The independent source for health policy research, polling, and news.
Medicaid Facts: Medicaid’s Role for Children
This fact sheet provides an overview of children’s eligibility and coverage under Medicaid, summarizes Mediciad benefits and expenditures for children, and highlights key issues facing the program as it continues to serve children.
A booklet to help health care consumers understand managed care.
The September/October 1997 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health stories covered by news media, including questions about AIDS, Condoms in Schools and Tobacco Companies. The survey was based on a national random sample of 1,007 Americans conducted October 17-21, 1997 which measures public knowledge of health stories covered in the news media the previous month. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories in the news Americans are following and what they understand about those health issues. Every two months, Kaiser/Harvard issues a new index report.
Health care benefits had been offered to active employees for a long period of time before health coverage became a retiree benefit offered by employers. The key event that made employer-sponsored retiree health care a possible benefit for retirees was the enactment of Medicare in 1965. It was then felt possible to provide a widely desired benefit at a relatively low cost, since the Medicare program would pay the majority of the costs.
Millions of Retirees Have Employer-Sponsored Coverage
Based on the 1995 Medicare Current Beneficiary Survey5 analysis by Physician Payment Review Commission (PPRC), about 12 million individuals (37 percent of Medicare aged and disabled beneficiaries) have employer-provided supplemental coverage, including about 2 million with employer-provided coverage and Medigap.
Retiree Health Is a Highly Valued Medicare Supplement
As with other matters related to retirement, the appreciation of retiree health benefits increases with age. For example, based on a Hewitt database of employee surveys, there is a twelve-fold increase in value assigned to retiree health care benefits for employees age 55 and over compared to the group age 25 to 34.6
The availability of employer-provided coverage is more critical for the pre-65 retirees because they will generally not have access to other insurance or it will be very expensive for them to purchase, if it is available at all. Post-65 retirees at least have Medicare if they have no other health insurance.
Even Medicare, however, provides a relatively low level of benefit when compared to the typical employer plan for active employees. Comparing the Medicare level of benefits to 250 large employers participating in the 1996 Hewitt Health Value InitiativeTM who offer indemnity type benefits, the Medicare design falls in the lowest quartile measured by plan value (18th percentile). That is, 82 percent of the indemnity plans offered by large employers to active employees provide richer or better benefit levels than traditional Medicare. Most of the employers participating in the 1996 Hewitt Health Value Initiative have more than 5,000 employees. Employers with fewer employees will tend to provide a lower level of benefit.
Assuming that the typical employer medical plan considers about 65 percent of total health care costs as a cost covered by the medical plan (excluded costs include items such as over-the-counter drugs, dental care and eye glasses)7, and that the average indemnity medical plan reimburses about 83 percent of covered costs8, the typical employer plan will pay 54 percent (0.83
State Reforms of Small Group Health Insurance
Between 1989 and 1995, 45 states enacted laws to make health insurance more accessible and attractive to small businesses. The small group market was targeted for reform because about half of all uninsured workers are either self-employed or working in firms with fewer than 25 employees (EBRI, 1996).
The problem is that only about half of all small firms offer health insurance (Figure 1). In 1995, 53% of small businesses (<50 employees) offered health benefits, and while this is up from 1989 when only 41% offered coverage, it is still much lower than health coverage among larger firms.
Many insurers are willing to sell coverage to small firms, but some insurer practices in the small group market have drawn concern. Some companies refused to sell policies to businesses in specific “high-risk” industries for example, or to firms with fewer than 10 employees. Also, because insurers tended to base premiums for small groups on the medical histories of prospective enrollees, some small businesses have reported that the poor health of their employees or employees’ dependents resulted in their inability to qualify for coverage.
Although these problems exist, they are not widespread. Most small firms say that they can get coverage if they want it. More than three-quarters (of both insured and uninsured small firms) say that they have been solicited to buy health insurance in the last six months, and more than a third indicate that they have received at least six or more inquires.
Three General Types of Small Group Reform
“Bare-bones” policies.
These laws allow insurers to sell “bare-bones” insurance to certain classes of small firms, typically those newly entering the group coverage market. The policies are dubbed “bare-bones” because they are usually exempt from most mandated benefit laws and premium taxes, which allows small firms to purchase basic coverage at lower premiums.
Premium regulations.
Premium rating bands or requirements that insurers follow community rating are two examples of such regulations. These rules are intended to narrow the range in premiums, so that coverage will be more affordable for higher-risk firms.
Standards for underwriting and contracting practices.
