Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

Behaviors and willingness to support HPV vaccination for women: a cross-sectional study of young adult men in China

BACKGROUND

Men's involvement in and support for women's decision-making concerning human papillomavirus (HPV) vaccination is crucial. However, the support provided by men to promote HPV vaccination among women, as a crucial part of intimate relationships has received limited attention. This study examined the behaviors and willingness of young Chinese adult men to support HPV vaccination in women and explored potential factors influencing supportive behaviors and willingness.

METHODS

From December 2020 to January 2021, a cross-sectional study was conducted among 1014 young men from eight universities in Zhejiang Province, China. The survey questionnaire assessed behaviors and willingness to support HPV vaccination, HPV-related knowledge, information seeking for male HPV vaccination, attitudes toward women's vaccination benefits, and sociodemographic variables. Multivariable logistic regression analyses adjusting for all covariates were used to identify factors associated with supportive behaviors and willingness.

RESULTS

Only 48.4% of respondents reported having acquired and shared information about HPV vaccination with loved ones, whereas 41.3% recommended HPV vaccination. Approximately 80% of the participants without supportive behaviors reported a willingness to support the vaccination. Positive attitudes toward the benefits of women's HPV vaccination, active seeking of information on male HPV vaccination, and relevant sociodemographic and health-related variables were associated with vaccination-supportive behaviors or willingness.

CONCLUSIONS

Young men expressed a relatively low level of support for female HPV vaccination. Promoting active information seeking regarding HPV vaccination among men and emphasizing the benefits of HPV vaccination for women could potentially foster more supportive behaviors. Targeted health education should include men to promote their involvement in shared decision-making regarding female HPV vaccinations.

Effects of Online Friendships on Safer Sex Communication and Behavior among Black Sexual Minority Men: A Study of Network Exposure

This study draws on social normative and social learning theories to examine the masspersonal safer sex communication (i.e., Facebook posts about safer sex) and safer sex behavior (i.e., condom use) in a cohort of Black sexual minority men (BSMM) (N = 340), with an eye toward understanding their relationship with the safer sex communication and behaviors of their BSMM Facebook friends. Using linear network autocorrelation regression models, results showed that BSMM's safer sex communication and condom use behavior were each associated with the communication and behavior of their online peers. Specifically, BSMM's condom use was positively associated with their friends' condom use and friends' safer sex communication, and BSMMs' safer sex communication was positively associated with friends' safer sex communication. Moreover, contrary to prior research, BSSM's safer sex communication and condom use were not related to one another, suggesting that talking about safer sex on social media should not be interpreted to be an indication of engageDment in safer sex behavior. These findings underscore an opportunity to leverage peer influence in social media networks, particularly in the form of masspersonal communication, to encourage cascades of safer sex messaging among peers and adoption of safer sex behavior.

Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

Condom use across casual and committed relationships: The role of relationship characteristics

BACKGROUND

While the existence of a complex variety of casual sexual relationships (CSRs) has been acknowledged, studies rarely describe the prevalence of condom use across these relationships or how their hybrid nature, specifically relationship characteristics, affect condom use. This study aims to describe condom use within committed relationships and various types of casual sexual relationships (CSRs), examining the influence of relationship characteristics on condom use among culturally validated relationship types (committed, friends with benefits, hookups, booty call).

METHODS

Emerging adults (N = 728, 18-29 years, M = 22.56; SD = 3.01) completed a survey with four blocks: sociodemographics; brief sexual history; relationships over the previous year; and current relationship, assessing relationship type, ten relationship characteristics (e.g., commitment, emotional and sexual exclusivity, partner acquaintance, sexual involvement) and condom use (vaginal, oral, and anal), operationalized by three measures (use at last encounter, likert-type scale and percentage of use).

RESULTS

The results showed patterns in condom use by relationship type and illuminated how relationship characteristics-grouped into three factors: commitment, intimacy, and sexuality-mediate condom use. Condom use was more frequent in vaginal than anal and oral sex, and less frequent in committed relationships. No significant differences were found in condom use in vaginal sex between committed relationships and hookups, with condom in these relationships being significantly lower than in booty call. Intimacy mediated between all contrasts tested and condom use in vaginal sex, while sexuality mediated between committed vs. CSRs and condom use in anal and oral sex.

CONCLUSIONS

Findings point to the need of considering the diversity of CSRs for understanding condom use and highlight the role of intimacy as a relevant mechanism associated with condom use in vaginal sex and of sexuality in oral and anal sex, which should be taken into consideration in the tailoring of health promoting efforts.

Let's Talk About Condoms: Social Engagement in a Sexual Health Intervention Targeting Young Adults in Denmark

Objectives

We tested whether social activities and interactions as part of a condom campaign strengthened young adults' condom-use intentions and normative perceptions of condoms compared to simple exposure to campaign information.

Method

Data from 3,041 young adults collected after four annual condom campaigns were analyzed and combined into a meta-analysis.

Results

Interaction about the campaign and engagement in campaign-related activities was associated with higher condom use intention and more positive pro-condom norms.

Conclusions

The authors call for a greater emphasis on social influence in youth-aimed sexual health campaigns. Implications for the research are discussed.

Effectiveness of Social Media-Based Intervention in Intention Change of Adolescents for Promoting Sexual Health Behavior in Western Terai of Nepal

BACKGROUND

Sexually transmitted infections (STIs) in adolescents are among the major public health challenges that have to be prevented in time. Traditional education falls short of reach; social media offers accessible ways. However, there is no research on such an issue in Nepal. Accordingly, this study was conducted to assess the effectiveness of a social media-based health education intervention in changing the intention of promoting sexual health among adolescents in Nepal. Study Design: A quasi-experimental study.

METHODS

A total of 160 adolescent students aged 14-19 years old from four purposively selected schools were evenly divided into intervention and non-intervention groups. Sampling and data collection were performed between May and June 2023. Data were collected through self-administered questionnaires for pretest and posttest evaluation. The intervention was delivered and followed up through a Facebook Messenger group. The obtained data were managed and analyzed using SPSS 21, with a significance level of 5%.

