Joshua Rosenberger - The Sex Education of Shawn C Fettig (And What Does "Queer" Mean?)

Sex and sex education is an exciting, and sometimes controversial topic. LGBTQ sex and sex education is, unfortunately, more controversial, especially in today’s political environment. But, for me – it’s also more exciting. And, having this conversation, and talking about sex can bring us joy; it can make us happier and more fulfilled people; it can enhance our relationships and our mental health; and it can literally save lives. 

My guest today – Dr. Joshua Rosenberger – is an expert on this subject. He is an associate professor of Biobehavioral Health at Penn State and the Director of the Survey Research Center. He’s also a very prolific researcher and author – focusing on the sexual development and health of gay and bisexual men, HIV /STI prevention, health disparities, and sexual marginalization.

We talk about all of these things, as well as the concept of gay age, the FDA’s recent reversal of their decades-old ban on men who have sex with men donating blood, Tennessee’s decision to deny accepting federal HIV funds, and the potential impact of that, and the idea of redemption in our contemporary politics.

Mentioned:
Vanderpump Rules
White Tears, Brown Scars: How White Feminism Betrays Women of Color – Ruby Hamad

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Transcript

Dr. Joshua Rosenberger: The Sex Education of Shawn C Fettig (And What Does "Queer" Mean?)

[00:00:00] Joshua: But the way the funding was coming through the state at the time, and Mike Pence was the senator, governor, I should know better. I went to school in Indiana. Governor, governor. He, he had declined to receive federal funds for HIV stuff around this sort of homophobia and, uh, going to gay stuff. And they had a huge outbreak.

[00:00:20] And in this particular town they had a hundred and something people become infected with HIV in a modern day world where all they would've had to do was test people and provide treatment. And, and that was what you ended up seeing is sort of being stubborn about how you associate it or who you took funds through ultimately led to an entire community becoming infected with HIV that could have been easily prevented.

[00:00:43] And so that's sort of my take on what will happen if, well, it seems like Tennessee has said they don't want the money, then that's what's gonna happen. Those that are at the highest risk are gonna just see an increase in infection and potentially other negative outcomes associated with lack of treatment.[00:01:00] 

[00:01:04] Shawn: Welcome to Deep Dive with me, Shawn C Fettig. Sex and Sex Education is an exciting and sometimes controversial topic. L G B T Q. Sex and Sex Education is unfortunately more controversial, especially in today's political environment, but for me, it's also more exciting and having this conversation and talking about sex can bring us joy.

[00:01:29] It can make us happier and more fulfilled people. It can enhance our relationships and our mental health, and it can literally save lives. My guest today, Dr. Joshua Rosenberger. He's an expert on this subject. He's an associate professor of biobehavioral Health at Penn State and the director of the Survey Research Center.

[00:01:51] He's also a very prolific researcher and author focusing on the sexual development and health of gay and bisexual men, HIV and S T I, prevention, health [00:02:00] disparities, and sexual marginalization. So we talk about all of these things as well as the concept of gay age, the FDA's recent reversal of their decades long ban on men who have sex with men donating blood, Tennessee's recent decision to deny federal HIV funds and the potential impact of that and the idea of redemption in our contemporary politics.

[00:02:23] If you like this episode or any episode, please feel free to give it a like on your favorite podcast platform and or subscribe to the podcast on YouTube. And as always, if you have any thoughts, questions, or comments, Please feel free to email me at Deep dive with Shawn gmail.com. Let's do a deep dive.

[00:02:48] Dr. 

[00:02:48] Joshua Rosenberger, thanks for being here. 

[00:02:50] Joshua: How are you? I'm very well. Thank you for having me.

[00:02:52] Shawn: Yeah, absolutely. I'm excited to have you here. I think we should level set right at the outset in that, you know, this is something that came up in our [00:03:00] discussions leading up to the interview. So what do we mean when we say queer?

[00:03:04] I often refer to the LGBTQ plus community as queer, and that's something that's evolved over time. When I was younger, I had a very kind of visceral, negative reaction to that word, but I'm referring to it now, or I'm using it to refer it to like a spectrum of identities in a social sense. But your work and your research and the research that you do doesn't wholesale fit into this bucket.

[00:03:25] So I wanna be sure that we're using the appropriate language at the appropriate time as we work through this conversation. And related to the research you're doing. So to that end, please feel free to correct me if I get something wrong here or prime your response to clarify who exactly you're talking about when responding.

[00:03:40] Okay. Yeah. I will have a tendency to just revert to, you know, queer folks or non-queer folks, and I do fully understand having graduate research and being a little familiar with it, that your research is not targeting an entire community all the time. 

[00:03:53] Joshua: Right. It's almost never targeting an entire community.

[00:03:57] Um, but with that said, as you've just pointed [00:04:00] out, queer, for some people it historically was a pejorative term, right? Which you could say politically reclaimed eighties, nineties, and, and is used as an umbrella term for sort of anyone that's not heterosexual or cisgendered identified. Mm-hmm. I typically don't use the term, I don't identify personally as queer.

[00:04:19] I identify as a gay man, which is neither here nor there. But I, I tend to think of it more in the academic sense of queer theory and queer culture and the sort of politics associated with queer. I'm also just mindful some people, as you've mentioned, some people love it and identify as queer. Other people still find it.

[00:04:38] To be a derogative term and are absolutely against it, and typically when it's quantitative or even qualitative academic research, I try to be very specific on the populations with whom I'm conducting surveys or interviews or collecting data with. Mm-hmm. Sometimes that is based on a gender or sexual orientation identity.

[00:04:58] Sometimes it is based on a [00:05:00] behavior. So you will hear me and I'll sort of explain what or whom I'm talking about. You know, a lot of the work I do talks about, or even C D. C talks about men have sex with men, and that's very much a behavioral term, even though I've yet to meet somebody who openly identifies and walks around as I'm an msm.

[00:05:18] But you'll see titles and papers that I write about MSM and I'm aware that then within that there are people that may have a different gender identity or a different sexual orientation. And so I am also fluid in the terms I use, just depending on what I'm talking about or whom I'm conducting research with.

[00:05:36] Mm-hmm. My general go-to then is LGBTQ plus, but I also recognize that that even sometimes can be exclusionary. And so it's difficult and everybody has their own sort of identity around which term they like and also what language. 

[00:05:52] Shawn: This in and of itself is its own fascinating conversation because it's making me think about how I actually identify.

[00:05:58] And, you know, I, I mentioned [00:06:00] I've kind of, for lack of a better way of saying, grown into identifying as queer. You said you identify as a gay man. I don't think I identify as queer in the same way that I identify as a gay man, which I, I think have internalized much more being a gay man than being a queer person.

[00:06:18] Joshua: Do you think of your queerness as more aligned with your political ideologies and your gay manness with your sexual orientation and your gender? Yeah, actually, yeah, you're right. And, and you're not limit, well, I mean, I'm not gonna tell you what you're limited to, but a lot of people identify as both, or one or the other.

[00:06:36] They're multiple identities. They, they can intersect, they can overlap, they can be exclusive depending on the person. But I, that is how I think of it personally, which is why then it's hard for me to say queer people, because usually when conducting research around sexual orientation or gender or behavior, we often give an option in a dropdown box of which of these best describes you.

[00:06:59] But because [00:07:00] queer is that more umbrella term, it's hard to, you know, you could have queer women and you can have queer men, and you could have queer males and queer gay people. And there are some that argue that they are heterosexual but queer. Mm-hmm. Right. Being an ally and their politics. So it's a, it's a confusing thing.

[00:07:17] Even across academic scientists, sociologist, anthropologists, et cetera. There's no one singular answer. 

[00:07:25] Shawn: You did also bring up something else that I wonder if you can respond to, and that is, there must be a reason that in academia or maybe in medical science, there's a reason that we refer to. As a behavior as opposed to an identity.

[00:07:40] So, you know, men who have sex with men versus gay men? 

[00:07:44] Joshua: Yeah, I, I think it really comes down to what the, a couple of things, what the discipline is that is exploring the topic. So when we think, certainly in medical sciences, things often get relegated to a behavior such as SM or [00:08:00] W S W, and the reason being is because then the outcomes they're interested in are usually associated with that behavior.

