Changing behaviours and continuing silence: sex in the post-immigration lives of mainland Chinese immigrants in Canada

In China, reluctance to discuss sex continues to be widely observed despite the sexual revolution there. That silence generates questions about health risks in the contexts of HIV/AIDS and international migration. Based on a qualitative study of mainland Chinese immigrants in Canada, this paper explores the impacts of immigration processes on sex and sexuality. The findings reveal a gap between these individuals' changing sexual behaviours and the continuing silence on sex. Although Canada has exposed them to a new living environment that has shaped the dynamics and patterns of their sexual practices, their incomplete integration into the host society and their close connections with China as the home country mean that traditional Chinese norms continue to influence their understanding of these changes. With the increasing openness of these immigrants' sexual relationships, the obsolescence of their consciousness and knowledge of sexuality should be addressed in order to reduce their vulnerability to sexual inequalities and consequent health risks.     

Sexual communication among married couples in the context of a microbicide clinical trial and acceptability study in Pune,India

Previous research in India indicates that there is little communication within marriage about sex. Lack of communication about safe sexual behaviours may increase couples' vulnerability to HIV. This study explores couple level sexual communication and socio-cultural norms that influence couples' communication about sex and its implications for HIV prevention. Data derive from in-depth interviews at two points in time with 10 couples. Secondary qualitative analyses of the interviews were conducted using inductive and deductive coding techniques. Half of the couples described improved communication about sex and HIV and AIDS after participation in the clinical trial and/or acceptability study, as well as increased sexual activity, improved relationships by alleviating doubts about their partner's fidelity and forgiving their partners. The findings show that creating safe spaces for couples where they can ask frank questions about HIV and AIDS, sex and sexuality potentially can improve couples' communication about sex and reduce their risk for HIV infection.     

Are Parental Relationships Always Protective? A Social Network Analysis of Black,Latino, and White Homeless Youth and Sexual Risk-Taking Behaviors

Black and Latino homeless youth are at high risk of HIV, and yet no HIV prevention interventions have been specifically designed for these groups. Given the success of parent–child intervention programs for housed Black and Latino youth, this study examined parental relationships that could be leveraged for future HIV prevention efforts targeting minority homeless youth, specifically the associations among presence of parents in social networks, parental influence, and parental support. A convenience sample of Black, Latino, and White homeless youth (N?=?754) was recruited from three drop-in centers in Los Angeles. Participants completed a computerized, self-administered questionnaire and an interviewer-led personal social network interview. Multivariate logistic regression models assessed the association between parental relationships and sexual risk behaviors. Forty-five percent (n?=?338) of youth identified a parent in their network. Having at least one parent in their network was significantly associated with decreased odds of using a condom for Black and White youth. Black youth were almost four times more likely to report being tested for HIV if they spoke to their parents about sex, whereas Latino youth were 91 % less likely to report being tested for HIV if they talked with their parents about sex. Black youth who identified a parent as a positive influence (i.e., promoting condom use or discouraging multiple partners) were almost four times more likely to have used a condom during their last sexual encounter. Parent–child HIV prevention interventions targeting homeless youth would benefit from culturally tailored adaptations.     

Secondary HIV prevention among Kothi‐identified MSM in Chennai,India

This study explored experiences and contexts of HIV risk and prevention among HIV‐positive kothi‐identified men in Chennai, India. In‐depth, semi‐structured interviews were conducted with 10 HIV‐positive men and three service providers, recruited using purposive sampling. Interviews were audio‐taped, transcribed in Tamil and translated into English. Data were analysed using a narrative thematic approach and constant comparative method. Misconceptions about HIV transmission; cultural taboos around discussing sexual behaviour and HIV; stigma related to same‐sex behaviour; harassment; and the criminalization of consensual sex between men present formidable challenges to HIV prevention. Frank and open discussion about male‐to‐male sexual behaviour and living with HIV, which may support health and HIV prevention, may be dangerous in the context of pervasive risks due to stigmatization, violence and criminalization. Instead, culturally appropriate, multi‐level interventions developed in collaboration with community stakeholders are needed to support HIV prevention among kothi‐identified men in South India.     

