Vanessa Cullins

Cervical Health Awareness Important All Year

2013-01-29T17:10:31-05:00

When women go through treatment for cancer, friends and family are often there to support them and to celebrate as they recover. As an ob/gyn, I've talked with women who are being treated for gynecological cancers, and many have said that they wish they had known as much about how to prevent cancer before their diagnosis as they do afterward. The truth is we spend a lot of time focused on cancer, especially when there is a bodily change that may signify it, and we spend very little time and effort focused on what it takes to prevent cancer

Even though January's Cervical Health Awareness Month is coming to an end, it's not the only opportunity we have to focus on a form of cancer that is nearly 100 percent preventable. Routine screenings for cervical cancer can detect precancerous conditions and allow health care providers to treat them before they progress. And vaccination against human papillomavirus (HPV), which causes cervical cancer, can prevent the initial infection that leads to cancer.

On an almost daily basis, Planned Parenthood health centers, like other providers of primary preventive care for women, see how important routine screenings is. A 25-year-old woman in Little Rock came to Planned Parenthood for contraception when she was "fresh out of the military." Having been busy on active duty for five years, she had not had regular cervical cancer screenings. Her Pap test revealed cervical dysplasia -- a precancerous condition. It was close to becoming cervical cancer, and she was treated in the "nick of time," thus preventing progression to cancer. If the precancerous cells had not been removed she probably would have lost her entire cervix, which would have left her infertile, or even worse, she might have lost her life. The happy ending to this story is that because she got the necessary screening and treatment, she was spared cervical cancer and was able to have the family she wanted.

Annually in the U.S. about 12,000 women are diagnosed with cervical cancer and for 4,000 of them, it's fatal. African-American women with cervical cancer are twice as likely to lose their lives to this disease than white women. That's because African-American women face greater obstacles to obtaining timely health care and as a result cervical cancer is more likely to have progressed to a later stage by the time it is detected.

So what steps can we take toward remaining cervical cancer-free? For starters, if you're 26 or younger you can receive the HPV vaccine. HPV vaccines are one of the most exciting medical developments in recent years. The vaccine protects against the two strains of the virus responsible for 70 percent of cervical cancer cases. The vaccination is most effective when the shots are completed before sexual intimacy. HPV infection can occur through skin to skin contact -- genital rubbing, mutual masturbation -- or sharing of sex toys. Because the vaccine protects best when you have never been exposed to sexual intimacy, it is recommended that boys and girls are vaccinated between 9 and 12. For those who are between 13 and 26, the vaccine may still be protective, but be sure to ask whether insurance will cover the cost if you are older. Regardless of whether you have the vaccine, cervical cancer screening is still required if you want the best strategy to prevent cervical cancer.

Beginning at age 21, women should get Pap tests -- even during periods without sexual activity, even if their partners are also female, even if they are not using prescription contraception, and even if they've been through menopause.

Updated screening guidelines recommend Pap tests every three years for women ages 21-29. For women ages 30-64, screenings are recommended every three years if the test is negative or every five years if both Pap and HPV tests are given simultaneously and both are negative.

Planned Parenthood health centers provide 585,000 Pap tests annually and provide advanced testing and treatment for thousands of women with abnormal Paps and precancerous conditions. Most importantly, these services are available to all women so taking charge of your cervical health is within your reach. We African-American women can change our reality when it comes to cervical cancer.

40 Years After Roe: A Doctor's Opinion on the Importance of Protecting Access to Safe and Legal Abortion

2013-01-22T12:23:00-05:00

Some of my more poignant experiences as a gynecologist were when a patient came to me, considering what to do about a pregnancy. What was so clear to me as a doctor, a woman, and frankly a human being, is that women approach these decisions in a thoughtful way, and look to their families and health care providers for information and support.

In fact, it was these conversations that cemented my lifelong commitment to help women access affordable birth control and safe and legal abortion. The federal legalization of abortion 40 years ago -- through Roe v. Wade -- made it a constitutional right for every woman to be able to make her own health care decisions, and for me to be able to fully care for my patients.

Roe v. Wade has had a huge impact on the health and safety of women. In 1965, illegal abortions contributed to nearly one-fifth of all pregnancy- and childbirth-related deaths. Today, less than 0.3 percent of women who end a pregnancy sustain a serious complication.

