Improving HIV prevention programs: the role of identity in shaping healthy sexual behavior of rural adolescents in South Africa

A large body of literature highlights the role of culture and identity in how individuals manage and maintain health. Disappointingly there was no statistically significant decline in HIV prevalence in the 15–24 years age group in South Africa since 2007, Millennium Development Goal 6 indicator. This warrants a new approach to youth HIV prevention, which considers identity and culture, in male-dominant environments. We used identity-based motivation theory, which predicts that possible identities have a crucial influence on health-promoting behavior, to argue that girls are not currently attaining their low risk possible identities because sociocultural factors influence their behavior and compromise their health and economic outcomes. This study employed a cross-sectional survey among 285 rural black South African adolescents (mean age 16.7 years; 48.8% boys) to determine the salient social identity and the associated possible identities. We then tested whether youth behave in accordance with their possible identities. The dependent variables are non-risky behavior, risky behavior, and confidence to discuss sex. The independent variables are age, previous sex experience, and poverty. The adolescents chose gender as the most prominent social identity. Girls chose a safer possible identity than boys did, and girls do not actualize their possible identities while boys do. For girls, no dependent variables were significant. These results show that sociocultural barriers prevent the girls from actualizing their non-risky possible identity. Future adolescent HIV prevention programs aimed at reducing HIV should promote rights and responsibilities and consider cultural norms and beliefs to create a more gender-equal society that embraces less risky sexual behavior, in line with the idealized identity of girls. This to convince both male and female adolescents of the benefits, risks, and social harms embedded in certain traditional practices in a high HIV-prevalent environment.     

Sexual coercion,consent and negotiation: processes of change amongst couples participating in the Indashyikirwa programme in Rwanda

Sexual coercion among married or cohabitating couples is a complex phenomenon with few effective strategies for prevention. This paper explores sexual coercion among couples from rural Rwanda who participated in Indashyikirwa, a 4-year intimate partner violence prevention programme that included a 5-month couples curriculum to promote equalitarian, non-violent relationships. Drawing on three rounds of longitudinal qualitative interviews with partners from 14 couples (28 individuals), this paper explores processes of change in experiences and conceptualisations of coerced sex over the course of the intervention and 1 year after. The data were analysed using thematic and dyadic analysis. Both partners of couples reported significant changes in their sexual relationship, including reduced experiences of coerced sex, greater communication about sex and increased acceptability for women to initiate sex. Men and women became more willing to disclose sexual coercion over the course of the interviews, both current and past experiences, and couples’ accounts generally became more concordant. Findings yield insights to inform programming to prevent coerced sex among spouses. These include grounding discussion of sexual coercion in an analysis of gendered power and norms, reflecting on the consequences of broader forms of sexual coercion and employing a benefits-driven, skills-based approach.     

大学女生性行为发生学校阶段和相关危险因素研究

目的调查浙江省某市大学女生性行为发生学校阶段与有关危险性行为和性生殖健康问题关联情况。方法采用统一的调查问卷，对浙江省某市两所大学所有学生进行自答式问卷调查。在963名已经发生性行为的女生中，670名回答了她们所有有关性行为的问题而被纳入了分析。结果较在大学期间发生性行为的女生，在大学前发生性关系的女生，首次性行为更可能不使用安全套，性伴更可能是非固定性的，更可能有怀孕或者流产的经历，过去和过去一年更可能有两个及以上性伴侣，过去一年更可能发生性行为。结论首次性行为发生学校阶段与性病／艾滋病关联危险行为有关联。针对青年人的性病／艾滋病预防策略应包括推迟性行为的发生和在较早的时间进行性安全教育。     

Preventing the high-risk sexual behavior of adolescents: focus on HIV/AIDS transmission, unintended pregnancy, or both?

