LGBTQ Mental Health Incorporation into Medical Education Curriculum by Hannah Forrestal
FIERCE: Conversation with Isabella Kills Michaels
April is STI Awareness Month-Kayla Matteo, Des Moines University Student Doctor
My high school sex ed class can be summed up as playing “toss the testicle” with rubber body organs. Sexual health was an awkward topic that my well-meaning health teacher seamlessly avoided — in hindsight, many would have had a difficult time rallying a class of 15-year-olds who could barely keep it together at any mention of “vagina.” One would assume that my college education would make up for the experience of only learning how to throw a curveball with a rubber testicle, but I never fully received that knowledge. Sure, we had some optional talks at the club fair's Planned Parenthood booth, but many other college students and I moved through our teenage and early adult years without foundational knowledge about sex, and the reality of the not-so-fun additions to sex: sexually transmitted infections.
Now I find myself here in medical school, finally learning the hard facts of STI prevention that I never fully picked up in all my 20 years of education. April is STI Awareness Month, and I am determined to ensure that knowledge about STIs and how to prevent them CANNOT only be reserved for medical students. Adolescents need to be armed with such knowledge to protect themselves and others, and have confidence in advocating for their own bodies and health when the time comes. So here are some common facts and myths about STIs that I wish I knew back then during health class, and what we need others to know now.
· Fact vs myth: Syphilis is an STI that was only prominent during the 1400s-early 1900s.
o MYTH: In fact, right here in Iowa, there has been a huge rise in syphilis cases based on data from 20211. So how do we protect ourselves from contracting syphilis? The only way to protect yourself from syphilis is to use condoms to prevent contact with sores. However, some syphilis sores are not fully covered by condoms, and syphilis can be contracted by contacting these sores 2. The best thing to do is use condoms, and stay aware! If you’re unsure where to get condoms, don’t feel comfortable buying them, or cannot afford them, here is a condom locator that shows places to get free condoms!
· Fact vs myth: There is a cure for syphilis.
o FACT: A single injection of Penicillin G can cure the earlier stages of syphilis2. If you need to be treated for syphilis, wait until the sores are completely healed before having sex again, and tell your partner so they can get treatment too!
· Fact vs myth: You can give someone genital herpes if you perform oral sex on them with an active cold sore.
o FACT: Oral herpes is usually caused by HSV-1 and genital herpes is usually caused by HSV-2. While these two strains of herpes prefer to hang out in different locations, they can sometimes change teams when exposed to the other location. If someone performs oral sex while having an active cold sore (aka an HSV-1 infection), it is possible for HSV-1 to pop up on the genitals. If someone has an active HSV-2 infection on the genitals, it is possible for HSV-2 to show up around the mouth 3,4.
· Fact vs myth: You can only give someone genital herpes with an active, symptomatic infection.
o MYTH: People can still spread herpes infections without any symptoms due to “viral shedding.” In fact, most people are infected with herpes during this asymptomatic shedding period5. Therefore, it is extremely important to keep barrier methods like condoms and dental dams in your back pocket (or wallet, whichever you prefer)!
· Fact vs myth: If you don’t have any symptoms, you don’t have an STI.
o MYTH: There are several STIs that can be asymptomatic, so it’s important to get tested when you are sexually active. Untreated STIs can cause infertility, chronic health problems, and more. Here are some of the most common asymptomatic STIs and possible health risks if they are left untreated, and how to prevent them 6,7.
STI: HPV (Human Papillomavirus)
Risks If Untreated- Cervical cancer (and others)
How to Prevent If Sexually Active-
GET VACCINATED!
Routine cervical cancer screening
Condoms
Monogamy
Getting tested before and after each new partner
2. STI: Chlamydia & Gonorrhea
Risks If Untreated- Pelvic Inflammatory Disease (scarring of fallopian tubes), which can lead to infertility
How to Prevent If Sexually Active-
Condoms
Monogamy
Getting tested before and after each new partner
3. STI: Trichomoniasis
Risks if Untreated: Increased risk of getting other STIs and HIV
How to Prevent if SexuallyActive:
Condoms
Monogamy
Getting tested before and after each new partner
4. STI: Herpes
Risks if Untreated: Spreading to sexual partners
How to Prevent if Sexually Active:
Condoms
Monogamy
Getting tested before and after each new partner
*Keep in mind that while condoms are the most effective form of STI prevention other than abstinence, they are not 100% protective. Even though the risks are low, you could be doing everything right and still might contract an STI.
