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Sarwar G, Morshed Khan MN, Gourab G, Irfan SD, Rahman M, Rana AKMM, Khan SI. Can oral sex be performed safely among men who have sex with men (MSM) and transgender women in Bangladesh? Challenges, complexities and the way forward. Heliyon 2023; 9:e15553. [PMID: 37128302 PMCID: PMC10148115 DOI: 10.1016/j.heliyon.2023.e15553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs. Methodology This qualitative study constituted 30 in-depth interviews, 14 focus group discussions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied. Results Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV intervention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities. Conclusions In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.
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Affiliation(s)
| | | | | | | | | | | | - Sharful Islam Khan
- Corresponding author. Head and Scientist Programme for HIV and AIDS Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, 1212 Dhaka, Bangladesh.
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2
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Gesselman AN, Ryan R, Yarber WL, Vanterpool KB, Beavers KA, Francis H, Grant BT, Wood K, Graham CA, Milhausen R, Sanders SA, Crosby RA. An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1665-1672. [PMID: 33151840 DOI: 10.1080/07448481.2020.1818753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.
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Affiliation(s)
- Amanda N Gesselman
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
| | - Rebecca Ryan
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - William L Yarber
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Karen B Vanterpool
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Karly A Beavers
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Heather Francis
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Brandon T Grant
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Katherine Wood
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Cynthia A Graham
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robin Milhausen
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Stephanie A Sanders
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Richard A Crosby
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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3
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Nguyen NC, Luong TN, Le VT, Hobbs M, Andridge R, Casterline J, Gallo MF. Effectiveness of erectogenic condom against semen exposure among women in Vietnam: Randomized controlled trial. PLoS One 2022; 17:e0263503. [PMID: 35176037 PMCID: PMC8853499 DOI: 10.1371/journal.pone.0263503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/14/2021] [Indexed: 01/22/2023] Open
Abstract
A key barrier to the consistent use of condoms is their negative effect on sexual pleasure. Although sexual pleasure is a primary motivation for engaging in sex and is an integral part of overall sexual health, most programs to improve sexual health operate within a pregnancy and disease-prevention paradigm. A new condom, CSD500 (Futura Medical Developments; Surrey, UK), containing an erectogenic drug was developed for use among healthy couples to improve sexual pleasure by increasing penile firmness, size and erection duration. We conducted a randomized controlled trial to test whether promoting the novel condom CSD500 for improved sexual pleasure is effective in reducing condomless sex compared to the provision of standard condoms with counseling for pregnancy and disease prevention. We randomized 500 adult, heterosexual, monogamous couples in Thanh Hoa province, Vietnam to receive either CSD500 (n = 248) or standard condoms (n = 252). At enrollment and after 2, 4, and 6 months, we interviewed women and sampled vaginal fluid to test for the presence of prostate-specific antigen (PSA), an objective, biological marker of recent semen exposure. We registered the protocol before trial initiation at ClinicalTrials.gov (identifier: NCT02934620). Overall, 11.0% of women were PSA positive at enrollment. The proportion of follow-up visits with PSA-positivity did not differ between the intervention (6.8%) and control arms (6.7%; relative risk, 1.01; 95% confidence interval, 0.66-1.54). Thus, we found no evidence that promoting an erectogenic condom to women in a monogamous, heterosexual relationship in Vietnam reduced their exposure to their partner's semen. These findings might not hold for other populations, especially those with a higher frequency of condomless sex.
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Affiliation(s)
- Nghia C. Nguyen
- Department of Obstetrics and Gynecology, Vinmec International Hospital, Hanoi, Vietnam
| | - Truong N. Luong
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - Van T. Le
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - Marcia Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - John Casterline
- Department of Sociology, College of Arts and Sciences, Ohio State University, Columbus, Ohio, United States of America
| | - Maria F. Gallo
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America
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4
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Levy E, Kaufman MR, Gidron Y, Deschepper R, Olley BO. Interventions targeting social cognitive determinants of condom use in the general Sub-Saharan population: A Systematic Review. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1637167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Einav Levy
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Lucien Research Center, The Israeli School of Humanitarian Action, Tel Aviv, Israel
| | - Michelle R. Kaufman
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yori Gidron
- Lucien Research Center, The Israeli School of Humanitarian Action, Tel Aviv, Israel
- SCALab, Lille3 University, Lille, France
| | - Reginald Deschepper
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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5
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Fortenberry JD. Trust, Sexual Trust, and Sexual Health: An Interrogative Review. JOURNAL OF SEX RESEARCH 2019; 56:425-439. [PMID: 30289286 DOI: 10.1080/00224499.2018.1523999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
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Wang Z, Lau JTF, Wang Q, Mo PKH. Prevalence of and Factors Associated With Inconsistent Condom Use With HIV-Discordant Male Regular Sex Partners Among HIV-Infected Women in China. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:339-349. [PMID: 30703336 DOI: 10.1080/0092623x.2018.1526835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study was to investigate the prevalence and associated factors of inconsistent condom use with HIV-discordant regular male sex partners (RP: defined as their husband or steady boyfriends) in the last six months among HIV-infected women in China. We interviewed 256 HIV-infected women who currently had at least one HIV-discordant RP and had had sexual intercourse with such RP since diagnosis. The prevalence of inconsistent condom use with HIV-discordant RP was 48.4%. Associated factors included perceptions related to condom use and perceived competence in communicating with HIV-discordant RP regarding condom use.
