Recent challenges to contraceptive access make the scenario all too easy to imagine: A woman goes to her health care provider to get her annual check-up and to renew her prescription for birth-control pills. She’s been going to the same health center and using the same birth control pills for years, but this time a nurse practitioner refuses to renew her prescription.

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Heavy smoking and use of birth control pills increase risk of a first-time heart attack by a factor of 30.

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The scenario is easy to imagine when we’ve seen the concept of religious liberty stretched beyond its limits. The concept has been used to trump other liberties, to excuse organizations from compliance with health care mandates that ensure access to the contraceptives that many struggle to afford. But the scenario just described is exactly what happened to a woman in Iowa, whose clinic refused to renew her prescription for birth control pills, not because of bills passed by lawmakers, but because of her age, 42, and the fact she smoked. Those two factors made use of birth control pills risky for her — and a liability for her provider.

Today is World No Tobacco Day, so this installment of our “Over 90 Percent” series takes a look at the toll smoking takes on sexual health, and what Planned Parenthood health centers can do to help people quit. The World Health Organization launched World No Tobacco Day in the late 1980s to encourage tobacco users around the world to quit tobacco for at least 24 hours. It has also served as a day to promote other anti-tobacco initiatives and raise awareness about the effects of tobacco use.

When people think of smoking, one of the first health effects that comes to mind is lung cancer — and for good reason. Smoking is the most significant risk factor for lung cancer and causes an estimated 90 percent of lung cancer cases in the United States. However, almost every organ in the body is susceptible to the effects of smoking. The most immediate effects occur in the respiratory, nervous, cardiovascular, immune, gastrointestinal, and metabolic systems.

Smoking also affects sexual health.

In the case of the Iowa woman, her smoking, age, and use of birth control pills were considered a combination that could put her at risk of blood clots. She was a light smoker, so the provider eventually compromised and gave her a 30-day prescription, as long as she signed a waiver of liability. However, had she been a heavy smoker, 25 cigarettes or more each day, it’s likely that the provider wouldn’t have taken that chance. One study found that heavy smoking and use of birth control pills can increase a woman’s risk of a first-time heart attack by a factor of 30, and those findings were true regardless of whether the woman was taking low-dose or high-dose pills. Since both can elevate blood pressure, cigarette smoking and birth control pills can put some women at a greater danger of both heart attack and stroke.

Smoking and tobacco use are associated with a host of other reproductive health disorders as well, including menstrual irregularity, diminished quantity and viability of ova, ectopic pregnancy (fertilized ovum outside of the uterus), miscarriages, lower sperm density, abnormally shaped sperm, and erectile dysfunction. Additionally, survey evidence indicates that smokers have sex less frequently than non-smokers and enjoy sex less.

For smokers and other tobacco users, there are many reasons to quit, and their sexual health is an important one. If you or someone you know is trying to quit smoking, Planned Parenthood’s Ask the Experts forum gives this advice for quitting:

• Try saving the money you would have spent on cigarettes to buy something special.
• Exercise to release endorphins and distract yourself from cigarette cravings.
• Socialize with nonsmokers.
• Snack on low-calorie vegetables to keep your hands and mouth active.
• Keep a list of reasons you want to quit and look at it every day.
• Enlist your family and friends to help you.
• Practice deep breathing and relaxation.
• Chew sugarless gum.
• Drink cold water.

Help is also available at Planned Parenthood health centers — Planned Parenthood Arizona has smoking-cessation programs to help you stay healthy and get the most out of your birth control. Although World No Tobacco Day serves as a good reminder and an occasion for people to quit together, any day is a good day to start quitting.

Gov. Jan Brewer isn’t shy about her goals. She wants to give government and employers power over women’s private medical decisions. She wants to undermine women’s access to reproductive health care. And she wants to take away public funding from every single Planned Parenthood health center in Arizona.

