I feel a bit conflicted about this supposed influx of PEP use. On one hand, it is good that people know about it and are able to request it in order to keep themselves safe. On the other hand, if there is in fact an increase in PEP requests, does that perhaps lead one to question the underlying reasons and factors... if more people are requesting PEP, does that mean more people are participating in risky behaviors? And if so, shouldn't the Peace Corps (and other organizations) question themselves on whether they are doing an adequate job of educating and preventing the risky behaviors to begin with? Yes, PEP saves lives, but shouldn't we make every attempt to mitigate the risks as much as possible before needing to take PEP?
Although a bit outdated, this is what the 2008 Volunteer Health Report says about PEP:
I have also added a new poll question for everyone, regarding other STIs or STDs. It is important to realize that all of these should be talked about too, not just HIV. Just for some extra information, here is what the 2008 Volunteer Health Report has on STDs:
* Viral = Difficult to treat. Must use antivirals, not antibiotics, to treat. Some vaccines have been developed to prevent some viruses. Some viruses may be impossible to cure.
Wow... just read in the 2008 Volunteer Health Report that there were 32 pregnancies amongst female volunteers in 2008. Pregnancy = Unprotected Sex. Just saying...
ReplyDeleteNot surprised at all. I am not sure what the medical services are like in the various countries that invite the Peace Corps to serve, but unless a woman decides to start her service with an IUD or Implanon (sorry I cannot spell) already inserted, I would think her access to contraceptives would be vastly more difficult/inconvenient than they would be in the USA.
DeleteIf you don't mind me asking, did you plan to utilize a long term form of contraceptive when you started your term of service? Do you know of any other women who did? If I am being too forward I apologize.
Hi Natalie,
DeleteAccess to oral contraceptives is actually incredibly easy, and VERY cheap, in the field - as is obtaining most forms of medications/antibiotics. Almost everything is over the counter, no prescriptions needed (or they ask for one, but it's not a deal breaker if you don't have it). The catch is, in third world countries, the likelihood of a medication/oral contraceptives having not enough active ingredient left due to expired shelf life or poor storage conditions is greater. I am not a PCV, but have been working in eastern/southern african countries for years, and personally choose to stock up on my own contraceptives/meds that are most important habitually when visiting home and bring them over with me. The other stuff -- cotrimoxazole/antibiotics and anti-malarials I get in-country, because it is not needed every day. I have many female friends who simply buy contraceptives here, though, and that works, too.
I think unplanned pregnancies are due to irresponsible behavior (everyone knows how to NOT get pregnant), while STDs are risky behavior mixed with not enough education. Just because someone does not have symptoms, doesn't mean they don't have an STD. There are plenty of asymptomatic ones out there (HPV/Herpes), which are spreading so fast because of that. Due to biology, most males are asymptomatic carriers and transmission rates from male to female is higher - and then the females present symptomatic. Many people assume they are ok, but unfortunately you don't know without being tested.
I agree, PEP should not be used as a safety net for risky behavior, just like the morning after pill should not be used as birth control. It's disconcerting to think if that is what people are using these things for.
Natalie, all female Peace Corps have access to birth control while their in service (even if they weren't using it when they joined), and all Peace Corps Volunteers have access to condoms. So it isn't a lack of access, though it may be a lack of planning on the part of individual volunteers (i.e., if you had no intention of beginning a sexual relationship, you would be less likely to request these items).
Deletewhile they're* Oh Christine, I expect better of you :P
DeleteThank you guys so much for responding to me! Yes Christine- lack of planning maybe be the problem(just like it is in the USA).
DeleteI don't know if this is true in other countries, but I felt like my office was really judgemental about PCVs who had sexual relationships, especially with HCNs. I wanted a backup method of birth control and I remember being really nervous about requesting birth control pills from my PCMO. In the end, she was fine and didn't ask me personal questions or lecture me but I had concerns about that based on things she had said in the past.
DeleteIn my experience and opinion, the PCMO's in country were just matter of fact about birth control. You want birth control pills? Okay, her you go. Boom. Done with. No questions. No follow up. I did not get the feeling that they made any kind of judgments about volunteers' sexual activities. However, I will say that once I got sick and they started questioning my HIV test results and sexual activities, I felt very judged indeed.