[00:08:07] Um, in medical sciences and public health, it's almost always disease related. Mm-hmm. That has expanded a little bit into more mental health, spiritual health, social health, but even a lot of that is still really outside of traditional medical science or public health approaches. Mm-hmm. When you can switch disciplines, if you're looking from an anthropology lens or a sociology, or certainly from a women and gender studies lens, more often than not the behaviors are.

[00:08:37] Of the least importance. And it's really about internalization identity, self-concept in the world, those types of themes. And therefore, who cares necessarily if somebody is an M S M or having sex with men? It's about how do they view themselves in the larger context of their community or [00:09:00] environment or historical period in time or global setting, et cetera.

[00:09:04] And so I think that in part is why you do see variations in which terms are most common, but in, I don't wanna lump everyone together, but in most of the public health medical sciences, it sticks to the behaviors and then those behaviors unfortunately get ascribed to. So for a long time it, they tried to interchangeably say, well, men who have sex with men, it's the same as gay men.

[00:09:29] Without understanding the nuances of bisexual men or even truly heterosexually identified men who are having sexual interactions with other males or men, which gets us into the gender versus sex argument. And so I think it started with just not being very thoughtful about it and just saying, you're either a man or a woman and you're either having sex with men or women, and therefore, and we have gotten more and more nuanced over time, but it hasn't necessarily caught up entirely with [00:10:00] that numerous combinations or possibility of combinations for gender, sexual orientation, sexual behavior, identity, et cetera.

[00:10:09] Shawn: Mm-hmm. Okay. So you're actually touching on a lot that I wanna dig deeper into, but before we get there, Let's establish a landscape and keeping in mind, you know, some of the difficulty parsing out the language that we use to identify communities. So when it comes to things like sexual education, socialization, and development, how do L G B T Q folks or specific folks within that community differ from non LGBTQ folks?

[00:10:36] Or, or, or the development of traditional heterosexual folks? 

[00:10:40] Joshua: Yeah, so I think, I mean, from an educational perspective, let's just start by saying from my perspective, we are as a country, really behind the curve with sexuality education as a whole, regardless of age, regardless of gender. 

[00:10:58] Shawn: Do you mean relative to other countries, [00:11:00] or do you just mean both?

[00:11:01] Joshua: I

[00:11:01] mean, relative to other countries, and certainly you could point to European nations and mm-hmm. Countries that sort of, everyone would say, oh yeah, but they're more progressive and in fairness, we are. Ahead or more advanced than other countries that are certainly more restricted around topics or conversations around sexuality.

[00:11:19] But I also mean within our own society and just educational system, um, we have not advanced that much in decades, if not even a half century. So if you were to ask somebody who is 70 years old, 40 years old, and 20 years old, you wouldn't see huge shifts in the amount and quality of sexuality education, broadly speaking.

[00:11:44] Certainly younger people are getting a little bit more than perhaps what somebody was 50 years ago, but not as much as you would expect with that amount of time that's passed. And so we're lacking across the board. What we know then is that within the education that [00:12:00] people are getting there then becomes this secondary class of individuals.

[00:12:07] I label them just broadly as sexual minorities, so anyone that does not identify as cisgender or heterosexual and the education around sexuality almost always excludes them or still limits the conversations to this is what the definition of sex is, which again, is very heterosexual and mm-hmm. Binary of sort of males have penises and girls have vaginas.

[00:12:33] We don't even really still talk about vulvas as an entire anatomical unit and penises go into vaginas that causes babies and also. Put you at risk of disease. So we still have a very lacking of comprehensive sexuality education. We don't talk about pleasure and satisfaction. It's still very disease and negative focused regardless of your gender and sexual orientation.

[00:12:58] But then thinking about where this [00:13:00] education is taking place. And for the most part, during developmental periods, in adolescence, it's supposed to quote unquote, be taking place in schools. That certainly changes based on geographic region and other things. But most individuals then are not subsequently talking about differences that might occur between two people that are same sex loving, or two people that are engaging in same sex behaviors.

[00:13:26] Or for sure people that might identify as non cisgendered or as trans, and what some of their particular sexuality needs are, or health needs or the nuanced differences than their heterosexual counterparts. 

[00:13:41] Shawn: This makes me wonder because you, you know, you were speaking specific to, you know, the L G B LGBTQ community and sexual development and where we've come over the past, let's say 70 years, and then that immediately makes me think, and I think you touched on this a little bit, but if we were to take the quote unquote queerness out of sexual education or [00:14:00] sexual development, have we advanced at all in this area, in how we talk about this?

[00:14:05] Joshua: Ooh, good question. Have we advanced at all? Yeah. I mean, I never, I'm always one to be open to acknowledging even when we have struggles, regardless of the topic that we certainly have moved forward from where we were 50 or 70 years ago. But again, to my point of, I, I like to think about it with, in terms of technology and how far we've come.

[00:14:29] Think about when the iPhone came out to where we are today, and the, the period of time and sort of a, as a. Human species, our ability to evolve in certain areas in just rapid advancement. And then when we think about sexuality, I think that regardless of the queer or the L G B T aspect of it, we're still sort of teaching the bare minimum, the birds and the bees.

[00:14:54] We talk about what is sex, how does conception happen, how to [00:15:00] prevent that, and then diseases and how to prevent those. There are very few places or individuals or communities, school systems, whatever it might be, that take that next step and really educate on what we talk about as comprehensive sexuality education.

[00:15:20] And that includes, like I mentioned previously, pleasure satisfaction. That includes power, that includes sexual violence, that includes sexual politics. All of those things are part of sexuality. As an umbrella term, and I don't think our sex education goes far beyond where do babies come from and what are the primary diseases and how to prevent them with condoms.

[00:15:44] Mm-hmm. That's where we're pretty limited.

[00:15:47] Shawn: Well, so this might be a subjective, well, this question might be in pursuit of a subjective response, but maybe there's an objective component to it, which is all of these other components that you mentioned that seem to be lacking in our sexual [00:16:00] education system.

[00:16:01] Now, do you think that those are necessary components to a holistic sexual education program? 

[00:16:07] Joshua: Yes, and there is the, I'm gonna get the acronym wrong. I think asec, American Association of Sexuality Education or Education Therapist, something to that degree that actually has and for a long time a published list of what actually meets the requirements of a comprehensive and holistic.

[00:16:31] Education around sexuality, and it includes many of the things and more that I've already talked about. And so I do think that, I don't even think that that's subjective. I think objectively, if we wanna talk about the domains of sexuality and people's sexual health and then the subsequent education around those things, here are all of the buckets or all of the circles that need to be addressed.

[00:16:56] And I think you can make a similar comparison. If you were talking about [00:17:00] mathematics and you just said, well, math, you know, it's not just arithmetic. Yes, arithmetic is a element or component of math, but there's also geometry and there's also trigonometry, and there's also calculus, et cetera, et cetera.

[00:17:16] And perhaps not everybody needs to and certainly doesn't get all of those elements. But we also don't walk around talking like, if you've been taught arithmetic, then you understand. Comprehensively math as a whole. Mm-hmm. 

[00:17:34] Shawn: What that essentially means is we're living, we're living in a reality that doesn't lean into or live up to a reality that you are suggesting, not just you alone, but objectively might be necessary for like a holistic sex education, sexual development.

[00:17:51] And it makes me wonder then, without that, what are we as a society, and we can talk about this as maybe if we wanna limit this geographically, you know, to the United States, what are we [00:18:00] as a United States society, what barriers have we erected and without those barriers, what type of growth could we expect as a society?

[00:18:10] Does that make sense? 

[00:18:12] Joshua: It, it does. A little bit, I'll answer and then you can tell me if I'm answering based on what you're trying to ask. Sure. What I see is, and it's a quote I often use when I start sort of any lecture or talk, I get that and I say, we being the collective public health system, Not that I represent them as a whole, um, but we spend far too much time trying to change behaviors that we don't even understand.

