Sex Quest 2004

In August 2004 the Residential Counselors and Women Peer Counselors at Brown participated in a training to up their knowlege on safer sex issues. Below are the questions they wanted to know - and perhaps you do too.

STIs

What percentage of college students contract an STI during their 4 years?
Somewhere between 20% and 25% of college students are or have been infected with an STI. Although there may be differences from campus to campus, chlamydia, HPV (the virus that causes genital warts), and genital herpes appear to be the most common STIs among college students in general.

What are symptoms of STIs to look out for? Of HIV? How soon after having unprotected sex will they appear?
The most common symptom of a sexually transmitted infection (STI) is no symptom at all - a frustrating fact. That's why it's so important for you to be in touch with your body and be aware of what's normal and what's not normal for you. Some general symptoms you'd want to get checked out include: frequent and/or painful urination, pelvic pain, painful intercourse, any sores, bumps or lesions on the genitals, abdomen or inner thighs, genital itching, tingling and/or burning, abnormal discharge, abnormal genital odor, and swelling or tenderness of the groin. If you have any concerns that you may be at risk of an STI, talk to your medical provider and get it checked out.

How easy is it to get tested for STIs and what does it involve for girls and guys? In other words, what happens when someone gets tested?
What is the STI testing procedure like and how long does it take?
Screening for STIs is usually fairly simple and generally involves collecting various samples. Medical providers may take a swab from the infected area (the anus, the throat, the urethra, or the cervix for women). For some STIs a urine sample is taken. Some STIs are screened by drawing blood samples from the arm. For other viral STIs, such as herpes and genital warts, visual identification is part of the diagnosis. After being screened for an STI, it takes a few days or even a couple of weeks to get test results, since the medical providers send the sample to a lab for analysis.

Most people want to know more specific details about the STI exams requiring a swab. For women, it's often a part of their regular GYN exams. During the exam a provider uses a long Q-tip to gently swab the cervix. The test itself is quick, although it might be uncomfortable and awkward, but it should not be painful. Currently for men, the provider will most often rely on urine sampling rather than a swab test.

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If one partner has a cold sore and they give oral sex - will genital herpes result?
Herpes can definitely be transmitted to the giver or receiver through unprotected oral sex if one of them is in the infectious stage with visible cold sores, and even sometimes when sores are not visible. To lessen the risks, it is important to avoid intimate contact when either partner has an open sore or feels the tingling sensation often felt before a sore surfaces. Using safer sex methods, such as condoms and dams during oral sex, is also a good idea to decrease your risk.

Which STDs or STIs stay with you for life (like herpes) and which can be treated?
The STIs that you manage for life include the H's: herpes, HPV (the virus that causes genital warts) sometimes persists in latent form, although some individuals clear the virus), HIV and sometimes hepatitis B (if you are a carrier). Bacterial STIs such as chlamydia, gonorrhea and syphilis can be treated and cured, unless you're exposed again.

If a totally committed couple wants to start having condomless sex and want to get preliminary STI screenings as a start, which STIs would you suggest they screen for?
The first question to ask would be what "totally committed" means. It's important to realize that serial monogamy - only having sex with one person at a time, for a limited period of time, and then having sex with someone else - is a pretty common pattern in college. But, the drawback of this pattern is thinking you're safe, simply because you're monogamous-in-the-moment, so you stop using condoms. But, the truth is that this kind of monogamy lasts a relatively short period of time -- 4 weeks, 2 months, a year -- and then you start dating someone else. You feel safe and comfortable with her/him, so you stop using condoms again. And, with each time, you are subjecting yourself to the risk of contracting or transmitting HIV, as well as other STIs.

Also, it's important to remember that not everyone is 100% truthful with each other. One's partner may say that s/he is a virgin, but not tell you that s/he has had oral sex, a potential route of STI transmission. Someone saying s/he has been "tested" is not a tried and true safe proposition either. For example, a person's test for the HIV antibodies will be negative from anytime up to 3 to 6 months after viral transmission. This period is called the window period, when the virus unknowingly can be transmitted to sexual partners. Also, many people are not clear about exactly which STIs they have actually been tested for.