DeletePersonally, I think that there was a lack of support in my country for PCVs having relationships with HCNs, not in the area of birth control, but in the areas of relationship, cross cultural, and communication issues. I've mentioned this before, but I'll say it again... there were multiple of us having some issues and desiring someone to talk to and help us work through them. The support there was lacking.
As a volunteer, and to reiterate Christine, there is plenty of access to contraceptives here in my Central American post. A friend of mine even had an IUD inserted while here and many more are on oral contraceptives.
DeleteI agree that there is some sense of judgement here in my post about sexually activities from PCMOs, maybe more so for women when they opt for longer-term forms of birth control, but I don't know any sexually active volunteers in my post who have let the feeling of being judged prevent them from actually getting contraception. They hand out condoms like candy here, for one thing.
I think LivingPositive is right that relationship dynamics is perhaps a much bigger issue overlooked by PC. It's one thing to have condoms or other contraceptives available and another thing to know how to approach the issue of STDs and unprotected sex effectively with your HCN (or non-HCN) significant other...
I don't know why it seems that some feel they may be invincible?? Or can they not convince their partners to use condoms and the emotions are running so high that they cave into unprotected sex? I wonder what the comparisons are to the US, say in colleges or the military? Where does one insert the correct information to create a postive behavior change?
ReplyDeleteso excited that your story and your bravery in sharing is leading people to take action and share as well! I love you and am continually so proud of you!
ReplyDeleteAs with any aspect of healthy living, having safe and healthy sex during one's PC service is "relative." I do not think you can fairly compare the two experiences. As prospective PCVs, I believe we absolutely have to understand that (1) we are not invincible, and (2) serving in a developing country, living as the nationals do brings a heightened risk. Especially in rural Africa, we are malnourished and in unsanitary environments. In a sense, the risks are the same (contracting STD, pregnancy, etc.). However, the circumstances make the PCV more vulnerable and add a heightened risk to each situation.
ReplyDeleteI am not surprised by these statistics. (sadly) Although, I am not sure it is the responsibility of the Peace Corps to educate adults about safe(r) sex. I agree the Peace Corps should offer its volunteers medical services and the like,one because its the right thing to do, and two because you all are an immeasurable asset to the countries you serve BUT every Peace Corps volunteer is a legal adult who is responsible for their own sexual health.
ReplyDeleteOne would assume they have heard this message over and over and over again (since the age of puberty)and choose not to follow the advice of medical professionals. As "aepafrica" pointed out, these numbers are probably similar to those of other young, sexually active individuals on a "typical college campus".
Not that I think educating adults is hopeless. EVERYONE needs to be educated about sexual health, however I believe the key to changing the trend of ignorance is starting the dialogue of sexual health and sexuality at puberty.
IMO, what makes your story so important to share (and thank you for sharing) is that it is NOT Peace Corps specific. The same situation that lead to your transmission could have (and does occur) on college campuses, bars, parties etc throughout the country. Even more reason open up the lines of communication and change the way the average person thinks of their sexual health.
What a powerful life story you are building.
ReplyDeleteI was really not a fan of PEP. Not that I think anyone's really a 'fan'. Definitely agree with using PEP as a way to mitigate things, not as a preventative PrEp mechanism; but I honestly didn't even know PEP existed before joining PC, and am really grateful that it does.
ReplyDeleteLivingPositive: I hope you do not mind, I have linked to your blog and written a short post about it on my own blog (y-otros-demonios.blogspot.com). I just discovered your blog and I am so inspired by your courage and commitment to educating people about this. Stay strong and please know that there are people all over the world, from all walks of life, that are learning from you. Please keep sharing your story, it needs to be heard.
ReplyDelete- Laura, PCV El Salvador
Hello,
ReplyDeleteI'm doing a paper on the necessity of Sex Education in High School throughout the US, and was hoping you could give me some input.
