Centering Pleasure and Future Health Goals

You know, we've been talking open about sex and pleasure. Look, I don't want you to be thinking about disease , right? I want you to be thinking about this is about to be the best three minutes and twelve seconds of your life , right? That's what it's supposed to be about . But in order for it to be about that, you gotta know what feels good for you . It's a new year. So that means many of us are taking time to check in with ourselves and our health from mental to dental . But I've been curious about how people are thinking about one particular kind of health , sexual health . My producer Corentonio Rose walked around downtown Oakland to ask how people are thinking about safer sex in the new year from the things they do to keep themselves and others safe to whether or not they knew about prep, a daily pill taken to prevent HIV . Safe sex means for me being cautious of who you lay with and abstaining. It means for me to think five steps ahead before I get to sex. Obviously using protection and I want to say also having consent and making sure that you guys both know that that's what you guys are about to do. For me, it's about being choosy with who my sex partners are , but definitely condoms. I don't want no kids. And it also means like I want to be more protective about my own health as a woman in this day and age because you never know what people are carrying around. Getting tested before you have sex and being transparent about any and all test results that you have. I'm going to ask anybody I'm dealing with like if me and them could go get tested together because there's all types of ways to fake documents and stuff like that . So I'm just Yeah, I want to save signs. You can take that over. Yeah , alright, all right . In the eighties and nineties, safe for sex was all about caution. The things you had to do to do your part in ending the eighth crisis. But in twenty twenty six, it's changing. It's more about competence, having the tools you need to feel confident in your own sexual health. So today I'm joined by Dr. Lisha McKinley Beach, founder and CEO of the Black Public Health Academy , and one of the founding members of Prep in Black America, and Dr. Jasmine Abrams. I'm a research scientist at the Yale School of Public Health to give us a new year booster on how to live our best sex lives. Hello, hello. I'm Brittany Lewis, and you're listening to B it'sit from Amin NPR, a show about what's going on in culture and why it doesn't happen by accident. Dr. Abrams, we're going to start with the study you conducted with the University of Maryland, Baltimore County, and the Yale School of Public Health on how people, specifically Black women think about sex and the decisions they make regarding saf er sex. What do the people you spoke to say safer sex meant to them? So this study was conducted just before twenty twenty and they told us that safer sex did include condoms , but it was much more than that. It was also getting tested. It was being aware of your partner's history , having conversations, like communicating with your partner about sex . A few people mentioned constant consent. Other people talked about being in an environment where I know that I'm not going to be physically harmed . And folks also talked about feeling trust with a partner to be able to engage in sex with them and not feel threatened in a way. It's interesting that there's like a combination there of practical cut and dry sort of action able things like using condoms and getting tested and knowing your partner's history and status , but also there's like a lot of sort of these intangibles like trust and comfort that are factoring in as well . I wonder, how did the people that you spoke with Dr. Abrams, how did they consider trust or think about trust when making decisions about their sexual health? This is such a great question. We saw trust permeated decision making, sexual health decision making almost completely. So thinking about establishing trust with a partner , that is what helped people experience comfort in a sexual relationship , that comfort then help them to feel more comfortable with engaging in unprotected sex . And then other portion of that was that sex was also more pleasurable for them. So they spoke about how feeling trust with a partner, feeling comfort and connection with them was more pleasurable. And often that was sort of the pathway to unprotected sex . People also talked about trust like a gatekeeper in some ways like for partners in particular. So for the women who spoke about , you know , you know, if I had ever told my husband I wanted to use a condom or if I'm in a relationship already and I mentioned bringing up condoms or even with newer partners wanting to use condoms, wanting to talk about sexual history that was seen as a violation of trust. I've experienced that, I've heard that. I've heard that before. Yeah, you don't trust me . Exactly. You don't trust me. You want to talk about my sexual history or know if I've been tested or see my results, I'm telling you that I don't have anything. You don't trust me? Yeah . That's something