But to get back to your question, if both partners are honest and willing to accept the risk, there is no standard set of STI tests that medical providers offer. They'll have a conversation with you about your risk and then make suggestions based on what you discuss.

Can you get an STI from "swallowing?" If you're giving oral sex and the guy doesn't ejaculate in your mouth, should you use a condom?
All the safer sex guidelines apply when you have oral sex, whether you "spit" or "swallow" or ejaculate elsewhere. Semen and vaginal secretions can transmit bacteria or viruses. There's research indicating HIV can be transmitted via semen and oral sex, though oral sex is a less likely route of HIV infection than anal or vaginal intercourse. Gonorrhea, chlamydia and syphilis can be transmitted through oral sex, as can human papillomavirus (HPV), the virus that causes genital warts. So yes, it is recommend to use a condom and/or a dental dam (and we have flavored condoms and dams available in Health Services) whenever you perform or receive oral sex.

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Birth control pills

How much do birth control pills on average cost?
A monthly pack of birth control pills will cost about $15 to $50 dollars. Depending on your insurance, it might be worth checking to see if prescription contraceptives are covered.

I'm not exactly sure about the birth control process in terms of how it works with periods. How do birth control pills work, and what are the disadvantages of taking them?
Birth control pills "fool" the body into acting as if it's pregnant. The combined BCP, is a combination of 2 synthetic hormones, estrogen and progestin. The pill prevents ovulation by suppressing the natural hormones in the body that would stimulate the ovary to release an egg. By taking this estrogen throughout the month, you insure that no egg will be developed or released for that cycle. Progestin thickens the cervical mucus, hindering the movement of sperm. Progestin also prevents the uterus's lining from developing normally; so, if an egg were fertilized, implantation is unlikely.

Minipills, another kind of BCP that contain only progestin, inhibit the egg's ability to travel through the fallopian tubes, alter the cervical mucus to block sperm, partially suppress the sperm's ability to unite with an egg, and partially inhibit implantation in the uterine wall. This type is rarely prescribed. Your medical provider will decide if this pill is indicated.

Disadvantages of taking birth control pills vary from woman to woman and from one type of pill to another. Just because a friend has a good or bad experience on a particular type of pill does not mean that you will have the same experience. Your provider will review side effects, risks and worries you have.

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What are the side effects? What kinds of effects do birth control pills have? What side effects, especially dangerous ones, are there to using contraceptives like birth control pills?
A few of the more common effects from taking birth control pills include breakthrough bleeding and nausea. As far as the breakthrough bleeding, it usually happens during the first or second pill cycle and often clears up after that, as your uterus gets used to the new levels of hormones in your body. If breakthrough bleeding doesn't stop after a few months, see a medical provider to find out whether you need to try a different brand or whether you may have another problem. Breakthrough bleeding does not mean that the pill isn't working as a contraceptive, unless you've missed pills or have taken them late. Break through bleeding is extremely likely after missed or late pills.

Nausea is a common early negative effect of the pill, as the estrogen in the pill may irritate the stomach lining. Nausea usually goes away after 3 months; taking the pill with a meal or at bed time usually gives relief. Again, if this symptom persists, seeing a medical provider and switching pills might offer relief from the nausea.

Other minor side effects might include breast tenderness, mood changes and libido changes. Studies have shown weight changes are no different than women not on oral contraceptives. Many people have no side effects, others have side effects which wane in the first few months.

The pill may help cycle regularity, menstrual cramps, acne, decrease ovarian cysts and decrease risk of ovarian and endometrial cancer.

There is no evidence that pill use increases the risk of breast cancer if a woman has a female relative with breast cancer. However, there is some concern that since estrogen can promote some breast cancers, a woman with a strong family history of breast cancer may be at higher risk and wish to choose another method. But, since the pill may protect against breast cancer by stabilizing hormones within the breast tissue, the pill can be used for daughters of mothers with breast or ovarian cancer as long as they are carefully monitored and have regular breast exams as advised by their health care providers.

