Month: July 2024

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This AI chatbot was trained on drag queens

— And it wants to help protect your sexual health

By Mohana Ravindranath

A few months ago, a young Black gay patient in a southern state tapped out a message on his phone that he might not have been comfortable raising in-person at his local sexual health clinic. “I’m struggling with my relationship with sex,” he wrote, knowing there’d be an immediate response, and no judgment. “I feel like sometimes it’s an impulse action and I end up doing sexual things that I don’t really want to do.”

“Oh, honey,” came a swift response, capped with a pink heart and a sparkle emoji. “You’re not alone in feeling this way, and it takes courage to speak up about it.” After directing him to a professional, it added, “while I’m here to strut the runway of health information and support, I’m not equipped to deep dive into the emotional oceans.”

That’s among thousands of delicate issues patients have shared confidentially with an artificial intelligence-powered chatbot from AIDS Healthcare Foundation, a nonprofit offering sexual health and HIV care at clinics in 15 states. The tool can dispense educational information about sexually-transmitted infections, or STIs in real time, but is also designed to manage appointments, deliver test results and support patients, especially those vulnerable to infections like HIV but who are historically underserved. And as part of a provocative new patient engagement strategy, the foundation chose to deliver those services with the voice of a drag queen.

“Drag queens are about acceptance and taking you as you are,” said the foundation’s vice president for public health, Whitney Engeran-Cordova, who told STAT that he came up with the drag queen persona concept. “You’re getting the unvarnished, non-judgmental, empathetic truth.”

For several months, the foundation has offered the “conversational AI” care navigation service based on OpenAI’s GPT-4 large language model, and thousands of patients across the country have opted in to using it to supplement their in-person care. While they can select a “standard” AI that’s more direct, early data from a pilot at seven clinics in four states suggests the majority — almost 80 percent — prefer the drag queen persona.

The model, developers told STAT, was fine-tuned using vocabulary from interviews with drag performers, popular shows like RuPaul’s Drag Race, and input from staff familiar with drag culture. Health care workers, patients and performers are regularly invited to test it out and improve it.

It’s an early case study on the vast potential, and limitations, of AI tools that reach patients directly without immediate human oversight. Fearing hallucination, bias or errors, health care providers have so far largely avoided deploying AI-powered tools directly to patients until their risks are better understood. Instead, they mostly use AI to draft emails or help with back-office workflow.

But the foundation and Healthvana, the Los Angeles-based tech company that built the tool, said they are comfortable with the technology. They say they adhere to rigorous testing, strictly avoid giving medical advice, and constantly calibrate the model to help clinics safely field more patients than in-person staff could otherwise manage. By the time patients get to their appointments, they often have already received basic sexual health information through the chatbot, which can serve as a friendly, conversational source for potentially life-saving tips, like using condoms or PrEP.

Patients can consult the bot at any time, meaning they can also ask about precautions right before having sex, Engeran-Cordova added. “We’ve never been able to get this close to the moment of action, as a prevention provider” in a way that’s “comfortable, not stalker-y.”

It’s not perfect — sometimes the chatbot uses the wrong word or tone — but its creators assert that the benefits of reaching more patients outweigh the risks. Its missteps have also been minor, they say: An early version of the bot was overzealous, and congratulated a patient when she disclosed a pregnancy that might have been unwanted, for instance.

“What is [the] cost of a wrong answer here, versus what is the benefit of tens of thousands of people who suddenly have access to care? It’s a no-brainer,” said Nirav Shah, a senior scholar within Stanford Medicine’s Clinical Excellence Research Center and an advisor to Healthvana.

Engeran-Cordova said he also has pressure-tested the technology to ensure it doesn’t repeat or reflect back harmful or offensive questions about sexual health or sexuality.

“We would intentionally have yucky conversations that somebody might say, and I even felt creepy typing them in,” he said. The tool, he recalled, “would come back around and say, ‘We don’t talk about people that way, that’s not really a productive way for us to discuss your health care.’”   