As a doctor, it's my job to make sure that a woman has accurate information about all of her options about her pregnancy. Fully informed, the decision of whether to choose adoption, end a pregnancy or raise a child must be left to a woman, her family and her faith, with the counsel of her health care provider. This is and should always be a private decision, one that should never be judged.

But far too often a woman's medical decision is judged -- and threatened by politicians

Within just a couple of years of the Supreme Court's ruling in Roe v. Wade, politicians began to chip away this fundamental right. In 1976, Congress passed the Hyde amendment, which bars federal funding for almost all abortions. This restricts a woman's ability to make her own personal health decisions, and it hurts low-income women and women of color all across the country.

Some of the most egregious recent attacks on safe and legal abortion have been in state legislatures.

Since 2011, there have been an unprecedented number of state legislative attacks aimed at restricting and criminalizing abortion. In state after state, we've seen laws that dictate how and when women can access abortion, force doctors to make political, rather than medical, statements to their patients, and attempt to drive health care providers out of communities. These laws have nothing to do with keeping women safe and everything to do with judging and shaming women, or even denying them care.

The public does not support these attacks. In fact, a majority of Americans believe Roe v. Wade must be upheld and abortion should remain safe and legal for a woman to consider if and when she needs it. The 2012 election confirmed what nationwide polls have shown for years--Americans don't want politicians pretending to be doctors and telling women what medical decisions make the most sense for them.

As a doctor and as a woman, I know firsthand just how important it is to every woman to be able to make her own decision about her pregnancy. There is no decision more important, personal, or complex. On this 40th anniversary of safe, legal abortion, women--and the men who love them -- must commit to continue to fight for our health and rights.

We will not stand for interference from politicians in the most personal of health care decision. Not now, not ever.

Now We Have a Fighting Chance Against HIV

2012-12-01T10:00:24-05:00

Today is World AIDS Day, and as an African-American physician focused on women's health, I'm especially aware of the challenge HIV/AIDS poses to the black community. I divide my time between New York and Florida -- two states that have substantial African-American populations and some of the highest HIV infection rates in the country. So, I know all too well that there is still a lot of work to do to fight this pandemic in our communities.

HIV infection is an almost entirely a preventable disease, yet it remains epidemic in the African-American community. We account for almost half of all HIV infections in the U.S., and the Centers for Disease Control and Prevention (CDC) estimates that one in 16 black men and one in 32 black women will be diagnosed with HIV in their lifetime. These numbers are simply too high, and part of the reason is that many of us believe we can't be infected or exposed to a sexual partner with HIV. That life-threatening falsehood fuels a cultural stigma about regular testing for HIV, which can save lives. As a result, too many of us are going undiagnosed and untreated, putting our lives and our partners' lives at risk.

Stigma isn't our only roadblock to ending the HIV epidemic. People of color are also more likely to be uninsured or under-insured than Caucasians, and, therefore, we're often delayed in getting care because of cost. But thanks to the Affordable Care Act (ACA), 3.8 million African-Americans stand to gain health care coverage, providing millions of women, men, and young people access to HIV screening, education and, if needed, treatment that they otherwise would not have had. As a part of the ACA's preventive care benefits, insurers will be required to cover annual counseling and screening for HIV infection with no co-pay for all sexually active women, as well as HIV screening for adolescents and adults ages 13-64, who are at higher risk for contracting HIV. This could help reduce the annual rate of HIV transmission in the U.S. by ensuring that more people get regularly tested and counseled about how to prevent HIV, and by ensuring that those who are HIV positive receive timely treatment.

But if we really want to win the war against HIV, testing and counseling must become a routine part of care for everyone -- not just those most at risk. That's why I was so excited when the United States Preventive Services Task Force recently recommended that all Americans aged 15-65 -- not just those at higher risk -- receive routine HIV testing. If that recommendation is adopted, and the Affordable Care Act is implemented as intended, insurers will cover HIV screenings for people aged 15-65 with no co-pay -- making screenings much more accessible to millions, and helping to stunt the growth of HIV rates in our communities.

Making testing a routine part of care is something that Planned Parenthood takes very seriously, and Planned Parenthood health centers are working every day to get more people educated about HIV, tested and into treatment if they need it. In 2011, Planned Parenthood provided 680,000 HIV tests -- 16 percent more than we did in 2010. A few years ago, we co-founded the Get Yourself Tested (GYT) campaign as a way of raising awareness among young people about the need for periodic STI, including HIV, testing. In recent years, Planned Parenthood health centers also switched to rapid HIV tests so that patients can know their status by the end of a health care visit.

