Healthy People

Sexual Health: Asking the Tough Questions

Using the research tools of social science — questionnaires, focus groups, interviews and data analysis — Marie Harvey, chair of OSU’s Department of Public Health, delves into the most private of human behaviors and the attitudes that shape them.

By Lee Anna Sherman

Using the research tools of social science — questionnaires, focus groups, interviews and data analysis — Marie Harvey, chair of OSU’s Department of Public Health, delves into the most private of human behaviors and the attitudes that shape them.

From her viewpoint, the stakes are far too high to avoid asking the tough questions. Studying the reproductive health of vulnerable women is, she argues, one of our era’s most urgent tasks — a lynchpin in the quest for social justice. Minority women can’t hope to achieve economic parity when they are disproportionately affected by HIV, other sexually transmitted diseases (STDs) and unintended pregnancy.

Helping Latina and African-American women stay healthy and plan their pregnancies will take nothing less than a paradigm shift — a revolution in contraception and disease prevention that gives women wider choices and greater control over their reproductive lives, Harvey says. The first step is to identify factors that put women at increased risk for HIV and STDs. They are complex and not entirely clear — a Gordian knot of social conditions and contextual issues including relationship dynamics, culture, poor housing and access to health care. To tease out the strands, the scientific methods must be as rigorous as the subject matter is delicate.

So Harvey and her team of OSU researchers devote countless hours to designing their instruments. Crafting a questionnaire for a $1.3 million Centers for Disease Control and Prevention study on rural Latinos, for example, they hash over every linguistic fine point in excruciating detail. Working shoulder-to-shoulder with members of underserved racial and ethnic minority populations has attuned Harvey to the nuances of words — those shades of meaning that can carry powerful subtexts. “Being respectful of cultural issues and differences,” she says, “is absolutely essential in undertaking this kind of research.”

Harvey’s work also takes her into the trenches of the culture wars. The book she co-edited with Linda Beckman in 1998, The New Civil War: The Psychology, Culture and Politics of Abortion, is a case in point. As Professor Carole Joffe of UC Davis says of the collected writings: “This exhaustive analysis of the way Americans feel about abortion reveals that, at core, abortion continues to be defined primarily as a moral issue, often at the expense of women’s health and well-being.”

Harvey’s groundbreaking studies have earned her a national reputation — one that extends beyond her scores of scholarly articles to include wide citations in the popular press, ranging from the intellectually weighty (Los Angeles Times and National Public Radio’s “All Things Considered”) to the supermarket mainstay (USA Today and Glamour magazine).

Her reformer’s spirit took hold 35 years ago. As a history grad in need of a job, she fell back on her minor in psychology to land a social work position in Los Angeles. The teen moms she worked with sealed her future, inspiring her to earn a doctorate in public health at UCLA with a plan to go “upstream” to find the sources of the poverty defeating her clients.

The barrios of southern California were light years from her early-childhood home in the high desert of eastern Oregon, where diversity meant a mix of Lutherans, Catholics and Baptists. Maybe it was the hardscrabble life on a ranch, helping to herd cattle and bale hay in a one-horse town called Twickenham, that girded her for the challenges of social work. Maybe it was attending a one-room schoolhouse without indoor plumbing or central heating. Or rising at dawn to pick sugar beets, bush beans, and strawberries when her family moved west to a Willamette Valley truck farm.

The CDC study has brought her back to those agricultural roots. After years of studying sexual health in urban populations, she has broadened her research to include the rapidly growing Hispanic communities of rural Oregon. The bigger barriers that block protective behaviors among rural populations are under Harvey’s scrutiny. “We’re interested in how broader issues such as racism, medical mistrust, poverty, health literacy and culture interact and how they impact access to and use of reproductive health services.”

With a $2 million grant from the National Institutes of Health, she is also investigating the skyrocketing rate of HIV infections among primarily African-American and Hispanic men and women in Los Angeles. Unlike the typical reproductive health study, which focuses on women or on men separately, Harvey’s work looks at the interplay between the sexes. How, for example, do gender-based power and control issues affect decision-making about contraception and disease prevention? After all, sex is what Harvey calls a “dyadic” behavior — that is, “It takes two to tango.” How that tango unfolds through personal relationships is still a big unknown.

“Research in this area is in its infancy,” Harvey notes. “A thorough understanding of how relationship dynamics influence sexual behavior is needed.”