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The New Gay Sexual Revolution

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PrEP, TasP, and fearless sex remind us we can’t advance social justice without including sex in the equation.

By Jacob Anderson-Minshall

The sexual revolution of the 1960s and ’70s came to an abrupt and brutal end for many gay and bi men the moment AIDS was traced to sexual contact. In the early days of the epidemic, sex between men was equated with AIDS, not just in the mainstream media, but also in prevention efforts by other gay men. Since AIDS in those days was seen as a death sentence, for men who had sex with men, every sexual interaction carried the risk of death. Indeed, tens of thousands died of AIDS-related conditions.

“I was alive when homosexuality was [still] considered to be a psychological illness,” David Russell, pop star Sia’s manager, recently told Plus magazine. “The two generations ahead of mine, and a good portion of my generation, were completely decimated by AIDS. They’re gone.”

While some men with HIV outlasted all predictions and became long-term survivors, the widespread adoption of condoms is credited with dramatically reducing HIV transmissions among gay and bi men in subsequent years. Yet reliance on nothing but that layer of silicone — a barrier some complain prevents true intimacy and pleasure — couldn’t erase the gnawing dread gay men felt that every sexual encounter could be the one where HIV caught up to them.

There have been, of course, moments when nearly every gay or bi man has allowed their passions to override their fears and enjoyed the skin-on-skin contact that opposite-sex couples often take for granted. Thinking back on those unbridled and unprotected moments of passion filled many of these men with terror, regret, and guilt.

“Shame and gay sex have a very long history,” acknowledges Alex Garner, senior health and innovation strategist with the gay dating app Hornet. “And it takes much self-reflection — and often therapy — to feel proud and unashamed of our sex when everything around us tells us that it’s dirty, immoral, or illegitimate.”

Since the late 1990s and the advent of lifesaving antiretroviral drugs, some of the angst around sex between men faded — and with that came changes in behavior. Condom use, once reliably high among gay and bisexual men, has dropped off in the past two decades. According to a recent study published in the journal AIDS, over 40 percent of HIV-negative and 45 percent of HIV-positive gay and bi men admitted to having condomless sex in 2014. Researchers found the decrease in condom use wasn’t explained by serosorting (choosing only partners believed to have the same HIV status) or antiretroviral drug use. And despite what alarmists say, condom use had been declining long before the introduction of PrEP.

Garner, who has been HIV-positive for over two decades, says he’s almost relieved he acquired the virus at 23, because “My entire adult life I have never had to worry about getting HIV.”

The Rise of PrEP

Now there’s hope the younger generation may also experience worry-free sex lives — without the side effects of living with HIV.

The use of the antiretroviral drug Truvada as pre-exposure prophylaxis, or PrEP (it’s the only medication approved for HIV prevention), has been shown to reduce the chance of HIV transmission to near zero. Since the medication was first approved as PrEP in 2012, only two verified cases of transmission have been documented among those who adhere to the daily schedule (a third, according to HIV expert Howard Grossman, could not be confirmed). New, longer-lasting PrEP injectables should reach market in the next few years. Studies suggest that on-demand PrEP (such as taking it before and after sexual activity) may also be effective.

“This is a revolution!” Gary Cohan, MD, who prescribes PrEP, told us in 2016. “This should be above the fold in The New York Times and on the cover of Time magazine. A pill to prevent HIV?”

Undetectable Equals Untransmittable

Those who are already HIV-positive also have a sure-fire option for preventing the transmission of HIV that doesn’t rely on condoms. It’s called treatment as prevention, or TasP. Those who are poz, take antiretroviral medication, and get their viral load down to an undetectable level, can’t transmit HIV to sexual partners. Last year, The New England Journal of Medicine published the final results of HPTN 052, a study that proved antiretroviral medication alone is enough to prevent HIV transmission among serodiscordant couples. In a Facebook Live interview for AIDS.gov, Dr. Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, noted, “The chance of transmitting [HIV] if you are virally durably suppressed is zero.

Since Dieffenbach’s statement, a number of HIV organizations and medical groups have joined the “Undetectable Equals Untransmittable” bandwagon, including GMHC, APLA Health, and the Latino Commission on AIDS.