All of these measures are aimed at creating an AIDS-free generation. But, doing so will take organizations and individuals battling the virus on every front. That starts with realizing that HIV testing should be a routine part of your care if you're sexually active, and that you should protect yourself and your partner by using condoms -- either the male and female version -- and dental dams to prevent to prevent the spread of HIV. There is no stigma in getting tested, and there is no shame in practicing safer sex. It's about maintaining good health!

Education, prevention, and testing are the means to ending this epidemic. With new investments in the health of our communities and the advent of technology that can educate and communicate with more people than ever before, we have the tools to end the HIV epidemic and in particular curb the toll it takes on the African-American community. Talk to your friends and family about this global problem, and make sure your loved ones get the information and care they need and deserve.

For more information about how to prevent HIV, get tested, select an appropriate method of birth control, and find a local health center, visit Plannedparenthood.org.

Early Cancer Detection Saves Lives

2012-08-17T14:33:27-04:00

As an ob/gyn, I understand the critical need for women to have access to preventive breast care and clinical breast exams - care that helps to detect breast cancer early when there is the best chance of successful treatment. During my more than 10 years in practice, I provided countless breast exams that have identified potential cancers in women, and this early detection no doubt helped save lives (and brought peace of mind for my patients).

I also understand the need from a personal perspective: Breast cancer runs rampant in my family. My mother died from breast cancer in 1987. My grandmother was a survivor. My first cousin was also diagnosed with the disease. I've seen firsthand the ravages and pain that breast cancer can create for a woman and her family. Considering how prevalent the disease is in my family, it should come as no surprise that I'm considered high risk. I'm lucky, though, in that I have health insurance that covers my routine breast exams, mammograms, and biopsies.

But women who are uninsured or underinsured don't have that luxury.

So many patients that we see at Planned Parenthood health centers are these women--women who have lost their jobs, and have then lost their insurance as a result. Women who work for small businesses that don't offer health insurance benefits. Women struggling to put food on the table and take care of their families. Women who want to take care of their health too, but don't have time or the money.

At Planned Parenthood, we're always looking for ways to provide more care to women like this, in need of affordable, quality health care. And now we can--thanks to an outpouring of donations from the public after the Susan G. Komen for the Cure Foundation stopped providing grants to Planned Parenthood because of intense pressure from political groups and then quickly reversed course earlier this year.

As a result of this incredible support, we are expanding our breast health work to provide more services to our patients. The program is designed to help more young women and women with above average risk understand their risk and what screening is needed, and also connect them with needed follow-up care, such as diagnostic mammograms, ultrasounds, or biopsies. Where possible, we will aim to provide financial assistance for this care for patients who need it. Additionally, our promotores who do outreach in Spanish-speaking, underserved communities will receive training and resources to integrate breast health into their existing programs. And we are designing a digital education and outreach program which provide women looking for information online with additional tools to educate them about breast health and the importance of clinical exams. Finally, Planned Parenthood doctors and nurses will be trained to use a new tool that will help them better assess risk in patients -- including younger patients.

Planned Parenthood is uniquely suited to do this work, as a trusted provider for all women and especially low-income women, who often have nowhere else to turn. Last year, Planned Parenthood health centers performed nearly 750,000 breast cancer screenings nationwide, helping women detect breast cancer and empowering them to take control of their health. Now, we will be able to serve our existing patients with even more resources--and reach new patients.

Birth Control Is a Critical Health Need

2012-06-28T05:48:58-04:00

As physicians focused on reproductive health, we hear every day from women whose health and well-being are affected by their inability to afford basic preventive care such as birth control, breast and cervical cancer screenings, and basic checkups. That's why today's historic decision by the Supreme Court to uphold the Affordable Care Act (ACA) is a victory for millions of people across the country and one of the greatest advances in women's health that we've seen in a generation. Among many other benefits, nearly 13 million women of reproductive age will be newly eligible for insurance coverage under the ACA. Under the law's women's preventive health services provision, women will also have guaranteed access to ob/gyn providers without referrals and, starting this August, their birth control will be covered without co-pays.

Today's decision will provide women with peace of mind and crucial health care that until today has been elusive for too many. One such woman is Yvette, a Brookings, SD, resident who has polycystic ovarian syndrome. She struggles with weight gain and borderline diabetes, which are likely related to her condition. Diabetes is a serious, sometime fatal condition for pregnant women and their babies, so delaying pregnancy until she is healthier is a critical health goal for Yvette. In addition, use of a hormonal birth control method can also help prevent many of the complications of polycystic ovarian syndrome, such as endometrial cancer.

