Science of Sex: HIV and AIDS

October 24th, 2017

Welcome to the seventh installment of a feature on Of Sex and Love that I call Science of Sex. In this feature, I discuss the science of sexuality in an easy-to-digest format that’s accessible to the casual reader. I will also follow up with some extended reading material for people who want to know more about the subject of each post.

I update Science of Sex every second Saturday of the month — except for this one thanks to issues with connection, computers, and inspiration. Better late than never! 

Science of Sex HIV and AIDS

We’ll dive right in. I assume you all know that HIV, Human Immunodeficiency Virus, is a sexually transmitted infection that compromises the immune system by destroying CD4 T-cells. When it progresses to the most advanced stage, we refer to it as Acquired Immune Deficiency Syndrome or AIDS. In the final stage of HIV, the immune system has become too compromised to fight off HIV or other infections and illnesses (including pulmonary tuberculosis,  and recurrent pneumonia), which will take advantage of this time to infect the person. Treating the virus can put off progression to this final stage.

When HIV and AIDS first came on the scene in 1981, it was a death sentence. Within the first year, around half of the American men who were diagnosed with HIV died. There is much I could say about the cultural impact, especially because HIV/AIDS affected homosexual and bisexual (as well as their female partners), the most. We’re all familiar with the endemic and the ensuing panic that arose after the discovery of HIV.

While the infection remains an epidemic in some areas, including Cameroon and the Democratic Republic of Congo, where the infection originated, our understanding of HIV and AIDS has greatly increased over the last three and a half decades.

For example, promising tests of a new antibody in primates indicate that it is capable of preventing contraction of 99% of HIV strains. Testing on humans should begin next year. This is good news, but getting there was a difficult process for several reasons.

One of the main reasons that tackling HIV is difficult is becaise there are different types and subtypes of HIV. When most people speak of HIV, they mean HIV-1, which is the most common in the United States and the UK, among other locales. 95% of all HIV cases are HIV-1, but HIV-2 remains common in western Africa but has spread to other countries, and it’s even possible to contract a hybrid of the two strains.

Doctors have had the most success treating HIV-1, which is better understood. HIV-2 doesn’t respond to all of the treatments that HIV-1 responds to. It is less likely to develop into AIDS. People with HIV-2 are less likely to be diagnosed or to receive treatment for the virus, however. Originally, most HIV tests looked for HIV-1 antibodies, but modern tests search for signs of both types of HIV.

I’ll focus on HIV-1 from here because that’s what we know the most about and where we’ve made the most progress. HIV-1 presents challenges because there are 4 groups: M, N, O, and P. The majority of people in the M group have subtype B; although, subtypes A, C, D, F, G, H, J, and K exist as well as 89 hybrid viruses or ‘circulating recombinant forms’. Cameroon still has the widest variations of strains. Just like more research is needed into the other groups and the less common subtypes of group B, including CRFs,

There is good news when it comes to treatment, however. Because HIV is a retrovirus, researchers have designed antiretroviral therapies (ART), to treat people with HIV and also sexual assault victims who may have been exposed (official CDC guidelines recommend ART for high-risk victims). The first ART took six years to develop and approve, but there are now six categories:

  1. Entry Inhibitors work by stopping HIV entry into CD4+ cells
  2. Nucleoside Reverse Transcriptase Inhibitors, also known as nukes or NRTIs, help to block the reverse transcriptase proteins that HIV needs to multiply
  3. Non-Nucleoside Reverse Transcriptase Inhibitors, also known as non-nukes or NNRTIs, work by binding to and disabling the reverse transcriptase proteins that HIV needs to multiply
  4. Integrase Inhibitors block the enzyme that HIV needs to infect CD4+ cells with its genetic material
  5. Protease Inhibitors, also known as PIs, inhibit an enzyme that HIV needs to make copies of itself

When a doctor prescribes a combination of three ARTs from two different categories, it’s known as highly active antiretroviral therapy (HAART).