Fact vs Myth: Having a sexual relationship is not possible if I contract an STI.
o MYTH: There is a ton of shame and stigma associated with contracting an STI, which can often make people feel like sex in the future is out of the question. However, not only are STIs quite common, most of them are extremely manageable. For example, chlamydia, gonorrhea, and syphilis can be treated with a course of antibiotics. Herpes and HIV may be incurable, but their infectiousness can be significantly lowered with antiviral medications. It may be difficult to tell your partner about your STI status, but letting your partner know before you have sex allows both of you to make informed choices about having sex. Open and honest communication creates a safe environment for you and your partner to decide how to proceed8.
Talking about STIs can often be uncomfortable, but arming yourself with the knowledge early on can make all the difference when it comes to prevention. To learn more about STIs and how to prevent them, chat with a trusted healthcare provider — they’ve got your back.
Sources
1. Iowa Public Health Tracking Portal, Syphilis Data, 2021. https://tracking.idph.iowa.gov/Health/Sexually-Transmitted-Diseases/Syphilis-Data
2. Center for Disease Control and Prevention. Syphilis & MSM Fact Sheet, 2022. https://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm#:~:text=Using%20latex%20condoms%20the%20right,sores%20can%20still%20transmit%20syphilis
3. Center for Disease Control and Prevention. Genital Herpes Fact Sheet, 2022. https://www.cdc.gov/std/herpes/stdfact-herpes.htm#:~:text=Yes.,are%20due%20to%20HSV%2D1
4. Planned Parenthood. Oral & Genital Herpes. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes
5. Mount Sinai Health Library. Herpes simplex. https://www.mountsinai.org/health-library/report/herpes-simplex#:~:text=Genital%20herpes%20is%20contagious%20from,not%20present%20(asymptomatic%20shedding)
6. Michael Cackovic, MD. Ohio State University Wexner Medical Center. STIs you can have with no symptoms, 2019. https://wexnermedical.osu.edu/blog/stis-without-symptoms
7. Center for Disease Control and Prevention. Sexually Transmitted Infections Fact Sheets. https://www.cdc.gov/std/healthcomm/fact_sheets.htm
8. Center for Disease Control and Prevention. STI Awareness Week: Conversation Tips, 2022. https://www.cdc.gov/std/saw/pbyt/conversation.htm
Obscuring Mirrors and Windows: The Effects of Book Banning
Obscuring Mirrors and Windows: The Effects of Book Banning
By Elliott Nassif, Lead Implementation Specialist
Book banning. It’s a tale as old as time. Books are mirrors that reflect back to us what our society values. When books are banned, it shows us our collective fears. When values around topics like politics, religion, education, and sex start to change, our society tends to recoil. What implications does book banning have for the futures of young people? I recently had the privilege of speaking to Christine, a high school librarian, to hear her thoughts about book banning in Iowa’s school libraries.
Elliott: What trends have you seen recently in book banning?
Christine: Book banning tends to go in waves. We haven’t had many in recent years, but the tide is turning.
E: In Iowa and around the country, books are being banned or challenged because of themes like LGBTQ+ inclusion, racial justice, teen sexuality and sexual assault, and sometimes because of language that may be deemed “vulgar.” What strategies do librarians use to defend these topics?
C: Many times, materials are challenged when excerpts are cherry-picked from a story. Context is critical. One stipulation we have before our district’s libraries will consider a book challenge is that the material is read cover to cover. Oftentimes when that happens the reader realizes why the scene/word/objectionable material was included.
E: What happens when a book is ultimately pulled from the shelves? Does it affect education?
C: When materials are restricted or unavailable it is the students that suffer. Not all materials are right for every student. That is the point. We are not all the same. We have different preferences, experiences and needs. Choice is key. It is the job of the librarian to provide materials that offer students a wide range of options so students can pick what is right for them.
