Heterosexual anal sexuality and anal sex behaviors: a review

Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research.

Freethought, free love and feminism: secularist debates on marriage and sexual morality, England c. 1850-1885

This article examines the previously unexplored current of Freethinking feminism in the second half of the nineteenth century. Active in the women's movement of this period, Freethinking feminists were nonetheless viewed as a liability—an attitude that contributed to their exclusion from much of the subsequent historiography. Such marginalisation was due not only to their vocal opposition to all forms of religion, but also their openness to discussing new ways of organising heterosexual relationships. This article focuses on Freethinking feminist critiques of marriage and support for free unions. It demonstrates that these issues continued to be debated in the Secularist movement at a time when many other radical organisations—including much of the women's movement—kept silent on such topics. In this way, Freethinking feminists kept alive the more radical and libertarian critiques of traditional sexual morality developed by Owenite feminists in the 1830s and 40s. The author argues that the ideology of Freethought propelled its adherents to readdress questions of sex within a new 'Secularist' ethical framework. Fierce debate ensued, yet commitment to freedom of discussion ensured that 'unrespectable', libertarian voices were never entirely silenced. Freethinking feminism might, then, be viewed as the 'missing link' between early nineteenth-century feminist visions of greater sexual freedom and the more radical discussions of sexuality and free love that began to emerge at the fin de sicle.

Similar faces of same-sex sexual behavior: a comparative ethnographical study in Brazil, Turkey, and Thailand

This is a cross-cultural ethnographical description of same-sex sexual behavior of male sexuality among slums dwellers (working class) and university students (middle class) in three cities: Florianopolis (Brazil), Istanbul (Turkey), and Bangkok (Thailand). The main goal of this study is to describe the similar aspects and issues of homosexual ghettos in urban environments of developing countries where two basic same-sex systems stand side by side: the "bugger system" and the "gay system." This survey compares the same-sex sexual behavior and self-declared sexual-identity of those who practice same-sex, opposite-sex, and both-sex behaviors. The quantitative data from this study simply confirms other studies showing commonalities in terms of gender orientation among people who consider themselves homosexuals and those who consider themselves heterosexuals using the Kinsey Scale.

The quality of young people's heterosexual relationships: a longitudinal analysis of characteristics shaping subjective experience

CONTEXT

Research on young people's sexual relationships often overlooks subjective experiences and enjoyment. Perceived quality of sexual relationships may be related to gender, background characteristics, circumstances of first intercourse and subsequent sexual history.

METHODS

Longitudinal data from 13-16-year-olds who participated in randomized trials of school sex education in either Scotland (N=5,356) or England (N=6,269) were used to examine young people's subjective experiences of heterosexual relationships. Logistic regression models tested for associations between selected variables and pressure and regret at first intercourse, pressure and enjoyment at most recent intercourse, and three measures of relationship quality.

RESULTS

Of the 42% of youth who reported having had sex by follow-up, most assessed their first and most recent sexual relationships positively. Greater proportions of females than of males felt pressure at first sexual intercourse (19% vs. 10%), regretted their first time (38% vs. 20%) and did not enjoy their most recent sex (12% vs. 5%). Younger age at first sex was an important correlate of partner pressure and regret at first intercourse (odds ratios, 2.0 each, for those 13 or younger vs. 15-16-year-olds). Negative experiences were associated with less control (e.g., feeling pressure, being drunk or stoned, and not planning sex) and with less intimacy (e.g., sex with a casual partner and less frequent sex). Background social characteristics had limited influence compared with circumstances of first intercourse and subsequent sexual history.

CONCLUSION

Most young people evaluated their early sexual experiences positively. The quality of relationships was enhanced by better communication and greater physical intimacy. For a vulnerable minority, however, early sexual experiences were negative. They could be protected by delaying first intercourse, restricting sexual activity to established relationships and learning skills to improve control in sexual encounters.