Between 2008 and 2014, new HIV infections dropped 18% in the United States with the biggest drops in drug users and heterosexuals. We lack research into HIV transmission rates for victims of sexual assault and sex workers. The data have is dated (around 1% of sexual assault survivors were tested for HIV in 1998, and half of them tested positive, presumably because they fell into the high-risk group. Furthermore, sex workers are ten times as likely to contract HIV, and approximately 12% of sex workers have the infection.), and change hasn’t been tracked. Hopefully, transmission rates have dropped for those groups as well.

The progress that has been made not only improves quality and length of life but reduces the risk of spreading HIV to new partners. The CDC has recently updated its HIV/AIDS guidelines for the first time since 1990. The updated guidelines finally indicate that the risk of spreading HIV-1 to sexual partners, to fetuses or infants via breastfeeding is virtually none as long as the person with HIV takes a daily HAART treatment. Mixed-status couples can safely try to conceive without worrying about the risk of HIV contraction.

While this has been one of the longer Science of Sex posts, it was one of the most fascinating to research. I knew very little about HIV/AIDS when I began, and encourage you to go through the extensive list of resources below if you want to know more about HIV.

Further Reading

Comment


Science of Sex: HPV and the HPV Vaccines

June 17th, 2017

Welcome to the fourth installment in a new feature on Of Sex and Love: Science of Sex. In this feature, I plan to discuss the science of sexuality in an easy-to-digest format that’s accessible to the casual reader. I will also follow up with some extended reading material for people who want to know more about the subject of each post.

Enjoy!

Science of Sex HPV

Human Papilloma Virus in a Nutshell

HPV is the virus that causes genital warts, but just because you don’t have any symptoms doesn’t mean you don’t have HPV. It’s one of the most common sexually-transmitted infections with over 200 strains (strains 16 and 18 cause over two-thirds of all cervical cancer while low-risk strains 6 and 11 cause most warts). Over 80 million people or about 1 in 4 people have it. It’s easy to transmit through skin-to-skin contact, so even using condoms may not prevent HPV. The CDC advises that ‘nearly all’ men and women will contract HPV in your life, and it’s likely that many people don’t even know they have it.

HPV doesn’t just cause warts. It can lead to irregular PAP smear results for women and cause cervical cancer (HPV can also be the culprit for other cancers, including that of the throat and anus). Those results can lead to a woman getting tested for HPV, but there is currently no test for HPV in men who have an asymptomatic strain (some sources indicate that a test does exist but it’s expensive and invasive).

Treatment of HPV may mean doing nothing at all. Most cases clear up within two years, but this isn’t always the case.

The HPV Vaccine

A vaccine for several of the most common strains of HPV, including some that cause cervical cancer, Gardasil, became available about 10 years ago. There are now three different vaccines for HPV available (Cervarix, quadrivalent Gardasil, and 9-valent Gardasil-9), the latter of which cover more strains of HPV than the original. One study concludes that HPV vaccines can prevent “most” invasive cervical cancers (around 70% of cervical cancer for the 9-valent vaccine and 66% for original Gardasil) as well as some oral cavity, penile, laryngeal and vulvar cancers. These vaccines are at least 90% effective at blocking those strains.

The vaccines consist of three doses that you can take between ages of  11 and 27 (for women) or 21 (for men). Younger patients may only need two doses. Even if you can’t take all shots within this time frame, you’ll still benefit from at least one dose. Similarly, the vaccine is still beneficial if you’ve already become sexually active, but it’s more beneficial if administered before sexual activity. In this case, the younger the better.

Although at first recommended for girls, HPV vaccines are beneficial for boys who can contract and transmit HPV. But it’s less likely that a male will no if he’s HPV-positive, which means he’s more likely to transmit it to a partner.

Still, fewer boys than girls are being vaccinated (12% of boys had received all three doses compared to 36% of girls in 2013), and vaccination occurs at a later age. Fortunately, vaccination rates have increased through the years, perhaps as no serious side effects have arisen over the years and the efficacy of the vaccines have been proven. For girls, infections by strains of HPV that the vaccine prevents has dropped 64% since 2006.