that came up time and time again from my producer Core Antonio, among the people that they talked to out in the field. How do those conversations about testing go? They're usually uncomfortable, but they're also a pretty good litmus test on whether or not I should be with someone. If someone is uncomfortable about any of the conversations, it's an immediate red flag. I need you to login into your Mind Chart. We're not going to do the screenshot or anything. I need you to share your screen. I need to see your name. I need to see the date. I need to see what you got tested for. And if you can't show me that then we don't need to have sex at all. So I have gotten a lot of friction about that like, oh, you think I'm not, you know, clean , but I just stand my ground . And then the other way it was spoken about was if there's a partner that was cheating , you know, there's infidelity in the relationship, that's broken trust, right? And that's going to encourage me to engage in safer sex behavior. Interesting. I' Ifm going to continue to have sex with this person, now I want to definitely use a condom. Now I definitely want to make sure we've been tested if there's been infidelity . What are some of the stereotypes or social stigmas out there spec,ifically surrounding men or even black men that might be coming up for them when they're hearing oh I want to get tested or oh can you please show me your results? To speak plainly a lot of them act like it's you just slap them in the face and like you're working their nerves. What pain point is being hit or what assumptions about them are they worried that other people might be projecting onto them? There's so many cords that are getting struck . When a partner is asking about your sexual history, your testing , asking you to wear a condom , the trust cord is getting struck , the Do you think I'm dirty c,ord is being struck? Do you think I'm gay? Cord is being struck ? Do you think I'm irresponsible? I've already told you I don't have anything, you don't believe me. Wait, now are you cheating on me ? And even in our study, we saw that this was one of the reasons a lot of women had anxiety around these conversations because of how they thought their black male partners might respond to them bringing it up. But one of the things that has happened in the past few years that for me was like, oh my goodness, I wish it could be like this . COVID . When COVID happened , people spoke very openly. Have you been tested? When was your last test? What were your results? When did you need to test again? Who did you get it from? Oh, well maybe we need to do some social distancing. Like, it's cool. You could still come over, but you have to wear a mask. But suddenly everybody was very attuned to kind of the rhythms of public health initiatives . Yes . And receptive to that knowledge and wanting to apply it immediately. There was no icky stigma around you trying to protect yourself or your loved ones . And I was like, Oh my gosh, I wish people could be like this with HIV . I wish it wasn't so much negative stigma around protecting yourself or the people that you care about . Coming up, I'm not even going to define it as safer. I'm going to define it as pleasurable. Stay with us . Okay, so when we talk about sexual health and STI prevention, there's a lot of focus on preventing the transmission of HIV. My producer Corntonio went out into the field and asked people about how much they knew about prep, a daily pill you take to prevent HIV. And the results were mixed. Have you ever heard of PREP? Yes, from TikTok . I don't take prep, but I have known PREP to be something that prevents HIV I just know it's preventative measures for HIV . And that's pretty much all I know about it . I have a little bit of an idea. When I worked at a clinic, we did ask some patients that they were all men . But I automatically go, oh, it's for gay men to not get HIV. That's what I think when I see commercials. Who do you think purpose for? Usually gay men would think, but also like anybody who wants to participate in sex sex. Yes, yes, o,kay because a lot of people don't know that women can take prep. Oh, I didn't know that at all. Okay . I'm here with Dr. Lisha McKinley Beach, founder and CEO of the Black Public Health Academy. Lisha, what are the cultural narrat ives out there about the kind of woman that takes prep? And how does that impact people's decisions to start taking it? Sure . Part of what we see in terms of culture are some , you know, things that have been passed down that prevent women from feeling comfortable enough to even have conversations with their provider such as sex is something we don't talk about, right? What happens in this house stays in this house, right? Like why you out here telling folk you know that you had something that was itching or burning , you know, and those kinds of things and so they're less likely to say you know I was interested in prep, which means I got to disclose that I'm sexually active. Baby, you have had five kids in the past decade. They know you are sexually active . Right ? But for me to have the courage to say I am sexually active