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Affiliation(s)
- Zixin Wang
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
| | - Joseph T F Lau
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
| | - Qian Wang
- c Department of Prevention of Mother to Child Transmission of Disease, National Center for Women and Children's Health , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Phoenix K H Mo
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
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7
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Wang Z, Yang L, Jiang H, Huang S, Palmer AE, Ma L, Lau JTF. High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:31-43. [PMID: 29741446 DOI: 10.1080/0092623x.2018.1474408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners' responsibility of using condoms.
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Affiliation(s)
- Zixin Wang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
- b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
| | - Ligang Yang
- c Dermatology Hospital, Southern Medical University , Guangzhou , China
- d Guangdong Provincial Dermatology Hospital , Guangzhou , China
| | - Hui Jiang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
| | - Shujie Huang
- c Dermatology Hospital, Southern Medical University , Guangzhou , China
- d Guangdong Provincial Dermatology Hospital , Guangzhou , China
| | - Allison E Palmer
- e Tulane University , School of Public Health and Tropical Medicine , New Orleans , Louisiana , USA
| | - Lu Ma
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
| | - Joseph T F Lau
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong
- b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
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8
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Agunbiade OM, Togunde D. 'No Sweet in Sex': Perceptions of Condom Usefulness among Elderly Yoruba People in Ibadan Nigeria. J Cross Cult Gerontol 2018; 33:319-336. [PMID: 30128832 PMCID: PMC6133031 DOI: 10.1007/s10823-018-9354-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emerging evidence has shown a gradual increase in sexually transmitted infections among elderly. This study explores the views of elderly Yoruba men and women (60+) on condoms use and its suitability against sexual infections. The research design was a sequential exploratory mixed method that consisted of vignettes based focus group discussion and a structured questionnaire. Twelve vignettes based Focus Group Discussion and a survey of 252 elderly Yoruba people (aged 60+) were carried out. The findings revealed limited awareness and experience with condoms. Few of the male (20.4%) and 2.8% of the female respondents felt condom use can prevent sexually transmitted infections. A marginally proportion of the females (29.2%) than the males (25.0%) perceived condom as more useful for younger people. Condom use as a preventive measure against sexual infections varies by gender and marital status (p = .000). Gender and marital status also had an influence on whether condom use could reduce sexual pleasures (p = 0.000). These findings offer strong support of the sexual pleasure hypothesis which is often invoked to explain attitude toward condom use in a variety of social and cultural contexts. Social marketing of condoms is urgently required to address misconceptions around condom use and encourage uptake among sexually active elderly people.
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Affiliation(s)
- Ojo Melvin Agunbiade
- Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa.
- African Population and Health Research Center, Nairobi, Kenya.
| | - Dimeji Togunde
- International Studies Program, Spelman College, Atlanta, GA, USA
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9
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Milhausen RR, McKay A, Graham CA, Sanders SA, Crosby RA, Yarber WL, Wood J. Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students. JOURNAL OF SEX RESEARCH 2018; 55:21-30. [PMID: 28358218 DOI: 10.1080/00224499.2017.1298713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.
