21st Century Sexuality

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2 21st Century Sexualities
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311 A new “digital sexual revolution” is shaping the way we understand, experience, and
4 live sexuality in the twenty-first century. The Internet, in particular, enables individuals
5 and groups to learn about sexuality, experience their sexuality in new ways, create
6 identities and sexual communities, and advocate for sexual rights and social justice.
7 Exploring this new era, 21st Century Sexualities brings together more than fifty timely
8 and accessible contributions to create a wide-ranging and compelling picture of
9 contemporary American sexuality. Including a superb editorial overview, it incorporates
20 the latest controversies, theory, and methodological material in the areas of:
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2 • sexual literacy
3 • media and sexual commodification
4 • sexual health and wellness
5 • sexual rights and activism
6 • globalization.
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8 Written by researchers and academics, as well as advocates and community-based
9 practitioners, this lively and comprehensive collection is packed with cutting-edge
30 research and advocacy material in sexuality studies. While it focuses on the US context,
1 attention is given to global dimensions of sexuality, particularly its social and cultural
2 aspects. It will appeal to undergraduates in women’s and gender studies, anthropology
3 and sociology, psychology and human development, contemporary media studies, and
4 public health.
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6 Gilbert Herdt, a cultural anthropologist, is Professor of Human Sexuality Studies and
7 Anthropology and Director of Human Sexuality Studies at San Francisco State
8 University, USA. He is also Director of the National Sexuality Resource Center.
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40 Cymene Howe is Assistant Professor of Anthropology at American University,
1 Washington, DC, USA.
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21st Century Sexualities
4 Contemporary issues in health,
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6 education, and rights
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311 Edited by
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5 Gilbert Herdt and
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Cymene Howe
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First published 2007

by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
1 by Routledge
270 Madison Ave, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2007 selection and editorial matter, Gilbert Herdt and Cymene Howe;
individual chapters, the contributors
This edition published in the Taylor & Francis e-Library, 2007.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
All rights reserved. No part of this book may be reprinted or reproduced or

utilized in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
21st century sexualities: contemporary issues in health, education,
and rights/edited by Gilbert Herdt and Cymene Howe.
p. cm.
Includes bibliographical references and index.
1. Sex—Social aspects. 2. Sex—Social aspects—United States.
3. Sexual ethics—United States. 4. Sex customs—United States.
5. Sex instruction—United States. 6. Sexual minorities—United States.
7. Hygiene, sexual—United States. 8. Sex—Computer network
resources. I. Herdt, Gilbert H., 1949–. II. Howe, Cymene.
III. Title: Twenty-first century sexualities.
HQ16.A18 2007
306.770973e090511—dc22 2006039007
ISBN 0-203-94747-9 Master e-book ISBN
ISBN10: 0–415–77306–7 (hbk)

ISBN10: 0–415–77307–5 (pbk)
ISBN10: 0–203–94747–9 (ebk)
ISBN13: 978–0–415–77306–5 (hbk)

ISBN13: 978–0–415–77307–2 (pbk)
ISBN13: 978–0–203–94747–0 (ebk)
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2 Contents
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311 List of contributors xi
4 Acknowledgments xix
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Introduction 1
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GILBERT HERDT AND CYMENE HOWE
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20 PART 1
1 Sexual literacy and learning sexuality 15
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3 1 What is sexual literacy, and why is it needed now? 17
4 GILBERT HERDT
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6 2 Folklore and the sexual lives of adolescents 20
7 MARIAMNE H. WHATLEY
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9 3 Contesting the dangerous sexuality of Black male youth 24
30 LINWOOD J. LEWIS
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2 4 Homophobia and harassment in school-age populations 29
3 CHRISTINE E. PETTETT
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5 5 Citizenship lessons: sexuality education in the United States 32
6 JESSICA FIELDS AND CELESTE HIRSCHMAN
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8 6 Transmen: behind assimilation, problems exist 35
9 JAMISON GREEN
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1 7 The meanings of rape 38
2 ANN J. CAHILL
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4 8 A play that looks at rape: a crime against women (and men?) 41
5 LESLIE SIMON
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7 9 The “down low”: new jargon, sensationalism, or agent of change? 44
118 GILBERTO R. GERALD
vi Contents
11 10 Teaching and learning: Latina sociology of sex 47
GLORIA GONZÁLEZ-LÓPEZ
11 Christian right rhetoric: exploring anti-gay politics online 50

A PROFILE OF JANICE M. IRVINE
PART 2
www., TV, and sexual commodification 53
12 Surfing for healthy sexualities: sex and the Internet 55

DEBORAH LEVINE
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13 Sexual networks online 57
GREGORY REBCHOOK AND ALBERTO CUROTTO
14 Halflings and ogres and elves, oh my!: sex, love, and relationships
in EverQuest 60
BRANDEE WOLESLAGLE
15 Finding Nemo and transgender creatures 63

JUDITH HALBERSTAM
16 The L Word: a little something for the femmetrosexual? 67

KRIS SCOTT MARTÍ
17 Six Feet Under brings abortion to the surface 69

TRACY A. WEITZ AND ANTHONY HUNTER
18 The pornography of consumption/the consumption of pornography 74

LINDA WILLIAMS
19 InnovAsian in pornography? Asian American masculinity

and the “porno revolution” 78
AMY SUEYOSHI
20 The Yin and Yang of sex work: female and male prostitution
compared 81
ANN M. LUCAS
21 Strip clubs and their regulars 85

KATHERINE FRANK
PART 3
Sexual health, wellness, and medical models 89
22 Doctors, patients, and sexuality 92

8 YOLANDA WIMBERLY AND SANDRA E. MOORE
Contents vii
1111 23 Capitalizing on women’s health: the myth of “female sexual
2 dysfunction” 95
3 LEONORE TIEFER
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5 24 Medical abortion and activism in medicine 98
6 ANGEL M. FOSTER, JENNIE SPARANDARA, AND LINDA PRINE
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8 25 Bringing medical abortion to rural America: interview with
9 an abortion provider 101

10 CAROLE JOFFE
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2 26 Aging and HIV: the changing face of AIDS 104
311 DAVID M. LATINI AND DAVID W. COON
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5 27 No place to call home: transgender persons, discrimination,
6 and HIV 107
7 RITA M. MELENDEZ
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9 28 High risk sexual behavior among young adults in the
20 US Navy 110
1 GENEVIEVE AMES, ANDREW BICKFORD, AND ANN RUSS
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3 29 Sexual networks of truckers, truckchasers, and disease
4 risks 112
5 YORGHOS APOSTOLOPOULOS, SEVIL SÖNMEZ, JENNIE KRONENFELD,
6 AND DONNA JO SMITH
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8 30 Addiction and the sex offender: is mental illness an excuse
9 for calculating crimes? 115
30 STANTON E. SAMENOW
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3 PART 4
4 Sexual activism and rights 119
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6 31 Not separate, still unequal: the Beijing agreement and the
7 feminization of HIV/AIDS 121
8 ADRIENNE GERMAIN AND JENNIFER KIDWELL
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40 32 The rise of the abstinence-only-until-marriage movement 124
1 MARTHA KEMPNER
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3 33 Beyond immigrant brothels: the criminal justice system and
4 trafficked persons 130
5 JUHU THUKRAL
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7 34 Marriage equality: the evolution of a traditional institution 132
118 ROBERT M. KERTZNER
viii Contents
11 35 Sexual prejudice: the erasure of bisexuals in academia and
the media 135
LORAINE HUTCHINS
36 Seeking help in rural communities: homophobia and racism

impact mental healthcare 140
CATHLEEN WILLGING, LISA CACARI-STONE, LOUISE LAMPHERE,
RAE LEWIS, AND BONNIE DURAN
37 Disability and sexuality: from medical model to sexual rights 145

RUSSELL P. SHUTTLEWORTH
1 38 Pity dates and the paralyzed playa: the dating scene after
spinal cord injury 149
TRE TREFETHEN
39 Heterosexual and bisexual S/M: cultural formations 154

KATHY SISSON
40 Ms etiquette and the transgender employee: is nothing private

any more? 157
JILLIAN TODD WEISS
41 At the Cesar Chavez Institute: bridging academic research

and community empowerment 160
JOYCE NISHIOKA
42 My intersex journey: from awkward teenager to human rights

activist 163
DAVID CAMERON
PART 5
The globalization of sexuality 167
43 Global perspectives on sexual rights 170

SONIA CORRÊA WITH CYMENE HOWE
44 Global impact: US sexual health and reproductive policy 174

RENÉE T. WHITE AND CYNTHIA POPE
45 Abstinence goes global: the United States, the right wing,

and human rights 178
CYNTHIA ROTHSCHILD
46 Sex work in contemporary Vietnam: foreign plague or

homegrown problem? 182
8 CHRISTOPHE ROBERT
Contents ix
1111 47 The moral economy of sex in Russia 186
2 JAKOB RIGI
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4 48 Nicaragua’s changing erotiscapes: hot bed of cold war takes
5 on sexual rights 190
6 CYMENE HOWE
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8 49 Sexuality in times of war 194
9 GILBERT HERDT
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1 50 Revealing the soldier: peacekeeping and prostitution 198
2 PAUL HIGATE
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4 51 “R and R” on a “hardship tour”: GIs and Filipina entertainers
5 in South Korea 203
6 SEALING CHENG
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Index 209
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2 Contributors
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311 Genevieve Ames, Ph.D. received her doctorate in medical anthropology from the
4 University of California at San Francisco and Berkeley. She is currently Adjunct
5 Professor in the School of Public Health, University of California, Berkeley and
6 Associate Director/Senior Scientist at the Pacific Institute for Research, Prevention
7 Research Center.
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9 Yorghos Apostolopoulos, Ph.D. is Visiting Professor of Social Epidemiology with
20 the Cyprus International Institute/Harvard School of Public Health, Cyprus
1 and Associate Clinical Professor of Medicine with the Emory University School
2 of Medicine, USA. His work examines the ways social structure and the built
3 environment affect health outcomes.
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5 Andrew Bickford, Ph.D. is an Assistant Professor of Anthropology at George Mason
6 University whose research centers on militarization, masculinity, public health, and
7 post-socialist societies. He has received awards from the Fulbright Foundation and
8 the Social Science Research Council and has a forthcoming book, Red Radiation:
9 The Cultural Politics of Militarized Citizenship in Germany.
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1 Lisa Cacari-Stone, Ph.D. is a W.K. Kellogg and Alonzo Yerby Post-Doctoral Scholar
2 at the Harvard School of Public Health. Her research focuses on public policies as
3 determinants of health for racial and ethnic populations in the southwest and Latino-
4 heterogeneity in health status, access and service utilization.
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6 Ann J. Cahill, Ph.D. is Associate Professor of Philosophy at Elon University. Her
7 research interests include feminist theories of the body and social and political
8 philosophy. She is the author of Rethinking Rape and is currently working on a
9 critique of the feminist concept of objectification.
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1 David Cameron, as a person with XXY sex chromosomes, has written about his
2 experience in Hermaphrodites with Attitude, Chrysalis, and Alice Dreger’s Intersex
3 in the Age of Ethics. He is an appointed member to the San Francisco Human Rights
4 Commission LGBT Advisory Committee and was a member of their Intersex Task
5 Force.
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7 Sealing Cheng, Ph.D. is Henry Luce Assistant Professor in the Women’s Studies
118 Department, Wellesley College. She researches issues of sexuality with a particular
xii Contributors
11 focus on sex work, migration, HIV/AIDS, and human rights. She is currently work-
ing on her manuscript Transnational Desires: Filipina Entertainers in US Military
Camp Towns in South Korea.
David W. Coon, Ph.D. has conducted extensive research on issues of sexuality, aging
and HIV, and has worked with the Institute on Aging in San Francisco.
Sonia Corrêa is the founder of SOS-Corpo, Gênero, Cidadania, a feminist non-

governmental organization based in Recife, Brazil. Since 1992 she has been a
member of DAWN (Development Alternative with Women for a New Era) as the
coordinator for sexual reproductive health and rights.
Alberto Curotto, Ph.D. is a Research Analyst at the Center for AIDS Prevention
1 Studies at University of California, San Francisco. In 2001, he began work on
research projects to study gay men’s Internet use and helped to design and evaluated
web-based, HIV-prevention programs tailored for the sociocultural needs of
gay men.
Bonnie Duran, Ph.D. is an Associate Professor in the Department of Family and

Community Medicine at the University of New Mexico. Her research focuses on
American Indian mental health and community-based participatory research.
Jessica Fields, Ph.D. is an Assistant Professor of Sociology at San Francisco State

University and a Research Associate in the SFSU Center for Research on Gender and
Sexuality. Her research explores the lessons students take from sex education about
the intersections of sexuality, race, and gender inequalities.
Angel M. Foster, D.Phil., A.M. is an Associate at Ibis Reproductive Health and the
2003–2004 President of Medical Students for Choice.
Katherine Frank, Ph.D. is a cultural anthropologist, fiction writer, and former exotic
dancer. She is the author of G-Strings and Sympathy: Strip Club Regulars and Male
Desire and a co-editor of Flesh for Fantasy: Producing and Consuming Exotic
Dance. She is currently researching how couples negotiate monogamy and writing
an ethnography of erotic couples’ tourism.
Gilberto R. Gerald, a Panamanian native and naturalized US citizen, is a 1974 Pratt

Institute graduate in architecture. Since 1983 he has worked in the lesbian and gay
rights movement and HIV/AIDS community-based work. He now supports these
efforts through consulting work. His writing has appeared in several books and
journals.
Adrienne Germain is President of the New York-based International Women’s Health

Coalition, which works to protect and promote the rights and health of girls and
women worldwide. She was a member of US government delegations to United
Nations conferences in the 1990s including the 1995 Fourth World Conference on
Women, in Beijing.
Gloria González-López, Ph.D. is Assistant Professor of Sociology at the University

8 of Texas at Austin. Born and raised in Monterrey, Mexico, she earned her Ph.D.
Contributors xiii
1111 from the University of Southern California. Her book Erotic Journeys: Mexican
2 Immigrants and their Sex Lives focuses on sexuality and immigration.
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4 Jamison Green is a writer and educator specializing in transgender and transsexual
5 health, safety, and civil rights, working internationally out of the San Francisco Bay
6 Area. He transitioned from female to male in 1988 at the age of 40, and is the author
7 of Becoming a Visible Man. For information, see www.jamisongreen.com.
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9 Judith Halberstam, Ph.D. is Professor of English and Director of the Center for
10 Feminist Research at University of Southern California. She is the author of Skin
1 Shows: Gothic Horror and the Technology of Monsters and Female Masculinity,
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and co-author with Del LaGrace Volcano of The Drag King Book and In a Queer
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Time and Place: Transgender Bodies, Subcultural Lives.
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6 Gilbert Herdt, Ph.D., a cultural anthropologist, is Professor of Human Sexuality
7 Studies and Anthropology and Director of Human Sexuality Studies at San Francisco
8 State University. Professor Herdt is also Director of the National Sexuality Resource
9 Center, a Ford Foundation-funded project. To learn about NSRC’s campaign for
20 sexual literacy go to sexliteracy.org.
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2 Paul Higate, D.Phil. is a Senior Lecturer in the Department of Politics at the University
3 of Bristol in the UK. His main interest is the masculine culture of the military. He is
4 currently researching perceptions and experiences of security in peacekeeping
5 missions using the concepts of space and place.
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7 Celeste Hirschman, M.A. is a researcher at the Center for Research on Gender and
8 Sexuality and a certified sexological bodyworker.
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30 Cymene Howe, Ph.D. is an Assistant Professor of Anthropology at American Univer-
1 sity whose research centers on social movements, subjectivity and sexuality in the
2 US and Latin America. She was a Mellon Postdoctoral Fellow at Cornell University
3 with a book forthcoming, Erotiscapes: Sex, Social Justice and Nicaragua’s New
4 Media Era.
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Anthony Hunter, B.A. completed his undergraduate work in Speech and Com-
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munication at San Francisco State University and attended the graduate program
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9 in Rhetoric and Communication at the University of California, Davis.
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1 Loraine Hutchins, Ph.D. teaches LGBT Studies, women’s health and health issues in
2 sexuality at the college level. She co-edited Bi Any Other Name: Bisexual People
3 Speak Out and is one of the co-founders of the US bisexual liberation movement.
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5 Janice M. Irvine, Ph.D. is a Professor of Sociology at the University of Massachusetts.
6 She is also the Director of the Five College Women’s Studies Research Center. Her
7 most recent book is Talk About Sex: The Battles Over Sex Education in the United
118 States.
xiv Contributors
11 Carole Joffe, Ph.D. is a Professor of Sociology at the University of California, Davis
and a Visiting Professor at the Bixby Center for Reproductive Health Research
and Policy at University of California, San Francisco. She is the author of Doctors
of Conscience: The Struggle to Provide Abortion before and after Roe v. Wade.
Martha Kempner is the Associate Director of Information and Education of SIECUS,

The Sexuality Information and Education Council of the United States. She oversees
the activities of SIECUS’s Community Advocacy Project including the monitoring,
analysis, and reporting of trends in sexuality education, as well the activities of

opponents of comprehensive sexuality education.
Robert M. Kertzner, M.D. is Associate Clinical Professor of Psychiatry at University

1 of California, San Francisco and Adjunct Associate Research Scientist in the
Department of Psychiatry, Columbia University. He has published in the areas of
adult development and gay and lesbian mental health, sexuality in older adults and
HIV and mental health.
Jennifer Kidwell is Communications Associate at the International Women’s Health

Coalition and a student at Columbia University’s Mailman School of Public Health.
Jennie Kronenfeld, Ph.D. is Professor of Sociology in Arizona State University’s

School of Social and Family Dynamics. Her research is in medical sociology, health
policy, health across the life course, health care utilization, and health behavior. She
is editor of research for Sociology of Health Care and co-editor of Health.
Louise Lamphere, Ph.D. is a Distinguished Professor of Anthropology at the

University of New Mexico. Her research focuses on gender and sexuality, women
and work, and health care policy.
David M. Latini works at the University of California, San Francisco in the urology
department.
Deborah Levine, M.A. is Executive Director of Internet Sexuality Information

Services. Ms Levine has worked online for 12+ years, beginning with Columbia
University’s Go Ask Alice! She teaches “Sexuality and the Internet” at San Francisco
State and is the author of The Joy of Cybersex and numerous academic papers.
Linwood J. Lewis, Ph.D. is Associate Professor of Psychology at Sarah Lawrence

College and Adjunct Assistant Professor of Medical Psychology at Columbia
University. His research interests range from development of sexuality in ethnic
minority adolescents and adults to the effects of culture and social context on
conceptualization of genetic health.
Rae Lewis, M.S., M.P.H., is a faculty member of Axia College of University of

Phoenix. Her research focuses on public health problems among special populations
and the ethics of research on people with serious mental illness.
Ann M. Lucas, J.D., Ph.D. earned her doctoral and Jurisprudence and Social Policy
8 degrees at the University of California, Berkeley. She is currently Associate Professor
Contributors xv
1111 in Justice Studies at San José State University. Her recent publications include “The
2 Work of Sex Work” (Deviant Behavior) and “The Currency of Sex,” in Rethinking
3 Commodification.
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5 Kris Scott Martí is a writer and researcher with a degree in Cultural Anthropology. She
6 specializes in lesbian culture and has contributed to Curve Magazine, Girlfriends,
7 National Gay and Lesbian Review, San Francisco Bay Area Reporter, and American
8 Sexuality. She is a former editor for AfterEllen.com and currently blogs for
9 Krisbeep.blogspot.com and AmericanSexuality.blogspot.com.

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1 Rita M. Melendez, Ph.D. is Research Associate at the Center for Research on Gender
2 and Sexuality and an Assistant Professor in Human Sexuality at San Francisco State
311 University. She received her Ph.D. in Sociology from Yale University and a Master’s
4 Degree in Biostatistics from the Mailman School of Public Health at Columbia
5 University.
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7 Sandra E. Moore, M.D. is an Assistant Professor of Clinical Pediatrics at the
8 Morehouse School of Medicine in Atlanta. She obtained her B.S. in Biochemistry
9 and African American Studies, and received her Medical Degree from the University
20 of Maryland Baltimore, completing her Pediatric Residency at the University of
1 Maryland Medical Center.
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3 Joyce Nishioka has received journalism awards for her writing on transgender issues
4 and sexual stereotypes of Asian Americans in the media. She is the editor of American
5 Sexuality magazine: americansexuality.org.
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7 Christine E. Pettett is a Ph.D. candidate in anthropology at Yale University with
8 research interests in sexuality, gender studies, public health, and public policy. Her
9 doctoral dissertation addresses the role of political economic factors in social justice
30 activism for lesbian and bisexual women in New Orleans, Louisiana.
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2 Cynthia Pope, Ph.D. is an Assistant Professor of Geography and Women’s Studies at
3 Central Connecticut State University. Her research focuses on gender and health
4 issues in the developing world. Her most recent work concentrates on HIV prevention
5 and risk perception in the Caribbean area (Cuba, Jamaica, Belize) and Uganda.
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7 Linda Prine, M.D. is a family physician at the Institute for Urban Family Health, and
8 is on the faculty of the Beth Israel Residency Program in Urban Family Practice in
9 New York City. She teaches abortion care and speaks at academic meetings on
40 integrating abortion care into mainstream family practice.
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2 Gregory Rebchook, Ph.D. is a researcher at University of California, San Francisco’s
3 Center for AIDS Prevention Studies. He is a sociocultural psychologist and has been
4 working in HIV prevention since 1987. His current interests include HIV prevention
5 for young gay/bisexual men and gay men’s Internet use.
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7 Jakob Rigi, Ph.D is an Assistant Professor in the Department of Anthropology at
118 Cornell University and the author of Post-Soviet Chaos: Violence and Dispossession
xvi Contributors
11 in Kazakhstan. He has published on the formation of the state, ethnicity, corruption,
youth, and the relationship between the state and capital in Kazakhstan and Russia.
Christophe Robert, Ph.D. earned his doctorate at Cornell University and is a

Postdoctoral Associate in the Council of Southeast Asia Studies and a Lecturer in the
Department of Anthropology at Yale University. He has conducted ethnographic
research in Saigon/Ho Chi Minh City, the Mekong Delta, and the city of Hue in
central Vietnam.
Cynthia Rothschild has been a human rights and sexual rights activist for close to
two decades. She is the Senior Policy Advisor for the Center for Women’s Global
Leadership, the author of Written Out: How Sexuality is Used to Attack Women’s
1 Organizing and other publications related to LGBT rights and HIV/AIDS. The article
included in this collection was written when the author was the program officer in
international policy at the International Women’s Health Coalition in New York.
Ann Russ, Ph.D. is an Associate Research Scientist at the Prevention Research Center.
Stanton E. Samenow, Ph.D. is a Clinical Psychologist in Alexandria, Virginia. He is

the author of Inside the Criminal Mind and Before It’s Too Late: Why Some Kids Get
Into Trouble and What Parents Can Do About It.
Russell P. Shuttleworth, Ph.D. is currently a Visiting Scholar at the Institute of Urban

and Regional Planning, University of California, Berkeley, and a lecturer in the
Human Sexuality Studies Program at San Francisco State University. Dr
Shuttleworth’s primary research and teaching interest is critical disability and
sexuality studies.
Leslie Simon, Ph.D. chairs the Women’s Studies Department at City College of San
Francisco and coordinates Project SURVIVE, the campus sexual violence prevention
program. Along with several community-based organizations, Project SURVIVE
has recently launched Expect Respect SF, which intends to bring a healthy relation-
ship program to all San Francisco high-school students.
Kathy Sisson serves on the Board of Directors for the Society for the Scientific Study
of Sexuality and the Advisory Board for the Woodhull Freedom Foundation. She has
published in the journals, The Journal of Sex Research, Archives of Sexual Behavior,
Sexualities, and the Lesbian and Gay Psychology Review.
Donna Jo Smith, M.A. is a doctoral candidate in the Graduate Institute of Liberal

Arts at Emory University and Research Associate in the Division of Infectious
Diseases, Emory University School of Medicine, where she specializes in qualitative
health research and gender and sexuality as they affect populations most at risk of
HIV.
Sevil Sönmez is Associate Professor with the Cyprus College School of Business in
Nicosia, Cyprus. Her research centers on the social psychological links between
8 population mobility (leisure and occupational) and health.
Contributors xvii
1111 Jennie Sparandara worked as Outreach Coordinator at the Access Project, an
2 organization committed to strengthening community action, promoting social
3 change, and improving health, especially for those who are most vulnerable.
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5 Amy Sueyoshi, Ph.D. teaches classes on race, gender, and sexuality in Ethnic Studies
6 and Human Sexuality Studies at San Francisco State University. She has published
7 works on Asian America sexuality history, cross-dressing, and same-sex marriage.
8 She is currently working on a manuscript on the intimate life of poet Yone Noguchi.
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10 Juhu Thukral, J.D. is the Director of the Sex Workers Project at the Urban Justice
1 Center. Her work on the legal concerns of sex workers combines her experience with
2 economic justice, health, and safety issues among low-income women of color,
311 particularly immigrants, and her work on sex workers’ labor rights.
4 Leonore Tiefer, Ph.D. earned her doctorate in physiological psychology. She re-
5 specialized as a clinical psychologist and has been affiliated with several New
6 York City medical schools. She has a sex therapy practice and authored Sex is Not a
7 Natural Act and Other Essays. In 2000 she began an educational campaign about
8 medicalization: www.fsd-alert.org.
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20 Tre Trefethen is a freelance writer in the Bay Area who has examined the divisions of
1 sexuality in science, sports, and politics.
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3 Jillian Todd Weiss, J.D. Ph.D. is Assistant Professor of Law and Society at Ramapo
4 College. Her area of research is law and transgender issues. She is the author
5 of journal articles on the subject and has consulted with many corporations on
6 transgender policy, training, and customer communications strategies.
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8 Tracy A. Weitz, PHD, MPA directs the Advancing New Standards in Reproductive
9 Health Program of the Bixby Center for Reproductive Health Research and Policy
30 at the University of California, San Francisco and serves as Associate Director for
1 Public Policy at the University of California, San Francisco’s National Center of
2 Excellence in Women’s Health.
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Mariamne H. Whatley, Ph.D. is Professor of Women’s Studies/Curriculum and
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Instruction, and Associate Dean in the School of Education at the University of
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Wisconsin-Madison. She writes about women’s health and sexuality education.
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She co-authored with Elissa Henken, Did You Hear About the Girl Who. . .?: Con-
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temporary Legends, Folklore, and Human Sexuality.
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9 Renée T. White, Ph.D. is Professor of Sociology and Co-Director of Black Studies at
40 Fairfield University. Her books include Putting Risk in Perspective: Black Teenage
1 Lives in the Era of AIDS and the forthcoming Globalization of HIV/AIDS: An
2 Interdisciplinary Reader. She co-edits the Journal of HIV/AIDS Prevention in
3 Children & Youth.
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5 Cathleen Willging, Ph.D. is a Research Scientist at the Behavioral Health Research
6 Center of the Southwest, a division of the Pacific Institute for Research and
7 Evaluation. Her research focuses on health care policy and the delivery of mental
118 health services in rural settings.
xviii Contributors
11 Linda Williams, Ph.D. is Professor of Film Studies and Rhetoric at the University of
California, Berkeley and teaches about popular moving-image genres, modes, and
media embodiment. Her books include: Hard Core: Power, Pleasure and the Frenzy
of the Visible and Playing the Race Card: Melodramas of Black and White, from
Uncle Tom to O.J. Simpson. She is currently completing a book entitled Screening
Sex.
Yolanda Wimberly, M.D., M.Sc. is an Assistant Professor of Clinical Pediatrics at

Morehouse School of Medicine in Atlanta, Georgia who practices adolescent

medicine and is on staff at Grady Health Systems in Atlanta and at Clark Atlanta
University Student Health Center.
1 Brandee Woleslagle is a Master’s degree candidate at San Francisco State University

in the Human Sexuality Studies Program.
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2 Acknowledgments
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311 The editors would like to sincerely thank Joyce Nishioka, Editorial Assistant, and
4 Ruslan Valeev, Administrative Manager, for their tireless and careful work coordin-
5 ating this project and contributing valuable perspectives from the outset. We also want
6 to thank each of the authors whose academic and advocacy work has made this
7 collection possible. This book has also been enriched by the keen editorial support
8 we have received at Routledge, and we extend our appreciation to our Editor, Grace
9 McInnes, and the editorial team headed by Sue Leaper at Florence Production. Finally,
20 we wish to thank the Ford Foundation for its generous support of the National Sexuality
1 Resource Center and the American Sexuality magazine project.
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2 Introduction
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Gilbert Herdt and Cymene Howe
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311 In the twenty-first century, sexuality has become more public than ever before—with
4 the media and Internet serving as new vehicles for sexual expression. This anthology
5 explores how these changes in sexuality have influenced American culture and in turn
6 have been influenced by the global society. Today, sexuality is more present in print
7 media, television and film, but it is also more talked about than it has been in the past.
8 Yet the real revolution in sexuality is how the Internet has infused our think-
9 ing, intimate relations, and politics. For the first time in history people are making
20 friends and finding sexual and romantic partners online, some of which result in
1 marriages and long-term relationships. People are also forging political movements
2 online as never before. These transformations in intimacy and politics have expanded
3 the ways that we think about sexuality, too. Such changes in technology and social
4 development and political change also go a long way in explaining why sexuality has
5 taken on an unprecedented importance in the twenty-first century.
6 This book serves two kinds of purpose. It provides an overview of many of the
7 contemporary dynamics, including politics, regarding sexuality in the United States
8 and around the globe in the twenty-first century—often from an “insider’s” point of
9 view. Additionally, the chapters are analytically challenging, providing new ways
30 to think about sexuality, in all of its meanings, in many cultural contexts, online, and
1 in the “real world.”
2 The definition of sexuality has expanded dramatically in the past generation. It has
3 come to mean not simply sex, but gender identities and roles, sexual orientation,
4 eroticism, pleasure, intimacy, and reproduction, all of which correspond to the way that
5 Americans have come to understand sexuality today.1 The Web2 is an enormous and
6 expanding global information platform, providing new forms of communication as well
7 as new romantic and sexual possibilities for individuals and groups. The Internet helps
8 people to become sexually literate by facilitating sexual experiences that allow people
9 to create new identities and sexual communities. These tools also support political
40 advocacy for new sexual rights and social justice in the US and globally. This anthology
1 provides rich but succinct materials through which the student can make a study of such
2 changes online and in real social encounters.
3 Tracking the changing faces of sexuality and encouraging new kinds of sexuality
4 education, is part of the mission of a major online magazine, American Sexuality
5 (americansexuality.org).3 American Sexuality features the work of interdisciplinary
6 research scholars, social scientists, advocates, and teachers in the fields of anthropology,
7 sociology, psychology, and health—striving to better understand sexuality in the context
118 of US and global cultures. This book draws together many of the stories and experiences
2 Gilbert Herdt and Cymene Howe
11 of diverse individuals and groups, as well as cutting-edge research in the field of
sexuality studies that we have gathered through our work with American Sexuality. We
particularly support the positive side of sexuality, while also providing the information
needed to separate fact from fiction and science from superstition.
“Sexuality + Internet” brings revolutionary change. Both the cultural and individual
meanings surrounding sexuality have undergone such a radical transformation that
sexuality will never be the same again. From our vantage point, communications
technologies and the community platforms they provide constitute a new “digital sexual
revolution” shaping the way people understand, experience, and live their sexuality in
the twenty-first century. Using the Internet as a powerful tool to address structural
inequalities between sexual cultures, young people and social scientists, alike, have
engaged a new way of thinking about the nature of sexual inequalities in the world
1 today (Teunis and Herdt, 2006). This book is about the many sides of contemporary
sexuality and gender in the real world and on the Internet—both of which suggest that
we are in a new era for sexuality and for sexuality studies.
Surprisingly, this new sexual revolution has not been a part of school curricula or
integrated into most classrooms. Quite a few universities now offer courses on sexuality
and the Internet,4 but as of yet, few of these general courses on gender, sexuality, women,
and lesbian, gay, bisexual, transgender, and queer (LGBTQ) identities have incorporated
the world of online sexuality into their curricula. Sexuality online is, broadly understood,
an array of informational websites and recreational services related to romance and
dating, sexual health, and diverse sexual and gender communities on the Internet.
Information about sexuality now comes via digital books, research papers about
sexuality and sexual development, and ever multiplying media sources from TV,
newspapers, and magazines to blogs, MySpace, and Facebook.
Increasingly, the media portrays sexuality online as a preoccupation of young people,
with some spending up to fifteen hours a day on the Internet, much of it devoted to
friendship, sexual and romantic interests, and games. Undoubtedly some of this con-
tent online concerns parents, who may already face difficulties addressing sexual
development in their children. Meanwhile, the commercialization of the Internet has
accelerated at a dizzying pace: providing packaged sex and literally millions of com-
mercial sites, selling products from Viagra to pornography and sex toys. Not long
ago a New York Times article about a new strain of HIV reported that many men now
use the Internet for finding sexual partners, bypassing bars and other social spaces. As
authors such as Yorghos Apostologpoulous et al. point out in this book, the incidence
of HIV infection is often predicated, not simply on individual risk behaviors, but upon
the larger social contexts in which people make choices about their sexual health. Dating
and sexual services are becoming more frequent on the Internet, and with this has come
a rise in incidents of exploitation and victimization. In very public spaces, such as
shopping malls and high schools, young people now also use cell phones to text message
for dates, seeking out romantic and sexual relationships. Parents and the older generation
remain relatively oblivious to these changes in how dating and relationships are being
shaped by technology in this new information age.
Exploring sexuality via new technologies poses many challenges to people—how do
you separate the good from the bad, the ludicrous from the dangerous, or truth from
fiction? How do you make decisions about online dating, sexual health, pornography,
and romantic experiences, and how do you avoid sexual predation? Teachers,
8 understandably, may be hesitant to introduce these topics into discussion. However,
Introduction 3
1111 these experiences are already happening right there in the classroom, through cell
2 phones, laptops, handhelds, iPods, and other bridging technologies that connect people.
3 In order to better understand the cultural changes we are all facing, we need to think
4 broadly and comprehensively.
5 This collection addresses the sweeping changes that are unfolding before us everyday.
6 21st Century Sexualities is divided into five parts. We begin with “Sexual Literacy
7 and Learning Sexuality” seeing sexuality, not merely as a biological process or “drive,”
8 but as something that is learned and socially constructed. In “www., TV, and Sexual
9 Commodification” we query how technologies, the media, and sexuality as a commod-

10 ity are changing how we negotiate our sexuality on a daily basis. In the third part of
1 this collection, “Sexual Health, Wellness and Medical Models,” the medicalization
2 of sexuality is critiqued. Here, we also recognize the dire need for medically accurate
311 and easily (and anonymously) accessible information on sexually transmitted infec-
4 tions (STIs) and unintended pregnancies. As Yolonda Wimberly and Sandra Moore
5 point out, honest communication with physicians is critical particularly considering
6 the health disparities faced by many communities of color in the United States. The
7 articles collected in “Sexual Activism and Rights” and “The Globalization of Sexuality”
8 —such as Joyce Nishioka’s discussion of the Cesar Chavez Institute and Cymene
9 Howe’s article on sexuality activism in Nicaragua—identify strategies and new models
20 of activism in the United States and transnationally.
1
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Sexual literacy and twenty-first century sexuality
3
4 Today’s world requires a new kind of pedagogy that teaches people how to navigate
5 sexuality online and make use of a vast new world of informational tools and data, while
6 also sorting fact from fantasy. In this book we call that goal sexual literacy. Sexual
7 literacy is defined here, and in Gilbert Herdt’s chapter, as the ways in which people
8 become knowledgeable and healthier sexual beings—protecting themselves from
9 HIV/AIDS and STIs, avoiding unintended pregnancy, and understanding sexual
30 violence such as date rape. Indeed, as both Ann Cahill and Leslie Simon describe in their
1 respective articles on rape, understanding the meaning of rape in society is critical to
2 eliminating it. One of our goals in supporting “sexual literacy” is to follow the US
3 Surgeon General’s lead in helping young people make healthy sexual choices.5 The
4 United States has fallen behind other Western countries in creating healthy sexual
5 communities because it has not followed the advice of the top medical doctor in the
6 United States. Part of the reason has to do with the way that politics and ideology have
7 replaced science and education.6 But sexual literacy also centers on the positive side of
8 sexuality—learning to enjoy and appreciate sexual identities, the body, romance,
9 pleasure, and intimate relations. The process of becoming sexually literate links
40 individuals to larger communities and ultimately to society, supporting individual
1 development and democracy.
2 People in their teens and twenties have grown up with the Internet. It is not surprising
3 that many students think in ways adapted to this new technology. For young people
4 today, information has always been just a few clicks away. But sometimes the
5 information is biased, inaccurate, or saturated with politics. Young people think
6 differently about the world because they are able to communicate with friends from
7 across the country or across the globe. And yet, there are many differences in education,
118 cultural models, and values surrounding sexuality. So far, this developmental experience
11 with the Internet has hardly been reflected in what or how college students learn in the
classroom. Meanwhile, as this technological revolution has occurred, sex education in
schools and in the public domain has gone on the defensive. The US government’s
official policy promoting “abstinence only” sex education undermines sexual literacy
(as Cynthia Rothschild shows in “Abstinence Goes Global: The United States, the Right
Wing, and Human Rights”).
The new ease and comfort of working with computers and on the Internet creates a
distinct developmental subjectivity—or way of thinking about sexuality—that makes
sexuality online seem normal and natural. Yet this is all so new! Sexuality and the
Internet intersect, but there are also more familiar domains of learning about sexuality
through experiences in school, like the “myths” we hear growing up, as Mariamne H.
Whatley describes in “Folklore and the Sexual Lives of Adolescents.” The media poses
1 developmental challenges for young Black men—as Linwood J. Lewis describes in
“Contesting the Dangerous Sexuality of Black Male Youth”—which coincides with
the experience of many people of color who face racism and discrimination. On the
other hand, Judith Halberstam finds children’s media, like the movie Finding Nemo,
reflecting potentially transgressive narratives that allow for more gender and sexual
ambiguity than one might expect from Hollywood fare. Living with the Internet over
the past decade, young people have forged a revolution without fully realizing its
implications.
Sexuality and reproductive research: just now catching up

with the digital sexual revolution
Given the huge changes introduced by the digital revolution at the advent of the twenty-
first century, it should not be surprising that sexual cultures have adopted this new
electronic platform. However, few experts predicted it. As recently as the mid 1990s,
experts reviewing sexuality research and policy completely ignored the Internet.7 The
Web, meanwhile, grew exponentially. When President Clinton came into office in 1992,
for example, there were fewer than a hundred websites and email correspondence was
uncommon. Fourteen years later, as many as seven million new sites are added to the
World Wide Web daily, some 50 to 80 percent originating in the United States alone
(Schrader, 2002). There are literally tens of millions of websites, blogs, chat rooms,
and online commercial venues associated with cybersex and sexual and romantic
interactions online. In other words, sexuality has been a critical element in motivating
the emergence of the Internet and the new cultural forms we find online. A new world
of sexual identity formation, sexual health information, and sexual rights advocacy and
debate has been born in this medium.
Sex has expanded exponentially on educational, commercial, governmental, political,
and personal websites and blogs. However, the study of sexuality and reproductive
health has fallen far behind this massive increase in sexual information online. In many
of these venues, sexuality is portrayed as an individual issue, as something medical, or,
in the words of Leonore Tiefer in this collection, “medicalized.” WebMD and a variety
of related sites provide excellent sexual health information. But it is important to
recognize that sexuality is also a social, cultural, political, and legal issue, subject to
definition by the government at times and often the topic of debates. As Stanton E.
Samenow describes, a fixation on medical reasoning in the case of “sex addiction” can
8 too easily dismiss abusive behavior. Legal dictates that define certain behaviors,
Introduction 5
1111 identities, and relationships as “good” and integral to “good citizenship” are part and
2 parcel of defining putatively “appropriate” persons in the contemporary United States.
3 Often, these political and legal codes are extended to include what is acceptable in
4 schools, neighborhoods, towns, and communities, as Jessica Fields and Celeste
5 Hirschman describe in their article. The “culture wars” (Duggan and Hunter, 1995) that
6 have raged over issues such as abstinence-only education, abortion rights, and same-
7 sex marriage exemplify the volatile debates that erupt when culture, society, and
8 sexuality are brought together in public forums.
9 The lag in how sexuality education is taught is another important reason for the
10 gap between sexuality, reproductive research and the digital sexual revolution. Sex
1 education, as it is bandied about in the culture wars, Janice Irvine (2002) notes, is largely
2 confined to classrooms, school boards, and community meetings. It is notable that the
311 major battles over abstinence-only sex education, the official US government policy,
4 center entirely on the classroom, not on the Internet, even though new technologies of
5 sexual information are clearly having an enormous impact on what we know and learn
6 about sexuality. In short, the major institutions of our society, especially public
7 education in middle and high schools, have failed to keep up with the technological
8 revolution in the arenas of sexuality education, health, and rights. In fact, there are
9 powerful contradictory trends online. As Deborah Levine suggests here, the Web has
20 expanded what is considered “normal” sexuality, even as certain extremist groups aim
1 to restrict what counts as normal in the definition of sexuality.
2 Today, in our late capitalist market economy, we should not be surprised to find that
3 money and power are inextricably linked to sexuality and romance online. Sex and
4 adult entertainment is big business. Billions of dollars are spent on commercial online
5 venues, including those devoted to hardcore pornography. Some of America’s most
6 prestigious media companies net billions of dollars of annual profit from these adult
7 entertainment platforms, while very little money is spent to promote sexual literacy.
8 Obviously, the market for sexual entertainment is strong, provoking moral and political
9 concerns for many people. It is important that sexual education not fall by the wayside.
30 As any perusal of the Internet will show, many websites use sexual imagery or content
1 and spam with gratuitous and often offensive sexual content, even when there is no
2 apparent connection to the stated goals of the Web host. Despite the exponential growth
3 of sexual content online, many people still fail to appreciate how easily sexual cultures
4 have adapted to the Internet. How did American sexuality get to such a place? A brief
5 glance at its history over recent decades sheds light on this question.
6
7
A history of sexuality: from moral panic to moral panic
8
9 The sexual history of the United States follows from important social, economic, racial,
40 and political fault lines that have been intensively studied.8 A brief history of sexuality
1 after World War II shows how the rise of the Web is a dramatic departure from the past.
2 America has a legacy of sexuality that reveals repeated cycles of “sexual hygiene,”
3 “social purity” movements, and crises in gender politics. Sexuality in America has
4 been subject to “moral panics”—that is, periods when sexuality becomes a heightened
5 political, moral, or ideological issue. Rather than focusing upon intimacy, romance,
6 and sound public health, these periods of panic place attention on questions of morality
7 that are, not surprisingly, contentious, embattled, and often cyclical. Coined in the early
118 1970s by British sociologist Stanley Cohen to identify “conditions, persons, episodes,
11 and groups that are defined as a threat to societal values and interests,” moral sexual
panics have historically inflamed such issues as masturbation, abortion and reproductive
rights, teen pregnancy, homosexuality, AIDS, and, most recently, marriage rights for
gay and lesbian people.
A notable review of the field of sexuality research conducted by sociologist John
Gagnon and anthropologist Richard Parker in 1995 identified several fundamental
transformations that have occurred during this turbulent period of history. A key change
they uncovered was a shift in epistemologies, or ways of knowing. In researching
sexuality, some scholars moved away from psychoanalytic frameworks and began to
favor social and cultural approaches to understanding sexual processes. Methodologies
also changed among some researchers, from clinical or psychological survey methods
to more social and cultural approaches. With these shifts in scientific thinking, there was
1 an expansion in the populations studied, including homosexuals, women, and diverse
ethnic and racial communities. Finally, researchers realized the key importance of the
media, following the tremendous attention paid to the famed studies of zoologist Alfred
Kinsey beginning in 1948. As dramatized in the film Kinsey, Kinsey’s work got him on
the cover of Time magazine and awakened America to the chasm between small town
ideals of sexuality (which excluded masturbation and extramarital sexual relations) and
the realities of Americans’ sexual behavior.
Government-funded studies in the late 1950s to 1970s tended to focus on adolescent
mothers and unintended pregnancy. Following the invention of the birth control pill in
1964, a greater “de-coupling” of reproduction and sexual behavior began to occur
in American attitudes toward sexuality. The work of psychologists Masters and Johnson
dramatically demonstrated a shift in understanding: sexuality was not only a matter of
reproduction, but also one of pleasure and intimacy. In particular, women’s sexual-
ity became an important new arena through which to understand the complexity of
human sexuality. During the 1960s, the “sexual revolution” saw the advent of what
Edward Laumann and colleagues (1994) referred to as “recreational sex” in American
culture. Gradually displacing an older discourse on disease, sexual dysfunction,
and gender abnormalities, was a newer dialogue about adult consensual pleasure and
intimacy. Social constructionist views on sexuality have rightly emerged and are
gradually replacing the “disease model” that has so often pathologized female sexuality.
However, as Leonore Tiefer describes in this collection, this has not meant the end
of medicalizing sexuality. Meanwhile, new forms of sexual citizenship—that is, the
full acceptance of sexual identities within public life—have became a part of society,
media, and individual development (Weeks, 1985). Years later sexual citizenship
remains highly contested, as it is in the question of whether same-sex couples have the
right to marry or adopt children.
Feminism and gay and lesbian rights movements further shifted American sexuality.
The women’s health movement in the 1970s created a new paradigm for women taking
charge of their health. Following the landmark decision of Row v. Wade in 1973,
abortion rights were established and back-alley abortions and coat-hanger surgeries
were laid to rest. Coincidentally, in that same year, the American Psychiatric Association
declassified homosexuality as a disease, beginning a transformation in debates about
sexual rights and the lives of LGBT people in the United States.
Beginning in the late 1970s and early 1980s, sexuality education became increas-
8 ingly embattled and the focus of a new wave of sexual conservatives. This political
Introduction 7
1111 transformation grew during the emergence of the AIDS epidemic in the early 1980s when
2 homosexuals, commercial sex workers, Haitian immigrants, and others were targeted
3 as scapegoats. This rising tide of reaction led to moral panic surrounding homosexuality
4 but, paradoxically, it provided unprecedented funding for research on gay men, lesbians,
5 bisexuals, and their communities since HIV prevention became an urgent public health
6 priority. Bisexuality also came to be viewed as a “bridge” to HIV and STI infection
7 (Gagnon, 2004). The twin concepts of “desire” and “danger” became central new van-
8 tage points for sexuality research and education during this time (Vance, 1984) and
9 have continued to be influential, now, increasingly, on television and online. As Kathy

10 Sisson points out here in her discussion about S/M activism, online communities provide
1 new ways of talking about desire and danger, providing fertile territory for exploring
2 new variations in sexual and emotional relationships among heterosexuals.
311 Compared to other “First World” or “developed” countries, the United States con-
4 tinues to have an abysmal level of sexual literacy. The continued prevalence of HIV
5 transmission, unintended pregnancies, sexual violence, STIs, abortion complications,
6 and homophobic violence in US high schools, as Christine Pettett describes in
7 “Homophobia and Harassment in School-Age Populations,” all point toward a decline
8 in sexual literacy. The quantity of research on sexuality has generally been on the
9 increase but the relative rise in sexual literacy has been low. The sheer increase in
20 sexuality information should have resulted in a well-educated public but because of
1 cultural and political forces has remained largely unrealized.
2 The 1990s opened new paradigms concerning sexual rights among research scholars,
3 influenced by sexual health and rights advocacy, LGBT social movements, and
4 emphases on gender and feminist perspectives (Parker et al., 2000). Sexuality became
5 increasingly politicized and fiscally conservative—an integral element of what Lisa
6 Duggan and others have described as the neoconservative social, political, and sexual
7 movement (2003). Masturbation, for example, became a topic of scientific study and
8 public health discussion; yet Dr Jocelyn Elders, MD, was immediately fired from her
9 position as US surgeon general for just mentioning that masturbation might provide an
30 alternative to risky sexual practices (Irvine, 2005). Growing partly from the AIDS-
1 prevention and education movement, queer politics and advocacy also emerged as
2 a challenge to liberal articulations of gay and lesbian identity (Vaid, 1995; Warner,
3 1999; Howe, 2001). Intellectual innovations intent on “queering” the social sciences
4 and humanities (Foucault, 1978; Butler, 1990) were also instrumental in rethinking
5 transgender identity and practice. While gender nonconformity, akin to contem-
6 porary transgender sensibilities, certainly existed in the United States prior to this
7 time (Kennedy and Davis, 1993; Feinberg, 1993), the 1990s saw new opportunities for
8 creating transgender communities. Now, as Jillian Weiss explains in this collection,
9 transgender people are challenging their workplaces to adequately provide for gen-
40 der diversity. Only near the close of the twentieth century has an online transgender
1 movement emerged, capitalizing on the Internet as a unique platform for mobilizing
2 a global transgender movement—one of the most dramatic forms of new social justice
3 advocacy using the Web (Herdt, 2004). Perhaps because there are few “symbolic
4 homes” for transgender people in society, online venues have become extremely
5 important. As Rita M. Melendez suggests in her article, many transgender people are
6 vulnerable to discrimination and HIV infection; at the same time, Jamison Green points
7 out that new opportunities for transforming one’s gender have become more accessible
118 and acceptable in recent years.
11 The pedagogy of sexuality has radically changed with the introduction of online
materials. The coupling of the digital revolution with the pioneering Surgeon General’s
report (Call to Action) on comprehensive sexuality education in the US (Satcher, 2001)
represents a watershed of change. Notably, this is the only Surgeon General’s Report,
one which covered topics such as the health risk of smoking, that was never officially
endorsed by the US Government. The Report was released to provide a counterweight
to the US government’s official policy on “Abstinence Only” education rather than the
previously widely used “comprehensive sexuality education” policy (which included
education on abstinence and use of contraceptives, etc.). Abstinence-only is an

educational policy largely bereft of scientific credibility (Kirby, 1997). To understand
these federal policies, as Martha Kempner points out here, we must acknowledge the
contemporaneous rise of the abstinence-only-until-marriage movement. The US
1 government opposed publication of the Report and it was bitterly contested by right-
wing anti-sex education organizations (Irvine, 2002). The emphasis on abstinence-only,
as Renée T. White and Cynthia Pope describe in “Global Impact: US Sexual Health and
Reproductive Policy,” has not been limited to the United States but also has had global
impact since these policies are deployed worldwide.
In the 1990s, sexual rights as a human right became established. Sexual rights, a
concept growing from “women’s rights as human rights” and the United Nation’s con-
ferences and forums on the status of women, have proliferated in many places around
the world. As Sonia Corrêa notes in “Global Perspectives on Sexual Rights,” the con-
cept of universal human rights has changed the way governments and international
governmental networks, such as the United Nations, now treat sexuality. Adrienne
Germain and Jennifer Kidwell explain, for example, how the “feminization of AIDS”
is a phenomenon that must be addressed at the international level. Just as the second
wave of feminism and gay and lesbian rights movements from the 1960s and 1970s in
the United States changed the shape of society and research on sexuality, so too do
sexual rights discourses now impact the way in which rights on the global stage are
advocated. Admittedly, however, sexual rights remain challenging to American society.
Sexuality in the twenty-first century has been changed by online sexuality, sexual
politics, and emerging sexual cultures that have come through a variety of national and
international debates, both old and new. From abstinence-only policies in school sex
education, medicalization and sexual dysfunction in popular culture, abortion and
reproductive politics, same-sex marriage debates, the “Don’t Ask, Don’t Tell Policy”
in the military, and the media’s role in representing all these dynamics—we have found
that in order to successfully engage with the study of education, health, rights, and
culture in general, one must first understand how these sexual controversies are linked
to broader concerns in science and research. Our approach incorporates the theoretical
and substantive perspectives of gender and socioeconomic status, race and ethnicity,
sexual diversity, and disability. We also know that advocates are looking for a “big
picture.” In order to undertake productive activist work, one needs to know how these
issues fit together with theory and politics as part of a larger cultural system. In light of
the historical changes we have experienced in the United States around sexuality, what
meanings are now attributed to sexuality, broadly, in our culture?
Searching: making meaning out of sexuality online

Reviewing history provides a context for thinking about changes in sexuality theory,
8 methodology, and themes in both American society and research priorities. While
Introduction 9
1111 expanding meanings and practices of sexuality, romance, and intimacy online may have
2 seemed inevitable, as we have shown, they are so recent that rules and norms have not
3 yet been established to fully deal with these changes. Based on these dramatic shifts,
4 we have found key themes that frame how we understand sexual desire, sexual politics,
5 gender and sexual behavior, HIV/STIs, and adolescent and adult sexual behavior and
6 intimate relations:
7
8 • The pedagogy of sexuality is sex education online, gender and reproductive infor-
9 mation, and, to a lesser extent, sexual rights. But it is more than that, too. As we
10 spend more time online and begin to form social spaces and sexual lives there, we
1 now face fundamental shifts in the way we understand sexuality.
2 • Sexual health and wellness constitutes a sea of information online—some specious
311 and some accurate—about sexual health, behavior, transmission, and treatment.
4 This wealth of information is often politicized, requiring a careful analysis of the
5 sources of information.
6 • The Internet, online worlds, and the commodification of sexual experience are
7 all issues we have to deal with today. Think of online dating, blogs and chat
8 rooms, adult entertainment and pornography, online commercial sex websites,
9 and the multiple sites available to create intimate relationships, often organized for
20 profit.
1 • New sexual communities have formed online and in the “real world.” These are
2 now often the spaces where identities are formed, advocacy strategies planned,
3 and communities created—transgender and intersex communities being recent and
4 important case in point.
5 • The Internet has also led the way to global interconnections, communications, and
6 political and social justice advocacy. It is no secret that the Internet has shaped
7 media and advocacy strategies. From local nonprofits to global organizations such
8 as the United Nations or Amnesty International, online advocacy now crosses many
9 borders. For sexual rights, the online world is now a key staging ground for
30 innovations in social justice struggles, where ideas and political practices from
1 multiple cultures and political contexts can be exchanged.
2
3 The tremendous availability of sexuality online can have the negative effect of
4 reproducing racial and heterosexist stereotypes about gender, sexual, and ethnic
5 minorities in particular. These stereotypes, like the sexual panic surrounding the “down
6 low” in African American communities, existed long before the Internet. But they have
7 been exaggerated by television, print media, and the Web, as Gilberto R. Gerald points
8 out here. The media may perpetuate “bi-phobia” or erasure, as Loraine Hutchins writes.
9 Or, as Gregory Rebchook and Alberto Curotto point out, Internet chatrooms may
40 reinforce stereotypes about gay men being “overly” interested in sexual encounters.
1 The Internet also provides a new space of pedagogy for queer, transgender, and straight
2 youth who find support in their efforts to mobilize responses to homophobia in the
3 schools. As these advocacy perspectives show, the Internet allows a means of avoiding
4 intolerance, hostility, and judgment online and expanding the concept of what is
5 “normal.”
6 But how far can normality extend, some authors ask? For example, can a man with
7 cerebral palsy or spinal cord injury actually “do that”—that is, engage in sex? Russell
118 P. Shuttleworth notes in “Disability and Sexuality: From Medical Model to Sexual
11 Rights” that people often ask this question, following the stereotype that people with
disabilities do not have a sexual life. From Shuttleworth’s vantage point, disability
rights must be about more than access to buildings and employment; they must include
sexual rights for disabled persons. Tre Trefethen would agree: since he became wheel-
chair bound, dating, sex, and love are perhaps more important to him now than before
his accident. In these and others cases, as Gloria González-López describes, a
fundamental question for minority populations in teaching and learning about sexuality
is: How do we challenge inequalities?
As we consider how we now negotiate sexuality online and in our lives, it may be
helpful to remember an important theory introduced by sociologist John Gagnon
(2004)—the sexual script. Scripts are the means by which sexual interactions are socially
organized, according to Gagnon, providing “lines” and “roles” for people to play as if
1 they were performers on stage. Sexual scripts help provide the necessary beliefs and
meanings to accompany each stage of sexual development as well as the changes that
occur from one life stage to the next, from childhood to young adulthood for example.
Sexual scripts have three primary dimensions: intrapsychic, what goes on inside
someone’s head; interpersonal, guides to intimate relations in dating, courtship,
marriage, extramarital relations, etc.; and cultural, the specific and often gender-specific
rules and beliefs for playing out a role in a particular sexual culture, institution, and social
event.
The Internet, it should be fairly obvious, blurs the boundaries between these different
types of sexual scripts. Take for example online gaming, which involves hundreds of
thousands of individuals. As Brandee Woleslagle reports from her research about
Everquest, some people locate romantic partners and even find marriage through their
personas online. When someone’s private reality can be merged with their online world,
and then collectively transformed through an online game, chat room, or symbolic
identity, the personal and the cultural become reflected and connected as never before.
Sexual roles, identities, and activities in the online medium are highly ambiguous,
allowing for the creation of new sexual networks. Television commercials that promote
dating services are indirectly driving people to these new electronic venues for romance,
love, and sexual connection. Television, film, and commercial pornography also tend
to blur the sexual scripts that have existed in US culture. TV shows such as Will and
Grace and The L Word have made great strides toward expanding viewers’ sense of
sexual diversity, working to “normalize” gay and lesbian identities and practices.
However, as Kris Scott Martí notes here about The L Word, critiques can be leveled
about the commodification of lesbian and gay identities. In cable TV shows such as Six
Feet Under, subjects, such as abortion, are brought into the public domain through
entertainment, but not without controversy, as Tracy Weitz and Anthony Hunter note
in their review.
In the world of online relationships and TV portrayals, readers may ask: Isn’t this just
an illusion, imagination, or fantasy? Perhaps television, media, and pornography do
appear this way with their mass appeal and high profit dimensions. Are we witnessing
a phenomenon that is “onscence” rather than one that is “obscene”? asks Film Studies
and Rhetoric scholar Linda Williams. The porn industry produces immense quantities
of material designed for sexual entertainment, and as Amy Sueyoshi describes, some
of this material reproduces racial and gender stereotypes. Cutting across the world of
televised and online images is the commodification of sexuality. In some sense, this
8 is nothing new: we have all heard the hackneyed expression that “prostitution is the
Introduction 11
1111 world’s oldest profession.” But with the rapid circulation of images and the trafficking
2 of people, rights regarding sex work and pressing questions about transnational sex
3 work are critical matters of our times. Juhu Thukral describes how combating sexual
4 trafficking has become central to activists working on both local and global levels,
5 though often to the exclusion of other social justice concerns. The advent of sex work
6 on a global scale has been augmented by the Internet, though again, it certainly preceded
7 the Internet. While Katherine Frank analyzes the motives of men for visiting strip
8 clubs and its socioeconomic dimensions, Ann M. Lucas underscores the racialized
9 and gendered dimensions of sex work on the streets of the United States. Jakob Rigi
10 and Christophe Robert provide international dimensions of changing values around
1 sex work, respectively on “moral economies” in Russia and “foreign plague” discourses
2 in Vietnam.
311 Of course, sexual health, risk, and wellness are not fantasies—they are real and can
4 have deadly consequences if mishandled or handled with ignorance. A decision made
5 in the heat of passion, conditioned by social values or motivated by love, can have
6 lifelong health effects. Whether for women seeking abortion care in rural settings, as
7 described by Carole Joffe in “Bringing Medical Abortion to Rural America: Inter-
8 view with an Abortion Provider” or among aging men and women across the country
9 who are at risk for HIV infection, as described by David M. Latini and David W. Coon,
20 concerns that appear to center on private decisions are in fact couched in very public
1
policies generally. Medicine, itself, for Angel Foster et al., has now become a site for
2
health advocacy among some medical students, who are trying to change the politics
3
of the medical industry. In rural settings too, as Cathleen Willging and colleagues
4
show, homophobia impacts the provision of mental healthcare for indigenous people
5
and Latino/as in the southwestern United States. Medicine and healthcare are not areas
6
7 without controversy, which is especially clear in debates around intersexuality and
8 genital surgery. As David Cameron illustrates, these medical interventions have now
9 become a concern of human rights activists. In all of these examples, the intersection
30 of sexuality and medicine now often speaks to much broader arenas for social concern
1 and activism.
2 Movements are afoot in the United States and other parts of the world to legalize
3 marriage for gay men and lesbians. It is a unique moment in history that is controversial,
4 strongly opposed by some and welcomed by others. Here, Robert M. Kertzner has
5 reviewed these issues and provides a foundation for thinking about this latest chapter
6 in the long history of the sexual rights movement. While same-sex marriage is
7 controversial on the national political stage, the “normalization” of gay and lesbian
8 relationships has also been contentious among some queer rights activists who aim to
9 disrupt categories of sexuality and gender, and the trappings of marriage. Following
40 Michael Warner’s argument in The Trouble With Normal, has “normalcy” in gay and
1 lesbian life been purchased to accommodate heterosexual norms at the expense of
2 creating queer alternatives to social life?
3 Sexual rights movements and advocacy around the world have become one of the
4 most fertile arenas for understanding sexuality. How are women able to negotiate
5 condom use and remain healthy when their sexual and reproductive rights are questioned
6 or undermined? Raising the rights of women following the Beijing Accord, trying to
7 combat homophobia, or advocating for the rights of sexually trafficked persons are new
118 arenas for thinking about social justice and offer new venues for mobilizing opposition
11 to inequality. For example, the first official act of President George W. Bush was to re-
instate the global “gag rule,” which forbids US foreign aid funding to be given to family
planning NGOs (non-governmental organizations) that provide counseling or referral
for abortion, or which advocate to make abortion legal or more accessible in their
countries (Girard, 2004). Abstinence-oriented HIV/AIDS prevention programs raise a
new specter of US sexual and health policy influence abroad. In sexual and reproductive
rights work, people are now questioning and critiquing the potential damage that has
been done to women, men, and children’s health in developing countries through such
global programs.
The role of war, militaries, and peacekeepers are things not often associated with
sexuality. However, it is very clear, especially in recent years, that these are deeply
interrelated. Too often in the twentieth century, as Gilbert Herdt explains, hyper-
1 masculinity, sexual humiliation, and rape are used as tools of war. As we enter new
conflicts in the twenty-first century, such as the Iraq war, a fundamental question
remains: Why does sexual conquest and sexual humiliation continue to be a part of war
today? Genevieve Ames, Andrew Bickford, and Ann Russ show how military cultures
become partially shaped by alcohol consumption and the intermediate social space of
having a “leave” for recreational sex. Paul Higate, writing about the war-ravaged Congo,
explains that condom distribution and notions of appropriate behavior and relationships
with local people is critical for UN peacekeepers in the region. Sealing Cheng also
describes the intimate relationship between militarization, US military bases in the
Philippines, and the rise of sex work in and around these outposts. Does the relationship
between war and sexual abuse reveal a dark side of human nature that requires further
study? We suspect so. Connecting research to these real world challenges is a critical
aspect of sexuality and gender studies today.
Sexual cultures and online sexual communities are not simply about finding sex,
romance, and chat. They are, rather, sites that are filled with possibilities for cultural
creativity, political change, and the emergence of new forms of human development and
human rights. “Sex” or “sexuality” in our twenty-first century model, profoundly
impacted by visual and communications media, does not preclude marriage and
reproduction. Far from it. But neither does it imply a singular focus on love and marriage
between men and women, as was typical in an earlier era of history. Today the Internet
is transforming all these sexualities—and we invite you to reflect deeply on how your
life is changing too, as you enter the world of these readings about sexuality online.
Notes
1 The World Health Organization suggests this omnibus working definition as well.
2 The Web is “made of many sites linked together; users can travel from one site to another by
clicking on hyperlinks.” Or “The World Wide Web is the universe of network-accessible
information, an embodiment of human knowledge.”—Tim Berners-Lee, inventor of the World
Wide Web. Retrieved; On-line Encyclopedia, 1998.
3 A publication of the National Sexuality Resource Center at San Francisco State University—
a long-term project supported by the Ford Foundation.
4 In 2000, The Program in Human Sexuality Studies at San Francisco State University created
a regular elective course on Sexuality and the Internet, taught in a “smart classroom,” that has
been highly successful.
5 See A Call to Action: Surgeon General David Satcher’s Report (2001) on sexual health, sexual
health disparities, and the need for accurate information.
8 6 F. Girard (2004).
Introduction 13
1111 7 For example, in her 1995 (Ford Foundation funded) report on sexuality in the United States,
2 Dr Diane DiMauro, one of the foremost leaders on sexuality and social issues in the US, did
not need to mention the net in her comprehensive review of the scientific literature!
3 8 See, for example, J. Weeks, Sexuality and Its Discontents (New York: Routledge & Kegan
4 Paul, 1985); J. D’Emilio and E. Freedman, Intimate Matters (New York: Harper & Row, 1988);
5 and contrast Smith-Rosenberg, C. 1975. “The female world of love and ritual: Relations
6 between women in nineteenth century America.” Signs 1: 1–29.
7
8 References
9 Butler, J. 1990. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.
10 DiMauro, D. 1995. Sexuality Research in the United States. New York: Social Science Research
1 Council.
2 Duggan, L. 2003. The Twilight of Equality? Neoliberalism, Cultural Politics, and the Attack on
311 Democracy. Boston, MA: Beacon.
4 Duggan, Lisa, and Nan D. Hunter. 1995. Sex Wars: Sexual Dissent and Political Culture. New
York: Routledge.
5
Feinberg, L. 1993. Stone Butch Blues: A Novel. Ithaca, NY: Firebrand.
6 Foucault, Michel. 1978. The History of Sexuality: An Introduction. New York: Vintage.
7 Gagnon, J.H. 2004. An Interpretation of Desire. Chicago, IL: University of Chicago Press.
8 Gagnon, J. H., and R. Parker. 1995. Introduction: Conceiving Sexuality. New York: Routledge.
9 Girard, F. 2004. Global implications of US domestic and international policy on sexuality. IWGSSP
20 Working Paper No. 1. New York: Columbia University.
1 Herdt, G. 2004. “Sexual development, social oppression, and local culture.” Sexuality Research and
2 Social Policy 1: 1–24.
3 Howe, Cymene. 2003. Queer pilgrimage: the San Francisco homeland and identity tourism.
4 In Lee D. Baker (ed.) Life in America: Identity and Everyday Experiences. Oxford: Blackwell,
pp. 284–264.
5 Irvine, Janice. 2002. Talk About Sex. Berkeley, CA: University of California Press.
6 Irvine, Judith. 2005. Harmful to Minors. Preface by Jocelyn Elders. Minneapolis, MN: University
7 of Minnesota Press.
8 Kennedy, E., and M.D. Davis. 1993. Boots of Leather, Slippers of Gold: The History of a Lesbian
9 Community. New York: Routledge.
30 Kirby, D. 1997. No easy answers: research findings on programs to reduce teen pregnancy.
1 Washington, DC: National Campaign to Prevent Teen Pregnancy.
2 Laumann, E.O., J.H Gagnon, R.T. Michael, and S. Michaels. 1994. The Social Organization of
3 Sexuality: Sexual Practices in the United States. Chicago, IL: University of Chicago Press.
Parker, R., M.R. Barbosa, and P. Aggleton (eds) 2000. Framing the Sexual Subject: The Politics
4
of Gender and Power. Berkeley, CA: University of California Press.
5 Satcher, D. 2001. The Surgeon-General’s Call to Action to Promote Sexual Health and Responsible
6 Sexual Behavior. July 9, 2001. Available from URL: http://www.surgeongeneral.gov/reports
7 publications.html.
8 Schrader, A.M. 2002. Technology and the Politics of Choice: Information Literacy, Critical
9 Thinking, and Intellectual Freedom. March 15, 2002. Available from URL: http://www.learning
40 resources.ab.ca/Freedom.html.
1 Teunis, N., and G. Herdt (eds) 2006. Sexual Inequalities and Social Justice. Berkeley, CA: Univer-
2 sity of California Press.
3 Vaid, U. 1995. Virtual Equality: The Mainstreaming of Gay and Lesbian Liberation. New York:
Anchor Books.
4 Vance, Carole. 1984. Pleasure and Danger: Toward a Politics of Sexuality. New York: HarperCollins.
5 Warner, M. 1999. The Trouble with Normal: Politics, and the Ethics of Queer Life. New York: Free
6 Press.
7 Weeks, J. 1985. Sexuality and Its Discontents; Meanings, Myths, and Modern Sexualities. New
118 York: Routledge.
8
1
11
1111
2 Part 1
3
4
5 Sexual literacy and learning
6
7
8
sexuality
9
10
1
2
311 The very idea of needing to “learn” sexuality may seem like nonsense. After all, aren’t
4 we all born with innate sexual drives, desires, and the biological capacity to reproduce—
5 making us all naturally sexual beings? Don’t we all have a sexual self that is a physical,
6 psychological, and emotional part of who we are? Well, yes and no. Clearly, we do not
7 learn our sexuality in the same way that we learn the multiplication table or the periodic
8 chart. And it is true that science has shown us a variety of physiological, endo-
9 crinological, and developmental factors that influence our physical sexuality and hence
20 our sexual selves. But we also know that the cultural and social environments in which
1 we grow up and live have at least as much, if not more, to do with how we think about,
2 and live, our sexuality.
3 This Part is an opportunity to consider how it is that we each learn about sexuality—
4 whether through personal experience, through friends and family, in school, or,
5 increasingly, online. But even beyond considering how you have learned your sexuality
6 as an individual, this Part asks you to think about how society and the cultural contexts
7 in which we live actually shape and determine how we learn about sexuality and,
8 ultimately, how we behave. Learning sexuality encompasses many processes over
9 time—shaping how we think about our bodies, our desires, our emotions as well as how
30
we relate to other people through those channels. Sexuality goes beyond our genitals to
1
be sure. We now know that it involves the whole body. But sexuality is also profoundly
2
influenced and learned according to the ways that our families, communities, and culture
3
4 talk about, understand, and conceive of it. In this sense, our sexuality is not simply
5 “ours” as individuals but part and parcel of larger social dynamics that are constantly
6 unfolding around us.
7
8 From sex ed to sexuality education in schools
9
40 Many of us have had sex education classes. Sex ed in schools can be traced all the way
1 back to the 1900s when a venereal disease epidemic in the United States led the Society
2 of Sanitary and Moral Prophylaxis to insist that schools prepare young people to protect
3 themselves from disease. For the next fifty years, schools and organizations—such as
4 the YMCA and the National Education Association—created and taught sex education,
5 not only to maintain public health, but also to promote gender roles and behaviors
6 considered appropriate for males and females. Priority was placed on making positive
7 choices through knowledge about one’s body rather than on practicing avoidance
118 techniques associated with earlier VD-prevention curricula.
11 In the 1980s sex education in schools also began to question traditional gender role
socialization and included diversity components in the curricula, allowing non-
heterosexual students to see themselves reflected in a range of human sexual behaviors
and identities. During this time, sex education in many schools broadened its purpose—
becoming “sexuality education” that addresses human sexual diversity as well as
strategies for avoiding disease and pregnancy. This was also the era of a new public
health crisis: HIV/AIDS. Sexuality education needed to approach the epidemic from
many angles, including instruction on the proper use of condoms and strategies to build
self-esteem in order to encourage less risky sexual behaviors. In some sense, sex ed had
come full circle: from a concern with sexually transmitted diseases, to a stress on family
planning and alternative sexualities, and back again to a focus on disease transmission.
The 1980s were also the beginning of the battles around sex education, which continue
1 into the present.
The big questions and controversies surrounding sex education have revolved around
how much information young people should receive about contraception (birth control)
and different kinds of sexual practices and sexual identities. For many, the question is:
If young people hear about these things aren’t they more likely to do them? For others,
the real concern is about young people having access to a wide range of information
so they can make good decisions about their sexual behavior and identities. As one
would imagine, sexuality education curricula has led to charged controversies about
the morals and values underlying each of these approaches. Heated debates around
what should be included and what should be excluded continue to rage in school board
meetings, church gatherings, and the national political arena. Currently, federal dollars
are being funneled into “abstinence only until marriage” sex education curricula
and teaching. This approach to educating young people has not been scientifically
proven to delay intercourse, prevent pregnancy, or curb the spread of STDs, but its core
tenet—namely that teens should not have sex until they are married—seems to appeal
to many policymakers.
Understanding sexuality in context