RESULTS

Social media-based health education interventions played a significant role in promoting the sexual health behavior of adolescents. The adolescents' knowledge and attitude scores on STIs increased from 2.33 to 4.62 and from 21.87 to 26.30. In addition, their scores on subjective norms, perceived behavioral control, and intentions in promoting sexual behavior increased from 13.93 to 17.59, from 19.96 to 25.40, and from 13.07 to 18.06, respectively, which were statistically significant.

CONCLUSION

The utilization of social media platforms such as Facebook Messenger groups is an effective medium for delivering health educational messages. Hence, increasing social media-based health education is a cost-effective intervention for promoting the health and sexual behaviors of adolescents.

Using the behaviour change wheel to examine facilitators and barriers to assertive contraception-use conversations for Indonesian women

Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.

Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain

Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.

Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

Patterns of Verbal and Nonverbal Communication During Sex

Sexual communication functions as an important relational process expediating satisfying sexual experiences (Sprecher & Hendrick, 2004). Much of the existing literature on sexual communication concerning sexual pleasure biases verbal communication (Babin, 2012). This study adds to the existing research regarding patterns of communication surrounding sex and during sex through qualitative analysis. Further, this inquiry focused on participants' full histories, rather than their tendencies within any current relationship. We analyzed 78 qualitative interview transcripts from participants between the ages of 18 and 69. Participants reported a reluctance to communicate anything but pleasure, discomfort, or dislike during sex to avoid discouraging their partners. Though participants reported a perception that communicating pleasure served as encouragement and affirmation to their partners, most preferred to communicate pleasure nonverbally. Some participants reported a tendency to communicate pain or dislike verbally. Some preferred communication about sexual topics only before or after sexual activities. Participants shared that a high level of comfort with their partner increased sexual communication. How sexual partners communicate sex not only affects pleasure but can only affect intimacy between partners and health. This adds to the scant literature on nonverbal communication during sex and some people's preference for that style (Blunt-Vinti et al., 2019).

Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study

Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.

Opening a portal to pleasure based sexual and reproductive health around the globe; a qualitative analysis and best practice development study

Pleasure is often left out of sexual and reproductive health and rights (SRHR) interventions. The expanding evidence base suggests that the inclusion of pleasure can improve SRHR outcomes and increase safer sex practices. However, there is a lack of research into how to include pleasure in applied SRHR work, particularly outside of key groups. This study aims to present the experiences of a cohort of pleasure implementers and develop a series of implementation best practices. Data were gathered from a structured survey filled out by pleasure implementers (n = 8) twice between September 2021 and October 2022 at 6-month intervals. Focus group discussions (FGDs) were carried out remotely with pleasure implementers, those that funded their pleasure work (n = 2) or provided technical support (n = 2) in January 2023. Pleasure implementers, based in Central, East and Southern Africa and India, reported tangible outcomes of their pleasure-based work in various contexts and across diverse groups. Themes that emerged from analysis of the FGDs and survey responses included pleasure as a portal to positive outcomes, barriers to a pleasure approach, and mechanisms by which pleasure allows for open and non-judgmental discussion about sex and pleasure. A series of best practices emerged from pleasure implementer experiences. This study concludes that a pleasure-based approach can be introduced to a wide range of groups and communities, even those assumed too conservative to accept a pleasure approach. The best practices developed offer a range of practically driven recommendations, that others can lean on when integrating a pleasure approach into their work.

Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study

Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy "on-demand" SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.

Measuring the prevalence of autistic traits in a cohort of adults living with HIV or taking HIV pre-exposure prophylaxis and mapping safer-sex barriers and facilitators: a study protocol

INTRODUCTION

Autistic individuals identify with a wider range of sexual orientations than non-autistic individuals, including higher rates of bisexual orientation in autistic men. Gay, bisexual and other men who have sex with men are at greater risk for HIV. Prevalence data of autistic traits in people living with HIV or using Pre-Exposure Prophylaxis (PrEP) for HIV are lacking so far. Such data, combined with insights in barriers and facilitators for safer sex in autistic people living with HIV or using PrEP, are a first step to improve health support for autistic people in HIV clinics. This support is crucial since autistic individuals have worse physical and mental health outcomes. The objective of this research is to determine the prevalence of autistic traits within the group of people living with HIV or using PrEP in Belgium and to describe specific facilitators and barriers for sexual safer behaviour in people living with HIV and PrEP users with autistic traits.

METHODS AND ANALYSIS

The research is a cross-sectional, observational and multicentre study with recruitment of individual participants. The research consists of two phases. In phase 1, adults coming for HIV/AIDS care or HIV PrEP in participating Belgian HIV Reference Centres will be invited to fill in the validated Autism Spectrum Quotient questionnaire. In phase 2, participants with a score above the predefined cut-off for autistic traits (>26), who agreed to be informed about this score, will be invited to complete an additional survey, inquiring facilitators and barriers for sexual safer behaviour.

ETHICS AND DISSEMINATION OF RESULTS

Institutional Review Board Institute of Tropical Medicine Antwerp, 25 July 2022, REF 1601/22 and University Hospital of Antwerp, 12 September 2022, Project ID 3679: BUN B3002022000111. Study results will be published in peer-reviewed journals and presented to Belgian HIV Reference Centres and at conferences.

Sexual self-efficacy and sexual communication among adolescent girls: moderated mediation results from a randomized controlled trial

OBJECTIVE

Guided by the Operating Conditions Framework, the goal of this study was to identify how and for whom an online sexual health program called Health Education and Relationship Training (HEART) worked.

DESIGN

Data come from a randomized controlled trial among 198 U.S. high school girls who completed HEART or an attention-matched control. We conducted mediation and moderated mediation models to determine if sexual self-efficacy was a mediator and if program acceptability and sexual activity status were moderators of HEART efficacy.

MAIN OUTCOME MEASURE

Sexual communication skills were assessed with a behavioral role-play task.

RESULTS

HEART significantly improved sexual communication skills. These effects were fully mediated through sexual self-efficacy. Specifically, HEART improved sexual self-efficacy which in turn increased sexual communication skills. Also, when participants liked the program more, the effect of HEART on sexual self-efficacy was stronger. Further, among girls who had engaged in sexual activity, sexual self-efficacy was significantly associated with sexual communication skills.

