Sexual Episodes Research Articles

Why do people make noises in bed?

Many primates produce copulation calls, but we have surprisingly little data on what human sex sounds like. I present 34 h of audio recordings from 2239 authentic sexual episodes shared online. These include partnered sex or masturbation, but each recording has only one main vocalizer (1950 female, 289 male). Both acoustic features and arousal ratings from an online perceptual experiment with 109 listeners recruited on Prolific follow an inverted-U curve, revealing the likely time of orgasm. Sexual vocalizations become longer, louder, more high-pitched, voiced, and unpredictable at orgasm in both men and women. Men are not less vocal overall in this sample, but women start moaning at an earlier stage; speech or even minimally verbalized exclamations are uncommon. While excessive vocalizing sounds inauthentic to listeners, vocal bursts at peak arousal are ubiquitous and less verbalized than in the build-up phase, suggesting limited volitional control. Human sexual vocalizations likely include both consciously controlled and spontaneous moans of pleasure, which are perhaps best understood as sounds of liking rather than signals specific to copulation.

The Impact of Making Proud Choices! on Youth's Sexual Health Attitudes, Knowledge, and Behaviors

PurposeTo estimate the effect of the Making Proud Choices! (MPC) curriculum, one of the most popular evidence-based teen pregnancy prevention curricula being implemented nationwide. MethodsA cluster randomized trial was used to assign high schools to receive the MPC program or to serve as a standard care comparison group. The study took place in 15 schools in four cities in the United States. A total of 31 clusters and over 2,800 youth (predominantly in grades 9 and 10) were assigned to condition between 2016 and 2019. Student surveys administered at baseline and approximately 9 months after baseline were used to estimate the effects of MPC on risk and protective factors (knowledge, attitudes, self-efficacy) as well as sexual behavior outcomes. ResultsThe evaluation showed several large, statistically significant, and favorable impacts on nearly all of the risk and protective factors for risky sexual behavior. In addition, the study found a favorable effect of MPC on reducing the number of episodes of sex in the past 3 months. DiscussionThe evaluation showed that MPC, as it is commonly implemented today, has evidence of effectiveness on improving both risk and protective factors, and sexual behavior outcomes. Based on these findings, MPC will continue to be seen as an evidence-based teen pregnancy prevention program for implementation through federal grant programs.

Lower 6-minutes walk test result and presence of cardiovascular risk factors linked to healthcare facility visits of pilgrims: the importance of fitness in hajj pilgrimage

Abstract Background Hajj pilgrimage, a mandatory religious practice for the Muslims, is a physical rite attributed heavily on the fitness of the participants due to increased workload in performing its activities. The 6-minutes walk test is a simple assessment to predict candidates’ fitness level. Objective We sought to determine the association between pilgrim candidate fitness level, determined by 6-minutes walk test result during predeparture preparation, as well as pre-existing potential risk factors of hajj pilgrim participants. Method In this retrospective cohort, we obtained the data of 2022 pilgrimage participants from Indonesian Ministry of Religious Affairs, consisting of demographic characteristics, anthropometric indexes, medical history, physical examination, and functional exercise capacity predicted by 6-minute walk test conducted during pre-departure preparation. Baseline demographic, bivariate tests for each variable, and multivariate test were analyzed by IBM SPSS 26. Result There was significant correlation between age of ≥60 (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p < 0.001), 6-minutes walk test (p < 0.001), smoker status (p = 0.008), high LDL-C (p = 0.026), obesity (p =0.033), female sex (p = 0.043) and healthcare visit episode of pilgrims. The risk ratio value for low result group of 6-minutes walk test (< 500 meters) against outpatient incidence during hajj period was 1.08 (95% CI; 1.04 -1.12). It indicated that the inability of reaching >500 meters in 6-minutes walk test is related to outpatient incidence by 1.08 times. Conclusion There is a slight increase in healthcare visit incidence in pilgrims with low result of 6-minutes walk test. The 6-minutes walk test, a simple and reproducible assessment of fitness level, may provide useful information to improve preparation of pilgrimage.

Evidence for cryptic sex in parthenogenetic stick insects of the genus Timema.