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“I do not support the goals of Planned Parenthood. They believe in choice. So let’s just cut right through the fat and tell it like it is.” — Gov. Jan Brewer

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Opponents of women’s health in the Arizona legislature have done everything they can to give Gov. Brewer whatever she wants. In the face of these relentless attacks, providing care to Arizona women and families has become more difficult than ever.

But I’m not giving up on our patients, and I’m not giving in to Gov. Brewer’s bullying. Neither are the doctors, nurses, staff, and volunteers at Planned Parenthood Arizona health centers. Arizona women continue to make their way to our 14 health centers to protect their health, and our doors will be open to them no matter what. And attacking Planned Parenthood in Arizona is attacking Planned Parenthood everywhere.

Gov. Brewer has done more damage to women’s health in her three years in office than any governor in Arizona history. But nothing compares to the attacks on women’s health in 2012. This year, she and other opponents of women’s health in the Arizona legislature passed four bills restricting women’s access to health care. They’re forcing women to live by their rules on birth control, cancer screenings, and testing and treatment for sexually transmitted infections.

Arizona’s current political leaders are endangering women’s health, dismantling our constitutional protections, and overriding modern medical standards — and women will pay the price for years to come

We have fought assailants like Jan Brewer before. And despite one assault after another, we have kept our doors open, our staff have come to work, and women’s health needs have been met. We will continue to do what we’ve done throughout our 78-year history, in good times and bad: provide for the health and well-being of all Arizona women.

That’s what Planned Parenthood does, in Arizona and everywhere – but it’s only possible because of the courage and generosity of our supporters in the community – the 70 percent of Arizonans who support the work we do.

In an interview last week, Gov. Brewer made it clear that she doesn’t care what the majority of Arizonans who support Planned Parenthood think. Asked about her relentless attacks on Planned Parenthood and women’s health, she said, “I guess it’s imposing what I believe in.”

Women in Arizona can’t afford to let Gov. Brewer impose her dangerous ideology on them. And I can promise you that Planned Parenthood won’t stop fighting back.

We are proud to provide our health care services to women, men, teens – all Arizonans.

If you would like to help, please share this on your blog, Facebook, Google+, Twitter, Pinterest, LinkedIn … spread the word.

You can also provide your financial support to provide Arizonans with the health care they need.

Thank you!

Hepatitis A virus particles are pictured in this electron micrograph. Image: Betty Partin, CDC

Hepatitis isn’t commonly thought of as a sexually transmitted infection (STI) — for most people, hepatitis conjures images of contaminated food or unsanitary restaurants. But hepatitis should be on the radar of anyone who is sexually active. There are several different viruses that cause hepatitis, and some can be sexually transmitted, including hepatitis A (HAV), hepatitis B (HBV), and, to a lesser extent, hepatitis C (HCV).

While HBV is most efficiently transmitted through blood, it can also easily hitch rides from person to person via sexual fluids. However, we covered HBV in depth last year in observance of World Hepatitis Day. As May is Hepatitis Awareness Month, we’ll turn the spotlight on HAV and HCV for this month’s installment of our STI Awareness series.

Hepatitis A (HAV)

HAV spreads through fecal-oral contact and is more widespread in parts of the world with poor sanitation. It is relatively rare in the United States, although in 2003 there was a hepatitis A outbreak outside of Pittsburgh — the largest in the United States — that was traced to improperly washed raw scallions. All told, there were 650 confirmed illnesses and four deaths. HAV is very resilient and can survive outside a host for long periods of time – other foodstuffs it can contaminate include filter-feeding shellfish, which can concentrate HAV from contaminated seawater in their tissues. When these shellfish are undercooked, they can pack quite a punch as billions of virus particles are released into the unsuspecting diner’s body.

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Vaccination against hepatitis A confers lifelong immunity while sparing you from illness caused by a natural infection.