To think that we learn about sex and sexuality only in school would be naive. Many of
us talk with friends about sexual techniques and experience during adolescence and
sometimes throughout our entire lives. Talking about sex and sexual feelings with
friends is a great thing if you feel comfortable doing so. But, of course, there is always
the question about whether the information you are getting is accurate. Can you get
herpes if you use a condom? Is homosexuality a lifestyle choice or biologically
determined from birth? Some answers can be found by going to good, reliable sources
of sexual health information. Other questions are really better understood through
talking, analyzing, and thinking about what sexuality means for you, your friends,
family, and social world. In this Part, it will also become very clear that not everyone
has an equal opportunity to learn about, explore, and think about their feelings around
sexuality. There are ways that racial and gender stereotypes impact the way we see
others, and sometimes ourselves. The media, for one, continues to play a major role in
what we consider attractive, what we desire, and what we think is a “correct” kind of
sexuality. This Part puts these kinds of questions up for discussion. Here you can
challenge what you think you know about sexuality and consider learning through a new
8 set of lenses.
1111
2 1 What is sexual literacy, and why
3
4 is it needed now?
5
6 Gilbert Herdt
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311 Americans are fixated on sex. This obsession is age-old and not unique to the United
4 States, but the packaging is new—and it is causing harm.
5 Contrary to what the pundits say, we do not love sex. We are deeply ambivalent about
6 sexual pleasure and intimacy. Parents worry about whether their teens are “doing it.”
7 Teachers of sexuality education avoid mentioning the “P” word—that is, pleasure—
8 because it inspires fear and near panic, even among parents. Why is this? Poor sexual
9 literacy. Part of the problem is that sexuality education is too little and too late, and, for
20 many people growing up, that leads to misunderstanding and fear. We can change the
1 climate and this chapter suggests why we should.
2 Americans harbor a collective concern about issues such as unintended pregnancy,
3 sexually transmitted diseases, and sexually active youth, and now fear, bordering on
4 panic, of gays and lesbians gaining the right to marry. Indeed, moral panics are common
5 in the history of American sexuality. The term “moral panics” was coined in the early
6 1970s by sociologist Stanley Cohen to identify conditions, persons, episodes, and groups
7 that are defined as a “threat to societal values and interests.” In the nineteenth century,
8 the public viewed masturbation as a moral threat; in the twentieth century, people feared
9 teen pregnancy, STDs, and abortion. Today’s moral panics include homosexuality,
30 HIV, and marriage equality. Unfortunately, sexuality is an easy target, and politicians
1 have continuously employed a politics of moral panic to disrupt competent sexuality
2 education. The tactic has succeeded to a degree because of sexual illiteracy, an inability
3 to comfortably and competently discuss the many dimensions of sexuality. Sexual
4 literacy, on the other hand, is the knowledge and skills needed to promote and protect
5 sexual wellness—having healthy intimate relationships, being able to prevent disease,
6 understanding sexuality beyond just the act of sex. Sexual wellness comes from having
7 comprehensive sexuality education and then continuing to learn throughout life.
8 In contrast, our national fixation concerns sex that is packaged to market products or
9 to titillate, rather than sexuality that is genuine, well rounded, and healthy. Commercial
40 ad campaigns and other market forces, which are well planned and executed, produce
1 and shape packaged sex. Packaged sex is the image of a curvaceous woman in lingerie
2 plastered on a billboard, and television innuendos that sell everything from cars to cell
3 phones. Packaged sex can be found in pornography, on reality TV shows, and even in
4 the messages of extremist organizations opposed to sexuality education. Packaged sex
5 is commercialized (sex for sale, sex for marketing). Packaged sex is also politicized (sex
6 for votes), used to promote “morality” campaigns against sexuality education, abortion
7 rights, and HIV prevention. Examined closely, these efforts to promote particular forms
118 of sexuality, such as the movement for abstinence-only sex education, are grounded, not
18 Gilbert Herdt
11 in ethics or scientifically based understanding, but rather in conventionalized morality
that denies accurate knowledge to the young people who need it, and that marginalizes
others.
As a nation, we fail to make progress with sexuality because we confuse packaged
sex with genuine sexuality. Parents hesitate to have frank discussions about sexuality
with their children, fearing the promotion of packaged sex and fearing that if they discuss
the “P” word it will lead their offspring to become sexually promiscuous. While
understandable, this fear is groundless. There is strong evidence to suggest that when
young people get a good sex education they are much less vulnerable to sexual and
gender abuse. Many educators are concerned about what happens when teens are not
taught about ways to avoid pregnancy, sexually transmitted diseases, and date rape. In
this packaged sex climate, however, many adults flinch from any mention of sex, either
1 as parents at home or as teachers in the classroom, because of extremist attacks on
comprehensive sexuality education.
It’s no wonder. We have reached a milestone for sexual illiteracy in the United States.
During the 2004 presidential campaign packaged sex clouded politics and distorted
debate on issues such as abortion rights, marriage equality, and abstinence-only
education. Obscenity was also a political football: remember Janet Jackson’s “wardrobe
malfunction” during the Super Bowl halftime performance? Through these panics
extremist organizations fanned the flames of ignorance and successfully promoted
sexual illiteracy. Democracy suffers in such a climate.
As a country we must realize that people are suffering. Studies show that medical
doctors are uncomfortable asking patients the most basic questions about sexual health,
questions that may provide critical indicators of mental and physical problems. Other
studies indicate that healthcare professionals have failed to help teenagers with questions
about sexual development. And many physicians admit being uncomfortable asking
patients, young or old, about sexual abuse or violence, even when they suspect it.
Though some people would be comfortable talking to leaders in their faith communities
about sexual development and intimate relationships, ministers, rabbis, and imams often
lack the knowledge and language to communicate and counsel effectively on these
matters, even when they have the motivation to do so.
Ironically, as Americans, we pride ourselves on our love of progress. But when it
comes to sexuality, we are lagging behind. American rates of unintended pregnancy,
abortion, sexual coercion, and HIV infection are the highest in the industrial world.
Rape and sexual violence are all too common. And the sexuality of individuals who are
disadvantaged or discriminated against, whether by race, gender, orientation, class, or
ability, suffers even more as a result of the sexual illiteracy that governs the national
dialogue. As a result of our history of imposing ideology and morality upon science and
public health, sexual literacy is in decline in the United States. In the major arenas of
sexual health (including unintended pregnancy, STD rates, HIV infection, complications
from abortion, sexual violence, and assaults related to gender and sexual orientation),
we trail our Western allies. As with other arenas of social democracy and education, our
society will continue to suffer until literacy improves and everyone shares alike in
positive sexual health.
We need to encourage greater tolerance for and acceptance of sexuality and sexual
literacy in American society. It is important for each of us—citizens, parents, teachers,
spiritual beings, and policy makers—to speak out in support of sexual literacy for all.
8 Only then can we break the vicious cycle that has led to treating sex, not as something
What is sexual literacy? 19
1111 precious about the human condition, but as a package for sale or for the promotion
2 of fear. Someone wise once commented that a journey of a thousand miles must begin
3 with a single step. Take the step toward better sexual literacy today—read, go online,
4 get better informed about sexuality to make a difference in the lives of those you care
5 about!
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2 Folklore and the sexual lives
of adolescents
Mariamne H. Whatley
1 Whoever believes middle school students don’t talk about sex without prompting from
sexuality education classes is probably suffering from both amnesia and complete
isolation from adolescents. Everyone surely remembers the sexual stories they heard as
teens and preteens. As adults we may be shocked or amused by these stories, but we
should not ignore them. Rather than dismissing a legend as ridiculous, impossible, or
too disgusting, we should pay attention to adolescent legends and other folklore, such
as beliefs and even jokes. By inviting adolescents to bring their folklore to family
conversations or to the classroom, we may get a new perspective on their pressing
concerns. By engaging with folklore and not dismissing it, we may have new avenues
to approach adolescents’ anxieties and fears.
Take this story, for example, told by a college student recalling middle school:
When I was in seventh grade living in (hometown), there was a story about a girl
(name). Supposedly she was experimenting in some solo sexual activity with a hot
dog (that means masturbating with a hot dog, but of course no one said that word
then; if they even said the word, usually you just got “the look”) and it—the hot
dog—got stuck. Her father had to take her to the emergency room. She went to one
of the other junior highs in turn, so we never got a chance to stare at her and giggle,
and I guess most of us forgot by the time we hit high school.
This story, which circulates in various forms through middle and high schools, is a
contemporary legend, commonly known as an urban legend, and a form of folklore.
Adolescents are a folk group—with many subgroups of jocks, cheerleaders, Goths,
various racial and ethnic groups, LGBT (lesbian, gay, bisexual, and transgendered)
students, and others. Folklore is the unofficial culture of a group, the means by which
information and attitudes are transmitted and interpreted within the group. It is part of
every individual’s everyday life. Though folklore is often used as a synonym for false,
it can be completely true in the sense of portraying actual events or being scientifically
accurate. What is more important than folklore’s accuracy is the truth folklore conveys
about the attitudes, fears, and beliefs of a group, which in turn help shape and maintain
the identity of the group.
We found in our research with young people that students repeatedly report stories
similar to the hot dog legend. Does this mean that there is an epidemic of girls
incompetently and disastrously experimenting with masturbation? Certainly not, but
there are reasons why such stories are told again and again by adolescents and there is
8 a lot that can be learned from them.
Folklore and the sexual lives of adolescents 21
1111 In these legends, masturbatory experiments by girls and young women result in
2 humiliation at the very least, and sometimes escalate to emergency-room visits and
3 even fatal infections. They demonstrate a lack of knowledge of anatomy and a strong
4 discomfort with sexuality, particularly with the idea of women having sexual autonomy.
5 Numerous legends show that girls’ sexual desires and experimentation without a man
6 merit severe folkloric punishment. These legends exert powerful social control over
7 the girls who hear the stories: they learn what is not acceptable and they know who the
8 “sluts” are, even if none of these alleged cases of masturbation actually occurred.
9 The girls in these legends are often not anonymous and in our research the women
10 who told stories in their middle school years reported that students who did not fit in,
1 who had physically developed early, or who were “weird” in some way were usually
2 singled out. These stories can follow girls to high school and even college. Recent
311 research about girls identified as sluts and the impact this labeling has had on them
4 makes it clear how destructive such stories can be even beyond adolescence.
5
6
7 Spanish Fly, biology class, and social control
8 Fear of unleashing powerful sexual desire in young women appears in many folkloric
9
forms. Moving beyond the naiveté of the hot dog experiments are such disturbing stories
20
as this:
1
2
This girl was out on a date and the guy gave her some Spanish Fly so that she’d be
3
4 more receptive to his advances. He left her alone in the car for a few minutes and
5 when he came back, he found she’d gotten so horny while he was gone that she’d
6 impaled herself on the gear shift.
7
8 The legends often conclude that if the young woman survives such dramatic
9 masturbation, “she had to change schools.” The man who gave her the alleged aphro-
30 disiac doesn’t suffer and doesn’t live under a cloud of rumor as does his victim. She is
1 seen as sexually deviant; he as merely trying to make her “receptive.”
2 Other stories, such as the following, demonstrate the role of folklore in social control:
3
4 There is a story told in Augusta about a girl who attended a local high school. During
5 sex ed class the subject of semen entered the discussion. During the discussion the
6 teacher stated that semen was high in glucose. Suddenly the girl raised her hand and
7 blurted out, “Then why does it taste so salty?” Realizing what she had done, she
8 ran out of the room and transferred to a different high school the next day.
9
40 In other versions of this story, a biology teacher identifies sperm in a young woman’s
1 cheek scraping on a microscope slide. In these legends, the punishment for fellatio is
2 not emergency surgery or death but total humiliation. Folklore can function as a warning
3 about unacceptable behavior and what will happen if norms are violated.
4
5
6
Changing trends, changing stories
7 As social norms, technologies, and trends change, folklore shifts to accommodate social
118 and cultural transformations. Recently, for example, we have begun to hear versions of
22 Mariamne H. Whatley
11 these legends that substitute a young woman for a young man, with the telltale sperm
serving to “out” him as gay to his entire class. Again, it doesn’t matter if the stories are
true; the message is still powerful and in this case helps to patrol the borders of
heterosexuality.
A school counselor in the UK repeated a legend that had only recently begun to
circulate. Numerous high school girls reported stories of other girls whose tongue-
piercing got caught in a boy’s foreskin during fellatio. These new legends get created
because of the increased prevalence of both oral sex and body piercings in students’
lives. As there is more pressure on young women to perform fellatio, there may come
a time when humiliation in the classroom focuses on the young woman who does not
know what semen tastes like.
Legends about HIV/AIDS have also changed in response to shifts in attitudes. For
1 many years the predominant legend about HIV transmission was some version of the
two tales below:
There was this girl vacationing over spring break in Florida. She met some guy, and
they fell in love. They did everything together and by the final night of vacation she
conceded to sleeping with him. The next day as he saw her off, he gave her a small
gift-wrapped box and told her not to open it until she got back to school. She got
back, eagerly unwrapped it, and sat, numbly reading the inscription on the miniature
coffin: “Welcome to the wonderful world of AIDS . . .”
This guy went to Florida for spring break and he met this really beautiful lady in
a bar. And they went back to his hotel room. When he woke up in the morning, she
was gone but scrawled across the mirror in red lipstick was the message, “Welcome
to the Wonderful World of AIDS.”
Comparing these two chilling legends can give interesting insights into the stereotypes
of what young women and men want in a sexual encounter—romance versus a one-night
stand. They also conveyed very important messages about the risks of heterosexual sex
at a time when that population felt protected. But these stories also reinforced the
incorrect belief that it was strangers who carried HIV risk; adolescents explained their
protection from HIV as “I only go out with people from my high school.”
Legends about HIV transmission through heterosexual sex have been almost
completely replaced by legends about hidden infected syringes that prick unsuspecting
people watching a movie, pumping gas, or buying a can of soda. In one discussion with
students, where I asked why they thought AIDS legends have changed, one student
pointed out that it takes any blame away from someone who is HIV-positive because
the emphasis is not on sexual transmission. “After all,” she said, “everyone needs to buy
a Coke.” Of course, this new form of the folk legend also undermines messages about
safer sex.
Other legendary dangers

There are other legends that give warnings to adolescents about sexual dangers they may
face as they leave high school and go to college or other new settings. For example,
young women are warned about the dangers of drinking and fraternities in a common
8 and disturbing legend:
Folklore and the sexual lives of adolescents 23
1111 At a fraternity party, a girl drank too much and passed out leaning out the window.
2 One of the fraternity brothers came into the room and saw her. He lifted up her
3 dress and violated her. When he was done, he went and retrieved one of his friends
4 from the party. He brought his friend into the room, and his friend violated the
5 woman also. They decided to see who she was and so they pulled her in. They
6 looked at her face and the second frat boy said, “Oh my God, that’s my sister!”
7
8 While the women may learn to be wary of fraternity parties and heavy drinking, young
9 men receive a message that may be read as, “Every woman is someone’s sister, mother,
10 daughter, so think (or at least look) before you rape.”
1 These legends reflect a reality—an increased danger of sexual assault associated
2 with alcohol consumption. Another common legend reflects imagined dangers from
311 “predatory” gay men:
4
5 A student went to the doctor complaining of pain in his anus. The doctor claimed
6 it was from anal intercourse, and the guy freaked out. He was not a homosexual and
7 had never had anal intercourse, but the doctor said there was definitely evidence of
8 this occurrence. Apparently his roommate was putting ether on his bed at night to
9 knock him out and then proceeded to have anal intercourse with him. He had seen
20 the ether and Vaseline in the room, but this was not unusual because the roommate
1 was an entomology major. In the end, this roommate was kicked out of school.
2
3 These legends are troubling to hear, but if we pay attention to adolescent folklore, we
4 have a better understanding of their fears, anxieties, and concerns. It also may give us
5 ideas about what both formal and informal sexuality education should address. If
6 students are talking about masturbation and oral sex, then educators, parents, and youth
7 leaders ought to be ready to participate in the dialogue.
8
9
Talking about folklore
30
1 Adolescents talk to each other about a wide range of topics related to sexuality. In their
2 folklore there is a lot of misinformation not just about scientific “facts” but also in terms
3 of stereotyping, whether it is gay men, sexually active women, or fraternity brothers.
4 Educators need to intervene in these conversations and move them into an environment
5 where appropriate information can be provided and where values, ethics, and such topics
6 as discrimination and violence can be explored. Folklore tells us what students are
7 already thinking and talking about. Following the often rapidly evolving folklore can
8 help us understand trends in adolescent sexual norms and attitudes.
9 The next time you hear a “gross,” strange, or scientifically impossible story, don’t
40 dismiss it or its teller; listen to the messages behind the legend to learn what’s really
1 going on.
2
3
4
5
6
7
118
11
3 Contesting the dangerous
sexuality of Black male youth
Linwood J. Lewis
1 Portrayals of Black1 men during National African American Heritage Month have
always been an interesting but conflicted issue for me. As an armchair student of history,
and because of my professional interest as a Black developmental psychologist, I know
that how Black men are represented is important. Each February, loving and positive
portrayals of figures such as Martin Luther King, Jr, Booker T. Washington, W.E.B.
DuBois, Paul Robeson, and Frederick Douglass are revered by all Americans as African
American history is explored in many of the nation’s schools. These positive portrayals
in the nation’s classrooms are a welcome advance, particularly when one realizes that
it has only been fifty years since Black students were legally allowed to enter these
classrooms. Unfortunately, these positive February portrayals are juxtaposed against
omnipresent media depictions of Black men as criminals, mack daddies, and urban
sexual predators. Adolescent males that I have worked with do not describe the sexual
aggressiveness that popular culture often portrays, but they are impacted by these images
and ideas. My research with Black and Latino adolescent males examines their
emotional and psychological experiences related to sexual activity. My work also
focuses on how Black and Latino male adolescents’ beliefs and expectations about their
sexual lives are influenced by their social environments.
Keeping it in perspective
Stereotypes of Black male sexuality in general, and Black adolescent male sexuality in
particular, abound in popular culture. Reality TV shows as well as print and broadcast
news present ethnic minority crime at much higher rates than nonminority crime—so
much so that the cliché of the “perp walk” has become the first introduction to ethnic
minority youth for many viewers across the United States. Hypermasculinized,
misogynous images and lyrics are produced for mass consumption on MTV by hip hop
music producers and have become more prevalent over the past fifteen years.
Matthew Henry, in “He is a ‘bad mother *$%§!#’: Shaft and contemporary black
masculinity,” writes that the 1971 film Shaft and its remake in 2000 demonstrate how
hypermasculine portrayals of Black men have increased over time. According to Henry,
the first Shaft—from Isaac Hayes’s singing how Shaft is “the Black private dick who’s
a sex machine to all the chicks” to the double entendre of his name—is a movie obsessed
with the phallus. Yet the first Shaft weaves in elements of social movements, particu-
larly the Black Power movement, as well as scenes of romance largely missing in
the remake. It is clear that the original John Shaft is a lover as well as a fighter. In con-
8 trast, contemporary images of Black hypermasculinity emphasize an urban aesthetic of
Contesting the dangerous sexuality of Black male youth 25
1111 physical prowess and strength. Respect comes through the imminent threat or use of
2 violence and misogyny, avoiding sentimental ties to lovers and promoting a particular
3 kind of sexual aggressiveness. This sexual aggressiveness focuses on the ability to
4 “get some” while steering clear of emotional entanglement and remaining true to
5 one’s “boyz.”
6 Of course, media representations of Blacks are more complex than simply hapless
7 criminals running from the police on Cops or the latest gangsta video on MTV. But as
8 youth move through puberty toward adulthood, the media and the cultural beliefs they
9 reflect clearly have an important influence on adolescent behavior. How do Black male
10 adolescents negotiate sexual development in a place where Black men are stereotyped
1 as instinctually skilled lovers as well as powerful, violent, misogynic, and sexually
2 aggressive hustlers?
311 In my work as a research psychologist, I’ve interviewed a number of urban Black and
4 Latino male adolescents between fourteen and eighteen years old. In order to assess how
5 these youth understood their sexuality, I began by asking nineteen of them to describe
6 their thoughts and feelings about sex, as well as their sexual development over time.
7 After analyzing a series of extensive interviews with these adolescents, I found that
8 these young men are very willing to talk about sex and sexual matters. Although they
9 may not have a formal, academic vocabulary to describe the racial, gender, and sexual
20 complexities they encounter, their stories do turn the cultural stereotypes of Black male
1 sexuality upside down.
2
3 Sexual aggression?
4
5 Most of the youth in my study said that they, along with their friends, had whistled and
6 yelled sexually suggestive statements at adolescent girls. Many of them explained,
7 however, that their first encounter with sexual intercourse happened when the girl took
8 control. Joseph* described:
9
30 I was in her house, whatever, turning on her computer when she starts undressing
1 . . . And then she kissed me. So I kissed her back. And she was like trying to take
2 it further. (Eighteen years old, Black/Spanish.)
3
Ricky*, a fourteen-year-old African American boy, relayed something similar:
4
5 She pulls down my pants and then I was like what are you doing and I don’t know
6 what the heck she was saying. She was drunk and stuff. Then she put a condom on
7 me and then she just started.
8
9 These experiences clearly don’t match the hypermasculine stereotypes of sexually
40 assertive Black males that have become so prevalent in US culture. Furthermore, the
1 youth I worked with did not consider the girls’ making the first move to be wrong.
2 Instead, they considered sexual activity to be a normal activity for both males and
3 females. It was okay for either to initiate sexual activity in private. When adolescent girls
4 violated age norms in pursuing older sexual partners, however, they were rejected by
5 these youths as “hos” and “chickenheads.” Here, the double standard was at work: the
6 older partners of these girls were not stigmatized by having sex with younger girls.
7
118 *Names changed to protect privacy.
26 Linwood J. Lewis
11 What are youth saying?
When I asked why they had sex, all the youth in my research group said it felt good
physically. But many of them also described emotions and the importance of having a
close relationship. Henry* came to the interview thugged out, in a football jersey and
baggy jeans. He told me about his love for his girlfriend who is, he said, “always there
for me.” Finding someone who is “there for me” was an important and recurring theme
among these young men. They also reported strong positive relationships with girls and
women in their lives, both family and friends. Finally, youths described how they had
changed as they got older and how their behaviors and beliefs had changed with them.
Older youths, between sixteen and eighteen years old, compared their current attitudes
toward their partner (respectful and monogamous) to their more promiscuous and
uncaring behavior when they were young. Older youths were less influenced by peer
1 pressure, and they remarked on how this same peer pressure had had a lot more impact
when they were younger. I found that the younger, less experienced guys bought more
of the cultural stereotypes of Black hypermasculinity than their older peers. All in all,
the experiences, beliefs, and emotions these youth described show that they must juggle
contradictory expectations from parents, peers, and their own ideas about sexuality and
masculinity.
During the course of this research, it also became clear to me that politicians,
researchers, and the media often misunderstand and misrepresent the beliefs of ethnic
minority youth. For example, Jackie*, a nineteen-year-old college student commenting
on my research, explained that listening to gangsta rap and watching rap videos does
not mean that you believe in the misogyny and violence they represent. She felt that these
were entertainment, similar to video games, and not to be taken seriously. Many cultural
studies of Black humor agree with Jackie. Mel Watkins, author of On the Real Side: A
History of African American Comedy, describes “snapping” or the “dozens” (rapid-fire
insults directed at friends or others in public) as entertaining, rather than insulting as
many earlier commentators on Black life have mistakenly related. In “Looking for the
‘Real’ Nigga: Social Scientists Construct the Ghetto,” Robin D.G. Kelley describes
how urban African American life has been homogenized by social scientists. Social
scientists in search of “authentic” Black culture were doomed to follow their pre-
conceptions and oversimplify the complexity of people’s lives. Unfortunately, cultural
misapprehensions and stereotypes originating in high prestige sources, like the media
and academic research, have real teeth and can cause lasting harm.
What is the media saying?

One example of this damage is the rape case of a Central Park jogger. In 1989 five
African American and Latino adolescents were arrested for the brutal beating and rape
of a white female investment banker who was jogging in New York’s Central Park.
Police picked up the adolescents in the park, although no physical evidence linked them
to the crime. Media frenzy ensued, with tabloid newspapers referring to the five as a
“wolfpack.” Donald Trump paid $85,000 for full page ads in The New York Times
demanding the death penalty if the adolescents were convicted. The unstated and
underlying assumption was that these “dangerous urban sexual predators” were clearly
capable of such a crime—a belief that was bolstered by many years of stereotyping.
Once the young men confessed, their confession was taken at face value despite
8 evidence of coercion.
Contesting the dangerous sexuality of Black male youth 27
1111 Contrast this case with the rape of a white female high school student in suburban Glen
2 Ridge, New Jersey. In 1989 four white high school athletes raped their mentally
3 handicapped classmate in a basement. But instead of calls for the death penalty, these
4 young men received considerable support from their community and from the tabloid
5 press in New York City. According to Bernard Lefkowitz’s book Our Guys: The Glen
6 Ridge Rape and the Secret Life of the Perfect Suburb, the assumption was that nice,
7 middle-class, suburban, white athletes could not possibly have raped their mentally
8 handicapped classmate with, among other objects, a broomstick. In other words, unlike
9 the “wolfpack” in Central Park, they were presumably incapable of such atrocities. The
10 athletes received bail, and although they were ultimately convicted of sexual assault,
1 they got suspended sentences and probation. After all, to convict them of such a crime
2 would ruin their lives.
311 The press, perhaps inadvertently, has a hand in these cases. Bakari Kitwana, in The
4 Hip Hop Generation: Young Blacks and the Crisis in African American Culture, argues
5 that tabloid reporters, without knowledge of adolescent youth culture, misused terms.
6 In the Central Park case, the media made much of the term “wilding”—supposedly, a
7 widely used term for gang rape among New York City’s ethnic minority youth cultures.
8 No evidence suggests that this term ever existed. By repeating the term “wilding,” the
9 media implied that there was an organized culture of Black-Latino gang rape. No doubt,
20 this misconception contributed to the conviction of these youths. In 2003 the verdicts
1 condemning the Central Park youth were overturned. DNA evidence and a confession
2 from a serial rapist who had raped a woman in a similar manner two days before the
3 Central Park rape absolved the youth, but not until they had served many years in prison.
4 Despite similarities between the Central Park case and a previous rape, police ignored
5 this connection and prosecuted the five adolescents. The serial rapist went on to rape
6 four more women, killing one, after the Central Park incident. He is currently serving
7 thirty-three years to life in prison.
8
9 Histories of “dangerous” sexualities
30 The perception that urban Black adolescents are sexually dangerous is not new.
1 Disenfranchised communities, such as the poor and ethnic minorities, have long been
2 demonized with this narrow view in places such as the United States and United
3 Kingdom. In Dangerous Sexualities, Frank Mort writes that during the nineteenth
4 century the sexuality of the urban poor was considered a moral danger, supposedly
5 corrupting upstanding citizens. According to this logic, the poor threatened racial purity.
6 African slaves, whose humanity was called into question in order to justify their
7 enslavement, were cast as animals. Their sexual needs were like other animals, unrefined
8 by civilization and requiring governmental control—supposedly for their own good as
9 well as for the good of society.
40 John D’Emilio and Estelle Freeman, in Intimate Matters: A History of Sexuality in
1 America, illustrate how formal and informal social controls over racial and ethnic
2 minority sexualities have been a part of the United States for 400 years. Miscegenation
3 laws were used to formally prevent sexual interactions between whites and non-whites.
4 Informal controls have included lynching, such as the 1955 murder of Emmett Till, a
5 fourteen-year-old Black adolescent killed in Mississippi for saying “Bye, baby” to a
6 white female store clerk. Such killings were often defended as protecting white women
7 from the sexual predations of Black men, although there was often little or no evidence
118 of sexual behavior on the part of these men.
28 Linwood J. Lewis
11 There are consequences when we construct Black male sexuality in particular ways:
these beliefs, stereotypes, and media representations affect the way Blacks are treated.
While the adolescent males with whom I have worked do not describe the sexual
aggressiveness that popular culture often portrays, clearly, they are impacted by these
images and ideas. Psychologists, judges, and other commentators of Black youth culture
must get it right. It is past time to understand ethnic minority lives and sexuality in more
complex ways and to portray that complexity over the entire year.
Note
1 The use of the term Black, a racial signifier, masks the grouping of diverse ethnic groups of
African descent under one banner. I use the term African American here to identify persons
who self-identify with African ancestors who were involuntary immigrants to the United States.
1 This is in contrast to voluntary immigrants such as Afro-Caribbeans, who were involuntary
immigrants to their own country but who have immigrated to the United States voluntarily. This
distinction is especially important because some Afro-Caribbeans hold themselves in
contradistinction to African Americans, who are perceived as morally suspect, lazy, and
sexually undisciplined. Cultural differences abound across groups that may be perceived as
racially monolithic but are ethnically and, thus, culturally diverse.
References
D’Emilio, J., and E. Freeman. 1988. Intimate Matters: A History of Sexuality in America. New York:
Harper & Row.
Henry, M.A. 2004. “He is a ‘bad mother *$%@!#’: Shaft and contemporary black masculinity.”
African American Review 38(1): 1–9.
Kasinitz, P., J. Battle, and I.M. Miyares. 2001. “Fade to black? The children of West Indian
immigrants in South Florida.” Ethnicities: Children of Immigrants in America, eds. A. Portes and
R. Rumbaut. 267–300. Berkeley, CA: University of California Press.
Kelley, R.D.G. 2004. “Looking for the ‘real’ nigga: social scientists construct the ghetto.” That’s
the Joint! The Hip-Hop Studies Reader. New York: Routledge.
Kitwana, B. 2002. The Hip Hop Generation: Young Blacks and the Crisis in African American
Culture. New York: BasicCivitas Books.
Lefkowitz,. B. 1997. Our Guys. New York: Vintage.
Mort, F. 2000. Dangerous Sexualities: Medico-moral Politics in England Since 1830. London:
Routledge.
Watkins, M. 1994. On the Real Side: A History of African American Comedy. New York: Simon
& Schuster.
8
1111
2 4 Homophobia and harassment in
3
4 school-age populations
5
6 Christine E. Pettett
7
8
9
10
1
2
311 It was midafternoon and I had just completed interviewing an expert on homophobia
4 in America’s schools. I walked outside and saw that the neighborhood convenience
5 store was filling up with its daily crowd of high school students. A boy of about fifteen
6 shouted across to one of his peers—“Hey faggot!”
7 This kind of teasing, which centers on insulting someone’s sexuality or gender
8 presentation, happens daily in schools across the country. According to a year-long Des
9 Moines, Iowa study (www.youth.org/loco/PERSONProject/Alerts/States/Iowa/slurs.
20 html), high school students hear anti-LGBTQ (lesbian, gay, bisexual, transgendered, and
1 questioning) slurs an average of once every seven minutes in a typical school day. More
2 than half of teens surveyed in 2002 by the National Mental Health Association (NMHA)
3 said classmates use terms such as “fag” and “dyke” on a daily basis—and not just to
4 refer to LGBT students. Three of four students targeted for harassment are straight.
5 According to Laura Lockwood, director of the Trinity College Women’s Center and
6 founder of the Trinity Safe Zone program for LGBTQ students, name-calling is the most
7 common form of anti-gay sentiment in schools. Lockwood expresses particular concern
8 about, not just the presence of homophobic insults, but also the “ease with which students
9 use terms like ‘gay,’ ‘dyke,’ and ‘fag’ casually” to register displeasure or banter with
30 classmates without an awareness that doing so might be hurtful or offensive.
1 Verbal harassment is not an innocuous form of mischief. In the book We Don’t Exactly
2 Get the Welcome Wagon: The Experiences of Gay and Lesbian Adolescents in Child
3 Welfare Systems, Gerald P. Mallon documents that “verbal harassment causes as much
4 hurt as physical violence because it profoundly damages self-esteem.” Slurs and verbal
5 sexual harassment seriously impair mental health and increase rates of depression,
6 suicidal thoughts (and actions), anxiety disorders, and isolation among its victims.
7 Harassment is also linked to poor school attendance, tardiness, inflated dropout rates,
8 and declines in academic performance. Anti-LGBTQ slurs bear a causal relationship to
9 impaired academic opportunity for all students, none of whom are immune to the teasing
40 and stress that homophobic school environments foster.
1 The nonprofit organization Human Rights Watch (HRW) estimates that two million
2 US students are bullied every year because they are, or are thought to be, homosexuals.
3 A 2001 HRW study of 140 LGBTQ students found that all of those interviewed
4 witnessed or experienced incidents of verbal harassment and other forms of nonphysical
5 harassment, such as written notes, whispered rumor campaigns, obscene telephone calls,
6 graffiti scrawled on walls or lockers, or suggestive cartoons and pornography. Students
7 are no strangers to physical assaults and violence as well. For example, young lesbians
118 and bisexual girls are more than twice as likely as heterosexual girls to be touched or
30 Christine E. Pettett
11 grabbed in a sexual way, and four times as likely to have experienced physical
sexual harassment including rape, according to the HRW report “Hatred in the Hall-
ways: Violence and Discrimination Against Lesbian, Gay, Bisexual and Transgendered
Students in US Schools” (www.hrw.org/reports/2001/uslgbt/toc.htm).
Forced sexual contact is not the only form of physical assault experienced by
those who are, or are perceived to be, LGBTQ. Students also report having their
clothing torn, and being spit upon, shoved, slammed into lockers, cut, hit by broken
bottles and other thrown objects, and pushed or dragged down stairwells. The
NMHA reports that one third of gay students are physically harassed due to their sexual
orientation and one in six is beaten badly enough to need medical attention. A number
of national social welfare and advocacy organizations—including the National Educa-
tion Association (NEA), Centers for Disease Control (CDC), HRW and the NMHA,
1 as well as groups specifically oriented towards LGBTQ issues, such as GLSEN
(Gay, Lesbian and Straight Education Network), PFLAG (Parents, Families and Friends
of Lesbians and Gays), and NYAC (National Youth Advocacy Coalition)—advocate
developing tolerance and diversity curricula. However, school board members,
administrators, counselors, and teachers do not always greet such initiatives favorably.
Leif Mitchell, Northeast member of the GLSEN National Board of Directors and author
of the report Tackling Gay Issues in School, notes with regret that “too often, teachers
do not intervene when they see homophobia in action.” Similarly, the 1997 Des Moines
study found that fully 93 percent of the time, teachers ignored incidences of LGBTQ
insults and harassment.
By and large, the failure of many teachers and counselors to serve lesbian, gay,
bisexual, and transgender youth originates from a lack of training. Advocacy groups and
educators who support the inclusion of gender expression and LGBTQ identities in
tolerance programs assert that prejudice and harassment can only be dispelled by talking
directly and frankly about the issue and providing resources for in-school mentoring and
support. For example, Lockwood’s Safe Zone program incorporates a training module
in which members of the college community learn to be sensitive to LGBTQ bias on
campus and to provide resources to bias victims. GLSEN has developed another
strategy, a teacher training program and advocacy campaign to “make anti-LGBTQ
harassment unacceptable within the next three years,” reports Mitchell.
One of the most effective strategies to reduce LGBTQ bias in schools is through the
development of Gay–Straight Alliances, or GSAs. GSAs are student groups that build
support networks among students to address the systematic verbal and physical bullying
that students encounter on a daily basis. As an extracurricular activity in public schools,
GSAs are entitled to receive equal access to school resources just like all other kinds of
nonacademic clubs.
Despite evidence that students are increasingly able to confront and reduce anti-gay
bias, not everyone is in favor of such initiatives. Across the country a number of school
districts that oppose such organizations have opted to abolish all extracurricular
activities rather than permit GSA activity. Actions such as these not only deprive
students of the opportunity to build anti-harassment coalitions but may, in fact, create
a backlash and exacerbate ill will toward LGBTQ students and their allies.
Some socially conservative groups argue that programs designed to protect LGBTQ
youth repress those who believe nonheterosexual behavior is morally wrong. This
8 sentiment is particularly evident in recent debates over Safe Schools initiatives, designed
Homophobia and harassment in school-age populations 31
1111 to prevent school violence of the kind that happened at Columbine High School in
2 Colorado (in which the student shooters were known to have been repeated victims of
3 bullying that included frequent use of homophobic insults).
4 According to a Wall Street Journal report, “conservative groups say the safe-schools
5 effort has become a vehicle to promote homosexuality.” Karen Holgate, a conservative
6 activist, believes that “gay-rights advocates ‘have very cleverly come in under the guise
7 of something that sounds wonderful, and they are promoting another agenda.’ School
8 officials and program advocates say they haven’t seen similar objections to discussions
9 of bullying based on race, religion or ethnicity.” Nonetheless, following objections to

10 LGBTQ-support initiatives in public schools, funding has been withdrawn from many
1 programs designed to combat student harassment.
2 Furthermore, current federal budget proposals to divert funding from public to private
311 schools through the use of vouchers, such as the Bush administration’s “No Child Left
4 Behind,” have been of particular concern to LGBT advocates, such as GLSEN Director
5 of Public Policy Mary Kate Cullen. “Faced with the choice of a private school that
6 doesn’t ensure a discrimination-free learning environment or a system of public
7 education that is further depleted of much needed funding, LGBT students and their
8 families stand to lose”.
9 In the United States 75 percent of people committing hate crimes are under age thirty,
20 and one in three of these are under eighteen. Educating LGBT youth and straight
1 students about homophobia and its detrimental effects has the potential to transform
2 school culture and create positive change for all minorities in the future. When bias of
3 any kind is condoned in the learning environment, it teaches young people that division
4 and prejudice is appropriate behavior to model. On the other hand, policies and prac-
5 tices that demonstrate tolerance teach young people to uphold the civil rights and
6 basic humanity of all individuals. Today, our schools acknowledge that it is not only
7 inappropriate to condone harassment of ethnic minorities and disabled students, but
8 that doing so has a detrimental effect on the learning environment and the development
9 of a more tolerant society. Organizations like HRW, GLSEN, NEA, and others are
30 currently engaged in a struggle to achieve the same parity for LGBTQ students and
1 those who support them.
2
3
References
4
5 Mallon, G.P. 1998. We Don’t Exactly Get the Welcome Wagon: The Experiences of Gay and
6 Lesbian Adolescents in Child Welfare Systems. New York: Columbia University Press.
7 Mitchell, L. (ed.). 1999. Tackling Gay Issues in School: A Resource Model. Stamford, CT: The
8 Gay, Lesbian, and Straight Education Network of CT and Planned Parenthood of Connecticut.
9
40
1
2
3
4
5
6
7
118
11
5 Citizenship lessons
Sexuality education in the
United States
Jessica Fields and Celeste Hirschman
1 Contemporary debates over school-based sexuality education are about more than
just whether young people should learn about contraceptives, disease prevention, or
abstinence-until-marriage. School-based sexuality education is a highly contested
arena in the contemporary struggle over heterosexuality and citizenship in the United
States.
As school boards, teachers, young people, parents, and legislators argue over whether,
what, and when young people should learn about sexuality in school, they are also
struggling over what it means to be a sexual person. They are helping to decide what
kinds of sexual behaviors, identities, and decisions are acceptable in their schools,
neighborhoods, and towns. They are helping to define “good” sexual citizens by delineat-
ing which sexual desires, behaviors, and identities confer the rights and responsibilities
of belonging, and which preclude full, legitimate citizenship.
Exclusive federal funding for abstinence-only education makes clear the prevailing
government definition of the good sexual citizen. Current funding streams require
educators receiving federal support to teach that sexual expression is safe only within
the confines of monogamous heterosexual marriage. In this abstinence-only education,
conservatives have tied the rights and responsibilities of citizenship to a person’s
participation in private married heterosexuality. According to these conservative
regimes, the public pursuit of any other sexual life is contrary to the interests of the US
government. These conservative efforts challenge the citizenship claims of the many
straight, lesbian, gay, bisexual, poor, divorced, single-parenting, widowed, cohabitating,
and marriage-resisting people living sexual lives in the United States.
Promoting heterosexual marriage

Currently, the federal government spends over $100 million annually on abstinence-only
education. Under the 1981 Adolescence Family Life Act (AFLA), the government funds
programs that promote chastity as a means to prevent teen pregnancies. An amendment
to the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (what
many know as “welfare reform”) strengthened AFLA’s message when it established
Section 510(b) of Title V of the Social Security Act. Title V funds abstinence-only
programs that promote monogamous heterosexual marriage; all funded programs must
adhere to an eight-point definition of abstinence education that sexuality education
teachers, administrators, and researchers commonly refer to as “A-H.” According to
A-H, abstinence educators must teach the benefits of confining sexual expression to
8 heterosexual marriage and emphasize that sexual activity under any other circumstances
Sexuality education in the United States 33
1111 violates standards of behavior and risks broad physical, psychological, and social harm.
2 Another funding stream, Community-Based Abstinence Education (CBAE) enforces
3 A-H more stringently: while Title V programs must not be inconsistent with any aspect
4 of A-H, CBAE programs must explicitly address each of the definition’s eight points.
5 George W. Bush’s administration aims not only to continue funding for abstinence-
6 only education but also to link the receipt of welfare benefits to heterosexual marriage.
7 In the welfare program he proposed early in his administration, Working Toward Inde-
8 pendence (WTI), Bush left Title V and the A-H funding guidelines intact and increased
9 the annual federal budget for abstinence-only education to $120.75 million. WTI also
10 included provisions that would require states to provide “family formation and healthy
1 marriage efforts” for welfare recipients.
2
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Heterosexuality and marriage in crisis
4
5 Sexuality education has long been tied to sexual morality, and contemporary abstinence-
6 only education is no different. The Bush administration promotes abstinence-only
7 education even while admitting that, to date, there has been no research able to
8 demonstrate that abstinence-only education reduces teen pregnancies, delays first
9 intercourse, or prevents sexually transmitted infections (STIs). The efforts of the
20 president and his allies don’t seem to address these health concerns. Instead, funding
1 for abstinence-only education is part of a broad and concerted effort to reassert
2 heterosexuality’s dominance and to reestablish sanctions against those who are sexually
3 active outside marriage.
4 Ironically, efforts to establish heterosexuality as the official sexuality of the United
5 States reflect the extent to which heterosexuality is changing and may even be in
6 crisis. Traces of the crisis abound. Vermont recognizes civil unions between gay and
7 lesbian couples, Massachusetts has legalized same-sex marriage, and California offers
8 domestic partnerships. The New York Times now includes among its wedding announce-
9 ments descriptions, complete with photographs, of lesbian and gay unions. Television
30 audiences celebrate—and advertisers align themselves with—the gay and lesbian
1 content of shows like Will and Grace, Queer Eye for the Straight Guy, Ellen, Queer as
2 Folk, Six Feet Under, and Oz. In San Francisco a group from the Women of Color
3 Resource Center, wearing wedding dresses and calling themselves “welfare brides,”
4 gathered on Valentine’s Day 2003 outside the city’s busiest transportation hub to protest
5 federal legislation tying welfare benefits to participation in marriage education and
6 counseling programs. The US Supreme Court asserted in its June 2003 Lawrence v.
7 Texas decision that the civic right to privacy protects homosexual activity. For conserva-
8 tives, abstinence-only sexuality education is a response to these changes—one way to
9 reassert that sexuality is a private concern and to publicly reestablish the dominance of
40 private married heterosexuality.
1 Companion efforts include the 1993 institution of the federal “Don’t Ask, Don’t Tell”
2 policy, in which the US government rejected the possibility that one could acknow-
3 ledge same-sex desire, in word or deed, and still serve one’s country honorably. The
4 government has also refused to acknowledge the partnered lives of gay men and
5 lesbian women: the 1996 Defense of Marriage Act explicitly granted states the right to
6 deny legal recognition to same-sex partnerships. The assault continues with renewed
7 vigor under George W. Bush and a conservative US Congress. In 2002 the US House
118 of Representatives introduced an amendment to the Constitution establishing that
34 Jessica Fields and Celeste Hirschman
11 “Marriage in the United States shall consist only of the union of a man and woman.”
Together with abstinence-only education policies and funding, these governmental acts
help to shore up heterosexuality and marriage—institutions in crisis.
Liberatory models of education and citizenship

As researchers concerned with the social and political implications of sexuality
education, we advocate shifting the terms of the debate over sexuality education to
address directly the agenda of those promoting abstinence-only instruction. Much

academic research continues to evaluate sexuality education’s effects conventionally
by measuring whether or not sexuality education programs lower pregnancy rates, STI
rates, and incidences of sexual activity. Researchers, educators, and policymakers need
1 to broaden notions of “effects.” We need also to ask: In what ways might the assertion,
that sexual activity outside of private marriage is harmful to person and nation, constitute
an assault on young people’s rights? What are the broad social consequences of
instructing young people that those who do not confine their sexual lives to marriage
not only defy established sexual standards but also compromise the well-being of their
loved ones and their country?
Conservatives have claimed school-based sexuality education as one field in which
to promote a national heterosexuality and establish sexual abstinence as a standard for
unmarried people. In contrast, progressive educators, policymakers, and activists have
largely neglected the citizenship implications of sexuality education. This neglect
effectively concedes to conservatives an important site in the struggle over what it
means to be a citizen of the United States. We advocate recognizing the citizenship
claims at stake in abstinence-only education. We insist upon a model of sexual citizen-
ship that extends the rights and legitimacy of membership to those whose sexual lives
do not conform to established standards and promotes healthy sexual expression;
encourages people to articulate dissent, curiosity, and knowledge; and equips citizens
to critique social institutions and practices that enforce sexual conformity.
8
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2 6 Transmen
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4 Behind assimilation, problems exist
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Jamison Green
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311 In popular culture images of awkward, hairy men in dresses are always good for a laugh.
4 Graceful drag queens appear in magazines, films, and television, and serve as mistresses
5 of ceremonies at community events. The media tells us that men may admire them, but
6 if they are tricked into having sex with one, they should be ashamed and disgusted or
7 they may themselves become targets for ridicule.
8 But mainstream media finds nothing funny, nor particularly glamorous, about female-
9 to-male (FTM) people. Not that there aren’t some talented performers, musicians,
20 writers, actors, and even stand-up comics among the FTM transgender population—
1 there are! The public, though, doesn’t treat them with the same fascination it has for MTF
2 transgendered people. Perhaps that’s because outwardly, FTM people assimilate more
3 easily. In many cases, it’s difficult to even imagine that they were ever women.
4 This invisibility is a powerful factor in the lives of FTM transgendered and transsexual
5 people.
6 When a female-bodied individual transitions to life as a male, he is usually on a long
7 trajectory. While some people can simply put on men’s clothing and pass for male and
8 live full-time as men, and while there are drag kings who enjoy performing as men
9 periodically but who live as women most of the time, once people take on the label of
30 FTM, they are making a physical transition that often takes several years at best. If the
1 transition is well-managed and legally acknowledged, it requires collaboration with the
2 medical profession—and thousands of dollars.
3 Trying to imagine the motivation that might drive a person to change sex, some
4 theorists have postulated that sexual expression is a primary drive—in this case, the
5 notion being that FTM people want to be men so they can “correctly” have sex with
6 women, or so that they can indulge in sex as a man would do.
7 This theory is, doubtless, a gross oversimplification. First, the sexuality of FTM
8 people is as varied as that of any other population segment. There are FTM individuals
9 who are heterosexual, homosexual, bisexual, and asexual, though no research exists
40 that adequately estimates any percentages of people occupying each category. FTM
1 people often have very masculine psyches and physiques, but their genital organs are
2 often very different from those of non-transsexual men. Some may have managed to
3 have phalloplasty, or the surgical creation of a penis, but the majority of FTM people
4 have not had the procedure, either because they cannot afford it or because they are not
5 convinced that the practical result is worth the sacrifice.
6 Whether the object of their sexual attraction is men, women, transsexual women, or
7 other transsexual men, FTM people often struggle with issues of physical inadequacy,
118 or at least the fear that any potential partner would not be interested in their body. Those
36 Jamison Green
11 transmen who have undergone surgical genital reconstruction are often pleased with the
results for themselves, but they still may be afraid that others would not find their penises
erotic.
This physical difference, with or without surgical reconstruction, is often sufficient
to render many FTM people reticent at best, and avoidant at worst, when it comes to
initiating sexual encounters. Though sexual drive is probably not a primary motivator
for initiating transition, once a man’s body and mind are integrated through transition
and he feels connected to the body he occupies, he may enjoy sex more than he did
before. This seems to be derived from the gestalt of personality integration. In other
words, people are better able to enjoy sex when they feel connected to, at home in, and
happy with their own body.
Other issues specific to FTM transpeople are socialization as men and access to
1 healthcare. If they intend to function as men as opposed to “in-between,” they need
to learn expected male behaviors and how to moderate their own behavior so they can
manage social situations within an acceptable range of actions. This does not mean
learning how to pretend to be male, or learning to reinforce stereotypes. It is the same
socialization procedure that young men experience.
There is nothing false or deceptive about learning appropriate social behavior; it is
just that society doesn’t provide a “place” for adult people to do this while they are also
managing adult responsibilities. He must learn the ropes of being male in his cultural
environment, whether that environment is determined by his race, his economic
situation, his class, and/or his sexual orientation (which may be different from what
he anticipated, too!). In addition, the transman must also do what is required to preserve
the health of the body he has, even if that body has female internal organs. This may be
a daunting prospect if he lives in an area where there is little medical support available
for transsexual people.
The documentary film Southern Comfort shows the danger of poor healthcare access.
It witnesses the last year in the life of a transman who is dying of ovarian cancer because
of the fear, bigotry, and ignorance of the medical community where the man lived.
Countless transmen are living in the United States right now who are avoiding healthcare
because they fear being ridiculed, mistreated, or having their confidentiality violated by
insensitive or inexperienced providers or administrators, and insurance plans that
specifically exclude services for transsexual people.
There is one other classic story that reflects a potential challenge for transmen,
rendered in the feature film Boys Don’t Cry and the original documentary The Brandon
Teena Story. This story of rape and murder generated by the discovery of a young
transman’s still-female body (the actual event took place in Nebraska in 1993) has been
experienced countless times by MTF transwomen, such as Gwen Araujo, who was
murdered in Newark, California in 2002 after a group of men discovered she was
anatomically male.
Violence and murder are the ultimate insults that all transsexual, transgender, and
otherwise gender-variant people are forced to anticipate simply because they exist. The
efforts to eliminate this threat to trans lives, to improve access to healthcare, and to
reduce stigma and increase understanding for all people who are differently gendered
or embodied are the reasons behind the educational effort that has inspired the present-
day “Transgender Movement.”
The present-day movement began in the early 1990s but has roots in the Stonewall
8 Riots of 1969 in New York, when gender-variant people, some presumed to be drag
Transmen 37
1111 queens and masculine (“butch”) lesbians, fought with police alongside gay and lesbian
2 people. Gender-variant people who cross-dressed or changed their sex were excluded
3 from acknowledged participation almost immediately, as gays and lesbians sought to
4 define the terms of their own liberation. They felt they would find more mainstream
5 acceptance if they didn’t have too many different types of people in their contingent.
6 Transsexual people and people who break gender boundaries in various ways began
7 to publish and agitate for civil rights in the early 1990s, led by people as diverse as
8 Leslie Feinberg, Virginia Prince, Riki Anne Wilchins, Anne Ogborne, Sandy Stone,
9 Kate Bornstein, Louis G. Sullivan, Phyllis Frye, and myself, among many others.
10 As our work continues, we are making society a safer and kinder place not only for
1 gender variant people, but for everyone.
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7 The meanings of rape
Ann J. Cahill
1 Questioning the meaning of rape may appear, at first, to be a ridiculous proposition.

Given the advances in our understanding of sexual violence over recent decades, we
have, as a society, at least come to the conclusion that rape is a horrific, violent, and
damaging crime—one that is not to be tolerated or excused. The problem with this
perspective is that it assumes that merely viewing rape as negative is equivalent to
counteracting its pervasive sexist effects and ramifications. History shows us that this
is not so. Rape has been defined legally in a variety of ways, from theft to a violation
of civil rights, and the fact that a society condemns rape does not necessarily indicate
that it respects women’s sexual or political autonomy.
In US culture, we needed feminism to name rape as a political, systematic phe-
nomenon that has oppressed women in particular. Susan Brownmiller took up the issue
in her groundbreaking work Against Our Will: Men, Women, and Rape, and a variety
of feminist thinkers pursued the topic throughout the 1970s. Catharine MacKinnon
reexamined rape in a strikingly different way in Toward a Feminist Theory of the State.
Since that work, little has been done to deepen our understanding of the phenomenon
of sexual violence even though feminist thought has developed increasingly sophisti-
cated analytical approaches. These advances make it possible to render new insights
about rape and sexual violence and begin to correct the flaws inherent in previous
theories. While recognizing the importance of past theories about rape, we must engage
with new tools and new paradigms to arrive at a more complex and nuanced under-
standing of the role sexual violence plays in the everyday lives of women.
The work of Brownmiller and MacKinnon represent two main branches of feminist
thought concerning rape. In many ways, the position of Susan Brownmiller is the one
most familiar to contemporary US culture and the one that has had the largest influence
on reforms to rape law in the United States. In the pithy formula that has trickled down
to our common consciousness, Brownmiller (and other feminists who took up her theory)
claimed that rape was about violence, not sex. Brownmiller wanted to demonstrate the
sheer folly and utter offensiveness of investigating rape by focusing on, for example, what
the victim was wearing or her former decisions regarding her sexual behavior. For
Brownmiller rape was a violent instrument of power, situated firmly within a political
structure that gave a disproportionate amount of power to men at the expense of women.
Brownmiller’s contribution to our understanding of rape and, therefore, our ability
to counteract it was certainly crucial. It led to legal prohibitions against considering
the victim’s clothing as evidence of consent, and it provided opposition to the familiar
assumption that raped women “asked for it.” Nevertheless, this understanding of
8 rape has significant problems. For one, it tends to define rape as essentially equivalent
The meanings of rape 39
1111 to other forms of violent assault. Following this logic, many states have done away
2 with rape as a distinct category of crime. Equating rape with other forms of assault
3 seems counterintuitive and contradicts the experiences of many women who have sur-
4 vived rape. The theory also assumes that, although sex was effectively the means
5 of violence, the relevance of sex to the nature of the crime and the experience of the
6 victim is limited and perhaps peripheral. Again, this assumption seems counterintui-
7 tive. Finally, Brownmiller’s theory explicitly adopts a gender-neutral theory of rape,
8 which, given its emphasis on political inequality, veils the fact that, overwhelmingly,
9 men commit rape against women. Brownmiller’s theory, then, while effectively freeing
10 women’s sexuality from the culpability found in traditional approaches to rape,
1 nevertheless seems to overlook some crucial aspects of rape.
2 Catharine MacKinnon’s approach to rape can be seen as an inversion of Brownmiller’s
311 formula. Rather than seeking to minimize the role of sexuality in the phenomenon of
4 rape and sexual violence, MacKinnon situated rape within the context of compulsory
5 heterosexuality. In MacKinnon’s view heterosexuality is a political structure that
6 prohibits female autonomy—and rape is merely one end of the continuum. Thus, the
7 problem with rape is not that it is violence but that it is the natural extension of a sexuality
8 that eroticizes and demands female submissiveness and dependence.
9 Again, this theoretical move was an important contribution toward furthering feminist
20 understandings of rape. Specifically, it allowed for productive connections to be drawn
1
between different types of sexual coercion, and it helped to explain the difficulty of
2
distinguishing rape from other instances of (hetero)sexual encounters. However, it also
3
presented a host of theoretical and practical difficulties. As many critics of MacKinnon
4
have noted, her theory tends to define women, their desires, their experiences, in fact,
5
their total being, solely in relation to patriarchy. This is a difficult position to defend
6
7 because it risks making feminism itself a logical impossibility. If women are completely
8 defined by patriarchy, how would any woman or group of women develop the con-
9 ceptual tools to criticize sexist political structures? Finally, while the notion of a sexual
30 coercion continuum is useful, it also appears to contradict women’s experiences, which
1 generally distinguish between rape and pleasurable, desired heterosexual sex.
2 Both theories fail because they misunderstand the complex relationships among the
3 body, self, and society. While Brownmiller addresses rape as a political problem, she
4 grounds it in biology, claiming that rape happens because it is a biological possibility.
5 This position is highly unpersuasive because there are many biological possibilities that
6 are not political realities. Brownmiller, then, fails to understand the body and sexuality
7 as social and political artifacts. MacKinnon, on the other hand, has an unsophisticated
8 understanding of the capacities of power, seeing them as total and unrelenting. A notion
9 of power that brings with it the possibility of resistance is both more convincing and of
40 greater explanatory strength because women and their experiences of rape (including
1 their various ways of resisting rape, both individually and collectively) cannot be
2 understood as solely defined and limited by patriarchy.
3 If rape cannot be reduced to “only violence” or “only sex,” then we must look to
4 newer feminist concepts. We should use recent feminist work on the concept of embodi-
5 ment to update our theories of rape—positions that neither reduce women to victims nor
6 deny the relevance of sexuality; positions that recognize the multiple forms that rape
7 can take and the multiple harms it creates; and positions that place the body at the center
118 of the experience of being raped.
40 Ann J. Cahill
11 By making the body central to subjectivity—and by understanding the body as both
a political construct and a biological one—we avoid many of the dichotomies that seem
to underlie the theories of both Brownmiller and MacKinnon. Rape should be
approached primarily as an embodied experience. This reasoning allows for a critique
of models of the self that prioritize nonmaterial aspects of being (the intellect, rationality,
etc.) over material aspects, such as the body and its sensations, “physical memory,” and
the like. Sexuality and politics no longer manifest themselves as discrete arenas of
experience as Brownmiller seems to imply. The body is also capable of resistance, and
so while individuals may be impacted by patriarchy and heteronormative roles, they are
never reducible to them, as MacKinnon seems to hold. We are able, therefore, to claim
that sex is a necessary element in rape and sexual violence, and, therefore, we can more
readily focus on the particular sexual harms that rape and sexual violence cause to
1 victims.
Emphasizing the bodily nature of rape also helps us to understand the multiplicity of
the forms that sexual violence takes. Different persons live through different bodies; this
observation leads us to the obvious conclusion that differences among persons (age,
race, sexual orientation, class, etc.) will result in strikingly different experiences of rape
and its effects. In previous theories these differences were perceived as problematic: If
we cannot arrive at a universal understanding of the phenomenon of rape, are we doomed
to silence about it? Addressing a diversity of experiences refuses a hierarchy of sexual
abuse and avoids universalizing the meaning of rape. Instead, the unique experiences
of individuals are allowed to speak for themselves.
Other benefits accrue from approaching rape as an embodied experience. Because
rape is experienced differently by men and women, an embodiment approach allows for
gender-specific analysis rather than gender-neutral theories, which have erased these
distinctions. Since the person is no longer understood as primarily autonomous and
independent, but rather as a nexus of interweaving relationships and experiences, we
are able to articulate more clearly just how damaging rape can be to a person—and how
healing is able to occur. Most importantly, we are able to name a victimization that
occurs disproportionately to women without considering them as nothing but victims.
References
Brownmiller, S. 1975. Against Our Will: Men, Women, and Rape. New York: Penguin Books.
MacKinnon, C.A. 1989. Toward a Feminist Theory of the State. Cambridge, MA: Harvard
University Press.
8
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2 8 A play that looks at rape
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4 A crime against women (and men?)
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Leslie Simon
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311 Picture this: four bodies dressed in black on a small partially lit stage, two men and two
4 women, the men in the middle and the women on either side of the men, bodies poised
5 and upright, eyes focused on the audience, a group of people assembled to hear stories
6 of four rape survivors—two women and two men.
7 Is this heresy? How dare a play that deals with a crime primarily perpetrated against
8 women suggest that rape victimizes men and women equally? And, as the play unfolds,
9 we might also ponder, how dare it talk about rape, a crime of power and domination, as
20 if it had anything to do with sex.
1 Let me tell you how. Let me try to convince you why it works so powerfully.
2 Drawing the Shades, written by a former rape prevention peer educator April Elliott,
3 is performed by student actors in colleges and universities across the country. It portrays
4 the trauma of sexual assault by telling the stories of four survivors.
5 I teach women’s studies at City College of San Francisco. The first time I saw
6 Drawing the Shades performed at a conference about eight years ago, I knew Elliott,
7 who wrote the play in 1993, had created a classic. By interviewing actual rape survivors
8 and listening carefully to their pain and the details of their stories, she succeeded in
9 constructing a moving twenty-minute exploration about the trauma of rape. By allowing
30 Female 1 and 2 and Male 1 and 2 to speak singly and together, with two, three, and
1 sometimes all four voices, the play demonstrates how each story is completely different,
2 yet each experience of trauma chillingly similar.
3 When we first produced Drawing the Shades at City College of San Francisco, one
4 particularly astute student remarked: “Wherever you are on the sexuality and gender
5 map, you can find a situation close, if not exactly equivalent, to your own.”
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Putting it in context
9 According to 2002 data from the Bureau of Justice Statistics, approximately 66 percent
40 of sexual assault victims knew their assailant. In other words, the victim knows the
1 perpetrator, perhaps as a friend, lover, neighbor, or even someone she or he has just met
2 at a party or through a mutual friend. The typical rapist is not a stranger on the street
3 jumping out of the shadows on a dark night.
4 Drawing the Shades stays faithful to these statistics. Three of the four survivors
5 know their assailants. Moreover, the characters, ranging in age from nineteen to twenty-
6 two represent the group most vulnerable to rape: fifteen to twenty-four-year-olds. But
7 whereas half of the survivors in the play are men, in reality women are overwhelmingly
118 the victims of adult rape.
42 Leslie Simon
11 Nationally, approximately 13 percent of rape victims were male in 2002, according to
the National Crime Victimization Survey. Meanwhile, San Francisco Rape Treatment
and Trauma Recovery Center reports that about 15 percent of the victims it treats are men.
Of course, men may be more reluctant to report rape, and statistics don’t account for
the male-on-male rapes that occur all too frequently in prisons. Nonetheless, from our
best estimates, we know that an adult female has a much greater chance of becoming a
rape victim than an adult male does.
Take note, though, Elliott never intended for the play to stand by itself. An eight-
minute video following the performance clearly indicates that among the adult popula-
tion women are targetted far more than men. But instead of frightening her audiences
with grim rape statistics, Elliott wants them to feel compassion for rape survivors. And
they do.
1 Female 1’s story is the most typical. She is a straight woman raped by a straight man
who wants a sexual relationship with her but with whom she only wants to be friends.
Male 1, a bisexual man, has a crush on a man who ends up raping him. Female 2 is a
lesbian, gang raped along with her female lover after coming out of a bar; she represents
rape by a stranger. Finally, Male 2 is raped by a woman. Although he is sexually
interested in her, he makes clear to her that he wants to go slower and postpone sexual
intercourse until they get to know each other better. This character could have been the
play’s undoing. Instead, Elliott’s bravery in telling his story moves the piece from mere
rhetoric to provocative drama.
In the end, Drawing of Shades is a play that teaches us much more than one based
solely on statistics would. It looks at a situation that, though less common than other
types of rape, is a similarly painful experience. According to Paul Isley, who has studied
adult male sexual assault, male victims experience the same reactions to rape as female
victims, which include depression, anger, guilt, self-blame, and sexual dysfunction.
Drawing the Shades shows that rape is a violent crime that happens in sexually
charged situations. It also demonstrates that violence, a major component of rape, is
not inherent in heterosexual relationships, as some radical feminists have argued.
Female 1, the only heterosexual woman in the play, knows the difference between sex
she wants and sex she doesn’t want.
Gender roles
In “The Politics of Sexual Violence” class that I teach, we analyze the political, social,
and psychological causes of sexual violence. We look at hierarchical systems of power
that grant privileges to certain groups of people while denying them to others. Privileged
groups—such as whites, men, and heterosexuals—can discriminate and perpetrate
violence against nonprivileged groups, as was seen in the United States when white
male slave owners systematically raped black women.
We also examine the role of social conditioning in the perpetuation of violence, such
as the gender roles in our culture that encourage men to be aggressive and women to
be passive. Finally, we study how an insecure person, who has been granted powers
and privileges, may resort to violence as a means of boosting an unstable ego. In their
book You Can Be Free: An Easy-To-Read Handbook for Abused Women, Ginny
NiCarthy and Sue Davidson put it this way: “He’s afraid he’s weak, so he acts tough.”
To fight rape, we need to make political and social changes so that power and wealth
8 are not concentrated among an elite group that perpetuates a system of abuse in housing,
A play that looks at rape 43
1111 jobs, healthcare, education, and social relations. But we also need to stop perpetuating
2 the psychological conditions that foster abusive behavior. If children grow up in loving
3 homes where they are not subject to physical, sexual, and/or emotional abuse, they will
4 become healthy, secure adults not prone to inflicting their pain on people weaker than
5 themselves.
6 We need to care about boys and men as potential victimizers of rape. And as Drawing
7 the Shades teaches us, we need to care about women—and men—be they straight, gay,
8 or bisexual, as potential victims of rape.
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9 The “down low”
New jargon, sensationalism, or
agent of change?
Gilberto R. Gerald
1 Mounting anxiety about sexual encounters with high-risk partners spotlights hush-hush
concern—Laura Randolph, “The Hidden Fear: Black Women, Bisexuals and the AIDS
Risk,” Ebony, 1988.
Long before being on the “down low” became part of the vernacular, Laura Randolph,
a writer for Ebony, sought to illustrate that black women are unwittingly at risk for
HIV through sexual relations with men who lead secret sexual lives with other men. To
demonstrate the point, Ms Randolph provided an inaccurate account of how an HIV/
AIDS prevention activist had put the lives of black women in jeopardy. I was that
activist.
It was clear to me and others, once the article was published, that Ms Randolph needed
an example of a man on the “downlow” (or “DL”) and that any black man who admitted
having sex with other men as well as with women would do. In my case, a simple line
of inquiry would have revealed that I was an unsuitable representative of what she had
hoped to show in her article. In reality, I had engaged in vaginal sex nearly nine years
prior to the emergence of the AIDS epidemic. The sexual exchange was with an Asian
woman and it involved the use of condoms to prevent conception.
Fast forward to 2003 and 2004 and there is again media hype about an old issue, this
time with a new hook—the term “down low.” Thankfully, the media no longer needs
a substitute for the real subject of concern. J.L. King, author of On The Down Low: A
Journey Into the Lives of “Straight” Black Men Who Sleep with Men, was not only
willing to write about the issue from firsthand experience but also willing to appear on
The Oprah Winfrey Show in 2004. The episode’s title was “A Secret Sex World: Living
on the ‘Down Low.’ ” Several major newspapers also featured men on the “DL,”
including The New York Times Magazine, which ran an August 2003 cover story written
by Benoit Denizet-Lewis entitled “Double Lives on the Down Low.”
Living on the “DL” is but one of several terms in a broader arsenal of code language
that is in constant flux. The term serves to describe a specific sexual interest and a shared
sensibility among individuals and groups in the black community about male-to-male
sexuality and black manhood. These sensibilities are, more often than not, distinct from
sensibilities held by black men and by non-black men who identify themselves as gay.
Men on the “DL” may have sex with men but they do not relate to the established gay
community, and, rather than coming out, they choose to keep their sexual activities
private—in other words, on the “down low.”
The recent attention in the media to black men on the “DL” makes it appear as though
8 this is a new development in black male behavior. Further, it suggests that this behavior
The “down low” 45
1111 differs essentially from behavior found in other racial or ethnic groups. This current
2 public discourse shows a lack of knowledge of earlier concern with the issue, leaving
3 solutions to the HIV/AIDS epidemic among the African American population unex-
4 plored and unsupported. Culturally grounded HIV-prevention models based on evidence
5 of effectiveness in the black community are lacking, and a deeper understanding of the
6 factors that contribute to risk behavior in black men and women is needed.
7
8
Beyond the talk
9
10 In 1986, long before the term “DL” came into common use, the now defunct National
1 Coalition of Black Lesbians and Gays (NCBLG) carried out one of the earliest efforts
2 to address HIV/AIDS within the black community. NCBLG developed a nationally
311 distributed HIV-prevention brochure that included the term “men who go both ways,”
4 code language that had currency in some quarters of the black community at the time,
5 along with other terms such as “In the Life,” which is the title of Joseph Beam’s 1986
6 groundbreaking anthology of essays by black gay writers and artists. NCBLG and others
7 engaged in HIV prevention incorporated these terms and other language into their work
8 to recognize the large community of black men who slept with other men but would
9 never identify with the word “gay” or with gay culture.
20 While it is important to examine changing jargon, the bigger issue, since the beginning
1 of the epidemic, is that research to support effective HIV prevention for blacks is sorely
2 needed. In the midst of this media focus on the “DL,” the Centers for Disease Control
3 and Prevention (CDC) embarked in late 2003 on a new initiative to provide multiyear
4 funding for community-based efforts to stop the spread of HIV. The CDC required that
5 applicants for grants use one or more of the interventions included in the Procedural
6 Guidance, which catalogued evidence-based intervention models that the CDC had
7 endorsed as effective. For organizations interested in providing targeted outreach and
8 health education/risk reduction to high-risk, non-gay identified black men, picking a
9 model from the CDC menu was challenging. While the Procedural Guidance described
30 processes for adapting and tailoring models to meet the needs of specific populations,
1 only one of the CDC models, Community Promise, was specifically described as having
2 been tested among non-gay identified men who have sex with men.
3 The paucity of CDC endorsed models that have been researched and developed for
4 use in the diverse groups of black men at high risk for HIV infection or transmission is
5 not surprising. In light of the need for more effective approaches, researchers are saying
6 more study is needed. This need should enter into the public discourse to promote the
7 development and dissemination of effective models.
8 In the February 2004 issue of the Journal of Black Psychology, Vickie Mays, Susan
9 Cochran, and Anthony Zamudio call for a renewal in public funding for research that
40 examines how social, interpersonal, and community contexts factor into HIV risk taking.
1 This article also identifies best practices in mental health interventions for black men
2 who have sex with men and measures sexual orientation and behavior in studies
3 involving large numbers of the black population.
4 Similarly, in a paper published in the same issue of the Journal of Black Psychology,
5 Lula Beatty, Darrell Wheeler, and Juarlyn Gaiter recommend:
6
7 using and developing, if necessary, well-articulated theories appropriate to the
118 culture and experiences of the African American population to guide research;
46 Gilberto R. Gerald
11 acknowledging and controlling for diversity of the African American population
[as part of research], especially in regard to factors that are associated with
HIV/AIDS . . . ; [and] conducting more studies on structural interventions that
investigate how sociopolitical and environmental factors shape and can effectively
change health behaviors in African American communities.
It remains to be seen if the attention recently given to black men on the “DL”
represents just another spike in sensational media attention to the issue of HIV/AIDS
in blacks—or a turning point spawning renewed and expanded community action and
scientific research.
8
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2 10 Teaching and learning
3
4 Latina sociology of sex
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7
Gloria González-López
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311 Recent US census figures confirmed a phenomenon that I have been anticipating for
4 some time. The changing demographics show that Latinos make up the largest minority
5 group in the United States (37 million). According to one study, Latinos represent
6 the majority of births in California. As I reflect on these statistics, I return to the ways
7 in which these demographics impact the study of human sexuality in the United States.
8 I am also reminded of why I first began to conduct sexuality research with Latino
9 immigrant populations.
20 In the fall of 1995, I led a Latina adult women’s support group in Los Angeles as part
1 of my clinical training as a therapist. For many women in the support group, this was
2 their first opportunity to explore their emotional lives in a safe atmosphere with other
3 adult women. Over the course of eight weekly meetings, women in the group developed
4 deep bonds with each other and with me as their group facilitator. They expressed a
5 desire to explore the most intimate details of their lives as women. However, they
6 remained surprisingly silent about one issue: their sex lives.
7 When I questioned the women in the group about this silence, they immediately asked
8 whether they could discuss their intimate experiences and their sexual lives. The sessions
9 became intense and their sexual concerns seemed endless. During our group sessions,
30 we explored countless issues involving virginity, orgasm and sexual satisfaction,
1 relationships, homosexuality (gay and lesbian), sexual practices, reproduction and sex,
2 sexual fantasies, extramarital affairs, prostitution, sexually transmitted diseases, sexual
3 morality, machismo, as well as their concerns about providing sex education for their
4 children.
5 Some women felt secure about sharing experiences of sexual victimization (rape and
6 incest), while others disclosed their deepest sexual fears, such as becoming a lesbian.
7 These dialogues around sexuality enhanced the quality of our discussions and extended
8 the longevity of the group, which continued for an extra eight months. While the life of
9 the group was extended, it seemed relatively short compared to the women’s curiosity
40 and desire to learn as much as possible about sexuality. What was so powerful about
1 the sex lives of these women? Why, originally, was there so much silence around these
2 issues?
3 When I began my doctoral program in sociology, very few of these issues were
4 adequately addressed. In my graduate seminars on sex, gender, and feminist studies,
5 there was a glaring lack of attention to Latina sexualities. On the other hand, the women
6 in the group had endless questions about sexuality, which they put in the context of
7 gender, class, race, citizenship, language, religion, and other social factors. Cultural
118 difference, inequality, socioeconomic segregation, and social injustice had shaped their
48 Gloria González-López
11 views of sexuality and reproductive health. These factors also influenced the kind of sex
education they were providing for their children. However, these concerns were rarely
a part of my academic training.
Witnessing the social process that shaped the sex lives of the women in the group,
I embarked upon my own personal transformation. The group compelled me to revisit
my well-considered professional plans, and I chose to begin research on the sex lives
of Mexican immigrant women. This was only the beginning of a never-ending quest to
investigate and draw attention to the sexual lives of Latina women.
It has been some time since I led the Latina group, but I continue to learn about
sexuality from the Latina women with whom I interact. Now as a professor teaching
an undergraduate class entitled “Chicana/Latina Sexuality,” I realize that part of my
motivation to teach the class arises from my own unresolved issues. I wanted to teach
1 the class that I would have liked to take eight or nine years ago.
Enthusiastic and prepared with an extensive reading list of Chicana/Mexicana
sexuality research, I still encountered a challenge. How would I teach a group of mostly
young Chicanas about Latina sociology and sex?
I have always known that passion is an inevitable part of sexuality. Blending
pedagogy and passion seemed like a good combination for the course. Following one
of the most admired apostles of education in Latin America, Paolo Freire, I opted for a
form of education that would aim toward freedom, justice, and change. From day one
I invited my students to emotionally engage the reading material. Beyond thinking about
Chicana/Latina sexuality, I invited students to start feeling about Chicana/Latina
sexuality. During class discussions, we navigated differences in the ways in which
Chicanas and Mexicanas shaped their sexual lives. In learning about the history of
Chicana and Mexicana sexualities, I encouraged students to imagine back through
history to the collective experiences of women who were raped—a history that shaped
the conquest of California and the southwestern United States. This dynamic is also
mirrored by more recent atrocities in Ciudad Juárez, Mexico. The testimony of a Chicana
lesbian, who volunteered to speak to the class, illustrated the social and cultural forces
involved in freely embracing her sexuality and the difficulties of attempting to come out.
As my students and I embarked on this learning journey, “conscientizacão,” or the
“awakening of consciousness” promoted by Freire, we broadened our understanding of
sexuality. The relationship between the feelings surrounding sexuality, alongside the
issues that shape Latina sexualities, triggered intense reactions. But it also generated
enthusiasm and curiosity. We approached issues through the “nosotras” perspective—
a concept proposed by Chicana feminist Gloria E. Anzaldúa. The nosotras approach
(nosotras meaning “we, female”; nos meaning “us”; and otras meaning “the other”) allows
us to place Chicanas and Mexicanas at the center of our discussions and analyses. The
nosotras perspective encourages a feminist sociological perspective, emphasizing
structural causes of marginalization.
Invariably, my students would ask, “So, how do we challenge all these inequalities?
How do we promote social justice and change? How do we reclaim our sexualized
bodies? How do we teach Chicanas and Mexicanas to develop gender consciousness
with regard to sexuality?”
My experiences have exposed me to the same challenges. Each semester I have
different students, but the questions are often the same and equally profound. The
8 questions are also endless, and all of us explore potential answers.
Latina sociology of sex 49
1111 At times I have no choice but to remain silent while listening to the engaging
2 and interesting discussions of students. By the time they identify new themes for future
3 research, a ringing sound indicates that it is time to dismiss our class—interrupting their
4 stimulating debates. After erasing the board and getting rid of the chalk on my hands,
5 I choose to stay after class, alone, by myself. After taking a deep breath, I inevitably
6 go back in time to those years in Los Angeles. Then, the image of those eight women
7 who changed my professional fate appear inside my empty classroom to remind me
8 that their daughters grew up and now attend college. Their daughters are my students.
9 The echo I did not find those years while trying to learn about Latinas and sex I am now
10 finding while doing my very best to both teach and learn from a new generation of
1 Chicana women eager to explore the sociology of Latinas and the intricacies of sex.
2
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11 Christian right rhetoric
Exploring anti-gay politics online
A profile of Janice M. Irvine
1 Janice Irvine has examined the inner workings of a culture war and seen firsthand the
power of propaganda. She has dodged fist fights and endured screaming matches. Her
work, at times, has left her depressed.
Irvine studies the Christian right.
Since the 1960s, she says, the right wing has used rhetoric to mobilize communities
and gain political clout. One of the group’s earliest targets was sex education; their
tactic was to spread untruths and demonize sex educators. Depravity narratives—that
teachers were taking off their clothes for anatomy classes, that young children were
being taught about sodomy—riled otherwise calm individuals.
“We have a culture of sexual shame in general,” Irvine says. “The rhetoric of the
Christian right taps into that. They don’t have to say much to make people scared.”
More recently, Irvine, a sociology professor at University of Massachusetts at
Amherst, has looked at how conservative Christians direct similar strategies toward
sexual rights. Her article, “Anti-Gay Politics Online: A Study of Sexuality and Stigma
on National Websites,” appears in Sexuality Research & Social Policy (Vol. 2, No. 1).
For the study, Irvine examined the websites of six groups that were prominent in
opposing gay rights—Concerned Women for America, Focus on the Family, the Family
Research Council, Traditional Values Coalition, the American Family Association, and
Americans for Truth—monitoring and analyzing the content for six months. She found
that rather than using extreme stigmatizing rhetoric, as has been done in the past, these
groups tended to present biased information as objective news and opinions as scientific
argument.
The websites of Traditional Values Coalition (TVC) and Concerned Women for
America contained the strongest language, depicting sexuality as degrading or
embarrassing, and linking gay men to child molestation and other depraved acts. For
example, in September 2003, Irvine points out, TVC featured a story titled “California
Congresswoman Proudly Supports Obscene Bisexual Conference”; a summary of the
article read, “San Diego Congresswoman Susan Davis (D) attended a bisexual conference
over the weekend that featured full female and male nudity and workshops on sex toys.”
In the same month, the group published two articles online, “North Carolina Homosexual
Teacher Arrested on Molestation Charges” and “Two Homosexuals Arrested on Child
Molestation Charges,” in addition to posting its regular link “Homosexual Child
Molesters.” TVC describes itself as the largest nondenominational church lobby in the
United States with a membership of 43,000 churches.
Focus on the Family, the Family Research Council, and the American Family
8 Association had much less anti-LGBT coverage on their sites, Irvine found, and yet, they
Christian right rhetoric 51
1111 are leaders in anti-gay politics. To get their word out, these groups used other media
2 outlets, such as radio, email, and newsletters.
3 “In November 2003, Massachusetts legalized gay marriage; there was a volatile
4 reaction,” Irvine says.
5
6 I expected more use of the Internet for organizing. Focus on the Family sent
7 representatives to Massachusetts and launched a legal challenge, but there was no
8 mention of the issue on their Web site. It seems that some of these organizations
9 are at an early phase in the use of the Internet.

