Risky sexual behavior in low-income African American women: the impact of sexual health variables

The effect of sexual education based on the Sexual Health Model on sexual function among women living in the suburbs: study protocol for a randomized controlled trial

INTRODUCTION

Suburban population is increasingly growing in Iran. People in the suburbs usually have limited sexual information and there are limited studies into their sexual issues. This study aims the effect of sexual education (SE) based on the Sexual Health Model (SHM) on sexual functioning among women living in the suburbs.

METHODS

This is a randomized controlled trial with two parallel groups. Seventy-six women will be selected through simple random sampling from healthcare centers in suburban areas and will be allocated to a control group (n = 38) and an intervention group (n = 38) with a randomization ratio of 1:1. Participants in the intervention group will receive SHM-based SE in three120 min weekly sessions which will be held using the lecture, question-and-answer, group discussion, and educational booklet methods. Data will be collected through a demographic and midwifery characteristics questionnaire, the Female Sexual Function Index, the Depression Anxiety Stress Scale, and the Sexual Quality of Life-Female, and will be analyzed through the analysis of covariance as well as the independent-sample t, the paired-sample t, and the Chi-square tests.

DISCUSSION

We hope this study provides a clear framework for decision-makers and healthcare providers to provide appropriate policies and interventions for SE and thereby improve the sexual health of women in the suburbs.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials on 2024.03.05 (code: IRCT20231121060133N1).

Reframing Sexual Health for Black Girls and Women in HIV/STI Prevention Work: Highlighting the Role of Identity and Interpersonal Relationships

While Black girls and women are disproportionately impacted by sexual health disparities, there continues to be an overwhelming focus on individual risk behaviors within prevention initiatives, which offers a fragmented narrative of the multidimensional nature of risk and plausibly limits effectiveness of prevention programs and attenuates reductions in disparities. Because sexual health is experienced within an individual's beliefs/values, interpersonal relationships, and behaviors and reflects larger social and cultural systems, it is important to critically examine common theories used to inform HIV/STI prevention interventions for Black women and girls. To fill this gap in the literature, we critique two commonly used theories in HIV/STI prevention interventions, namely the social cognitive theory and the theory of gender and power, by highlighting theoretical and practical strengths and weaknesses. We propose research implications that incorporate key strengths of the two theories while adding new concepts grounded in the intersectionality theory. The overall goal is to introduce a more comprehensive conceptual model that is reflective of and applicable to the multidimensional sexual experiences of Black girls and women within the evolving definition of sexual health and behavior.

The Effect of Sexual Education based on Sexual Health Model on the Sexual Function of Women with Infertility

Background

Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility.

Materials and Methods

A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90-min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t-test, Mann-Whitney test, and Wilcoxon test were run.

Results

The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann-Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups (Z = -4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention (Z = 2.81, p < 0.001).

Conclusions

Given the positive effects of SHM-based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.

Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women

Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology.

Incorporating Communication into the Theory of Planned Behavior to Predict Condom Use Among African American Women

The present research extends the theory of planned behavior (TPB) to investigate how communication-related variables influence condom use intention and behavior among African American women. According to the TPB, attitudes, subjective norms, and self-efficacy are associated with behavioral intent, which predicts behavior. For women, it was argued that condom negotiation self-efficacy was more important than condom use self-efficacy in predicting consistent condom use. Moreover, an important environmental factor that affects condom use for African American women is fear or worry when negotiating condom use because the sex partners might leave, threaten, or abuse them. Fears associated with negotiating condom use were predicted to be negatively associated with attitudes, subjective norms, and self-efficacy. African American women (N = 560; M age = 20.58) completed assessments of TPB variables at baseline and condom use 3 months later. Condom negotiation self-efficacy was a significant indicator of behavioral intent, while condom use self-efficacy was not. Fear of condom negotiation was negatively associated with all TPB components, which was in turn significantly associated with behavioral intent and condom use. Implications for the TPB, safer sex literature, and sexually transmitted infection prevention intervention design are discussed.

Methodological issues in defining aggression for content analyses of sexually explicit material

There exists an important tradition of content analyses of aggression in sexually explicit material. The majority of these analyses use a definition of aggression that excludes consent. This article identifies three problems with this approach. First, it does not distinguish between aggression and some positive acts. Second, it excludes a key element of healthy sexuality. Third, it can lead to heteronormative definitions of healthy sexuality. It would be better to use a definition of aggression such as Baron and Richardson's (1994) in our content analyses, that includes a consideration of consent. A number of difficulties have been identified with attending to consent but this article offers solutions to each of these.

When two is better than one: differences in characteristics of women using condoms only compared to those using condoms combined with an effective contraceptive

BACKGROUND

There remain high rates of unintended pregnancy around the world. Adding an effective contraceptive to those who currently only use male condoms may reduce these rates. The aim of this study is to identify the prevalence of and factors associated with the combination use of an effective contraception with male condoms in sexually active women who are already using male condoms.