These are designed to make coverage both more attractive and available to employers. Included under this category are laws which:
The most common reforms are listed in Figure 2 with the number of states that have enacted them. In many cases, the state enacted a small package of measures in 1991 or 1992 and then adopted additional reforms a couple of years later. By 1995, most states had enacted all of the reforms listed here.
Figure 2Small Group Reforms at the State Level Number of States with the Measure as of: Type of State Legislative Reform: ’89 ’91 ’93 ’95 Bare-Bones Insurance Plans Can be Sold 1 9 31 43
To provide an independent source of information about the cost of covering uninsured children in California, the Henry J. Kaiser Family Foundation commissioned an analysis by the Actuarial ResearchCorporation (ARC), which provides actuarial assistanceto a variety of public and private clients. ARC’s analysis suggests that expanding California’s Medicaid program (which is called Medi-Cal) would be substantially less expensive than developing a new private insurance program as proposed.
Now I am going to ask you a series of questions about sexually transmitted diseases other than HIV or AIDS, such as gonorrhea, syphilis, herpes, and chlamydia. We want to learn from you how the topic of sexually transmitted diseases, also called STDs, was handled in your visit so that we can help doctors do a better job of addressing STDs with their patients.
Again, please remember that your answers to these questions will be kept completely confidential, and your responses will be shown only in combination with those of the other people we survey.
28. Now, thinking back to this last visit, were there any patient education materials like brochures or videos, about STDs in the (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Single response)
Yes 61 No 30 Don’t know 9 Refused 0 29. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss sexually transmitted diseases, other than AIDS, with you at this visit? (Single response)
Yes 15 No 85 Don’t know * Refused 0 30a. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Single response)
Based on those who discussed STDs. (n=72)
You 17 Someone in your doctor’s office/clinic 83 Don’t know 0 Refused 0 30b. Please tell me whether each of the following apply to how you felt when the health professional raised the subject of STDs with you? Did you feel (insert list)? (Single response) (Record Yes/No/DK/Ref for each) (Rotate first two statements only)
Based on those who discussed STDs. (n=72)
Yes No Don’t know Refused Relieved 47 47 4 1 Offended or insulted 4 94 1 0 It was expected 86 14 0 0 30c. Where did this discussion take place? (Do not read list) (Multiple response) (If respondent says “examining room” probe with: Was that while you were dressed or undressed?)
Based on those who discussed STDs. (n=72)
In examining room while you were dressed 44 In doctor’s personal office 36 In examining room while you were undressed 17 In counseling room 4 All other 3 In waiting room 1 Don’t know 0 Refused 0 30d. Where would you have preferred this conversation took place? Would you say (read list)? (Single response)
Based on those who discussed STDs. (n=72)
In doctor’s personal office 46 In examining room while you were dressed 42 Doesn’t matter 6 In examining room while you were undressed 4 Don’t know 1 Refused 1 31a. Please tell me whether each of the following apply to how you would have felt if the health professional had talked about STDs with you? Would you have felt (insert list)? (Single response) (Record Yes/No/DK/Ref for each) (Rotate first two statements only)
Based on those who did NOT discuss STDs. (n=408)
Yes No Don’t know Refused Relieved 24 72 4 * Offended or insulted 6 93 1 0 It was expected 64 36 0 * 31b. Do you think the health professional should have raised the subject with you? (Single response)
Based on those who did not discuss STDs. (n=408)
Yes 33 No 66 Don’t know 2 Refused 0 31c. Do you think you should have raised the subject of STDs? (Single response)
Based on those who did NOT discuss STDs. (n=408)
Yes 15 No 85 Don’t know 1 Refused 0 32. Why not? (Do not read list) (Multiple response)
Based on those who did not believe they or health professional should have raised STDs. (n=255)
Don’t feel at risk for STDs/only one partner/married 77 Discussed with doctor or health professional before 7 Visit was for other reason 7 No reason to (unspec.) 6 Already know about STDs/Office knows my history 2 Already been tested 2 Don’t know what STDs are 1 Don’t know 0 Refused 0 33. In general, do you think STDs should be discussed as part of seeing a new doctor orhealth professional for gynecological care? (Single response)
