And the winner is…

“1. Consent; 2. (with an arrow pointing to the mouth of the dispenser)”

This choice was the clear favorite, with approximately 43% of the votes. This phrase will  appear on condom dispensers located in selected campus restrooms, which will be installed sometime this Spring.

Thanks to the 1,000+ of you who voted yesterday! Stay tuned to UNC Student Wellness’ Healthy Heels blog for more information on dispenser installation, as well as lots of other great posts about health. In fact, why not check us out while you’re here?

You can friend us on Facebook, or follow us on Twitter to get updates on new HealthyHeels posts and other health-related updates!


Vote today for your favorite awareness slogan for condom dispensers!

In a program to increase accessibility of condoms to UNC students, Student Wellness and the Sexual Wellness Specialists (formerly CHECS) have started a project to install condom dispensers at a few
locations throughout UNC campus. These dispensers are expected to be installed this Spring.

In February, we asked students about their ideas for slogans or catchphrases to go on the dispensers. These ideas have shown us both your creativity and your commitment to safer sex and protective practices on the Carolina campus. We’ve narrowed it down to 6 slogans.

Now we need your help to pick the top slogan! We want your opinion on your favorite submission. Please vote below, and spread the word to UNC students! Limit one vote per person. Voting will take place today, Wednesday, March 6th from 8AM to 9PM.

Please click here for more information and to vote:

And stay tuned to Student Wellness’ Healthy Heels blog — the winner will be announced here later this week!


You have probably heard this phrase ad nauseum in physical education classes, at health centers, or perhaps from partners, friends or family members:

“Abstinence is the only sure way to prevent pregnancy and sexually transmitted infections”.

As sexual health counselors, we talk a lot about sexual abstinence being at the low-risk side of the STI/pregnancy risk spectrum, but we don’t always talk enough about what it is, or how to be abstinent. We recognize that many college students choose to be abstinent, and also recognize that healthy sexual expression isn’t just about, nor does it necessarily include, having sex. So, in this blog post, we’ll give abstinence our full attention and go beyond the basics.

What is abstinence?

In general, most people would agree that abstinence is just abstaining from sex. Simple, right? Well, people have very different definitions of “sex” to begin with, and therefore different definitions for “abstinence”. Some definitions of abstinence that we’ve heard before include:

  • Abstaining only from vaginal sex
  • Abstaining from anal, vaginal or oral sex
  • Abstaining from any sexual touching, including masturbation
  • Abstaining from romantic relationships altogether

Abstinence is different to different people: it may include one type of sex, but not another; it may be abstaining from all types of sex; or, it could be abstaining from any sexual contact or touching. The definition of abstinence may also vary depending on the partners involved. For example, two males in a partnership may have a different working definition for abstinence than two females in a partnership, or a male and female in a partnership. The definition of abstinence may also vary by time. For example, some people may say they are abstinent if they have no sexual relationships currently, while others might define abstinence as never having had a sexual relationship, or waiting until a certain time to have a sexual relationship (graduation, meeting a lifetime partner, etc.).

This is not to say that there’s a right or wrong way to be abstinent, but it is important to understand that abstinence does differ from person to person, and partnership to partnership.

How “low-risk” is abstinence?

Generally speaking, abstaining from sexual activity translates to a much lower risk for most STI and/or pregnancy. However, how one defines abstinence influences that level of risk. For example, if one’s definition of abstinence is abstaining from vaginal sex but still having oral or anal sex, there is still a risk for STI because oral and anal sex can transmit infections like herpes, chlamydia, gonorrhea and syphilis. In another example, if one defines abstinence as abstaining from oral, anal or vaginal sex, but still includes sexual touching, there still may be an STI risk because skin-to-skin contact can still transmit STI like herpes or HPV.

Therefore, abstinence is only no-risk for STI and/or pregnancy when one is abstaining from all the potential ways that STI transmission or pregnancy may occur. However, there are many ways to make abstinence as low-risk as possible, for example, by using condoms or other barriers during oral or anal sex.

Being abstinent

Just like choosing to have sex, choosing to be abstinent is a big decision. It’s important to make sure you have a clear definition of what abstinence is and means to you, and to communicate this to potential partners. Answering the following questions can help you start conceptualizing what sex and abstinence mean to you:

  • Why are you choosing to be abstinent?
  • What does “sex” mean to you, and to a partnership?
  • Which activities, specifically, will you be abstaining from?
  • For how long is it important for you to be abstinent?

Abstinence Resources

The following are some great resources for abstinence:

How is HIV different from AIDS?