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Unfortunately, no matter how well you clean your fresh produce or how long you cook shellfish, certain sexual activities can increase your risk of acquiring HAV. As with intestinal parasites, which can be present in minuscule amounts of fecal matter, so too can virus particles be present in microscopic bits of feces. Oral contact with the anus (“rimming” or anilingus) is the riskiest activity in terms of HAV transmission — oral-genital contact can also do the trick, as can manual contact between the anus and the mouth. While hepatitis A outbreaks have been reported among MSM – men who have sex with men – populations, oral-anal contact is associated with increased risk for HAV infection regardless of sexual orientation. To reduce your risk of sexual HAV transmission, use latex condoms or dental dams during oral activities. HAV can also be transmitted via blood, and hepatitis A outbreaks have been reported among IV drug users.

Upon exposure, a host will incubate HAV for about four weeks before developing symptoms. These symptoms can vary, but they might include:

• low-grade fever
• headaches and muscle aches
• anorexia
• nausea or vomiting
• diarrhea
• dark urine
• jaundice

HAV can be fatal, though deaths only account for about 0.1 to 0.2 percent of cases.

Just before an HAV infection manifests as a disease, the virus is shed in abundance in the feces – at this time, an individual can be at his or her most infectious despite not yet being aware of infection. After the first two weeks of illness, infectiousness decreases. Luckily, unlike many other viruses, HAV does not become a chronic infection – once your immune system clears it, you’re immune for life.

This line graph shows the incidence of hepatitis A infections. A preventive vaccine was introduced in 1996. (Click to enlarge.) Graph: CDC

Being vaccinated against HAV, however, will confer lifelong immunity while saving you the trouble of illness and infectiousness. There is even a nifty combination vaccine that will protect you from both HAV and HBV. Vaccination is definitely worth looking into if you are at risk for exposure to these viruses. Sexual activities involving oral-anal contact can put you at risk, as can illicit drug use or simply traveling to a region where HAV is prevalent.

According to the Centers for Disease Control and Prevention, before the vaccine, HAV caused an estimated 200,000 to 300,000 infections annually in the United States. By 2009, there were less than an estimated 21,000 infections. It is currently recommended that children be vaccinated against both hepatitis A and B, but since these vaccines are relatively new, many sexually active adults have never been vaccinated.

Maurice Hilleman developed the vaccine by weakening HAV and killing it with formaldehyde. After successful animal tests, he ran a clinical trial in Kiryas Joel, a Hasidic enclave where 70 percent of residents were infected. This disproportionate HAV infection rate was due in part to a very high birth rate and crowded conditions among children, who bathed together in pools and ate from communal food at school. Uninfected children were split into two groups, one of which received the vaccine while the other received a placebo injection. Based on this small study, the vaccine was declared 100 percent effective. Merck licensed the vaccine in 1995 and it became available in 1996, after which the infection rate fell by 75 percent in the United States.

More information about hepatitis A virus can be found at the CDC’s website.

Hepatitis C virus, colored yellow in this transmission electron micrograph, is magnified approximately 100,000 times. Image: Thomas Deerinck, National Center for Microscopy and Imaging Research, UC San Diego

Hepatitis C (HCV)

HCV can be considered a sexually transmitted infection because, although it is not primarily transmitted sexually, the evidence shows that it can be. However, it is more strongly associated with the use of IV drugs.

Despite similar names, HAV and HCV aren’t closely related on a genetic level — they received their names based solely on their association with liver disease. Furthermore, while HAV is cleared by the immune system, 60 to 85 percent of HCV infections become chronic, and a lifelong infection can lead to liver damage, putting carriers at increased risk for cirrhosis, liver failure, and liver cancer. Additionally, while one can be vaccinated against hepatitis A and hepatitis B, there is currently no vaccine for hepatitis C.

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Every year, hepatitis C causes more deaths in the United States than HIV.

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Hepatitis C has surpassed HIV in terms of the number of deaths it causes every year in the United States. While this represents good news for the management of HIV as a chronic disease, it’s not good news for the estimated 3.2 million chronic carriers of HCV in the United States, most of whom are baby boomers. And because the infection is often asymptomatic — or has nonspecific symptoms, such as fatigue — in many cases it remains undiagnosed until it has wrought significant liver damage, a process that typically takes decades. HCV infection can be exacerbated by heavy drinking, obesity, insulin resistance, and HIV or HBV infection.