Obligately parthenogenetic species are expected to be short lived since the lack of sex and recombination should translate into a slower adaptation rate and increased accumulation of deleterious alleles. Some, however, are thought to have been reproducing without males for millions of years. It is not clear how these old parthenogens can escape the predicted long-term costs of parthenogenesis, but an obvious explanation is cryptic sex. In this study, we screen for signatures of cryptic sex in eight populations of four parthenogenetic species of Timema stick insects, some estimated to be older than 1 Myr. Low genotype diversity, homozygosity of individuals and high linkage disequilibrium (LD) unaffected by marker distances support exclusively parthenogenetic reproduction in six populations. However, in two populations (namely, of the species Timema douglasi and T. monikensis) we find strong evidence for cryptic sex, most likely mediated by rare males. These populations had comparatively high genotype diversities, lower LD, and a clear LD decay with genetic distance. Rare sex in species that are otherwise largely parthenogenetic could help explain the unusual success of parthenogenesis in the Timema genus and raises the question whether episodes of rare sex are in fact the simplest explanation for the persistence of many old parthenogens in nature.

Relationship Between Criminal and Status Offense Behaviors, Substance Use, and HIV Risk Among Adolescent Girls and Young Women in Cape Town, South Africa

AbstractThis study aimed to examine the relationship between externalizing behaviors, substance use, and sexual risk among adolescent girls and young women (AGYW) in Cape Town, South Africa, who experience social disadvantage characterized by poverty and school dropout. We analyzed baseline data from 500 AGYW in a cluster-randomized trial who had dropped out of school. Multivariate logistic regression models explored associations between self-reported criminal behaviors and other status offenses, heavy episodic drinking, polydrug use, and condomless sex. Engagement in status offenses was associated with heavy episodic drinking (OR = 3.56, 95% CI: 2.05–6.20), while crimes against other people were associated with polydrug use (OR = 1.65, 95% CI: 1.03–2.63). Drug-related illegal behavior was associated with polydrug use (OR = 7.78, 95% CI: 3.53–8.69) and reduced odds of condom use during last sexual episode, after adjusting for drug use (OR = 0.56, 95% CI: 4.00–5.15). As externalizing behaviors are prevalent among this sample of AGYW and associated with greater likelihood of problem substance use and condomless sex, interventions to improve the physical and mental well-being of AGYW should assess for and address engagement in criminal and status offenses.

Combinations of Sexual Activities During a Sex Episode with Recent Casual Male Partner Among Men Who Have Sex with Men: A Cross-Sectional Study

ABSTRACT We examined combinations of nine sexual activities that occurred during a sex episode with a recent male partner among men who have sex with men (MSM) who attended an urban sexual health clinic from April-2017 to September-2017. We collected the following sexual activities: tongue-kissing, penises touching, using saliva during mutual masturbation, performed rimming, received rimming, performed fellatio, received fellatio, insertive anal sex, and receptive anal sex. During a single-sex episode, the most common combinations of sexual activities involved all nine activities (10.6%, 166/1542). We assessed the agreement between any two sexual activities that occurred together during a sex episode. Agreement was highest for receiving rimming and receptive anal sex (kappa = 0.40; 95% CI: 0.35, 0.45), and performing rimming and insertive anal sex (kappa = 0.38; 95% CI: 0.33, 0.42). Agreement was lowest for insertive anal sex and receiving fellatio (kappa = −0.01; 95% CI: −0.05, 0.03), and receptive anal sex and insertive anal sex (kappa = −0.08; 95% CI: −0.13, 0.03). The sexual activities that occur between men are correlated with one another and this will influence transmission between anatomical sites.

Pre-exposure prophylaxis in real life: experience from a prospective, observational and demonstration project among men who have sex with men in Benin, West Africa.

Since many countries in sub-Saharan Africa are willing to implement HIV oral pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate-TDF 300 mg and emtricitabine-FTC 200 mg (TDF-FTC) was offered daily or on-demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month-6 and month-12, participants answered to a face-to-face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. Overall, 204 HIV-negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month-3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month-6 and month-12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self-reported), that is seven pills taken during the last week. For event-driven PrEP, the corresponding proportions for perfect adherence (last seven at-risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month-12 (p-value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month-6) and 36% (month-12). Three HIV seroconversions (2-daily and 1-event-driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31-4.50)/100 person-years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month-12 (p-value = 0.017). In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP.

