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Mills R, Northcott K, Kovacs E, Philpott A. Opening a portal to pleasure based sexual and reproductive health around the globe; a qualitative analysis and best practice development study. Sex Reprod Health Matters 2023; 31:2275838. [PMID: 38037813 PMCID: PMC10833112 DOI: 10.1080/26410397.2023.2275838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Pleasure is often left out of sexual and reproductive health and rights (SRHR) interventions. The expanding evidence base suggests that the inclusion of pleasure can improve SRHR outcomes and increase safer sex practices. However, there is a lack of research into how to include pleasure in applied SRHR work, particularly outside of key groups. This study aims to present the experiences of a cohort of pleasure implementers and develop a series of implementation best practices. Data were gathered from a structured survey filled out by pleasure implementers (n = 8) twice between September 2021 and October 2022 at 6-month intervals. Focus group discussions (FGDs) were carried out remotely with pleasure implementers, those that funded their pleasure work (n = 2) or provided technical support (n = 2) in January 2023. Pleasure implementers, based in Central, East and Southern Africa and India, reported tangible outcomes of their pleasure-based work in various contexts and across diverse groups. Themes that emerged from analysis of the FGDs and survey responses included pleasure as a portal to positive outcomes, barriers to a pleasure approach, and mechanisms by which pleasure allows for open and non-judgmental discussion about sex and pleasure. A series of best practices emerged from pleasure implementer experiences. This study concludes that a pleasure-based approach can be introduced to a wide range of groups and communities, even those assumed too conservative to accept a pleasure approach. The best practices developed offer a range of practically driven recommendations, that others can lean on when integrating a pleasure approach into their work.
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Affiliation(s)
- Rhiana Mills
- Independent Researcher, London, UK. Correspondence:
| | | | - Emese Kovacs
- Monitoring and Evaluation Specialist, AmplifyChange, London, UK
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2
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Effectiveness of an Unguided Online Intervention for Sexual Pleasure in Women: A Randomized Controlled Pilot Study. SEXES 2023. [DOI: 10.3390/sexes4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The importance of sexual pleasure as a factor promoting sexual and public health is increasingly recognized. Nevertheless, hardly any theory-based and empirically tested interventions exist for fostering sexual pleasure. Consequently, we developed an unguided online intervention called PleaSure to promote sexual pleasure in women. In a randomized controlled pilot trial with a mixed-method design, we evaluated the effectiveness of PleaSure by comparing the intervention group to a waitlist control group in pre–post measurements over 4 weeks. With 657 participants (Mage = 31.46, SDage = 8.78), we evaluated an index of sexual pleasure and five facets: sensual pleasure, pleasure-related mastery, pleasure-related validation, interaction pleasure, and bonding pleasure. The results show that the online intervention primarily strengthened the intrapersonal domain of sexual pleasure by increasing pleasure-related mastery. Neither the other facets nor the index was significantly influenced by the intervention. Although the effects of the quantitative data are small, the qualitative data support overall positive effects on participants’ sexual experience. We discuss the content of the intervention and the methods used. Our pilot study suggests that sexual pleasure can be promoted but that major improvements are needed to the intervention’s content and design to do so effectively. Therefore, future studies are encouraged to further develop and implement such resource-efficient interventions in clinical and non-clinical samples to better understand the importance of sexual pleasure to sexual health.
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Ownership, Enjoyment, Arousal Troubles, and Robust Education: Pleasure in LGBTQ+ Alt-Sex Members’ Responses to Consent Violations. SEXES 2022. [DOI: 10.3390/sexes3030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Alt-sex practitioners are a diverse group with diverse unconventional sexual behaviors including consensual non-monogamy (CNM), kink, fetishism, and bondage/discipline dominance/submission, sadomasochism (BDSM). Perhaps because of their openness to non-normative sexuality, these communities often comprise a large proportion of lesbian, gay, bisexual, trans, queer, among others (LGBTQ+) individuals. LGBTQ+ individuals experience higher rates of sexual violence and consent violation than their cisgender, heterosexual peers both inside and outside of formalized alt-sex communities. Pleasure, including but not limited to sexual pleasure, is often a motivator for engaging in sexual and alt-sex activities. This study examines how consent violations influence pleasure among LGBTQ+ alt-sex members. Methods: We conducted an electronic one-time survey of LGBTQ+ alt-sex practitioners (N = 1354). In this study, we analyze open-ended responses for ways pleasure was described in response to questions about consent violations. We use thematic analyses in Dedoose online software. Results: Two subthemes emerged related to the violation itself, (a) pleasure as a motivator for violating consent and (b) pleasure in spite of consent violation. As the second theme that emerged, pleasure was a component of the aftereffects of the violation in two ways: (1) pleasure was reduced or inhibited by consent violations; (2) pleasure was a motivator for healing and advocacy. Conclusions: We discuss practical and research implications based on the complex relationships between violations and pleasure reported by participants.
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Kamke K, Stewart JL, Widman L. Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:822-833. [PMID: 36212514 PMCID: PMC9542138 DOI: 10.1007/s13178-021-00594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 06/03/2023]
Abstract
Introduction Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. Methods This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active. Results Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. Discussion We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - J. L. Stewart
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Zaneva M, Philpott A, Singh A, Larsson G, Gonsalves L. What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis. PLoS One 2022; 17:e0261034. [PMID: 35148319 PMCID: PMC8836333 DOI: 10.1371/journal.pone.0261034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/21/2021] [Indexed: 01/14/2023] Open
Abstract
Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005–1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations’ RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen’s d = 0·37 (95% CI 0·20–0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.
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Affiliation(s)
| | - Anne Philpott
- The Pleasure Project, United Kingdom and India
- * E-mail:
| | | | | | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ford JV, Corona-Vargas E, Cruz M, Fortenberry JD, Kismodi E, Philpott A, Rubio-Aurioles E, Coleman E. The World Association for Sexual Health's Declaration on Sexual Pleasure: A Technical Guide. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 33:612-642. [PMID: 38595778 PMCID: PMC10903694 DOI: 10.1080/19317611.2021.2023718] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 04/11/2024]
Abstract
This article provides technical guidance on the content, meaning, and application of the World Association of Sexual Health (WAS) Declaration on Sexual Pleasure to various stakeholders and practitioners working in the area of sexuality, sexual health, and sexual rights. A growing body of work shows that sexual pleasure is integral to broader health, mental health, sexual health, well-being and rights and indeed can lead to improvements in health. Yet, more research is needed to identify the best ways to incorporate sexual pleasure to achieve sexual health for different outcomes and populations. In the first part of this article, we deconstruct each statement from the WAS Declaration on Sexual Pleasure and provide key evidence from the literature supporting these statements. In the latter part of the article, we provide guidance on how to include sexual pleasure as a fundamental part of sexual health and sexual rights work. We include a series of case studies and highlight key actions and principles for advocacy, implementation, and quality assurance in terms of law and policy, comprehensive sexuality education, health care services and dissemination of knowledge. This technical document seeks to inspire our partners and collaborators to embark on a journey toward a pleasure-based approach to sexual health and sexual rights. Our hope is that the literature, guidance and case studies provided here can ignite ongoing advocacy and collaboration to embrace sexual pleasure in all settings.