Having staff scrutinize the bot and routinely evaluate its responses after they’re sent helps it come across as human and empathetic, Engeran-Cordova said. “There’s an emotional intelligence that you can’t program.”

The chatbot also saves clinical staff time, according to Engeran-Cordova. “Our interactions with people get fairly limited in time — we’re talking about a 10-minute, a 15-minute amount,” he said. If a patient has already asked the tool basic questions, it “moves the conversation down the road” during the appointment, allowing the provider to focus on more immediately pressing issues.

Some outside experts agree that humans don’t necessarily need to review each message before it’s sent. If the tool isn’t giving medical advice, but rather information about scheduling or STIs, “the fact that they are overseeing the interaction [at all] is a lot more than what consumers get when they use Dr. Google (Internet search),” Isaac Kohane, a Harvard biomedical informaticist and editor-in-chief of the New England Journal of Medicine’s AI publication NEJIM AI, said in an email. “At least in this instance which information they see first will not be influenced by paid sponsorships and other intentional search engine optimizations.”

Healthvana has an agreement with OpenAI to protect patients’ health information under the  federal privacy rule HIPAA. Any identifiable information was stripped from conversations shared with STAT.

The creators of the drag queen model and its evaluation process hope to detail their findings in an upcoming research paper, which hasn’t yet been accepted by a medical journal. Part of the goal is to demonstrate to other public health groups that rigorously tested AI tools might not always need the so-called “human-in-the-loop” in real time — as long as they’re evaluating the communication after the fact, Healthvana founder Ramin Bastani said.

The health industry hasn’t yet established standards for benchmarking patient-facing tools; one of Healthvana’s executives sits on a generative AI workgroup within the Coalition for Health AI — the industry body working with federal regulators to set evaluation and safety standards — to begin tackling these questions.

While deploying the technology too early could certainly harm patients, “if there’s no access for communities of color…then we’re going to be left behind,” said Harold Phillips, formerly director for the White House Office of National AIDS Policy, who co-authored the unpublished paper on the pilot.

Seventy-percent of messages sent to the chatbot during the pilot were from people of color. If tested carefully, chatbots won’t necessarily propagate medical discrimination, stigma and bias, Phillips said, adding, “many health care providers today are still really uncomfortable talking about sexual health or answering questions, and some patients are uncomfortable asking questions.”

It’s too early to tell whether the bot has actually made people measurably healthier. But Engeran-Cordova said he plans to work with an epidemiologist and research staff to monitor how interacting with the bot impacts patients’ STI testing patterns and their adherence to medication, for instance.

While the tool is meant to be lighthearted, it has the potential to draw the ire of conservative politicians at a time when sexual and reproductive rights have been increasingly restricted.

But it’s designed to foster especially difficult conversations — about, say, a positive STI result — with sensitivity and empathy, Engeran-Cordova said. And if a patient feels playful, like the millennial male who asked if he “should be worried about it raining men,” it can match their tone. “Honey, if it’s raining men, grab your most fabulous umbrella and let the blessings shower over you!” it said, before reminding him, “in the world of health and wellness, always make informed choices that keep you sparkling like the star you are!”

And what’s the bot called? During an evaluation session, Engeran-Cordova said, it named itself. “I asked her what her drag name would be, and she said ‘Glitter Byte.’”

Complete Article ↪HERE↩!

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‘A Dick’s Day Off’

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A little after 8 p.m. on a Monday night in June, I find myself running down a quiet street in Prospect–Lefferts Gardens looking for the dungeon where Mistress Red says men turn into sluts. The heat dome has briefly let up, and outside a neighboring townhouse, three men in cotton shirts drink flat beers and watch me fuss with Google Maps. “Down there,” one says, pointing to a set of ivy-lined concrete steps. I follow an alien-shaped fuschia sign downstairs and wait on a wooden bench alongside two eager subs and somebody’s pet’s Chewy box. Pegfest is about to begin.