and I want to know what's available does go against how many of us older women are taught and I preference that because some younger women like my daughter , that's not their narrative . You know, we've been talking open about sex and pleasure. I don't want you to be thinking about disease , right? I want you to be thinking about this about to be the best three minutes and twelve seconds of your life , right? That's what it's supposed to be about . But in order for it to be about that, you got to know what feels good for you , right? And part of that toolkit may indeed be prep. Yes, Lisha, you were touching on such an important point . The spectrum of women's sexual health has been narrowly framed by risk in disease . And I love that you were teaching your daughters that it's more expansive than that baby, it can hold pleasure , it can hold dysfunction. It can hold all of these things. Your sexual health is more than whether or not you're getting pregnant or getting an STD. Lisha, I wonder in terms of making sure everyone who should be on PERP at least knows about it and knows it's for them, how would you characterize the rollout of PERP ? I would say in terms of women and in terms of black communities it was a failure . Some of the first imagery that I saw promoting prep right back to what we have seen for the first couple decades of the epidemic to white gay men , they got ready to live their best lives because prep is available for them . And I just thought when are we going to get it right ? You know? And so when we look at who has benefit from Prep since its approval in twenty twelve, so that puts us what about thirteen that prep has been available. I got that country math y'all. I think that's right. thirteen years . We know that for white men , about ninety one percent of white men who could benefit from prep already have it. Wow, wow. So my producer Corantonio just pulled up some numbers from the CDC in twenty twenty two, and it says that estimates suggest ninety four percent of eligible white people have been prescribed Prep. Okay, so it sounds like that's what success looks like. That's what success got that right. I'm not hating, let's learn from it, right? Let's learn from how they were able to get to nearly every white man that needed has it. And those are some strategies that we have to implement as well . I am not naive that the starting line is not the same . And that was one of the reasons for the continued advocacy with Gile about there's got to be a campaign , right ? When women are watching and this is actually a true story. So Georgia still has an HIV hotline and had someone to contact me from the hotline saying that they were getting these calls from women all across Georgia, rural communities, metro Atlanta , they wanted to know one question and that was prep for them . And so they didn't know what was happening . Like why were you know all these women calling? And so I said, Oh, that's easy . You know, day up at night, they watched Hulu . It was a commercial , one medication for prep that says this medication is not for those assigned female at birth , right? So but if you don't know anything about prep , then you would believe that that means that that's it, that's it. I see. Like they wouldn't know that there are different versions of prep that women absolutely can take like Truvad a. Based off that one glance, they would think prep overall is literally not for them. Wow , wow. I mean, I do like housewives. My husband loves housewives. So we watch a lot of housewives. And on peacock , we are consistently getting ads for prep. And they even if they don't have that specific kind of language, right? Saying this is not for you if you meet this biological characteristic or whatever, it's more so like even just the framing or the branding or what you see . Yeah, it's what you see. It's very much like it's very much speaking to people that are not us . Even though there is clear ly a strategy for placing these ads, you know, in the middle of these really popular programs, there's still not enough diversity of strategy, in my opinion, to reach as many people as probably need to be reached. To that point , there will be some people that hear this conversation about black women and unequal access to prep and think, What's that got to do with me? Like I am a married white man who's been with this S womayan for forty years two , like this is this conversation doesn't have. I don't see myself anywhere in this. They might think this is unimportant or that it doesn't apply to them . I wonder how does black women's unequal access to prep impact everyone regardless of background? That's a loaded question . Obviously it triggers something in me because I think about it from the reverse that for decades in this movement , black women have been out here advocating and serving and protecting and all of the above in HIV for folks who don't look like them, who don't love like them , you know? And so now we're at a moment where we're saying we need folks to do the same for us. We need folks to be standing up to advocate for sexual health services , not having to face medical