Let’s hope that vaccination rates rise, gaps close and strides can be made to cover more strains of HPV in future vaccines!

Further Reading

2 Comments


Science of Sex: Lube

April 11th, 2017

Welcome to the second installment in a new feature on Of Sex and Love: Science of Sex. In this feature, I plan to discuss the science of sexuality in an easy-to-digest format that’s accessible to the casual reader. I will also follow up with some extended reading material for people who want to know more about the subject of each post.

Enjoy!

science of sex lube

I am not the first person to write about lube, and I doubt I’ll be the most effective. But lube is so interesting from a scientific viewpoint, and I believe we can never talk about it enough.

Lube should make sex better, but it doesn’t always. For example, lubes that contain the spermicide nonoxynol are quite abrasive to sensitive tissues, resulting in micro-tears that actually facilitate the transfer of infections. Multiple studies have shown that Nonoxynol-9 contributes to HIV transmission.

Osmolality

Depending upon its osmolality, the measurement of particles per KG in a solution, lube may be doing unseen damage to your vagina or anus that increases the likelihood of an infection, too. Many lubes have a much higher osmolality (greater than 1,000 mOsm/Kg) than the vagina (~275 mOsm/Kg) or anus meaning there are more particles in the lube than the tissue it comes in contact with.

Osmolality is also important when it comes to sperm, which have a different measurement than vaginas, anuses, saliva and many lubes. By default, nearly all lube proves to be an inhibitor to sperm, so you’ll want to look for sperm-friendly lube when it comes to TTC.

Lube pH

If your lube has a pH that differs from your body’s natural pH (between 4.5 and 7 for most vaginas; pH varies during your cycle and life), you might find yourself dealing with a yeast infection while your body seeks balance.

Other Problematic Ingredients

And personal lubes that contain L-arginine, which is typically used to encourage sensitivity and arousal, can cause a herpes breakout. Sensation lubes (warming or cooling) typically rely on menthol or capsaicin to produce the desired effect, and every body responds to these chemicals differently.

Numbing agents such as lidocaine or benzocaine are sometimes found in anal lubricants. However, experts recommend against numbing the area because it both reduces pleasure and makes it harder to tell if you’re being too rough, which could lead to damage.

Lube and Your Toys

Even if lube is good for your body, it may not be compatible with your toys, which is the case with low-quality silicone lube and silicone toys. Using them together can cause an interaction that increases the porosity of your silicone toys, so they’re not as body-safe as they once were.

Further Reading

Did you enjoy the second installment of Science of Sex? Do you have further questions or suggestions for next month’s subject? Leave me a comment!

2 Comments


Stigma of STDs

November 24th, 2009

A while back I was reading a piece in Best Sex Writing 2009 about the advent of online dating communities for people with STDs. The article talked about these different communities, some aimed for STD sufferers in general and others aimed for folks with more specific STDs, which aid people in finding similar folks. It’s supposed to help folks in a couple ways. First, it helps to get the message across because the fact that So and So has X virus is right out in the open. There’s no third date jitters because you don’t know how your partner will react to the bad news. It also helps people look for others with the same STD/strain so they needn’t worry about giving it to someone else.

But it definitely reduces the dating pool. In the article, one of the users of such a site mentioned how there were only ever 1 or 2 folks in her location on the sites and those were not matches made in heaven. It can be difficult to find even a possibility, nevertheless a hit, on general dating sites whose users surely number in the thousands think AdultFriendFinder or a specific match sites like think Alt.com. So reducing those numbers even more can make the task of finding a partner even more hopeless, under the guise of hopefulness. To put it plainly, it’s hard enough to find someone (or sometimes several) when you’re considering all the fish in the sea but STD dating sites are just a little pond.