The Centers for Disease Control and Prevention recommends the use of condoms in addition to PrEP or TasP, primarily because neither biomedical approach prevents other sexually transmitted infections like gonorrhea or syphilis. Still, PrEP and TasP make it safer to have condomless sex — and that could jump-start the new sexual revolution. “When the threat of HIV is removed from sex there is a profound sense of liberation,” Garner says. “Sex can just be about sex.”

One hurdle is PrEP stigma, furthered by the myth of “Truvada whores,” and AIDS Healthcare Foundation’s Michael Weinstein’s deliberate efforts to portray the HIV prevention pill as “a party drug.”

“Fear and shame have been ingrained in gay sex for decades,” Garner admits. “And it will take time and a great deal of work to extricate those elements.” But he remains optimistic that “together negative and poz men can shift the culture away from fear and toward liberation.”

He argues that what’s at stake is far more than just a better orgasm.

“Our sexuality is at the core of our humanity,” Garner says. “Our sexuality is as integral to us as our appetite. We can’t advance social justice without including sex. As queer people and as people of color, our bodies have been criminalized, our sexuality has been pathologized, and structures continue to dehumanize us. It’s a radical act of resistance when, as gay men, we choose to find pleasure and intimacy in our sex. Our sex has been, and will continue to be, intensely political. It can change our culture and our politics if we embrace it and run to it instead of away from it.”

Complete Article HERE!

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What To Do If You Get A Panic Attack During Sex

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By Sophie Saint Thomas

A few years ago, while an ex-partner was going down on me, I realized I was having trouble breathing. Then a sense of dread filled my head, and I felt like I was being stabbed in the chest. So I quickly asked him to stop — not because he was doing anything wrong, but because I was having a panic attack during sex.

One of the (few) good things about panic attacks is that they usually only last for about 15 minutes, says Gail Saltz, MD, psychiatrist and author of The Power of Different: The Link Between Disorder And Genius. When I had my attack, I sat on the edge of the bed and did a series of breathing exercises. Gradually, I did begin to feel better.

But one of the most perplexing aspects of panic attacks is that they’re intensely fearful physical reactions that occur in the absence of any real danger or identifiable cause, as the Mayo Clinic explains. In my case, I was in a safe space with someone I trusted when my ex was going down on me. However, I had very real and terrifying feelings of detachment, the aforementioned shortness of breath, and chest pains.

Of course, I’m speaking about panic attacks during consensual sex. Fear that happens during an assault or dangerous sexual experience is completely different than having a panic attack during healthy sexual intimacy. (Reach out to RAINN if that’s the case.)

Although there are many causes for panic attacks, post-traumatic stress disorder (PTSD) is often to blame, says Barbara Greenberg, PhD, clinical psychologist and relationship expert. That was true for me: I’m a survivor of multiple sexual assaults and have been diagnosed with PTSD by a psychiatrist. As a result, sometimes during sex, I’ll have a flashback of an incident and experience a panic attack. Although the attacks subsided thanks to therapy and medication, it’s an ongoing process.

That said, panic attacks during sex can also happen to people who haven’t been sexually assaulted or diagnosed with PTSD. Dr. Greenberg says that generalized anxiety disorder and panic disorder can also trigger panic attacks during intimacy, but anyone can have one during their life — with or without a diagnosed disorder. Sometimes these things just happen.

However, if your panic attacks are, like mine, recurring and have an identifiable root cause, it’s an especially healthy idea to see a psychiatrist, Dr. Saltz says. “If you are having multiple panic attacks or PTSD flashbacks you should 100% get treatment,” Dr. Saltz says. Treatment will begin with an evaluation of the cause of the panic attacks with a mental health professional. Then, that person will suggest therapy, medication, or both.

But is there anything you can do when you’re in the midst of a panic attack during sex? The first thing to do, if you can, is explain to your partner what’s happening — and step back from sex to take care of yourself. You can always try having sex again later when you’re feeling better. Deep breathing exercises, mindfulness practice, and reassuring self-talk can all be helpful in calming a panic attack, says Michael Aaron, PhD, a sex therapist and author of Modern Sexuality: The Truth about Sex and Relationships. Changing your physical position or getting up to walk around can also help comfort you.

At that point, Dr. Aaron says it’s okay to take any anti-anxiety medication you’ve been prescribed, such as benzodiazepines (e.g. Xanax, Ativan, and Klonopin). Because you can become dependent on such medications over time, they’re meant to be used on an as-needed basis, Dr. Aaron says. But, depending on your individual needs, you may be taking them for a week or have a prescription at-the-ready for the rest of your life. While you’re taking these medications, though, you’re also (ideally) learning other self-soothing techniques in therapy that will come in handy when you stop taking the meds as frequently.

