Sexual Decision-making Research Articles

Perceptions, experiences and concerns with sexually transmitted infections among current and former PrEP users: a longitudinal qualitative study of gay, bisexual and queer men in Canada.

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n =18) and British Columbia (n =20), Canada, as part of a mixed-methods implementation science study (2020-2022). Over 3years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

How Racism and Discrimination Impacts Black Young Women’s Sexual Health: The Influence of Racial and Sexual Stereotypes on Educational Access

PurposeStructural racism and racial discrimination may increase adverse sexual health outcomes in Black adolescent girls. However, the influence of racism on sexual health has not been well-described in qualitative studies. The purpose of this study was to explore definitions of structural racism and determine how experiences of racial discrimination impact sexual health and decision-making in a sample of adolescent Black girls. MethodsBlack girls aged 13–19 years were recruited from an ongoing longitudinal study. Virtual focus groups and individual interviews were facilitated, inquiring about understandings of structural racism, experiences with discrimination, and factors that influence sexual health decision-making and healthcare-seeking. Transcripts were professionally transcribed and coded by two independent, blinded team members. Thematic content analysis was used to identify emergent themes. ResultsFour themes emerged as follows: (1) slavery and medical racism in the United States impact the sexual and reproductive health (SRH) choices of Black girls; (2) stereotypes and oversexualization of Black girls are considered a barrier to SRH education; (3) adults serve as both barriers and facilitators to SRH and resource utilization; and (4) Black girls often seek information from friends or social media outlets to make SRH decisions. DiscussionReproductive health education for Black girls should integrate historical influences of systemic oppression. Practitioners should include reproductive justice to build trust in clinical and community spaces. Engaging caregivers in health education may reduce barriers for youth to engage in care.

Discrimination based on gender identity and decision-making regarding HIV/STI-protected sex, a cross-sectional study among trans and non-binary people in Germany

BackgroundTrans and non-binary people are often discriminated against. Discrimination has a negative impact on health and may affect sexual health and behavior. We explored the relationship between discrimination based on gender identity and the perceived ability to make decisions about their sex life to feel as protected as desired from HIV and sexually transmitted infections (STI) among trans and non-binary people in Germany. Secondarily, we assessed whether feeling unable of making HIV/STI-protected sex decisions was associated with behaviors related to increased HIV/STI risk.MethodsWe conducted a cross-sectional study using data from the Sexual Health and HIV/STI in Trans and Non-Binary Communities (TASG) survey conducted online between March-July 2022 among trans and/or non-binary people aged 18 years and older living in Germany. We described the prevalence of frequent discrimination based on gender identity. We calculated prevalence ratios (PR) with 95% confidence intervals (95% CI) for the associations between frequent experienced discrimination based on gender identity and feeling unable of making HIV/STI-protected sex decisions, and between feeling unable of making HIV/STI-protected sex decisions and behaviors related to increased HIV/STI risk.ResultsAmong 3077 participants, 22% reported frequent discrimination based on gender identity. Participants experiencing such discrimination reported 1.4 times more often to feel unable to make HIV/STI-protected sex decisions (PR 1.4, 95% CI 1.1–1.8). This perceived inability was associated with increased prevalence of sex under drug influence (PR 2.9, 95% CI 2.3–3.7) and condomless penetrative sex with multiple partners without PrEP (PR 2.0, 95% CI 1.4–2.9).ConclusionFeeling unable to make decisions to feel protected from HIV/STI among trans and non-binary people was associated with both frequent discrimination and behaviors that increase the HIV/STI risk. Strategies for empowering trans and non-binary people to assert their sexual decision-making needs should be explored.

Health Workers' Attitudes Toward Adverse Gender Norms and Implications for Young People's Sexual and Reproductive Health in Nigeria.