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Affiliation(s)
- Robin R Milhausen
- a Department of Family Relations and Applied Nutrition, University of Guelph; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention , Indiana University
| | | | - Cynthia A Graham
- c Department of Psychology, University of Southampton; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University ; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Stephanie A Sanders
- d Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Richard A Crosby
- e Department of Health Behavior, College of Public Health , University of Kentucky; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - William L Yarber
- f Department of Applied Health Science, Indiana University; Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Jessica Wood
- g Department of Psychology , University of Guelph
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10
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Anyanwu PE, Fulton J. Knowledge and perception of young adults in Nigeria on effectiveness of condom use in prevention of sexually transmitted infections. Int J Adolesc Med Health 2017; 29:/j/ijamh.2017.29.issue-2/ijamh-2015-0050/ijamh-2015-0050.xml. [PMID: 26536574 DOI: 10.1515/ijamh-2015-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/16/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although sexually transmitted infections (STIs) are a global health problem affecting every region of the world, the higher prevalence and mortality rate of STIs in developing countries of the world, like Nigeria, make them serious public health issues in this region. OBJECTIVE The aim of this study is to assess the knowledge and perception of young adults in Nigeria on the role of condom (both male and female condoms) as a preventive measure against STIs during heterosexual and homosexual intercourse. MATERIALS AND METHODS Data was collected from participants selected from the northern and southern Nigeria using self-administered questionnaire specifically designed for this study. RESULTS Knowledge of condom efficacy in STI prevention was satisfactory. However, knowledge and practice of the correct use of condom was poor. Only 47.1% of the 102 participants in this study reported correct condom use of wearing condoms before staring intercourse and removing condoms after ejaculation. As a strategy to include the experiences, knowledge and perception of men who have sex with men, this study asked the question on condom use during anal sex. Only 24.4% of the male participants indicated they have never had anal sex while for females, the percentage was more than half (53.5%). Condom use during anal sex was low with only 20.6% of participants reporting condom use during anal sex. Negative perceptions about condom use - such as that condom use promotes sexual promiscuity, and not using condoms with steady sexual partners - were significant in this study. Also, condom use errors were common in this study. CONCLUSION There is a wide gap in knowledge of correct condom use in this population. There is need for interventions that address the issue of condom use during anal and same-sex sexual intercourse in this population.
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Affiliation(s)
| | - John Fulton
- Department of Pharmacy Health and Well-being, University of Sunderland
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11
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Ballester-Arnal R, Ruiz-Palomino E, Gil-Llario MD. Structural Equation Modeling Test of an Integrated Model of Spanish Youth's Condom Use. AIDS Behav 2017; 21:1407-1416. [PMID: 27217037 DOI: 10.1007/s10461-016-1430-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heterosexual transmission represents 26 % of newly diagnosed infection in Spanish youth. Behavioral change models have emphasized the influence of multiple variables to predict condom use behavior. The aim of this study is to examine how those variables are organized and which theory explains the condom use behavior better. A sample of 424 young heterosexuals (M age = 20.62; SD = 2.16) filled out a battery of self-report questionnaires for assessing AIDS-related variables, personality traits and clinical variables (general, sexuality-related and health-related). A structural model was specified that included perceived pleasure and condom use self-efficacy as predictive variables. Depression and sexual compulsivity indirectly influence behavior. The final model accounted for 65.9 % of the variance in behavior. These results highlight the importance of cognitive and emotional variables as predictors of behavior (ex. expectations of pleasure and self-efficacy beliefs). This is important information for designing effective psychological interventions.
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12
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Mullinax M, Sanders S, Dennis B, Higgins J, Fortenberry JD, Reece M. How Condom Discontinuation Occurs: Interviews With Emerging Adult Women. JOURNAL OF SEX RESEARCH 2017; 54:642-650. [PMID: 26983682 PMCID: PMC5026563 DOI: 10.1080/00224499.2016.1143440] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We have almost no data on how and when couples stop using condoms. This qualitative study investigated the process of condom discontinuation. From November 2013 to April 2014, a total of 25 women living in a college town in the Midwest, ages 18 to 25, participated in semistructured interviews centered around three domains: partner interactions, contraceptive use, and sexually transmitted infection (STI) prevention. Analysis followed a critical qualitative research orientation. Participants described actively seeking the best options to prevent pregnancy, perceiving condom discontinuation in favor of hormonal methods as a smart decision, and reported wanting to discontinue using condoms due to physical discomfort. Oftentimes, nonverbal communication around contextual instances of condom unavailability paved the way for discontinuation. Participants indicated the decision to stop using condoms was neither deliberate nor planned. Condom discontinuation rarely occurred at one point in time; instead, it was preceded by a period of occasional use. Even after participants described themselves as not using condoms, sporadic condom use was normal (typically related to fertility cycles). This study provides a more detailed understanding of how and why emerging adults negotiate condom discontinuation, thereby enhancing our ability to design effective condom continuation messages. Attention should be paid to helping emerging adults think more concretely about condom discontinuation.