CONCLUSION

This study provides insights into the mechanisms of behavior change underlying HEART. Results highlight the need to further 'unpack' the effects of other sexual health programs, as we showed that programs may work better under certain conditions.

Focusing on Safety or Pleasure Determine Condom Use Intentions Differently Depending on Condom Availability and STI Risk

Objective

Regulatory Focus Theory suggests that goal pursuit is driven by two separate and fundamental motives. Being more focused on prevention motivates people to enact safer behaviors and avoid negative outcomes (e.g., to prevent diseases), whereas being more focused on promotion motivates people to take risks and pursue pleasurable experiences (e.g., condomless sex).

Methods

A quasi-experimental study (N = 476) examined if differences in regulatory focus (i.e., prevention vs. promotion) determined condom use intentions with a prospective casual partner, depending on condom availability delay and STI risk cues.

Results

Participants focused on prevention (vs. promotion) were less likely to consider having condomless sex across condom availability delays conditions. However, STI risk cues changed condom use intentions. When STI risk was lower, condom use intentions decreased as condom availability delays increased (particularly for participants focused on promotion). When STI risk was higher, condom use intentions were stronger and consistent across condom availability delays (particularly for participants focused on prevention).

Conclusions

These findings highlight the importance of distinct sexual motives when examining sexual health practices.

Uncertainty Management in Online Sexual Health Forums

Sexual health is critical to overall well-being, yet it is challenging and uncomfortable to discuss. Individuals frequently encounter uncertainty about their sexual health as they experience bodily changes, navigate romantic or sexual relationships, and explore their identities. In this study, we called on uncertainty management theory to guide an investigation of sexual health uncertainty. Specifically, we asked how people use social support to manage their sexual health uncertainty in online forums. Grounded theory analyses revealed that negative emotions, avoidance, and pursuing medical care prompted people to seek emotional and informational support online, and support served three functions: integrating information, assessing risk, and strategizing communication. The results point to stigma as a driving force in sexual health discussions online and imply practical recommendations for sexual education, communication about sexual topics, and patient-provider relationships.

Who Asks About HIV/STI Status?: An Analysis of Women Who Sell Sex and Inject Drugs

Communication about HIV and sexually transmitted infections (STI) is a cornerstone of risk reduction, yet there is a dearth of research that examines communication patterns among persons with dual risks for HIV/STI acquisition, such as women who sell sex and inject drugs (WSSID). We used logistic regression to identify factors associated with WSSID (N = 211) in Baltimore, Maryland always asking new clients about their HIV/STI status. Most WSSID were non-Hispanic White (73%) and 74% reported current homelessness. 50% of WSSID reported always asking new clients about their HIV/STI status. Experiencing depressive symptoms (adjusted odds ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.29, 0.96) and having condomless sex with clients (aOR 0.31; 95% CI: 0.17, 0.57) were inversely associated with WSSID always asking new clients about their HIV/STI status. Recent entry into sex work (aOR 2.99; 95% CI: 1.30, 6.87) was positively associated with always asking new clients about their HIV/STI status. Enhancing HIV/STI communication in combination with engagement in other risk mitigation strategies may decrease disease incidence among WSSID.

Behavioral Measures to Assess Adolescent Sexual Communication with Partners: A Scoping Review and Call for Further Studies

Sexual communication with partners is important for adolescents' sexual and socioemotional well-being. Behavioral assessments of partner sexual communication capture the complex and nuanced process of communication and are commonly used with adults, yet the existing literature among adolescents overwhelmingly relies on self-report measures. In the current paper, we reviewed the literature on adolescent partner sexual communication, identifying 14 studies including 2,043 participants (M age = 16) that used behavioral assessments (i.e., dyadic observations, role-plays with confederates, role-plays with vignettes). We also identify key gaps in the current literature: First, only one study recruited couples; studies that assessed dyadic interactions largely relied on confederates. Second, assessments often assumed that participants engaged in heterosexual sex, and no studies specifically recruited LGBTQ+ adolescents. Third, behavioral tasks often involved assumptions of participants' sexual goals (e.g., desire to refuse sex) and focused almost exclusively on sexual refusal and condom negotiation. Additionally, coding schemes lacked standardization and micro-analytic strategies (e.g., coding change over time). Finally, observational methods have been almost exclusively used to assess intervention efficacy, rather than to understand associations between behaviorally-assessed communication skills and sexual outcomes or self-reported communication in basic research. We discuss recommendations for future research, including regular use of behavioral observation methods with diverse samples, to triangulate across multiple methodologies and identify correspondence between behavioral and self-report measures.

Long-Term Effects of a U.S. University Human Sexuality Course on Use of Contraception

This study examined long-term effects of taking a university sexuality course on use of contraception. A questionnaire was given to two groups of students: 602 students enrolled in the first week of a comprehensive sexuality course, and 352 students who had completed the course 1–1.5 years earlier. A significantly smaller percentage of former students had used no contraception at last sexual intercourse (p < 0.005). Former students were less likely to have used a dual method, and favored either IUDs, implants, or birth control pills used alone. There was no notable change in the percentage of former students using withdrawal or condoms. Former students showed evidence of better communication about sex with their partners. The effect size for use of contraception was small, but if this result is true of other college sexuality courses, nationwide it translates into thousands of students who may have avoided unintentional pregnancies.

An Intervention to Increase Condom Use Among Users of STI Self-Sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial (Preprint)

BACKGROUND

Reducing the rates of sexually transmitted infections (STIs) among young people is a public health priority. The best way to avoid STIs from penetrative sex is to use a condom, but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when young people access self-sampling kits for STIs through the internet. The potential of this opportunity is enhanced by the increasing numbers of young people being tested through this route every year in England. Hence, in a cocreation by young people, stakeholders, and researchers, Wrapped was developed--a fully automated, multicomponent, and interactive digital behavior change intervention developed for users of STI self-sampling websites, who are aged 16-24 years.

