Sexual Health Attitudes Research Articles

Has untargeted sexual health promotion for young people reached its limit? A quasi-experimental study

BackgroundTheoretically, there may be benefit in augmenting school-based sexual health education with sexual health services, but the outcomes are poorly understood. Healthy Respect 2 (HR2) combined sex education with youth-friendly...

It's Supposed to Be Personal: Personal and Educational Factors Associated with Sexual Health Attitudes, Knowledge, Comfort and Skill in Health Profession Students

The health professional and the patient are cultural beings with beliefs and attitudes that are shaped by family traditions, social development, and exposure to novel experiences. As such, it is especially important for health profession students to gain awareness about the personal and educational factors that likely inform their practice and educational experiences and, as a result, impact their attitudes, knowledge, comfort, and skill in the area of sexual health. The current study sought to understand personal factors in health profession students associated with these sexual health competencies. Several early personal factors (gender, social class, and family sexuality communication), current personal factors (religion, spirituality, and relationship history), and educational factors (perceived quality of education and experience) were significantly related with sexual health competency. Results suggest that there is potential value to tailored interventions, student self-reflection, and interprofessional education among health profession students’ for the promotion of sexual health competency.

Navigating Risks and Professional Roles: Research with Lesbian, Gay, Bisexual, Trans, and Queer Young People with Intellectual Disabilities

We examine ethical issues that emerged during a community-based participatory research (CBPR) study in Toronto, Canada, exploring sexual health attitudes and practices among lesbian, gay, bisexual, trans, queer, and questioning (LGBTQ) young people (ages 17-26) labeled with intellectual disabilities. These ethical concerns included: (1) managing the risk of coercion, (2) consent to participate in the study, (3) issues of confidentiality and disclosure, (4) balancing beneficence with self-determination, and (5) role conflict for researcher-practitioners who participate in CBPR projects. Incorporating critical disability perspectives and a heightened awareness of professional role conflict into CBPR practices has the potential to foster development of more inclusive and accessible sexual health initiatives and research environments.

Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities

Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but ‘highly-visible’ populations.

The Role of Self-Image Concerns in Discrepancies Between Implicit and Explicit Self-Esteem

Four experiments examined the hypothesis that individuals who hold discrepant implicit and explicit self-esteem possess relatively strong self-image concerns. As a result, they may act irrationally when expressing sexual health attitudes. In support of the hypothesis, Experiments 1a and 1b demonstrate that large self-esteem discrepancy participants possess strong implicit self-image ambivalence relative to small self-esteem discrepancy participants. In Experiments 2 and 3, participants who varied in self-esteem discrepancies received either negative or positive (or no) feedback on an intelligence test, and then they were given an opportunity to express implicit and explicit attitudes toward condoms. Large self-esteem discrepancy participants who received a self-threat responded irrationally and expressed relatively strong negative implicit (but not explicit) attitudes toward condoms. However, this detrimental effect was completely reversed following a self-affirmation to large discrepancy participants. The implicit and explicit attitudes toward condoms of small discrepancy participants were unaffected by a self-threat or a self-affirmation.

Interventions Using New Digital Media to Improve Adolescent Sexual Health: A Systematic Review

New digital media (e.g., the Internet, text messaging, and social networking sites [SNS]) have dramatically altered the communication landscape, especially for youth. These communication platforms present new tools for engaging youth in sexual health promotion and risk reduction. We searched eight public databases across multiple disciplines for all peer-reviewed studies published between January 2000 and May 2011 that empirically evaluated the impact of digital media-based interventions on the sexual health knowledge, attitudes, and/or behaviors of adolescents aged 13-24 years. Of 942 abstracts, 10 met inclusion criteria. Seven studies were conducted in the United States. Eight described Web-based interventions, one used mobile phones, and one was conducted on an SNS. Two studies significantly delayed initiation of sex, and one was successful in encouraging users of an SNS to remove sex references from their public profile. Seven interventions significantly influenced psychosocial outcomes such as condom self-efficacy and abstinence attitudes, but at times the results were in directions unexpected by the study authors. Six studies increased knowledge of HIV, sexually transmitted infections, or pregnancy. This area of research is emerging and rapidly changing. More data from controlled studies with longer (>1 year) follow-up and measurement of behavioral outcomes will provide a more robust evidence base from which to judge the effectiveness of new digital media in changing adolescent sexual behavior.