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Affiliation(s)
- Margo Mullinax
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute
| | - Stephanie Sanders
- b Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University-Bloomington and Department of Gender Studies , Indiana University-Bloomington
| | - Barbara Dennis
- c Department of Counseling and Educational Psychology, School of Education , Indiana University-Bloomington
| | - Jenny Higgins
- d Department of Gender and Women's Studies , University of Wisconsin-Madison
| | | | - Michael Reece
- f Center for Sexual Health Promotion , Indiana University-Bloomington
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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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14
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Wood JR, Milhausen RR, Sales JM, Graham CA, Sanders SA, Diclemente RJ, Wingood GM. Arousability as a predictor of sexual risk behaviours in African-American adolescent women. Sex Health 2014; 10:160-5. [PMID: 23557603 DOI: 10.1071/sh12055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/19/2012] [Indexed: 11/23/2022]
Abstract
This study examined the impact of sexual excitation (arousability) on sexual risk-taking behaviours in a community sample of African-American adolescent women. A sample of 701 African-American adolescent women completed measures examining their propensity for sexual arousal, impulsivity and sexual behaviour. Compared with women with a lower propensity for sexual arousability, women with a higher propensity reported a greater number of sexual partners, more inconsistent condom use, a greater likelihood of having engaged in sexual intercourse with 'risky' partners, and sex while high on alcohol or drugs. These results indicate that women who have a greater propensity to become sexually aroused in a variety of situations may be at a greater risk for contracting HIV or sexually transmissible infections relative to women with a lower propensity for arousal. This suggests that individual differences in the propensity to become sexually aroused should be considered when developing intervention approaches targeting young African-American women.
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Affiliation(s)
- Jessica R Wood
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
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Lawani LO, Onyebuchi AK, Iyoke CA. Dual method use for protection of pregnancy and disease prevention among HIV-infected women in South East Nigeria. BMC WOMENS HEALTH 2014; 14:39. [PMID: 24602410 PMCID: PMC3973850 DOI: 10.1186/1472-6874-14-39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND sub-Saharan Africa continue to bear the greatest burden of HIV/AIDS epidemic due to its large population, high fertility rate and unmet contraceptive need, most especially with poor uptake of dual methods (use of condom and another effective family planning method) which protects against STIs/HIV and unplanned pregnancy. The aim of this study was to assess the awareness, pattern and practice of dual methods by HIV infected women, and factors influencing its use in southeast Nigeria. METHODS This was a cross sectional descriptive study of 658 HIV positive women attending the PMTCT/postnatal/family planning clinics in three health facilities in southeast Nigeria. An interviewer administered semi-structured questionnaire was used to abstract needed information. The data were analyzed with Epi-info™ version 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA), Odd ratio was determined and the test of statistical significance was with Fisher exact test at 95% CI. RESULTS The mean age of the participants was 29 ± 4.3 years. All the respondents were aware of their HIV status, 62.4% did not know their partners status; 23.1% were sero-concordant, while 14.5% were sero-discordant. Most (67.9%) of the respondents lack awareness on dual methods with only 179/658 (27.2%) practicing it. The commonest (141/179; 78.9%) dual method used was a combination of condom and injectable hormonal contraceptives. Lack of awareness (222/479; 46.3%) and non disclosure (133/479; 27.8%) were the main reasons for non use of dual method in the present study. STI's was higher amongst non users with odd ratio of 1.74 (1.26-2.41), p-value < 0.0004. Unplanned pregnancy was higher in non users with odd ratio of 3.89 (2.52-6.00), p-value < 0.0000 at 95% CI. CONCLUSIONS The awareness and uptake of dual methods amongst HIV infected women in southeast Nigeria is still low and thus associated with a higher risk of STIs and unplanned pregnancy. It is expected that increased awareness, uptake and consistent use will help prevention new infections of HIV/STIs and unplanned pregnancy.