Yes 83 No 6 Depends 9 Don’t know 2 Refused 0 34. Who do you think has the primary responsibility for raising the subject of STDs, the health professional or the patient? (Do not read list) (Single response)
Health professional 64 Patient 23 Both 12 Neither 0 Don’t know 1 Refused 0 35. Who would you prefer talk to you about STDs, a doctor, a nurse, a counselor, or someone else in the doctor’s office? (Do not read list) (Single response)
Doctor 71 Nurse 12 Doesn’t matter 12 Counselor 2 Either a doctor or nurse 2 All other * No one * Don’t know * Refused 0 36. Did you feel you and your health professional had enough time to discuss STDs? (Single response)
Based on those who discussed STDs. (n=72)
Yes, had enough time 94 No, not enough time 6 Don’t know 0 Refused 0 37a. Did the health professional seem embarrassed or uncomfortable during your discussion about STDs? (Single response)
Based on those who discussed STDs. (n=72)
Yes 4 No 96 Don’t know 0 Refused 0 37b. Were you embarrassed or uncomfortable during this discussion? (Single response)
Based on those who discussed STDs. (n=72)
Yes 7 No 93 Don’t know 0 Refused 0 38. Did the health professional seem like he or she was judging you during this discussion? (Single response)
Based on those who discussed STDs. (n=72)
Yes 6 No 94 Don’t know 0 Refused 0 39. Did the health professional suggest to you that you should be tested for any STDs? (Single response)
Based on those who discussed STDs. (n=72)
Yes 32 No 67 Don’t know 1 Refused 0 40. Which, if any, specific STDs did the health professional recommend you get tested for? (Read list) (Rotate) (Multiple response) Probe: Can you think of any others?
Based on those for whom health professional suggested STD testing. (n=23)
Gonorrhea 74 AIDS/HIV 70 Chlamydia 65 Syphilis 52 Herpes 35 Human Papilloma Virus, or genital warts 30 Trichomonas 13 All others 13 No specific STDs mentioned 9 41. Omitted
42. Would you say the subject of STDs was discussed in a way that made you feel very comfortable, somewhat comfortable, not very comfortable, or not at all comfortable? (Single response)
Based on those who discussed STDs. (n=72)
Very comfortable (4) 76 Mean: 3.7 Somewhat comfortable (3) 21 Not very comfortable (2) 3 Not at all comfortable (1) 0 Don’t know 0 Refused 0 43. Did you feel that the health professional asked you enough questions, and knew enough about you, to be able to tell whether or not you were at risk for STDs? (Single response)
Total Among womenwho did not talkabout STDs(n=408) Yes 80 80 No 19 20 Don’t know 1 * Refused 0 0 44. Next I’m going to describe different issues that might affect how comfortable a patient feels about discussing STDs with a doctor or other health professional. Please rate how important each one is to you, very important, somewhat important, not very important or makes no difference.
The first [next] is (insert list). (Single response)
Where the conversation takes place, such as the exam room or in a private office:
Very important (4) 26 Mean: 2.5 Somewhat important (3) 25 Not very important (2) 20 Makes no difference (1) 29 Don’t know 0 Refused 0 Whether you are certain that the conversation is completely confidential:
Very important (4) 80 Mean: 3.7 Somewhat important (3) 15 Not very important (2) 2 Makes no difference (1) 4 Don’t know 0 Refused 0 Whether you feel the health professional might be judging you:
Very important (4) 46 Mean: 3.1 Somewhat important (3) 27 Not very important (2) 14 Makes no difference (1) 13 Don’t know * Refused 0 Whether the health professional is a [rotate] woman or man/man or woman:
Very important (4) 19 Mean: 2.1 Somewhat important (3) 19 Not very important (2) 19 Makes no difference (1) 43 Don’t know 0 Refused 0
Talking About STDs With Health Professionals: Women’s Experiences:Press Release Report Survey Part One Part Two Part Three
Talking about STDs with Health Professionals: Women’s Experiences
Glamour/Kaiser Family Foundation National Survey
Methodology
Talking about STDS with Health Professionals: Women’s Experiences was conducted for the Kaiser Family Foundation and Glamour by Market Facts, Inc. The results are based on telephone interviews conducted between May 27 through June 1, 1997 with a sample of 482 women ages 18-44 who had been to a new doctor within the last year for gynecological or obstetrical care. These women were selected using Market Facts’ Consumer Mail Panel, a nationally balanced sample of households. All interviews were conducted by female interviewers. The margin of sampling error for results based on the total sample is plus or minus 5 percentage points at the 95 percent level of confidence.
Final Topline Data
Hello, may I please speak to (Ask for panel member)? This is ______ calling on behalf of Marie Brighton of the Consumer Mail Panel. Today I’d like to speak with the female aged (Insert age from sample) in your household. Would that be you?
