Intimate partner violence and increased lifetime risk of sexually transmitted infection among women in Ukraine

Population-based, cross-sectional data from 3587 ever-married Ukrainian women aged 17-44 are used to examine the association between physical violence perpetrated by a sexual partner (defined as kicking, hitting, slapping, pushing, or attacking with a weapon) and sexual health knowledge, sexual behavior, and the likelihood of reporting a sexually transmitted infection (STI). Such violence, both past and recent, is found to be associated with increased lifetime risk of acquiring an STI. Women who have been abused by a sexual partner, whether in the past 12 months or less recently, are significantly less likely to use condoms currently, and are significantly more likely to report having had multiple sexual partners in the past year. Findings from the study indicate that physical violence perpetrated by a sexual partner is associated with risky sexual behaviors and increased risk of sexually transmitted infection in Ukraine, and may constitute a barrier to prevention of HIV/STI transmission.     

"Opening a can of worms": GP and practice nurse barriers to talking about sexual health in primary care

BACKGROUND: There is evidence that health professionals do not discuss sexually related issues in consultations as often as patients would like. Although primary care has been identified as the preferred place to seek treatment for sexual health concerns, little is known either of the factors that prevent GPs and practice nurses initiating such discussions or of how they feel communication in this area could be improved. OBJECTIVE: The purpose of the present study was to identify barriers perceived by GPs and practice nurses to inhibit discussion of sexual health issues in primary care and explore strategies to improve communication in this area. METHODS: Semi-structured interviews were conducted with 22 GPs and 35 practice nurses recruited from diverse practices throughout Sheffield. RESULTS: The term 'can of worms' summarized participants' beliefs that sexually related issues are highly problematic within primary care because of their sensitivity, complexity and constraints of time and expertise. Particular barriers were identified to discussing sexual health with patients of the opposite gender, patients from Black and ethnic minority groups, middle-aged and older patients, and non-heterosexual patients. Potential strategies to improve communication about sexual health within primary care included training, providing patient information and expanding the role of the practice nurse; however, several limitations to these approaches were identified. CONCLUSION: GPs and practice nurses do not address sexual health issues proactively with patients, and this area warrants further attention if policy recommendations to expand the role of primary care within sexual health management are to be met.     

Are post-menopausal women "half-a-man"?: sexual beliefs, attitudes and concerns among midlife Chinese women

The objective of this study was to explore the concerns and issues specific to sexual behaviors and interests among postmenopausal women in a metropolitan urban city in Southern China. This was a qualitative study using semi-structured focus group discussions (FGDs). Twenty-two informants aged 50 and above recruited through an ongoing research project on early post-menopausal women under the purview of the School of Public Health at the Chinese University of Hong Kong. The main outcome measures were themes identified as health concerns towards sex among postmenopausal women. Contrary to prior expectations and stereotypes, we found that the respondents were very open in discussing their sexual concerns and shared extensively from their personal experiences. Our respondents perceived significant differences in sexual needs between older men and women. Many respondents identified the effects of menopause and general health problems, as well as environmental limitations and communication problems between spouses as barrier to healthy sexual relationships within their marriages. Conversely, sexual disharmony was seen as an important cause of marital strife among older couples. There is a growing need in studying health concerns among the fast-growing, Chinese middle-aged and older population. Our qualitative study revealed a wide gap in the knowledge regarding general and sexual health issues among post-menopausal Chinese women. Raising awareness among health professionals of these issues is essential in addressing health concerns regarding this traditionally taboo subject within the Chinese context.     

Sexually transmissible infections in aging HIV populations

There is limited published research on sexually transmissible infections (STI) among aging HIV populations. The available literature on sexual behaviour and STI among older people with HIV is reviewed here and contrasted with data from older individuals in the general population and from older populations at high risk of HIV. A sizeable minority of older people with HIV continue to engage in higher risk sexual behaviour and thus remain at high risk of STI. There is no clear evidence of a consistent effect of older age on STI rates, clinical presentation or clinical course among HIV-infected populations, although gay men with HIV aged in their 40s or older seem to be at higher risk than younger men of acquiring several STI, including syphilis and lymphogranuloma venereum. STI risks in older people living with HIV need to be regularly assessed. Higher risk sexual behaviour and disproportionately higher rates of STI indicate that regardless of age, a thorough STI assessment should be regularly undertaken for all HIV-positive gay men as part of their routine HIV care.     

Patient–Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals

BackgroundHealth care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient–provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.MethodsWe conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18–36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient–provider STI prevention communication.ResultsHeteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers’ heteronormative assumptions.ConclusionsOur study describes several barriers that AFAB sexual minorities felt inhibited their patient–provider sexual health communication. Interventions are needed to improve patient–provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.     