10
1 Historically, conservative Christians have been at the forefront of utilizing communi-
2 cations technology to spread their messages and sway politics, according to Irvine’s
311 research. In the 1920s and 1930s, she writes, they established radio broadcast minis-
4 tries. Father Charles Coughlin, who spouted anti-Semitic rhetoric and defended fascist
5 policies on his radio show, reportedly received 80,000 letters weekly in the mid-1930s.
6 Conservative Christians were also quick to realize the potential of television, Irvine
7 writes. Jerry Falwell, a popular televangelist in the 1970s and 1980s, heads The Faith and
8 Values Coalition, a political action committee, and has raised $2.5 billion for his causes.
9 Today, there are roughly one million online religion websites. Cyber-religion could
20 become the dominant form of religion, according to scholar Brenda Brasher, who is
1 cited in Irvine’s study. “If online religion . . . has the capacity to transform the future
2 of religion,” Irvine writes, “it will also transform the future of politics, because the
3 escalation of conservative religious political activity has been one of the hallmarks of
4 the late twentieth, early twenty-first century political landscape.”
5 During the past twenty-five years, national Christian right organizations have been
6 the most politically mobilized opponents of LGBT rights. Their rhetoric—calling gay
7 materials pornography or gay men pedophiles—associates lesbians and gay men with
8 negative and frightening meanings, Irvine says.
9 TVC’s online “Homosexual Urban Legends” series is an example of that. One article
30 of that series, “Exposed: The Myth That ‘10% are Homosexual’ Updated,” challenges
1 Kinsey’s analysis that 10 percent of males are “more or less exclusively homosexual”
2 (rating a five or six on the Kinsey scale). TVC’s article cites a National Health and
3 Social Life Survey, which found 2.8 percent of the male population and 1.4 percent of
4 the female population identify as gay, lesbian, or bisexual. TVC’s article, however,
5 fails to include data from surveys regarding men and women who reported same-sex
6 behavior and attraction but didn’t identify themselves as lesbian or gay. Irvine writes
7 that TVC’s article “argued that homosexuals used the ‘bogus’ figure in order to ‘recruit
8 children into the homosexual lifestyle and to lobby for . . . special legal protections for
9 homosexuals.’”
40 Irvine says:
1
2 The Christian right uses data in a distorted or misleading fashion, much of it based
3 on methodologically problematic studies. The uninformed may be less able to
4 evaluate these seemingly scientific reports, and there is potential for journalists
5 to take this material directly from sites.
6
7 Since the election of President George W. Bush, Irvine says, the right wing feels it
118 has been given license to continue and expand its rhetoric.
52 Profile of Janice M. Irvine
11 In the case of marriage equality, conservatives often warn of a domino effect. When
the Supreme Court struck down a law banning sex between adults of the same sex, for
example, Justice Antonin Scalia’s dissent argued that if sodomy laws were illegal, laws
against incest and bestiality would become illegal too. The Village Voice lampooned
his opinion in an article “Petaphilia: The Great American Man–Dog Marriage Panic.”
Irvine says, “People who want our country to value individual and civil rights, and a
quality of openness and freedom, need to be involved in educating people about the
problematic rhetorical strategy the right is engaged in and neutralizing it, even through
parody.”
Irvine’s research, which she started more than a decade ago, provides a strong
response to Christian right rhetoric. She first became interested in the phenomena during
debates in the 1980s and 1990s on sex education. Her book, Talk About Sex: The Battles
1 over Sex Education in the United States, was published in 2002.
In 1981, the US Office of Population Affairs began administering the Adolescent
Family Life Act, providing funding for what is now known as abstinence-only sex
education. “This curriculum showed up in communities and generated huge culture
wars,” Irvine recalls. “I was living in Cambridge and the surrounding communities
were completely coming apart over this. I knew this was the issue to take on.”
At one town hall meeting she attended, people were screaming and scuffles were
breaking out. Parents were pushing and shoving. One of the organizers got up to speak
but collapsed. No one knew what had happened, Irvine remembers. Then, they were
informed he had had an anxiety attack. “That has stuck with me. It was emblematic of
the intense emotions of that time.”
Even under the more liberal Clinton administration, issues of sexuality remained
taboo. In 1994, for example, then Surgeon General Joycelyn Elders said at a UN-
sponsored conference on AIDS that masturbation “is a part of sexuality, and it’s a part
of something that perhaps should be taught” as a means to prevent AIDS and as part of
comprehensive sex education. Less than two weeks later, Clinton asked for her
resignation.
“Clinton fired her and no one spoke out to defend her,” Irvine says. “People were
afraid of being stigmatized by the right wing as a pervert.”
8
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2 Part 2
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5 www., TV, and sexual
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commodification
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1
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311 Television and the Internet have at least a couple of things in common. They are both
4 visual mediums, driven by the desire to expedite communication and spread
5 information. They also proliferate sexuality, and in particular, the commodification of
6 sexuality. That is, sex that sells. In sexy survivor shows, Girls Gone Wild DVDs, and
7 the exponential rise in the amount of pornography now available online, we can see that
8 sexuality is used to both facilitate more conversations and to sell products. Of course,
9 this is not all that new.
20 Historically, there have always been controversies about television and sexuality. In
1 the “golden years” of television in the 1950s, married couples on TV were required to
2 have two separate beds. By the 1970s, Mr and Mrs Brady were sharing a super-sized
3 king bed while the rest of the Bunch slept tucked away in their gender-appropriate,
4 shared bedrooms. Certainly, no one would argue that explicit sexual content on TV, both
5 verbal and visual, has risen steadily since then. Indeed, some organizations have devoted
6 themselves to monitoring every show on the air and documenting the instances of sexual
7 material: implied, subtle, or otherwise. As more sexuality shows up on our TV screens,
8 how representative of real people’s experience are these images?
9 If there is more sex on TV—and certainly there is no lack of it on the Internet—what
30 does this mean for society? Social scientists have long debated how the media impacts
1 people’s behavior. On the one hand, some have argued that exposure to sexual images
2 effectively programs people to have more sexual desires and to mimic the behavior
3 they see on the screen. Others have argued that people have much more agency,
4 autonomy, or “will” when it comes to viewing sexual scenes (or any scenes for that
5 matter); people can distinguish fact from fantasy and act accordingly. Some would say
6 that the multitude of sexual images now available is simply a mirror for desires that have
7 always existed. These debates continue and promise to increase in intensity as more and
8 more people have access to previously “taboo” images.
9
40 Sexual democratization?
1
2 In this information age, one thing is for certain: equal access to images of sex and
3 sexuality exist more now than ever before. In the past, it was largely the elite and ruling
4 classes who were able to procure erotic images. Pornography as a genre has existed
5 since the rise of mass media (in the form of print, lithography, photographs, film, and
6 video). But only in the last thirty years have moving images been available to large
7 numbers of the general public. Now, as anyone reading this can attest, just about
118 everyone can find a limitless array of extraordinarily explicit sexual content, visual or
11 in print, live or recorded. This marks a new era for sexuality, when we are privy to more
sexual information and images than in any other time in history.
Through technology, there are new realms of possibility for sexual experience and
experimentation. We can communicate and meet with people whom we wouldn’t have
encountered otherwise. How do these forums change the way we, literally, “articulate”
our sexuality? As we go through the process of “marketing” ourselves online, describing
our physical looks, our fantasies, our preferences—how might this alter the way we
feel about ourselves as sexual persons? Are we simply honing our sexual sensibilities
as we peddle and profile our sexual wants and attributes? With technologies that
can erase any supposed imperfections—in size, color, shape, and age for example—how
do online images of others and ourselves impact us as sexual beings? In the 1970s,
there were people who regularly posted personal ads in newspapers, looking for love
1 or maybe just looking for a one-night stand. Now, an unprecedented number of
people are engaged in a similar process, in more rapid succession than was possible with
a print medium. Unlimited access of this kind also spells danger for some. Sexual
predators are nothing new, but they now have a superefficient forum in technologies that
regularly outstrip law enforcement’s monitoring abilities. In this section, consider how
media and the commodification of sexuality are linked. What do communications
technologies and the massive marketing of sexual images mean in terms of how our
sexualities are being shaped on a daily basis? Do these images simply quench a thirst
for desires already there, or do these images, online conversations, and encounters
actually influence what it is we want from our sexual lives?
8
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2 12 Surfing for healthy sexualities
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4 Sex and the Internet
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7
Deborah Levine
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311 Do you know the word most often searched for on the Internet? Yes, you’re right.
4 It’s SEX.
5 More and more people like you and me are turning to the Internet for sexual health
6 information, entertainment, and romantic rendezvous. Seventy percent of Americans
7 spend time online, according to the 2006 Pew Internet and American Life Project. That’s
8 approximately 128 million people, evenly split between men and women. Sixty-six
9 percent of online surfers look for health information; 18 percent search for information
20 on sensitive or embarrassing topics . . . Hmmm, could sex be one of them?
1 The anonymity of the Internet makes it the perfect place to get accurate sexual health
2 information. From scientific facts and advice to tips and techniques, this information
3 can help you maintain a long-term relationship, make new friends, or even find love and
4 romance.
5 Think about it: When’s the last time you asked a sex question to your doctor? Or
6 talked to your friends about what you and your partner did in bed last night? Or made
7 an appointment with your clergyperson for a frank discussion? The truth is we live in
8 one of the most overtly sexualized societies (look at current movies, music, fashion,
9 advertisements), but until recently we have had few places to find out if what we do
30 behind closed doors is considered “normal.” Then along came the Internet.
1 Since the advent of the Internet, the definition of “normal” has greatly expanded.
2 With its wealth of information, the Internet can alleviate any shame or embarrassment
3 that individuals may have about sexual issues. You can explore your sexual options in
4 the relative safety and obscurity of cyberspace, and if you spend some time surfing,
5 you’ll be surprised at the variety, depth, and breadth of what’s available.
6 Research shows that people who discuss sexuality openly and are comfortable with
7 their bodies are better lovers and life partners. Taking advantage of what the Internet
8 offers can provide you with the tools for a satisfying, active sexual life well into your
9 senior years.
40
1
2
Riffraff opinion versus high quality information
3 Everyone has an opinion and these days you can find many of them online. But if you
4 want facts and science, you need to “look for the union label.” In other words, if you go
5 to a sexual health Web site or a site professing sex advice, make sure you click and read
6 the credentials of the person or organization behind the site. Best bets are reputable
7 nonprofit organizations such as The Society of Obstetricians and Gynecologists of
118 Canada, Advocates for Youth, Planned Parenthood or the American Social Health
56 Deborah Levine
11 Association. Other good sources include international governmental organizations such
as Health Canada, the US National Institute of Health, or Britain’s National Health
Service. Universities are another good source of current and correct information.
If you are looking at a private site, click on the link usually found at the bottom of the
homepage that says “About Us” or “Who We Are” to find out who’s who and what’s
what. Look for credentialed columnists or an advisory board that reviews the material
as well as information such as where and what the people behind the scenes studied.
Experts need more than initials such as M.A. or Ph.D. behind their names because while
a Ph.D. in mathematics is a wonderful thing, it doesn’t qualify someone to write a sex

advice column.
Beyond textbook sexuality

1
If you want to learn about more esoteric sexual practices—from bondage to
voyeurism—you can find groups with similar interests on the Internet. Taking a peek
at the fringes never hurts and might help open your mind to the myriad of possibilities.
Even if you don’t end up regularly partaking in an alternative practice, you will have
learned in a safe and nonjudgmental way about the sexual possibilities that exist in the
world. One way to navigate through fetish and kink sites without being bombarded by
spam from commercial pornography producers is to start with Gloria Brame’s Kinky
Links. Gloria is the coauthor of Different Loving: The World of Sexual Dominance and
Submission.
We all need variation in our sexual styles, and the Internet is a good place to learn
new tips and techniques to keep things exciting. You can find sites that teach every-
thing from giving an erotic massage to pleasuring yourself. And you can get sex-toy
recommendations from women, men, and experts at places like Good Vibrations, My
Pleasure, or Libida.
Leveling the playing field

No matter what your interests are and what information you seek online, education can
help broaden your views of sexuality. The Internet levels the playing field and removes
the shame or embarrassment that some people may have about sexual issues. The
Internet allows us all to be novices and experts at the same time. You can quietly find
things you know nothing about. You can explore sexual fantasies without fear
of rejection. You can make mistakes without ever having to see the same people again.
You can become an expert in the art of sex and lovemaking without leaving the comforts
of home.
Armed with an understanding of the range of sexual expression, your newfound
knowledge can serve you well. You can, if you wish, take what you’ve learned online
and translate it into your personal life offline. Or, you can simply leave with greater
knowledge about the diversity of human sexuality.
Remember, people who are comfortable with sex are sexy. Let the Internet be your
new source of sexual health information, exploration, and education.
8
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2 13 Sexual networks online
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Gregory Rebchook and Alberto Curotto
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311 The Internet has changed my life . . . it has been like a third parent to me almost . . . I had
4 my first sexual experience through someone I met on the Internet. I had my first relationship
5 through someone I met on the Internet. I have learned so much about life, and how people
6 deal with each other through the experiences I have had through the Internet . . . but it has
7 also made me lie . . . because I like someone and I want them to like me so I adapt myself
8 to what I think they might like.
(Thirty-seven-year-old bisexual male, interviewed online)
9
20
1 Gay/bisexual men’s use of the Internet to meet sex partners has captured the attention
2 of public health officials, HIV-prevention professionals, community activists, and
3 researchers alike. The medical literature contains case studies of men who contracted
4 HIV through unprotected anal sex with men they met online, and syphilis has been
5 spread through sexual networks of gay/bisexual men that were formed on the Internet.
6 Focusing solely on the epidemiology of HIV and other sexually transmitted infections
7 among men who go online to seek out male sexual partners, however, barely scratches
8 the surface of the transformative effect that the Internet has had on the lives of many
9 gay/bisexual men.
30 To gain a broader understanding of the Internet’s role in the lives of gay/bisexual
1 men we obtained research grants from the University of California’s AIDS Research
2 Program and the National Institutes of Health, which enabled us to conduct detailed,
3 real-time online interviews with over a hundred individuals recruited from chatrooms.
4 This article relates some of the findings from our analysis of these interviews and
5 information about participants’ sexual behaviors collected in a self-administered online
6 survey.
7 The online environment is vast and rich in its diversity and complexity, and no less
8 so for gay/bisexual men. Countless gay-oriented websites provide access to community
9 resources; coming out support; education about political and activist initiatives that
40 are relevant to gay/bisexual men; gay men’s health information; opportunities for
1 socializing and communicating with others facing similar issues, regardless of their
2 geographic location; and all manners of sex-oriented entertainment—including sites
3 that eroticize unprotected anal intercourse, also known as “barebacking.”
4 Many websites and online service providers offer a variety of features, often organized
5 by location and/or special interest, which allow people to communicate with each other
6 in public chatrooms or via private chats. Chatrooms also provide a convenient way to
7 identify others who are online at any given moment by looking at the list of everyone
118 currently in a particular room. People who are looking to expand their social or sexual
58 Gregory Rebchook and Alberto Curotto
11 networks often browse through these lists and read other users’ personal profiles to
decide whether or not to contact any of them. Online profiles can contain almost any
information someone wants to reveal about themselves, including physical appear-
ance and photographs, sexual orientation, location, relationship information, sexual
interests, drug use, HIV status, a potential partner’s desired attributes, hobbies, etc. Any
subsequent communication may lead to immediate or future in-person meetings, the
development of online relationships, and/or sexually explicit online exchanges (some-
times called cybersex) via a chat client or a webcam.
The Internet offers men seeking to meet each other many ways to do so other than
chatrooms—from freely accessible e-groups and bulletin boards to websites with
personals advertising for everything from long-term relationships or friendships to
immediate, no-strings-attached, sexual encounters. An ever growing number of
1 subscription websites provides access to databases of personal profiles so members can
search for other subscribers with compatible interests and desires.
The variety of online venues has helped men create new social and sexual networks
among men and has provided new settings for sexual encounters. Nearly every
respondent in our study reported that, thanks to the Internet, their number of sexual
partners and encounters had increased. Many participants described the ease of find-
ing sexual partners in both a positive and negative manner. On the positive side, they
generally seemed to appreciate the convenience and directness of cruising online, as
well as the wide variety of partners available. Some described the anonymity of online
communication as one of the Internet’s major advantages over traditional sex-seeking
venues, allowing them to avoid hostile or intolerant environments and enabling them
to carefully choose which of their personas to present to potential sex partners. On the
negative side, many men were frustrated by the lack of more lasting and intimate
relationships resulting from these online encounters. Additionally, many participants
expressed a concern that the Internet could reveal gay men’s sexual lives to a larger
straight public, reinforcing conservative heterosexual notions that gay men are overly
fixated on sex.
Men in our study had mixed impressions about the relationship between Internet use
and risky sexual activity. Some men felt that “if someone is going to be risky they are
going to do it with or without the Internet. I think more people are satisfied with the
fantasy online.” Others felt that the Internet contributes to gay/bisexual men’s
willingness to engage in unprotected anal intercourse. One respondent said that the
Internet “has made ‘barebacking’ such an acceptable practice,” and another reported that
the Internet “is making [barebacking] readily available to everyone. I never had heard
of it until I got online.”
“Hook ups?” Yes. But a whole lot more . . .

Nearly all the men we interviewed reported sexual activity with a man they had met
online, and their behaviors regarding unprotected anal sex could be classified into
discrete patterns: never having anal sex; always avoiding casual online “hook-ups” and
using condoms in other sexual relationships; always using condoms for anal sex without
any discussion of condoms, HIV, or safer sex; or always using condoms for anal sex in
addition to discussing each partners’ HIV status, HIV testing, and sexual histories, and
8 expressing a desire to stay HIV-negative or to avoid infecting others.
Sexual networks online 59
1111 Other men did report instances of unprotected anal sex with someone they met online.
2 Some said that occasionally they had unprotected intercourse with men they met online
3 and that they never discussed HIV or condoms with them. Others said that they used
4 condoms with men they met online, but that they did not do so with “known” partners;
5 regrettably, from an HIV-prevention point of view, a “known” partner might simply be
6 someone they met in person more than once without ever discussing sexual risk. Some
7 of the men we interviewed who were not HIV-positive said that they would have
8 unprotected anal sex with someone they met online if he told them he was HIV-negative.
9 Such instances of “serostatus disclosure” were often incomplete since there was no
10 communication about testing or potentially risky sex shortly before, or since, testing.
1 Still others said that they had unprotected sex with men they met online without any
2 discussion of HIV status or condoms unless the partner insisted on condom use. Few
311 participants said they never used condoms, but many men left condom use decisions
4 entirely to their partners.
5 Whereas the Internet’s role in facilitating sexual risk behaviors among gay/bisexual
6 men is still unclear, our interviews have shown that the Internet plays an important and
7 multifaceted role in the lives of the gay/bisexual men in our study. For most men Internet
8 use resulted in increased occasions for sexual encounters, which provided opportunities
9 for risk-taking behavior. However, whether or not these men would have engaged in
20 risk behavior were it not for the Internet was beyond the scope of our study.
1 Exactly how the Internet does, or does not, contribute to gay men’s HIV-risk behavior
2 has not been unequivocally answered. What we did find is that, for many of our
3 participants, the Internet has been a unique and invaluable tool in the development of
4 their sexual identity and self-expression. Most men appreciated the opportunity the
5 Internet offered to socialize and access resources safely and anonymously. Occasionally,
6 men were able to develop and sustain supportive interpersonal relationships, and
7 sometimes they even met their boyfriends or life-partners online.
8 Since the Internet can facilitate both safe and unsafe sexual encounters, online
9 HIV/STD prevention programs will continue to expand and develop and further research
30 should be conducted to determine how best to facilitate a reduction in sexual risk.
1 Additionally, traditional HIV/STD prevention programs must also find ways to address
2 the specific prevention needs of men who meet sex partners online. Programs that
3 emphasize and build on the Internet’s strengths and assets, such as its exceptionally
4 wide reach and the online environment’s ability to foster self-empowerment, will be
5 more meaningful to the target population of gay/bisexual men than those that only focus
6 on epidemiological concerns.
7
8
9
40
1
2
3
4
5
6
7
118
11
14 Halflings and ogres and elves,
oh my!
Sex, love, and relationships in EverQuest
Brandee Woleslagle
1 The really cool thing that happened in this game is I found love again. I started playing this
game because I had just gotten out of a nasty marriage . . . I would have never started a
relationship in person. In this instance I fell in love before I knew it was happening.
(April*, forty-one-year-old female, Kansas)
Many people would balk if you told them that your romantic partner is a troll who
practices magic, slays dragons, and carries a wooden cudgel the size of her out-of-
proportion head. Yet players of EverQuest**, a massively multiplayer online role-
playing game (MMORPG), would probably just nod and ask how you met.
For several years Sony Online Entertainment dominated the MMORPG market
with EverQuest, their best selling online game. Boasting 420,000 subscribers with more
than 100,000 online at any one time, Sony has created a digital environment where
players from around the globe log on to a three-dimensional fantasy world to play,
socialize, and fight alongside one another.
For many, EverQuest is not a casual pastime. Participants rarely play less than two
to three hours a day, a couple of days a week, while more serious gamers will play six
to eight hours each weekday, with marathon stints of thirty or more hours over the
weekend. Unsurprisingly, friendships form among players, which sometimes evolve
into romantic partnerships.
It is important to understand the meaningfulness of relationships that are taking place
in cyberspace. These relationships—which develop through chat programs, message
boards, email, or in game environments—are becoming commonplace as more people
gain access to the Internet. Yet when the topic of online romance is broached skeptics
are still likely to say, “but it is not real!”
In order to gain an understanding of the relationships that are formed in online role-
playing games, I conducted ethnographic research in the realm of EverQuest in late
2003. I held thirty-seven, in-depth interviews with participants ranging from age
eighteen to sixty. The interviews were conducted online within the game world, allow-
ing me to speak with individuals from five countries, and across the United States.
Based on this study, I have found that relationships in EverQuest take several different
forms.
*Names changed to protect privacy.

8 **EverQuest is a registered trademark of Sony Computer Entertainment America, Inc.
Sex, love, and relationships in EverQuest 61
1111 The consummate relationship
2
3 For some, a relationship that begins in the game blossoms into a full-fledged romance
4 and a long-term relationship or marriage.
5 Kelly*, a twenty-six-year-old gamer from Pennsylvania, met her husband in the midst
6 of a battle between blue-skinned orcs. While fighting alongside her, Kelly’s husband-
7 to-be made a comment that sparked her interest: he asked her if she wanted a kitten.
8 Within one week she “just knew” that she had found her soul mate. A month after their
in-game introduction, they decided to meet face-to-face.
9
10 Two years later, Kelly and Martin* married in two different ceremonies, one online
1 and one offline. Kelly recalls that “it felt almost surreal because of that, like for some
2 strange moment I really was my character. When we got married in real life, a bunch
311 of our game friends who were at that (in-game) wedding were at the real wedding too.”
4 Kelly and Martin’s story is not atypical. During the course of my research I found that
5 many people are meeting in EverQuest and taking their relationships offline. Shared
6 interest in the game, and the ability to spend time with one another while playing, are
7 some of the major forces behind these couplings. The amount of chatting generally
8 multiplies after players exchange phone numbers and email addresses. The romance
9 may culminate in a face-to-face meeting, which typically involves several days tucked
20 away in a bedroom.
1
2 The online-only love affair
3
4 Not all romances end with the proverbial “happily ever after.” There are those
5 relationships that can never cross the digital boundary. Candace*, a nineteen-year-old
6 female player from Ohio, is currently in a romantic partnership with John*, a married,
7 fifty-two-year-old male.
8 Candace said of her relationship:
9
30 I think we both understand that this is more of a fantasy relationship, since obviously
1 it wouldn’t work (offline), but we both wish it could be so much more. I think that
2 kind of eats at both of us sometimes, but we’re also not stupid, so we know what
3 has to be.
4
5 Candace made it clear during the course of our interview that she was in love with John,
6 and he with her. Candace added that “he’s finally admitted that he’s crossed the
7 acceptable line in his feelings for me—I think if we lived closer together, there probably
8 would have been a ‘real’ affair going on.”
9 Candace and John ultimately decided not to take their relationship offline because
40 both already have partners and too many miles between them. But other couples found
1 other insurmountable obstacles, such as vast age differences. Common to these
2 relationships are the intense feelings people have for one another, even if circumstances
3 preclude them from taking the relationships offline.
4
5
6 The role-play relationship
7 A third type of relationship that occurs in EverQuest is based in role-play and does not
118 involve attraction between the real-life partners. Instead, gamers initiate this type of
62 Brandee Woleslagle
11 relationship as “something to do” in addition to fighting monsters or tailoring tunics;
role-playing a relationship adds to the atmosphere of the game.
Roxanne* described her role-play relationship as “mostly just a flirty fun relationship,
kinda like the guy you flirt with just because it’s a lot of fun, but you’d never really be
serious about.”
Adding role-play relationships to the game is a creative outlet for many people. In
fact, players have created numerous websites and forums dedicated strictly to role-play,
allowing players to share tales of their characters progression in the world of EverQuest
outside of the game.
The cybersexual relationship

1 Finally, some relationships are purely for virtual sex. Sex on the Internet is no secret;
perhaps less well known is the number of people who are finding sexual partners in the
MMORPG environment. While cybersex occurs in all of the relationship types
mentioned above, sex is the raison d’être for this partnership.
Perhaps the safest sex to be had, masturbating while chatting with another player is
a common sexual activity. Veronica*, a sixty-year-old female player from Canada, uses
some of her time while in game to find lovers. In order to find willing partners, Veronica
sends private messages to players and hopes for a positive—and equally flirtatious—
response.
Veronica said of her cyber relationships: “I am in total control here, I can disappear
at any time, it is fun, a little dangerous, and it satisfies my (sexual) needs at this time.”
Veronica is not alone in her quest for sexual partners. Matthew*, a thirty-three-year-
old male from Illinois, has had many sexual relationships in the game:
In this game I have met people of every sexual persuasion. I have met women who
are hardcore dominatrixes and who think nothing of having their submissives make
sounds like characters from the game, and I have met all manner of submissives and
everything in between.
The cybersexual relationships experienced by these participants allow them to express

their sexuality. While the participants often do not have long-lasting relationships, the
time that they spend with their partners is intensely satisfying.
The future of researching online romances

EverQuest is not the only MMORPG where gamers are forming romances. Researchers
interested in pursuing this topic further may find different relationship structures
in past or future games or nonfantasy games such as City of Heroes with its comic book
setting.
People enter digital worlds in order to have fun, play a game, or become a knight
in shining armor. At the same time, people are forming lifelong commitments with
partners as a result of meeting during the frivolity of game play. As Christine* put it,
“it certainly is something to tell the kids. It definitely beats ‘I met him in a bar!’”
8
1111
2 15 Finding Nemo and transgender
3
4 creatures
5
6 Judith Halberstam
7
8
9
10
1
2
311 In this short chapter I will explore the representation of transgenderism in popular
4 culture. Using the framework of “natural diversity” adapted from a more recent stereo-
5 type in Joan Roughgarden’s book, Evolution’s Rainbow, I will read popular images
6 of transgender beings (human and otherwise) as potential sources for the recon-
7 ceptualization of binary gender. In her book, Roughgarden puts pressure on the
8 Darwinian narrative of evolution by giving alternative interpretations of intermediate
9 genders, cooperative behavior, and competitive struggle in the animal world. Arguing
20 that researchers project narratives like “survival of the fittest” onto phenomena that
1 could as easily be interpreted according to some other logic, Roughgarden allows
2 us to see friendship systems between animals where other researchers have only seen
3 competition; she replaces Darwin’s theory of “sexual selection” with a concept of
4 “social selection” and she rejects “the primacy of individualism” in favor of cooperative
5 development. Roughgarden’s interpretations of creatures that change sex, engage in
6 same-sex erotics, or switch sex roles are refreshingly original and they reveal the
7 extent to which contemporary theories of human cross-gender identification are limited
8 by their commitment to dreary and unimaginative accounts of the body, the self,
9 and diversity.
30 Popular culture produces, almost accidentally, plenty of narratives of belonging,
1 relating, and evolving and they often associate these narratives with, or at least in
2 proximity to, transgender characters. For example, an odd little animated film about a
3 lost fish positioned queerness, and transgender queerness at that, in ways that may be
4 helpful to us as we look for inspired conceptions of transgender difference. Finding
5 Nemo told the story of a clownfish family that, in the film’s tragic opening, is decimated
6 by a hungry shark. The mother fish and almost all of her eggs are consumed, leaving a
7 very anxious adult male fish, Marlin, with one slightly disabled offspring (he has a small
8 fin on one side), Nemo. Marlin, whose voice is supplied by Albert Brooks, becomes
9 understandably paranoid about the safety of his only son and he nervously, and even
40 hysterically, tries to guard him from all of the dangers of the deep. Inevitably Nemo
1 grows tired of his father’s ministrations and, in a fit of oedipal rebellion, he tells his father
2 he hates him and swims off recklessly into the open sea only to be netted by a diver and
3 placed in a fish bowl in a dentist’s office. Marlin, his paranoid fears now realized, begins
4 a mad search for his missing son and swims his way to Sydney, Australia. When he
5 finally finds him, he and Nemo orchestrate a fish uprising against their human jailors
6 and they work out a different, non-oedipal, non-paranoid mode of relation.
7 Like Chicken Run, then, the Gramscian cartoon about organic chicken intellectuals—
118 Gramscian in the sense that it understands revolutionary leaders as emerging from
64 Judith Halberstam
11 within the proletarian class itself—Finding Nemo weds its story of family to a tale of
successful collective opposition to enslavement, forced labor, and commodification.
And, like Dude, Where’s My Car and 50 First Dates, Finding Nemo exposes the limits
to normal forms of knowledge and it casts forgetfulness as a powerful obstacle to
capitalist and patriarchal modes of transmission. Finding Nemo also makes queer
coalition, here represented by a seemingly helpful bluefish named Dory whose voice is
supplied by the very queer Ellen Degeneres, into a major component of the quest for
freedom and the attempts to reinvent kinship, identity, and collectivity. Dory
accompanies Marlin on his quest for Nemo.

Dory, however, suffers from short-term memory loss and so only remembers
intermittently why she and Marlin are swimming to Australia. Her odd sense of time
introduces absurdity into an otherwise rather straight narrative and it scrambles all
1 temporal interactions. When explaining her memory problem to Marlin, Dory says she
thinks she must have inherited it from her family but, then again, she comments, she
cannot remember her family so she is not sure how she came to be afflicted. In her lack
of family memory, her exile in the present tense, her ephemeral sense of knowledge,
and her continuous sense of a lack of context, Dory offers fascinating models of queer
time (short-term memory), queer knowledge practices (ephemeral insights), and anti-
familial kinship. In other words, she counters family time, with its long genealogical
lines of transmission, with the time of the here and the now. The queerness of her lack
of memory has to do with the way that she can never place herself in relation to others
in terms of biogenetic kinship or lines of familial connection. By aiding Marlin without
desiring him, finding Nemo without mothering him, and going on a journey without a
goal, Dory offers us a model of cooperation that is not dependent upon payment or
remunerative alliance. Dory, literally, swims alongside the broken family without
becoming part of it and she helps to repair familial bonds without being invested in
knowing specifically what the relations between Marlin and Nemo might be. The fact
that they are father and son is of no more interest to her than if they were lovers or
brothers, strangers or friends.
I focus here on Finding Nemo because I believe that popular culture, particu-
larly non-earnest and non-serious popular culture, can offer narratives and images
for the project of thinking through what J.K. Gibson-Graham calls “non-capitalist
imaginaries.” Furthermore, Finding Nemo covertly harbors a transgender narrative
about transformation. Clownfish, we learn from Joan Roughgarden, are one of many
species of fish that can, and often do, change sex. In Evolution’s Rainbow Roughgarden
writes that most biologists observe “nature” through a narrow and biased lens of socio-
normativity and they, therefore, misinterpret all kinds of biodiversity. Transsexual
fish, hermaphroditic hyenas, non-monogamous birds, homosexual lizards all play a
role in the survival and evolution of the species, but mostly their function has been
misunderstood and folded into rigid and unimaginative familial schemes of reproductive
zeal and the survival of the fittest. Roughgarden explains that human observers misread
competition into often cooperative activities, they misunderstand the relations between
strength and dominance, and they overestimate the primacy of reproductive dynamics.
In the case of the clownfish, according to Roughgarden, the mating couple does tend
to be monogamous, so much so that if the female partner should perish (as she does in
Finding Nemo), the male fish will transsex and become female. She will then mate
8 with one of her offspring to recreate a kinship circuit. Roughgarden explains clownfish
Finding Nemo and transgender creatures 65
1111 behavior, along with all kinds of other such morphing and shifting, less as evidence of
2 the dominance of the reproductive circuit and more as an adaptive process of affiliation
3 that creates stable community rather than familial structures.
4 Roughgarden’s remarkable readings of biodiversity and “social,” as opposed to
5 “sexual,” selection ask us to reconsider the very process of evolution as well as the
6 nature and function of diversity. Dory, for example, in Finding Nemo, becomes
7 recognizable in her relation to family if we use Roughgarden’s narratives of social
8 cooperation and the sharing of resources within any given animal community to replace
9 hackneyed notions of the dominance of the biological family, the centrality and stability
10 of the parent–child bonds, and the deliberate exclusion of non-relatives. And Marlin’s
1 overprotective parenting must now be read as a mode of transgender morphing in which
2 he has changed from male to female. Finding Nemo, with its subtle critique of oedipal
311 narratives of pleasure and danger, with its inspiring visions of collective fish rebellions,
4 and with its queer models of friendship and affiliation, speaks directly to a queer feminist
5 imagery and the possibilities of social change. In this film, as in a number of blockbuster
6 films of the last few years, memory is linked in very material ways to the project of re-
7 imagining kinship. Finding Nemo is just one of a spate of recent films (including Dude,
8 Where’s My Car, 50 First Dates, Memento) in which short-term memory loss plays
9 a major role. In many of these films, transgender characters form the backdrop for
20 the increasingly Byzantine methods by which heterosexual relations are cast as both
1 inevitable and utterly scripted.
2 There is not time here to discuss in detail the significance of the “forgetful” films, but
3 this developing genre does deserve some further thought, particularly since the drama
4 of forgetfulness often plays out in relation to a host of transgender characters. In Fifty
5 First Dates, for example, a film in which Drew Barrymore plays a woman afflicted by
6 short-term memory loss due to an injury to her “temporal lobe” and Adam Sandler plays
7 the man who tries to woo her, starting over every day, there are at least three transgender
8 characters—the steroid addicted brother, the androgynous zoo-worker, and an old friend
9 of Lucy’s who has transformed from Jennifer to John—and also some animal subplots
30 involving a randy penguin and a polyamorous but constipated walrus. The three
1 transgender characters serve no obvious purpose in terms of advancing the narrative.
2 Like the animals, they are supposed to represent the diversity of nature and culture!
3 The transgender characters in both Finding Nemo and 50 First Dates allow the films to
4 project pathology away from the oddly sinister scenario of the romantic hero wooing
5 the memory-deficient heroine everyday by reminding her of her place in the patriarchal
6 family. The transgender characters symbolically represent the general disorder that has
7 been created by disruptions to the family system. A conservative reading of such films
8 might lead us to conclude that popular culture is remembering nostalgically a mythical
9 time of continuity, locatedness, stability that is associated with the nuclear family and
40 gender stability, that has to be energetically recreated in their absence.
1 The more hopeful reading of the genre and of the notion of gender and collectivity
2 that it provokes might see the forgetful blue fish in Finding Nemo and the temporally
3 challenged chick in 50 First Dates as opportunities to think about the meaning of
4 transgenderism in popular culture and the associations that popular culture unwittingly
5 makes between social transformation and bodily change. The theme of forgetfulness
6 links in interesting ways to transgender and particularly transsexual self-narratives
7 because many TG and TS people have to “forget” their pasts as male or female in order
118 to realize their adult genders. All of these films cast forgetfulness as an affliction
66 Judith Halberstam
11 associated with immaturity—adolescence even—and all recommend hetero marriage
as a way of fixing, once and for all, the jarring sensation of waking up every day and
not knowing who you are, where you have been, and where you are going. But I suggest
that we recognize forgetting as a transgender trope and as a way of relieving the
transgender subject from playing out his or her anatomy as destiny; Finding Nemo,
surprisingly, with its emphasis on gender-morphing fish, forgetfulness, and non-familial
affiliations constitutes a beautiful and inspiring allegory for transgender becoming.
8
1111
2 16 The L Word
3
4 A little something for the
5
6
femmetrosexual?
7
8 Kris Scott Martí
9
10
1
2
311 The L Word is Showtime’s foray in lesbian and gay programming. It is the good—if
4 bland—twin to the American version of the British series, Queer As Folk. Swooping
5 over a dreamy and sensuous Los Angeles, The L Word’s action is set in a cozy west side
6 neighborhood of craftsman-styled bungalows, where gay daddy groups walk—yes, I
7 said walk—to their support groups and nary a strip mall is seen. The show opens with
8 a new lesbian stereotype: Bette and Tina, a gorgeous mixed ethnicity couple, who are
9 preparing to get pregnant. As one of the gay male characters explained, “The old joke
20 was, ‘What do lesbians bring to their second date? . . . A Uhaul.’ Now, the joke is,
1 ‘What do lesbians bring on a second date? A turkey baster!’”
2 Next door is Tim, the neighborhood straight guy whose girlfriend Jenny is flying
3 from the Midwest to live with him. We also meet the friends: Dana, a closeted tennis
4 pro; the young player Shane; her bisexual admirer Alice who is working on a hardcopy
5 version of the online networking service Friendster; the lascivious cafe owner Marina;
6 and the mysterious musician Kit.
7 The characters spend a lot of time mulling over dyke drama in the local cafe—one
8 full of women who look like they just finished a Jane magazine photo shoot. During the
9 course of the two-hour premiere directed by Go Fish writer/director/producer Rose
30 Troche, we find out that the perfect couple isn’t so perfect, the straight girl isn’t so
1 straight, the closeted athlete is paying for remaining closeted, and lesbians in LA don’t
2 have pets or queer friends.
3 Commentary about The L Word has set some online lesbian bulletin boards ablaze
4 with complaints of misrepresentation and non-representation of many real-life lesbians’
5 concerns. Bulletin board writers also wonder whether images of lesbians should be used
6 at all in the consumer oriented and often exploitive medium of TV.
7 The show, in some ways, is not about lesbians at all. Instead, it is about sensually
8 stunning women in stylish outfits looking at and longing to have sex with whomever
9 makes a more flattering accessory.
40 What we are witnessing on The L Word is the refinement of the “femmetrosexual”—
1 where image is more important than content. Mark Simpson coined the term
2 “metrosexual” to describe straight men who follow the fashion tastes of gay men. In
3 Salon magazine, Simpson claimed to be a “lesbosexual,” implying that being a
4 lesbosexual is an absence of style—and, in turn, liberation from the time-consuming
5 activities required to maintain the high style of the metrosexual. The L Word is the
6 dressed up, well-heeled, and lipstick sporting epitome of metrosexuality for women.
7 The ladies of The L Word look like rock stars and live in Pottery Barn perfection. The
118 “straight girl,” Jenny, catches on to this reality right away; she dresses up for her dates
68 Kris Scott Martí
11 with a woman but not for her man. Even the nurturing would-be mother Tina is thrown
into a serious quandary—more in the style of an after school special than any serious
introspection—about whether she wants to use an African American sperm donor. After
sweating, hyperventilating, and generally acting like a 1950s television hausfrau, she
finally justifies her hysterics to her partner. Tina doesn’t want to disadvantage the child
any more than necessary, and already the kid will have two mommies. The fact that her
partner is African American and Caucasian suggests that these racial dynamics will be
an ongoing issue for future episodes.
After the initial character development and conflicts, this luscious confection chock
full of frontal nudity and brooding sexual confusion is fun to watch. The L Word’s
premier was also interesting because it went beyond the stereotypical public imagination
of what a lesbian is; instead The L Word investigates the not-so-fabulous world of
1 average adulthood with all its loneliness, anxiety, betrayal, and defeat. As a lesbian,
I enjoyed watching successful, well-dressed women ranting about the women they live
with or want to love.
8
1111
2 17 Six Feet Under brings abortion
3
4 to the surface
5
6 Tracy A. Weitz and Anthony Hunter
7
8
9
10
1
2
311 Abortion is one of the most commonly performed medical procedures, but when was
4 the last time you saw someone on TV have the procedure? Although there are over
5 1.3 million abortions ever year in the United States, abortion is rarely depicted in
6 mainstream television. Whereas a decided majority of the US population is pro-choice,
7 television content appears to represent the voice of the pro-life constituency. Even with
8 the growth of cable programming, which flaunts the rejection of conservative network
9 standards related to language, violence, and sexuality, abortion continues to be too
20 controversial to present in any substantial way. Despite “politically correct” attempts
1 to pay lip service to supporting a woman’s right to choose, main female characters
2 rarely go through with an abortion.
3 In the routine television storyline, a woman confronted with an unintended pregnancy
4 considers all her options (abortion, adoption, or continuation with the pregnancy).
5 Inevitably, she decides to have the child or, miraculously, she has a miscarriage. An
6 example comes from the popular and award-winning series Sex in the City. As the
7 show’s official HBO Web site explained, Miranda Hobbes had planned on an abortion,
8 but just before the procedure she changed her mind. Years earlier another “feminist
9 character,” Murphy Brown, decided that age and resources allowed her to have the child
30 out-of-wedlock. Although she engendered Vice President Dan Quayle’s ire, the network
1 won support from abortion opposition groups who embraced Murphy’s decision.
2 Dawson’s mother on Dawson’s Creek was actually talked out of an abortion by her son,
3 and Andrea on Beverly Hills 90210 decided to continue her pregnancy and opt out of
4 going to Yale University. In perhaps the most melodramatic storyline, Jo on Melrose
5 Place chose to have her drug-dealing ex-boyfriend’s baby, even though she was forced
6 to kill the boyfriend to save her life. Although each of these women waxed poetically
7 about supporting the right to choose, none of them actually chose to have an abortion.
8 For the women on TV who do not continue their unintended pregnancies, most often
9 their pregnancies conveniently take care of themselves. Julia on Party of Five had a
40 miscarriage before she was able to get to the abortion clinic. Amanda on Melrose Place
1 had a ruptured ectopic pregnancy that would have left her sterile. Like their counterparts
2 who continued their pregnancies, these characters “seriously” considered having an
3 abortion. Such plot resolutions allow producers and network officials to stir interest
4 around the topic of abortion without having to deal with the impact on the story-
5 line should a character choose to have a child or an abortion. Critics on both sides can
6 be mollified: pro-choice supporters can envision that the woman “would have gone
7 through with it” and abortion opponents can argue that the character would have changed
118 her mind.
11 Some characters have been bold enough to admit having had an abortion in the past.
However, even a show like Cagney and Lacey—which had two female protagonists and
was considered very progressive—could only have a lead character admit to having
had an abortion within the context of choosing to continue a current pregnancy. A few
other television programs have used an abortion storyline, including Law and Order:
Criminal Intent, which covered the killing of an abortion provider, and ER, in which a
onetime client has an abortion. Everwood included the story of a young girl who obtains
an abortion from a doctor only after her main physician decides he can not provide her
care. But only Maude in 1972 and All My Children in 1973 dared to have main characters
who obtained abortions. That is, until now.
In May 2003 HBO bravely broke a long-established taboo by having Claire undergo
an abortion on Six Feet Under. This action represents a positive first step toward
1 addressing a common life experience for women. Despite this promising start, the
storyline reverted to traditional pro-life messages in both its portrayal of abortion
provision and in its comparison of a fetus with a fully developed baby.
Episode thirty-eight: abortion provision

In Six Feet Under’s thirty-eighth episode “Twilight” (directed by Kathy Bates and
written by Craig Wright), Claire discovers that she is pregnant by her estranged
boyfriend, Russell. The official HBO Web site summarizes the episode: “Claire
makes a difficult choice as well: to terminate her pregnancy.” The episode doesn’t
show Claire’s decision-making process, but the nonchalant manner in which she asks
Brenda for a ride to the clinic does not imply difficulty. “‘Do you think you could give
me a ride?’ Claire asks. ‘I have to get an abortion.’”1 The Web site’s description of
the abortion decision as “difficult” foreshadows what is to come. In episode thirty-nine
producers of the show seem to hedge their position on abortion by demonstrating
Claire’s conflicted feelings.
In this episode Claire undergoes an abortion according to the worst stereotypes
about abortion provision. The impersonal and highly medical portrayal of the pro-
cedure demonstrates the extent to which the anti-choice rhetoric of abortion has become
an accepted interpretation of reality. At the clinic Claire and Brenda sit in a waiting
room surrounded by other women, devoid of any positive support. Claire is called
from the waiting room with all the other women, en masse, and is shown in a room
wearing a surgical gown undergoing what appears to be general anesthesia.
The viewer is led to believe that Claire’s experience is routine for abortion. The
episode’s name “Twilight” stands for the type of anesthesia used for some abortion
procedures. Abortion is portrayed as starkly medical and complicated, as well as grossly
impersonal.
Postings on the Six Feet Under (SFU) Bulletin Board2 demonstrate the extent to
which this image took hold. One fan asked, “Do abortion clinics really function in such
a factory like manner?”(simiulacra 5/18/03).
Others respond:
– The Abortions ‘R Us place was like a factory. (isyou 5/18/03)

– [T]he way they called all the girl’s names; like hearding (sic) animals (at the clinic).
8 (KLV21 6/2/03)
Six Feet Under brings abortion to the surface 71
1111 – The writers on the show were treating abortion exactly like it is in real life . . .
2 Abortion clinics do “cattle call” the patients in and it is usually an emotional hardship
3 on the pregnant women. (Karen2240 6/2/03)
4 – YOU GOT THAT RIGHT! It is done in a “cattle call” fashion and it couldn’t be any
5 more accurate than that, as unfortunate as it may seem. (bajoros 6/2/03)
6 – The writers simply let it “all hang out,” showing a typical clinic without comment
7 or judgement (sic). If it’s an eye opener to the audience, then good. (meridithc6/2/03)
8
9
Why not the “abortion pill?”
10
1 One of the hopes of the 2000 US approval of mifepristone (also known as the “abortion
2 pill” or RU486 in France) was that abortion could be performed in regular healthcare
311 providers’ offices rather than in clinics, with minimal medical intervention. The negative
4 imagery Six Feet Under fans portray in these bulletin board postings reflect the
5 importance of continuing the effort to integrate abortion back into primary care, and to
6 continue to move away from the idea that abortion is provided according to an
7 impersonal clinic-based model.
8 With that said, it is also important to acknowledge that most abortion clinics do not
9 operate in such a manner. Instead, the majority of early abortions are performed under
20 local anesthesia while a patient wears her own clothes rather than a surgical gown.
1 Women are also given individualized, personal, and compassionate care. Research on
2 the quality of abortion care has demonstrated overwhelmingly high satisfaction among
3 abortion clients.3 The dialogue between the Six Feet Under fans exposes the extent to
4 which anti-abortion perspectives have become the accepted interpretation. The fan
5 dialogue about Six Feet Under also exposes the damage done by television’s failure to
6 realistically portray abortion provision.
7 That Six Feet Under does not include medical abortion is disappointing. Rather than
8 reinforcing old stereotypes, the writers and producers could have explored new ground.
9 They could have educated the public about medical abortion while also providing
30 entertaining television. The confusion and lack of knowledge about medical abortion
1 is apparent in the following exchange4 among Six Feet Under fans:
2
3 – These days, many early pregnancies are ended with RU486. Are the prolifers
4 picketing drugstores these days? (sandgann 5/19/03).
5 – RU486 isn’t available at the drugstore, either. You have to get it at a clinic, and you
6 have to get it the very next morning. (titannia 5/19/03)
7 – You’re thinking of the morning-after pill. That’s different from RU-486. (wolfgirl
8 6/4/03)
9 – You can only get the abortion pill at an abortion clinic, and you have to (be) watched
40 while it takes effect. (Maggiespancake 5/19/03)
1
2
Episode thirty-nine: a fetus becomes a baby in the “afterlife”
3
4 The greatest disappointment of Six Feet Under’s groundbreaking abortion story is its
5 attempt to balance appeals from both pro-choice and pro-life viewers. Whereas episode
6 thirty-eight shows Claire having an abortion without ramifications, episode thirty-nine
7 (“I’m Sorry, I’m Lost,” directed by Alan Ball and written by Jill Solway) appeases those
118 who might have opposed her decision. The HBO official Web site describes this episode:
11 “Claire remains conflicted over the abortion.” During the episode her dead father takes
her on a visit to the afterlife where she “encounters beatific versions of people she’s cared
for and lost: Lisa, Gabe Dimas—and the baby she decided not to have.”5 During her
exchange with Lisa, Claire is asked to care for Lisa’s living child in exchange for Lisa
caring for the “baby” Claire aborted. As one fan noted: “What makes me wonder about
the Lisa/Claire exchange is why they used a full-term baby as Claire’s baby and everyone
else in the ‘afterlife’ were exactly the age they were when they died.” (mpasq 6/2/03).6
Again, postings to the Six Feet Under fans bulletin board demonstrate the limitations
of the approach and its direct appeal to those who oppose abortion:
– Although I do not identify myself in the pro-life (or anti-abortion) camp, I cannot
interpret the image of Claire seeing her aborted baby with Lisa in the afterlife as
1 anything but a pro-life statement. (russjourn 6/1/03)
– Yet they had her have the abortion in the first place? I think the writers did a great
job of trying to please everyone. The pro-choicers for letting her decide to have the
abortion and the pro-lifers for giving the baby such a peaceful place of rest.
(NakkisGirl 6/1/03)
– I did think it was strange that the guy who wrote “twilight” said that SFU would be
taking a no opinion stance on the abortion thing. [The heaven] scene made a definite
statement. (1heather247 6/1/03)
What is clear from this exchange is how directly the fans understand the storyline to
be part of a larger public dialogue about abortion.
The power of television

Six Feet Under should be commended for its courage to have a primary character choose
an abortion. At the same time, however, the show reinforces old images of abortion
provision and makes an overt appeal to abortion opponents. Criticism of the coverage
of abortion on Six Feet Under should not discourage other shows from taking the bold
step to have main characters choose to have abortions when faced with unintended
pregnancies. Rather, the limitations explored in this review should serve as appeals to
writers and producers to forge ahead and explore new ground, rather than to find
compromises between the “pro-choice” and the “pro-life” positions. Abortion remains
fiercely polemic and therefore appeals as a plotline for courageous television.
Television, however, can be used as a force in changing the way we feel about issues.
Thirty years ago a positive storyline about a gay character would have seemed
impossible. Today, however, shows such as Six Feet Under, Will and Grace, Ellen and
The L Word have unapologetically presented gay characters. In these shows the related
storylines have moved beyond the question of whether such lifestyle choices are wrong
and immoral to a richer discussion on what it is to be gay in the world. These characters
are allowed to have full lives and relationships, and to integrate being gay with other
aspects of the plot.
Only by presenting abortion as what it is—a commonplace reality—can the media
move away from conventional stories and begin to reflect the complexity and
individuality of women’s experiences. Women should be allowed to have abortions
and talk about them, without blatant attempts to pacify those who oppose abortion.
8 HBO’s tentative first step should not be the last one.
Six Feet Under brings abortion to the surface 73
1111 Notes
2 1 HBO. Six Feet Under: Episode 38 “Twilight”. Home Box Office. Available at: http://www.
3 hbo.com/sixfeetunder/episode/season3/sea3_eps12.shtml. Accessed July 29, 2003.
4 2 HBO Six Feet Under Bulletin Boards. Available at: http://boards.hbo.com/forum.jsp?forum=117.
5 Accessed July 29, 2003.
6 3 The Picker Institute. 1999. The Patient’s Perspective: Quality of Abortion Care. Menlo Park,
CA: Kaiser Family Foundation.
8 Accessed July 29, 2003.
9 5 HBO. Six Feet Under: Episode 39 “I’m Sorry, I’m Lost”. Home Box Office. Available at:
10 http://www.hbo.com/sixfeetunder/episode/season3/sea3_eps13.shtml. Accessed July 29, 2003.
Accessed July 29, 2003.
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18 The pornography of consumption/
the consumption of pornography
Linda Williams
1 It is an industry in which quantity typically trumps quality—an industry that gluts the
market with goods of questionable social value. The captains are not selling burgers.
They are selling sex.
Where Hollywood makes approximately four hundred films a year, the porn industry
makes ten to eleven thousand a year and there are 700 million porn rentals annually.
Yearly pornography revenues—which in one estimation include magazines, Internet
websites, cable, in-room hotel movies, and sex toys—total between $10 to $50 billion.
And yet, pornography is a very different kind of excess. Unlike the rise of fast food,
the “McDonaldization” of porn marks an important shift in the place of sexuality in our
contemporary American culture. Of course, much pornography does offer predict-
able representations of heterosexual male fantasies, but this is just one direction of a
genre that can also give us decidedly unglamorous San Francisco lesbians having sex
with dildos on cluttered kitchen tables. Sometimes pornography can verge toward . . .
something.
The pornography of consumption

