Condom negotiation: experiences of sexually active young women

"I Just Wasn't Thinking": Strategic Ambiguity and Women's Accounts of Unprotected Sex

Heterosexual university students continue to endorse sexual scripts that preference men's desire and sustain gendered power imbalances in sexual relationships and encounters, leading women to risk pregnancy by engaging in unprotected sex. Because young women also endorse norms encouraging them to protect themselves and their partners from unintended pregnancy, women are caught in a bind between two often competing norms. We conducted semi-structured individual interviews with university women (n = 45) to examine how they navigate these competing norms. We found that women explained risky contraceptive decisions by saying they "just weren't thinking," thus employing strategic ambiguity, or vague language used to maintain social status, to navigate between competing norms. Our findings suggest that women were actually thinking about risks and making calculated decisions in the moment which often privileged men, putting themselves at risk and sometimes causing distress. To save face, women presented the idea that they "just weren't thinking" in different ways that conformed to traditional notions of romance and sexuality: being in the moment, love and trust for their partner, and deferring to the perceived or actual wishes of men. We conclude that there is a need to promote and achieve affirmative sexuality which includes women feeling empowered to express their own sexual needs - whether that be consent or refusal, contraception, pleasure, or all of these.

Sexual risk behavior among individuals seeking outpatient mental health services: Associations with childhood emotional neglect and identity dysfunction

This study was developed to examine sexual risk behavior among patients seeking community-based mental health services, including associations with psychological distress, identity dysfunction, and childhood emotional neglect. A mediation model was examined regarding identity dysfunction mediating the link between emotional neglect and sexual risk behavior. A total of 245 outpatients completed questionnaires regarding perceived risky sexual behavior, psychological distress, identity dysfunction, and emotional neglect. Sexual risk behavior was found to be a prevalent issue among individuals seeking outpatient mental health services, with 13% reporting engagement in unsafe sexual practices at least some of the time. Mediation analysis revealed that childhood emotional neglect was indirectly linked with sexual risk behavior through the mediating effect of identity dysfunction. Thus, findings suggest a pathway to sexual risk behaviors through perceived childhood emotional neglect and identity dysfunction. Clinical attention to identity-related vulnerability among this population may be warranted in aiming to mitigate risk-taking associated with sexual practices.

Childhood Environmental Instability and Social-Emotional Outcomes in Emerging Adults

Adverse childhood experiences (ACEs) can negatively affect social-emotional functioning. The association between individual and cumulative ACEs and social-emotional domains of self-esteem, loneliness, and negotiation in intimate partner relationships has not been explored in low-risk emerging adults, a gap this study aims to fill. An online survey was administered to undergraduate emerging adults, ages 18 to 25 years (M_age = 19.73, SD = 1.83; N = 436; 20.60% Hispanic; 63.80% female). The ACEs Survey, Child Abuse Potential Inventory, and Conflict Tactics Scale-2nd Edition were used. Three multivariate ordinary least squares regressions were run, each including predictors significant in bivariate analyses and outcomes of self-esteem, loneliness, and negotiation for each regression. Emotional abuse, B = -.20, p < .01; emotional neglect, B = -.21, p < .001; and substance using family member, B = -.12, p < .05, were negatively associated with self-esteem; emotional neglect, B = .11, p < .01, and cumulative ACEs, B = .16, p < .01, were positively associated with loneliness; and incarcerated family member was positively associated with negotiation, B = .12, p < .05. Overall, these findings suggest that individual ACEs associated with environmental instability (e.g., emotional abuse) are strong predictors of social-emotional outcomes, relative to ACEs associated with more direct physical harm (e.g., sexual abuse).

The Examination of Young Mexican American Women’s Contraceptive Use

The purpose of this paper is to review all literature on young Mexican American women’s contraceptive use practices in the U.S. to provide an overall picture of the largest Hispanic subgroup. We also discuss how sex education is important to contraceptive use and how parent-child sex communication takes place among young women of this specific population.

"I'm not Gonna Die Because of an STD": Female African American Adolescents' Perspectives on how they Protected Themselves from Sexual Risks While in Foster Care

PURPOSE

Youth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks.