E: What can libraries do to help prevent books from being banned?
C: One of the best things libraries can do right now is to make sure they have challenge policies in place. Facing a book challenge is inevitable. It's important to remember library materials and curriculum materials are not the same. Librarians do not require students to read all the books or even specific books. The purpose of a library is to provide a wide range of materials, so all students have windows and mirrors represented in available materials.
E: Thank you so much for sharing your insight, Christine, and thank you for all you do.
I LOVE Christine’s “windows and mirrors” metaphor. Everyone wants—and deserves—to have their stories told and to read stories about diverse experiences and worldviews. As a teen in the mid-2000s, I remember clinging to the handful of queer books in my hometown library. As an adult, I’m heartened by the wealth of books that center queer and trans characters, BIPOC characters, neurodivergent characters, and other marginalized populations.
So, what can we as educators and caretakers of young people do to make sure they see themselves in the media they consume?
1. Support your local library—through monetary donations, patronage, or volunteer time.
2. Pay attention to any book challenges in your school district. Attend school board meetings and advocate for retention.
3. Stay curious! Pick up a recently challenged book. Here are some titles:
· All Boys Aren’t Blue by George M. Johnson
· The Hate U Give by Angie Thomas
· Gender Queer: A Memoir by Maia Kobabe
Happy reading!
September is Suicide Prevention Month
September is Suicide Prevention Month. Suicide can affect anyone, and is the second leading cause of death for young people ages 13-24. Research shows that LGBTQ+ youth are at higher risk for suicide attempts than their straight and cisgender peers--lesbian, gay, bisexual, and queer youth are 3-4x more likely to attempt suicide, and trans and gender non-conforming youth are up to 8x more likely. According to The Trevor Project, at least one LGBTQ+ youth attempts suicide every 45 seconds in the US.
These numbers are alarming, yet can be understood through knowing the challenges young people face because of their identities and expression. Queer and trans youth may experience bullying at school and online, or come from invalidating, unaccepting home environments. They are more likely to experience physical, emotional, and sexual violence as well as houselessness or unstable housing. All these issues contribute to depression, anxiety, and other mental health concerns.
It's important for adults to know the signs of depression and potential suicidality in young folks:
· Withdrawing from friends and family
· Not keeping up with their personal hygiene or general self-care
· Decreased school performance
· Talking about dying or being suicidal
· Quitting activities or hobbies they usually enjoy
· Engaging in non-suicidal self-injury (cutting, burning, bruising)
· New or increased substance use
Note: these behaviors may show up outside the context of depression or suicidal ideation, but knowing the signs and keeping communication lines open is a vital step for prevention.
What are some other ways to prevent LGBTQ+ youth suicide?
Show support through your words and actions!
This can look like showing up for LGBTQ community events, using people's correct pronouns, and not assuming every person you encounter is cis or straight.
Representation.
Kids need and deserve to see themselves reflected in the media they consume and in what they learn in school. This includes learning about LGBTQ+ historical events and figures, reading books by and about queer and trans people, and receiving inclusive sex education. Inclusive education helps to affirm LGBTQ+ young people's identities and make school safer and more enjoyable. Not only that, it reduces the risk of suicide attempts and completed suicides.
Access to gender and sexuality affirming health care.
LGBTQ+ young people have unique health care needs--both mental and physical. By seeing inclusive and affirming providers, their needs are more likely to be met, and will result in better health outcomes.
Suicide is a daunting topic, but it's necessary to talk openly and honestly about it. This breaks down the stigma and lets young people know they are not alone. It just takes one caring adult to make a difference.
Local and national LGBTQ+ resources:
The Trevor Project – hotline, live chat, and live texting
Trevor Project Crisis Hotline 1-866-488-7386
The Trans Lifeline – hotline run by and for trans people, plus other resources
877-565-8860
Iowa Safe Schools – LGBTQ+ resources for students, caregivers, and educators
Primary Health Care – affirming and inclusive sexual and general health care
One Iowa – resources for finding LGBTQ inclusive mental health counselors and LGBTQ advocacy
Elliott Nassif, Lead Implementation Specialist at EyesOpenIowa
New Year's Resolutions
Here we are again, the in the land of New Year’s resolutions.