OBJECTIVE

This paper is a protocol for a feasibility randomized controlled trial (fRCT). The fRCT seeks to establish whether it is feasible to run a randomized controlled trial to test the effectiveness and cost-effectiveness of Wrapped. Wrapped aims to reduce the incidence of STIs through increasing correct and consistent use of condoms among users of STI self-sampling websites, who are aged 16-24 years.

METHODS

A 2-arm parallel-group randomized fRCT of Wrapped plus usual care, compared to usual care only (basic information on STIs and condom use), with a nested qualitative study. A minimum of 230 participants (aged 16-24 years) are recruited from an existing chlamydia self-sampling website. Participants are randomized into 1 of 2 parallel groups (1:1 allocation). Primary outcomes are the percentage of users recruited to the fRCT and the percentage of randomized participants who return a chlamydia self-sampling kit at month 12. Additionally, besides chlamydia positivity based on biological samples, surveys at baseline, month 3, month 6, and month 12, are used to assess condom use attitude, behavioral capability, self-efficacy, and intention, along with details of any partnered sexual activity and condom use, and health economic data. Nested qualitative interviews with trial participants are used to gain insight into the factors affecting recruitment and attrition.

RESULTS

Recruitment to the fRCT began in March 2021 and was completed in October 2021. Data collection was completed in December 2022.

CONCLUSIONS

This feasibility study will provide data to inform the design of a future-definitive trial. This work is timely given a rapid rise in the use of internet testing for STIs and the sustained high levels of STIs among young people.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN17478654; http://www.isrctn.com/ISRCTN17478654.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43645.

Speaking of Values: Value-Expressive Communication and Exercise Intentions

This study introduces the concept of value-expressive communication and examines its relationship with behavioral intent. Value-expressive communication is conceptualized as the verbal output of a value-expressive attitude. Value-expressive communication about exercise is examined in relationship to strength of religious faith, exercise attitudes, communication frequency, and intentions to exercise among a sample of self-identified Christians. The data indicate a significant interaction between value-expressive communication and communication frequency explains significant variance in exercise intentions. Interact to and exercise attitudes is significantly associated with intentions to exercise. Suggestions for using value-expressive communication in health communication research and practice are discussed.

Partner-Level and Sexual Networking Factors Are Associated With Vaccine-Type and Nonvaccine-Type Human Papillomavirus Infection After Vaccine Introduction in Young Women

BACKGROUND

The aim of this study was to determine individual-level, partner-level, and sexual networking factors associated with vaccine- and non-vaccine-type human papillomavirus (HPV) in young women, by vaccination status.

METHODS

Sexually experienced women 13 to 26 years old (n = 784) completed a survey and were tested for 36 HPV genotypes. We determined factors associated with 4-valent vaccine-type HPV (HPV-6, HPV-11, HPV-16, HPV-18) and non-vaccine-type HPV among vaccinated and unvaccinated women, using univariable and multivariable logistic regression models.

RESULTS

Participants' mean age was 19.2 years, 77.7% had received ≥1 vaccine dose, and 7.7% were positive for vaccine-type HPV (HPV-6, HPV-11, HPV-16, and/or HPV-18). Factors associated with vaccine-type HPV in vaccinated women included gonorrhea history (adjusted odds ratio [AOR], 2.71), new female sex partner(s) (AOR, 4.79), age at vaccination (≥15 vs. <15 years; AOR, 2.47), and age discordance with most recent partner (don't know vs. discordant; AOR, 9.17). Factors associated with non-vaccine-type HPV in vaccinated women included history of sexually transmitted infection (AOR, 2.69), male most recent partner (AOR, 2.85), age of first sex (AOR, 1.15), and partner concurrency (don't know vs. 1 other partner; AOR, 2.03). Factors associated with vaccine-type HPV in unvaccinated women included new female sex partner(s) (AOR, 7.45) and partner concurrency (don't know vs. no; AOR, 2.95). Factors associated with non-vaccine-type HPV in unvaccinated women included race (White vs. multiracial; AOR, 4.10) and partner concurrency (don't know vs. 0; AOR, 4.65).

CONCLUSIONS

Novel findings of this study, including associations between female sex partners and HPV, and between not knowing about partner concurrency and HPV, have implications for sexual education, clinical counseling, and public health interventions.

A Mixed-Methods Pilot Evaluation of Manhood 2.0, a Program to Reduce Unintended Pregnancy Among Young Men

One promising though understudied approach to addressing race/ethnic disparities in teen pregnancy rates is through sexual and reproductive health (SRH) programming for young men. This pilot study assessed the feasibility, quality, and preliminary efficacy of Manhood 2.0-a group-based, after-school SRH program for young Black and Latino men, which examines gender norms. This mixed-methods study describes program attendance and quality; participant experiences and engagement in the program; and changes in participant gender norms, knowledge, attitudes, self-efficacy, and social support. Quantitative data from baseline and post-intervention surveys (n = 51) were analyzed using paired t-tests and McNemar's tests. Qualitative data from five post-intervention focus groups (n = 27) were transcribed, coded, and analyzed for themes. At baseline, participants were ages 15 to18 years (M = 16.4 years), 30% were Latino, 66% were Black, 34% ever had sex, and 44% of sexually active participants had sex without any contraceptive method or condom. Quality ratings by program observers were high. The majority of participants (61%) attended at least 75% of sessions, and 96% rated Manhood 2.0 as "very good" or "excellent." Pre-post comparisons showed increases in receipt of SRH information; contraception knowledge; positive attitudes about supporting partners in pregnancy prevention; self-efficacy in partner communication about sex; discussing program content with friends and family; and social competence and support. Focus group participants described benefits from the Manhood 2.0 content (i.e., full range of contraceptive methods, sexual consent, gender norms) and delivery (i.e., reflective discussion, nonjudgmental facilitators). Findings suggest that Manhood 2.0 is a promising SRH program for young men.

