2013-05-24T13:29:38-04:00 Claire Surrey http://www.huffingtonpost.com/author/index.php?author=claire-surrey Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Claire Surrey Good old fashioned elbow grease. tag:www.huffingtonpost.com,2013:/theblog//3.2753435 2013-02-25T19:00:00-05:00 2013-04-27T05:12:01-04:00

Claire Surrey http://www.huffingtonpost.com/claire-surrey/ sky-rocketed in the past decade from 3,644 in 2002 to 16,549 in 2011. More than 80% of British, Canadian and American adults between 50 and 90 are sexually active. With the risk of pregnancy sharply reduced in older women, the stakes of casual sex can appear lower despite an increased susceptibility of the immune system to infection.

"They just don't think it can happen to them", explains American clinical psychologist Judy Kuriansky. "[Sexually transmitted infections] really started making news in the '80s and '90s. The fears and the warnings didn't hit their generation." Is the rise in STIs among the over-fifties in the UK due to a generational gap, as Kuriansky suggests, or a shortcoming in health services?

It's arguably a bit of both. John O'Doherty, director of The Rainbow Project, a gay, lesbian and transgender rights organisation in Northern Ireland, believes that fear of stigmatisation has led to high numbers of undiagnosed HIV cases among older men. One in five new HIV cases in Northern Ireland are in men over the age of 45. O'Doherty frames the issue as both cultural and generational, especially when concerning older men who have sex with men. "We're dealing with a community which spent a large part of their adult years being a criminal based on their sexual orientation", he observes. "The new freedom and openness and visibility of our community has provided a lot more opportunities for relationships and to meet new people, so it does put them at increased risk".

The availability and quality of services can also impact the sexual health of the over-fifties. Left untreated, STIs such as genital herpes and syphilis can increase the risk of HIV transmission. Early diagnosis and antiretroviral therapy can dramatically improve and extend the lives of people with HIV. Older patients and doctors often mistake the symptoms of HIV for other conditions associated with ageing, such as weight loss and fatigue. 2011 data from the UK Health Protection Agency reveals that a higher proportion of adults over 50 (61%) are diagnosed later compared with younger adults (45%).

Doctors at the Royal Victoria Hospital in Belfast are addressing the problem among older men who have sex with men by running monthly outreach clinics in gay venues. "Some people find it a step too far to come to a [sexual health] clinic and some people really regard confidentiality as the holy grail", says Dr. Carol Emerson, a sexual health consultant at Royal Victoria. "[B]ringing the clinic out has increased testing, increased knowledge and increased diagnoses."

Confidential and convenient at-home testing could be instrumental in diagnosing HIV and STIs among the over-fifties, particularly older men who have sex with men. In December, the UK Department of Health announced plans to review its ban on HIV home testing kits. A 2011 survey by the UK charity Terrence Higgins Trust found that almost two-thirds of people would consider using HIV home testing kits if they were regulated and available. Of the 490 respondents that had not been diagnosed with HIV, 51% believed that home kits would motivate them to get screened more frequently.

The service delivery framework for home testing already exists within the NHS' National Chlamydia Screening Programme, which provides free testing kits via post to young adults under 25. Extending home-based STI screening programmes to the general population could help redress the gap in testing and treatment among the over-fifties and marginalised groups.

Along with screening, awareness and prevention strategies targeting the over-fifties should be scaled up. "Free condoms and sexual health leaflets would be a really helpful part of any service for older people", says Steve Myers, Director of Social Work at University of Salford. "Websites would also be helpful - there are an awful lot of silver surfers out there. It's empowering for people to access information themselves."

In 2010, the Family Planning Association launched The Middle-age Spread, a poster campaign featuring fashion clips from the 1970s alongside condoms. "Remember wearing this?" the ads ask, referring to the leisure suits and bell-bottoms. Below the text is an image of a condom: "Then remember to wear this!"

A recent survey by Age UK points to the importance of outreach through informational sessions in clinics and care homes. The charity's online poll of over 2,000 people found that 69% of respondents over 65 had never sought sexual health advice. Health providers and social workers should take the first step in ensuring informed sexual decision making among the elderly. "Social workers need to talk to everyone about these issues - it's about acknowledging that it's an important part of people's self-image and well-being", argues Myers.

"People don't like to think about older people being sexual beings but it's self-fulfilling - if we don't talk about it then it will remain hidden."]]> tag:www.huffingtonpost.com,2013:/theblog//3.2451167 2013-01-13T17:13:09-05:00 2013-03-15T05:12:01-04:00

Claire Surrey http://www.huffingtonpost.com/claire-surrey/
Tim Hentzner, president of Lutheran Church Charities (LCC), uses the term "furry counsellors" to describe the comfort dogs his organisation provides. LCC launched K-9 Parish Comfort Dogs in 2008, after observing the vital role that pets played in areas affected by Hurricane Katrina. "[Pets] are safe. They show unconditional love. And dogs have a unique ability to sense hurt in people," Hentzer explains.

