Same-sex Preference Research Articles

Multiparity favors same-sex partner preference in male rats

Same-sex partner preference is present in many mammals, including rodents. Several possible causal factors have been proposed for the establishment of this preference. The Fraternal Birth Order effect refers to the observation that older brothers increase the probability of homosexuality in men, but no experiment has analyzed this possibility. In this study, partner preference (tested in a three compartments box) and female and male sexual behavior (studied in a cylindrical arena) were evaluated in young male rats (3 months) born to multiparous mothers that had 4-6 previous gestations and around 12 months of age. Control groups were young male rats born to primiparous young (4 months) or aged (12 months) mothers. In the partner preference test, the males born to multiparous dams spent less time interacting with the receptive female and more time interacting with the sexually active male, and a 39% exhibited same-sex partner preference. This high percentage seems related to multiparity of their mothers and not to maternal age, because the males born to primiparous aged females (12 months) showed a similar low proportion of same-sex partner preference than the males born to young (4 months) primiparous females (4%). In the sexual behavior tests, no male born of a multiparous dam and with same-sex preference ejaculated and 54% displayed proceptivity and lordosis. Present results suggest that the fraternal birth order effect may occur also in rats.

Distribution of estrogen receptors alpha and beta in the brain of male rats with same-sex preference

Two distinct estrogen receptors (ERs) exist, ERα and ERβ. Both receptors participate in sexual differentiation of the rat brain and likely participate in the regulation of adult sexual orientation (i.e. partner preference). This last idea was investigated herein by examining males treated with the aromatase inhibitor, letrozole, administered prenatally (0.56 μg/kg G10–22). This treatment usually provokes same-sex preference in 1–2 males per litter. Vehicle-treated males (with female preference) and females in spontaneous proestrus (with male preference) were included as controls. ERα and ERβ expression was analyzed by immunohistochemistry in brain areas known to control masculine sexual behavior and partner preference, like the medial preoptic area (MPOA), bed nucleus of the stria terminalis (BNST), medial amygdala (MeA) and ventromedial hypothalamic nucleus (VMH), as well as other brain regions suspected to participate in these processes. In addition, serum levels of estradiol were determined in all male groups. Letrozole-treated male rats that preferred sexually experienced males (LPM) showed over-expressed ERα in the hippocampal cornu Ammonis (CA 1, 3, 4) and dentate gyrus. The LPM group showed up-regulated ERβ expression in the CA2 and reticular thalamic nucleus. The levels of estradiol did not differ between the groups. Higher expression of ERs in these males was different than their expression in females, with male sex-preference. This suggests that males with same-sex preference showed a unique brain, this sui generis steroid receptor expression probably participates in the biological underpinnings of sexual preference.

From bespectacled, bearded and bald to explosions, potions and vaccines: Irish children’s changing perceptions of scientists and the effect of the COVID-19 pandemic on those perceptions

ABSTRACT Concern that stereotypical perceptions of scientists may influence attitudes towards science and willingness to pursue STEM-related careers has motivated interest in children’s perceptions of scientists. This study investigated primary children’s drawings of scientists at work based on Chambers’ ‘Draw-A-Scientist Test’ (DAST) and explored the influence of living during the COVID-19 pandemic on perceptions of scientists. One hundred and ninety-four children participated in the study; school closures interrupted the study resulting in fifty-one participating during the COVID-19 pandemic. Stereotypic views of scientists that increased with age were revealed; differences between age groups were statistically significant. Drawings frequently depicted smiling lab-coated males working indoors using chemistry equipment. Boys incorporated significantly more stereotypic views in their drawings than girls. Same-sex preference for drawings of scientists was evident with female scientists drawn only by girls; however, this same sex preference weakened for girls, and they drew more male scientists as they got older. The absence of many traditional stereotypical indicators and presence of positive dispositions towards scientists and their work were welcome findings. There was greater awareness of the work of scientists amongst younger participants and a shift to broader conceptions of this work, both associated with living during the COVID-19 pandemic.

