Sexual Health Prevention Research Articles

Pre-exposure prophylaxis in a sexual health clinic for Men who Have Sex with Men in Portugal

Abstract Background Pre-exposure prophylaxis (PrEP) is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal PrEP in Portugal, CheckpointLX, a community clinic targeted for MSM in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize PrEP users attending CheckpointLX before formal PrEP introduction in Portugal, and those who were referred to PrEP in the National Health Service (NHS) following formal approval of PrEP. Methods Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed EACS recommendations for PrEP eligibility, initiation and follow up. For formal PrEP, the General-Directorate for Health’s PrEP guidelines checklist was used. Results Until the end of May 2018, CheckpointLX had a total of 90 appointments for Wild PrEP, of which 64 (71%) were first time visits. As for the 380 service users referred to the NHS, most were Portuguese (N = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (N = 59, 83%). Conclusions PrEP delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care. Much remains to be done in Portugal to ensure that PrEP is available to those who need it the most. Offering PrEP at community clinics could be a first step. Key messages Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria for PrEP. PrEP delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration.

Acceptability of Using Geosocial Networking Applications for HIV/Sexually Transmitted Disease Partner Notification and Sexual Health Services.

Geosocial networking (GSN) app use among men who have sex with men (MSM) has presented new opportunities for increasing the reach and efficiency of sexual health interventions but also poses challenges to HIV/sexually transmitted disease partner notification. Understanding MSM's attitudes toward app-based preventive sexual health services can help inform their development and delivery. We recruited US MSM who had met a sex partner on GSN apps in the last year to participate in an online survey assessing acceptability and preferences regarding app-based partner notification, health department presence, and sexual health services. Three app-based notification strategies were presented: sending notification messages through participant's/partner's app profile, health department app profile, or in-app anonymous messaging. Of 791 respondents, a majority (70%) preferred to be notified by their partner directly; however, most would get tested if notified by health department profile (95%) or anonymous in-app message (85%). Given the options provided, 50% preferred notifying a partner using their own profile, 26% with health department assistance, and 24% via in-app anonymous message. A majority (71%) were comfortable notifying a partner through a health department profile, and 74% were comfortable using in-app anonymous messaging. Most participants (82%) were comfortable with health departments having app profiles to provide sexual health services. Our results suggest that GSN app-based partner notification and sexual health services would be used by and are acceptable to US MSM. Partnering with app companies to integrate these services and increase access to public health programs has potential to improve MSM sexual health.

Pre-Exposure Prophylaxis Counseling in a Community Sexual Health Clinic for Men Who Have Sex with Men in Lisbon, Portugal.

Pre-exposure prophylaxis is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals.Recognizing the increasing use of informal pre-exposure prophylaxis in Portugal, CheckpointLX, a community clinic targeted to menwho have sex with men in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This studyaims to characterize pre-exposure prophylaxis users attending CheckpointLX before formal pre-exposure prophylaxis introduction inPortugal, and those who were referred to pre-exposure prophylaxis in the National Health Service following formal approval of pre-exposure prophylaxis. Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database.Medical care followed the European AIDS Clinical Society recommendations for pre-exposure prophylaxis eligibility, initiation andfollow-up. For formal pre-exposure prophylaxis, the General-Directorate for Health's Pre-exposure Prophylaxis guidelines checklistwas used. Until the end of May 2018, CheckpointLX had a total of 90 appointments for wild pre-exposure prophylaxis, of which 64 (71%)were first time visits. As for the 380 service users referred to the National Health Service, most were Portuguese (n = 318, 84%), and themean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most commoneligibility criteria (n = 59, 83%). Pre-exposure prophylaxis delivery should be complemented with effective information on the importance of immunizationand education on safer practices of drug administration, in the scope of broader preventive sexual health care. Much remains to be done in Portugal to ensure that pre-exposure prophylaxis is available to those who need it the most.Offering pre-exposure prophylaxis at community clinics could be a first step.

Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men.

Sexual infidelity plays a significant role in the high rate of spousal transmission of HIV in Cambodia. The sexual beliefs and attitudes of a person begin in childhood and are developed through multiple chains in early adolescence, affecting his or her future sexual behavior and future incidence of HIV. A deeper understanding of the perspectives of adolescents regarding infidelity is critical to effective HIV prevention efforts during adulthood. Using a descriptive qualitative approach, this study explored the perceptions of male adolescents regarding male infidelity. Through the thematic analysis method, themes and subcategories were developed from the responses of 48 male high school students from three provinces. Majority of the participants (n = 33) were found to have liberal attitudes not only toward male infidelity but also toward the high possibility of their own future infidelity (n = 14). Almost 45% (n = 21) of the participants explained that men would fulfill their sexual desires outside, such as in karaoke, when their wives are unable to have sex with them. Participants believed it annoying for men to disclose their extramarital activities to their wives. The study concluded that the participants hold accepting perceptions about infidelity; they are part of the HIV problem and must be part of the solution. Educators and counselors need to deliver age-appropriate, scientifically correct, and culturally relevant messages about sexual health and HIV prevention to growing adolescents.