Seeing Fotis: Slavery and Gender in Apuleius’ Metamorphoses

The portrayal of the enslaved woman Fotis in Apuleius’ Metamorphoses exposes the intersection of gender, sexuality, and slavery. Apuleius’ novel allows a window into interactions beyond the relationship of slaveholder and the enslaved person over whom s/he claimed dominium. Centering Fotis in Apuleius’ narrative shows how a discourse of slavery worked: an enslaved woman is made present as a body that may be sexualized and surrounded with fantasies of sex and violence. The sexual episodes of Lucius and Fotis reveal an aesthetic, facilitated by the system of slavery, of consuming bodies, watching bodies consumed by violence, and framing effacement and degradation as romance, an operation of power at the core of chattel slavery.

Sexual risk behaviours among factory workers in Shenzhen, China: a cross-sectional study.

Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. A total of 2029 factory workers were included. Mean age was 37.2 (±4.4)years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24-0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05-0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96-4.69 and AOR 2.19, 95% CI 1.33-3.60), local workers (AOR 2.11, 95% CI 1.01-4.42 and AOR 3.42, 95% CI 1.63-7.21), being single (AOR 2.04, 95% CI 1.39-3.01 and AOR 2.49, 95% CI 1.61-3.87), having sexual debut aged Conclusions : Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China.

Sexual Harassments Related to Alcohol and Drugs Intake: The Experience of the Rape Centre of Turin.

A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the "Centro Soccorso Violenza Sessuale" (SVS) of the Sant'Anna Hospital in Turin between 1 January 2008, and 31 December 2017. Two hundred twenty-two patients were enrolled, 25 of which were minors, 141 were Italians, and most of them knew their aggressor and were raped in a private home. One hundred and fifty-five of them declared to the healthcare personnel to have taken alcoholic substances and/or drugs in conjunction with the event (86 reported having drunk alcohol, 36 having taken drugs and 33 disclosed both alcohol and drug abuse). If the woman knew her abuser, alcohol consumption was described as voluntary in more than 80% of cases, while in relation to drugs the consumption was equally voluntary or fraudulent. About 73% of women who reported having drunk alcohol just had amnesia or amnesia related to other symptoms, while amnesia was present in about 63% of women who reported only drug use. Physicians observed physical injuries on 156 women. Patients who reported to have assumed alcohol presented a significantly higher risk to suffer any physical injury and have a significantly increased risk to suffer injuries to their head and/or neck. The results obtained underline how even in Northern Italy alcohol intake represents the most widespread psychoactive substance in case of drug-facilitated sexual assault. There is therefore a need to promote education and prevention campaigns among citizens, especially among the youngest.

Depressive Dysfunctional Attitudes and Post-Traumatic Stress in Victims of Terrorist Attacks

ABSTRACT The DSM-5ʹs new conception of post-traumatic stress disorder (PTSD) includes, as a diagnostic criterion, the presence of persistent and exaggerated negative beliefs, thoughts, or expectations about oneself, others, the world, and one’s guilt. These symptoms increase the symptomatic similarity with major depressive disorder (MDD) and with the negative cognitive triad of Beck’s cognitive theory of depression and allow us to assume that the dysfunctional attitudes that this theory proposes as a vulnerability factor for MDD could also refer to PTSD. This study aims to examine the relationship between depressive dysfunctional attitudes and the symptoms and diagnosis of PTSD. A sample of 378 adult victims of terrorism completed measures of depressive dysfunctional attitudes (DAS-A), DSM-IV post-traumatic stress symptoms (PCL-S), depressive symptoms (BDI-II), and DSM-IV diagnosis of emotional disorders (SCID-I). A significant relationship was found between depressive dysfunctional attitudes and PTSD symptomatology, even after controlling for the effect of depression, sex, age, education level, anxiety, and previous depressive episodes. It was also found that victims with PTSD, with or without MDD, had more depressive dysfunctional attitudes than those without emotional disorders and more achievement-perfectionism attitudes than victims with emotional disorders other than PTSD or MDD. The results suggest that depressive dysfunctional attitudes could be a vulnerability factor for PTSD. The results also suggest the need to refine Beck's cognitive theory proposals about dysfunctional attitudes common and specific to each emotional disorder and identify potential therapeutic targets of cognitive therapies for these disorders.

