Promotion of responsible safe sex practices:

Sexuality and HIV/AIDS control

by W. Annesley Sumith Fernando

HIV/AIDS is observed more as a social problem than a medical condition. This situation has emerged sexual relationships being the main mode of it's spread.

Under the circumstances, attention to sexuality is demanding in the control of HIV/AIDS. It is absurd to make attempts at finding solutions to the problem of HIV/AIDS devoid of educational approaches that consider sexuality. As such, all activists involved in HIV/AIDS control are unanimous over this fact.

Sexual psychologists are not in concurrence about sexuality itself but there is agreement over the issue that sex act depends on diverse preferences of individuals and therein personality comes into prominence.

In discussing sexuality, mental, physical and social aspects associated with sexuality require due attention. Since sexuality concerns a particular individual, it cannot be depicted in detachment from other aspects of his or her life. Sexual motivation, an internal issue which leads to long lasting inclinations is the main factor that influences this tendency. Expression of sexuality is moulded by mental or social factors. Sexual motivation is considered an intrinsic motivation. Sexual psychologists opine that it is as well a basic feeling such as hunger and thirst.

Maturity

Sexual psychologists have expressed their view that the process of sexual maturity has some bearing on sexuality. Especially, the psychologists of the behavioural school emphasise this fact.

Sexuality is divisible into two stages as primary and secondary. Sexual excitement commences with the sexual hormones coming on-stage that results in features of secondary sexuality.

This is a result of impregnating blood with these potential chemicals which are secreted from glands on the command of pituitary gland located in the cerebral cavity. The process generates two female hormones oestrogen and progesterone and the male hormone testosterone. Sexual activity depends on this process.

We have to be watchful about tendencies that render sexuality in HIV/AIDS control programs because sexual propensities get personified.

Sexual psychologists divide sexuality into four stages i.e. self-sexuality, homosexuality, bisexuality and heterosexuality. There are differences in opinion regarding the age brackets pertaining to these stages but there is no dispute regarding the stages.

Although there is some convenience in making educational approaches to control HIV/AIDS with heterosexuals, there is immense difficulty in interventions with homosexuals. Most prominent difficulty lies with the identification of homosexuals.

Homosexuality exists in all societies. It has a long history too. Many countries which were inspired by the wave of Victorian morals proscribed homosexual relationships and brought them under the criminal law. Therefore, they maintain their homosexuality in a clandestine manner, averting possibilities of their identification. This remains a barrier to control HIV/AIDS.

According to the World Health Organisation, homosexuality is neither mental nor a physical sickness. It is only a sexual orientation. It is just another sexual involvement such as oral sex. Male homosexuals are at the highest risk in HIV infection. Anal sex is blamed for this because anal intercourse runs a high risk when compared to heterosexual intercourse.

Although there is no collective concurrence among sexual psychologists about homosexual association, all societies agree as to how homosexual practices take place. Some ideologies mention a genetical link to homosexuality.

However, the social background has a strong influence on homosexuality. According to some sexual psychologists, classifications of this nature are inappropriate. Since many engage in self-sexual, homosexual and heterosexual practices at different stages of life, these different views have transpired over time. Considering the small percentage of the population who are homosexual, some human rights activists believe that homosexuals should not be discriminated against. In addition to unsafe sexual behaviour by MSM, a majority engage in bisexual practices as well. This behaviour enhances the risks of HIV infection. By convicting homosexuals before law, the risk for infection may intensify further. In the absence of opportunity for heterosexual relationships or safe sex within prisons, homosexual connections are the only option available. Unsafe anal intercourse which is a main source of homosexual satisfaction, escalates the risk of HIV infection.

Therefore, in controlling HIV infection, showing homosexuals the way for safe sexual practices is of prime importance.

Since the law along cannot achieve this, there are educational interventions and programs to facilitate homosexuals to practise safe sex being implemented internationally.

It is a bounden duty of social activists who are concerned about health and social progress to introduce new processes and alternatives for the welfare of homosexuals.

These activities necessitate to be logical and realistic.

Identification of methodologies to control HIV/AIDS and making suggestions on alternatives is a responsibility not only of health authorities but of the society in its entirety also. In our interventions to control HIV/AIDS, there is another section of the population whom we cannot leave disregarded since they are subjected to social discrimination.

Known as ‘transgender’ individuals, they manifest physical features of one sex but their mental tendencies are focused on the opposite sex. For example, one with a male body, will reflect female behaviour.