Social critics have mobilized a previously existing distaste for the sheer lowness
of pornography to drive home important arguments about the loss of the real and
the emptiness of contemporary consumption. As George Ritzer—author of The
McDonaldization of Society and The Globalization of Nothing—puts it, pornography
stands for the obscenity of a consumption that lacks substantive content. In other words,
pornography represents the wasteful, greedy, and immoral consumption of “nothing.”
This “pornography of consumption” is a rhetorically powerful way to describe the
excess of our contemporary consumer society. This society superficially sates itself on
useless “goods” whose only real function is to lead to the consumption of more goods,
none of which really satisfies in any deep or lasting way.
The metaphor seems apt because of pornography’s sheer lowness on the scale of
cultural values. If ever there was a cultural “good” or product that was without what
sociologist Pierre Bourdieu calls “distinction,” then moving image pornography is it.
It is vulgar, it is low. It may help sexually hungry people sate sexual desires late at night
in an anonymous hotel room, but it does not deeply satisfy. It is, of all consumer goods
available in American culture, the one we can all most easily agree to hate.
The metaphor of a pornography of consumption also seems befitting because
pornography connotes the pervasive sexualization—and, by extension, feminization—
8 of this culture. Hardly anything in contemporary consumer culture is sold without the
The pornography of consumption/the consumption of pornography 75
1111 aid of a typically feminine “sex appeal.” French sociologist Jean Baudrillard writes,
2 “sexuality is ‘at the forefront’ of consumer society, spectacularly over-determining the
3 entire signifying field of mass communications.”
4 Finally, the metaphor seems suitable because pornography not only shows sex but
5 makes sex hypervisible. Cars are photographed in television advertising, much the way
6 bodies in moving-image pornography or weapons in CNN inserts are photographed:
7 from every possible angle. Film critic Richard Dyer calls the extreme close-up shots
8 “plumbing shots.” John Waters has remarked that porn always looks to him “like open-
9 heart surgery.”
10 But while there is a pornographic nature of American consumption practices, pornog-
1 raphy—as in moving images of explicit sex—is not itself pornographic. Pornography
2 deserves a better, more precise, critique than that leveled against the generic, uprooted,
311 dehumanized, immoral, nothingness of McDonald’s or McMansions.
4
5
From obscene to on/scene
6
7 Pornography as a genre has existed since the rise of mass media—print, lithography,
8 photograph, film and video. If we look at its history, however, we see that it is only in
9 the last thirty years that it has been available, in the form of moving images, to large
20 numbers of the public.
1 Recently, the details about explicit sex acts performed by politicians, celebrities, and
2 porn stars have become increasingly familiar to average people. This is not to say that
3 sexually explicit representation is without controversy or embarrassment. We have
4 certainly not attained the “end of obscenity” once optimistically predicted in the late
5 1960s by Charles Rembar. It is to say, however, that long before it surfaced as news from
6 the oval office, a contemporary “speaking sex” had ceased to be a private bedroom-only
7 matter and had come, as I like to put it, “on/scene.”
8 The term on/scene suggests that to think of pornography as obscene is, today,
9 something of an anachronism. The ultimate reason for this has less to do with obscenity
30 law than with the remarkable transition discourses of sexuality have made from shame-
1 ful whispers to a key factor in the articulation of human identity itself. The incitement
2 to speak and confess sexual secrets has been growing, according to historian Michel
3 Foucault, at least since the sixteenth century. Beginning in the twentieth century, and
4 especially with Freud, however, sexual confession, of which the genre of pornography
5 is most emphatically a form, has become central to who we think we are as individuals.
6 For better or for worse, one effect of the explosion of discourses of sexuality has been
7 a democratization of explicit sexual representations no longer cordoned off for specially
8 entitled viewers.
9 Sexual representations whose very purpose is to arouse readers or viewers were once
40 deemed ob/scene in the literal sense of being kept off—or “ob”—the public sphere have
1 today insistently appeared in the new public/private realms of Internet and home video.
2 I coined the term on/scenities to describe the paradoxical gesture by which American
3 culture brings onto its public arena the very organs, acts, bodies, and pleasures that have
4 heretofore been designated ob/scene and kept locked up for only a few. On/scenity marks
5 the controversy and scandal of the increasingly public representations of diverse forms
6 of sexuality and the fact that they have become increasingly available and quasi-normal.
7 So what does this on/scenity mean? Is it, on the level of sexual representation, the
118 same thing as the democratization of dining out made possible by the standardization
76 Linda Williams
11 of fast foods? Certainly, there is much that is cheap, badly acted, and boringly repetitive
about the genre. But some pornography differs from a Big Mac. Sometimes it can resist
this predictability and become . . . something.
Equalizing sexualities
Pornography has been a crucial way in which emerging sexual minorities—either
invisible or ridiculed in more mainstream representations—have recognized themselves
as sexual beings on screen. The genre of moving image pornography, unlike the genre
of fast food, can thus be seen as one of the ways in which American culture has been
talking to itself about what constitutes “good”—arousing, hot, desirable—sex.
For example, in the early 1970s right alongside feature-length theatrical pornography
1 like Deep Throat or Behind the Green Door, a parallel production and exhibition of titles
like Boys in the Sand and Sex Garage graced the screens of emerging urban, gay
neighborhoods. For the first time, emerging gay audiences were seeing and recognizing
themselves on screen.
Even as silly a movie as the 1972 Deep Throat was talking to itself about new
vociferous demands made by women for orgasm equity. The film’s narrative solution
of placing a clitoris in Linda Lovelace’s throat was not satisfying to most women viewers
but the resulting privileging of fellatio and “money shots”—external ejaculation in
proximity to the woman’s face—became a major trope of hardcore pornography that
was no longer satisfied by the mere spectacle of penetration.
Unlike the sameness of most other standardized consumer products, pornography
offers a surprising variety. Consider award-winning Shock, about the sexual fantasies
of a patient in a laboratory undergoing shock treatment by a decidedly sadomasochistic
female doctor. The protagonist, who seems to be a man but turns out to be woman, leads
a chorus in a song about the deceitfulness of appearances. It is glossy, high-tech, and
overproduced, a kind of Matrix avant la lettre. But it is also fascinating, even endearing,
in its philosophical and aesthetic ambitions.
At the other end of the aesthetic spectrum is crudely shot and amateurishly acted dyke
porn with primitive production qualities that contribute to the authentic nature of the
sex acts and counter standard images of so-called lesbian sex in heterosexual videos.
Indeed, all forms of pornography tending toward the amateur end of the spectrum
are likely to deliver “something” because of their valuation of authenticity over glamour
(no breast jobs allowed). These videos tend toward the unique and local. At the most
amateurish end they consist of a single shot from a camera posed on a tripod. Debra
and Earl from California, for example, “request correspondence from anyone viewing
their tape.” The tape is available in exchange for one showing the requestor’s own
sexual activity. Thus, the tape may only exist in a single copy, the very opposite of
standardization of its industrial counterparts and, more or less, outside the capitalist
economy all together. To further invoke Ritzer’s terms, it is also specific to the time
and place it is made (the actual California living room or bedroom of the couple), and
it is humanized (Debra and Earl are themselves and they communicate together about
what pleases them) and enchanted (certainly for them and they hope for someone else).
There is nothing in the genre of franchised food that can offer such a genuinely
oppositional resistance to standardization while still delivering a genre.
The list of humanized and enchanted pornographies can be extended beyond gay,
lesbian, and amateur pornographies to videos of transsexual, s/m, bondage, amputees,
8 geriatric, fat, ethnic, interracial, gonzo, and beyond.
The pornography of consumption/the consumption of pornography 77
1111 The point should be clear: if you have seen and tasted a Big Mac, you may very well
2 have seen and tasted them all. But if you have seen one pornographic feature you have
3 emphatically not seen them all. Like Westerns, musicals, and films noir, pornography
4 has remarkable deviations within the requisite standardization. And like these more
5 respected Hollywood genres marketed on the basis of generic expectation, authors
6 known for their distinctive styles within the confines of the pornography have emerged.
7 In a genre that forty years ago never had a single name attached, we now see a
8 proliferation of names: Radley Metzger, John Leslie, Michael Ninn, John Stagliano,
9 Candida Royalle, and Jenna Jameson. McDonald’s does not similarly celebrate its chefs.
10 Selling sexual fantasies is not the same thing as selling hamburgers. In critiquing
1 America’s overconsumption, we can reasonably say, as Ritzer implies, that the
2 perversion for a small portion of the world’s population to drive gas-guzzling cars forces
311 other motorists to buy similar cars for self-protection. This is a perversion of need that
4 is, in actual fact, immoral, and excessive.
5 To brand pornography with the same accusation is questionable because pornography’s
6 perversions are actually quite natural—built into the very structure of sexual desire
7 and pleasure. Unless we wish to buy into an archaic productivist notion of sexuality as
8 properly serving only reproductive ends, we cannot say the same thing of the proliferat-
9 ing perversions of contemporary pornography that we do of McMansions. Perversion of
20 sexual instincts—in the literal sense of swerving away from “normal” sexual object (say,
1 a man for a man rather than a man for a woman) or “normal” sexual aim (say exhibitionist
2 ejaculation for all to see rather than vaginal intromission)—is not necessarily similarly
3 immoral and is inherent to the work of sexuality itself. For sex is, as Freud put it, the
4 most “unruly of the instincts,” one that perpetually veers off from direct satisfaction
5 to more circuitous routes. These unruly instincts are inherently perverse. Freud wrote,
6 “No healthy person . . . can fail to make some addition [to sex] that might be called
7 perverse to the normal sexual aim.” Insofar as we do not proceed directly to heterosexual
8 vaginal penetration with intromission, we, and the pornographies we may watch, are
9 literarily perverted.
30 The consumption of pornography, then, is not, as Ritzer argues of the consumption
1 of Big Macs, the consumption of nothing. “Nothing” to Ritzer is generic, lacking local
2 context, lacking specific time, dehumanized, and disenchanted. Some pornography is
3 unique, embedded in a specific time and place, humanized and (perhaps) even
4 enchanted. But unlike a really good restaurant, pornography is not produced, as it once
5 was, only for the elite. No longer the province of upper-class men, or as it later became,
6 all men, it is now available to men, women, and sexual minorities who until the last ten
7 years did not have a pornography of their own. In setting up the nothing/something
8 continuum, Ritzer may be idealizing and nostalgicizing a time before industrialization,
9 standardization, and democratization.
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19 InnovAsian in pornography?
Asian American masculinity and
the “porno revolution”
Amy Sueyoshi
1 U.C. Davis Professor Darrell Hamamoto declared in a 2003 Salon article that Asian
Americans needed “sexual healing” and he, as the “doctor,” had arrived.
Hamamoto had just filmed Skin on Skin, a fifty-minute porn that hoped to reclaim
Asian American male sexuality from castration in American media. America had
brutally emasculated Asian men, rendering them sexually undesirable even to their
“yella womenz,” explained Hamamoto. By casting an Asian American man to play the
sexual partner of an Asian American woman, he saw his project as an innovative way
to fight the damaging effects of colonialism and racism upon Asian American sexuality.
Rallying around the unjust emasculation of Asian American men has long appeared
to be cause célèbre among those engaged in Asian American issues. From Fu Manchu
in the 1930s to Sixteen Candles’ Long Duk Dong in the 1980s, depictions of Asian
American men have appeared less than “manly” in popular culture.
James Hou, a filmmaker and former student of Hamamoto’s, traced the making of Skin
on Skin in a documentary titled Masters of the Pillow. More so than Skin on Skin itself,
Hou’s documentary powerfully drew media attention to Hamamoto’s porn project.
Between February 2003 and November 2004 over twenty articles appeared in city dailies
and online publications as a variety of film festivals screened the documentary.
Newspapers such as the Sacramento Bee and the Honolulu Star jumped on Hamamoto’s
Skin on Skin. Comedy Central’s Daily Show and NBC’s Tonight Show both featured
segments on the professor turned porn producer. Hamamoto himself declared a “porno
revolution.”
Hamamoto’s work would ultimately prove more rote than radical, though. Not only
would the porn itself appear numbingly mundane. Specific strains in gay porn had more
powerfully resurrected Asian American male sexuality nearly a decade before Skin on
Skin. Hamamoto took credit for a revolution already under way.
Hamamoto had indeed hoped to reassert the Asian male as more sexually potent, but
the content of his porn would ultimately prove more successful at reinforcing images
of Asian American women, rather than at re-imagining Asian American masculinity.
A camera sequence that focused on the naked woman and her acts to service the man
perpetuated stereotypes of Asian American women more than it salvaged the sexuality
of Asian American men. Hamamoto’s piece resembled the thousands of low-budget
productions that fill the shelves of adult video stores throughout Asia.
Yet Hamamoto asserted that according to the emails he received, 99 percent of his
“Asian American peeps” appreciated his innovation. Still, on one message board
discussing his work at ModelMinority.com, a Web site dedicated to Asian American
8 empowerment, reactions appeared less supportive. Out of sixteen different login IDs that
Asian American masculinity and the “porno revolution” 79
1111 contributed to an exchange of thirty-five comments, only nine appeared explicitly
2 supportive. Four openly criticized Hamamoto’s endeavor and three remained skeptical
3 about the positive value of his work. For this online community dedicated to social
4 justice for Asian Americans, support for Skin on Skin as a worthy endeavor appeared
5 ambivalent.
6 Meanwhile, gay porn may have already more successfully reclaimed Asian American
7 masculinity along Hamamoto’s standards of ideal masculinity. Though filmmaker
8 Richard Fung had pointed to the gay porn industry’s history of racism in casting Asians
9 as mere receptacles of sex, in the years that followed his seminal 1991 essay “Looking
10 for my Penis,” Asian American men appeared to be gaining significant sexual ground.
1 The gay porn production company Catalina Video, in particular, has produced close
2 to twenty videos with Asian content catering to Asian Americans since the 1990s—
311 significant considering Asian Americans make up about 5 percent of the US population,
4 among which less than 10 percent are queer. While many certainly deployed “Oriental”
5 clichés in titles and set decor, sexual interactions demonstrated the powerful sexuality
6 of Asian American men. Muscled Asian Americans with impressive phalluses played
7 confident “tops.” Asian Men Do featured the handsome Tony Chan, six feet tall with a
8 seven and a half inch penis. In Fortune Nookie when a penniless Asian American
9 Brandon Lee faced lawyer fees to white attorney Jacob Scott, he offered sex in exchange.
20 Notably, Jacob became the “bossy bottom” in anal sex.
1 Catalina Video promoted these Asian American actors with the language of un-
2 abashed “masculinity.” A summary of Asian Persuasion described Brandon Lee’s “thick
3 meat.” In Crème of Sum Yung Gai as well, when actor Al Wong penetrated fellow Asian
4 American actor Dematthew Yung, Catalina wrote of Al sending in the “heavy artillery.”
5 Moreover, Catalina Video described its Far East Feature Series as showcasing “horny
6 Asian studs getting man-nasty with their pals.” The production company promoted their
7 Asian actors as virile, sexual agents.
8 Gay porn star Brandon Lee may have been the true “pioneer” rather than Hamamoto.
9 With an eight and a half-inch phallus, rounded muscles of a water polo player, and
30 boyish good looks, the unrelenting top arrived in the porn industry seven years before
1 the U.C. Davis academic. He dominated Catalina Video’s Far East Features and cut
2 across genres to their non-racialized Blockbuster series as an “Asian stud.”
3 Might Hamamoto team up with Brandon Lee to reclaim Asian American male
4 sexuality? Likely not. At the Visual Communications Film Festival in May 2004, co-
5 producer of Skin on Skin and Hamamoto’s girlfriend Funie Hsu posed their porn project
6 as significant precisely because of its heterosexual context, battling against portrayals
7 of Asian American men as effeminate and homosexual. Ironically, in the Asian
8 American porn of Catalina Video, “gay” more likely signaled the type of masculinity
9 that Hamamoto and Hsu coveted, rather than the effeminacy they loathed. Indeed, Asian
40 gay masculinity might be the cure to the Asian straight man’s gender woes.
1 Queer masculinities have been revolutionizing Asian American male sexuality,
2 through not just production companies such as Catalina Video, but also independent
3 transgender porn producers such as Christopher Lee. Because men of color have
4 been denied access to normative (white) masculinity, creating alternative erotic ideals
5 that incorporated existing realities of Asian American men were more compelling for
6 many. While cultural critic Nguyen Tan Hoang would see Brandon Lee as reinforcing
7 white mainstream models of ideal masculinity, Christopher Lee’s erotic images more
118 potently depart from the norm.
80 Amy Sueyoshi
11 Yet, why are effeminate men necessarily considered undesirable? Why does sexuality
have to play such a central role in our self-worth? Why do we need Asian American men
in pornography? Indeed, the gender and sexual standards that we uncritically accept
might prove to be the more powerful obstacle against socio-sexual justice. Scrutinizing
these foundational issues might eventually lead more quickly down the path of “sexual
healing” rather than any porn project. After all, the master’s tools will likely never
dismantle the master’s house.
8
1111
2 20 The Yin and Yang of sex work
3
4 Female and male prostitution
5
6
compared
7
8 Ann M. Lucas
9
10
1
2
311 Say the word “prostitute” and what comes to mind? A woman in revealing clothing
4 standing atop four-inch platform shoes, soliciting prospective customers at night on the
5 street, as johns cruise slowly by in their cars; she works for an exploitative pimp, or if
6 not, she sells herself to feed the demands of her crack pipe or dime bag of heroin.
7 Despite a wealth of articles and books, both popular and scholarly, written on the
8 topic of prostitution, the practice remains shrouded in stereotype. While it is true that
9 the “typical” American prostitute is female, there is also a market for male sex workers.
20 Female prostitutes, though, receive greater media scrutiny, social opprobrium, and
1 police attention than male prostitutes, not only because of their greater numbers
2 and visibility, but also because society has a strong interest in deterring female prostitu-
3 tion in order to shore up dominant norms about “good” (monogamous, modest, and
4 noncommercial) female sexuality. Male prostitutes are not free of disapproval and
5 arrest, but their prostitution activity is not the primary cause of such negative attention;
6 rather, they stand at the intersection of social concerns about female prostitution and
7 male homosexuality and, therefore, suffer indirectly from moral campaigns directed at
8 these larger targets.
9
30
1
Who they are, who their customers are
2 The exact numbers of prostitutes, female or male, are impossible to obtain. Prostitution
3 is illegal in every state, except for a few rural counties in Nevada that have legal brothels.
4 Therefore, most prostitutes feel the need to conceal what they do in order to avoid arrest
5 and social stigma.
6 According to estimates on female prostitution, street prostitutes comprise about
7 10 to 20 percent of the prostitution population nationwide, and perhaps about 30 percent
8 in some cities, such as San Francisco, where the climate is more temperate year round.
9 That means the large majority of female prostitutes are less visible to the public;
40 70 to 90 percent work indoors, in massage parlors, lingerie shops, strip clubs, illegal
1 brothels, and the like, or in hotel rooms, private residences, and other private settings
2 as escorts and call girls. Male prostitutes also work on the streets, in bars and clubs,
3 and as escorts and call boys. Both male prostitutes of all types and indoor female
4 prostitutes receive less media attention and scholarly study than street prostitutes,
5 reinforcing our incorrect stereotypes.
6 Of female street prostitutes, figures from the late 1980s suggested that about
7 40 percent worked independently and 60 percent had pimps, although even fewer
118 prostitutes may work with pimps today. But these figures become even shakier because
82 Ann M. Lucas
11 the term “pimp” can be narrowly or broadly defined. That is, if a prostitute turns over
any portion of her earnings to another, is she working for a pimp? What if he is her
boyfriend who watches out for her while she solicits on the street? What if that person
is her adult child or a roommate she supports while that person is unemployed or going
through rehab? Some observers have argued that the “pimp” label is too widely applied
by some researchers to any person who is supported with the earnings of prostitution.
The term pimp, they say, should be reserved for those who engage in coercive
or exploitative relationships with prostitutes and function as managers of a “stable” of
women. Whatever its real incidence, true pimping is probably less common among
male prostitutes than female prostitutes. Because male prostitutes are less commonly
arrested, because they are less likely to be targeted by sexual predators, and because they
tend to be better able to defend themselves physically, they are not as vulnerable to
1 coercion from pimps. Female prostitutes, on the other hand, may need pimps for physical
and legal protection.
The overwhelming majority of customers of both female and male prostitutes are
men, although the number of women who hire prostitutes may be slowly rising. At some
Caribbean resort destinations, female tourists hire local men as sexual companions;
they are sometimes called “rent-a-dreads” in reference to the dreadlocks worn by many
Jamaican men. In the United States the few women who do patronize prostitutes are
usually accompanying a boyfriend or husband, rather than hiring a prostitute alone.
Although most customers are men, that does not say anything about the sexual
preferences of prostitutes themselves. Certainly, sexual orientation affects their exper-
iences with, and attitudes toward, customers. Straight women, lesbians, and bisexual
women work as prostitutes serving male customers, just as straight, gay, and bisexual
men work as prostitutes serving male customers. Transgendered women also work as
prostitutes serving male customers.
Because the customer sees the prostitution transaction in sexual rather than economic
terms, his actual sexual orientation is likely reflected in his choice of prostitutes,
although his avowed sexual orientation may be different. That is, most men who hire a
male prostitute enjoy or are curious about same-sex sexual activity, regardless of how
they label themselves, and most men who hire female prostitutes enjoy opposite-sex
sexual activity, even if they are not exclusively heterosexual. The same cannot be said
about the sexualities of the individuals being paid.
The policing of prostitution

Law enforcement activity related to prostitution is not evenly distributed among
prostitutes and customers, nor among types of prostitutes. Although street prosti-
tutes are a minority of all prostitutes, they make up as much as 85 to 90 percent of
prostitutes arrested. Women of color who work on the streets are especially (and dis-
proportionately) likely to draw police attention. According to estimates, women
of color represent 40 to 45 percent of street prostitutes but 55 percent of those arrested
and 85 percent of those given jail time. In other words, the racial, gender, and class
inequities we see in the larger society are reflected in prostitution. Those already margin-
alized or disadvantaged in some fashion tend to pay the most for their transgressions.
Although there are more customers than prostitutes in the general population—most
prostitutes could not earn a living otherwise—prostitution-related arrests overwhelm-
8 ingly involve the service provider, not the customer. Prostitutes make up 80 to 90 percent
Female and male prostitution compared 83
1111 of the arrests, with customers constituting the other 10 to 20 percent. Of all prostitution-
2 related arrests, 60 to 70 percent are women (almost all of these women are prostitutes,
3 with very few madams also arrested). Although some might claim the prostitute/
4 customer arrest disparity is a valid policy decision since prostitutes are repeat offenders
5 and, therefore, deserve more police attention, many patrons are also repeat customers.
6 Absent the demand—it is estimated that there are five to eight customers on the streets
7 for every prostitute working there—supply would diminish significantly.
8 Better explanations for the disparity are that many police officers share a general
9 social belief that it is more morally offensive for women to sell sexual services than
10 for men to purchase them—a “men are dogs” (but women are supposed to be pure)
1 mentality. Moreover, many officers recognize that an arrest for soliciting prostitution
2 will likely be more damaging to the customer, who may otherwise have a reputation as
311 a respectable and law-abiding citizen, than for the prostitute for whom an arrest may
4 simply be the cost of doing business. If the customer “can’t help it” and has more to lose
5 from an arrest, arresting the prostitute seems the better choice.
6 However, since it takes two people (or more) for the offense of prostitution to be
7 committed, this disproportionate enforcement pattern is not justifiable. Certainly in
8 some cities at specific times, there have been attempts to reverse this pattern by focusing
9 enforcement activity on customers, particularly through the use of a variety of shaming
20 tactics, from publishing the names of “johns” on television, in newspapers, on websites,
1 on recorded messages, or on billboards, to vehicle impoundment and “John Schools.”
2 Still, these experiments have yet to revolutionize the policing of prostitution offenses
3 in the United States.
4 The disparity between female prostitute arrests and male prostitute arrests may well
5 reflect their proportions of the prostitute population, but that is not the entire explanation.
6 It can be argued that police officers—who even today are mostly men—are largely
7 uncomfortable posing undercover as potential patrons of male hustlers. As one male
8 prostitute I interviewed put it, “Police will crack down on women before men, because
9 . . . homophobia acts as . . . some protection for male [prostitutes].” In addition, the
30 social outcry over male prostitution is minimal compared to that surrounding female
1 prostitution, and thus citizens are less compelled to demand something be done to reduce
2 this activity.
3 Stereotypes and arrest patterns reveal that the social stigma surrounding prostitution
4 is not evenly distributed among all its participants. Rather, female prostitutes bear the
5 brunt of social stigma, while male customers, although certainly not admired, largely
6 escape the fear and loathing—not to mention harassment and attack—directed at
7 prostitutes. Those critical of customers often find the men’s behavior slightly odious but
8 generally also believe that “boys will be boys.”
9
40
A demand for male bodies
1
2 When prostitution is discussed as a social problem, it often is considered a phenomenon
3 solely involving female service providers. Male prostitutes are invisible and neither
4 “gigolos” nor male hustlers garner much attention. Although male prostitutes do receive
5 their share of stigma in some situations, only a portion of it is based on prostitution. That
6 is, among the general public, those most opposed to male prostitution are opposed to
7 men having sex with men (paid or unpaid) in general. The objection to male prostitution
118 is an artifact of the stigmatization of homosexuality. On the other hand, most of those
84 Ann M. Lucas
11 opposed to female prostitution are particularly concerned about the commercial aspect
of the transaction.
Still, some members of gay communities do stigmatize gay male prostitutes, objecting
to the commercialization or commodification of sexuality and the negative image male
prostitution brings to the larger gay population. This stigma, though, is not identical to
that experienced by female prostitutes, either in form or intensity. Male prostitution
does not have the same image of abuse and exploitation as female prostitution does, so
it does not attract the same kinds of objections. In addition, a significant number of gay
men, particularly urban gay men, see gay hustling as an adolescent rite of passage or
youthful oat-sowing, rather than a practice that threatens “healthy” gay sexuality and
relationships.
1
The future
The most humane approach to prostitution would be the decriminalization of consensual
adult prostitution. This approach would enable those who choose to work as prostitutes,
or to hire them, to escape the social stigma attached to prostitution. It would free up
resources so that law enforcement could focus on more serious crimes. It would allow
our society to discuss prostitution more fully and honestly, both in regard to its actual
or potential benefits and its disadvantages. It would promote norms of professionalism
within the industry. Without criminal status and a marginal social position, prostitutes
who are victims of violent customers, abusive pimps, international traffickers, and the
like, would be more likely to seek help. Decriminalization of prostitution would also
promote greater social acceptance of sexual diversity in human societies.
Yet in the current political climate decriminalization of prostitution is highly unlikely.
Indeed, compared to legalization (i.e., regulation), decriminalization might be unlikely
in any context. As New York University law Professor Sylvia Law has argued, given
that work, in general, is extensively regulated in our society, it is unreasonable to think
that a practice as controversial as prostitution could escape regulation if it were no
longer illegal. Should legalization ever be pursued as an alternative to criminalization,
it ought to be designed with the participation of prostitutes and with prostitute welfare
in mind, rather than as a way to raise revenue through taxes (a “government as pimp”
approach), or a way to control a “dangerous” group through registration, fingerprinting,
and disease testing. These latter approaches would simply replicate the abuses that occur
under criminalization, and thus cannot truly constitute “reform.”
8
1111
2 21 Strip clubs and their regulars
3
4
5
Katherine Frank
6
7
8
9
10
1
2 Sexual services and products have long been a part of the US entertainment and leisure
311 industries. In a 1997 article for US News & World Report, Eric Schlosser reported
4 that in the prior year Americans spent “more than $8 billion on hard-core videos, peep
5 shows, live sex acts, adult cable programming, sexual devices, computer porn, and
6 sex magazines.” The number of major strip clubs catering to heterosexually identified
7 men nearly doubled between 1987 and 1992, and an estimate for late 1998 put the
8 number of clubs at around 3,000 with annual revenues ranging from $500,000 to more
9 than $5 million.
20 While some men dislike strip clubs or find them boring, a significant population of
1 heterosexual American males are willing to spend their money on the kind of public,
2 voyeuristic (although interactive) fantasy available in a no-contact strip club. Despite
3 popular beliefs to the contrary, strippers are generally not selling sex to their customers
4 in this type of club—although they are selling sexualized and gendered services. Rather
5 than fulfilling a biological need for sexual release, as some pop sociobiological accounts
6 suggest, or serving a masculine need for domination, strip clubs provide a kind of
7 intermediate space (not work and not home, although related to both) in which men
8 can experience their bodies and identities in particular pleasurable ways. In my book
9 G-Strings and Sympathy: Strip Club Regulars and Male Desire, published in 2002,
30 I investigated the sources and forms of men’s pleasure. I demonstrated how the material
1 inequalities and everyday lives of customers are intertwined with the meanings that
2 customers attribute to their visits to strip clubs. While I cannot discuss all of the com-
3 plexities underlying the men’s motivations for their visits in this chapter, I suggest a few
4 important aspects.
5 Strip clubs are stratified in terms of luxury, status, and other distinguishing features.
6 Whereas strip clubs were once primarily located in “red light” areas of towns and cities
7 associated with crime and prostitution, the upscale clubs are, now, quite often visible
8 and they work to develop reputations for safety, comfort, and classiness. Drawing
9 on cultural markers of status—such as luxury liquors, fine dining, valet parking, and
40 private conference rooms—upscale clubs advertise themselves as places for business-
1 men to entertain clients or for middle-class professionals to visit after work. Dancers
2 may be advertised as refined, well-educated women. Sophisticated sound and lighting
3 equipment, multiple stages, large video screens, and multimillion-dollar construction
4 budgets turn many contemporary strip clubs into high-tech entertainment centers. This
5 is not to say that smaller or “seedier” clubs have disappeared. The clubs in any locale,
6 however, are categorized through their relationships to one another and this system of
7 relationships helps inform both the leisure experiences of the customers and the work
118 experiences of the dancers.
86 Katherine Frank
11 The proliferation and upscaling of strip clubs during the 1980s is situated in late
capitalist consumer culture, within a variety of social changes and developments. In
many ways it makes sense that strip clubs should multiply during the last several
decades, along with the panic about AIDS and fears about the dissolution of “the
family.” The process of upscaling strip clubs, with a promise of “clean” and respectable
interactions, alleviated fears about contamination and disease. The fact that sexual
activity is not generally expected or offered in strip clubs also fit well with a growing
emphasis on monogamy and marriage for heterosexuals after the sexual experimentation
(and ensuing disillusionment for many) of the 1970s. Other social changes may have
influenced this rapid increase in strip clubs as well: women’s increased presence in the
workforce, continuing backlashes against feminism, ongoing marketing efforts to
sexualize and masculinize particular forms of consumption (sports, beer, and women,
1 for example), changing patterns of mobility that influence dating practices and intimate
relationships, and increased travel for businessmen and more anonymous opportunities
to purchase commodified sexualized services, to name just a few.
Despite their prevalence and popularity, strip clubs are still often the subject of intense
public scrutiny. Local ordinances have been drafted across the nation to harass, limit,
or eradicate strip clubs, often citing “adverse secondary effects”—such as increased
crime and decreased property values in neighborhoods that house such venues—
as justifications for these legislative actions. Many such ordinances seem to be based
on conjectures about just what the men (and women) are up to when they set foot in
a strip club. There is endless speculation about drug use, prostitution, and crime—by
customers, lawmakers, and people who have never even entered a strip club. Yet my
experiences as an anthropologist studying American strip clubs do not confirm the worst
of these fears. While these activities surface at times in often scandalous ways—as they
do in many industries—I came away from my research with a belief that most of the
customers were in search of something completely different through their interactions.
Media and scholarly attention to the customers of strip clubs has been far less
pervasive than that focused on the dancers or the clubs themselves. But what is it,
exactly, that the customers are seeking in these venues? After all, without enough men
willing to open their wallets each night, the industry would cease to exist. As a cultural
anthropologist dedicated to participant observation—that is, becoming immersed in the
community you study—I selected five strip clubs in one city, sought employment as an
entertainer, and interviewed the regular male customers of those clubs. For regulars,
visits to strip clubs were a significant sexualized and leisure practice; these were not men
who wandered into a club once or twice or visited only for special occasions like
bachelor parties. The majority of the regulars were middle age or older with enough
disposable income and free time that they could engage in this relatively private and
often expensive leisure practice. I also interviewed dancers, club managers and other
club employees, advertisers, and men who preferred other forms of adult entertainment.
Most of the regular customers claimed that they knew where to get sex if they wanted
it, and that they chose no-contact strip clubs (or clubs that offered table-dancing rather
than lap dancing) precisely because they knew that sex would not be part of the
experience. While watching the dancers perform on the stages was certainly appealing,
many of the regulars were also interested in the conversations that they could have with
dancers. Unlike burlesque performers of years past, contemporary exotic dancers
“perform,” not just onstage, but individually for the customers as they circulate among
8 the crowd selling table dances. Thus, dancers are also selling their personalities, their
Strip clubs and their regulars 87
1111 attentions, and conversation to the customers. Some of the regulars returned repeatedly
2 to see a particular dancer; others enjoyed briefer interactions with a number of dancers.
3 Either way, talk was one of the important services being provided, and conversations
4 would focus on work, family, politics, sports, sexual fantasies, or any number of other
5 topics.
6 Whether visiting a small neighborhood bar or a large, flashy gentleman’s club, the
7 customers repeatedly told me that they visited strip clubs to relax. Part of the allure of
8 strip clubs was their representation as somewhere out of the ordinary, somewhere
9 proscribed and perhaps a bit “dangerous”—yet safe for play and fantasy, where the
10 pressures, expectations, and responsibilities of work and home could be left behind.
1 In many ways, then, strip clubs were seen as relaxing because they provided a respite
2 from women’s demands or expectations in other spheres, as well as the possibility (not
311 always actualized) of avoiding competition with other men for women’s attention. Strip
4 clubs also offered the customers opportunities for personal and sexual acceptance from
5 women, a chance to talk about their sexual desires without reproach, even a chance to
6 fantasize that they were attractive enough to gain the interest of a dancer regardless of
7 whether or not they paid her. Some customers wanted an ego boost. As one man said:
8
9 It’s just absolutely an ego trip because you go in there, and if you’re a warthog, bald,
20 and got a pot belly, some good looking girl’s gonna come up and go, “Hey, do you
1 want me to dance for you?” Seducing women is something all men wish they were
2 better at . . . this seems like you’re doing it, and it’s easy!
3
4 Strip clubs were also relaxing because they provided a space where it was safe for
5 those who were married or committed to interact with women in a sexualized setting.
6 The services offered fit well with these particular men’s desires to remain sexually
7 monogamous. Customers were not expected to perform sexually or to provide any
8 pleasure to the dancer (beyond paying her for her time), and this was also seen as
9 relaxing by many of the men.
30 Although some regulars admitted to periodically reading Playboy or renting porno-
1 graphic videos, such practices were not as significant or enjoyable to them as their
2 experiences in strip clubs. The customers’ reasons for discomfort with other kinds of
3 sexualized services were different—worries about jeopardizing commitments, worries
4 about sexually transmitted diseases, ambivalence about commercialized sexual activ-
5 ities, legal concerns, etc.—and, the point is, this kind of no-contact strip club offered
6 them a “safe” space where this discomfort was eased.
7 However, because they provided a space in which many everyday expectations were
8 inverted (by featuring public nudity, for example), the clubs were still seen as “taboo,”
9 and as dangerous and exciting by the regulars. Many of the interviewees discussed
40 their experiences in the language of “variety,” “travel,” “fun,” “escape,” and “adventure”
1 and described themselves as “hunters” or “explorers” despite the fact that their experi-
2 ences in the clubs were highly regulated by local ordinances, club rules, and club
3 employees. Some customers enjoyed that their visits to strip clubs took them to marginal
4 areas of the city. Further, visits to the clubs were often unacceptable to the married
5 regulars’ more “conservative” wives or partners.
6 Significantly, then, strip clubs were dangerous enough to be alluring and a bit less
7 civilized and rowdier than the places these middle-class customers would ordinarily
118 enter. This balance between safety and excitement was very important, for if strip clubs
88 Katherine Frank
11 lost their edge or, conversely, became too transgressive, the customers might have lost
interest and sought a different form of entertainment.
Understanding the motivations of the men who frequent no-contact strip clubs can
help quell some of the fears that tend to drive oppressive regulation. There are indeed
problems with strip clubs as they currently exist, often rooted in material inequalities
between different classes of laborers, in the poor working conditions found in many
clubs, in the stigma that surrounds sex work, and in double standards for men’s and
women’s sexualities, for example. However, eradicating or more tightly regulating
strip clubs would do little to combat these problems, which are related to the organ-
ization of labor in late capitalism, to systemic inequalities and prejudices, and to the
stigmatization and fear that still surrounds issues of sex and sexuality in the United
States.
1
8
1111
2 Part 3
3
4
5 Sexual health, wellness,
6
7
8
and medical models
9
10
1
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311
4
5 What exactly do we mean when we talk about “sexual health”? Is it simply the absence
6 of sexually transmitted diseases or is there more to it than that? Wouldn’t a person’s
7 psychological and emotional health be a part of their overall sexual health—including
8 their ability to have a positive outlook on sexuality? This might include being un-
9 ashamed about one’s body, for instance, or about one’s sexual preferences. It might
20 also include being free from harassment and abuse based on one’s sexuality, whether
1 we are talking about hate crimes against lesbians and gay men or nonconsensual sex
2 between married couples. These are larger social and cultural questions that come into
3 play when we begin to expand our thinking about what counts as sexual health.
4 Sexual health can be thought of in positive terms, not simply the absence of sexually
5 transmitted diseases. Instead, sexual health may encompass sexual well-being and a
6 person’s quality of life regarding sexual behaviors and attitudes. The World Health
7 Organization, the largest association that deals with health issues on a global scale, uses
8 the following working definition of sexual health:
9
30 Sexual health is a state of physical, emotional, mental and social well-being related
1 to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual
2 health requires a positive and respectful approach to sexuality and sexual relation-
3 ships, as well as the possibility of having pleasurable and safe sexual experiences,
4 free from coercion, discrimination and violence. For sexual health to be attained
5 and maintained, the sexual rights of all persons must be respected, protected and
6 fulfilled.
7 (World Health Organization, 2002)
8
9 Here, sexual health is not just a physical or mental condition. Sexual health is set
40 within a larger social framework and defined in a positive way. It is not just the
1 avoidance of disease but the presence of positive social conditions—respect being a key
2 element in this equation.
3 Some observers, researchers, and healthcare professionals have suggested that we are
4 on the cusp of a new sexual revolution, one that is driven by public health imperatives.
5 In the last ten years, an incredible amount of research and scientific analysis has centered
6 on sexual health, primarily because of HIV/AIDS and the development of drugs (such
7 as Viagra) to treat sexual dysfunction in men. While sexual health is still largely situated
118 in the context of sexual education and health promotion, the concept of “sexual health”
11 has appeared at the same time that we have seen a major upsurge in dialogues about
sexual rights.
For some other observers, sexual health is a misnomer, placing undue emphasis
on “health” as a way of controlling people’s sexuality. For example, one might ask: Is
demanding mandatory HIV testing for sex workers a way of subjugating an already
marginalized population? Or, when we think of married couples who might not be
having as much sex as they once did—is this just a normal course for a relationship or
should they reach for a pill in order to stimulate their sexual lives? We might question
whether the concept of sexual health may, at times, function as a way of placing value
judgments and restrictions on people. Can the concept of sexual health be both a
positive way of thinking about individual, social, cultural, and medical approaches to
enhancing people’s sexual well-being and attitudes, while at the same time operating
1 to limit our horizons of what is legitimate and “normal”?
Disparities in sexual health

Everyone has heard about AIDS and the need to take preventative measures against
contracting STDs. However, many of us think of these preventative measures as a matter
of individual choice and responsibility. For example, one makes a rational and calculated
decision whether or not to use a condom. Many health campaigns focus attention in that
direction, encouraging us to make responsible choices for ourselves. Indeed, this
message can be life saving. However, examining how people make individual choices
about whether they will live sexually healthy lives is not enough. Many people cannot
obtain information and support, and lack options to make the right decisions.
Structural factors, such as limited access to healthcare facilities, or cultural taboos
against discussing sex, condoms, or STDs can impact individuals’ abilities to make
informed, proactive decisions. The more insidious and harder-to-track forces of
sexism, racism, and homophobia can also impact a person’s capacity to responsibly
care for their sexual health. Populations that are not as visible, such as transgender
people, may not have as many resources or social support for their sexual decision
making. Aging people, who are often incorrectly thought of as nonsexual, may likewise
not be able to find, or feel comfortable with, sexual health information and decision
making. Therefore, another important way to think about sexual health, according to
leading researchers, is to consider sexual health as an individual and commun-
ity condition. In other words, when we are able to think of sexual health as more
than simply the responsibility of individuals, and see particular behaviors and choices
set within a larger context, then we can understand the more complex dimensions of
sexual health as a social question, rather than just individual behaviors abstracted from
the world.
A US Surgeon General responds

In 2001 US Surgeon General David Satcher released a landmark publication, The
Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual
Behavior. The Surgeon General’s Report underscored how certain populations in the
United States—the economically disadvantaged, racial and ethnic minorities, persons
with different sexual identities, disabled persons, and adolescents—face serious
8 obstacles when it comes to sexual health and well-being. These discrepancies, or health
Sexual health, wellness, and medical models 91
1111 disparities, are a major public health challenge in the United States as HIV infection
2 rates, unintended pregnancies and abortion, sexually transmitted infections, sexual
3 dysfunction, and sexual violence continue at alarmingly high rates in comparison to
4 other industrialized countries.
5 In the Report, the Surgeon General notes that there are disparities in access to good
6 healthcare, in particular among communities of color. The Surgeon General’s defini-
7 tion of responsible sexual behavior is not focused solely on individual responsi-
8 bility, but centers on community responsibility for creating a larger framework of
9 support for people to exercise good decision making. In particular, Dr Satcher outlined
10 the need for:
1
2 access to developmentally and culturally appropriate sexuality education, as well
311 as sexual and reproductive healthcare and counseling; the latitude to make
4 appropriate sexual and reproductive health choices; respect for diversity; and
5 freedom from stigmatization and violence on the basis of gender, race, ethnicity,
6 religion or sexual orientation.
7
8 These are very big goals. And perhaps we are on the verge of a new sexual revolution
9 in sexual health. In this Part you will have a chance to explore the multidimensional
20 meanings of sexual health as more than simply the absence of disease, but rather the
1 absence of intimidation; and as more than simply individual choices, but reflective
2 of larger social dynamics.
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30
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11
22 Doctors, patients, and sexuality
Yolanda Wimberly and Sandra E. Moore
1 Many people think that you can talk to your doctor about anything. But, as doctors who
train medical students, we have found some obstacles. First, there are a lot of medical
students who are nervous or uncomfortable talking about sex and sexuality with their
patients. Second, there are a number of reasons why patients may not feel 100 percent
comfortable raising sexual concerns with their physicians. Our hope is to train new
doctors to be the kind of physician with whom patients feel comfortable and talk openly.
The relationship between doctors and patients can provide a foundation for innovative
prevention and education efforts in order to ensure sexual health, education, and rights
in African American communities.
In training sessions we send medical students to see new patients with these
instructions: speak to them, take a complete history, and do a physical examination.
More often than not, when medical students return, they have nothing to report about a
patient’s sexual history. Students will often say, “I did not know I was supposed to do
that” or “How do I start the conversation?” Trainees often believe that a patient’s sexual
history is something “special” or “private.” This is not surprising, given that sexuality
is not always openly discussed in the United States, especially in African American
communities, where the topic can be even more difficult to discuss. However, sexuality
and sexual behavior is an integral part of a patient’s complete medical history and it is
important that doctors and patients are comfortable talking about it.
A healthcare provider who forms a bond and establishes trust with a patient becomes
an obvious source for “intimate” or “personal” information. Access to accurate infor-
mation about sex and sexuality is vital to maintaining one’s overall health. Whether or
not healthcare professionals consider themselves experts in this field, many patients
believe that they can come to their doctor with these kinds of questions. Healthcare
providers’ feelings about sexuality influence the way they discuss the topic with patients.
A doctor’s background and religion may have a significant impact on their morals
and values regarding sexuality. If healthcare providers are uncomfortable discussing
sexuality themselves, then how can they talk about these things with patients?
What do we mean by “sexuality”?

Sexuality refers to a broad spectrum of elements that make us the people we are. The
World Health Organization (WHO) uses a working definition of human sexuality as
“sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and
reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires,
8 beliefs, attitudes, values, behaviors, practices, roles and relationships.” In the not so
Doctors, patients, and sexuality 93
1111 distant past, medical schools taught about human life from conception to death but
2 somehow managed to glaze over or ignore the topic of human sexuality altogether.
3 However, over the past three decades medical schools have made significant strides.
4 They have gradually introduced human sexuality into the curriculum—albeit somewhat
5 begrudgingly at times. Whereas some schools now have semester or year-long courses
6 geared specifically toward teaching human sexuality, other schools only offer such
7 information during a “sexuality week.” Still, other schools have integrated human
8 sexuality into existing courses. Whatever the venue, there is finally more awareness
9 that human sexuality is an important, if sometimes under appreciated, part of medical

10 school education.
1 Because educators and healthcare providers realize that understanding one’s sexuality
2 is an important part of evaluating a person’s physical and mental health, human sexuality
311 education has been added to the curriculum in medical schools nationwide. Sexuality
4 is no longer confined to sexual problems in the specialties of obstetrics, gynecology,
5 urology, or psychiatric therapy. Sexuality is better understood as a part of one’s overall
6 healthcare needs.
7 Medical professionals should be taught how to comfortably discuss sexuality with
8 patients. A general survey of medical professionals found that most do not ask patients
9 about sexuality as a part of the standard medical examination. Oftentimes, it is only
20 discussed if the patient has a complaint related to sexuality. Ignoring sex and sexuality
1 with patients, however, may lead to any number of preventable side effects, including
2 sexually transmitted infections (STIs), unintended pregnancies, low self-esteem, dis-
3 satisfaction with intimate relationships, and depression.
4
5
Sexuality and African Americans
6
7 Despite a barrage of sexualized images in the media, Americans are not receiving
8 information that leads to responsible sexual practices. The United States, for instance,
9 has one of the highest rates of teen pregnancy among industrialized countries and
30 Americans have some of the highest rates of STIs in the world.
1 Television networks broadcast shows that feature sex and dysfunctional relationships
2 and radio programming is not much better, often featuring songs with explicit sexual
3 lyrics. There is also a multibillion-dollar pharmaceutical industry aimed at enhancing
4 libidos and improving sexual function. Even as we are deluged by sex in American
5 society, it is still considered taboo to openly discuss human sexuality, especially in the
6 African American community.
7 The relationship between a doctor and her patient might encounter barriers to
8 prevention and education in sexual health and sexuality. There is an unwritten rule in
9 much of African American culture that sex is a private matter, not to be discussed,
40 especially with children. Sex is often treated with the adage, “what you don’t know
1 won’t hurt you.” However, in the case of sex, what you don’t know can hurt you—and
2 maybe even kill you. African Americans have an alarmingly high rate of teen preg-
3 nancy and STIs. Just imagine what would happen to these rates if there were an open,
4 honest, and, if necessary, religious dialogue around sexuality. Churches are an important
5 source of spiritual and social support for many African Americans, making the church’s
6 view on sexuality very important. If churches were to take the lead in educating the
7 community and having an open dialogue about all types of sexuality—there would
118 be a big difference in attitudes about sexuality in African American communities.
94 Yolanda Wimberly and Sandra E. Moore
11 If children are raised in homes or church environments where sexuality is ignored or
derided, are they truly prepared for the society in which they live? If they are not
prepared, then it is the responsibility of healthcare professionals to bridge the gap with
accurate information.
Care providers are not immune to social influences. Like everyone, healthcare
providers have their own individual ideals, values, and beliefs. Regardless, they need
to be able to educate, inform, and advocate for patients. Healthcare professionals must
be a source for, at the very least, clinical advice on human sexuality for their patients.
This means portraying sex neither positively nor negatively—and always informing
patients about the aspects of human sexuality that may impact their lives.
8
1111
2 23 Capitalizing on women’s health
3
4 The myth of “female sexual
5
6
dysfunction”
7
8 Leonore Tiefer
9
10
1
2
311 Younger women report pressure to have orgasms every time during sex because it seems
4 to make their partners feel masculine. Does this make their distress about orgasms a
5 dysfunction?
6 Many middle-aged women often want to be able to say no to sex without their partner
7 feeling personally rejected. Does that make declining interest and saying no a
8 dysfunction?
9 Many older women want intimacy and physical pleasure without vaginal penetration
20 because it’s painful. Does that make their pain a sexual dysfunction?
1 Do these women all need medical treatment? The pharmaceutical industry would
2 like us to believe the answer is yes.
3 Through public relations, direct-to-consumer advertising, and marketing disguised
4 as epidemiology, the drug industry is capitalizing on—and exploiting—the public’s
5 ignorance and embarrassment about sex, general sexual myths and misunderstandings,
6 and doctors’ inadequate knowledge base.
7 Of course, some women do have sexual problems. And, of course, some of those
8 problems are medically caused. But the fact that most are not is deliberately ignored
9 by an industry that can’t yet provide a pill for relationship blues, fears of abandonment
30 or violence, or pressures arising from overwork.
1 The medicalization of women’s sexual problems is occurring largely because
2 pharmaceutical companies and some medical opinion leaders see big profits and big
3 careers in a previously untapped market. If they can brand “female sexual dysfunction”
4 as a clear-cut medical condition, then they can promote FDA-approved prescription
5 products and over-the-counter nostrums and nutraceuticals (such as salves, supplements,
6 or vitamins that don’t need to be tested and don’t require prescriptions) to the large
7 population of women with sexual complaints or normal age-related, relationship-related,
8 or stress-related reactions.
9 In the process, though, this could exacerbate women’s sexual insecurity, enhance the
40 stigma of “sexual inadequacy,” and promote a one-size-fits-all notion of sexual function
1 that poorly serves the public.
2
3
4
What is medicalization?
5 Medicalization is a social process—both intellectual and institutional—whereby areas
6 of human behavior and aspects of everyday life are brought under the rubric of medicine.
7 Think of chronic drunkenness. In the past this was a deviant and immoral social
118 behavior. Now it is called alcoholism, a medical condition, needing assessment,
96 Leonore Tiefer
11 management, treatment. Think of shyness and moodiness. In the past these were two
ways that people expressed their personalities. Now these ways of relating are called
“affective disorder” or “emotional liability” or “social anxiety,” needing proper medical
diagnosis and treatment. Think of menstruation, pregnancy, or menopause, formerly
ordinary aspects of women’s lives, now all requiring medical surveillance to check for
deviations from alleged universal scientific health norms.
The principal methods of medicalization are the “discovery” and “definition” of
new “conditions” that need medical expertise and management. Sociocultural norms
(for example, weight, alcohol intake, emotional expression, physical activities, child-
rearing, child development, sexual activities) are reframed as health norms, and
deviation is asserted to be a matter of concern for health, possibly signaling illness
or a “risk” for illness. People learn to observe their own and each others’ habits and
1 behaviors, checking for healthy and unhealthy signs. Routine testing is undertaken to
search for signs of impending ill health.
Things that might have been perfectly ordinary a few years ago—like women’s wide
differences in interest for sex or orgasm—are now defined as areas for health monitor-
ing, and biological causes are frequently suspected.
Medicalization has been studied and criticized by a wide range of social scientists
who have argued that this process frequently creates misinformation, self-absorption,
unhappiness, conformity, and political disempowerment. Medicalization teaches people
to think they should all be perfect (and the same) and to look to biology to explain their
differences. Feminists have noted that it is primarily women’s lives and experiences
that have been medicalized, drawing attention away from social and cultural change
that would benefit women more than medical management.
Most importantly, social scientists have repeatedly demonstrated that medicalization
occurs, not merely because of scientific developments, but because biomedical claims
are actively promoted by those with professional and economic interests in expanding
medical domains.
A prime example of medicalization

Prior to the approval of sildenafil (Viagra) by the FDA in 1998, there wasn’t much
interest in women’s sexual health as an area of medical specialization. There was,
however, a great deal of research on women’s sexual lives and experiences in the
social sciences. Numerous effective psycho-educational clinical interventions, such as
masturbation education and body image counseling, addressed women’s sexual
problems born from the pervasive influence of sexism and the double standard on
health and social life.
Internationally, beginning with the 1994 Cairo Conference on Population and
Development, substantial attention was paid to women’s sexual health by several US
and UN conferences, which explicitly defined sexual health and outlined directions for
women’s full participation.
Research in social science and public policy always cited the deleterious impact of
medical problems on sexual life, but medical issues typically took back seat to social
and public health causes of women’s sexual suffering, such as political and religious
oppression, poverty and overwork, lack of education and access to healthcare services,
date and marital rape, domestic violence and child sexual abuse, and internalized
8 sexism. The term “sexual health” referred to a broad spectrum of issues.
The myth of “female sexual dysfunction” 97
1111 But in the late 1990s, following the blockbuster success of sildenafil (Viagra), a
2 phase of sexual medicalization entered the media and the health professions like a
3 steamroller. Urologists and others backed by generous pharmaceutical funding
4 suddenly claimed that there wasn’t any research on women’s sexual health, and that
5 they had arrived to remedy this situation.
6 These claims were made in the press and at urology congresses, bypassing the
7 well-established sexology organizations, journals, and scientific meetings. These new
8 sexuality experts convened their own meetings beginning in 1998 and established new
9 “consensus guidelines,” organizations, journals, websites, departments, and annual

10 conferences in the United States and abroad.
1 These structures institutionalized a medicalized view of women’s sexual satisfaction
2 and dissatisfaction and focused on a very narrow slice of sexual health, “sexual dys-
311 function.” The pharmaceutical industry bankrolled these meetings and structures,
4 eager to create a market among women comparable to that for erectile dysfunction
5 drugs. Ads and exhibits, as well as the content of the meetings and journals, testified
6 to the dominant drug company influence.
7
8
More damage than good
9
20 Medicalization relies on estimates of high prevalence, and articles about the new
1 “female sexual dysfunction” insist that “43%” of women had been shown to have
2 sexual dysfunction. This astonishing figure emerged in a 1999 JAMA (Journal of the
3 American Medical Association) paper, which, as The New York Times reported, was
4 based on a reanalysis of a 1994 survey, and authored by two people who had served
5 as consultants to a pharmaceutical company.
6 The “female sexual dysfunction” steamroller of simplistic diagnoses and assessments
7 has now spawned a small army of experts with websites, television and radio shows,
8 boutique clinics, off-label drugs, and scientific congresses, all aiming to profit from
9 women’s new opportunities and uncertainties regarding sex. Conflicts of interest are
30 now being attacked by professional and government groups and we can look forward
1 to greater restraint. But medicalization, itself, must also be challenged.
2 There are some medical causes for women’s sexual problems when they’re connected
3 to illness, surgery, or use of other medicines. There are treatments already available
4 for such medical causes. However, most sexual problems are not medical. They are the
5 result of sexual fears, lack of sexual information, or factors that, in sexual context, are
6 not sexual at all (for example, anger, fatigue, lack of privacy, fear of rejection). Taking
7 the new sex drugs for these causes is not likely to do much good. Rather, the new
8 diagnoses and new ad campaigns will create more self-criticism and self-consciousness,
9 increasing the market for new drugs but not the quotient of sexual happiness. Worst
40 of all, many women may be harmed by the new drugs as they were by the now
1 questionable Hormone Replacement Therapy.
2 The only appropriate professional response to female sexual dysfunction at this point
3 should be skepticism, caution, and a renewed commitment to disentangling the science
4 of women’s sexual lives and problems from marketing and public relations.
5
6
7
118
11
24 Medical abortion and activism
in medicine
Angel M. Foster, Jennie Sparandara,
and Linda Prine
1 The advent of medical abortion allows any physician to become an abortion provider.
It means that every doctor who professes to believe in “choice” has to ask herself if
she is willing to put her beliefs into practice. Physicians are well suited for activist
roles, as their profession has evolved to emphasize, not only healing and teaching, but
also empowering students and patients. Since the 2000 FDA approval of mifepristone
(the medical abortion pill), a new kind of activism based on reproductive rights is
growing among physicians and medical students. Through education, outreach, and
networking, organizations such as Medical Students for Choice, Physicians for
Reproductive Choice and Health, the American Medical Women’s Association, and
a coalition of like-minded organizations are helping physicians, in all stages of their
training, to become abortion providers.
Advocacy organizations
Founded in 1993, Medical Students for Choice (MSFC) is dedicated to ensuring
that comprehensive reproductive healthcare, including medical and surgical abortion,
becomes a standard part of medical education and residency training. Recognizing
that one of the greatest obstacles to safe and accessible abortion is the shortage of
trained providers, MSFC works to expand abortion education and training opportuni-
ties, foster pro-choice leadership, and develop a growing network of future providers.
MSFC has grown into a significant bi-national grassroots organization, with over
7,000 student and resident members in the United States and Canada. Through
organizing lectures, establishing elective courses, and mobilizing for curriculum
reform, MSFC activists are changing the opportunities available on their campuses. At
the national level MSFC engages in curriculum reform efforts and provides medical
students with support, mentors, and supplementary training opportunities. MSFC’s
Reproductive Health Externship program places nearly 100 students each year in
abortion facilities, the annual meeting brings over 300 MSFC activists together to learn
more about both the provision of abortion and pro-choice organizing, and the annual
Leadership Training Program provides new campus-based leaders with an opportunity
to cultivate organizing, recruitment, and communication skills. With groups at over 100
medical schools, MSFC represents a considerable network of emerging leaders in the
reproductive rights movement.
In 1992 Physicians for Reproductive Choice and Health (PRCH) was formed to help
physicians take a more active stand in providing universal reproductive healthcare
8 for women. PRCH envisions physicians as activists and advocates for their patients,
Medical abortion and activism in medicine 99
1111 a natural extension of the caregiver role. PRCH staff members have worked tirelessly
2 to promote this agenda to the public, media, physicians, and politicians. Among its
3 missions, PRCH maintains and develops comprehensive sexuality education curricula
4 in public schools, supports fetal tissue donation, supports the training of advance
5 practice clinicians (APC’s) in abortion provision, and supports an increase in the
6 accessibility of emergency contraception. PRCH has also joined forces with sister
7 organizations, such as Mergerwatch and the American Medical Women’s Association
8 (AMWA), in order to increase awareness of religious hospital mergers and the shortage
9 of trained abortion providers. The PRCH/Mergerwatch alliance has led to the Preserve
10 Project, which seeks to make physicians and consumers aware of the detrimental effects
1 some religiously affiliated hospitals can have on patients’ rights to comprehensive
2 reproductive healthcare. From the PRCH/AMWA partnership, the Medical Abortion
311 Education Project (MAEP) was developed.
4
5
Training organizations
6
7 MAEP was formed with help from the AMWA membership and foundation financial
8 support, and at the request of the National Abortion Federation (NAF) and the Associ-
9 ation of Reproductive Health Professionals (ARHP). It educates physicians, advanced
20 practice clinicians, medical students, and other health professionals about medical
1 abortion. Through varied resources, including didactic slideshows, small group teaching
2 sessions and conference presentations, clinicians can become educated specifically
3 about providing medical abortion. Responding to needs for increased access to abortion
4 and the shortage of trained abortion providers, MAEP helps providers put medical
5 abortion into a historical context and practice. AMWA also works with its student
6 membership and Medical Students for Choice to expand the MAEP initiative to medical
7 students.
8 NAF and ARHP are two more professional organizations that engage medical
9 providers as activists. NAF is the largest professional association of abortion providers
30 in the United States and Canada. NAF advocates for its physician members in order to
1 help them navigate through the twisted world of medical bureaucracy. The organization
2 also maintains a comprehensive Web site, which includes educational information for
3 patients and providers. ARHP is a longtime advocate of reproductive rights issues,
4 beginning as the physician education arm of the Planned Parenthood Foundation of
5 America. Recently, ARHP has gone public in its efforts to stop current political threats
6 to reproductive rights and science at large with its statement, “Preserving Core Values
7 in Science,” a bold effort to forcefully oppose ideological encroachments into science.
8 Planned Parenthood has long been one of the most recognizable forces in the world
9 of medical activism. Organized around the central issues of abortion and contracep-
40 tion access, sexuality education, and censorship, Planned Parenthood is a catalyst for
1 clinician activism. A new feature to Planned Parenthood’s Web site is their detailed
2 vision for the future. Like ARHP, Planned Parenthood articulates the need to meet
3 the challenges of a politically hostile climate head on and has outlined a clear plan for
4 doing so.
5 In 1998 the Society of Teachers of Family Medicine (STFM), the academic
6 professional organization for family physicians, added a task force or “Group On”
7 Abortion Training and Access. Members of this group have presented workshops at
118 regional and national meetings covering all aspects of abortion care. They host a listserv
100 Angel M. Foster, Jennie Sparandara, and Linda Prine
11 with a membership of more than 200. The listserv has become an important network
of support for practitioners to discuss, not only medical issues involved in providing
abortions, but administrative and financial barriers as well. Members of this group
have also published articles about abortion care in family medicine. They have made
efforts to give presentations within the American Academy of Family Practice, a
traditionally more conservative organization. Their proposals have been rejected for
every national conference and publication with the exception of the conference that is
jointly held with STFM on “Patient Education.” To address this censorship, student,
resident, and physician members of the AAFP have passed resolutions at local, state,
and national meetings asking that the Academy include education about abortion at its
meetings, on its Web site, and in its journals.
In 1999 the Access Project, a grant-funded organization, was founded with the
1 mission to integrate abortion into mainstream family medicine and primary care.
Believing that a woman’s access to abortion would be improved if abortion provision
moved beyond specialty clinics, the Access Project has developed a comprehensive and
informative Web site. Their Web site includes resources and information for primary
care clinicians who need to include abortion services, especially medical abortion
services, in the standard medical office practice setting. The Abortion Access Project
is a sister organization committed to training more providers and educating the public.
Through literature, a comprehensive Web site, and a nationwide network of organizers
and advocates, the Abortion Access Project spreads training, as well as the message
that clinicians can advocate for abortion access everyday in their practices. The
Abortion Access Project also has outreach and activist toolkits, making it easier for
everyone to organize around this important issue.
The Internet has become an important organizing tool for activists worldwide. In the
field of abortion care, email, websites, and listservs allow for long distance updating,
organizing, and training of physicians. The organizations described above facilitate
clinician activism by linking physicians with one another and with supportive political
organizations. Through their training, physicians are uniquely positioned to take action
in the fight to maintain women’s access to the spectrum of reproductive health options.
Small, dedicated groups of physician activists founded these organizations to ensure
that all women are guaranteed safe abortion services. With their help, a new generation
of physicians are being trained who welcome the opportunity to provide the full range
of women’s reproductive health services—including abortion—within the settings of
their primary care offices.
8
1111
2 25 Bringing medical abortion to
3
4 rural America
5
6 Interview with an abortion provider
7
8 Carole Joffe
9
10
1
2
311 Susan Golden* is a family practice physician in the rural Midwest. Like most in this
4 specialty, she and her partner practice obstetrics, pediatrics, nursing home visits,
5 treatment of heart disease and hypertension, and so on. Unlike most of their colleagues
6 in family practice, they also provide the women in their community with “medical”
7 abortions using the drug mifepristone (also known as “RU-486” or “the French abortion
8 pill”). If Dr Golden’s practice did not offer this service, these patients would have to
9 drive over three and a half hours to the nearest city that has a freestanding abortion
20 clinic, and, there, they would receive a conventional vacuum aspiration or “surgical”
1 abortion.
2 In many ways Dr Golden could be a “poster woman” for the pro-choice movement
3 and the abortion pill. Since mifepristone was made available in France in 1988, and
4 finally approved in the United States in September 2000, harassment and terrorism
5 against abortion providers has escalated dramatically (Risen and Thomas, 1999).
6 Access to abortion became a major difficulty for many, especially rural women, as the
7 number of facilities providing abortion dropped. Currently only 13 percent of US
8 counties have a known abortion provider (Finer and Henshaw, 2003). Abortion rights
9 activists hoped that mifepristone would address both the issues of violence outside
30 of abortion clinics and the shortage of abortion facilities. Dispensing a pill does not
1 involve the same kind of training associated with surgical abortion; in theory many
2 more doctors would be able to provide medical abortion in their primary care settings.
3 Advocates also presumed that if abortion were incorporated into general practice
4 medicine, it would be much harder to target both abortion providers and patients.
5 Dr Golden’s experiences to date, however, demonstrate that mifepristone provision
6 is more complex than abortion rights proponents had originally imagined. Dr Golden’s
7 story is a confirmation of medical abortion’s possibility to expand abortion care; at the
8 same time, her story is a reminder that there is no “technological fix” to the enduring
9 social conflicts over abortion in the United States.
40 I have interviewed Dr Golden a number of times, as part of a research project on the
1 potential of mifepristone to bring “new” providers—those not already trained in surgical
2 abortion—to abortion care. The following material is excerpted from these interviews.
3
4 Why did you initially decide to offer medical abortion to your patients?
5 I had been for many years a strong believer in reproductive rights, long before I became
6 a physician. When I was in college, I was active on this issue. When I opened my practice
7
102 Carole Joffe
11 in this town several years ago, I knew that women had to travel for hours to get to the
nearest clinic, and that didn’t make sense to me.
How did you learn to perform medical abortion?

I regularly go to regional meetings of AMWA (the American Women’s Medical
Association) and we had a presentation on mifepristone. . . . I realized that I could do
this in an office setting. I had met the presenter, Dr Lawrence*, a few times at other
AMWA events, and she offered to be my ‘mentor’—though she lives elsewhere in the
state. She offered to be available to me by phone, to answer any questions I might have.
That was really important to me—because there is no one in my local medical
community I could talk this over with.
1 What else did you have to do to get this set up?

I had to buy an ultrasound machine—that cost our practice over $10,000. I had to get
new insurance coverage—my malpractice rates were raised several thousand dollars
by my carrier, even though these abortions are among the safest procedures I do!
I had to hire staff who were going to be comfortable with abortion . . . my partner,
Dr. Perillo*, and I carefully interviewed our office people . . . we knew we needed a
tough bunch who could handle whatever might happen. We have a wonderful, dedi-
cated staff who are very on board with this. I also had to arrange for backup services
from some local obstetrician/gynecologists.1 That was not a problem—I have lined up
several backup ob/gyns. The local medical community here does not want to do
abortions themselves, but they are willing to help me in this way.
How has your provision of mifepristone worked, medically?

It’s worked great! Very smoothly. No problems at all for the two years we have been
doing this. I have never had to call Dr Lawrence about anything. We’ve been doing about
four per week. Only one person had to be resuctioned by one of the local ob/gyns.
How has it worked “socially”? What has been the reaction of this community? Of your
patients?
Well, that’s been more complicated. Shortly after we started, one of my patients—a very
conservative Christian—came into my office, and said, “Dr Golden, do you know they
are talking about you on Christian radio?! They are saying you do abortions here, and
they are calling you and Dr Perillo Sisters of Satan!” And a little while after that, this
prayer group started coming to our office every day—they’d come right at noon, say
prayers for about twenty minutes, then leave. They seem harmless enough. But more
worrisome, this guy comes every so often, with huge signs, with very graphic pictures—
he is creepier. So far though, nothing has happened. We are in touch with the police
about the situation.
My patients are for the most part supportive. We have lost a few, maybe six or so,
who left the practice because of this, but we have probably gained more. Even the
patients who are against abortion are annoyed by the protestors. And my patients seem
to trust me. One of my patients—a staunch Catholic—said to me, “If someone is dealing
with an unwanted pregnancy, you are exactly the kind of person I would want them to
have there, to help them make the right decision.”
8
Bringing medical abortion to rural America 103
1111 A divided community
2
3 Another incident reinforced for Dr Golden what it means to provide abortions provision
4 in a small town. She was scheduled to participate in a community health fair, speaking
5 about the various choices parents faced with the arrival of newborns. One of the local
6 anti-abortion groups heard that she was scheduled to speak and successfully persuaded
7 the staunchly “pro-life” owner of the building hosting the conference to withdraw his
8 offer. The health fair was abruptly cancelled, as there was not time to find an alternate
site. In the uproar that followed, most of the community, including the local newspaper,
9
10 expressed outrage that the mere presence of this local physician—scheduled to speak
1 on a topic that had nothing to do with abortion—caused the cancellation of the fair.
2 Reflecting on the event, Dr Golden was gratified to see such support, yet understandably
311 troubled by the fact of her abortion provision—only a small fraction of her total medical
4 practice—could play such a consequential role in the cancellation of a long-planned
5 community event.
6 So what does this brief glimpse of Susan Golden’s experiences tell us about the
7 prospects of mifepristone to change the abortion landscape? In some key respects the
8 hopes of the abortion rights movement have been realized. Dr Golden’s story makes
9 it clear that medical abortion provision can be safely and smoothly integrated into a
20 family practice setting. And access to abortion for the women in her community—who
1 no longer have to drive three and a half hours to a clinic—has increased enormously.
2 Her story also reveals that another hope pinned to this “abortion pill”—that it would
3 dilute the conflicts over abortion and make providers and patients less subject to
4 harassment—has not yet occurred. For Dr Golden and Dr Perillo, their devotion to their
5 patients and their strong belief in reproductive freedom keep them committed to
6 offering mifepristone. This overrides the negative events that have occurred. But not
7 all physicians can be realistically expected to have such courage. The next step in the
8 medical abortion chronicle, already underway in some institutions, is routine medical
9 abortion provision training in family practice residencies. As such training becomes the
30 norm, and as many more primary care clinicians take on medical abortion provision,
1 hopefully the “targeting” of providers will, ultimately, become fruitless.
2
3 Note
4 1 Such arrangements are required by the FDA, for those providers of mifepristone who do not
5 themselves do vacuum suction abortion, as some 1 to 5 percent of patients will require such
6 services to complete their abortions.
7
8
9 References
40 Finer, L.B., and S.K. Henshaw. 2003. “Abortion incidence and services in the United States in
1 2000.” Perspectives on Sexual and Reproductive Health 35(1): 6–15.
2 Risen, J., and J. Thomas. 1999. Wrath of Angels: The American Abortion War. New York: Basic
3 Books.
4
5
6
7
118
11
26 Aging and HIV
The changing face of AIDS
David M. Latini and David W. Coon
The face of HIV is changing. More older adults are becoming infected and more people
1 who have become infected before their fiftieth birthdays are now aging with HIV/AIDS.
These changing faces create new challenges for health educators, medical providers,
and clinical researchers.
Even among Americans age fifty years and older, the face of HIV is diverse. In the
HIV epidemic has primarily impacted white men who have sex with men. In contrast,
older Floridians diagnosed with HIV are primarily African American (47.4 percent),
with Latinos (16.1 percent), and women (18 percent) making up sizable proportions of
the epidemic.
Older adults are more frequently diagnosed with HIV at a later stage of the disease
and they are likely to die sooner than their younger counterparts. Among seniors,
AIDS-related symptoms, such as fatigue, weight loss, and diminished appetite, are
often misdiagnosed by healthcare professionals as age-related conditions rather than
symptoms of HIV/AIDS.
“It is difficult for me to think that HIV is why I feel old or have the problems of aging;
and, it is difficult to think entirely otherwise,” says Paul Quin, age sixty, who was
diagnosed with HIV seventeen years ago. “I feel unable to track symptoms or monitor
my health. I no longer understand what might be normal for a man my age and what
might come with HIV—what might be a warning.”
The picture is further complicated by the fact that there is little research regarding
the safety and efficacy of AIDS medications in older adults, including accurate under-
standings of dosage and frequency. Medical providers also appear to have a limited
understanding of how AIDS medications may interact with medications for other
conditions common in older adults, such as diabetes, heart disease, and arthritis. All-
too-common stereotypes about the sexuality of older adults persists among profes-
sionals and the public at large, making HIV prevention efforts more difficult. The myth
that “grandparents aren’t interested in sex, and if they are interested in sex, no one is
interested in them,” continues to be a prevalent assumption in the general public.
Debunking this myth is the 1999 survey by AARP (American Association of Retired
Persons) reporting that more than 50 percent of forty-five to fifty-nine-year-olds, and
more than 25 percent of those sixty to seventy-four years old had sex at least once,
if not more times, a week.
Another common misperception is that older adults only have sex within the context
of a heterosexual monogamous relationship. According to Florida’s Department of
Health (SHIP), the ratio of men to women in South Florida is 1 to 7. This gender
imbalance may make women more likely to have unprotected sex in order to secure a
8 male partner. SHIP also reports that older males may frequent sex workers, particularly
near the time that pension checks arrive.
Aging and HIV 105
1111 It is also assumed that older adults do not use or abuse illicit drugs, or if they have
2 used drugs, their use was so long ago that it does not carry any risk of HIV infection.
3 Even the use of prescribed medications may carry HIV risk. Because seniors often live
4 on a fixed income, they may be more likely to reuse and exchange needles for prescribed
5 medications such as insulin.
6 Healthcare providers may also share these misperceptions and may not assess older
7 patients for sexual and drug use risks, or counsel them about safer-sex practices.
8 “Medical providers often don’t ask seniors about their sexual behavior, much less their
9 recreational substance use,” said Monica Dea, a board member of the Northern
10 California Association on HIV Over Fifty, a California affiliate of NAHOF, the National
1 Association on HIV Over Fifty.
2 Seniors may hold their own misperceptions about their risk for HIV. In the early
311 years of the HIV epidemic, research with at-risk groups such as heterosexual adolescents
4 found that many teens who engaged in risky sexual practices did not believe themselves
5 to be at risk because they saw HIV/AIDS as a gay man’s disease. Some seniors still view
6 HIV/AIDS as a younger person’s disease and do not consider themselves to be at risk,
7 regardless of their sexual behaviors.
8 “Post menopausal women and their sexual partners won’t automatically consider
9 using condoms, since they are past childbearing age,” Dea reported. Even among older
20 adults who would like to use condoms, the subject can be difficult to discuss. Because
1 the reason for condom use would clearly be to prevent disease, the implication is that
2 there is a lack of trust in a current partner. Today’s cohort of widowed older adults
3 reentering the dating arena grew up during an era when sexual matters were talked about
4 less frequently. They may also have been in committed, long-term marriages where
5 sexually transmitted disease risk was limited. These seniors often lack the com-
6 munication skills necessary to negotiate safer-sex practices.
7 According to Dea, sexual behavior for seniors has also changed because of an increase
8 in the use of Viagra. “Viagra is passed around like candy and middle-aged and older
9 adults are continuing to get infected.” Viagra has permitted men who have not been
30 recently sexually active to reenter the dating and mating arena, perhaps in an environment
1 of HIV/AIDS risk they do not understand and for which they are not prepared.
2 The increasing number of seniors diagnosed with HIV presents a challenge to US
3 health educators, researchers, and policy experts to develop successful education and
4 intervention programs targeting middle-aged and older adults. Education campaigns
5 need to increase awareness among medical providers about the risk of HIV due to sexual
6 behavior and drug use among their older patients. Medical and senior service providers
alike often require additional skill training and age-appropriate patient or client
7
educational material to more effectively communicate with older adults.
8
Discussing risk-taking behavior may be difficult for providers to address, even
9
when the older adult raises questions about perceived risks for HIV. “Although it takes
40
only minutes to ask a couple of questions to determine the older individual’s risk for
1
HIV, providers often need incentives and education to do so,” says Dr. Nathan Linsk,
2
principal investigator of Midwest AIDS Training and Education Center and a founding
3
co-chair of NAHOF. “A number of groups nationally have begun to offer education
4
and information to health providers to help them to ask these questions,” and some of
5 these materials are listed on the Web site. Health policy experts also need to encourage
6 pharmaceutical companies to carry out research that includes older adults to ascertain
7 just how seniors react to HIV treatments and how those treatments interact with
118 treatments for other conditions.
106 David M. Latini and David W. Coon
11 HIV/AIDS education campaigns need to incorporate the aging faces of the epidemic
so that seniors increase their risk awareness and learn effective HIV prevention
strategies. HIV researchers and educators have learned that education programs tailored
to the cultural and linguistic needs of particular subgroups are more effective at
communicating information and encouraging behavioral change. Lessons learned from
earlier research with African Americans, Latinos, gay men, and other at-risk groups
provide evidence for the need to tailor HIV prevention interventions to older people in
general, as well as develop intervention strategies for older adults from specific socio-
economic and cultural groups.

“One in seven new AIDS cases in Chicago are in people over age fifty, and this is
typical of urban and suburban areas in the US,” says Linsk. However:
1 there is a dearth of age specific research and quality educational materials to

enhance our understanding about how HIV affects older adults. HIV affects elders
in terms of their own possible infection and illness, in terms of prevention and
in how they care for others affected by HIV. Good information is needed about
how to help them prevent HIV, how to care for their HIV related health issues
and how to help them help others.
“I need help monitoring my health and wellness, a way to balance between running
to the ER with every shift in my body’s balance and letting things go,” says Quinn. He
continued:
I also want to help push us all to learn more about what happens as we age with
HIV. We can help teach the world more about the disease, treatment options, and
possibilities—more about the normal life of the body, its strengths and limits, its
weakness and survival. Maybe, just maybe, we can figure out how to control HIV
without having it be so expensive, so prohibitively expensive.
Jane P. Fowler, director of a national program called “HIV Wisdom for Older
Women”, agrees that research and education programs for HIV-positive seniors are
noticeably absent. “Older HIV-positive women face a double hardship: the stigma of
living with a disease considered disgraceful and the burden of aging in a society that
neither values nor respects its seniors.”
Overcoming the taboos that older adults may hold about discussing their sexual
behavior with their partners and healthcare providers and dismantling ageist assump-
tions are critical steps in effective HIV/AIDS education for older people. Among the
stereotypes about older people, lies a particularly dangerous one: “You can’t teach an
old dog new tricks.” This adage fuels the assumption that older adults are unwilling or
unable to change their behavior. However, decades of gerontological research demon-
strates that older adults can, and will, change their behavior when provided with
appropriate education and interventions that target specific health concerns and provide
support for skill development for seniors’ real world concerns.
HIV/AIDS education and intervention programs allow providers and researchers
alike the unique opportunity to work with older adults and to help them protect them-
selves against HIV/AIDS, while at the same time extending pleasurable and responsible
sexual activity throughout the senior years.
8
1111
2 27 No place to call home
3
4 Transgender persons, discrimination,
5
6
and HIV
7
8 Rita M. Melendez
9
10
1
2
311 The men in the homeless shelter liked Clara*. They assumed she was one of the workers
4 who helped maintain the facility. They never imagined she was homeless. And they
5 were shocked when this young woman explained that city authorities placed her in the
6 men’s shelter because they felt it was inappropriate to send her to a women’s home.
7 Clara was born male. The relatives who raised her did not accept that the boy they
8 had known was taking female hormones and living as a woman. For Clara, this was
9 the only way she could live—but it was hard. Unable to reside with her family any
20 longer, she opted to live in a shelter instead.
1 Like Clara, many transgender women are forced to live in temporary shelters.
2 Besides not having physical homes, transgender people also suffer from lack of a
3 symbolic home in our society. We live in a world where it is acceptable to humiliate
4 and undervalue transgender persons. The stigma attached to being transgender is
5 enormous. Discrimination impedes, not only access to jobs and homes, but also the
6 ability to stay safe from HIV.
7
8
9
High risks
30 HIV is a concern for transgender women. The San Francisco Department of Public
1 Health conducted a study examining the occurrence of HIV among 392 transgender
2 women (male-to-female) and 123 transgender men (female-to-male). The results,
3 published in the American Journal of Public Health in 2001, were surprising and
4 saddening: 35 percent of transgender women were infected with HIV; half of those
5 infected did not know that they had contracted HIV. Transgender men faired better; of
6 those surveyed, 2 percent were infected with HIV.
7 With the assistance of the administrators and doctors at a community health clinic
8 located in the Bronx, I interviewed twenty transgender women over the course of
9 two months, including Clara. Transgender women include those born male who have
40 had genital reassignment surgery, those who take female hormones but do not get
1 reassignment surgery, and those who dress as women but do not take hormones or
2 get surgeries.
3 The transgender women I spoke to do not represent the experiences of all transgender
4 male-to-females in New York City or elsewhere; however, their unique stories illustrate
5 some of the ways transgender women are at risk for HIV. In this chapter, I concentrate
6
7
108 Rita M. Melendez
11 on some of the many ways that discrimination negatively impacts transgender women’s
ability to stay safe from HIV and to care for themselves if infected with HIV.
What happened to civil rights?