Invited Editorial Comment

<h3>Background</h3> Among certain communities and nations, the sexual health rights of women living with HIV (WLHIV) are often neglected and considered less important. Social, cultural, and religious believes may restrict safer sexual practices. This study examines the sexual health knowledge, attitude, and practices of WLHIV in Banten Province, Indonesia, and the factors influencing these practices. <h3>Methods</h3> A cross-sectional written survey of 209 WLHIV aged 18 to 50 years from seven Banten Province regions, was conducted between May and November 2017 using five peer recruiters. Descriptive and binary regression analysis were performed. <h3>Results</h3> The majority were Muslim (87.6%), married (58.9%), and high-school graduated (88.6%). 31.4% experienced intimate partner violence (IPV). 77% had some knowledge of sexually transmitted infection (STI), sourcing information from health care providers (56.9%) and the internet (23.0%). Most believed that a woman could refuse sexual intercourse with their partner because of postpartum/menstruation (78.9%), tiredness/unwillingness (67.7%), partner’s STI (64.1%), and his infidelity (62.7%). However, only 49.3% believed that they might refuse sex if the partner opposed condom use. Of the 171 sexually active participants, 78.4% had only one sexual partner. Condoms were the primary contraceptive used; however, 68.4% reported inconsistent condom use which was significantly associated with women’s inability to buy condoms (aOR6.54, 95%CI:2.29–18.74), negotiate condom use (aOR6.11%CI:1.69–22.15), and being unmarried (aOR3.04, 95%CI:1.14–8.13). 33.3% self-reported a history/symptoms of STI which was significantly associated with new HIV-diagnosis (aOR=4.53, 95%CI=2.07–9.91), multiple sex-partners (aOR=4.25, 95%CI=1.73–10.43), lack of internet exposure (aOR=4.24, 95%CI=1.55–11.55), IPV (aOR=3.04, 95%CI=1.22–7.55), or unprotected sex (aOR=2.97, 95%CI=1.33–6.60). <h3>Conclusion</h3> The sexual health of WLHIV in Indonesia is affected by their relationship status, access to condoms, and ability to negotiate their use. Strategies focused on building a women’s capability and support to defend their sexual rights are needed to improve the women’s health, facilitate choice and reduce risk of onward HIV transmission. <h3>Disclosure</h3> No significant relationships.

Sexual Health Attitudes, Knowledge, and Clinical Behaviors

This article explores the impact of practitioners’ attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent clinical mental health staff’s attitudes and knowledge of sexual health predicted their clinical behaviors. Results indicated that the practitioners’ attitudes about sexual health, not their sexual health knowledge level, predicted whether or not they addressed sexual health with clients. Implications and suggestions for counselors and counselor educators are provided.

Impact of community-based interventions on condom use in the Tłįcho region of Northwest Territories, Canada.

BackgroundSince 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tłįchǫ regional rates were nearly four times that of the NT – 91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention.MethodsA baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tłįchǫ region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI).ResultsOne in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90).ConclusionsThe measurable impact on condom use indicates a strong beginning for the Tłįchǫ community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tłįchǫ can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.

Identifying predictors of variability in sexual health knowledge, attitudes and practices among UK youth

Identifying predictors of variability in sexual health knowledge, attitudes and practices among UK youth

Identifying predictors of variability in sexual health knowledge, attitudes and practices among Eastern and Western European youth

Identifying predictors of variability in sexual health knowledge, attitudes and practices among Eastern and Western European youth

What is Community Psychology? Empowering young men to challenge and change negative sexual health attitudes

An article exploring research around young men and sexual health using community psychological approaches.

Con un pie en dos islas: cultural bridges that inform sexual and reproductive health in the Dominican Republic and New York

Immigrants from the Dominican Republic have grown in number and currently make up a substantial portion of New York City's population. In order to better understand the cultural context of Dominican women's sexual and reproductive health attitudes and practices, focus groups were conducted with Dominican women living in New York City as well as with women living in the Dominican Republic. Analysis found that women in the USA had more economic independence and a greater sense of freedom in regards to sexuality than women in the Dominican Republic. However, those in New York City also hoped to maintain their cultural identity in many ways. Women associated the prevalence of gender-based violence with male unemployment and alcohol abuse. Women in both locales reported limited condom use and saw contraception as a woman's responsibility. Many barriers to using the healthcare system were identified and, in many cases, there exists a preference for herbal treatments and folk remedies. This study provided many important insights that have the potential to increase the quality of sexual and reproductive health care for Dominican women.

Reaching Young Men: Lessons Learned in the Recruitment, Training, and Utilization of Male Peer Sexual Health Educators

The need to involve men in family planning and reproductive health services has gained increased recognition by health organizations and practitioners as an important strategy for reducing persistently high rates of sexually transmitted infections and unintended pregnancies. Peer education is one popular approach that has been shown to be effective in promoting healthy sexual behaviors as well as increasing sexual health knowledge, attitudes, and skills among young people. Although the efficacy of peer education programs is related to the recruitment, selection, and training of instructors, little information on these topics has been shared. Moreover, there is an even greater dearth in the literature regarding young male sexual health educators. This report addresses this gap and describes lessons learned about the selection, development, and contributions of young male health educators in a male-focused peer-based sexual health program.