Male sexual health concerns in Muong Khen, Vietnam

Male sexual health concerns are often construed in the medical literature as linked only to genital and reproductive difficulties and malfunctions. However, in reality, male sexual health concerns encompass a broader range of issues and should not be so narrowly conceived. This paper explores men's perceptions of sexual health concerns in Muong Khen, a rural town in northwestern Vietnam. Data were collected through observation, in-depth interviews and focus group discussions. Findings suggest that men's sexual health concerns are strongly related to worries about economic problems, excessive drinking, men's beliefs about how their bodies work and the hegemonic notion that a man should be responsible for his family's economic well-being.

Condom use among heterosexual immigrant Latino men in the southeastern United States

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). We examined correlates of condom use among adult heterosexual Latino men who are members of a large multicounty soccer league in rural North Carolina. Of 222 participants, the mean (+/-SD) age was 29.8 (+/-8.3) years. Approximately 60% reported Mexico as their country of origin, 60% reported Grade 8 or below as their highest level of education, and 50% reported using condoms during their most recent vaginal intercourse episodes. Adjusting for relationship status, multivariable logistic regression identified four correlates of condom use: having sought health care information from family members (adjusted odds ratio [AOR]=3.68; 95% confidence interval [CI]=1.48-9.13); greater knowledge of HIV transmission and prevention (AOR = 2.61; CI = 1.23-5.54); greater condom use self-efficacy (AOR = 4.45; 95% CI = 2.12-9.36); and greater adherence to traditional masculine norms (AOR = 2.10; 95% CI = 1.02-4.33). Our findings underscore the need for innovative and targeted HIV and STD prevention programming among the emerging Latino community in the southeastern United States.

Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults

Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bisexual respondents.

Using Intervention Mapping to develop a programme to prevent sexually transmittable infections, including HIV, among heterosexual migrant men

Background

There is little experience with carefully developed interventions in the HIV/STI prevention field aimed at adult heterosexual target groups in the Netherlands. The ability to apply intervention development protocols, like Intervention Mapping, in daily practice outside of academia, is a matter of concern. An urgent need also exists for interventions aimed at the prevention of STI in migrant populations in the Netherlands. This article describes the theory and evidence based development of HIV/STI prevention interventions by the Municipal Public Health Service Rotterdam Area (MPHS), the Netherlands, for heterosexual migrant men with Surinamese, Dutch-Caribbean, Cape Verdean, Turkish and Moroccan backgrounds.

Methods

First a needs assessment was carried out. Then, a literature review was done, key figures were interviewed and seven group discussions were held. Subsequently, the results were translated into specific objectives ("change objectives") and used in intervention development for two subgroups: men with an Afro-Caribbean background and unmarried men with a Turkish and Moroccan background. A matrix of change objectives was made for each subgroup and suitable theoretical methods and practical strategies were selected. Culturally-tailored interventions were designed and were pre-tested among the target groups.

Results

This development process resulted in two interventions for specific subgroups that were appreciated by both the target groups and the migrant prevention workers. The project took place in collaboration with a university center, which provided an opportunity to get expert advice at every step of the Intervention Mapping process. At relevant points of the development process, migrant health educators and target group members provided advice and feedback on the draft intervention materials.

Conclusion

This intervention development project indicates that careful well-informed intervention development using Intervention Mapping is feasible in the daily practice of the MPHS, provided that sufficient time and expertise on this approach is available. Further research should test the effectiveness of these interventions.

Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk?

This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions.

Going beyond "ABC" to include "GEM": critical reflections on progress in the HIV/AIDS epidemic

A considerable number of studies have sought to identify what factors accounted for substantial reductions in HIV seroprevalence after several countries deployed "ABC" (abstinence, be faithful, condom use) strategies. After much public discourse and research on ABC success stories, the Joint United Nations Programme on HIV/AIDS 2004 epidemic report indicated that nearly 50% of infected people worldwide were women, up from 35% in 1985. In light of the feminization of HIV/AIDS, we critically assess the limitations of ABC strategies. We provide 3 additional prevention strategies that focus on gender relations, economics, and migration (GEM) and can speak to the new face of the epidemic. Pressing beyond ABC, GEM strategies provide the basis for a stronger central platform from which national efforts against HIV/AIDS can proceed to reduce transmission risks.