The most serious complications attributable to birth control pills have been cardiovascular and circulatory system diseases. Cardiovascular disease is most likely to occur in women who are: smokers, sedentary, overweight, more than 50 years old, high blood pressure, diabetic, history of heart or vascular disease, and/or those women who have an elevated cholesterol level. These factors are much more important in determining a woman's risk for cardiovascular disease than are the possible side effects of low-dose combined oral contraceptives (the most commonly prescribed birth control pills). These new low dose pills have much less effect on blood clotting than earlier pills, and there is much less risk for women who don't have any of the other risk factors listed above for cardiovascular disease. The estrogen in the combined pills seems to be the component capable of activating blood clotting mechanisms. If there is a family history of clotting disorders, this is something you need to discuss with your provider when you have your annual exam and talk about contraceptive options. If you have any of the predisposing factors to cardiovascular disease, the combined pill may not be for you. If you don't, the risk from these pills alone is relatively small. In order to make a good decision for you as an individual, talk with your provider before s/he writes the prescription.

Any problem lasting more than 2 or 3 cycles should be reported to a medical provider. The following are symptoms of serious problems: severe pain or swelling in the legs (thigh or calf), bad headache, dizziness, weakness, numbness, blurred vision (or loss of sight), speech problems, chest pain or shortness of breath, abdominal pain. Report these immediately; they mean you should stop taking the pill.

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What are chances that you can still get pregnant while on the pill? How effective are contraceptive pills?
With "perfect" use (which means the pill is taken consistently and correctly at around the same time each and every day - never missing a pill), there is a 0.1% failure rate. This means that 1 time out of 1000, pregnancy will occur regardless. Typical use, which means pills are taken correctly some of the time and incorrectly (not taken the same time every day or pills are missed but taken later) the other times, has about a 3% failure rate, meaning 3 women out of 100 will get pregnant even though they are on the pill.

How many hours have to pass between the "usual pill-taking time" and the time a person take the pill for a birth control pill to be considered missed?
If you are less than 12 hours late for your pill, take it as soon as your remember. An hour or 2 isn't significant, but the longer you miss a pill the less effective your protection will be. You may wish to consider using a condom for the next 7 days, if you are not already consistently using condoms for STI protection. If you are more than 12 to 24 hours late, it is recommended that you take the forgotten pill as soon as you remember it, and take the next pill at its appointed time, even if it means taking 2 pills in one day and use condoms for the next 7 days. If you forget to take 2 pills, consult our birth control pills page for specific details on what to do or Brown students can call a medical provider here at Health Services at 401.863-3953.

Is there a way to get on the pill at Brown without your parents knowing? i.e. it won't show on any bills that your parents might receive/have access to.
You would first need to make an appointment with a medical provider here at Health Services. Even if you're already on the pill, if you want to use the Pharmacy here, you'll need one of the Brown medical providers to write your prescription. If you've recently had a GYN appointment at home, you can ask that office to fax over your results (you'll probably have to sign a release form) and most likely, you won't need to have another GYN exam this year. Your GYN visit at Health Services is covered by the health fee all students pay so there's no charge or fee that will show up on a bill. If you want to buy pills from the Pharmacy here, you can opt to pay by cash or credit card and no bill will go to your insurance company or your parents. If you want your family's insurance to cover the pills you'll have to contact your insurance company to ask them about their billing procedures, it varies from one insurance company to another.

What kinds of medication can make birth control pills ineffective? Is it the same with the patch?
While the risk is very low, medical providers encourage women taking hormonal birth control to use condoms for the duration of their antibiotic prescription and for the following 7 days. And as with any medication you take, be sure and tell your medical provider any and all drugs you're taking to avoid adverse reactions.