The Incidence Rate of Sexual Behaviors Among Cisgender Men Who Have Sex with Men Attending a Sexual Health Clinic.

Although nuanced parameterization of sexual behavior may improve estimates from mathematical models of human immunodeficiency virus and sexually transmitted infection transmission, prospective estimates of the incidence of specific sexual behaviors among men who have sex with men (MSM) are limited. From December 2014 to July 2018, MSM with and without nongonococcal urethritis (NGU) completed weekly diaries over 3-12weeks. Incidence rates of any sex, receptive anal sex, insertive anal sex, insertive oral sex, receptive rimming, and receptive hand-penile contact were 1.19, 0.28, 0.66, 0.90, 0.24, and 0.85 episodes per person-week, respectively, among 104 MSM with NGU at baseline, and 1.33, 0.54, 0.32, 0.95, 0.44, and 0.88 episodes per person-week, respectively, among 25 MSM without NGU at baseline. Most receptive anal sex (NGU + 83%, NGU - 86%) and insertive anal sex (NGU + 85%, NGU - 76%) episodes were condomless. MSM engaged in sex just over once per week, and condom use was infrequent. Insertive oral sex and receptive hand-penile contact were the most common behaviors.

Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape.

Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.

The Information-Motivation-Behavioral Skills Model and Unprotected Sex: Assessing the Model's Utility and Predictability Among Bar Patrons in Tshwane, South Africa.

The Information-Motivation-Behavioral skills (IMB) model has been a useful tool for understanding sexual risk behavior. However, its utility in predicting sexual risk behaviors among bar patrons, for whom the bar setting poses a higher risk of alcohol-related sexual risk behavior, has been underexplored. We assessed (1) the extent to which the IMB predicted number of episodes of unprotected sex in the past six months and (2) whether incorporating sex under the influence of alcohol and alcohol use improved the predictability of the model among bar patrons. Hierarchical regression models were conducted on data from 406 men and women from bars in rural areas of North-West province, South Africa. Behavioral skills were the sole IMB variable to predict unprotected sex with main partners (β = - 0.40; p < .001), explaining 18% of the variance. Variance explained increased to 21% with addition of sex under the influence of alcohol (β = 0.13; p = .019) and further increased to 26% with the addition of alcohol use (β = 0.24; p < .001). Motivation (β = - 0.21; p = .006) and behavioral skills (β = - 0.21; p = .006) were the significant IMB predictors of unprotected sex with casual partners (explaining 15% of the variance). Variance explained increased to 22% with the addition of sex under the influence of alcohol (β = 0.26; p = .001), but alcohol consumption was not an independent predictor of episodes of unprotected sex with casual partners. Interventions for improving HIV prevention behaviors among bar patrons should focus on enhancing individuals' behavioral skills and motivation and reducing their alcohol consumption.

Rechallenge after anti-tuberculosis drug-induced liver injury in a high HIV prevalence cohort.

BackgroundThere are limited data on the outcomes of rechallenge with anti-tuberculosis therapy (ATT) following anti-tuberculosis drug-induced liver injury (AT-DILI) in a high HIV prevalence setting.ObjectivesTo describe the outcomes of rechallenge with first-line ATT.MethodHospitalised participants with AT-DILI who were enrolled into a randomised controlled trial of N-acetylcysteine in Cape Town, South Africa, were followed up until completion of ATT rechallenge. We described rechallenge outcomes, and identified associations with recurrence of liver injury on rechallenge (positive rechallenge).ResultsSeventy-nine participants were rechallenged of whom 41 (52%) were female. Mean age was 37 years (standard deviation [s.d.] ±10). Sixty-eight (86%) were HIV-positive, of whom 34 (50%) were on antiretroviral therapy (ART) at time of AT-DILI presentation. Five participants had serious adverse reactions to an aminoglycoside included in the alternate ATT regimen given after first-line ATT interruption: acute kidney injury in three and hearing loss in two. The median time from first-line ATT interruption to start of first-line ATT rechallenge was 13 days (interquartile range [IQR]: 8–18 days). Antiretroviral therapy was interrupted for a median of 32 days (IQR: 17–58) among HIV-positive participants on ART before AT-DILI. Fourteen participants had positive rechallenge (18%). Positive rechallenge was associated with pyrazinamide rechallenge (P = 0.005), female sex (P = 0.039) and first episode of tuberculosis (TB) (P = 0.032).ConclusionRechallenge was successful in most of our cohort. Pyrazinamide rechallenge should be carefully considered.