Sexual behaviour of people living with HIV in London: implications for HIV transmission

OBJECTIVE

To examine the sexual behaviour of gay men as well as black African heterosexual men and women living with diagnosed HIV in London, and to consider the implications for HIV transmission.

METHODS

People living with HIV receiving treatment and care in outpatient clinics in north east London were asked to complete a confidential, self-administered questionnaire in 2004-2005. Respondents were asked about unprotected anal or vaginal intercourse in the previous 3 months, and the type (main or casual) and HIV status of their partner(s).

RESULTS

A total of 1687 people with diagnosed HIV returned a completed questionnaire (response rate 73% of eligible clinic attenders) including 480 black African heterosexual women, 224 black African heterosexual men and 758 gay/bisexual men (464 white, 112 ethnic minority). One in five gay men with HIV (20.1%, 144/715) reported unprotected anal intercourse with a partner of unknown or discordant HIV status (usually a casual partner). This presents a risk of HIV transmission. By comparison, one in 20 (5.1%, 32/623) black African heterosexual men and women with HIV reported unprotected vaginal intercourse that presented a risk of HIV transmission; odds ratio (gay men versus black African men and women combined) 5.28, 95% confidence interval 3.52, 7.91, P<0.001. Neither viral load nor being on HAART were significantly associated with unprotected intercourse among gay men or black African heterosexual men and women (P>0.05).

CONCLUSION

Behavioural research among people with diagnosed HIV in London shows that gay men are more likely than black African heterosexual men and women to engage in sexual behaviour that presents a risk of HIV transmission.

Population differences in finger-length ratios: ethnicity or latitude?

The relative length of the second and fourth fingers (the 2D:4D ratio) has been taken to be an indicator of prenatal exposure to testosterone, and hence possibly relevant to sexual orientation and other sex-differentiated behaviors. Studies have reported a difference in this ratio between Caucasian males in Britain and in the U.S.: higher average 2D:4D ratios were obtained in Britain. This raises the question of whether differences among different Caucasian gene pools were responsible or whether some environmental variable associated with latitude might be involved (e.g., exposure to sunlight or different day-length patterns). This question was explored by examining 2D:4D ratios for an Australian adolescent sample. The Australians were predominantly of British ancestry, but lived at distances from the equator more like those of the U.S. studies. The Australian 2D:4D ratios resembled those in Britain rather than those in the U.S., tending to exclude hypotheses related to latitude and making differences in gene pools a plausible explanation.

Manufacturing heterosexuality: hormone replacement therapy and menopause in urban Oaxaca

For several decades, hormone replacement therapies have been prescribed to women, not only to prevent disease but to improve the sexual functioning of menopausal women. The medical promotion of continued sexual activity in a woman's post-reproductive years is exported to locations outside of North America and Europe, which provides an opportunity to critically examine the cultural roots that have informed expert biomedical representations. This ethnographic study examined menopause and social class in Oaxaca de Juarez, Mexico using interviews, questionnaires, and textual analysis. The research found that biomedicine in conjunction with the pharmaceutical industry promoted culturally constructed gender hierarchies under the guise of optimal menopausal health. However, women's actual experience of gender and sexuality in mid-life diverged significantly from these expert representations. Themes that emerged in interviews and questionnaires included the importance of motherhood in old age, diminished sexual desire as not problematic, and greater sexual freedom at a post-reproductive age. Ultimately, biomedical discourse was not the sole arbiter of appropriate menopausal womanhood and femininity.

Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention

Little research has examined predictors of condom intention within concurrent partnerships. This study examined predictors of intention among 259 male African-American crack smokers with multiple partners. Each participant reported personal condom intention at next sex, condom use self-efficacy, responsibility and outcome expectances for himself and his perceptions for his last two sex partners. Stepwise logistic regressions showed that for both partners one and two, condom use at last sex and personal responsibility for condom use were predictors of intention to use condoms at next sex. Perceived partner responsibility was an additional positive predictor with Partner 2. Hierarchical generalized linear model analyses showed that positive intention was associated negatively with perceived partner responsibility and intimacy, while positively related to situational self-efficacy. Personal responsibility interacted with intimacy such that only men who indicated the highest levels of intimacy were more likely to intend to use condoms. Overall, the findings in this study support the need for examining additional social cognitive constructs that capture the interpersonal aspects of sexual relationships such as personal and perceived responsibility, intimacy and how beliefs may change between multiple partners and across time. Finally, the differences in the valence of perceived partner responsibility across analyses and the interaction of personal responsibility with intimacy suggest the need for studies that include measure of power within the relationship.

Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian Men in New York City

OBJECTIVES

secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population.

METHODS

A survey was mailed to all members of an American Indian community organization in New York City.

RESULTS

The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men).

CONCLUSIONS

Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.

Convergence of behaviour change models for AIDS risk reduction in sub-Saharan Africa

There is increasing programme focus on the impact of HIV and AIDS and the advances in biomedical research that are taking central stage even in sub-Saharan Africa. Perhaps out of frustration, communication and behaviour change efforts are receiving lesser attention. But as long as heterosexual intercourse remains the predominant means of transmission of HIV in sub-Saharan Africa, there is the inherent danger of more people getting infected thus mopping up the gains from other approaches. This paper therefore argues for evidence based behaviour change interventions in sub-Saharan Africa, revisits the behaviour change theories and their relevance to the African situation. It proposes an integration of models based on the convergence of three existing theories of social learning, diffusion of innovation and social networks and the author's understanding of some African culture. The beauty of the model is based on the fact that 'social norms are best understood and influenced at the level of social networks'; existing chains of communication and the naturalness of exchange of information. A case is made for application of the 'model' to precipitate sexual behaviour change and HIV reduction in sub-Saharan Africa.

Focusing "down low": bisexual black men, HIV risk and heterosexual transmission

INTRODUCTION

Black men who have sex with men (MSM) and women but who do not identify as gay or disclose their bisexual activities to main female partners, also known as men "on the down-low," have been cited as the main reason for the increase in HIV infections in black women.

METHODS

Three online databases (PsychInfo, MEDLINE and AIDSLINE) were searched for scientific articles related to men on the down-low. A total of 24 articles and two conference abstracts were selected for review.

RESULTS

Data from existing studies of MSM reveal low agreement between professed sexual identity and corresponding sexual behavior among black and other MSM; show that black MSM are more likely than MSM of other racial or ethnic groups to be bisexually active or identified; and, compared with white MSM, are less likely to disclose their bisexual or homosexual activities to others. However, black MSM who do not disclose their homosexual or bisexual activities engage in a lower prevalence of HIV risks than black MSM who do disclose; and black men who are currently bisexually active account for a very small proportion of the overall population of black men (2%).

CONCLUSION

The high prevalence of HIV in the black community and the greater likelihood of bisexuality among black men place heterosexual black women at risk for HIV infection. However, the contribution of high-risk heterosexual black men to the rising HIV caseload among black women has been largely ignored. Future research must evaluate the relative contributions of bisexual men and exclusively heterosexual black men to HIV cases among black women.

A reanalysis of five studies on sexual orientation and the relative length of the 2nd and 4th fingers (the 2D:4D ratio)

Five studies have examined the relationship between sexual orientation and the relative lengths of the 2nd and 4th fingers (the 2D:4D ratio). Although differences have commonly been found between heterosexuals and homosexuals, the direction of the difference has not been consistent across studies. The original data from all five studies were reanalyzed in a search for possible explanations of the discrepancies. Because ethnicity is known to affect the 2D:4D ratio, the reanalysis focused on participants who identified themselves as White or Caucasian, the ethnic group that was most numerous in all of the studies. Age differences did not account for the discrepancies. Differences in variability within different groups were minor. One interesting result to emerge from the reanalysis was that the 2D:4D ratios for the homosexual groups were relatively similar across studies. It was the 2D:4D values for the heterosexual participants that varied most, particularly between the USA and the British studies, and these were responsible for many of the discrepancies in the conclusions across studies. The constancy of the 2D:4D ratio for the White homosexuals did not appear to extend to homosexuals of three other ethnicities, and there were also subpopulation differences related to right or left hands.