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Condoms

Do you think it would be beneficial for us (as counselors) to do the "condom demonstration" for 1st years?
Yes, we do think it is beneficial, and for several reasons. Not only will your residents know where to find condoms & dental dams and how to use them, but they will also learn about other resources available to them and will know that they can approach you with questions. It may be awkward for some people to watch, but one alternative would be to make the condom demo an optional part of the meeting, scheduled at the end during snacks. The knowledge gained is definitely worth a few moments of potential awkwardness.

I feel like I don't know enough about dental dams.
Dental dams are small, thin, square pieces of latex that are used for oral-vaginal or oral-anal sex. They get their name from their use in dental procedures. Dental dams help to reduce the transmission of STIs during oral sex by acting as a barrier to vaginal and anal secretions that contain bacteria and viruses. They come in a variety of sizes and flavors - so you can find a dam that satisfies your tastes.

Unlubed or flavored condoms can easily be made into good substitutes for dams. With scissors, carefully snip off the elastic band part and tip of the condom and then cut down its length. The resulting rectangular piece of latex (or polyurethane if someone is latex sensitive) is stretchable. If you're in a pinch, you can use plastic wrap.

Tips on condom use
To use condoms consistently and correctly:

  • Use a new condom each time you have sex.
  • Store condoms in a cool, dry place, out of direct sunlight.
  • Don't use a condom if it is damaged, discolored, deflated, brittle, or sticky from lube.
  • Check the expiration date before you use it.
  • Carefully open the condom package, being sure not to tear the condom.
  • Put it on the erect penis before you have intercourse.
  • When placing the condom on the penis, leave space at the tip for ejaculate (pinch an inch), and gently squeeze this tip as you unroll the condom all the way down the shaft.
  • Use water-based lubes.
  • If the condom breaks during sexual intercourse, withdraw the penis immediately and put on a new condom before resuming intercourse. If you are concerned about the risk of pregnancy, contact your medical provider to ask about emergency contraception. You can call Health Services at 401.863-3953 during the weekdays or 863-1330 after hours. If you're at home or traveling, you can also call (1.888.NOT.2.LATE).
  • While the penis is still erect, withdraw it immediately after ejaculation: grasp the rim of the condom between the fingers and slowly pull out (with the condom still on) so that no semen is spilled.

How does the "feeling" differ with and without a condom? What about a dental dam?
There are many different types of condoms available, many offering an array of "feelings" or sensations. Ribbed, studded, and other textured condoms are intended to heighten sexual pleasure. Some condoms have these extras layering the inner surface for the wearer to feel; others have them covering the exterior for the partner's enjoyment. Plus, condoms are now available as shaped or contoured, or have a baggier tip, mainly to increase the wearer's sensation, comfort, and confidence (for a better fit so that they won't slip off). In any case, these condoms have the potential to enhance sensitivity during vaginal or anal sex. For some people, using these specialty condoms during intercourse does increase pleasure; others may think they help boost sensation, and therefore they do; and yet others find the added features too subtle to notice. Dental dams are made of a similarly thin piece of latex and the sensation derived during oral sex can actually be heightened for both the giver and receiver. Some people say that they enjoy the sensation of not wearing or their partner not wearing a condom and/or dental dam. But, it comes down to each couple's comfort with the risk of STI transmission and/or the risk of pregnancy.

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Aren't condoms one size fits all? Aren't the different sizes just a marketing tool
Most condoms are manufactured as one-size-fits-all, though this size tends to vary by manufacturer. Condoms generally fit men whose erect penis is average size - anywhere from 4 to 7 inches. Remember, most penises do not differ that much in size when erect. Some condoms are labeled as "snugger fit," while others are labeled as "larger sized." It makes sense to purchase a variety to see what appeals to you both and fits your partner.

What are the chances or percentage probability that a condom can break during sex?
Approximately 2% to 5% percent of condoms tear during use. The majority of these failures are caused by human error, which can include: not using enough lube, creating microscopic tears with rings or fingernails, among other possibilities.