Let's Talk about Sex… and ADHD: Findings from an Anonymous Online Survey.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity. A dearth of studies have investigated psychosexuality in this population, often with few (predominantly male) participants. We recruited individuals with and without ADHD via an anonymous online survey distributed electronically by ADHD support organizations and social media. We investigated sexual history; interests and practices; and relationships. Of 1392 respondents, we classified an 'ADHD' group (n = 541; 30.5% male) and compared them to individuals of similar ages without ADHD, ('Other' group; n = 851; 37.6% male). The ADHD group (both males and females) had a significantly higher preference for same-sex or either-sex partners; and higher rates of electronic sexual exchanges, masturbation, and sexually transmitted diseases. They were more adventurous in sexual interests and practices and substantially less satisfied with their partners, both sexually and generally. Within the ADHD group, significant sex differences emerged: females had younger onset of sexual activities, used contraception less frequently, had more sexual partners and practiced more infidelity. Sexual interests differed between the sexes, but females more commonly acted on them, whereas males did not. Findings suggest both sexes engage in risky sexual behaviors, perhaps driven by impulsivity, but risk is substantially greater for females with ADHD.

Androgen receptors immunoreactivity in the rat brain of males with same-sex preference

Androgen receptors (AR) are crucial in the control of male sexual behavior and sex preference. AR are particularly concentrated in areas related with the neuroendocrine control of sex preference including the medial amygdala (MeA), the ventromedial nucleus of the hypothalamus (VMH), the bed nucleus of the stria terminalis (BNST), the medial preoptic area (MPOA), the nucleus accumbens (Acb), the suprachiasmatic (SCh) and supraoptic (SO) nuclei, but also seem to be important for the control of reproductive processes in the hippocampus (CA1-CA4 and dentate gyrus, DG). In the present study we analyzed the density of AR in these brain areas of adult male rats with sexual preference (established in a three-compartment box). Same-sex preference was produced in male rats by the prenatal administration of the aromatase inhibitor, letrozole (0.56 μg/kg/ml s.c. G10-22) that usually produces 1–2 animals per litter with same sex preference, while the others retain a female sex preference. We also included a group of proestrus females that had a clear preference for a sexually active male. AR were analyzed by immunocytochemistry using PG21 as primary antibody. We also measured total plasma testosterone concentrations by radioimmunoassay. In males with same sex preference there was a specific AR overexpression in CA3 and CA4 that suggests a feminized pattern because females in proestrus trend to show a higher density of AR in these hippocampal areas. Sex differences in AR density were found in the anterior cingulate cortex (ACg) and frontoparietal cortex (FrPa). Serum levels of testosterone did not differ between groups. Data are discussed based on the role of AR in the hippocampus.

Life in Rainbow Colors: Homosexuals Experiences

The term homosexuality has changed depending on the historical and social context. Although, in the past, significant progress was made in accepting homosexuality, the social exclusion of homosexuals is still not uncommon. Yet, the existence of certain barriers such as homophobic behavior and various forms of violence does not prevent a homosexual person from revealing their homosexual identity. That is why this research aims to examine the experiences of homosexual people regarding the quality of their lives. In this context, research questions were formulated regarding participants’ experience in terms of same-sex preferences, hiding sexual orientation, feelings of exclusion, same-sex relationships and having children, and opinions about Gay Pride. The paper presents the results of research conducted in 2021 using the method of semi-structured interviews on a sample of twelve participants in the Republic of Croatia. The research has found that understanding their homosexuality represents a stressful period of their lives as well as the process of coming out, which they decide on most often during puberty and adolescence. The participants generally did not experience social exclusion, violence, and rejection. They would like to have children, and adoption would be the most likely option. In their opinion, there is no difference between raising children in a homosexual and a heterosexual family. Most of them are satisfied with their lives, and Gay Pride is considered important, especially in terms of increasing the visibility and rights of homosexuals.

Factors and scenarios influencing Arab Americans’ preference for male versus female physicians

As the Arab American community sees an increase in female physicians, knowledge of patients' perceptions is necessary to foster the physician-patient relationship. The objective of this study was to better understand physician gender preference among Arab Americans when given a range of selected medical scenarios. An anonymous survey was distributed electronically through social media. The survey elicited gender preferences of Arab Americans given different scenarios. Data was collected from 325 participants. No physician gender preference was noted for 6 out of 7 scenarios with the exception for sensitive medical issues. Same-sex gender preference was noted in the cases of sensitive medical issues, routine medical visits, medical emergencies, and minor medical procedures. Predominant visitations to male physicians across specialties was found. The current study shows that although most Arab Americans expressed no preference for physician gender, the majority currently visit male physicians. The study highlights similarities to other populations in terms of same-sex physician gender preference when it comes to patient choices. Our study shows, however, that physicians’ experience and empathy were leading criteria as opposed to gender or Arab identity when it came to physician selection by Arab American patients.