[00:18:37] And what I mean by that is that we spend all of this effort, money, resources, with a particular goal in mind. It might be reducing h i v, reducing teen pregnancy, reducing s t D outcomes, thinking of those things associated in the medical science field. And yet the way we go about creating our policies and our [00:19:00] programs and our education are in direct opposition to those goals.

[00:19:06] And so what we end up seeing is programs that don't work, we are, again, if we're just picking a, a demarcation in time, I typically make that point around 1980 or so solely because of HIV and the AIDS crisis or AIDS epidemic. That followed shortly after, but you can pick any time point really. And what we see is that 30 years into the AIDS epidemic, incidents and prevalence of HIV cases haven't gone down.

[00:19:34] What we see around sort of disease burden and incidents and prevalence of sts like chlamydia and gonorrhea haven't changed. And so all this effort is being put into trying to fix these things. And yet we're not seeing any differences 20, 30, 40 years in. And so to me, it becomes a matter of the studies that have looked at it, the more education that [00:20:00] is comprehensive that people have, the less sex they have, the less disease outcome they have, the less negative mental health outcomes they have, the less stigma they have, the more likely they are to use contraception than condoms.

[00:20:11] And so if we were to really implement and support a comprehensive sexuality education universally and socially, we could get on board with it. What we would see as the product of that is all of the negative aspects associated with sexuality and sex would decrease. We would have a better overall set of outcomes for our society around those types of things.

[00:20:37] Shawn: Hmm. Is it fair to say, given what you just said, are we still in, you know, a quote unquote AIDS crisis? It's just that we have learned how to perhaps medically address it in a way that makes it seem like less of a crisis? 

[00:20:51] Joshua: Yes. Is the answer. And I would actually, and I'm thinking of this on the spot as you just said it, I would actually, from an epidemiological [00:21:00] perspective, say the start of what we identified in this country, so early eighties, up until introduction of antiretroviral therapy, which is mid nineties as an AIDS epidemic, and that is the sort of terminology that people are familiar with now that we have had a pandemic, which is the global epidemic.

[00:21:18] Actually HIV has been a global pandemic, but the crisis element of AIDS slash HIV I think very much in the eighties was around who was being impacted most and what was being done about it. And there is much historical reference about the politics associated, the lack of, for lack of a better term, care or urgency because it was primarily impacting the L G B T community.

[00:21:49] But really, I mean, it was gay men, men who have sex with men and trans women that were most directly impacted early on. And therefore the crisis was a, a [00:22:00] government that was slow to respond, a delay in the development of medications, treatments, et cetera, et cetera. So I would say that from an epidemiology perspective, we still have an HIV epidemic.

[00:22:13] We still see. Plenty of new cases of HIV in this country. They are predominantly found within men who have sex with men. Um, there has been an uptick or a shift because of the opiate crisis slash epidemic that has occurred. So we have seen an increase in injection drug users who may or may not identify as L G B T plus plus, but really the, the focus of the disease burden in this country is men who have sex with men.

[00:22:41] And so I think the crisis piece of it has shifted. So I would still argue that we have an HIV crisis. It is that we have come up with really phenomenal medical treatment. So people living with HIV have no difference [00:23:00] from life expectancy than their sort of non H I V. Counterparts, and in fact it is now listed as a chronic disease under the C D C.

[00:23:10] If you were diagnosed with diabetes type two diabetes, which we have an epidemic of in this country, your life expectancy is actually shorter than if you were diagnosed with HIV because of medication management and lifestyle and so on and so forth. But what we have still, or currently now face are bigger issues around stigma and mental health and other aspects that I would lump into the the crisis or crisis bucket, if that makes sense.

[00:23:40] Shawn: Mm-hmm. So I do wanna circle back to this. Yep. And I also want to dig into some very specific components of your research. But before we get there, to just kind of finish establishing a landscape, I do wanna talk a little bit about mental health because I think there is a nexus between mental health and sexual [00:24:00] health.

[00:24:01] Yep. And, and I'm not sure how steeped in this you are, but it does seem to me that, you know, with all the negative attention lately on social media and the impact that it has on mental health, particularly an emphasis on the mental health of youth, there is perhaps, uh, corollary that is both true, but also in the negative for queer youth.

[00:24:22] And that is that it may have a detrimental impact on the mental health of queer youth in the same way that it does for other youth. But we also do have research that shows that it plays a critical role in improving the mental health of queer youth, especially when it comes to connection and socialization with other people like themselves.

[00:24:42] And so I'm wondering if you have any thoughts here.

[00:24:46] Joshua: I do. And let me, let me preface it by saying, luckily for you, during the pandemic, I decided to not learn how to bake bread and instead I did actually. Oh, good. Well, I'm glad. I'm glad that you did. I [00:25:00] instead thought it would be fun to get yet another degree, so I went and got a clinical mental health counseling degree so that I could also start looking at some of the work that I do from an actual clinical counseling perspective and working with patients one-on-one.

[00:25:15] Mm-hmm. And so I am a little bit more steeped in that side of things and the mental health research scope of things. The other caveat is I personally have never used social media. It's not to say that I don't know what it is, but I've never had. An Instagram or a TikTok or even so much as a Facebook.

[00:25:36] Mm-hmm. So I am also, while someone who claims in their bio uses and examines the use of technology Yeah. As, as it relates to people's sexuality and sexual health. I don't, uh, use any social media. So I wanna just put that out there before I make a comment on what I think about other people's engagement.

[00:25:57] Sure. With social media platforms, and I think [00:26:00] that you, you hit the nail on the head, and the problem is, is that I don't know that we have enough research to suggest how much weight can be attributed to you. To each category, and what I mean by mm-hmm that is that universally we do see regardless of sexual orientation, this negative impact, there are positive aspects of social media, but more and more we're seeing a negative impact.

[00:26:22] A lot of that gets into mental health and online bullying and self-esteem and trying to live up to sort of false narratives and stereotypes that are portrayed online, et cetera. What we also know, as you pointed out, is that for those youth in particular, but also those living in rural areas or lower socioeconomic advantaged areas, or in communities that are less accepting or more traditionally marginalized around sexual minority status, online, social media, whatever you want to call it, has given a a space for [00:27:00] people to interact with like-minded people, to talk to people that they might not previously have had access to.

[00:27:05] If it was 1995 and you didn't have. A local gay bar or something to go to as a communal space to meet and see people like yourself, then you were really isolated. And so that certainly has helped and improved what we don't know yet, and where I'm still particularly concerned, because when I do work with clients and I work in inpatient facilities, the overwhelming majority and all the data that we see coming out of National Institutes of mental health is that things like suicidality, things like self harm, things like being bullied, are still anywhere from four to 10 times higher in those who identify as sexual minorities.

[00:27:51] And the higher the those numbers are becomes more about if you are a minority of color, if you are a trans-identified individual, so on and so forth. [00:28:00] And so while we see these outlets for connection or improvements around that one particular thing, We also see more broadly that it is the same group of people that are still having the worst mental health outcomes.

[00:28:15] Mm-hmm. And so I'm not, I don't know how to fully wrap my head around that, because as much as you can connect with someone online, that also identifies as being, let's say, a, a bisexual black woman, you also then have the ability for those who have negative opinions about you to spew that messaging or hate or whatever towards you in an anonymous online fashion.

[00:28:43] Mm-hmm. I, I, I'm not sure that anyone is yet to really be able to do the research, to figure out, you know, is, does the good outweigh the bad, or how much, how much of that is worth it? And so on and so forth. 

[00:28:56] Shawn: Mm-hmm. I mean, it is making me think about, you know, I was that [00:29:00] kid in the nineties that was in a very rural Midwestern town.

[00:29:04] That connected online in the late nineties. Right. And it's making, as you're talking, it's making me think about what was different then. Because for me it was, it really was about connection and making friends. Right. Which I would otherwise not have, you know, I'd spent 18 years of my life in the same town and I hadn't met anyone.

[00:29:21] And then, you know, suddenly I have access to the internet and I've got like four new friends just like me. Right, right. And, and I didn't have to worry about, and I didn't have to deal with that second component that you mentioned, which is like the space in which there's a backlash or that people are leveraging some type of hate, either publicly or, or personally at me that I was intersecting with.

