A mixed methods study of sexuality education experiences and preferences among bisexual, pansexual, and queer (bi+) male youth

Low HIV Testing and PrEP Uptake of Adolescent and Young Men who have Sex with Men in Vietnam

Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06-2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06-1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47-0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06-1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03-1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35-0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.

Inclusion Goals: What Sex Education for LGBTQIA+ Adolescents?

According to the World Health Organization and the World Association for Sexual Health (WAS) Declaration of Sexual Rights, sex education aims to provide children and adolescents with comprehensive knowledge, skills, attitudes, and values, promoting equality and nondiscrimination while upholding freedom of thought and expression. However, current school curricula often focus on dichotomous sexual identity and hetero-cis-normative prevention strategies, neglecting the needs of gender minority (GM) and sexual minority (SM) youths. In family settings, discussions typically revolve around sexual risk reduction and basic contraception, omitting relational aspects and components of sexual identity such as orientations and gender expressions. This discrepancy highlights a gap between the official goals of sex education and its practical implementation, reflecting a cultural deficit in familial sex education. This study reviews the scientific literature on sexual health promotion interventions from 2015 to 2024 to identify inclusive approaches that enhance the participation of all youths, not just hetero-cis-normative individuals. The hypothesis is that most interventions primarily serve heterosexual and cisgender youths, indicating a need for more inclusive strategies to achieve better sexual health and educational outcomes. The study also suggests expanding curricula to align with recognized guidelines and the diverse needs of youth.

Sexual Health Education Experiences and Recommendations from the Perspective of LGBTQ+ Youth

Despite the well-known benefits of comprehensive sexual health education, the majority of school sexual health education curricula in the United States (U.S.) is non-comprehensive and excludes LGBTQ+ students. This exclusion may contribute to poor health outcomes in LGBTQ+ youth, with some research beginning to document these experiences and provide recommendations for curricula changes. Using a sample of LGBTQ+ youth across the U.S. (ages 13-17; N = 809), this study characterizes youths' sexual health education experiences and provides curricula recommendations using a mixed methods approach. Quantitative analyses revealed that LGBTQ+ content is often excluded from sexual health education, particularly topics surrounding sexual orientation and gender identity, which youth wanted to learn more about. Furthermore, participants identified several extracurricular sources of sexual health education, including online spaces, friends, and personal experiences, which were often preferred. Qualitative analyses suggested that LGBTQ+ youth described their sexual health education as exclusive of LGBTQ+ content, often being based in abstinence, religious principles, or described as oppressive (e.g. hearing LGBTQ+ negative remarks) or suppressive (e.g. skipping required LGBTQ+ content). LGBTQ+ youth also provided recommendations for future curricula. Findings can inform curricula development and implementation, as well as policy change, to ascertain that all youth have access to inclusive and comprehensive sexual health education.

Are Queer Men Queering Consent? A Scoping Review of Sexual Consent Literature Among Gay, Bisexual, Trans, and Queer Men

Objectives

To review the literature on Gay, Bisexual, Trans, and Queer (GBTQ) men and sexual consent.

Methods

Eight electronic databases were searched in June 2022, yielding 1924 articles; 30 were included for review after screening.

Results

We found a growing body of literature focused on GBTQ men, with an increasingly intersectional lens. Most studies adopted a nuanced definition of sexual consent. Many discussed the unique sexual scripts developed by GBTQ men to communicate consent, especially in sex venues, and how unfamiliarity with these scripts creates vulnerability for newly "out" men. A common theme was the impact of heteromasculine norms on sexual encounters between GBTQ men.

Conclusions

The reviewed literature problematizes binary definitions of consent and miscommunication theories of assault. It both celebrates and problematizes GBTQ sexual cultures. We encourage future research to adopt more explicitly anti-carceral approaches to studying sexual consent and violence.

Self-Reported Sexual Behavior of Transgender Youth

INTRODUCTION

Research indicates transgender/gender diverse (TGD) youth are more likely to engage in sexual behavior, have more sexual partners, and initiate sexual behavior earlier than their cisgender peers. However, no gender-inclusive self-report survey questionnaires (i.e., those that do not assume the gender of sexual partners or body parts used for sex) exist to assess sexual behavior of TGD youth. The current study illustrates a questionnaire with nuanced wording to more accurately portray the sexual behavior of TGD youth presenting for gender-affirming medical care compared to national adolescent norms.

METHODS

Retrospective chart review of 323 youth, ages 13-18, presenting to a pediatric gender clinic between 2015-2021. Youth self-reported their gender identity (i.e., masculine, feminine, gender queer, questioning/unsure), sexual behaviors, and partners via a REDCAP survey.

RESULTS

Rates of dating among TGD youth were significantly lower than national norms (33.7% v 68.3%; X2=172.644, p< 0.0001), as was sexual behavior (14.9% vs. 39.5% X2=80.419, p< 0.0001). Rates of self-reported involuntary sexual activity among TGD youth did not differ significantly from national norms (7.1% vs. 6.9%, ns). Body parts used for sex, the number of sexual partners, and the gender identity of sexual partners are reported.

DISCUSSION

Results suggest that rates of dating and sexual behavior among TGD youth are significantly lower than national norms, supporting a need for screening of sexual health among TGD youth utilizing gender-inclusive measures. A standardized gender-inclusive questionnaire of sexual behavior is needed to improve data accuracy and help develop inclusive programs to address the sexual health needs of TGD youth.

Sexual Orientation and Gender Identity/Expression in Adolescent Research: Two Decades in Review

There is a long history of research among adolescents who are minoritized and marginalized for their sexual orientation and gender identity/expression (SOGIE). However, it remains unclear how we can best conceptualize and assess SOGIE in adolescence, resulting in different subpopulations and findings across studies. Addressing this issue, we present a narrative literature review of the conceptualization and assessment of SOGIE, and provide recommendations for conceptualizing and operationalizing these concepts. Our review indicated that most research with adolescent populations still almost exclusively assesses isolated dimensions of sexuality and gender (e.g., attraction but not identity). We argue that to make research inclusive and equitable, scholars are required to make clear substantiated decisions and be transparent about the SOGIE dimensions and, thus, subpopulations they represent.

Mind the Gaps: The Need for Inclusion of Male-Identified Voices in Adolescent Sexual and Reproductive Health

Adolescent sexual and reproductive health (ASRH) inequities are well documented for historically excluded youth (i.e., youth of color, LGBTQIA+ youth, youth with disabilities, recently im/migrated youth) living in the U.S. Northeast. However, the lived experience of male-identifying young people from historically excluded backgrounds in ASRH remains largely unexamined. The purpose of this paper is to present findings related to male-identified perspectives on social constructions of sexuality, sexual and reproductive health, and sexuality education. A research team composed of two local youth-serving organizations, eight youth researchers, and university researchers, used Youth Participatory Action Research (YPAR) methods to examine how structural violence contributes to inequitable ASRH outcomes for historically excluded youth. Photovoice and community mapping were used as YPAR methods. We also completed individual interviews on the same topic with the youth and with 17 key stakeholders that either provide services to youth or are emerging adult service recipients. Community-driven data reveal two major themes around the silencing of male-identified voices in ASRH: lack of culture-centered and gender-expansive approaches for ASRH, and the subsequent toll of sexism and (cis)gendered social and educational norms on young people. Our findings highlight that sexuality education, cisgender hetero culture, and social norms have put the onus of responsibility on people identifying as women for sexual and reproductive health. An unintended consequence of that is that young people identifying as men may feel powerless and uninformed around their own SRH. Our findings illustrate the importance of using culture-centered and gender-transformative approaches to ASRH to address inequity.