Homosexuality in K. Sello Duiker’s The Quiet Violence of Dreams: Demythologising the Imaginings and Universalising the Reality

Sello Duiker’s The Quiet Violence of Dreams offers an extensive treatment of homosexuality, a preoccupation which, until recently, is rare in black African fiction. On this account, as well as its depth and openness, the work has attracted some critical attention. It has been read from a masculinity perspective, as a coming-out novel, as a national allegory, as a work that challenges the notion of fixed sexuality, as a work that normalises same-sex sexuality, and so forth. Unlike these studies, this article examines the representation and disquisition around same-sex preference in the novel, with a view to demonstrating how some myths about homosexuality are exploded in the groundbreaking work, and showing that the narrative could also be apprehended as intellectual advocacy for the right to same-sex orientation.

Meta-Analyses of Fraternal and Sororal Birth Order Effects in Homosexual Pedophiles, Hebephiles, and Teleiophiles.

This study investigated the relations between numbers of older brothers, numbers of older sisters, and the odds of homosexuality in later-born males, including males who are most attracted sexually to prepubescent or early pubescent children (pedohebephiles) and males who are most attracted sexually to adults (teleiophiles). The authors meta-analyzed data from 24 samples of homosexual and heterosexual men, originally reported in 18 studies, and totaling 18,213 subjects. The results confirmed that older brothers increase the odds of same-sex preference in pedohebephiles as they do in teleiophiles. They also replicated the recent finding that older sisters have a similar but weaker statistical association with the odds of homosexuality. These findings have two theoretical implications. First, the findings for older brothers and older sisters indicate some commonality in the factors that influence sexual preference in teleiophiles and those that influence sexual preference in pedohebephiles. Second, the finding for older sisters confirms a prediction stemming from the hypothesis that male fetuses stimulate maternal antibodies that increase the odds of homosexuality in later-born males. Such immunization could result from miscarried as well as full-term fetuses, and number of older sisters should correlate with number of male fetuses miscarried before gestation of the subject.

Juvenile social dynamics reflect adult reproductive strategies in bottlenose dolphins

AbstractThe juvenile period is a challenging life-history stage, especially in species with a high degree of fission–fusion dynamics, such as bottlenose dolphins, where maternal protection is virtually absent. Here, we examined how juvenile male and female bottlenose dolphins navigate this vulnerable period. Specifically, we examined their grouping patterns, activity budget, network dynamics, and social associations in the absence of adults. We found that juveniles live in highly dynamic groups, with group composition changing every 10 min on average. Groups were generally segregated by sex, and segregation was driven by same-sex preference rather than opposite-sex avoidance. Juveniles formed strong associations with select individuals, especially kin and same-sex partners, and both sexes formed cliques with their preferred partners. Sex-specific strategies in the juvenile period reflected adult reproductive strategies, in which the exploration of potential social partners may be more important for males (which form long-term alliances in adulthood) than females (which preferentially associate with kin in adulthood). Females spent more time alone and were more focused on foraging than males, but still formed close same-sex associations, especially with kin. Males cast a wider social net than females, with strong same-sex associations and many male associates. Males engaged in more affiliative behavior than females. These results are consistent with the social bonds and skills hypothesis and suggest that delayed sexual maturity in species with relational social complexity may allow individuals to assess potential associates and explore a complex social landscape without the risks associated with sexual maturity (e.g., adult reproductive competition; inbreeding).

