Abstract

Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women.Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading).Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners.Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.

Highlights

  • Experiences of trauma and stress across the life span influence the development of adverse health outcomes and engagement in behaviors that threaten health and wellness.[1,2,3] Sexual health outcomes in the context of traumatic and stressful experiences are of particular interest due to the (1) interpersonal transmission of sexually transmitted infections (STIs); (2) lifelong health impact of STIs when untreated or are recurrent or those a Natalie Leblanc et al 2020; Published by Mary Ann Liebert, Inc

  • The current study investigates the relationship of these experiences with three specific sexual health outcomes and behaviors: lifetime history of STIs, current partner concurrency, and lifetime sex trading

  • Bivariate analysis (Table 3) revealed that lifetime sex trading was the single dependent variable significantly associated with most predictors

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Summary

Introduction

Experiences of trauma and stress across the life span influence the development of adverse health outcomes and engagement in behaviors that threaten health and wellness.[1,2,3] Sexual health outcomes in the context of traumatic and stressful experiences are of particular interest due to the (1) interpersonal transmission of sexually transmitted infections (STIs); (2) lifelong health impact of STIs when untreated or are recurrent (i.e., infertility, pelvic inflammatory disease) or those a Natalie Leblanc et al 2020; Published by Mary Ann Liebert, Inc. Sexual health involves a sex-positive perspective on sexuality, sexual relationships, and sexual behaviors that incorporates experiences free of coercion and violence, and prevention and/or treatment of diseases transmitted sexually.[5] Threats to sexual health can involve individual behaviors, interpersonal and ecological factors that heighten one’s exposure to acquiring or transmitting an STI, or a context that compromises volitional control over one’s sexuality, sexual behavior, and sexual safety.[5,6,7]. A hierarchical block analysis was conducted to investigate associations between women’s experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency.

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