Losing the (Quarantine) Weight.
Eating Healthier
Sticking to a Budget
Being a Better Person (whatever that means…we’ve done it too)
And yet, every year, it’s easy to track that after the initial hype, we’re all sort of over New Year’s resolutions by January 6th or so.
Many of us work with young people to help build their self-esteem. This work is critical and can be so rewarding. But it is equally important to keep track of and nurture our own relationship to ourselves as adults.
Usually, New Year’s resolutions are a thinly veiled mechanism for telling ourselves we are not enough and need to be BETTER.
This year, in addition to/instead of reliving the typical New Years resolution cycle, we offer you the following strategy for learning more about yourself and finding greater freedom within:
Step one: Pick one of your resolutions. For instance, “I want to lose 10 pounds” (a familiar one to many of us).
Step two: Instead of immediately proceeding headlong into an almost-sure-to-eventually-fail cycle of diet deprivation and positive/negative self-talk, try first asking yourself, “why do I want to lose 10 pounds?”
Common answers include, “to feel lighter, to feel as though I have more energy, to feel better about myself.” Sit with the question until you find one that feels the most true for you.
Step three: Pick your answer/one of your answers and make a list of all the ways and places in your life that this statement isn’t true – outside of weight concerns.
So, for example, if your reason was, “I want to feel lighter”, make a list of all the places in your life that feel heavy:
“I feel really bogged down at work with projects I keep saying yes to but don’t want to do” or
“I feel the weight of friendships or family relationships that don’t give to me as much as I give to them” or
“The grief I feel from having lost my mother feels like a weight in the middle of my chest.”
Step four: Decide to take a step to heal one of these places. For example, seeking therapy to work on why you constantly find yourself in relationships where you give, but don’t get, very much. Or to process grief. Or to examine your patterns at work.
It doesn’t mean we can’t carry on with weight loss or self-improvement. But doing this deeper work is the only thing that can provide the kind of freedom we seek in making New Year’s resolutions in the first place.
Wishing us all love and a little more lightness in 2021. And let’s go easy on ourselves – we survived 2020, which is no small feat on its own.
Gail Cowan, MSW, is EOI’s Director of Development. A former therapist, she also runs her own coaching business. Find her at www.gailcowan.com.
Dating While Social Distancing: How to Maintain a Healthy (and Fun) Relationship
By: Tricia Ingram Williams, Training Specialist
Let’s admit it; this whole social distancing thing can be a little stressful. There’s school-work to do, siblings and parents to tolerate at all hours of the day, and friendships to maintain. On top of all of that, some teenagers are also trying to continue a relationship with their significant other.
Dating is hard enough when you see your significant other (SO) at school 5-days a week. How the heck are teens supposed to keep their relationship happy and healthy when they can’t even meet up with their partner in person?
Below are five tips to help you maintain a healthy relationship with your SO while social distancing (and even a few social distancing date ideas).
Set boundaries. Since most of us are stuck at home right now, we’re spending more time than ever on our phones and other devices. This makes it tempting to text your romantic interest at all hours of the day (and night). But it’s important to spend time away from all those screens. Set boundaries with your partner about how often you’ll be in communication, so that you have plenty of time to focus on your school-work, exercise outside, spend quality time with your family, and get plenty of rest.
Respect boundaries. If your SO sets boundaries about how often they’d like to talk, be sure to respect those! You can’t expect your partner to always respond to your text immediately, even if they did just post on Snapchat.
Have a robust support system. Quick! Write a list of 5 people that you enjoy talking to. This list could include your best friend, a parent or other family member, a teacher; whoever you feel like you can rely on and trust. Now make it a goal to reach out to each of these people at least once this week. Sometimes we can rely too much on our significant other to be our best friend, romantic interest, therapist, and comedian all in one! This can put too much pressure on one person, and that’s not fair. Instead, it’s important to have a handful of people in our life that we can talk to about significant things, especially during stressful times (like a global pandemic).