Adverse gender norms within the health care system are detrimental to the sexual and reproductive health of young people. This study assessed the attitudes of health workers toward adverse gender norms related to intimate partner relationships across three domains: intimate partner violence (IPV); sexuality; and reproductive health behavior. A cross-sectional quantitative survey was conducted among 255 health workers in youth-friendly primary health centers in Ebonyi State, Nigeria. Attitudes to gender norm statements were assessed on a 3-point scale of agree (3 points), partially agree (2 points), and disagree (1 point). Mean attitude scores were estimated for each statement and the predictors of attitudes were determined through multiple linear regression analysis with p-value set at .05. Majority of the health workers held gender biases regarding male control over sexual decision-making, men's higher desire and value for sex, and the woman's responsibility to prevent pregnancy. Over 40% of the respondents associated women carrying condoms with promiscuity, and 39.6% believed that only men have the "social" rights to purchase condoms. Urban residence predicted health workers' attitudes to adverse gender norms related to sexuality (β = -.179, p = .003). Findings from this study provide a basis for in-service training programs that are designed to change the attitudes of health workers to adverse gender norms and transform their practices.

Large Language Models in an App: Conducting a Qualitative Synthetic Data Analysis of How Snapchat’s “My AI” Responds to Questions About Sexual Consent, Sexual Refusals, Sexual Assault, and Sexting

ABSTRACT Comprehensive sexual health education for young people often remains largely inaccessible, leaving gaps in knowledge about sexual consent, refusals, sexual assault, and sexting. Snapchat’s My AI, tailored to its users, offers accessible and potentially stigma-free responses to sexual health queries, showing promise in addressing these gaps. This study aimed to evaluate My AI’s effectiveness in handling questions related to sexual communication, assault, and sexting, and its response consistency across users. Collaborating with young adults and leveraging prior literature, our team formulated questions on sexual consent, refusals, sexual assault, and sexting submitted to My AI by 15 researchers. Each team member opened a chat with My AI in Snapchat and asked it a set of questions in the same order. We then conducted a qualitative content analysis to assess for consistency across users. My AI responses emphasized the importance of clear, honest consent and refusal communication through physical contact or direct conversation. With potential experiences of sexual assault or sexting, it advised consultation with a trusted caregiver. While My AI provided similar responses across researchers, variations were noted. My AI’s responses mirrored common sexual health education messages and the responses used language reflective of sympathy toward potential assault victims or those who were asked for sexual images. My AI’s potential to enhance accessibility to sexual health information could empower young people in making informed sexual health decisions. However, variability in responses may limit impact and comprehension, underscoring the importance of educators complementing these tools.

Evaluation of the Sources of Sexual Knowledge and Information among Men in Kenya

AbstractSources of sexual knowledge and information among men have impact on quality of their sexual literacy and decision making. Sexual knowledge impacts on sexual attitudes, which underpin sexual behaviours and in turn impacts the sexual health outcomes of men. A cross-sectional quantitative survey was used to assess the sources of sexual knowledge and information among 484 Kenyan adult men aged 18–54. Data analysis was performed with STATA-16. Results showed that 79% of men learned about sex from school-based sex education, 75% and 72% from peers and mass media respectively while healthcare professionals (35%) and parents (28%) had the lowest influence on sexual knowledge and information. Understanding men’s sources of sexual knowledge and information that informs their sexual decision making can influence sexuality education planning and sexological practice policies targeted to out of school youths and older men. Hence, appraising formal peer educator’s knowledge could provide transformative sexual and reproductive health support services to men.

How does integration of comprehensive sexuality education in schools shape sexuality decisions among adolescents in Zambia?: A community based participatory research driven realist evaluation study protocol

How does integration of comprehensive sexuality education in schools shape sexuality decisions among adolescents in Zambia?: A community based participatory research driven realist evaluation study protocol

A Qualitative Analysis of Victims' Perceptions of Procedural Justice for Sexual Victimization.