Lack of interaction between prenatal stress and prenatal letrozole to induce same-sex preference in male rats

Same-sex partner preference between males has been observed in all species in which this behavior has been studied. Disruption of brain estradiol synthesis during development has been proposed as one of the biological causes underlying this behavior in some mammals. In support of this possibility, perinatal administration of aromatase inhibitors (such as letrozole) to male rat pups, induces around half of them to have same-sex preference and female sexual behavior in adulthood. Another putative factor that modifies sex preference is prenatal stress. Several stress protocols, applied to the pregnant dam, cause some of the adult male progeny to have an increased male preference, a decreased preference for the female, and lordosis behavior. Interestingly, these effects of stress might be mediated by its inhibitory action on brain aromatase. The aim of the present study was to analyze a possible interaction between these two factors in male rats. Pregnant dams were exposed to one of the four treatments across gestation days 10–22 (G10–G22): 1) vehicle-treated non-stressed controls; 2) letrozole (0.56 µg/kg); 3) 30 min immobilization stress); 4) both letrozole and stress combined. The male offspring were tested in adulthood for partner preference in a three-chambered arena, where we also recorded the masculine and feminine sexual behaviors. One week later males were tested for masculine and feminine sexual behavior in cylindrical arenas where they interacted for 30 min with a receptive female and thereafter with a sexually active male for another 30 min. Letrozole, stress and their combination resulted in same-sex preference in 40, 31 and 50% of males, respectively, compared to 5% in the control group. In the sexual behavior tests, prenatal stress reduced the percentage of males displaying intromissions and ejaculation (impaired masculinization), while letrozole mainly increased lordosis (impaired defeminization). The males prenatally submitted to stress and treated with letrozole presented these behavioral features but did not differ from both treatments given independently. The results indicate that the changes induced by stress or the aromatase inhibition produced by letrozole only accounts for a shift in partner preference in around half of the males and that there was no interaction between these two factors.

Female degus show high sociality but no preference for familiar peers

Group-living animals vary in social behavior across multiple dimensions, including in the selectivity of social interactions with familiar versus unfamiliar peers. Standardized behavioral tests can be used to tease apart different dimensions of behavior. These serve a dual function—on one hand, helping to isolate behavioral factors that may support collective behavior in natural habitats, and, on another, providing a basis for comparative approaches to understanding physiological mechanisms of behavior. Degus (Octodon degus) are South American caviomorph rodents that nest and forage in groups with relatively low genetic relatedness. Flexibility in group membership is likely supported by gregariousness toward strangers, but the relative preference for strangers compared with familiar individuals has not been systematically tested. We assessed the specificity of social preferences in female degus using a same-sex partner preference test. Degus huddled extensively with both familiar and unfamiliar peers, with no average preference for one over the other. Detailed analysis of social interactions demonstrated an effect of familiarity on social investigation and aggressive behaviors, indicating that degus distinguished between familiar and unfamiliar conspecifics, even though it did not impact huddling. This behavioral profile is thus far unique to degus; in similar tests, meadow and prairie voles exhibit strong partner preferences for known peers, while mice exhibit low social huddling and spend relatively less time in social chambers. Understanding how group-living species differ in specific aspects of social behavior such as familiarity/novelty preference and propensity for social contact will offer a foundation to interpret differences in neural systems supporting sociality.

Fear of crime and preference for aggressive-formidable same-sex and opposite-sex friends

Previous research has found that when faced with dangerous environments, women may have an evolved preference for physically strong and aggressive men. This phenomenon has been named as the Bodyguard hypothesis. The aim of the present studies was to explore whether the same principle exists in non-romantic male friend selection. In Study 1, (n = 118), an on-line sample of British women was assessed for objective crime rates in their childhood and current environment, subjective vulnerability to crime, and preference for aggressive and formidable opposite-sex friends. Women’s subjective fear of crime predicted their preference for aggressive-formidable ideal male friends, as well as aggressive-formidable actual male friends. In Study 2 (n = 228), an internet sample of both sexes was assessed for their subjective fear of crime, as well as their preference for aggressive-formidability and other characteristics in same and opposite-sex friends. Fear of crime was not correlated with characteristics (intelligence, funniness, kindness) that were unrelated to aggressive-formidability. There was a small positive correlation between fear of crime and preference for aggressive-formidable friends in both sexes. The correlation between fear of crime and preference for ideal male friend’s aggression-formidability was the only statistically significant one, and none of the correlations differed significantly from each other. Together, these two studies provide some tentative evidence for the Bodyguard hypothesis in preferred friendship characteristics. Environmental influence on friendship selection is an under-investigated area of research, benefiting from future research replicating the methodology from studies on romantic partner characteristics.