Founded in 2016 by sex-workers’ rights activist and dominatrix Charlotte Taillor, the Taillor Group is a Brooklyn-based kink collective that teaches BDSM practices to the kink curious. After short-lived stints in a number of other neighborhoods, the collective moved to a basement apartment last September and offers workshops exploring every niche fetish, from good-old foot worship to bondage and roleplay.

But one of the collective’s most popular offerings is the pegging workshops, one-hour sessions in which experienced dommes teach and facilitate the penetration of newbie submissives. The workshop is so in demand that it runs three times a month, and couples and single men frequently request private classes. Pegfest is usually attended by women looking to hone their skills with a strap-on, straight men looking to dip their toes in, and repeat customers with fully realized kinks. Some subs enjoy the exhibitionism of group classes; others wear masks to obscure their identity. For many attendees, pegging is a novel way to subvert gendered dynamics in the bedroom. Whether you’re into BDSM or just want to explore dildos, pegfest is a safe space to learn how to do it comfortably.

“Pegging is a dick’s day off,” says Taillor, dressed in a “Ceasefire” T-shirt and denim shorts, to a few subs as they take their seats on the dungeon’s black velvet couch. The dimly lit living room spills over into a kitchen where a few other subs stand or sit on stools around an island. Four subs would like to be used as bottoms, the other two are here to watch and learn. I eye the cart of colorful curved dildos next to Taillor. “You can relax and be a hole,” she tells us.

This time, no other dommes have signed up to learn, and Taillor and two other collective-affiliated dommes are here to help Mistress Red, a leather-clad dominatrix with waist-length red hair who’s heading up the workshop. Mistress Red has taught here for the past two years, and while pegging isn’t her favorite workshop to lead — it’s not as kinky or creative as the straight men doing it may like to think, she tells me — she enjoys helping them dispel their shame about enjoying penetration. She’s tired of taboos suggesting “that you’re gay or weak or not a man if you want to get fucked in your ass. It’s like, no, it’s just a normal thing to want to feel,” she says. “There’s this sort of very fun gender switch that happens. It’s crazy, the physical and mental transformation putting in a dildo will do. You have totally changed as a person.”

Mistress Red sits opposite the sofa on an ornate wooden throne backed by a red curtain, a few paces away from a fridge covered in tiny yellow magnets, each plastered with the words “hot girl shit.” Taillor grabs a grape Poppi from the fridge while the crowd of mostly cis-het male newbies go around the room to share what brought them here. Agewise, the subs range from their 20s to their 60s. There’s a college student who “loves to be filled up”; a regular submissive who loves the collective so much he cleans the dungeon and has a fresh tattoo of a dominatrix on his back; two divorced men who arrive wearing butt plugs and say they discovered pegging after leaving their vanilla relationships behind; a 29-year-old finance guy curious to see traditional male-female roles reversed; and a married-with-adult-kids 60-something kinkster from the Midwest who had a painful experience with pegging and wants to correct that. “A man is never more submissive than when getting pegged,” he tells me. “It’s pure giving up of control and power. Plus it just looks so sexy, a cock on a woman,” he says, adding that he would kneel for me anytime.

After a brief on anal hygiene and how to locate your prostate, Mistress Red starts looking for a wicker basket. “Where’s the picnic basket of dildos?” she asks Taillor, but it’s missing today so she straps on a modest member, sliding a condom over it and slipping her fingers into a pair of black gloves. She’ll peg the regular first. Is he fine with slap marks on his ass? Yes, Mistress. Any injuries or conditions to take note of? Any anal fissures? IBS? No, Mistress. Triggers or traumas? No slurs, Mistress, though bitch, slut, and dumb anal slut are all fine. He strips down under faint green neon lights and apologizes as he tosses his underwear on my sandal; it’s a tight space. Then he’s down on all fours, the dominatrix tattoo raw and pink around the edges. “I won’t spank or scratch that,” Mistress Red assures him. She inserts one gloved finger inside his anus, then another. It’s awkward to penetrate in silence, so a domme turns on instrumental dance music. “See, he’s loose,” Mistress Red tells the room, and switches to using the strap-on. “Now I have my hand on his hip.”