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Affiliation(s)
- Lucky O Lawani
- School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
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Gurav K, Bradley J, Chandrashekhar Gowda G, Alary M. Perspectives on condom breakage: a qualitative study of female sex workers in Bangalore, India. CULTURE, HEALTH & SEXUALITY 2014; 16:575-586. [PMID: 24588078 DOI: 10.1080/13691058.2014.883642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A qualitative study was conducted to obtain a detailed understanding of two key determinants of condom breakage - 'rough sex' and poor condom fit - identified in a recent telephone survey of female sex workers, in Bangalore, India. Transcripts from six focus-group discussions involving 35 female sex workers who reported condom breakage during the telephone survey were analysed. Rough sex in different forms, from over-exuberance to violence, was often described by sex workers as a result of clients' inebriation and use of sexual stimulants, which, they report, cause tumescence, excessive thrusting and sex that lasts longer than usual, thereby increasing the risk of condom breakage. Condom breakage in this setting is the result of a complex set of social situations involving client behaviours and power dynamics that has the potential to put the health and personal lives of sex workers at risk. These findings and their implications for programme development are discussed.
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Affiliation(s)
- Kaveri Gurav
- a Karnataka Health Promotion Trust , Bangalore , India
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17
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Affiliation(s)
- Kaye Wellings
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
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18
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Higgins JA, Fennell JL. Providing for women's pleasure in the next generation of condoms. J Sex Med 2013; 10:3151-3. [PMID: 23981853 DOI: 10.1111/jsm.12299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Alam N, Chowdhury ME, Mridha MK, Ahmed A, Reichenbach LJ, Streatfield PK, Azim T. Factors associated with condom use negotiation by female sex workers in Bangladesh. Int J STD AIDS 2013; 24:813-21. [PMID: 23970599 DOI: 10.1177/0956462413486452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Negotiation for condom use by female sex workers with their male clients can enhance condom use. A cross-sectional study was conducted among 1395 female sex workers; 439 from two brothels, 442 from 30 hotels, and 514 from streets of two cities in Bangladesh to determine the predictors of condom use negotiation. Consistent condom use rates in the 7 days prior to interview were reported to be 16.2%, 21.7%, and 4.5% among the brothel, hotel, and street-based female sex workers, respectively. Overall, 28.1% of female sex workers negotiated for condom use with their clients. Participation in behaviour change communication (BCC) programmes (AOR, 1.5; 95% CI, 1.2-2.0) and self-perceived risk of human immunodeficiency virus infection (AOR, 1.8 95% CI, 1.6-2.1) were positive predictors for condom negotiation. Compared to the hotel-based female sex workers, street (AOR, 0.6; 95% CI, 0.4-0.9) and brothel-based female sex workers (AOR, 0.7; 95% CI, 0.5-0.9) were less likely to negotiate for condom use. Female sex workers in Bangladesh are at high risk for sexually transmitted infection / human immunodeficiency virus infection because of low overall negotiation for condom use. Participation in BCC programmes had positive effect on condom negotiation by female sex workers, and should be strengthened in commercial sex venues.
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Affiliation(s)
- Nazmul Alam
- Centre for Reproductive Health, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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20
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Jesmin SS, Chaudhuri S, Abdullah S. Educating women for HIV prevention: does exposure to mass media make them more knowledgeable? Health Care Women Int 2013; 34:303-31. [PMID: 23394327 DOI: 10.1080/07399332.2012.736571] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mass media is an important vehicle for health promotion in developing countries. In Bangladesh multiple media campaigns are being carried out to educate people about HIV/AIDS. We examined the extent of HIV/AIDS knowledge and the association of exposure to mass media among women in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) provides data for this article. We found that media exposure (combined index of television, radio, and newspaper) was a highly significant predictor of women's knowledge about HIV and AIDS. Other significant predictors of HIV knowledge include women's education, age, employment, and urban residence.
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Affiliation(s)
- Syeda S Jesmin
- Department of Sociology and Psychology, Division of Liberal Arts and Life Sciences, University of North Texas at Dallas, Dallas, TX 75241, USA.
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21
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Hensel DJ, Stupiansky NW, Herbenick D, Dodge B, Reece M. Sexual pleasure during condom-protected vaginal sex among heterosexual men. J Sex Med 2013; 9:1272-6. [PMID: 22781082 DOI: 10.1111/j.1743-6109.2012.02700.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event-specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. AIMS To examine event-level factors associated with ratings of sexual pleasure during condom-protected vaginal intercourse. METHODS Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom-protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. MAIN OUTCOME MEASURES Event-specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). RESULTS Vaginal intercourse was reported on 29.8% (N = 8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word "all sexual events." Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. CONCLUSIONS These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use.