HCV is possible to transmit sexually, but it’s not spread this way as efficiently as are HAV and HBV. It is spread through contact with blood, so if your sexual activities are such that they could result in abrasions or cuts, it is especially important to be aware of blood-borne pathogens and how to protect yourself from them. However, even within relationships in which only one partner is HCV-positive, it is still quite rare for the virus to be transmitted.

Researchers have undertaken many studies to assess what sexual practices increase risk for HCV, but these studies haven’t always had consistent results. However, it seems that risk for sexual transmission of HCV might be correlated with:

• previous infections with syphilis or rectal gonorrhea
• anal intercourse
• lack of condom use
• a high number of sexual partners (defined as anywhere from five to 50 partners per year)

Some drug combinations have been known to cure HCV, with a 50 to 80 percent cure rate, and more pharmaceuticals are being developed. Treatment can be more difficult if patients have a history of drug or alcohol abuse. There is currently no vaccine for HCV, although researchers are working toward that goal.

More information about hepatitis C virus can be found at the CDC’s website.

Click here to check out other installments of our monthly STI Awareness series!

Jesse Kelly is an avowed anti-choice candidate and has received support from the National Right to Life Political Action Committee. Barber, when asked about his position on choice and women’s health care, said he has always been pro-choice and believes women’s health care decisions must be made between women and their doctors.

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Ron Barber is running to finish Gabrielle Giffords’ term in the June 12, 2012, special election. Early voting starts on May 17.

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“There has been too much political debate about limiting our freedoms,” he told us. “Women have the right to make their own choices about contraception and any interference from the government or employers is an affront to personal liberty.”

The debate on women’s health care used to center on abortion. It has now expanded to include the availability of contraception and the “right to refusal” –  so-called consciousness clauses that allow pharmacists to refuse to dispense emergency contraception, employers to opt out of providing insurance coverage for birth control, and health care providers to refuse emergency care for pregnant women. Barber, as do most Americans, believes that the “availability of contraception was an issue we settled 50 years ago” and employers, insurance companies, and pharmacists should not put themselves between a woman and her doctor.

Arizona’s 8th Congressional District encompasses much of Pima and Santa Cruz counties, as well as Cochise County. To find out what district you live in, click here.

“I will be a strong voice to make sure that basic contraception continues to be available to women. I will vote against any proposal to defund Planned Parenthood,” Barber promises. Though many of the laws on this issue are being implemented at the state level, he says that he will oppose any restrictions on contraception and be a voice of support for access to contraception at home in Arizona.

In the last round of budget debates, Republicans made Planned Parenthood a bargaining chip. When asked how he would deal with this tactic as a congressman, Barber said he believes that while bipartisan solutions can be found to some of the issues, he “will not cave to any attempt to extract a vote against Planned Parenthood in exchange for movement on other important legislation. The American people deserve a Congress willing to vote on each issue – not have legislation held captive by an extreme part of the Republican caucus.”

Barber continued, “Our country – and certainly Southern Arizona – is facing enormous challenges: a disappearing middle class, unemployment and underemployment, aging infrastructure. To play partisan games with the budget – to risk programs that support our veterans, support our children, and support our seniors – is not business-as-usual, it is totally unacceptable. Our federal and state budgets should reflect our values and not the extreme positions of a few legislators.”

Defunding Planned Parenthood is a stated goal of the presumptive Republican presidential candidate. As a supporter of Planned Parenthood, Barber holds that Planned Parenthood “should not be held hostage in the debate about contraception and abortion rights.” He appreciates that Planned Parenthood has provided critical health services for nearly 100 years, and its cancer screenings, mammograms, and preventive care must continue to receive federal support. Barber has stated that when he is in Washington, he will “fight to ensure that Planned Parenthood receives the political and financial support to continue these essential services.”