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Affiliation(s)
- Jessie V. Ford
- Sociomedical Sciences, Columbia University, New York, NY, USA
| | | | | | | | - Eszter Kismodi
- International Human Rights Lawyer on Sexual and Reproductive Health and Rights Research, Policy and Programming, Geneva, Switzerland
| | | | | | - Eli Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MNUSA
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George WH, Blayney JA, Stappenbeck CA, Davis KC. The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda. AIDS Behav 2021; 25:347-364. [PMID: 34244871 DOI: 10.1007/s10461-021-03351-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.
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Affiliation(s)
- William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA.
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cynthia A Stappenbeck
- Department of Psychology, Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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Thorpe S, Ware S, Tanner AE, Kugler KC, Guastaferro KM, Milroy JJ, Wyrick DL. Sexual sensation seeking, hookups, and alcohol consumption among first-year college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:897-904. [PMID: 31995458 PMCID: PMC7387156 DOI: 10.1080/07448481.2020.1713136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore sexual sensation seeking (SSS) among an ethnically-diverse sample of first-year college students and their hookup behaviors. PARTICIPANTS 1,480 first-year college students who hooked up in the last 30 days were recruited from four universities in 2016. METHODS Students completed an online survey before completing an online STI and alcohol prevention intervention. RESULTS Male and sexual minority students had significantly higher SSS scores compared to female and heterosexual students respectively. Students with higher SSS scores were less likely to report condom use at last vaginal and anal hookup, more likely to hookup under the influence of alcohol and participate in a wide range of sexual behaviors. There were no significant mean differences in SSS scores by level of intoxication during their last hookup. CONCLUSION These findings highlight the role of SSS in predicting sexual risk behaviors of first-year college students and the overall low SSS scores among this sample.
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Affiliation(s)
- Shemeka Thorpe
- The University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Samuella Ware
- The University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Amanda E. Tanner
- The University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Kari C. Kugler
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, Pennsylvania
| | - Kate M. Guastaferro
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
| | - Jeffrey J. Milroy
- The University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - David L. Wyrick
- The University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, North Carolina
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Mark K, Corona-Vargas E, Cruz M. Integrating Sexual Pleasure for Quality & Inclusive Comprehensive Sexuality Education. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:555-564. [PMID: 38595784 PMCID: PMC10903684 DOI: 10.1080/19317611.2021.1921894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 04/11/2024]
Abstract
The lack of inclusion of sexual pleasure in comprehensive sexuality education (CSE) could be detrimental to sexual development, misses opportunities for inclusive education, and may have a long-term impact on sexual well-being. The WAS' Declaration on Sexual Pleasure provides the opportunity to advocate for pleasure as an indispensable part of CSE. Specifically, the inclusion of pleasure in CSE will positively impact six outcomes: traditional risk-reduction, cultivating healthy relationships, celebration of sexual diversity, exercise of sexual rights, empowerment, and consent, and prevention of gender-based sexual violence. Messages of sexual pleasure are crucial for sexuality education to be comprehensive, effective, and inclusive.
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Affiliation(s)
- Kristen Mark
- Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Mariana Cruz
- International Planned Parenthood Federation Western Hemisphere Region, London, UK
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Philpott A, Larsson G, Singh A, Zaneva M, Gonsalves L. How to Navigate a Blindspot: Pleasure in Sexual and Reproductive Health and Rights Programming and Research. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:587-601. [PMID: 38595783 PMCID: PMC10903683 DOI: 10.1080/19317611.2021.1965690] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 04/11/2024]
Abstract
Objectives: Despite billions of dollars in funding spent each year on sexual and reproductive health and rights (SRHR) and HIV programming, sexual pleasure is insufficiently addressed. This paper therefore has three key aims: (1) to introduce the concept of sexual pleasure in SRHR programming, while providing context regarding investment and research, (2) to introduce and situate an upcoming systematic review and meta-analysis to quantify whether and to what extent incorporating sexual pleasure into SRHR interventions can improve health outcomes, and (3) to examine the key practical, methodological, and theoretical challenges in carrying out such a review. Methods: We undertook a literature review and analysis of conference abstract publications to highlight the 'pleasure gap' in evidence in sexual and reproductive health and rights programming and research. We detailed the scope, search strategy and challenges for our subsequent systematic review. Results: This paper and the subsequent review highlights the need to equip the SRHR and HIV fields to better meet the needs of communities by considering key reasons people have sex, and understand the challenges of undertaking a review of this nature. Conclusions: We conclude that this a focus on pleasure is particularly pertinent in the context of the Sustainable Development Goals and the ratification of the declaration on sexual pleasure at the 2021 World Congress of the World Association for Sexual Health.
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Affiliation(s)
| | | | | | - Mirela Zaneva
- Department of Experimental Psychology, University of Oxford, UK
| | - Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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11
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Ford JV, El Kak F, Herbenick D, Purdy C, Tellone S, Wasserman M, Coleman E. Sexual Pleasure and Healthcare Settings: Focusing on Pleasure to Improve Healthcare Delivery and Utilization. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:572-586. [PMID: 38595777 PMCID: PMC10903612 DOI: 10.1080/19317611.2021.1955802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 04/11/2024]
Abstract
Sexual pleasure is best attained through facilitating access to the highest standard of health. Today global data show a persistent high burden of sexual health issues. Yet, pleasure remains a sensitive, stigmatized, and unspoken topic in healthcare services. This article examines how to incorporate a value for pleasure into healthcare services, grounded in the assumption that pleasure is a fundamental reason why people have sex and that acknowledging this can support people in creating safer, more pleasurable sexual experiences. Drawing upon examples from the literature and field experience, this article explores how to better address pleasure in healthcare settings.
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Affiliation(s)
- Jessie V. Ford
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Faysal El Kak
- Women Integrated Sexual Health Program, Department of Obstetrics and Gynecology, Medical Center, American University of Beirut, Beirut, Lebanon
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | | | - Stephen Tellone
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Eli Coleman
- Institute for Sexual and Gender Heath, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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12
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Boydell V, Wright KQ, Smith RD. A Rapid Review of Sexual Pleasure in First Sexual Experience(s). JOURNAL OF SEX RESEARCH 2021; 58:850-862. [PMID: 33871295 DOI: 10.1080/00224499.2021.1904810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While researchers have thoroughly studied the who, what, and when of first sexual experiences, we know much less about how people construct, experience, and proceed (or not) with sexual pleasure in these experiences and beyond. To address this knowledge gap, the Global Advisory Board for Sexual Health and Wellbeing (GAB) coordinated a rapid review of published peer-reviewed research to determine what is currently known about sexual pleasure in first sexual experiences. We found 23 papers exploring this subject and its intersections with sexual health and sexual rights. The results reveal significant gaps in erotic education, gender equity, vulnerability and connection, and communication efficacy; and highlight important domains to consider in future research. Our findings draw out the key features of pleasurable first sexual experience(s), namely that individuals with the agency to formulate their definition and context of what pleasure means to them are more likely to experience pleasure at first sex. This finding points to promising ways to improve first sexual experiences through erotic skills building and through addressing knowledge gaps about having sex for the first time among disadvantaged groups.