Their sexual behaviour also is moulded accordingly. These individuals cannot be accused for their behavioural propensities. The challenge in controlling HIV/AIDS lies in making behaviour of this group and any similar ones safe too.

Support

Reasonable societal support is needed to manage these situations effectively in controlling HIV/AIDS. Therein, certain attitudes established in society pose barriers. Attempts to dispel these barriers through intellectual dialogue offer immense support to the control HIV/AIDS.

National HIV/AIDS Policy mentions as follows about the development of safe and responsible behaviour:-

Sri Lanka has recognised the importance of HIV/AIDS prevention through promoting behaviour that is responsible to self, family and the society.

The necessities of the groups specifically at risk should be addressed through planned interventions of behaviour change communication. Promotion of responsible safe sex practices such as abstinence from sex, postponement of sex and use of devices for safe sex among youth in particular and general population in general should be established. Condom use should be promoted among vulnerable groups.

Empowerment of women and responsibility of men in promoting good behaviour is emphasised here.

Minimising of HIV/AID related discrimination would result in generating an increased interest to seek for services for prevention.

The article is based on an interview with Sirimal Peiris on behalf of the People's Health Movement, Sri Lanka

Motivation improves when working out with someone better

The key to motivation in physical activity may be feeling inadequate.

One researcher found that those who exercised with a team-mate whom they perceived to be better increased their workout time and intensity by as much as 200 percent.

The study tested whether individuals engage in more intense physical activity when alone, with a virtual partner or competing against a teammate.

“People like to exercise with others and make it a social activity,” principal investigator Brandon Irwin said. “We found that when you're performing with someone who you perceive as a little better than you, you tend to give more effort than you normally would alone.”

For the first part of the study, college-age females exercise on a stationary bike six sessions in a four-week period. They told participants to ride the bike as long as they could. On average, each participant rode for 10 minutes.

Next, the same group of participants returned to the lab for more exercise sessions, but was told they were working out with a partner in another lab whom they could see on a screen. In reality, this was only a looped video. Participants also were told that their virtual partner was part of the first study and had ridden the bike approximately 40 percent longer than them.

“We created the impression that the virtual partner was a little better than the participant,” Irwin said. “That's all they knew about their partner. In this group, participants rode an average of nine minutes longer than simply exercising alone.”

While this 90 percent increase was promising, Irwin said he and his team had a hunch that the motivation could go even further. The participants were invited back to the lab for more exercise sessions with a virtual partner. This time, though, they were told they were on a team with their partner.

“We told them they were working together to achieve a team score,” Irwin said. “The team score was the time of the person who quits first. The participants believed that in the previous trial, they didn't exercise as long as the other person. We created a situation where the participant was the weak link.”

Participants in this team trial exercised approximately two minutes longer than simply working out alongside someone. However, Irwin added that the results look different over time.

“This was an average, but over time the difference got much bigger,”

he said. “In the beginning, the participants were exercising about a minute longer than the partner group. By the last session, participants in the team group were exercising almost 160 percent longer than those in the partner group, and nearly 200 percent longer than those exercising as individuals.”

Irwin said this might be because those who believed they were exercising with a partner built a rapport over time and didn't want to let the partner down.

 - MNT

How to remember a person's face

They say that the eyes are the windows to the soul. However, to get a real idea of what a person is up to, according to researchers Miguel Eckstein and Matt Peterson, the best place to check is right below the eyes. Their findings are published in the Proceedings of the National Academy of Sciences.

“It's pretty fast, it's effortless - we're not really aware of what we're doing,” said Miguel Eckstein, professor of psychology in the Department of Psychological and Brain Sciences. Using an eye tracker and more than 100 photos of faces and participants, Eckstein and graduate research assistant Peterson followed the gaze of the experiment's participants to determine where they look in the first crucial moment of identifying a person's identity, gender, and emotional state.

“For the majority of people, the first place we look at is somewhere in the middle, just below the eyes,” Eckstein said. One possible reason could be that we are trained from youth to look there, because it's polite in some cultures. Or, because it allows us to figure out where the person's attention is focused.

However, Peterson and Eckstein hypothesise that, despite the ever-so-brief - 250 millisecond - glance, the relatively featureless point of focus, and the fact that we're usually unaware that we're doing it, the brain is actually using sophisticated computations to plan an eye movement that ensures the highest accuracy in tasks that are evolutionarily important in determining flight, fight, or love at first sight.

