• Suspicious Prescriptions for HIV Drugs Abound in Medicare The inspector general of the U.S. Department of Health and Human Services finds Medicare spent tens of millions of dollars in 2012 for HIV drugs there’s little evidence patients needed. A 77-year-old woman with no record of HIV got $33,500 of medication.


    Medicare spent more than $30 million in 2012 on questionable HIV medication costs, the inspector general of the U.S. Department of Health and Human Services said in a report set for release Wednesday.
    The report offers a litany of possible fraud schemes, all paid for by Medicare's prescription drug program known as Part D.
    Among the most egregious:
    In Detroit, a 77-year-old woman purportedly filled $33,500 worth of prescriptions for 10 different HIV medications. But there's no record she had HIV or that she had visited the doctors who wrote the scripts.
    A 48-year-old in Miami went to 28 different pharmacies to pick up HIV drugs worth nearly $200,000, almost 10 times what average patients get in a year. The prescriptions were supposedly written by 16 health providers, an unusually high number.
    And on a single day, a third patient received $17,500 of HIV drugs — and none the rest of the year. She got more than twice the recommended dose of five HIV drug ingredients.
    The inspector general's report raise new questions about Medicare's stewardship of Part D. A ProPublica series last year showed that Medicare's lax oversight has enabled doctors to prescribe massive quantities of inappropriate medications, has wasted billions on needlessly expensive drugs, and exposed the program to rampant fraud. Part D cost taxpayers about $65 billion in 2013.
    Previous inspector general reports have criticized the way Medicare oversees doctors and pharmacies, but this one focuses on patients, who are not usually the focus of inquiries into fraud and abuse.
    The inspector general flagged 1,578 Medicare beneficiaries who received HIV medications worth $32 million in 2012. (This figure does not include beneficiaries who, based on their records, appeared to be taking the drug Truvada for HIV prevention.)
    More than half the patients identified by the inspector general had no diagnosis of HIV, had no records of laboratory tests to monitor the use of the drugs, and had not received any medical services from any of the prescribers.
    Two pharmacies, both in Miami, dispensed drugs to 321 of these beneficiaries. Most of them were women with an average age of 74, two decades older than the typical patient who received HIV drugs in Medicare. These two pharmacies collected more than $350,000 for the drugs, the inspector general reported.
    "While some of this utilization may be legitimate, all of these patterns warrant further scrutiny," the report says. "These patterns may indicate that a beneficiary is receiving inappropriate drugs and diverting them for sale on the black market. They may also indicate that a pharmacy is billing for drugs that a beneficiary never received or that a beneficiary's identification number was stolen."
    The inspector general's analysis did not say if beneficiaries were complicit in the questionable activity or if their IDs had been used without their knowledge or permission.
    Medicare places a premium on getting patients their medications in a timely way, particularly for conditions such as HIV.
    HIV drugs pose a thorny problem for Medicare. Under the program's rules, the drugs are a "protected class." Insurance companies paid to administer Part D for the government must cover them without exception and cannot require prior approval for patients. Insurers are freer, however, to manage other drugs and can impose restrictions to control spending, prevent overuse and spot fraud.
    The unscrupulous have tried to exploit the special status of HIV drugs, leading to a number of recent prosecutions against pharmacy owners and others. Sometimes pharmacies bill for the drugs, do not dispense them, and then bill Medicare or private insurers for them again. Beneficiaries may be misusing the HIV drugs, too; the inspector general noted that some medications have psychoactive effects or enhance the effects of painkillers.
    The amount of suspicious activity involving HIV drugs is small relative to the overall usage of such medications. Medicare paid $2.8 billion to supply HIV drugs to 135,500 beneficiaries in 2012.
    In addition to patients receiving HIV drugs without a history of HIV, other areas of possible fraud include patients receiving excessive doses of HIV drugs; patients receiving an excessive supply of an HIV drug; patients whose prescriptions were filled by a high number of pharmacies; patients receiving prescriptions from multiple prescribers; and patients taking HIV drugs that are not supposed to be taken together.
    Fully 38 percent of beneficiaries with questionable utilization patterns lived in Miami or New York, a rate three times higher than the percent of patients receiving HIV drugs who live in those cities.
    One 37-year-old in Miami received $146,160 in HIV drugs in 2012. He received 16 different HIV medications in a single month. "Several times during the year, he received these drugs from two different pharmacies on the same day," the report says.
    The inspector general recommended that the Centers for Medicare and Medicaid Services take steps to rein in fraud and abuse of HIV drugs, including using prescription data to look for aberrant behavior among beneficiaries. The report says health plans should be required to conduct reviews looking for unusual patterns of HIV medication use. It also encourages Medicare to expand the ability of health insurers to put controls in place and restrict certain beneficiaries to a limited number of pharmacies or prescribers.
    CMS generally agreed with the recommendations and said it would be open to Congress taking steps to limit the number of pharmacies or prescribers for beneficiaries who appear to be abusing drugs or engaging in fraud.
    To check how your doctor prescribes drugs in the Medicare program and compares to peers, check outProPublica's Prescriber Checkup tool.
    ABOUT THE AUTHOR