In Connecticut, parents of Sandy Hook students told LCC volunteers that their children had initially been reluctant to return to school after the tragedy. "[T]hey changed their minds when they found out the dogs would be there for them," LCC member Deb Kinne told reporters. "The dogs just created a bridge of sorts to help bring people back from a dark period...into a place where they can begin the healing process."

Founded in 1983, Pets As Therapy (PAT) is a community-led charity that certifies and places pets and volunteers in hospitals, care homes and schools across the United Kingdom. "The act of stroking a dog reduces both blood pressure and stress levels and brings a little bit of comfort and normality to a life which might be spent mainly in a hospital or hospice," Maureen Hennis, chief executive of PAT, explains. "We've had a wonderful response from healthcare professionals, especially when we work with people who are clinically depressed."

In a controversial move last year, the U.S. Veterans Association pulled funding for mental health service dogs, citing health and safety concerns and inconclusive evidence of the benefits. "I understand the need for further published scientific evidence, but the overwhelming anecdotal personal stories of veterans who say they've gotten their lives back as a result of a service dog should matter," says Amy McCullough, director of National Animal-Assisted Therapy at the American Humane Association. Critics of the new regulations also point out that while veterinary care for service dogs can be pricey, anti-anxiety medication and therapy arguably rack up more expenses in the long-term.

A recent study by Deborah Custance and Jennifer Mayer of Goldsmiths College, University of London assessed canine responses to individuals in distress. "Regardless of whether it was their owner or the stranger, when an individual cried most of the dogs went up to them in a quiet, submissive way suggesting comfort-giving," Mayer observed. "They didn't go up to their owner when the stranger cried, which would have been seeking comfort for their own distress rather like infants who cry when another baby cries...they were responding to the person's emotion, not their own needs." Custance tempers their findings by clarifying, "We're not saying this is definitive evidence that dogs have empathy--but I can certainly understand why people would think they do, at least."

The demand for animal-assisted therapy in the UK is increasing: last year, Pets As Therapy had over 900 establishments on their waiting list. PAT relies on charitable donations and the work of volunteers. PAT's team--numbering approximately 5,000 dogs and 120 cats--provides comfort and companionship to over 150,000 people every week, including the elderly, disabled and terminally ill. Beyond healing, PAT's furry charges also help build social skills and confidence in children. The charity's new "Read to Dogs" programme aims to improve young students' reading abilities.

"When humans show us affection, it's quite a complicated thing that involves expectations and judgments," Custance explains. "But with a dog, it's a very uncomplicated, non-challenging interaction with no consequences. And if you've been through a hard time, it's lovely to have that."]]> tag:www.huffingtonpost.com,2012:/theblog//3.2287655 2012-12-13T19:00:00-05:00 2013-02-12T05:12:01-05:00

Claire Surrey http://www.huffingtonpost.com/claire-surrey/ Girls wraps on Sky Atlantic this Monday. Produced by and starring 26 year-old Lena Dunham, Girls frankly examines twenty-something female friendships, body image, sex and--to borrow an oft-quoted line from its second episode--the "stuff that gets up around the sides of condoms."

In episode two, "Vagina Panic," Dunham's character Hannah enters the condom query into Google, pausing to nervously peek beneath the bath towel she's wearing. She also tries searching for "diseases that come from no condom for one second." A doctor's visit later reveals that Hannah has human papillomavirus (HPV), a virus which can cause genital warts and, in rare cases, cervical cancer.

A Google search of my own leads to the NHS web entry on genital warts, which effectively answers Hannah's question: "Condoms do not provide complete protection because it is possible for the skin around your genital area (not covered by the condom) to become infected." In the UK, genital warts resulting from HPV are the second most common type of sexually transmitted infection (STI), after Chlamydia. The virus is otherwise asymptomatic and, despite Hannah's partner's claims that he "tested negative," there are currently no tests approved for men.

HPV can be detected in women through a smear test, which the NHS recommends every three years for women between 25 and 49. In September 2008, the UK government launched a national programme to vaccinate girls aged 12 to 13. The NHS estimates that up to eight out of 10 people are infected with HPV at some point in their lives.

"Jessa has HPV," Hannah's friend Shoshanna informs her on Girls, "like a couple of different strains of it. She says that all adventurous women do." Although critics have pointed out errors in Dunham's depiction of HPV, her character's surprise diagnosis highlights the invisible symptoms of sexually transmitted infections in many young people.

Chlamydia is the most commonly diagnosed STI in the UK: the NHS estimates that 1 in 14 sexually active people under 24 years old are infected. Left untreated, the condition--which is largely asymptomatic--can cause infertility and other health problems. The National Chlamydia Screening Programme (NCSP) offers free and confidential testing and treatment through the NHS to people under 25. Some NCSP areas conveniently provide testing kits through the post.