On top of managing what’s happening in your own mind and body, explaining it to your partner presents another challenge. In particular, when I had a panic attack, my partner had a hard time understanding that he did nothing wrong. But Dr. Saltz says that, in the moment, it’s enough to “tell your partner [your panic attack] will pass, take slow and deep breaths, and relax your muscles.” After the crisis has passed, you can get into a more detailed description of what you experienced — and how it wasn’t your partner’s fault.

If you’ve been a witness to someone else’s panic attack, know that they have likely experienced panic attacks before meeting you and probably will have them after you’ve parted ways, says Amanda Luterman, MA, OPQ, a psychotherapist who specializes in sexuality. “What you can do is be a soothing and stabilizing partner for that person, keep the focus on them, and reassure them that it’s going to pass,” she explains.

So, remember that panic attacks do go away. But if you continue to have them during sex as part of a larger mental health issue or due to unresolved trauma, you should seek treatment. Trust me, it can be a life- (and sex life-) saving experience.

Complete Article HERE!

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How to Talk Openly With Your Kids About Sex

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By Michele Hutchison,Rina Mae Acosta

This spring, Rina’s four-year-old kindergartner Bram Julius will learn about colors, shapes, how to play nicely with other children, and take his first steps towards learning about sexuality at school. In these early sex ed lessons the class will discuss butterflies in your stomach, friendship, and whether or not you’re happy to hold hands with another child. Meanwhile, my nine-year-old daughter Ina will be having class conversations about the physical changes during puberty and romantic relationships.

Each spring, Dutch children between the ages of four and twelve receive a week-long national sex-education program at school. The aim of these lessons is to allow for open, honest discourse about love, relationships, feelings, personal boundaries, and sex. The Dutch approach is even more surprising when I think about the climate I grew up in. Sex-ed was something you were taught at school in an embarrassing biology lesson. You couldn’t talk about it openly. The Dutch national sex-ed school program might seem odd or controversial, especially since a recent CDC study shows that nearly 80% of American children and teenagers do not receive any formal sex and sexuality education before having sex. But given the bigger picture, we think the Dutch are onto something.

The United States has the highest teen pregnancy rate in the developed world while the Dutch have among the lowest—eight times lower than their American counterparts. Research also indicates that, on average, teens in the Netherlands do not have sex at an earlier age than those in the US. This is the case even though Dutch society and parents are more relaxed, even allowing romantic sleepovers in their own homes. If you treat teenagers as if they are mature and responsible enough to make decisions, they might actually live up to those expectations.

It seems that with American children being constantly exposed to sexual content in the media through music videos, prime-time TV, and the internet, American parents anxiously avoid talking to their children about sex in the hope of not exposing them any further. This, in a climate where sexting, sending sexually explicit texts, is becoming increasingly common, even as early as in middle school.

While Dutch schools are providing age-appropriate lessons on intimacy and sexuality, instilling in children a safe code of conduct and respect for others, Dutch parents keep nothing from children. Nothing is taboo. Questions are answered simply and honestly, at the child’s level of understanding and maturity, as they arise. It was one of the first pieces of parenting advice we received from other parents here. Recent questions from my son, Ben, who is just a couple of years shy of becoming a fully-fledged teen, include: “Is sex fun? How?” and “How does a sperm donor get the sperm out?” I have been answering my kids’ questions on anatomy and reproduction from almost as early as they could talk.

Of course, sex can be a tricky, embarrassing topic no matter what culture you’re a part of. But by talking more openly about sex, parents can ease into discussing topics that become more complicated as their children grow older. Topics like gay marriage, sexuality, gender issues, and consent. There’s an added bonus to all this communication: children who have a good relationship with their parents tend to wait longer before having sex.

Like most expats, we were shocked to hear that Dutch parents allow their teenage children to have friends of the opposite sex to stay the night. But here, most teenagers have their first sexual experience in the safety of the parental home—how many Americans can say the same? According to a UNICEF report, 75% of Dutch teenagers use a condom the first time they have sex, and data from the World Health Organization shows that Dutch teens are among the top users of the birth-control pill. So teenage sex is allowed, but preferably in a controlled environment, that is, under the teen’s parents’ own roof. A safe place to have sex encourages safe sex.