This year marks 31 years since AIDS was first recognized by the CDC. News of the highly-fatal AIDS epidemic was initially met with profound concern, panic and confusion.  Still today, there are plenty of misconceptions about what HIV and AIDS are, and who is affected.  In honor of World AIDS Day (this Friday, December 1st), we’ll provide an abbreviated history of the discovery of HIV and AIDS, discuss how they’re different, and talk about how you can get tested for FREE!

AIDS and HIV: History

In 1981, the Centers for Disease Control and Prevention (CDC) received several reports of Karposi’s sarcoma, a rare cancer, among young gay men. This wave of cases was highly unusual as Karposi’s sarcoma was typically seen in those with severely comprised immune systems and the elderly. Suspecting that there may be other factors at-play, the CDC began an outbreak investigation. At this stage of the epidemic, there was no identifiable cause, transmission remained a mystery. There was also no single name for the phenomenon. Various organizations referred to it with different names, among them “gay-related immune deficiency” (GRID).  As the epidemic spread, it became clear that several groups were affected, including injection drug users, hemophiliacs and Haitians.  The CDC proposed using a unifying name for the condition, as there was mounting evidence that it was not limited to the gay community. In 1982, with over 400 cases reported globally, the CDC proposed the term “Acquired Immune Deficiency Syndrome” or (AIDS). At the same time, cases of mother-to-child transmissions of AIDS were reported, and a child who had received blood transfusions also appeared to have developed AIDS. Additionally, cases of AIDS among women who reported having sex with men were recorded. All of these cases provided evidence that an infectious agent was likely responsible for AIDS, and suggested several possible routes of transmission: through blood, breast milk, and sexual activity. After years of intense investigation and research, the idea that AIDS was transmitted through an infectious agent was still a theory, yet to be confirmed.

A breakthrough in research, Robert Gallo and Luc Montagnier isolated viruses thought to cause AIDS – initially named HTLV and LAV. In 1986, at least five years after AIDS cases were initially reported, the name for the virus that causes AIDS was born: “Human Immunodeficiency Virus”, or HIV.


The history of AIDS and HIV helps clarify how and why they’re different. AIDS refers to a syndrome, meaning the presence of clinical features or phenomena (example:  weakened immune system), and what was initially seen and reported. In contrast, HIV is the virus responsible for causing AIDS.  HIV is a necessary but not sufficient cause of AIDS. In other words, HIV infection always precedes AIDS, but HIV doesn’t always develop into AIDS. HIV can be detected with a variety of tests that identify either HIV itself or circulating HIV antibodies. AIDS diagnosis is more complicated, and requires the presence of certain signs and symptoms, such as decreased white blood cell count and certain  AIDS-defining illnesses.

HIV Testing

In honor of World AIDS Day, UNC Counseling and Wellness Services will host a FREE, walk-in HIV testing event in the Carolina Union from 11AM-5PM on November 30th! Please see our event page for more information. Additionally, at UNC Campus Health Services, we offer a rapid oral test (results available in about 20 minutes), and a blood test. More information about HIV testing at UNC is available on the Campus Health webpage; for more information about making an HIV appointment with the Sexual Wellness Specialists (formerly CHECS) by calling 919.966.3658.

The Power of Peers: Health Benefits of Peer Education

Here’s a question: how often do you turn to siblings, roommates or friends for health-related advice or information?

If you’re like most young adults, pretty often. According to a 2010 analysis of students participating in the National College Health Assessment (NCHA), approximately 62% of college-aged students reported getting health-related information from friends.

Your peers have a big impact on the way you feel, the things you know, and what you do. And, in turn, you have a similar impact on your peers.

Peer influence affects lots of things, from academic achievement, to adopting healthy behaviors (ex: positive body image, safer sex) or unhealthy behaviors (ex: binge drinking, disordered eating), to feelings of motivation and confidence.  So, when peers are given accurate information to disseminate to others, it can have an extremely powerful effect for both the peer educators and the people receiving peer health education. Peer-led education is a way of harnessing peer influence to enact positive change, and there lots of opportunities to get involved on the UNC campus and beyond!

Peer Education?

Let’s break down peer education. First, who are your “peers”?  Essentially, those in a similar age range – like your friends, roommates, residence hall advisors, etc. Next, what does peer education entail? Peer-led education is a combination of several health education and public health models whereby peers themselves are trained* to educate their peers. The goals of peer education are to reinforce, inspire or change behaviors through workshops, advocacy projects, discussion, interactive activities, role-playing, and more.

[*Although being informed in general has the potential to have an extremely positive effect on the people around you – and something we at Campus Health absolutely endorse! — I am talking about formally trained peer health education initiatives in this post. In order to have maximum effect, peer educators should be trained in the education area of interest, in how to facilitate discussion or activities, in how and when to refer peers to other resources, and in how to inspire change.]  