For Yvette and millions of other women, effective birth control is not a convenience; it is a critical health need. In fact, birth control has had such a dramatic impact on women and families in this country that the Centers for Disease Control and Prevention named it one of the top 10 public health achievements of the past century. There's plenty of proof to support that assertion. In the 47 years since the U.S. Supreme Court issued another landmark decision in the case of Griswold v. Connecticut -- which recognized the use of contraception as a constitutionally protected right and expanded women's access to birth control -- we have seen a dramatic improvement in maternal and infant health. In 1965 (the year of the court's ruling), 32 women died for every 100,000 live births in this country. Today, the rate is less than half that. Infant mortality has made an even more significant decline, falling by 74 percent as more children are born to parents who plan and space their pregnancies by at least 18 months. Bottom line: better access to birth control has given women like Yvette the means to reduce the likelihood that they and their newborns will experience poor health outcomes related to mistimed or never- intended pregnancies.

The falling U.S. teen birthrate -- which hit a record low in 2010 (the most recent year reported by the CDC) -- is almost exclusively the result of better use of birth control by teens. Reducing the teen birthrate is a critical public health goal in part because infants born to teens are more likely to have low birth weight, suffer from childhood health problems, and be hospitalized than those born to older mothers.

Still, too many women and sexually active teens in this country aren't able to realize the health benefits facilitated by nearly five decades of legalized access to contraception simply because they struggle to pay for it. Today's Supreme Court decision will remove cost as a barrier to birth control, and that's a significant gain since decades of public health data shows that childbirth- related deaths are higher among women who have greater problems accessing birth control. These preventable deaths begin with the fact that unintended pregnancy rates for poor, low- income, young, and minority women are higher than for non-Hispanic white women, in large part because women in the former groups have greater difficulty accessing birth control. Those women are the very ones who experience higher maternal and infant mortality rates.

As doctors, it is heartbreaking for us to talk with women who want to take the steps necessary to prevent unintended pregnancy, but for whom a birth control prescription is nothing more than a piece of paper because they don't have the up to $600 to pay out-of-pocket every year for contraception. In fact, a third of women voters have struggled at some point to afford their prescription birth control methods, causing them to use it inconsistently, according to a 2010 Planned Parenthood poll. The numbers are even more dramatic among young black women and Latinas, with 54 percent and 57 percent respectively saying they sometimes have not been able to pay for their birth control.

For us, the Supreme Court's decision to uphold the ACA means women will no longer have to decide between paying rent and getting the care they need. It provides the opportunity to change the health care dynamic in this country and improve outcomes for millions of women and their families.

Time to Make Our Health a Priority

2012-05-14T18:00:50-04:00

"Your health should come first, but when you're a healthy and busy working adult, you tend to forget how quickly the time flies."

This is Beth, a Planned Parenthood patient, talking about how, when she was 32, her doctor found a lump in her right breast. The discovery was made during an appointment that Beth was nearly too busy to keep.

"Had I not gone in for my checkup, I wouldn't have known about the lump. And while it was determined to be benign, the knowledge that I have a lump in my breast and the skill of knowing what a lump feels like in the future -- I value Planned Parenthood for helping me stay a healthy woman."

Beth's story is a reminder of how crucial preventive care is, and National Women's Health Week (May 13 - 19) is a good time for us all to prioritize our health. In observance of the week, we're encouraging women to use Monday, May 14 -- National Women's Checkup Day -- to schedule a check-up with their health care provider.

There's never enough money or time, and too often our health falls to the bottom of the list. But Beth's story is also a good reminder that there are health centers like Planned Parenthood that provide affordable, lifesaving preventive care such as breast and cervical cancer screenings and testing and treatment of sexually transmitted diseases, as well as contraception.

If you're uncertain about what regular health screenings you should have, talk with your provider about whether you're due for a breast exam or a Pap test. You can visit The Check to learn whether you should get screened for STDs so you can protect your and your partner's sexual health.

If you use birth control, National Women's Health Week is also a good time to talk with your provider about your contraception options and whether the method you're using is ideal for both your current life and future plans. Birth control is not one-size-fits-all. Visiting My Method and answering a few questions before your appointment can help you prepare for a conversation with your provider about your options.