Sexual violence is a prevalent crime that is heavily underreported. Police behaviors when responding to such crimes can influence decisions to report. Furthermore, there is a dearth of knowledge on the relationship between procedural justice tenets (e.g., dignity/respect, trustworthiness, fairness/neutrality, and having a voice) and survivors of sexual violence decisions to report. The current study uses 55 semistructured interviews with survivors of sexual violence across the United States to explore procedural justice tenets on individuals' decisions to report their victimization (or not). Findings underscore the importance for police to interact with survivors with tenets of dignity/respect. Practical implications are further discussed.

The State of Sex Education in Pakistan: The Way Forward

Sex education has been found to be associated with informed sexual decision making and enhanced sexual well-being. But in Pakistan, sex education has been remained a subject of taboo and stigma and has been associated with a number of myths. This article tries to discuss the current state of sex education in Pakistan by justifying the need for the sex education and uncovering the factors responsible for the non-implementation of sex education on mass level in Pakistan. Two major factors considered responsible for a lack of implementation of sex education are several myths associated with the sex education and portrayal of sex education as fundamentally non-Islamic. This article analyzes the scientific validity of several myths associated with the sex education and proposes that sex education is not against the Islamic traditions and values. The sex education needs to be embedded in existing cultural and educational setup of Pakistan so that it may be accepted. This study highlights the comprehensive nature of United Nations Educational, Scientific and Cultural Organization (UNESCO) guidelines in the development and implementation of sex education and explores the implementation of sex education under the umbrella of Life Skills Based Education (LSBE) developed by the School Education and Literacy Department of Government of Sindh. This article further proposes steps to implement LSBE on mass level by involving parents, religious leaders, teachers, provincial education boards, and universities. It is further suggested that LSBE should be delivered as part of traditional educational system in a step by step manner and should be in accordance with the cultural norms of Pakistan.

Adaptation and psychometric assessment of a sexual and reproductive empowerment scale in Arabic among refugee and non-refugee adolescent girls.

Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study.

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.

The Impact of Socioeconomic Factors on HIV Prevalence and Treatment Accessibility in Nigeria: A Comprehensive Review

HIV/AIDS remained a major public health challenge in Nigeria, with approximately 1.9 million people living with HIV (PLHIV), making it one of the most affected countries globally. This comprehensive review explored the impact of socioeconomic factors on HIV prevalence and treatment accessibility in Nigeria, focusing on key determinants such as poverty, education, gender inequality, and geographic disparities. Poverty exacerbated the risk of HIV infection by limiting access to prevention resources and creating barriers to treatment, while educational disparities affect awareness and prevention behaviors. Gender inequality, particularly in patriarchal societies, increases women’s vulnerability to HIV due to limited control over sexual health decisions and economic dependence. Geographic disparities, especially between urban and rural areas, contributed to uneven HIV prevalence and treatment access, with rural regions often facing significant healthcare infrastructure challenges. Additionally, the strength of health system infrastructure and funding played a crucial role in shaping the effectiveness of HIV services, with underfunding and reliance on external donors posing significant risks to sustainability. The methodology used in this article involved a review and synthesis of existing literature and data on HIV/AIDS in Nigeria, emphasizing the socioeconomic determinants of the epidemic. Addressing these factors required targeted interventions, such as strengthening social protection programs, enhancing education, promoting gender equality, improving healthcare infrastructure, and ensuring sustainable funding. These efforts were essential for reducing HIV prevalence and improving treatment outcomes in Nigeria. Keywords: HIV/AIDS, Socioeconomic determinants, Nigeria, Healthcare infrastructure, Gender inequality.

Examining the Relationship Between Condom Use Self-Efficacy, Sexual Empowerment, and Sexual Health Knowledge Among Latino College Men

Despite recent increases in institutional efforts to improve sexual health safety, few studies have explored Latino college men’s sexual risk behaviors. Considering prior research examining links between sexual risk behaviors and factors such as condom use self-efficacy, sexual health knowledge and education, and sexual empowerment, it is critical to examine their influence on Latino college men’s sexual health in the context of cultural values and sexual scripts. Quantitative cross-sectional design and linear regression models were utilized to analyze responses from 177 Latino college men attending a Hispanic Serving Institution (HSI) in the Southeastern region of the United States (U.S.). Our findings revealed that higher satisfaction with sexual health knowledge and education when obtained from informal sources such as family members and peers significantly increased condom use self-efficacy. Contrastingly, greater levels of sexual empowerment significantly decreased Latino college men’s condom use self-efficacy. Findings underline the importance of considering the dynamic interaction of multilevel factors and the sexual decision-making process from a developmentally appropriate, evidence-based, and culturally syntonic lens to address sexual risk behaviors among Latino college men students.