Peer education has worked extremely well in many contexts. Why? Well, for starters, peers are often more approachable than other health sources, and getting information from your peers means that you’re talking to someone who probably knows what it’s like to be in your shoes.  Particularly for things that are difficult to talk about, like sexual health, peers can be an important way of disseminating information. By becoming informed on health topics, peer educators put themselves in a position where they are able to disseminate accurate, helpful information to friends, classmates, residents and others when they need it.

Let’s take a look at some of the health benefits of peer education on peers, and the health benefits for the educators themselves.

Benefits to peers

Peer education has been shown to be effective in enacting positive change in various spheres of health. In a paper by White, Park and Israel (2009), the authors found that college students in contact with a peer educator were significantly less likely to engage in dangerous alcohol consumption. The authors also found that over time, students in touch with a peer educator were less likely to engage in unhealthy weight management and “fat talk”. Another study found that peer education programs in physical activity increased physical activity among women who were physically inactive. Various sexual health-focused peer education programs have also been effective in increasing healthy behaviors such as increased condom use.

Peer education programs have even been shown to be more effective than adult-led education programs in terms of changing behaviors, attitudes and norms. However, studies on combined peer and adult-led health education programs (ex: classroom based course led by an adult or professional, with the addition of peer education on the same topics) is thought to provide maximum impact in terms of credible information dissemination, and behavior change.

Benefits to peer educators

As a peer educator, one obvious benefit is simply knowing more, and being in touch with mentors, and reliable sources of information. By itself, that’s a great thing, but it’s not the only benefit. Peer educators also advance their leadership and facilitation skills. They often positively change their own behavior as a result of participating, and gain essential skills like effective communication with others. In one study of 65 peer educators by Sawyer and colleagues, nearly half (48%) of peer educators reported increased self-esteem, and over 20% reported being more open to students’ behaviors and opinions. Additionally, 43% adopted safer sex behaviors, 20% had changed their career direction, and most found it an extremely valuable activity.

Getting Involved

Interested in getting involved with peer education here on UNC campus?

  • Consider joining a peer-based group, attending peer-led events, or reaching out to them to plan an event! At Campus Health, we’ve got several peer programs geared to different topic areas:
    • Active Minds – focus on mental health, coping skills, personal growth
    • CHISEL – promote healthy lifestyles through various health-related events on campus.
    • Diversity and Inclusiveness in College Enviroments (DICE) – a student-led program with the goal of creating greater diversity awareness and programming inclusiveness for students at UNC.
    • Interactive Theatre Carolina – uses scripted and improvisational theatre as a platform to promote health, wellness and social justice. You can request a scene, be trained They have various scenes performed throughout the year.
    • OneACT – a program for preventing interpersonal violence; you can become a peer educator, or serve on a committee.
    • Peer Health Advocates – trained to have conversations within groups of friends on health topics.
    • Student Advocates for Sexual Health (SASH)– promotes healthy sexuality; SASH members are trained in facilitating discussions, and are dedicated to making Carolina a safer and sexier place.
  • If you’re a resident hall advisor or community director, Campus Health Services has a Health Programming Guide with a variety of programs, facilitation guides and bulletin boards to get you started in your own peer-led workshops. Topics include: alcohol and other drugs, cultural competency, finances, fitness, LGBTQ topics, nutrition, sexual health, stress and more. If you need help or guidance on a topic area, seek out our help at Campus Health!

Whose responsibility is it to carry condoms?

The condom is like the Swiss army knife of protected sex:  in one unit, you’ve got protection that can be used for a variety of situations, for a variety of sex acts, for a variety of partnerships.

Condoms are the only contraceptive method that helps prevent both pregnancy and sexually transmitted infections (STI). Male condoms can be used on men during oral, vaginal and anal sex; female condoms can be used in women during vaginal sex and anal sex. With a quick snip, both male and female condoms can also be converted to dental barriers for use during oral-anal and oral-vaginal sex.

But in the heat of the moment, who provides the condoms?

There are plenty of people who would argue that it’s a particular person’s “job” to have condoms available: “the guy’s responsibility”; “the girl’s responsibility”; “’responsibility of whoever initiates sex”, etc.

There are no rules out there about who needs to buy or bring safer sex supplies. In theory, if it’s a shared goal to prevent pregnancy and/or STI, then it’s a shared responsibility to do things to prevent those outcomes.

