Seeking trust and transcendence: sexual risk-taking among Vietnamese youth

This paper contends that sexuality research has paid far too limited attention to the phenomenology of sexual experience, thus failing to recognize the importance of embodied sensory experience for sexual perceptions and practices in general and for sexual risk-taking in particular. In order to comprehend the cultural rationales of sexual risk-taking among urban Vietnamese youth, the author presents an analysis which combines a detailed attention to the phenomenology of sexual experience with a social analysis of the wider socio-economic contexts within which sexual practices are embedded. It is demonstrated that the sexual encounters of Vietnamese youth involve much more than strivings for intimacy and pleasure: at stake are also fundamental questions of the moral integrity of the self and the socio-political shaping of intimate relations. Moreover, obstacles to safer sex stem not only from individual choices or intimate interpersonal interactions, but also from larger systems of moral meaning and social constraint. While the acknowledgement of individual capacities for action in the sexual sphere is important, it is equally important to recognize the responsibility of communities and political systems for the shaping of sexual interactions. Current limitations in the understanding of sexual experience and practice have consequences which seriously affect health interventions and education programmes targeting high-risk sexual behaviour. In order to develop more appropriate sexual health interventions, cultural transformations at the levels of both individual practice and societal organization are needed.     

‘I am a mother’: young women’s negotiation of femininity and risk in the transition to adulthood

In studies of sexual risk behaviour among youth, the role of dominant conceptions of masculinity and femininity has received increasing attention. However, where research has sought to explore femininity, it has predominantly focused on adolescent girls. This paper departs from previous research by offering insights into how young women negotiate their femininity as they transition from adolescence to adulthood and encounter changing social contexts. Drawing on data from ethnographic enquiry, it argues that as young women transition out of school and into emerging adulthood, their options for negotiating different types of femininity become constrained, with consequences for engagement in sexual risk behaviours. This may to some extent explain why in some South African contexts older young women are more vulnerable to HIV infection than adolescent girls. The paper offer insights into future prospects for youth development programming seeking to reduce young women’s vulnerability to risk.     

A conceptual framework for the social analysis of reproductive health

The dominant conceptual framework for understanding reproductive behaviour is highly individualistic. In this article, it is demonstrated that such a conceptualization is flawed, as behaviour is shaped by social relations and institutions. Using ethnographic evidence, the value of a social analysis of the local contexts of reproductive health is highlighted. A framework is set out for conducting such a social analysis, which is capable of generating data necessary to allow health programmes to assess the appropriate means of improving the responsiveness of service-delivery structures to the needs of the most vulnerable. Six key issues are identified in the framework for the analysis of social vulnerability to poor reproductive health outcomes. The key issues are: poverty and livelihood strategies, gender, health-seeking behaviour, reproductive behaviour, and access to services. The article concludes by briefly identifying the key interventions and strategies indicated by such an analysis.     

Peer education by medical students in a public health course

Sex education by peers is becoming popular in Japan. To improve youth's reproductive health by continuous peer education and to encourage medical students to obtain the methodology necessary for health promotion, we started peer sex education by medical students in the annual public health course. One junior high school and one senior high school in Kitakyushu City in Japan asked medical students to conduct peer sex education classes at their schools. Medical students planned and carried out these classes based on the results of a questionnaire that they gave to the junior high school and senior high school students before the peer education. After the class, the students' responses to the class were investigated by another questionnaire. In this questionnaire, over 90% of the students answered that they were interested in talking about sexual issues with medical students. As for the medical students, they said that they could understand better the methodology of health promotion and also gained confidence by this experience. We will continue to carry out peer education in the medical school's public health course, and we intend to research further how junior high school and senior high school students' sexual behavior may change in the future.     

The experience in Uruguay: the Bill for the Defense of Reproductive Health

This article reports on the recent Uruguayan experience with the debate on sexual and reproductive rights. While the Bill for the Defense of Reproductive Health did not pass in the Senate, both the prior process and the subsequent impacts have been relevant, generating a social debate that is still incipient but has involved the mass media, academia, and the political parties and spawning a discussion that has involved both houses of Congress for the first time. Within this context, an outstanding role has been played by NGOs devoted to the defense of women's rights (especially sexual and reproductive), who established a coordinating body that included the trade union movement, which supported the bill. The debate also led to international ties that projected it beyond the country's borders. The article briefly reviews the background and basis for the bill, the research it entailed, and the international commitments assumed by Uruguay, before concluding with a summary of the bill itself and the challenges it poses in terms of sexual and reproductive rights, specifically with regard to voluntary interruption of pregnancy.     