First, some background info:
I graduated from a high school in New York back in 2006. Sex Ed was mandatory in the school, and if you did not participate you had to have your parents sign several documents stating why you weren't going to participate in Sex Ed. classes. The classes were pretty in depth. The teacher touched upon contraception, STD, preventive methods, and many other information. Before I graduated from high school I knew without a reason of a doubt that one could contract STDs by giving unprotected blow jobs, or by even kissing someone who has sores in their mouth. Conversely, my friend who graduated from a high school in Utah did not have any kind of Sex Ed class, and was completely ignorant as to the risks of unprotected sex. She informed me how before her graduation there had been no less than 6 girls pregnant from her class.
If possible, could you please let me know what year you graduated from high school, and if your school had Sex Ed classes, and how in depth did your teacher go into way to prevent STDs.
My hopes are that once I gather the data, and get my paper published, that I'd take to it congress and form a petition demanding that Sex Ed be taught all across the US, and now just in some schools.
Thanks!
Diana Belz
Diana,
DeleteI graduated high school in 2004. Graduated college with my Bachelor's in 2008, and with my Master's in 2009. I was a straight A and GPA 4.0 student all throughout. I received sexual education classes in various grades and settings since Middle School. I also had sexual education courses in college and in the Peace Corps.
Somehow, through all of that- I still didn't get the complete picture or information. And, judging by my grades and excelling in these classes, I don't think it was a lack of listening on my part. But somehow, the message did not come through clearly enough... or maybe I took the percentages and statistics too literally... somehow I still held the misconception that I shouldn't worry about unprotected oral sex. My understanding, through all of my trainings, was that it was such a minute risk. My understanding was that if I didn't have open cuts and sores in my mouth, it was even less of a risk. I don't want to place blame on others (for I know that my safety and my choices are solely my own responsibility), but when you are told over and over and over that something is such a small or low risk, I think the mind starts to equate that to "no risk". This was my mistake, and the mistake of my trainings. Hope this helps.
I have been reading your blog for a while now. I truly do feel for you and admire your courage. There is just one thing I have noticed you continue to mention and that is your issue with PC training, although many of us have made similar mistakes as you (unprotected sex etc.) I do not think it is PC responsibility to teach us how exactly we should be having sex. Please do not get me wrong, I am not judging you nor am I blaming you for anything, but this is a matter of personal responsibility , what we do as PCV on our own time cannot be controlled by the PC. We are given tools to protect ourselves and it is up to us to use those tools, it is not fair to blame the PC because of their choice of words "low risk vs. high risk". I truly wish you the best thank you again for sharing your story.
ReplyDeleteThanks. I can assure you that those of us with HIV deal with the self blame and personal responsibility of it for the rest of our lives ;-)
DeleteI agree with the Anon above. I have 3 friends who are currently in the PC, and I talked to two of them yesterday after reading your blog. They said that PC provides good information as far as how to protect yourself if you're going to have sex while you're abroad. They couldn't understand what information might have been omitted that you didn't have the full picture.
ReplyDeleteAlso, from reading your response to the above comment, I find it baffling how you could equate "low risk" to "no risk." Even if there is a 1% risk, there IS still that 1% risk, and one should always protect themselves, so as not to become part of that 1% - especially if you're going to be engaging in sexual activities in a country like Africa. Hopefully you will touch upon this when you speak with future PCV, that a risk is, a risk, is a risk.
I am sorry that you're going through this, and really do wish you the best. There is comfort to be taken in the fact that today there are so many more ways of managing HIV, and our mentality of the illness and the people who have it has improved from what it used to be in the past. You also have your youth on your side, who knows, the way science is going, there could be major breakthroughs in the near future. I remember back when I was in high school (in 2000) a woman and her daughter came to speak with us about HIV. They were both infected. They showed us a bag full of pills and a bunch of other pill bottles that they had to take throughout the day just to be able to function. Now, you only need to take that one pill, so things are getting better.
Just a note: trainings and peace corps administration is not uniform across all countries. So, we have all been exposed to different trainings and information. One PCVs account cannot be taken as truth for all. I am merely sharing my account, and some others that have contacted me and shared their concerns with me. I'm so very glad that your friends got great information.