METHODS

Women attending Family Planning Victoria Clinics from April to July 2011 were approached to complete a questionnaire about contraception usage in the last 3 months and 34 associated variables. Univariate and multivariate analyses were conducted to determine women with greater odds of an effective contraception together with male condoms compared with those using male condoms only.

RESULTS

Of 1006 women surveyed, 872 women stated it was "very important" or "important" to avoid pregnancy at this stage of their life. Of these 872 women, 690 reported male condom use-274 women used male condoms and an effective contraception, while 416 used male condoms only. Of note, only 67 (16%) of the 416 solely male condom users were using this consistently. On multivariate analysis, characteristics associated with combination use (compared with condom use only) were discussion with a health professional in the last 12 months (adjusted odds ratio [AOR] 2.9; 95% confidence interval [CI] 1.9, 4.4), satisfaction with contraception (AOR 1.8; 95% CI 1.3, 2.7), having more than 1 partner in the last 3 months (AOR 1.8; 95% CI 1.2, 2.6) and past pregnancy (AOR 0.3; 95% CI 0.1, 0.5).

CONCLUSIONS

In a group of women not intending to be pregnant who were using male condoms, a significant number remained at risk for unintended pregnancy due to inconsistent use of male condoms and poor use of concurrent effective contraception.

Sexual risk behavior and type of sexual partners in transnational indigenous migrant workers

Indigenous migrant workers (IMWs) have a high vulnerability to HIV and STDs due to poverty and marginalization. This study examined factors associated with sexual risk behavior (SRB) according to type of partner in transnational young male IMWs at a sugar cane agro-industrial complex in western Mexico. A total of 192 sexually active IMWs were recruited from four laborer shelters to participate in a sexual partner survey. The IMWs were interviewed about their sexual partners and practices over the last 12 months during which it emerged that they had had a total of 360 sexual partners. Multiple linear regression analyses were performed to identify factors related to SRB in 222 main (spouse, mistress and girlfriend) and 138 casual partners (colleague, friend, casual encounter and sex worker). Results showed a significantly higher SRB score with casual partners. For the main partner regression model, prior exposure to HIV- and STD-preventive information and sexual intercourse with higher employment status partners (formal workers vs. self-employed in informal activities and unemployed) were associated with lower SRB scores, but if the sexual relations occurred in Mexico (vs. the U.S.), the SRB scores increased. For the casual partner model, the practice of survival sex (sex in exchange for basic needs), sexual relations in Mexico (vs. the U.S.), and being a circular migrant (person traveling for temporary work to return home when the contract is over) were related to higher SRB scores. Findings support the implementation of preventive interventions using different messages depending on the type of partners, main or casual, within the labor migrant context.

Predictors of consistent condom use among young African American women

The purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.

Feeling good in your own skin: the influence of complimentary sexual stereotypes on risky sexual attitudes and behaviors in a community sample of African American women

Although negative racial stereotypes may affect the mental and physical health of African Americans, little research has examined the influence of positive or complimentary racial stereotypes on such outcomes. More specifically, this study explored the relationship between African American women's endorsement of complimentary stereotypes about their sexuality and attitudes/behaviors that have been associated with sexual risk. Data were gathered from 206 African American women as part of the Black Women in the Study of Epidemics project. Multivariate regression models were used to examine associations between women's endorsement of complimentary stereotypes about their sexuality and selected sex-related attitudes and behaviors. Participants' endorsement of complimentary sexual stereotypes was significantly positively associated with beliefs that having sex without protection would strengthen their relationship (B = .28, SE = .10, p < .01) and that they could use drugs and always make healthy choices about using protection (B = .31, SE = .09, p < .01). Significant positive associations were also found between complimentary sexual stereotypes and the number of casual sexual partners women reported in the past year (B = .29, SE = .15, p = .05) as well as their willingness to have sex in exchange for money or drugs during that time (B = .78, OR = 2.18, p < .05). These findings suggest that endorsement of complimentary sexual stereotypes by African American women can lead to increased risk behavior, particularly relating to possible infection with HIV or other sexually transmitted infections.

Gender differences in sexual risk behaviour among adolescents in Catalonia, Spain

OBJECTIVE

To analyze the factors associated with sexual risk behavior in adolescent girls and boys in order to plan future school health interventions.

METHODS

A cross-sectional study with two-stage cluster sampling that included 97 schools and 9,340 students aged between 14 and 16 years old was carried out in 2005-2006 in Catalonia (Spain). For the survey, a self-administered paper-based questionnaire was used. The questionnaire contained items on sociodemographic variables, use of addictive substances and mood states, among other items. These variables were tested as risk factors for unsafe sexual behavior.