In addition to your check-up, here are a few other health-related questions you may want to check in with yourself on:

Am I eating healthy and staying hydrated?

Am I getting enough exercise?

Am I getting enough sleep?

Am I avoiding unhealthy behaviors like smoking?

Am I paying attention to my mental health, including stress management and the health of my relationships?

Remember, early detection and treatment can save your life. This week, ask yourself: What have I done today to get -- and stay -- healthy? And then make an appointment.

HIV-Positive Women Need Better Birth Control Options

2012-02-29T15:39:00-05:00

This month and last, the World Health Organization (WHO) convened two meetings of public health experts and citizens from some of the countries of the world most affected by HIV/AIDS. Participants were asked to review a new study suggesting that hormonal contraception increases women's risk of transmitting HIV to their partners and determine whether the WHO should revise its guidance for HIV-positive women. The results are in -- and it's a resounding no.

The panel found there was not enough evidence to recommend that HIV-positive women abandon hormonal methods of contraception. Soon thereafter, the WHO announced that there would be no change in official guidance, which includes no restrictions on hormonal contraception for HIV-positive women to prevent unintended pregnancy.

This study in question appeared this past November in the Lancet, a medical journal, and caused quite a stir among those of us working in the field of reproductive health and HIV prevention. Experts around the world immediately raised concerns about this new study. The findings contradicted the majority of previous research on the same topic, including a dozen prior studies. The International Planned Parenthood Federation and the United States Agency for International Development (USAID) immediately issued statements advising health professionals around the world not to limit women's access to lifesaving contraceptive methods before all the facts were in.

More than anything, what the brouhaha around this flawed study underscores is the importance of dual protection for couples who wish to avoid unintended pregnancy and prevent HIV transmission. According to Guttmacher, "women in sub-Saharan Africa not only face the world's highest risk of maternal death, but also the highest risk of HIV infection. Voluntary contraception is crucial for women who have or are at risk of HIV because it helps prevent unintended pregnancy and its health risks."

Male and female condoms are the only methods currently available that protect against both. Women simply need more options. As Michael Sidibé, executive director of UNAIDS put it in a statement on the WHO decision:

"Women need safe contraceptive and HIV prevention options that they can own and manage. New investments into research for female controlled HIV prevention options and safe contraceptive methods are essential."

Globally, about half of people living with HIV are women, and women account for more than half of new infections. This epidemic disproportionately affects women of color and poor women. Why? Because women of color and poor women lack sufficient access to methods of prevention. Too often, women must rely on men's condom use to protect them. Too often men's condom use is inconsistent.

This is as true in the U.S. as it is overseas. African-American women also have disproportionately high rates of HIV/AIDs and other sexually transmitted infections. Though African Americans represent 14 percent of the population, we account for 69 percent of gonorrhea cases and about half of all cases of HIV/AIDS, chlamydia, and syphilis.

Women need research, not restrictions. Donors, governments, and the pharmaceutical industry should invest in better technologies to increase the number of options on the market. Women in this country and around the world need convenient, affordable access to methods that empower them to prevent unintended pregnancy and HIV.

Clarification: The original opening line of this post "It was another victory for women's health" was added by an editor at Black Voices and is not the tone Planned Parenthood Federation of America would have cast on the news. The opening line has been removed. The Lancet study referenced in the original post was published online in October, not November. While the study described in this post was the main impetus for the World Health Organization (WHO) review, the meetings focused not just on this particular study but on all known evidence on the topic of hormonal contraception and HIV-positive women.

Why Parents Need to Talk With Their Kids About Sex

2011-10-05T18:55:00-04:00

There is one thing I can't stress enough about sex: The need to talk about it. My previous post on Black Voices was about how hard it is for adults to talk about sex -- with each other! So you can imagine how tough it is for us to talk about it with our kids. But talk we must! According to the Centers for Disease Control and Prevention, African Americans ages 13-24 account for 56 percent of new HIV cases, and nearly half of all African-American girls between 14 and 19 are infected with a sexually transmitted infection such as chlamydia, herpes, or HPV.

Now is the time to have that conversation. October is Let's Talk Month, during which several national organizations, including Planned Parenthood, focus on encouraging parents to talk with their children about sex and sexuality. It can absolutely make a difference. Studies have shown, for example, that teens who talk about sex with a parent are more likely to delay sex, have fewer sexual partners, and use condoms and birth control when they do have sex.