Systematic Review of Interventions to Prevent Spread of Sexually Transmitted Infections, Including HIV, Among Young People in Europe

To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union. For this systematic review, we examined interventions that aimed at STI risk reduction and health promotion conducted in schools, clinics, and in the community for reported effectiveness (in changing sexual behavior and/or knowledge) between 1995 and 2005. We also reviewed study design and intervention methodology to discover how these factors affected the results, and we compiled a list of characteristics associated with successful and unsuccessful programs. Studies were eligible if they employed a randomized control design or intervention-only design that examined change over time and measured behavioral, biologic, or certain psychosocial outcomes. Of the 19 studies that satisfied our review criteria, 11 reported improvements in the sexual health knowledge and/or attitudes of young people. Ten of the 19 studies aimed to change sexual risk behavior and 3 studies reported a significant reduction in a specific aspect of sexual risk behavior. Two of the interventions that led to behavioral change were peer-led and the other was teacher-led. Only 1 of the 8 randomized controlled trials reported any statistically significant change in sexual behavior, and then only for young females. The young people studied were more accepting of peer-led than teacher-led interventions. Peer-led interventions were also more successful in improving sexual knowledge, though there was no clear difference in their effectiveness in changing behavior. The improvement in sexual health knowledge does not necessarily lead to behavioral change. While knowledge may help improve health-seeking behavior, additional interventions are needed to reduce STIs among young people.

Knowledge, attitude and practices of adults of the reproductive years on reproductive health matters, with emphasis on HIV infected people in a Caribbean society

Background:South and Southeast Asia represent the largest number of new HIV infections, while Sub-Saharan Africa represents the highest rate of new infections, followed by Latin America and the Caribbean. Yet no study that has emerged in the Caribbean has comprehensively examined young people's sexual and reproductive health attitudes, knowledge and practices, comparing the result with those who are HIV infected.Aim:The present study examines core issues of sexual and reproductive health among youths, particularly with respect to HIV.Material and Methods:The sample was 1,800 respondents ages 15-49 years. Multivariate logistic regressions were fitted using one outcome measure: self-reported confirmed positive HIV test results.Results:Almost 34% of the sample had been tested for HIV, and 16.9% had done this in the past 12 months. Only 0.2% of the sample knew that they were HIV positive and 4% had positive HIV test results when they did the test. Of those with a positive HIV test result, 58.1% were females. Approximately 16% of those with HIV have had an STI infection in the past, and 61% were actively practicing religion. The mean age of first sexual relations for the sample was 15.4 years (SD = 3.2 years), and 15.6 years for those infected with HIV. Four variables emerged as statistically significant factors of Jamaicans’ willingness to do an HIV test in the future.Conclusion:The findings of this research are far-reaching and can be used to guide public health policy formulation.

Reproductive and Sexual Health of Chinese Migrants

Objective To investigate the reproductive and sexual health situation, including knowledge, attitudes, and behaviors, among a population-based sample of internal migrant workers in China. Method A cross-sectional survey of 4 900 rural-to-urban migrants in 6 provinces of China was conducted. Participants completed a 30-min semi-structured questionnaire about contraceptive practices, sexual behavior, and HIV-related knowledge. Results Migrants lacked knowledge of reproductive and sexual health issues. Among those who had heard any sexually transmitted infections (STIs), only 79.1%, 46.2%, 86.1%, 14.5% and 82.2%, respectively, knew that gonorrhea, condyloma, syphilis, chancroid, and AIDS were STIs. About three-quarters of participants had not used any contraceptive method at sexual debut. Among current users of contraceptive methods, 85.5% indicated that they were satisfied with the method. Before adoption of a contraceptive method, 46.6% of the migrant workers were unaware of the advantages/disadvantages of the method and 75.3% had no knowledge of emergency contraception. Nearly one-quarter (23.4%) reported that they had premarital sex. Among migrants who were sexually active one month prior to the survey, only 14.0% reported that they had used condoms. Conclusion The limited sexual and reproductive health knowledge and unmet reproductive health services of migrant workers in China underscore the need for a comprehensive package of sexual and reproductive health interventions that combine cognitive and behavioral skills training and target both migrants and health care providers.