RESULTS

This study included 4,653 boys and 4,687 girls with a mean age of 15 years. A total of 38.7% of students had had sexual relations at least once and 82.3% of boys and 63.0% of girls were engaged in sexual risk behaviors. The prevalence of sexual relations and risk behaviors was generally higher in boys than in girls, independently of the variables analyzed. Boys had more sexual partners (P<.001) and used condoms as a contraceptive method less frequently than girls (P<.001). Foreign origin was related to unsafe sexual activity in both genders. Alcohol consumption was also a risk factor in boys.

CONCLUSIONS

Sexual risk behaviors among adolescents in Catalonia are higher in boys than in girls. Factors related to unsafe sexual activity in boys were foreign origin and alcohol consumption. In girls only foreign origin was a significant risk factor.

Sorting through chickens and eggs: a longitudinal examination of the associations between attitudes, norms, and sexual risk behavior

OBJECTIVE

Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true--that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions.

DESIGN

Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities--that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse.

RESULTS

Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior.

CONCLUSIONS

These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men.

Application of the sexual health model in the long-term treatment of hypoactive sexual desire and female orgasmic disorder

Using the Sexual Health Model as a framework, this case study illustrates the treatment of female orgasmic and low desire disorder in a long-term case with numerous complexities and other co-morbid mental health diagnoses. Derived from a sexological approach to education, the Sexual Health Model defines 10 key components posited to be essential aspects of healthy human sexuality: talking about sex, culture and sexual identity, sexual anatomy and functioning, sexual health care and safer sex, challenges to sexual health, body image, masturbation and fantasy, positive sexuality, intimacy and relationships, and spirituality. The client was selected because of the commonality of her initial presenting concerns and the etiological and treatment complexity of the case, which necessitated the use of all the sexual health treatment modalities provided at our center-individual, couple, and group therapy, sexual medicine, and psychiatric care. Her case is distinct in that her sexual dysfunctions and negative cognitions, while common, occurred in the context of serious relational, family sexual abuse, depression, and life-threatening medical problems, which necessitated long-term treatment. This case illustrates the multifactoral etiology of complex sexual dysfunctions requiring treatment that deals with varied psychosocial and biological factors.

An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults

Despite the recent increase in the number of HIV infections in Central and Eastern Europe, patterns of sexual behavior have not been extensively researched, particularly among young people. The aim of the present study was to provide a comprehensive assessment of HIV/AIDS-related vulnerability and sexual risk-taking among young adults in Croatia. Data were collected in 2005 using a nationally representative, multi-stage stratified probability sample (n = 1,093) of women and men aged 18-24 years. The focus in this article was on predictors of sexual risk-taking measured by a composite risky sexual behaviors scale. Using hierarchical regression models, we analyzed gendered effects of community, family, peer group, and individual level factors. For both men and women, peer pressure, sensation seeking, personal risk-assessment, behavioral intention, condom use at first sexual intercourse, and sexual victimization were significant predictors of sexual risk-taking behaviors. A number of predictors were gender-specific: sexual assertiveness and condom self-efficacy for women and parental monitoring, traditional morality, HIV knowledge, and talking about sex with partner for men. Documenting substantial prevalence of potentially risky sexual behaviors among young people in Croatia, the findings call for prevention and intervention efforts that should focus on individual capacity building for responsible sexual behavior.

Partnership concurrency status and condom use among women diagnosed with Trichomonas vaginalis

INTRODUCTION AND BACKGROUND

Partner concurrency increases the risk of sexually transmitted infections (STIs) such as Trichomonas vaginalis. Women diagnosed with T. vaginalis have a 2- to 3-fold higher risk of acquiring the human immunodeficiency virus and developing the acquired immunodeficiency syndrome.

GOALS

We sought to describe partnership concurrency (multiple sexual partners during the same time period) and condom use among women diagnosed with T. vaginalis, and to compare reports of concurrency between matched female and male dyads.

METHODS

A baseline interview on partnership status and condom use was administered to women diagnosed with T. vaginalis at a public sexually transmitted infections (STI) clinic. A male partner substudy was also conducted. Seventy-three dyads were matched by unique identifier and female and male responses were compared.

RESULTS

The participants were 319 African American women and 10 white women aged 15-40 years (N = 329). Almost three fourths (72.3%) had only 1 partner over a 3-month period, compared with more than one fourth (27.7%) with > or =2 partners. Regular condom use was low (16.4%), especially with regular partners (9.1%). In the matched substudy, men reported significantly higher rates of concurrency than women (47.3% vs. 23.0%; p < or = .002). Men who practiced concurrency were not significantly more likely than other men to use condoms with regular partners.

CONCLUSIONS

Women seldom used condoms with their regular male partners and these partners had significantly higher rates of concurrency and low rates of condom use. Women may underestimate the risk of acquiring STI from regular partners. Counseling strategies should include the risk of being infected with STDs such as trichomonas by regular partners as well as by casual partners in the absence of condom use.