Yes (Continue with remainder of Introduction) No (Ask to speak with that person, reintroduce and continue with remainder of Introduction — If not available, arrange callback) No one that age (Ask: Are you, or any other female in your household between the ages of 18 and 44? If Yes — Ask to speak with a female 18-44 and continue with remainder of Introduction; If No, terminate) Today I have a few questions regarding doctors and screening for sexually transmitted diseases. I’d like to remind you that your responses will be kept strictly confidential and that your responses here will be combined with that of approximately 700 other women we are interviewing and shown only as percentages.
1. My first question is… in general, how would you describe your own health? Is it excellent, good, only fair, or poor? (Single response)
Excellent 47 Good 48 Only Fair 3 Poor 1 Don’t know 0 Refused 0 2. Do you have a doctor or other health care professional who you see regularly for gynecological care that is, for annual exams, birth control, or other reproductive health care? (Interviewer Note: If respondent has a regular place to go for care, but no regular provider at that place, record as “no.”) (Single response)
Yes 93 No 7 Don’t know 0 Refused 0 3. When was the last time you visited a doctor or clinic for gynecological or pregnancy-related care? Would you say your last visit was within (read list)? (Single response)
The past month 24 1-3 months ago 30 4-6 months ago 23 7 months to 1 year ago, or 23 More than 1 year ago Terminate) Never Been (Don’t read) (Terminate) 4. And was this most recent visit for prenatal care or gynecological care? (Single response)
Prenatal/Pregnancy-related care 18 Gynecological 82 Don’t know * Refused 0 4b. Was this most recent visit at a private doctor’s office, a family planning clinic, or some other type of clinic? (Single response)
Private doctor’s office 75 Family planning clinic 10 Some other type of clinic 15 Don’t know 0 Refused 0 5. Was this most recent visit your first appointment with this (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) or had you been there before? (Single response)
First visit 46 Been there before 54 Don’t know 0 Refused 0 5b. How long ago was your first appointment with this (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Read list) (Single response)
Based on those whose most recent appointment was not their first appointment. (n=261)
The past month 2 1-3 months ago 15 4-6 months ago 21 7 months to 1 year ago, or 62 More than 1 year ago (Terminate) Never Been (Don’t read) (Terminate) [If “been before” at Qu. 5 say:] For the remainder of this survey, we are going to ask about your first visit to this (doctor’s office [If private “doctor’s office” or “DK/REF” AT Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])
6. What type of doctor or health professional did you see at (this visit [If first at Qu. 5] / your first visit [If been before at Qu. 5])? Was it an ob/gyn, a general practitioner, some other type of doctor, or health professional? (Single response)
Ob-gyn/Gynecologist/Obstetrician 70 General Practitioner/Family Practice Doctor/Internist 18 Other type of doctor, such as a specialist or a surgeon 3 Other, such as a nurse practitioner, a nurse midwife, or physician’s assistant 9 Don’t know * Refused 0 7. Was the health professional a man or woman? (Single response)
Male 49 Female 51 Don’t know 0 Refused 0 8. Why did you go to a new health professional? (Do not read list) (Multiple response)
I changed health insurance coverage/health plans 20 I moved 17 Because of current problem or question 11 Referred to this doctor by another health professional or clinic 10 I got pregnant 8 Previous doctor closed/moved 8 Didn’t like previous doctor 6 I got health insurance coverage 6 For a pelvic exam or pap smear 5 To get established with a doctor in case of need 4 My first gynecological visit 3 Just wanted change/Other general change mentions 3 Wanted doctor closer/More convenient 3 Regular doctor not available 2 Wanted female doctor 2 Friend/relative/co-worker recommended 2 Less expensive 1 I lost health insurance coverage 1 Previous doctor too expensive * I am planning to get pregnant * I don’t have a regular doctor * Refused * 9. Thinking about this first visit, were you asked to fill out a form with questions about your medical history? (Single response)
Yes 92 No 7 Don’t know * Refused 0 10. Did this form have specific questions on it about current or past sexual activity, such as number of sexual partners, contraceptive use, or sexually transmitted diseases? (Single response)
Based on those asked to fill out a form. (n=445)
Yes 54 No 40 Don’t know 7 Refused 0 11. Were you worried about whether your answers to the questions on this form would be keptconfidential? Would you say you were (read list)? (Single response)
Based on those who filled out a form with sexual history questions on it. (n=239)
Very worried 1 Somewhat worried 2 Not too worried, or 16 Not at all worried 81 Don’t know 0 Refused 0 Now I am going to ask you some questions about what you and your health professional discussed at this first visit. Your answers to these questions will be kept completely confidential, and your responses will be shown only in combination with the many other women we survey.
12. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss pap smears with you at this visit? (Single response)
(If respondent says the doctor did a pap smear, probe with: Did he or she just perform the pap smear, or did they have a discussion with you about pap smears?)
Yes 74 No 26 Don’t know * Refused 0 13. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed pap smears. (n=357)
You 16 Someone in your doctor’s office/clinic 81 Don’t know 3 Refused 0 14. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss breast self-exams with you? (Single response)
(If respondent says the doctor did a breast exam, probe with: Did he or she just perform the breast exam, or did they have a discussion with you about breast self-exams?)
Yes 74 No 26 Don’t know * Refused 0 15. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed breast self-exams. (n=357)
You 6 Someone in your doctor’s office/clinic 94 Don’t know 1 Refused 0 16. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss mammograms with you? (Single response)
(If respondent says the doctor did a mammogram, probe with: Did he or she just perform the mammogram, or did they have a discussion with you about mammograms?)
Yes 41 No 58 Don’t know 1 Refused 0 17. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed mammograms. (n=197)
You 16 Someone in your doctor’s office/clinic 83 Don’t know 1 Refused 0 18. Have you ever had a mammogram yourself? (Single response)
Yes 34 No 66 Don’t know 0 Refused 0 19. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss birth control with you? (Single response)
Yes 54 No 46 Don’t know 0 Refused 0 20. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed birth control. (n=259)
You 37 Someone in your doctor’s office/clinic 62 Don’t know 1 Refused 0 21. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss alcohol use with you? (Single response)
Yes 25 No 73 Don’t know 2 Refused 0 22. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed alcohol use. (n=121)
You 5 Someone in your doctor’s office/clinic 95 Don’t know 0 Refused 0 23. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss AIDS or HIV with you? (Single response)
Yes 21 No 78 Don’t know 1 Refused 0 24. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed AIDS or HIV. (n=101)
You 10 Someone in your doctor’s office/clinic 89 Don’t know 1 Refused 0 25. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) ask you about your sexual history and current sexual activity? (Single response) (Do not read list)
Yes 38 No 59 Asked about sexual history, but not current sexual activity * Asked about current sexual activity, but not sexual history 1 Don’t know 2 Refused 0 26. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)
Based on those who discussed sexual history or sexual activity. (n=188)
You 7 Someone in your doctor’s office/clinic 92 Don’t know 1 Refused 0 27a. Where did the discussion take place? (Do not read list) (Multiple response) (If respondent says “examining room” probe with: Was that while you were dressed or undressed?)
Based on those who discussed sexual history or sexual activity. (n=188)
In doctor’s personal office 42 In examining room while you were dressed 41 In examining room while you were undressed 14 In counseling room 3 In waiting room 2 All other 2 Don’t know 1 Refused 0 27b. Where would you have preferred this conversation took place? Would you say (read list)? (Single response)
Based on those who discussed sexual history or sexual activity. (n=188)
In doctor’s personal office 45 In examining room while you were dressed 43 Doesn’t matter 4 In examining room while you were undressed 3 Don’t know 5 Refused 1
Talking About STDs With Health Professionals: Women’s Experiences:Press Release Report Survey Part One Part Two Part Three
If a condom breaks, a diaphragm slips, or you realize after having sex that you forgot to take the pill for three days in a row, it can be enough to make the calmest person very upset! Fortunately, there is something you can do. If you act within 72 hours after unprotected intercourse, two doses of a special combination of birth control pills, available by prescription, can prevent or delay ovulation and reduce the chance of pregnancy by about 75 percent. The method is called emergency contraception (the morning-after pill).
You can get the pills from a doctor or a family planning clinic. If there is any chance you might already be pregnant you’ll need a pregnancy test. (If you are pregnant, the treatment won’t work.) The medication isn’t without side effects, though; nausea, especially, is very common for a day or so. And it’s not foolproof – it only reduces your chance of pregnancy by 75%. And even if it does work, the pregnancy protection doesn’t last so you’ll need to go back to another birth control method right away. Generally, emergency contraception costs $55 to $245 for the whole shebang (examination, pregnancy test, and pills); costs are less – or even free – at family planning clinics and health centers. To find a provider near you, you can call the Emergency Contraception Hotline at 1-888-NOT2LATE.