The knowledge-risk-behaviour continuum among young Ugandans: what it tells us about SRH/HIV integration

BackgroundWith a human immunodeficiency virus (HIV) prevalence of 2.1% among 15–24 year olds, opportunities for further integration of sexual and reproductive health (SRH) and HIV prevention services for young people in Uganda exist. We examine a range of factors that contribute to variance in risky sexual behaviour among young Ugandans.MethodsA cross-sectional, nationally representative household survey was conducted between February and March 2016. The questionnaire used assessed knowledge, attitudes and practices related to SRH among young people aged 10–24 years. A composite indicator was constructed to assess risky sexual behaviour, defined as being involved in sexual relations under the influence of alcohol or drugs, engaging in sexual activities without a condom, and having multiple sexual partners in the 6 months preceding the survey. Exploratory analysis was conducted to provide descriptive statistics. Logistic regression was conducted to determine the factors associated with risky sexual behaviour. This analysis focuses on the sub-category aged 15–24 years, comprised of 2725 respondents.ResultsKnowledge levels of family planning (FP), sexually transmitted infections (STIs) and HIV across all respondents were high (above 82%). Self-reported perceived risk of STIs and pregnancy was consistently higher among 20–24 year old respondents, with 61.5% feeling at risk of STIs compared to 46.2% of 15–19 year olds. A total of 22.7% of respondents reported having been involved in risky sexual behaviour. Factors associated with risky sexual behaviour among the 15–19 years group included gender, single orphanhood, casual work, schooling status, FP knowledge and self-perceived risk of STIs/HIV. For the 20–24 year old respondents, significantly associated factors included gender, educational level, relationship to head of household, place of residence, and self-perceived risk of pregnancy.ConclusionsDespite high general SRH/HIV knowledge and perceived risk of pregnancy and HIV, risky sexual behaviour among young Ugandans remains high. Effectiveness gaps in the integrated SRH/HIV response for young people should be addressed and targeted interventions focused on holistic prevention at individual level through information, risk awareness, and skill development should be combined with interventions targeting social structures affecting individual behaviour.

Utilization and avoidance of sexual health services and providers by YMSM and transgender youth assigned male at birth in Chicago

ABSTRACTYoung men who have sex with men (YMSM) and transgender youth assigned male at birth (AMAB) bear a disproportionate burden of the HIV epidemic, yet are sub optimally engaged by sexual health service providers and HIV prevention services. To increase sexual health and HIV prevention behaviors and address disparities in HIV incidence and outcomes among YMSM and AMAB transgender youth, it is critical to understand patterns of service utilization and avoidance. This study examined how and why YMSM and AMAB transgender youth use or avoid sexual health services and service providers in a large Midwestern city within a survey administered to 890 participants from a longitudinal cohort study (RADAR). Results demonstrate low overall use of sexual health services and minimal interest in seeking pre-exposure prophylaxis (PrEP), consistent with prior research. Low awareness of available services was associated with how and where YMSM and trans youth AMAB seek care, with 76% of our sample reporting this as their primary reason for not seeking specific sexual health services. Additional associations are discussed, and recommendations are made for how to improve available services and access.

Studying the “sexuality-health-technology nexus”: a new materialist visual methodology

A school of critical sexual health scholars argues that biomedical and digital technologies need to be understood not as mere objects of use, but as having the agentic capacity to effect new senses of the self and transform social/sexual health relations and outcomes. Such a call to grapple with the multidimensionality of technologies, their affects and effects poses a challenge to current methodological frameworks. To address this challenge, we introduce a novel visual methodology called “embodied mapping” that builds on the arts-based method of body mapping. Drawing from new materialism scholarship, embodied mapping extends the scope of inquiry of sexual-health research and conventional qualitative methods. It does so by interrogating the capacities and properties of sexual agents, technologies and readily available discourses on sexual health and HIV prevention as co-constitutive within the sexual-health-technologies nexus itself. Embodied mapping’s research process is collaborative and emergent; researchers, together with an artist and research participants co-create a visual collage tracing the thick moments of sexual/health encounters. Embodied mapping’s methodological and analytical capacity to approach sexual health phenomena as performative and immanent to the research process could open new sight lines for comprehending and intervening in this globalised era marked by an increasing technologising of sexual health care.