Alignment of PrEP use and sexual behavior over four months among men who have sex with men in the southern United States.

Unlike antiretrovirals for HIV treatment, pre-exposure prophylaxis (PrEP) does not require continual adherence to be fully effective; rather, PrEP adherence is important only in the context of episodes of sexual risk. Therefore, studies of PrEP adherence and persistence must incorporate contemporaneous measurement of sexual behavior. Short, frequent surveys of PrEP use and sexual behavior allow for the measurement of the alignment between PrEP use and sexual behavior. We assessed the feasibility of using biweekly PrEP use and sexual behavior questionnaires to measure adherence and persistence on PrEP over a period of four months. We also measured the alignment of PrEP use and condomless anal sex. PrEP-using MSM in the southern US were recruited using online advertisements. Participants completed a baseline survey followed by brief surveys every two weeks for 16 weeks to report their PrEP use and sexual behavior over the preceding two-week period. Study retention was high: 91% of participants completed the baseline and final survey and, overall, 86% of study surveys were completed. Self-reported PrEP adherence and persistence were high, but instances of PrEP non-adherence were observed to frequently overlap with episodes of condomless anal sex. The most prominent reasons cited for missing PrEP doses were being too busy, not having PrEP on hand, and not being sexually active. Completing short, biweekly surveys of PrEP use and sexual behavior is feasible and acceptable to MSM in the southern US. Future studies should investigate incorporating biomarker measurements to validate self-reported adherence.

Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad.

BackgroundSyphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.MethodsA cross-sectional study was conducted during the period September 2020-June 2021 among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.ResultsTwo hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33 years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264) and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI, 1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.ConclusionThere is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission dynamics of T pallidum infection in this population, thus urgent public health prevention interventions are warranted.

PrEP acceptability and initiation among women engaged in sex work in Uganda: Implications for HIV prevention.

SummaryBackgroundWomen engaged in sex work (WESW) are disproportionately affected by HIV. In Uganda, HIV prevalence among WESW is estimated at 37%, accounting for 18% of all new infections in the country. WESW experience poverty, gender-based violence, and other issues that reduce their power and limit their ability to negotiate condom use. Female-controlled strategies, including pre-exposure prophylaxis (PrEP), may afford women more transmission protection, but barriers to access and use persist. This cross-sectional study examined baseline PrEP acceptability and initiation among WESW recently enrolled in a randomized clinical trial in Uganda to test the impact of a combination HIV risk reduction and economic empowerment intervention on sexual risk outcomes (clinicaltrials.gov, NCT03583541).MethodsA total of 542 WESW from 19 high HIV-prevalent geographical areas were enrolled in the Kyaterekera study between June 2019 and March 2020. Women were eligible for the study if they: (1) were age 18 or over; (2) reported engagement in transactional sex (a sex act in exchange for pay) in the past 30 days; and (3) reported engagement in one or more episodes of unprotected sex in the past 30 days. Women completed a baseline assessment, were tested for HIV and other sexually transmitted infections (STIs) at enrollment, and were connected with antiretroviral therapy (ART), STI treatment, or PrEP, based on need and interest. Descriptive statistics examined baseline data on PrEP acceptability and initiation. Independent variables (i.e. years in sex work, recent sexual coercion, perceived HIV and sex work stigmas, harmful alcohol use, barriers to medical care, and social support) were derived from the empirical literature and women's self-report. Bivariate analysis was performed to test associations between main effects of these variables. Using binomial logistic regression, predictive models were evaluated for two distinct outcomes—PrEP acceptability and PrEP initiation/uptake.FindingsAt baseline, 59% of women (n = 322) tested HIV negative. Among WESW testing negative, 11% (n = 36) were already PrEP enrolled. Most women reported willingness to use PrEP (n = 317; 91%). Slightly over half of WESW not already on PrEP agreed to initiate PrEP (n = 158; 55%). Logistic regression models demonstrate that acceptability of or willingness to use PrEP was significantly associated with fewer years engaged in sex work (AOR= ·18, 95% CI 0·05-·66, p<·01) and greater perceived social support from family (AOR= 1·39, 95% CI 1·03 -1.88, p<·05). PrEP initiation was negatively associated with greater perceived social support from friends (AOR=·81, 95% CI ·68–0·97, p<·05) and positively associated with higher perceived stigma due to sex work among family members (AOR=2·20, 95% CI 1·15–4·22, p<·05).InterpretationDespite endorsing PrEP use, many WESW remain reluctant to use it. This gap in prevention practice highlights the heart of a failing PrEP prevention cascade. Findings point to the important role family and friend support may play in destigmatizing sex work and PrEP use for women. Social and structural-level efforts are needed to improve educational messaging and to integrate positive messaging into health promotion campaigns for women and their families, while also working toward decriminalizing sex work.FundingThis paper was made possible with funding from United States National Institute of Mental Health (Grant number: R01MH116768).