I’m not entirely sure that folks with STDs should have to limit themselves to that little pond. Not only are the pickings sometimes slim but it’s all too easy to write off someone because their STD status is displayed so prominently. Assuming everyone chooses their partners wisely (ha!), there are circumstances where STDs do not have to be the deciding factor of a relationship but the stigma is so high that it can even penetrate a community intended for those whose STDs run the gamut. If someone with disease X can turn his nose down on someone with infection Y, it’s no wonder there’s such a stigma around STD sufferers in general. It’s no wonder someone thought it would be a good idea to make such a dating site (not that it’s not).

And the stigma? Is there. It’s certainly real. There’s a “them versus us” mentality. I’m not proud to say that I’d had an STI invade my body and I still think that way sometimes. I try not but it comes so easily. I imagine the type of person who could possibly be so stupid or silly and I realize that.. I was that person. I start thinking about my friends and acquaintances, knowing at least 3 of them have all had at least one STD or STI. We’re not loose women – some of us have only ever been with one person – and we’re certainly not stupid. Our cabinets aren’t stocked with cocaine nor are we sex workers. Basically, no one I know with an STD has fit any fantastic stereotype of an STD sufferer.

It’s then that I realize it’s now “us” and “them” because they are us and vice versa. If I could have an STD, then so could my best friend, my mom, my coworker or my neighbor. Not only is it plausible, but it’s likely that more of my friends and family than I know have struggled with an STD and, by its nature, the stigma involved with it. Science agrees: “Among those ages 15-49, only one in four Americans has not had a genital HPV infection” and 12 million Americans contract an STD each year 1. That means the other 75% have HPV and it’s likely they don’t even know it because many strains have no symptoms even even those which do can lay low for some time. I wouldn’t have known, if not for my yearly Pap and there’s currently no test for men at all. Of course, HPV is only one of many STDs. It becomes clear; although, many people who perpetuate the stigma actually have an STD. The reality is, not only is there no way to distinguish between people, it becomes far less necessary to do so (simply to feed the gossip and stereotypes), when considering the numbers.

Of course, I don’t even realize the stigma has affect me, even as I wonder if I would ever be able to have sex with someone besides my husband (should we ever get to that point) and I cringe because I don’t know what to say about my HPV. I don’t realize how easily it is to perpetuate the problem even as I picture that stereotypical “STD-person” all covered in warts and strung out in my head. It’s a stigma that does no one any good and a stigma which could use a good boot to the butt.

So does a dating site for STD sufferers help? I guess it depends on how you define the problem.

1 – American Social Health Association, Myths and Misconceptions about HPV

5 Comments


Importance of Sex Education

February 23rd, 2009

I have always believed in sex education. Coming from a liberal, midwest state I know the sex education I got (which started in second or third grade and last, on and off, until my sophomore year) was much better than the sex ed others were getting which ranged from “Don’t do it” to “Masturbation is a sin” to none at all. Still, the focus was on not engaging in sex; although I felt my teachers gave me good reasons why (and I was listening), more information about safer sex would be preferred.

I know I’m not the only one who values sex education that is actually, well, educational but not everyone does. There are some people who feel that educating our nation’s youth about sexuality isn’t the way to go (is it any wonder that these people have unsatisfactory sex, got pregnant in their teens, caught a multitude of STDs because of risky behaviour or have never known how to please themselves or their lovers?) and to them I say “Listen up!”

I think most of us agree that the purpose parenting and teaching is to communicate to our children the risks they will have to deal with once they leave the walls of home or school and set them up to make the best decisions when it comes to these risks. We certainly exert more control over theirs lives when children are younger; no one is going to let a toddler cross the road by himself but as children grow, we impart on them more responsibility regarding life’s risks and trust that we have reared a child or a generation of children who will choose the best course of action for them. Notice, I don’t say “right” because what is right for one individual may not be for another.

I believe it’s important for us to recognize that life is full of risks but we can’t simply shelter our children; this almost always leads to more harm than good. By allowing them to make their own decisions and mistakes, we help them grow and give them a sense of confidence. So why is it that so many people think the best way to teach about sexuality is to say “Don’t do it” and leave it at that – the equivalent of “Because I say so,” another cheap cop out that no responsible person should use?

