Safer Sex Messages Research Articles

(Safe) Sex on My Mind: The Effects of a Safe Sex Prime and an Alcohol Prime on Sex-Related Perceptions and Behavior

Previous research suggests that exposure to alcohol primes (i.e., stimuli associated with alcohol) affects drinkers' perceptions and behaviors. The present study investigated the effects of an environmental alcohol prime (being in a simulated bar setting) and a safe sex message prime (a public health safe sex message) on sexually active alcohol drinkers. Participants (n = 80) were assigned to one of four conditions according to priming allocation and engaged in a simulated video chat with a potential partner. They reported their sex-related self-perceptions and perceptions of a potential partner upon procedural completion. The alcohol-related environmental prime led participants to rate their potential partner as being significantly less inhibited and more sexual. The safe sex message significantly reduced reported sex-related self-perceptions and perceptions of their partners' disinhibition. There was a significant effect of primes on participants' perceptions of their partner's friendliness--participants exposed to either or both prime(s) perceived their partner as being friendlier than participants exposed to no prime. Results suggest that environmental alcohol primes may strengthen sexually active drinkers' perceptions of a potential partner's disinhibition and sexuality even before alcohol consumption begins, and that a safe sex message may moderate these effects. The presence of safe sex messages in alcohol-related environments may positively influence sexual risk decision making among sexually active drinkers.

Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey.

There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16-24 years, 5.5% in 25-34 years, 7.8% in ≥35 years, p trend =0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR=5.74, 95% CI: 1.20-27.44), followed by dating apps (aOR=2.99, 95% CI: 1.36-6.58), friends/family (aOR=2.99, 95% CI: 1.34-6.69) and social venues (e.g. bar) (aOR=2.73, 95% CI: 1.18-6.30). Group sex was strongly associated with STI positivity (aOR=6.24, 95% CI: 2.41-16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.

Sexual activities and condom use among heterosexual men and women engaged in mixed-gender group sex events in Melbourne, Australia.

Few studies investigate group sex among heterosexuals. The aim of this study was to provide an exploration of characteristics and practices among heterosexual men and women who engage in group sex. We conducted a cross-sectional survey between May 2019 and March 2020 among heterosexual men and women attending a sexual health clinic in Melbourne, Australia. Participants were asked whether they had participated in group sex (sex involving more than two participants) in the past 3months, the size of the most recent event, sexual activities in which they engaged, and condom use. Of 3277 heterosexuals surveyed (1509 women and 1768 men), the mean age was 29.9years (s.d. 8.8) and more than half (56.0%, n =1834) were born outside Australia. One in 20 participants (5.4%) had engaged in group sex in the past 3months with the number of events ranging 1-10times. Kissing was the most common activity in group sex, and women were significantly more likely to kiss a same-sex partner than men. Overall, of 165 participants who engaged in vaginal sex, 57 (34.5%) reported always using condoms and changing condoms between consecutive partners. Of the 100 men and women who had condomless vaginal sex, 79 (79.0%) received or performed fellatio after condomless vaginal sex. About two-thirds of heterosexuals who engaged in group sex neither used condoms nor changed condoms between partners in the most recent group sex event. Safe sex messages on changing condoms between partners and between sexual activities should be reinforced for sexually transmitted infections prevention.

Safer Sex Practice Among Female Chinese College Students and Its Antecedents: A Culture-Centered Approach

In response to the increasing rates of HIV/AIDS among Chinese college students, this study investigated the informational, motivational, behavioral, and cultural factors affecting female college students’ sexual behavior and safer sex practice in China. An online survey was conducted on a purposive sample of 1,247 female Chinese college students. The study lent partial support to the Information-Motivation-Behavioral Skills Model of AIDS-Preventive Behavior model in a non-U.S. context and revealed that among sexually active women, close adherence to a female gender role was associated with lower condom use in the current sexual culture in China. The findings could help public health practitioners tailor safe sex messages targeting young females.

Effect of a Community-Level HIV Prevention Intervention on Psychosocial Determinants of HIV Risk Behaviors among Young Black Men Who Have Sex with Men (YBMSM).