[00:29:40] And it's, it's making me wonder if it was just this lucky moment in time where the internet was so new and it was so undeveloped that those spaces didn't really exist for, for people to, well, one that had, they hadn't really wrapped their brain around how to use it, but two, there weren't those spaces for people to really cause too much harm to each other.

[00:29:58] Right. Like, that evolved over time and, [00:30:00] and built up. 

[00:30:01] Joshua: I think that's exactly what it is. And I always feel, and this is where I struggle interpersonally, like am I just the old man then now that's like nostalgic for the old days. Mm-hmm. But I do. Mm-hmm. I, I think exactly what you were starting to describe is if that in those initial phases, the way, if we think from a communications perspective, the different styles and types of communication, it was actually still one directional and that you chose the space and the space still rep, it was the virtual representation of physical spaces.

[00:30:30] So it really was as if you went to a L G B T group meeting, or you went to the gay bookstore, or you went somewhere that didn't have outsiders. It wasn't actually a public right space that the whole world was a part of. You met those few people, but it was in a, in a way that was sort of underground or at least not open.

[00:30:57] Come one, come all. Whereas I think where [00:31:00] we're currently at is that, that those interactions are fully in part of the public domain, and so everyone gets to see it and comment on it. And I, yes, I'm sure there are private chat groups, not sure. I know there are, but more broadly speaking then what, what it does then let's say, okay, yeah, great.

[00:31:19] Now we have given you the tools to feel more empowered to come out earlier and to be more open about your sexual identity. And now you put that into your Instagram profile or in your Facebook, and then it opens you up to Susie Q from Idaho, who's never met you, that just wants to sit at home and say, I think you're a ho, horrible person.

[00:31:43] Or I think that you know you're going to hell because of these things, whatever it might be. And no offense to anyone named Susie Q or anyone from Idaho. It's just. Arbitrary example, but that's the piece that didn't exist. If you used to go to a physical gay space, anything before the [00:32:00] nineties, or you in the early days, quote unquote, of the internet, those you didn't have those outside voices or commentators.

[00:32:08] It really was just those that are like-minded, getting together and sharing their stories, their experiences, et cetera. 

[00:32:16] Shawn: Right. And very much, if we could replicate that same environment today, that would be the same if we could create some type of online space wherein the voices are very like-minded, that would be very supportive and very affirming.

[00:32:29] Joshua: If we do have 'em, I think they're physical spaces. Right, right. And I think that been a shift increasingly so in the last couple years to move back to really endorsing and embracing queer spaces. Mm-hmm. And I use the term queer there because it has become more encompassing and it's not just, we know the problems, at least academically about.

[00:32:46] The exclusion of being at a gay bar that's for men or a lesbian bar that's for women or even a trans bar. Um, but more and more we're seeing this reversion back to let's have queer space where people can [00:33:00] come and be safe and be together and be able to block out, at least in those moments, those outside negative voices so that they can not focus on that piece.

[00:33:11] And we know that that does improve mental health, having those connections, having youth groups, having things of that nature. Mm-hmm. All right. 

[00:33:20] Shawn: Dr. Rosenberger, you open to talking about some of your research? I sure am. Okay. So there are two, two particular pieces of your research that I'm interested in that I'd like to touch on, but we can go wherever we go with it.

[00:33:33] So one of them is that some of the research that you've done focuses on satisfaction with first time sex experiences of gained by sexual men and, and specifically anal sex experiences. And there's some of your findings that I think have implications for maybe how we can talk about or how we can socialize relationships.

[00:33:55] But I wanna get your sense, I don't wanna, you know, extrapolate too much out of it. So [00:34:00] in your research you find that people that report the least satisfaction with that first time anal sex experience are people in which that experience occurred as a one-off, or with people with which they didn't have some type of an enduring relationship.

[00:34:14] And like I said, I don't wanna extrapolate too much out of this, and I don't wanna overgeneralize, and I don't wanna put words in your mouth, but I do think there's something important here, not only maybe how we think about a person's first sexual experience, but again, like I said, how we socialize people into their sexuality and then how we talk about sex.

[00:34:31] That being said though, what do you take away from this research and then what do you think the implications are? 

[00:34:36] Joshua: Yeah. So I mean, I just to clarify for those who don't spend their time reading academic journals, which is mess up a sliver, a sliver of the population, everyone, um, you know, a a a couple of things.

[00:34:48] One, the, the work you're referring to, I, I've done actually multiple studies that have looked a lot around first sex. Some of that has been qualitative. Um, with, regardless of sexual orientation, we actually [00:35:00] followed a cohort of young men. We recruited them prior to having ever had sex, and then followed them for a couple of years doing interviews with them over time, which eventually they developed and had sexual intercourse.

[00:35:11] Sexual intercourse. When I say that, I mean penile vaginal and or penile anal intercourse. And then the other studies that you're talking about focused specifically large survey data sets, which we ask men who have sex with men. We also have done this with women who have sex with women, but about their first experience with anal intercourse.

[00:35:31] It's important when I say that because I've done separate work, a lot of separate work that looks at sexual repertoire more broadly and what we know, and it's an important takeaway, I want people to understand when we talk about gay sex, at least with men who have sex with men, it is about one third of all sexual interactions actually involve any type of anal intercourse.

[00:35:55] So there are a variety of other behaviors. There's mutual masturbation and oral sex [00:36:00] and lots of other things that can occur. And gay sex is not always equal anal sex.

[00:36:06] Shawn: Can I, I say that just can I, I mean, that's fascinating to me. And I guess I wanna just, I want some clarification. So when you say one third, do you mean that one third of the sex that people engage in.

[00:36:21] Men who have sex with men, or I suppose anyone that might have anal sex one. One third of the sex they engage in includes anal sex. Or do you mean that one third of people that have some type of sex with someone of the same sex or gender, that it's anal sex. And so two-thirds of the people don't engage in anal sex two-thirds for any sexual interaction.

[00:36:43] Joshua: So the way that this would look is we asked, and literally we've asked almost a hundred thousand people mm-hmm. To give us this huge, expansive set of details about just the last time you had sex. And just thinking about that as a singular sexual event. Okay? [00:37:00] We look at things at the event level, and we can do this over time with multiple events, rather than saying like, in your lifetime if you ever had sex, it's think about the last time you had sex.

[00:37:09] And then we go through who did you have sex with, how did you know them? And all the behaviors that you did. And what we found with asking. Almost a hundred thousand people, men, uh, a hundred thousand men whose last sex was with men. We've done this with other combinations. But in that particular group, two-thirds of the time, the last time they had sex, quote sex, they did not have anal intercourse.

[00:37:37] Shawn: Okay, but that doesn't mean they don't have anal intercourse. 

[00:37:39] Joshua: No. And in fact, got it. Okay. We actually still subsequently asked them about anal intercourse in the last week, last 30 days, 90 days, six months past year. Um, overall, you do find that the majority of men who have sex with men, about 85 plus percent in the past year have had anal intercourse.

[00:37:58] But if you ask just the last [00:38:00] time you fooled around or had sex with another guy, two-thirds of the time, it's not anal sex. And the takeaway from that is every time we talk about two males or two I men identified individuals. Engaging in sexual interactions. We shouldn't just jump to, they're putting penises inside of Anuses.

[00:38:19] Mm-hmm. Because there's so much more that they're doing and it's not always that way. The reason I say that is cuz then what we're now talking about is in fact the first anal intercourse experience that young men have and young men is a relative term. But I, I say that also because we know the sort of age or the developmental period in which people engage in sexual behavior.

[00:38:41] Oftentimes they're experiencing things like kissing, mutual masturbation and oral sex prior to engaging in anal intercourse. Mm-hmm. What we do see then is then young men who have had anal intercourse and it actually holds true for young women as well. Have, or report more [00:39:00] physical and more emotional satisfaction.

[00:39:03] If their first partner was someone that they had more of a connection with, someone that they trusted, someone that they were. And this term is not well defined, but dating or in a relationship with, from their perspective, they reported greater amounts of pleasure, both emotionally and physically. The emotional piece is particularly important I think, for young men or young males because we socially try to strip away emotional components around sexuality.