Adolescents are at high risk for negative health outcomes associated with unprotected sexual intercourse including infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and unintended pregnancy. That unprotected sexual intercourse is the risk behavior common to both problems has not been fully capitalized on in prevention programs. Limited knowledge about the effects of type-of-outcome expectancy (i.e., disease vs. pregnancy) on the association between risk perceptions and precautionary or health-protective sexual behavior makes it difficult to determine what preventive approach would be most effective with adolescents. The literature suggests that pregnancy prevention is a greater concern for adolescents than disease prevention. This review focuses on the implications of these differential risk perceptions for HIV/AIDS prevention programs targeting adolescents.     

Meanings and Dilemmas of Sexual Safety and Communication for Transgender Individuals

HIV prevention efforts stress interpersonal communication skills and their protective benefits; however, research on sexual communication has lagged behind interventions that emphasize communication. This project was undertaken to determine how sex talk unfolds in a specific relational and sociocultural context--the transgender community—as well as what constitutes effective or satisfying safer sex talk. Goldsmith's normative theory guided semistructured interviews with 41 transgender individuals. Transgender participants held multiple, often competing goals in safer sex conversations, which resulted in communicative dilemmas. Creative management strategies allowed participants to achieve desired outcomes, like safer sex, without threatening identities and relationships. Implications for communication and health behavior theory and practice are discussed in light of these findings.     

重庆市中学生性健康知识、态度、教育需求及性别差异分析

目的 了解重庆市不同性别中学生的性健康知识、态度及性教育需求,为制定针对性的中学生性健康及防艾宣传策略提供依据.方法 在重庆主城和近远郊各3个区采取整群抽样的方法抽取初一到高三共六个年级的学生(男生1765名,女生2028名),采用自行设计问卷开展横断面调查.结果 中学生性健康知识总体知晓率较低,女生在性生理发育特点、...     

Risks and prevention of sexually transmissible infections among women who have sex with women

Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.     

The Social/Sexual Environment of Gay Men Residing in a Rural Frontier State: Implications for the Development of HIV Prevention Programs

CONTEXT: The incidence and prevalence of HIV/AIDS is increasing among rural men who have sex with men (MSM). Yet little is known about the social/ sexual environment of rural frontier areas. PURPOSE: The purpose of this study was to assess the social/sexual environment of gay men living in rural areas and how this environment contributes to the development of HIV/AIDS prevention programs. METHODS: A qualitative study was conducted in Wyoming. In-depth guided interviews were conducted with 39 self-identified gay men. Data were analyzed for emergent themes using constant comparative analysis. FINDINGS: Four broadly related themes emerged. Participants perceive that they live in a hostile social environment in which the potential for becoming a target of violence is present. In order to cope with this social reality, men adopt strategies to assimilate into the predominant heterosexual culture and to look for sex partners. These, in turn, are related to their attitudes about HIV/AIDS and prevention activities. Notably, the Internet was discussed by participants as a means for men to connect to a larger gay society and look for sex partners and as a potential venue to HIV/AIDS prevention programs. CONCLUSIONS: Data provided a number of implications for developing HIV/AIDS prevention programs targeting rural MSM. Especially apparent was the need for programs to be mindful of the desire to keep one's sexual preferences shielded from public knowledge and the effect this may have on recruiting rural MSM to participate in prevention activities. The Internet, because men can access it privately, might provide a venue for prevention projects.     

Attitudes toward online HIV/sexually-transmitted infection prevention programs and Internet user profiles among men who have sex with men

Objectives

To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs.

Method

A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis.

Results

Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not interested in online prevention among those with a lower educational level, bisexual men and HIV-positive men. Conversely, those most receptive to online prevention were men self-identified as gay, those with a bachelors degree, those who had been tested for HIV and those who were HIV-negative.

Conclusion

The internet can facilitate sexual health promotion among MSM. Characterization of user profiles offers the possibility of segmenting prevention programs and of combining online and offline strategies.     

Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood

Childhood sexual abuse (CSA) is associated with HIV sexual risk behavior. Although many psychosocial correlates of sexual risk among HIV-positive persons have been identified, studies predicting continued risk among HIV-positive adults with histories of CSA are limited. This cross-sectional study identified variables predictive of sexual transmission risk behavior among an ethnically diverse sample of 256 HIV-positive adults (women and men who have sex with men; MSM) with CSA histories. Participants were assessed for trauma symptoms, shame related to HIV and sexual trauma, substance use, coping style, and sexual risk behavior. Logistic regression analyses were conducted to identify variables predictive of unprotected sexual behavior in the past 4 months. Unprotected sex was significantly associated with substance use and trauma-related behavioral difficulties among women and men, and less spiritual coping among men. Unprotected sex with HIV negative or serostatus unknown partners was significantly associated with greater trauma-related behavioral difficulties, more HIV-related shame, and fewer active coping strategies. Thus, trauma symptoms, shame, coping style, and substance use were significantly associated with sexual risk behavior among HIV-positive adults with histories of CSA, with models of prediction differing by gender and partner serostatus. HIV prevention intervention for persons with HIV and CSA histories should address trauma-related behavioral difficulties and enhance coping skills to reduce sexual transmission risk behavior.     

Sexual Regret in College Students

A questionnaire study was conducted to assess the relationship between sexual regret and sexual behaviors and demographic factors among 348 college-aged students prior to attending an educational program about sexual health issues. Analyses conducted on the portion of the sample who were sexually active (n = 270) indicated that the majority (71.9%, n = 194) has regretted their decision to engage in sexual activity at least once. The most cited reasons for regret by students included their sexual decision making as inconsistent with their morals (37%), an acknowledgment that alcohol influenced their decision (31.7%), the realization they did not want the same thing as their partner (27.9%), the lack of condom use (25.5%), feeling pressure by their partner (23.0%), and their desire to wait until marriage to have sex (15.4%). The only significant sex difference was that women reported regret due to feeling pressured by a partner more often than men. Multiple and logistic regression analyses indicated that the only significant predictor of regret regarding one's sexual decisions was the number of sexual partners. These results demonstrate the need for sexual educators to incorporate sexual regret into their curricula as the phenomenon of regret is more common than pregnancy and sexually transmitted diseases, the usual focus of sexuality education.     

Using human rights‐based approaches to conceptualise lesbian and bisexual women’s health inequalities

This article makes a contribution to current debates in human rights‐based approaches to lesbian and bisexual (LB) women’s health. With reference to concepts embodied in the Yogyakarta Principles, it is proposed that the right to health includes access to health information, participation, equity, equality and non‐discrimination. Specifically, the article examines how LB women’s health can be considered as a health inequality and discusses international developments to reduce disparities. Drawing on qualitative data collected in an online survey, the article reports on sexual minority women’s experiences of health‐care. Participants were recruited via a purposive sampling strategy; questionnaires were completed by 6490 respondents of whom 5909 met the study criteria of residence in the UK, sexual orientation and completing the survey once. Analysis revealed four broad themes: heteronormativity in health‐care; improving attitudes among healthcare professionals; equality in access; raising awareness and informed communities. The accounts highlight the centrality of human rights principles: fairness, respect, equality, dignity and autonomy. The implications for healthcare policy and practice are discussed including ways to empower staff and service users with knowledge and skills and ensuring non‐discrimination in health service delivery.     

武汉市某高校大学生性教育、性行为现状

目的 了解武汉市大学生性态度、性行为现状及当前性教育效果,为高校更好地开展大学生性教育工作提供参考. 方法 采用随机整群抽样方法,于2019年7-10月抽取武汉市某高校大一至大五593名学生进行问卷调查,主要内容为基本情况、两性卫生知识等性教育普及情况及性生活现状等. 结果 大学生对于婚前性行为态度较为宽容,80.44...     