Sexuality, culture and society: shifting paradigms in sexuality research

Over the course of the past three decades, there has been a significant increase of research on the social and cultural dimensions of sexuality. This paper reviews three major phases in the development of this work. In the first phase, work focusing on the social construction of sexual experience developed an important critique of the biomedical and sexological approaches that had dominated the field over much of the twentieth century. In the second phase, increasingly detailed studies of sexual life were developed which highlighted the cross-cultural diversity of sexual cultures, sexual identities and sexual communities. In the most recent phase, there has been a growing recognition of the complex relationship between culture and power, and increasing attention to the political and economic dimensions of sexuality. In spite of the significant conceptual and methodological advances that have taken place over time, however, it is also possible to identify a number of important questions that have not yet been adequately addressed and that may have been precluded by some of the perspectives that have come to dominate the field. The paper ends by focusing on the silences and invisibilities that continue to characterize this field of research and the challenges that must still be confronted in seeking to expand our understanding of these issues.     

The limits of behaviour change theory: condom use and contexts of HIV risk in the Kolkata sex industry

This paper uses ethnographic data from a sex workers' HIV project in India to consider the appropriateness of individual, social/group and structural theories of health behaviour when applied to HIV-prevention initiatives. Existing theories are critiqued for their modernist representation of behaviour as determined by individual rational decision-making processes or by external structural forces, with inadequate recognition being given to the roles that human agency, subjective meaning and local context play in everyday actions. Analysis of sex workers' accounts of their sexual practices suggests that existing theories of health behaviour can only partially account for sexual behaviour change retrospectively and that they have limited predictive value with respect to the outcomes of individual sexual encounters. Our data show that these outcomes were, in fact, highly context dependent, while possibilities for action were ultimately strongly constrained by structural forces. Findings suggest that interventions need to adopt an integrated, structurally-oriented approach for promoting safer sexual practices in sex work settings. Recognising that no one model of health behaviour is likely to be adequate in explaining or predicting behaviour change encourages responsiveness to local people's agency, recognises the different (health- and non-health-related) registers of risk with which people operate and encourages flexibility according to local contingencies and contexts.     

Men who have sex with men in Southeastern Europe: Underground and at increased risk for HIV/STIs

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activity takes place both in public spaces and private homes. Many men believe that careful partner selection and closing sexual networks to outsiders mitigate risk. Risk behaviours include unprotected sex within multiple partnerships, inconsistent condom use and the use of oil-based lubricants that compromise the integrity of condoms. Perceived susceptibility for infection is low and misconceptions exist about modes of transmission. Stigma and discrimination force men into clandestine settings and relationships where safer sexual behaviour is difficult. HIV prevention programmes should convey messages through the internet and peer networks, improve access to condoms and water-based lubricant, raise awareness about STIs, link men who have sex with men to appropriate services and reduce stigma to enable safer behaviour.     

Men who have sex with men in Southeastern Europe: Underground and at increased risk for HIV/STIs

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activity takes place both in public spaces and private homes. Many men believe that careful partner selection and closing sexual networks to outsiders mitigate risk. Risk behaviours include unprotected sex within multiple partnerships, inconsistent condom use and the use of oil‐based lubricants that compromise the integrity of condoms. Perceived susceptibility for infection is low and misconceptions exist about modes of transmission. Stigma and discrimination force men into clandestine settings and relationships where safer sexual behaviour is difficult. HIV prevention programmes should convey messages through the internet and peer networks, improve access to condoms and water‐based lubricant, raise awareness about STIs, link men who have sex with men to appropriate services and reduce stigma to enable safer behaviour.     

在初中生中开展性与生殖健康同伴教育初探

目的　了解以小组活动方式在初中生中开展性与生殖健康同伴教育的效果 ,为进一步研究提供资料。方法　同伴教育采取同伴教育者与学生小组活动的形式 ,每次活动分 3或 4种模式 ,采用不记名问卷调查方式测量学生知识和正向态度得分情况 ,比较教育前后的变化并了解学生对同伴教育的评价。结果　女生本班组知识和正向态度得分教育前后的平均增长高于外班组 (P <0 .0 5) ,男生本班组远高于对照组 (P <0 .0 5) ;学生对同伴教育以积极的评价为主。结论　同伴教育是青少年乐于接受的性与生殖健康教育的有效方法 ,在学校内建立性与生殖健康同伴教育社团值得探索     