    Charles Ornstein is a senior reporter for ProPublica covering health care and the pharmaceutical industry.
    Credit: HIV

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  • Report: Children of LGB Parents Functioning 'Quite Well' The study also shows a high proportion of bisexual adults are parents.

    Another study released this summer shows that lesbian, gay, and bisexual parents are as effective and nurturing as heterosexual parents, if not more so.
    The July report by the University of California, Los Angeles, School of Law's Williams Institute indicatesthat LGB families deal with extra pressures such as heterosexism in various societal settings, added legal implications in states that don’t allow same-sex marriage or adoption, and discrimination in medical settings. Despite these pressures, however, LGB families continue to prosper.
    “The findings are consistent in suggesting that despite confronting heterosexism in a variety of social contexts — including the health care system, the legal system, and the school system — LGB parents and their children are functioning quite well,” the report's authors write. 
    The study mirrors others that cite the benefits of LGB-headed families, including one released in early July from the University of Melbourne, which said children raised by same-sex couples are healthier and happier than those raised by opposite-sex pairs.
    The report also points to the large portion of LGB parents — 64 percent — who are openly bisexual. The Williams Institute cited a 2013 Pew Research survey, which found that more than a third of all LGBT individuals report being a parent. An estimated 59 percent of bisexual women and 32 percent of bisexual men report having had children, while 31 percent of lesbians and 16 percent of gay men are parents.
    Although many LGB parents are bisexual, most of the research on LGB parenting has been has been limited to specific gender, racial, and economic demographics.
    “The research on LGB parenting is characterized by a variety of sampling- and methodological-related problems,” the authors of the Williams Institute report wrote. “The samples that are utilized in studies of LGB parents tend to be small, white, well-educated, and financially stable, and are often drawn from metropolitan areas.”
    Credit: Children

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  • STUDY: Tivicay Surpresses HIV Even in Those Who are Drug Resistant The recently approved HIV integrase inhibitor showed a high rate of suppressing the virus, even among those who are drug-resistant.


    Tivicay, the recently approved HIV integrase inhibitor — a class of antiretroviral drug that is designed to block a virus from entering the DNA of a host cell — demonstrated high rates of viral suppression in a recent study. Significantly, Tivicay is also proven effective for people who are resistant to HIV antiretroviral drugs, according toNAM.
    The study concluded that among people starting treatment for the first time, there was no resistance detected during the 96 weeks of follow up, according to findings presented at the recent 20th International AIDS Conference in Melbourne, Australia.
    Modern antiretroviral treatments are highly effectively and are well-tolerated. However some people who have resistance to the existing drugs or may have difficulty tolerating specific side-effects.
    Jim Demarest of ViiV Healthcare lead a team that analyzed the outcomes among participants that were part of phase three trials with Tivicay. Three studies followed people who had not previously taken any HIV medications, while one trial focused on those who have received treatment before and had experienced resistance to two or more drug classes.
    In the studies that followed treatment-experienced participants, 71 percent of participants that took Tivicay saw viral suppression at 48 weeks, compared to the 64 percent of those who took Isentress, another drug used to treat HIV.
    Regulators in the U.S. are currently evaluating a fixed-dose medication containing Tivicay and Kivexa or Epzicom. If the drug is approved, it will be the first one-pill, once-daily regimen that does not contain tenofovir DF (brand name, Viread), which some people with HIV have avoided because of its risk of kidney and bone toxicity. This combination has already received approval by the European Medicines Agency and will be marketed as Triumeq in Europe.