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Affiliation(s)
| | | | - Robert D Smith
- Global Health Centre, The Graduate Institute, Geneva (IHEID)
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Brown E, Lo Monaco S, O’Donoghue B, Nolan H, Hughes E, Graham M, Simmons M, Gray R. Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179063. [PMID: 34501652 PMCID: PMC8430747 DOI: 10.3390/ijerph18179063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.
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Affiliation(s)
- Ellie Brown
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-3-9966-9100
| | - Samantha Lo Monaco
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Brian O’Donoghue
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Hayley Nolan
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Elizabeth Hughes
- School of Healthcare University of Leeds, Woodhouse, Leeds LS2 9JT, UK;
| | - Melissa Graham
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
| | - Magenta Simmons
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Richard Gray
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
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Abrams JA, Odlum M, Tillett E, Haley D, Justman J, Hodder S, Vo L, O'Leary A, Frew PM. Strategies for increasing impact, engagement, and accessibility in HIV prevention programs: suggestions from women in urban high HIV burden counties in the Eastern United States (HPTN 064). BMC Public Health 2020; 20:1340. [PMID: 32883248 PMCID: PMC7469400 DOI: 10.1186/s12889-020-09426-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Merely having the tools to end HIV is insufficient. Effectively ending the epidemic necessitates addressing barriers that impede engagement in biomedical and behavioral prevention and wide scale implementation and utilization of existing interventions. This qualitative study identifies suggestions for increasing access to, engagement in, and impact of HIV prevention among women living in cities in high HIV burden counties in the eastern US. METHODS Data analyzed for the current study were collected via a qualitative sub-study within the HIV Prevention Trials Network Study 064 (HPTN 064), a multisite observational cohort study designed to estimate HIV incidence among women residing in communities with elevated HIV prevalence who also reported personal or partner characteristics associated with increased risk of HIV acquisition. Focus group and interview participants in the qualitative sub-study (N = 288) were from four cities in the eastern US. RESULTS Thematic analyses revealed four themes describing women's most frequently stated ideas for improving prevention efforts: 1) Promote Multilevel Empowerment, 2) Create Engaging Program Content, 3) Build "Market Demand", and 4) Ensure Accessibility. We conducted additional analyses to identify contradictory patterns in the data, which revealed an additional three themes: 1) Address Structural Risk Factors, 2) Increase Engagement via Pleasure Promotion, 3) Expand Awareness of and Access to Prevention Resources. CONCLUSIONS Findings may be useful for enhancing women's engagement in and uptake of behavioral and biomedical HIV prevention resources, improving policy, and addressing multilevel risk factors. TRIAL REGISTRATION Clinicaltrials.gov: NCT00995176 , prospectively registered.
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Affiliation(s)
- Jasmine A Abrams
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue (Crosstown Center), Rm 434, Boston, MA, 02118, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Michelle Odlum
- Columbia University School of Nursing, New York, NY, USA
| | - Emily Tillett
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Danielle Haley
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue (Crosstown Center), Rm 434, Boston, MA, 02118, USA
| | - Jessica Justman
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
| | - Linda Vo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paula M Frew
- School of Public Health, University of Nevada, Las Vegas, NV, USA
- Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
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15
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Singh A, Both R, Philpott A. ‘I tell them that sex is sweet at the right time’ – A qualitative review of ‘pleasure gaps and opportunities’ in sexuality education programmes in Ghana and Kenya. Glob Public Health 2020; 16:788-800. [DOI: 10.1080/17441692.2020.1809691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Marcantonio TL, Willis M, Jozkowski KN. Women’s Sexual Consent: Potential Implications for Sexual Satisfaction. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00267-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Hood KB, Shook NJ, Dunn CE, Belgrave FZ. The effect of affective versus cognitive persuasive messages on African American women's attitudes toward condom use. Psychol Health 2020; 36:739-759. [PMID: 32530298 DOI: 10.1080/08870446.2020.1776284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Health decision making models propose that affective associations at both the implicit and explicit level and cognitive beliefs influence health behaviours. The current studies investigated whether affective or cognitive persuasive messages would lead to more positive implicit and explicit condom use attitudes and higher intentions among African American college women. DESIGN Participants (Study 1 N = 109; Study 2 N = 112) explicit attitudes were assess prior to watching a short video that contained either affective (e.g., safe sex is pleasurable) or cognitive messages (e.g., latex condoms are effective in preventing HIV) in favour of condom use. MAIN OUTCOME MEASURES Following the video, participants completed the Affect Misattribution Procedure (AMP), a measure of implicit attitudes, explicit measures of condom use attitudes that assessed attitudes at the overall and component level, intentions to use condoms, and interest in receiving free sample of condoms. RESULTS Participants in the affective message condition reported more positive condom use attitudes on both the implicit and explicit measure, higher intentions to use condoms, and more interest in receiving free condoms than those in the cognitive message condition. CONCLUSION These results suggest that affective messages may be more effective in changing condom use attitudes, which can be used in interventions to promote protective condom use behaviours.
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Affiliation(s)
- Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Natalie J Shook
- School of Nursing, University of Connecticut, Mansfield, Storrs, CT, USA
| | - Chelsie E Dunn
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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18
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Kever E, Van den Broucke S, Hack D. The use of sexually explicit material by Belgian sexologists. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2019.1659949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Emmanuelle Kever
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Dana Hack
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Newby K, Crutzen R, Brown K, Bailey J, Saunders J, Szczepura A, Hunt J, Alston T, Sadiq ST, Das S. An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study. JMIR Form Res 2019; 3:e11242. [PMID: 31042156 PMCID: PMC6658247 DOI: 10.2196/11242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/04/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. OBJECTIVE Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. METHODS The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. RESULTS Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. CONCLUSIONS This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status.
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Affiliation(s)
- Katie Newby
- Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Rik Crutzen
- Health Promotion, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Katherine Brown
- Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Julia Bailey
- Primary Care and Population Health, Institute of Epidemiology and Health, University College London, London, United Kingdom
| | - John Saunders
- Health Protection Services, Public Health England, London, United Kingdom
| | - Ala Szczepura
- Enterprise and Innovation, Coventry University, Coventry, United Kingdom
| | - Jonny Hunt
- Going Off The Rails, Coventry, United Kingdom
| | | | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Satyajit Das
- Coventry and Warwickshire Partnership Trust, Coventry, United Kingdom
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20
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Buckley TR, Awais YJ. Understanding HIV Prevention With College‐Going Black Women: An NIMH‐Funded Pilot Study. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jmcd.12123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tamara R. Buckley
- Educational Foundations and Counseling Programs, City University of New York
| | - Yasmine J. Awais
- College of Nursing and Health Professions, Creative Arts Therapies, Drexel University
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21
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Nelson KM, Pantalone DW, Carey MP. Sexual Health Education for Adolescent Males Who Are Interested in Sex With Males: An Investigation of Experiences, Preferences, and Needs. J Adolesc Health 2019; 64:36-42. [PMID: 30292649 PMCID: PMC6309651 DOI: 10.1016/j.jadohealth.2018.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior. METHODS AMSM (N = 207; ages 14-17) in the United States completed an online sexual health survey. Bivariate associations between sexual education exposure/preferences by sexual behavior were assessed using Fisher's exact tests and one-way analyses of variance. RESULTS Eighty-nine (43%) participants reported no sexual contact with male partners, 77 (37%) reported sexual contact without condomless anal sex, and 41 (20%) reported condomless anal sex. Participants received sexual health information from their parents/guardians (n = 122, 59%), formal sources (n = 160, 78%), and the Internet (n = 135, 65%). The most commonly covered topics by parents/guardians and formal sources were how to say no to sex, how to prevent HIV and other sexually transmitted infections, and methods of birth control. The most common online-researched topics were how to safely have anal sex, the types of sex you can have with a male partner, how to use a condom, and how to use lubrication. Participants noted preferring a sexually-explicit online sexual health program that addresses male-male sex. CONCLUSIONS Online sexual education programs that explicitly address male-male sex are needed. Tailored programs can help AMSM develop healthy sexual behaviors and decrease their HIV/STI risk.