Exploring the Protective Value of Using Sexting for Condom Negotiation on Condom use Determinants and Practices Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda

Given the global growth of adolescent texting, we evaluate texting-based sexual communication as a potential site for interventions encouraging condom use cascades, particularly among displaced adolescents-a population with disproportionate levels of sexually transmitted infections, including HIV. With data from 242 forcibly displaced adolescents in the slums of Kampala, Uganda, we used path analysis to examine pathways from gender/dating relationship to condom determinant (knowledge of where to access condoms) and practices (access/use of condoms), through sexting-based condom negotiation, controlling for sexting practices. We found direct pathways from gender (boys vs. girls) and from dating relationship (dating vs. not) to condom determinant. Sexting-based condom negotiation partially mediated the pathway from gender/dating relationship to condom determinant, and fully mediated the pathways from gender/dating relationship to condom practices. Future digital sexual health interventions should consider the utility of texting-based applications in promoting knowledge and use of condoms among adolescents.

An Examination of Condom Brand's Social Media Influence on Sexual Health Messages

Social media is a primary source of sexual health information for young adults. Increased exposure to sexual health education on social media is associated with safer sexual behavior. Given the diversity of social media accounts, condom brands may be a trusted source of sexual health information. We quantified user interactions on the social media posts of the three most frequently used social media sites of condom brands from January 2020 to June 2021. We analyzed the reach each account had in terms of sexual health information separated into three categories: sexual health education, sexual health resources and social issues relating to sexual health. On Instagram, 48% of posts provide sexual health education, 5% mention resources, and 23% mention social issues. On YouTube 68% of posts provide sexual health education, 35% mention resources, and 31% mention social issues. Providing sexual health education had a positive association with likes on Instagram (n = 923, t = 4.09, p < .001). In terms of sexual health education topics, posts pertaining to reproductive health and sexual self-acceptance were a positive predictor of likes on Instagram (n = 56, t = 7.00, p < .001, n = 77, t = 2.37, p = .015 respectively). Posts pertaining to sex were a positive predictor of likes both on Instagram (n = 74, t = 2.79, p = .005) and YouTube (n = 57, t = 2.21, p = .029). These findings suggest that the sexual health education and resources provided by condom brands have significant reach and positive reception. To promote sexual health to a larger and more receptive audience, future research and education campaigns should recognize and utilize the social media influence of condom brands.

Improving communication between American Indian youth and caregivers to prevent teenage pregnancy

American Indian (AI) youth are at increased risk for poor reproductive health outcomes. Parental communication and monitoring are established predictors of sexual risk-taking among adolescents. No program evaluations of sexual risk avoidance programs have focused exclusively on AI youth and parents. This study assesses the impact of the Respecting the Circle of Life (RCL) Teenage Pregnancy Prevention program on parent-youth communication and parental monitoring through a randomized controlled trial with AI youth ages 11-19 and their trusted adults (parents/caregivers) (N = 518). RCL consists of 8-peer group and one parent-youth session. Trusted adult participants completed the Parental Monitoring Scale and the Parent Adolescent Communication Scale at baseline and 3 and 9 months post-intervention via self-report. Intervention impact was evaluated using linear regression models, which included an indicator for study group. At 3 months post, trusted adults in the intervention reported significantly higher levels of sexual health communication (P = 0.042) and spoke to their child more often about how to get condoms (P = 0.001), get birth control (P = 0.014) and protect themselves from human immunodeficiency virus (P = 0.005) compared with trusted adults in the control condition. Program impact varied by age and sex. This study adds to literature and extends findings on RCL impact.

Cannabis use and sexual risk among MSM who drink: Understanding why more frequent cannabis users may engage in higher rates of condomless sex

BACKGROUND

Condomless anal intercourse (CAI) is the major risk factor for HIV transmission among men who have sex with men (MSM). MSM who are heavier cannabis users engage in CAI more frequently. However, little is known about the processes that may underlie this association. This study sought to understand the potential role of condom attitudes and condom-related planning in the association between cannabis use and CAI.

METHODS

This is a secondary data analysis of a study on alcohol use and sexual decision-making among MSM. Two hundred and fifty-eight MSM with moderate to heavy drinking were enrolled. Measures included CAI, cannabis use, attitudes about the influence of condoms on sexual pleasure, condom use planning, age, heavy episodic drinking, and use of pre-exposure prophylaxis (PrEP).

RESULTS

We conducted a negative binomial regression analysis controlling for age, PrEP, and heavy episodic drinking. Cannabis use frequency was a significant predictor of CAI (b =.333, p < .001). Indirect effects showed that while heavier cannabis users exhibited less condom-related planning (b = -0.106, p = 0.015) and more negative attitudes toward the impact of condom use on pleasure (b= -0.177, p = 0.004), cannabis use had a significant indirect effect on CAI only through attitude ratings.

CONCLUSIONS

MSM who are heavier cannabis users engage in more frequent CAI and exhibit an indirect effect on CAI through negative attitudes toward the impact of condoms on pleasure. These findings suggest the potential importance of addressing these condom attitudes in HIV-prevention interventions among MSM who use cannabis.

A Media Literacy Education Approach to High School Sexual Health Education: Immediate Effects of Media Aware on Adolescents' Media, Sexual Health, and Communication Outcomes

Media may function as sex educators for adolescents; unfortunately, media messages often glamorize risky sexual behaviors and unhealthy relationships and neglect sexual health behaviors and communication. Media Aware is a web-based comprehensive sexual health program for high school students that uses a media literacy education approach. It is designed to improve adolescents’ critical thinking about media messages and provide medically-accurate information and skills building related to sexual health and communication. A randomized controlled trial was conducted in 2019-2020 with students (grades 9 and 10; n = 590) from 17 high schools across the United States. The sample was 53% female, 58% white/Caucasian; and 13% Hispanic/Latinx. One high school teacher per school and all of their 9th and 10th grade students were randomly assigned to either the intervention or delayed-intervention (control) condition. The study assessed the immediate (posttest) and short-term (3-month) effects of Media Aware on adolescents’ media, sexual health, and communication outcomes. For 9 of the 17 schools, students were home from school due to the beginning of the COVID-19 pandemic during the time of their 3-month data collection, which left the short-term analyses underpowered. However, several impacts of the program were found in the immediate posttest analyses. Media Aware was found to improve sexual health knowledge and redress inaccurate normative beliefs about the frequency of risky teen sex. Media Aware also improved critical thinking about media messages with demonstrated improvements in media message deconstruction skills and decreases in the perceived realism of media messages. Moderator analyses found some differential immediate effects of the program attributable to gender. Media Aware reduced girls’ normative beliefs about teen sex, generally, and increased their sexual health communication with parents as well as reduced boys’ acceptance of dating violence. Students gave positive feedback about Media Aware, especially related to the online format of the program. The results from this study provide evidence that Media Aware is an effective web-based program for positively enhancing high school students’ media, sexual health, and sexual health communication outcomes.