What Doesn’t Work
If you’re considering any of these folklorist contraceptive methods, fuhgeddaboudit!!! Here’s why:
How to Negotiate with Your Partner
Think you might be ready to have sex with a special someone? Before deciding, make sure you’ve considered all the issues and discussed them with your partner. After all, the decision is – always! – up to both partners. Here are three tricky sexual scenarios and solutions for how to handle them:
Scenario #1: You’re thinking about having sex but you’re just not comfortable talking about it with your partner.
Solution: First things first: If you can’t talk about it, how are you going to feel comfortable doing it? Maybe one of you thinks that talking about sex kills the mood or that it should just happen naturally when the moment is right. Wrong, wrong, wrong. Talking about sex can actually help you trust each other more and feel closer to each other because it shows you care. But most importantly, it helps you make wiser decisions, and if you decide to begin a sexual relationship, to plan ahead to protect yourselves against pregnancy and STDs. In fact, you should hash out what you’re willing to do and what you’re not and agree to use condoms for your mutual protection before things get too intimate.
Scenario #2: Your partner does not want to use a condom.
Solution: Some people will use a zillion lame excuses to weasel out of using condoms so you’d better be armed with a snappy comeback. If she says, “It takes away the romance,” you could say, “So could getting an STD.” If he says, “I can’t feel anything with a condom,” tell him “You’ll feel even less if you don’t use one because we won’t be having sex.” If she swears she won’t give you any diseases, tell her it’s nothing personal but you want to make sure both of you stay healthy. The bottom line: Don’t feel bad about saying “No condom, no sex.”
Scenario #3: You’ve already had intercourse together but now you realize that it’s just too soon for you – and you don’t want it to happen again.
Solution: It’s not too late to slam on the brakes. One thing to keep in mind is that just because you’ve done it once or twice doesn’t mean you have to do it again and again. It’s okay to say “no” to any part of sex at any time, regardless of what you’ve done in the past. The key is to be firm and clear – hopefully, before you get to the undressing stage – about how you’re feeling and what you want for the future. If your partner tries to push the issue, stand your ground, and remind him or her how strongly you feel about slowing things down. Anyone worth your time and affection should respect that.
You’ve heard about all these scary things that can happen to you if you don’t practice safer sex, and you may even know people who have caught sexually transmitted diseases (STDs). Which isn’t surprising, considering that at least one in four people will contract an STD at some point in his or her life. What is there to worry about? Plenty. Here’s what you need to know about the risks of unprotected sex.
Each year more than 12 million Americans, including 3 million teenagers, are infected with STDs, and many of them probably thought they didn’t need to worry about protection. While a few STDs are just annoying, many others can have lasting effects on your health and sex life. We all know that HIV is an incredibly deadly STD. In fact, half of all new HIV infections occur in people under 25, and AIDS has become the leading cause of death among Americans between the ages of 25 and 44. And if you think the new AIDS drugs you have been hearing about are a magic cure, forget it. They are hard to take, often have strong side effects, and do not always work. Other STDs can cause nasty recurrent symptoms, such as painful or itchy sores, and a select few can cause death or increase the risk of cancer for both women and men. What’s more, several STDs can cause infertility, meaning you could never have children.
And get this: Almost any STD increases your chances of contracting HIV. In fact, people who already have an STD, like herpes, gonorrhea or chlamydia, are three to five times more likely to become infected with HIV than someone who does not have an STD if they have unsafe sex with an HIV-positive partner.
It’s a myth that you can tell if someone has an STD by the way he or she looks or acts. That wholesome-looking guy or woman may look safe and seem safe but appearances can be deceiving. After all, you’re not just having sex with that person but with everyone they’ve ever had sex with . . . and everyone THEY’VE ever had sex with… and… well, you get the point. Because lots of STDs have no symptoms (or only subtle ones), your partner may not even know he or she has one. That’s why if you have had sex in your life, you should get tested for STDs like chlamydia, and for HIV, even if you have no symptoms and are feeling just fine.
To be blunt about it: The only way to be sure you’re having safer sex is to keep your partner’s blood, semen, or vaginal fluids out of your body. Abstinence is the safest course. But, if you’re going to have sex, always use a condom.
How can you tell if you’re infected with an STD?What should you do if you are?
If you’ve been experiencing burning urination; heavy, smelly discharge from the vagina, penis or anus; bumps, sores or itching in the genital area; pain or tenderness in the pelvic area; or other funky symptoms, you may have a sexually transmitted disease. In that case, you need a medical visit right away so you can get tested.