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Affiliation(s)
- Kimberly M. Nelson
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA,Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts, Boston, MA, USA,The Fenway Institute, Fenway Health, Boston, MA, USA,Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Michael P. Carey
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA,Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
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22
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Siegler AJ, Boos E, Rosenberg ES, Cecil MP, Sullivan PS. Validation of an Event-Level, Male Sexual Pleasure Scale (EMSEXpleasure) Among Condom-Using Men in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1745-1754. [PMID: 29392486 PMCID: PMC6035083 DOI: 10.1007/s10508-017-1103-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/28/2017] [Accepted: 10/16/2017] [Indexed: 05/31/2023]
Abstract
Sexual pleasure is a key determinant of condom use. We developed and validated a male, event-level sexual pleasure scale (EMSEXpleasure) among a sample of condom-using men in the U.S. in order to facilitate improved measurement of sexual pleasure. Based on an expert panel process, a 12-item scale was developed. An online sample of 169 men who have sex with men and 162 men who have sex with women were recruited. Factor analysis yielded a two-factor solution that matched domains identified a priori by the expert panel, general pleasure and condom-specific pleasure, indicating internal validity of the instrument. One item was deleted from the scale due to poor validity performance. The overall EMSEXpleasure scale, and each subscale, had high (> 0.8) Cronbach's alpha coefficients, indicating internal reliability. The scale demonstrated convergent validity, with theoretically related constructs associated both with individual scale items and with scale totals. Overall relationship quality (b 3.0, 95% CI 2.0, 4.0), sexual relationship quality (b 2.9, 95% CI 2.0, 4.0), foreplay quality (b 7.5, 95% CI 2, 13), positive feelings about condoms (b 18.8, 95% CI 15, 23), and erection problems while using condoms (b - 17.9, 95% CI - 22, - 14) were associated with the EMSEXpleasure scale in expected directions. The validated EMSEXpleasure event-level scale may be advantageous for future assessments of the ephemeral experience of sexual pleasure, including clinical trials of condoms and other interventions, because it can be used immediately after sex, potentially limiting recall error.
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Affiliation(s)
- Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | | | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | | | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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23
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Golub SA, Gamarel KE. Psychometric evaluation of the Condom Barriers and Motivations Scale (CBMS). J Behav Med 2017; 40:494-505. [PMID: 27995366 PMCID: PMC6372104 DOI: 10.1007/s10865-016-9815-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/28/2016] [Indexed: 01/05/2023]
Abstract
The Condom Barriers and Motivations Scale (CBMS) was developed to measure four distinct categories of barriers and motives to condom use, including: risk reduction motivations, pleasure reduction barriers, intimacy interference barriers, and partner pressure barriers. The CBMS is a 16-item scale with four items that correspond to each of these subscales. The CBMS was tested in two samples of gay and bisexual men. Results support the reliability and validity of the scale and its structure. Results also indicate that CBMS subscales are distinct from general measures of sexual wellbeing, personality factors, or relationship quality (i.e., discriminant validity) and are associated with self-reported condom use with different partner types (i.e., construct validity). The CBMS can be helpful in better understanding the dynamics of condom use in the context of pre-exposure prophylaxis decision-making, and can shed light on innovative approaches to enhance condom use as part of comprehensive HIV prevention and sexual health goals.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
- Basic and Applied Social Psychology PhD Program, The Graduate Center of the City University of New York, New York, NY, USA.
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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24
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Hood KB, Shook NJ, Belgrave FZ. "Jimmy Cap Before You Tap": Developing Condom Use Messages for African American Women. JOURNAL OF SEX RESEARCH 2017; 54:651-664. [PMID: 27136298 DOI: 10.1080/00224499.2016.1168351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined which characteristics of persuasive communications are most effective in changing African American women's condom use attitudes. Focus groups were convened with 40 African American women (Mage = 25.54, SD = 4.67) to assess their opinions on current effective strategies used to promote condom use among their peers. Participants discussed effective characteristics of messaging campaigns (i.e., source, message type, channel) and how these could be used in future prevention messages. Findings revealed that making messages that are fun, catchy, and informative, delivered frequently through social media, TV, or radio by a peer or celebrity would be perceived as most effective in changing young African American women's attitudes. Other themes that emerged were that condom use is more strongly associated with pregnancy prevention than HIV prevention and that sexual partners were perceived to have negative condom use attitudes. Recommendations centered on increasing exposure of HIV prevention messages by placing messages on the Internet and including a funny phrase or jingle in the message so that it is easy to remember and could potentially serve as a conversation starter for discussing safe sex with partners.
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Affiliation(s)
| | | | - Faye Z Belgrave
- c Center for Cultural Experiences in Prevention , Virginia Commonwealth University
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25
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Nelson KM, Eaton LA, Gamarel KE. Preferences for Condomless Sex in Sexually Explicit Media Among Black/African American Men Who Have Sex with Men: Implications for HIV Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:977-985. [PMID: 27987085 PMCID: PMC5438767 DOI: 10.1007/s10508-016-0878-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 05/28/2023]
Abstract
Accumulating evidence suggests that viewing sexually explicit media (SEM; i.e., pornography) may be related to the sexual behaviors of men who have sex with men (MSM). Furthermore, stereotypical depictions of Black/African American MSM engaging in sexual risk behaviors in SEM may serve to normalize condomless sex, reinforce low peer norms around condom use, and facilitate HIV risk taking among Black/African American MSM. Despite this evidence, very little is known about the correlates of SEM consumption among Black/African American MSM, including HIV risk behaviors and their relation to preferences for viewing condomless sex in SEM. Participants were 653 HIV-seronegative Black-identified MSM ages 18-62 (M 33.58, SD 11.01) who completed a cross-sectional survey as a part of a HIV prevention trial in Atlanta, Georgia. Over three-quarters of the men (n = 514) reported a preference for condomless sex in SEM. In multivariate models, engaging in serodiscordant condomless sex was not significantly associated with preferences for condomless sex in SEM; however, men who self-identified as bisexual, engaged in transactional sex, and reported greater agreement with sexual risk cognitions (i.e., heat-of-the-moment thoughts about condom use) had significantly greater odds of reporting a preference for condomless sex in SEM. Study findings highlight the need for future research exploring the role of SEM in the sexual health of Black/African American MSM, including the extent to which SEM exposure alters norms and expectations about sexual behaviors among Black/African American MSM and how this might be addressed in HIV prevention programs.
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Affiliation(s)
- Kimberly M Nelson
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Kristi E Gamarel
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Macapagal K, Janssen E, Matson M, Finn PR, Heiman JR. The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:385-394. [PMID: 26696408 PMCID: PMC4917478 DOI: 10.1007/s10508-015-0679-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 05/31/2023]
Abstract
Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA.