[00:39:38] Particularly as a culture. When we talk around, uh, being masculine and machismo and all of those things, we try to remove the emotional component from sex For men, we try to frame it as being very physical for men and very emotional for women or for males or for females, and I apologize. I'm using those terms interchangeably.[00:40:00] 

[00:40:00] Mm-hmm. What we find then is that having a closeness, having a relationship, Actually improves that physical satisfaction, that emotional satisfaction. So what is, what some people would say, who cares? Well, if we know that your first sexual experience is actually a developmental milestone and a marker for the way you feel about yourself, but also about subsequent sexual interactions in the future, mm-hmm.

[00:40:24] Then we really should care. If you don't enjoy it as much and you didn't get as much satisfaction, you're more likely to engage in behaviors that are less satisfying in the future. What that sets you up for is relationships or interactions, which also could be more unhealthy emotionally, also more unhealthy.

[00:40:43] Physically. We see a connection between those that then are engaging in higher risk behaviors using condoms, less likely being more exposed to potential STIs. And so there is a big need or reason that we should really promote the first time that you have sex being something that [00:41:00] should be as much as possible highly.

[00:41:04] Connected, emotionally satisfying, physically satisfying. It won't come as a surprise that same sex males having sex compared to same sex. Females, males, regardless of sexual orientation, always report much higher rates of physical satisfaction than do females. A lot of that is related to sexual anatomy, um, and lack of sexual education, but also lack of communication with a partner.

[00:41:28] We do see those same differences in males when we look at being the receptive versus the inserted partner in anal intercourse and just biologically and physiologically. There is the potential for more pain, discomfort, other physical aspects associated with being the receptive partner, and a lot of that drops off if you feel more emotionally connected or trusting or loving of the person with whom you're engaging in sexual behavior.

[00:41:55] Shawn: So you mentioned gay age. I'm really fascinated by this concept. [00:42:00] So my friends and I kind of offhandedly will refer to something as I, I don't think we use gay age, but you know, we talk about how the experience of dating or being with people or our first sexual experiences that we're with somebody that we were sexually attracted to as just being, you know, offset by maybe a decade then or straight peers.

[00:42:18] And I don't know that that's necessarily what you're talking about, but I do think that gay men, and maybe this is true of gay people generally go through sexual development in different ways and through different processes than do people that are in, you know, traditional straight relationships. And I'm sure that some of this has to do with our socialization.

[00:42:34] Now you can correct me if I'm wrong. The value that our society puts on straight culture. But I do think that understanding this difference, as it is, is important to understand a host of other things that might be impacting the gay community. So I'm wondering if you can explain when you say gay age, what this is, and maybe also help us to understand some of the things that I think it might impact, like sexual and relationship development for gay people, and also how it could influence sexual [00:43:00] health and infections such as H I V, which we touched on a little bit.

[00:43:03] Joshua: Yeah. So I think that it's two different things, but one, I, I think both are true. So a little bit about what you're referring to. I totally agree with, and we have the data to support it, is that developmentally, because we live in a heteronormative society, and broadly speaking, including the education pieces we talked about earlier, we know that sort of sexual debut, which is.

[00:43:30] Monitored by first coitus, which means first penetrate in the academic language. You know, on average it's around 15 years of age in this country is what we would call first sexual debut. Um, and that is collectively including all individuals, what we see if you've done separated out of first same sex experience.

[00:43:50] When we talk about anal intercourse or female to female intercourse, those numbers go up to about around 18 on average, slightly younger. [00:44:00] So you have already got that gap in just sort of what is quote unquote your first sexual experience, depending on if it's a same sex experience or if it is an opposite sex experience.

[00:44:10] So there are those delays that just naturally occur and some of those delays get even further about first real romantic relationship and other pieces. I will say that those numbers have gotten closer together. Um, I think that is mm-hmm. One of the positives of younger people and social media and being out sooner and being able to have a.

[00:44:29] A gay partner go to prom with you or whatever that might be. So some of that has gotten better, uh, but it still does exist. Those differences exist on, on a broad level, when I'm talking about the term gay age, and it's been written about, and I have to give full credit, the concept was first introduced to me by a colleague, Dr.

[00:44:46] Kara xt stem, and she sat down in my office and, and sort of ran me through this. It essentially was a theory at the time that she had, and as soon as she said it, it just, it sat with me and [00:45:00] resonated with me in a way of like, wait a minute, that's exactly like, that's it. I've just never figured out a way to measure it or talk about it.

[00:45:08] And so conceptually what it is arguing is that we have chronological or birth age. So if you ask me how old I am, I would say it's, I'm 40. How old am I? I'm 42 years old. Um, because I know what my birth date is. But then the argument is, is that there is your quote unquote gay age, and what that really gets to is around when did you first come out, when did you first start experiencing some of the sexual behaviors it's associated with being a sexual minority, and then what does that look like for your developmental trajectory?

[00:45:47] When we thought about sexuality as a whole, we've always take it chronologically, and you can go back to psychologists and Ericsson and Freud, and we talk about your infant stage and your adolescent stage, but if we ever thought about it with the [00:46:00] cultural piece of being a sexual minority, you know, what is, what does it look like if your first pride event is when you're 13 versus 36?

[00:46:08] Mm-hmm. What does it look like if your first exposure to substance use, which we know is higher in sexual minority populations, is it 40 versus 22? And can we use chronological age as a singular measure to just say, well, you're 40 years old and so this is what it should look like. Or, you're 20 years old based on your date of birth.

[00:46:30] And so this concept of gay age was a way of trying to take both things into account, take what your chronological age is, but then also create essentially how old are you in gay years? Um, you've probably heard or potentially heard the so, or the sort of pop culture term, a gayby, which is like a new gay person.

[00:46:52] But you can see that there is a developmental trajectory around relationships, around sexual behaviors, and people will use different [00:47:00] terms. They're in their quote unquote slutty phase or their relationship phase, or they've been together for a long time and now they're in their post divorce phase. But a lot of that tends to hold true regardless of what your chronological age is.

[00:47:13] And so we see then relationships with different age dynamics. We see men who have mental health issues or substance abuse issues that are in their forties that might be more typically seen in non-sexual minority populations of their twenties. And so it was a way to look at and measure, do we actually see differences if we assign everybody a gay age?

[00:47:37] And the answer is yes. We see developmental differences based on if we lump everyone together based on chronological age, here's what it would look like, what 18 year olds do, and what 20 year olds do, and what 40 year olds do. And then if we take those same people and give them a gay age, suddenly they fall into a different bucket or a different category.

[00:47:55] And should we then be thinking, when we talk about development and sexual [00:48:00] development, should it be based on birthday or chronology of age, or should it be based on where you are in the sort of trajectory of. Coming out and living your life in the world of a, as a sexual minority.

[00:48:14] Shawn: Hmm. Do you find anything different when it comes to intersectionalities?

[00:48:19] Do you find that there's, I guess the question is, is gay age fluid enough to account for one static group might be the hegemonic gay age, but that they're, you know, when we start to consider something like trans men of color that their gay ages may be offset a bit? 

[00:48:39] Joshua: Yeah. Yes. Uh, I'm trying to think how to say that.

[00:48:42] Like un unfortunately, or the reality being every marginalized identity that gets added to any individual skews the numbers. Mm-hmm. And it's also in a negative way. Right. What we know is that if you are a minor racial or ethnic minority, your [00:49:00] outcomes and all of the things are worse than your white counterpart, even if you're both sexual minorities.

[00:49:05] Add on top of that, if you have a gender minority status, so if you are a trans and a trans person of color, which is why we know they get, have higher rates of suicide, they get murdered at higher rates, all of those things, they have higher rates of substance abuse and homelessness. And so all of that does complicate this.

[00:49:22] What we also know is that the way we examine and test these things is in certain populations or subsections in individual studies. So we can never generalize truly to the population as a whole. You know, there are fancy statistics and we can wait the sample and say it's a representative, but we've never been able to go and ask the entire population individually one-on-one to answer all these questions.

[00:49:52] And I always want to be mindful that these are academic exercises to a degree. They implement theories, they implement [00:50:00] statistics. And they are a snapshot or a picture of our best yes, as scientists based on scientific methods as to the way people and the world work. But I would never, ever want to suggest that.