Barber sees access to basic health care as a major issue that must be addressed in the remainder of this legislative term – and into the next term. He believes it will be important to ensure that Planned Parenthood and other providers continue to receive funds to provide basic health care, regardless of state laws on abortion or funding. He recognizes that low-income women and women in rural areas don’t have easy access to preventive care, and he wants to work to improve this access. Barber has said he “will put a high priority on this issue when I go to Congress.”

Ron Barber has lived in Southern Arizona most of his life. He went to high school in Tucson, and graduated from the University of Arizona. He married his high school sweetheart, Nancy, and they raised their two girls there. Together they ran a small business, Toy Traders/Stork’s Nest, where families could buy and trade used toys, clothing, and equipment. He also worked for 35 years as an advocate for people with disabilities. As his website tells us, he ran one of the five most cost-efficient, high-quality family-service programs in the country.

Wanting to continue his commitment to improving people’s lives and solving community problems, Barber headed up Congresswoman Gabrielle Giffords’ district operations in 2006. In that position, he got results by cutting through federal agency red tape for constituents. After the tragic shooting in Tucson in January 2011, Giffords stepped down from her position to focus on her recovery. Barber, less critically wounded in the shooting, recovered and was encouraged to run to fill the remainder of Giffords’ term, as well as to run for the next full term. With Gabrielle Giffords’ encouragement and endorsement, Barber accepted the opportunity to continue his commitment to public service.

If you believe it is critical for the people of CD8 to have a strong proponent for women’s health care representing them in Washington, you might like to volunteer or contribute to his campaign. Please go to www.ronbarberforcongress.com to sign up to help. You can also join Planned Parenthood in Tucson on May 24 at 6 p.m. to call voters and encourage them to vote for Ron Barber — contact Michelle Steinberg to RSVP and receive details. If you are registered to vote in CD8, you can request an early ballot here.

Today, Arizona’s Asians and Pacific Islanders, or APIs, represent nations throughout Asia and the Pacific, with Indians and Filipinos constituting the two largest API ethnic groups in Arizona. Although APIs are a small percentage of Arizona’s total population — 2.8 percent — their population is now the fastest-growing in Arizona, increasing by 85,000 in the last decade. In this respect, Arizona mirrors a larger trend; nationally, the Asian and Pacific Islander population grew by 43.3 percent between 2000 and 2010.

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More than two-thirds of Asians and Pacific Islanders have never been tested for HIV.

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Asians and Pacific Islanders experience the same health problems as the population at large, but like other minority groups, their health needs are best met by understanding how health problems affect them uniquely, and by providing culturally competent health interventions and health care. There’s an increasing need for both as their population grows, especially when it comes to addressing HIV/AIDS in their population. Although APIs have low rates of officially reported HIV/AIDS compared to other racial and ethnic groups, their incidence of unreported HIV/AIDS most likely hides a larger problem. As Dr. C. N. Le of the Asian & Pacific Islander Coalition on HIV/AIDS explains, “The statistics say that the prevalence rate among Asians is relatively small, and much smaller than among the black community or the Latino community … But those are official statistics, and official statistics are notorious for undercounting minorities, and especially for undercounting immigrants.”

Lending credence to Dr. Le’s argument is the fact that more than two-thirds of APIs have never been tested for HIV. Even with that low rate of testing, APIs have the highest rate of increase in new HIV infections compared to other racial and ethnic groups. To raise awareness about HIV/AIDS among APIs — and to promote effective prevention and screening — May 19 is National Asian & Pacific Islander HIV/AIDS Awareness Day.

National Asian & Pacific Islander HIV/AIDS Awareness Day serves as a day to observe ongoing efforts of education, prevention, and screening, as well as to plan partnerships and capacity-building for the continuation and expansion of these efforts.

Activists and advocates have cited an assumption among health care providers that APIs are at a low risk for HIV/AIDS as one of the reasons APIs are undercounted in HIV/AIDS statistics. Among the issues addressed on this awareness day are the stigma of HIV/AIDS diagnosis in the API community and the promotion of HIV/AIDS screening by health care providers.