     Credit: STUDY

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  • 7th Sexuality Institute The 7th CSBR Sexuality Institute will be on December 2-8, 2014 in Tunisia.

    What is the Sexuality Institute?

    Designed as a comprehensive curriculum on sexuality, sexual and reproductive health and rights with an in-depth discussion on the linkages between research and practice, the CSBR Sexuality Institute offers a holistic interdisciplinary program combining history, theory, research and politics of sexuality with applications of advocacy and fieldwork.
    The CSBR Sexuality Institute brings together leading sexual and reproductive rights activists, academics and researchers. Held previously in Turkey (2009), Indonesia (2010), Malaysia (2008-2011), Egypt (2012) and Nepal (2013) with participants from 23 countries throughout Asia, Africa and the Middle East, the institutes include lectures, group work, round-tables, panels, site visits and film screenings, as well as a methodology to engage participants’ own experiences around sexuality.
    The realization of sexual and reproductive health and rights is an integral part of gender equality, development and social justice. However, sexuality continues to be a contested site of political struggles both in Muslim societies and across the globe. Increasing global militarism, conservatism, and nationalism over the last decades provoked a serious backlash on sexual and reproductive health and rights, both at national and global levels. Given the current polarizations, it is more pertinent than ever to strengthen critical insight, further research, enhance knowledge and capacity on sexual and reproductive health and rights, and build an inclusive and affirmative discourse on sexuality.
    In the above mentioned context, the aims of the CSBR Sexuality Institute are:
    • To further knowledge on the multi-dimensional and intersecting aspects of sexuality, health and rights;
    • To develop a deeper theoretical understanding of sexuality through a historical overview and analysis of current debates and research at the global level;
    • To provide a comprehensive and holistic understanding of sexuality in Muslim societies through a discussion of the history, legal frameworks, research, and current discourses;
    • To enhance participants’ sexual and reproductive health and rights advocacy skills on national and international levels;
    • To increase participants’ capacity as leading advocates, practitioners and researchers on sexuality issues at national, regional and international levels.

    What is CSBR?

    Founded in 2001, the Coalition for Sexual and Bodily Rights in Muslim Societies (CSBR) is an international solidarity network of organizations, and academic institutions working to promote sexual and reproductive health and rights as human rights in Muslim Societies. CSBR includes institutional members from Algeria, Bangladesh, Egypt, Indonesia, Jordan, Lebanon, Malaysia, Morocco, Pakistan, Palestine, the Philippines, the Sudan, Tunisia, Turkey, and Yemen.
    Until 2011, Women for Women’s Human Rights (WWHR) – New Ways, co-founder of the Coalition, acted as the international coordination office of CSBR. A decade after its inception, the coalition appointed CSBR member and Beirut-based feminist collective Nasawiya as the new international coordinating office.
    As the only international network working on sexual and bodily rights in Muslim societies, CSBR has played a pivotal role in terms of advocacy, activism and research on sexual and bodily health and rights in the Middle East, North Africa, South Asia and Southeast Asia. CSBR has succeeded in creating an alternative discourse and progressive spaces around sexuality and sexual rights in Muslim societies.

    Who Can Participate?

    The Institute will be limited to 20 participants, as it is designed as an intensive six-day participatory group training. Applications will be reviewed by the CSBR Training Committee.
    The language of the Institute will be English.
    Travel and accommodation costs for participants from the South will be covered by the Institute. All participants from the North are required to pay for full tuition and travel costs.
    Tuition costs for all participants are 100 USD.
    Eligible applicants for the Institute must:
    • Have a minimum of 2 years experience working in the field of sexual and reproductive health and rights;
    • Have a commitment to undertake efforts to promote sexual and bodily health and rights at national and international levels;
    • Represent an organization/institution engaged in sexual and reproductive health and rights advocacy, research or fieldwork;
    • Be fluent in English.

