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Download Transcript (00:08): Welcome everyone to the December 9th Lunch and Learn. This is a special Lunch and Learn that was delayed because of the occurrence of Veteran's Day on our usual date. My name is Margie Urban, and I am the Medical Director of the New York State Department of Health AIDS Institute Clinical Education Initiative Sexual Health Center of Excellence. And that was formerly known as the STD Center of Excellence and sort of the origin of that change is what brings us to our discussion today. I want to thank our panelists for agreeing to be here. Today we're going to have a short PowerPoint type of presentation and then really spend a lot of our time in a panel discussion format to review our topic. Why sexual health? So before we get going I just wanted to introduce the panelists. Originally we had Joanne Morin scheduled and she unfortunately was unable to be here and Karen Hagos on my left here, is stepping in. (01:19): Karen is the Director of the Office of Planning and Community Affairs within the New York State Department of Health AI. Her responsibilities include coordinating the implementation of the Ending the Epidemic blueprint in New York state, coordinating the institute's strategic planning process, and assisting in the development and implementation of changes to public health laws and regulations. Karen served as the lead coordinator for the New York state ETE task force. She received her MPH from SUNY Albany with a concentration in health policy and management. (01:53): Morning! (01:54): And joining her, to her left, is Charles Gonzalez. Dr. Gonzalez is an immunologist and infectious disease specialist and Medical Director of the New York State Department of Health AIDS Institute. After completing medical school at Columbia University, a residency at NYU Bellevue, and then both ID and pharmacology fellowships both at Yale, Charles directed immunology and HIV research in his laboratory at NYU. As well as investigating Hep C therapies and HIV medications and vaccines as part of the NIH AIDS clinical trials group. Charles is the clinical officer for ADAP, STI, Hepatitis B and C, HIV, and PrEP at the AIDS Institute. And a believer in syndemics, he considers himself a happy warrior in the Ending the Epidemic battle in New York state. (02:48): Thank you Margie. My mom wrote that post. (02:53): And then joining us also is Rachel Hart-Malloy. Dr. Malloy has worked the field of public health for the past 15 years with a predominant focus on STIs, HIV and Hepatitis C, epidemiology, surveillance, evaluation, policy, and programming. She currently serves as the Director of the Office of Sexual Health and Epidemiology at the New York State AIDS Institute. In this role, she provides oversight of sexual health programming, policy, and surveillance in New York state, with direction over HIV and STI partner services data for the state, all reportable STI surveillance in New York state, the New York state STD/HIV disease intervention services training center, sexual health education and programming, and coordination of sexual health related policies. Dr. Hart-Malloy additionally serves as an Assistant Professor at the University of Albany School of Public Health, department of epidemiology and biostatistics since 2011. So with that, I do thank you all for joining us today. Our plan was to go into just a little bit of background with some PowerPoint slides and we'll ask our help located in Rochester to share the slides now so we can get started with that PowerPoint. (04:19): Okay. All right, well, good afternoon everyone. It's very wonderful to be here with you today. Again, my apologies that you have myself instead of Joanne Morin, but I certainly know that she is very much in favor of this conversation and would love to be here if she could. I'm going to echo some of the sentiments that she shared at this year's Ending the Epidemic Summit. As you heard from the bio that Dr. Urban read, a lot of my work revolves around strategic planning and our Ending the Epidemic blueprint. And something that we've already started doing is looking at 2020 and beyond Ending the Epidemic. And something we're hearing over and over again from our community is that we really need to engage this effort and be looking at sexual health in totality as we move forward with our Ending the Epidemic efforts. (05:14): So this is certainly a wonderful opportunity for me to be here, both to share some information as well as to learn as well. So the AIDS Institute has been embracing a philosophical shift towards sexual health and we've seen it almost universally celebrated. It's not only reflected in how we speak, but also in our programming and messaging. And I share with you this quote today, you can see it on your screen, but I'll read it for you. "Ironically, it may require a greater intimacy to discuss sex than to engage in it." And I remember I was in a training where I saw this for the first time and I thought it really summed up a lot of the conversations that we hear time and time again. When we started developing the Ending the Epidemic blueprint, something we saw recommended over and over again is the need for comprehensive sexual health education. (06:01): And I think this quote helps to bring that forward in terms of something that is really at the forefront of our work and something we really need to strive to achieve for Ending the Epidemic in 2020. We know that looking at issues through a disease lens creates stigma, which is a barrier to screening, treatment, care, and having open conversations with sexual partners. At the basis, shifting our focus to sexual health and acknowledging it as an essential aspect of one's overall health and wellbeing is one step in reducing some of those barriers. The more we can normalize and provide culturally responsive, nonjudgmental sexual health, the more we can see those barriers minimized and realize better outcomes. And I think that's a big opportunity that we have through opportunities like this today. So I'm going to move forward and turn the microphone over to my colleague Dr. Gonzalez. (06:51): Well, thank you. The next slide I guess would be appropriate. Or I might say that the slide is inappropriate, the Kama Sutra. As a fundamental component of human existence and relationships and the only synonymous with health and wellbeing, we in the health professions, and I want to emphasize the word healthcare professsions. We in the health professions have traditionally circumscribed and approached sexuality, essentially only in the context of a disease entity, but one exception of this rather blinkered view is sexuality in the context of reproduction. I put the Kama Sutra there, you'll see a rather contortionist x-ray view, but we've tended to look at this particular document which is over 2000 years old, as some sort of eroticized version of human activities. The way it was originally written was in trying to place this within human sexuality and how it conforms to a well-ordered life I will grant that it was probably done from a male perspective, but the treatise was to try to help explain pleasure both for the individual and their partner. (08:12): Studies have documented the extraordinary change in sexual behavior that have occurred since the latter half of the 20th century. This has been characterized by a fall in age of first intercourse, increased numbers of sexual lifetime partners, changes and patterns of partnership, formation, and childbearing. This is from the, sort of the land of our church and fathers, these are the British studies. I think at least we have gone over that there have been generational changes, whether it be in HIV or in general sex risk that we discuss over time. This has changed over the short course of these 20 years studies. And I would note that people's ability or reasons to discuss them, whether they're same sex or not, or at least to acknowledge them is now at least more current. But also point out that these changes in sexual behavior pre-date the advent of PrEP. Well in advance. (09:24): Sexual behavior is shaped by its social and historical context of a lens through which we view sexual health as change. This is the WHO's definition of sexual health and it views sexual health as not merely the absence of disease, but recognizes the importance of having pleasurable and safe sexual experiences that are free of coercion, discrimination and violence. It does avoid the framing of sexual health exclusively in terms of prevention of adverse sexual outcomes and widens the view to include the enhancement of quality of sexual experience and relationship. This is often quoted, but it's yet to be incorporated fully into either public health messaging or for that matter the way it's placed in institutions. (10:28): I put up a means by which you might want to compare a sort of sexual disease framework versus sexual health. In terms of sexual disease framework, it is disease focused, highly specialized, segmented and siloed, and put aside, and it has targeted outcomes. And it has been effective. One of the aspects though is that clinics are likely to spend more time on partner services, on treatment than on education and how it fits into the broader aspect of one's life.
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