“Magical”: Using Substances During Sex Among Substance-Involved Sexual Assault Survivors

Review Questions/Objectives The objective of this review is to synthesise the best available evidence on the effectiveness of population based (public health) risk reduction programs and services (interventions) on sexual and reproductive health risk taking among young people (aged 10 to 24 years old) in developing countries (countries with low and middle gross national income (GNI) per capita as defined by World Bank). The specific review questions are: 1. What is the effectiveness of population based (public health) risk reduction programs and services (interventions) on risky sexual behaviors among young people? 2. What are the characteristics of population based interventions that are effective in reducing risky behaviors among young people? 3. What specific outcome measures best assess the impact of interventions that effectively reduce sexual risk taking among adolescents in developing countries? Inclusion Criteria a. Types of Participants The review will consider individuals of ages 10 to 24 years residing in developing countries. b. Types of interventions The review will consider population based (public health) risk reduction programs and services that target young people in developing countries. c. Types of Outcomes Anticipated outcomes related to reduction in risky sexual behavior among young people include the following: Primary outcomes: Abstinence rates, rates of early/premarital sexual initiation, numbers of sexual partners, condom use at first sex, consistent and correct contraceptive (condom) use during sexual encounters among the study population, alcohol and/or substance use prior to or during sexual encounters (short term outcomes). Secondary outcomes: Pregnancies and their outcomes including rates of abortion, births (live and still), etc., STI rates, HIV/AIDS rates, maternal mortality and educational attainment levels of adolescents in the study population (Long term outcomes).

Although adolescents with substance use disorders (SUDs) are at high risk for sexually transmitted infections (STIs) including HIV, few interventions have been tailored to address sexual risk for young people in substance use treatment. Guided by the Social-Personal Framework for HIV Risk Behavior, this study sought to elucidate the motives, norms, meanings, and contexts of sexuality and sexual risk behavior, especially with respect to substance use, to inform the development of tailored intervention programs for them. Using purposive sampling, we recruited a diverse sample of 30 adolescents ages 13 to 18 in five substance use treatment programs in lower and upper Manhattan in New York City. We conducted qualitative individual in-depth interviews and focus group discussions with adolescents. Qualitative data were analyzed for salient themes and variations using framework analysis. Several major themes emerged related to adolescent sexual experience and the salient psychosocial, relational, and contextual risk and protective factors related to sexual behavior, including thoughts and feelings about having sex; aspects of sexual safety and prevention of STIs/HIV and pregnancy; sexual decision-making; substance use and intoxicated sex; sexual abuse; and peer and family influences on sexual risk. Findings underscored the importance of STI/HIV risk prevention interventions tailored to this population of teens, including their feelings about sexual satisfaction and intimacy, safer sexual behaviors, and the role of substance use in their sexual lives. Study results may guide the adaptation of efficacious risk reduction interventions for adolescents in SUD treatment.

This study employed a mixed-methods design to examine victim service barriers on local and state levels for Black/African-American (AA) sexual assault (SA) survivors. Victim-serving organizations (VO, n = 22) across a state-wide SA coalition were surveyed along with non-victim organizations (NVO, n = 26) that serve Black/AA clients/individuals (e.g., public service agencies/churches) in a local urban area. Survey findings highlight the most critical barrier was fear and mistrust of the legal system. Other significant barriers included: fear of perpetrator retaliation, cultural disclosure norms, lack of service awareness and transportation, mismatch between survivor-provider demographic characteristics, and survivor shame/stigma. In addition, a focus group (n = 8) of Black/AA SA survivors, VOs, and NVOs was conducted in response to the survey findings. Thematic analysis indicated a multi-system approach across individual, organizational, and system levels was necessary to effectively impact barriers and improve access for Black/AA SA survivors. Lessons learned include the importance of cultural context and relevance in offering organizational services for victimized marginalized populations. Such knowledge may be translated into prevention and intervention efforts to improve services. Recommendations for future inquiry include replicating this study by using larger sample sizes that include Black/AA SA survivors and evaluating the effectiveness of the recommendations offered in this study.