    Training Committee

    The Institute faculty consists of internationally renowned experts in the field of sexuality. Issues addressed will include a conceptual and historical framework of sexuality; contemporary discourses and debates around sexuality, sexual and reproductive rights; sexuality in Muslim societies; sexual diversities; sexuality and human rights; sexuality education; sexual and reproductive health; HIV/AIDS; youth sexuality; national and international advocacy on sexual and reproductive health and rights. The Institute will also incorporate sessions focused on application and experience-sharing including round-tables featuring participants’ work on sexuality; as well as a panel with activists based in Tunisia.

    Participant Testimonials

    “I would summarize the experience I had at the CSBR Institute in one word – that is: LIBERATING. The novelty of this [CSBR’s] discourse in our socio-cultural context is certainly one important aspect, but more importantly, the silence that our society harbors around sexuality has become so “normal” that we often forget how integral it is to our existence and well-being.” (Mahrukh Mouhiddin, BRAC University – Bangladesh, CSBR Sexuality Institute 2008).
    “In one sentence; the Institute has shown me that sexuality is not only about problems, ill-being and repercussion; it is also about pleasure, happiness, well being and CHANGE” (Gulalai Ismail, Aware Girls – Pakistan, CSBR Sexuality Institute 2009).
    “The Institute provided us with a very holistic picture about the issues around sexuality. The sessions were interconnected and helped me integrate feminist perspective into the sexual health perspective. The Institute gave me very important tools to deal with the issues in my own country, and empowered me to talk about the real issues of the society from the perspective of sexuality, sexual health and rights.” (Dr. Muhammed Aslam Bajwa, Organization for Participatory Development – Pakistan, CSBR Sexuality Institute 2010).
    “In face of the rise of the so called fundamentalism or hard line Islamic revivalism, the Institute gave me the basic paradigm to see and analyze how we take position in order to challange the repression.” (Dwi Ayu, Komnas Perempuan – Indonesia, CSBR Sexuality Institute 2008).
    “I have never been to anything this exhaustive and detailed. It shed light on the intersections between religion, sexuality, health, the terminology and bodily rights. I learned more about the international arena and how to use it to advance your case. It was very instrumental for me both at the personal and professional level, basically shaping the way I will address my work.” (Joelle, MEEM – Lebanon, CSBR Sexuality Institute 2009).
    Credit: CSBR

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  • New Regulation Further Restricts Legal Abortions

    Jakarta. Experts have lashed out a new government regulation that they warn will severely restrict one of the few circumstances in which a woman can legally get an abortion in Indonesia.

    The regulation on reproductive health, signed with little media attention last Friday by President Susilo Bambang Yudhoyono, stipulates that women who get pregnant as a result of rape may apply for a legal abortion, but only within 40 days of their last period.

    An existing article in the 2009 Health Law, however, places no such restriction on when a rape victim may get an abortion.

    The new rule, critics say, will give rape victims virtually no time to make a clear and informed decision about whether they want to abort the fetus.

    “There shouldn’t be this 40-day restriction,” Masruchah, a member of the National Commission on Violence Against Women, or Komnas HAM, told the Jakarta Globe on Tuesday.

    “Rape victims in rural areas, for instance, often never find out that they’re pregnant” until two or three months later, she added.

    Suryono Slamet Iman Santoso, a gynecologist at Jakarta’s Abdi Waluyo Hospital and former reproductive health lecturer at the University of Indonesia, notes that most women don’t even think about testing for pregnancy until after 40 days from their last period.

    “That’s when their expected period is typically about two weeks late. So it’s only after 40 days that you can make a reasonably accurate determination of whether a woman is pregnant or not,” he told the Globe.

    “I believe there shouldn’t be this restriction. It will be hard to implement,” he added.

    The new regulation also fleshes out the process for determining what constitutes a life-threatening health condition for the mother or fetus, which is another circumstance in which a woman may get an abortion — but restricts this too by requiring that the woman obtain approval from her husband.