In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.

Differences in travel-related incidence of chlamydia by age groups, gender and destination: Sweden 2000-2013.

The absolute number of travel-related Chlamydia cases in Sweden has consistently increased between 2000 and 2013. Given the growth in international travel, we aimed to study the trends of travel-related Chlamydia incidence to determine differences and identify high-risk groups and destinations. For 2000-2013 we calculated annual Chlamydia incidence per 100,000 travels by dividing the number of notified travel-related cases by the number of travels; the latter were collected from a yearly survey among Swedish residents. For specific destinations 95% confidence intervals were calculated and monotonic yearly trends tested. The overall median annual travel-related Chlamydia incidence was higher for women than for men, but the opposite was true in age groups >25 years. For men, Thailand had the highest incidence, which was 3-7 times higher than the next highest destination in each age group. Spain, Turkey and Thailand had the highest incidence among women, but differences between countries were smaller than for men. For most destinations the yearly trends were stable. We showed different profiles for men and women and age groups in terms of high incidence destinations. This specific information could allow to better tailor safe sex messages and advocate post-travel Chlamydia testing to target groups travelling to certain destinations.

The Influence of Conversational Content on College Students’ Safe Sex Intentions: A Mixed Method Approach

Even though health campaign designers are advised to specifically focus on triggering conversations between people about health issues, there is still a lot unknown about what aspects of a conversation may contribute to safe sex behavior and intentions. Empirical research in this field so far has mainly focused on conversational occurrence rather than conversational content, and where content is taken into account, this mostly concerns self-reports. In this mixed method study, we looked into the quantitative effects of real-life conversations about safe sex, triggered by a safe sex message, on college students’ intentions related to safe sex. We then used a qualitative analysis to try and identify content-related aspects that may be related to the quantitative effects. Two weeks after filling in a questionnaire on their safe sex-related intentions, participants (N = 24) were instructed to watch and talk about a safe sex video with a conversation partner of choice, followed by filling in a questionnaire. The conversational data were analyzed qualitatively. The results suggest that the conversations increased safe sex-related intentions compared to pretest scores, and that content-related aspects such as conversational valence, type of communication behavior and behavioral determinants were related to these effects. Thus, our findings provide enhanced insight into the social norms and behavioral patterns related to safe sex, and indicate that it is important to look at conversational content in detail rather than to focus on mere conversational occurrence or quantitative effects.

If You Film It Will They Watch? Factors Associated with Willingness to View Safer Sex Messaging in Internet-Based Sexually Explicit Media.

Research on the association between viewing condomless sex in sexually explicit media (SEM) and engaging in risk behavior suggests the need for SEM-based safer sex messaging (e.g., PrEP, condom use), though few studies have considered viewer willingness to watch SEM containing HIV/STI prevention messages. Online survey data from a racially diverse sample of 859 men and women were used to investigate factors associated with willingness to watch SEM with safer sex messaging. Analyses were conducted separately for three groups: heterosexual men and other men who only report sex with women, heterosexual women and other women who only report sex with men, and gay, bisexual, and other men who have sex with men. All three groups expressed some willingness to view safer sex messages in SEM and a majority viewed the SEM industry as having some responsibility to provide this type of messaging. Factors associated with greater willingness varied across the three groups. These findings have implications for the design and implementation of safer sex messaging in SEM.

Negotiating the Edge: The Rationalization of Sexual Risk Taking Among Western Male Sex Tourists to Thailand

Every year thousands of Western men travel to Thailand as sex tourists to participate in paid-for sex. Although many of these men will use condoms to protect themselves against sexually transmitted infections (STIs), others will not, despite the risks. By applying Steven Lyng’s (1990) concept of edgework to data collected from 14 face-to-face interviews with male sex tourists in Pattaya, Thailand, and 1,237 online discussion board posts, this article explores the ways in which these men understood and sought to rationalize the sexual risks they took. We argue that notions of likelihood of infection and significance of consequence underpin these behaviors, and we identify the existence of understandings of sexual risk that reject mainstream safer-sex messages and frame condomless sex as a broadly safe activity for heterosexual men. The article concludes by summarizing the difficulties inherent in driving behavior change among this group of men, for whom sexual risks appear to be easily rationalized away as either inconsequential or irrelevant.