Sexual risk associated with gambling among the youth in Rubaga Division,Kampala

The status of sexual and reproductive health of youths and adolescents in urban areas across the globe is alarming. Evidence from Uganda Aids Indicator Survey 2011 indicates that over 31% youths who have never married are engaged in sexual intercourse but have never tested for HIV. Gambling is clearly on the increase in major towns and cities drawing in several youths. However, the risk that this practice poses on the youth's sexual behavior has not been investigated in Uganda. This study intended to fill this gap. This study examined the sexual risk associated with gambling among youths in Rubaga Division of Kampala Capital City of Uganda. The study employed a quantitative cross sectional design to survey 397 youths aged 15 to 24 years. It employed a systematic sampling scheme in selecting households with youths who responded to the household survey questionnaire. Results showed that more male than female youths are engaged in gambling, majority of whom start gambling below 18 years. Most of the gambling youths are pulled by competition with peers and desire to earn money. Compared with nongambling youths, gambling youths have more sexual encounters, initiate sexual activity at a young age, have unprotected sex, have sex with more than one partner whom they do not know their HIV status, and have sex under the influence of alcohol. The study recommends for government to form and enforce policies to regulate gambling with a view of minimizing its associated risks especially unsafe sex. Through the ministry of health and civil society organizations, government can create programs to reach the gambling youths with sexual reproductive health services.     

Advancing sexual health through human rights: The role of the law

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.     

Sexual capital: an extension of Grossman's concept of health capital

This essay extends Grossman's concept of health capital to the domain of sexual behavior. Two components of "sexual capital" are discussed, both pertaining to health. One is the person's assets that are effective in preventing contraction of sexually transmitted infections, such as habits in selecting sex partners and the social networks from which those partners are selected, and sexual practices including use of condoms. A second is the person's assets useful in achieving sexual intimacy, an element in positive health. Like other forms of human capital, these embedded assets are acquired through strategic choice and experience as well as inheritance.     

Sexual Health Behaviors and Sexual Orientation in a U.S. National Sample of College Students

Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association–National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.     

Sexual health: some young people's views in Lima,Peru

Among lower-class youth in Lima, Peru, sexual activity is frequently initiated at 12 or 13 years of age, with little knowledge about pregnancy prevention or acquired immunodeficiency syndrome (AIDS). Parents may send young boys to brothels, and sexual activity is often associated with alcohol drinking. Few young people receive guidance about sex from their parents, and most cases of sexual abuse are not disclosed. Young women who become pregnant often leave school, and many are banished from their parents' homes. Recommended, to address these issues, are formally scheduled times in the school schedule for students to discuss their sexual and emotional problems; school-based audiovisual presentations by neighborhood youth programs; opportunities, through neighborhood centers, health centers, and schools, for parents and children to talk to each other; and peer counseling in the schools on topics such as equality in relationships, pregnancy prevention, and sexuality.     

Safer sex maintenance and reduction of unsafe sex among homosexually active men: a new therapeutic approach

To date, publicly funded HIV/AIDS prevention efforts for homosexually active men have largely been limited to two traditional public health strategies: mass media information campaigns and HIV testing/contact notification programs. Health educators using either of these strategies have addressed the spread of HIV as they would many other infectious diseases and have relied heavily upon fear tactics or moral arguments to 'sell' the concept of safer sex. Grass-roots gay community efforts to prevent HIV transmission have also largely relied upon these two strategies, as well as upon more informal individual and group counseling activities. In general, however, strategies used by the gay community have tried to present more positive approaches to AIDS prevention, including eroticizing safer sex practices. This article reviews the efficacy of traditional public health approaches as well as the educational models underlying them, and argues that a major shift in focus is needed. A comprehensive health care and sexuality education model for homosexually active men based on the 'PLISSIST' sex therapy model is described and advocated. This model is presented as a more useful one for identifying populations at risk, reducing unsafe sexual behavior and promoting safer sex maintenance. The model identifies five sub-populations among homosexually active men and recommends specialized interventions appropriate to each. Adequate funding for the services included in this model is also advocated.