DESIGN AND METHODS

Semi-structured interviews were conducted with 16 female African American adolescents, ages 18-20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks.

RESULTS

Participants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy.

CONCLUSIONS

Study findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use.

PRACTICE IMPLICATIONS

Findings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

Perceived barriers and facilitators to female condoms among UK based healthcare professionals

OBJECTIVES

The female condom (FC) is an effective strategy against sexually transmitted infections (STIs) in susceptible women and men who have sex with men. FCs are the only female-initiated dual protection method that protects against both STIs and unintended pregnancy. As healthcare professionals (HCPs) are a key element in the promotion of contraceptive use, it is important to examine attitudes towards FCs among this group. Study participants: 15 male and female HCPs aged between 22 and 57 years recruited from sexual and reproductive health settings located in Brighton, London, and Glasgow. Sampling method: Purposive sampling with targeted advertisements (newsletters and bulletins). Study design: face-to-face and telephone interviews with sexual health HCPs. Main outcome measure: potential barriers and facilitators to FCs in the UK. Data were analysed thematically to identify common views and perspectives.

RESULTS

FCs were thought to be unacceptable to most women due to stigma, design, negative visual appeal, insertion difficulties and lack of familiarity. The perceived unavailability and higher cost of FCs, in comparison to male condoms, are major barriers to their use.

CONCLUSIONS

HCPs are reluctant to promote FCs, often due to the perceived social stigma surrounding FCs. Further education and promotion are needed to increase acceptability and correct usage. Future research needs to explore strategies to increase the acceptability of FCs among women, men who have sex with men and HCPs.

Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service

Background This cross-sectional study investigated sexually transmissible infection (STI) knowledge, safer sex attitudes and behaviours of sexually active, heterosexual men using an Internet dating service, and explored factors associated with protective attitudes.

METHODS

An anonymous online survey was sent to men who had logged onto an Internet dating service within the previous year. Factors associated with discussing STIs before sex and condom use intention with a new partner were analysed.

RESULTS

In total, 2339 responses were analysed. Men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex as age increased. Younger men (aged 18-29 years) were more likely to report intentions of only having sex with a new partner if a condom was used compared with older men aged over 60 years. Predictors of having a discussion about STIs with a new partner were older age, better knowledge of STIs, greater distress at a potential diagnosis of an STI and stronger future condom use intention. Intention to only have sex with a new female partner if a condom was used was associated with higher STI knowledge, discussing STIs with a new partner and distress at a diagnosis of an STI. Men with a higher number of sexual partners in the last year were less likely to have an STI discussion with new partners or intend to use a condom with a new partner.

CONCLUSIONS

Older Internet-dating, heterosexual men are vulnerable to STIs. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline

The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants' IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.

Traditional Sex and Gender Stereotypes in the Relationships of Non-Disclosing Behaviorally Bisexual Men

Traditional stereotypes about sex and gender present men as assertive, aggressive, sexually adventurous, and emotionally restrained, and women as docile, passive, sexually modest, and emotionally sensitive. Past research has shown that such stereotypes impose constraints on heterosexual relationships that decrease sexual satisfaction for men and women. This study examined the impact of traditional sex and gender stereotypes on a sample of 203 behaviorally bisexual men who were in a heterosexual relationship with a woman to whom they did not disclose their same-sex behaviors. Participants' descriptions of their partners reified several traditional stereotypes regarding men's and women's sexual dispositions (e.g., men are more sexually adventurous than women), role during sex (e.g., men should be dominant and women submissive), relationship desires (i.e., women prefer long-term intimate relationships and men prefer unattached sexual gratification), and emotional involvement (e.g., women are emotionally sensitive and men emotionally detached). These stereotypes shaped participants' sexual relations with women and men, which were widely conceived as acts of domination-submission. Perceiving women as more skilled for emotional intimacy and affection, most participants would only develop intimate relationships with them; however, some participants also perceived women as too emotionally sensitive and described men as better companions. Many participants were dissatisfied with these gender norms although they conformed to them, further supporting that traditional sex and gender stereotypes impose constraints on relationships that can limit authentic sexual expression and intimate satisfaction.