Discrimination makes transgender women especially vulnerable to HIV. Finding
work can be difficult and for some, practically impossible. In most parts of the United
States, you can legally fire or discriminate against someone because they are trans-
gender. Many transgender women turn to sex work to survive. For example, one person
I interviewed for my research mentioned making small amounts of money in sex work
that allowed her to buy female hormones not covered by her medical insurance. Many
of her clients would pay extra for her to engage in unprotected sex.
1 Discrimination hinders transgender women from engaging in safer sex in other less
obvious ways. The women I spoke to knew they needed to get their partners to wear
condoms, but the space between knowledge and action can be complicated. When dis-
crimination is constant throughout life, the need to be with someone who loves you can
take on supreme importance, resulting in a decision to “forget” about condoms or to
back down when a partner insists on not using a condom. Consider Vanessa* who was
recently diagnosed as HIV-positive. Vanessa says:
We know how hard “the life” is so when you meet a guy it’s like you go through
all means to keep this man, because you really want to be with him, you know what
I’m saying? So it’s really hard. You just want to be loved, that’s it. Being ridiculed
so much, called this called that, being used . . . It’s just like after a certain point in
your life you just . . . you get needy, I guess.
An intimate relationship may offer a space where transgender women feel loved—
something missing from many other parts of their lives. For Vanessa, the relationship
ended when she realized that her partner knowingly infected her with HIV.
After the diagnosis

When transgender women are infected with HIV, accessing healthcare can be difficult.
Although New York City has a number of services available for LGBT (lesbian,
gay, bisexual and transgender) individuals, many transgender women I spoke to
did not want to attend those clinics or be associated with “gay” organizations. All
my participants identified primarily as women. They knew they were transgender but
disclosed this identity only when they felt safe. Identifying with the T in the LGBT was
not important to them.
Many women I spoke to discussed how they felt discriminated against by the gay
community. One transgender woman said:
Gays think we are the worst face of homosexuality, we are the shame of
homosexuality. . . . But in reality what they think doesn’t affect me. I do not live
in their world, I don’t stop in places they stop. . . . I have seen a lot of discrimination
towards “transgenders” and they think many horrible things about us.
The tensions between the gay community and transgender women make it difficult
8 to provide transgender women with HIV care in health clinics that target the LGBT
Transgender persons, discrimination, and HIV 109
1111 community. Services specifically geared to include transgender people are often not
2 utilized due to perceived or real discrimination.
3
4
Taking action
5
6 Discrimination in its various forms makes it harder for transgender women to take steps
7 to protect themselves against getting infected with HIV. HIV is a biological reality
8 but its path of infection is social and cultural, one where discrimination lays the
9 groundwork.
10 Community healthcare clinics have an opportunity to make their services open to
1 transgender women. The clinic where I conducted my interviews was not geared to
2 the LGBT community but was open to all members of the community, including
311 transgender women. The clinic had doctors and nurses who were familiar with the
4 healthcare needs of transgender women. Doctors provided hormones as well as other
5 health needs such as HIV medications. The staff was incredibly supportive and kind
6 to all clients and never flinched when learning that one of the clients was a transgender
7 woman—making sure to use the names and pronouns preferred by their clients. Their
8 openness made the clinic a safe place.
9 Eradicating discrimination against transgender people will eventually curtail HIV
20 infection. We need to ensure that transgender people find homes in our society—
1 making sure that we not accept any form of discrimination in our laws, employment
2 practices, housing opportunities, or healthcare facilities.
3 Importantly, we need to appreciate the resilience, strength, and grace that transgender
4 people exhibit.
5
6
7
8
9
30
1
2
3
4
5
6
7
8
9
40
1
2
3
4
5
6
7
118
11
28 High risk sexual behavior among
young adults in the US Navy
Genevieve Ames, Andrew Bickford, and
Ann Russ
1 Similar to young adults in college settings, young men and women in the military
develop specific cultural beliefs about drinking, using drugs, and “partying.” These
social environments have been shown to influence the incidence of sexually transmitted
diseases and unplanned pregnancies. What remains to be discovered is the degree to
which alcohol consumption behaviors are related to high risk sexual practices in this
younger age group of first-term enlistees in the military. In order to develop prevention
programs that are relevant, successful, and which “speak” to the experiences of young
people in the military, it is important to understand the impact that alcohol, along with
other factors in cultural environments such as the military, have on sexual behavior.
Beginning in 2002, a research team comprised of cultural anthropologists and
epidemiologists at the Prevention Research Center in Berkeley, California began a
five-year study of high risk sexual behavior (HRSB) among young adults who were in
their first three years of service in the US Navy. Focusing on the US Navy and its unique
work and institutional culture, this study is examining important health and social
issues surrounding drinking and sexual behavior with young adults during their first
enlistment period.
The research team is examining the characteristics of military work culture and the
ways in which this influences commonly held beliefs and assumptions about high risk
sexual behavior. The research centers on three main objectives, which include
evaluating the extent of HRSB among recently enlisted Navy personnel—such as
having multiple sexual partners and not using condoms and contraception. The research
also analyzes the relationship between beliefs and expectations about HRSB and how
the Navy’s occupational culture influences these beliefs and expectations. Finally, the
project addresses how each of these factors relates to enlistee’s social backgrounds.
Most of the interviews are being conducted with young adults in their first period of
enlistment. Personnel who serve to mitigate the difficulties faced by new enlistees, such
as Navy chaplains, medical personnel, counselors, and educators will also take part in
the study.
During their initial enlistment period, many of these young men and women face
stresses, constraints, and pressures as they come to terms with life in the US Navy. The
Navy presents unique challenges to enlistees, such as deployments, which are
comparable only to those faced by the US Marines. Long operational deployments at
sea create a host of problems for young recruits, particularly in regard to drinking and
HRSB. Enlistees are not only exposed to the rigors of sea duty and life on base, they
must also contend with the pressures to “let off steam” during port calls and liberty,
8 and during their everyday lives on land.
High risk sexual behavior among young adults in the US Navy 111
1111 It is the intersection of these two elements—duty and desire—which creates tensions
2 that may lead to HRSB in the US Navy. New recruits find themselves in a work
3 environment unlike the civilian world, where strict rules and regulations circumscribe
4 and structure what they are allowed to do—or not do. Navy rules and regulations,
5 including strict fraternization policies and rules of conduct aboard ship, often run
6 counter to recruit’s desires and wishes related to dating and sexual relationships.
7 A key element of this research focuses upon the intersection of strict discipline and
8 sexuality. In what ways do young recruits experience these restraints in relation to their
9 lives as sexual beings? How do young men and women live as sexually active people
10 within the Navy environment? Do constraints and rules intended to curb sexual activity
1 instead promote activities and forms of sexual experience that contribute to HRSB and
2 STDs?
311 It is important to advance our understandings of sexuality in the Navy, especially
4 given the changing gender composition and the mission of the US Navy. Unplanned
5 pregnancies, which have been found to be highest among women in their first
6 enlistment, can result in costly problems for the women involved and the Navy. For
7 women serving aboard ships, unplanned pregnancies require arranging transfers to a
8 shore job, finding replacements with similar skills, and providing additional training.
9 Many women who have been unable to find or arrange for childcare have been
20 discharged from the Navy.
1 The high rate of STDs in the Navy are equally troubling. From the Navy’s viewpoint,
2 this impacts the lives of enlistees who contract STDs and can also lead to problems
3 in low morale and productivity, diminished readiness, and a need for additional training
4 and replacements. HRSB is most commonly defined or understood as condom non-
5 use. However, this research also examines other factors and variables, such as contra-
6 ceptive non-use, lack of pre-sex communication (that is, communication about
7 contraceptives, condom use, and status of STDs and/or HIV/AIDS before sex), and the
8 number of partners or sexual history. These factors are critical to the research because
9 they highlight a broad range of issues and activities that may be associated with HRSB.
30 This study represents a significant advance in alcohol research in the military. The
1 culture of educational and work organizations that involve large populations of young
2 adults (such as colleges, universities, and the military) have not been fully analyzed,
3 particularly in their potential for ritualized and enabling systems for heavy drink-
4 ing. Clearly, these environments can contribute to undesirable social and health
5 consequences for those involved as well as for families, friends, and communities.
6 To understand the health risks of the millions of Americans who attend college
7 or serve in the military, it is important that research such as this be conducted. The
8 unique contribution of anthropologists to HRSB research is an understanding of, and
9 appreciation for, the cultural differences regarding which acts and activities count as
40 sex, risky sexual behavior, and STDs. While many public health educators and officials,
1 for example, would advocate condom use as the most significant factor in HRSB
2 prevention, anthropologists recognize that not all cultural groups and societies share
3 this view. To fully understand the ways in which drinking is associated with HRSB
4 among young recruits in the US Navy, it is important to examine all the potential
5 practices that can prevent high risk sexual behavior.
6
7
118
11
29 Sexual networks of truckers,
truckchasers, and disease risks
Yorghos Apostolopoulos, Sevil Sönmez,
Jennie Kronenfeld, and Donna Jo Smith
1 When truckers cross state lines they carry not only their cargo but also their accumu-
lated disease pathogens.
The risk of disease transmission by 3.3 million US truckers and their approximately
300,000 Canadian counterparts is both real and under-investigated. Despite significant
research done in developing regions (for example, sub-Saharan Africa, Southeast Asia)
that demonstrates links between high risk sexual activity within the trucking sector and
disease diffusion, social and health scientists in the United States are only beginning
to investigate risky sexual and substance use behaviors of several populations along
US interstates.
Dale Stratford and colleagues’ groundbreaking study of long-haul truckers in
northern Florida in the late 1990s is the first study delving into sexual behavior among
US truckers and its links to HIV. Nearly one-third of the interviewed truckers said they
had frequent sex with female sex workers and that condom use was rare. A number of
truckers indicated that “some truckers” use the services of male sex workers because
they are less expensive than their female counterparts and more easily available. Some
truckers acknowledged using drugs, primarily methamphetamines, cocaine, and alcohol.
Many of the drivers knew little about AIDS, with some believing that it is a disease
that only affects gay men or that condoms are of no use. Stratford’s study, as well as
overwhelming anecdotal evidence on truckers’ risk-laden social networks, served as
the impetus for our investigation. Here we present preliminary descriptive findings from
ethnographies we conducted in Arizona and Oklahoma in 2001, and from ongoing
fieldwork in metro Atlanta.
Our research reveals extensive high-risk sexual and drug transactions among several
population groups (stationary, transient, or mobile) that coexist in close proximity to
truck stops and highways. Informal and in-depth interviews with truckers and their risk
contacts in various highway milieux indicate that truckers frequently engage in
unprotected oral, vaginal, and anal intercourse with sex workers and other men and
women along highway routes, and that they often combine their sexual encounters
with drug use. Truckers’ use of amphetamines, marijuana, cocaine, and crack—either
to stay awake and alert while driving, to get high while partying, or to relax and/or sleep
during layovers and rest periods—also emerged as a prevalent pattern.
Truckers’ risk networks include a number of varied populations. The nucleus of this
network—the male trucker (straight, gay/bisexual, or non-gay identified [NGI])—is
often surrounded by female sex workers (for example, “lot lizards,” CB-prostitutes,
“traveling ladies,” US and Mexican brothel workers, hustlers), MSM (men who have
8 sex with men) (for example, “truck chasers,” “good buddies,” or “buffaloes” [male
Sexual networks 113
1111 counterparts of “lot lizards”]), drug dealers, pimps, “polishers” (transient workers who
2 polish the chrome details of trucks), “lumpers” (workers who load/unload cargo),
3 transient and seasonal laborers, homeless individuals, hitchhikers, as well as truck
4 company and truck stop employees.
5 Members of these networks often play multiple roles, either simultaneously or
6 interchangeably. Every person in the truckers’ risk network can offer distinct insights
7 into the ways that these subcultures operate and how this may impact the transmission
8 of disease. However, space limitations do not allow a detailed discussion of them all.
9 Instead, the remainder of this chapter focuses on the truckers (whether non-gay
10 identified, gay, or bisexual) and “truck chasers” (men who pursue sexual encounters
1 with truckers in various highway milieux) because, as a result of their high risk sexual
2 behaviors, they represent the most critical component of these networks in terms of
311 disease transmission.
4 Despite our study participants’ unanimous descriptions of extreme heterosexism
5 in the long-haul trucking industry, our interviews make clear that sexual transactions
6 between truck chasers and NGI and/or gay/bisexual truckers are common. While all
7 of the thirty-eight self-identified heterosexual truckers whom we interviewed vehe-
8 mently denied any personal experience with truck chasers, the great majority of these
9 heterosexual truckers were highly knowledgeable about the ways that other truckers
20 hook up with “good buddies” (trucker slang for gay men) in “pickle parks” or highway
1 rest areas, brake inspection areas, and truckstops.
2 For obvious reasons NGI men who have sex with men present a real challenge for
3 researchers. Our knowledge of NGI truckers has thus far been heavily based on
4 interviews with truck chasers and gay/bisexual truckers, located through elaborate
5 websites, associations, newsletters, and events that are created by gay/bisexual truckers
6 and other MSM interested in truckers. An annual convention of truck chasers and
7 gay/bisexual truckers provided our research team with a rich opportunity to conduct
8 interviews and focus groups. Convention participants were almost exclusively white
9 men (mostly gay/bisexual truckers) between their mid-thirties and mid-forties. A
30 number of truckers reported previous marriages and children, while others reported
1 continued periodic sexual encounters with women. Truck chasers reported extensive
2 and mostly anonymous sexual encounters with truckers, some numbering their
3 encounters into the hundreds, a couple even into the thousands.
4 Of course the idea of men cruising for other men in public spaces is not a new
5 phenomenon and has been documented by numerous sources, beginning with Laud
6 Humphrey’s infamous 1970 book, The Tearoom Trade. Cruising in the United States
has been traced back to the 1890s and was fueled by the proliferation of highway rest
7
stops after World War II. Public or semipublic sex between NGI truckers, gay/bisexual
8
truckers, and truck chasers is a concern only to the degree that these settings can
9
increase the potential for engaging in risky behaviors. While fear of arrest by police
40
and/or fear of homophobic backlash on the part of NGI truckers can enhance the
1
excitement of the encounter, these factors simultaneously raise the level of risk.
2
Our research suggests that NGI men who have sex with men don’t accurately perceive
3
their own risky behaviors, assuming that their straight identity places them in a low risk
4
category. One of the truck chasers whom we interviewed noted that “straight” truckers
5 who were married to women often voiced a preference for other “straight” married men:
6
7 [S]ometimes they will ask you if you are married because sometimes they feel safer
118 having sex with other married men. I don’t know why they think they are not
114 Yorghos Apostolopoulos, et al.
11 going to contract HIV from having sex with other married men. I think they feel
like that they are not having sex with gay men, so it is going to be OK.
This notion that married men would be less risky partners than gay men is based on
the erroneous but popular logic that sexual identity, rather than sexual behavior, is the
best predictor of risk.
In contrast to their descriptions of NGI truckers, most of the gay and bisexual men
interviewed revealed a fairly sophisticated understanding of safer-sex behavior.
Overall, they reported low risk perceptions of HIV-infection from oral sex (their
predominant sexual activity) and pro-condom attitudes toward anal sex. Paradoxically,
however, a number of the truck chasers and gay/bisexual truckers interviewed also
admitted irregular condom use for anal sex, explaining their selective use in a variety
1 of ways: some based it on their insertive, rather than receptive, role during anal sex;
others on their sex partner’s healthy appearance; and still others on a desire to increase
intimacy and/or illustrate their trust in their partners.
It’s definitely a trust issue. Using condoms means no trust. I carry condoms, so if
someone asks, then yes, I’ll use it. But I never take it out myself. I do look their
bodies over for karposis sarcoma, drainage, red marks, anything out of the ordinary.
I don’t do anything unless I can see their body. But I’m trained in health.
This truck chasers’ assertion that he can “see” HIV status reveals a shocking level
of ignorance regarding HIV transmission. Yet, his admission that condom use implies
a lack of trust in his partner raises an equally troubling specter: that some truck chasers
might not insist on the use of condoms in risky sexual encounters in order to avoid the
implication that the NGI trucker is in fact gay, out of fear of a homophobic backlash.
Many of the truck chasers interviewed shared experiences of being physically
threatened and/or attacked, sometimes during, sometimes after, a sexual encounter
with a NGI trucker.
Our research thus far has only scratched the surface of NGI-MSM trucker/truck
chaser networks and issues of sexuality and health risks. At the same time, it dramatic-
ally illustrates that as social and health scientists, we need to have a better understanding
of the multitude of diverse risk factors that adhere in trucker network milieux in
order to create interventions that will adequately educate these diverse and hidden
populations.
8
1111
2 30 Addiction and the sex offender
3
4 Is mental illness an excuse for
5
6
calculating crimes?
7
8 Stanton E. Samenow
9
10
1
2
311 Addiction! We hear about it constantly in one form or another. The word is commonly
4 used to characterize a person’s consuming passion for a particular substance or activity.
5 A person who loves chocolate and devours a lot of it is called a chocolate addict or
6 “chocaholic.” A physical fitness enthusiast who is intent on never missing his daily
7 jog is a running addict or “jogaholic.” There’s even a term for the incessant reader;
8 she’s a “biblio-maniac,” addicted to reading. And now there is a book about people who
9 constantly seek to please others, a condition termed “approval addiction.”
20 The word “compulsive” is often used to characterize addictive behavior. The man
1 who gambles away money he cannot afford to part with becomes known as a com-
2 pulsive gambler, addicted to this pastime. The young woman who steals wherever she
3 goes is considered a compulsive thief or kleptomaniac, addicted to stealing. And so it
4 goes with other types of behavior that are repetitive, persistent, and destructive. They
5 are diagnosed as addictions and considered diseases.
6 I do not intend to tackle the wide range of these behaviors. My focus is on so-called
7 sexual addiction—in particular the person who gets into legal trouble because of it. The
8 concept of addiction with respect to sexual behavior is really no different from the
9 concept applied to other areas of life. Addiction is regarded as a disease with elements
30 of dependency in which the person with the condition finds it difficult, if not impossible,
1 to break away from the cycle of repeating the behavior at issue, suffering consequences
2 but continuing anyway. In some circles, addiction is conceived of as an involuntary
3 brain disease.
4 This concept, though, is flawed and is advanced by those who do not understand the
5 mental processes that underlie exploitative sexual behavior.
6 Take Gary*, for example. Gary appeared to be a successful professional and a
7 responsible husband and father. He had everything going for him until the day he was
8 arrested for attempting to expose his penis to a thirteen-year-old girl. It happened
9 shortly after 3 p.m. when Gary saw the youngster leaving school. He pulled over and
40 parked his car under a tree. As she drew near, he called to her. The girl approached to
1 see what he wanted, thinking he was lost and needed directions. Nearing the door, she
2 looked in and saw him with his pants down. She fled! Not long after the encounter, Gary
3 was arrested for indecent exposure and solicitation of a minor. I interviewed Gary
4 upon referral by his attorney for a psychological evaluation.
5 As it turned out, there was an entire dimension to Gary’s existence that lurked behind
6 the responsible facade. Cheating on his wife, Gary had occasional one-night stands with
7
118 *Names have been changed to protect the identity of the individuals profiled.
11 women, including paid prostitutes. Reluctantly, he admitted involvement in sexual
contacts with men. Asked about interest in pornography, Gary first said he occasionally
glanced at pictures of scantily clad adult females. Eventually, and with considerable
embarrassment, he admitted downloading many types of pornography. In what had
become a ritual on weekdays before work, he would leave his slumbering wife and
stealthily enter the den, switching on the computer in the darkness of early morning
(usually around 4 a.m.), then masturbate while viewing pornography.
Since adolescence Gary had peered into windows hoping to glimpse females
engaging in sexual activity. He had exposed himself in the past both to juveniles and
adults. With all this going on, he still managed to maintain good standing at his
accounting firm and spend time with his wife and little boy.
Gary said that he was “addicted” to sex. It was constantly on his mind. No matter
1 how many sexual outlets he had, he sought more. He regarded the urgency of his sexual
drive as a force over which he had no control. But in my professional opinion, Gary
had plenty of control and no addiction existed.
Tony*, a man in his 40s, had a top-secret security clearance and was on track to
becoming a high-ranking government official. Married and with two children, he was
arrested for exposing himself in a community park. Tony confessed to me he had been
exposing himself since the age of eleven, but authorities had never before apprehended
him. He told me about the careful calculations he made while on business trips. It was
easier to remain anonymous in locations where he didn’t live and would spend only a
short time. He would request a hotel room several stories up but not too high,
overlooking a pedestrian area or parking lot so he could be seen. He would part the
curtains in his room, but not open them all the way. He would stand naked with an
erection in the window but partially hide his face behind the curtain. As soon as he saw
someone look up, he’d instantly draw back, and then masturbate in private. He also
staked out parks and exposed himself there.
It is understandable that people like Tony and Gary would be considered to have a
disorder because they risked everything they valued in a quest for cheap thrills. People
would naturally conclude that such individuals are in the grip of a compulsion or
addiction—that they must be sick.
During thirty-five years of specializing in the evaluation and treatment of criminal
offenders, I have interviewed many men like Gary and Tony. An in-depth psychological
analysis of these individuals reveals that, for them, illicit sex is an ego boost, a vehicle
for conquest and excitement. Their preoccupation with sex has nothing to do with the
lack of a responsible sexual outlet. Like Gary and Tony, most have spouses or partners
who are available for them. These men are far more interested in the conquest than
they are the sex. One told me, “I find ’em, feel ’em, fuck ’em, and forget ’em.” Another
asserted, “I don’t care if she’s deaf, dumb, and blind; all I wanted was her body.”
Even with a valued job, a spouse, children, and financial security, these men seek
excitement by doing the forbidden. Sex with a consenting partner leaves them restless
and dissatisfied. “Take my crime away, and you take my world away,” one offender
exclaimed. Like Gary and Tony, he meant that life without the excitement of his
sexually illicit activities was not worth living. Such a world view does not constitute
disease but a preference that results in a series of choices.
There is increasing excitement during every phase of a sex offense—the fantasy, the
pursuit, the commission of the act, and the aftermath. Some offenders report experiencing
8 pangs of guilt, but these are fleeting and of little value in deterring future misconduct.
Addiction and the sex offender 117
1111 These men know the ruinous consequences to themselves of being discovered, but they
2 have a chilling capacity to banish these considerations from their thoughts while they
3 pursue their objectives. Twinges of conscience are similarly brushed aside.
4 Sex offenders differ in their modus operandi. Some are deceptive, insinuating
5 themselves into others people’s lives in order to extract sexual favors. Once they obtain
6 what they want, they often discard their partners like used Kleenex. Others resort to
7 intimidation or force. Regardless of the method, they share similar thinking patterns
8 as they pursue power and control. The voyeur has a sense of power while secretly
9 intruding into private lives. The flasher has a sense of control as he surprises his victim,
10 attracting or, more often, repelling her. Rape is a raw act of exercising power as the
1 perpetrator reduces a woman to a quivering, pleading speck of humanity who submits
2 and does his ultimate bidding. A rapist recalled, “I brandished my penis like a sword.”
311 I interviewed Gary’s wife, Alice*, and Tony’s wife, Diane*. Naturally, they were
4 shocked and devastated by their spouses’ arrests. Eager to get their husbands help,
5 each spoke to me candidly. Both Alice and Diane thought their spouses were “sick.”
6 It is my experience that in trying to make sense of deviant and shocking behavior,
7 professionals and the public use the concept of addiction as an explanation.
8 Alice informed me that several years ago she had caught Gary with another woman.
9 She left him but reconciled several months later. Chastened by the experience, Gary
20 resolved to be faithful. The couple went ahead and had a child. One day when Alice
1 went to check the email, she was horrified by what she saw on the computer screen—
2 graphic images of women in sexual acts. When confronted by his wife, Gary acknow-
3 ledged he had been curious but avowed he had no further interest in pornography.
4 Alice did her best to convince herself that he meant it.
5 Alice remained frustrated, as she long had been, by her husband’s failure to
6 communicate. But she reassured herself that many men are that way. She also observed
7 that her husband constantly complained about being exhausted. Alice attributed this
8 to Gary being so worried about work that he would go to the office early, even on
9 Saturdays. She hadn’t the faintest idea of his early morning forays into computer
30 pornography. Alice’s main concern, however, was that when Gary was home, he
1 seemed distracted, like he was in another world.
2 Diane told me that Tony was a control freak. She was expected to run the household
3 like clockwork, precisely on the schedule he dictated. She was tired of his constant
4 criticism. She could not fathom how he found time to prowl around parks and other
5 public places as busy as he was at work and at home.
6 Both Gary and Tony disclosed to me how they managed to find the time and
7 opportunity for their sexual adventures. They lived a double life, carefully concealing
8 their behavior from the very people who ostensibly knew them best. The most accurate
9 diagnosis for these men is that they have elements of both narcissistic and antisocial
40 personality disorders.
1 Like scores of other sex offenders whom I have evaluated, Gary and Tony were
2 making choices. Sex offenders plan what they are going to do. If they think the risk is
3 too great, they resist the temptation of going ahead. The person who exposes himself
4 scouts out the area. If he thinks a getaway will be problematic, he’ll wait for a more
5 propitious opportunity or search out a different spot. Sometimes, a perpetrator becomes
6 complacent or careless and takes an unnecessary risk. He miscalculates and is caught.
7 This becomes more likely if he has been drinking or using drugs. Whatever behavior
118 he engages in, it is freely chosen, not a compulsion or addiction.
11 An offender remarked, “If I didn’t have enough excuses for crime, psychiatry gave
me more.” The concept of addiction as a disease to explain sexual offenses falls into
that category. I am not suggesting that a person’s sexual orientation is freely chosen
(i.e. whether an individual is homosexual, heterosexual, or attracted to children). I am
saying that people make choices in how they conduct themselves sexually, whatever
their orientation. Engaging in behavior that victimizes other people is not a disease. It
is freely chosen by men and women who seek excitement at the expense of other
people. As one fellow said of his so-called addiction, “I like it too much to quit.”
Sex offenders are not suffering from the disease of addiction. They are excitement
seekers in pursuit of conquests. They do not have a condition over which they are
helpless and lack control. Behavior is a product of thinking. And they think in a
particular fashion and make particular choices to do what they do. If the consequences
1 of their behavior become unbearable, they are able to make other choices that are more
responsible. Some do, in fact, change their thinking and become disgusted with
behavior that they formerly found exciting.
Successful treatment entails a cognitive-behavioral approach. The individual is taught
to recognize the thinking processes that gave rise to the irresponsible and destructive
behavior. He is encouraged to look in the mirror, so to speak, at the harm he has
inflicted in order to generate motivation to change. He is taught corrective concepts.
In short, he is taught to become self-critical in a constructive manner. Through the
process, he becomes aware of his thoughts, deters the thoughts, thinks of the potential
impact of acting on such thoughts, and changes his thinking so he can act in a
responsible fashion. With prolonged effort, he can succeed in living a life in which he
does not have to look over his shoulder to avoid apprehension. Abandoning criminal
patterns of thinking and behavior, he eventually earns the trust of others.
8
1111
2 Part 4
3
4
5 Sexual activism and rights
6
7
8
9
10
1
2
311 Sexual rights is a very recent addition to the lexicon of human rights. The term “sexual
4 rights” arrived on the world stage in the early 1990s, emerging from earlier discourses
5 on reproductive and women’s rights. At the United Nations (UN) Vienna World Con-
6 ference on Human Rights, the Program of Action called on countries to eliminate
7 gender-based violence, sexual harassment and exploitation [including trafficking in
8 women], systematic rape, sexual slavery, and forced pregnancy. In 1994, at the Inter-
9 national Conference on Population and Development in Cairo, Egypt, there was
20 embattled debate over birth control and abortion. However, the Program of Action that
1 was ultimately developed at that meeting described sexuality as a positive aspect of
2 human life, explicitly stating that “sexual health” is integral to reproductive health and
3 fertility control, as well as a requirement for a “satisfying and safe sexual life.” While
4 the Program of Action managed to include sexual health needs within the purview of
5 sexual rights, there is no mention of sexual pleasure or freedom for sexual expression
6 or sexual orientation.
7 Not surprisingly, sexual rights are contested terrain with highly charged ethical
8 questions. In international treaties and declarations, gender and sexual rights have
9 largely centered on the right to reproductive self-determination or freedom from
30 conditions of sexual abuse and discrimination. But other ethical questions pertain-
1 ing to sexual diversity, including family formations that are not cut from the mold of
2 the heterosexual, nuclear family, are also salient. Sexual rights involve the right
3 to a safe and satisfying sex life, autonomy and “bodily integrity”—the ability to make
4 decisions about one’s body, sexuality, and health. Bodily integrity requires access to
5 information about sex, reproduction, and pleasure, as well as a supportive environment
6 in which to exercise one’s sexual decisions. Other critical ethical questions surrounding
7 sexual rights include principles of equality, including gender equality, fair and equal
8 treatment for sexual “minorities,” and attention to the ways that racial stereotypes
9 negatively impact the right to a supportive environment for all people.
40 The Internet and the information age have provided new platforms for sexual rights.
1 Vast numbers of people have become organized, visible, and active by linking to each
2 other through the Web. There are forums for debate and sites for people to become
3 politically active around sexual rights, regarding issues such as S/M and intersexuality,
4 for example. There is also a qualitative increase in information about sexual rights.
5 Violations of sexual rights, ranging from rape during armed conflicts or police violence
6 against transgender people, is information that is almost instantly disseminated through
7 the media, email lists, and letter campaigns. While the proliferation of sexual rights
118 organizations and grassroots groups has certainly boomed in the digital age, it is
11 important to recognize the genealogy of “sexual rights” and its intimate connection to
the women’s and feminist rights movements, and lesbian and gay rights movements
from the 1970s to the present. Both of these massive social justice campaigns were
indispensable to the development of sexual rights. Activism for HIV/AIDS research
and treatment has also invigorated new questions and demands about sexual health and
well-being and how these imperatives fit with sexual rights.
While we want to recognize the global dimensions of sexual rights in other coun-
tries, we do not want to forget that plenty of questions remain about sexual rights
here at home in the United States. Recent research shows that many young women
in the United States do not believe they have even the most basic sexual rights. They
do not realize that they have the right to say “no” to sex or to tell a partner he or she is
being too rough. From this vantage point, sexual rights must also include the right
1 to be assertive, forthright, and heard in these kinds of situations. The right to accept or
decline sexual advances and to decide for one’s self how one’s body is touched is a
concern in both the developed and the developing world. Recent research in US schools
shows that discrimination, name calling and physical violence continues against
students perceived to be lesbian, gay, bisexual, or transgender. An estimated two
million students are bullied each year in the United States because they are, or are
thought to be, homosexual.
In this Part, be prepared to confront complex questions of ethics, pleasure, gender
and racial equality, sexual health, and the right to a safe and satisfying sexual life,
remembering that sexual rights are both a global and a local concern.
8
1111
2 31 Not separate, still unequal
3
4 The Beijing agreement and the
5
6
feminization of HIV/AIDS
7
8 Adrienne Germain and Jennifer Kidwell
9
10
1
2
311 The Beijing Conference stands as a milestone for women’s human rights. In 1995 the
4 world’s governments, with leadership from the United States, adopted the Platform for
5 Action, an outcome document agreeing that women have the right to control matters
6 relating to their sexuality, including their sexual and reproductive health. They also
7 discussed ways to ensure adolescents’ right to comprehensive, accurate sexuality
8 education and health services, including access to condoms.
9 Ten years later, how well has the world implemented the Beijing agreement? And
20 what are the consequences for girls and women when we fail to move forward? While
1 there has been progress in areas like access to contraception, education, and political
2 participation, the most telling indicator is the feminization of HIV/AIDS.
3 HIV/AIDS rates in general, and for girls and young women in particular, are soaring.
4 Nearly 50 percent of the thirty-eight million people living with HIV/AIDS around
5 the world are female, up from 41 percent in 1997. Females now account for 62 percent
6 of the people from fifteen to twenty-four years old, living with HIV/AIDS world-
7 wide. In sub-Saharan Africa, 75 percent of those living with HIV in this age group are
8 female.
9 Even in Brazil, where the epidemic has stabilized in the past six years, in 2001 and
30 2002 the number of cases in girls under twenty was six times higher than the number
1 of cases in boys that age. In Thailand, also considered an HIV/AIDS success story,
2 the epidemic is advancing among women infected by husbands who visit, or have
3 visited, sex workers, with as many as half of new infections every year occurring
4 among cohabiting couples. Here in the United States, women accounted for 27 percent
5 of new AIDS diagnoses in 2003, up from 8 percent in 1985. Low-income women and
6 women of color are disproportionately affected. African American women, for
7 example, accounted for 67 percent of female AIDS cases in the United States in 2003,
8 but only 13 percent of the female population.
9 There are no band-aids or medical solutions for girls’ and women’s vulnerability.
40 We are at least ten years away from even one preventive vaccine, and work on
1 microbicides—topical gels or another substance that women can apply in the vaginal
2 area to reduce transmission of HIV and other sexually transmitted diseases—while very
3 promising, is probably at least five years away from a marketable product. A female
4 condom that is less expensive and easier to use than the current model is under
5 development and will ultimately be an important option for at least some women if
6 subsidized and widely disseminated.
7 But as UNAIDS Executive Director Peter Piot said on World AIDS Day last
118 year:
122 Adrienne Germain and Jennifer Kidwell
11 We will not be able to stop this epidemic unless we put women at the heart of the
response to AIDS. . . . The number of women living with HIV is on the rise in
every region. Prevention methods such as the ABC approach—abstinence, be
faithful, and use condoms—are good, but not enough to protect women where
gender inequality is pervasive. We must be able to ensure that women can choose
marriage, to decide when and with whom they have sex, and to successfully
negotiate condom use.
Full implementation of the Beijing agreement would dramatically reduce girls’ and
women’s vulnerability and offers long-term solutions. The Platform for Action outlines
the interventions needed, outside the health sector, to eliminate discrimination and
poverty, sexual coercion and violence, and unequal power in relationships and marriage
1 that put women and girls at risk in the first place. We must invest in programs to ensure
that all girls complete at least secondary school and that all women live free of violence,
marry by choice, preferably as adults with their full consent, and have access to
productive economic opportunities, including full property and inheritance rights.
When governments came together again this March to assess progress on Beijing,
more than a hundred countries unanimously reaffirmed their commitment to imple-
menting the agreement. Going forward, national and international financing must be
significantly and immediately ramped up to secure women’s rights and empowerment.
As Noeleen Heyzer, head of UNIFEM, has noted, in 2004 the UNIFEM Trust Fund to
Eliminate Violence Against Women received $15 million in project requests but only
has $1 million in its budget.
We must also focus on what the health sector can do better to protect women and
girls from HIV/AIDS in the countries most affected and those where epidemics are at
the take-off stage, such as Nigeria and India. Universal access to comprehensive
reproductive health services is the logical starting point. We can best reach these girls
and women by strengthening and expanding access to services they already use—
namely, comprehensive reproductive health services. Unlike HIV-specific clinics and
education programs, which are too often stigmatized, reproductive health services have
community support and a head start of several decades.
Donors, national governments, and the United Nations must provide substantially
more resources to reproductive health, both to reach more girls and women, and to add
HIV/AIDS-prevention capabilities to reproductive health services. If we invest wisely,
we will at the same time fundamentally strengthen weak public-health systems.
Reproductive health service providers need updated counseling skills and information
materials so that they can talk with all patients about, not only HIV/AIDS, but also other
STDs, and issues such as combating sexual coercion and violence, and negotiating
condom use.
Investments in health and sexuality education must go hand in hand with investments
in health services. The only way we can protect today’s two billion young people—
and enable them to protect themselves—is to shape and implement programs that
provide factual information and social support. These programs must also train and
educate youth to establish equality within relationships, to end violence and sexual
coercion, and to respect the right to consent in sex and marriage.
These investments will build social and political acceptance for long-lasting change.
They will also bring an end to the underlying engines of the HIV epidemic—sexual
8 violence, child marriage, skewed power in relationships, and the exclusion of young
The Beijing agreement and the feminization of HIV 123
1111 people and the unmarried from services—which drive unwanted pregnancy, maternal
2 mortality, and wider injustice.
3 Inexcusably, the United States and the donor community at large, as well as national
4 governments, continue to duck their Beijing commitments and hedge on key HIV/AIDS-
5 prevention strategies, including sexual and reproductive services, protection of sexual
6 and reproductive rights, and comprehensive sexuality education.
7 In terms of US foreign policy, President Bush’s $15 billion Emergency Plan for
8 AIDS Relief (PEPFAR) offers a critical opportunity to reverse this trend and to gain
9 control of the HIV/AIDS pandemic. High priority for implementation should be

10 given to the PEPFAR provisions authored by US Representative Joseph Crowley. The
1 Crowley amendment advances programs to encourage men to be responsible for their
2 sexual behavior; to end sexual violence and coercion, including various practices that
311 force girls and women into dangerous sexual relations (for example, girls’ marriages
4 to older men who have had sex with others, or widow inheritance, in which the widow
5 is forced to marry or have sex with her deceased husband’s brother); and to increase
6 women’s economic opportunity. Equally critical to PEPFAR’s success will be the
7 abandonment of the dangerous and ideology-driven requirement that one-third of its
8 prevention funds go to abstinence-only programs.
9 When HIV/AIDS rates start to fall in every region of the world, we will know that
20 the world’s governments have made good on the promises of Beijing. As it did in 1995,
1 the US government should lead the way.
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
9
40
1
2
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4
5
6
7
118
11
32 The rise of the abstinence-only-
until-marriage movement
Martha Kempner
1 In 1992 the Sexuality Information and Education Council of the United States
(SIECUS) began the Community Advocacy Project in an effort to help communities
respond to an increase in controversies surrounding sexuality education. The goals of
the project were twofold; first, to provide technical assistance to these communities and
second, to track controversies around the country in order to gain perspective on trends.
Clearly the most dramatic trend that we have seen is the rise of abstinence-only-until-
marriage programs.
When SIECUS began the Community Advocacy Project, the federal government
spent very little money each year on these experimental programs. A few homegrown
organizations distributed fear- and shame-based curricula, a handful of communities
across the country had adopted such programs, and chastity rallies were still the
exclusive province of faith-based communities.
Today, the federal government spends over $150 million dollars each year on these
programs, abstinence-only-until-marriage organizations represent a multimillion-dollar
business worldwide, and students in numerous communities are exposed to fear- and
shame-based curricula, abstinence-only assemblies and presentations, and chastity
rallies on school grounds.
The need for sexuality education

Programs that receive any of these federal monies must follow a strict eight-point
definition that among other things, teaches youth that “sexuality activity outside of the
context of marriage is likely to have harmful psychological and physical effects.” The
definition also describes “abstinence from sexual activity outside marriage as the
expected standard for all school age children.”
While many adults may wish this were true, it is simply not the case. According to
the CDC’s (Centers for Disease Control and Prevention) Youth Risk Behavior survey,
by senior year, more than 60 percent of high school students report having had sexual
intercourse. Even if teens do not engage in sexual intercourse, they may be participating
in other sexual behaviors that put them at risk for sexually transmitted disease, including
HIV. An analysis of data by the Guttmacher Institute found that among young men aged
fifteen to nineteen who had never had vaginal intercourse, 67 percent reported that they
had touched a woman’s breasts, 22 percent had been stimulated to the point of orgasm
by a partner, 18 percent had received oral sex, and 14 percent had given oral sex.
Whether we agree with their behavior or not, we cannot ignore that at some point
8 during their teen years a clear majority of our young people will engage in sexual
The rise of the abstinence-only-until-marriage movement 125
1111 behaviors. The federal criteria for abstinence-only-until-marriage programs, which
2 prohibit discussion of pregnancy and disease prevention methods other than abstinence,
3 fail to meet the needs of this majority.
4 Instead, these young people need comprehensive and age-appropriate, school-based
5 sexuality education in every grade. Such programs provide young people with the
6 information and skills they need to make responsible decisions. Studies (www.teen
7 pregnancy.org/resources/data/pdf/emeranswsum.pdf) show that comprehensive edu-
8 cation about sexuality—programs that include messages about abstinence as well as
9 pregnancy and disease prevention—can help teens delay sexual activity, reduce the
10 number of partners, and increase contraceptive use.
1 When surveyed, the majority of adults agree that young people should receive broad-
2 based sexuality education. A 1999 poll by SIECUS and Advocates for Youth (www.
311 siecus.org/siecusreport/volume27/27–6.pdf) found that 93 percent of Americans sup-
4 port sexuality education and believe that young people “should be given information
5 to protect themselves from unplanned pregnancies and STDs.”
6
7
The funding streams
8
9 Nonetheless, the federal government currently has three separate funding streams for
20 abstinence-only-until-marriage programs. The first and oldest funding stream, the
1 Adolescent Family Life Act (AFLA), was established in 1981 to prevent teen pregnancy
2 by promoting chastity and self-discipline. Although AFLA was established before the
3 federal definition of abstinence education was written, currently programs that receive
4 AFLA funds must comply with the eight-points. Since it was established, the federal
5 government has spent over $100 million on chastity programs under AFLA.
6 In 1996, the second funding stream was established as part of the Temporary
7 Assistance to Needy Families Act, better known as “welfare reform.” The federal
8 government attached a provision to this law that established an entitlement program
9 for abstinence-only-until-marriage initiatives. This new program, Section 510(b) of
30 Title V of the Social Security Act (referred to as Title V), funnels $50 million per year
1 to states. Those states that choose to accept Title V funds are required to match every
2 four federal dollars with three state-raised dollars and then disperse the funds for
3 abstinence-only-until-marriage activities in school and community-based organizations.
4 In 2006 the federal government issued new guidance that required Title V programs
5 to adhere to all eight points of the definition of “abstinence education.” By focusing
6 entirely on the less ideological components of the definition which speak to the role of
7 drugs and alcohol in sexual behavior and the importance of self-sufficiency, it was
8 possible for a grantee to use Title V funds for positive youth development programs.
9 The new rules mean that all grantees must espouse the federal government’s views on
40 premarital sexual behavior or risk losing the funding. The new guidance also suggested
1 that states focus their Title V programs on young people aged 12–29.
2 In 2001 the federal government created a third funding stream—the Community-
3 Based Abstinence Education (CBAE) program. The CBAE program is widely thought
4 of as the strictest, in part because grants are made directly from the federal government
5 to state and local organizations.
6 Many view these stricter standards and the state bypass as an attempt by conservative
7 lawmakers to gain greater control over the programs and messages youth receive.
118 Certain lawmakers have sought to prevent money from supporting media campaigns,
126 Martha Kempner
11 youth development, and after-school programs—asserting that such programs dilute the
abstinence message.
In 2006 CBAE programs became even stricter and more ideological when the federal
government issued a new funding announcement. In it, sexual abstinence before
marriage is credited with leading to a happier life, including having a healthier marriage,
having more money, having healthier future children, being more “responsible” parents,
being honorable and having integrity, attaining a better education, having fewer
psychological disorders, avoiding drug, alcohol, and tobacco use, committing fewer
crimes and staying out of prison, and having a longer life span. To live up to these
proclamations which have no basis in sound evidence and very little grasp on reality,
programs are encouraged to rely on fear, shame, and the promotion of biases.
In fiscal year 2006 funding for the CBAE program was $150 million, a 425 percent
1 increase from its original $20 million in 2001. These three specific funding streams,
however, do not represent the total amount of money spent on abstinence-only-until-
marriage programs. Additional funding for these programs has been allocated through
a variety of federal funding vehicles, including special earmarks and traditional HIV/
AIDS and STD prevention accounts such as those administered by the CDC.
Why should we be concerned?

Advocates for comprehensive sexuality education have many reasons to be concerned
about the federal government’s large-scale investment in abstinence-only-until-
marriage initiatives. Some federally funded programs rely on messages of fear and
shame; deny young people lifesaving knowledge about pregnancy and disease preven-
tion methods; present inaccurate, biased, and exaggerated information as fact; and
teach specific religious beliefs.
Abstinence-only-until-marriage programs claim their goal is the prevention of
unintended pregnancy and sexually transmitted diseases (STDs) among teens. And
yet, they consistently ignore the needs of those young people who are most at risk
including gay and lesbian youth, victims of sexual abuse, pregnant and parenting teens,
and teens who are already sexually active.
More importantly, however, no evidence exists that abstinence-only-until-marriage
programs will help teens avoid or even delay sexual activity. In fact, recent research sug-
gests that some of these programs, virginity pledges in particular, may prove harmful.
Teens who take virginity pledges rarely postpone sexual intercourse until marriage and
are less likely to use condoms and contraception when they do become sexually active.
Abstinence-only programs in practice

Despite these problems, the federal investment in abstinence-only-until-marriage
programs has made this approach very appealing to schools and communities for two
simple reasons. First, the federal funding appears, to many, to be a stamp of approval
for this type of education. Second, in this time of fiscal crisis, schools are very willing,
even eager, to take on fully funded programs.
Abstinence-only-until-marriage programs vary widely; some states and communities
sponsor media campaigns, while others fund traditional classroom lectures, one-time
assemblies or plays, after-school clubs, and chastity rallies. It is important that parents,
educators, policymakers, and advocates pay close attention to the messages these
8 programs impart to students.
1111 The speaking circuit
2
As early as 1994, SIECUS noted the emergence of a national circuit of abstinence-only-
3
until-marriage speakers, including Pam Stenzel, Molly Kelly, Mike Long, and Marilyn
4
Morris. These speakers address auditoriums full of middle and high school students
5
across the country. During the 1999–2000 school year Pam Stenzel presented “The
6
Price Tag of Sex” to students in Sarasota, Florida; Cary, Illinois; Geneva, Illinois; Butler
7
Township, Ohio; Rochester, Minnesota; Paulsborough, Washington; and other com-
8
munities nationwide. She told students in Whittier, California:
9
10 I did not come here today to make decisions for you. I don’t have time . . . I came
1 here to tell you that if you have sex outside of a monogamous—and by monog-
2 amous I don’t mean one at a time—relationship you will pay the price.
311
4 In Russellville, Arkansas, Marilyn Morris, president of Aim for Success, an abstinence-
5 only program, discussed the “freedom” that comes with sexual abstinence. She and
6 other Aim for Success speakers explained to students “your dog can have sex. It takes
7 a strong person with self-control, self-discipline, and self-respect to say no.”
8
9
20 Chastity rallies
1 Events in which young people pledge to remain abstinent until marriage were originally
2 organized exclusively by faith communities. In recent years, however, schools and
3 other secular organizations have begun to sponsor such rallies.
4 In 1998, 8,000 students attended a chastity rally in Chicago, Illinois held during the
5 school day and sponsored by Project Reality, an abstinence-only-until-marriage
6 organization. Students carried signs with slogans such as “Save Sex” and “Teen Sex
7 Leads to Death.” True Love Waits (TLW), another national organization, run by
8 LifeWay Christian Resources, which is owned and operated by the Southern Baptist
9 Convention, sponsors rallies all over the country and around the world. In 1998 then-
30 Governor George W. Bush attended a TLW rally on the steps of the Texas Capitol and
1 commended the young people in attendance for their leadership. In 2000 more than 600
2 people attended a weekend TLW rally at Schuyler Central High School in Nebraska.
3 Kate Shindle, Miss America 1997, spoke to the crowd and outlined four steps that
4 young people (“especially girls”) need to follow to remain abstinent until Biblical
5 marriage.
6
7
8 Statewide campaigns
9 Religious messages are not uncommon in abstinence-only-until-marriage programs.
40 The Louisiana’s Governor’s Program on Abstinence (GPA), for example, funds a
1 theater group called Just Say Whoa. In its skits a character named “Bible Guy” explains,
2 “As Christians, our bodies belong to the Lord and not to us. God wants more for you
3 than a one-night stand. We belong to Him and He has plans for us beyond Saturday
4 night.” The successfully brought suit against the GPA, charging that the program used
5 federal funds to promote specific religious messages.
6 A statewide media campaign in Las Vegas became controversial, not for religious
7 messages, but for messages of fear and shame. One radio ad (www.rgj.com/news/
118 stories/html/2003/08/13/49266.php) feature a girl talking about her boyfriend who
128 Martha Kempner
11 wants to have sex. She says condoms won’t protect her from all diseases and virgins
are less likely to commit suicide than sexually active teens. The speaker then explains
that many of her friends lost their boyfriends after having sex and ended up “feeling
dirty and cheap.”
Opponents have called the shots

Proponents of a strict abstinence-only-until-marriage approach have had a great deal
of success. There has been a dramatic rise in the amount of money that both federal
and state governments spend on abstinence-only-until-marriage programs; admin-
istrations have been committed to funding them; and communities have welcomed
abstinence-only speakers, fear-based curricula, and chastity rallies into their school with
1 hardly a second thought.
These successes are not based on luck, nor do they indicate that proponents of this
approach have tapped into the will of the general public. When surveyed (http://www.
siecus.org/pubs/fact/fact0017.html), the majority of parents, educators, and voters
repeatedly say they want a more comprehensive approach to sexuality education.
Opponents have been very successful because they have been calling the shots and
framing the debate. From the outset, conservative far-right organizations targeted
sexuality education as an arena in which they could successfully affect social change.
Whereas they initially called for sexuality education to be removed from school on the
grounds that only parents should teach young people about sex, they gradually began
to shift strategies. Chastity education was born in the early 1980s and opponents of
comprehensive sexuality education saw this as a way to change what young people
learn. Instead of arguing for the removal of sexuality education, they began to argue
for a new message—young people should abstain until marriage. This was easier for
many communities to accept.
The success of the abstinence-only-until-marriage movement is owed in large part
to the ability of its proponents to change their tactics and try new messages. Over the
years they have responded to many of the criticisms against them. Early versions of
fear-based abstinence-only-until-marriage curricula were clearly religious in nature
and made outrageous and dangerous suggestions, such as washing one’s genitals with
Lysol after sexual activity. In today’s programs overt religious statements have been
replaced with subtle references to spirituality and morality, and blatantly false informa-
tion has been replaced with mild exaggerations based on legitimate sources.
Today, the message of abstinence-only advocates is savvy and unified. School
boards and lawmakers across the country are presented with the same requests and hear
the same arguments: “comprehensive sexuality education encourages promiscuity”;
“condoms don’t work”; “responsible adults know that teens should be abstinent”; “the
only morally acceptable approach is to tell teens to remain abstinent until they marry.”
These unified messages are reinforced and publicized on the national level by powerful,
far-right organizations, such as Concerned Women for America and Focus on the
Family.
Turning back the tides

There is some good news, however. In recent years, many communities have rejected
8 abstinence-only-until-marriage education. States have begun to institute regulations
1111 assuring that all sexuality education is medically accurate, and advocates on the state
2 and federal level have introduced legislation that supports comprehensive sexuality
3 education.
4 Students in Lubbock, Texas, for example, have received national attention for their
5 efforts to replace the abstinence-only-until-marriage program in their school with com-
6 prehensive sexuality education. These dedicated teens have pointed to the alarmingly
7 high rates of STDs and teen pregnancy among their peers and argued that the current
8 abstinence-only approach is clearly not working. Similarly, a parent in Mt Diablo,
9 California worked to remove Crybabies, an abstinence-only-until-marriage program

10 sponsored by a local crisis pregnancy center, from her son’s school. She became
1 involved in this issue after reading disturbing and highly biased information about
2 abortion in her son’s notebook and learning that this “sexuality education” program
311 contained no information on contraception or sexual orientation.
4 Advocates for comprehensive sexuality education have made progress on the state
5 and federal levels as well. A number of states including California, Maine, and New
6 Jersey have rejected Title V funding saying that it is too restrictive and not the best way
7 to educate their young people. Legislators in Illinois, New York, and Minnesota among
8 other states have sought to improve sexuality education by introducing legislation that
9 would require medical accuracy, mandate comprehensive sexuality education, and/or
20 fund such programs. In addition, a number of federal bills working their way through
1 the United States Congress, including the Responsible Education About Life (REAL)
2 Act, the Guarantee of Medical Accuracy Act, and the Prevention First Package have
3 the potential to positively impact what young people learn in sexuality education
4 classrooms.
5
6
Moving forward
7
8 Unfortunately, by funding unproven abstinence-only-until-marriage programs, the
9 federal government is promoting a conservative ideological agenda at the expense of
30 a sound national public health policy, the health and well-being of our nation’s youth,
1 and the will of the American people.
2 In order to turn back this tide and ensure that more students receive high quality
3 sexuality education, advocates will have to remain vigilant, create unified messages,
4 and take proactive steps to support comprehensive sexuality education in states and
5 communities.
6
7
8
9
40
1
2
3
4
5
6
7
118
11
33 Beyond immigrant brothels
The criminal justice system and
trafficked persons
Juhu Thukral
1 At the age of seventeen, Cathy* came to the United States from Thailand, expecting to
work off a debt. As soon as she arrived, though, her traffickers demanded the money.
If they weren’t paid, they said, she would have to go into prostitution.
Cathy was able to escape on her own and eventually found a job in a restaurant, but
she was stressed about the money that she owed. Threatened by her traffickers, her
family in Thailand had gone into hiding.
When I met with Cathy, I told her she might be eligible for assistance as a victim of
trafficking given that she had been held against her will, had experienced threats against
her family, and had been threatened with forced prostitution. Unfortunately, in order for
adults to access benefits and assistance under the anti-trafficking law, they must be
willing to cooperate with law enforcement in the investigation or prosecution of their
traffickers. I explained to Cathy that I thought she should explore that option, but she
refused. She did not see how going to the authorities would help her pay off her debt
and she did not think that trying to get legal work was worth it since she already had a
job. She also distrusted law enforcement.
At her job at the restaurant, Cathy was also in an exploitative situation but not in a
trafficking or forced-labor environment. She worked close to eighty hours per week
and received no overtime pay. When I explained that her employer was violating the
law and owed her a great deal of money, she explained that she felt safe at this job and,
therefore, did not want to take any action.
Cathy moved through many different categories of undocumented migrant worker.
She came into the United States as a person who was smuggled; then, she was a
trafficked person because she was held against her will and was threatened with forced
prostitution; and finally, she became a worker whose labor is exploited but who is not
afraid that her employers will harm her.
Government raids on brothels

Trafficking in persons is clearly a severe human rights violation often involving violence
and coercion, which demands a response from the US government. In fact, the Bush
administration has in recent years made trafficking in persons their signature human
rights issue. Unfortunately, the administration focuses on only one industry: the sex
industry. Their official position is that all forms of prostitution and a demand for sex
work are the driving forces behind this international problem. The focus on sex work
8 * Name changed to protect privacy.

The criminal justice system and trafficked persons 131
1111 also justifies the government’s preferred method of addressing trafficking in persons,
2 which is to prosecute traffickers, rather than to examine the economic and immigration
3 policies that are root causes for human trafficking. People migrate to the United States
4 because they cannot make enough money to support themselves and their families in
5 their home countries, and increased border security means that people will take more
6 chances in dangerous situations in order to enter the United States.
7 While forced prostitution is obviously a severe human rights violation, it is not the
8 only form of labor into which migrants are trafficked. The attention and allocation of
9 resources to the problem are important in fighting coercive situations for migrant
10 workers, but the anti-prostitution agenda behind it is dangerous for a number of reasons.
1 The focus on prosecution intimidates many trafficked persons from coming forward to
2 seek assistance, and the increased interest in raiding brothels where migrant prostitutes
311 work often leads to negative consequences for migrant sex workers and worsens
4 relationships between immigrant communities and the government.
5 The focus on prostitution to the exclusion of other industries where trafficking exists,
6 such as agriculture, domestic work, and construction, means that law enforcement has
7 prioritized raiding brothels where migrant sex workers are, in the hopes of rescuing
8 them from this work. While this seems to be a good idea, it is actually more complex
9 than it appears and can have negative consequences for the trafficked persons and for
20 migrant sex workers.
1 There are two ways that trafficked persons can come forward: via a raid, where they
2 are discovered by law enforcement; or by escaping on their own and learning about their
3 rights either from a community-based organization or through outreach and education
4 in an immigrant community. Outreach and education into immigrant communities is
5 a critical piece of any anti-trafficking plan. It is a natural form of information sharing
6 within a community, and encourages people to know their rights and gives them tools
7 to assert these rights. Because the trafficked person engages with law enforcement on
8 his or her own terms in these situations, he or she is also much more likely to want to
9 cooperate with law enforcement. Many sex workers who have escaped from trafficking
30 situations and have cooperated with law enforcement were helped in their escape by
1 other brothel workers who knew that the coercive situation was wrong and wanted
2 to help them leave those conditions.
3 Raids, on the other hand, often leave migrant sex workers in immigration detention
4 or jail for months while law enforcement determines who is and is not a victim. While
5 the trafficked persons may be happy to be out of the coercive situation, they are often
6 distressed with the experience of having been arrested and kept in detention, and of not
being able to work and support their families. Often they are not able to contact their
7
families to let them know where they are. Or they may feel uncomfortable with their
8
families learning that they have been engaging in sex work. These types of raids also
9
create more fear and distrust in immigrant communities, making people less likely to
40
volunteer information or assist people whom they know to be trafficked.
1
It is critical that as a society, we create safe and confidential places to house people
2
who may have been trafficked, to connect them immediately with attorneys and
3
counselors so that they know what their rights and options are, and to provide them
4
with the opportunity to work and make contact with their families. Furthermore, while
5 of course there are always times when we need criminal justice involvement in
6 trafficking cases, it should not do so at the expense of the welfare of migrant workers.
7 The government’s view that sex work is the driving factor behind trafficking in persons
118 justifies such over-reliance on a criminal justice model.
11
34 Marriage equality
The evolution of a traditional
institution
Robert M. Kertzner
1 “How the world can change. It can change like that. Due to one little word: married.”
The words of lyricist Fred Ebb in the musical Cabaret have an unintended resonance
for same-sex marriage today. An issue brewing for more than a decade, marriage
equality became a major flashpoint in 2004 and the recent US elections. This one little
word, marriage, does indeed raise the specter of major changes—in traditional defini-
tions of marriage, in sexual minority rights, and in the lives of present and future
generations of Americans for whom marriage may now be possible.
Although marriage equality as a national issue caught many by surprise, it shouldn’t
have. Changes in the institution of marriage and in lesbian and gay lives point toward
an inevitable union of “same sex” and “marriage” in one phrase.
Trends in marital and lesbian and gay lives

Marriage in Western culture has undergone significant change over the last half of the
twentieth century. Increased rates of divorce, larger numbers of cohabiting couples,
and more frequent parenting outside of marriage all suggest shifts in the role of marriage
in family life. Meanwhile, with longer life expectancies in the West, more adults are
finding themselves single, divorced, or widowed. In addition, married adults are living
longer in their post-reproductive years, making non-procreative sex an increasingly
important chapter of their lives.
All told, marriage, sexuality, and procreation have become increasingly separate in
the West.
At the same time, many lesbians and gay men have embraced family life in the forms
of long-term relationships and parenthood. To protect and honor commitments to loved
ones, lesbian and gay partners and parents have become increasingly interested in
marriage as an institution that supports families and the reverence and mutuality of
vows.
In Massachusetts the court recognized the importance of including lesbians and gay
men in this institution. In November 2003 the Massachusetts Supreme Judicial Court
ruled that the state can not deny the protections, benefits, and obligations of marriage
to same-sex couples. The court stated that the Massachusetts Constitution “forbids the
creation of second-class citizens” and that the Commonwealth of Massachusetts “failed
to identify any constitutionally adequate reason for denying civil marriage to same-sex
couples.”
8
Marriage equality 133
1111 The issue as social policy
2
3 Marriage equality elicits very different views about how the world can—and should—
4 change. And it raises the question: Upon what basis (law, religion, social science, or
5 social justice) should policy be formed?
6 From the perspective of the social and sexual sciences, research supports the premise
7 of marriage between same-sex couples. Studies have established that many lesbians and
8 gay men create stable, long-term relationships; that predictors of successful relationships
do not differ by sexual orientation; that sexual orientation and same-sex relationships do
9
10 not affect parental fitness; and that children of lesbian and gay parents have the same
1 psychological health as children raised by heterosexual parents. Many of these find-
2 ings are summarized in a policy statement of the American Psychological Association
311 supporting marriage equality (http://www.apa.org/pi/lgbc/policy/marriage.pdf).
4 We also know that self-acceptance and integration of sexual identity into other aspects
5 of personal identity are tied to psychological well-being. For many lesbians and gay
6 men, marriage is a joyous affirmation of deeply held aspirations for love and intimacy
7 and a welcomed placement of sexual identity in the larger context of family and public
8 life. These observations, of course, are true for heterosexuals as well.
9 Studies of marriage also suggest that the public- and state-sanctioned aspects of
20 marriage confer important economic and psychological benefits to spouses and children.
1 Indeed, the whole of marriage is greater than the sum of its parts. Even if you could
2 afford the time and expense to create a master contract that replicates innumerable
3 federal and state benefits, survivorship safeguards, and proxy designations for healthcare
4 and financial decisions, it’s not the same as being married, which automatically includes
5 these protections and is recognized across state and national boundaries.
6 Social conservatives cite several overlapping arguments that emphasize what is not
7 known or what is beyond the province of research. These include the fears of potentially
8 negative effects of legalizing marriage between same-sex couples on norms of moral
9 conduct and on children’s well-being. Conservatives also argue that abandoning the one
30 man-one woman criterion for marriage opens a Pandora’s Box of moral hazards. After
1 same-sex marriage what would come next, they ask. The legalization of polygamist or
2 incestuous unions?
3
Some religious opponents say that allowing lesbians and gay men to marry provides
4
a disincentive for them to change their orientation, a view based on the belief that
5
homosexuality is a sin or disease. Other more moderate opponents argue that sanctioning
6
marriage between same-sex couples is unnecessary: lesbians and gay men can achieve
7
8 many legal safeguards inherent in marriage on a contractual basis as permitted by law.
9
40 What the future holds
1
2 The current legal and political landscape of marriage equality is very much in flux.
3 Recent enactments of state constitutional amendments codify marriage as an exclus-
4 ively heterosexual institution, while more than twenty lawsuits seeking marriage
5 rights are being argued or appealed in eleven states. Recent legislation and some
6 state constitutional amendments ban domestic partnerships, civil unions, or, as in
7 the case of Virginia, contracts between two individuals of the same sex that suggest
118
134 Robert M. Kertzner
11 the privileges of marriage. On the other hand, recent court decisions in New York City
and San Francisco assert that individuals have a right to marry a person of one’s choice,
that no rationale reason exists for limiting marriage to opposite-sex partners, and
that anything short of marriage is a “separate but equal” status that perpetuates dis-
crimination.
Amidst these developments, a majority of Americans favor some form of legal
recognition for same-sex couples. According to a New York Times/CBS poll, 23 percent
of Americans support same-sex marriage and 34 percent some form of civil union.
Of course, that little word marriage continues to make a big difference. Like so many
other aspects of human sexuality, marriage is a touchstone for often highly divergent
views about what is sacred and secular, personal and communal, pleasurable and
purposeful. Some have noted with irony that maritally inclined lesbians and gay men
1 are endorsing more conservative views of sexuality by seeking inclusion in a traditional
institution that stipulates the context for love and intimacy.
Perhaps the biggest unknown posed by marriage equality is the potential to discover
that married lesbians and gay men share many similarities with married heterosexuals.
Regardless of sexual orientation, many adults see in marriage an opportunity to affirm
their love and to support their efforts to raise children, participate in the lives of
extended families, and contribute to civic and community life.
Like heterosexuals, a large majority of lesbians and gay men want to get married at
some point in their lives (as reported by a recent Kaiser Foundation Family study).
Many would agree with Evan Wolfson, executive director of Freedom to Marry, who
wrote: “Bottom line: there’s nothing more human than our relationships with one
another and our families.”
8
1111
2 35 Sexual prejudice
3
4 The erasure of bisexuals in
5
6
academia and the media
7
8 Loraine Hutchins
9
10
1
2
311 The scapegoating of bi men
4
Men who call themselves bisexual are liars. At least that’s what the New York Times
5
6 science section said in “Straight, Gay or Lying: Bisexuality Revisited” (July 5, 2005).
7 We often hear this kind of prejudice and misinformation in popular media, even in
8 the gay and lesbian press. But how did a distinguished daily come to such a conclusion?
9 How did the “national newspaper of record” decide that men who are attracted to more
20 than one gender are really inventing their interest in women and repressing a “true”
1 homosexual identity?
2 The following is an account of what the research underlying this article is really about,
3 and what kind of impact it has had on millions of bisexual people and those who love
4 them. It’s a story I know a lot about. I debated reparative therapist Joseph Nicolosi on
5 CNN in 1993. For over twenty years I have worked to educate people about biphobia
6 and how it’s interwoven with homophobia, heterosexism, and gynophobia in our
7 society. Still, I was taken by surprise by the Times story. Times reporter Benedict Carey’s
8 article was based on his reading of “Sexual Arousal Patterns of Bisexual Men” by Gerulf
9 Rieger, Meredith L. Chivers, and J. Michael Bailey, which appears in Psychological
30 Science (August 2005, 16 [8]), the journal of the American Psychological Society.
1 Bailey, the senior author of the article, was until recently chair of the psychology
2 department at Northwestern University. He lost that position last year but still serves
3 as a professor there. The article questions the veracity of bi men’s self-definition, and
4 thus, the very legitimacy of bisexuality as an orientation, at least for men. (Women, the
5 authors say, are not as easily quantified. They’ve done other research showing all women
6 are essentially bisexual, but that’s another story.)
7 What they stuck on the men—a group of about a hundred who were pretty evenly
8 divided into those who self-labeled as homo, hetero and bi—was a penis meter that
9 measures genital blood flow or level of erection (technically called a plethysmograph).
40 No subject was offered film footage representing penile–vaginal intercourse because,
1 as the researchers later explained, they were afraid that kind of footage would be too
2 confusing to evaluate, since they wouldn’t be able to tell whether the men’s penises were
3 responding to the female or the male or both. Each subject was, therefore, shown several
4 two minute male/male porn films and also several two minute clips of female/female
5 porn. The researchers threw out 35 percent of their sample as “non-responders” (guys
6 of all orientations for whom the lab/wiring/porn thing didn’t work to get them aroused).
7 Since out of that remaining group the men who self-identified as bi had penises that, for
118 the most part, didn’t get hard during the female/female clip(s), the researchers concluded
136 Loraine Hutchins
11 that the bi men were only masquerading as such and were homosexuals who hadn’t
faced their gayness yet.
Casting doubt
Further, they opined that since arousal in men equals orientation, bi men don’t exist.
The study might have been just another academic paper that never makes it out of
obscure sex research journals and sex research conference presentations, but the
researchers provided the Times with an advance copy of it. Reporter Carey wrote, “a
new study casts doubt on whether true bisexuality exists, at least in men.” By saying
that the study “casts doubt on” the existence of bisexuality, the Times moved away from
objective reporting and toward taking a position on its validity. (This would not have
1 been an issue had the article simply read, “A new study questions whether true
bisexuality exists . . .”)
The Times effectively endorsed the researchers’ opinion, giving the research much
more credibility than it would have otherwise had. The story made its way into other
news media outlets and was reprinted and commented on around the world. The
researchers also were strategic, or perhaps just lucky, to get the story into the Times the
same week a major sex research conference was occurring in Ottawa, The International
Academy of Sex Research (IASR), thus assuring even more publicity for their
assertions.
When the Gay and Lesbian Alliance Against Defamation (GLAAD) challenged the
Times about its inflammatory headline, their response was that “straight, gay or lying”
is a well known idiomatic comment gays make about bisexuals, and therefore was
appropriate. Thinking this line of reasoning could sanction a lot more inaccuracies and
hate speech, GLAAD requested that the Times at least change this article’s headline
on their Web site. They refused to do so. GLAAD issued a statement and mounted
an online campaign to help mobilize people’s response.
The organized response

Within twenty-four hours of the article’s release an ad hoc coalition of LGBT activists
and academics came together, under the leadership of the National Gay and Lesbian
Task Force, to coordinate a national response. The Task Force prepared, and posted on
its Web site, critiquing the study the article was based upon. More importantly, they
enlisted BiNet USA: The National Bisexual Network, the Bisexual Resource Center of
Boston, and GLAAD in a series of nationwide conference calls that helped strategize a
way to hold the Times accountable for its hate speech and misinformation. At least one
group beyond the LGBT community—the progressive media watchdog group Fairness
and Accuracy In Reporting (FAIR)—also issued a statement protesting the Times’
handling of the research.
A week later, amidst a flurry of criticism, the Times published a small selection of the
many letters they had received on the article. The only published letter defending the
article was by conservative gay writer Chandler Burr, who contributes to the Times.
The story continued to grow legs well into the second and third weeks after its initial
release. While it remained one of the Times’ Web site most forwarded articles for more
than two weeks, the Philadelphia Inquirer and Los Angeles Times covered public
8 response to the story and asked additional questions about the research’s original
The erasure of bisexuals in academia and the media 137
1111 content. Increasing media response came from blogs of all sorts, bisexual listservs,
2 websites, LGBT magazines, and local newspapers around the English-speaking world—
3 with reprints and discussions from Belfast to Baltimore, Toronto to Atlanta, Sydney to
4 Seattle, and many points in between. Meanwhile, the ad hoc coalition moved ahead
5 with plans to arrange a meeting with the editor of the New York Times science section
6 to discuss the coverage of the research and their future coverage of bisexuality and other
7 sexual orientation/identity issues. A meeting did finally take place on July 27, 2005.
8 There, coalition representatives aired their concerns and suggestions, and the Times
9 promised to take these into consideration in future reporting.