Secondary HIV prevention among kothi-identified MSM in Chennai, India

This study explored experiences and contexts of HIV risk and prevention among HIV-positive kothi-identified men in Chennai, India. In-depth, semi-structured interviews were conducted with 10 HIV-positive men and three service providers, recruited using purposive sampling. Interviews were audio-taped, transcribed in Tamil and translated into English. Data were analysed using a narrative thematic approach and constant comparative method. Misconceptions about HIV transmission; cultural taboos around discussing sexual behaviour and HIV; stigma related to same-sex behaviour; harassment; and the criminalization of consensual sex between men present formidable challenges to HIV prevention. Frank and open discussion about male-to-male sexual behaviour and living with HIV, which may support health and HIV prevention, may be dangerous in the context of pervasive risks due to stigmatization, violence and criminalization. Instead, culturally appropriate, multi-level interventions developed in collaboration with community stakeholders are needed to support HIV prevention among kothi-identified men in South India.     

Psychosocial Correlates of Unprotected Sex Without Disclosure of HIV-Positivity among African-American,Latino, and White Men Who Have Sex with Men and Women

African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.     

Reproductive consequences of unwanted sexual debut among young adult women from Metro Cebu,Philippines

ABSTRACT

The circumstances surrounding sexual debut influence subsequent sexual and reproductive outcomes. We analysed longitudinal data from 397 women who participated in the Cebu Longitudinal Health and Nutrition Survey in Cebu, Philippines, to examine associations between unwanted first sex and number of pregnancies, unintended pregnancy, and use of modern contraception. 72% of women reported unwanted first sex. Women whose first sex was unwanted had increased odds of unintended pregnancy compared to women whose first sex was wanted (aOR = 2.2, 95% CI 1.3, 3.6). Nationally representative surveys should include culturally relevant questions about sexual debut to inform public health programmes aimed at improving sexual/reproductive health.     

Needs,Risks, and Context in Sexual Health Among Temporary Foreign Migrant Farmworkers in Canada: A Pilot Study with Mexican and Caribbean Workers

Every year Canada hosts approximately 40,000 temporary foreign migrant farmworkers (MFWs). They are predominantly Mexican and Caribbean married men or single mothers who leave their families for months at a time over a span of many years. This pilot study investigated their knowledge about HIV/AIDS, attitudes towards condoms and their use, and perceived barriers to accessing sexual health services. A survey (n = 103) and four focus groups (n = 21) were conducted in Ontario’s Niagara Region. The results suggest that MFWs commonly face vulnerabilities to HIV/AIDS, STIs and other sexual health issues due to personal, social–cultural, environmental and structural factors. The findings highlight the need for increasing culturally and gender sensitive sexual health education and harm reduction outreach and providing information about local health care systems and resources for MFWs. The study also calls for further community-based research and actions to reduce MFWs’ perceived access barriers to health care services.     

Socio-cultural influences on the transmission of HIV among gay men in rural China

Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive sampling. Face-to-face in-depth interviews were conducted to explore participants’ views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants’ efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their individualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China.     

The Cedar Project: historical trauma, sexual abuse and HIV risk among young Aboriginal people who use injection and non-injection drugs in two Canadian cities