    No such condition is listed in the 2009 Health Law.

    Government officials, however, are crowing over what they call a progressive regulation, saying that it places women’s health at the fore.

    “It takes into consideration every aspect of the health, safety and comfort of the woman, her family and the fetus,” Anung Sugihantono, the Health Ministry’s director general for maternal and child health, said in Jakarta on Tuesday.

    “It should also be understood that this regulation does not legalize abortion,” he added.

    The government regulation will be shored up with a Health Ministry regulation that details the processes and mechanisms for a legal abortion, Anung said.

    Credit: Legal abortions

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  • Exclusive: 9 Former Ex-Gay Leaders Join Movement To Ban Gay Conversion Therapy “We all got together and said it’s time to produce a statement that is not a statement of apology, but a statement on our beliefs on how conversion therapy harms people.”


    Michael Bussee
    John Smid

    As advocates mount a national campaign against the practice, several former leaders of the ex-gay conversion therapy movement are now coming out in opposition to conversion therapy, or efforts to turn gay people straight, BuzzFeed has learned.
    Nine former ex-gay leaders, from organizations like Exodus International and ministries like Love in Action, have signed onto a letter in partnership with the National Center for Lesbian Rights calling for a ban on gay conversion therapy and saying that LGBT people should be celebrated and embraced for who they are.
    “At one time, we were not only deeply involved in these ‘ex-gay’ programs, we were the founders, the leaders, and the promoters,” they said in the letter. “Together we represent more than half a century of experience, so few people are more knowledgeable about the ineffectiveness and harm of conversion therapy. We know first-hand the terrible emotional and spiritual damage it can cause, especially for LGBT youth.”
    The former ex-gay leaders, many of whom worked at organizations involved in the practice for several years, say they “know better now.” And many of the organizations they were involved in have shuttered or rebranded, like Exodus International, which very publicly announced it would shut down last summer. But gay conversion therapy is still practiced in many parts of the country, according to the NCLR.
    Many of the signatories on the letter have previously spoken out against — and in some cases apologized for — supporting and advocating for gay conversion therapy. But for some included, it’s the most public statement they’ve made since renouncing the practice, like John Smid, who was a member of Exodus International and who served on its board for 11 years.
    “We all got together and said it’s time to produce a statement that is not a statement of apology, but a statement on our beliefs on how conversion therapy harms people,” Smid told BuzzFeed. “We felt like we needed to make that statement.”
    Smid said he experienced the harms of gay conversion or reparative therapy firsthand — enduring what he described as the damaging message that gay people are somehow “broken and sick and that they need to be repaired,” he said. Leading medical and psychological associations, such as the American Psychological Association, have discredited and criticized gay conversion therapy.
    “In my own life, that message kept me trapped in a cycle of believing that I was emotionally ill and incapable of having a healthy life until those things are fixed,” he said. “For over two decades, I lived in that mind-set. That’s why reparative therapy is so damaging. That was the message that I received and that I taught in my involvement with Exodus and Love in Action.”
    On Monday, Yvette Cantu Schneider announced via GLAAD that she is sorry for her work in the ex-gay and conversion therapy movement, “and is now fully supportive of LGBT people.” She, too, has signed on to the letter in support of banning gay conversion therapy efforts.
    The former ex-gay leaders coming forward to unite in opposition the practice comes as LGBT advocates such as those at NCLR and other organizations are pushing for a movement against gay conversion therapy, including in state legislatures. Just this month, Michigan state Rep. Adam Zemke (D-Ann Arbor) introduced a bill that would ban conversion therapy for minors.
    “This is about the civil rights of children,” Zemke told BuzzFeed. “A lot of children look up to adults and follow their advice blindly and innocently. They’re kids — they don’t know any better in some cases. As lawmakers, we have the responsibility to protect those kids from things proven to be harmful and this is no different. This is protecting the right for kids to be kids, whoever they are.”
    Zemke said he is seeking support from lawmakers in the chamber, particularly among members of the Republican majority, to whom he points out that GOP New Jersey Gov. Chris Christie signed similar legislation into law just last year. Action or progress on the bill, though, likely won’t happen until later this fall, Zemke said.
    However, recent efforts to ban gay conversion therapy for minors in some states have fallen short. Last month, GOP leadership in the New York State Senateblocked such legislation and in April, a similar bill was defeated on the floor of the Illinois House.
    Either way, advocates and other critics of gay conversion therapy, hope to expand the debate over the practice coast to coast. The letter from the former leaders comes as part of NCLR ramping up its #BornPerfect campaign, which it launched last month.
    “We are committed to protecting LGBT children and their families from the severe harms caused by these dangerous practices,” NCLR Executive Director Kate Kendell said in a statement. “These practices have been thoroughly discredited by every major mental health organization, and yet, every day, young lives are wrecked. We intend to stop the practices once and for all.”