But do parents really talk with their kids about sex? Planned Parenthood recently partnered with the Center for Latino Adolescent and Family Health at the Silver School of Social Work at NYU to find out. Released today, our new, nationally representative poll shows that most parents are talking to their kids about topics related to sexuality, agree that they are influential in the decisions their children make about sex, and are overwhelmingly supportive of sex education in schools.

Importantly, the survey of 1,100 parents of 10 to 18-year-olds found that African Americans were more likely than any other group to say that they would like help talking to their kids about sex. That's encouraging news when you consider that 64 percent of all parents surveyed said their own moms and dads didn't do a very good job talking to them about sex. That more of us are asking for help in figuring out how to best prepare our kids to make good decisions about their sexual health provides us the opportunity to set examples for how all parents can be successful in helping their kids navigate these waters. However, the poll also found that fewer parents are talking with their kids about tougher, more complicated topics. More than a quarter aren't talking about how to say no to sex, and, while 94 percent of parents believe they are influential in whether or not their kids use condoms or other forms of birth control if they do have sex, only 60 percent are actually talking with their children about birth control. Why? Many of us are too embarrassed or uncomfortable. But we must get over that.

The consequences of not talking are simply too great. A recent http://www.thenationalcampaign.org/underpressure/PDF/under-pressure.pdf study conducted by Essence and the National Campaign to Prevent Teen and Unplanned Pregnancy of 1,500 African American teen boys and girls found that nearly half of the 13 to 15 year-olds surveyed don't talk with their parents about sex because they think it would be too awkward. Yet two-thirds say there would be fewer teen pregnancies if more kids were able to talk with their parents. Two-thirds also said they would wait longer before starting to have sex if they were able to have open and honest conversations about it at home.

How can you make it less awkward? Talk openly and honestly, answer your kids' questions, and seize opportunities to help them make smart decisions about their relationships and behavior. Parents can begin the discussion as early as age six or seven. When a child reaches puberty, it's important to discuss love, relationships, and respect, but it's also important to teach teens how to say no to sex and how to access and make decisions about birth control when they do become sexually active. Throughout the teen years, it's critical to help your child understand the consequences of certain behaviors, and to help them establish boundaries. Should your teen become sexually active, you can help ensure that the relationship is emotionally healthy and that your child protects her/himself from pregnancy and sexually transmitted infections.

It's also essential that parents set guidelines that will make teens less likely to engage in sexual behavior before they're ready, and role-play with your kids, especially daughters, about how to negotiate boundaries in certain situations in age-appropriate ways.

Most of all, we need to help our children build self-esteem so they will want to take care of themselves and respect others. Parents can do that by giving their kids credit for their talents and accomplishments, and encouraging them to have long-term goals, like college. Talking with our kids about their plans will not only strengthen our relationships with them, it will also allow us to help them consider how the risks they take today may affect their dreams for tomorrow.

Planned Parenthood is an excellent resource for information on how to talk with your kids about sex and sexuality. Visit www.plannedparenthood.org to find out more. So, let's talk about sex!

Time to Start Talking

2011-09-15T18:00:00-04:00

How many negative statistics do we have to read before we get the message? When it comes to practicing safer sex, much work still needs to be done. According to the Centers for Disease Control and Prevention (CDC), as many as 19 million new sexually transmitted infections occur in the U.S. each year. While STIs cross all racial lines, African Americans are disproportionately at risk for such common infections as chlamydia, gonorrhea, herpes, and syphilis. African Americans make up just 13 percent of the U.S. population, yet in 2009 we accounted for approximately half of all new cases of chlamydia and syphilis (48 percent and 52 percent respectively), and some 71 percent of gonorrhea cases. We also experienced more than half of newly diagnosed HIV infections; in fact a report last month from the CDC found a significant increase in the number of new infections of gay and bisexual African-American men between the ages of 13-29.

African-American women must take the first step to protect our health: Talk about sex. I know that can be difficult. Many of us live in communities that consider explicit discussions about sex embarrassing or shameful. Or we may be too worried about what our partners will think or do. Will he think I'm promiscuous? Will he get sex from another woman? Some women have been led to falsely believe there's a shortage of good men out here and feel pressured to please their partners, even when they refuse to use condoms. Some women falsely think they're not at risk.