Recent Indigenist scholarship has situated high rates of traumatic life experiences, including sexual abuse, among Indigenous peoples of North America within the larger context of their status as colonized peoples. Sexual abuse has been linked to many negative health outcomes including mental, sexual and drug-related vulnerabilities. There is a paucity of research in Canada addressing the relationship between antecedent sexual abuse and negative health outcomes among Aboriginal people including elevated risk of HIV infection. The primary objectives of this study were to determine factors associated with sexual abuse among participants of the Cedar Project, a cohort of young Aboriginal people between the ages of 14 and 30 years who use injection and non-injection drugs in two urban centres in British Columbia, Canada; and to locate findings through a lens of historical and intergenerational trauma. We utilized post-colonial perspectives in research design, problem formulation and the interpretation of results. Multivariate modeling was used to determine the extent to which a history of sexual abuse was predictive of negative health outcomes and vulnerability to HIV infection. Of the 543 eligible participants, 48% reported ever having experienced sexual abuse; 69% of sexually abused participants were female. The median age of first sexual abuse was 6 years for both female and male participants. After adjusting for sociodemographic variables and factors of historical trauma, sexually abused participants were more likely to have ever been on the streets for more than three nights, to have ever self-harmed, to have suicide ideation, to have attempted suicide, to have a diagnosis of mental illness, to have been in the emergency department within the previous 6 months, to have had over 20 lifetime sexual partners, to have ever been paid for sex and to have ever overdosed. The prevalence and consequences of sexual abuse among Cedar Project participants are of grave concern. Sexual trauma will continue to impact individuals, families and communities until unresolved historical trauma is meaningfully addressed in client-driven, culturally safe programming.     

Men who have sex with men's sexual relations with women in Bangladesh

Studies of men who have sex with men in South Asian countries including Bangladesh have tended to focus mainly on measuring male-to-male sexual risk behaviours, with less attention being given to understanding the nature and meaning of their sexual relations with women. This can result in missed opportunities for HIV/AIDS-related intervention. This paper, based on a small scale qualitative study, attempts to develop a cultural model to understand men who have sex with men's sexual relations with women within a gender and masculinity framework. Findings reveal that in Bangladesh men who have sex with men frequently surrender to societal pressures to marry, become husbands and shoulder fatherhood. This forces some women to become the silent sufferers of some of the negative consequences of hetero-normative patriarchal practice. Importantly, however, men who have sex with men consider sex with women a form of real sex within a framework of masculine sexual potency irrespective of preference, desire or eroticism. Thus, challenges exist to undertaking sexual health promotion and HIV/AIDS prevention in culturally sensitive ways.     

Substance use,sexual behaviour and prevention strategies of Vancouver gay and bisexual men who recently attended group sex events

Group sex events are an epidemiologically important part of some gay and bisexual men’s sexual culture in Canada. Associated with condomless anal intercourse and polysubstance use, such events have been cited as disproportionally contributing to HIV infection rates. We analysed questionnaire data from the Momentum Health Study in Vancouver, Canada, to understand substance use, sexual behaviour, psychosocial variables (Sexual Sensation Seeking, Sexual Escape Motivation, Treatment Optimism) and HIV prevention strategies (sero-sorting, strategic positioning, avoiding anal sex, disclosure, treatment as prevention) of men attending such events, which were defined as group (n ≥ 4 partners) sex parties, blackout events and darkrooms. Analysis by multivariable logistic regression compared men attending group sex events within the past six months (n = 180) with non-attendees (n = 539). Results showed that attendees reported: (1) significantly higher use of sex drugs and alcohol consumption, (2) higher scores on the Sexual Sensation Scale, more anal sex partners, greater odds of any condomless anal sex with sero-discordant partners and greater odds of reporting fisting and sex toy use and (3) different prevention practices that varied by HIV-serostatus. Findings are interpreted in light of the importance of pleasure, sociality and HIV/STI prevention strategies associated with group sex events. Findings contribute to the development of appropriate education and intervention for attendees.     

Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample

Abstract: The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.     