Of mosquitoes and men: mitigating Zika risk via Men's family planning and male contraception

BACKGROUND

Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men's family planning and developing novel male contraceptives.

MAIN BODY

To prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adherence to these recommendations is neither practical nor adequate to address Zika's sexual transmission. As up to 13% of couples who use condoms experience unintended pregnancy, semen and consequent viral exposure is imminent. The use of contraception beyond just barrier methods is essential. However, the burden of contraception largely falls upon women and efforts to prevent vertical transmission are often aimed at educating women, when the outcome is equally undesirable among their male partners. These short-comings highlight the lack of attention to men's options for family planning. Educating men about the full range of contraceptive options, correcting misconceptions about the efficacy of withdrawal and barrier contraceptive methods, increasing access to vasectomy, and developing novel male contraceptive options would allow shared responsibility for the prevention of unintended pregnancy and Zika-related morbidity.

CONCLUSION

Gaps in recommendations to prevent the sexual transmission of Zika provide an opportunity to develop men's family planning initiatives and the range of accessible contraceptives to men.

"I'm in control: I'm not stumbling in the dark anymore": Midlife women's experiences of successfully negotiating safer sex with new partners

The rates of STIs in women over 45 years have been steadily increasing in Australia and other Western countries. Traditionally sexual health and STI prevention and research has positioned young people as the priority population; to date, insufficient attention has been paid to the sexual health of women over 45 years. Using a strengths-based approach, the objective of this study was to explore the factors and mechanisms that enable Australian women aged 45 to 64 years to successfully negotiate safer sex practices in new relationships. Interpretative Phenomenological Analysis (IPA) was employed for an in-depth exploratory study of a sample of eight women. Three broad themes emerged: being informed, being prepared, and being empowered. These findings provide a valuable insight into how we can initiate change and support safer sex practices for this target group.

Black Women's Approaches to Encourage a Male Partner to Test for HIV: Preliminary Adaptation and a Factor Analysis Study of the HIV Testing Approach Scale

BACKGROUND AND PURPOSE

Black women are disproportionately affected by HIV. Increasing status awareness through partner testing can improve status awareness and reduce transmission. Varying approaches to encourage HIV testing are described but a measurement instrument is lacking. The AIDS Discussion Strategy Scale (ADSS) was adapted into the HIV Testing Approach Scale (HTAS) to measure Black women's approaches to encourage partners to test for HIV.

METHODS

Preliminary adaptation included five steps to ensure validity. Participants comprised 158 sexually active 18-29-year-old Black women. The HTAS was analyzed with principal components analysis (PCA).

RESULTS

PCA indicated a four-factor model explaining 67% of variance. Four distinct approaches were Active Persuasion, Decisive Collaboration, Ultimatum, and Sweet Talking. The HTAS approaches demonstrated adequate reliability.

CONCLUSION

The HTAS may serve as a valid and reliable instrument for research. HIV prevention should encourage testing discussion to increase status awareness.

Accounts for Unprotected Sex with Partners Met Online from Heterosexual Men and Women from Large US Metropolitan Areas

For about 30 years, soon after the onset of the AIDS epidemic, sexual-health messaging has emphasized personal responsibility for using condoms to protect from acquiring or transmitting HIV or other sexually transmitted infections. Those who did not use condoms during casual sexual encounters may therefore feel compelled to offer to others aware of their behavior what sociologists have called "accounts," an impression-management strategy to avoid unfavorable judgment. We analyzed accounts-excuses and justifications-from qualitative interviews with 150 adults who had unprotected sex in the past 3 months with at least two different partners met online (ages 18-50, mean: 33.7, equally divided among black, Hispanic, and white men and women, over half were college educated and the median yearly household income range was $50-$75,000). Many participants made excuses that aimed to defer responsibility for unprotected sex: they claimed that consistently practicing safer sex was impossible, that they got carried away by sexual passion, that they were inebriated, that they were influenced by emotional or psychological problems, or they put fault on their partners. Participants also provided justifications, claiming that unsafe sex had been acceptable because the risks taken were likely minimal or negotiated with their partner. Understanding the accounts heterosexual adults offer to excuse and justify condomless sex with partners met online can be helpful in developing prevention messages that debunk these explanations for their behavior.