The Judge's Paradigm In Deciding Criminal Cases Of Sexual Violence From A Victimological Perspective

Criminal acts of sexual violence are widespread in society, and the aim of the research is to study and analyze a decision. The research methods used by researchers are normative juridical with case, statutory, and philosophical approaches. The primary legal material is the Sexual Violence Crime Law and Decision Number 72/Pid.Sus/2023/PN.Bau. while secondary materials: books, journals, etc., the interpretation used is grammatical and systematic interpretation. The results of the research show that the paradigm used by the Panel of Judges does not have a victimology perspective, as evidenced by the statement expressed by the victim witness who explained that the defendant was not the perpetrator of a crime of sexual violence, while the actual perpetrator had been appointed by the victim witness based on the photo submitted by the Counselor. The law and the perpetrator are still at large, while the defendant was legally and convincingly found guilty of committing the crime of sexual immorality. Therefore, the Panel of Judges ignored the facts of the trial. Apart from that, the panel of judges did not interpret the victim's witness statement as a standalone piece of evidence as regulated in the Sexual Violence Crime Law. So the author's suggestion is that it is important for the judge to have the victim's perspective, in this case, what the victim said is information that must be acknowledged at trial and It is necessary to evaluate the panel that examined and decided the case.

A comprehensive view of adolescent sexual health and family planning from the perspective of Black and Hispanic adolescent mothers in New York city

Black and Hispanic adolescents in New York City experience high rates of pregnancy and sexually transmitted infections. A comprehensive understanding of the complexity of adolescent sexual health and family planning decisions and experiences can provide insights into the sustained disparities and inform practice, policy, and future research. The goal of this study was to explore and analyze this complexity, centering Black and Hispanic adolescent mothers as the experts on sexual and reproductive experiences from pre-pregnancy through parenting. As part of formative research for a human-centered design study, we interviewed 16 Black and Hispanic adolescent mothers living in New York City. Using situational analysis, we mapped relationships, discourse, and social structures to explore the various factors that inform adolescent sexual health decisions, in particular choices about contraception. Situational analysis found that, besides interpersonal factors, organizations and non-human elements like social media and physical birth control devices affected adolescent family planning in three social arenas: home, healthcare, and school. Within and across these arenas, adolescents lacked consistent sexual health education and contraceptive counseling and faced gendered expectations of their behaviors. Participants described parents and healthcare providers as most responsible for providing sexual health counseling yet described parents as uncomfortable or overreactive and healthcare workers as paternalistic and biased. A consideration of the many factors that inform sexual health decision-making and recognition of adolescents’ desire for parents and healthcare providers to be a source of education can address health disparities and promote adolescent sexual health and wellbeing.

Safety and Pleasure Motives Determine Perceived Risks and Rewards in Casual Sex

AbstractPeople differ in their predispositions to value safety maintenance (i.e., disease prevention regulatory focus) or pleasure pursuit (i.e., pleasure promotion regulatory focus). Extending recent research, results of a cross-sectional study with participants living in Portugal and Spain (N = 770) showed that these individual differences resulted in a trade-off between potential health risks and pleasure rewards in sexual practices and experiences with casual partners. Specifically, people who were more focused on promotion (vs. prevention) reported riskier and more unrestricted sexual activities (more frequent condomless sex activities; more casual partners) and experienced more positive sexual outcomes (more sexual satisfaction; more positive and less negative affect related to condomless sex). This pattern of results remained the same after controlling for country differences, suggesting the robustness of our findings across different cultural contexts. Our study shows the complexity of sexual decisions and align with our reasoning that prevention-focused people tend to prioritize health safety, whereas promotion-focused people tend to prioritize sexual pleasure. Theoretical and applied implications are discussed.