We need different music. “Let’s play Britney Spears. I’m old,” Taillor says. Another domme puts on “Soda Pop,” which I haven’t heard since 1999. Mistress Red pegs the regular to the bubblegum beat. To my left, the finance spectator asks me how my article is coming and invites me to cover an art show.

When Mistress Red decides she’s finished with the regular, he’s on cleanup duty, wiping the mat for the next participant. After cleaning himself up, he sits back down on his stool as the two divorcés head to the bathroom and remove their plugs. We’re strapped for time so they take to the mat together, facing in different directions, and Taillor and Mistress Red repeat the process with both of them, chatting with each other as their fingers assess the laxity of the opposing anuses. The men are disappointed — they’re not ready for dildos — but having an expert assess the muscle is part of the experience. “This is literally why people do anal training,” Mistress Red explains. “It’s a muscle you have to work at. You can’t just be sticking big things in your ass.”

Last up is the college student, who appears to have been scrolling on his cell phone for the majority of the pegging demonstrations. He too isn’t ready for a dildo, but the dommes think up an alternative proposition.

“Want to Eiffel Tower?” Taillor asks him, strapping on an extremely girthy cherry-red member covered in a banana-split-scented condom. Mistress Red’s finger is one side of the tower equation; Taillor’s strap-on is the other. “Have you ever sucked a dildo?” Taillor asks the student. He hasn’t, but this space is so nonjudgmental he’ll try it. The dommes praise his finesse and enthusiasm. “A prodigy,” one says.

After class, we go around the room with our reflections and revelations. Many of the men thank the dommes. The college student says he never realized how much he likes sucking dick. When we catch up over email later, he’s more expansive: Choking on the dildo reminded him of a girlfriend he used to deep-throat with. “I never knew it was choking her like that,” he says. “I’m feeling more vague about the barrier between males and females.” The blurring, he says, helps him allow himself to be more open to love and vulnerability. He’ll definitely be back.

The regular, meanwhile, never left. “He stayed afterwards for hours and cleaned the whole dungeon,” says Mistress Red.

Pegging Class Is in Session

Complete Article ↪HERE↩!

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How food (almost) replaced sex in my life

— When the kitchen threatens to become more alluring than the bedroom, beware…

Food became my link to the sensual world, writes Chesterton

BY George Chesterton

Admitting you’ve got a problem is the first step. About the time I became regrettably middle-aged, some vague moment a few years ago, I also became obsessed with food. Preparing it, cooking it and eating it. The troublesome thing about this obsession was not so much that, if left unattended, it would make me unhealthy (though it surely did that too) but that food became my link to the sensual world. It was so easy. And so much fun. It being essential to life was just a bonus. As food took over, the rest of life’s experiences began to shrink back. For a while, it even replaced the thing that is supposed to bind a relationship together (and I’m not talking about Netflix). My wife is an alluring, beautiful woman, just not – at my weakest moments – as alluring as paella.

There is a need for delicacy when discussing marital relations, so it must be said that the weakness lay not in the bedroom but in my expanding stomach. If I’m going to compare eating to sex I will need, as Laurence Olivier says in Spartacus, to “tread the ridge between truth and insult with the skill of a mountain goat.” It’s not that eating literally replaced sex, but that taste became – by some distance – the dominant sense, the way through which I experienced pleasure most keenly.

I lost my sense of smell and taste in the first wave of Covid and it took ages to get it back. I’m not certain I ever got it back the way it used to be. Rather than put me off food, the desperation to taste again, to know the craven thrill of a bouillabaisse and a Basque cheesecake – or even just a cottage pie – became overwhelming. And as my wife’s business became busier and more demanding, I became the unchallenged official family cook.