The social construction of male 'homosexuality' in India: implications for HIV transmission and prevention

Over the past 20 years, there has been a growing recognition of the relativity of sexual norms and of the difficulties of exporting Western conceptions of sexuality to different socio-cultural settings. This view has been most clearly articulated in studies of men who have sex with men (MSM) which suggest that the ways in which male-male sexual activity is shaped and constituted vary significantly from place to place. Despite this, 'homosexuality' continues to be treated as an unproblematic category in HIV/AIDS discourse, epidemiological studies of and HIV prevention strategies for MSM in widely different contexts being based on the North American/West European example of gay men. This paper, which draws upon ethnographic research in Madras, highlights important differences between India and the West, not only in the sexual identities and circuits of MSM, but in their sexual partnerships and practices. These differences, it is argued, are not only significant to the epidemiology of HIV transmission, but have important implications for the development and implementation of HIV prevention strategies.     

Unsafe sexual behaviour in South African youth

A growing body of evidence points to the complexity of sexual behaviour. HIV risk behaviour is influenced by factors at three levels: within the person, within the proximal context (interpersonal relationships and physical and organisational environment) and within the distal context (culture and structural factors). This paper presents the findings of a review of research on the factors promoting and perpetuating unsafe sexual behaviour in South African youth. Papers included in the review were dated between 1990 and 2000 and addressed sexual behaviour of youth between the ages of 14 and 35 years. Both published works and unpublished reports and dissertations/theses were included. The review concluded that at least 50% of young people are sexually active by the age of 16 years; the majority of school students who had ever experienced sexual intercourse reported at the most one partner in the previous year, with a persistent minority of between 1% and 5% of females and 10-25% of males having more than four partners per year; and between 50% and 60% of sexually active youth report never using condoms. In terms of explanations for unsafe sexual behaviour among South African youth, the findings illustrate the powerful impact of the proximal and distal contexts, and in particular, the pervasive effect of poverty and social norms that perpetuate women's subordination within sexual relationships. Personal factors and the proximal and distal contexts interact to encourage HIV risk behaviour in ways that are not fully captured by social-cognitive models. The findings will be of interest to researchers and practitioners in the fields of adolescent sexual behaviour and HIV prevention in developing countries.     

Challenging Pentecostal moralism: erotic geographies, religion and sexual practices among township youth in Cape Town

Research on constructions of sexuality in Pentecostalism often struggles with the fact that the research setting is defined ex ante in terms of church communities, which imposes upon ethnographic accounts the same limitations Pentecostal morality imposes upon church members' discourse. Taking young Pentecostals operating in a space that is not explicitly religious as the methodological entrance to the field, this paper explores negotiations over sexuality, intimate relationships and love among Xhosa-speaking township youth. It introduces the notion of erotic geographies to consider how possible influences of religious discourses on sexuality are refracted by alternative cultural orientations and material contexts. Findings suggest that premarital abstinence appears as a highly exceptional ideal for youth. Even among Pentecostal youth, notions of sexuality are largely severed from religiosity and faithfulness and romanticism are dominant ideals. Future research on Pentecostalism and sexuality should be less religious-centric and rooted more firmly in ethnographies of youth sexual cultures.     

Digital storytelling as critical narrative intervention with adolescent women of Puerto Rican descent

This article focuses on findings of a two-year pilot research study focused on addressing sexual and reproductive health inequities faced by adolescent women of Puerto Rican descent living on the mainland United States. Working with three groups of young women, in the pilot study we gathered ethnographic data in and around a group-based digital storytelling process to inform the development of a larger intervention. Digital stories are short (1–3 minute), participant produced videos that synthesize still and moving image, a voiceover recording of the participant telling her story, and background music and text to document personal experiences. Based on narrative analysis of digital stories and field notes written in and around the digital storytelling workshop process, as well as follow-up individual interviews with workshop participants, our findings center on the ways that trauma has specifically shaped participants’ sexual and reproductive health experiences. We argue that digital storytelling serves as a critical narrative intervention, whereby participants’ engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them. We introduce our project methodology, and then present key findings on trauma as it informs sexual and reproductive health practices, with digital storytelling showcased as a modality for critical narrative intervention. We conclude by discussing implications for critical public health research and practice.     