Incorrect use includes unrolling a condom backwards, not unrolling the condom to the base of the penis, not leaving a half-inch of empty space at the tip of the condom, and not holding the rim of the condom down along the base of the penis when removing the penis after ejaculation. Condom failure may also be more likely if either of you have pierced genitals.

If condoms break when used correctly, the tear is most likely due to hidden weaknesses in the rubber. These weaknesses may get past manufacturing regulation as some tests administered for strength and leaks are used to spot check a batch of condoms as opposed to testing each individual condom. The U.S. Food and Drug Administration (FDA) sends inspectors to different condom manufacturers to carry out water leakage tests, which determine if there are holes in the condoms, and air-burst tests, which link a condom's air-burst volume to its resistance to breakage during sexual activity. In the water leakage test, if more than 4 out of 1000 condoms have leaks, the entire lot is destroyed. For the air-burst test, no more than one-and-a-half percent of the condoms in the lot can fall short of the required pressure and volume limits. Interestingly, condoms do not have to pass a friction test.

During a year of typical condom use for heterosexual couples, 14 out of 100 women will become pregnant. During a year of perfect condom use, that number drops to 3 out of 100 women becoming pregnant. Just for the record, 21% (typical use) and 5% (perfect use) of women who use the Reality female condom experience an unintended pregnancy within the first year of use.

Is a condom the only/best way to prevent HIV? Are there additional measures that can be taken to protect both individuals?
The best way to prevent HIV is to avoid contact with bodily fluids that carry the virus: blood, semen, vaginal secretions, and breast milk. Latex condoms, which are the least expensive, most accessible type of condoms, are designed so as not to allow transmission of the HIV virus, or any virus for that matter. The HIV virus is larger than the pores in condoms. If using a lube with your condom, make sure that it is water-based, as oil-based lube causes the latex in condoms to deteriorate. Wearing a condom will decrease your risk, but not 100%. The only 100% safe sex is no oral, anal, or vaginal sex, or abstinence.

If we have sex at the very start or very end of my cycle, is a condom really needed? We're monogamous and disease-free.
A woman can become pregnant from unprotected intercourse up to 5 days before ovulation. And women have been known to ovulate at any time during their cycle, including during menstruation, although this is unusual. Sperm can survive in a woman's body for 3 to 5 days, waiting to fertilize that egg during ovulation. Therefore, guessing how long your period usually is and counting backward 14 days is not an effective method of birth control. As college students, your schedules vary dramatically: your diet, exercise, stress, etc. all change from one day to the next and all of these things can effect the timing of your menstrual cycle. So it is important for you and your partner to decide what level of risk you are comfortable taking. And remember that EC is available 24 hours/day at Health Services 401.863-3953.

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Health Services/Testing

How does Health Services differ from Planned Parenthood when it comes to distribution of contraceptives?
Because all students pay a health fee, Health Services does not charge an additional fee for your medical visits, whereas Planned Parenthood charges $20 to $25 per visit. Pregnancy tests are also included in the Brown health fee, where it costs $20 for a urine test and $30 for a blood test at PP. Contraceptives are available through the Health Services Pharmacy and cost approximately the same as they do at PP, although if you need a specific birth control option that is not available at Brown, your medical provider could call in the prescription to a local drug store. If you qualify as having low income, which many students can, you can apply for funding at PP to deduct $40 from your visit fee.

Where can Brown students get tested? How can one get STI testing at Brown? Where can you get tested for STIs in Providence? Does Health Services offer free STI testing?
Brown students pay a health fee that covers your routine medical visits, however the fee does not cover lab testing. During your appointment for STI testing you will have a conversation with your medical provider about which STIs you would like to be tested for and at that time the provider can tell you how much each test will cost if you pay out of pocket. Some insurance plans cover screening for STIs. Health Services does not offer free STI testing, but you can click here to find other sites in Providence that do offer free testing.