Perceptions of Pornography and Attitudes Toward Condom Use in Heterosexual Chinese Adults: The Effect of Sexual Pleasure, Safer Sex Communication Apprehension, and Shared Pornography Use During Sex

Chinese people's pornography use is increasing and condomless sex is prevalent in pornography. However, both the relationship between pornography and condom use among Chinese adults and the mechanisms underlying this relationship are underexplored. This study examined how perceptions of pornography were associated with attitudes toward condom use through the mediating effect of gratification of sexual pleasure and safer sex communication apprehension, and how shared pornography use with a partner during sex moderated these relationships. A total of 658 participants (391 women and 267 men) aged 18-65 years and involved in a romantic relationship completed an online survey assessing pornography consumption, condom use, gratification of sexual pleasure, and safer sex communication apprehension. Results showed that expressive/erotic perceptions of pornography were associated with higher levels of gratification of sexual pleasure, which were, in turn, associated with more negative attitudes toward condom use. Expressive/erotic perceptions of pornography were also associated with lower levels of safer sex communication apprehension and lower levels of negative attitudes toward condom use. Higher levels of shared pornography use with a partner during sex strengthened the direct positive relationship between expressive/erotic perceptions of pornography and negative attitudes toward condom use. Higher levels of shared pornography use during sex also strengthened the positive relationship between expressive/erotic perceptions of pornography and gratification of sexual pleasure, and the negative relationship between expressive/erotic perceptions of pornography and safer sex communication apprehension, which in turn, were significantly associated with attitudes toward condom use. Implications for sexual health education and limitations are discussed.

Sexual Communication and Sexual Consent Self-Efficacy Among College Students: Implications for Sexually Transmitted Infection Prevention

PURPOSE

Obtaining affirmative consent, a hallmark of sexual violence prevention education on college campuses, may influence sexual communication and behaviors such as condom use. This study examined the relationship between self-efficacy to obtain sexual consent with sexual health communication and behaviors among a sample of U.S. college students.

METHODS

Data were from 2,291 students enrolled in a cluster-randomized controlled trial conducted on 28 college campuses from 2015 to 2017. Students reported their self-efficacy to obtain sexual consent, communication about sexual health, and sexual health behaviors. Multivariable logistic regression, adjusted for school clustering, history of violence victimization, and sexually transmitted infection history, estimated odds ratios and 95% confidence intervals (CIs) for sexual consent self-efficacy and sexual health communication.

RESULTS

Females (n = 1,150) reported higher self-efficacy to obtain consent than males (b₁ = .32, 95% CI = .23, .41), but lower odds of communication about condom use (adjusted odds ratio [AOR] = .75, 95% CI = .60, .96) and HIV prevention (AOR = .63, 95% CI = .48, .81). Black and other race students reported higher odds of HIV/sexually transmitted infection prevention communication than white students. Odds of consistent condom use were highest among students reporting condom use communication and high self-efficacy to obtain sexual consent (AOR = 1.99, 95% CI = 1.58, 2.51).

CONCLUSIONS

Campus sexual assault prevention education that focuses narrowly on obtaining sexual consent may be missing an opportunity to enhance sexual health communication broadly, including condom and contraceptive use discussion to promote overall sexual health.

Adolescents' Perception of Their Sexual Self, Relational Capacities, Attitudes Towards Sexual Pleasure and Sexual Practices: a Descriptive Analysis

Positive psychosexual development in adolescence is crucial to sexual health. Evidence suggests that adolescent's psychosexual development is influenced by the sexual self-concept, relational skills, attitudes toward sexual pleasure, and sexual practices. To date, however, understanding of normative dispositions and experiences that positively shape adolescents' psychosexual development remains limited. The goal of the study was to provide a descriptive analysis of adolescents' perceptions of their sexual self, relational skills, and attitudes towards sexual pleasure as well as their sexual practices while considering age and gender differences. A Canadian sample of 1584 adolescents (49.7% girls, 49.4% boys and 0.9% gender diverse) aged 14 to 18 years old (M = 15.53, SD = 0.93) completed a self-reported questionnaire evaluating various aspects of sexuality and sexual practices. Results indicated that most youth are sexually active through autoerotic or partnered sexual practices, and that positive perceptions towards the sexual self, relational capacities and pleasure increase with age. Moreover, compared to girls, boys presented a more positive sexual self-concept, less positive perceptions of their relational skills and they were more likely to report autoerotic sexual practices. Cluster analysis supported classifying adolescents into the following profiles: positive, mildly positive, mildly negative and negative perception of the sexual self and sexuality. These profiles varied according to sexual practices, gender and age. This study provides further insight into general patterns and heterogeneity of adolescents' sexuality that are relevant for adapting sexuality education and sexual health intervention.

Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model

Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

A Longitudinal Investigation of Observed Adolescent Text-Based Sexting and Adjustment

Despite strong concerns that sexting poses risks for adolescents' well-being, previous research finds mixed results. Moreover, these studies rely heavily on self-report measures and cross-sectional designs. This study utilizes observational methods to examine longitudinal relations between text-based sexting and both negative and positive indicators of psychosocial adjustment. An ethnically diverse sample of 197 adolescents was provided smartphones that captured their text messages across high school, from 2008-2012. Two, two-day samples of text messages from grades 9-12 were content-coded (468,201 total observations). Sexting was defined as sending and receiving text-based statements about past, present, or hypothetical sexual behaviors occurring between dyadic texting partners. Each year, adolescents reported on negative (internalizing, externalizing, and social problems; borderline personality features) and positive (life satisfaction, group belongingness, and positive self-perceptions) indicators of their psychosocial adjustment. Using concurrent and longitudinal multilevel models, greater sexting at one time point than one's average (within-person) was only associated with lower levels of group belongingness within the same year. For girls only, text-based sexting more than others on average (between-person) was related to increased externalizing symptoms and borderline personality disorder features, as well as decreased life satisfaction, group belongingness, self-perceived social competence, and global self-worth. No within-person differences by gender emerged, nor did longitudinal associations. Future studies and intervention efforts should examine when and why higher sexting might be related to psychosocial problems among girls.

Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic

Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.

Shame and STIs: An Exploration of Emerging Adult Students' Felt Shame and Stigma towards Getting Tested for and Disclosing Sexually Transmitted Infections

Emerging adulthood is identified as a time of identity exploration, during which emerging adults (EAs) may engage in sexual exploration and risky behaviors, potentially resulting in the contraction of a sexually transmitted infection (STI). Many EAs, do not disclose their status to partners or those who can provide social support, like parents. Nor do they often get tested. This may be due to the changing status of stigma surrounding STIs. This study examines traditional measures of the stigma/shame of STI diagnoses, treatment, and testing, and their relevance alongside both increased opportunities for casual sex and not only heightened education surrounding STIs, but also heightened prevalence of STIs in the U.S. Results show EAs perceived that if their community found out they got tested, they would likely be treated differently. They also felt they would be uncomfortable disclosing an STI to parents as well as to sexual partners. However, disclosing to a monogamous partner yielded less felt shame and stigma by EAs. Lastly, stigma/shame was associated with STI communication, as well as with overall perception of STI knowledge, and getting tested. Further explanation of the results and possible implications of this study are discussed.

Let's Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru

Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Sexual health communication warrants greater attention as it may help to reduce the rates of HIV incidence among youth. A growing body of literature suggests that conversations about sexual health among Black and Latino youth may serve as a potential strategy for HIV prevention. The current study investigates whether sexual health communication-in particular, conversations about sexual health and HIV-influences Black and Latino youth's personal agency regarding their role in achieving an HIV-free generation. For this secondary data analysis, we used the National Survey of Teens and Young Adults on attitudes towards HIV/AIDS (n = 701). Participants included youth between the ages 15 and 24, and the average was 20 years. We used a multiple regression analysis to examine whether sexual health communication contributed to youth knowledge and awareness of (1) the national plan for EHE, and (2) their role in ending the epidemic". (1) knowledge and awareness of the national plan for EHE, and (2) role in ending the epidemic. The final multiple regression model was statistically significant [R2 = 0.16 F (12, 701) = 001, p < 0.001] for both outcomes. Study results found that sexual health communication was positively related to Black and Latino youth's awareness of efforts to end the HIV epidemic (EHE) and their belief that they could play a role in achieving EHE. In addition, HIV stigma influenced personal agency and whether youth were aware of efforts to achieve EHE. Our results demonstrated that openly communicating about sexual health and HIV may contribute to a sense of personal agency among Black and Latino youth. In addition, understanding whether sexual health communication contributes to a sense of personal agency among youth may inform HIV prevention efforts to achieve the goals set forth by the national EHE plan for the U.S.

Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study

Background

Female Sex Workers (FSW) play a crucial part in HIV transmission. Having unprotective condom during sexual activity can lead to HIV infection. Having lower power in condom negotiation with client can lead FSW not to using condoms during the sexual act. Alcohol consumption was also mediated HIV risk behavior among FSW. This study aimed to evaluate the relationship between condom use-negotiation, alcohol consumption and HIV-risk sexual behavior among female sex workers (FSW) in Kupang.

Design and Methods

A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The data were analyzed using univariate and the Chi-square test.

Results

The majority of FSWs (61.6%) reported had low negotiation condom use with their clients, about 77.6% reported high levels of alcohol consumption and 64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003) and alcohol consumption (p-value: 0.037) were found to be significantly associated with HIV-risk sexual behavior.

Conclusions

Future interventions on HIV prevention should focus on empowering young FSWs with condom negotation skills in order to increase condum use. It is also recommended to include information about alcohol consumption and it's relationship wit HIV-risk behavior in order to have better health outcomes for FSW.

Toward A Typology of Identity Gaps in "Non-Normative" Sexual Partner Communication

The present study presents a typology of identity gaps (Hecht, 1993), or cognitive, affective, and behavioral discrepancies between and among different parts of the self, that emerge in sexual partner communication. A total of 504 individuals in relationships they identified as or others ascribed as less common or less accepted than other kinds of relationships, including LGBQ, transgender and non-binary, BDSM, polyamorous, and interracial relationships, described instances in which parts of the self were in tension amid their intimate partner communication. These identity gaps occurred in tension with personal identity, or sense of self, or communal identity as a member of particular sexual and gender minority groups. Implications and areas for future research are discussed.

Sexual Excitation and Sexual Inhibition in the Context of Sexual Risk-Taking

The current study examined the roles of sexual excitation and sexual inhibition in the context of sexual risk-taking among heterosexual women and men to better understand the link between sexual arousal and sexual risk-taking. We set out to determine which factors in the Sexual Excitation and Sexual Inhibition Inventory for women and men (SESII-W/M) were most predictive of sexual response and sexual risk-taking behavior. Participants (N = 266, women = 166) completed the SESII-W/M instrument and responded to items assessing their sexual risk-taking intentions and their risk-taking indicators. A sub-sample (n = 133, women = 83) also completed a sexual arousal manipulation. Sexual excitation was linked with higher levels of self-reported sexual arousal (among women and men) and greater risk-taking intentions (among women only). However, controlling for gender, sexual inhibition was a better predictor of sexual risk-taking intentions, compared to sexual excitation. The Dual Control Model offers unique insights into conceptualizations of sexual response to erotic stimuli and behavioral risk-taking. These findings can inform more effective interventions to promote risk reduction through sex positive approaches that capitalize on the pleasure enhancing capabilities of safer sex strategies.