Make informed choices about virtual sexual behavior. Since you can’t be with your boyfriend or girlfriend in person, you might want to be sexual in socially distant ways. While sexuality is nothing to be ashamed of, it’s important to learn about the potential positives and negatives of virtual sexual behavior (like sexting). For more information on sexting and its potential legal ramifications, check out Eyes Open Iowa’s blog post, “New Rules of the Digital Age - Sexting.”
Keep social distancing. The longer this pandemic goes on, the more likely it is that you will begin to feel “quarantine fatigue.” You may have noticed that your determination to maintain social distancing has waned in the past week or two, and you may be tempted to meet up with your SO in person. But it is so important that you continue to social distance, wear a mask in public, and stay home when possible. If you don’t want to get sick and you don’t want your SO to get sick, be sure to keep social distancing!
Even though social distancing means that you can’t be with you partner in person, it’s doesn’t mean that you can’t have some awesome date nights! Here are a few social distancing date ideas:
• Pick out a recipe and cook the same meal from your respective kitchens while FaceTiming. You could even make it a competition (who’s meal looks the best at the end)! Then sit down and enjoy the fruits of your labor
. • Use Netflix Party (or a similar website) to watch a show or movie together and chat throughout.
• Have a scavenger hunt for the most random objects you can find in your house. Set a time limit, and when the time is up show each other what you were able to find!
What other social distancing date ideas do you have? Comment below to let us know!
Moving Beyond “you will get pregnant and die.”
By Shari Stucker, Director of Programs
“Don’t have sex because you will get pregnant and die.”
--Coach Carr, Mean Girls
https://www.youtube.com/watch?v=U5xkxTfVLSA
While the scene is a parody, it is not far from what sex education looked like in the recent past, before sex education became a well-researched and evidence-based field.
Fortunately, sex education in Iowa and the nation has come a long way from the days of “you will get pregnant and die.” Federal, state, and local agencies, advocates, and communities worked together over the last two decades to develop and evaluate sex education curricula and approaches. Multiple published study results have shown that the strategies of providing teens with medically accurate information about sexuality and related topics in school actually reduces the teen birth rate, delays the onset of sexual activity, and prepares teens for a lifetime of well-informed sexual health decision-making.
And comprehensive sex education works. The national teen birth rate at 20.3 in 2016 is the lowest it has been, following decades of almost continuous decrease. Iowa continues to reflect the national trend, with a teen birth rate of 17.2 in 2016 (CDC).
Comprehensive sex education receives overwhelming support from parents as well, with 93.5% of parents feeling it is important to have sex education taught in middle school and 96% feeling it is important to teach it in high school (Kantor and Levitz, July 2017).
And yet, the days of “you will get pregnant and die” are not completely behind us. While comprehensive sex education has made a considerable positive impact in states, including Iowa, abstinence-only-until-marriage (AOUM) programs have continued to receive federal funds and support.
Over the last three decades, the federal government has spent more than $2 billion on AOUM programs. These programs use scare tactics and false or misleading information to encourage teens to remain sexually abstinent until they married. AOUM programs have been consistently shown to be ineffective at best and harmful at worst for teens and are denounced by professional medical associations.
Rebranding: Sexual Risk Avoidance and Public Health Strategies
Federal support for AOUM programs decreased in the Obama administration and there was greater negative public feedback during that time. To counter that, AOUM programs underwent significant rebranding and changed their title to “sexual risk avoidance (SRA).”
The new SRA approach uses public health risk avoidance strategies for behaviors that are typically risky or dangerous for teens, such as smoking and illicit drug use. Risk avoidance makes perfect sense when the behavior is a choice and when the outcomes are clearly harmful, such as smoking or illicit drug use. One of the major flaws in the SRA approach, however, is that sexuality is not a choice and is not inherently risky. Despite Coach Carr’s claim, sex does not automatically cause one to “get pregnant and die.”
SRA goes further still in its rebranding. SRA programs also attempt to link teen sexual activity to teens giving birth and then continuing to live in poverty into adulthood. Again, this attempt conceals a crucial flaw in the SRA approach by assuming that teens who are sexually active automatically become pregnant and live in poverty. In contrast, as has been demonstrated over decades, if teens are provided with medically-accurate information and access to resources, the teen birth rate declines. In addition, while a young parent is more likely to live in poverty, with proper supports and resources, that is less likely.