Establishment of partner preference in male rats: Effect of prenatal letrozole and sexual experience

Repeated testing for masculine sexual behavior influences female sex preference in males. Males perinatally treated with aromatase inhibitors show male preference, but also copulate with the receptive female. Such copulation modifies sex preference most likely because of its rewarding properties. In this study, we intended to equal the incentive value of both stimuli -in the sex preference test- by using receptive females with vaginal occlusion. Vehicle and letrozole-treated (0.56 μg/kg, gestation days 10–21) males were repeatedly tested for sex preference at 40, 55, 70, 85 and 100 days of age. These ages were selected because males of 40 days are unable to copulate, while by 100 days of age almost all males show the complete repertoire of masculine sexual behavior. At 40 days of age, males of all groups fail to show sex preference and none of them was able to copulate. In controls of 100 days of age all males showed female-sex preference and all intromitted the female. A large proportion (44%) of vehicle-treated males that could not copulate the female showed male preference. Twenty to 30% of the prenatally letrozole treated males also had same-sex preference even if they could copulate; and most of them (67%) had a male preference when copulation was precluded. These data support the idea that copulation is crucial for developing a female preference in control animals. The results suggest that brain changes produced by estrogens along early development and stimuli coming from the partner are essential for shaping sex preference.

\u201cWe are not gays\u2026 don\u2019t tell me those things\u201d: engaging \u2018hidden\u2019 men who have sex with men and transgender women in HIV prevention in Myanmar

BackgroundIn Myanmar, HIV is concentrated among key populations, yet less than half of the estimated 250,000 men who have sex with men (MSM) and transgender women (TW) report recent HIV testing. As many as 50% of MSM and TW may conceal their same-sex preferences and behaviors, yet little is known about the barriers faced by those who are locally regarded as ‘hidden’ – that is, MSM who do not disclose same-sex preferences and/or identify as gay. This study explored specific barriers to accessing HIV testing and other prevention services among ‘hidden’ MSM to inform appropriate models of service delivery.MethodsIn-depth interviews with MSM (n = 12) and TW (n = 13) and focus group discussions (FGD) with MSM and TW community members, leaders and key informants (n = 35) were undertaken in Yangon during June – September 2015. Participants were recruited by word-of-mouth by trained peer data collectors. Responses to questions from semi-structured guides were transcribed and coded using Atlas Ti. Codes were based on key domains in the guides and applied to transcripts to identify and analyze emerging themes.ResultsFear of stigma and discrimination and the need to meet gender expectations were key reasons for non-disclosure of same-sex preferences and behaviors; this typically manifested as avoidance of other MSM and settings in which sexual identity might be implicated. These concerns influenced preference and interaction with HIV services, with many avoiding MSM-specific services or eschewing HIV testing services entirely. The difficulties of engaging hidden MSM in HIV prevention was strongly corroborated by service providers.ConclusionHidden MSM face multiple barriers to HIV testing and prevention. Strategies cognizant of concerns for anonymity and privacy, such as One-Stop Shop services and online-based health promotion, can discretely provide services appropriate for hidden MSM. Enhanced capacity of peer-service providers and mainstream health staff to identify and respond to the psychosocial challenges reported by hidden MSM in this study may further encourage service engagement. Overarching strategies to strengthen the enabling environment, such as legal reform and LGBTI community mobilisation, can lessen stigma and discrimination and increase hidden MSM’s comfort and willingness to discuss same-sex behavior and access appropriate services.

Male rats with same-sex preference show higher immobility in the forced swim test, but similar effects of fluoxetine and desipramine than males that prefer females