    Read the full letter:


    Former Ex-Gay Leaders Unite in Opposition to Conversion Therapy
    Conversion therapy, also known as “reparative therapy”, “ex-gay therapy,” or “sexual orientation change efforts” (SOCE), professes to help lesbian, gay, bisexual, and transgender people to change or overcome their sexual orientation or gender identity. The majority of those who practice this “therapy” often do so with little or no formal psychological training, operating instead from a strict religious perspective, believing homosexuality to be a “sin.”
    At one time, we were not only deeply involved in these “ex-gay” programs, we were the founders, the leaders, and the promoters. Together we represent more than half a century of experience, so few people are more knowledgeable about the ineffectiveness and harm of conversion therapy. We know first-hand the terrible emotional and spiritual damage it can cause, especially for LGBT youth.
    We once believed that there was something morally wrong and psychologically “broken” about being LGBT. We know better now. We once believed that sexual orientation or gender identity were somehow chosen or could be changed. We know better now. We once thought it was impossible to embrace our sexual orientation or sexual identity as an intrinsic, healthy part of who we are and who we were created to be. We know better now.
    Looking back, we were just believing (and sometimes teaching) what we had been taught— that our identity needed mending. We grew up being told that being LGBT was disordered, sick, mentally ill, sinful, and displeasing to God. We grew up being told that loving, same-sex relationships were shallow, lust-driven, deceived, disordered, and impossible.
    We grew up with the repetitive message that LGBT people were not enough — not straight enough, not Christian enough, not manly or womanly enough, not faithful enough, not praying enough. Never, ever enough. “Toxic” probably sums it up best. That message is poison to the soul. Especially a child’s soul.
    It can take a lifetime to get rid of that old programming and replace it with healthy, non-toxic views of yourself. Recovery from conversion therapy is difficult at best. Some remain forever scarred, emotionally and spiritually. Conversion therapy reinforces internalized homophobia, anxiety, guilt and depression. It leads to self-loathing and emotional and psychological harm when change doesn’t happen. Regrettably, too many will choose suicide as a result of their sense of failure.
    In light of this, we now stand united in our conviction that conversion therapy is not “therapy,” but is instead both ineffective and harmful. We align ourselves with every major mainstream professional medical and mental health organization in denouncing attempts to change sexual orientation or gender identity. We admonish parents to love and accept your LGBT children as they are. We beseech the church to accept, embrace, and affirm LGBT persons with full equality and inclusion.
    As former “ex-gay” leaders, having witnessed the incredible harm done to those who attempted to change their sexual orientation or gender identity, we join together in calling for a ban on conversion therapy. It is our firm belief that it is much more productive to support, counsel, and mentor LGBT individuals to embrace who they are in order to live happy, well- adjusted lives. We fully support the aim of #BornPerfect to bring an end to conversion therapy.
    Brad Allen
    Lay Leader Volunteer (2005–2007) 
    Church Network Coordinator (2007) 
    Exodus International Headquarters
    Darlene Bogle
    Founder, Director, Counselor (1985–1992) 
    Paraklete Ministries
    Michael Bussee
    EXIT (1974–1979) 
    Co-founder (1976–1979) 
    Exodus International
    Catherine Chapman
    Project Coordinator (2000–2003) 
    Women’s Ministry Director (2005–2007) 
    Portland Fellowship
    Jeremy Marks
    Founder (1988–2000) 
    Courage UK
    Exodus Europe (1988–1989)
    Bill Prickett
    Founder, Executive Director (1986–1988) 
    Coming Back
    Tim Rymel
    Outreach Director (1991–1996) 
    Love in Action
    Yvette Cantu Schneider
    Executive Director (2001–2005)
    Living in Victory Ministry
    Director of Women’s Ministry (2008–2011) 
    Exodus International
    John J Smid
    Executive Director (1987–2008)
    Love in Action
    Exodus International Board of Directors (1990–1995; 2002–2008)
    Credit: 9 Former ex Gay