10
1
The research flaws
2
311 The Task Force, with input from LGBT academics who had read advance copies of the
4 Bailey et al. study, developed a preliminary fact sheet. It points out that the Times fails
5 “to note several serious and obvious questions about the study’s methodology and
6 underlying premises” and also “misstates some of the study’s conclusions.” As the Task
7 Force writers said, the assertion by Bailey, Rieger, and Chivers that arousal, at least in
8 men, equals sexual orientation, is a ridiculous oversimplification of the complexity of
9 sexual desire. Rather, arousal is “a combination of cognitive and physical responses, not
20 reducible to genital responses to pornography.”
1 They also questioned the validity of the plethysmograph. The controversial device
2 was developed in Eastern Europe during the 1950s and brought to Canada and the
3 United States soon thereafter. It has been used to measure sexual response in relation
4 to screening-out alleged homosexuals from those seeking government service or
5 citizenship. The Task Force fact sheet further asked how seriously one could take any
6 study that had to throw out 35 percent of its respondents as non-responders (those men
7 who had no measurable erections while watching the films), and pointed out that the
8 researchers said that this study was part of a larger group of other such studies but that
9 it really was not.
30 In addition to the above methodological problems, the fact sheet noted “many serious
1 controversies that have plagued one of the study’s authors” (Bailey). The New York
2 Times didn’t mention that Bailey’s research reputation has been seriously questioned.
3 As the Task Force efforts continued, it became increasingly clear that the controversy
4 over his past writings and research methods was wide indeed.
5 Bailey made an unwelcome name for himself within the transgender community
6 several years ago, culminating in the 2003 publication of his book about trans women,
7 The Man Who Would Be Queen. When The Man Who Would Be Queen came out
8 Publishers Weekly said that:
9
40 Bailey’s scope is so broad that when he gets down to pivotal constructs, as in
1 detailing the data of scientific studies such as Richard Green’s about “feminine
2 boys” or Dean Hamer’s work on the so-called “gay gene,” the material is vague,
3 and not cohesive. Bailey tends towards overreaching, unsupported generalizations,
4 such as his claim that “regardless of marital laws there will always be fewer gay
5 men who are romantically attached” or that the African-American community is
6 “a relatively anti-gay ethnic minority.” Add to this the debatable supposition that
7 innate “masculine” and “feminine” traits, in the most general sense of the words,
118 decidedly exist, and his account as a whole loses force.
138 Loraine Hutchins
11 Since the book came out Northwestern University received many complaints from
transsexual women Bailey interviewed, who complained that they didn’t know he was
using them as research subjects, and that distorted versions of their case histories would
appear in his book. Northwestern opened a formal investigation into charges of research
misconduct against Bailey, as reported in a series of articles in the Daily Northwestern
and the Chronicle of Higher Education. In October 2004 Bailey resigned from his
chairmanship of the psychology department, following the completion of the
investigation and implementation of undisclosed sanctions against him by the university
(Chronicle of Higher Education, December 10, 2004).
Sexuality research: the larger picture

1 The Bailey, Rieger, Chiver research is part of a long line of studies that look for a genetic
link to sexual orientation, as developed most recently by Dean Hamer, Simon LeVay,
et al. In an interesting yet probably totally unintended coincidence, the national gay
news magazine The Advocate came out with a related cover story on July 5, 2005 the
same day the New York Times released “Straight, Gay or Lying.” The Advocate’s story,
“Scents and Sexuality,” by Lisa Neff, reports on new studies about sexual orientation
and smell. She then segues into a summary of genetics and sexual orientation studies
over the past hundred years. While the survey article is quite well done, it overlooks
bisexual, transgender, and intersex people and the increasing body of research developed
on them in the past twenty years. Why does this disconnect still exist? There’s no simple
answer. However, examining the origins of sexual orientation research does provide
some clues.
Psychologists look at sexual orientation in two essentially different ways: the
dichotomous approach (that which is not heterosexual is homosexual) and the more
multidimensional approach, which views orientation more as a spectrum than two
separate and distinct poles. Of course, the best known example of this spectrum view
is the Kinsey scale, which encompasses a range from exclusively heterosexual (0) to
exclusively homosexual (6), with most people falling somewhere in between.
According to bisexual psychologist and author Ron Fox, the field has been evolving
through a three stage reinterpretation of sexual orientation since the early 1970s when
therapists stopped seeing homosexuality as an illness. At the first stage it’s fine to be
lesbian or gay since homosexuality is no longer an illness, but sexual orientation itself
is still seen as dichotomous, either/or, same sex or different sex oriented, with nothing
in between. Most of psychology has now moved beyond that stage and sees dichotomous
sexual orientation as too simplistic. At this second stage bisexuality is recognized as a
legitimate orientation. This stage also reflects the point at which gay organizations
began adding bisexual to their names, as in LGB. When the multidimensionality of
sexual orientation is sufficiently explored it becomes clear that gender identity and
expression, as well, exist along a similar continuum rather than only at two poles. This
is the third stage, where, as a result of lesbian, gay, bisexual, and transgender psychol-
ogists working together with heterosexuals to develop a more complex understanding
of sexual orientation, the same complex understanding of gender becomes integrated
into how psychology and sexuality research is conducted and taught.
And this new, more nuanced understanding of both sexual orientation and gender as
spectrums isn’t only confined to the research field. Activists and educators must often
8 position their media advocacy and public sexuality education work in the gap between
The erasure of bisexuals in academia and the media 139
1111 the old dichotomous view of sexual orientation and the newer, more multidimensional
2 one. As they do this they hone classic bisexual skills, particularly the roles of bridge
3 builder and diplomat. It is their talent to move back and forth—translating between
4 groups and different sets of ideas, interpreting each to the other, and helping everyone
5 see we’re not so far apart as it seems—that helps them survive with their identities and
6 integrity intact. A positive outcome from the New York Times article is the coordinated
7 effort to critique Bailey et al.’s research.
8 This particular story of how we responded to one article elapsed over a mere month
9 in time. But the larger picture of how this experience relates to other queer stories with
10 unexplored bi angles remains to be told. We look forward to discussions on related
1 topics such as: the developing definition of bisexual orientation, the relationship between
2 transgender and bisexual identities, and ex-gay reparative/conversion therapy and its
311 connection to bisexuality. All of this and more came up in our brainstorming around how
4 to respond to the New York Times. It’s been a valuable learning experience, one that has
5 provided some sense of comfort and accomplishment to counterbalance the underlying
6 pain and human suffering for bisexuals and those who love us that the publication of
7 the Times’ “Straight, Gay or Lying” story initially exposed.
8
9
20
1
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
9
40
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118
11
36 Seeking help in rural
communities
Homophobia and racism impact
mental healthcare
Cathleen Willging, Lisa Cacari-Stone,

Louise Lamphere, Rae Lewis, and Bonnie Duran
1
Karen*, an Anglo woman from the urban West Coast, moved to a rural community in
New Mexico four years ago. Her partner, Mary*, an American Indian woman, was from
the area and had family there. Karen was an underpaid school teacher, while Mary
worked odd jobs. Terrified about losing her teaching position—the couple’s main source
of income—Karen let few people know that she was a lesbian. The transition from
urban to rural life was not easy for Karen, who became despondent and socially isolated.
While Mary did her best to help Karen adjust to the new surroundings, Karen remained
emotionally distressed and, occasionally, was suicidal.
Two years ago Karen decided to get professional help, settling on a mental health
provider available at no cost through the Employee Assistance Program at work. Karen
felt “violated” by this encounter, however. During her one and only session, the provider
unashamedly revealed that his clinical knowledge of homosexuality derived from an
abnormal psychology class that he took more than thirty years ago. He then went on to
disparage Karen for being a lesbian and to insinuate that her partner, Mary, must be an
alcoholic since she was American Indian. Furthermore, because Karen opted to be in
an interracial relationship with a woman and to live in a rural area, the provider opined
that it was simply “too much” to ask other people in the community “to swallow” her
“lifestyle choice.” Though she still felt depressed, Karen refused to see other local
providers in the years that followed.
Karen’s story is not unique. We conducted in-depth interviews with thirty-eight
lesbian, gay, bisexual, and transgender (LGBT) people in rural New Mexico about how
they tried to access professional services for their mental health problems. These
discussions were supplemented with in-depth interviews with twenty mental health
providers who both live and practice in rural communities. From these discussions, we
learned that fear, loneliness, and off-putting interactions within heteronormative
treatment settings were common themes in the help-seeking experiences of LGBT
people in rural areas. The cultural ideal of “self-reliance” (preference to solve emotional
problems on one’s own) and the view of mental illness as a “weakness” or personal
shortcoming were often strong in rural communities, discouraging LGBT people from

Seeking help in rural communities 141
1111 getting care. Leroy*, an American Indian gay man and lifelong rural resident, was
2 overcome with grief after losing his aunt, but it took him more than one year to break
3 free from this stigma and make an appointment with a mental health provider. The
4 provider, however, “laughed” in disbelief when Leroy said that he was gay, causing
5 them both discomfort during their session together.
6 Money, distance, and stigma make it hard for rural LGBT people, like Karen and
7 Leroy, to get LGBT-affirmative services. Social support networks, composed of family
8 and friends, and informal mental health resources, including those found in indigenous
9 healing systems, often serve as alternatives to professional mental healthcare. In lieu of

10 counseling, for example, Karen and Mary turned to American Indian traditional healers,
1 who offered prayers and advice that aided them in their everyday dealings with people
2 in the broader community. Mary’s own parents and members of her extended family
311 also provided unwavering support to both women. Similarly, at the urging of his
4 extended family, Leroy consulted with a traditional healer, whom he credited with
5 helping him grapple with his grief and depression, while affirming his personhood.
6
7
Our limited knowledge about LGBT mental health
8
9 The combination of prejudice and discrimination hampers both research and services
20 targeting the mental health of LGBT people. The federal government’s historical
1 disinterest in supporting studies concerning LGBT issues and more recent political
2 pressure have limited research regarding these traditionally underserved groups. Some
3 researchers also worry about being marginalized in scholarly communities if they center
4 their work on LGBT people. Additionally, the methodological challenges of undertaking
5 such research are quite considerable. These challenges include lack of personal
6 identification among potential participants with externally imposed social categories,
7 such as “lesbian,” “gay,” “bisexual,” and “transgender,” and the problem of recruiting
8 “hidden” populations to take part in studies on sensitive topics. These challenges
9 increase substantially in rural areas, where individual privacy and confidentiality are
30 highly valued and people are more likely to conceal their LGBT identities and mental
1 health problems in order to sidestep community gossip.
2 As a result of such challenges, we know little about the mental health needs of LGBT
3 people. However, findings published in 2001 from the National Comorbidity Survey—
4 one of the largest population-based epidemiological studies of mental illness undertaken
5 in the United States—clearly show that LGBT people are at increased risk for psychiatric
6 problems.
7 Anti-LGBT discrimination and violence can trigger mental distress and illness,
8 alcohol and drug abuse, and even suicide. Discrimination may affect the employment,
9 housing, and healthcare opportunities of LGBT people, making them especially
40 susceptible to adverse mental health outcomes. “Hate crimes,” which encompass threats
1 and acts of violence against LGBT people, occur in schools, homes, work, and public
2 spaces, and are carried out by family members as well as strangers. In the rural area
3 where Karen and Leroy live, “hate crimes” remain underreported or are simply ignored
4 by the legal authorities. The effect of discrimination and violence may be exacerbated
5 in rural areas, where mental healthcare and basic social services are often insufficient
6 for the general population and virtually nonexistent for LGBT people.
7 What we do know about LGBT mental health issues is based mostly on research
118 involving convenience samples of self-identified gay men and lesbians who are white,
142 Cathleen Willging, et al.
11 middle class, educated, and urban or suburban—rather than racial and ethnic minorities,
poor or working-class individuals, and people who reside in rural settings. Of 124
lesbian, gay, and bisexual specific articles published in American Psychological Associ-
ation journals over a ten-year period, only six pertained to people of color (Harper,
Jernewall, and Zea, 2004). The way we talk about “coming out” processes or LGBT
identity formation has been shaped by studies that privilege the experiences of the
dominant group. The available research underscores that discrimination associated
with sexual orientation and gender non-conformity can have a damaging effect on a
person’s mental health. This research, however, does not accurately reflect the
experiences of people of color for whom multiple layers of oppression based on race,
ethnicity, and socioeconomic status, in addition to gender and sexuality may take a
greater toll. The complicated ways in which these intersecting issues affect the mental
1 health of rural people of color is a topic that is woefully understudied.
Access problems and quality of care

Although lack of healthcare coverage pervades LGBT populations in this country, this
problem is even greater in rural areas, where local economies are in sharp decline and
rates of unemployment and uninsurance are escalating. The largely rural state of New
Mexico has one of the highest rates of poverty in the nation. Poverty increases one’s
risk for developing a mental health problem, while uninsurance makes it all that much
harder to get care. The costs of care are a likely deterrent for rural LGBT people in need
of professional mental health services.
As suggested in the Healthy People 2010 Companion Document for LGBT Health,
a supplement to the federal government’s blueprint for public health published by the
Gay and Lesbian Medical Association in 2001, rural LGBT people may experience
specific and unique stress related to disclosure. They may be afraid of having their
sexual orientation or gender identity revealed along with their mental health status.
They may also fear losing their job, as was Karen’s concern, or their house or apartment.
Furthermore, rural LGBT people may internalize homophobic (as well as racist) beliefs
and attitudes espoused by other people in their communities; this can also contribute to
self-devaluation.
Because of these substantial access barriers and everyday stressors, the decision to
seek out mental healthcare does not always come easily for rural LGBT people. For
example, Serena*, a transgender Hispanic woman, refused to get services from her
community’s local mental health clinic because the providers there “look at you or
make you feel like you’re dirty.”
LGBT clients may encounter negative reactions from mental health providers, from
overt forms of hostility and intolerance to subtle forms of bias. Underlying these
reactions is the historical role that the mental health professions have played in
reinforcing negative societal attitudes and beliefs about LGBT people. The psychiatric
profession played a dominant role in promoting the view of “homosexuality” as
a mental disease. The label sanctioned societal discrimination against LGBT people.
The American Psychiatric Association (APA) officially expunged “homosexuality”
from its list of diagnosable illnesses in the 1970s and in subsequent decades issued
professional practice codes that prohibit LGBT discrimination. (The diagnosis of
Gender Identity Disorder was not removed, however.) The APA even asserted that the
8 alignment of providers with lingering anti-LGBT societal attitudes and behaviors can
Seeking help in rural communities 143
1111 reinforce self-hatred already experienced by lesbian, gay, and bisexual clients, and
2 cause harm to them during treatment. Other professional associations, including the
3 American Psychological Association and the National Association of Social Workers,
4 followed suit with the adoption of similar position statements and practice codes.
5 Without enforcement, however, these codes are ineffectual in countering negative
6 therapeutic practices, including the practice of now debunked “reparative” or “con-
7 version” therapies to assimilate clients into heteronormative lifestyles.
8 Lack of accurate, contemporary knowledge about LGBT people and heterosexist bias
9 may lead some rural mental health providers to base their decisions about clinical
10 assessment and treatment based on outmoded models. One such model is the “deficits
1 paradigm,” in which “sick” people (LGBT individuals) must assimilate into “normal-
2 ity” (a heterosexual lifestyle) to achieve mental wellness. Most tellingly, Eric*, an
311 Anglo provider at a rural residential treatment center, explained how his colleagues
4 would sometimes let clients know that they did not think it was okay for them to be
5 LGBT: “If they would get over that, things would fall into place.”
6 Rural mental health and substance-abuse treatment facilities commonly lack LGBT
7 providers, despite growing evidence suggesting that LGBT clients are more apt to take
8 part in programs that address LGBT issues and less likely to comply with treatment
9 from homophobic providers. On the flip side, however, some rural providers are fearful
20 of gossip and disapproving judgment if their own LGBT status becomes publicly
1
known, an admission that can result in decreased client referrals and caseloads.
2
LGBT clients who do make use of available services may risk rejection from fellow
3
clients, particularly when they take part in treatment that relies on group therapies.
4
Elena*, an American Indian provider, reported that clients went “haywire” when a
5
woman mentioned that she was a lesbian during group therapy. Providers may also
6
7 discourage LGBT clients from broaching their sexuality and gender issues and do not
8 necessarily quell the negative reactions of non-LGBT clients when such issues are
9 raised. Their failure to address these reactions enables hostile attitudes to thrive, while
30 ultimately diminishing the effectiveness of group therapy.
1
2 It takes a community
3
4 Without access to LGBT-supportive mental healthcare and support organizations, some
5 rural LGBT individuals may experience heightened feelings of social isolation and
6 mental distress. Such is the case for Karen, who lost her LGBT friends and contacts
7 when she moved to a rural area. For those who grow up in such areas, lack of LGBT-
8 specific information and ties to other LGBT people can also hinder the development
9 of an affirmative sense of self.
40 Yet, unique protective mechanisms operate among LGBT populations in rural
1 settings. For example, social bonds and supportive relationships are considered to be
2 essential to the maintenance of positive mental health. In the LGBT population at
3 large, researchers have found that strong family connections, including a close
4 relationship with a parent or accepting relative, attachment to external support systems
5 (for example, church, school, community group), and well developed social networks
6 can all help prevent LGBT people from developing mental health problems. Likewise,
7 these connections can contribute to recovery. For example, in an effort to overcome
118 his addiction to methamphetamine, Lorenzo*, a Hispanic gay man, swore off his
144 Cathleen Willging, et al.
11 anonymity, moving from a metropolitan area with a large LGBT population to receive
emotional support from his family within the rural community where he was born and
raised.
Cultural factors influence experiences of mental distress and help-seeking among
rural LGBT populations. As noted previously, such factors shape ideas about “self-
reliance” and concerns about confidentiality that can inhibit rural residents from
accessing professional services. However, LGBT people can draw upon a broad range
of mental health resources that are available in rural communities, but which are not
typically associated with professional treatment systems and, moreover, are oftentimes
devalued or misunderstood by providers working within these systems. The use of
curanderismo and other cultural healing practices, for instance, is pervasive among
rural Hispanics in New Mexico. Traditional medicine and alternative therapies are
1 widely used among rural American Indians, including self-identified LGBT people—
some of whom assume culturally sanctioned roles as health practitioners within the
healing systems of their societies.
Religiosity and spiritually based healing practices among African American,
Hispanic, and American Indian populations are associated with enhanced health status,
and may play a constructive role promoting positive mental health for LGBT people
living in otherwise medically underserved rural environments. Understanding the
importance of such protective mechanisms is necessary terrain to be covered in future
LGBT mental health services research.
In order to understand the social dynamics of how at-risk groups of rural LGBT
people creatively and effectively address mental health problems, we must acknow-
ledge the critical functions of social support networks, nonprofessional healing systems,
and informal resources. At the same time, we must take stock of the experiences of
those rural LGBT people who do seek services within professional treatment systems.
Even though we did learn of clinical settings where services were rendered responsibly
and misconceptions about LGBT mental health issues were not condoned, the
experiences of rural residents, such as Karen and Leroy, attest to the fact that immediate
steps must be taken to ensure that all LGBT people can benefit from quality care.
Reference
Harper, G.W., N. Jernewall, and M.C. Zea. 2004. “Giving voice to emerging science and theory
for lesbian, gay, bisexual people of color.” Cultural Diversity and Ethnic Minority Psychology
10(3): 187–199.
Acknowledgment: This article was funded by grants from the National Institute of Mental Health (1R21
8 MH068628–01 and 1R03 MH65564). We thank Nancy Nelson for her helpful comments on an earlier draft.
1111
2 37 Disability and sexuality
3
4 From medical model to sexual
5
6
rights
7
8 Russell P. Shuttleworth
9
10
1
2
311 Everyone agrees sexuality is an important part of life. But when I told people that my
4 doctoral research focused on the sexual narratives of men with cerebral palsy, it was not
5 uncommon for non-disabled people to ask, “Can they do that?” The people who asked
6 this question were not unintelligent, but they had bought into the myth that disabled
7 people are asexual. Unfortunately, the Disability Rights Movement and academic
8 disability studies have been slow to politicize disability and sexuality. As Barbara
9 Waxman, a disabled feminist activist and scholar, charged in the pages of the Disability
20 Rag in 1991:
1
2 the disability rights movement has never addressed sexuality as a key political
3 issue, though many of us find sexuality to be the area of our greatest oppression.
4 We are more concerned with being loved and finding sexual fulfillment than in
5 getting on the bus.
6
7 There are a wide range of issues related to disability and sexuality that deserve social
8 and political attention, including sexual abuse, asexual and hypersexual media images
9 of disabled people, disability and gender issues, sexual identity and orientation,
30 interpersonal barriers and sexual intimacy, the use of sex workers and sexual surrogates,
1 facilitated sex, and barriers to sexual access for significantly disabled persons living
2 in institutions and group homes. Although activists and researchers have begun to
3 politicize these issues, disabled people continue to confront ignorance about their sexual
4 potential and face sexual oppression in their everyday lives. By considering the history
5 of the disability community’s politicization of these issues, we are able to develop
6 research and advocacy strategies that will effectively dispel the myth of disabled people
7 as asexual.
8 The disability and sexuality research of the 1950s through much of the 1970s was
9 generated in response to the loss of sexual function and/or sensation by heterosexual
40 men who were disabled in early to mid-adulthood because of a major physical trauma,
1 often a spinal cord injury. These men were sexually compromised in varying degrees
2 depending on the location of the injury. They came under intense scrutiny by research
3 scientists who investigated their loss of ejaculatory ability and/or physical sensation in
4 their genital area. Operating from a medical model—which emphasizes function over
5 other aspects of the person—these researchers’ initial concern was with disabled World
6 War II veterans. In retrospect, this obsession with sexual and reproductive function also
7 seems part of a larger cultural anxiety that views any lessening of penile potency as a
118 diminishment of masculinity. This same anxiety is likely related to the phenomenal
11 sales of the impotency drug Viagra among middle and older adult males. This early
research largely ignored women, and completely ignored racial and sexual minorities,
reflecting that white, heterosexual masculinity was prioritized.
In the past, medical experts have routinely sterilized people with developmental
disabilities—and as recently as the early 1970s, disabled people have reported unwanted
sterilization. A man whom I interviewed explained that at age twenty-five he underwent
a bladder operation but was not told by his physician that one of the outcomes would
be loss of ability to ejaculate outside of his body. Instead sperm would be deposited in
his bladder. As a young teenager this same man, after having undergone surgery on an
undescended testicle, reported that an attending nurse said, “Why did they bother?”
While blatant rights violations such as the first example are more infrequent today, the
eugenics policies of the past often take more subtle forms such as inherent biases against
1 impairment in genetic and abortion counseling of parents to be.
Because medicine has emphasized correcting deficiencies, it is questionable whether
adequate attention has been given to disabled people’s capacity for sexual pleasure and
reproduction. It is still not unusual for disabled people to report that during physical
exams they are not asked any questions about sexuality by their physicians, which is
not the case for most non-disabled people. Medical-model research that focuses
exclusively on sexual function goes hand in hand with the power and authority medicine
wields in disabled people’s everyday sexual lives.
Normative understandings of how the body is supposed to function underlie medical
diagnoses, treatments, and even rehabilitation and any deviations are targeted for
correction. In the case of disease, the medical model is appropriate in order for the
patient to “get better.” However, impairments are usually permanent and are better
understood as bodily variations rather than “deviations.” In my own research most of
the men I interviewed had reached maturity with poor body images. The majority had
a history of medical procedures, surgeries, and rehabilitation therapies, which were
aimed at correcting and normalizing their bodies, often to no avail. This medical framing
of their bodies as deviant, not only negatively influenced these men’s sense of their
bodies, but also negatively affected their sexual selves. One of the men I talked to, who
had experienced various medical interventions lamented:
My body image comes directly in my face when I’m dealing in some kind of
relationship with a woman. It comes up a lot . . . once again I put pressure on myself.
. . . I would say how can she like me with my weird-ass fucking body and the way
I walk?
For some disabled people medicine’s authority has been diminished by the Disability
Rights Movement’s success in separating biological impairment from disabling socio-
cultural attitudes and practices. On the surface, this distinction between “impairment”
and “disability” appears to limit medical authority by focusing clinical attention
upon impairment. Disabled people are, in turn, empowered to protest against overt
prejudice and oppression in their day to day lives. Disabled people can, it seems, “put
medicine in its proper place!” However, upon closer inspection a focus on impairment
cannot be easily restricted to disabled people’s encounters with physicians and the
medical system. A fundamental medical bias that attempts to impose norms upon
bodily functions remains unchanged and this influences cultural values and attitudes
8 toward disabled people. Medicine has helped to create and maintain a worship of the
Disability and sexuality 147
1111 “body beautiful” as a cultural imperative. It is a moral edict that exerts tremendous
2 influence on disabled people’s body images and sexual selves—as it also impacts many
3 non-disabled people’s perceptions of disabled people’s sexual desirability.
4 The emergence of the Disability Rights Movement in the 1970s was a major impetus
5 for challenging the medical model’s dominance in understanding disability. This
6 critique was only weakly extended in the case of disability and sexuality research and
7 practitioner interventions. In the late 1970s and early 1980s there was a brief time when
8 disability and sexuality seemed primed to move out from under medical dominance.
9 A disability and sexuality unit at the University of California, San Francisco, which
10 incorporated a social understanding of disability and sexuality issues, was one example
1 of progress in this direction. While some of this work criticized the asexual social
2 attitudes and cultural prejudices directed toward disabled people, and focused on
311 educating professionals who worked with disabled people, a politically charged critique
4 was never sustained. Were it not for a lack of funding during the Reagan years, a political
5 understanding of disability and sexuality might have grown.
6 In the early 1980s through the mid-1990s, a few advocates attempted to put sexuality
7 on the political and research agendas of the Disability Rights Movement. People such
8 as the late Barbara Waxman and Harlan Hahn, a disabled political scientist, railed
9 against a pronounced lack of social and political analysis on these issues. However, as
20 Waxman has suggested, the Disability Rights Movement as a whole has focused on
1 what they saw as more important access issues such as architectural, transportation,
2 and employment barriers and neglected the more difficult challenge of changing values
3 and attitudes, which underlie much of the sexual oppression of disabled people.
4 The publication in 1996 of The Sexual Politics of Disability: Untold Desires was a
5 major turning point in the debate about disability and sexuality. This critical study
6 conducted in the United Kingdom by Tom Shakespeare, Kath Gillespie-Sells, and
7 Dominic Davies, put sexuality squarely on the political map of the Disability Rights
8 Movement. The authors argue that research on disability and sexuality is still pre-
9 dominately conducted by professionals from medical, psychological, and sexological
30 backgrounds. But this medical and clinical focus has not been sufficiently challenged
1 by disability rights advocates and disability studies scholars. The researchers contend
2 that, “both academics and campaigners have de-prioritized sex and love.” The work
3 by Shakespeare, et al. is the first systematic study of disability and sexuality that has
4 prioritized the relatively simple goal of discovering what disabled people think and feel
5 about their sexuality. The book chronicles both the sexual oppression encountered by
6 disabled people, as well as the more positive sexual experiences of disabled people. The
7 Sexual Politics of Disability has the distinction of having galvanized disability rights
8 activists and disability studies scholars. The subject of disability and sexuality no
9 longer appears to be “fluff” that can wait until after other obstacles to disabled people’s
40 rights have been abolished.
1 Disability and sexuality conferences, a spate of new politically charged writing
2 on sexual oppressions and disabled people’s sexual rights, and a lively disability and
3 sexuality listserv all attest to a burgeoning interest in these issues. It has taken a long
4 time but disabled people’s sexuality has finally become a central item on the agenda
5 of the Disability Rights Movement and academic disability studies. Progress in trans-
6 forming disabled people’s sexual status and enhancing their sexual well-being will
7 depend on a range of research and advocacy strategies including the framing of issues
118 in terms of sexual rights, the broad public dissemination of disability and sexuality
11 research findings, advocate and activist pressure on media and policymakers, and the
self-promotion by disabled people of positive models of their sexuality. Hopefully,
increased academic and activist attention to critical disability and sexuality issues
coupled with strategies such as these will result in positive changes in public perception
of disabled people’s sexuality; for starters, replacing the myth of disabled people’s
asexuality with the more accurate understanding that “of course, they can do that!”
8
1111
2 38 Pity dates and the paralyzed
3
4 playa
5
6 The dating scene after spinal
7 cord injury
8
9
10 Tre Trefethen
1
2
311
4
5
The BBC talks out their blow hole
6 A couple of years ago when I was visiting the UK, I caught part of an arts program on
7 the BBC that had two guys squabbling about David Cronenberg’s film Crash. If you
8 haven’t heard of that film, it’s about people who get sexual thrills from car accidents.
9 This might seem like a farfetched fetish unless, like I do, you happen to live in San
20 Francisco, where no sexual practice is considered arcane. This was provincial London,
1 however, and one noisy guy in particular was put off by the female lead because she
2 wore a brace. His premise was that the movie was implausible because disabled people
3 have more to worry about than sex, “and it is rather troublesome to think of them in
4 this context.” Sigh.
5
6
7
Broken backed Barney Gumble
8 From a social and sexual standpoint, probably the most frustrating part about break-
9 ing my back was having to endure people in the media making simpleminded
30 pronouncements like that one. Not to generalize, but most of the disabled people I know
1 are obsessed with sex and relationships, probably even more so than the average,
2 nondisabled person, such as pasty film reviewers with bad teeth who work for the
3 BBC. If my own case is an example, in the first years after my accident, everything in
4 my life was about sex. Thoughts like: Would I ever have it again? Would it ever be
5 good? Would anyone love me as I had become? Or barring love, could I at least get
6 a little action without having to pay for it? Sex, sex, sex. It was an all consuming
7 obsession. On the verge of death I would have faded away looking down a nurse’s shirt
8 thinking, “Nice tiiiiiiii......ts.”
9 I use a wheelchair and everyone with an obvious impairment like that is lumped into
40 the overarching category, “disabled.” People with spinal cord injury, though, are treated
1 as special cases since we provide great human interest stories: there is the sudden loss
2 of many things generally thought of as defining existence. This makes us versatile
3 since we can be either tragic or inspirational, depending on the programming needs,
4 which endears us to the media. Our situation is generally described using a fixed
5 vocabulary of tidy clichés, such as “wheelchair bound” or “paralyzed from the waist
6 down,” and these terms strum on familiar cords that produce an emotion unburdened
7 by the exigencies of reality. I get out of bed in the morning and I am the never-say-die
118 hero; I can’t feel my cock, I am the tragic eunuch.
150 Tre Trefethen
11 It was no wonder, then, that at every party or bar I went to right after my injury I was
typecast as the designated neuter. There seemed to be an “Impotent: Flirt with Impunity”
sign on my back that told women it was safe to chat with the guy in the wheelchair; there
was no danger of me hitting on them. I was inoffensive, harmless, the cute disabled guy.
How could their boyfriends object? And guys could relax around me, too, since I wasn’t
going to compete with them for female attention. I was like the friendly sidekick. Barney
Gumble in a wheelchair.
Secret stud
After a few months of this, I began to understand that it was simply a reality that my
stature, both physically and psychically, had been diminished by my paralysis, even
1 among my closest friends. For instance, I used to be six feet tall, but I am now something
like 3e10u with my tires pumped. And there’s the lack of sensation thing; if you can’t
feel your cock, people wonder what is the point of having sex? And can you even call
it sex? Howard Stern says he would rather be dead than have that happen—that is how
incomplete, how bereft of meaning life is without penile sensation. People only see the
heroic side of spinal cord injury when we are doing something physical. When they first
meet us what they see is always the tragedy.
There are only three ways for a single guy to deal with such a sudden diminution: he
could become bitter and sit in his room all day; he could don a zen-like acceptance that
he is fated by the stars to live alone; or he could deny it by trying to prove to everyone
that everything is just like before. In my own coming to grips with paralysis, the first
two methods were out of the question. My libido had survived my accident so I was as
horny as ever. There was no way I was going to return to the celibacy of youth if I could
possibly beg, borrow, or steal even a semblance of a real sexual encounter.
It was a kind of cross between Maslow and the Twilight Zone that women no longer
considered me a commodity, that they didn’t even ignore me as an equal in public any
more. Even now most women fix me with absent, though benevolent, smiles as they pass
by, or chit chat over my head with their friends when I take an elevator. My reaction to
this was that I went overboard to demonstrate to everyone how, despite appearances and
popular belief, I was a stud.
Blunderbuss Technique, pity dates, and rope-a-dope dating

The first obstacle to proving my virility was overcoming my eunuch status. I figured that
most women I knew already established me as nondate material since they had seen my
fall from star to humble supporting role. Therefore, I developed what I called the
Blunderbuss Technique™, wherein I would ask out as many women as possible. The
idea was that, with such a wide spray of propositions, I would hit the mark with some
of them and I would get a date.
Of course, this technique by its very nature precludes a hundred percent success, and
I knew that the chances were that the woman would refuse; after all, I was living in
Vermont at the time, a state where wheelchairs are even scarcer than non-Caucasians.
And, too, agreeing to go out does not necessarily constitute a sexual interest. A woman
might say “yes” for any number of reasons that may not have been flattering to my ego.
Guys in wheelchairs have to be constantly wary of possible humiliation. The way she
8 agrees is the first clue. On the continuum of enthusiasm between “YES!” and “NO!”
The dating scene after spinal cord injury 151
1111 the “Pity Date” will be located at “. . . ok”, just before the negative, and it is a curse for
2 disabled men, worse than outright refusal.
3 She says “. . . ok” but when you are out with her, you discover from subtle hints that
4 she only agreed to come because she just feels bad for you, the poor friendly guy in the
5 wheelchair. Rejecting you outright would not mesh with her definition of herself as a
6 politically correct person. Such an evening is not a real date-date, it is a sort of penance
7 she has to endure for being a good and caring person. Women like this, I decided, were
8 to be avoided at all costs.
9 To forestall other defensive-dating maneuvers, I discovered it was essential to feign a

10 strictly platonic interest and give the impression that this would be just a casual soirée.
1 The best venue in such circumstances was to have dinner at an upscale restaurant. Not
2 only would the place impress, but the woman was seated and, when we were both at that
311 level, I was like any other guy. Even the nice girls who had never thought of me as other
4 than a cute little wheelchair guy would be surprised and gratified that they were sitting
5 across from an actual man. It was a kind of sleight of hand. A feint. Rope-a-dope dating.
6
7
The Internet: perpetual ladies’ night
8
9 Once when we were playing bridge, my grandmother warned me not to shuffle the cards
20 so much or they would end up right back where they started. If the Blunderbuss
1 Technique™ proved successful when I was living in Vermont, it really took off when
2 I moved to San Francisco and there were more women in the deck. Eventually, though,
3 there was a limitation on the number of new women I could meet. That’s when I
4 discovered Internet dating.
5 The Internet is a boon and a bane to disabled people. In one sense, too many disabled
6 people become Internet addicts to the exclusion of getting out in the world and really
7 living. But it also opens up vast horizons, especially for those in rural areas who have
8 no contact with the outside world. Obviously, given the outsider position many of us
9 have in society, it is lonely and isolating for many disabled people. Most don’t have the
30 support structure I had, and most don’t live in communities that readily accept their
1 difference, so they are forced to be introverts. The Internet works as an equalizer since
2 the person with whom you are communicating cannot see you, can only imagine you
3 based on what you tell them about yourself, and so does not associate you with the
4 clichés and the biases created by the media.
5 I discovered that it was unwise to tell women I met on the Internet that I use a
6 wheelchair until after we had chatted and they had established a solid idea of me as a
7 man. The idea of a wheelchair is not exactly a chick magnet. After all, paralysis is never
8 going to be a cool thing. No one sane is going to emulate us. And besides, it is perpetual
9 ladies’ night on these dating sites and very few self-respecting females would make a
40 wheelchair guy her first pick. So I would send them a couple pictures of myself from
1 the chest up and then, once I had established that I was a regular guy and they showed
2 an interest in meeting, I would send them a couple of me in my chair with the remark
3 that, if they weren’t interested after seeing the picture, I understood and no hard feelings.
4 Some I never heard back from, but other women thought of my “confession” as a sign
5 of intimacy, as if I were opening up and revealing a painful truth about myself, and they
6 would agree to go out with me, even if just as a friend. In some weird way, it established
7 me as a “sensitive male.” And in some ways, my paralysis was a liberating factor
118 between us. After all, I probably wasn’t going to assault them, and if I did, they could
152 Tre Trefethen
11 no doubt run away, climb a tree, or walk up a few steps to escape me. The fact that I did
not ejaculate also made sex with me “safer,” at least from a pregnancy standpoint.
All systems go and the two date limit

The paralyzed guy’s reaction to society’s belief that he is less of a man is to pretend like
everything is working in perfect order—so there are several women I was with who
never did understand that my penis had no sensation. Even if I had explained this to
them, they couldn’t reconcile the truth with my Viagra-induced erection, assuming that
they had somehow managed to create in me a natural erection. The real reason for this
misunderstanding is that I never let on that I had taken the drug. I was like Ray Milland
in The Lost Weekend, hiding little blue pills around my place so that I could secretly take
1 a little pick-me-up if the situation warranted.
My lack of penile sensation made it so that my focus was not on my own ejaculatory
needs and I could concentrate on their pleasure. It wasn’t an unselfish giving, though,
just the opposite. My purpose was to make love in the strictest sense: to make women
love me, or at least to become infatuated with me. I didn’t analyze why I was doing
this, though. I knew I had something that attracted a certain type of woman to me with
first blush; I projected an air of confidence people don’t usually associate with the
disabled. I had subverted their defenses against men and I was dedicated to their
pleasure. In my mind, I did not have anything more than a surface attraction to offer
and, if they eventually saw beneath the surface, they would see the realities of my life,
the wheelchair and the worries, and be repulsed. After a couple of dates, it felt like the
odds were that I would do something to disgust them. I don’t mean the stuff you can
laugh off, like peeing on a date or causing coitus interruptus by going on a farting jag,
but the serious realities of my existence, the exigencies of being a human with no
control of body functions. And then she could say to you, you know what, you’re a great
guy and don’t get me wrong, but I would just like to be friends with you. Better by far,
I reasoned, was to just hit it and quit it, leaving my mark so that, years from now, they
might look back on our time together with regret that I had gotten away. Or at the very
least, it was better that they disliked me as a playa, that they actively reviled me, rather
than to have them discover the ugly secrets of my real life.
And besides, if you get too close and somehow you have managed to defer the
embarrassment or she can laugh when you piss on her, there will come a time when her
inability to give you an orgasm begins to pall and she asks, “What can I do to make you
feel good?”
The meaning of sex

It’s next to impossible to convince a doubtful sensate person that sex without sensation
is anything other than a waste of time, but that’s not my purpose here. You accept that
a paralyzed person is a sexual being or you, like Howard Stern, can’t fathom the idea
that sex without orgasm can still be fantastic and no amount of talking will convince
you otherwise. I can just say that during those early years of my paralysis, I found
erogenous zones I didn’t know I had. My desires, my fantasies, my ideals of what a
woman should look like, all of these became less restrictive than they were before and
my enjoyment expanded to all of my senses, not just the enjoyable, but short-lived
8 finale.
The dating scene after spinal cord injury 153
1111 Of course, that may sound like I am in denial or trying to play down my losses. After
2 all, if we men with spinal cord injury aren’t being portrayed as geldings, we are often
3 striking pre-emptive poses to fend off people patting us on the head, talking down to us
4 like children, or dismissing us entirely. When we get the chance to tell our own stories,
5 you will frequently see us smiling and waving as if everything is just as it always was,
6 or giving a secret wink and a nod to insinuate that we have it even better than before.
7 But the truth is I do have it better than I did. What happened was that somehow during
8 my sexual peregrinations, a specific woman managed to subvert all my defenses and we
9 realized we love each other. With her it is a totality of sex, the actual physical sharing
10 of the act, but also the emotion of loving someone and the realization that I am loved
1 for who I am despite my limitations and weaknesses. We share a hope and a faith that
2 some day either I will learn some other method than genital stimulation to have orgasms
311 or that future advances will cure my paralysis. In the meantime, our sex is as exciting
4 and as pleasurable as anyone, able-bodied or not, could hope for.
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118
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39 Heterosexual and bisexual S/M
Cultural formations
Kathy Sisson
1 It’s hard to believe sadomasochism once hid underground. One has only to pick up a
magazine or turn on HBO to observe that the cultural visibility of sadomasochism (S/M)
has increased dramatically in the past three decades. Sadomasochistic images appear
in fashion and in advertising campaigns. S/M themes punctuate popular books, movies
such as 2002’s Secretary and music such as Madonna’s 1992 album Erotica. Internet
sites with explicit S/M content have proliferated, and books “explaining” S/M to
potential participants can be found in the sexuality section of many major bookstores.
The 1990 Kinsey Institute New Report on Sex estimates that, at least occasionally,
5 to 10 percent of the population engages in S/M behavior such as spanking, restraining,
or blindfolding. Therefore, using even the most conservative research estimates, millions
of individuals in the United States are likely to engage in S/M interactions.
The recent and rapid proliferation of S/M iconography and practice suggests that S/M
is a unique reflection of contemporary Western culture. Several cultural theorists claim
that late twentieth-century social developments have created mainstream consumers who
are receptive to avant-garde representations of transgression, power, sexuality, and risk.
In her 1993 essay Anne McClintock writes that S/M sexuality is uniquely suited to our
postmodern society because it illustrates the social construction of power, gender roles,
identity, and eroticism. After the sexual revolution in the United States and Europe, and
in an era when high reproductive rates are less necessary to national economies because
of technological innovations, sexual encounters have become easily arranged. They may
not, though, have the novelty, uncertainty, and tension that often lent drama to sexual
interactions in the past when sex was less readily available for many people. In this
context, Foucault described S/M as a power game to heighten sexual intensity.
S/M’s apparent increase in popularity in the United States may also be simply the most
recent manifestation of an erotic style that predates the use of terminology such as
“sadomasochism.” Language is tricky in this case because the terms “sadism” and
“masochism” only entered the lexicon in 1886 in Krafft-Ebing’s Psychopathia Sexualis,
and “sadomasochism” debuted in 1905 in Freud’s Three Contributions to the Theory
of Sex. Therefore, while we cannot describe behaviors occurring prior to these dates
by the term “S/M,” abundant evidence suggests that behaviors that are similar to
contemporary S/M practices have occurred throughout history.
S/M-type interactions have evolved over time, from isolated instances of individuals
seeking to satisfy their particular sexual desire to today’s highly visible, nascent S/M
culture. These erotic practices and ideals—encompassing a wide range of consensual,
interpersonal interactions, from extreme physical sensation to fantasy, and involving
8 eroticized power exchange—have gone through several stages of cultural development.
Heterosexual and bisexual S/M 155
1111 Examples of isolated individuals combining pain and/or dominance with sexual
2 arousal may date as far back as the Ice Age and at least to antiquity. In The Prehistory
3 of Sex, published in 1996, Timothy Taylor describes Venus figurines with bound hands
4 and breasts, estimated to be 25,000 years old. Taylor speculates that these figurines
5 may embody “themes of objectification and possession.” Eva Keuls provides photo-
6 graphs of fifth century BCE Grecian vases that depict S/M-like interactions between
7 clients and prostitutes in Reign of the Phallus, published in 1985. The Kama Sutra (450
8 CE) discusses sexual biting, pinching, and scratching. Ancient Greek and Roman
9 authors, including Aristotle, Ovid, Petronius, and Lucian, mention various S/M-type
10 interactions in their writings, and several sources from the Middle Ages, such as Pico
1 della Mirandola’s Disputationes Adversus Astrologiam Divinatricem (1496) and Otto
2 Burnfels’ Onomasticon (1534), clearly describe individuals who obtained sexual
311 stimulation from whipping.
4 In the seventeenth, eighteenth, and nineteenth centuries, the second stage in S/M’s
5 cultural development emerged as individuals began to increasingly make public their
6 own or others’ S/M-type interests. In the seventeenth century, physicians and prosti-
7 tutes described flagellation as a remedy for erectile dysfunction. S/M-type themes
8 laced popular fictional works such as The Presbyterian Lash, The Virtuoso, and Venice
9 Preserv’d. In the eighteenth century the Marquis de Sade penned his infamous novels
20 and essays, Rousseau wrote about his masochistic predilections in his Confessions, and
1
brothels specializing in flagellation began to appear in major European cities.
2
These trends expanded into the nineteenth century. Industrialization brought a
3
number of social developments—dramatized power relations, increased privacy, ano-
4
nymity, leisure time, consumerism, urbanization, and secularization—which promoted
5
6 particular concepts of sexuality. These social developments also facilitated the public
7 visibility of S/M-type behaviors and increasing numbers of practitioners. Special-
8 ized brothels flourished in the United States and Europe and S/M-type themes became
9 more common in popular fiction. Perhaps most importantly, at the century’s end the
30 German physician Krafft-Ebing placed S/M behavior squarely into cultural conscious-
1 ness with the publication of Psychopathia Sexualis. His popular typology conferred a
2 name, etiology, and pathology on erotic behaviors and desires that had been considered
3 unremarkable or, at best, medical curiosities.
4 These nineteenth-century developments fostered the next juncture in S/M’s cultural
5 evolution—the formation of practitioner networks and communities. According to
6 Robert Bienvenu, author of a forthcoming book, the modern S/M phenomenon can be
7 traced directly to the early twentieth century, when individual practitioners convened
8 in local, and eventually national and international, networks. S/M moved from public
9 brothels into private spaces and the range of S/M behaviors dramatically expanded. S/M
40 equipment became increasingly specialized and elaborate. Preferences for materials
1 used in S/M activities shifted from soft media (fur, satin, velvet) to hard media (leather,
2 rubber, latex). These materials remain integral in contemporary S/M practice.
3 By the 1940s S/M practitioners in the United States and Europe formed tight-knit
4 communities around S/M-oriented artists, including photographers, artisans, writers,
5 and publishers. Specialized magazines provided opportunities for contact between like-
6 minded individuals across the country and mail order businesses provided access to
7 equipment and materials. Government censorship and prosecution limited the scope
118 of these communities and enterprises until the 1960s. In the late 1940s and 1950s, a
156 Kathy Sisson
11 discrete, gay male S/M community emerged, embraced unique iconography and prac-
tices, and developed quite differently from the heterosexual/bisexual S/M community.
Several developments in the 1960s contributed to heterosexual/bisexual, S/M cultural
evolution. First, the Warren Court handed down increasingly liberal obscenity interpret-
ations in Roth v. US (1957), Manual Enterprises v. Day (1962) and Fanny Hill (1966).
These rulings facilitated the growth of the pornography industry and S/M iconography
began to appear in popular pornographic movies and “mainstream” pornographic
magazines and books, which drove many small, independent erotica producers out
of business. Technological advances made S/M equipment and costumes easier to

mass produce, further eroding the small erotica producers’ role. Finally, haute couture
adopted S/M motifs and S/M began to slowly move toward mainstream fashion. The
confluence of these developments ultimately led to the emergence of the first modern
1 heterosexual/bisexual, S/M support groups in the United States in the early 1970s.
Throughout the 1970s, 1980s, and 1990s, increasing numbers of S/M support groups
and organizations formed on a national and international scale. By the late 1980s many
of these organizations wielded sufficient economic, social, and political power to herald
the next stage of cultural development—the formation of a social movement. The
Internet greatly accelerated this process by making information about S/M accessible
to individuals who were unable or unwilling to join established S/M organizations. The
Internet provided cybervenues for likeminded individuals to meet and share experi-
ences. Increased communication between practitioners spurred S/M activism, and those
involved with S/M social movements continue to focus on ongoing legal issues
involving discrimination, obscenity, and consent. Recently, S/M activists have turned
their attention to removing the psychiatric diagnoses that pathologize consensual
sadomasochism.
In the 1990s S/M moved into the last stage of cultural development as an embryonic,
heterosexual/bisexual, S/M culture emerged. A sexual culture, from an anthropological
perspective, is a collective system of meanings and practices that emerges from
historically specific social and psychological conditions. Contemporary S/M conforms
to this model because S/M practitioners organize, identify, and understand their sexual
desires and behaviors through shared mechanisms and ideologies. The emergence of
S/M groups also coincide with specific, late twentieth-century cultural conditions—
namely, acute social upheaval beginning with Vietnam, the Civil Rights movement, and
feminism, and extending through postmodern philosophy’s rejection of traditional
intellectual paradigms.
Contemporary S/M culture reflects both historical and more recent social develop-
ments but this does not mean that this new sexual culture is static. As S/M sexual
culture becomes further integrated into mainstream culture, it continues to be malleable
and subject to internal and external pressures similar to those faced by other stigmat-
ized, emergent sexual cultures.
Will S/M cultures continue to merge with mainstream fashion and eventually be
regarded as passé by a public with a short attention span? Will this ultimately lead
to certain practitioners rejecting S/M because it no longer reflects a significant trans-
gression of the status quo? Or will S/M retain its distinctive ideology, iconography, and
cultural attributes—securing a place as a recognized sexual identity? How S/M con-
tinues to evolve in Western culture over the next century will demonstrate as much
about mainstream sexualities as it does about alternative sexualities.
8
1111
2 40 Ms etiquette and the
3
4 transgender employee
5
6 Is nothing private any more?
7
8 Jillian Todd Weiss
9
10
1
2
311 Gender transition used to be a very private matter. The patient would disappear from
4 his or her hometown and reappear somewhere else, ready for a fresh start with a
5 different gender. The patient was strongly advised to keep the past secret. Those who
6 failed to do so often regretted the severe social disapproval their indiscretions reaped.
7 Now, however, gender transition commonly occurs in the workplace as law, public
8 relations, and political correctness combine to make society and employers more trans-
9 friendly. Upper management and nameless coworkers know intimate details of the
20 private life of an employee in transition. Even something as personal as who can use
1 what bathroom has become an HR issue.
2 The bathroom is a flashpoint for conflicting levels of social tolerance. The importance
3 of these strictly private spaces for males and females is taught to us very early in life.
4 The separation of the sexes is a product of the understanding that a person’s biological
5 sex determines their psychology, their social role, and their sexuality. Now, we are
6 asked to accept that George can become Christine, contradicting what we have been
7 taught about the gulf between the sexes. Violation of these spaces touches on many
8 pivotal identity issues—privacy of excretory functions, fear of public nudity, our
9 identification with people of the same gender, appropriate sexuality, sexual harassment,
30 and violence against women. The image of a “man in a dress” in the ladies’ bathroom
1 (or the men’s bathroom) brings up these issues in a visceral way. As an abstract proposi-
2 tion, many are prepared to live and let live. The abstract becomes concrete, however,
3 when we find ourselves standing next to Christine in the bathroom mirror. As a society,
4 we do not tolerate gender ambiguity well.
5 Is nothing private any more? Some would prefer that issues of sexuality be restricted
6 to the private sphere and kept out of the workplace. Most transgender employees would
7 prefer that as well. However, when gender transition takes place in the workplace,
8 there can be little expectation of complete privacy because it is, by its very nature, a
9 public changing of gender identity. How do we reformulate the balance between what
40 is private and what is public?
1 There is no easy answer because “privacy” is itself a relative term in modern society.
2 When a worker goes from female to male or vice versa, he or she must give up the
3 notion of a discreet transition. Does that give distant coworkers the right to ask rude
4 questions? Hardly. But management—don’t they at least have to know, well, shall we
5 say certain details in order to assign the proper bathroom? And don’t coworkers who
6 share the facilities have a right to know who is standing (or sitting) next to them in the
7 lavatory? What is the proper business etiquette? What would Emily Post say? (I imagine
118 she would be speechless.)
158 Jillian Todd Weiss
11 Men’s restroom?
One of the factors in this privacy determination is the traditional law of employment,
called the “employment at will doctrine.” It gives a private employer the right to hire
or fire an employee for any reason or no reason at all. Employers also have the right to
set the terms and conditions of employment. This rule has been undermined, however,
in regard to certain forms of discrimination. Race discrimination became illegal in the
United States about forty years ago. The list of protected categories has expanded
greatly, and now it is widely considered immoral (though not necessarily illegal) to
discriminate on any grounds unrelated to the job. More than a dozen states and well over
a hundred local governments have prohibited employers from discriminating on the
basis of “gender identity.” This does not, however, remove signs from bathroom doors.
There is a law, for example, in Minnesota that forbids discrimination against transgender
1 employees. An employee who transitioned from male to female used the women’s
restroom. The employer objected and effectively terminated the employee. The em-
ployee filed a lawsuit, and the Minnesota Supreme Court decided the employee had
no discrimination claim based on her transgender status. It ruled that the law was not
intended to overturn the “cultural preference” for sex segregated facilities. It did not
consider the irony that similar reasoning once justified race segregated facilities.
In its ruling the court unwittingly subordinated another principle that we value highly:
medical privacy. We consider it improper (and unlawful) for an employer to ask about
the medical history of employees unless there is some bona fide need because of the
nature of the job requirements, for example, the vision of airline pilots. Asking an
employee in the accounting department about their genitals is probably not a bona fide
occupational requirement. And yet, allowing guys into the ladies’ room is definitely not
an idea whose time has come.
Whole is greater than the sum of its parts

The medical realities of sex reassignment surgery are important here. There is a popular
idea that “sex change surgery” transforms a hypermasculine Arnold Schwarzenegger
into a super-feminine Nicole Kidman, or vice versa. There is, however, no such thing.
Instead, there are several dozen medical treatments and surgical procedures that can
be involved in sex reassignment. These change various primary and secondary sexual
characteristics. The choice of procedures varies greatly and may depend on medical and
financial health. While many trans people undergo surgery that creates genitals of
the opposite sex, most do not. Fewer female-to-male transsexuals have full phallo-
plasty, as genital surgery for female-to-male transsexuals is much more expensive
and the results are often less than convincing. Genital surgery also does not change
one’s public appearance or the ability to pass as the opposite sex—that’s mostly a
matter of dress and grooming. The level of coworker comfort usually relates to the level
of visible gender ambiguity—how well the transgender person blends into their chosen
sex. Mental health professionals use an eight-point test to discuss gender1 and often talk
about gender being a “social construction” rather than a biological one. Thus, a simple
surgical requirement doesn’t pass muster.
As a consultant to large employers on this issue, I have found that while initially,
managers often zero in on medical and legal issues, this focus rarely provides satis-
factory answers. No sane employer wants to become part of the transgender employee’s
8 medical team or litigate the complex issues of gender transition. The imposition of a
Ms etiquette and the transgender employee 159
1111 surgical requirement by a company may pose legal problems with the typical health
2 insurance exclusion for transsexual surgery. At the same time, a business decision
3 must be made about sensitive issues such as bathroom usage. The decision should, of
4 course, respect the transgender employee, while also accounting for the concerns of
5 coworkers. The lack of social consensus about gender transition means that there can
6 be no hard and fast rules. Each case must be approached on its own merits. However,
7 while a case-by-case approach sounds reasonable, it can turn into arbitrary and
8 capricious decision making that unfairly burdens trans employees. This is not good for
9 employers if there is future litigation. There are, however, several general criteria that
10 can be used to point managers in the right direction. For example, managers may
1 consider the number of bathrooms within reasonable walking distance, the availability
2 of single use or lockable bathrooms, the length of the trans employee’s transition, and
311 the comfort level of trans employees and coworkers. One possible option: an employer
4 could host an information session for coworkers to notify them of company policy and
5 expected norms of conduct, announcing that Jane will henceforth use the third-floor
6 restroom. This permits uncomfortable coworkers to use another restroom. Generally,
7 such coworkers get over it after a while, but forcing ideas upon them can cause bad
8 feelings and litigation.
9 The etiquette of modern business is tricky—we want employers to “do the right
20 thing,” but figuring out the “right thing” is often confusing. There is an increasing
1 occurrence of workplace gender transitions. It was unknown in 1952, when George
2 Jorgensen’s transition to Christine hit the nation’s headlines. My research with large
3 employers shows that the current prevalence in large organizations is probably up to
4 0.01 percent. This is a small number, but it means that in a corporation of 10,000 there
5 is probably one person who has transitioned on the job. The increasing acceptance of
6 gender transition in society means that many employers, particularly large ones, will
7 likely face such decisions at some time in the near future.
8 Transgender employees who transition in the workplace can not expect others to
9 ignore the change, for it is by nature a public event. At the same time, privacy and
30 dignity have their place even in public events. From a sound business policy viewpoint,
1 the public nature of the event requires reasonable accommodation and clear policy to
2 set the norms of corporate behavior, but private details of the transition should remain
3 private. Like any business decision, workplace transition rules are informed by medical
4 and legal opinions, but primarily based on business considerations of workplace
5 harmony and the increased productivity and profit that results. Not even Emily Post
6 would disagree with that, I am sure.
7
8 Note
9
40 1 See Brown, Mildred L., and Rounsley, Chloe Ann. 1996. True Selves: For Families, Friends,
Coworkers and Helping Professionals. Jossey-Bass, San Francisco, CA, p. 20. Brown and
1 Rounsley assert that there are at least eight factors to be considered in determining gender, five
2 biological and three social and psychological. “The biological determinants are chromosomes,
3 hormones, gonads (glands that produce sex hormones), internal sexual and reproductive organs
4 and external sex organs. The social and psychological determinants are gender of rearing,
5 gender role, and gender identity.” While it is true that the DSM mentions four factors to be
considered in making a diagnosis of “gender identity disorder,” I am speaking here about a
6 determination of “gender,” not “gender identity disorder.” In addition, even under the DSM,
7 one must also consider the physical differential factors to be used in excluding a diagnosis of
118 intersex.
11
41 At the Cesar Chavez Institute
Bridging academic research and
community empowerment
Joyce Nishioka
1 Rafael Diaz works on the corner of 16th and Mission, an area of San Francisco
populated with underprivileged immigrants and down-and-out natives, a place with
more than its share of wheelchairs and despair, where heroin dealers deal and homeless
addicts come to get their fix. In his office on the third floor of a lowrise building, Diaz
recalls the experiences that compelled him to work for social justice. In the early 1990s
he was a tenured professor at Stanford, a “rising star,” he says. At the same time, many
of his friends were dying from AIDS. Nearly every weekend he would descend from
the ivory tower and head north to San Francisco for yet another memorial. “This was
the reality of life,” he explains.
Searching for work with a more direct impact on people, Diaz resigned from Stanford
in the early 1990s and enrolled in a post-doctorate epidemiology program at the
University of California, San Francisco. Through studying gay Latino men, he came
to grasp the value of people’s real life experiences. Theorizing about social problems
without first collaborating with those affected no longer made sense to him. That
conviction led him to the streets of San Francisco’s Mission District, where, with micro-
phone in hand, he conducted interviews with gay and bisexual Latino men at risk for
HIV infection. His research culminated with the publication of his book Latino Gay Men
and HIV: Culture, Sexuality and Risk Behavior, a seminal work exploring the diversity
of gay life in the backdrop of the AIDS epidemic.
Today, Diaz’s socially engaged approach to scholarship is the foundation of San
Francisco State University’s Cesar Chavez Institute (CCI), where he is the director.
Acting as a bridge between academic research and the community empowerment, the
institute produces studies documenting the impact of social oppression on the health
and well-being of minority communities—while affirming the strength and resiliency
of the underprivileged and underserved. The lineage of Diaz’s philosophy can be traced
back to Paulo Freire’s theory of critical consciousness. Freire, a Brazilian educationalist
who wrote Pedagogy of the Oppressed, viewed learning as an act of freedom. Through
education and dialogue, people could gain the knowledge and power needed to expand
their social capital and improve their communities.
Hermanos de Luna y Sol (Brothers of the Moon and Sun) embodies Diaz’s community-
approached research and Freire’s philosophy. The nonprofit program, housed three
blocks from the Cesar Chavez Institute at Mission Neighborhood Health Center, targets
gay and bisexual men, as well as transgender women, among the district’s Latino immi-
grant community.
There, Project Coordinator Héctor Ceballos refrains from lecturing to participants.
8 Instead he encourages them to share their experiences and learn from each other. They
At the Cesar Chavez Institute 161
1111 examine the history of their oppression and then analyze their behaviors. They look at
2 situations where they were vulnerable and eventually, become empowered to use better
3 self-judgment.
4 And they talk with brazen honesty. Even when discussing serious topics, they feel
5 comfortable enough to chime in and challenge each other while managing to laugh at
6 themselves and each other. Ceballos recalls one man who in describing an encounter
7 quipped, “I was trying to convince him to wear a condom—and on top of that his dick
8 was so enormous that it was not going anywhere!” Ceballos says, “These men and
9 women are resilient and have overcome so much, yet they are convivial. They come
10 here and their experiences are validated.”
1 Ceballos’s work is a crucial part of the attempt to stem the AIDS epidemic among
2 Latinos. Nationwide, this group makes up about 13 percent of the US population but
311 accounts for 18 percent of all AIDS cases reported and 20 percent of diagnoses made
4 in 2002. Latino men who have sex with men (MSM) face even grimmer statistics.
5 A 2002 study by University of California’s AIDS Research Program found more than
6 35 percent of young gay and bisexual Latino men in the border town of San Diego were
7 infected with HIV.
8 So far, some 1,200 people, mostly Mexican immigrants, have participated in the
9 Hermanos de Luna y Sol. Most of them live on the outskirts of the mainstream. In the
20 United States they struggle because of language barriers and limited job opportunities,
1 but at the same time, discover newfound freedom to express their sexuality. “That is
2 very alluring,” Ceballos says. “In Mexico many gay men idealize white men. They come
3 here and can have them. It is easy to have sex; guys want them; they are exoticized.”
4 Too often, though, they do not have the confidence or skills to negotiate safe sex:
5
6 In Latino culture you do not talk about sex, especially not gay sex. I find that many
7 of the men new to the program will use euphemisms to allude to sex—for example,
8 “We did what we had to do and then left.” We encourage them to be graphic, to
9 use whatever vocabulary they need to communicate with their sexual partners.
30
1 Diaz acts as Hermanos de Luna y Sol’s program evaluator. The discrimination many
2 gay and bisexual Latino men are confronted with—mainly racism, poverty, and
3 homophobia—results in social isolation and psychological distress, he explains. Such
4 distress makes them vulnerable to risky behavior: they may be less able to negotiate
5 safe sex because of an enhanced fear of rejection or unequal power sharing in the
6 relationship; they may use sex and/or drugs to relieve their distress. Social isolation
7 traps them in this destructive cycle. “Sexual risk behavior is predicted by discrimin-
8 ation. Factors that help moderate the situation may be gaining family acceptance,
9 having a sense of community with friends and social networks, or participating in
40 social activism,” Diaz says.
1
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More work to be done
3
4 One of Cesar Chavez Institute’s five current onsite projects is the Family Acceptance
5 Program, directed by Caitlin Ryan. Like all of the work at the Institute, it is a good
6 example of the process of socially-engaged scholarship.
7 The Family Acceptance Program was created in 2002, based on an earlier finding
118 that there was only one program in California to help LGBT youth engaged families.
162 Joyce Nishioka
11 “Families are important but most programs get away from the family, in a sense protect
young people from their families,” Diaz says. “We wanted to see if family acceptance
could actually protect youth.” In the first phase of the project, researchers conducted
in-depth interviews with underserved LGBT youth and their families throughout
California, in English and Spanish. They included immigrant families, as well as rural
and resource-poor families. Some of the young people were in foster care. Researchers
then converted the interviews into a survey that they administered to twenty-one to
twenty-five-year-old gay men and lesbians. The survey consisted of experiential
questions, Diaz says, such as: “Did your parents connect you to LGBT resources?” “Did
your parents express homophobia or anger when you came out?” “Did your parents
allow your LGBT friends into the house?” “Did your parents support how you looked
and how you dressed?”
1 “The questions were asked retroactively, so that from the data we could find out
which parental actions are helpful and which are risky. It is all based on the voices
of the community,” he says. The Family Acceptance Program is now in the stage of
developing evidence-based training and intervention materials. “It may be that taking
your child to PRIDE is not helpful, but helping them find role models who are suc-
cessful sexual minorities with jobs and regular lives, is. Practitioners need to know this
and involve the family.” Throughout the process the community—advocates, health
workers, teachers, youth—was involved, helping to recruit interviewees, discussing
interview data, and interpreting survey results.
Diaz is continuing his own research. Currently, he is studying drug use among Latino
gay and bisexual men and transgender women, testing his hypothesis that community
involvement tempers the negative effects of poverty, racism, and homophobia. Though
Diaz is himself a gay, Latino man, he says, “I’m not studying myself.” His upper-
middle-class family fled Cuba when he was eleven and settled in Venezuela. At twenty-
two he came to the United States to study social work at NYU, and then went to Yale
to earn his doctorate in psychology. Despite his privileged upbringing, he says with
some reserve, “My family did suffer as immigrants; my parents were Cuban exiles
coming to a new country trying to gain acceptance. Yes, I have experienced homo-
phobia too. My own wounds fuel my passion and activism.”
8
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2 42 My intersex journey
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4 From awkward teenager to human
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311 At fourteen I hadn’t developed like other boys and was often teased for having very
4 small testicles. They often stayed up inside of me. It was an awkward time for me as I
5 was very tall and slender. I was a self-conscious, sensitive, and emotional kid. My
6 mother, concerned about my lack of development, took me to the family doctor for an
7 examination. Without any tests, he assured her that I would grow up “normal” and be
8 able to have children.
9 But by my early twenties I developed breasts and had cellulite-type hairless fatty
20 tissue over most of my body. I had gender identity issues and generally was sexually
1 attracted to men. In college after taking interest tests, I was told that my interests were
2 “too feminine.” My father used to tell me, “You are just like your mother.” I often felt
3 wedged between genders and had to deal with my difference alone.
4 I remembered from high school biology that “giants” were usually sterile. I wondered
5 if I might be, too, since I was 6’ 10”. In my late twenties I went to an infertility clinic
6 to investigate. I was shocked by the diagnosis!
7 The term “intersex” is still an enigma to many people. I was introduced to the term
8 in 1995, when I went to my first intersex support group led by Cheryl Chase, the founder
9 of the Intersex Society of North America (ISNA). There, it was explained that intersex
30 was a variation in sexual anatomy as compared to what one might consider standard
1 “male” and “female.”
2 Intersex is an umbrella term. It could be a large clitoris that doctors decide needs to
3 be trimmed down, or a micropenis that physicians examine to determine if it is big
4 enough for heterosexual sex. Many intersex people have standard XX (female) and XY
5 (male) sex chromosomes while others do not. In Androgen Insensitivity Syndrome
6 (AIS), XY children’s genitals feminize without any internal female sex organs and,
7 depending on the person, individual gender identity can vary. Those with Turner’s
8 Syndrome have XO chromosomes (a missing X chromosome). Those with the endocrine
9 and chromosomal variation called Klinefelter’s Syndrome, which occurs in about one
40 out of every 500 to 1,000 “male” births, have XXY sex chromosomes.
1 After extensive examinations and tests, I was told that I had Klinefelter’s Syndrome.
2 I was informed that I was sterile and that my tiny testicles only produced 10 percent of
3 the testosterone levels of “normal males.”
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Medicalizing intersex
7 Without any emotional counseling I was advised to immediately start testosterone
118 replacement therapy. I was told that my sex drive would increase, I would gain weight
164 David Cameron
11 and my shoulders would broaden, and that I would have to inject myself with 300mg
of testosterone every two weeks for life. Medical journals called my condition
“feminized” male.
Doctors offered breast reduction surgery and testicular implants but I refused. My
gender identity was never discussed. And they didn’t tell me that I was about to go
through puberty again with a vengeance . . . in my thirties. It was fun to be a teenager
again. I wasn’t particularly horny the first time I went through puberty. This time was
different. I grew a beard, got very hairy everywhere and started to go bald. I liked the
beard but not the other side effects, including prostate enlargement.
Within five years, my small prostate had grown so large that I had to take medication
to urinate. When injecting testosterone I experienced a sexual energy surge within a short
time. I was not used to this and became extremely sexually active. And then I contracted
1 HIV. As a result of the testosterone, my body changed in ways that altered my sense of
self.
In retrospect, after twenty-eight years of injections, I now realize that my body was
alright the way it was. I didn’t need to change it. My endocrinologist was not God,
although I trusted that he knew what was best for me at the time. My sexuality and
gender confusion was based on the idea that I was supposed to turn out heterosexual—
not homosexual. My attraction to men was supposed to be a phase.
In a sense, I was a heterosexual female. I feel that I was rushed into an experience
that I wasn’t ready for and that my doctor deceived me. Doctors do not have all the
correct information on sex, gender, and sexuality diversity. Not everything needs to be
pathologized just because it is different. I’ve had to learn to trust my own life experience,
not fitting into our “two sex/two genders: Western binary system.” I often wonder why
I was created, never to reproduce in our family-obsessed culture.
Proud to be me
After that first intersex support group, I learned that, for me, my sense of gender as a
“blend” is okay. One’s “sex” and “gender” are separate issues. I became Cheryl’s first
ISNA volunteer and eventually lead its support group. I now speak at many venues
where I share my experience of living with an intersex anatomy.
In 1996 Cheryl and I were part of a small panel that informed the San Francisco
Human Rights Commission’s (HRC’s) Lesbian, Gay, Bisexual, and Transgender
(LGBT) Advisory Committee of the reality of intersex people. This panel started my
journey as an intersex human rights activist. In 2000, I was appointed to the San
Francisco Transgender Civil Rights Implementation (SFTGCRI) Task Force as an
intersex person. At that time “intersex” was included under the “transgender” umbrella.
There is some overlap between the two, but intersex has its own “umbrella” of different
anatomical realities.
Through my participation and education of the Task Force, I was able to get intersex
separated from the transgender umbrella and put into a category all its own. It was ironic
to me that transgender persons who wanted to transition to another sex had to pay out
of pocket for those “cosmetic” interventions, while intersex children were covered by
their parents’ insurance companies as long as their transition occurred before they
could give legal consent.
After the conclusion of the SFTGCRI Task Force, I continued to work with the
8 Human Rights Commission Lesbian, Gay, Bisexual, Transgender Advisory Committee
My intersex journey 165
1111 on their Gender Identity working group as a community member. We voted to create
2 an Intersex Task Force. The task force worked on creating a public hearing at the
3 request of the Commissioners and this “historic event” was held on May 27, 2004. This
4 was the first time a governmental body in the United States had ever addressed intersex
5 human rights issues! A resolution approved by the San Francisco Board of Supervisors
6 proclaimed October 26, 2004 as the first annual Intersex Awareness Day. A group of
7 intersex activists attended the ceremony at San Francisco City Hall. Emi Koyama,
8 executive director of Intersex Initiative (www.intersexinitiative.org), requested the
9 resolution’s adoption on behalf of intersex persons worldwide. Betsy Driver, executive