Most survivors of sexual assault who disclose their experience do so within their social network. Prior research on disclosure among individuals who experience sexual trauma has mainly focused on childhood sexual abuse, college-aged women, or disclosure to formal sources of support (e.g., treatment providers). There is limited research on disclosure among veteran survivors of military sexual assault (MSA). The current qualitative study aimed to explore the disclosure experiences of treatment-seeking survivors of MSA. Participants were 17 veterans (n = 13 women, n = 4 men), aged 33-65 years, who reported experiencing MSA. During semistructured interviews, participants were asked about their experiences disclosing MSA to informal support persons (e.g., family members, partners, friends). A narrative thematic analysis identified 11 themes that emerged throughout different aspects of the disclosure, including (a) preparation and reason for disclosure (reactive or spontaneous disclosures, disclosure as an explanation/obligation), (b) expectations about the disclosure experience (no expectations, negative expectations grounded in socialized beliefs, positive expectations based on specific relationships, mismatch between experience and expectation), (c) the actual disclosure experience (negative experiences of personalization, supportive responses, share shame), and (d) military context (disclosing to another member of the military, reporting dynamics). Additional subthemes were nested within these categories. The findings indicated common experiences across participants, particularly regarding disclosure rationale. Key differences were largely influenced by contextual factors (e.g., response of the disclosure recipient). These findings hold implications for clinicians working with survivors of MSA who are preparing for and coping with the consequences of disclosure.

Significant and Non-significant Associations Between Technology Use and Sexual Risk: A Need for More Empirical Attention

In the United States, more than half of the cumulative total of adult male AIDS cases are among men who have sex with men (MSM) (Centers for Disease Control and Prevention [CDC], 2001). Even with an increase in reported AIDS cases among injection drug users (IDUs) and heterosexual men in the past decade, MSM continue to constitute the largest proportion of annually reported AIDS cases in this country. In the most recent CDC report, a total of 31,901 adult male AIDS cases were reported. Of these, the largest proportion of cases (42%) was among MSM compared with 16% among IDUs, 9% among heterosexuals, 5% among MSM IDUs, and 28% whose risk was not reported (CDC, 2001). A similar pattern exists in HIV infection rates among males. Cumulative rates of HIV infection for MSM exceed those of IDUs and heterosexuals (CDC, 2001). Even with new HIV infections, MSM are still the largest subgroup among males (CDC, 2001). In the United States, however, the AIDS epidemic has had a disproportional impact on racial and ethnic populations. Today, it is people of color who carry the burden of this disease. In 2000, for example, the U.S. AIDS rate among non-Hispanic Blacks was 57 per 100,000, among Hispanic/Latinos the rate was 22 per 100,000, among Asian-Pacific Islanders (APIs) the rate was 3 per 100,000, and among Whites the rate was 6 per 100,000 (CDC, 2002; U.S Census Bureau, 2002). As we enter the 3rd decade of this epidemic, MSM of color represent the largest number of persons living with AIDS in this country. In communities of color, the impact of AIDS is even more uneven across ethnic groups in large urban epicenters such as Chicago, Miami, New York, San Francisco, and Los Angeles. In Chicago, for example, HIV disease disproportionately affects non-Hispanic Blacks compared with other ethnic groups. Since 1990, non-Hispanic Blacks have had the highest annual AIDS incidence rates in the city. The most recently reported AIDS rate for non-Hispanic Blacks was 54 per 100,000 compared with 18 per 100,000 for Hispanics/Latinos, and 14 per 100,000 for Whites (Chicago Department of Health, 2002). In other parts of the country, such as Miami, non-Hispanic AIDS Education and Prevention, 15, Supplement A, 1–6, 2003 © 2003 The Guilford Press

We conducted a mixed methods study to explore links between substance use and sexual risk among Aboriginal young people in British Columbia, Canada. Individual in-depth interviews were conducted in 2004–2005 with 30 young people ages 15–19; we present a descriptive thematic analysis. Data from a 2003 provincially representative survey that included 2,467 Aboriginal young people attending secondary school were used to model relationships between substance use and sexual behaviour outcomes. Young people perceived that substance use affected community and extended family relationships and could shape behaviour during sexual encounters. Survey data show different age trajectories of risk. For young men, there was a strong and consistent linear relationship between substance use and potentially risky sexual behaviour across all age groups. For women, using more substances at younger but not older ages was a strong marker of sexual initiation. Using more substances in older but not younger age groups was a strong indicator for having more sexual partners. For both young women and young men, lifetime substance use and substance use at last sexual encounter did not predict condom use. Interventions must consider the effects of substance use on community structures and family relationships in addition to individual risk.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