Pioneers in partnership: lesbian and gay male couples in civil unions compared with those not in civil unions and married heterosexual siblings

This study compared 212 lesbians and 123 gay men who had civil unions in Vermont (during the first year legislation made this available) with 166 lesbians and 72 gay men in their friendship network who had not had civil unions, and also with 219 heterosexual married women and 193 heterosexual married men consisting of civil union couples' siblings and their spouses. Married heterosexual couples had been together longer and had more traditional division of labor and child care than did lesbians and gay men in both types of couples. Lesbians in civil unions were more open about their sexual orientation than those not in civil unions, and gay men in civil unions were closer to their family of origin than gay men not in civil unions. This is the first study on same-sex couples with civil unions, and the first to compare lesbians and gay men with their married siblings. At a time of legal changes for same-sex couples, these results indicate that legalized same-sex relationships are related to visibility of same-sex couples to their family and the general public.

Black Caribbean adults with HIV in England, Wales, and Northern Ireland: an emerging epidemic?

BACKGROUND

HIV is now well established in the Caribbean, with prevalence in several countries being surpassed only by those of sub-Saharan Africa. Continuing inward migration from the Caribbean and a high incidence of some bacterial STIs among Britain's black Caribbean communities, suggests a considerable potential for HIV spread.

METHODS

Data from three national HIV/AIDS surveillance systems were reviewed, providing information on new HIV diagnoses, numbers accessing treatment and care services, and HIV prevalence.

RESULTS

Between 1997 and 2001, 528 black Caribbean adults were newly diagnosed with HIV; 62 new diagnoses in 1997, rising to 176 in 2001. Probable heterosexual acquisition accounted for 335 (63%) infections (161 (48%) males, 174 females), and sex between men 171 (32%). Infection was acquired both in the Caribbean and in the United Kingdom. Numbers of black Caribbeans accessing treatment and care services more than doubled between 1997 (294) and 2001 (691). In 2001, 528 (76%) black Caribbeans accessing services were London residents. Among the Caribbean born previously undiagnosed heterosexuals, HIV prevalence was 0.7%; among men who have sex with men (MSM) it was 10.4%. Of those born in the Caribbean, 73% of male heterosexuals, 50% of female heterosexuals, and 65% of MSM who were previously undiagnosed left the clinic unaware of their HIV infection.

CONCLUSIONS

Numbers of black Caribbean adults newly diagnosed and accessing treatment and care services in England, Wales, and Northern Ireland increased between 1997 and 2001. Despite a high prevalence of diagnosed bacterial STIs, prevalence among Caribbean born heterosexuals remains low, but it is high among MSM. Surveillance data highlight the need for targeted HIV prevention among black Caribbeans.

Sociocultural and behavioral contexts of condom use in heterosexual married couples in India: challenges to the HIV prevention program

This article examines sociocultural expectations of sexual behavior and the reasons why not using condoms may be logical to married heterosexual couples in India. Married women who report monogamous sexual relationships with their husbands are a high-risk group for HIV infection in India. Based on the public health model and a population-based perspective on HIV infection prevention, this article illustrates the underlying mechanisms that link the role of women in society, holistic health beliefs, and cultural beliefs about the transmission of HIV with the precursors to nonuse of condoms. The author concludes that promoting condom use requires an emphasis on family health, not only as contraceptives. Challenges for reducing the social stigma and developing a comprehensive policy on HIV prevention and AIDS treatment and care are discussed.

The damage of separation: Krishna's loves and Kali's child

The publication of Kali's Child by Jeffrey Kripal in 1995 ignited a furious debate that persists unresolved today. Two questions are paramount. First, is it right to think of the religious and erotic realms as overlapping, particularly when a homosexual dimension is involved? Second, if Hindus and Hinduism are the subject, should non-Hindus refrain from speaking? In this article I revisit the Kali's Child debate by highlighting one of its central terms-vyakulata, the desperate agitation felt by lovers separated from the objects of their desire. What light is cast on Ramakrishna's same-sex longing by turning to a broader context: the agitation that male poets feel for Krishna when they speak through the female personae of his gopis? Conversely, what light might Ramakrishna's apparently homoerotic impulses cast on the cross-gendered moods of Krishna's male devotees? And what is one to make of the delight these men feel as they depict the sufferings of Krishna's women? Is this the dark side of Krishna's famously sunny world, and is it also the homosexual shadow of his dominant, flamboyant heterosexuality?