10 director of Bodies Like Ours (www.bodieslikeours.org), cosponsored the event.
1 For intersex people, who often travel a painful and long journey to gain acceptance,
2 this was truly a joyous and monumental occasion.
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5 The globalization of sexuality
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311 With millions of dollars funneled into HIV/AIDS-prevention campaigns around the
4 world and pornography from the far reaches of the planet available almost instantan-
5 eously, with sex tourism in Southeast Asia and panics about sexual slavery in the United
6 States, it is clear that we now live in an age where sexuality, in its many manifesta-
7 tions, has gone global. To think about sexuality—one of the most personal and intimate
8 aspects of our lives—in this way may seem counterintuitive. However, by bringing the
9 personal into a larger political context, the multiple facets of sexuality in our contem-
20 porary era come together; we cannot ignore how sexuality is implicated in the large-
1 scale changes occurring around the world.
2 Considering sexuality in global and transnational frameworks links together sexual
3 rights, health, education, and commodification, along with questions about what counts
4 as morality or social values in different cultural settings. Taking national, historical,
5 and economic differences into account becomes mandatory when we think about
6 sexuality on global terrain. It also demands that we “think outside the box” and evaluate
7 our own assumptions and value systems. Understanding the intimacies of sexuality in
8 global dimensions, we are pushed to question and problematize our own assumptions
9 about what is right and wrong or what we perceive as “natural” regarding sexuality.
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Understanding sexuality across human experience
3 In Western societies there has been a long tradition of studying sexuality from the
4 point of view of biology, medicine, and pathology, and sex as a function in the per-
5 petuation of our species. In addition to biomedical approaches to the study of sexuality,
6 the social sciences and humanities have approached the question of sexuality, in
7 general, in two distinct ways. On the one hand, sexuality has been assessed through the
8 lens of psychoanalysis and Freudian concepts of desire, repression, and sublimation.
9 More recently, following the French theorist Michel Foucault, the study of sexuality
40 has emphasized the “proliferation of discourse” surrounding sexuality. From this
1 vantage point, a critique of the psychoanalytic approach, Freud’s “repressive hypo-
2 thesis,” becomes yet another cog in a larger machine that produces “sexuality” as an
3 abstraction in the service of medical, educational, military, and identity projects.
4 Studies of sexuality outside of the West have sometimes been criticized for
5 exoticizing (or some would say, fetishizing) the sexuality of people in faraway lands.
6 Some academic and popular literatures have tended to emphasize the salacious and
7 shocking aspects of sexual difference found around the world. However, a large body
118 of comparative studies, in anthropology for example, emphasizes a shared continuum
11 of sexual behavior and desire across human experience, from homoerotics in Papua
New Guinea to shifting notions of romance across the US/Mexican border. Works
such as these maintain that cultural variation accounts for very different manifestations
of sexual behavior. Given this history in scholarship, are there ways that we can think
about sexuality both within and outside the borders of the United States that neither
homogenizes nor exoticizes human sexuality?
Sexuality in the global morality market

By flipping on the television in just about any country in the world, one will find traces
of US-styled sexuality, exported through syndicated TV shows, movies, and advertising.
Has the advent of global capitalism and the spread of information technologies led
1 to an “Americanization” of sexuality? Are soap opera-styled liaisons or surgically
endowed femininity becoming the norm internationally, much like the supposed “Coca-
Cola-ization” of culture? Or is the opposite at work, with the United States becoming
exposed to alternative conceptions of sexuality from other countries and cultures?
Before we can begin to answer this question, we must first ask what exactly is “American
sexuality.” Is there only one or are there many different and disparate ways of
understanding sexuality in the United States and thus around the world? According to
recent analyses of sexuality in the world system, we must begin to see sexuality very
much like we see the movement of people, commodities, and capital investment in the
twenty-first century: circulating.
However, sexuality is not experienced the same everywhere. For instance, there
have been very different concepts about what constitutes “homosexuality” in Latin
America versus the Middle East or urban North America. Is homosexuality a matter
of one’s behavior (sexual acts with someone of the same biological sex) or is
homosexuality a self-claimed identity, a process of exiting the closet and articulating
one’s desire and same-sex attraction? “Homosexuality” as a medical term might not
even be capable of capturing the diversity of people’s experiences, much less designate
the significance attributed to these experiences. In a similar vein, the meaning ascribed
to prostitution and the “selling” of sexual acts is different in West Africa than it is in
Atlanta. How do we then account for different cultural, as well as individual,
interpretations of sexual labor in a transnational context?
Sexuality in global perspective involves volatile controversies. The trafficking of
women and children for sexual labor—whether forced or voluntary—involves multiple
networks, border crossings, and financial transactions. Sexual trafficking also begs the
question of what counts as “voluntary” involvement in prostitution. With so many
girls and women struggling for a basic existence in many parts of the world, “survival
sex” or subsistence prostitution, raises many questions about the commodification of
sex, moral responsibility, and the governmental and social structures that have led to
these situations. When feminists ally themselves with social conservatives in attempts
to eradicate the illicit trade in women and girls in “sexual slavery,” we find the politics
of morality deeply implicated in contemporary policy debates around sexuality.
Prostitution surrounding military bases is nothing new; it has long been considered
by many military planners to be requisite for the rest and relaxation of troops. As
military and militia presence is transformed, dislocated from cold war bastions and
stationed in newly volatile regions, we must inquire into how this is changing the
8 shape of the sexual world in conflict zones and back at home. Sexual war crimes such
The globalization of sexuality 169
1111 as mass rape demand that we account for sexual violence in more troubling and vast
2 dimensions. In these kinds of situations, sexuality cannot be understood as simply a set
3 of negotiated desires between consenting adults. Whether we are talking about UN
4 peacekeepers stationed in African conflict zones, or US military bases abroad, regional
5 militarization and the implications this has for residents are profound on both social
6 and sexual levels.
7 As we increasingly bring questions of “morality” to bear upon global sexuality,
8 we are at an historic crossroads. How do we begin to formulate a set of universally
9 recognizable and agreed-upon attitudes when social values are so different in diverse
10 cultural contexts? Global debates about female genital surgery or FGS (also called
1 female genital mutilation, circumcision, or “cutting”), for example, have tread upon
2 questions of health, reproduction, pleasure, the status of women, and transnational
311 values, as well as international legal norms. Are these surgeries a violation of human
4 rights? Or are they simply a manifestation of a cultural ethos surrounding women’s
5 sexuality? And must the two be diametrically opposed? Huge sums of funding are put
6 toward population control programs, abstinence-oriented sex prevention campaigns,
7 HIV/AIDS reduction strategies, and sexual exploitation abatement. These financial
8 flows of capital and investments in what we might call a “sexual infrastructure,”
9 demonstrate how sexual morals and values are deployed by countries that donate large
20 amounts of funding. In turn, we see how sexuality may be changed and assumptions
1 shifted by the kind of outreach that occurs on the ground. In this Part, consider how
2 cultural values and moralities about sexuality in diverse contexts coincide. Ask whether
3 there is a global norm to be established around sexual rights, sexual health, and
4 sexuality education as you consider sexuality on a global scale.
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43 Global perspectives on sexual
rights
Sonia Corrêa with Cymene Howe
1 In the international news and in social justice struggles here in the United States, we hear
a lot about “human rights.” However, many people may not know its history. Human
rights principles and discourses of the eighteenth century were revived in the context
of the United Nations in response to the Nazi Holocaust. Many countries signed onto
these principles, and since then human rights has grown and changed. In the last thirty
years we have seen major developments in the ways that governments and non-
governmental organizations and advocates have turned to human rights in order to create
gender and sexual equality and to protect sexual diversity around the world. Of course
the controversies are many. In this conversation, we speak with a leading thinker and
activist who has been involved with the struggle for gender and sexual rights, to ask her
about the origins of, and possible futures for, sexual rights in the twenty-first century.
Can you tell us about the genesis of human rights and how they have become so central
to our contemporary understanding of the world and social justice movements?
SONIA CORRÊA: The history of human rights has been the history of integrating civil
and political rights with economic and social rights. It has also been the history of
expanding the potential subjects and areas to which human rights can be applied—
women, children, black people, indigenous people. This expansion characterizes the
modern and contemporary history of human rights. Within this, the very last frontier
was sexuality, sexual orientation, and identity. The first time it appeared at the level of
intergovernmental negotiations was in the 1994 International Conference on Population
and Development in Cairo. The term “sexual rights and reproductive rights” was
drafted, though in the end just “reproductive rights” was retained in the final document.
But long before that, we had been struggling with the idea that sexuality is a domain
of freedom, as well as one where persons must be protected from inequality and abuse.
In the 1960s in the United States, notions of sexual liberation and sexual politics
evolved concurrently with the civil rights movements. In Latin America in the late
1970s and 1980s, a similar trend was witnessed in connection to democratization. The
road was then open to strongly link sexuality and citizenship rights.
The next step would be the transportation of these struggles to human rights regimes
that are not bounded by nation-states. Within that move it is important to underline that
until the 1990s the main approach to human rights on a global scale was largely derived
from the French and US revolutions, which underscored that citizens must be protected
from powerful governments, usually their own. It has taken us two hundred years to
acknowledge that human rights abuses are also perpetrated by other agents, not just
8 in the public sphere but also in the private sphere. Still, the notion that human rights
Global perspectives on sexual rights 171
1111 abuses are carried out by private agents, particularly in the context of families, is not
2 entirely settled upon, either politically or conceptually.
3
4 More specifically, how have sexual rights developed through the United Nations’
5 meetings, conferences and forums of the last twenty years or so?
6 SONIA CORRÊA: The first reference to gender equality and human rights appears in the
7 Universal Declaration of Human Rights, which was developed in 1948. Article 2 states:
8 “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without
9 distinction of any kind, such as race, color, sex, language, religion, political or other
10 opinion, national or social origin, property, birth or other status.” This very clearly
1 spells out that nobody can be discriminated against upon the basis of sex—in this case,
2 “sex” actually refers to gender.
311 However, as recently as the 1993 World Conference on Human Rights in Vienna,
4 the notion of women’s human rights was contested.
5 The term “sexual rights” appeared for the first time in 1994 in a UN intergovernmental
6 document on the Cairo Program of Action at the International Conference on Population
7 and Development. However, “sexual rights” was not yet a part of an agreed text. At the
8 Fourth World Conference on Women in 1995, the Beijing Declaration finally legitimized
9 the notion of women’s human rights in all spheres of life. A definition was adopted of
20 women’s human rights in the realm of sexuality, which would become the icon of sexual
1 rights in current global and national debates on the subject. However, a consensus could
2 not be reached on the issue of discrimination based on sexual orientation. The next step
3 was the 2001 World Conference Against Racism, Racial Discrimination, Xenophobia,
4 and Related Intolerance in Durban, South Africa, where a paragraph on discrimination
5 on the basis of sexual orientation was presented but rejected.
6 The 2003 resolution on human rights and sexual orientation presented by Brazil at
7 a United Nations Human Rights Commission session was the culmination of this
8 process. For the first time a full UN text will explicitly state that sexual orientation is
9 not a justifiable basis for discrimination. If adopted, the resolution would be a critical
30 step for transforming international legislation on the matter. If nothing else, in the
1 current global climate where the voices of Bush and the Vatican on homosexuality gain
2 increasing leverage, the Brazilian Resolution has crucial symbolic value.
3
4 Can you describe the importance of the Beijing World Conference on Women in 1995
5 and Beijing+5 in 2000, as well as other UN conferences, in transforming ideas and
6 legislation around gender and sexual rights?
7 SONIA CORRÊA: The Beijing conference has to be situated in a larger historical frame.
8 It was not the first conference on women; in fact, it was the fourth. It was preceded by
9 Nairobi in 1985, Copenhagen in 1980, Mexico in 1975, as well as by the adoption in
40 1979 of the Convention for the Elimination of all Forms of Discrimination Against
1 Women, not yet ratified by the United States.
2 At the same time, you cannot understand what happened in Beijing and the previous
3 conferences without taking into account what is happening in societies around the
4 world. The outcomes of the conference can not be seen as something floating, abstractly
5 hovering above us. In the last decade, the UN has really opened itself up to listening
6 to civil society, nongovernmental organizations, and advocacy groups. This has been
7 a strategic process to create a new global consensus on relevant issues like women’s
118 rights, human rights, and population.
172 Sonia Corrêa with Cymene Howe
11 The Beijing conference was particularly relevant because it expressed very power-
fully the fact that women’s issues were a subject of public concern and discourse in the
most diverse societies. The diversity of women present in the Beijing Forum, which was
run parallel to the UN conference, was much more evident than in previous conferences.
I was in Nairobi in 1985, and I would say that probably 80 percent of the delegates
were men. Very few delegations, particularly from developing countries had women
heading the delegations. In 1995, 95 percent of the delegates were women and this was
true even of delegations from countries that were openly resistant to notions of gender
equality, like Yemen. Even those countries felt embarrassed to send male delegates,
which tells you a lot about the changes we saw in just ten years’ time.
In terms of content the Beijing Platform for Action was a very ambitious policy
document. We were there not just to talk about specific problems of gender inequal-
1 ity; we were addressing human rights, violence, media, health, armed conflicts, and
market economies. There was also a more clear understanding of how gender systems
and gender inequality are structural dimensions that need to be addressed when you
are talking about development projects such as economic structural adjustment pro-
grams, the labor market, the environment, safe water, housing initiatives, and disease
prevention and reduction.
Each of the UN conferences you have been describing are of course global in scope,
drawing from countries around the world and attempting to come to consensus on what
are often very controversial and pressing issues. But what role does the United States
play, in particular, in these negotiations? Perhaps Beijing provides a good illustration
of the dynamics.
SONIA CORRÊA: Frankly, something very big happened in the 1990s at the global
level. An incredible, visionary, and forward-looking consensus had been reached in
relation to human rights, population, and the environment. The end of the cold war
had created promises, a decline in military expenditures, and the possibility of better
understanding in the global community. The Clinton administration had a very strong
commitment to gender equality and the human rights of women. The US position
was often conservative in regard to economic and security issues. But under the
pressure of US-based activists and of Southern countries, it showed relative flexibility
with respect to economic issues when conflicts between the North (“developed” or
“first” world) and the South (“underdeveloped” or “third” world) that surged at the
conferences, threatened gender equality and women’s human rights.
This changed entirely with the Bush administration. On the most controversial
dimensions of women’s human rights, which relates to reproduction and sexuality, the
Bush administration has been systematically regressive. It is an awkward and seemingly
contradictory discourse because, on the one hand, there is much discussion about women
in political positions of power in Afghanistan and Iraq, or the argument that one of the
objectives for the invasion of Afghanistan was the liberation of women from the Taliban.
At the same time, there has been a lack of support for women’s human rights in practice.
In the UN process anybody can say, “I don’t agree.” You can make reservations,
declarations, or resolutions. But the United States has also bullied countries. They
refer to the amount of money that they are providing. It is very problematic to have a
negotiation under those conditions because many of these countries are extremely
fragile. It’s very hard for a poor country to take a stand when the United States is
8 saying, “If you don’t behave, we’re going to suspend all the money you’re getting.”
Global perspectives on sexual rights 173
1111 The so-called Cairo-friendly or Beijing-friendly countries have been very concerned
2 about a global conference for women in 2005 because the political conditions were
3 very, very risky. Even before the current US administration came to power, the Vatican
4 and Islamic countries resisted the Cairo and Beijing conferences. With that combination
5 of forces—and the possibility that a global conference could destroy the consensus built
6 in 1995—there is a lot of concern.
7
8 If you were to predict some of the issues the UN will face over the next ten years with
9 regards to its sexual rights efforts, what would you say are the key struggles?
10 SONIA CORRÊA: A new backlash, now global, is clearly underway, which is largely
1 generated by fundamentalism in various forms: theocracy in Islamic countries and
2 Pentecostal and radical fringes of the Catholic Church in many other countries. In Latin
311 America, for example, we see a growing emphasis on fundamentalist interpretations,
4 not only in relation to gender among religious forces, but also in other realms as it is
5 the case of ethnic and nationalist based movements. All over the world these regressive
6 forces increasingly zero in on sexuality and gender equality as a primary target. This
7 necessarily reflects on global policy arenas.
8 All of this is taking place at a moment in history when we have extreme inequalities
9 around the world; there are huge numbers of people being integrated into a larger
20 global system, while many others are left outside. Many of the fundamentalist forces
1 are drawing from those on the margins, those who have not been included. Therefore,
2 a prospectively sound human rights agenda—with respect to gender equality and
3 sexuality—must be deeply connected to providing livelihoods. There are groups of
4 women and gays and lesbians who are well integrated into a global market and have
5 access to the global governance complex, to which the UN belongs. In contrast, vast
6 amounts of people—women, gays, lesbians, transvestites, transgender people remain
7 excluded. They are clearly much more vulnerable to gender hatred and sex wars. A
8 major challenge is, then, to connect issues of sexual differences to social and economic
9 dimensions, to think of sexual rights as social and economic rights in order to bring
30 people together around common causes.
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44 Global impact
US sexual health and reproductive
policy
Renée T. White and Cynthia Pope
1 Rose Wanjera was one of the lucky ones. A Kenyan widow in her mid-twenties, Wanjera
was suffering from pregnancy related complications, according to a 2003 New York
Times article. She went to a local clinic funded by Marie Stopes International (MSI).
There, she received help and immediately enrolled in a maternal healthcare program.
Had Wanjera’s problems happened today, she might not have received the care she
needed. MSI, known internationally for their healthcare for the poor, has recently lost
all of its funding from the United States Agency for International Development
(USAID). As a result, MSI Kenya had to close two of their twenty-one clinics, lay off
more than eighty medical professionals, and reduce comprehensive care services offered
in the remaining clinics.
MSI lost USAID funding due to a June 2002 reactivation of the Mexico City Plan,
also known as the Global Gag Rule. The Global Gag Rule no longer allows distribution
of USAID funds to nongovernmental organizations (NGOs) that either provide or
discuss abortion, or if they advocate less restrictive abortion laws in their own countries.
MSI refused to sign the Global Gag Rule.
The challenges of the Global Gag Rule that confront MSI are also faced by other
well-established family planning and comprehensive health NGOs such as the London-
based International Planned Parenthood Association (PPA). In Zambia, PPA has lost
24 percent of its USAID funding and is no longer allowed to share contraceptive supplies
with smaller NGOs. Lesotho, where 25 percent of women live with HIV/AIDS, is one
of twenty-nine developing countries no longer receiving any USAID-supplied condoms.
In Ethiopia, Amare Badada, of the Ethiopian Family Guidance Association, refused to
sign the gag rule as well. According to a 2003 BBC article, since then, one region—
Nazareth—had to close forty-four of their fifty-four clinics. “Under the gag rule, I can
treat a woman who comes bleeding after an illegal abortion but I am not allowed to
warn her of the dangers before she goes.” One of the MSI clinics that is now closed—
Mathare Valley clinic in Nairobi—was the only healthcare resource for approximately
300,000 people.
In each of these situations, US policies have direct and measurable impacts on the
global provision of family planning and family health services—services can make the
difference between life and death. The World Health Organization estimates that every
minute 380 women become pregnant, 190 women face an unplanned or unwanted
pregnancy, 110 women experience a pregnancy-related complication, 40 women have
an unsafe abortion, and one woman dies. A review of policies from the 1960s through
current times shows that as the domestic political pendulum swings on sexual and
8 reproductive rights, so too do US policies on global reproductive health.
US sexual health and reproductive policy 175
1111 Foreign aid for family planning
2
3 The 1960s marked a period of innovative policy and program development in the United
4 States. The United States first allocated foreign assistance for family planning with the
5 Foreign Assistance Act of 1961, which provided funds for research on family planning
6 and the provision of family planning resources. By the 1970s the United States became
7 the major contributor to the United Nations Fund for Population Activities (UNFPA).
8 This fund was to serve three main purposes: to reduce poverty, raise standards of living,
and improve health. The US administration recognized that these three goals were the
9
10 central tenets of a human rights framework.
1 Support for generous international and domestic family planning funding continued
2 through the 1970s, but a shift in the national reproductive rights debate began to be felt
311 internationally. In 1973, the year that abortion was legalized in the United States,
4 Congress passed the Helms Amendment to the Foreign Assistance Act (FAA). The
5 Helms Amendment prohibited the direct use of US foreign assistance for abortion
6 services in nations receiving FAA funding. Thus, by the time Ronald Reagan was elected
7 president in 1980, reproductive health and family planning had been redefined as
8 “abortion services” and public discussion of reproductive health was increasingly cast
9 in moral terms. Since the Reagan administration a series of initiatives have attempted
20 to reinforce the association between family planning, reproductive rights, and abortion.
1 Presidents Reagan and George H.W. Bush represented a sea change in how the United
2 States carries out its role in global reproductive health policy. They broke from previous
3 international policies and human rights-centered approaches. One of the targets was
4 abortion. The Reagan administration did not get domestic support for its anti-abortion
5 stance, so it looked to the international arena to put laws in place.
6 As such, in 1984 Reagan enforced the Global Gag Rule, also known as the Mexico
7 City Policy, which put his abortion rhetoric to action; the Reagan administration would
8 no longer disburse USAID funding to NGOs that either provided or discussed abortion.
9 In 1985 the Kemp Kasten Amendment, which was attached to the Foreign Operations
30 Appropriations Act, stipulated that no federal money would go toward “coercive
1 abortion or involuntary sterilization.” This was a reaction to China’s one-child policy.
2 The US president was the person to determine to which cases this rule applied. When
3 considered together, the Global Gag Rule and the Kemp Kasten Amendment function
4 as anti-abortion policies, not as ones intended to further women’s health or human rights
5 abroad.
6 President Clinton rescinded this Global Gag Rule soon after he assumed office. The
7 Clinton administration assumed a leadership role in the 1994 Cairo International Con-
8 ference on Population and Development (ICPD) and was one of the key actors that
9 drafted the Programme of Action. One of the important conference results was the
40 signing of the 2015 Goal: to provide reproductive and sexual health services for all
1 citizens in the world, thus reducing maternal mortality and HIV prevalence rates.
2 After the Clinton administration’s eight-year international commitment to repro-
3 ductive and human rights, the United States is experiencing a return to a pre-Clinton
4 ideology. In July 2002 Bush repealed $34 million in committed funds to UNFPA
5 (As Francoise Girard notes in Global Implications of Domestic and International
6 Policies on Sexuality [2004], 12 percent of the fund’s annual budget) because it operates
7 in China, which since the 1970s has had a one child per family policy. The State
118 Department said the money would be redirected to family planning programs in thirteen
176 Renée T. White and Cynthia Pope
11 African countries, but it was eventually used for unrelated projects in Afghanistan and
Pakistan.
Ironically, more abortions are likely to result from the current cuts in reproductive
health funds. In the executive summary of Access Denied: US Restrictions on Inter-
national Family Planning, the authors observe that:
When the [Mexico City] policy was previously in effect, however, from 1984 to
1992, there was little evidence that the policy reduced the incidence of abortion, as
women continued to seek clandestine procedures. There is little reason to believe

it will be any more effective this time around. In practice, the policy is likely to have
the opposite effect; it will reduce access to contraception, leading to more unwanted
and high-risk pregnancies, more unsafe abortions, and more maternal illness, injury,
1 and even death.
Family health clinics around the world have been forced to cut services, and many
clinics have been shut down, thus denying citizens access to any sort of medical care,
increasing the “global burden of disease.” According to a 2004 “Issues in Brief ”
circulated by the Guttmacher Institute, this global burden of disease can be calculated
as an annual loss of 250 million years of production due to death or disability resulting
from poor sexual and reproductive health.
A question of human rights

In response to the tenth anniversary of the United State’s commitment to the ICPD, the
current administration has verbally renewed support for the Programme of Action.
However, actions speak louder then words. The Global Gag Rule is still in place and
the $15 billion President’s Emergency Plan for AIDS Relief (PEPFAR) is beginning
to have global impacts. For example, in The War on Choice, Gloria Feldt, president of
Planned Parenthood Federation of America reports that:
Already there are 78,000 deaths from unsafe abortions each year, and the continued
enforcement of the gag rule will only make that number go up. Deaths by AIDS have
increased measurably . . . Under the gag rule, some countries have been unable to
maintain their level of contraceptive supplies and healthcare services, many clinics
have closed, and family planning providers are having more difficulty working with
the governments to coordinate healthcare.
The Global Gag Rule, since reactivation, has resulted in the closing of clinics in
Bangladesh, Ghana, and Kenya. These anti-abortion policies also play into the PEPFAR
policies. Suzanne Goldberg reports in an October 2004 Observer article that the spill-
over effect from the Global Gag Rule casts an ideological shadow on PEPFAR. Instead
of relying on experienced organizations and the Global Fund for AIDS, the first phase
of the funding has been channeled through faith-based organizations that support an
abstinence-only, no-condom agenda to halting the spread of HIV.
In Ethiopia, for example, the Orthodox Church was awarded $5 million to work on
HIV prevention. In Nigeria as well, the bulk of the $5 million in aid will be distributed
8 through primarily Christian faith-based organizations.
US sexual health and reproductive policy 177
1111 In 2006 the administration implemented a requirement that at least one-third of all
2 HIV-prevention funds be devoted to abstinence-only programs. Ironically, Bush has
3 heralded Uganda’s dramatic reduction in rates of HIV transmission. However, this
4 reduction was not due to abstinence but rather due to the availability of condoms and
5 the promotion of monogamy. “People are frustrated,” says Adrienne Germain, president
6 of the International Women’s Health Coalition. “The legislators who are in control right
7 now firmly believe that everyone can and should simply abstain until marriage and have
8 only one partner in marriage ever in life, and that is totally contrary to reality.”
9 Given the tenth-year anniversary and the continuation of PEPFAR global funding,
10 it is imperative to revisit the issue of reproductive and sexual health in terms of human
1 rights. Since 1965 US organizations have generally been recognized as leaders in the
2 family planning field, so one must ask whether US global health policy will shape how
311 other nations prioritize their international health aid.
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45 Abstinence goes global
The United States, the right wing,
and human rights
Cynthia Rothschild
1 A range of organizations has pointed out that the Bush administration has made vital
public health decisions based, not on scientifically proven fact, but on ideology. Since
this article first appeared in 2003, the Bush administration has continued to promote,
and filter resources to, abstinence and abstinence-only-until-marriage programs.
Whether through HIV prevention or anti-violence programs, funds have been directed
to discriminatory, anti-sex and ideologically driven efforts with significant human rights
and public health implications, many of which have direct impact on women. Of
particular concern is the President’s Emergency Plan for AIDS Relief (PEPFAR), which
continues to channel a significant proportion of global HIV prevention funds to
abstinence-only programs. From AIDS organizations to the American Civil Liberties
Union (ACLU), groups in the United States have argued that abstinence-only programs
constitute a lethal form of censorship by withholding information on methods known
to prevent HIV and STI (sexually transmitted infection) transmission.
Since its earliest days the administration has promoted abstinence-only-until-marriage
programs as its preferred means of HIV prevention. A like-minded Congress approved
over $120 million for domestic abstinence programs in its fiscal year 2003 budget,
$50 million of which was connected to the US Welfare Reform Act and to pro-
grams that teach that a “mutually faithful monogamous relationship in the context of
marriage is the expected standard of human sexual activity.” These federally funded
initiatives limit all discussion of contraceptives—and condoms—to a focus on their
failure rates.
Most organizations concentrate on US domestic concerns about abstinence-only
education and funding. However, it is also vital to consider the global arena, where the
US administration exports its sectarian ideology and morality, primarily through
restrictions on foreign assistance funds and the policy positions of US delegations at the
United Nations. Both domestically and internationally, scientifically sound argu-
ments could be strengthened by use of a human rights perspective, namely one that rests
on the ideas enshrined in the Universal Declaration of Human Rights and other
internationally agreed instruments that all people have the right to information, to
education, to enjoy the benefits of scientific progress, to be free from discrimination, to
freedom of expression and to enjoy the highest attainable standard of health. Taken
together, these and other standards form the basis of international human rights law. The
denial of these rights, and others, in relation to public health threatens each person’s right
to life and constitutes an infringement of international law for which governments,
including the current US administration, must be held accountable.
8
Abstinence goes global 179
1111 Human rights organizations are especially well positioned to address abstinence-only
2 programs as a rights issue. In doing so they could hold governments accountable for
3 human rights violations inherent in the implementation of many abstinence-only
4 programs, which are enforced through discriminatory and moralistic restrictions on
5 what can and cannot be taught or discussed. They could build coalitions between
6 domestic and international groups concerned with public health and discrimination.
7 They could also capitalize on the opportunity to develop their own advocacy positions
8 on gender and health.
9 The people who have the most to gain from collaborative work grounded in human
10 rights analysis are those who need and want information but are denied accurate,
1 scientifically proven information about disease prevention and transmission, condom
2 use, and contraception. While false and misleading information about health jeopardizes
311 the well-being of all people, certain groups are at particular risk when accurate
4 information is censored, altered, or withheld. These include women and young people
5 (particularly girls) and people who are already marginalized, including sex workers,
6 lesbian, gay, bisexual and transgender people, and people who inject drugs.
7
8
US abstinence agenda: policy without proof
9
20 Fictional claims, manipulation of information, and imposition of gag rules are emerging
1 as three consistent tools in the administration’s implementation of its domestic and
2 international public health agenda. This is especially true where sexuality and repro-
3 ductive rights are concerned. The Bush administration’s First Secretary of Health and
4 Human Services, who was also the chair of the Global Fund to Fight AIDS, Tuber-
5 culosis and Malaria, justified increased domestic spending on abstinence-only programs
6 knowing that there was no credible proof that they were effective. At the time, these
7 posts were held by Tommy G. Thompson who once said: “Let’s try them out and see
8 if we can’t get it to work.” The policy, in effect, denies scientifically proven methods
9 of reducing HIV transmission in order to promote an idea that is popular with a core
30 of conservative Republican voters.
1 In this administration, the desire to “make abstinence work” trumps the human right
2 to life. The consequences of these skewed priorities are deadly, especially as young
3 people constitute one of the groups with the most rapidly rising rates of HIV infection.
4 US polices are, in effect, eliminating one of the only tools available that can save
5 people’s lives: information.
6 In Congress, right-wing policy makers such as Rep. Chris Smith (R-NJ) and Rep.
7 Joseph Pitts (R-PA) have worked to ensure that programs with no medically proven
8 effectiveness have been funded. Political pressure also has been used to de-fund family
9 planning programs (such as the United Nations Family Planning Association). HIV
40 prevention and other sexuality education programs have been audited when their work
1 was seen to stray from the abstinence-only line. While there is a growing list of
2 organizations that have been targeted, two examples are worth noting: San Francisco’s
3 Stop AIDS program faced over a year of continuous federal reviews, and Advocates for
4 Youth endured three audits in one year.
5 One of the more egregious examples of Congressional efforts to promote abstinence-
6 only ideology in the international arena is directly pegged to fighting the AIDS
7 pandemic. Even though the US administration called for $15 billion to fight AIDS in
118 Africa and the Caribbean, the Congressional budget appropriations process shows this
180 Cynthia Rothschild
11 commitment to be subject to conservative ideological constraints. Congress earmarked
one-third of prevention funds to programs that promote abstinence-only ideology, and
reduced funding for comprehensive prevention efforts that have shown positive results.
Members of Congress and the administration, in part, justify this allocation of funds
by touting the success of abstinence programs in Uganda, even though public health
officials in Uganda and elsewhere question the validity of those claims. The Lancet
medical journal reported on July 6, 2002 that increased condom use also contributed to
the decline in prevalence rates and that conclusions crediting only the abstinence portion
of Uganda’s AIDS-prevention programs are based on scientifically unsound data

collection and manipulation of numbers.
Policies from Washington are fundamentally flawed because they ignore the realities
of millions of people, particularly women and girls, all over the globe. Abstinence is
1 meaningless for many women and girls who have limited or no power to negotiate
condom use or to resist violence by male partners or strangers. There are 82 million
young women in developing countries currently between the ages of ten and seventeen
who will marry before their eighteenth birthdays. It is foolish to insist that these young
women “just say no” to sex demanded by their older and more powerful husbands. In
many scenarios it is the husbands who have the power to abstain; too often, they don’t
and their young wives can’t.
The United States and abstinence at the United Nations

Many of the same groups that promote the most conservative and restrictive policies
on sexual and reproductive rights domestically are appearing on the global scene, and
in recent UN meetings related to health, children, and population issues. In these
settings US delegations have attempted to insert abstinence in their negotiations
on international agreements and have protested if abstinence provisions were removed.
In many of these meetings, the US administration worked directly with advisers from
right-wing organizations such as the Family Research Council (FRC), Focus on the
Family (FoF), and Concerned Women for America (CWA). Whether in relation to
abstinence specifically, or reproductive rights more generally, US delegation statements
and positions reflect a swing to an extremist ideology.
At the UN General Assembly Special Session on Children in 2002, the US delega-
tion, which included FRC and CWA, tried to block international consensus on compre-
hensive sexuality education and related services for young people. In an official written
explanation of its position, the delegation emphasized its “commitment to programs that
address . . . the need to stress the practices of abstinence, of delaying sexual initiation,
monogamy, fidelity and partner reduction” to prevent HIV infection. In its positions,
the US delegation supported myopic and moralistic domestic policies that sought to
position abstinence as the only worthwhile method of reducing transmission.
In 2002, over thirty Asian countries voted against conservative US positions at an
important regional meeting on population and development in Bangkok. At the end of
the meeting, the entirely isolated US delegation issued an official statement on the final
agreed document. The statement repeats the language from the earlier meeting on
children and adds that the “United States made every effort to insert language in the
document reaffirming the importance of abstinence” and “remains disappointed” that
the assertion that “abstinence is the healthiest choice for unmarried adolescents” was
8 deleted from the final text.
Abstinence goes global 181
1111 During 2004 and 2005, in regional and global meetings related to the tenth anni-
2 versaries of the International Conference on Population and Development (“the Cairo
3 conference”) and the Fourth World Conference on Women (“the Beijing conference”),
4 US delegations persistently advocated for inclusion of references to abstinence in
5 documents under negotiation by governments. At many of these meetings, the US
6 delegations issued official “statements of explanation,” which elaborated on the US
7 government’s commitment to abstinence and on the limitations of their interpretations
8 of references to abortion.
9
10
Resistance
1
2 Disinformation and ideologically driven funding are beginning to be challenged.
311 Feminist and reproductive rights organizations, such as Catholics for a Free Choice,
4 the Center for Health and Gender Equity, Development Alternatives with Women for
5 a New Era, and the International Women’s Health Coalition, are working to counter
6 extremist ideologues at the United Nations and in other global policy fora. Progressive
7 coalitions of nongovernmental organizations are cooperating with ally delegations here
8 and overseas to share accurate information about comprehensive sexuality education
9 and to strengthen the ability to refute abstinence-only messages.
20 There is clear progress domestically as well. Human Rights Watch compiled a bold
1 and first-of-its-kind report critiquing abstinence-only programs in Texas. Rep. Henry
2 Waxman (D-CA) recently issued a report criticizing the Bush administration’s persist-
3 ent misuse and manipulation of science. Whistleblowers persist within the National
4 Institute of Health and the Centers for Disease Control, despite being pressured to alter
5 or suppress scientifically accurate information. And AIDS service organizations have
6 begun to decry the prioritization of abstinence in US global AIDS funding.
7 The right wing has been very effective at melding its domestic and global strategies.
8 Progressive organizations and social movements must do the same, and with urgency.
9 Using a human rights lens to critique abstinence-only programs and the manipulation
30 of valid scientific data would go a long way in fostering effective coalitions. Coalitions
1 of human rights organizations, and sexual and reproductive health and rights
2 organizations, must increasingly take their fight to global and UN levels to protect gains
3 already won.
4 Organizations working in domestic and international arenas would do well to build
5 on one another’s analyses and work together to challenge the current administration’s
6 “make abstinence work” philosophy and to expose its strong links with conservative
7 extremist advisors. We must do this by deploying a variety of rights-based arguments
8 and by making a renewed and passionate commitment to linking the domestic with the
9 global.
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46 Sex work in contemporary
Vietnam
Foreign plague or homegrown problem?
Christophe Robert
1 Teenage Vietnamese girls in high heels and short skirts crowd around sunburned,
sweating, middle-aged white men in a bar in central Saigon. It’s hot and dark outside;
inside, the music is loud, the beer cold. Young women smile and giggle, teasing the men
in broken English. They stand in the doorways of bars and hail the foreign tourists who
pass by in the street.
The scene is familiar, too much so, perhaps. This type of Asian prostitution is
immediately recognizable. It forms part of the common stock of images inherited from
Hollywood films and from the Vietnam War, and is reminiscent of representations and
practices of prostitution in other cities in Southeast Asia, from Thailand to the
Philippines. And yet this image may say more about the fantasies of Western journalists
than about the realities of prostitution since the “open door” period of the 1990s, when
the Vietnamese Communist Party instituted market-oriented reforms. Anthropological
research, such as the project I conducted in Ho Chi Minh City (still commonly referred
to as Saigon)—which includes interviews and discussions with prostitutes, journalists,
civil servants, and members of various nongovernmental organizations involved in
HIV/AIDS prevention and care—can provide a more realistic picture of prostitution and
social problems in Vietnam.
Statistics on the extent of prostitution in Vietnam are unreliable, varying from around
60,000 to over 200,000 female prostitutes. Police and security agencies favor the latter,
unrealistically high estimates, in order to support their repressive approaches to the
problem. State agencies and organizations use unreliable and often fraudulent data in
the war of words and turf battles to assert control over prostitution. In addition,
Vietnamese state-controlled media have promoted the image of prostitutes catering
primarily to foreign men in an attempt to account for the imagined perils of the market
economy, with HIV/AIDS as the new foreign-born plague. In the 1990s newspapers
started featuring moralizing stories about greedy young female prostitutes in new
foreign-tourist neighborhoods, with titillating titles such as “‘Sentimental Services’ in
the Western Backpacker District” (Phu Nu [Woman], Sunday edition, November 6,
2005, p. 6). Photographs are an important aspect of these stories. They show young
women dressed provocatively and made up in ways that seem foreign to the majority
of Vietnamese who have no access to these new tourist neighborhoods. The official
response of the government is ideological but vague, as evidenced from Directive 14-
CT (1993), which states, “In our country today, prostitution is growing, with negative
consequences for the cultural life of our society, for social order and peace among our
people, and polluting the moral traditions and beautiful customs of our nation.”
8 Similarly, government decrees 05/CP, 87/CP, and 88/CP (1996) state that prostitution
Sex work in contemporary Vietnam 183
1111 combines three kinds of danger: a threat to public health, a source of crime and disorder,
2 and cultural pollution and moral degeneration.
3 This representation hides important parts of the puzzle of social problems in Vietnam
4 in the 1990s. The very visible sex trade with white foreigners masks the existence of
5 much less visible, but more prevalent, local forms of prostitution between Vietnamese,
6 as well as cases of HIV/AIDS transmission that have nothing to do with foreigners.
7 Linking prostitution to the arrival of foreign male tourists, thirsty for alcohol and hungry
8 for drugs and sex, takes the focus off the domestic sex trade sector in Vietnam under
9 socialism.
10 It is true that establishments catering to a foreign male clientele—with English-only
1 names such as Apocalypse Now, Gossip, Hazard—sprang up in Vietnamese cities in
2 the 1990s. They are a reminder of “R&R” (“rest and relaxation”) during the Vietnam
311 War when American soldiers heavily patronized Vietnamese prostitutes. But, now as
4 then, these establishments open and remain open only thanks to formal authorizations
5 and informal arrangements, such as bribes and favors to the local police. When pressed
6 by journalists, government officials answer that the situation is “complex,” and promise
7 better coordination between various police agencies. An interview with Nguyen Ngoc
8 Thach, Head of the Ho Chi Minh City Office of the Campaign against Social Evils in
9 Phu Nu (Woman) magazine (November 6, 2005) exemplifies this position. The
20 Vietnamese media criticizes these establishments for their sleaziness, and rightly so.
1 They also criticize young female prostitutes for their greed and laziness, and for violating
2
ideals of the soft-spoken, obedient, hardworking Vietnamese woman. For example, a
3
typical headline from the hugely popular tabloid newspaper Public Security (published
4
by the Public Security of Ho Chi Minh City) reads, “Committing crimes stems from an
5
unwholesome life” (May 18, 2000, p. 26). The article blames prostitutes and drug addicts
6
7 for fostering criminality.
8 This type of criticism assigns blame for social problems on scapegoat groups, as
9 opposed to treating prostitution or drug use as symptoms of larger social dysfunctions,
30 such as poverty. We can set up the problem differently and note that the development
1 of the market economy in Vietnam in the 1990s has created tremendous opportunities,
2 while fostering economic inequalities. Aren’t young female prostitutes, then, showing
3 entrepreneurial spirit? Are they not being dutiful daughters, bowing down to the oft-
4 asserted ideal of filial piety and feminine obedience? Aren’t young women from the
5 countryside being recruited to work as karaoke hostesses or waitresses, while their
6 families know that their real occupation is prostitution and benefit from the remittances
7 the daughters send home every month?
8
9 Male urges and women’s work
40
1 Foreign tourism did not single handedly give rise to prostitution in Vietnam today. A
2 commercial sex sector catering to foreign tourists does exist. Yet explaining prostitution
3 this way obscures broader gender issues and socioeconomic problems.
4 A new class of wealthy Vietnamese businessmen emerged in the 1990s. Thanks to
5 their connections with government officials, these men received large contracts in the
6 transition from a state-run to a more liberalized economy. They display their status and
7 wealth by gathering in expensive restaurants and karaoke bars and by patronizing
118 prostitutes. The common practice of inviting one’s clients or bosses to clinch a deal or
184 Christophe Robert
11 curry favor usually includes a meeting with hostesses who also provide sexual services.
At the other end of the economic scale, a lot of poor, uneducated, younger men have
not reaped the benefits of economic development. In interviews they say that they are
now too poor to be attractive marriage partners so they turn to prostitutes to relieve
“sexual urges.” In Vietnam, these male urges are assumed to be irresistible and to require
discharge; common wisdom, then, reinforces the normalization of prostitution. Men
from various socioeconomic classes use the commodified bodies of prostitutes to relieve
their sexual urges. Female prostitutes stroke male egos, buttress insecure masculinities,
and act as status symbols for the wealthy and powerful.

Shifting focus away from foreign men as the cause of social problems brings to light
Vietnamese cultural patterns that may be intertwined with sex work. Sex work in
Vietnam is far from new and far from radically threatening the social order, contrary to
1 what media representations and government officials assert. Perhaps, then, sex work is
a continuation, now in the market economy, of long-standing forms of female work
in the family.
Notions of womanhood in Vietnam idealize a female who has little self-interest: a
woman finds true realization of who she is only through marriage and through giving
birth to children, preferably sons who will continue the family line. Her fulfillment,
economically, socially, and sexually, is not the question. The question instead is to
insure that through a web of obligations and demands on her body and mind she submits
willingly to these demands. This is the primary goal of education in the family and in
state institutions, which often rely on strategically redefined Confucian values. Yet, if
we study the history of Vietnam, we see that far from being a cultural bedrock of
Vietnamese society, “Confucianism,” with its emphasis on hierarchy and duty, has been
used to assert conservative and repressive agendas and stifle social dissent, particularly
from subjugated groups, such as the rural poor, women, and youth. Anthropology, the
practice of encounters and interviews with actual people, enables us to question current
assertions of conservative leaders that “Confucian values” or even “traditional
Vietnamese culture” ought to dictate the proper behavior of women.
By publicizing the question of prostitution the Vietnamese media highlight the
contradictions in women’s roles in society. The image of deviant young women
cavorting with foreign, white men is convenient. It helps avoid the more complicated
questions of who benefits from the sex work of these young women and from the work
of women throughout Vietnamese society.
In interviews Vietnamese women complain that their contributions to family life are
not recognized, since their husbands or their families take them for granted. They are
expected to perform domestic chores and to contribute to the household budget by
working outside the home. And yet, women say, most men bristle when they are asked
to share some of the domestic chores. Women complain that their husbands routinely
patronize prostitutes. Notions that this is “what men do” contribute further to the
normalization of prostitution. In this context, why assume that prostitution strictly results
from the evils of contact with foreigners and the market economy?
Following what Vietnamese women themselves say, a better way to pose the question
would be to argue that the prevalence of commercial sex work stems from tensions in
gender roles in Vietnam today. A good place to start would be to examine Vietnamese
women’s daily lives and note how notions of marriage, sexuality, child rearing,
8 education, even the very notion of the family are changing much more rapidly than
Sex work in contemporary Vietnam 185
1111 political or media discourses about them. This shift helps explain why the official
2 demonization of female prostitutes is so popular in Vietnam today: leaders are trying
3 to reassert some sense of control over social realities that escape their grasp, in particular
4 over the beginnings of the emancipation of women who are becoming educated and
5 joining the workforce in ever larger numbers.
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47 The moral economy of sex
in Russia
Jakob Rigi
1 In the global market for sex, some of the most valuable women are from Russia.
As with other post-Socialist countries, when the Soviet Union collapsed, sex became
a commodity and thousands if not millions of women—and men—were eager to trade.
Several dynamics led to this growth. Reforms that replaced communism with capitalism,
coupled with a scarcity of well-paying jobs, forced many women to get involved in sex
work in order to survive. The dismantling of the welfare state undermined the service
sector (mostly healthcare and education), which was the primary employer of women.
These traditionally female jobs were devalued and salaries for them decreased. Many
women lost their jobs all together.
At the same time, these neo-liberal reforms created a small class of wealthy
capitalists. For many women, the only access to an expanding consumerist culture was
through rich men, either through kinship or through sexual relationship. If not the
daughter of a capitalist, women were the wives, lovers, or prostitutes of these men.
Advertisements and pornography propagated new idealized images of sexy female
bodies and people began questioning the former sexual morality, which focused on
women as mothers and workers. This was the beginning of a radical and commercial-
ized sexual revolution in the former Soviet bloc. The consumption of women’s bodies
as sexualized commodities became part of capitalist’s masculine and social identities.
Still, Russians have very diverse moral attitudes toward sex work. Rural populations
and the older generation tend to find sex work or prostitution reprehensible. Prior to
the Soviet Era women’s identity in official discourses was based on their contribution
as mothers to the family and as workers to society. Although prostitution existed
marginally, the sale of women’s bodies was considered wrong. Men’s identity was
determined mostly through their social position and the ways their work was useful to
society as a whole. In the family men were considered the primary breadwinners.
The younger generation, though, tends not to pass moral judgment on sex work. The
following discussion, which took place in St Petersburg in the summer of 2003 with
three Ph.D. students, illustrates this attitude. These young people were blasé about sex
work and found nothing wrong with prostitution, reflecting their embrace of neo-liberal
ideology. In this ideology everything is for sale, including the body and soul. The
conversation was drawn from a larger anthropological research project, which considers
the radical changes related to sexuality that occurred in Russia since the end of the
Soviet era.
VLADIMIR: Our society with regard to sexuality is a very cunning society. It is erotic
8 but also hierarchical. No one in this city can live without money. Telephone, gas,
The moral economy of sex in Russia 187
1111 electricity, and all other goods and services—without money these are not available.
2 If there is money you can keep the city going on. In the sexual sphere it is the same:
3 without money you cannot do anything. Even people who think their relations are
4 not based on money rely on money for their relations.
5 JAKOB: Sex is the exchange of two bodies. Why must one pay for it?
6 IRENA: Well if I have sex with someone, it means that I am giving something, and so
7 I must get something in exchange. In this way it is a kind of exchange. In exchange
8 equivalents are exchanged. If I give you sex, you must give me money. Anyway,
9 in order to have good sex, you need to have good material conditions.
10 VLADIMIR: You cannot do it on the street; you need to do it at home.
1 IRENA: You need a good apartment and clean sheets.
2 JULIA: For me to be able to do it, I need to drink good wine and eat good food.
311 JAKOB: But this is not exactly what I mean by commoditization of sexuality.
4 VLADIMIR: Well the obvious form is when people hire prostitutes. But there are other
5 forms. Say a woman goes to a shop and there she meets a man who invites her to a
6 good restaurant. There, he buys her good wine and good food and gets her expensive
7 presents. She will be very happy that someone has paid so much attention to her.
8 And she may sleep with him.
9 JAKOB: But other people have told me that this is a Russian tradition, for a man to
20 “wine and dine” a woman and then expect sex in exchange.
1
VLADIMIR: People buy sex for themselves but then call it the Russian tradition. Others
2
are more honest; they go to sex shops and buy pornography, rather than buying
3
women. But both buy sex. Prostitution is a financial operation.
4
IRENA: There is nothing horrible about it. If you need bread, you go to the shop and
5
6 buy it. If you need sex, you go to the street and buy it.
JAKOB: I think that there is a difference between sex that is non-commercial and the
7
8 buying of a woman’s body as a commodity. In sex, both partners are actively
9 engaged. In prostitution one side is active, while the prostitute is reduced to an
30 object, not unlike the example you give of bread . . .
1 JULIA: That is bullshit. You have it completely wrong. What is an object and what is
2 objectification? If I am on the street and working [as a prostitute] a man will ask
3 me to go home with him and I will. He will behave like a gentleman. He will gently
4 touch my breasts, he will caress me, and he will tell me, “If you don’t want to go
5 home with me, we can meet each other another time and befriend each other, and
6 then we will do it.”
7 JAKOB: But maybe what you are talking about is an exception. I interviewed prostitutes
8 in Kazakhstan. They told me that for them there was essentially no difference
9 between their clients and the condoms they used—that is they were both just objects
40 that were part of the business, not really human beings. The only difference is that
1 the clients paid money.
2 IRENA: We are talking about different types of prostitutes. When I go to the street I am
3 ready to sell my body, but I can sell it in different ways. If I don’t like the client,
4 then I am an object. If I like him, then I am not. I can have emotions and pleasure.
5 JULIA: As long as there is emotion, there is no objectification. I have a friend who is a
6 prostitute. She speaks with clients and chooses those she likes and rejects the others.
7 She enjoys having sex with them but may receive money as well. You can work as
118 a librarian in different ways; you can also fuck men in different ways.
188 Jakob Rigi
11 VLADIMIR: Our prostitutes are different. Sometimes they don’t take money from men
they like. I have a friend who was a pimp in a brothel in Germany, and he told me
that they had difficulty in convincing some Russian girls to take money from their
favorite clients. Here our prostitutes may not charge a client whom they like. In
Germany this is not possible because the pimps will not allow it. Marriage is like
prostitution. A man and a woman marry and the husband supports the wife; it is a
contract.
JAKOB: Will you practice prostitution?
IRENA: Of course I would if it were safe. Yes, if I had a good figure, and if I had a good
pimp who could protect me. Some men are maniacs.
JULIA: You have a strange image of prostitution. I don’t want to sleep with a man who
has no money. Nobody will marry someone who doesn’t have a car and a good
1 salary and cannot provide her with a good material life. What is the difference?
Prostitution is cheaper.
JAKOB: How do people relate morally to prostitution?
IRENA: They think it is okay.
VLADIMIR: The prostitutes are spiritual.
JAKOB: What is the social morality on this?
IRENA: There is not a common morality; people have different opinions.
VLADIMIR: Some people may publicly denounce prostitution, but in private they are
jealous of prostitutes. Many women who cannot engage in prostitution dream of
doing so.
IRENA: If her occupation is formally prostitution, people do not condemn it.
VLADIMIR: But if she does it hypocritically, people may condemn it.
JAKOB: If you were to fall in love with a girl who is a prostitute, would you marry her?
VLADIMIR : Yes, but I will try to convince her to change her job.
JAKOB: Why? If I love an accountant I will not ask her to change her job.
VLADIMIR: It would be difficult with sexual relations.
JAKOB: Why? Do you mean morally?
VLADIMIR: Not morally but practically. There is no morality here. My previous wife
was a prostitute.
JAKOB: Are you kidding?
VLADIMIR: Of course not. It is better. If a prostitute chooses you as her husband, it
means that you are the greatest man because she has experienced so many different
men.
JAKOB: You said something about soderzhanka [a woman who is a lover of a well off
man and gets financial support from him; or a “kept woman”].
IRENA: Well any woman is soderzhanka. A woman who does not get money is ready
to go to a good niche (Khorshia Nisha) in order to earn money. It is really a good
thing. A prostitute is in a much better situation than a soderzhanka. A soderzhanka
is living like a slave, waiting for the man and always looking to his hands for money,
while the prostitute has her own money and decides about her own life and time.
Soderzhanka is materially and emotionally dependent on her sponsor, insecure.
She suffers a lot while the prostitute does not suffer. She does not wait for the man
to appear at the door, to be available at his will and always at his service.
JAKOB: Why, then, are older people against prostitution?
IRENA: These old people are the children of Komsomol [the communist party’s youth
8 organization in the USSR] and their supposedly Orthodox attitudes come from
The moral economy of sex in Russia 189
1111 Komsomol, not from the Orthodox Church. Anti-prostitution morality really comes
2 from the Soviet era.
3
4 The attitudes reflected by Vladimir, Julia, and Irena about sex work in Russia are
5 widespread among youth in St Petersburg. For them, sex work is similar to any other
6 kind of work and, for many in the younger generation, it should be recognized as such
7 rather than stigmatized. However, we also find that other perspectives, from the older
8 generation as well as young people, consider prostitution an immoral practice and they
9 patently condemn it. The growth of prostitution, coupled with these contradictory moral
10 values about it are symptoms of wide-reaching changes in Russia that can be called
1 “post-Soviet capitalism.” In this form of capitalism, many aspects of life such as
2 education, knowledge, and sexuality, which were previously outside the purview of a
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48 Nicaragua’s changing erotiscapes
Hot bed of cold war takes on sexual
rights
Cymene Howe
1 In the swelter of a June afternoon, Carlos* and I sat together drinking sweet coffee
in front of his sister’s pink house in a working-class neighborhood in Managua,
Nicaragua’s capital. As part of my anthropological research on sexual and gender
rights in contemporary Nicaragua, Carlos and I were meeting to discuss his early
days of activism for sexual rights in Nicaragua in the 1980s. He explained:
We went to the media, we went to the radio and the TV and we sat down and we
said, “we are homosexuals, we are lesbians and we want you to respect our rights.
That you respect our human rights. We are all equal to whoever. We are good kids,
we are good fathers, we are good mothers, we are good neighbors and we are good
workers. Equal. There are bad ones too, like everyone. But we are humans and here
we are.”
Carlos’s comment may seem common enough from the perspective of lesbian and
gay rights movements in the United States, but in Nicaragua the remark is striking.
When Carlos began his activist work, the revolutionary regime of the Sandinistas held
power and while the socialist-inspired agenda of the Sandinistas made wide reaching
changes in Nicaragua’s distribution of wealth, including increasing education and
health services for the impoverished masses, the government’s reforms focused on the
liberation of “the people” as whole. That often meant sidestepping the specific concerns
of sexual minorities and women. The Sandinistas did not practice the heavy-handed
persecution of homosexual men and women as had been the case in Cuba, but neither
were sexual rights part of the Sandinistas’ social agenda.
Currently, Nicaragua is the second poorest country in the Western Hemisphere. In
a place where whole sectors of the population are victims of what international
development experts call “extreme poverty,” social activism takes on a degree of
urgency. By necessity, scarce human and material resources must be channeled into
effective campaigns and there is a delicate balance that must be struck between
economic, social, and human rights. Sexual rights advocacy in Nicaragua must have
broad transformative potential, as activists aim to reconfigure cultural meanings
regarding sexual values and behaviors. But Nicaragua, partly because of its revolu-
tionary experience, is a place quite familiar with social change.
Since the end of the revolutionary era in 1990, the Nicaraguan government has made
the country’s anti-sodomy law (Article 204) more virulent with increased prison

Nicaragua’s changing erotiscapes 191
1111 sentences. International human rights organizations have dubbed the law “the most
2 repressive in all of Latin America.” Article 204 indicts not only men who practice
3 homosexual acts, but women as well, making it unusual among anti-sodomy legisla-
4 tion around the world. While the law is not widely enforced, it threatens not only
5 those who participate in same sex sexual behavior, but also those who “promote or
6 propagandize homosexuality”—a category that could include newspaper reporters,
7 therapists, and activists. Sexual and gender rights advocates and nongovernmental
8 organizations (NGOs) around the country have protested the regressive legislation,
9 asserting its unconstitutionality and receiving broad support from international

10 advocacy organizations.
1 Despite Article 204, an annual “sexuality free from prejudice” (una sexualidad libre
2 de prejuicios) celebration is held every June in cities around Nicaragua. The events
311 include film screenings (such as Fresa y Chocolate, Boys Don’t Cry, Ma Vie en Rose),
4 research presentations, talks by experts in the field of sexuality, discussion groups, radio
5 programs and not surprisingly, a great final party. During the rest of the year transvestic
6 beauty pageants are regular fare at the discos gay in Managua, and local NGOs host rap
7 groups about lesbian and gay identity and HIV prevention. These are some of the ways
8 in which gender and sexuality activists, working together on what they see as related
9 vectors of inequality, are attempting to craft interventions for social justice in what
20 many described as a “very socially conservative” and “hostile” environment. Com-
1 munity members and organizations are attempting to change an ethos in Nicaragua that
2 makes lesbians largely invisible, places hombres efeminados (effeminate men) at the
3 center of derision, and in the most extreme cases, mandates up to four years in prison.
4
5
What does it mean to be “lesbiana” or “gay”, “cochóna” or
6
“cochón” in Nicaragua?
7
8 In the past, Nicaraguans, like many in Latin America, have not rigidly separated male
9 homosexuality from male heterosexuality; neither did they designate a “sexual identity”
30 based on homoerotic behavior. Rather, cultural assumptions have focused on men’s
1 role—as either a “passive” or “active” partner in the sex act. In other words, it is not
2 whether a man had sex with another man, but how. Men were stigmatized as a cochón
3 (loosely translated as “fag”) based upon the presumed role played in homoerotic
4 encounters. In the past cochones never accrued the respect that the putatively “real men”
5 who had insertive sex with them did, and they were the target of burla, or mockery—
6 often because of their failure to conform to gender roles.
7 Unfortunately, women’s same sex sexuality has been largely ignored in studies of
8 sexuality in Nicaragua, leaving the question of how women conceive of their same
9 sex relationships and desires largely unanswered. What is clear, however, is that
40 women who are considered “too masculine” (“marimacha” or “cochóna” [dyke]) face
1 much more stigma than do feminine appearing women who may also have affective
2 and sexual relationships with other women.
3 Now in Nicaragua a new era appears to be in the making. The categories of “homo-
4 sexual,” “gay,” and “lesbiana” are becoming more pervasive particularly in Nicaragua’s
5 urban centers. Consequently, many men and women are identifying with, while at the
6 same time being stigmatized by, these terms. These discursive changes and the
7 emergence of sexual identities in Nicaragua mirror transformations globally, as cities
118 in most countries can now claim organizations or social movements that advocate for
192 Cymene Howe
11 lesbian and gay rights. Concepts about sexual rights and a kind of universally
recognizable homosexual subject now circulate on the world stage.
However, as identity politics in the United States have demonstrated, there are many
ways in which identities operate: sometimes to the benefit of self-constituted minority
groups and sometimes to the detriment of those who are accused of asserting “special
privileges” or rights. The case is likewise complex in Nicaragua. Adding to this com-
plexity is the question of whether categories such as “lesbian” and “gay” are well
suited to the Nicaraguan context; these identity monikers have been, at various times,
criticized as “foreign imports” from Europe and the United States. Given Nicaragua’s
history of both English and Spanish colonialism and North American military and
economic interventions, these critiques have teeth. A number of women and men I
interviewed during my research felt both empowered by these new identities and at the
1 same time reported an increase in violent attacks against them because of their
perceived status as “homosexual ” or “lesbiana.” Where hate crimes against non-
heterosexual people were rare or non-existent in the past, they appear to be on the
increase at the same time that new sexual identities are creating greater visibility for
same-sex attracted people in Nicaragua.
Telenovelas and the entertainment politics of sexuality

Conveying particular images and narratives on television has become increasingly
important to Nicaraguan activists hoping to create a greater range of cultural models
around gender and sexuality. El Sexto Sentido (the Sixth Sense), a television show in
Nicaragua, produced by a local feminist NGO, quickly became the most popular TV
show when it began in 2001. According to poll research, 70 percent of Nicaraguan
viewers were tuned in to Sexto Sentido every Sunday afternoon. Part soap opera, part
sitcom, Sexto focuses on the lives of three young women and three young men. Funding
proposals to USAID (United States Aid for International Development) hailed the show
as a Nicaraguan version of the US-produced sitcom Friends. While the show’s format
may have a US legacy, during interviews people unanimously agreed, “We love the
show because it is pura Nicaragüense.” That is, it is “really Nicaraguan,” in comparison
to the usual TV programming from Mexico, Colombia, Brazil, and the United States.
Shot on location with small digital cameras, and using colloquial expressions and jokes
from around Nicaragua, the show is an intimately local production.
One of the show’s producers, Iliana*, described the program as “pro-social enter-
tainment TV,” meant for Nicaraguan youth and their families. Sexto is a didactic show
but definitely entertaining. It addresses reproductive health, gender and family vio-
lence, sexism, racism, prejudice against disabled individuals, negative stereotyping of
rural peoples, and heterosexismo (heterosexism). The show features gay and lesbian
characters and each episode focuses on the dynamics around romance, acceptance,
and friendship—all of which are meant to instigate conversations on Nicaraguan street
corners and family’s living rooms. The show itself is a vehicle for stories out of which
people spin more stories, providing a place for reflection and unfolding discussions
around tolerance, identity, sexuality, desire, and behavior. Given the controversial
topics, including abortion (illegal in Nicaragua), unintended pregnancies, and homo-
sexuality—there is plenty for families and youth to talk about.
As an outreach device, the TV show is proving itself effective locally. If only a
8 certain segment of the Nicaraguan population was privy to homosexuality as an identity
Nicaragua’s changing erotiscapes 193
1111 in the past, these ideas are now available to everyone in the country. The show is inex-
2 pensive and delivers potent messages on the local level. But the show also has inter-
3 national appeal and is being screened in other Central American countries. The TV
4 show draws together transnationally available concepts of human rights and other
5 burgeoning universalisms, such as gay and lesbian identity, as well as the more
6 established discourse of women’s rights.
7 Carlos’s political history and his comments at the beginning of this chapter pre-
8 figure, in an uncanny way, much of what would occur in Nicaragua over the next
9 twenty years. His experience foreshadows the reciprocal relationships between one
10 era’s socialist aspirations and a next generation of identity-based movements for social
1 justice that have taken media and technology as their platform. In the heat of the cold
2 war, Nicaragua was a decisive battleground in global struggles around political
311 economic systems and a thorn in the side of the US. Now, it is a place where dynamic
4 and innovative approaches to sexual rights are being played out not only in the form
5 of street protest, but perhaps more importantly, on Nicaraguan televisions. For advo-
6 cates hoping to change the sexual culture of Nicaragua, media has a powerful potential
7 to transform the way people think and talk about sexuality. In many ways, what we
8 might call an “erotiscape” concerning sexual rights in Nicaragua is emerging now, both
9 on the street and on the screen.
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49 Sexuality in times of war
Gilbert Herdt
1 In the early 1930s Freud and Einstein exchanged letters that debated the critical question
of their time: Why war? The exchange of ideas between two of the greatest minds of
the century foreshadowed a terrible and dark reminder of the roots of war—atrocities
and terrorism committed in the name of national service, and the deadly results of human
suffering with which all people are faced today. Why do humans wage war? Their
passionate public letters, coming in the early 1930s between the two great wars, continue
to haunt everyone who is concerned with the world order.
These great minds did not, however, question the impact of war upon sexuality and
the exaggeration of masculinity, or the role that rape and sexual violence plays in the
humiliation of groups and nations at war. Gender roles are very much a part of the fabric
of society, and thus implicated in the social and material conditions of warfare. Yet
the question of how war distorts gender and exaggerates male prowess, conquest,
prostitution, and rape as a tool of war were absent from the discussion of how war effects
gender, sexual intimacy, and bodily integrity.
Those questions were to await a new century with its own growing recognition of
sexuality as a human right. Today, there is an emerging international recognition that
war has helped produce prostitution or commercial sex throughout world history.
Moreover, rape is increasingly defined as a tool of war, which ought to be viewed as a
crime against humanity—as defined by the International Criminal Court. This
recognition is nascent and only beginning to seep into the understanding of how gender
expectations impact the creation and continuance of war and the valorization of the
kind of masculine personalities that often brutalize “the enemy” in sexual ways,
including sexual violence and rape.
Domestic violence and sexual coercion, which is often hidden, haunts soldiers and
their families—extending the war abroad to a war at home. In the ranks of all branches
of the US military, homophobia continues to operate and influence judicial decisions
and the operation of policies such as “Don’t Ask, Don’t Tell.” Sexual commerce,
trafficking, and prostitution typically follow in the wake of military deployments.
Sexually transmitted disease epidemics have often erupted in the aftermath of war.
Warfare and militarization in the United States, Latin America, and around the world
have undermined human dignity and rights—especially women’s rights. The integrity
of women and children’s bodies has been sacrificed as rape continues to be a weapon
of warfare even today. As militarization increases around the globe, we should be
concerned about the physical and psychological impact that this will have upon all
8 people’s sexuality.
Sexuality in times of war 195
1111 Warfare and sex commerce
2
3 Wherever armies go, it has been observed, there follows sexual commerce and the worst
4 forms of rape, sexual abuse, and prostitution. Women and children are the targets;
5 however, boys and men have also been used as a means to humiliate enemies—bringing
6 local authority to its knees. Objectifying the enemy as a sexual target and utiliz-
7 ing rape as a means to accomplish humiliation of “the other” have been used by
8 warriors and armies since ancient times. We need only remember that as the Roman
Empire expanded to encompass the Known World, prostitutes (some of them sexually
9
10 enslaved or colonized as spoils of war) followed the Roman legions to the far
1 corners of the empire, sickening or dying there. Likewise, the British Empire, with its
2 Victorian double standard, was to treat colonized local peoples in India, South Africa,
311 and Borneo as effeminate or less than masculine savages—sexual chattel that would
4 produce bastards in the Heart of Darkness—never to mix with the gentile legal wife
5 and heirs at home and unlikely to see the mother country and enjoy its privileges back
6 in England.
7 Social scientists know only too well the dreadful impact of war upon society and
8 culture, but until recently we did not study its pernicious impact within the military. As
9 Margaret Mead once wrote in Sex and Temperament in Three Primitive Societies (1935),
20 war may be natural, but the aggression and violence necessary to execute is not. A
1 masculinity that is ruthless and aggressive requires ritual and mythology to mold men
2 into phallic warriors able to maim and kill in the hand to hand combat, which was
3 prevalent before the modern period.
4 My work among the Sambia of New Guinea has continually demonstrated that men
5 must be trained and molded into warriors; it is not a natural outcome. Even then, some
6 men do not have the personality capable of killing upon demand. Warfare serves,
7 however, to magnify gender roles, twisting men and women into the extreme and
8 exaggerated stereotypes we recognize in mythology around the world; these exaggerated
9 stereotypes are also familiar to anyone who has seen Hollywood movies.
30 Consider the Sambia mythology of the Great Man/War leader. A Sambia man was
1 trained in the men’s house in secret for years through initiation rituals; this compression
2 of gender training produced the desired effect. Rape was a constant threat in Sambia
3
society; women and children were ever poised for constant attack from enemies, for the
4
Sambia lived with the sense that “a war is going on.” A young man was not accepted
5
as a real man until he had stolen another man’s wife and traveled with a war raiding
6
party into the neighboring enemy tribe to kill the men. There, he was required to ruin
7
8 their gardens and destroy their village, carrying away as many women as possible as
9 political spoils.
40 Margaret Mead once referred to women abducted in the Admiralty Islands off the
1 coast of New Guinea as “prostitutes” who serviced the men’s house that had taken them.
2 The film Guardians of the Flutes (British Broadcasting Corporation, 1993), titled after
3 my first book, depicts a Sambia war leader who aggressively turns his pig’s tusk nose
4 plug so that its tusks point upward on his face. When Sambia men went to battle, the
5 tusk signified how their penises were erect as well—a direct challenge to the masculinity
6 of their enemies. It was said that such an image struck terror into the hearts of their
7 opponents.
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196 Gilbert Herdt
11 Military sexual conquest and modernity
In the last century the dark and ugly large-scale impact of war upon sexuality repeatedly
appeared before and during World War II. Consider the Japanese invasion in the 1930s
of Nanking, China, in what was to become known as the “rape of Nanking”—a dreadful,
brutalized, sexual assault on women and children. It is an episode of military sexual
conquest that remains a terrible sore point in Sino-Japanese relations today. Remember
also the parallel sexual conquest of Korea by the Japanese, and the creation of Korean
“comfort women,” whose shame and anger even today remains a matter of bitter and
painful international dispute.