An Evaluation of Mpowerment on Individual-Level HIV Risk Behavior, Testing, and Psychosocial Factors Among Young MSM of Color: The Monitoring and Evaluation of MP (MEM) Project.

Young men who have sex with men (MSM) of color are at increased risk for HIV infection. Mpowerment (MP) is an intervention designed to reduce risky sexual behavior and increase HIV testing among young MSM ages 18-29. From 2009 to 2012, three community-based organizations with support from the U.S. Centers for Disease Control and Prevention evaluated MP among N = 298 participants. Following a repeated measures design, data from 3- and 6-month follow-ups were compared to baseline. HIV testing and self-efficacy for safer sex increased at both follow-up time points; self-acceptance as an MSM was higher at follow-up 2. Condomless anal/vaginal sex was lower at follow-up 1 only. Frequency of exchange of safer sex messages among gay/bisexual/transgender friends was lower at follow-up 1, but similar to baseline at follow-up 2. Exposure to MP was associated with improved perceived positive social norms about safer sex and safer sex messages among gay/bisexual/transgender friends.

Message fatigue: Conceptual definition, operationalization, and correlates

ABSTRACTDespite growing concern over the public’s fatigue toward inundated health messages, communication research has largely neglected such ramifications of prolonged, real-life campaign exposure. This paper offers an initial conceptual and empirical treatment of message fatigue, an important, but understudied, side effect of campaigns. Specifically, it proposes conceptual and operational definitions of the construct and examines psychometric characteristics of a proposed message fatigue scale. The findings from two studies concerning safe sex (N = 412) and anti-obesity messages (N = 396) demonstrated solid support for the scale’s unidimensionality. In support of construct validity, the scale exhibited significant associations with message avoidance, annoyance, information seeking, and desensitization. Moreover, in an experimental setting in Study 2, message fatigue negatively predicted attention and message elaboration, while positively predicting counterargument.

Individual and population level impacts of illicit drug use, sexual risk behaviours on sexually transmitted infections among young Aboriginal and Torres Strait Islander people: results from the GOANNA survey.

BackgroundSexually transmitted infections (STIs) have been increasing among Australian Indigenous young people for over two decades. Little is known about the association between alcohol and other drug use and sexual risk behaviours and diagnosis of STIs among this population.MethodsA cross-sectional, community based self-administered survey was conducted among young Aboriginal people aged 16–29 years of age. Questionnaires included socio-demographic characteristics, knowledge, sexual risk behaviours alcohol and other drug use and health service access including self-reported history of diagnosis with a STI. Logistic regression models and population attributable risks were used to assess individual and population level impacts of illicit drug use on high risk sexual behaviours and ever reported diagnosis of an STI.ResultsOf the 2877 participants, 2320 (81 %) identified as sexually active and were included in this study. More than 50 % of the study population reported that they had used at least one illicit drug in past year. Cannabis, ecstasy and methamphetamines were the three most commonly used illicit drugs in the past year. The prevalence of self-reported STI diagnosis was 25 %. Compared with people who did not report using illicit drugs, risky alcohol use and sexual behaviours including inconsistent condom use, multiple sexual partners in the past year and sex with casual partners were all significantly higher among illicit drug users. In adjusted analysis, participants who reported using illicit drugs were significantly more likely to engage in sexual risk behaviours and to ever have been diagnosed with an STI. Adjusted Odds Ratios ranged from 1.86 to 3.00 (males) and from 1.43 to 2.46 (females). At the population level, more than 70 % of the STI diagnoses were attributed to illicit drug-use and sexual risk behaviours for males and females.ConclusionIllicit drug use in this population is relatively high compared to other similar aged populations in Australia. Illicit drug use was associated with risky sexual behaviours and STI diagnoses among this study population. Developing and implementing effective STI prevention strategies should include not only safe sex messages but also include drug and alcohol harm reduction messages.

Evaluating the Sharing Stories youth theatre program: an interactive theatre and drama-based strategy for sexual health promotion among multicultural youth.