Although I’m not a parent, I can tell you that when I was given a solid “No” without meaning, it only made me want to rebel against my mother. However, if she took the time to explain why she said no, I was more wiling to consider her side and listen to her advice. When we tell our young children not to cross the road (without looking both ways), we explain to them that cars sometimes drive very fast and drivers may not see them when they’re doing so. Not looking could result in a painful or even deadly accident. And when we tell them not to talk to strangers because strangers may want to hurt them, they learn not to talk to strangers.

Of course, even as we try to teach these life lessons, we must recognize that, at some time, our youth will cross the road without a trusting hand to hold and that everyone begins a stranger so we must be somewhat trusting. We take as active a role as possible: we tell them some strangers are helpful like police officers, doctors or teachers and we send them into the world, armed with knowledge. We teach them how to drive, explain that a car is a powerful machine and they must be observant and obey laws and rules of the road. And then we let them go.

So why should sex be the exception? Why should something, without which none of us would exist, be glossed over, tucked in the back of the book or ignored altogether? It shouldn’t. Sex is a part of life and will always be a part of life. It has the potential to be riskier than other activities, certainly, which makes it even more important that we educate youth about it.

Of course, it also makes us want to protect them from it even more and it’s certainly understandable but if we don’t give them the information they need to make the best decisions, doesn’t this endanger them even more? By withholding information about the risks of sex, teens may be walking into a dangerous situation blindly. In fact, I would call this very irresponsible in terms of parenting and educating. Furthermore, by not educating how sex can be a positive, healthy and pleasurable thing (within and outside of a relationship), we could be setting up the next generation to a life of mediocrity.

I don’t think we should be bringing porn starts into our class rooms or waking up our kids with skin mags but I think that a level of responsible parenting and teaching is necessary. And, no, I don’t think that illustrating why waiting to have sex but outliningg ways to engage in safer sex at the same time will prompt teens to engage in sex earlier. I think that, by nature of our species, adolescents will be curious and some will have sex, yes. I also think that if we show them the potential risks including pregnancy, STDs, physical discomfort and emotional tolls, we allow them to make the most educated decision and, should they decide to have sex, they know to protect themselves from all the possible negative consequences. Hopefully, teaching about the risks will also deter some teens from having sex at a young age.

But if we don’t teach them and they race to the sack with the first person who is open to advances, they may not know to use condoms to protect from STDs and prevent pregnancy. How many know someone who thinks “pulling out” is an effective form of birth control? Or who wonder if you can get pregnant from oral sex? Or who think that you cannot get pregnant while a female has her period? How many people are aware that condoms don’t protect against all STDs, should only be worn for 30 minutes at a time, should have room at the tip for semen to accumulate and should never be worn doubled up? Not everyone and that is a problem.

Yet, it’s not the only problem. I think it’s important to recognize that not teaching today’s youth about their bodies can limit the pleasure they will experience during their life on Earth. This is especially true with the female half of the population, some of whom do not even know what the clitoris is or that female cans masturbate or that it’s okay to communicate what they like during sex. Comprehensive sex education not only leads to safer sex but leads to more meaningful, positive sex which enhances, not harms, relationships.

Although I discuss mostly young people and their ignorance when it comes to sex, I think that most young people are better educated than some adults. Do our parent’s and grandparents’ generation even know a fraction of what we do? How many grown women engage in dangerous vaginal douching to be “fresh” and clean? Would some hard learned lessons have made sex and relationships better had someone care enough to take the time to explain the basics? Absolutely.

There is no need to drill into youth that “Sex is bad! Sex is bad! Sex is bad! Don’t talk about it.” However, there is every need to explain that the best sex can be physically and emotionally fulfilling by knowing the risks and preparing for the consequences. And that is no different from every other lesson we teach at home or school.

1 Comment