Sexual desire among Mexican-American older women: a qualitative study

Although researchers have related sexual desire in older women to quality-of-life variables such as overall physical health, well-being, and life satisfaction, little is known about the socio-cultural mechanisms that shape sexual desire in minority ethnic older women. We investigated this sexual variable among Mexican-American older women in a qualitative fashion. Data were collected from 25 community-dwelling women of Mexican descent (aged 59–89 years) using a semi-structured interview protocol and a grounded theory approach. We inquired about dimensions of sexual desire including sexual fantasies and the desire to engage in sexual activity within the context of several socio-cultural and health-related factors. Using content analysis, we were able to identify key themes differentiating among respondents’ levels of sexual desire and fantasies. These included the availability of a suitable partner, cultural and religious norms pertinent to women's sexuality, stigma related to sexuality in older age, and health status. Traditional socio-cultural restrictions coupled with unmarried status and physical health problems emerged as critical issues associated with limited or no sexual fantasies and desire in our sample. Many respondents indicated that their sexual needs were unmet.     

Working Sensitively with Child Sexual Abuse Survivors: What Female Child Sexual Abuse Survivors Want from Health Professionals

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22–65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.     

Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing

We describe levels of sexual activity, problems with sexual functioning, and concerns about sexual health among older adults in the English Longitudinal Study of Ageing (ELSA), and associations with age, health, and partnership factors. Specifically, a total of 6,201 core ELSA participants (56 % women) aged 50 to >90 completed a comprehensive Sexual Relationships and Activities questionnaire (SRA-Q) included in ELSA Wave 6 (2012/13). The prevalence of reporting any sexual activity in the last year declined with age, with women less likely than men at all ages to report being sexually active. Poorer health was associated with lower levels of sexual activity and a higher prevalence of problems with sexual functioning, particularly among men. Difficulties most frequently reported by sexually active women related to becoming sexually aroused (32 %) and achieving orgasm (27 %), while for men it was erectile function (39 %). Sexual health concerns most commonly reported by women related to their level of sexual desire (11 %) and frequency of sexual activities (8 %). Among men it was level of sexual desire (15 %) and erectile difficulties (14 %). While the likelihood of reporting sexual health concerns tended to decrease with age in women, the opposite was seen in men. Poor sexual functioning and disagreements with a partner about initiating and/or feeling obligated to have sex were associated with greater concerns about and dissatisfaction with overall sex life. Levels of sexual activity decline with increasing age, although a sizable minority of men and women remain sexually active until the eighth and ninth decades of life. Problems with sexual functioning were relatively common, but overall levels of sexual health concerns were much lower. Sexually active men reported higher levels of concern with their sexual health and sexual dissatisfaction than women at all ages. Older peoples’ sexual health should be managed, not just in the context of their age, gender, and general health, but also within their existing sexual relationship.     

Sexually active older Australian's knowledge of sexually transmitted infections and safer sexual practices

Objective: Rates of sexually transmitted infections (STIs) are rising among older Australians. We conducted a large survey of older people's knowledge of STIs and safer sexual practices. Methods: A total of 2,137 Australians aged 60 years and older completed the survey, which included 15 questions assessing knowledge of STIs and safer sexual practices. We examined both levels of knowledge and factors associated with an overall knowledge score. Results: In total, 1,652 respondents reported having sex in the past five years and answered all knowledge questions. This group had good general knowledge but poorer knowledge in areas such as the protection offered by condoms and potential transmission modes for specific STIs. Women had better knowledge than men. Men in their 60s, men with higher education levels, and men who thought they were at risk of STIs reported better knowledge than other men. Knowledge was also better among men and women who had been tested for STIs or reported ‘other’ sources of knowledge on STIs. Conclusions: Many older Australians lack knowledge of STIs and safer sexual practices. Implications for public health: To reverse current trends toward increasing STI diagnoses in this population, policies and education campaigns aimed at improving knowledge levels may need to be considered.     

Discussing STIs: doctors are from Mars,patients from Venus

BACKGROUND: Primary care plays an important role in promoting sexual health, but in this setting counselling regarding sexually transmitted infections (STIs) is rarely performed and often inadequate. OBJECTIVE: Our aim was to identify and quantify the barriers physicians encounter in discussing STIs with their patients. METHODS: A postal questionnaire-based survey was carried out in a random sample of 200 primary care physicians in Antwerp, Belgium. RESULTS: The response rate was 68%. Among the 122 respondents, only 44.3% provide some form of counselling (asking about sexual history, informing about safe sex or informing about STIs) regularly, at least once a week. Major barriers are language and comprehension problems (for 74.2% of respondents), ethnic differences (68.4%), insufficient training (69.4%), lack of time (60.8%), presence of the patient's partner (89.2%) or mother (94.2%), first contact with a patient (60.8%), fear of embarrassing the patient (30.6%) and a patient without genital complaints (71.4%). About half of the GPs fail to counsel an asymptomatic patient with obvious STI risk, and as many give no safe sex advice in a first contraception consultation. CONCLUSIONS: Physicians have many and various barriers to discussing STIs with their patients. Features of contemporary STI counselling and solutions to its problems are discussed. Education of health care providers should be given priority.     