Structural Violence and Racial Disparity in HIV Transmission

Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Alternative HIV testing methods among populations at high risk for HIV infection

OBJECTIVE

The purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection.

METHODS

Data were collected as part of an anonymous, cross-sectional interview study--the HIV Testing Survey (HITS)--conducted in seven states from September 2000 to February 2001. Three high-risk populations were recruited: men who have sex with men, injection drug users, and high-risk heterosexuals. Respondents were asked about their awareness and use of alternative HIV tests.

RESULTS

The overall awareness and use of the alternative tests was limited: 54% of respondents were aware of the home collection kit, 42% were aware of the oral mucosal transudate collection kit test, and 13% were aware of rapid tests. Among those aware of alternative tests, self-reported use of the tests was also low. The most common reasons given for not using alternative HIV tests were: preference for the standard test; concern that the results could be less accurate; and that alternative tests were not offered.

CONCLUSIONS

The low levels of awareness and use of alternative HIV tests suggest that the potential for promoting testing among individuals at high risk for HIV by encouraging use of alternative HIV tests has not been fully realized. Alternative tests should be made more broadly available and should be accompanied by education about these tests for physicians and people at risk. Educational efforts should be evaluated to determine if promoting alternative HIV tests increases the numbers of people at risk for HIV who are tested.

HIV/AIDS and the African Refugee Education Program in New Zealand

In the past decade, the resettlement of African HIV-positive refugees in New Zealand has meant dramatically changing patterns of new HIV infection. This increase in heterosexually acquired HIV has been met by mounting disquiet on the part of the public, politicians, and health officials. The voices of the refugees themselves have been lost in this debate. This article discusses the experiences of African refugees with HIV, being in New Zealand, and the establishment of the National HIV/AIDS Refugee Health Education Program, designed to meet the needs of African communities in New Zealand.

Psychosocial predictors of risky sexual behaviors in African American men: implications for prevention

Psychosocial predictors of sexual risk taking were investigated in a community sample of 502 HIV-positive and HIV-negative African American men enrolled in the African American Health Project. Poisson regression analyses were used to estimate the relative contributions of psychosocial risk and protective factors in predicting sexual risk as measured by a sexual risk behavior index. HIV-negative men, men who have sex with men and women (MSM/W), and men who have sex with men (MSM) engaged in more high-risk sexual behaviors than heterosexuals and HIV-positive men, but men who were HIV-positive carried a heavier burden of psychosocial risk factors. High psychological distress, being HIV-negative, older age, low socioeconomic status (SES), and being an MSM/W were the best predictors of sexual risk. HIV serostatus and sexual orientation differences were obtained, with high psychological distress being the most consistent predictor regardless of serostatus or sexual orientation. Results confirm previous findings of riskier sexual lifestyle among MSM/W, men with low SES, and men who are experiencing significant psychological distress.

Contextual factors and the black-white disparity in heterosexual HIV transmission

ABSTRACT African-Americans have the highest rates of human immunodeficiency virus (HIV) transmission, including heterosexual transmission, in the United States. Although numerous factors probably contribute to the extreme racial disparity, reasons for its persistence remain poorly explained. Mathematical modeling demonstrates that concurrent sexual partnerships speed transmission of HIV through sexual networks more effectively than does serial monogamy, for the same total number of sexual partners. This paper examines the evidence that the social and economic environment for many African-Americans discourages long-term monogamy and promotes concurrent sexual partnerships, which may, in turn, fuel the HIV epidemic in this population.

HIV infection among people of foreign origin voluntarily tested in Spain. A comparison with national subjects

OBJECTIVES

To describe exposure categories and HIV prevalence among subjects voluntarily tested in Spain by country of origin.

METHODS

HIV prevalence and exposure categories were compared between national and non-Spanish subjects voluntarily tested in 18 sexually transmitted disease/HIV testing clinics from 16 Spanish cities in 2000.