How often do people actually come in to Health Services to get screened for STIs before starting unprotected sex with their partner? Does it make sense to get tested before you even become sexually active?When is it necessary to get tested (when used before a situation rather than after)?
It's common for students to come into Health Services to have STI testing when they enter a new intimate relationship. If you've never had sex (vaginal, oral or anal sex) the chances of having an STI is extremely low, although any skin-to-skin contact between genitals can still transmit STIs. If it's been some time since your last intimate encounter, you might decide to get tested simply for your own knowledge.

Being tested allows you to take charge of your own health. If you test negative, you can continue to protect against future risks. Should you test positive, your provider will help you access a variety of resources. Some people get tested with the idea that if they test negative, they don't need to practice safer sex anymore. This is not true. If you test negative, you still need to protect yourself and your partners.

If you test positive for an STI, early medical intervention will allow you to take measures needed to maintain your health. Many STIs, such as chlamydia and gonorrhea, can be treated with antibiotics. Others, such as HPV and herpes, can be managed to decrease symptoms and reduce the risk of transmission. If you test positive for HIV, there are treatment possibilities to prolong your life and improve your overall health. Whatever your results, you can make changes that will make your life longer, healthier and happier.

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What is the easiest way to get tested for HIV at Brown? (Where should we send people who want to get tested and what can we tell them about it?)
The easiest way is to set up an appointment with a medical provider to have an HIV test. Just call ahead and most likely you could even get a same day appointment. The cost is $25 and you can pay by check, money order or you can bill your bursar account. If you bill your busar account the bill will say "HS lab," if you are concerned about testing information reaching your parents.

Are morning after pills and/or STI testing available at Health Services?
Yes, morning after pills or Emergency Contraception is available without a prescription at Health Services 24 hours a day. EC can be taken up to 120 hours (5 days) after unprotected sex, but the sooner the better. If you also want STI testing, this can be scheduled by calling 863-3521. You can talk to a Nurse if you have questions about EC by calling 401.863-1330 or by coming to Health Services.

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Miscellaneous

At what age do most people become sexually active?
According to the Center for Disease Control's 2001 Youth Risk Behavioral Surveillance Survey:

  • 6.6 percent of students reported initiating sexual intercourse before age 13
  • 45.6 percent of high school students (48.5 percent of males and 42.9 percent of females) reported having had sexual intercourse
  • 60.5 percent of twelfth graders, 51.9 percent of eleventh graders, 40.8 percent of tenth graders, and 34.4 percent of ninth graders reported having had sexual intercourse
  • 60.8 percent of Black students, 48.4 percent of Hispanic students, and 43.2 percent of White students reported having had sexual intercourse
  • 33.4 percent of students reported they were currently sexually active (defined as having had sexual intercourse in the three months preceding the study)
  • 16.3 percent of Black students, 7.6 percent of Hispanic students, and 4.7 percent of White students reported having had sexual intercourse before age 13

The National Campaign to Prevent Teen Pregnancy recently released Fourteen and Younger: The Sexual Behavior of Young Adolescents. This comprehensive report looks at sexual relationships and activity among young teens. The report found:

  • Approximately 1 in 5 adolescents has engaged in sexual intercourse before his or her 15th birthday
  • Boys who are 14 or younger are slightly more likely to have had intercourse than girls of the same age
  • A substantial proportion of teens who are 14 and younger who have had intercourse are not currently sexually active
  • More than one in 10 girls who first had intercourse before age 15 describe it as non-voluntary and many more describe it as relatively unwanted

I read that you shouldn't use nonoxynol 9 during anal intercourse. True? False? Why?
Originally, N-9 was thought to reduce sperm mobility and thus help prevent pregnancy. However, if a condom were to break or slip off, research shows that there is not enough N-9 on the condom to prevent pregnancy. N-9 was also added to condoms as a microbicide (a chemical substance that kills viruses and bacteria). However, recent research has found that N-9 may facilitate HIV transmission. Since some people are allergic or sensitive to spermicide, it's better to use dry or plain lubed condoms.