Think again. The truth is all of us are at risk. The misconception that you have to be promiscuous to get a sexually transmitted infection just isn't true. We have to be just as honest with ourselves about our risks -- and the reasons why. For a number of reasons -- including a lack of affordable health care, men who have multiple sex partners, bisexual men, and the high incarceration rate of African-American men, who are exposed to STIs, including HIV, while in prison -- these infections are much more prevalent in African American communities. If you live in an area where an infection is widespread, your risk of meeting an infected partner is automatically higher -- and protecting yourself takes even more diligence. Untreated infections can not only lead to HIV/AIDS but to infertility, chronic pelvic pain, cervical cancer and other serious conditions.

Remember, you only know your own sexual behaviors and sexual history. And you trust that what your partner tells you about his or hers is true. But until you are feeling supremely trustful, or are in a serious, monogamous relationship, do whatever it takes to protect your health and wellness. When it comes to sex, that means honest discussions about sex, since dialogue and observation of his or her behaviors are the only way to determine trustworthiness. That doesn't mean you have to give up sex to stay safe. But you do have to use protection; there simply is no reason for anyone not to.

These things may not be easy to talk about, but the conversation has to happen. Start by asking your partner if he or she has ever been tested for a STI. Then explain that it's important to you to use protection -- to not only prevent an infection but an unintended pregnancy. Talk about the different kinds of protection, what will work best for the two of you, and then find ways to make using it fun.

You also need to get yourself tested every year. So does your partner. Don't let cost or embarrassment keep you from getting tested. Nowadays, the urine tests are quick, painless and readily available at Planned Parenthood health centers and other community clinics. And don't let fear hold you back. Any sexually transmitted infection can be controlled with medication, and many can be cured completely. Even testing positive is more an opportunity than a curse, both for you and your partner, because if you don't know you're infected, you can't get treated and stay healthy.

You can only protect your health -- and that of your partner -- by taking the first step. Talk.

Why Birth Control With No Co-Pay Will Help African-American Women

2011-08-04T09:00:00-04:00

It's a delivery that is long overdue: Federal health officials on Monday defined birth control as preventive health care. That means that, starting next year, private insurers of new plans will have to cover FDA-approved contraceptives without any fees or co-payments (public insurance plans already provide basic birth control coverage without co-pays). This is a huge victory for millions of women -- and especially for African-American women, who have long struggled to pay for birth control and, as a result, suffer from the nation's highest rates of unintended pregnancy.

Birth control is critical to the well-being of women and their families. Studies have shown that women who have access to contraceptives and use them consistently have a greater chance of graduating from high school and establishing careers. When women lack access to contraception, they experience many disadvantages, including achieving less education and earning lower salaries. These disadvantages also affect their children, who are less likely to finish high school and have higher rates of incarceration.

For many African-American women, cost often determines whether we can choose and maintain the most appropriate method of birth control, especially during hard times. In a recent survey, 51 percent of African-American women ages 18 to 34 said they'd had trouble purchasing birth control and using it consistently due to the cost. That's one reason African-American women are three times more likely than white women to have an unintended pregnancy and, as a result, have higher rates of abortion. But we're not alone: a 2008 report from the Guttmacher Institute showed the vast majority of abortions in the U.S. were due to unintended pregnancies, regardless of race or economic status. Overall, nearly the half of all U.S. pregnancies are unintended.

The new federal ruling has the potential to change that. Under the current system, women with health insurance have to pay a deductible before they get any coverage for birth control. And once the coverage kicks in, they still have to make a co-payment every time they refill the prescription. For women struggling to keep food on the table, contraception becomes an unaffordable luxury. The new system eliminates this burden for the millions of women who will be covered under new health insurance plans.

This announcement is a victory for women's health, but not yet a complete one. Federal health officials are now considering a proposal that would allow some religious employers to deny women access to this vital health care service. For the next 60 days, HHS is accepting public comments on this week's announcement before finalizing the details of the ruling. Now is the time to let them know that we fully support their decision to help millions of American women have better access to preventive care, and that all women, regardless of their employer or insurer or health care provider, should have timely access to affordable birth control if they want it or need it. You can read the new guidelines here, and make your voice heard by posting a comment here.

There is no question that eliminating co-pays for birth control will help reduce unintended pregnancies. As access improves I hope all black women will seize the opportunity to plan their pregnancies. In doing so, we will improve the quality of our lives and families.

Vanessa Cullins is vice president for medical affairs at Planned Parenthood Federation of America.