How Condom Discontinuation Occurs: Interviews With Emerging Adult Women

We have almost no data on how and when couples stop using condoms. This qualitative study investigated the process of condom discontinuation. From November 2013 to April 2014, a total of 25 women living in a college town in the Midwest, ages 18 to 25, participated in semistructured interviews centered around three domains: partner interactions, contraceptive use, and sexually transmitted infection (STI) prevention. Analysis followed a critical qualitative research orientation. Participants described actively seeking the best options to prevent pregnancy, perceiving condom discontinuation in favor of hormonal methods as a smart decision, and reported wanting to discontinue using condoms due to physical discomfort. Oftentimes, nonverbal communication around contextual instances of condom unavailability paved the way for discontinuation. Participants indicated the decision to stop using condoms was neither deliberate nor planned. Condom discontinuation rarely occurred at one point in time; instead, it was preceded by a period of occasional use. Even after participants described themselves as not using condoms, sporadic condom use was normal (typically related to fertility cycles). This study provides a more detailed understanding of how and why emerging adults negotiate condom discontinuation, thereby enhancing our ability to design effective condom continuation messages. Attention should be paid to helping emerging adults think more concretely about condom discontinuation.

Violated and vulnerable: women's experiences of contracting a sexually transmitted infection from a male partner

AIMS AND OBJECTIVES

To explore women's stories of contracting a sexually transmitted infection from a male partner and elucidate the gendered constructs and violence experienced that made the women vulnerable to these infections.

BACKGROUND

Violence against women can result in both physical and psychological consequences and expose women to multiple health risks including sexual health adversity.

DESIGN

Feminist storytelling approach.

METHODS

Qualitative interviews were conducted with 10 women. All data underwent thematic analysis.

FINDINGS

Findings from this study revealed the women were vulnerable to contracting sexually transmitted infection/s from their male sexual partners as a result of unequal gender and abusive relationship dynamics. Subsequently, contracting a sexual infection within this context potentially increased their vulnerability in both current and future relationships, through their loss of self-confidence and perceived ability to have a trusting loving heterosexual relationship as women with sexually transmitted infection/s.

CONCLUSION

Women in relationships in which they are subordinate to their male partner are at heightened risk of sexual health adversity, including contracting a sexually transmitted infection. Contracting a sexually transmitted infection within the context of an abusive relationship can further increase women's vulnerability to dominant male partners, thus further exposure to sexual risk and adversity.

RELEVANCE TO CLINICAL PRACTICE

Nurses working in clinical settings are well placed to conduct opportunistic screening of women's sexual health, including assessment of sexually transmitted infections and the nature of the encounter in which they were contracted. Thorough assessment can potentially identify relationship and personal factors that can increase a woman's risk to both sexual adversity and forms of abuse. Also, if women do divulge that they have suffered abuse, nurses are positioned to provide support and guidance in implementing strategies to minimise risk as well as referring them to specialised services.

'I don't want to be that guy walking in the feminine product aisle': a Photovoice exploration of college men's perceptions of safer sex responsibility

Incidence and prevalence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and other sexually transmitted infections (STIs) continue to increase among young heterosexual men and women in the United States. Although research studies examine the reasons why these young people are not engaging in safe sex behavior, many have not explored factors beyond individual behaviors. Much of the current research focuses on young women, for the most part leaving men out of the equation. In this study, a Photovoice methodology was used to examine social norms, media messaging and perceptions of responsibility surrounding safe sex practices, specifically condom use, among male heterosexual undergraduate students. Results showed that college-aged men are still prioritizing pregnancy prevention over disease prevention, which leads to assumptions that their female partners are on birth control and they do not need to use condoms. Participants pointed to media messages and condom placement that supports women's responsibility for safer sex and condom negotiation. Future health promotion research and practice should focus on including men in the design and implementation process to address social norms and increase their sense of responsibility.