Issue addressed Rates of sexually transmissible infections among young people are high, and there is a need for innovative, youth-focused sexual health promotion programs. This study evaluated the effectiveness of the Sharing Stories youth theatre program, which uses interactive theatre and drama-based strategies to engage and educate multicultural youth on sexual health issues. The effectiveness of using drama-based evaluation methods is also discussed. Methods The youth theatre program participants were 18 multicultural youth from South East Asian, African and Middle Eastern backgrounds aged between 14 and 21 years. Four sexual health drama scenarios and a sexual health questionnaire were used to measure changes in knowledge and attitudes. Results Participants reported being confident talking to and supporting their friends with regards to safe sex messages, improved their sexual health knowledge and demonstrated a positive shift in their attitudes towards sexual health. Drama-based evaluation methods were effective in engaging multicultural youth and worked well across the cultures and age groups. Conclusions Theatre and drama-based sexual health promotion strategies are an effective method for up-skilling young people from multicultural backgrounds to be peer educators and good communicators of sexual health information. Drama-based evaluation methods are engaging for young people and an effective way of collecting data from culturally diverse youth. So what? This study recommends incorporating interactive and arts-based strategies into sexual health promotion programs for multicultural youth. It also provides guidance for health promotion practitioners evaluating an arts-based health promotion program using arts-based data collection methods.

P123 Drug and alcohol use in GU medicine attendees – what is the impact on sexual health?

Background/Introduction Patients attending sexual health services report higher rates of drug and alcohol use. This may lead them to ignore safer sex messages putting them at greater risk of STIs. ‘Chemsex’ has been recognised as an additional risk factor in MSMs, but it is unclear how widespread this is in heterosexual individuals or outside large conurbations. Aims/Objectives This service evaluation aimed to assess the extent of the alcohol and drug use in all patients attending a GU clinic and its impact on sexual behaviour. Methods Self-completed detailed questionnaires were incorporated into the clinic dataset for 600 consecutive patients during February 2016. Data was anonymised and analysed using SPSS v23. Results Results show 70% of women and 75% of men reported alcohol use in the last month, however fewer than 1/3 reported drug use. Men were more likely to have taken recreational drugs (37% v 25%). Fewer women than men reported engaging in chemsex (2% v 5% respectively). 25% of women and 30% of men regretted sex they had had in the last year with men more likely to attribute this to alcohol. Women reported alcohol use contributing to worse partner choice but better sex, with the converse for men. There was no association between drug and alcohol use and STI rates. Discussion/conclusion Alcohol does not appear to impact as much upon sexual behaviour as previously suggested. Chemsex is prevalent amongst heterosexuals as well as MSMs and questions on this should be incorporated into standard data collection in clinic.

Responsible men, blameworthy women: Black heterosexual men's discursive constructions of safer sex and masculinity.

Although Black heterosexual men (BHM) in the United States rank among those most affected by HIV, research about how safer sex messages shape their safer sex behaviors is rare, highlighting the need for innovative qualitative methodologies such as critical discursive psychology (CDP). This CDP study examined how: (a) BHM construct safer sex and masculinity; (b) BHM positioned themselves in relation to conventional masculinity; and (c) discursive context (individual interview vs. focus group) shaped talk about safer sex and masculinity. Data included individual interviews (n = 30) and 4 focus groups (n = 26) conducted with 56 self-identified Black/African American heterosexual men, ages 18 to 44. Analyses highlighted 5 main constructions: (a) condoms as signifiers of "safe" women; (b) blaming women for STI/responsibility for safer sex; (c) relationship/trust/knowledge; (d) condom mandates; and (e) public health safer sex. Discourses positioned BHM in terms of conventional masculinity when talk denied men's agency for safer sex and/or contraception, or positioned women as deceitful, or apathetic about sexual risk and/or pregnancy. Notably, discourses also spotlighted alternative masculinities relevant to taking responsibility for safer sex or sexual exclusivity. Discursive context, namely the homosocial nature of focus group discussions, shaped how participants conversed about safer sex, and masculinity but not the content of that talk. In denying BHM's responsibility for safer sex, BHM's discourses about safer sex and masculinity often mirror public health messages, underscoring a critical need to sync these discourses to reduce sexual risk, and develop gender-transformative safer sex interventions for BHM.