Why is it important to get tested early? Because if you have an STD and don’t know it – and so don’t get treatment – you could pass it on to your partner and you could risk your health and your ability to have kids in the future. Not all STDs are curable, but even for ones that aren’t, treatments are available that can help. If you have HIV, for example, finding out early means you can take advantage of new medications that are more effective if you take them before you start to get sick.
If you are a woman and you’ve been experiencing cramping or persistent pain in the abdomen or back; abdominal tenderness with movement or going to the bathroom; abnormal vaginal discharge; pain during intercourse; or any of these symptoms with a fever over 100.5 degrees Fahrenheit – these may be signs of pelvic inflammatory disease (PID). If you have these symptoms, see a doctor or go to a clinic or a hospital emergency room immediately; PID can lead to infertility in a woman if it’s left untreated. PID can also be silent – an infection that spreads to your tubes from chlamydia or gonorrhea with no severe signs that could alert you that something is wrong.
Now, to get the inside scoop on the most common STDs, consult this table:
STD: Chlamydia What it is: A bacterial infection of the genital area. How many get it: About 4 million Americans each year; the highest rates are among women aged 15 to 19 – in fact, in some communities studies have found that up to 30 percent of sexually active teenage women and 10 percent of sexually active teenage men are infected. Signs: There are no symptoms in most women and many men who have it. Others may experience abnormal vaginal bleeding (not your period), unusual discharge or pain within one to three weeks of having sex with an infected partner. How it’s spread: Through vaginal or anal intercourse. Treatment: Oral antibiotics cure the infection; both partners must be treated at the same time to prevent passing the infection back and forth – and need to abstain from intercourse until the infection is gone. Possible consequences: Pelvic inflammatory disease (PID) in women, tubal (ectopic) pregnancy, infertility, and increased risk of HIV infection.
STD: Trichomoniasis (“Trich”) What it is: A parasitic infection of the genital area. How many get it: As many as 3 million Americans each year. Signs: Often there are no symptoms, especially in men. Some women note a frothy, smelly, yellowish – green vaginal discharge, and/or genital area discomfort, usually within 3 to 28 days after exposure to the parasite. How it’s spread: Through vaginal intercourse. Treatment: Antibiotics can cure the infection. Both partners need to be treated at the same time to prevent passing the infection back and forth – and need to abstain from intercourse until the infection is gone. Possible consequences: Increased risk of HIV infection; can cause complications during pregnancy. Also, it’s common for this infection to happen again and again.
STD: Gonorrhea What it is: A bacterial infection of the genital area. How many get it: Approximately 800,000 Americans a year; the highest rates are among women aged 15 to 19. Signs: Most women and many men who get it have no symptoms. For those who do get symptoms, it can cause a burning sensation while urinating, green or yellowish vaginal or penile discharge, and for women, abnormal vaginal bleeding, pelvic pain, and/or fever within 10 days of getting infected. It takes 1 to 14 days for symptoms – such as discharge or pain – to appear. How it’s spread: Through vaginal, oral, or anal intercourse. Treatment: Oral antibiotics. Both partners need to be treated at the same time to prevent passing the infection back and forth – and need to abstain from intercourse until the infection is gone. Possible consequences: PID, tubal (ectopic) pregnancy, sterility, increased risk of HIV infection. The infection can spread into the uterus and fallopian tubes. It can also cause complications during pregnancy (including stillbirth) or infant blindness or meningitis (from an infected mom during delivery).
STD: Human Papilloma Virus (HPV) What it is: A viral infection with 60 different types, primarily affecting the genital area, both the outer and inner surfaces. How many get it: An estimated 500,000 to 1 million Americans per year; about 40 million people already have it. Signs: Soft, itchy warts in and around the vagina, penis, and anus, may appear two weeks to three months after exposure. Many people, however, have no symptoms but may still be contagious. How it’s spread: Through vaginal or anal intercourse, or by touching or rubbing an infected area. Treatment: There is no cure. Warts can be removed through medication or surgery. Even with such treatments, the virus stays in the body and can cause future outbreaks. Possible consequences: Increased risk of genital cancer for men and women. Some virus types cause the most common form of cervical cancer in women.