RESULTS

Of 8861 testers, 2810 (31.7%) came from foreign countries; 73.1% from Latin America, 9.1% from western Europe, 6.2% from central/eastern Europe, 4.4% from northern Africa, and 4.2% from sub-Sahara Africa. Among women from Latin America, 78% were sex workers compared to 5.5% Spanish women. HIV infection was diagnosed in 170 persons, 34.7% from foreign countries. HIV prevalence for Spanish subjects (23% for men and 1.0% for women) was significantly different from men and women from Latin America (11.3% and 0.3% respectively), Sub-Saharan Africa (9.1% and 7.5% respectively), and women from the north of Africa (11.8%). Compared with Spaniards, analyses of persons of the same exposure category showed higher HIV prevalence in men who had sex with men from Latin America (odds ratio: 4.1; 95% CI: 2.4-6.9), heterosexual men from sub-Sahara Africa (OR: 19.3; 95% CI: 6.4-58.0), and Latin America (OR: 9.4; 95% CI: 3.4-25.9), heterosexual women from sub-Sahara Africa (OR: 16.9; 95% CI: 3.5-82.4) and from northern Africa (OR: 15.3; 95% CI: 3.2-73.2).

CONCLUSIONS

An important proportion of HIV testers from these clinics came from foreign countries and some groups showed a high prevalence of HIV infection. Specific prevention and testing programmes adapted to the needs of migrants in Spain should be developed.

Prediction of depressive distress in a community sample of women: the role of sexual orientation

OBJECTIVES

This study compared factors known or hypothesized to influence depressive symptomatology in a community sample of lesbians and heterosexual women.

METHODS

Data were collected in a multisite survey of lesbians' physical and mental health.

RESULTS

Findings confirmed earlier reports suggesting that traumatic life events such as physical and sexual abuse, and individual traits and coping styles are risk factors for depressive distress. However, findings of higher rates of suicidal behavior and of several risk factors for depressive distress among lesbians suggest that risk for depression may differ among lesbians and heterosexual women.

CONCLUSIONS

Sexual orientation may represent an important but poorly understood risk factor for depressive distress as well as suicidal ideation and behavior.

Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation

OBJECTIVES

This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County.

METHODS

Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed.

RESULTS

Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women.

CONCLUSIONS

Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.

Jesus, Mama, and the constraints on salvific love in contemporary country music

The discourse of contemporary country music creates a world permeated with religion and centered on the notion of salvific love. This form of salvation arises in the connection between people (or between people and God) and includes elements of sacrifice and transformation. Although highly conventional, country music must meet standards of 'authenticity' and 'relevance', which require the incorporation of contemporary American religious values (including self-love and self-actualization). An analysis of recent country music lyrics reveals the remarkable openness to new religious messages. However, the only acceptable messages are those that can be harmonized with the implicit Protestant Christian sensibility of the music. Salvific love, for this reason, is always heterosexual and at least compatible with a Christian message. While the music industry does its best to erase minority sexualities, the music itself is often surprisingly open to a queer interpretation.

HIV transmission risk among sub-Saharan Africans in London travelling to their countries of origin

Migrant black African communities bear the brunt of heterosexual HIV/AIDS epidemic in the UK. This study confirms the close links that exist between UK resident black Africans and their countries of origin. A total of 43% of men and 46% of women visited their home countries within the last five years. While there, men were more likely than women to have acquired a new sexual partner. Previous diagnosis with a sexually transmitted disease, and the use of condoms at last intercourse were independently associated with this practice. This represents a potential risk of HIV transmission, and highlights an area for targeted health promotion within these communities.