A new public health context to understand male sex work.

BackgroundResearching male sex work offers insight into the sexual lives of men and women while developing a more realistic appreciation for the changing issues associated with male sex work. This type of research is important because it not only reflects a growing and diversifying consumer demand for male sex work, but also because it enables the construction of knowledge that is up-to-date with changing ideas around sex and sexualities.DiscussionThis paper discusses a range of issues emerging in the male sex industry. Notably, globalisation and technology have contributed to the normalisation of male sex work and reshaped the landscape in which the male sex industry operates. As part of this discussion, we review STI and HIV rates among male sex workers at a global level, which are widely disparate and geographically contextual, with rates of HIV among male sex workers ranging from 0% in some areas to 50% in others. The Internet has reshaped the way that male sex workers and clients connect and has been identified as a useful space for safer sex messages and research that seeks out hidden or commonly excluded populations.Future directionsWe argue for a public health context that recognises the emerging and changing nature of male sex work, which means programs and policies that are appropriate for this population group. Online communities relating to male sex work are important avenues for safer sexual messages and unique opportunities to reach often excluded sub-populations of both clients and male sex workers. The changing structure and organisation of male sex work alongside rapidly changing cultural, academic and medical discourses provide new insight but also new challenges to how we conceive the sexualities of men and male sex workers. Public health initiatives must reflect upon and incorporate this knowledge.

Sexual health screening in people living with HIV--are we getting the whole story?

Patients' notes were audited to evaluate sexual health screening in 385 people living with HIV. A total of 76% were offered sexually transmitted infection (STI) screening; 85% of these accepted; 62% reported regular partners of whom 44% were also people living with HIV. In men who have sex with men (MSM), 64% reported consistent condom use for anal sex; of these, 15% had rectal STIs diagnosed. Of all patients, 62% reported monogamous relationships; in this MSM sub-group, 12% had STIs diagnosed. STIs are still being diagnosed despite continued safe sex messages and significantly in those reporting monogamous relationships and consistent condom use. Sexual history and safe sex education should be integral to routine care and STI screening offered annually regardless of sexual history as recommended by 2013 British HIV Association Standards of Care for People Living with HIV. More frequent STI screening may be required in high-risk patients.

Seeking sex online: social and sexual risk factors among adolescent and young gay and bisexual men.

Background With the increased use of the Internet to seek sex, research has documented its associated sexual risk behaviours, especially among gay and bisexual men. Only a few studies to date have been conducted among adolescent and young men, and these have focussed on behavioural components to do with seeking sex online, without considering the role of same-sex identity formation processes. The current study aimed to identify behavioural and identity formation variables associated with seeking sex online among adolescents and youth. A web sampling of young Israeli gay and bisexual men aged 12-30 years (n=445) was used to assess their seeking sex online characteristics, mental health, sexual risk behaviours, substance use, same-sex disclosure and acceptance and coping resources. Nearly half of the sample used the Internet to seek sex, which was correlated with substance use and sexual risk behaviour. Young adults seek for sex online more commonly than adolescents. Higher numbers of: sexual partners, level of outness, levels of friends support and stronger connectedness to the gay community predicted seeking sex online. Seeking sex online was found to be more of predictor for sexual risk behaviour than any other predictor. Seeking sex online is influenced by the gay sub-culture climate and peer group relationships, rather than by social stressor variables related to sexual orientation formation processes, or by the subject's general mental health condition. These results underscore the possible risks pertaining to seeking sex among gay and bisexual men and the possible use for this venue to convey safe-sex messages to adolescents and young adults.

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O23.2 Correlates of Inconsistent Condom Use During Anal Sex with Female Sex Workers (FSWs) Among Male Clients: Survey Findings from Three High Prevalence States of India

BackgroundRecent studies from India show that self-reported anal sex increased from 3% to 22% among female sex workers. However, comparable data from male clients’ of FSWs are lacking. Using data...