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA.
| | - Erick Janssen
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium
| | - Margaret Matson
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Julia R Heiman
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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Abstract
PURPOSE Concern about young people's sexuality is focused on the need to prevent harmful outcomes such as sexually transmitted infections and unplanned pregnancy. Although the benefit of a broader perspective is recognized, data on other aspects of sexuality, particularly sexual function, are scant. We sought to address this gap by measuring the population prevalence of sexual function problems, help seeking, and avoidance of sex in young people. METHODS A cross-sectional stratified probability sample survey (Natsal-3) of 15,162 women and men in Britain (response rate: 57.7%), using computer-assisted self-interviews. Data come from 1875 (71.9%) sexually active, and 517 sexually inactive (18.7%), participants aged 16-21 years. Measures were single items from a validated measure of sexual function (the Natsal-SF). RESULTS Among sexually active 16- to 21-year-old participants, 9.1% of men and 13.4% of women reported a distressing sexual problem lasting 3 months or more in the last year. Most common among men was reaching a climax too quickly (4.5%), and among women was difficulty in reaching climax (6.3%). Just over a third (35.5%) of men and 42.3% of women reporting a problem had sought help, but rarely from professional sources. Among those who had not had sex in the last year, just >10% of young men and women said they had avoided sex because of sexual difficulties. CONCLUSIONS Distressing sexual function problems are reported by a sizeable minority of sexually active young people. Education is required, and counseling should be available, to prevent lack of knowledge, anxiety, and shame progressing into lifelong sexual difficulties.
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Clinical challenges in HIV/AIDS: Hints for advancing prevention and patient management strategies. Adv Drug Deliv Rev 2016; 103:5-19. [PMID: 27117711 DOI: 10.1016/j.addr.2016.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 01/01/2023]
Abstract
Acquired immune deficiency syndrome has been one of the most devastating epidemics of the last century. The current estimate for people living with the HIV is 36.9 million. Today, despite availability of potent and safe drugs for effective treatment, lifelong therapy is required for preventing HIV re-emergence from a pool of latently infected cells. However, recent evidence show the importance to expand HIV testing, to offer antiretroviral treatment to all infected individuals, and to ensure retention through all the cascade of care. In addition, circumcision, pre-exposure prophylaxis, and other biomedical tools are now available for included in a comprehensive preventive package. Use of all the available tools might allow cutting the HIV transmission in 2030. In this article, we review the status of the epidemic, the latest advances in prevention and treatment, the concept of treatment as prevention and the challenges and opportunities for the HIV cure agenda.
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Culbert GJ, Bazazi AR, Waluyo A, Murni A, Muchransyah AP, Iriyanti M, Finnahari, Polonsky M, Levy J, Altice FL. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons. AIDS Behav 2016; 20:1026-38. [PMID: 26400080 PMCID: PMC4805506 DOI: 10.1007/s10461-015-1198-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.
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Affiliation(s)
- Gabriel J Culbert
- Department of Health Systems Science, University of Illinois at Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA.
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
| | - Alexander R Bazazi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Agung Waluyo
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Astia Murni
- Directorate General of Corrections, Indonesian Ministry of Law and Human Rights, Jakarta, Indonesia
| | | | - Mariska Iriyanti
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Finnahari
- Directorate General of Corrections, Indonesian Ministry of Law and Human Rights, Jakarta, Indonesia
| | - Maxim Polonsky
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Judith Levy
- Department of Health Policy & Administration, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Distal and Proximal Influences on Men's Intentions to Resist Condoms: Alcohol, Sexual Aggression History, Impulsivity, and Social-Cognitive Factors. AIDS Behav 2016; 20 Suppl 1:S147-57. [PMID: 26156881 DOI: 10.1007/s10461-015-1132-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent scientific evidence demonstrates that many young men commonly resist condom use with their female sex partners and that both alcohol intoxication and a history of sexual aggression may increase the risk of condom use resistance (CUR). Using a community sample of heterosexual male non-problem drinkers with elevated sexual risk (N = 311), this alcohol administration study examined the direct and indirect effects of intoxication and sexual aggression history on men's CUR intentions through a sexual risk analogue. State impulsivity, CUR-related attitudes, and CUR-related self-efficacy were assessed as mediators. Results demonstrated that alcohol intoxication directly increased CUR intentions, and sexual aggression history both directly and indirectly increased CUR intentions. These findings highlight the importance of addressing both alcohol use and sexual aggression in risky sex prevention programs, as well as indicate the continued worth of research regarding the intersection of men's alcohol use, sexual aggression, and sexual risk behaviors, especially CUR.
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Perceived Pros and Cons of Condom Use as Predictors of its Consistent Use with a Heterosexual Romantic Partner Among Young Adults. CURRENT PSYCHOLOGY 2015. [DOI: 10.1007/s12144-015-9357-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nesoff ED, Dunkle K, Lang D. The Impact of Condom Use Negotiation Self-Efficacy and Partnership Patterns on Consistent Condom Use Among College-Educated Women. HEALTH EDUCATION & BEHAVIOR 2015; 43:61-7. [PMID: 26194206 DOI: 10.1177/1090198115596168] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to explore the impact of condom negotiation self-efficacy, interpersonal factors, and sensational factors on condom use behavior among a population of college-educated women with different patterns and types of sexual partner. We administered an online questionnaire capturing sexual behavior, partnership patterns, perceived benefits of and barriers to condom use, and condom use negotiation self-efficacy. A total of 433 women completed the online survey. Perceived sensual, erotic, and interpersonal benefits and barriers to condom use, along with negotiation self-efficacy, were found to be significantly associated with consistent condom use. When compared to respondents reporting only main partners, respondents reporting only casual partners were more likely to use condoms while respondents reporting both main and casual partners were least likely to use condoms. Previous negative experiences with condoms were significantly associated with decreased condom use, while history of sexually transmitted infection diagnosis was not consistently associated with condom use. This study supports the importance of negotiation self-efficacy in promoting condom use; however, building women's self-efficacy is not enough for effective condom use promotion among women. The impact of interpersonal, sensual and erotic factors, as well as the context of different partnership patterns, must be considered in future interventions.
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Affiliation(s)
| | - Kristin Dunkle
- South African Medical Research Council, Pretoria, South Africa
| | - Delia Lang
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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McMahon JM, Pouget ER, Tortu S, Volpe EM, Torres L, Rodriguez W. Couple-based HIV counseling and testing: a risk reduction intervention for US drug-involved women and their primary male partners. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:341-51. [PMID: 25512179 PMCID: PMC4310810 DOI: 10.1007/s11121-014-0540-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To help reduce the elevated risk of acquiring HIV for African-American and Latina women drug users in primary heterosexual relationships, we developed a brief couple-based HIV counseling and testing prevention intervention. The intervention was based on an integrated HIV risk behavior theory that incorporated elements of social exchange theory, the theory of gender and power, the stages-of-change model, and the information-motivation-behavior skills model. In this article, we describe the development, content, and format of the couple-based HIV testing and counseling intervention, and its delivery to 110 couples (220 individuals) in a randomized effectiveness trial, the Harlem River Couples Project, conducted in New York City from 2005 to 2007. Components of the couple-based intervention included a personalized dyadic action plan based on the couple's risk profile and interactive exercises designed to help build interpersonal communication skills, and facilitated discussion of social norms regarding gender roles. The couple-based HIV testing and counseling intervention significantly reduced women's overall HIV risk compared to a standard-of-care individual HIV testing and counseling intervention. Experiences and perceptions of the intervention were positive among both clients and interventionists. The study was the first to demonstrate the effectiveness and feasibility of delivering a brief couple-based HIV counseling and testing intervention to reduce risk among drug-using heterosexual couples in high HIV prevalent urban communities in the USA. The intervention can be expanded to include new HIV prevention strategies, such as pre-exposure prophylaxis. Further research is needed to evaluate cost-effectiveness and implementation of the intervention in clinical settings.