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Affiliation(s)
- Devon J Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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22
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Handlovsky I, Bungay V, Kolar K. Condom use as situated in a risk context: women's experiences in the massage parlour industry in Vancouver, Canada. CULTURE, HEALTH & SEXUALITY 2012; 14:1007-1020. [PMID: 22900640 DOI: 10.1080/13691058.2012.712720] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Investigation into condom use in sex work has aroused interest in health promotion and illness prevention. Yet there remains a dearth of inquiry into condom use practices in the indoor sex industry, particularly in North America. We performed a thematic analysis of one aspect of the indoor sex work by drawing on data from a larger mixed-methods study that investigated women's health issues in the massage parlour industry in Vancouver, Canada. Using a risk context framework, condom use was approached as a socially situated practice constituted by supportive and constraining dynamics. Three analytic categories were identified: (1) the process of condom negotiation, (2) the availability of condoms and accessibility to information on STI and (3) financial vulnerability. Within these categories, several supportive dynamics (industry experience and personal ingenuity) and constraining dynamics (lack of agency support, client preferences, limited language proficiency and the legal system) were explored as interfacing influences on condom use. Initiatives to encourage condom use must recognise the role of context in order to more effectively support the health-promoting efforts of women in sex work.
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Warner L, Gallo MF, Macaluso M. Condom use around the globe: how can we fulfil the prevention potential of male condoms? Sex Health 2012; 9:4-9. [DOI: 10.1071/sh11072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/19/2011] [Indexed: 11/23/2022]
Abstract
Despite a global epidemic of sexually transmissible infections and the availability and endorsement of condoms as an effective intervention, the overall use of condoms remains low. This review explores various challenges and opportunities to fully realizing the prevention potential for condoms.
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24
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Graham CA. Condom use in the context of sex research: a commentary. Sex Health 2012; 9:103-8. [DOI: 10.1071/sh11103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/21/2011] [Indexed: 02/04/2023]
Abstract
This commentary highlights some recent trends in sex research that have particular relevance for research on condom use, including studies investigating the meaning of sexual arousal, desire and pleasure; a focus on couple-level investigations; and the relevance of individual differences and personality characteristics to sexual risk-taking. Although historically, sexuality-related issues have received little systematic attention in the field of public health, researchers are now paying more attention to the role of pleasure and sexual arousal in condom use. It is argued that a better integration of findings from the area of sex research into the HIV and sexually transmissible infection (STI) field is needed to develop and improve programs to reduce the risk of STIs and unintended pregnancy.
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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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26
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Nobelius AM, Kalina B, Pool R, Whitworth J, Chesters J, Power R. "The young ones are the condom generation": condom use amongst out-of-school adolescents in rural southwest Uganda. JOURNAL OF SEX RESEARCH 2011; 49:88-102. [PMID: 21516591 DOI: 10.1080/00224499.2011.568126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article reports on factors influencing condom use among out-of-school adolescents in rural southwest Uganda. Despite an abundance of negative discourses and myths about condoms in the community, these adolescents believe condoms protect them from sexually transmitted infections, HIV, and premarital pregnancies. Girls want partners to use condoms, but most lack the confidence to insist. Girls aged 13 to 14 reported the least difficulty asking for condoms; older girls attributed this to coming-of-age in the era of AIDS when condom use is the norm. Boys under 16 years want to use condoms, but lack confidence in application skills. Boys over 17 years always use condoms with casual partners, but only occasionally for pregnancy prevention with steady partners. Girls need skills training to improve confidence in negotiating condom use. Younger boys require training to improve confidence in skills with condom application. These findings are compared with studies conducted with in-school adolescents in the same study area. Health promotions that provide this skills training and focus on the need to think of the health of future family would be most effective for out-of-school adolescents. This study shows that it is self-confidence, rather than years of schooling, that has the greatest impact on condom use in this cohort.
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Affiliation(s)
- Ann-Maree Nobelius
- School of Rural Health, Centre for Medical and Health Sciences Education, Monash University.