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How do you address the issue of race/ethnicity when discussing STIs and risk without coming across as racist? (In reference to the PSA about 1 in 50 black men have an STI).
The public service announcements you watched in the counselor training, were developed by the Kaiser Family Foundation and Viacom as part of the Know HIV/AIDS initiative. This campaign uses a number of PSAs and advertisements that are produced under the partnership with MTV's Fight For Your Rights: Protect Yourself and BET's Rap It Up campaigns. Each ad was developed to be aired along with specific TV shows and each ad was created to address a particular television audience. To complete the picture of how HIV affects different ethnic/racial groups, ages, genders and sexualities, you can consider the following statistics:

Impact of HIV/AIDS on Young People:

  • At least one-half of all new HIV infections are estimated to be among those under the age of 25.
  • Most young people are infected through sex.
  • Young people, women and people of color have been particularly affected.

Impact of HIV/AIDS on People of color:

  • People of color now represent the majority of new HIV infections, new AIDS cases and of Americans living with AIDS in the U.S.
  • Although African-Americans and Latinos represent 12% and 14% of the U.S. population respectively, in 2002, they accounted for 50% and 20% of newly reported AIDS cases.
  • The majority of new HIV infections are among African-Americans (54%); 19% are among Latinos.

Impact of HIV/AIDS on Women:

  • Women are estimated to account for 30% of new HIV infections.
  • Women of color are particularly affected.
  • African-American women account for 64% of new HIV infections among women and Latinas account for 18%.

Impact of HIV/AIDS on Men Who Have Sex With Men (MSM):

  • Men who have sex with men account for approximately 42% of all new HIV infections and 60% of new infections among men.
  • Younger MSM and MSM of color are at particularly high risk.
  • MSM of color now account for the majority of AIDS cases reported among MSM.

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What's the best way to address problems of unsafe sex that you know are going on in your unit?
What can we do to educate about safer sex?
There's really no "best" way but there are many options you can take advantage of. The first step is letting your residents know that you are a resource, or if you prefer, letting them know where to find resources to answer their questions about STIs, contraception and relationships. The key is developing a genuine, open and caring atmosphere where residents (and your friends) know they can trust you. It's ok not to know everything, who does, but your willingness to find out goes a long way. Another way would be to have a Health Educator come facilitate a workshop in your unit! You can follow up with more opportunities for discussion. You could put up a "graffiti board" with a question of the day and let people respond. You could send out weekly emails addressing different safe sex questions with links to Health Ed's web site.

How can one comfortably bring up the topic of safe sex with a likely partner?
Many people find it very difficult to talk about their sexual health. But discomfort and shame can keep people from taking good care of themselves and their partners. Remember that protecting yourself against pregnancy and/or STIs can reduce anxiety and make sex a lot more enjoyable. One way would be to simply admit how difficult it is to bring up the subject. "You know, I'm kindof fumbling on how to bring this up, but what are your thoughts about safe sex?" Or you could be direct and state what you expect. "I always use condoms when we have sex. No glove, no love." Addressing the issue can relieve a lot of anxiety and can actually increase intimacy with your partner.

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Is any one (or more than one) form of contraception better than the others? What is the safest/most effective form of protection in heterosexual sex?
There is no "best" contraceptive method. There are many points you need to consider as you and your partner chose a method that fits both of your lifestyles. To help you decide which method to use, consider the following questions:

  • Will it fit into your lifestyle?
  • How convenient is it to use?
  • If pregnancy is a concern, how effective is it in preventing pregnancy?
  • Will it help prevent sexually transmitted infections (STIs)?
  • How safe is it?
  • How much will it cost?

You can also schedule an appointment with a medical provider at Health Services to talk through these questions and about your options.

Condoms and dental dams are often recommended as the best safer sex choice for all college students. Both condoms and dams are widely available from counselors and programmers in the residence halls or from Health Services and Health Education. If pregnancy is a concern, you may need to try different contraceptive options until you find the one that best suits you. An individual may switch methods because of changes in relationships, age, health, economic security and lifestyle.