[00:50:15] Then I could find any person on the street, ask them to tell me, are you X, Y, and Z? And then say, well, this is what bucket you fit into and this must be your lived experience. And that's where you have to sort of discern between using science and scientific methods to gain a broader perspective, but not put that broader perspective as a way to label or suggest you can speak on behalf of any one particular person.

[00:50:43] Shawn: Mm-hmm. So a lot is happening in the realm of queer rights on the political front, particularly in red states. And there are a handful of things that I wanted to talk to you about, because I think they have a nexus with some of your research. The first is, you know, Tennessee recently announced that they're gonna stop accepting [00:51:00] federal funds to address, uh, HIV infections.

[00:51:03] And I guess, I think there's this general sense of why this might be alarming, but given your research and you know, what we know about HIV infection rates and you know, what we talked about earlier in this episode, and then the communities that are impacted, what stands out or, or what are you worried about with this?

[00:51:19] Joshua: What I'm always worried about is when, when we limit it, it just makes zero sense to me. And, and this is as a mathematician kind of guy, the government's saying, we'll give you, it's almost $9 million. The federal government is saying, Hey, Tennessee, we'll give you $9 million to do HIV prevention. Now remember our earlier conversation about, we say we wanna reduce HIV infections, which are higher in rural places, Tennessee being one of them.

[00:51:42] And then the state says, no, we don't want that money. We'll do, we're gonna provide our own 9 million, and then figure out how best to direct those funds because we don't want that dependence on the federal government. My initial brain goes to, who doesn't want 9 million? [00:52:00] Like someone's saying, here's free money to solve a problem.

[00:52:02] Why don't you want it? And if you really have 9 million of your own dollars, then why wouldn't you still want another 9 million? So you had 18 million to deal with it. That is my initial reaction to it. Now, the way that the federal funding works is it comes through c d, C, just like states have the right to make decision about funding.

[00:52:22] Um, this biggest conversation usually comes up in the context of abortion and Planned Parenthood and funding what's allowed and what's not allowed. C d C requires if you accept funding from them that around HIV and STIs, that the funding has to then be utilized or implemented within those that are at the highest risk and have been identified as the riskiest populations in all cases.

[00:52:49] That includes gay men and transgender women. And so for me, it feels like the only reason you would refuse these funds is because you don't want to [00:53:00] use the money to provide services to those populations. That is a decision at the state and government level. I don't live in Tennessee or vote in Tennessee, so I will respect the constitution that says states get to make these decisions.

[00:53:13] From a public health perspective, what we know is if you offer less services and you provide less testing and less treatment options and so on and so forth, you will get more disease, plain and simple. And so it, regardless of what your political affiliation or motivations are, if someone says, we're gonna give you money to reduce disease infection, and you don't take the money, you're gonna have more diseases.

[00:53:36] We actually saw this play out in Indiana. It was pre covid. I'm almost sure my timing always gets messed up, but if you look in Indiana and southern Indiana, we had a, I will say huge. And although the total sample is not huge, but proportionally, it was huge. A huge outbreak of HIV in southern Indiana. It was specific to a group of injection drug users, so it had [00:54:00] nothing to do with sexual orientation, but the way the funding was coming through the state at the time.

[00:54:04] And Mike Pence was the senator, governor, I should know better. I went to school in Indiana, governor, governor, he, he had declined to receive federal funds for HIV stuff around this sort of homophobia and going to gay stuff. And they had a huge outbreak and in this particular town they had a hundred and something people become infected with HIV in a modern day world where all they would've had to do was test people and provide treatment and, and that was what you ended up seeing is sort of being stubborn about how you associated or who you took funds through ultimately led to an entire community becoming infected with HIV that could have been easily prevented.

[00:54:45] And so that's sort of my take on what will happen if, well, it seems like Tennessee has said they don't want the money, then that's what's gonna happen. Those that are at the highest risk are gonna just see an increase in infection and potentially other negative outcomes associated with lack of [00:55:00] treatment.

[00:55:00] Shawn: And not that this would be okay if it was even limited to Tennessee, but while the state itself has borders, infections don't. Nope. So like that is one weakness with when it comes to quote unquote state's rights on issues like this. So for Tennessee to say that they're not going to accept or address, you know, h HIV infections in the same way as they have in the past, then you know, they're potentially putting at risk, not even, not just their own community, but you could argue global.

[00:55:26] Joshua: Yeah, I mean, that's the way the world works. We're, we're a global society now, and you have to think globally. People move around. I mean, if the, you know, the history lesson of. Who we used to think of as patient. Zero being a Canadian gay flight attendant. Mm-hmm. Traveling around the world. And a lot of that has been obviously debunked, but still we live in a world where you're talking to me now and I'm in Ecuador and I actually two days ago, had to go sign a notary in Miami and I did that in the same day.

[00:55:49] And then I was back here and I'll go from here to Turkey and then now I'll be moving around and, and people do all over the world. Um, and this is not, in fairness, [00:56:00] just a conservative issue. This becomes around how we delegate or delegate funding and treatment and testing. I see this, I was in, in DC before I moved to Penn State and I was at George Mason University and working in this space.

[00:56:14] That is a clear example of DC, Maryland and Northern Virginia, which is a metro region in which most people in some fashion or another live work commute across those lines. But all funding and services are separated. And it really is like, well, if you live here or you test there or you work there, it's your problem over there without taking into the reality that everybody is moving across those borders daily.

[00:56:40] Mm-hmm. And what they look like. I think New York runs into some of that with the boroughs. And what is, and I'm not an expert on New York, but I think that there have been issues around organizations and funding that are borough specific versus in Manhattan as if we're all just actually, just because your zip code or your voting block is a particular area doesn't mean that [00:57:00] as a human being, you don't travel and then engage in risky behaviors, what, whatever those might be in other areas.

[00:57:07] Shawn: So on the flip side, what is seemingly good news? The F D A recently announced that it's gonna lift its restrictions on men who have sex with men from donating blood. And maybe a bit of history here might be helpful, but what are your thoughts about this and what it means? 

[00:57:22] Joshua: I. So I just recently did an interview for, I don't know, wall Street Journal or something a couple weeks ago when this first announcement came out, and I am gonna be a more of an naysayer than you.

[00:57:34] In terms of the flip side and it being positive. Mm-hmm. It's twofold in my perspective. Yes, it is positive. I said before, I always, always acknowledged progress. Historically, starting in 1982, there was a ban put on blood donation for anyone that had had sex with men ever in their lifetime since 1977.

[00:57:55] This was a direct response to HIV AIDS epidemic crisis. [00:58:00] The, the new development of HIV being found in this population. A hundred percent agree in the moment of time, contextually that made sense. There was still very little known about transmission, what the disease looked like. All we really knew, at least at the time, was that the majority of individuals carrying the disease were those who identified or had had sex with other men.

[00:58:23] As we developed into the mid nineties, we understood what HIV was, we understood how it was transmitted, we understood who got it, and subsequently came up with treatments for it. There started to become a pretty loud voice, both among community members, but then moving into the early two thousands among medical organizations that we need to revisit the F D A rules on who can donate blood.

[00:58:49] And that went as far as into the sort of American Red Cross, I think, which was in, uh, I wanna say [00:59:00] 96 or two. Was it? No, it was like 2006, um, or mid two thousands, like the American Red Cross said. Hey, F D A, you shouldn't be banning blood. The American Medical Association as much as like 2010, 2011 said, Hey, F D A, this is based on bad science.

[00:59:19] We now screen all of our blood. Also, keep in minding the way we tested blood in the eighties is much different as we've come up with genomics and other ways to run tests. So we could identify these diseases regardless and for everyone to know if you donate blood, now all blood is screened regardless of what the status is to look for these types of diseases and any donor.

[00:59:39] And so all of those things advanced. It was in by more than a decade ago. It was, okay. There is no additional risk based on this restriction of a man who's ever had sex with a man. So the F D A, just last month, a couple of weeks ago, put out their revised guidelines for donation and [01:00:00] what that looks like for men who have sex with meth.

