During the 2018 National Conference of Constituency Leaders (NCCL) held here April 26-28, AAFP members from the five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and lesbian, gay, bisexual and transgender (LGBT) physicians and those supportive of LGBT issues -- acted on resolutions considered by the Reference Committee on Health of the Public and Science.
During the Reference Committee on Health of the Public and Science hearing, Anita Ravi, M.D., M.P.H., a general registrant from New York, N.Y., discusses a resolution she co-authored, explaining that educating patients about consent could be an incredibly powerful tool to preventing sexual assault.
Among resolutions discussed during the April 27 committee hearing were a handful that focused on sexual education, and the prevention and treatment of sexually transmitted infections (STIs).
Addressing Sexual Issues
A theme among a handful of resolutions adopted during the business session on April 28 was use of sexual education to curb harassment and other issues arising from a lack of understanding on the subject.
One resolution adopted asked the AAFP to bolster its current policy on intimate partner violence by partnering with the White House Task Force to Prevent Sexual Assault in supporting its "It's On Us" campaign(www.itsonus.org) to stop sexual assault on college campuses.
Resolution co-author Kevin Bernstein, M.D., M.S., M.M.S., a uniformed services delegate from Jacksonville, Fla., explained during the reference committee hearing that the "It's On Us" effort began by asking victims how they thought sexual assault could be stopped; they said it needed to start with education.
- A theme among a handful of resolutions considered by the Reference Committee on Health of the Public and Science at the National Conference of Constituency Leaders was the use of sexual education to curb harassment and other issues arising from a lack of understanding on the subject.
- Delegates also adopted resolutions that address the prevention and treatment of sexually transmitted infections, including the use of pre-exposure prophylaxis for HIV.
- Another resolution asked the Academy to develop an evidence-based clinical practice guideline that provides recommendations for optimizing the postpartum period.
"We need to talk to everyone who is involved -- men, women -- 'it's on us.' We shouldn't need #MeToo campaigns," he said.
The "It's On Us" campaign currently has 95 partner organizations, and students on more than 500 college campuses are involved.
Bernstein pointed out that family physicians treat many college students, as most colleges require a physician's visit and immunization. He concluded by saying that of the more than 90 organizations that formally support this campaign, not one is a medical organization.
Another resolution looking to better educate students about sexuality focused on elementary, middle and high schools. Adopted during the business session as amended by substitution, the resolution called on the Academy to promote health education programs that are "age-appropriate, culturally relevant and include evidence-based medical information on contraception, sexually transmitted infection (STI) prevention, consent, and sexual and gender minority issues."
Additionally, it asked the AAFP to define comprehensive sexual education in its current policy on adolescent health care, sexuality and contraception.
Mary Catherine Harrel, M.D., a women's delegate from Tucson, Ariz., spoke in support of the resolution, saying it would build on the Academy's current policy by adding support for evidence-based sexual education programs in public schools.
"We know from CDC data that the number of evidence-based, gender-inclusive sex-ed programs being utilized in the public health sector has been on the decline," she said. "Now with the federal government saying it will be promoting abstinence-only sexual education programs,(www.hhs.gov) I think it's really important the AAFP take a very strong stance on this topic and update its policy so the public knows where family physicians stand on evidence-based, inclusive sex ed."
An interrelated concept in the sexual education discussion is that of consent, which was the focus of another resolution delegates adopted that asked the AAFP to create a policy on sexual health, to include a statement that says consent in sexual encounters is a public health issue.
In addition, the resolution asked that this policy recommend that family physicians "discuss with and educate all patients on the concept of consent to sexual activity and what to do if sexual contact takes place against one's consent."
Finally, the resolution asked the Academy to create a consent toolkit to help family physicians educate patients on sexual consent, bodily autonomy and other appropriate resources.
Co-author Anita Ravi, M.D., M.P.H., a general registrant from New York, N.Y., said she thought educating patients about consent could be an incredibly powerful tool to prevent sexual assault.
"I cannot tell you how hard it is when a patient comes in asking me if they have been raped," she said. "That's a hard question to answer that we aren't properly trained for. I wish I were more educated in being able to talk about this at age-appropriate levels throughout my training and with all of my patients."
Marty Player, M.D., lesbian, gay, bisexual and transgender constituency delegate from Charleston, S.C., explains a resolution he co-authored that asked the Academy to send a letter to the Federal Bureau of Prisons requesting the integration of pre-exposure prophylaxis into routine HIV prevention strategies in prisons.
Sexual harassment and assault can happen at any social or professional level, including with family physicians. That's why a substitute resolution was adopted that, among other things, would expand the AAFP's policy on violence, harassment and bullying to include information about the negative impact of sexual harassment of family physicians and medical trainees.
Additionally, it asked for the Academy to provide resources on its website for physicians who are dealing with sexual harassment in the workplace from colleagues, superiors or patients.
Furthermore, the substitute resolution asked for sessions about sexual harassment to be included during the Family Medicine Experience and National Conference for Family Medicine Residents and Medical Students.
Co-author Jessica Heselschwerdt, M.D., a women's delegate from Okemos, Mich., said, "The AAFP isn't going to stop sexual harassment, but it needs to be a resource for our trainees -- residents and medical students -- as well as for our physicians in providing them resources, education and avenues to deal with this problem."
Preventing and Treating STIs
Delegates also adopted resolutions addressing the prevention and treatment of STIs, including the use of pre-exposure prophylaxis (PrEP) for HIV.
First off, a substitute resolution asked that the AAFP's policy statement on prevention and control of sexually transmitted and bloodborne infections include language that opposes discrimination in the purchase of life insurance or health insurance by people who take PrEP for HIV.
Co-author Scott Hartman, M.D., a general registrant from Rochester, N.Y., said this issue is important because patients currently are being denied access to PrEP through insurance providers.
Natalie Hinchcliffe, D.O., an LGBT delegate from Cleveland, said she treats many of her patients with PrEP.
"I recognize that PrEP is preventive health care for my many diverse patients; however, until everyone recognizes it as preventive health care, we won't end the HIV epidemic," she said.
Another resolution asked the Academy to send a letter to the Federal Bureau of Prisons requesting integration of PrEP, along with medication, condoms, education and frequent HIV/STI screening, into routine HIV prevention strategies in federal prisons.
Co-author Marty Player, M.D., an LGBT delegate from Charleston, S.C., said there is a disproportionate number of people in prisons with HIV.
"But they don't receive the education (on PrEP) that the general population does, and we feel this should be a fundamental right for them, as well," he said.
Among other measures considered by the reference committee, NCCL delegates adopted resolutions that asked the Academy to
- oppose shackling incarcerated women who are in active labor or postpartum period,
- investigate and promote successful community-based programs that address food disparities,
- create a policy statement defining implicit bias and its impact on disparities of care,
- advise the website stopbullying.gov(www.stopbullying.gov) about how family physicians can help address bullying, and
- develop an evidence-based clinical practice guideline that provides recommendations for optimizing the postpartum period, including a comprehensive family-centric partnership.
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