Sexual identities and sexual health within the Celtic nations: An exploratory study of men who have sex with men recruited through social media

ABSTRACT

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.     

Re-emerging syphilis: a detrended correspondence analysis of the behaviour of HIV positive and negative gay men

Background  

Recent syphilis outbreaks in the UK have raised serious concerns about the sexual health of the population. Moreover, syphilis appears more likely to facilitate HIV transmission than any other sexually transmitted infection (STI).     

Sexual health care training needs of general practitioner trainers: a regional survey

OBJECTIVES: The National Strategy for Sexual Health and HIV aims to facilitate improved patient access to sexual health care, primarily in general practice. This study aimed to identify sexual health care provision in general practitioner (GP) training practices and highlight training and resource implications of the strategy for GPs and prospective GPs. METHODS: Data were gathered from interviews with five key representatives (all of whom had a special interest in GP training and/or sexual health care) and a self-completed questionnaire survey of all 374 GP trainers in the West Midlands region. The questionnaire was developed from the interviews and comprised three sections: sample characteristics; current practice; and 30 statements to elicit attitudes, knowledge and training implications. The questionnaire was mailed out in March 2002 with two re-mailings at 2-week intervals. RESULTS: Most GP trainers (79%; n=295) returned completed questionnaires. Most respondents were already offering some 'Level 1 services' or were prepared to including cervical screening (100%; n=295), sexual history taking (95%; n=271), sexually transmitted infection (STI) testing (74%; n=217), HIV testing (68%; n=198) and contraceptive services (71%; n=208). However, most (86%; n=251) needed further information on the Strategy detail and its implications. Training needs in sexual history taking, STI testing and HIV testing were also highlighted. Most GP trainers (62%; n=181) believed GP registrars were relatively unprepared for sexual health care and proposed improved training and assessment. Appropriate nurse training should also be provided. CONCLUSION: Although 82% (n=242) of respondents would implement the Strategy if properly resourced, considerable training and support needs were identified.     

The development of an innovative,theory-driven,psychoeducational HIV/STI prevention intervention for heterosexually active black adolescents with mental illnesses

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to disproportionately affect Black adolescents. Those experiencing the psychological sequelae of mental illnesses are at increased risk. Here, we outline the development of an HIV/STI prevention intervention for heterosexually active Black adolescents with mental illnesses. This research was guided by a psychosocial expansion of the Theory of Planned Behavior, nested within a broader social determinants of health framework. A youth community advisory board provided study oversight. Heterosexually active Black adolescents aged 14–17 were recruited from community-based outpatient mental health providers for focus groups, surveys and two ‘dress rehearsals’ of the intervention protocol (N = 68). The qualitative and quantitative findings indicated that knowledge, attitudes and skills related to consistent condom use, reduced number of sexual partners, routine HIV/STI testing, abstinence and emotion regulation were important areas to target. These elicitation data provided insight into the context of HIV/STI risk for the study population, and were used to develop the intervention content. ‘Project GOLD: We are Kings and Queens’ was designed to be delivered over two days (3 hours per day), with eight, 45-min modules. The activities address behaviors, as well as cognitive, emotional, psychological and social processes associated with HIV/STI risk. Alongside evidence-based HIV/STI prevention strategies (e.g. sexual partner communication skills), the intervention activities are rooted in principles of Cognitive Behavioral Therapy. Dress rehearsal participants were in favor of the intervention and provided feedback on activity length, gender and cultural relevance and strategies to sustain attention; this information was used to finalize the curriculum. In partnership with the community, we developed a theoretically driven, gender and culturally relevant, developmentally and psychologically appropriate HIV/STI prevention program. Our ultimate goal is to standardize sexual health assessment and intervention in outpatient mental health treatment settings to meet sexual health needs in this underserved population.     