[01:00:04] Here's where I think that we have struggled or are not being honest with ourselves from a policy perspective. So what the ultimate new recommendations or guidelines is, is that they are no longer going to make any blood donations or decisions about the ability to donate blood based on sexual orientation or gender identity.

[01:00:33] So at the surface, one would say like, that's great. Now gay men are not being marginalized and they have the ability to donate blood just like everybody else. But what they have come up with is a system, what they call deferrals. And so the deferrals are, here are all of the things that exclude you from being able to donate blood.[01:01:00] 

[01:01:00] So that does include still, if you are a man who has had sex with men within the past three months. Mm-hmm. Okay. I, I'm okay with that. We're still using a little bit of an outdated standard. Three months really. We can detect HIV in one month, but I'm okay with that. From a science perspective, we do know that men who have sex with men have the highest rates of HIV in this country.

[01:01:22] Although what we also know is that the rates of blood donation and then transmission is so low, it's, it's almost laughable. Go beyond that as deferrals. Any individual who is taking prep, which is pre-exposure prophylaxis, which is an HIV prevention medication, is now excluded from being able to donate in the United States.

[01:01:45] 95% of those who are taking prep are gay men. So now anyone who takes prep, which the US government has been encouraging gay men to take, because it does in fact reduce the risk of HIV by 99% when taken [01:02:00] effectively and appropriately, meaning you take it every day, you're now all excluded, and there are a couple of other caveats.

[01:02:09] And when you go through the list, while the sort of title says We release the ban on gay men, all of the things that require or allow for a deferral essentially are those that directly pertain to someone who I would be gay man who's engaging in any sort of sexual behavior. So functionally, it's the same, so it's functionally the same.

[01:02:32] We haven't, we've changed the language, but we actually haven't changed the policy or the outcome. They have just figured out a more politically correct way of excluding people. And so that's where I really struggle. And again, I want to say I always applaud that at least we're trying to make a step forward.

[01:02:53] But to suggest that suddenly everyone can now donate blood is actually just a fallacy. Hmm. [01:03:00] And I worry what that implication is. I also worry what that implication looks like for prep in particular. Because if they're saying you should take prep because it will prevent H I V, but you cannot donate blood if you're on prep because you're at risk of giving someone HIV that then tells people, well wait a minute.

[01:03:19] You told me this drug wouldn't make it so I couldn't have HIV and now you're telling me if I'm taking this drug, I might be a person who has HIV in my blood. And that's a real mixed message. Mm-hmm. And it's not based on any scientific data. Prep works. Full stop period prep works.

[01:03:37] Shawn: Well, that's a bubble bursted.

[01:03:39] Sorry. No, it's good. I mean, it, it actually does have maybe unintended but consequences as well, even from like, uh, like a mental health perspective or a social perspective. Imagine as most people I'm sure, do they see the headline and think they can donate and wanna do some civic duty, and they go only to find out now in a pub in some quasi-public setting that they [01:04:00] can't, right?

[01:04:01] Joshua: Yeah. And they get turned away, which then essentially outs them. Because the only restrictions, the only way that you can be restricted now is because you're either on prep or you're having sex with a man as a man. So that just, if they turn you away in a public space, you've now been outed as someone who has sex with men or takes prep.

[01:04:17] And if you're taking prep, at least in this country, you're likely someone. Who is having sex with men, right? You just got outed and you're still not able to donate blood. And it goes above and beyond blood. They focus always on the blood donation, which I find very fascinating politically because they were able to temporarily suspend these restrictions during covid when blood donation was low.

[01:04:40] So apparently you've been a dangerous population for almost 30 years now, that we really, really need your blood. The rules don't apply now that the pandemic's over the rules are back. But what I was gonna say beyond blood is that people don't realize one of the biggest areas is around cornea donation when you die.

[01:04:57] Um, we have a real need for people who have a [01:05:00] lack of eyesight to get corneas donated, and there's a huge list of people that need them and a huge deficiency in who can donate them. There is no scientific evidence that you could. Transmit, HIV from a corneal donation. But gay men and anyone that fits this blood band is restricted from being an organ donor.

[01:05:18] Even around corneas, other organs are a different story. And so you are essentially telling people on one side you can't help out. And on the other side, sorry that you are blind or going blind, but it's not even up to you. If you'd be willing to take a cornea from someone who was living with HIV where there is no scientific evidence, you could get HIV from that corneal transplant.

[01:05:40] Um, so there's much broader and, and bigger things. Hmm. Alright. 

[01:05:45] Shawn: Final question. Are you ready for it? Yep. What's something interesting you've been reading, watching, listening to or doing lately? And it doesn't have to be related to this topic, but it can be, 

[01:05:54] Joshua: well it depends what you classify as interesting, but like, because.[01:06:00] 

[01:06:00] The rest of the cultural world has normalized it. I have been fully invested and obsessed with Vanderpump Rules and Tom Sandoval and Ariana and all things Sandoval. And if you don't know what that is, I can't help explain it, but JLo knows about it and so does, they've made a, uh, reference to it at the correspondence dinner.

[01:06:23] So I feel like that reality TV show mess has been my, has been something that I've been completely invested in and is my, what do you, what do you call it when you're like your guilty pleasure? Um, so Vanderpump Rules is my guilty pleasure, but, well, and I was gonna say in all seriousness, but I was being serious.

[01:06:42] One of the particular issues I've been, I've been interested in reading a lot recently about two topics, not connected necessarily. One I've been really focused on, in, in my classes I teach. Really just increasingly interested around issues of race and racism as it plays out in [01:07:00] sexuality and with a particular emphasis on the black female voice and what that looks like in comparison to the white female voice.

[01:07:11] I just used a book called White, white Tears, brown Scars. Ruby Hammad, I believe is the author's name. Uh, she's out of Australia. And just really talking about Me Too movement and the women's movement and looking at sort of historical oppression of gender, sort of male to female, but then sort of, sort of how white women have, and, and white people, but white women in particular as in this conversation have, uh, weaponized their whiteness when it becomes necessary over their gender.

[01:07:42] And so it, it sort of becomes that question of marginalization and like, we're all in this together until it becomes not a fight about men and women, but about. Men and women. And if white women can then sort of throw black women under the bus or women of color more broadly, then it's like, oh, well we [01:08:00] promised to help you out later on.

[01:08:01] So just some of those issues around sexual racism and what that looks like has been particularly interesting to me. And then what we've talked about a little bit throughout this conversation, um, I, I'm increasingly worried and interested in the division, the factions, the verbalization, which is not a word, but, uh, the intentionality of people surrounding themselves and being insular and not being open to hearing opposite thoughts or perspectives because they feel more protected to just reinforce their beliefs by surrounding themselves with literature and other people that endorse those same beliefs.

[01:08:46] And what that. Ultimately, I think is going to lead to, really already has, but will continue to divide us and not help us try to look at the humanity of things and listen to the [01:09:00] perspectives of those that we fundamentally disagree with. Mm-hmm. And I really try to read and listen and watch and as much as I can use the word befriend, people who are polar opposites of me in so many of my views, because I think that's the only way I can either fully be confident in my own views or really try to understand why it is that they're so confident in, in their perspectives and their views.

[01:09:29] And I worry about the inability for people to speak freely and say stuff and make mistakes and say things that are inappropriate to one particular group, but in a, in a way that we can then learn from it and use it to try to understand rather than. Cancel or divide or, or whatever. I, I always struggle for the terms when it comes to that, but that's sort of, I've been reading and listening to things and been sort of all over the place.

[01:09:57] I don't have any answers to it yet [01:10:00] other than everybody seems to say it's going on and no one seems to have a solution. 

[01:10:03] Shawn: Mm. This is a fascinating topic for me as well, and something I've been thinking about, and one of the things that I've noticed, I think there's always some type of polarity polarization.

[01:10:14] There's always some division in any society, right? Like you just, you can't have a utopian society wherein everybody agrees and you don't want it. Yeah. So what that means is you have varying degrees of the intensity to it, and we're living through a very high intensity moment. But what I find scary about it is where it's coupled at a time when we also have really jettisoned the idea of redemption.