If there is sperm on sheets and a girl rolls over it, can she get pregnant? Can you get pregnant without penetration? i.e. there's ejaculation, etc. that's near you, but not actually inside.
Sperm can survive outside the body as long as the ejaculate is still wet. And pregnancy can occur any time sperm (ejaculate) gets in the vagina, or on or near the vulva. (STIs can also be transmitted this way.) There is a slight possibility that ejaculate or pre-ejaculate could seep through sheets, clothing or underwear, so people who engage in body rubbing should be careful to keep ejaculate and pre-ejaculate from coming in contact with a woman's vulva.

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Can you go blind if you get sperm in your eye?
No way! It's a common myth that if you masturbate too much you'll go blind and along those lines, rumors may have circulated saying that sperm will make you go blind. Neither masturbation nor sperm causes blindness. Masturbation is a perfectly healthy activity, it's actually one of the body's most effective ways to relieve stress.

It's unfortunate that so many people worry about masturbation. Men and women masturbate throughout their lives, whether or not they are in sexual relationships with other people. But because masturbation is so misunderstood, the majority of people who masturbate have unnecessary guilty feelings and shame about it. This shame and guilt can lead to difficulties in a person's sense of self-esteem and in a person's relationships with other people.

How/where can we refer a 1st year if they need/want an abortion?
If any student thinks she might be pregnant, she can make an appointment with one of the medical providers at Health Services to have a pregnancy test. If she is pregnant, the medical provider will be there to talk about all of her options - whether she wants to keep the pregnancy or have an abortion. Health Services does not offer abortions but can refer students to local hospitals and clinics. Health Services does not provide obstetrical (pregnancy) care, but the medical provider will be glad to give referrals for an obstetrician or nurse-midwife in the community.

Is there any risk that a woman who has an abortion won't be able to have kids later in life?
A safe, uncomplicated, legal abortion does not affect a woman's ability to have children in the future. So, unless there are significant complications, such as a damaged cervix, a woman's ability to have kids later in life is not affected by abortion. Contrary to what you may have heard, abortion does not make miscarriage more likely, make ectopic or tubal pregnancy more likely, increase the risk of birth defects, premature birth, or low birth weight in future pregnancies. Abortion is a very safe procedure. It's about twice as safe as having tonsils removed, and is much safer than giving birth. However, the need for abortion can be prevented by proper use of birth control.

Sources used to write these responses include Columbia University's Go Ask Alice web site, as well as Planned Parenthood's Teenwire site.

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Links you can use

It's normal to wonder about these kinds of intimate details but feel too embarrassed to ask a medical provider or even a friend. We recommend the online sexual health resources listed below to get those questions answered and to learn more about your sexuality.

Like any other web site, these resources cannot diagnose a medical condition. For medical help, you can always call Health Services at 401.863-3953 if you have a question or want to make an appointment.

Go Ask Alice
This is a question-and-answer web site where you can anonymously email any health questions you have. Alice not only answers your questions in a fully detailed and comprehensive way, but she offers a bit of wit and humor along with her advice. This site has a huge archive that you can read through or search before posing your own question. Alice has answered a range of questions from "Is shoe size a predictor of penis length?" to "Does masturbation inhibit my growth?" Check out this in-depth web site for information about relationships, sexuality, emotional health, alcohol and other drugs, and nutrition. This site is provided by Columbia University's Health Education Program.

Teenwire
Don't be fooled by the title of this site; it's not just for the pre-college crowd. These entertaining pages will test your sex IQ through games, quizzes and movies with titles like "Jim Dandy and His Very Gay Day," and "You Want to put WHAT WHERE?" You can post any health question you have at "Ask the Experts" or you can read through the responses to previously asked questions like "What's Up with that Wet Spot?" You can also browse the "Warehouse," a collection of articles written by teens about the human body, relationships, and reproduction.

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.