Ascend: name change, same goals, same effects
Ascend is the leading national advocacy and training organization for SRA programs. Ascend was formerly the National Abstinence Education Association and Valerie Huber was the president and CEO. Ms. Huber is now with the federal Health and Human Services Department and is in a role where she has oversight of sex education programs across the country.
A review of Ascend training materials, for providers of sex education, shows that the vocabulary has changed, however, the intended impact, harmful attitudes, false information, and goals of the program remain the same.
Ascend continues to promote false information about contraception and stereotypes about gender and LGBTQ teens. This is all potentially very harmful to teens as they navigate their own sexual health development and make sexual behavior decisions into adulthood.
Moving Beyond “you will get pregnant and die.”
Ascend and SRA programs are similar to Coach Carr’s approach. Because, despite all the rebranding and alignment with public health approaches, Ascend and SRA are essentially telling teens that any sexual activity is harmful, while the programs withhold vital information and perpetuate damaging stereotypes.
And yes, the SRA approach exists in the state of Iowa. It can be difficult for parents, schools, and the public to differentiate between what is a healthy, comprehensive sexual health education program and one that is more likely to cause harm to students.
EyesOpenIowa encourages all stakeholders in teen sexual health education, including schools, parents, teens, and providers, to become educated on what is being provided or offered. EOI has been a leader in this field for over 20 years, knows the field of adolescent sexual health, and can assist with understanding the differences of various curricula and approaches. It can be challenging to figure out or become misled by the “lingo” and make the best choice for all young people. Contact us with any questions or concerns you might have.
Check out the national resources below for more information and let’s keep moving Iowa teens into a well-informed future.
Boyer, Jesseca: Guttmacher Policy Review: New Name, Same Harm: Rebranding of Federal Abstinence-Only Programs, 2018, volume 21.
SIECUS: On Our Side: Public Support for Sex Education, August 2018
SIECUS: Sexual Risk Avoidance? Let's Avoid it.
Saying No to Mission Creep
By Shari Stucker, Director of Programs
One of the first tasks of a nonprofit board and staff is to develop a mission statement. The development of a mission statement is crucial to providing the nonprofit with a strong sense of purpose. It is good practice for a nonprofit to continually review programs and goals to make sure they are aligning with the mission statement.
It is difficult to adhere to a mission though! In today’s nonprofit world there is increasing competition for funds while the amount of funds available in some fields is decreasing. It can be tempting for a nonprofit to go outside its mission statement to “chase the money,” either to keep the agency afloat or to be seen as a large capacity agency.
While funding is critical, it is even more important for a nonprofit to say “no” to potential opportunities that stray far from its intended mission. “Mission creep” is the nonprofit term for seeking funds or programming that go outside the original mission. Mission creep can lead to unforeseen and sometimes negative consequences. (Mission creep is different from a nonprofit’s strategic adaptation of a mission or goals which needs to be done on a regular basis.)
Mission creep can lead to the following:
Inability of staff and board to clearly articulate the mission of the organization to potential funders, donors, and stakeholders;
Questions from funders and donors about the mission;
Agency staff having to work in a field outside their expertise and often without training or experience;
Stretching of staff resources in attempts to manage multiple programs in varying fields with varying requirements.
All of the above can significantly negatively impact the ability of staff and board to carry out all its programs, including those within its mission, effectively.
As daunting as it may seem sometimes, there are many positives for a nonprofit that adheres to its mission:
Staff and board can easily articulate the purpose with knowledge and passion;
Fundraising is easier when the mission and programs align;
A strong sense of purpose strengthens staff and board;
Mission focus allows staff, board, and stakeholders to explore other methods to achieve its mission. These methods lead to an expansion of the nonprofit’s network of support.
Finally, many donors, funders, and stakeholders are supportive of a nonprofit that makes the hard decision to stay with its mission. It is exceedingly difficult for a nonprofit to make the decision to not “chase funds,” however, the return on that decision is an engaged and committed staff and board, renewed support by donors and funders, and expanded support and awareness of the nonprofit’s mission.