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Affiliation(s)
- James M. McMahon
- University of Rochester Medical Center, School of Nursing, 601 Elmwood Avenue, BOX SON, Rochester, NY 14642; 585-276-3951; FAX: 585-273-1270
| | | | - Stephanie Tortu
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | | | - Leilani Torres
- University of Rochester Medical Center, School of Nursing, Rochester, NY
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Downs JS, Bruine de Bruin W, Fischhoff B, Murray PJ. Behavioral Decision Research Intervention Reduces Risky Sexual Behavior. Curr HIV Res 2015; 13:439-46. [PMID: 26149165 PMCID: PMC5523954 DOI: 10.2174/1570162x13666150511145328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/08/2014] [Accepted: 01/06/2014] [Indexed: 11/22/2022]
Abstract
Although adolescents are at disproportionate risk for sexually transmitted infections, most sex education programs have shown little effect on sexual behavior. An interactive video intervention developed by our team has been identified as one of a few programs that have been documented to reduce sexually transmitted infections in this population. Building on behavioral decision research, we used a mental models approach to interview young women about their sexual decisions, finding, among other things, the strong role of perceived social norms. We based our intervention on these results, aiming to help young women identify and implement personally and socially acceptable decision strategies. A randomized controlled trial found that the video reduced risky sexual behavior and the acquisition of chlamydia infection. We recently revised the video to suit more diverse audiences, and upgraded it to modern standards of cinematography and interactivity. It is now in field trial.
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Affiliation(s)
- Julie S Downs
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213- 3890, USA.
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Effects of behavioral intervention content on HIV prevention outcomes: a meta-review of meta-analyses. J Acquir Immune Defic Syndr 2014; 66 Suppl 3:S259-70. [PMID: 25007195 DOI: 10.1097/qai.0000000000000235] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Numerous meta-analyses have examined the success of trials of interventions to reduce the behavioral risk of acquiring or transmitting HIV. Yet, to date, meta-reviews have not systematically examined which type of intervention content is more likely to lead to successful HIV outcomes. The current study addresses this gap. METHODS Published meta-analyses on HIV prevention (k = 56) were retrieved, then coded, and analyzed in terms of the intervention content. RESULTS Past meta-analyses have examined relatively few dimensions of intervention content. Larger meta-analyses were more likely to find that information content dimensions, especially skill provision and motivational enhancement, relate to risk reduction. CONCLUSIONS Fully incorporating behavior change technique (BCT) taxonomies into both intervention research and systematic reviews of this research offers considerable potential. It can improve the precision of conclusions about which specific types of content best promote HIV prevention behaviors and help to lower the cost of interventions. International efforts to improve reporting standards and generate the scholarly expertise necessary to discern BCTs reliably and validly help to address some of the challenges to including BCTs in study reports. Contextualizing research on effective strategies for HIV prevention by reporting and including in analyses community, social, and sample factors is also recommended. Together, such efforts can help refocus the field of HIV prevention on improved research strategies to further improve future interventions by discerning the content design factors related to success for particular populations, rather than merely to assess whether interventions have been successful.
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Higgins JA, Davis AR. Contraceptive sex acceptability: a commentary, synopsis and agenda for future research. Contraception 2014; 90:4-10. [PMID: 24792147 PMCID: PMC4247241 DOI: 10.1016/j.contraception.2014.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Jenny A Higgins
- Gender and Women's Studies, University of Wisconsin-Madison, 475 North Charter Street, 3414 Sterling Hall, Madison, WI 53706, USA.
| | - Anne R Davis
- Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
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Davis KC, Schraufnagel TJ, Kajumulo KF, Gilmore AK, Norris J, George WH. A qualitative examination of men's condom use attitudes and resistance: "it's just part of the game". ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:631-43. [PMID: 23912776 PMCID: PMC3859530 DOI: 10.1007/s10508-013-0150-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 05/17/2012] [Accepted: 05/22/2012] [Indexed: 05/08/2023]
Abstract
The purpose of this study was to investigate the variability in young heterosexual men's perceptions of the advantages and disadvantages of condom use in their casual sexual relationships. Because men who perceive greater disadvantages of condom use may be more likely to resist using them, we also explored the tactics that men employ to avoid using condoms. Semi-structured focus groups were conducted with single men who have sex with women (n = 60), aged 21-35 years, all of whom reported using condoms inconsistently. Transcripts were analyzed using a framework analysis approach. As expected, participants reported advantages and disadvantages to condom use that pertained to the likelihood and quality of sex, physical sensations during intercourse, and the risk of sexually transmitted infections and unwanted pregnancies. Within each of these topics, however, participants' appraisals of the relative pros and cons of condom use varied considerably. Additionally, participants reported that men use a wide range of condom use resistance tactics, including seduction, deception, and condom sabotage, and that the use of these tactics was viewed as normative behavior for men their age. These findings suggest that the effectiveness of sexual health prevention efforts could be enhanced by increasing young men's motivations to use condoms and by targeting social norms regarding condom use resistance. Additionally, the issue of men's condom use resistance clearly merits increased empirical investigation and intervention attention.
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Affiliation(s)
- Kelly Cue Davis
- School of Social Work, University of Washington, 4101 15th Ave NE, Box 354900, Seattle, WA, 98105, USA,
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40
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Chitalu N, Mumbi M, Cook R, Weiss SM, Jones D. The Impact of Key HIV Intervention Components as Predictors of Sexual Barrier Use: The Zambia Partner Project. J Int Assoc Provid AIDS Care 2014; 15:51-8. [PMID: 24482105 DOI: 10.1177/2325957414520980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Behavioral interventions have utilized a variety of strategies and components to reduce HIV risk. This article describes the partner intervention, a couple-based group HIV risk reduction intervention implemented in 6 urban community health clinics in Lusaka, Zambia, and examines the components of the intervention and their relationship with condom use. Couple members completed assessments on condom use, acceptability, willingness to use condoms, communication, intimate partner violence (IPV), self-efficacy, and HIV information at baseline and 6 months' follow-up. This study examined the relative impact of elements of the intervention as predictors of condom use. Changes in acceptability had the greatest overall influence on condom use, followed by social support, relationship consensus, and willingness to use condoms. Changes in self-efficacy, IPV, negotiation, and information had no influence. Results support the use of multidimensional approaches in behavioral interventions and highlight the importance of identifying critical elements of interventions to maximize risk reduction outcomes.