"Red tips for hot lips": advertising cigarettes for young women in Britain, 1920-70

The girl or woman smoker is a twentieth-century phenomenon. In 1900, smoking was invariably associated with sexually deviant womanhood. Today, smoking is firmly, if contentiously, established as a feminine practice in British society. This article examines one aspect of the twentieth-century feminisation of smoking in Britain, namely, the ways in which smoking practices have been presented as appropriate for young women in the period 1920-70. Advertisements featured in magazines for young women aged 15-29 years have been chosen as a particularly apt medium through which to explore some of the ways in which cigarettes and smoking practices have been delineated and infused with meaning. These advertisements constituted a discourse for the circulation of messages about the relationship of women to cigarettes. Findings reveal a number of shifts in cigarette advertisements featured in Women's magazines from 1920 to 1970. Firstly, during the 1930s and early 1940s, advertisements were, in contrast to later counterparts, preoccupied with establishing smoking as a feminine practice. Key to processes by which smoking was feminised were various mechanisms whereby the cigarette was depicted as part of the presentation of a heterosexual identity and where smoking practices were embedded in heterosexual relations and rituals. Secondly, there was a discernible shift in the way women were addressed by advertisements, from potential women smokers in the 1930s to more general consumers in the 1960s. Thirdly and relatedly, the significance attached to women smoking changed between 1920 and 1970. In the 1930s, smoking was utilised to signify that women were "modern"; in the period 1960-70, smoking served to indicate that women were recognised, and accorded status, as consumers.

Sex and celibacy in early modern Venice

This article explores the nature of relationships formed between nuns and male clergy in early modern Venice. It is based on the records of trials for the violation of conventual enclosure, the principle at the centre of the reforms of nunneries decreed by the Council of Trent, which aspired to sever all links between nuns and the world outside the cloister. The trials offer detailed insights into the interactions of male and female celibates, whose relationships were frequently monogamous, long-term, and intense, although rarely overtly sexual. I argue that the constraints of enclosure conditioned the nature of celibate desire, promoting a model of heterosocial engagement in which bodily intimacy was surprisingly unimportant.

Sex differences in aggression between heterosexual partners: a meta-analytic review

Meta-analyses of sex differences in physical aggression to heterosexual partners and in its physical consequences are reported. Women were slightly more likely (d = -.05) than men to use one or more act of physical aggression and to use such acts more frequently. Men were more likely (d = .15) to inflict an injury, and overall, 62% of those injured by a partner were women. The findings partially support previous claims that different methods of measurement produce conflicting results, but there was also evidence that the sample was an important moderator of effect size. Continuous models showed that younger aged dating samples and a lower proportion of physically aggressive males predicted effect sizes in the female direction. Analyses were limited by the available database, which is biased toward young dating samples in the United States. Wider variations are discussed in terms of two conflicting norms about physical aggression to partners that operate to different degrees in different cultures.

Prevalence of sexual dysfunction in new heterosexual attenders at a central London genitourinary medicine clinic in 1998

OBJECTIVE

To determine the prevalence of sexual dysfunction and dissatisfaction (SD) among new heterosexual attendees at a central London genitourinary medicine (GUM) clinic.

METHODS

Consecutive new attendees seen by a single clinician were asked a probe question about SD in the previous year. A clinical interview followed a positive response to the probe question. Demographic information was obtained using standard clinic forms.

RESULTS

37% of 103 men and 20% of 100 women participants gave positive responses, and 24% of the men and 12% of the women wanted treatment for their problems.

CONCLUSIONS

Our results indicate a relatively high rate of SD in new GUM clinic attendees that is not currently being detected or managed. SD may lead to psychological problems, which can be reversed with appropriate treatment. The financial implications of such treatment are discussed.

Consequences of impending national change: symptoms of psychological distress among homosexual and heterosexual men living in Hong Kong

Now that Hong Kong has reverted to Chinese rule, the people of Hong Kong face many social and political uncertainties. It is likely that residents are experiencing significant symptoms of psychological distress. Homosexual men may be particularly apprehensive about impending government change given the persecution of those with this sexual orientation in the People's Republic of China. The Brief Symptom Inventory was administered to heterosexual (N = 46) and homosexual (N = 26) men living in Hong Kong. As predicted, both groups showed elevated symptoms levels compared to nonpatient norms (ps < .001) and the homosexuals were found to have more intense stress symptoms than heterosexuals. Correlations between concerns about life after 1997 and depression and hopelessness were significant (ps < .01). Surprisingly, somatization was the least elevated symptom among Chinese participants and of equivalent magnitude in both sexual orientation groups. Socio-political implications of the findings are discussed.