“When you look at a scene, or at a person's face, you're not just using information right in front of you,” said Peterson.

The place where one's glance is aimed is the place that corresponds to the highest resolution in the eye - the fovea, a slight depression in the retina at the back of the eye - while regions surrounding the foveal area - the periphery - allow access to less spatial detail.

However, according to Peterson, at a conversational distance, faces tend to span a larger area of the visual field. There is information to be gleaned, not just from the face's eyes, but also from features like the nose or the mouth. But when participants were directed to try to determine the identity, gender, and emotion of people in the photos by looking elsewhere - the forehead, the mouth, for instance – they did not perform as well as they would have by looking close to the eyes.

Using a sophisticated algorithm, which mimics the varying spatial detail of human processing across the visual field and integrates all information to make decisions, allowed Peterson and Eckstein to predict what would be the best place within the faces to look for each of these perceptual tasks.

- MNT

Gastric bypass surgery helps diabetes but doesn't cure it

After gastric bypass surgery, diabetes goes away for some people - often even before they lose much weight. So does that mean gastric surgery “cures” diabetes? Not necessarily, according to the largest community-based study of long-term diabetes outcomes after bariatric surgery. For most people in the study, e-published in advance of print in Obesity Surgery, diabetes either never remitted after gastric surgery or relapsed within five years.

Among the two-thirds of the study's patients whose diabetes at first went away, more than a third re-developed diabetes again within five years after gastric surgery. After adding in the one quarter of patients whose diabetes never remitted after surgery, most (56 percent) of the study's patients had no long-lasting remission of their diabetes following gastric surgery. However, when diabetes did go away, the research team extrapolated, it stayed away for a median of eight years.

Which kinds of obese people with type 2 diabetes are likely to get the most benefit from gastric surgery? “Our results suggest that, after gastric surgery, diabetes stays away for longer in those people whose diabetes was less severe and at an earlier stage at the time of surgery,” said principal investigator David E. Arterburn, a general internist and associate investigator at Group Health Research Institute. “Gastric surgery isn't for everyone,” he said. “But this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn't seem to be a cure for most patients.”

The multi-site study tracked 4,434 adults at Kaiser Permanente Northern California, Kaiser Permanente Southern California, and HealthPartners for 14 years: from 1995 to 2008. The research arms of all three of these integrated health care delivery systems - and Group Health Research Institute, where the study's results were analysed - belong to the HMO Research Network. The patients had type 2 diabetes that was either controlled with medication or else uncontrolled, and they were also obese enough to be candidates for gastric bypass surgery.

“Diabetes is an increasingly common disease that tends to keep getting worse relentlessly,” Dr. Arterburn said. More than 25 million American adults have diabetes - and as populations age and keep gaining weight, 50 million are predicted to have it by 2050. Already, diabetes accounts for 5 percent of all U.S. health care spending. And it raises the risk of blindness, kidney disease, heart attacks, strokes, and deaths.

“Prevention is by far the best medicine for diabetes,” Dr. Arterburn said. “Once you have diabetes, it's really hard to get rid of.

Attempts to treat it with intensive lifestyle changes and medical management have been disappointing.” For instance, the National Institutes of Health recently halted the Look AHEAD study of intensive lifestyle changes for people with diabetes. Despite improvements in risk factors like body weight, fitness, and blood pressure, sugar, and lipids, that study showed lifestyle changes did not lower the outcomes that matter most: heart attacks, strokes, and deaths.

“No wonder so many were excited to learn that diabetes can remit after gastric surgery - even, in some cases, before any significant weight loss - and many were hoping that gastric surgery might be a ‘cure’ for diabetes,” Dr. Arterburn said. “Our study is the first major evidence that diabetes often recurs after gastric bypass surgery.”

Still, he added, even after diabetes comes back, having had a long period of post-surgery remission is likely to have many positive effects, such as fewer complications of diabetes: less damage to eyes and kidneys, and fewer heart attacks, strokes, and deaths. The researchers are now funded by the National Institutes of Health to study that possibility in this same population. Dr. Arterburn is also leading a randomised controlled pilot trial of intensive behavioural treatment vs. gastric surgery at Group Health with colleagues from the University of Washington.

It's still not clear whether diabetes relapse happens because of gaining weight back or because of underlying the progression of diabetes.

But patients’ weight - before and after surgery - was not strongly correlated with remission or relapse of diabetes in this population.

- NYT