls also meet with the Komera social worker (one of only two paid Komera staff members!) regularly when she visits each school throughout the year. Their next goal is to launch a university mentoring program, and they have started to do some outreach to universities in Kigali (the Rwandan capital) to see if there is interest among Rwandan university women to mentor these girls.

Leadership is another key component of the Komera Project. The Komera scholars attend Leadership Empowerment camp during their month-long summer break, where they take part in the now-annual Girls Fun Run and participate in workshops focused on topics like English-speaking skills, how to use computers, and sex education. These have been essential for the girls, because these month-long breaks can be vulnerable times for the girls who go back home. Most stay with extended family, get pulled back into working with the family and can potentially be convinced that they need to leave school – especially true for the nearly 20% of girls who come from families who don’t fully support their education efforts.

In regards to the new Social Entrepreneurship Program that Spark is helping to support, most recently the idea of sustainability has come up – how does Spark keep the momentum of being a Komera Scholar going once the girls graduate from secondary school? This was particularly pressing since 15 girls will be graduating in 2013.

The girls had been requesting a social entrepreneurship type training for some time – wanting to learn the skills necessary to starting and maintaining a business, a non-profit or grassroots venture. When asked about social entrepreneurship training, all the girls said that they had never even considered how they might be able to give back to their community or considered themselves leaders, and they were really excited about the idea of learning how to create something to benefit and incorporate their community.

The winter break, in November-December hasn’t been able to be filled by Komera because they haven’t been able to fund camps both in May-June when they have the leadership and empowerment camps as well as during the winter months. Finding funding for this new social entrepreneurship training became essential, as well as a way to get a tested and evaluated curriculum in their hands.

A local Rwandan group, Global Grassroots, has been offering entrepreneurship, business training, and skills-based workshops for women in Rwanda since immediately after the genocide – and they’ve been doing so pretty successfully. They have agreed to modify their program for a weeklong intensive program for teen girls, as well as moderate the weekly follow-ups. This will be called the “Girls Academy for Global Conscious Change.”

The girls will work in groups of ten, separated by interests – they’ll select a topic they want to focus on, like health, education, water, and they will learn how to craft a mission statement, develop a program goal and implementation plan, and how to write and follow a budget. They will be given small grants of $50, which will be managed by the social worker and through each phase can retrieve part of the money for supplies, then implementation or advertising. The goal is to have them create these mini-organizations and incubate them throughout the school year, with the hope of maintaining it beyond that year, turning it into a profitable business, and growing it beyond their immediate school community.

When I heard that this was their well thought out plan, I thought Spark would be the perfect place for Komera to seek funding help to cover the costs of the girls supplies, food, transportation, and personal supplies throughout the training. The perfect way to blend two of the organizations that are most dear to me.

The Komera Project embodies the exact kind of values and practices that Spark looks for in grantees, and I look forward to what these budding entrepreneurs are up to in just a few years.

Check out their Facebook and Twitter pages, and visit their site to learn more about Komera and meet some of their scholars.

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Planned Parenthood Drops the Pro-Choice/Pro-Life Labels

And here is their video explaining why.

Thoughts?

I generally agree that using labels in an incredible complex and nuanced decision like terminating a pregnancy is for the most part unhelpful. However, I never much liked “pro-life” for those opposed to abortion rights anyway, and preferred to use the term “anti-choice,” for the reasons that many have articulated – that a woman’s life must be considered above that of a fetus, that choosing to terminate a pregnancy based on one’s personal circumstances is in fact being pro-life and thinking of a potential child’s future, that a fetus is not yet an actual life, that a woman has a right to decide what goes on in her own body. As with all things, the weight and emotions of descriptors sometimes get too heavy, and I do hope that this will encourage more in-depth conversation around abortion rights.

Additionally, Guttmacher recently release a series of infogrpahics covering the racial/ethnic disparities in accessing abortion care, income disparities, how women pay for abortions, and a cross-sectional look at abortion in the United States. Check them out:

U.S. Women who Have Abortions

 

How do Women Pay for Abortions?

How do Women Pay for Abortions?

 

Racial and Ethnic Disparities

Racial and Ethnic Disparities

 

Abortion Concentrated Among the Poor

Abortion Concentrated Among the Poor

 

Barriers to Abortion Access

Barriers to Abortion Access

 

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Filed under Feminism, Public Health, Reproductive and Sexual Health, Women's Health

My 2012 Year in Review

Who doesn’t love stats? WordPress compiles a great little summary of one’s bog at the end of the year, and I thought I’d share the highlights.

My top five posts – ones with the most traffic in 2012:

1) Yes, Summer’s Eve has Bad Marketing. Oh, and the Product is Not Good for You. (holding the top spot for the second year in a row!)

2) Is This Real Life? The Reproductive Rights Version.

3) Think Domestic Violence is Funny?

4) I’m Rarely Speechless.

5) Fox News: No.

The top five referrers to my blog:

1) Facebook

2) Feministe

3) patheos.com

4) Twitter

5) Google Reader

Top search terms leading people to my blog:

1) “is summer’s eve bad for you”

2) “does summer’s eve cause yeast infections”

3) “can summer’s eve cause yeast infections”

Looks like this is unquestionably my signature piece…

Readers came from 160 countries! Much bigger reach than last year in that respect. Thanks for reading everyone!

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Retraumatization: The Increased Risk of HIV Transmission among Abuse and Assault Victims

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

  • The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom
  • Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections
  • People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

  Sample size Number (%) of participants with each characteristic
Sexual activity
Any sexual activity in the past 6 months 113 61 (54.0%)
 With a main partnerMedian number of main partners (if any) 61 43 (70.5%)1 (range 1–2)
 With casual partnersMedian number of casual partners (if any)a 61 23 (37.7%)1 (range 1–25)
Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months 61 51 (83.6%)
 Disclosure of HIV status less than all of the time with these partners 51 29 (56.9%)
 Using condoms less than all of the time with these partners 51 31 (60.8%)
 Detectable viral load 51 30 (58.8%)
 Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load 51 16 (31.4%)
Substance use (any, recent)
Cigarettes 110 71 (64.5%)
Alcohol 111 50 (45.0%)
Marijuana 111 39 (35.1%)
Crack/cocaine, heroin, and/or methamphetamines 111 45 (40.5%)
IDUb 112 11 (9.8%)
 IDU who share needles 11 5 (45.5%)
 IDU who have a detectable viral load 11 6 (54.5%)

aOne participant had a very high number of sexual partners (N = 250) and was excluded from the analysis; b IDU injection drug use; ©2012 Machtinger, et al. (retrieved December 16, 2012.)

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.

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Filed under Epidemiology and Population Health, Feminism, Health Behavior, Mental Health, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Violence Against Women, Women's Health

The Staggering Incidence of Breast Cancer in the Bay Area

Check out this piece in Tuesday’s edition of my hometown paper, the San Francisco Chronicle, discussing research by the Public Health Institute on the bizarrely high incidence of breast cancer in Bay Area counties. It’s fascinating. Marin County has for years been considered a hotbed for this disease, without much explanation as to why, but now it seems that multiple Bay Area counties – with the exception of San Francisco County itself – are showing similar rates. No research was undertaken in this project to determine why, but getting a handle on which regions have the highest incidence rates is a good first step for further exploration.

This image shows the counties and regions in which invasive breast cancer is 10%-20% higher than in other parts of the state – two other regions were seen with similar incidence rates in Southern California:

Picture copyright of San Francisco Chronicle

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Filed under Epidemiology and Population Health, Public Health, Women's Health