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27
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Weaver JB, Weaver SS, Mays D, Hopkins GL, Kannenberg W, McBride D. Mental‐ and Physical‐Health Indicators and Sexually Explicit Media Use Behavior by Adults. J Sex Med 2011; 8:764-72. [DOI: 10.1111/j.1743-6109.2010.02030.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Rebello LEFDS, Gomes R, Souza ACBD. Homens e a prevenção da aids: análise da produção do conhecimento da área da saúde. ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s1414-32832010005000045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O envolvimento de homens na prevenção da aids tem sido um dos grandes desafios mundiais. Na busca de subsídios para o enfrentamento desse desafio, este estudo analisa a produção do conhecimento da saúde sobre prevenção da aids, voltada para homens. O método ancora-se numa revisão crítica de artigos científicos, publicados no período de 1997 a 2009, acessados na Biblioteca Virtual em Saúde. O corpo analítico, constituído de 25 artigos, foi trabalhado numa perspectiva qualitativa, priorizando-se a interpretação dos sentidos das ideias centrais presentes no conjunto da literatura analisado. Como resultados da análise destacam-se três temas: representações da aids; potencialidades e limites da informação na prevenção primária, e o preservativo como personagem central da prevenção. Conclui-se que a produção científica acerca do assunto impõe um grande desafio da prevenção que é o de transformar aspectos culturais e sociais que potencializam a vulnerabilidade à transmissão do HIV.
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Higgins JA, Hoffman S, Dworkin SL. Rethinking gender, heterosexual men, and women's vulnerability to HIV/AIDS. Am J Public Health 2010; 100:435-45. [PMID: 20075321 PMCID: PMC2820057 DOI: 10.2105/ajph.2009.159723] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2009] [Indexed: 11/04/2022]
Abstract
Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and men's sexual power and privilege. Conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Although the women's vulnerability paradigm was a radical revision of earlier views of women in the epidemic, mounting challenges undermine its current usefulness. We review the etiology and successes of the paradigm as well as its accruing limitations. We also call for an expanded model that acknowledges biology, gender inequality, and gendered power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men.
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Affiliation(s)
- Jenny A Higgins
- Office of Population Research, Princeton University, Princeton, NJ, USA.
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30
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Gagnon AJ, Merry L, Bocking J, Rosenberg E, Oxman-Martinez J. South Asian migrant women and HIV/STIs: Knowledge, attitudes and practices and the role of sexual power. Health Place 2010; 16:10-5. [DOI: 10.1016/j.healthplace.2009.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 06/05/2009] [Accepted: 06/13/2009] [Indexed: 11/25/2022]
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31
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Higgins JA, Tanner AE, Janssen E. Arousal loss related to safer sex and risk of pregnancy: implications for women's and men's sexual health. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2009; 41:150-7. [PMID: 19740232 PMCID: PMC2988073 DOI: 10.1363/4115009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
CONTEXT Few studies have examined arousal loss associated with safer-sex practices or the perceived risk of unintended pregnancy, let alone its associations with sexual risk practices. METHODS An Internet survey conducted in 2004-2006 among 2,399 men and 3,210 women asked respondents about arousal loss related to the use of condoms or other safer-sex products and perceived unintended pregnancy risk. Regression analyses gauged associations between arousal profiles, unprotected sex in the last year and lifetime experience of unintended pregnancy. RESULTS Many respondents reported arousal loss related to the use of safer-sex products (34%) or the risk of unintended pregnancy (46%). Participants who strongly agreed that use of safer-sex products can lessen their arousal were significantly more likely to have had unprotected sex in the last year than were those who strongly disagreed (odds ratios, 1.8 for men and 3.7 for women); those who strongly disagreed that pregnancy risk can lessen their arousal were significantly more likely to have been involved in an unintended pregnancy than were those who strongly agreed (2.0 for men and 1.4 for women). Arousal loss related to safer-sex practices was more strongly associated with unprotected sex among women than among men, whereas arousal loss related to pregnancy risk was more strongly associated with unintended pregnancy among men than among women. CONCLUSIONS Some men and women are turned off by safer-sex practices or by pregnancy risk. Given arousal profiles' potential contributions to unintended pregnancies and STD transmission, they should be integrated into sexual health behavioral models, research and programming.
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Affiliation(s)
- Jenny A Higgins
- Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
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Braun V. “She'll be right”? National identity explanations for poor sexual health statistics in Aotearoa/New Zealand. Soc Sci Med 2008; 67:1817-25. [DOI: 10.1016/j.socscimed.2008.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To identify barriers to condom use. METHODS Data were extracted through MEDLINE from papers published between 1993 and 2007. Surveys, reviews, clinical studies and comments were included in this review. The impact of cost, moral, social, personal and psychological factors were taken into consideration. RESULTS Several factors were associated with non-use of a condom during sexual intercourse. Their cost often posed a barrier to condom use for the poor, even in developed countries. In many communities, moral values, ethnic and religious factors also played a role. Among other social factors, gender inequality, lack of a dialogue among partners with regard to condom use, and the stigma attached to the condom could all lead to unprotected sexual intercourse. Personal factors such as aversion to the condom, consumption of alcohol or use of drugs prior to sexual intercourse, and anxiety and depression all were negatively associated with condom use. CONCLUSION Their cost evidently poses a barrier to the use of condoms by the poor. Beside social stigmas and personal reluctance, prevailing moral norms and religious interdicts also adversely affect use of these devices in many communities. Because of their disastrous consequences in the domain of public health each of these barriers must be effectively addressed.