Sexual health among young adults in Finland: assessing risk and protective behaviour through a general health survey

OBJECTIVE: To describe the extent of sexual risk and protective behaviours and reproductive health outcomes comparing men and women of 18-29 and assess the demographic correlates of these indicators within genders. DESIGN: A module of questions on sexual behaviour and reproductive health outcomes was integrated into a population-based general health survey in Finland. METHODS: A representative sample of people over 17, including 1,894 individuals between 18 and 29 years, was drawn from the population registry in 2001. Individual interviews and self-administered questionnaires were used with a response rate of 79% for the interview and 68% for the questionnaire. RESULTS: It was more common for younger men to stay single and have multiple partners while women of the same age were cohabiting or married and chose a regular sex partner. The mean number of sexual partner for men was 5.0 (SD 5.1) and for women 3.4 (SD 2.1). Besides higher prevalence of multiple partners, men reported also casual sex contacts more often than women, 33% vs. 20%. Both genders reported relatively high and concordant rates of contraception use. However, in casual sex contacts a condom was used consistently only by less than half of both sexes. Marital status was the strongest predictor for behaviour and health outcomes. CONCLUSIONS: Casual sex is common among young adults in Finland and often occurs without a condom. This study shows that it is feasible to incorporate sexual behaviour questions as part of a larger health survey offering an option for monitoring sexual behaviour when funding for large-scale HIV surveys is decreasing.     

Towards a psycho-social theoretical framework for sexual health promotion

Numerous interventions have been designed to promote safer sexual behaviour amongst young people. However, relatively few have proved effective, which is, at least partially, due to the lack of development of theoretically based programmes. An understanding of the origins and control of sexual behaviour can be derived from basic social science research. Unless this is applied to the design of behaviour-change programmes they are unlikely to target the most important determinants of young people's sexual behaviour and are, therefore, unlikely to be effective. This paper outlines some of the key theoretical insights which have been drawn upon in the development of a new sex education programme currently being tested in Scottish schools. The theoretical basis is intentionally eclectic, combining social psychological cognitive models with sociological interpretations, since we are not concerned to advance any particular theory but to find which are most useful in promoting sexual health. First, the social influences on sexual behaviour are considered, and then the way in which these translate into individual perceptions and beliefs. Finally, the paper attempts to develop a theoretical understanding of sexual interaction and the social contexts of sexual behaviour.     

Evaluating a peer intervention strategy for the promotion of sexual health-related knowledge and skills in 10- to 14-year-old girls. Findings from the "Entre amigas" project in Nicaragua

PurposE: Report effects on knowledge of sexual health and gender from an intervention using peer methodology in Nicaragua. DESIGN: A prepost nonequivalent control group design. SETTING: Ciudad Sandino, Managua, Nicaragua. SUBJECTS: A total of 599 girls were surveyed, 60% nonintervened and 40% intervened. INTERVENTION: Peer methodology consisted of (1) meetings in which girls talked and worked with other girls, (2) mothers taking an active role in the peer groups, and/or (3) girls watching the soap opera "Sexto Sentido." MEASURES: Indices measuring changes in sexual knowledge and gender vision. RESULTS: Girls participating in the peer groups were twice as likely to have satisfactory sexual health-related self-esteem as those who did not participate. Eleven percent of the girls achieved satisfactory self-esteem as a result of the (peer groups x mothers) interaction and 15% due to the (peer groups x mothers x "Sexto Sentido") interaction. Girls participating in the peer groups were three times as likely to have satisfactory gender visions; if exposed to all three components, they were almost four times as likely to develop satisfactory gender visions. CONCLUSIONS: Peer methodology, participation of a female family member, and an educational soap opera seem beneficial in promoting sexual health-related knowledge and gender vision in young girls.     

Milking the cow: Young women's construction of identity and risk in age-disparate transactional sexual relationships in Maputo,Mozambique

Abstract

Sexual relationships between young women and older men involving economic transactions have been offered as a likely explanation for gender differences in HIV prevalence in many parts of sub-Saharan Africa. This study employed peer ethnography to explore young women's construction of social identity and risk within age-disparate transactional sexual relationships in Maputo, Mozambique. Peer ethnography, a rapid approach derived from the anthropological method and based upon training members of the target group to carry out in-depth qualitative interviews with their peers, was adopted in order to gather ethnographic data within a short timeframe to produce actionable results for the design of a communications intervention. The study highlights young women's perception of agency and power in these relationships. Through a strategy of extracting financial and material resources from men based on the power of their sexuality, young women construct a positive identity and esteem linked to perceptions of modernity and consumption and their ability to access consumer goods. Current behaviour change HIV prevention messages have little meaning in relation to young women's perceived goals, in a context in which structural conditions offer few opportunities and limited hope for a secure economic future.