By Kevin Halenda ‘12
Princeton’s University Health Services (UHS) recently announced a major change in their policy on testing for sexually transmitted infections (STIs). “Working in partnership with the New Jersey Department of Health, UHS is now able to offer gonorrhea and Chlamydia testing to all students, regardless of insurance coverage, for $14 effective November 2010,” writes Olga Hernandez, Coordinator of Sexual Health and Wellness Services at UHS. According to this same source, testing previously came at a cost of upwards of $250 for students lacking insurance coverage due to the use of private labs.
In light of this news, the Undergraduate Student Government (USG) sponsored an event in the Frist Campus Center on January 11th, entitled “Safe is Sexy.” The event was intended to “announce and celebrate updated policy surrounding HIV testing,” and “broaden the scope of what it means to be sexually healthy,” as well as “destigmatize” HIV testing,” according to Andrew Blumenfeld, a Class of 2013 Senator, and one of two student coordinators for the event. Co-sponsors of the of the event also included several students groups devoted to issues of sex and sexuality, such as Sexual Health Advisors (SHA), Sexual Harassment/ Assault Advising, Resources, and Education (SHARE), Princeton Pride Alliance, Let’s Talk Sex (LeTS), as well as the Program in Women and Gender Studies.
The event, which featured food, massage therapists, and a giveaway—a dinner for a couple, to the person who came closest in guessing the correct number of free condoms in a bowl– came at a cost of roughly $1,000, according to Blumenfeld. Both the masseuses and the testers were “working at full capacity” the entire time, says Blumenfeld, estimating that roughly 30-40 students actually received the rapid HIV test. While Blumenfeld states that currently there are no official plans to hold this event again, he hopes the USG will revisit this idea “conceptually” in the future.
Still, not all were celebrating, and some were offended by the event’s presentation. According to Blumenfeld, the most significant opposition towards the event was received from the Anscombe Society. In a blog post dated January 11th, Anscombe’s then-president, Shivani Radhakrishnan, wrote, “Aside from the strangeness of the USG advertising this event to the entire campus and the mixed messages that intertwine dating and sex (not to mention cookies and condoms), I’m surprised that I haven’t heard much mention of the posters/event. It seems as though the advertisements hypersexualize and almost trivialize important health information.”
But “Safe is Sexy” highlights issues beyond free cookies and condoms. Professor Adel Mahmoud, M.D., Ph.D., the former president of Merck Vaccines who holds a joint appointment in the Molecular Biology Department and the Woodrow Wilson School, expresses positive sentiment towards the new policy, citing the increased awareness as a step forward in addressing HIV as a “serious public health challenge” and the “epidemic of our generation.” However, one wonders whether the goal of promoting HIV awareness through such an event could have been achieved through alternative means, at a lower cost and with a more neutral stance on sexual issues.
According to a 2006 study by the Center for Disease Control and Prevention (CDC), more than a million people are living with HIV in the U.S., with roughly 21% of this population unaware of their infection. Mahmoud estimates that approximately 58% of transmission of the virus stems from people ignorant of their own status. Roughly 56,300 were newly infected with HIV in the U.S in 2006, the most recent available statistic. Still, the actual threat of HIV at Princeton, let alone any college campus remains unclear. In 2008, the CDC estimated that the number of new HIV infections diagnosed amounted to 1,870 and 5,427 for the 15-19 and 20-24 age groups, respectively.
Whether intentional or not, the University undoubtedly seems to have placed a certain priority on HIV testing over screening for more common STDs by making it available to all students free of charge. University Health Services also offers testing for herpes type 2 (HSV-2), syphilis, and HPV (women only), with out-of-pocket expenses of $98-$150, $35, and $105, respectively, according to UHS executive director John Kolligan. The testing for trichomoniasis is also free for all students.
Naturally, one also wonders how this initiative is being subsidized. According to Kolligan, “[t]here has been no change in UHS/University funding with respect to STI testing.” Rather, he adds, this new policy has been made possible by “working in partnership with the New Jersey Department of Health and Senior Services,” through which Princeton UHS recently achieved status as an “approved HIV testing site.”
Providing trichomoniasis testing at no cost to all students seems reasonable. With over 7.4 million new cases yearly in the U.S., this STD is quite common, and the test is done in-house, rather than by a private laboratory. But is high frequency of infection alone really enough to warrant free testing? According to the CDC, roughly 1 in 6 people aged 14-49 nationwide is infected with genital HSV-2. The CDC also categorizes HPV as the most common sexually transmitted virus in the U.S, and Chlamydia as the most common bacterial STD in the U.S., presenting about 1,200,00 new infections annually. Given this particular context, it seems that the relatively rare HIV has attracted a disproportionate amount of attention by the New Jersey Department of Health and Senior Services.
Surely, there is a considerable difference in the severity between HIV and these other diseases. While HIV is fatal if left untreated, these other STIs are either quite curable or easily managed. Nevertheless, the choice to fully subsidize such an uncommon infection rather than more frequently contracted diseases fundamentally seems to reflect an inefficient allocation of resources.
In explaining the rationale behind the policy change, Kolligan writes: “We had received student input that testing not covered by insurance was expensive and students’ concerns for privacy were major factors in our attempt to find more cost effective and private alternatives.” Undoubtedly UHS has reached this goal: HIV testing is now more accessible at Princeton than ever before. While the “Safe Is Sexy” event may have generated favorable publicity for the UHS’s new policy, ultimately, a basic cost-benefit analysis shows that the decision to offer free HIV tests represents an inefficient allocation of University resources. This, combined with the bias implicit in the event’s advertisement and content, suggests that the USG’s sponsorship of the event, while well-intended, was fundamentally misguided. One hopes that the USG will explore different formats in the future as it seeks to foster awareness of sexual health issues.