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Affiliation(s)
- N N Sarkar
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India.
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Higgins JA, Hirsch JS. Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use. Am J Public Health 2008; 98:1803-13. [PMID: 18703457 DOI: 10.2105/ajph.2007.115790] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We know surprisingly little about how contraception affects sexual enjoyment and functioning (and vice versa), particularly for women. What do people seek from sex, and how do sexual experiences shape contraceptive use? We draw on qualitative data to make 3 points. First, pleasure varies. Both women and men reported multiple aspects of enjoyment, of which physical pleasure was only one. Second, pleasure matters. Clear links exist between the forms of pleasure respondents seek and their contraceptive practices. Third, pleasure intersects with power and social inequality. Both gender and social class shape sexual preferences and contraceptive use patterns. These findings call for a reframing of behavioral models that explain why people use (or do not use) contraception.
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Affiliation(s)
- Jenny A Higgins
- Office of Population Research and Center for Health and Wellbeing, Princeton University, Princeton, NJ 08544, USA.
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Higgins JA, Hirsch JS. The pleasure deficit: revisiting the "sexuality connection" in reproductive health. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2007; 39:240-247. [PMID: 18093041 DOI: 10.1363/3924007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jenny A Higgins
- Office of Population Research, Princeton University, New Jersey, USA.
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Philpott A, Knerr W, Maher D. Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet 2006; 368:2028-31. [PMID: 17141710 DOI: 10.1016/s0140-6736(06)69810-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Anne Philpott
- Department for International Development, London, UK
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37
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Philpott A, Knerr W, Boydell V. Pleasure and Prevention: When Good Sex Is Safer Sex. REPRODUCTIVE HEALTH MATTERS 2006; 14:23-31. [PMID: 17101419 DOI: 10.1016/s0968-8080(06)28254-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Most sexual health education programmes use fear and risk of disease to try to motivate people to practise safer sex. This gives the impression that safer sex and pleasurable sex are mutually exclusive. Yet there is growing evidence that promoting pleasure alongside safer sex messaging can increase the consistent use of condoms and other forms of safer sex. To this end, the Pleasure Project created The Global Mapping of Pleasure, a document that identifies projects and organisations worldwide that put pleasure first in HIV prevention and sexual health promotion, and sexually provocative media that include safer sex. This article summarises some of the findings of this mapping exercise and what we learned about incorporating pleasure from it. We found that there are a variety of organisations, including religious and youth groups, and HIV/AIDS organisations and NGOs, promoting pleasurable safer sex. The techniques they use include promoting sexual techniques and dialogue about sex, teaching married couples how to have better sex and putting images of desire in sexual education materials. This paper focuses on ways of eroticising female and male condoms as examples of effective ways of using pleasure in HIV prevention and sexual health promotion.
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Plummer ML, Wight D, Wamoyi J, Mshana G, Hayes RJ, Ross DA. Farming with your hoe in a sack: condom attitudes, access, and use in rural Tanzania. Stud Fam Plann 2006; 37:29-40. [PMID: 16570728 DOI: 10.1111/j.1728-4465.2006.00081.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines condom knowledge, attitudes, access, and practices in rural Mwanza, Tanzania. From 1999-2002, six researchers carried out participant observation in nine villagesfor a total of 158 person-weeks. Many villagers perceived condoms negatively for multiple reasons, for example, the method's association with infection or promiscuity, reduced male sexual pleasure, and cultural understandings of meaningful sex. Men controlled the terms of sexual encounters and reported that they would use condoms only with risky partners, but few perceived their partners as such. Use of condoms appeared to be very low, primarily as a result of limited demand, although barriers to access also existed. These qualitative findings contrast with inconsistent survey reports of relatively high condom use in the same population. Intervention efforts should address the tradeoff between possible short- and long-term consequences of condom use, particularly for men, for example, reduced pleasure versus reduced HIV risk. If possible, surveys should assess the validity of reported condom use through comparison with other data, including qualitative findings and distribution/sales records.
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Affiliation(s)
- Mary L Plummer
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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