stigma, because oftentimes I hear from women who have been successful at getting prep, they talk about all the hurdles that they had to face to be able to get it. I went to the doctor and the doctor said, Oh, you don't need that , right? So I go see another doctor and the doctor says, Oh, well, that's not something for somebody like you, right? That's for somebody who's promiscuous. And so I would say that for anybody listening to this and to say like this isn't my fight. This has nothing to do with me It has everything to do with you . We all deserve to have access to the preventative services that's available to us. Whether we are talking about prep for sexual health , whether we're talking about metform in for diabetes . Some of these preventative measures , we don't always have access and we should not be in places where we have to become our own health advocate to get what everybody else has available to them . That is a very important point that you just made And to close this conversation very quickly, I'd love to hear from each of you. I personally believe that sex is an important part of life throughout I think an adult's entire lifespan . But as you mentioned, the kinds of structural supports and institutional supports to help people make health promoting decisions about their sexual health are suffering to a certain degree right now . So bearing that in mind, new year, new us , what from your perspective as professionals defines safer sex in twenty twenty six I'm not even going to define it as safer. I'm just I'm going to define it as pleasurable . And that's what I'm going to center in twenty twenty six and ensuring that anyone under the sound of my voice has a pathway to get to that pleasure. That pathway might be knowledge about prep and where they can access it . That pathway may be information doxype , which is something we didn't talk a lot about, but a way of preventing bacterial sex ually transmitted infections . So we talkin' about biomedical strategies that we can start checking off the list like oh , hey, you told me something new just now, okay? Yeah, so we working on , you know, all these other tools , but it's also a pathway of ensuring that you know you are worth it , right ? That whatever is available , that you are worth having access to it, honey, because you are something extraordinary and divinely made and as public health officials , it's our job to give you all the tools that you need to go on with your best sexy self. So for twenty twenty six, I would have to agree. I would love for people to be pleasure centered, pleasure focused , not just physically, right? In mind, body, and spirit, if you on that vibe. When we're thinking about mentally , what it looks like , what it feels like to have pleasurable sexual experiences . For me and the people in my research , that looks like being able to have guilt free sex, shame free sex, that looks like being able to go into a situation and not be concerned for your safety or your well being . And how do you do that ? You do that through conversation and communication. You do that through regular screening for your self. Your partner is also getting screened. You do that through being knowledgeable of things. So one thing I want to name is HIV is not the devil or a demon . It's a condition. We've seen people have decades long relationships where they are what we call serro discordant. They do not have the same HIV status. A person is HIV negative and a person is HIV positive. That is completely possible. So I don't want to frame this conversation like in the light that pleasure doesn't involve HIV, it absolutely can . The pleasure can hold both . So yeah, I'm excited about, you know, people having better sex in twenty twenty six and being more knowledgeable and aware . Well, I'll tell you what, with the tips that you all have given, I think that our listeners are going to be well on their way. Oh my gosh, Dr. Abrams, Lisha, thank you both so much. I really, really enjoyed this conversation. Like always, thank you for having us. Thank you . That was Dr. Lisha McKinley Beach, founder and CEO of the Black Public Health Academy and Dr. Jasmine Abrams, a research scientist at the Yale School of Public Health. So you all know I love hearing from you. And over the past few weeks, some of you have left the sweetest notes for me in the comments and reviews. One yall wrote This is my favorite podcast produced by NPR . Me too . Another wrote, Thanks for enriching my life . You guys , I'm blushing. And if any of those comments resonate with you, I would love, love, love it if you rated and reviewed this show wherever you're listening. It helps other people find the show and that means this community we're building will get even bigger. So join the team. Rate and review this show right now. And thank you. This episode of Its Vitamin was produced by Cory Antonio Rose. This episode was edited by Nina Potter. Our supervising producer is Barton Girdw ood. Our executive producer is Verilyn Williams. Our VPA programming is Yolanda Sanguini. All right, that's all for this episode of It's Bit Amin from NPR. I'm Brittany Lewis. Talk soon