230. Adolescent Male Perspectives On Sex And Reproductive Health

In recent decades, sexual health education and prevention have focused disproportionately on female adolescents due to both their higher burden from risky sexual behavior and their bundled sexual and reproductive healthcare. Young men have been relatively ignored by these efforts, and their utilization of sexual and reproductive health services in general remains low due to barriers including shame, fear, stigma, denial, lack of social support, and not knowing where to go for care. Further, young men are exposed to pervasive toxic masculinity in American culture that may reward them for making risky sexual choices. The goal of this project is to better understand male adolescent sexual decision making In order to identify areas where we might intervene in the future. Expert Model Development - We used a mental models approach from decision science to create an expert model of male adolescent sexual decision making with the input of ten leading experts in male sexual and reproductive health from multiple disciplines, such as medicine, psychology, sociology, public health, and intervention development, implementation, and evaluation. We organized input conceptually, identified and analyzed key concepts, and determined agreement among experts. We synthesized these results into a conceptual model describing young men’s sexual decision. Interviews - We used this expert model of male sexual decision making to guide in-depth, semi-structured interviews with racially diverse male adolescents ages 12-17 on topics related to their emerging sexual identities and decisions, including puberty, relationships, and knowledge of sexual consequences and risk. Expert Model Development - Expert opinion extended existing findings from the literature, providing context and experience related to the idea of toxic masculinity. A point of divergence was how widely endorsed experts believed these norms to be, with some arguing that adolescents feel constrained by the norms but secretly desire the love and intimacy normatively associated with females, indicative of pluralistic ignorance. There was broad consensus among experts about the power of this norm, with disagreement only about degree of internalization. Interviews - Participants spoke candidly, describing lying about virginity to impress a partner, the crude sexual joking and social posturing among young men, and their experiences with pornography. Many expressed frustration with limited sex education, the use of “scare tactics” such as graphic presentation of STIs, the lack of candid discussion by teachers, and the neglect of healthy communication and relationships. There was discussion of norms and peer influence. For example, participants described a “hunter/prey mentality” around sex, identifying each girl as a conquest, and explicitly or implicitly endorsing an objectified view of female partners. Peers were important for communicating norms and conveying reputation. Sexually experienced peers hold considerable social capital. Few described mutual, collaborative decision making around sex beyond cursory statements about consent. Adolescent males confirm our experts’ conceptualization of the power of toxic masculinity norms on their goals and behavior. Future research can explore then for phenomenon further to identify opportunities for intervention.

Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic

ObjectiveInternet-based HIV testing offers the potential to address privacy-related barriers to testing and increase frequency of testing but may result in missed opportunities related to sexual health education and prevention...

Sexual and gender minority youth's perspectives on sharing de-identified data in sexual health and HIV prevention research.

Funding agencies encourage and sometimes require data sharing. However, there is limited empirical research on participant perspectives on sharing de-identified data from research on sensitive topics (e.g., HIV, sexual health) with other researchers, and virtually none from adolescents or sexual and gender minority (SGM) participants. SGM teens (N = 197) ages 14-17 completed an online survey with multiple choice and open-ended items assessing perspectives toward sharing survey responses and blood samples from sexual health and HIV testing studies with other researchers. SGM youth were willing to share data but frequently cited confidentiality and privacy concerns, including fears about parents finding out about their identities even after de-identification was explained. Researchers need to ensure youth understand explanations of data security protections in order to make well-informed decisions about participating in research.

Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica

Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18–30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.

“I’m in control: I’m not stumbling in the dark anymore”: Midlife women’s experiences of successfully negotiating safer sex with new partners

ABSTRACTThe rates of STIs in women over 45 years have been steadily increasing in Australia and other Western countries. Traditionally sexual health and STI prevention and research has positioned young people as the priority population; to date, insufficient attention has been paid to the sexual health of women over 45 years. Using a strengths-based approach, the objective of this study was to explore the factors and mechanisms that enable Australian women aged 45 to 64 years to successfully negotiate safer sex practices in new relationships. Interpretative Phenomenological Analysis (IPA) was employed for an in-depth exploratory study of a sample of eight women. Three broad themes emerged: being informed, being prepared, and being empowered. These findings provide a valuable insight into how we can initiate change and support safer sex practices for this target group.

Is Online Partner-Seeking Associated with Increased Risk of Condomless Sex and Sexually Transmitted Infections Among Individuals Who Engage in Heterosexual Sex? A Systematic Narrative Review.