Dutch children are well equipped with knowledge about sex before they enter puberty. If they are, the Dutch have learned, they will take fewer risks later on and know how to protect themselves.

It’s no wonder that Dutch kids are considered to be the happiest kids in the world! The Dutch have a very different view of what a child actually is—including accepting the reality that their children will have sex at one point or another . If American parents are anxious to keep their children safe, perhaps it would be better if they, and teachers, were more open about sex after all.

Complete Article HERE!

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Cross-Cultural Evidence for the Genetics of Homosexuality

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Mexico’s third gender sheds light on the biological correlates of sexual orientation

By Debra W. Soh

The reasons behind why people are gay, straight, or bisexual have long been a source of public fascination. Indeed, research on the topic of sexual orientation offers a powerful window into understanding human sexuality. The Archives of Sexual Behavior recently published a special edition devoted to research in this area, titled “The Puzzle of Sexual Orientation.” One study, conducted by scientists at the University of Lethbridge in Alberta, Canada, offers compelling, cross-cultural evidence that common genetic factors underlie same-sex, sexual preference in men.

In southern Mexico, individuals who are biologically male and sexually attracted to men are known as muxes. They are recognized as a third gender: Muxe nguiiu tend to be masculine in their appearance and behavior, while muxe gunaa are feminine. In Western cultures, they would be considered gay men and transgender women, respectively.

Several correlates of male androphilia — biological males who are sexually attracted to men — have been shown across different cultures, which is suggestive of a common biological foundation among them. For example, the fraternal birth order effect—the phenomenon whereby male androphilia is predicted by having a higher number of biological older brothers—is evident in both Western and Samoan cultures.

Interestingly, in Western society, homosexual men, compared with heterosexual men, tend to recall higher levels of separation anxiety — the distress resulting from being separated from major attachment figures, like one’s primary caregiver or close family members. Research in Samoa has similarly demonstrated that third-gender fa’afafine—individuals who are feminine in appearance, biologically male, and attracted to men—also recall greater childhood separation anxiety when compared with heterosexual Samoan men. Thus, if a similar pattern regarding separation anxiety were to be found in a third, disparate culture—in the case, the Istmo region of Oaxaca, Mexico—it would add to the evidence that male androphilia has biological underpinnings.

The current study included 141 heterosexual women, 135 heterosexual men, and 178 muxes (61 muxe nguiiu and 117 muxe gunaa). Study participants were interviewed using a questionnaire that asked about separation anxiety; more specifically, distress and worry they experienced as a child in relation to being separated from a parental figure. Participants rated how true each question was for them when they were between the ages of 6 to 12 years old.

Muxes showed elevated rates of childhood separation anxiety when compared with heterosexual men, similar to what has been seen in gay men in Canada and fa’afafine in Samoa. There were also no differences in anxiety scores between women and muxe nguiiu or muxe gunaa, or between the two types of muxes.

When we consider possible explanations for these results, social mechanisms are unlikely, as previous research has shown that anxiety is heritable and parenting tends to be in response to children’s traits and behaviors, as opposed to the other way around. Biological mechanisms, however, offer a more compelling account. For instance, exposure to female-typical levels of sex steroid hormones in the prenatal environment are thought to “feminize” regions of the male brain that are related to sexual orientation, thereby influencing attachment and anxiety.

On top of this, studies in molecular genetics have shown that Xq28, a region located at the tip of the X chromosome, is involved in both the expression of anxiety and male androphilia. This suggests that common genetic factors may underlie the expression of both. Twin studies additionally point to genetic explanations as the underlying force for same-sex partner preference in men and neuroticism, a personality trait that is comparable to anxiety.

These findings suggest childhood separation anxiety may be a culturally universal correlate of androphilia in men. This has important implications for our understanding of children’s mental health conditions, as subclinical levels of separation anxiety, when intertwined with male androphilia, may represent a typical part of the developmental life course.

As it stands, sexual orientation research will continue to evoke widespread interest and controversy for the foreseeable future because it has the potential to be used—for better or worse—to uphold particular socio-political agendas. The moral acceptability of homosexuality has often hinged on the idea that same-sex desires are innate, immutable, and therefore, not a choice. This is clear when we think about how previous beliefs around homosexuality being learned were once used to justify (now discredited) attempts to change these desires.