"Taking Care of Ourselves": The Experiences of Black Women Approaching and Encouraging Male Partners to Test for HIV

Sixty percent of young adults living with HIV in the United States are unaware of their status despite recommendations to screen everyone. Effective approaches to encourage partner testing may increase status awareness. The purpose of our study was to understand young Black women's experiences when encouraging a partner to test for HIV, preferred approaches, and whether interpersonal context influenced the approach. Black women (n = 26) participated in the study in Boston-area focus groups (n = 6). Discussions ranged from difficult and stressful to positive and empowering. A variety of approaches (expressing caring, seeking understanding, leveraging the relationship, ultimatums, subtlety) were described in varied interpersonal contexts. Testing and sharing results fostered trust and relationship growth. If a partner was resistant, some ended relationships while others tested themselves and interpreted their results as their partners' status. Our findings could encourage HIV prevention initiatives to consider varied interpersonal contexts and enhance partner testing.

Predictors of Condom Use Among Iranian Women at Risk of HIV

Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.

An Interactive Website to Reduce Sexual Risk Behavior: Process Evaluation of TeensTalkHealth

Background

Different theoretical frameworks support the use of interactive websites to promote sexual health. Although several Web-based interventions have been developed to address sexual risk taking among young people, no evaluated interventions have attempted to foster behavior change through moderated interaction among a virtual network of adolescents (who remain anonymous to one another) and health professionals.

Objective

The objective was to conduct a summative process evaluation of TeensTalkHealth, an interactive sexual health website designed to promote condom use and other healthy decision making in the context of romantic and sexual relationships.

Methods

Evaluation data were obtained from 147 adolescents who participated in a feasibility and acceptability study. Video vignettes, teen-friendly articles, and other content served as conversation catalysts between adolescents and health educators on message boards.

Results

Adolescents’ perceptions that the website encouraged condom use across a variety of relationship situations were very high. Almost 60% (54/92, 59%) of intervention participants completed two-thirds or more of requested tasks across the 4-month intervention. Adolescents reported high levels of comfort, perceived privacy, ease of website access and use, and perceived credibility of health educators. Potential strategies to enhance engagement and completion of intervention tasks during future implementations of TeensTalkHealth are discussed, including tailoring of content, periodic website chats with health educators and anonymous peers, and greater incorporation of features from popular social networking websites.

Conclusions

TeensTalkHealth is a feasible, acceptable, and promising approach to complement and enhance existing services for youth.

How does intimate partner violence affect condom and oral contraceptive Use in the United States?: A systematic review of the literature

INTRODUCTION

Intimate partner violence (IPV) is estimated to affect 25% of adult women in the United States alone. IPV directly impacts women's ability to use contraception, resulting in many of unintended pregnancies and STIs. This review examines the relationship between IPV and condom and oral contraceptive use within the United States at two levels: the female victim's perspective on barriers to condom and oral contraceptive use, in conjunction with experiencing IPV (Aim 1) and the male perpetrator's perspective regarding condom and oral contraceptive use (Aim 2).

STUDY DESIGN

We systematically reviewed and synthesized all publications meeting the study criteria published since 1997. We aimed to categorize the results by emerging themes related to each study aim.

RESULTS

We identified 42 studies that met our inclusion criteria. We found 37 studies that addressed Aim 1. Within this we identified three themes: violence resulting in reduced condom or oral contraceptive use (n=15); condom or oral contraceptive use negotiation (n=15); which we further categorized as IPV due to condom or oral contraceptive request, perceived violence (or fear) of IPV resulting in decreased condom or oral contraceptive use, and sexual relationship power imbalances decreasing the ability to use condoms or oral contraceptives; and reproductive coercion (n=7). We found 5 studies that addressed Aim 2. Most studies were cross-sectional, limiting the ability to determine causality between IPV and condom or oral contraceptive use; however, most studies did find a positive relationship between IPV and decreased condom or oral contraceptive use.