Gradually, my love of food and cooking crept closer to infatuation than was good for me. I thought about food all the time: in the morning I thought about lunch, in the afternoon I wondered what I would cook for dinner. By Thursday I was planning the entire weekend’s menu. When anyone asked me what I wanted for Christmas or a birthday, my requests for Pyrex jugs, a conical sieve or a potato ricer were met with puzzlement and suspicion.

Instagram is a terrible influence – chefs from around the world demonstrating this or that genius shortcut recipe for ravioli or curries and the endless drool-scrolling of cheeseburgers and ribs. I tap through videos of giant sandwiches the way other men do PornHub. I don’t think the sight of oozing steak and stringy cheese is literally sexual – a vibe especially easy to associate with American-style food – but it does stand in for sex in that it is an immediate physical experience. Sting once boasted that his tantric sex lasted for days. Instagram food is more akin to a quickie behind the pub bins.

I even planned a podcast about crisps called “Crunch Time with George Chesterton” – with taste tests and reviews of new brands and flavours, debates over classic crisps of the past, and in-depth analysis of the role of crisps in culture and the arts.

If you catch me in repose, I won’t be daydreaming about swinging parties (or the Roman Empire, for that matter). I’ll be thinking about that Le Creuset skillet I want and whether I should buy a really good mixing bowl. Food provides a reliable and daily gratification in a way nothing else does. Whereas when married relations – how can I put it – level out a little, sex tends to be less reliable and rarely daily.

I’ve always been a bit greedy. But cooking and eating became all-encompassing. It was like I was having an affair with food. My wife began to tut and raise her eyebrows, though where derision met sheer disappointment is hard to say. Finding time for intimacy with a partner – especially with pesky children around all the time – is a challenge, but stuffing your face is as easy as, well, stuffing your face. Food was my catnip, with much the same effect on me as hearing Chaka Khan’s Ain’t Nobody has on a 50-year-old woman in an Essex nightclub.

The importance of food to family life is often considered its greatest quality, (though probably less so in Britain than anywhere else in the world). Some treasure it most as the fuel of their social scene; for others food is the raw material of pure gluttony. To me it was simply life-affirming. When I fasted, the day lay before me like a featureless desert.

Most of my time is spent reading and writing. I don’t make anything practical with my hands. I don’t ski. I don’t like gardening and, since my knee went south I can’t jog. My relationship with music has been deteriorating for the past 20 years from the be-all and end-all to background noise to now just music to cook to. But at least I “make” food and then I taste it. Food is the main empirical counterweight to the work of the mind and spirit. I’m never too tired to cook, whereas I’m sometimes too tired to do “other things”.

The sensory overload of youth can become sensory deprivation as you get older. Food – preparing, cooking and eating it – picked up the slack. To the surprise of no one, all those carefully curated, extravagantly flavoured paninis and bowls of Malaysian noodles left me out of shape and listless. The terrible truth is food hadn’t replaced sex, it had replaced everything. With that came the necessity of admitting I was in danger of no longer being attractive to my wife. She was fit and youthful; I was tubby and prone to food comas. That was an unpleasant but necessary admission.

There are probably worse things to become obsessed with than food: heroin, breeding dangerous dogs, local politics – but I was not operating at optimum level. I was not the “best George I could be”. Though I was the fullest George I could be. It’s easy to joke about drugs, but that’s exactly what food had become. Like all addictions, this was essentially selfish. But now it’s time to refocus, before it’s too late. I want my wife to think of me as a fit, attractive man who looks after himself. I want her to think “Darling, I’m home” means “get upstairs and get your kit off” not “dinner will be ready in half an hour”. Having said that, she’d probably just settle for the dinner, to be honest. I am quite good at it.

Complete Article ↪HERE↩!