Although the rate of reported HIV/AIDS among APIs in Arizona has dropped somewhat in the last decade, it’s too soon to call a success, especially given the low rate of testing among APIs. Both here and nationally, we will need to confront HIV/AIDS in our many cultural communities to stop its spread. Along with many other services offered, Planned Parenthood health centers are a resource in confronting HIV/AIDS in Arizona’s diverse communities, with staff who can talk to individuals about STIs and help them get the testing or treatment they may need. The Planned Parenthood website also has an online tool called The Check that can help individuals decide if they should get tested for chlamydia, gonorrhea, or HIV.

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Bronski frames LGBTQ history as one that is woven into the fabric of U.S. history — not separate from or additional to it.

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Bronski explains in the introduction to his book that he is interested in providing something more than a history of “who might have been ‘gay’ in the past or had sexual relations with their own sex.” In fact, his mention of individuals is often pared down to the sheerest character sketches and profiles. Far from a collective biography of LGBTQ Americans, Bronski’s interest in individuals is often limited to a person’s role as agents in a process of evolving gender expectations, agents who sometimes shape those expectations and other times act independently of them. He explains that he doesn’t want to reduce history to “names, dates, political actions, political ideas, laws passed and repealed.” Instead, borrowing the words of Shulamith Firestone, he wants to present history “as process, a natural flux of action and reaction.”

To inform this view of history, Bronski draws on past literature and research on LGBTQ history, adds to it, and rethinks it to create his own retelling. His retelling begins with a glimpse of the Americas on the cusp of contact with Europe, looking briefly at the role of Two-Spirit people (individuals considered to have a mixed or third gender role) in indigenous societies. It moves forward chronologically to arrive in the 1990s (and then touches on the recent past and the present in an epilogue).

For many readers, Bronski’s book will add new dimensions to familiar history. For example, he argues that the institution of slavery had a significant impact on LGBTQ history, because “acceptance of slavery as a philosophical concept and political reality laid the groundwork for the justification of ‘othering’ — designating a group of people as ‘different,’ placing them outside of the legal, social, and moral framework granting full citizenship.” The introduction of the birth-control pill, on the other hand, had a more positive impact on LGBTQ history, because it undermined the argument that same-sex sexual activity, because it did not lead to reproduction, was unnatural; the introduction of the birth-control pill normalized “the separation between sex and reproduction.”

The interaction of phenomena that are known to general U.S. history and phenomena that are more specific to LGBTQ history is a theme throughout Bronski’s book, and it’s central to how he wants to write his chronicle. His book frames LGBTQ history as one woven into the fabric of U.S. history — not separate from or additional to it. His hope is “to give a secure and realistic sense of how the lives, thoughts, and actions of LGBT people have made this nation into the country it is today, and show all non-LGBT people how this history has affected them as well.” The influence of LGBTQ people on this country’s historical landscape is seen from their role in the earliest intentional communities to their political influence in the Roosevelt years and beyond.

Ambitious in its approach, at times Bronski’s book does seem to shortchange history a bit by focusing on processes first and the people in those processes second. While some readers might like to read about ideas rather than people, for others, the personal framework can give history a more meaningful and concrete narrative. Another shortcoming is Bronski’s occasional reliance on prose and poetry to reveal historical episodes of same-sex bonding and intimacy. This shortcoming is understandable, given that any scholar of LGBTQ history has to deal with a scarcity of frank and forthright documentary evidence of private behavior that was often shunned and persecuted by social purity movements. Bronski does make up for it by using very compelling evidence from literature — evidence that, while subject to interpretation, has obvious interpretations that are hard to ignore.

One of the first books of its kind, Bronski’s work won the American Library Association’s Stonewall Book Award after its hardcover release. Soon to be released in paperback, it should be a welcome resource for the LGBTQ community, as well as its allies (like this blogger).