CONCLUSIONS

Quantitative, qualitative, and mixed methods research has demonstrated the linkages between female IPV victimization/male IPV perpetration and condom or oral contraceptive use. However, additional qualitative and longitudinal research is needed to improve the understanding of dynamics in relationships with IPV and determine causality between IPV, intermediate variables (e.g., contraceptive use negotiation, sexual relationship power dynamics, reproductive coercion), and condom and oral contraceptive use. Assessing the relationship between IPV and reproductive coercion may elucidate barriers to contraceptive use as well as opportunities for interventions to increase contraceptive use (such as forms of contraception with less partner influence) and reduce IPV and reproductive coercion.

'They think it's all up to the girls': gender, risk and responsibility for contraception

Much research suggests that attitudes towards responsibility for use of contraception amongst young people are strongly gendered. However, decision making, if 'decisions' happen at all, is bound up with notions of hegemonic masculine and feminine roles as well as factors concerning relationship status. Data from two earlier qualitative studies were re-analysed with an emphasis on findings related to gender and responsibility for use of contraception. The first study investigated unintended conceptions amongst 16-20-year-old women. Interviews focused on knowledge and views about contraception, sex education and sexual health services. The second study involved focus groups with two groups of 14-18-year-old men to explore their views on sex education, sexual health and contraception. Almost all the young women said that young men viewed contraception as 'not their job'. In contrast, the young men thought that responsibility should be shared. The key issue, however, related to relationship status, with decision-making being shared in long-term relationships. There are some gender differences in accounting for decisions about use of contraception, however the key issue revolves around relationship status.

A culture of future planning: perceptions of sexual risk among educated young adults

In this study we examined how social processes, specifically the acquisition of postsecondary education and capital, shaped perceptions of sexual risk and impacted sexual practices and sexual health among young adults. Using qualitative research methods we collected and analyzed data among students attending a 4-year university in the northeastern region of the United States over a 1-year period. By analyzing participants' narratives, we found that the reproduction of shared norms and values encouraged educated young adults to focus on educational and professional success, pressing many of them to be concerned about preventing pregnancy rather than preventing disease transmission, and increasing their risk for sexually transmitted infections, including HIV/AIDS. Sexual-health educators need to address how social processes shape sexual practices, encourage educated young adults to challenge unequal gender expectations, and consider how sexually transmitted infections might also interfere with life plans.

Condom negotiation: findings and future directions

The aim of this review was to summarize factors associated with condom negotiation among heterosexual men. Literature searches were conducted using multiple databases spanning several disciplines. Studies examining psychological, demographic, relational, communication, and environmental factors related to condom negotiation are described, and a three-dimensional framework of condom negotiation is proposed. This framework of condom negotiation may aid researchers in operationalizing this construct, organizing this literature, and facilitating measurement development. We used this three-dimensional framework to articulate the influence of gender, ethnicity, relationship type, partner characteristics, trauma history, post-traumatic stress, and alcohol use on condom negotiation. Areas for future research are outlined. More research is needed to understand how these factors interact to influence condom negotiation, as well as the interaction between gender and the identified factors.

Factorial validation of the Attitudes toward Women Scale for Adolescents (AWSA) in assessing sexual behaviour patterns in Bolivian and Ecuadorian adolescents

BACKGROUND

Adolescents' health is greatly influenced by social determinants, including gender norms. Although research has shown that there is an association between gender attitudes and adolescents' sexual behaviour, few studies have assessed this relationship carefully. The Attitudes toward Women Scale for Adolescents (AWSA) is widely used to assess gender attitudes among adolescents; however, to our knowledge it has not been applied in Latin America.

OBJECTIVE

To apply AWSA in Latin America for the first time, to perform a factorial validation of this scale and to assess the relationship of gender attitudes and sexual behaviour in Bolivian and Ecuadorian adolescents.