STD: Genital Herpes What it is: A viral infection of the genital area (and sometimes around the mouth). How many get it: Between 200,000 and 500,000 Americans each year; an estimated 40 million Americans already have genital herpes. Signs: There are two kinds of herpes. Herpes 1 causes cold sores and fever blisters on the mouth but can be spread to the genitals; Herpes 2 is usually on the genitals. Nearly two – thirds of people who are infected with herpes don’t even realize it. An outbreak can cause red bumps that turn into painful blisters or sores on the vagina, penis, buttocks, thighs, or elsewhere. During the first attack, it can also lead to fever, headaches, and a burning sensation when you urinate. Symptoms usually appear within 2 to 20 days of infection but can take longer in some cases. The first outbreak is usually more severe than later recurrences. How it’s spread: By touching an infected area or having vaginal, oral, or anal intercourse. Warning: some people may be contagious even when they don’t have symptoms. Treatment: There is no cure. An antiviral drug can help the pain and itching and also reduce the frequency of recurrent outbreaks. Possible consequences: Recurrent sores (the virus lives in the nerve roots and keeps coming back), as well as increased risk of HIV infection. May cause complications during pregnancy, possibly causing severe illness, disabilities, or (in rare cases) death for an infant if there is active infection during childbirth. (A cesarean section delivery can reduce this risk.)
STD: Syphilis What it is: An infection caused by small organisms, which can spread throughout the body. How many get it: About 120,000 Americans a year. Signs: In the first phase, sores may appear on the genitals or mouth about three weeks to three months after exposure, lasting for three to six weeks. Often, however, there are no noticeable symptoms. In the second stage, about three to six weeks after sores appear, a variety of symptoms can appear, including a rash (often on the palms of the hands and soles of the feet). How it’s spread: Through vaginal, oral, or anal sex – and through kissing. Treatment: Antibiotic treatment can cure the disease if it’s caught early, but medication can’t undo damage the disease has already done. Both partners must be treated at the same time. Possible consequences: Increased risk of HIV infection. If syphilis is untreated, about a third of people who reach the disease’s late phase may experience brain damage, heart disease, nerve damage, and other incapacitating health problems. If untreated, it can seriously harm or even kill a developing fetus during pregnancy.
STD: Hepatitis B Virus (HBV) What it is: A viral infection primarily affecting the liver. How many get it: About 200,000 Americans a year; more than 1.5 million people in the U.S. now have HBV. Signs: Many people don’t have any symptoms. Others may experience severe fatigue, achiness, nausea and vomiting, loss of appetite, darkening of urine, or abdominal tenderness, usually within one to two months of exposure. Yellowing of the skin and whites of the eyes (called jaundice), and darkening of the urine can occur later. How it’s spread: Through vaginal, oral, and anal sex – and through kissing. Also by sharing contaminated needles. Treatment: Most cases clear up within one to two months without treatment, during which complete abstinence from alcohol is recommended until liver function returns to normal. Some people are contagious for the rest of their lives. A vaccine is now available to prevent this STD. Possible consequences: Chronic, persistent inflammation of the liver and later cirrhosis or cancer of the liver; plus, 90 percent of babies born to women with HBV will carry the virus unless they are vaccinated within an hour of birth.
STD: HIV What it is: The human immunodeficiency virus (HIV), the cause of AIDS. How many get it: An estimated 40,000 to 80,000 Americans are infected each year. AIDS is the leading cause of death among Americans between the ages of 25 and 44. Signs: Many people who have HIV don’t even know it because symptoms may not appear for 10 years or longer. Others experience unexplained weight loss, flu-like symptoms, diarrhea, fatigue, persistent fevers, night sweats, headaches, mental disorders, or severe or recurring vaginal yeast infections. How it’s spread: Through body fluids such as blood, semen, vaginal fluids and breast milk – in other words, during vaginal, oral or anal intercourse; by sharing contaminated needles; via pregnancy or breast – feeding. During vaginal intercourse, the risks of catching the virus are higher for women than for men. Treatment: There is no cure – and AIDS is considered fatal. Several new antiviral medications can slow progression of the infection and delay the onset of AIDS symptoms. Early treatment can make a big difference. Possible consequences: It is the deadliest STD of all and can weaken the body’s ability to fight disease, making someone with HIV vulnerable to certain cancers and infections such as pneumonia. Fifteen to thirty percent of babies born to HIV – positive mothers can get the disease if the mother is not receiving treatment, but treatment can reduce that rate significantly.
Do you or your partner have any of these symptoms? If so, you can review the information in the corresponding sections, and consult your doctor.
It’s Your (Sex) Life; Your Guide to Safe & Responsible SexReport Two Part One Part Three