Substance using juvenile offenders have some of the highest rates for engaging in risky sexual behaviors compared to other adolescent subgroups. An overview of the literature on sexual risk behaviors among these youth is provided, including the empirical support for including caregivers/parents as critical partners in sexual risk reduction efforts with this population. In particular, there is (a) evidence that family factors contribute to adolescent sexual risk, (b) emerging support for caregiver focused interventions that target adolescent sexual risk, and (c) established support for caregiver focused interventions that target other complex adolescent behavior problems. In addition, this paper presents preliminary results from a randomized controlled trial evaluating a family-based intervention for substance using juvenile delinquents that combines contingency management (CM) for adolescent substance use with a novel sexual risk reduction (SRR) protocol. Results through six months post-baseline (corresponding with the end of treatment) are presented for intervention fidelity and outcomes including number of intercourse acts (Sex Acts), use of condoms or abstinence (Safe Sex), and obtaining HIV testing (Testing). In comparison to youth focused group substance abuse treatment, the CM-SRR intervention was associated with significantly greater therapist use of SRR techniques and greater caregiver involvement in treatment sessions (supporting treatment fidelity) and significantly lower increases in Sex Acts (supporting treatment efficacy). There were also higher odds for Safe Sex and for Testing, although these results failed to reach statistical significance. Findings add to the growing literature supporting the feasibility and efficacy of caregiver focused interventions targeting sexual risk behaviors among high-risk adolescent populations.

Evaluation of documentation practices of sexual assault nurse examiners

Sexuality remains central to well-being in later life, yet how individual factors operate within dyadic health contexts is unclear. We examined whether age, gender, and attitudes toward sexuality (ASKAS) predict sexual behavior and sexual satisfaction and whether self-rated health (SRH) and perceived partner health (PPH) moderate these links. Cross-sectional Structural Equation Modeling (SEM) was conducted with 185 adults aged 50-90 years. Outcomes were two latent variables: Sexual Behavior (intimate activity, sexual talk, vaginal sex, or oral sex) and Sexual Satisfaction (physical and emotional pleasure). Age and gender predicted lower behavior and satisfaction; attitudes showed no direct effects. Moderation tests showed that better SRH buffered the negative associations of age and gender with sexual satisfaction and that higher PPH reduced gender differences in sexual behavior. The health of both partners shapes sexual outcomes in later life. Clinically, supporting vitality and addressing partner health may help mitigate age- and gender-linked disparities in sexual well-being.