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  • How many men are paedophiles?
    The Pope was recently reported to have said that about 2% of Catholic clergy are paedophiles. But how does this compare with society as a whole - is it more or less than average?

    As soon as you give this question a moment's thought, you realise that it's not going to be an easy one to answer. Paedophiles are not easy to identify.
    "Because paedophilia is so secretive and so few people are willing to admit it, there is no meaningful way to get a reliable estimate," says Dr James Cantor, a psychologist and sexual behaviour scientist at the University of Toronto.
    "There's no meaningfully ethical way of taking 200 men, hooking them up to detectors, showing them pictures of adults and children and seeing how many respond most to children."
    One person who has attempted an estimate is Dr Michael Seto, a clinical and forensic psychologist at the Royal Ottawa Healthcare group.
    In 2008 he wrote a book in which he put the prevalence of paedophilia in the general population at 5%.
    The figure was based on surveys conducted in Germany, Norway and Finland in which men were asked whether they had ever had sexual thoughts or fantasies about children or engaged in sexual activity with children.
    But Seto stresses that 5% was an upper estimate, and that the studies were limited in what they revealed.
    "What those surveys don't include are questions on the intensity of those thoughts and fantasies, whether they were repeated or not. Someone might say 'Yes' because they once had a fantasy but our understanding of paedophilia would be that that person recurringly had sexual thoughts and fantasies about children."
    Now, with more data and better methodology, he has revised his figure down to about 1% of the population, though he makes clear this is still only an educated guess.
    One problem is that the term "paedophile" means different things to different people.
    "It's very common for regular men to be attracted to 18-year-olds or 20-year-olds. It's not unusual for a typical 16-year-old to be attractive to many men and the younger we go the fewer and fewer men are attracted to that age group," says Cantor.
    He thinks that if we say that a paedophile is someone attracted to children aged 14 or less, then he estimates that you could reach the 2% figure.
    "If we use a very strict definition and say paedophilia refers only to the attraction to pre-pubescent children [then it] is probably much lower than 1%," he says.
    The term is often applied to a person who sexually abuses someone below the age of 16, but given that in some countries - and even some US states - you can marry below the age of 16 this definition would clearly not be universally accepted.
    There is consensus on the clinical definition. Michael Seto and his colleagues agree that a paedophile is someone who has a sexual interest in pre-pubescent children, so typically those under the ages of 11 or 12.
    But whether the prevalence using this definition is 0.5%, as James Cantor says or 1%, as Michael Seto says, you can be assured than in any large group of people - whether they be politicians, entertainers, or Catholic clergy - you are likely to find some paedophiles.
    Paedophilia is not restricted to men - some women also sexually abuse children, although research suggests this is much less common.
    But back to the Pope. How would he define "paedophile"? We don't know, but there is a clue.
    There is one well-known study of paedophilia among Catholic clergy, carried out by John Jay College of Criminal Justice in New York. Its researchers went to each diocese in the US and found all the plausible accounts of abuse involving clergy who served between 1950 and 2002 - and they found that 4.2% of had been plausibly accused of abuse.
    That included allegations of abuse of adolescents as well as pre-pubescent children.
    But if you use the stricter, clinical definition of paedophilia the figure drops to between 1-2% according to Prof Philip Jenkins from the Institute of Studies of Religion at Baylor University in Texas. This corresponds, more or less, with the figure attributed to the Pope.
    "If he was using a different word like 'abusive clergy' then I think he would be going for a higher figure," says Jenkins.
    The John Jay College study is not perfect, though. For some reason, 40% of the allegations referred to abuse said to have been carried out in a six-year period between 1975-1980.
    It seems unlikely that cases of paedophilia in the clergy would have been so heavily concentrated in one period. Furthermore, even if there was a peak in the 1970s, a lot of the perpetrators are probably no longer active in the church.
    All we can confidently say is that, firstly, the figures are imperfect - both for Catholic clergy and the general population. And secondly, that these imperfect figures are in the same ballpark.
    Credit: How many