Unveiling the Path: A Qualitative Study on the Initial Sexual Experiences of Cambodian Adolescents.

There still remains a significant gap in understanding the sexual and reproductive health challenges faced by adolescents, particularly in the context of early sexual activity, teenage pregnancy, and sexually transmitted diseases. This study seeks to fill this gap by exploring the initial sexual experiences of Cambodian adolescents, highlighting the complex interplay of cultural, social, and personal influences that shape their sexual health decisions and outcomes. A descriptive qualitative research design was used. Thirty Cambodian adolescents were interviewed from March to June 202 and data were analyzed using thematic analysis. Participants met their sexual partners in school and through friendships and social networking sites. Their motivations for sexual activities ranged from intrinsic desires to influences of inebriation, love, and trust. Consent was crucial but some were influenced by partners. Awareness of sexual protection varied, affecting condom use and information-seeking behaviors. After initial encounters, participants grappled with complex emotions and physical changes. The findings suggest the need for educational interventions that address substance use; promote safe behavior, consensual conduct, open communication, and mutual respect; and provide coping strategies.

Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women’s Sexual Decision-Making

ABSTRACT Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18–29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women’s sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women’s decisions.

An analysis of the risk factors for intimate partner sexual violence against women and girls in Mexico

The goal of this study is to identify the extent to which a set of risk factors from the ecological model are associated with intimate partner sexual violence victimisation in Mexico. To achieve this goal, a structured additive probit model is applied to a dataset of 35,004 observations and 42 correlates. Findings indicate that age at sexual initiation, women’s sexual and professional autonomy, and social connectedness are associated with their victimisation risks. The findings provide evidence of factors that were previously unknown in Mexico or were solely based on theory but lacking empirical analysis. There are four key contributions. First, findings indicate that factors closer to the individual, such as personal experiences and interpersonal relationships, are more influential in explaining the women’s risks of IPSV victimisation. Second, significant factors were identified, including age at first sexual intercourse, autonomy in sexual and professional decision-making, and social networks. Third, it was possible to identify high-risk population subgroups that are often overlooked, such as women who had their sexual initiation during childhood. Finally, the introduction of some emerging indicators allowed for the examination of the experiences faced by women in various aspects of life, such as decision-making power and social networks.

Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Sexual Risk Behaviors Among College Women.

Using substances before sex may affect sexual decision-making among young women and increase their risk for a variety of negative consequences, including sexual victimization, sexually transmitted infections, and unintended pregnancies. A brief, web-based intervention combining alcohol reduction strategies with emotion regulation skills demonstrated initial efficacy at reducing heavy drinking and improving emotion regulation abilities among college women with sexual victimization histories. The present study represents a secondary analysis of this intervention to evaluate its preliminary efficacy in reducing sexual risk behaviors, specifically alcohol and other drug use before sex. The sample comprised 200 heavy-drinking college women with histories of sexual victimization randomized to an assessment-only control or the intervention consisting of 14 brief online alcohol reduction and emotion regulation skill-building modules administered daily over a 2-week period. The analytic sample included 173 women who reported their substance use before sex at baseline and at least one of two (1-month and/or 6-month) follow-up surveys. Repeated-measures mixed models revealed significant time-by-intervention interaction effects on alcohol use. Women who received the intervention had a significant decrease in alcohol use before sex from baseline to 1-month follow-up. Although levels of alcohol use before sex continued to be lower at the 6-month follow-up relative to baseline, differences did not reach statistical significance. Time-by-intervention interaction effects on drug use before sex were not statistically significant. Skills to reduce alcohol use and improve emotion regulation skills may be beneficial in helping women make adaptive decisions surrounding their sexual well-being.