Framing Sexual Refusal Experiences among Emerging Adult Women: Politeness Theory in Unscripted Territory

ABSTRACT Although sexual refusal can be a complex, face-threatening interpersonal exchange, the nuances of these encounters are often overlooked by sexual and consent education messages. To examine this phenomenon more closely, the current study analyzed emerging adult college women’s descriptions of past sexual refusal episodes to better understand how they frame their sexual refusal experiences in terms of face needs and risks, and the cultural roles and scripts are reflected in the descriptions of sexual refusal. Two primary frames emerged through the analysis: Refusal as successful and refusal as failure. Thematic characteristics within each frame are examined in terms of politeness theory and face needs, as well as the broader cultural sexual scripts that impact norms surrounding who, how, when, and if sexual refusal can occur. Theoretical implications include consideration of how the discourse of U.S. sexual consent education emerges in the findings, the limitations of politeness theory in understanding sexual refusal, and suggest alternative theoretical approaches.

Sexual Function in Women With Differences of Sex Development or Premature Loss of Gonadal Function

Previous studies have suggested that sexual function may be compromised in women born with differences of sex development (DSD) or early loss of gonadal function. To describe sexual function and sexual wellbeing in women with complete androgen insensitivity syndrome (CAIS), complete gonadal dysgenesis (GD) and premature ovarian insufficiency (POI) in relation to gynecological measures and in comparison with unaffected women. A cross sectional study including 20 women with CAIS, 8 women with 46,XY GD, 8 women with 46,XX GD, 21 women with POI, and 62 population-derived controls. Study participants underwent gynecological examination for anatomical measurements and evaluation of tactile sensitivity. They responded to the validated Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and the Personal Distress Scale (PDS). The women with CAIS, XY GD, XX GD and POI showed overall satisfying sexual function in comparison to unaffected age-matched population female controls with a median of 1 to 2 satisfying sexual episodes per week among both the patients and the controls depending on available partner. Women with CAIS had shorter vagina and smaller clitoris and women with XY GD had a significantly shallower vagina in comparison to controls. Clitoral width was also significantly smaller among women with XX GD compared to controls. However, results showed overall good genital touch sensitivity with no significant differences between groups. Women with DSD or POI can be informed on overall satisfactory sexual function and normal genital touch sensitivity. The strength is the use of age-matched population-based controls to these rare conditions of DSD and POI. Limitations are the nonresponder rate of recruited controls, as well as the small groups of women with DSD. Women with differences of sex development or early loss of gonadal function show overall good sexual well-being, however clinicians have to make efforts to optimize caretaking and treatment to ensure good sexual quality of life for all patients.