[01:10:39] Meaning, yeah, we do not let people make mistakes and then work their way back from it and. I'm not in any way advocating that we should live in a society wherein people can do almost anything and then somehow be redeemed through something. You know? I do think that there are, to some degree irredeemable things or things that just like come with punishment that last for a long time.

[01:10:59] But [01:11:00] I think if you take redemption off the table altogether, all it does is reinforce for people that whatever camp they're in is the safest camp to stay in. Right. Let's say you're a white supremacist, right? Like, why would you ever leave that if it meant that you were gonna be in the wilderness?

[01:11:15] Because nobody else is gonna ever, you know, right. Forgive you or, you know. 

[01:11:20] Joshua: It also just to me, I mean, and I, and I fully agree with you, I, I, I'm not. And I've been accused of like, oh, well no, you're people are just being held accountable. I believe in accountability a hundred percent. Mm-hmm. I think me too, to the beginning of our conversation, one of the first things I said is around how we classify things.

[01:11:38] It's like, well, what is your ultimate outcome? What are you trying to get to? And if, if the answer is just to get rid of any and all people that aren't like-minded, then I guess no redemption and cancellation is the solution. However you have to understand then that would occur on quote unquote both. I hate using both sides anymore.

[01:11:59] Right. Yeah, [01:12:00] I know, but I mean, and the argument works for either side of whatever the debate is. If it used the white supremacist, it's like, well then their argument on why we should cancel anyone that's not white supremacist works in the exact same logical way as anyone who says we should cancel anyone who is.

[01:12:17] A white supremacist. And it's like, if, so, if the outcome is getting rid of them, then you're, that is a fine approach, but that's not realistic because we live in a world where people do, or at least have had diverse opinions, perspectives, and whatever. And so there has to be some sort of path forward for anyone and everyone.

[01:12:38] And, and that path will differ on a case by case basis. It is not binary, it's not black and white. And for some people, maybe whatever you did was so heinous that your path forward is to go to prison for the rest of your life and have to sit in your cell and think about it. Right. And for others it might be like you need to say, I'm sorry and move on.

[01:12:57] Mm-hmm. But I just, I worry, [01:13:00] and I, and I do worry then how that can be manipulated with. With modern technology. I think that, you know, we saw what happened with election stuff and just manipulation. We're, uh, reading more and more and seeing about sort of AI and just, again, other terms I hate, but quote fake news, like just the ability to manipulate the human mind with false information.

[01:13:21] And we've, we've moved so far away from the idea of, i, I believe in subjective and objective and, and truth and the epistemology of words, but we've sort of just turned into, you can say whatever you want and if you believe it, it's the truth and that's all there is to it. And I, and I think that's very dangerous repercussions for society as a whole.

[01:13:41] Uh, I think we need to start coming back to having collective truths. Whether you agree or ascribe to them is separate, but saying, okay, this is the reality, or this is the collective truth. I don't agree with that truth. It's different than I don't believe it. It's not true. It's like mm-hmm. It just, it, it, it [01:14:00] works.

[01:14:01] Shawn: Dr. Rosenberger, thanks for the conversation. I really appreciate it. 

[01:14:04] Joshua: Thank you so much. I appreciate it as well.

[01:14:12] Shawn: In my final thought, I wanna shift gears and talk about the ways that politicians can avoid accountability for the ramifications of deliberately discriminatory legislation. I've been thinking a lot lately about the impact of abortion laws in conservative states that outlaw abortions under all circumstances, even in cases of rape and inces, or when the life of the mother is at stake, an anti-trans legislation that outlaws trans-affirming healthcare.

[01:14:39] When people contact HIV in Indiana, because then Governor Mike Pence refused federal funding for H HIV prevention and care, something that was predicted and well-established as a consequence of doing so. And when current Governor Bill Lee of Tennessee does the same against all medical science that tells us that this will lead to increases in H HIV V infection rates, then these governors are [01:15:00] complicit in a harm and should be held accountable to it.

[01:15:03] In Florida, doctors can deny healthcare based on personal beliefs or values. It's hard to imagine, but do you wanna be a queer person on a layover or worse living in Florida when you have a healthcare emergency? And the only thing standing between you and lifesaving medical care is a highly right wing religious doctor that believes that homosexuality is punishable by death.

[01:15:24] Do you wanna be a woman in Idaho who was raped and now must carried a term even if your own life is at stake beyond the posturing and the ideology inherent in this type of legislation? These types of laws have fundamental real impacts on people's lives and their health and their bodies. Politicians driven by personal beliefs, by hatred, maybe religion, but certainly not science, are passing legislation today that is intended to harm specific people, and in some cases it kills people and they're doing so via the legislative process, which also protects them from any legal accountability for the damage [01:16:00] they're doing.

[01:16:00] Because in the United States, we have a long held norm, and in some cases actual law that shields politicians from the negative impacts of the legislation they write and pass and sign, et cetera. In fact, the constitution protects members of Congress from arrest and prosecution for things said and done in their official capacity, and I get it.

[01:16:20] This makes sense for a handful of reasons. Most legislation has both beneficial and harmful impacts. There are winners and losers to most legislation, so if all losers could claim harm and pursue politicians criminally for that harm, There'd be chaos. Also, we need legislation related to complicated issues, and it's not always clear how to do that to best reduce harm.

[01:16:42] And finally, I get that it's difficult in some circumstances, although not all, to draw a direct line between legislation and harmful outcomes. And so I wanna make a distinction here between legislation that is doing its level best to address serious issues in pursuit of doing the most good [01:17:00] for the most people.

[01:17:01] Legislation that's driven by and subsequently reflects science and the input of subject matter experts versus legislation that is specifically designed to harm certain people. Legislation that's derived from animus and used toward political ends targeting specific groups or communities that have negative real world, sometimes physical, sometimes deadly consequences for people when that is intended and a predicted result.

[01:17:26] This should not be shielded from accountability. It's not good government that allows individuals to hold an office that they can then leverage to legally hurt people, especially when personal animus motivates the legislation and that legislation flies in the face of established science. In fact, when politicians do things that are so counter to this science, in fact, I think there's an argument to be made here that they should be held legally accountable for the harm that is caused.

[01:17:54] As a result, when personal animus drives legislation and that legislation leads to [01:18:00] illness or death, then an official capacity designation should not shield the creators of these policies and this legislation from some legal liability. Look, I'm not naive. I understand there's a can of worms here with regard to how we hold politicians accountable for vengeful, discriminatory, and prejudice legislation that causes real harm to people.

[01:18:19] Some might argue that the political process itself is a form of accountability, but let's be real, it's not working so well these days. And I'd like to suggest that frankly, the current situation is a can of worms. It protects legislators that craft deliberately targeted and harmful legislation from any accountability in a way that the rest of us are not protected for the harms that our behaviors and actions might cause.

[01:18:43] Legislation should not be a free pass or a backdoor or a golden ticket to cause injury and with impunity, but rather a highly regulated process through which people are governed. It should be designed to hinder people from weaponizing it in discriminatory ways, and in some cases, [01:19:00] maybe it should be designed to punish people that do so.

[01:19:03] I'm suggesting that this is something we should visit, perhaps reform, perhaps restructure. The guardrails we place around the legislative process to limit the ability of bad actors to hide behind the governing process, to create abusive and prejudicial legislation intended specifically to harm certain people.

[01:19:20] Blanket protection for politicians from any legal accountability for legislation that one blatantly FFLs science or fact, and two, carves out certain communities for specific, especially life-threatening harm should not exist. There are questions we should be asking here, is this fair? Is this just, are there creative ways on certain types of legislation or issues to require input from experts and specialists that then impacts the construct and structure of legislation in a meaningful way so as to reduce harm or to identify particular issues or issue areas on which legislation has a direct and individual impact [01:20:00] on people that then requires heightened scrutiny of that legislative process, how that law is crafted and implemented.

[01:20:07] This is not simple, but at minimum we should have this conversation in the absence of it. Queer people and women and people of color and immigrants children, essentially, all people that don't make up dominant, white, heteronormative Christian society are being deliberately abused and violated and harmed by legislation intended to do just that, and that's not acceptable.

[01:20:31] Alright, check back soon for another episode of Deep Dive. Chat soon 

[01:20:36] folks.