Taking the Maximum Risks for Satisfaction: Understanding the Process of Condom Discontinuation among National Youth Service Corps' Members in Nigeria

Objectives: To examine the process of condom discontinuation among members of the National Youth Service Corps in Nigeria who had been required to take part in a compulsory one year national service right after tertiary graduation. Methods: We used a qualitative research design to achieve this objective. Results: Findings revealed that the motivations for condom discontinuation among our sample include the need to achieve pleasure, the perception of the withdrawal method skill as an alternative to condom use, intimacy and trust among others. Cultural influence such as the promise of marriage and proof of fertility motivated both men and women to discontinue condom use. For many, intermittent condom discontinuation was normal throughout the course of relationships. Also, while verbal communication was more common among males than females, non-verbal communication strategies were employed by more of the females in their condom discontinuation behaviour. Conclusions: Overall, the findings improve our understanding of how condom discontinuation processes occur among young people and concludes that many young people (respondents) are yet to grapple with the potential consequences of unsafe sex.

Black College Women's Interpersonal Communication in Response to a Sexual Health Intervention: A Mixed Methods Study

We investigated interpersonal communication generated from a successful sexual health intervention for Black college women attending a Historically Black College/University (HBCU). Guided by the integrative model of behavioral prediction and the theory of gender and power, the intervention combined point-of-access health messages with condom distribution via condom dispensers. Using a mixed-methods approach, we examined communication partners, content, mode, valence, and perceived impact. Data were gathered from surveys (N = 105) and interviews (n = 10) with young adult women at an HBCU campus, conducted three months after the intervention. The findings revealed that 43% of women engaged in interpersonal communication and 21% engaged in online interactions about the dispensers. Friends were the most common conversation partners, and the conversations were mainly about condoms and the dispensers themselves. In general, the discussions were positive, showing support for the dispensers. Regression analyses revealed positive, significant associations between interpersonal communication and two key outcomes: condom acceptability and condom intentions. Overall, this study adds to research linking health communication interventions to interpersonal communication and subsequent attitudes and beliefs. Health communication interventions should actively encourage young Black women to share health-promoting information within their social networks to extend both the reach and impact of those interventions.

A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study

BACKGROUND

The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear.

OBJECTIVE

The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator.

METHODS

Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator.

RESULTS

The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: -0.80, 95% boot CI -1.67 to -0.36) but not in sexual minority women (indirect effect: -0.33, 95% boot CI -0.86 to 0.31).

CONCLUSIONS

The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.

Negotiating HIV and pregnancy prevention and sexual pleasure amongst heterosexual men and women in South Africa

Heterosexual sex, foremost its gender-power dynamics, is embedded in and informed by the socio-historical context in which it occurs. While safer sexual communication skills are well documented as key to the success of sexual and reproductive health programming and education, communication skills about the positive aspects of sexuality such as sexual pleasure are often limited if not absent. Using data from in-depth qualitative interviews with men and women aged 26-39 from a diverse set of backgrounds in Cape Town, South Africa, this study examines the ways in which gender-power dynamics manifest in negotiations of HIV and pregnancy prevention and sexual pleasure in the intimate spaces of heterosex. Findings fall under three themes: 1) condom negotiation as a replacement for other aspects of sexual communication; 2) self-efficacy in negotiating prevention and negotiating one's own sexual pleasure; and 3) the integral role men play in heterosexual encounters in the facilitation of women's sexual autonomy and women's sexual pleasure. This study contributes to research not only examining the positive and more nuanced realities of heterosex in the South African context, but also argues for the need to integrate positive aspects of sexuality into sexual and reproductive health programming in general.

Young adults' sexual health in the digital age: Perspectives of care providers

OBJECTIVES

This study examined care providers' views on young people's sexual health in the digital age. Young people have high rates of sexually transmitted infections (STIs), indicating sexual risk-taking behaviours. Adolescents transitioning to adulthood may be particularly at risk due to increased sexual behaviour and exposure to risk factors for unsafe sex, such as less parental monitoring. These risks may be accentuated in the digital age, where the availability of dating apps and pornography have potentially influenced young people's sexual behaviours. Care providers give a unique insight into sexual health in the digital age as they are able to identify changes over time.

STUDY DESIGN

Qualitative semi-structured interviews were conducted with general practitioners, nurses, counsellors and university residential college staff (N = 15, six female) who work with young people aged 17 and 18. Interviews took 20-40 min, and were recorded and transcribed verbatim. Transcripts were coded by the primary researcher and an independent coder using thematic analysis.

RESULTS

We identified four themes depicting predictors for sexual risk-taking among young people: media influence on norms (influence on sexual behaviours, relationships and appearance), transition to adulthood (independence, social opportunity), communication difficulties (gender and sexuality differences, greater fear of pregnancy than STIs), and impulsive behaviour (disinhibition, substance use).

CONCLUSION

Findings highlight targets for prevention of sexual risk-taking among adolescents, such as addressing changing norms depicted in media. Further, the complex interplay of contextual and individual factors highlights the need for more comprehensive theory and holistic approaches to STI prevention.

Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation

Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process. Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales. Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies. The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.

Latin American Women´s Beliefs, Views and Ideas About Sexual Assertiveness: A Focus Group Study in Cuenca (Ecuador)

In an attempt to extend our understanding of how social contexts co-create female sexuality in Latin America, the aim of the current study was to explore the beliefs, views, and ideas about sexual assertiveness in Latino emerging adult women. Seventeen women between 22 and 30 years old living in Cuenca, Ecuador, participated in focus groups. A constructivist grounded theory approach was used to analyze the data. Findings suggest that the overall views about sexual assertiveness in emerging adult women can be grouped into five categories: (1) gender role schemata; (2) concerns about the partner's thoughts and reactions; (3) gendered attitudes towards the use of specific methods of contraception; (4) talking about sexual histories as a challenging task; and (5) replication of family patterns. The findings of this study are discussed within existing literature that highlights the influence of gender role schemata on sexual assertiveness. Finally, a plea for more culturally sensitive research is formulated as well as some educational - the need to reinforce sex education programs - and clinical - highlighting the ability to be sexually assertive from the start of a relationship - implications are mentioned.