Use of Internet websites and mobile applications to meet potential romantic and sexual partners is becoming increasingly popular. While the Internet might foster better communication and sexual negotiation between partners, it can also be a deceptive environment that instigates and accelerates sexual risk-taking. Given the complexities of the Internet, it is critical to examine the association between risky sexual behaviors (RSBs) and online partner-seeking. Five databases (i.e., Google Scholar, PubMed, PsycINFO, Web of Science, and Ovid Medline) were searched for articles published before September 10, 2017, that examined the association between online partner solicitation (either for romantic and/or sexual reasons) and RSBs. Studies were eligible for inclusion if they were empirical papers published in English-language peer-reviewed journals looking at samples of online partner seekers who practice heterosexual sex (with a comparison group) and reporting either condom use or sexually transmitted infections (STIs) status, which were the two primary outcomes. A total of 25 studies met the criteria to be included in our review. Results from this literature search do not indicate a clear association between online partner-seeking and condom use or STI status. Potential moderators (i.e., age, gender, reasons for online partner solicitation, duration of Internet correspondence, and Internet modalities) that should be included in future research were identified. Sexual health prevention efforts should address methods to negotiate safe practices between sexual partners and to encourage healthy non-virtual relationships, particularly among vulnerable populations.

Youth and provider perspectives of Wahine Talk: A holistic sexual health and pregnancy prevention program developed with and for homeless youth

Half of homeless youth experience pregnancy at some point during their adolescence. Few programs exist to address pregnancy prevention among homeless youth, particularly from a holistic health promotion framework. Wahine Talk, an innovative adolescent pregnancy prevention and sexual health program, helps to fill this gap. The current study is part of a larger examination of Wahine Talk's initial feasibility, appropriateness, and acceptability, exploring experiences of both homeless youth participants (n = 11) and an interdisciplinary team of providers (n = 4) in three focus groups (N = 3). Template Analysis of focus group data resulted in five main themes characterizing participant and provider experiences of the intervention: 1) basic needs services are foundational; 2) peer mentorship takes many forms; 3) group is good, but is not for everyone; 4) putting a person in the clinic; and 5) holistic sexual health promotion. Findings suggest that Wahine Talk is initially feasible to provide, appropriate for homeless young women, and acceptable as delivered. Implications for practice, policy, and research are discussed.

Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya

BackgroundFemale Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives.MethodsWe focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’ResultsFindings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives.ConclusionsWe recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV prevention.

Sexual Behaviors, Mobile Technology Use, and Sexting Among College Students in the American South.

To examine sexual, mobile technology, and sexting behaviors of college students. A cross-sectional study design was employed. Study sites were 2 universities in the southern United States. Data were collected from 254 participants via online survey of college students. The survey included 268 items inclusive of measures from previously validated sources. Variables for this study included technology ownership/use, online/mobile dating site use, sexting behaviors/attitudes, and sexual behaviors. In particular, the Sexting Attitudes Scale has been previously validated with other researchers providing comparative data. Chi-square and Mann-Whitney tests were used for group comparisons. Logistic regression analysis was used to examine predictors of sexting behavior. Of the 254 participants, over 80% had ever had sex, and participants were more likely to use condoms with partners who they were not in a committed relationship compared to those to whom they were committed (χ2 = 27.324, P = .0001). Seventy percent had ever sexted, and sexting attitudes ranged from approximately 80% agreeing that sexting is "risky" or can leave one "vulnerable" compared to 43% agreeing that sexting is "fun." Sexting was associated with having multiple sexual partners (odds ratio [OR] = 2.47, 95% confidence interval [CI]: 1.36-4.47) and sexually transmitted infection testing history (OR = 2.08, 95% CI: 1.03-4.18). Study findings should be considered as interventionists plan sexual health and risk prevention programs for college students.

Minding the gap: health and social care provider perceptions of parental communication and Black-Canadian youths’ sexual health

Health and social care providers’ perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers’ perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents’ and young people’s sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers’ perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths’ sexual health.

Abortion and sex-related conditions in substance-dependent Brazilian patients.

Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Gender Norms and Discourses Informing College Men’s Perceptions of Heteronormative Sexual Health Responsibilities and HPV Prevention

Focus group data revealed that despite reporting expectations for high levels of sexual activity, college men primarily identifying as heterosexual were ambivalent about sexual health responsibility and their role in preventing human papillomavirus (HPV). Participants identified shared sexual health responsibility as an ideal but invoked heteronormative gender discourses to rationalize inequality in partnered sexual health. Self-categorization processes based on gender may prevent college males from engaging self- and partnered protective behaviors. Yet, self-categorization processes also enabled college men to envision a future relational identity as husband and father in which they engaged protective sexual health behaviors. Although discourses may signify latent benevolent sexism, they may also make room for behavior change through dissonance or messages encouraging superordinate categorization that urges engaging in preventive sexual health behaviors regardless of gender. Implications for self-categorization processes in HPV prevention are discussed.

Tamera Coyne-Beasley

Tamera Coyne-Beasley