Like genital warts, the herpes simplex virus (HSV) can be transmitted through oral sex, vaginal or anal intercourse, and skin-to-skin contact. As Hannah would phrase it: HSV is among the "stuff that gets up around the sides of condoms," and is especially prevalent among people aged 20 to 24. According to NHS data, at least 8 out of 10 individuals carrying HSV were unaware that they had been infected, as there are often minimal or no initial symptoms.

Gonorrhoea and syphilis, although less common than Chlamydia, HPV and herpes in the UK, also feature invisible symptoms. Approximately 1 in 10 men and nearly half of women infected with gonorrhoea do not report any symptoms. Signs of syphilis are easy to miss: symptoms include one or more small sores, typically painless, in the area where the bacteria entered the body.

HIV is arguably the most dangerous sexually transmitted condition. In 2010, an estimated one in four people with HIV in the UK were not aware of their status. HIV's initial symptoms include a flu-like illness that occurs a few weeks after infection, followed by a latent period of virtually no symptoms. Statistics from the UK Health Protection Agency estimate that 95% of new HIV infections in 2010 were sexually transmitted.

"Sex is not when we are being at our most logical. Love and passion usually take over and people can make stupid decisions," argues Sir Nick Partridge, chief executive of the Terrence Higgins Trust, a British HIV/AIDS charity. Dunham echoes Partridge's views: "Women have been having sex that confuses them and vice versa for as long as humanity has been around."

"[W]e need to make sure that people at risk know exactly how to keep themselves safe from HIV," Partridge concludes.

Condoms, when properly used, can help prevent STI and HIV transmission. If you're sexually active, use your judgement and ask whether your partner has been tested. Better yet, why not nix the suspense and make getting regular STI screenings a New Year's resolution?

The season finale of Girls airs Monday, December 17 at 10pm on Sky Atlantic.]]> tag:www.huffingtonpost.com,2012:/theblog//3.2236929 2012-12-04T19:00:00-05:00 2013-02-03T05:12:01-05:00

Claire Surrey http://www.huffingtonpost.com/claire-surrey/
Although Victorian novelist Charlotte Brontë is rumoured to have died from hyperemesis gravidarum in 1855, the condition - which affects approximately 1% of pregnancies and is characterised by vomiting, weight loss and severe dehydration - was not widely recognised until the 1950s. It is now, thankfully, easily managed with intravenous rehydration and anti-nausea medication. Despite inroads in treatment, however, "there is a real lack of understanding about the condition," argues Caitlin Dean, a registered nurse and trustee of the UK charity Pregnancy Sickness Support.

Dean, a mother of three, has also suffered from hyperemesis gravidarum, which typically affects first-time mothers and women expecting twins. "One of the big issues with it is isolation because it causes many women to be bed-bound," she notes. "I had hyperemesis gravidarum whilst pregnant & its horrible," British model Peaches Gedolf tweeted on 2 October, sharing a link to Pregnancy Sickness Support's website.

The celebrity media's role in bringing a previously obscure maternal condition to the forefront of popular culture - just imagine the pub quiz questions to be mined from hyperemesis gravidarum's Wikipedia entry this week - carries important implications for health communication.

Despite predominantly catering to tabloid entertainment, in recent years celebrity media has fostered open dialogue about reproductive health and the challenges of motherhood. American actress Brooke Shields' struggles with post-partum depression prompted her to pen the best-selling memoir, Down Came the Rain, which resulted in a widely-publicized feud with Tom Cruise over her antidepressant use. "I hope this will help new moms not feel alone or desperate, and that there is no shame in their feelings," the actress stated. "PPD is out of their control, but the treatment and healing process is not." In her memoir, Shields - who describes herself as "cervically challenged" - also detailed several failed attempts at in-vitro fertilisation and five miscarriages.

In promoting awareness and encouraging positive health-seeking behaviours, the three D's of health communication - demystification, de-stigmatisation, and dialogue - are key touchstones. Celebrity coverage has proven to be an unexpected and effective medium for promoting reproductive health and highlighting common challenges. Pop star Lily Allen and English model Kelly Brook have both publicly discussed their miscarriages. Their stories undoubtedly resonate with many women coping with similar losses - and the numbers are high: 11 babies are stillborn every day in the UK.

Actress Gwyneth Paltrow, Friends star Courtney Cox, and British TV personality Jodie Kidd are among numerous other celebrities who have opened up about fertility setbacks and post-partum depression in the past years. Some have harnessed their social capital and public visibility to promote health issues. Christy Turlington's maternal mortality awareness campaign, Every Mother Counts, has earned the former model and activist global recognition. "Social media and Twitter have been really helpful to get our message out," Turlington observes. "It's all wellness and health oriented. I don't talk about my favorite latte."

Over the coming weeks, I wish the Duchess of Cambridge a healthy and speedy recovery as the world anxiously looks on, and possibly learns a thing or two about women's health.]]>