Sexual consent: Exploring the perceptions of heterosexual and non-heterosexual men

Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people

OBJECTIVES

This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing.

METHODS

SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault.

RESULTS

Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS.

CONCLUSIONS

Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.

A Qualitative Account of Coping Following Non-Consensual Sexual Experiences among Gay, Bisexual, and Other Men Who Have Sex with Men

Sexual consent among gay, bisexual, and other men who have sex with men (GBMSM) has not been thoroughly documented in the academic literature. Research has suggested that GBMSM incur a greater risk for experiencing non-consensual sexual experiences (NSEs) compared to heterosexual, cis-gendered men. Despite the high prevalence of NSEs impacting this population, little research has been conducted on how GBMSM cope after NSEs. The purpose of this study was to examine how GBMSM cope following NSEs. Responses were analyzed from 206 GBMSM, aged 18-77 (M = 31.84), recruited across Canada. Participants completed an online survey, answering open-ended questions on experiences of NSEs and how they coped afterward. Guidelines for thematic analysis were followed to analyze the responses, indicating that GBMSM cope both maladaptively (e.g., avoidance, withdrawal from social networks and sexual relationships) and adaptively (e.g., seeking therapy, social support) following NSEs. Some participants were affected by and needed to cope with their NSEs over a longer term (e.g., ongoing rumination, enjoying sexual and intimate relationships less). Participants used a range of coping skills and showed openness to reach out for help from formal and informal sources, but also noted that resources were not always accessible or culturally sensitive to GBMSM's needs. Responses are discussed in the context of barriers to effective coping, such as perceptions of masculinity and maladaptive sexual scripts.

Clickable Consent: How Men Who Have Sex with Men Understand and Practice Sexual Consent on Dating Apps and in Person

Smartphone-based dating applications like Grindr are popular among men who have sex with men (MSM), and it is common for MSM to engage in sexual activity with other users. Despite this, there is limited research on MSM's negotiations of consent for online sexual interactions and in-person sexual encounters. This study examined MSM's understandings and practices of consent on dating apps and in person. Interpretative phenomenological analysis of 25 interviews with MSM dating app users revealed that many participants could identify key aspects of consent but did not always apply those understandings to their own practices. For online sexual interactions, some participants viewed consent as connecting to a dating app - a practice I term "clickable consent" - while other participants viewed consent as continuous and communicated consent in explicit and implicit ways. Although all participants negotiated consent online in preparation for an in-person sexual encounter, some renegotiated consent in person with explicit or non-explicit communication, while others did not renegotiate consent in person. Results shed light on how MSM's online conversations impact their in-app and in-person sexual activities, and reveal challenges that MSM face in digital and physical spaces. Conclusions, implications, and suggestions for future research are discussed further.

Sexual Consent Norms in a Sexually Diverse Sample

Sexual consent has received increased attention in mainstream media, educational, and political settings since the rise of the #MeToo movement in 2017. However, long before #MeToo, sexual consent has been a core practice among people who engage in Bondage and Discipline, Dominance and Submission, Sadism, and Masochism (BDSM). This study examined sexual consent norms among a sexually diverse sample, including people who practice BDSM (n = 116), people who identify with another sexual minority group, such as swingers and sex workers (n = 114), and people who did not identify with a sexual minority group, termed sexual majority group members (n = 158). Explicit consent for both BDSM- and non-BDSM-related activities was rated as more common (descriptively normative) among people who were a member of the BDSM community compared to majority participants. Further, BDSM participants rated consent discussions as less sexually disruptive compared to majority participants. We found no significant group differences in the extent to which people thought sexual consent should be discussed. We also discuss findings from an open-ended question asking participants to recall a recent sexual experience with a new partner. This study demonstrates variability in consent norms between groups and points to the potential to shift sexual consent behaviors among majority participants.

Defining and Measuring Sexual Consent within the Context of University Students' Unwanted and Nonconsensual Sexual Experiences: A Systematic Literature Review

Lack of sexual consent forms the foundation of unwanted (and nonconsensual) sexual experiences (USEs), yet research suggests it is not well understood amongst university students. While the prevalence of USEs has been well documented within the university context, less is known about how sexual consent is defined or measured. This review aims to identify a consistent sexual consent definition and how current research examining USEs defines and measures sexual consent amongst university students. A systematic review of nine electronic databases (2000-2022) was conducted, and the results were assessed against inclusion criteria (e.g., studies had to focus exclusively on university students). Thirty-three articles were identified and reviewed against the study aims. Sexual consent was more often implicitly defined across measures and articles. Four themes were identified (incapacitation, use of force, use of threats, and lack of wantedness) across the implicit definitions but varied by study with some implicitly defining sexual consent within the context of a relationship. Only three studies explicitly defined sexual consent, referring to it as a willingness to engage in sexual behavior. Measures assessed sexual consent communication or, attitudes and behaviors that might predict sexual aggression. Two studies examined students' individual sexual consent conceptualizations. Sexual consent appears to be contextual so future research should examine the variability of sexual consent in student samples. Students may indeed rely on implicit sexual consent definitions (rather than explicit) but more research is needed. Lastly, researchers should take care to be clear on their sexual consent definitions, both in text and within measures.

Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites

Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.

"You're Gay, It's Just What Happens": Sexual Minority Men Recounting Experiences of Unwanted Sex in the Era of MeToo

Our grounded theory analysis derives from in-depth interviews conducted with 24 gay, bisexual, queer, and other men who have sex with men (GBM) living in Toronto, Canada, to understand their experiences of sexual coercion. Participants drew on discourse from the #MeToo movement to reconsider the ethics of past sexual experiences. The idea that gay or queer sex is inherently risky and unique from heterosexual relations made negotiating sexual safety challenging. These notions were enforced by homophobic discourses on the one hand, and counter discourses of sexual liberation, resistance to heteronormativity, hegemonic masculinity, and HIV prevention on the other. Biomedical advances in HIV prevention such as pre-exposure prophylaxis (PrEP) and undetectable viral load affected how some participants felt about sexual autonomy and safety. Participants held themselves responsible for needing to be more assertive within sexual encounters to avoid coercion. Many believed that unwanted sex is unavoidable among GBM: if "you're gay, it's just what happens." Targeted education aimed at GBM communities that incorporates insights on GBM sexual subcultures is necessary. This work must be situated within a broader understanding of how gender norms and hegemonic masculinity, racism, HIV status, and other power imbalances affect sexual decision-making, consent, pleasure, and sexual harm.

Assessing Young Adults' Internal Feelings Related to Refusing Sexual Behavior

Young people describe refusing sexual activity as difficult or embarrassing; however, what specific internal feelings young adults associate with refusing sexual activity is unclear. We assessed the positive and negative internal feelings related to refusing different sexual behaviors using sentiment analysis. We also examined if positive and negative internal refusal feelings varied by gender and the intersection of gender and racial/ethnic identity. Young adults (n = 574, 481 women, 93 men, M = 19.2, SD = 1.43) from Canada and the U.S. completed an open-ended survey about how they felt about their experiences refusing sexual activity. Using sentiment analysis, responses were coded as either positive or negative and overwhelmingly, feelings associated with refusing sexual activity were identified as negative. Women and women of color reported more negative feelings than men and White women. However, there were some distinct positive feelings noted from young adults (e.g., feeling respected, comfortable). Young adults appear to internalize negative feelings about their refusals which may relate to social and cultural norms. Moving forward, sexual health programs could focus on normalizing and destigmatizing refusals so that young adults do not feel negatively about refusing sexual activity, with a particular emphasis on helping women and women of color to feel confident and empowered in their refusals.