Sex preference in male rats is partly determined by the organizational action of estradiol. Thus, several paradigms have used aromatase inhibitors to manipulate sex preference. We recently showed that a subpopulation of male rats prenatally treated with letrozole (0.56 μg/kg, G10–G22), a non-steroidal third generation aromatase inhibitor, had same-sex preference, female sexual behavior (including lordosis and proceptivity) and penile erections when exposed to other males. These males, in addition, displayed high levels of experimental anxiety in the plus maze test and were insensitive to the anxiogenic-like acute effect of FLX (10 mg/kg). The two main purposes of the present work were: a) to study the behavioral profile of males displaying same-sex preference in the forced swim test (FST), and b) to analyze if the antidepressant-like effect of the subchronic treatment with FLX (10 mg/kg, 3 times) or desipramine (DMI, 10 mg/kg, 3 times) vary according to sex preference. Males treated prenatally with letrozole with same-sex preference showed more immobility and less active behaviors (swimming and climbing) in the FST than males with female preference. Subchronic treatment with FLX and DMI reduced immobility when compared to saline controls, while FLX increased swimming and DMI increased climbing behavior. Treatments were equally effective in males with preference for other males and those that preferred females. These results indicate that an association exists between prenatal letrozole treatment, same-sex preference and immobility in the FST.

Brain activation associated to olfactory conditioned same-sex partner preference in male rats

Sexual preferences can be strongly modified by Pavlovian learning. For instance, olfactory conditioned same-sex partner preference can occur when a sexually naïve male cohabits with an scented male during repeated periods under the effects of enhanced D2-type activity. Preference is observed days later via social and sexual behaviors. Herein we explored brain activity related to learned same-sex preference (Fos-Immunoreactivity, IR) following exposure to a conditioned odor paired with same-sex preference. During conditioning trials males received either saline or the D2-type receptor agonist quinpirole (QNP) and cohabitated during 24 h with a stimulus male that bore almond scent on the back as conditioned stimulus. This was repeated every 4 days, for a total of three trials. In a drug-free final test we assessed socio/sexual partner preference between the scented male and a receptive female. The results indicated that QNP-conditioned males developed a same-sex preference observed via contact, time spent, olfactory investigations, and non-contact erections. By contrast, saline-conditioned and intact (non-exposed to conditioning) males expressed an unconditioned preference for the female. Four days later the males were exposed to almond scent and their brains were processed for Fos-IR. Results indicated that the QNP-conditioned group expressed more Fos-IR in the nucleus accumbens (AcbSh), medial preoptic area (MPA), piriform cortex (Pir) and ventromedial nucleus of the hypothalamus (VMH) as compared to saline-conditioned. Intact males expressed the lowest Fos-IR in AcbSh and VMH, but the highest in MPA and Pir. We discuss the role of these areas in the learning process of same-sex partner preferences and olfactory discrimination.

Olfactory conditioned same-sex partner preference in female rats: Role of ovarian hormones

The dopamine D2-type receptor agonist quinpirole (QNP) facilitates the development of conditioned same-sex partner preference in males during cohabitation, but not in ovariectomized (OVX) females, primed with estradiol benzoate (EB) and progesterone (P). Herein we tested the effects of QNP on OVX, EB-only primed females. Females received a systemic injection (every four days) of either saline (Saline-conditioned) or QNP (QNP-conditioned) and then cohabited for 24h with lemon-scented stimulus females (CS+), during three trials. In test 1 (female-female) preference was QNP-free, and females chose between the CS+ female and a novel female. In test 2 (male-female) they chose between the CS+ female and a sexually experienced male. In test 1 Saline-conditioned females displayed more hops & darts towards the novel female, but QNP-conditioned females displayed more sexual solicitations towards the CS+ female. In test 2 Saline-conditioned females displayed a clear preference for the male, whereas QNP-conditioned females displayed what we considered a bisexual preference. We discuss the effect of dopamine and ovarian hormones on the development of olfactory conditioned same-sex preference in females.

Sexual and non-sexual social preferences in male and female white-eyed bulbuls

While the function of ornaments shaped by sexual selection is to attract mates or drive off rivals, these signals may also evolve through social selection, in which the social context affects the fitness of signallers and receivers. Classical ‘mate choice’ experiments often reveal preferences for ornaments, but few studies have considered whether these are strictly sexual or reflect general social preferences. Indeed, an alternative possibility is that ornaments evolve through ‘non-sexual social selection’ (hereafter ‘social selection’). We examined the role of ornamentation (yellow ventral patch) and familiarity (individuals recognize group mates with which they have had previous interactions) on mate choice (opposite-sex stimuli preference) and social choice (same-sex stimuli preference) in both male and female white-eyed bulbuls (Pycnonotus xanthopygos). In the mate choice test, females preferred unfamiliar males with increased yellow. There were no biologically important differences in male preferences based on familiarity or intensity of patch colour. In the social choice test, females preferred to associate with familiar females. Males preferred to associate with familiar males but also preferred to associate with less ornamented males. Our results suggest that ornamentation and familiarity are important features, playing different roles in males and females, in both social and sexual selection processes.