Creating Teachable Moments: A Clinic-Based Intervention to Improve Young Men’s Sexual Health

A multicomponent health education intervention for men was integrated into initial visits at the Young Men's Clinic in New York City. In all, 157 predominantly low-income, Latino and African American patients completed pre- and post-test surveys to assess their sexual and reproductive health knowledge, beliefs, attitudes, and behaviors. Paired t tests compared respondents' scores on outcome variables at baseline and follow-up. Intervention participants significantly increased their knowledge (e.g., emergency contraception) and frequency of safer sexual behaviors (e.g., condom use) during the 3 months following their initial visit. The intervention was not as successful promoting positive beliefs about health care utilization or attitudes about condoms. Participants reported high levels of satisfaction with the intervention. This study provides evidence that it is feasible to effectively disseminate sexual health information to men at each step of a routine clinic visit, including down time in waiting rooms and individual encounters with health educators and medical providers.

Reproductive health for refugees by refugees in Guinea II: sexually transmitted infections

BackgroundProviding reproductive and sexual health services is an important and challenging aspect of caring for displaced populations, and preventive and curative sexual health services may play a role in reducing HIV transmission in complex emergencies. From 1995, the non-governmental "Reproductive Health Group" (RHG) worked amongst refugees displaced by conflicts in Sierra Leone and Liberia (1989–2004). RHG recruited refugee nurses and midwives to provide reproductive and sexual health services for refugees in the Forest Region of Guinea, and trained refugee women as lay health workers. A cross-sectional survey was conducted in 1999 to assess sexual health needs, knowledge and practices among refugees, and the potential impact of RHG's work.MethodsTrained interviewers administered a questionnaire on self-reported STI symptoms, and sexual health knowledge, attitudes and practices to 445 men and 444 women selected through multistage stratified cluster sampling. Chi-squared tests were used where appropriate. Multivariable logistic regression with robust standard errors (to adjust for the cluster sampling design) was used to assess if factors such as source of information about sexually transmitted infections (STIs) was associated with better knowledge.Results30% of women and 24% of men reported at least one episode of genital discharge and/or genital ulceration within the past 12 months. Only 25% correctly named all key symptoms of STIs in both sexes. Inappropriate beliefs (e.g. that swallowing tablets before sex, avoiding public toilets, and/or washing their genitals after sex protected against STIs) were prevalent. Respondents citing RHG facilitators as their information source were more likely to respond correctly about STIs; RHG facilitators were more frequently cited than non-healthcare information sources in men who correctly named the key STI symptoms (odds ratio (OR) = 5.2, 95% confidence interval (CI) 1.9–13.9), and in men and women who correctly identified effective STI protection methods (OR = 2.9, 95% CI 1.5–5.8 and OR = 4.6, 95% CI 1.6–13.2 respectively).ConclusionOur study revealed a high prevalence of STI symptoms, and gaps in sexual health knowledge in this displaced population. Learning about STIs from RHG health facilitators was associated with better knowledge. RHG's model could be considered in other complex emergency settings.

Sexual health knowledge, attitudes and behaviours: variations among a religiously diverse sample of young people in London, UK

Objective. To report young people's variations in sexual health knowledge, attitudes and behaviours by religious affiliation. Design. A cross-sectional, questionnaire-based survey administered in 16 Secondary/High schools in London, UK. The sample consisted of 3007 students in school Years 11–13 (aged 15–18), present in school on the day of questionnaire administration. Excluding those who described themselves as ‘Other religious’, 15.9% (n=418) described themselves as having no religious affiliation, 36.3% (n=957) were Christian, 25.8% (n=679) were Muslim and 22.1% were Hindu (n=582). The religious affiliation varied within and across different ethnic groups. Method. Self-administered questionnaire completed under ‘exam’ conditions, either in tutor groups or a school hall. The 30-minute questionnaires were distributed and collected by a team of ethnically and religiously diverse fieldworkers. Results. Religious students, as opposed to those reporting no religious affiliation, generally reported poorer sexual health knowledge, and were more conservative in their attitudes to sex. Among males and females, those with no religious affiliation and Christian students reported the highest prevalence of sexual intercourse by some margin (around 20 percentage points) over the Hindus and Muslims. Christian males most frequently reported sexual intercourse at 49.7%, and Muslim females the least at 9.0%. Among those reporting sexual intercourse, risk behaviours among all religious and non-religious students were evident. Over one-third of Muslim females who had sexual intercourse did not use contraception on their first occasion compared to 10% of those with no religious affiliation, 12% of Christians and 20% of Hindus. Christian and Muslim females reported the highest prevalence of ever not using contraception at 55%, and non-use of contraception with two or more sexual intercourse partners at 14%. Conclusion. The findings demonstrate diverse sexual health knowledge, sexual attitudes and sexual behaviours among young people with different religious affiliations. These variations demonstrate the importance of tailoring health education and promotion interventions to meet the specific needs of young people from a variety of different religions. The challenge ahead is to find ways to work with these young people to broach such sensitive issues.