Of course, in practice we at Campus Health Services (CHS) recognize that there are lots of reasons why people don’t have condoms available. Condoms can be expensive. Acquiring condoms before sex requires some planning and foresight. Additionally, for many, condoms can be kind of embarrassing to get or buy. Having them available makes some people nervous that their partner will think they’re promiscuous.

Luckily, CHS makes it easy to get condoms for those who want them! First, they’re FREE to students, so no need to worry about cost. Second, they’re available at various locations in fishbowls and examination rooms throughout CHS, and provided free of charge to most students through their resident advisors or housing communities.

Here at CHS, we strongly believe that sex is a healthy part of relationships and there shouldn’t be shame or judgment associated with having sex or acquiring condoms on campus. We also believe that having condoms does not make you or your partner promiscuous; it makes you prepared. If you’re shy about getting condoms at fishbowls in campus health locations, reach out to a Sexual Wellness Specialists (formerly CHECS)( and we’ll hook you up with condoms privately.

And for tips on how to discuss sex (and condom use) with your partner, see our previous blog post on conversation with sex partners.

Of Warts, Nuns and Jackalopes: A Brief History of the HPV Vaccine

This spring marks the 6-year anniversary of the vaccine for HPV, a common sexually transmitted infection that causes warts, cervical cancer, and other cancers. Since the vaccine’s debut back in 2006, millions worldwide have been vaccinated against HPV —an effort which is expected to have a serious impact on reducing the incidence of cervical and other anogenital cancers around the globe.

What’s now a commonplace vaccine, however, represents a long (and occasionally weird) history of scientific discovery. On this 6-year vaccinaversary, let’s nerd out for a minute and revisit the complex, sometimes strange, and ultimately successful history of the HPV vaccine.

Continue reading

Condom effectiveness: What’s brand name got to do with it?

Condoms are one of the most commonly used contraceptive/STD prevention products used worldwide. The United Nations Population Fund estimated that over 10 billion condoms were used in 2005.  Here on campus, Campus Health Services provides thousands of condoms to students each year.

As a sexual health counselor, I have noticed that many people’s preferences for certain condom brands are based (almost entirely) on their perception of that condom brand’s effectiveness. We offer a variety of condom brands for free to students through Campus Health Services. Occasionally, when people check out the condoms we have available, they’ll ask: “are those safe to use?”, and “don’t those break more than [other condom brand]?”.

So, do some condoms in fact perform better than others in terms of STD/pregnancy prevention?

The answer is no, not really. Condoms are regarded by the United States Food and Drug Administration (FDA) as “Class II medical devices”, a designation that includes pregnancy tests and powered wheelchairs.  Products in this category have to meet special labeling requirements and performance standards. For condoms, the FDA standards include systematic “water leak” tests to ensure that no fluid can leak out of the condoms. To meet standards, all condoms must have at least 996 out of 1,000 condoms, on average, pass this test. This means that FDA-approved condoms must be at least 99.6% effective in laboratory tests to be available to consumers.

In a 2004 publication, Walsh and colleagues used condom use data from trials of three bands of condoms, including Trojan, LifeStyles and Ramses – all of which are FDA-approved condom brands. Out of 3,677 condom-protected sex acts analyzed in the study, the authors found that 55 condom acts failed, either due to breaking (16 condoms broke; break rate = 0.04%) or slipping (39 condoms slipped; slip rate = 1%). The likelihood of condoms breaking during sex was not statistically associated with condom brand.

FDA-approved condoms are all quite effective at preventing pregnancy and STD, and performance is probably not related to brand type. You might be wondering if the condoms you’re using are FDA-approved. With the exception of novelty condoms (which are pretty uncommon), just about all of the condoms you’ll come across in the United States are approved by the FDA.  All the condoms we provide through Campus Health Services are FDA-approved, and same goes for places like Planned Parenthood and local STD/HIV clinics. If you’d like to be certain, you can check the condom packet to look for wording about STD and pregnancy prevention. If it’s on the packet, those condoms meet federal regulations for quality and safety.

Check out the following pictures to see how we’ve looked for this language on some condoms we provide at Campus Health Services:

If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved.
If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved for STD/HIV and pregnancy prevention.

All of this said, although condoms must be at least 99.6% effective in safety trials, testing conditions do not necessarily mean 99.6% real-life effectiveness for any condom brand. But here’s the good news:  there’s a lot you can do to increase the effectiveness of condoms. One of the biggest challenges to condom effectiveness is correct use.  Some of the most common errors with condom use are: using the wrong lubricant (water-based, NOT oil-based, lubricants should be used with condoms); incorrect storage (ie, storing a condom in a hot place, like a glove compartment, or in a place with lots of friction, like a wallet or pocket); and not checking the expiration date.