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Affiliation(s)
- Ndashi Chitalu
- Department of Pediatrics, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mirriam Mumbi
- Department of Pediatrics, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Ryan Cook
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Davis KC, Stappenbeck CA, Norris J, George WH, Jacques-Tiura AJ, Schraufnagel TJ, Kajumulo KF. Young men's condom use resistance tactics: a latent profile analysis. JOURNAL OF SEX RESEARCH 2014; 51:454-65. [PMID: 23548069 PMCID: PMC3723757 DOI: 10.1080/00224499.2013.776660] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Research suggests that many men have used a variety of tactics to avoid using condoms when having sex with women. Guided by previous work demonstrating that men's use of coercive condom resistance tactics was predicted by negative attitudes toward women, inconsistent condom use, multiple partners, and sexual sensation seeking, the current study used latent profile analysis (LPA) to determine whether similar constructs were associated with a variety of resistance tactics. A community sample of 313 moderate-drinking men participated, of whom 80% reported employing at least one condom use resistance tactic since adolescence. The LPA revealed three classes of men. In general, men with the least negative beliefs about women, low levels of sexual sensation seeking and impulsivity, and positive beliefs about condoms (Condom Positive/Low Hostility) reported less use of resistance tactics than men with moderate sexual sensation seeking and impulsivity, negative beliefs about condoms, and moderate (Condom Negative/Moderate Hostility) or high (Condom Negative/High Hostility) negative attitudes about women. The classes also differed in terms of their sexual behaviors. This study demonstrated that sexual risk behavior interventions should not only address the tactics through which men resist using condoms but also tailor these efforts to men's individual characteristics.
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Affiliation(s)
- Kelly Cue Davis
- School of Social Work, University of Washington, Seattle, WA
| | | | - Jeanette Norris
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
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Crosby RA, Milhausen RR, Graham CA, Yarber WL, Sanders SA, Charnigo R, Shrier LA. Condom use motivations and selected behaviours with new versus established sex partners. Sex Health 2014; 11:252-7. [DOI: 10.1071/sh13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/06/2014] [Indexed: 11/23/2022]
Abstract
Objective To compare condom use motives and behaviours in the context of penile–vaginal intercourse (PVI) with new versus established sexual partners, using daily event-level data among a clinic-recruited sample. Methods: Participants (ages 15–65 years old) were recruited from five sexually transmissible infection (STI) clinics in three United States cities. They were provided with personal digital assistants and instructed to respond to daily questionnaire items regarding PVI events from the past 24 h. Generalised estimations equations were used to make inferences on age-adjusted estimated odds ratios, comparing events occurring with established versus new partners. Results: For males, pregnancy prevention was a more common motivation for condom use in new relationships (P < 0.001). Males with new sex partners were more likely to report condom use (P < 0.005) and also reported fewer errors or problems in condom use with new sex partners (P < 0.001). For females, pregnancy prevention (P = 0.03), STI acquisition (P < 0.001) and STI transmission (P = 0.005) were more likely to be motives for condom use with new versus established partners. Also, females with new sex partners were more likely to report condom use (P < 0.001) as well as using multiple condoms during a single event (P = 0.03). Conclusion: Event-level findings suggest that condom use motivations and behaviours vary depending on whether PVI occurs between established versus new sex partners. Condom use is more likely for PVI with new partners, but other condom-associated behaviours and motivations differ between females and males.
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von Sadovszky V, Draudt B, Boch S. A systematic review of reviews of behavioral interventions to promote condom use. Worldviews Evid Based Nurs 2013; 11:107-17. [PMID: 24119245 DOI: 10.1111/wvn.12017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a major public health problem. Realistically, condom use is still the primary means to prevent STIs. Because many behavioral intervention studies have been performed to increase condom use across multiple populations and many reviews have been done, a review of all these reviews is warranted. AIMS The purpose of this paper is to examine Level I evidence of behavioral intervention studies to promote condom use. The purpose of this evidence-based practice (EBP) review is to examine the evidence and determine: (a) if behavioral interventions are effective; and (b) if they are, what are the common characteristics of successful interventions that need to be implemented in practice. METHODS A systematic search for literature was conducted in the following databases: Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, and Psychological and Behavioral Sciences Collection. The following parameters were used for the search: (a) a meta-analysis or level 1 synthesis of literature containing only intervention (randomized control trials or quasi-experimental) studies; (b) peer-reviewed journals; (c) published in the past 10 years (2002-2012); (d) had adolescents or adults as the sample (13-44 years of age); and (e) were published in English. RESULTS Behavioral interventions were effective in promoting condom use and other safer sexual practices and reducing STIs. They were not effective in promoting abstinence. Tailoring to certain characteristics of the population and including skills building exercises were primary characteristics in the successful interventions IMPLICATIONS There is a preponderance of evidence that behavioral interventions do promote condom use and reduce STIs across diverse groups of individuals. Clinicians can use these interventions with confidence in practice.
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Affiliation(s)
- Victoria von Sadovszky
- Associate Professor, College of Nursing, The Ohio State University and Nurse Scientist, Nationwide Children's Hospital, Columbus, OH
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Hood KB, Shook NJ. Conceptualizing women's attitudes toward condom use with the tripartite model. Women Health 2013; 53:349-68. [PMID: 23751090 DOI: 10.1080/03630242.2013.788610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (2011) estimated that women represent 24% of HIV diagnoses in the United States, with most infections resulting from heterosexual contact. However, consistent condom use is highly effective in preventing the spread of HIV. The current study examined women's attitudes toward condom use and potential inconsistencies related to the conceptualization and measurement of attitudes. METHOD Data were collected from October 2009 through March 2010. Researchers included 556 female undergraduate students from the Southeast region of the United States. Exploratory and confirmatory factor analyses were used to determine whether women's condom use attitudes were composed of an affective and a cognitive component. RESULTS Evidence for a two-factor model of condom use attitudes consisting of an affective and cognitive component was found, with participants reporting slightly negative feelings toward condom use but favorable beliefs about using condoms. Affect accounted for more variance (42%) than cognition (8%) in condom use attitudes. Notably, affect and cognition were differentially associated with past behavior and intentions to use condoms. CONCLUSION Understanding the structure of women's attitudes toward using condoms can aid in the creation of appropriate HIV prevention and condom use messaging targeted toward promoting positive attitudes and normative change. Changing women's attitudes in this manner could enhance the effectiveness of condom use interventions.
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Affiliation(s)
- Kristina B Hood
- Department of Psychology, Mississippi State University, Mississippi State, MS 39762-6161, USA.