Generational sex work and HIV risk among Indigenous women in a street-based urban Canadian setting

In Canada, Indigenous women are over-represented among new HIV infections and street-based sex workers. Scholars suggest that Aboriginal women's HIV risk stems from intergenerational effects of colonisation and racial policies. This research examined generational sex work involvement among Aboriginal and non-Aboriginal women and the effect on risk for HIV acquisition. The sample included 225 women in street-based sex work and enrolled in a community-based prospective cohort, in partnership with local sex work and Aboriginal community partners. Bivariate and multivariate logistic regression modeled an independent relationship between Aboriginal ancestry and generational sex work and the impact of generational sex work on HIV infection among Aboriginal sex workers. Aboriginal women (48%) were more likely to be HIV-positive, with 34% living with HIV compared to 24% non-Aboriginal women. In multivariate logistic regression model, Aboriginal women remained three times more likely to experience generational sex work (AOR:2.97; 95%CI:1.5,5.8). Generational sex work was significantly associated with HIV (AOR = 3.01, 95%CI: 1.67–4.58) in a confounder model restricted to Aboriginal women. High prevalence of generational sex work among Aboriginal women and three-fold increased risk for HIV infection are concerning. Policy reforms and community-based, culturally safe and trauma informed HIV-prevention initiatives are required for Indigenous sex workers.     

洛阳市中学生艾滋病性行为知识态度调查

目的了解河南省洛阳市中学生艾滋病性行为知识、态度现状，以便更好地开展中学生艾滋病及性行为健康教育活动。方法2004年9至12月采用分层整群随机抽样方法，对洛阳市6个区6所普通中学初中和高中的1980名学生进行了艾滋病性行为知、信、行结构式问卷调查。结果中学生没有接受过预防艾滋病的健康教育的比例为54．5％；艾滋病知识的掌握、传播途径不完全知道的比例为38．3％；不知道日常生活接触不传播艾滋病的比例为28．8％；没有与亲友谈论过艾滋病的比例为76．3％，而且91．2％的学生表示不愿意和AIDS／HIV感染者同班学习。中学生看过描写性行为的书刊、音像制品等的比例为21．7％；赞成婚前性行为的比例为13．4％；中学阶段学生曾发生性行为的比例为1．1％；80．5％的中学生认为艾滋病及性知识健康教育很有必要；18．9％的中学生希望从父母、教师或专家获得有关艾滋病及性的知识。结论中学生艾滋病及性知识缺乏，尽快在中学生中开展艾滋病及性行为健康教育。使之安然度过性困惑期已刻不容缓。     

Sexual practices and STI/HIV testing among gay,bisexual, and men who have sex with men in Ottawa,Canada: examining nondisclosure prosecutions and HIV prevention

In 1998, the Supreme Court of Canada ruled that prosecuting people for HIV-status nondisclosure would neither affect people’s willingness to undergo HIV testing, specifically, nor undermine HIV prevention, more generally. Since that time, limited research has explored this topic. This paper reports a survey of a convenience sample of 721 gay, bisexual, and other men who have sex with men. The aim was to examine participants’ sexually transmitted infection (STI) and HIV testing practices, sexual activities, and perceptions about nondisclosure prosecutions. Results suggest that nondisclosure prosecutions appear to have affected the STI testing practices of the participants in this research who were: (a) the most likely to have reported a sexual history involving unprotected receptive anal sex, and (b) least likely to have undergone testing for STIs.     

上海市青少年危险行为现状研究(一)--艾滋病及性行为的知识态度行为

目的：了解上海市中学生艾滋病及性行为的知识态度行为现状。方法：2002年4月至6月选取105所普通中学和中等职业学校的初一、高一9246名学生，采取KAP(知、信、行)问卷调查。结果：中学生在学校里没有接受过预防艾滋病的健康教育的比例为49．3％。艾滋病知识的掌握，3条传播途径不完全知道的比例为27．8％，不知道日常生活接触不传播艾涝病的比例为24．7％，没有与亲友谈论过艾滋病的比例为66．7％，而且86．0％学生都表示不愿意和AIDS／HIV感染者同班学习。中学生看过描写性行为的书刊、音像制品等的比例为23．8％，赞成婚前性行为的比例为18．5％，高中阶段学生曾发生性行为的比例2．3％。结论：用多种形式，包括同伴教育在内健康教育方法，在中学生中尽快开展艾送病预防和生殖健康教育。