Prevalence of Sexually Transmitted Infection/Human Immunodeficiency Virus Counseling Services Received by Teen Males, 1995–2002

PurposeTo examine whether improvements have been made in the delivery of sexually transmitted infection and/or human immunodeficiency virus (STI/HIV) counseling services to teen males.MethodsAnalysis was performed using the 1995 National Survey of Adolescent Males (N = 1,729, response rate = 75%) and the 2002 National Survey of Family Growth (N = 1,121, response rate = 78%), which are two nationally representative surveys of 15–19-year-old males. Main outcome measure included discussion about STIs/HIV with a doctor/nurse. Weighted bivariate and multivariate Poisson regression analyses examined the association of outcome measures and survey year among males engaging in various types of sexual behaviors (e.g., varying partner numbers, higher risk sex) unadjusted and adjusted for sociodemographic and health care access factors.ResultsIn 2002, STI/HIV counseling receipt in the past year was reported by one-third of males who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners. Only 26% of males reporting high-risk sex (e.g., sex with prostitute, person with HIV or often/always high with sex) reported STI/HIV counseling receipt. Overall, no improvements were found between 1995 and 2002 in STI/HIV counseling, even after controlling for sociodemographic and health care access factors.ConclusionsMechanisms are needed to raise the importance of STI/HIV counseling services among sexually active male teens as well as to improve health care providers' delivery of these services.     

'I daresay I might find it embarrassing': general practitioners' perspectives on discussing sexual health issues with lesbian and gay patients

The present paper explores general practitioners' (GPs') perspectives on the difficulties which they face when discussing sexual health issues with lesbian and gay patients in primary care consultations. It draws upon data obtained from a qualitative interview study with 22 GPs aged between 34 and 57 years who were practising in Sheffield, UK. Interviews were transcribed verbatim and the data were analysed thematically. The results indicate that (non-hetero)sexual orientation could form a barrier to talking about sexual health matters for almost half of this GP sample. Difficulties related primarily to ignorance of lesbian and gay lifestyles and sexual practices, and also included concerns about the appropriate language to use and assumptions about the nature of gay men's relationships. Homophobic attitudes were also identified in a minority of the sample. Participants suggested improvements around improving communication about sexual health with lesbian and gay patients. These included training at undergraduate and postgraduate levels, taking a proactive role during consultations, not making assumptions about patients' sexual orientation and having a non-discriminatory policy for their practice.     

‘It's raining stones’: stigma,violence and HIV vulnerability among men who have sex with men in Dakar,Senegal

Research in many countries has highlighted the vulnerability of men who have sex with men to HIV and other sexually transmitted infections (STIs). Yet in Africa, such men have received little attention in HIV/AIDS programming and service delivery because of the widespread denial and stigmatization of male homosexual behaviour. In Dakar, Senegal, a study conducted by researchers from Cheikh Anta Diop University, the Senegal National Council Against AIDS, and the Horizons Program elicited quantitative and qualitative data about the needs, behaviours, knowledge, and attitudes of men who have sex with men. Findings reveal that respondents have distinct identities and social roles that go beyond sexual practices, that sex with men is driven by many reasons, including love, pleasure, and economic exchange, and that respondents' lives are often characterized by stigma, violence and rejection. The data also highlight that many men are at risk of HIV because of unprotected sex with other men, a history of STI symptoms, and poor knowledge of STIs. The study underscores the need for non‐stigmatizing, sexual health information and services.     

Lesbians' Sexual Activities and Efforts to Reduce Risks for Sexually Transmitted Diseases

Introduction: Little information is available regarding the specific sexual practices of lesbians, and whether these activities may carry an associated health risk. Methods: Self-identified lesbians from all U.S. states (N = 6935) responded to a questionnaire that was printed in a national biweekly gay, lesbian and bisexual news magazine. Items included sexual practices engaged in with women during the past 1 and 5 years, past history of a sexually transmitted disease (STD), number and gender of lifetime and recent sexual partners, concerns regarding STDs, and risk reduction behaviors. Results: Lesbians engaged in a variety of sexual activities with female partners including orogenital sex, use of a dildo, and anilingus. Seventeen percent reported a lifetime diagnosis of an STD. Women with a history of an STD were more likely to be concerned about STDs, to ask questions of their new female sexual partners, and to have had an HIV test. Conclusions: Lesbians participate in a variety of sexual activities with their female partners that involve the exchange of body fluids, potential exposure to blood, and genital and anal stimulation that may put them at risk for STDs.     

Rationale and development of a survey tool for describing and auditing the composition of,and flows between,specialist and community clinical services for sexually transmitted infections

Background  

National health strategies have called for an expansion of the role of primary care in England to increase access to sexual health services. However, there is little guidance for service planners and commissioners as to the public health impact of different combinations of specialist genitourinary medicine (GUM) clinics and primary care based services for local populations. Service planning for infectious diseases like sexually transmitted infections (STI) is further complicated because the goal of early detection and treatment is not only to improve the health of the individual, but to benefit the wider population and reduce future treatment costs by preventing onward transmission. Therefore, we are developing a survey tool that will enable service planners to better understand the needs of their local STI care-seeking population and which will help inform evidence-based decision-making about current and future service configurations. Here we describe the rationale and development of this survey tool.     

Sexuality and Intimacy in Alzheimer's Patients and Their Partners

Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in today's clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.