DESIGN

This cross-sectional study was carried out in 2011 among 14-18 year olds in 20 high schools in Cochabamba (Bolivia) and six in Cuenca (Ecuador) as a part of a larger project. Schools were purposively selected. A Spanish version of the 12-item AWSA was employed for this study. The assessed aspects of adolescent sexual behaviour were: reported sexual intercourse, reported positive experience during last sexual intercourse and reported current use of contraception. The psychometric properties of AWSA were investigated, and both explanatory and confirmatory factorial analyses were performed.

RESULTS

The number of questionnaires included in the analysis was 3,518 in Bolivia and 2,401 in Ecuador. A factorial analysis of AWSA resulted in three factors: power dimension (PD), equality dimension (ED) and behavioural dimension (BD). ED showed the highest correlates with adolescent sexual behaviour. Higher scores of this dimension were associated with a more positive experience of sexual relationships, a higher current use of modern contraception and greater sexual activity among girls.

CONCLUSIONS

This study revealed a three-factorial structure of AWSA and demonstrated that by employing factors, the sensitivity of AWSA increases as compared to using the scale as a whole to assess sexual behaviour. This could have important implications for future research on gender and the sexual experiences of adolescents.

Redefining gender-based power to move beyond interpersonal approaches to HIV prevention

Drawing on the recent work of Teitelman et al, this article explores the notion of gender-based power imbalances in the production of HIV risk. It focuses on the need to extend an understanding of gender-based power beyond the interpersonal realm and as a broader social problem, defined collectively within public arenas. The public arenas model is used to explore how gender-based power is currently defined and how its definitions can be expanded. We consider how HIV prevention policy solutions need to extend beyond interpersonal definitions to incorporate conceptions of gender-based power that include how broader social inequalities and power imbalances influence condom negotiations.

Controlling the HIV/AIDS epidemic: current status and global challenges

This review provides an overview of the current status of the global HIV pandemic and strategies to bring it under control. It updates numerous preventive approaches including behavioral interventions, male circumcision (MC), pre- and post-exposure prophylaxis (PREP and PEP), vaccines, and microbicides. The manuscript summarizes current anti-retroviral treatment options, their impact in the western world, and difficulties faced by emerging and resource-limited nations in providing and maintaining appropriate treatment regimens. Current clinical and pre-clinical approaches toward a cure for HIV are described, including new drug compounds that target viral reservoirs and gene therapy approaches aimed at altering susceptibility to HIV infection. Recent progress in vaccine development is summarized, including novel approaches and new discoveries.

Stigma and stereotypes: women and sexually transmitted infections

Sexually transmitted infections have long been associated with stigma and stereotypes due to their very nature. Throughout history sexually transmitted infections have been associated with female prostitution and deviant immoral behaviour making women who contract these infections particularly vulnerable to being stigmatised and stereotyped. Although the stigma attached to such infections has previously been documented in the literature, the aim of this research was to gain in depth insight into young Australian women's experiences of having a sexually transmitted infection from a feminist perspective. Findings from this study provide insight into the onerous effects stigma can have on women with these infections and sheds light on how these effects can influence self-perceptions, fear of rejection and feelings of unworthiness. These findings can provide nurses with greater understanding and insight into the effects of stigma on women's experiences of having a sexually transmitted infection. Having this understanding and insight has the potential to promote therapeutic care and minimise the stigma that may be felt among women who have contracted this type of infection.

Sex education during the school-aged years influences sexual attitudes and sexual health in college: a comparative study from Korea

Sex education is provided routinely to school-aged children in many countries without enough evidence that it will benefit them when they become adults. The purpose of this study was to examine the long-term influence of the sex education that was provided during the school-aged years on the attitudes, behaviors, and sexual health among male and female college students in Korea. For this descriptive, comparative study, the data were obtained from 3609 male and 2180 female college students by using the proportional quota sampling method. Overall, the female students had more opportunities for sex education. Receiving this education during the school-aged years lowered the sexual double standard score but was not related to sexual activity among the male and female students. Receiving sex education at different time points during the school-aged years had differential influences on the sexual attitudes and indicators of sexual health between the male and the female students. The results of this study suggest extending the role of school nurses to include redesigning the content of sex education programs, based on the sex and age of the students, and using midwives to provide sex education in community settings.