The Nazi’s sexual humiliation of women was part of a systemic attitude of profound
violation of all human dignity and rights that led to the horrible abuses suffered by
1 women and homosexuals in concentration camps. Cruel sexual commerce was therein
created, one of the most shameful chapters of the Holocaust. When the Allies liberated
Western Europe, local village and townspeople were the first to attack the women who
had sexually mingled with the Germans for favors including food. Before the Allies got
to the scene, local people’s rage and shame was vented upon these local women. They
were dragged into the streets and stripped naked, their heads were shaved, and they
were further physically abused. Exile was often the only means of escape for these
women; in one sense they were double victims of warfare.
Rape remains a weapon of choice in war today. During the long and bitter warfare in
Bosnia-Herzegovina, it has been reported that thousands of women and children,
including boys, were raped by enemies. Military conquest seemed to invite this horrific
violation of bodies. Today, women and children are reportedly being raped on a large-
scale basis in the Congo, as civil war and international political and economic
circumstances create the setting for the most terrible forms of sexual assault and murder.
American military sexualization

These examples from other countries and other historical periods should not lead us
away from examining our own specific American history and policies regarding the
impact of war upon sex. Warfare has continuously exaggerated gender in our society,
especially the performance of masculinity—creating the awful extremes of idealized
women and men—even comic-book-like parodies of intimacy, romance, sexual
intimidation, conquest, and rape, all of which are familiar in the movies, mass media,
and Internet today.
The beautiful and tragic opera Madame Butterfly by Italian composer Puccini is based
on a nineteenth-century myth about the sexual colonization of the East and exotic others
by the West—in this case the United States, in its “opening” of Japan. Captain Pinkerton,
a young and swashbuckling American officer in the US Navy, has a sexual liaison with
a beautiful Japanese woman, who is both well born and then fallen. Butterfly falls in
love with the handsome sea captain, but he abandons her and her offspring and refuses
to take responsibility for his actions. When Pinkerton returns with his proper American
wife, Butterfly realizes how he has betrayed her and her ensuing shame is so great that
only ritual suicide (seppuku) can end the abuse and thus salvage her honor. Here is but
the first “modern” example of a general process: wherever the US military has gone,
8 sexual commerce, rape, and sexual spoils have followed in its wake.
Sexuality in times of war 197
1111 American armed forces were central to the epidemic of syphilis created in World
2 War I and World War II. The spread of the disease was controlled by quarantine and
3 the internment of prostitutes, thus denying their rights. In the decades to follow, sexual
4 liaisons between Americans and Japanese during the postwar occupation of Japan, and
5 the sexual commerce with Korean women during and after the Korean War in the 1950s
6 were but harbingers of a global phenomenon to come.
7 The Vietnam War inaugurated an era of massive consumption of sexual services.
8 The French initiated the creation of a huge sex industry in Thailand and other corners
9 of Southeast Asia. There, French and then American men who took “R and R” in these
10 exotic places were provided with a sexual outlet sanctioned by the authorities and
1 implicitly financed by the US government through the salaries and transport of men
2 routinely sent for “relaxation.” This was part and parcel of the gender and sexual climate
311 of the times, which pitted the “good guys” against the “bad guys”—often framed as a
4 struggle against Communism. Take note that many of the offspring of these sexual
5 unions, occupied bodies in Germany, Japan, Korea, and Southeast Asia, were treated
6 as illicit, expendable “nonhumans.” Americans often chose not to take responsibility
7 for these children, just as Pinkerton had done in Madame Butterfly.
8 The sexual victimization and exploitation that occurred in brothels and sex clubs in
9 Southeast Asia foreshadowed much worse to come—the sex tourism industry on a
20 gigantic scale and its dependence upon poverty and even the kidnapping of young
1 women from Burma and other countries in the 1990s. Women and young males brought
2 into this sex trade were exposed to a human suffering made worse by the horrors of the
3 AIDS epidemic swiftly spreading among sex workers. The effort today to teach about
4 safer sex and to provide condoms for barrier protection against HIV and other STDs has
5 to some extent been successful. However, the legacy of sexual tourism remains. Granted,
6 this sex trade is in part a form of income and commerce for individuals and the countries
7 involved. Nevertheless, it cannot be denied that this form of sexuality was created in
8 the context, at least partially, of war and poverty and the effects of countries that failed
9 to take responsibility for the results of their actions during war.
30 In the early twenty-first century it is ours to ask: Not why war? But why sexual
1 conquest and rape in war? How can we put a stop to rape and the dreadful impact of war
2 upon gender roles and sexual intimacy; including the creation of unwanted pregnancy,
3 HIV/AIDS, and the wholesale sexual conquest of people that violates human rights and
4 bodily integrity?
5 One of the keys is for all nations, including the United States, to recognize the twenty-
6 first-century principle that rape is a crime of war. The United States has refused to accept
7 this ruling. Gender and sexuality are too fragile to resist the intimidations of war
8 and warrior training, and the American experience is no different. Brutality wrought
9 by sexual conquest must stop. The use of forced prostitution and sexual slavery must
40 stop. It is time for all of us who regard human rights as inviolable to insist upon a
1 higher standard by which all nations outlaw sexual violence during peace and war
2 and forbid the use of rape as a weapon of warfare. The United States ought to act upon
3 the values that we purport to uphold by ratifying the International Criminal Court’s
4 Rome statute that enforces rape as a crime of war. There is no single act that will better
5 signal our commitment to ending sexual violence and sexual exploitation in times
6 of war.
7
118
11
50 Revealing the soldier
Peacekeeping and prostitution
Paul Higate
1 The links between the presence of peacekeepers and the growth of prostitution in UN
mission areas has received increased attention in recent years. In addition, and perhaps
more disturbingly, a series of sexual violations against women and girls by peacekeepers
have also been documented across the range of UN peacekeeping missions.
These include the rape and murder of a twelve-year-old Kosovo-Albanian girl by a
UN peacekeeper, the alleged rape of a ten-year-old Congolese girl by a Moroccan
peacekeeper, the production of a pornographic film through the exploitation of a local
woman by an Irish peacekeeper in Eritrea, and the high-profile exchange of goods vital
for survival—such as food and material for shelter—for sex by humanitarian workers
and peacekeepers in refugee camps in Guinea, Liberia, and Sierra Leone.
These and numerous other reports appear to point to the flourishing of an aggressive
sexuality that fails to discern between minors and adults and that may even result in the
rape and death of vulnerable female, and in some cases male civilians (such as occurred
in Somalia) in conflict and post-conflict societies. We must critically evaluate the sexual
dynamics of peacekeeping contexts and at the same time recognize the valuable work
that the UN continues to undertake.
The existence of prostitution and sexual violation of minors in mission areas is all the
more shocking since it involves personnel in whom considerable trust is placed. To
many, the peacekeeper is synonymous with security and a sense of reassurance and
professional commitment. This imagery is powerfully influenced by the media whose
dominant representation of peacekeepers accords with the popular psyche in that they
are typically presented as blue-bereted saviors of the war-torn citizenry. Television
pictures of peacekeepers holding babies, handing sweets to children, and disarming
militia foreground the softer and more positive side of mainly (military) men trained in
the use of force.
The peacekeeper comes to symbolically represent the conscience of the international
community, and in this way we may project onto them our hopes and desires for societies
that have endured genocide, massacres, and interminable suffering. It is hardly
surprising then that perception of peacekeeper-identity tends toward a professional uni-
dimensionality, as this links with their official activities in the public realm. Given this
dominant portrayal, it is unsurprising that reactions to reports of sexual violations by
peacekeepers invoke despair and outrage and are rooted in a sense that these men have
reneged on their moral duty in the most pernicious of ways. The actions of a number of
these peacekeepers (thought of as “GIs,” “squaddies,” and “troops”) toward women
and girls begins to fit with a commonly held view that military hypermasculinity can
8 impact negatively on particular members of a vulnerable civilian population.
Peacekeeping and prostitution 199
1111 Making military men
2
3 In order to begin to illuminate the factors that appear to dispose some peacekeepers to
4 sexually exploit local women and girls, it is necessary to consider the dominant form
5 of masculinity that is developed in the military. Broadly speaking, this serves to create
6 and reinforce a firm distinction between the genders and is expressed in the celebration
7 of an aggressive, and frequently misogynist, heterosexuality. This gendered divide takes
8 a multitude of forms though typically treats the feminine as the inferior “other.” The
feminine is linked to poor performance, inadequacy, incompetence, and weakness. In
9
10 offsetting masculinity against femininity, the former is celebrated as all that the latter
1 is not. Yet, the military is not unique in its gendered ideology; rather, it represents a
2 microcosm and amplification of civilian institutions including the police force and fire
311 service. It remains the case that, as Joshua Goldstein argues, soldiers show an “almost
4 universal preoccupation with sex,” and that, particularly in times of war (and we might
5 add, in times of peace), “most soldiers were ready to have sexual intercourse with any
6 woman wherever they could.”
7 Discussions about sex, images of sex, constant references to sex, and the sexual
8 conquest of women are relayed graphically and frequently, functioning as the lynchpin
9 upon which the soldiering profession turns. As the Canadian sociologist Deborah
20 Harrison has suggested: “the members of especially macho [military] units celebrate
1 their shared maleness by objectifying women, viewing pornography films and joking
2 about making women the targets of violence.” In order to develop military masculine
3 sexuality, it is necessary for recruits to be exposed to an intense period of military
4 socialization.
5 This process starts prior to enlistment with the idea of the archetypal warrior figure
6 whose tough, invulnerable, and sexually potent persona is revered and celebrated
7 throughout popular and other cultural mediums. Military recruits—in the main
8 adolescent men—are already likely to be familiar with this aspect of soldiering from
9 comic books and movies. Undoubtedly, many are motivated by the possibility that
30 enlistment into the military will encourage the development of heterosexual virility
1 through the organization’s association with the “making of men.” Perhaps a number of
2 enlistees are subconsciously seeking out an environment conducive to fostering and
3 attaining manhood that many of their peers and family will quietly celebrate.
4 One aspect of military indoctrination that may also be of relevance to understanding
5 the nature of gendered relations in, and around, military installations is the ability for
6 troops to dehumanize the enemy or the “other.” Women, as a socially subordinate group,
7 are frequent victims of this othering as the Mai Lai massacre, in which US troops
8 butchered women and girls in a Vietnamese village, graphically demonstrates. When a
9 macho culture promoting aggressive heterosexuality is combined with strategies
40 designed to strip away the humanity of others, the possibilities for sexual violation of
1 women and girls increase significantly and have been powerfully portrayed in the movie
2 Casualties of War.
3
4
5 Variations on a theme: sexualities in the military
6 When focusing on the sexuality of military personnel, it is important to recognize the
7 heterogeneity of the organization in terms of the existence of sexualities that come into
118 sharp focus when subject to a more fine-grained analysis. This is significant, not only
200 Paul Higate
11 in respect of the more obvious distinction between homosexuality and heterosexuality
(a more liberal approach to homosexuality in the military has emerged on both side of
the Atlantic in recent years) and the growing proportion of military women, but also in
terms of how masculinity is performed. It is important to note that not all military men
use prostitutes or rape, for example. Further, in discussing peacekeeping troops, there
should be an acknowledgment that nationalities may differ in how they manage
gendered relations together with the extent to which they view women and girls as
subordinate. It is all too easy to work with a monolithic understanding of military
masculine heterosexuality that may limit policy responses intended to modify the more
destructive variants of peacekeeper’s impact on gendered relations. In addition to rank,
there may also be differences in the ways that Military Observers (commissioned
officers) manage their sexuality when contrasted with the heterosexual performances
1 of members of the contingent personnel (non-commissioned ranks who guard UN
assets). The former may exercise discretion in their sexual liaisons, while contingent
soldiers tend to celebrate their heterosexuality in public in bars and brothels, easily
identifiable in their uniform and large groups.
Cynthia Enloe has written about the military’s support of prostitution in close
proximity to its bases or in zones designated for the rest and recreation of officers and
men. Throughout the extensive history of the close relationship between camp-following
women and the military, the psychological and health interests of military men have
been prioritized over those of the women whose role it is to provide a vital sexual outlet,
while being under medical surveillance by the military authorities. This control and
monitoring of militarized prostitutes has involved oppressive practices, including the
use of degrading examinations through which their part in the spreading of sexually
transmitted diseases has been highlighted, while the role of the men in this process has
been ignored. The direct and unapologetic involvement of the military in prostitution
lies in its belief systems that turn on a particular understanding of male sexuality.
To deny their men this sexual “safety valve” for a natural and barely controllable sex
drive is to court serious problems, in which aggressive heterosexuality might prove
dysfunctional. According to the military, denial of sex could result in a significant
diminution in combat effectiveness as, in the absence of heterosexual activity, military
men are unable to affirm all aspects of their warriorhood. Unscientific theories abound
concerning testosterone levels and potential for aggression in respect of regular sexual
intercourse, though there is little credible empirical evidence to support such a
proposition. More disturbingly, so far as the military are concerned, is the possibility
that men who are denied heterosexual contact, born of sheer desperation, will seek out
homosexual liaisons with soldier colleagues. In this scenario it is envisaged that the
military masculine “glue” cementing unit cohesion is likely to melt away, rendering
impotent the now feminized fighting force. Thus, male sexuality in the military is akin
to a truck whose brakes have failed. The best that can be hoped for is to steer it onto the
correct highway; alternative routes are bound to result in disaster.
Exchanges of sharp inequality: peacekeepers and

prostitution
In contemporary debates the question of prostitution divides commentators. The two
extreme positions are represented by the notion that either all prostitution represents
8 violence to women, or that women should be free to choose what they do with their
Peacekeeping and prostitution 201
1111 bodies, seeing commercial sex as a form of sexual labor. Military thinking errs toward
2 the latter position, and the frequent retort that poverty-stricken women are gaining
3 financially from their interactions with peacekeepers is used to obscure the harsh realities
4 of survival sex work. Many women and girls are forced into this form of income
5 generation when faced with life and death circumstances for themselves and their
6 families. Another argument made by the broad spectrum of prostitute clients—including
7 military men—is that the women are “very active” in attracting their custom. The argu-
8 ment is made that because prostitutes “come on to you readily . . . and tell you that you
9 are handsome,” it is the woman, not the peacekeeper, who is responsible for the
10 exchange. In this way peacekeepers are able to cast themselves as “helpless victims”
1 with a biologically powerful sex drive that prostitutes “exploit.”
2 There has been rather less discussion, at least in terms of those who might be described
311 as military apologists, for the wide-scale existence of prostitution across the unique
4 and frequently dysfunctional context of the peacekeeping mission. The post-conflict
5 environment is one in which gendered relations are heavily distorted, and peacekeeper’s
6 involvement with prostitutes represents an exchange of fundamental financial inequality.
7 For example, in terms of sharp financial disparity, in the MONUC mission in the
8 Democratic Republic of Congo (DRC), the Mission Subsistence Allowance for UN
9 peacekeeper Military Observers and some other UN civilian personnel is $138 per day,
20 whereas the average annual income per head of Congolese citizen is $100. Such
1 inequalities fuel the commodification of women and girls, many of whom bear the full
2 brunt of conflict and—as was witnessed during the Balkan War—are raped as a key
3 strategy designed to weaken the enemy’s morale. A number of these rapes may result
4 in pregnancy and the birth of babies who then place an additional burden on an already
5 traumatized survivor of sexual violation. Many of these women become locked into a
6 cycle of prostitution because of pressure to support a young family and facilitated by
7 the damage to the mother’s self-esteem; she may become resigned to meeting the sexual
8 demands of UN clients. These factors, along with the age of consent and of marriage in
9 both Sierra Leone and the DRC (currently fourteen years of age), contribute toward the
30 cocktail of circumstances in which peacekeeper abuse is likely.
1
2
Zero tolerance
3
4 Kofi Annan, in responding to the scandals that continue to damage the UN’s reputation,
5 has called for a climate of “zero tolerance” with regard to the activities of peacekeeper
6 violation of women and girls. However, there is ambiguity here as it is not entirely clear
7 if prostitution is exempt from this strategy. In recent years across all peacekeeping
8 missions, various Codes of Conduct have been formulated. The generic UN Blue
9 Helmets Code of Conduct states that “peacekeepers will never commit any act that
40 could result in sexual harm to members of the local population including women and
1 children.” Codes that reflect the particular conditions of the mission area (for example,
2 the age of consent and marriage) have also been drawn up, along with the establishment
3 of committees (for example, the UNAMSIL mission in Sierra Leone) whose terms of
4 reference are specifically to monitor and highlight the issue of peacekeeper exploitation
5 of women and girls. These codes use the language of “strict prohibition” of sexual
6 contact with minors and of sexual exploitation of local women and girls by UN
7 personnel, and they are uncompromising in their tone. They also suggest that bona fide
118 relationships between peacekeepers and local women over age eighteen are acceptable.
202 Paul Higate
11 Clearly, the codes are open to interpretation, not least because they are intended for a
multinational audience who vary in their understandings of cultural norms and the
nuances of language.
Ultimately, the UN is attempting to regulate the sexuality of its personnel and
particularly its peacekeepers whose reputation for exploitation is of greater visibility
than that of civilian staff. In this way, the UN stands at the interface of troop-contributing
countries and concerned onlookers, who consider that prostitution in a post-war setting
is unacceptable for personnel who have unique responsibilities. If it is considered that
prostitution and exploitation are inseparable, then, for many, these codes are unworkable.
Soldiering and prostitution—argued by some to be the “two oldest professions”—feed
off one another and exist in a symbiotic relationship that can only be detached by resorting
to, according to the military, oppressive practice, such as turning troop barracks into
1 virtual prisons. If, however, prostitution is not considered as exploitation, then the codes
have some chance of success and the masculinized culture of the UN retains a key outlet
for certain elements of its personnel.
It would appear that the aggressive heterosexuality of a significant number of
peacekeepers is somewhat unique. Yet in many ways, the activities of these men differ
little from those of sex tourists, for example. UN peacekeepers encounter extreme
inequality and vulnerable minors, similar to conditions found at many sex tourism
destinations.
This should not be taken as a condemnation of the work of the UN, as undoubtedly
its interventions over the years have proved crucial to the preservation of life and the
creation of peace. However, the UN is caught between national militaries on which it
depends for peacekeepers and demands by those deemed to be “outsiders” that they
significantly temper the aggressive heterosexuality of these troops. One place to start,
and here we add to a growing clamor for action of this sort, is for the perpetrators of
sexual violation against women and girls to be brought to rapid and decisive justice. The
impunity they currently enjoy sits closely with the notion that these men really are at
the whim of a biological drive that can override their sense of moral duty.
8
1111
2 51 “R and R” on a “hardship tour”
3
4 GIs and Filipina entertainers in
5
6
South Korea
7
8 Sealing Cheng
9
10
1
2
311 Eddy* was a twenty-year-old GI who had heard a lot about cheap sex in Korea. By the
4 time he arrived in the country, he felt compelled to try the “thirty-buck-a-trick”
5 experience negotiated through a pimp on the street. He explained, “I had to do it. I have
6 heard so much about it that I had to do it.”
7 Eddy then spent the next six months of his time and money, buying drinks for women
8 and hoping to find a girlfriend in one of the clubs. Many of his peers did the same. He
9 finally gave up because, he said:
20
1 It’s not sincere. That’s why I don’t like it. A relationship with a “drinkie girl” is not
2 normal. But it’s just almost impossible to have a GI girl, there are about two
3 (women) to every eight hundred men. We call it the “hateway” rather than the
4 gateway. You have to fight so hard to get through it. And one day, I just decided
5 that I couldn’t take it anymore. Of course I feel lonely . . . Yes, there is the loneliness,
6 but I can handle it.
7
8
9
The history of rest and relaxation
30 Prostitution has become synonymous with the rest and relaxation (R and R) industry
1 for the US military abroad, particularly in East and Southeast Asia. Clubs for GIs have
2 sprung up around US military camp towns in the Philippines, Japan, in particular
3 Okinawa, Vietnam, and South Korea. These GI clubs are the progeny of a global
4 network of US military bases formed for the containment of Communism and the
5 preservation of US geopolitical interests. Recent reports of the trafficking of women
6 from the Philippines and former Soviet countries to GI clubs in South Korea have fueled
7 criticisms of the US military overseas.
8 South Korea—still technically at war with North Korea due to the legacy of the
9 Korean War—remains one of the most heavily armed zones on earth. In 2001, 37,000
40 US military personnel are standing by for war on the Korean peninsula. For GIs, clubs
1 around bases provide a welcome relief from work in the form of alcohol, music, and
2 most importantly, women. For people working in the R and R industry, the GIs’ desires
3 and patronage are vital to their livelihood.
4 The profile of women entertaining GIs in Korea has changed significantly in the last
5 decade. In the post-war years, Korean women worked in GI clubs and were dubbed
6
7
204 Sealing Cheng
11 with such derogatory terms as “Western whores” and “Western princesses.” In the
1990s Korea’s rapid economic advancement led to a shortage of Korean women will-
ing to serve these American soldiers; the stigma and relatively low income made
it a losing proposition for many Korean women. In order to fill the vacancies left
by Korean women, women were imported from the “third world.” Since the 1980s
the Korean government has allowed for a limited number of cheap foreign laborers to
take up the “3D” (dangerous, dirty, and difficult) jobs abandoned by Korean nationals.
According to some Korean and Filipino activists, Filipino women have been “trafficked”
to relieve the shortage of entertainers in military camp towns in South Korea

(kichich’on) since 1996.
In the 1990s customer profiles changed. In addition to US military personnel,
foreigners on business trips or working in nearby factories, as well as Koreans, now
1 frequent the clubs. Korean men often visit the clubs because of the perceived exoticness
of foreign women entertainers. With more spending power than GIs, coupled with often
extravagant spending habits, Korean men have become an increasingly important source
of revenue for kichich’on clubs.
The changing demographics in kichich’on clubs, at the level of patrons and workers,
are impacted by the changing power relationship between the United States, Korea, and
the Philippines. Even though US military domination continues in the Asian-Pacific
region, US military forces have lost much of their economic sway. Korea has not only
achieved greater economic independence from the United States, but has gained
economic power in the region. Changing economic conditions have made it possible for
Korea to invest in and import cheap labor from poorer countries such as the Philippines.
My fieldwork in two US military camp towns in South Korea, between 1998 and
2001, focused on how migrant Filipinas make sense of their lives as entertainers in GI
clubs. I also set out to understand the meanings that GIs and Korean club owners
attributed to their interactions with Filipina entertainers, and how these dynamics
between individuals are embedded in the larger political economy of the Asian-Pacific
region.
Many social science analyses of military prostitution have largely focused on the
voice of women who perform sex work. For the most part, this body of literature has
identified their oppression and suffering as a casualty of masculinist state projects, their
prostituted bodies serving as a symbol of poor nations’ dominated status. While this
perspective accounts for the structural relationship between GIs and women entertainers,
it does not provide insight into the everyday interactions between them. My perspective,
here, adopts the rather unconventional method of introducing R and R industry in South
Korea from the GIs’ perspective.
Previous research has not paid much attention to GIs’ experiences due in part to an
ambivalent understanding of military servicemen in the eyes of middle-class America.
In times of war, they are heroes, as seen in the media coverage of the Iraq War. In times
of peace, they are mere hirelings of the military machinery who have failed to “make
it” in American society. According to this stereotype, young American male soldiers
are regarded as drunkards and sexual predators who, were it not for military discipline
and their roles as warriors, would live on the margins of US society. Recent statistics
from the US Department of Defense detailing the educational achievements and ethnic
composition of active duty US military personnel show that although GIs do not rank
in the top percentages of academic prowess, neither are they “rejects” of the education
8 system. Overall, stereotypes about military personnel that configure GIs as mere dupes
GIs and Filipina entertainers in South Korea 205
1111 of the military machine do not account for the reality of military men and women. My
2 position is that it is important to account for GIs’ motives and emotions when
3 considering the dynamics of sex work, military camps, and militarized territories.
4
5
GI clubs in Korea
6
7 A mission to Korea is, according to military categorization, a “hardship” tour. There is
8 no government sponsorship for family members and most GIs live alone while overseas
9 in Korea. The tour normally lasts for one year. The short duration of the assignment
10 seems to justify the absence of programs to integrate GIs into the host country. There
1 are no language skills training or briefing sessions on the social and cultural makeup of
2 the country.
311 In this context the R and R facilities around US military bases become the main venue
4 for American soldiers’ off-post activities. What actually does the R and R in Korea
5 offer?
6 The minute they step off the base, GIs find clubs where they come face to face with
7 scantily clad Asian women—all of whom are eager to shower their attention on any man
8 for the price of a drink. While some GIs go to clubs in groups to play pool or darts, a
9 patron who arrives alone sends a clear message that he is in search of a woman. As soon
20 as he enters a club, an entertainer will greet him and bring him to his table. A US$10
1 drink will buy him the company of a woman for a short while. (Some club owners set
2 the time limit to twenty minutes.) Continual company requires his purchasing more
3 drinks. A woman might just sit next to the customer, perform a provocative dance, or
4 rub herself against the man’s groin before requesting a drink. What a woman will do in
5 exchange for drinks depends upon the customer, the club, the woman, and her need for
6 drinks and remuneration on any particular day.
7 The euphoria men enjoy while they are being fawned over by women is, however,
8 constantly at risk. A man’s popularity declines or increases according to the hard cash
9 he possesses. Low-ranking GIs, whose salaries are likewise low, are more likely to have
30 short lived encounters with entertainers. High-ranking GIs with a handsome salary are
1 able to buy multiple drinks for entertainers and coworkers; it is high-ranking GIs who
2 are greeted most enthusiastically in the clubs. Those who refuse to buy the ladies drinks
3 are often goaded with the name “Cheap Charlie.” This directly challenges masculine
4 pride, an assault that many young GIs find hard to endure. Many Filipinas are familiar
5 with the power of such tactics to get more out of male customers.
6 Eddy, the twenty-one-year-old GI I interviewed, offered his own analysis of
7 relationships with entertainers. “You see, they either make you feel pity for them, or
8 make you feel special, or make you think that you are going to get something.” Eddy’s
9 insight points to three common elements and tactics used by entertainers to gain
40 customers’ patronage: their own powerlessness, their customers’ individuality, and the
1 prospect of sex. These factors may operate separately, but more frequently they are
2 combined to create an illusion of intimacy in kichich’on clubs.
3 In the context of kichich’on clubs, the “game of love” is an important element
4 impacting the interactions between GIs and Filipinas. The “play” often has the potential
5 to end in serious emotions. Mediated by the idioms of romantic love, money and sex
6 become more than a matter of simple remunerative service transactions. In this context
7 “boyfriends” have become synonymous with “customers”; “I love you” is a daily
118 utterance and marriage proposals a weekly occurrence. Relationships in clubs are more
206 Sealing Cheng
11 complex than simply “male domination” and “female subordination”—the model put
forward in most prostitution studies. This complexity is not readily revealed in many
representations of the R and R industry; instead these complicated emotional and power-
laden dynamics are often unambiguously categorized as “prostitution.”
Filipina “entertainers”
The Filipinas who I interviewed were between the ages of seventeen and thirty-five,
most of them in their early twenties. They were primarily from Manila, Pampanga, and
the Laguna region of the Philippines. Only a few of them had worked in a club before
coming to Korea. The women held E-6 visas (for “entertainers”) and had one-year
contracts. Before 1999 women arrived in Korea with the promise of a job as a waitress,
1 dancer, or guest relations officer. Most of the women who have arrived since 2000
auditioned to be “entertainers,” during which they posed in bikinis. Most women had
a vague idea of what their jobs would entail but rarely did they understand from the
outset the exact nature of their working conditions. Because of managers’ attempts to
conceal the truth of the working conditions and different kinds of club management,
women were unsure of what they would encounter in the workplace. One thing they
were aware of was the illegal nature of their migration and job. Because of the detour
they took en route, via Hong Kong or Bangkok, and the lies they were taught to tell at
immigration check points, women were well aware of their marginal legal status.
Upon arrival at the clubs, women’s passports are often taken by club owners and a
portion of their salaries are not paid until they leave Korea to prevent them from running
away. The women are required to entertain GIs by encouraging them to buy as many
$10 ladies’ drinks as possible. The work day for women is sometimes as long as eighteen
hours. Some women do not get a single day off for the entire year that they work in
Korea, and some clubs require drink quotas that women must fulfill or they may be
penalized. Entertainers receive only $2 for every $10 drink a customer buys for them.
Some clubs with VIP rooms allow customers to bring a woman into the room for half
an hour, providing that he buys four drinks for his female companion. A customer may
also pay a “bar fine” in order to take a woman out of the club. According to the time of
the month—bar fines are more expensive on pay days—and the length of time desired,
bar fines range from $100 to $300. The women can expect to receive 20 percent of the
money. Whatever happens in the VIP room, or on a “bar fine” outing, is negotiated
between the woman and the customer.
“It’s up to you,” was the refrain commonly asserted by Filipina entertainers. The
voluntary nature of their work was fundamental to the way many women articulated
their professional lives. Katie* believed, for example, that “it’s up to you” whether one
prostituted oneself or not. She said that women could choose to run away—as she
herself had done. Similarly, women who went on a “bar fine” with GIs might run
off at any time, even before sex had been initiated. Janet* also said that “it’s up to
you” whether or not one performed oral sex for a customer in a VIP room. Many
women did complain about pressure from club owners to increase sales. However,
unlike many activists’ claims that focus upon women’s powerlessness, many enter-
tainers I interviewed preferred to see themselves as autonomous agents, exercising
control over their bodies and sexuality.
However, we should not underestimate the potential for abuse in the clubs. Because
8 women are aware that they are engaged in an illegitimate trade, entertainers are reluctant
GIs and Filipina entertainers in South Korea 207
1111 to file complaints, fearing negative repercussions. Since their passports are held by club
2 owners and their running away would immediately make them illegal aliens, it is only
3 with tremendous courage, and usually following severe abuses, that the women leave
4 the clubs. Many women are also reluctant to easily forgo their hard earned jobs in Korea,
5 especially given the lack of employment opportunities in the Philippines.
6 Both local and international nongovernmental organizations (NGOs) identify these
7 women as “victims of trafficking.” Whether or not this is an accurate description, we
8 should not be blind to the fact that women’s structural vulnerability does not necessarily
9 translate into personal powerlessness. In fact, entertainers’ “weakness” may become

10 their “weapons,” prompting young American soldiers to answer their calls for “love”
1 and support in the “game of love.”
2
311
Recent developments
4
5 Increasingly, Filipina entertainers have fled the clubs and started to work in factories
6 or live with their GI boyfriends—some in long-term relationships, others in a kind of
7 “temporary marriage.” In my last visit to a kichich’on in June 2003, I saw many more
8 pregnant Filipinas around “American Alley” than I did three years previously. While a
9 few of these relationships do end up in marriages, there is also a high degree of GIs
20 abandoning their girlfriends, especially after she is pregnant, creating a difficult set of
1 circumstances for the Filipina women and their children who are left behind. In some
2 ways these Filipina women have become heiresses to both the lifestyles and the
3 problems of their Korean predecessors in kichich’on.
4 The US military had planned on moving forces southwards, away from the border and
5 Seoul. The fate of kichich’on in the north remains uncertain, while the major kichich’on
6 in the south are celebrating the move. Military redeployment will likely be followed by
7 a wave of foreign entertainers. Meanwhile, in June 2003 the Korean Ministry of Justice
8 stopped issuing E-6 visas for foreign women entertainers. Because of the human rights
9 violations implicit in this form of service, women entertainers’ status has become a
30 “diplomatic issue.” While some may see this as a victory for the international anti-
1 trafficking campaign, concerned NGOs and individuals worry that such a drastic move
2 will only drive the flow of entertainers underground, increasing the incidence of abuse.
3
4
Understanding military prostitution—the case of South
5
Korea
6
7 Our understanding of “military prostitution” and “trafficking” must be both more
8 politicized and more personalized. On the one hand, beyond the role of the US military,
9 other institutions allow for the abuses found in some GI clubs. These include local
40 governments, government bureaucrats, club owners, and brokers (men and women who
1 benefit in one way or another from the industry). Gender-based violence that has driven
2 many women away from their homes to work overseas and a racialized nationalism
3 that has subjected foreign women to greater discrimination impacts how entertainers are
4 treated in Korean clubs. The international imbalance of power that has exacerbated
5 individual countries’ economic dependence on remittances has also impacted the lives
6 of women who may feel compelled to undertake work as entertainers to support families
7 back home. On the other hand, underlying this commercial exchange is the often
118 romantic parable of discovery—the conquest of the US American (white) explorer,
208 Sealing Cheng
11 who is rewarded with an alien and exoticized lover who is both submissive and devoted.
Notions of intimacy and love are commonly considered elusive, if not downright
irrelevant, in the sexual services industry. Yet in the case of GI clubs, these transactions
are often “personalized” and occur over a period of time—giving rise to a complexity
that is difficult to untangle or grasp with a singular concept of “prostitution.”
8
1111
2 Index
3
4
5
6
7
8
9
10
1
2
311 AAFP (American Academy of Family AIDS Research Program, University of
4 Practice) 100 California 161
AARP (American Association of Retired Aim for Success 127
5
Persons) 104 AIS (Androgen Insensitivity Syndrome)
6 abortion 12, 69–73, 98–100, 101–3, 174–7; 163
7 and rights 6; see also mifepristone alcohol 23, 110–11
8 Abortion Access Project 100 American Academy of Family Practice
9 abstinence-only-until-marriage 177; and faith (AAFP) 100
20 communities 127; globalization of 178–81; American Association of Retired Persons
1 movement 124–9; and the right wing (AARP) 104
2 178–81; sexuality education 5, 8, 12, American Family Association 50–1
3 17–18, 32–4, 52; in Texas 129; in Uganda “Americanization” of sexuality 168
4 180 American Journal of Public Health 107
academia: treatment of bisexuals 135–9 American Medical Women’s Association
5 Access Denied: US Restrictions on (AMWA) 99, 102
6 International Family Planning 176 American Psychiatric Association (APA)
7 Access Project 100 142–3
8 activism: sexual 119–20 American Psychological Association 133,
9 addiction: sexual 115–18 142, 143
30 Adolescent Family Life Act (AFLA) (1981) American Sexuality 1
1 32, 52, 125 Ames, Genevieve 110–11
2 adults: older see seniors AMWA (American Medical Women’s
3 advocacy organizations 30 Association) 99, 102
Advocate, The 138 anal sex 58–9
4
Advocates for Youth 125, 179 Androgen Insensitivity Syndrome (AIS)
5 AFLA (Adolescent Family Life Act) (1981) 163
6 32, 52, 125 Annan, Kofi 201
7 African Americans 28, 92–4 “Anti-Gay Politics Online: A Study of
8 Afro-Caribbeans 28 Sexuality and Stigma on National
9 Against Our Will: Men, Women, and Rape Websites” (Irvine) 50
40 (Brownmiller) 38–9 anti-sodomy law (Article 204) 191
1 age norms 25 anthropology 184
2 Aggleton, Peter 7 Anzaldúa, Gloria E. 48
3 aggression: sexual 25 APA (American Psychiatric Association)
“A-H” 32–3 142–3
4 AIDS 7, 22, 160–2; and the black community Apostologpoulous, Yorghos 112–14
5 45–6; and black women 44; feminization Araujo, Gwen 36
6 of 8, 121–3; and homosexuality 7; and the arousal 135–7
7 Internet 57–9; prevention of 121–3; and Article 204 (anti-sodomy law) 191
118 seniors 104–6; in Vietnam 182–3 Asian Americans 78–80
210 Index
11 Asian Men Do 79 Bush, George W. 12, 51, 127, 175, 177;
Asian Persuasion 79 administration 33, 172, 178; misuse of
assault: physical 29–30 science 181
“awakening of consciousness” 48 Butler, J. 7
Badada, Amare 174 Cabaret 132

Bailey, Michael J.: The Man Who Would Be Cacari-Stone, Lisa 140–4
Queen 137–8; “Sexual Arousal Patterns of Cahill, Ann J. 38–40
Bisexual Men” 135, 137, 138 Cairo Conference on Population Development
Baudrillard, Jean 75 (1994) 96

Beam, Joseph: “In the Life” 45 Call to Action (Satcher) 8
Beatty, Lula: Journal of Black Psychology Cameron, David 163–5
45–6 capitalism: post-Soviet 186–9
1 behavior, sexual 118; and alcohol 110–11; Carey, Benedict 135, 136; “Straight, Gay or
high school students 124–5; truckers 112; Lying: Bisexuality Revisited” 135
in the US Navy 110–11 Casualties of War 199
Behind the Green Door see Deep Throat Catalina Video 79
Beijing Declaration 11–12, 121–3, 171 CBAE (Community-Based Abstinence
Beijing World Conference on Women (1995) Education) 33, 125–6
171–2 CCI (Cesar Chavez Institute) 160–2
Bickford, Andrew 110–11 CDC (Centers for Disease Control and
Bienvenu, Robert 155 Prevention) 45, 181
BiNet USA: The National Bisexual Network Ceballos, Héctor 160–1
136 Centers for Disease Control and Prevention
biodiversity 64 (CDC) 45, 181
Bisexual Resource Center of Boston 136 Cesar Chavez Institute (CCI) 160–2
bisexuals in academia and the media 135–9 Chase, Cheryl 163, 164
black, as racial signifier 28 chastity rallies 127
black community 45–6; and stereotyping chatrooms 57–8
24–8 Cheng, Sealing 203–8
black women 44 Chicana: sexuality 48
Blunderbuss Technique 150, 151 Chivers, Meredith L.: “Sexual Arousal
Bodies Like Ours 165 Patterns of Bisexual Men” 135, 137,
“bodily integrity” 119-20 138
body, the 40 Christian right and communications
Bosnia-Herzegovina 196 technology 50–2
Bourdieu, Pierre 74 Chronicle of Higher Education 138
Boys Don’t Cry 36 church: role in sexual health 93–4
Brame, Gloria: Different Loving: The World citizenship: and sexuality 34, 170–3
of Sexual Dominance and Submission civil rights, transgender persons 108–9
56 Clinton, Bill 52, 175
Brandon Teena Story, The 36 clownfish 64
Brasher, Brenda 51 Cochran, Susan 45
Brothers of the Moon and Sun (Hermanos de Cohen, Stanley 5–6, 17
Luna y Sol) 160–1 Columbine High School, Colorado 31
Brown, Mildred L.: True Selves: For communities: black 45–6; online 9; as
Families, Friends, Coworkers and Helping support system 143–4, 161–2
Professionals 159 Community Advocacy Project 124
Brownmiller, Susan: Against Our Will: Men, Community-Based Abstinence Education
Women, and Rape 38–9 (CBAE) 33, 125–6
Bureau of Justice Statistics, rape 41–2 Community Promise 45
Burnfels, Otto: Onomasticon 155 Concerned Women for America (CWA) 50,
8 Burr, Chandler 136 180
Index 211
1111 condom use 114 Disability Rights Movement 145, 146, 147
2 Confucianism 184 discrimination: and gender 21; against
3 Congo 196 healthcare providers 143; and homophobia
4 “conscientizacão” 48 140–4; transgender persons 108–9, 158;
consumerism and sexuality 74–7 in US schools 120
5
Coon, David W. 104–6 disease: homosexuality as 6, 142–3;
6 cooperation, model of 64 transmission 15–16, 112–14
7 Corrêa, Sonia 8, 170–3 Disputationes Adversus Astrologiam
8 Coughlin, Charles 51 Divinatricem (Mirandola) 155
9 Crème of Sum Yung Gai 79 “Don’t Ask, Don’t Tell” 33

10 criminal justice system and trafficked persons “Double Lives on the Down Low” (Denizet-
1 130–1 Lewis) 44
2 Crowley, Joseph 123 “down low”, the 44–6
311 Crybabies 129 Drawing the Shades (Elliott) 41, 43
Cullen, Mary Kate 31 Driver, Betsy 165
4
culture: sexual 156 drug use: seniors 105; truckers 112
5 Curotto, Alberto 9, 57–9 Duggan, Lisa: Sex Wars: Sexual Dissent and
6 CWA (Concerned Women for America) 50, Political Culture 5
7 180 Duran, Bonnie 140–4
8 cyber-religion 51 Dyer, Richard 75
9 cybersexual relationships 62
20 Ebb, Fred 132
1 Dangerous Sexualities (Mort) 27 economic conditions, and prostitution 201,
2 Darwin, Charles 63 207
3 dating: impact of spinal cord injury on education 31; and the Internet 56; and medical
149–50; online 9, 61, 151–2 students 93; sexuality 2–3, 4, 5, 6–7, 8, 12,
4
Davidson, Sue: You Can Be Free: An Easy- 15–18, 32–4, 124
5 To-Read Handbook for Abused Women Elders, Jocelyn 7, 52
6 42 Elliott, April: Drawing the Shades 41
7 Davies, Dominic: Sexual Politics of Emergency Plan for AIDS Relief (PEPFAR)
8 Disability: Untold Desires, The 147 123, 176, 177
9 Davis, M.D. 7 “employment at will doctrine” 158
30 Davis, Susan 50 Enloe, Cynthia 20
1 Dea, Monica 105 equality in marriage 52, 132–4
2 Deep Throat 76 Ethiopian Family Guidance Association
Defense Marriage Act (1996) 33 174
3
D’Emilio, John Intimate Matters: A History ethnic minorities 27
4 of Sexuality in America 27 EverQuest 10, 60–2
5 Denizet-Lewis, Benoit: “Double Lives on the evolution 63
6 Down Low” 44 Evolution’s Rainbow (Roughgarden) 63,
7 Des Moines, Iowa 29, 30 64–5
8 Diaz, Rafael: Latino Gay Men and HIV: exclusion and fundamentalism 173
9 Culture, Sexuality and Risk Behavior
40 160–2 Fairness and Accuracy In Reporting (FAIR)
1 Different Loving: The World of Sexual 136
2 Dominance and Submission (Brame, Faith and Values Coalition 51
Brame, and Jacobs) 56 faith communities, and the abstinence-only-
3
digital revolution 4–5 until-marriage movement 127
4 disabilities, people with 9–10 Falwell, Jerry 51
5 disability: research 147; rights 9–10; and family 65; planning 174–7
6 sexuality 145–8, 149–53 Family Acceptance Program 161–2
7 Disability Rag (Waxman, Barbara) 145, Family Research Council (FRC) 50–1,
118 147 180
212 Index
11 Feinberg, L. 7 Gay and Lesbian Alliance Against Defamation
Feldt, Gloria: War on Choice, The 176 (GLAAD) 136
female genital surgery (FGS) 169 Gay and Lesbian Medical Association 142
female-to-male (FTM) 35–6 gays: marriage 11, 51, 132; and pornography
feminism: and HIV 121–3; and patriarchy 39; 79; and rape 23; television characters 72;
and rape 38 and transgender women 108–9
feminization: of AIDS 8, 121–3; of Gay–Straight Alliances (GSAs) 30
consumption 74–5 gender: determining 159; and discrimination
“feminized” male 164 21; and fundamentalism 173; roles 184–5,
femmetrosexual 67 194, 195; violence based on 207

FGS (female genital surgery) 169 Gender Identity Disorder 142
Fields, Jessica 5, 32–4 genital reconstruction 36; see also sex
50 First Dates 64, 65 reassignment surgery
1 Filipina entertainers 206–7 Gerald, Gilberto R. 9, 44–6
Finding Nemo 63–6 Germain, Adrienne 8, 121–3, 177
Finer, L.B.: “Abortion incidence and services Gibson-Graham, J.K. 64
in the United States in 2000” 101 Gillespie-Sells, Kath: Sexual Politics of
flagellation 155 Disability: Untold Desires, The 147
Florida 104–5 Girard, Francoise: Global Implications of
Focus on the Family 50–1, 180 Domestic and International Policies on
folklore 20–3 Sexuality 175
Foreign Assistance Act (1961), Helms GIs, in South Korea 203–8
Amendment 175 “Giving voice to emerging science and theory
Foreign Operations Act, Kemp Kasten for lesbian, gay, bisexual people of color”
Amendment 175 (Harper, Jernewall, and Zea 142
forgetfulness 64; and transgenderism 65 GLAAD (Gay and Lesbian Alliance Against
Fortune Nookie 79 Defamation) 136
Fos, Ron, on sexual orientation 138 Global Gag Rule 12, 174, 175, 176
Foster, Angel M. 98–100 Global Implications of Domestic and
Foucault, Michel 75, 154, 167 International Policies on Sexuality (Girard)
Fourth World Conference on Women (1995) 175
171 Globalization of Nothing, The (Ritzer) 74
Fowler, Jane P. 106 globalization of sexuality 167–9
Frank, Katherine: G-Strings and Sympathy: Gloria Brame’s Kinky Links 56
Strip Club Regulars and Male Desire GLSEN (Gay, Lesbian and Straight Education
85–8 Network) 30
FRC (Family Research Council) 50–1, 180 Goldberg, Suzanne 176
Freeman, Estelle: Intimate Matters: A History Goldstein, Joshua 199
of Sexuality in America 27 González-López, Gloria 47–9
Freire, Paul: Pedagogy of the Oppressed 48, GPA (Louisiana’s Governor’s Program on
160 Abstinence) 127
Freud, Sigmund 75, 77, 167; Three Great Man/War leader 195
Contributions to the Theory of Sex 154 Green, Jamison 7, 35–7
FTM (female-to-male) 35–6 GSAs (Gay–Straight Alliances) 30
fundamentalism and exclusion 173 G-Strings and Sympathy: Strip Club Regulars
Fung, Richard 79 and Male Desire (Frank) 85
Guardians of the Flutes 195
Gagnon, John 6, 7, 10 Guttmacher Institute 124; “Issues in Brief”
Gaiter, Juarlyn: Journal of Black Psychology 176
45–6
“game of love” 205–6 Hahn, Harlan 147
Gay, Lesbian and Straight Education Network Halberstam, Judith 63–6
8 (GLSEN) 30 Hamamoto, Darrell 78
Index 213
1111 harassment: against abortion providers 101; Hoang, Nguyen Tan 79
2 and homophobia 29-31 Holgate, Karen 31
3 “hardship tour” 203–8 Holocaust 196
4 Harper, G.W.: “Giving voice to emerging homelessness, transgender people 107–9
science and theory for lesbian, gay, homophobia: and discrimination 140–4;
5
bisexual people of color” 142 and harassment 29–31; and violence
6 Harrison, Deborah: “Violence in the military 141
7 community” 199 homosexuality: and AIDS 7; definition
8 HBO Web site 69, 71–2 168; as a disease 6, 142–3; in the military
9 health: and African Americans 92, 93–4; 200

10 definition 89–90, 92; disparities in 90–1; “Homosexual Urban Legends” 51
1 LGBT people 141–2; sexual 9 18, 89–91, “hook–ups” 58–9
2 93–4 Hou, James 78
311 healthcare 11; for FTM people 36; for LGBT Howe, Cymene 1–13, 15–16, 53–4, 89–91,
people 140–4; providers, and 119–20, 167–9, 190–3
4
discrimination 143; and transgender HRC (Human Rights Commission) Lesbian,
5 women 109 Gay, Bisexual, and Transgender (LGBT)
6 Healthy People 2010 Companion Document Advisory Committee 164–5
7 for LGBT Health 142 HRSB (high risk sexual behavior), in the US
8 “He is a ‘bad mother *$%§!#’: Shaft and Navy 110–11
9 contemporary black masculinity” (Henry) HRW (Human Rights Watch) 29, 181
20 24 Hsu, Funie 79
1 Helms Amendment 175 Human Rights Commission (HRC) Lesbian,
2 Henry, Matthew: “He is a ‘bad mother Gay, Bisexual, and Transgender (LGBT)
3 *$%§!#’: Shaft and contemporary black Advisory Committee 164–5
masculinity” 24 Human Rights Watch (HRW) 29, 181
4
Henshaw, S.K.: “Abortion incidence and Humphrey, Laud: The Tearoom Trade 113
5 services in the United States in 2000” 101 Hunter, Anthony 69–73
6 Herdt, Gilbert 1–13, 15–16, 17–19, 53–4, Hunter, Nan D.: Sex Wars: Sexual Dissent
7 89–91, 119–20, 167–9, 194–7 and Political Culture 5
8 Hermanos de Luna y Sol (Brothers of the Hutchins, Loraine 135–9
9 Moon and Sun) 160–1 hypermasculinity 24–5; see also masculinity
30 heterosexuality: compulsory 39; extreme 113,
1 199, 202; in Nicaragua 190–3 IASR (International Academy of Sex
2 heterosexuals: and equality in marriage Research) 136
32–4; and rape 23; sex 22; and strip clubs ICPD see International Conference on
3
85–8 Population and Development
4 Heyzer, Noeleen 122 International Academy of Sex Research
5 “Hidden Fear: Black Women, Bisexuals and (IASR) 136
6 the AIDS Risk” (Randolph) 44 International Conference on Population and
7 Higate, Paul 198–202 Development (ICPD) 175, 176; on
8 high risk sexual behavior (HRSB), in the US sexuality 119
9 Navy 110–11 International Conference on Population and
40 Hip Hop Generations: Young Blacks and the Development (1994) 170
1 Crisis in African American Culture International Criminal Court 194
2 (Kitwana) 27 International Planned Parenthood Association
Hirschman, Celeste 5, 32–4 (PPA) 174
3
HIV 2, 22, 160–2; and the black community International Women’s Health Coalition 177,
4 45; and black women 44; feminization of 181
5 121–3; and the Internet 57–9; prevention Internet 2; AIDS on 57–9; and abortion
6 of 121–3, 176–7; and seniors 104–6; activism 100; chatrooms 57–8; dating on 9,
7 transgender people 107–9; in Vietnam 61, 151–2; and education 56; HIV on 57–9;
118 182–3 and sadomasochism 156; sex on 55–6,
214 Index
11 57–9; sexuality 2, 8–13; sexual networks Krafft-Ebing, Richard von: Psychopathia
57–9; see also websites Sexualis 154, 155
Intersex Awareness Day 165 Kronenfeld, Jennie 112–14
Intersex Initiative 165
Intersex Society of North America (ISNA) Lamphere, Louise 140–4
163 Lancet, The 180
Intersex Task Force 165 Latinas 47–9
intersexuality 163–5 Latini, David M. 104–6
“In the Life” (Beam) 45 Latino adolescents 25–8
Intimate Matters: A History of Sexuality in Latino Gay Men and HIV: Culture, Sexuality
America (D’Emilio and Freeman) 27 and Risk Behavior (Diaz) 160–2
Irvine, Janice M. 5, 6, 8, 50–2; “Anti-Gay Laumann, Edward 6
Politics Online: A Study of Sexuality and Law, Sylvia 84
1 Stigma on National Websites” 50; Talk law enforcement, and prostitution 82–3
About Sex: The Battles over Sex Education Lawrence v. Texas 33
in the United States 52 Leadership Training Program 98
Irvine, Judith 7 Lee, Brandon 79
Isley, Paul 42 Lee, Christopher 79
ISNA (Intersex Society of North America) Lefkowitz, Bernard: Our Guys: The Glen
163 Ridge Rape and the Secret Life of the
“Issues in Brief” (Alan Guttmacher Institute) Perfect Suburb 27
176 Lesbian, Gay, Bisexual, and Transgender
(LGBT) Advisory Committee 164
JAMA (Journal of the American Medical Lesbian, Gay, Bisexual and Transgender
Association) 97 (LGBT) people, mental health of
Jernewall, N.: “Giving voice to emerging 141–2
science and theory for lesbian, gay, lesbians: equality in marriage 11, 51, 132;
bisexual people of color” 142 in Nicaragua 190–3
Joffe, Carole 101–3 lesbosexual 67
Johnson, Virginia E. 6 Levine, Deborah 5, 55–6
Journal of Black Psychology 45–6 Lewis, Linwood J. 24–8
Journal of the American Medical Association Lewis, Rae 140–4
(JAMA) 97 LGBT (Lesbian, Gay, Bisexual and
Just Say Whoa 127 Transgender) people, mental health of
141–2
Kama Sutra 155 Linsk, Nathan 105, 106
Kelley, Robin D.G. 26 literacy, sexual 3–4, 7, 15–19
Kemp Kasten Amendment 175 Lockwood, Laura 29, 30
Kempner, Martha 8, 124–9 “Looking for my Penis” (Fung) 79
Kennedy, E. 7 “Looking for the ‘Real’ Nigga: Social
Kertzner, Robert M. 132–4 Scientists Construct the Ghetto” (Kelley)
Keuls, Eva: Reign of the Phallus 155 26
kichich’on clubs, 203, 205, 207 Los Angeles Times 136
Kidwell, Jennifer 8, 121–3 Lousiana’s Governor’s Program on
King, J.L. 44 Abstinence (GPA) 127
Kinsey, Alfred 6, 51; on sexual orientation Lubbock, Texas, abstinence-only-until-
138 marriage program 129
Kinsey Institute New Report on Sex 154 Lucas, Ann M. 81–4
Kirby, D. 8 L Word, The 10, 67–8
Kitwana, Bakari 27
Klinefelter’s Syndrome 163 McClintock, Anne 154
Komsomol 188–9 MacDonaldization of Society, The (Ritzer)
8 Koyama, Emi 165 74
Index 215
1111 MacKinnon, Catharine: Toward a Feminist military: sexuality 199–200; view of women
2 Theory of the State 38 199
3 Madame Butterfly (Puccini) 196 Mirandola, Pico della: Disputationes Adversus
4 MAEP (Medical Abortion Education Project) Astrologiam Divinatricem 155
99 miscegenation 27
5
Mai Lai massacre 199 Mitchell, Leif: Tackling Gay Issues in School
6 Mallon, Gerald P.: We Don’t Exactly Get the 30
7 Welcome Wagon: The Experiences of Gay ModelMinority.com 78–9
8 and Lesbian Adolescents in Child Welfare Moore, Sandra E. 92–4
9 Systems 29 moral panics 5–8, 17–19

10 Man Who Would Be Queen, The (Bailey) Morris, Marilyn 127
1 137–8 Mort, Frank 27
2 Marie Stopes International (MSI) 174 MSFC (Medical Students for Choice) 98
311 marriage: equality 52, 132–4; for gays and MSI (Marie Stopes International) 174
lesbians 11, 51, 132; heterosexual 32–4; MSM (men who have sex with men), choice
4
same-sex 33, 132–4; studies of 133; US of partners 113–14
5 House of Representatives on 33–4
6 masculinity: Asian American 78–80; Nanking, “rape of” 196
7 exaggeration of 194; in the military 199; National Association of Social Workers
8 see also hypermasculinity 143
9 Massachusetts, gay marriage in 51, 132 National Coalition of Black Lesbians and
20 Massachusetts Supreme Judicial Court Gays (NCBLG) 45
1 132 National Comorbidity Survey 141
2 Masters, William 6 National Gay and Lesbian Task Force 136,
3 Masters of the Pillow 78 137
masturbation 7, 20–1, 52 National Health and Social Life Survey
4
Mays, Vickie 45 51
5 Mead, Margaret: Sex and Temperament in National Institute of Health 181
6 Three Primitive Societies 195 National Mental Health Association (NMHA)
7 media, treatment of bisexuals 135–9 29, 30
8 medical: students, and sexuality education 93; natural diversity 63–6
9 surveillance, of prostitutes 200 NCBLG (National Coalition of Black
30 Medical Abortion Education Project (MAEP) Lesbians and Gays) 45
1 99 Neff, Lisa: “Scents and Sexuality” 138
2 medicalization: definition of 95; impact of New Mexico, poverty in 142
96–7; of intersex people 163–4; negative New York Times 135, 136–7
3
effects of 97; viewpoint of social scientists New York Times Magazine 44
4 96 NGOs (nongovernmental organizations) 174,
5 Medical Students for Choice (MSFC) 98 175
6 medicine 11, 141, 145–6 Nicaragua 190–3
7 Melendez, Rita M. 7, 107–9 NiCarthy, Ginny: You Can Be Free: An
8 memory loss, short-term 64, 65 Easy-To-Read Handbook for Abused
9 men, rape of 41–3 Women 42
40 mental health, LGBT people 141–2 Nishioka, Joyce 160–2
1 men who have sex with men (MSM), choice NMHA (National Mental Health Association)
2 of partners 113–14 29, 30
Mergerwatch 99 “No Child Left Behind” 31
3
metrosexual 67 nongovernmental organizations (NGOs) 174,
4 Mexicanas 48 175
5 Mexico City Plan see Global Gag Rule Northern California Association on HIV Over
6 Midwest AIDS Training and Education Fifty 105
7 Center 105 Northwestern University 135, 138
118 mifepristone 71, 98, 101, 102, 103 “nosotras” perspective 48
216 Index
11 Onomasticon (Burnfels) 155 pregnancy: statistics 174; unplanned
“on/scene” 75–6 111
On the Down Low: A Journey Into the Lives of Prehistory of Sex, The (Taylor) 155
“Straight” Black Men Who Sleep with Men Preserve Project 99
(King) 44 President’s Emergency Plan for AIDS
On the Real Side: A History of African Relief (PEPFAR) 123, 176, 177
American Comedy (Watkins) 26 Prevention Research Center 110
Oprah Winfrey Show, The 44 “The Price Tag of Sex” (Stenzel) 127
orientation, sexual 82: and arousal 135–6; Fos Prine, Linda 98–100
on 138; Kinsey on 138; psychological privacy, transgender persons 157–9

approach 138–9 Procedural Guidance 45
Our Guys: The Glen Ridge Rape and the pro-choice 69, 71, 72
Secret Life of the Perfect Suburb pro-life 69, 71, 72
1 (Lefkowitz) 27 prostitution 81–4, 168; economic conditions
Oz 33 201, 207; and law enforcement 82–3;
medical surveillance 200; and
packaged sex 17, 18 peacekeepers 198–202; in South Korea
Parker, Richard 6, 7 203–8; in Vietnam 182–5
partnerships, same-sex 33 psychology, approach to sexual orientation
patriarchy, and feminism 39 138–9
peacekeepers: and sexuality 12; and Psychopathia Sexualis (Krafft-Ebing) 154,
prostitution 198–202 155
pedagogy, of sexuality 9 Public Security 183
Pedagogy of the Oppressed (Freire) 48, 160 Publishers Weekly 137
penis meter 135 Puccini: Madame Butterfly 196
PEPFAR (President’s Emergency Plan for
AIDS Relief) 123, 176, 177 queer politics 7
Personal Responsibility and Work
Opportunity Reconciliation Act (1996) Randolph, Laura: “Hidden Fear: Black
32 Women, Bisexuals and the AIDS Risk”
Pettett, Christine E. 29–31 44
pharmaceutical companies: and female R and R, South Korea 203–8
sexual dysfunction 95; treatments for racism, and rape 26–7
seniors 105 rape: and feminism 38; gay 23; heterosexual
Philadelphia Inquirer 136 23; and Latinas 48; meanings of 38–40;
Phu Nu 182, 183 of men 41–3; “of Nanking” 196; and
Physicians for Reproductive Choice and racism 26–7; statistics on 41–2; as tool
Health 98–9 of war 194–7
pimps 82 “rape of Nanking” 196
Piot, Peter 121–2 Reagan, Ronald 175
Pitts, Joseph 179 Rebchook, Gregory 9, 57–9
“Pity Date” 151 recreational sex 6
plethysmograph 135 Reign of the Phallus (Keuls) 155
“Politics of Sexual Violence, The” (Simon) relationships, cybersexual 62
42–3 religion, and the abstinence-only-until-
poor, the 27 marriage movement 127
Pope, Cynthia 8, 174–7 Rembar, Charles 75
pornography 10–11, 75; and Asian Americans “rent-a-dreads” 82
78–80; and gays 79 Reproductive Health Externship program
“pornography of consumption” 74–5 98
poverty 142 research, into sexuality 7, 147
PPA (International Planned Parenthood Rieger, Gerulf 135–6, 137; “Sexual Arousal
8 Association) 174 Patterns of Bisexual Men” 135–6, 138
Index 217
1111 Rigi, Jakob 186–9 Senior HIV Intervention Project (SHIP)
2 rights: abortion 6; and disability 9–10; sexual 104–5
3 7, 8, 9, 119–20, 170–3 seniors: and AIDS/HIV 104–6; drug use 105;
4 right wing, the, and abstinence-only-until- pharmaceutical treatments for 105;
marriage 178–81 sexuality 104–6
5
Risen, J. 101 sex: addiction 115–18; anal 58–9;
6 risk networks, truckers 112–13 heterosexual 22; and the Internet 55–6,
7 Ritzer, George 74, 76, 77; Globalization of 57–9; meaning of 152–3; offenders
8 Nothing, The 74; MacDonaldization of 115–18; packaged 17, 18; recreational 6;
9 Society, The 74 tourism 197; trafficking 11; unprotected

10 Robert, Christophe 182–5 108; workers 11, 130–1; see also sexual;
1 romances, online 60–2 sexuality
2 Rothschild, Cynthia 178–81 Sex and Temperament in Three Primitive
311 Roughgarden, Joan 63, 64–5 Societies (Mead) 195
Rounsley, Chloe Ann: True Selves: For sexes, separation of 157
4
Families, Friends, Coworkers and Helping Sex in the City 69
5 Professionals 159 sex reassignment surgery 158–9, 164; see also
6 Rousseau, Jean-Jacques 155 genital reconstruction
7 Row v. Wade (1973) 6 Sexto Sentido, El 192–3
8 RU486 see mifepristone sexual: activism 119–20; addiction 115–18;
9 Russ, Ann 110–11 aggression 25; commodification 53–4;
20 Russia, sexuality in 186–9 communities 9; culture 156; dysfunction
1 Ryan, Caitlin 161 89, 95–7; function 145–6; literacy 3–4, 7,
2 15–19; research 147; rights 7, 8, 9, 119–20,
3 Sade, Marquis de 155 170–3; scripts 10; see also behavior,
sadomasochism (S/M) 154–6 sexual; health, sexual; orientation, sexual;
4
Safe Schools initiatives 30–1 sex; sexuality
5 Safe Zone program 30 “Sexual Arousal Patterns of Bisexual Men”
6 Sambia 195 (Rieger, Chivers, and Bailey) 135, 137,
7 Samenow, Stanton E. 4, 115–18 138
8 same-sex partnerships 33 sexualities: dangerous 27; equalizing 76–7
9 Sandinistas 190 sexuality: “Americanization” of 168;
30 San Francisco Human Rights Commission changing faces of 1–2; Chicana 48; and
1 (HRC) Lesbian, Gay, Bisexual, and citizenship 34, 170–3; consumerism 74–7;
2 Transgender (LGBT) Advisory Committee definition 1; and disability 145–8, 149–53;
164–5 education 2–3, 4, 5, 6–7, 8, 12, 15–18,
3
San Francisco Transgender Civil Rights 32–4, 124; and fundamentalism 173;
4 Implementation (SFTGCRI) Task Force globalization of 167–9; history of 5–8;
5 164 International Conference on Population
6 Satcher, David 8; Surgeon General’s Call and Development (ICPD) 119; military
7 to Action to Promote Sexual Health and personnel 199–200; Nicaragua 190–3;
8 Responsible Sexual Behavior 90–1 online 2, 8–13; and peacekeepers 12;
9 Scalia, Antonin 52 pedagogy of 9; research 4–5, 7; in Russia
40 “Scents and Sexuality” (Neff) 138 186–9; and seniors 104–6; and war 12,
1 Schlosser, Eric 85 194–7
2 schools: discrimination in 120; sexuality “sexuality free from Prejudice” (una
education 2–3, 4 sexualidad libre de prejuicios) 191
3
Schrader, A.M.: Technology and the Politics Sexuality Information and Education Council
4 of Choice: Information Literacy, Critical of the United States (SIECUS) 124, 125,
5 Thinking, and the Intellectual Freedom 4 127
6 Scott Marti, Kris 67–8 Sexuality Research & Social Policy 50
7 scripts, sexual 10 sexually transmitted diseases (STDs): and
118 Secretary of Health and Human Services 179 truckers 112–14; in the US Navy 111
218 Index
11 Sexual Politics of Disability: Untold Desires, Stop AIDS program (San Francisco) 179
The (Shakespeare, Gillespie-Sells and “Straight, Gay or Lying: Bisexuality
Davies) 147 Revisited” (Carey) 135
“sexual selection” theory 63 Stratford, David 112
Sex Wars: Sexual Dissent and Political strip clubs 85–8
Culture (Duggan and Hunter) 5 students; high school 124–5; medical 93;
SFTGCRI (San Francisco Transgender Civil middle school 20–3
Rights Implementation Task Force) 164 Sueyoshi, Amy 78–80
Shaft 24 support system, community as 143–4,
Shakespeare, Tom, Sexual Politics of 161–2

Disability: Untold Desires, The 147 Surgeon General’s Call to Action to Promote
Shindle, Kate 127 Sexual Health and Responsible Sexual
SHIP (Senior HIV Intervention Project) Behavior (Satcher) 90–1
1 104–5 Surgeon General’s Report 8
Shock 76 “survival sex” 168
Shuttleworth, Russell P. 9–10, 145–8 syphilis 197
SIECUS (Sexuality Information and
Education Council of the United States) Tackling Gay Issues in School (Mitchell)
124, 125, 126 30
sildenafil (Viagra) 96, 105 Talk About Sex: The Battles over Sex
Simon, Leslie 41–3; “Politics of Sexual Education in the United States (Irvine)
Violence, The” 42–3 52
Simpson, Mark 67 Taylor, Timothy: The Prehistory of Sex
Sissons, Kathy 7, 154–6 155
Six Feet Under 10, 33, 70–3 Tearoom Trade, The (Humphrey) 113
Skin on Skin 78 technologies 2–3, 4–5
slaves, African 27 Technology and the Politics of Choice:
S/M (sadomasochism) 154–6 Information Literacy, Critical Thinking,
Smith, Chris 179 and the Intellectual Freedom
Smith, Donna Jo 112–14 (Schrader) 4
social policy on marriage equality 133 television 10; abortion storylines 69–70; gay
social scientists, on medicalization 96 characters 33, 72
“social selection” theory 63, 64–5 Temporary Assistance to Needy Families Act
Society of Sanitary and Moral Prophylaxis (1996) 125
15 testosterone replacement therapy 163–4
Society of Teachers of Family Medicine Teunis, N 2
(STFM) 99–100 therapeutic practices, on homosexuality
soderzhanka 188 143
sodomy 191 Thomas, J. 101
Sonmez, Sevil 112–14 Three Contributions to the Theory of Sex
Southeast Asia, sex tourism 197 (Freud) 154
Southern Comfort 36 Thukral, Juhu 130–1
South Korea, prostitution in 203–8 Tiefer, Leonore 95–7
Sparandara, Jennie 98–100 Till, Emmett 27
spinal cord injury, affects on dating 149–50 Title V (Social Security Act) 32, 125
STDs (sexually transmitted diseases): and Todd Weiss, Jillian 157–9
truckers 112–14; in the US Navy 111 tourism, sex 197
Stenzel, Pam “The Price Tag of Sex” 127 Toward a Feminist Theory of the State
stereotyping 9, 21; black male youth 24–8 (MacKinnon) 38
sterilization 146 Traditional Values Coalition (TVC) 50
STFM (Society of Teachers of Family trafficked persons 130–1
Medicine) 99–100 trafficking sex 11
8 Stonewall Riots (1969) 36–7 transgenderism 63–6
Index 219
1111 “Transgender Movement” 36–7 Vienna World Conference on Human Rights,
2 transgender persons 107–9, 157–9 and rights 119
3 transgender women, and gays 108–9 Vietnam: AIDS/HIV in 182–3; prostitution in
4 Trefethen, Tre 149–53 182–5; view of women 184–5
Trouble with Normal, The (Warner) 11 Village Voice 52
5
truckers: disease transmission 112–14 violence: gender based 207; and homophobia
6 True Selves: For Families, Friends Coworkers 141
7 and Helping Professionals (Brown and virginity pledges 126
8 Rounsley) 159
9 Trump, Donald 26 Wade see Row v. Wade (1973)

10 Turner’s Syndrome 163 Wall Street Journal 31
1 TVC (Traditional Values Coalition) 50, 51 Wanjera, Rose 174
2 war: rape as tool of 194–7; and sexuality 12
311 Uganda, abstinence-only-programs in 180 Warner, M. 7
una sexualidad libre de prejuicios (“sexuality Warner, Michael: Trouble with Normal, The
4
free from Prejudice”) 191 11
5 UNFPA (United Nations Fund for Population War on Choice, The (Feldt) 176
6 Activities) 175 Warren Court 156
7 UNIFEM Trust Fund to Eliminate Violence Waters, John 75
8 Against Women 122 Watkins, Mel 26
9 United Nations, the: role of the United States Waxman, Barbara: Disability Rag 145,
20 172–3, 180; and sexual rights 171 147
1 United Nations Blue Helmets Code of Waxman, Henry 181
2 Conduct 201–2 websites, anti-gay 50–2; see also Internet
3 United Nations Fund for Population Activities We Don’t Exactly Get the Welcome Wagon:
(UNFPA) 175 The Experiences of Gay and Lesbian
4
United Nations General Assembly Special Adolescents in Child Welfare Systems
5 Session on Children (2002) 180 (Mallon) 29
6 United Nations Human Rights Commission Weeks, J 6
7 (2003) 171 Weiss, Jillian 7
8 United States Agency for International Weitz, Tracy A. 69–73
9 Development (USAID) 174, 175 welfare organizations 30
30 United States of America, role in United “welfare reform” 32, 125
1 Nations conferences 172–3, 180 Whatley, Mariamne H. 20–3
2 Universal Declaration of Human Rights Wheeler, Darrell: Journal of Black
(1948) 171, 178 Psychology 45–6
3
University of California, AIDS Research White, Renée T. 8, 174–7
4 Program 161 “wilding” 27
5 University of California, San Francisco, Will and Grace 10, 33
6 disability and sexual research 147 Willging, Cathleen 140–4
7 unprotected sex 108 Williams, Linda 74–7
8 urges, male 183–4 Wimberly, Yolanda 3, 92–4
9 USAID (United States Agency for Woleslagle, Brandee 10, 60–2
40 International Development) 174, 175 “wolfpack”, the 26, 27
1 US House of Representatives, on marriage women: and AIDS 44; military view of 199;
2 33–4 rights of 11–12; in Vietnam 184–5
US Navy, HRSB 110–11 Women of Color Resource Center 33
3
US Office of Population Affairs 52 Working Toward Independence (WTI) 33
4 US Supreme Court 33 World Conference Against Racism, Racial
5 Discrimination, Xenophobia, and Related
6 Vaid, U. 7 Intolerance (2001) 171
7 Vance, Carole 7 World Conference on Human Rights (1993)
118 Viagra (sildenafil) 96, 105 171
220 Index
11 World Health Organization 89, 92, 174 young people 2; 24–8
WTI (Working Toward Independence) 33
Zamudio, Anthony 45
You Can Be Free: An Easy-To-Read Zea, M.C.: “Giving voice to emerging
Handbook for Abused Women (NiCarthy science and theory for lesbian, gay,
and Davidson) 42 bisexual people of color” 142

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Downloaded by [Central Uni Library Bucharest] at 22:46 23 September 2013

First published 2007

All rights reserved. No part of this book may be reprinted or reproduced or

ISBN 0-203-94747-9 Master e-book ISBN

ISBN10: 0–415–77306–7 (hbk)

ISBN13: 978–0–415–77306–5 (hbk)

11 Christian right rhetoric: exploring anti-gay politics online 50

12 Surﬁng for healthy sexualities: sex and the Internet 55

15 Finding Nemo and transgender creatures 63

16 The L Word: a little something for the femmetrosexual? 67

17 Six Feet Under brings abortion to the surface 69

18 The pornography of consumption/the consumption of pornography 74

19 InnovAsian in pornography? Asian American masculinity

21 Strip clubs and their regulars 85

22 Doctors, patients, and sexuality 92

9 an abortion provider 101

36 Seeking help in rural communities: homophobia and racism

37 Disability and sexuality: from medical model to sexual rights 145

39 Heterosexual and bisexual S/M: cultural formations 154

40 Ms etiquette and the transgender employee: is nothing private

41 At the Cesar Chavez Institute: bridging academic research

42 My intersex journey: from awkward teenager to human rights

43 Global perspectives on sexual rights 170

44 Global impact: US sexual health and reproductive policy 174

45 Abstinence goes global: the United States, the right wing,

46 Sex work in contemporary Vietnam: foreign plague or

Sonia Corrêa is the founder of SOS-Corpo, Gênero, Cidadania, a feminist non-

Bonnie Duran, Ph.D. is an Associate Professor in the Department of Family and

Jessica Fields, Ph.D. is an Assistant Professor of Sociology at San Francisco State

Gilberto R. Gerald, a Panamanian native and naturalized US citizen, is a 1974 Pratt

Adrienne Germain is President of the New York-based International Women’s Health

Gloria González-López, Ph.D. is Assistant Professor of Sociology at the University

Martha Kempner is the Associate Director of Information and Education of SIECUS,

analysis, and reporting of trends in sexuality education, as well the activities of

Robert M. Kertzner, M.D. is Associate Clinical Professor of Psychiatry at University

Jennifer Kidwell is Communications Associate at the International Women’s Health

Jennie Kronenfeld, Ph.D. is Professor of Sociology in Arizona State University’s

Louise Lamphere, Ph.D. is a Distinguished Professor of Anthropology at the

Deborah Levine, M.A. is Executive Director of Internet Sexuality Information

Linwood J. Lewis, Ph.D. is Associate Professor of Psychology at Sarah Lawrence

Rae Lewis, M.S., M.P.H., is a faculty member of Axia College of University of

9 Krisbeep.blogspot.com and AmericanSexuality.blogspot.com.

Christophe Robert, Ph.D. earned his doctorate at Cornell University and is a

Stanton E. Samenow, Ph.D. is a Clinical Psychologist in Alexandria, Virginia. He is

Russell P. Shuttleworth, Ph.D. is currently a Visiting Scholar at the Institute of Urban

Donna Jo Smith, M.A. is a doctoral candidate in the Graduate Institute of Liberal

Yolanda Wimberly, M.D., M.Sc. is an Assistant Professor of Clinical Pediatrics at

Morehouse School of Medicine in Atlanta, Georgia who practices adolescent

1 Brandee Woleslagle is a Master’s degree candidate at San Francisco State University

9 Commodiﬁcation” we query how technologies, the media, and sexuality as a commod-

Sexuality and reproductive research: just now catching up

9 have continued to be inﬂuential, now, increasingly, on television and online. As Kathy

education on abstinence and use of contraceptives, etc.). Abstinence-only is an

Searching: making meaning out of sexuality online

Understanding sexuality in context

Other legendary dangers

What is the media saying?

9 of bullying based on race, religion or ethnicity.” Nonetheless, following objections to

Promoting heterosexual marriage

Liberatory models of education and citizenship