The cross-cultural similarities evinced by the current study offer further proof that being gay is genetic, which is, in itself, an interesting finding. But we as a society should challenge the notion that sexual preferences must be non-volitional in order to be socially acceptable or safe from scrutiny. The etiology of homosexuality, biological or otherwise, should have no bearing on gay individuals’ right to equality.

Complete Article HERE!

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It’s time to end the taboo of sex and intimacy in care homes

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Imagine living in an aged care home. Now imagine your needs for touch and intimacy being overlooked. More than 500,000 individuals aged 65+ (double the population of Cardiff) live in care homes in Britain. Many could be missing out on needs and rights concerning intimacy and sexual activity because they appear to be “designed out” of policy and practice. The situation can be doubly complicated for lesbian, gay, bisexual or trans individuals who can feel obliged to go “back into the closet” and hide their identity when they enter care.

Little is known about intimacy and sexuality in this sub-sector of care. Residents are often assumed to be prudish and “past it”. Yet neglecting such needs can affect self-esteem and mental health.

A study by a research team for Older People’s Understandings of Sexuality (OPUS), based in Northwest England, involved residents, non-resident female spouses of residents with a dementia and 16 care staff. The study found individuals’ accounts more diverse and complicated than stereotypes of older people as asexual. Some study participants denied their sexuality. Others expressed nostalgia for something they considered as belonging in the past. Yet others still expressed an openness to sex and intimacy given the right conditions.

Insights

The most common story among study participants reflected the idea that older residents have moved past a life that features or is deserving of sex and intimacy. One male resident, aged 79, declared: “Nobody talks about it”. However, an 80-year-old female resident considered that some women residents might wish to continue sexual activity with the right person.

For spouses, cuddling and affection figured as basic human needs and could eclipse needs for sex. One spouse spoke about the importance of touch and holding hands to remind her partner that he was still loved and valued. Such gestures were vital in sustaining a relationship with a partner who had changed because of a dementia.

Care staff underlined the need for training to help them to assist residents meet their sexual and intimacy needs. Staff highlighted grey areas of consent within long-term relationships where one or both partners showed declining capacity. They also spoke about how expressions of sexuality posed ethical and legal dilemmas. For example, individuals affected by a dementia can project feelings towards another or receive such attention inappropriately. The challenge was to balance safeguarding welfare with individual needs and desires.

Some problems were literally built into care home environments and delivery of care. Most care homes consist of single rooms and provide few opportunities for people to sit together. A “no locked door” policy in one home caused one spouse to describe the situation as, “like living in a goldfish bowl”.

But not all accounts were problematic. Care staff wished to support the expression of sex, sexuality and intimacy needs but felt constrained by the need to safeguard. One manager described how their home managed this issue by placing curtains behind the frosted glass window in one room. This enabled a couple to enjoy each other’s company with privacy. Such simple changes suggest a more measured approach to safeguarding (not driven by anxiety over residents’ sexuality), which could ensure the privacy needed for intimacy.

Conclusions

Our study revealed a lack of awareness by staff of the need to meet sexuality and intimacy needs. Service providers need guidance on such needs and should provide it to staff. The information is out there and they can get the advice they need from the Care Quality Commission, Independent Longevity Centre, Local Government Association and the Royal College of Nursing.

Policies and practices should recognise resident diversity and avoid treating everyone the same. This approach risks reinforcing inequality and doesn’t meet the range of needs of very different residents. The views of black, working-class and LGBT individuals are commonly absent from research on ageing sexuality and service provision. One care worker spoke of how her home’s sexuality policy (a rare occurrence anyway) was effectively a “heterosexuality policy”. It may be harder for an older, working-class, black, female or trans-identified individual to express their sexuality needs compared to an older white, middle-class, heterosexual male.

Care homes need to provide awareness-raising events for staff and service users on this topic. These events should address stereotyping and ways of achieving a balance between enabling choices, desires, rights and safeguarding. There is also a need for nationally recognised training resources on these issues.

Older people should not be denied basic human rights. This policy vacuum could be so easily addressed over time and with appropriate training. What we need now is a bigger conversation about sex and intimacy in later life and what we can do to help bring about some simple changes in the care home system.

Complete Article HERE!

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