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  • China activists fight gay 'conversion therapy'
    Gay rights activists in China are preparing for what they say could be a legal milestone in their fight to stop homosexuality being treated as an illness.

    Later this month, a Chinese court will hear the first case of its kind brought against a clinic that offers so-called "gay conversion therapy".
    A long campaign in Europe and America has been successful in shifting the medical consensus against such treatment, and now campaigners want Chinese doctors to follow suit.
    In an office block in the eastern city of Nanjing, down a gloomy corridor, I find the Nanjing Urban Psychiatric Consultancy Centre.
    It's a small office with a sparsely-furnished treatment room upstairs, from which - seemingly prompted by our arrival - a young male patient hurriedly leaves.

    China declassified homosexuality as a mental illness well over a decade ago, but clinics like this one are still easy to find.
    Dr Zhou Zhengyou shows me some of the books he's written on the subject over the course of his career.
    One of them is a guide for parents who suspect their son or daughter might be gay.
    The overriding message appears to be that it is their own parenting methods that are somehow to "blame".
    Dr Zhou now claims to cure up to 70% of his gay patients, although he says it is a long and difficult process.
    And, his critics point out, at $120 (£70) a session - a lot of money on an average Chinese wage - long and difficult can mean lucrative.
    Dr Zhou tells me that today he uses counselling alone and does not treat his patients with so-called aversion-therapy offered elsewhere in China. But he is happy to describe how it works.
    "One common method is electric shock. When the patient has a gay thought, we electrocute them or inject them with drugs that make them sick," he said.


    Legal challenge
    China's gay community has begun to fight back. They've organised a number of protests - small in number but nonetheless brave in China.
    Video footage of one demonstration shows activists holding up a protest banner at a Beijing medical conference. "Being gay is not an illness," it reads.
    The delegates do not seem convinced. "We cannot support homosexuality," a doctor said. "Although we try to understand it," his colleague adds.
    In addition to such direct action, the campaigners have been given another avenue to pursue.

    For the first time, China has allowed them to challenge gay conversion therapy in the courts.
    "I had electric shock therapy only once," the man bringing the case, who calls himself Xiao Zhen, told the BBC. "Imagine those who've had it many times."
    He put himself through the treatment in order to gather the evidence and he's now hoping that a successful court ruling in his favour will effectively ban the practice.
    It's a battle that has been fought elsewhere, of course.

    Aversion therapy has been the target of campaigners in Europe and America for decades and today, the notion of the gay conversion has not completely gone away.
    But the modern medical consensus in the West is that there's no good evidence that sexual orientation can be changed.
    Some people suggest that attitudes in China have been slower to evolve because of the one-child-policy as well as heavy Confucian pressure on young people to get married and produce a family heir.
    Attitudes in China, though, are changing fast - that Shanghai now holds an annual gay pride event is proof of that. It includes gay film screenings, discussion groups and a fun-run.
    Being China, participants are not allowed to march.
    Now the court case, it's hoped, will be another step forward, sending a message that the enduring medical prejudice needs to stop.
    Credit: China activists

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Agenda

7th Sexuality Institute, 2-8 December 2014, Tunisia

International AIDS Conference in Melbourne, Australia 20-25 July, 2014 Melbourne, Australia

6th Ewha Global Empowerment Program, 29 june - 13 july 2014 Seoul, Korea

Crea: Sexuality, Gender, and Right Institute, 21 - 29 June 2014 Istanbul, Turkey

World Conference on Youth 2014 6-10 May, 2014 Colombo, Sri Lanka

5th WLEC - Women's Leadership and Empowerment Conference 2014 1-3 March 2014, Bangkok, Thailand


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