HIV Bio-behavioral Risk Study Implementation in Resource-poor Military Settings

ObjectiveWe present lessons learned from over a decade of HIV bio-behavioral risk study implementation and capacity-building inAfrican militaries.IntroductionCircumstances within the military environment may place militarypersonnel at increased risk of contracting sexually transmittedinfections (STI) including HIV. HIV bio-behavioral risk studiesprovide a critical source of data to estimate HIV/STI prevalenceand identify risk factors, allowing programs to maximize impact byfocusing on the drivers of the epidemic.MethodsSince 2005, RTI has provided technical assistance (TA) to supportHIV/STI Seroprevalence and Behavioral Epidemiology Risk Surveys(SABERS) in 14 countries across Sub-Saharan Africa and Asia.SABERS are cross-sectional studies consisting of a survey to assessknowledge, attitudes and behaviors related to HIV, coupled with rapidtesting for HIV and other STIs. RTI tailored each survey instrument tobe culturally appropriate in content and methodology, trained militarypersonal to serve as data collection staff, and provided logisticalsupport for study implementation.ResultsKey lessons learned are summarized below:Data collection mode varied from paper-based to computer-assisted surveys, depending on country preference, in-country staffcapabilities, and the country’s technological capacity. Computer-assisted data collection systems were preferable because theyimproved data quality through the use of programmed skip patterns,range, and consistency checks. By eliminating the need for data entry,computer-assisted systems also saved program resources and enabledfaster access to the data for analysis.Survey administration method varied from self-administeredto interviewer-administered surveys. Literacy rates, technologicalfamiliarity, and confidentiality concerns were key drivers indetermining the best data collection method. Self-administeredsurveys such as computer-assisted self-interview (CASI) werepreferable due to the high-level of confidentiality they provide,but required a high-level of literacy and computer familiarity.If confidentiality was a big concern in low-literacy settings, audiocomputer-assisted self-interview (ACASI) was used if the populationhad some computer familiarity. Interviewer-administered surveyssuch as computer-assisted personal interview (CAPI) were used inmost low-literacy settings.Tailoring the survey instrument and administration for culturalappropriateness was vital to the acquisition of sound, viable data.Sexual behaviors and the definition of “regular sexual partner”and other terms varied according to local custom. The sensitivenature of the survey questions also impacted survey administrationoperationally. The preference for same-sex or opposite sexinterviewers varied by country and military setting. It was imperativeto pre-test the survey.A skilled workforce and staff retention are essential to providehigh quality data. Literacy levels, technological familiarity, HIVknowledge, and time commitments must all be considered whenselecting data collection staff. Retention of staff throughout theduration of data collection activities can be a major issue especiallyamong military personnel who were often called away from studyactivities to perform military duties.Host military ownership was integral to the success of the SABERSprogram. By engaging military leadership early and involving themin all decision making processes we ensured the partner military wasinvested in the study and its success and found value in the resultingdata and findings. Host militaries were actively involved in SABERSby providing staff for data collection, leading sensitization activities,and monitoring data collection activities in the field.Inclusion of capacity building elements during studyimplementation led to increased host military buy-in. Capacitybuilding included staff trainings and practical experience in surveymethodology, use of electronic data collection instruments, studylogistics and data monitoring.Confidentiality of survey data and HIV test results was of increasedconcern given that these studies were conducted in a work placeenvironment. For this reason, it was imperative to assure participantsthat disclosures of drug or alcohol use and positive HIV/STI testresults would remain confidential and would not affect their militaryemployment.ConclusionsBased on our experience, the following are required for thesuccessful implementation of an HIV Bio-behavioral Risk Study inresource-poor military settings: (1) selection of a data collection modeand survey administration method that is context-appropriate, (2)utilization of local wording and customs, (3) a skilled workforce, (4)local buy-in/partnership, (5) inclusion of capacity building elements,and (6) assurance of confidentiality.