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LaCroix JM, Pellowski JA, Lennon CA, Johnson BT. Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis. Sex Transm Infect 2013; 89:620-7. [PMID: 23918756 DOI: 10.1136/sextrans-2013-051135] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy. METHODS A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression. RESULTS Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use. CONCLUSIONS Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
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Affiliation(s)
- Jessica M LaCroix
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, , Storrs, Connecticut, USA
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Do safer sex self-efficacy, attitudes toward condoms, and HIV transmission risk beliefs differ among men who have sex with men, heterosexual men, and women living with HIV? AIDS Behav 2013; 17:1873-82. [PMID: 22252475 DOI: 10.1007/s10461-011-0108-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To understand sexual decision-making processes among people living with HIV, we compared safer sex self-efficacy, condom attitudes, sexual beliefs, and rates of unprotected anal or vaginal intercourse with at-risk partners (UAVI-AR) in the past 3 months among 476 people living with HIV: 185 men who have sex with men (MSM), 130 heterosexual men, and 161 heterosexual women. Participants were enrolled in SafeTalk, a randomized, controlled trial of a safer sex intervention. We found 15% of MSM, 9% of heterosexual men, and 12% of heterosexual women engaged in UAVI-AR. Groups did not differ in self-efficacy or sexual attitudes/beliefs. However, the associations between these variables and UAVI-AR varied within groups: greater self-efficacy predicted less UAVI-AR for MSM and women, whereas more positive condom attitudes--but not self-efficacy--predicted less UAVI-AR for heterosexual men. These results suggest HIV prevention programs should tailor materials to different subgroups.
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Carswell K, McCarthy O, Murray E, Bailey JV. Integrating psychological theory into the design of an online intervention for sexual health: the sexunzipped website. JMIR Res Protoc 2012; 1:e16. [PMID: 23612122 PMCID: PMC3626157 DOI: 10.2196/resprot.2114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 09/09/2012] [Accepted: 09/01/2012] [Indexed: 11/19/2022] Open
Abstract
Background The Internet can provide a confidential and convenient medium for sexual health promotion for young people. Objective This paper describes the development of an interactive, theory-based website (Sexunzipped) aimed at increasing safe sexual behavior of young people, as well as an outline of the evaluation protocol. Methods The website focuses on safer sex, relationships, and sexual pleasure. An overview of the site is provided, including a description of the theoretical constructs which form the basis of the site development. An integrated behavioral model was chosen as the guiding theory for the Sexunzipped intervention. A randomized trial design will be used to evaluate the site quantitatively. Results The content of the site is described in detail with examples of the main content types: information pages, quizzes, and decision-making activities. We describe the protocol for quantitative evaluation of the website using a randomized trial design and discuss the principal challenges involved in developing the site, including the challenge of balancing the requirements of theory with young people’s views on website content and design. Conclusions Considerations for future interventions are discussed. Developing an online behavior-change intervention is costly and time consuming. Given the large public health potential, the cost involved in developing online interventions, and the need for attractive design, future interventions may benefit from collaborating with established sites that already have a user base, a brand, and a strong Internet presence. It is vital to involve users in decisions about intervention content, design, and features, paying attention to aspects that will attract and retain users’ interest. A central challenge in developing effective Internet-based interventions for young people is to find effective ways to operationalize theory in ways that address the views and perspectives of young people.
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Affiliation(s)
- Kenneth Carswell
- The Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, United Kingdom.
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Golub SA, Starks TJ, Payton G, Parsons JT. The critical role of intimacy in the sexual risk behaviors of gay and bisexual men. AIDS Behav 2012; 16:626-32. [PMID: 21630012 DOI: 10.1007/s10461-011-9972-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research indicates that high numbers of gay and bisexual men report infrequent or inconsistent condom use, placing them at risk for HIV and other STDs. The present study examined positive and negative condom-related attitudes along three dimensions-risk reduction, pleasure reduction, and intimacy interference-and examined their relative predictive power in determining condom use among a sample of sexually risky gay and bisexual men in New York City. In a multivariate model, both risk reduction and intimacy interference attitudes emerged as significant predictors of unprotected sex; however, the variance accounted for by a model including intimacy interference was almost three times that accounted for by a model including risk reduction alone. These data suggest a pivotal role for intimacy in shaping condom attitudes and behavior among gay and bisexual men. HIV prevention interventions should consider incorporating intimacy as a motivating factor for sexual behavior and a potential barrier to condom use.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College, City University of New York (CUNY), 695 Park Avenue, Room 714N, New York, NY, USA.
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Higgins JA, Mullinax M, Trussell J, Davidson JK, Moore NB. Sexual satisfaction and sexual health among university students in the United States. Am J Public Health 2011; 101:1643-54. [PMID: 21778509 PMCID: PMC3154236 DOI: 10.2105/ajph.2011.300154] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2011] [Indexed: 11/04/2022]
Abstract
Despite the World Health Organization's definition of sexual health as a state of well-being, virtually no public health research has examined sexual well-being outcomes, including sexual satisfaction. Emerging evidence suggests that sexual well-being indicators are associated with more classic measures of healthy sexual behaviors. We surveyed 2168 university students in the United States and asked them to rate their physiological and psychological satisfaction with their current sexual lives. Many respondents reported that they were either satisfied (approximately half) or very satisfied (approximately one third). In multivariate analyses, significant (P < .05) correlates of both physiological and psychological satisfaction included sexual guilt, sexual self-comfort, self-esteem (especially among men), relationship status, and sexual frequency. To enhance sexual well-being, public health practitioners should work to improve sexual self-comfort, alleviate sexual guilt, and promote longer term relationships.
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Affiliation(s)
- Jenny A Higgins
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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50
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Knerr W, Philpott A. Strange bedfellows: bridging the worlds of academia, public health and the sex industry to improve sexual health outcomes. Health Res Policy Syst 2011; 9 Suppl 1:S13. [PMID: 21679380 PMCID: PMC3121130 DOI: 10.1186/1478-4505-9-s1-s13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The public health response to sexually transmitted infections, particularly HIV, has been and continues to be overwhelmingly focused on risk, disease and negative outcomes of sex, while avoiding discussion of positive motivations for sex (e.g. pleasure, desire, love). Recent advocacy efforts have challenged this approach and organisations have promoted the eroticisation of safer sex, especially in the context of HIV prevention.This paper is a case study of one of these organizations - The Pleasure Project. It gives a brief background on the public-health approach to sex and sexual health, and recommends an alternative approach which incorporates constructs of pleasure and desire into sexual health interventions. The Pleasure Project's aims and unorthodox communications strategies are described, as are the response to and impact of its work, lessons learned and ongoing challenges to its approach.The Pleasure Project combines evidence (rigorous and experimental as well as qualitative and anecdotal) with experiential knowledge from the sex industry and safer-sex promotion to communicate messages about eroticising safer sex to influence researchers, public health practitioners and policymakers, mainstream media and the porn world. There are significant barriers to this work, because it challenges common and entrenched norms and values related to sex and pleasure and their role in the public health sphere. Other barriers include: the limited range of existing rigorous intervention trials which incorporate pleasure constructs; the lack of effective indicators to measure pleasure constructs; limited funding and resources; discomfort among public health practitioners, researchers and donors with concepts of pleasure and sex; and rejection of erotic media as a potential tool for prevention.Despite the backdrop of sex-negative public health practice, there is anecdotal evidence that safer sex, including condom use, can be eroticised and made pleasurable, based on qualitative research by The Pleasure Project and other like-minded organisations. Yet there is a need for more research on the effectiveness of pleasure components in sexual health interventions, particularly in high-risk contexts. This need has become urgent as practitioners look for new ways to promote sexual health and as new prevention technologies (including female condoms and microbicides) are introduced or disseminated.
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Affiliation(s)
- Wendy Knerr
- Taking Action For Sexual Health, P.O. Box 1502, Oxford, OX4 9ED, UK
| | - Anne Philpott
- Taking Action For Sexual Health, P.O. Box 1502, Oxford, OX4 9ED, UK
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