DeleteYes, I take one pill a day... for now. But there are many people who still must take multiple pills at multiple times of the day due to drug resistance and other factors, just as I may have to do in my future.
In response to Anonymous, I do think it's Peace Corps's responsibility to do everything possible so that its HIV/safe sex training curriculum puts everyone on the same page. Not everyone comes from the same educational settings or backgrounds. Whether the volunteer stays awake in the training or what she does with that info of course is the volunteer's responsibility.
DeleteLivingPositive is totally right that trainings vary by country. I for one never clearly got the message that oral sex presented a notable risk for HIV transmission (never. I was paying attention, FYI). Notable in the sense of "hey! listen up and do something about this!"
We know that risk perception is subjective. It is established in the field of risk perception that humans often modulate "low risk" to mean "no risk" - especially if that message of "low risk" is infrequently or inconsistently repeated, as may be the case with something such as HIV transmission via oral sex.
I'm not quite sure how Anonymous would be baffled by that. It's a common psychological phenomenon.
And for me that exactly one of the most practical and compelling points of LivingPositive's story: trainers need to be cognizant of their word-choice and the way in which they present risks.
Unfortunately, risk is grey-scale and actions are black and white. The mind has to make some generalizations at some point, influenced by the way in which those risks are presented to it, and yes, influenced by factors such as whether a trainer uses a word such as a "low-risk" or "high-risk".
(Among other important factors... for example whether the trainer tells a personal story about that risk. Story-telling- that is, telling a story about something bad that happened to someone else- is a technique that has been proven to increase risk aversive behavior. Yet how many PCMOs or HIV trainers working for Peace Corps, have ever shared a personal story about HIV transmission through oral sex, despite the long video we watch with personal testimony from volunteers who contracted HIV?)
Point being we're not stiff calculators... we're emotional beings! And if we want HIV prevention education to succeed, we need to get analytical about the most effective ways to educate -- using human nature, not scoffing at it.
First off, I want to commend you for your courage in sharing your story with the world. I admire you and your strength. I'm a PEP statistic from 2007. That particular year there were about 17 cases in my country of service alone. Hearing numbers like that might provoke judgements that people are treating it like a "morning after pill", but I don't think that's necessarily the case. I think that as people become more aware that it is available, they are seeking it as a viable solution...as they should! I won't go into detail about my case, but at the time I thought I was exercising caution, but had an accident that I felt exposed me to risk so I got on PEP. I later found out that my partner was HIV+ and I was grateful to have made the decision I did, because I originally had reservations about contacting the PCMO for fear of being judged. The following year, I shared my experience at PST, but it was one of the hardest things to do because before I shared my testimony I caught snippets of various flippant remarks by trainees mocking volunteers on PEP as being promiscuous and irresponsible (they didn't know I was there to give a testimony about PEP at the time). I guess my point in saying this is that I feel your fellow volunteer friend in Zambia, while his intentions are good, should be more careful when saying that people are treating it as a "morning after pill". It sounds so frivolous when you put it that way and I think it's stigmatizing. It might discourage others from seeking out the help when they really need it. I do however, agree that it sounds like some changes could be made to your PST, such as having someone on PEP share their experience. However, language that ostracizes "PEPers" must stop if anyone expects to get a testimony from them. ~ Hugs!
ReplyDeleteThank you for your story and courage to share. I just wanted to point out that your “ Viral = forever. Bacterial = Curable”
ReplyDeletestatement is not completely accurate. Not all viral infections are forever. The human body is capable of clearing many types of virus from its system. When you get a cold or flu, you get better, you don't stay sick forever. Unfortunately, this is not the case for HIV, but just so people understand that not all viruses are like HIV.
I apologize, you are definitely correct. I have edited my original statement. Thanks for catching that!
DeleteEdit:
* Bacterial = Relatively easy to treat and cure with the use of antibiotics.
* Viral = Difficult to treat. Must use antivirals, not antibiotics, to treat. Some vaccines have been developed to prevent some viruses. Some viruses may be impossible to cure.