BackgroundHuman immunodeficiency virus/sexually transmitted infections, sexual risk, substance (alcohol and other legal and illegal drugs) use and mental ill health constitute a ‘syndemic’ of mutually reinforcing epidemics among men who have sex with men. Electronic health (e-health) interventions addressing these epidemics among men who have sex with men might have multiplicative effects. To our knowledge, no systematic review has examined the effectiveness of such interventions on these epidemics among men who have sex with men.ObjectiveThe objective was to synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective?Data sourcesA total of 24 information sources were searched initially (October–November 2018) [the following sources were searched: ProQuest Applied Social Sciences Index and Abstracts; Campbell Library; EBSCO Cumulative Index to Nursing and Allied Health Literature Plus, Wiley Online Library The Cochrane Library; Centre for Reviews and Dissemination databases (the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database); the Health Technology Assessment database; Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) database of health promotion research (Bibliomap); ProQuest Dissertations & Theses Global; OvidSP EconLit; OvidSP EMBASE; OvidSP Global Health; OvidSP Health Management Information Consortium; ProQuest International Bibliography of the Social Sciences; Ovid MEDLINE ALL; OvidSP PsycINFO; Web of Science Science Citation Index Expanded; Elsevier Scopus; OvidSP Social Policy & Practice; Web of Science Social Sciences Citation Index Expanded; ProQuest Sociological Abstracts; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform; EPPI-Centre Trials Register of Promoting Health Interventions; and the OpenGrey database], and an updated search of 19 of these was conducted in April 2020. Reference lists of included reports were searched and experts were contacted.Review methodsEligible reports presented theories of change and/or process, outcome and/or economic evaluations of e-health interventions offering ongoing support to men who have sex with men to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk behaviour, alcohol/drug use and/or common mental illnesses. References were screened by title/abstract, then by full text. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised using qualitative methods. Outcome and economic data were synthesised narratively; outcome data were meta-analysed.ResultsOriginal searches retrieved 27 eligible reports. Updated searches retrieved 10 eligible reports. Thirty-seven reports on 28 studies of 23 interventions were included: 33 on theories of change, 12 on process evaluations, 16 on outcome evaluations and one on an economic evaluation. Research question 1: five intervention types were identified – ‘online modular’, ‘computer games’ and ‘non-interactive’ time-limited/modular interventions, and open-ended interventions with ‘content organised by assessment’ and ‘general content’. Three broad types of intervention theories of change were identified, focusing on ‘cognitive/skills’, ‘self-monitoring’ and ‘cognitive therapy’. Research question 2: individual tailoring based on participant characteristics was particularly acceptable, and participants valued intervention content reflecting their experiences. Research question 3: little evidence was available of effects on human immunodeficiency virus or sexually transmitted infections. The analysis did not suggest that interventions were effective in reducing instances of human immunodeficiency virus or sexually transmitted infections. The overall meta-analysis for sexually transmitted infections reported a small non-significant increase in sexually transmitted infections in the intervention group, compared with the control group. Meta-analyses found a significant impact on sexual risk behaviour. The findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health. Research question 4: evidence on cost-effectiveness was limited.LimitationsThe quality of the eligible reports was variable and the economic synthesis was limited to one eligible study.ConclusionsThere is commonality in intervention theories of change and factors affecting receipt of e-health interventions. Evidence on effectiveness is limited.Future workFuture trials should assess the impact of interventions on multiple syndemic factors, among them sexual risk, substance use and mental health; incorporate sufficient follow-up and sample sizes to detect the impact on human immunodeficiency virus/sexually transmitted infections; and incorporate rigorous process and economic evaluations.Study registrationThis study is registered as PROSPERO CRD42018110317.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.

Background: Sexual function and satisfaction are 2 important components of sexual health. Both sexual function and satisfaction of women are influenced by various internal and external factors over their life cycle. This study aims to explore the factors of sexual function and satisfaction among nonworking married women in Bengaluru using a qualitative exploratory study. Materials and Methods: This is a qualitative exploratory research study that adopted an inductive thematic data analysis. In-depth qualitative interviews were conducted with 11 nonworking working married women of Bengaluru. The interviews were audio recorded, and the transcribed data were analyzed with ATLAS.ti software. The results were presented thematically. Results: It was found that somatic and personal factors such as health and appearance, pregnancy and postpregnancy issues, compatibility between couples, and spousal qualities; psychological factors such as stressors and stabilizers that related to emotional and mental health; and situational and extrinsic factors such as pressure to conceive, child-rearing, types of family, traditional beliefs and practices, societal stigma and taboo, daily schedules of couples, and ambiance and privacy were influencing the sexual function and satisfaction of women. Conclusion: The study could find positive and negative factors of sexual function and satisfaction. These factors need further exploration with larger studies from other cultures and groups.

Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed. To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres. Staff and adult survivors in English sexual assault referral centres and partner agency staff. A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5). There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma. The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic. People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have 'complex' needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault. Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21. This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347.

ABSTRACTObjective: High rates of sexual victimization among college students necessitate further study of factors associated with sexual assault risk detection. The present study examined how social information processing relates to sexual assault risk detection as a function of sexual assault victimization history. Participants: 225 undergraduates (Mage = 19.12, SD = 1.44; 66% women). Methods: Participants completed an online questionnaire assessing victimization history, an emotion identification task, and a sexual assault risk detection task between June 2013 and May 2014. Results: Emotion identification moderated the association between victimization history and risk detection such that sexual assault survivors with lower emotion identification accuracy also reported the least risk in a sexual assault vignette. Conclusions: Findings suggest that differences in social information processing, specifically recognition of others' emotions, are associated with sexual assault risk detection. College prevention programs could incorporate emotional awareness strategies, particularly for men and women who are sexual assault survivors.