Being fast or cautious? Sociocultural conditions influencing the sexual pathways of Black females in the United States

BACKGROUND

Black females in the United States face unique sociocultural conditions that impact their sexual development and increase their risk for sexually transmitted infections (STI), including but not limited to chlamydia, gonorrhea, and HIV. Research has not adequately explained how sociocultural conditions contribute to this increased risk. The purpose of our investigation was to explore the sociocultural conditions that influence Black cisgender females risk for STI.

METHODS

This grounded theory study involved in-depth audio-recorded interviews with 20, primarily heterosexual, Black females ages 19-62.

RESULTS

Findings informed a conceptual model that builds on previous theory about the sexual development of Black females and explains how sociocultural conditions impact two, participant identified, sexual pathways: Fast and Cautious. Movement on these sexual pathways was not always a linear trajectory; some participants shifted between pathways as their sociocultural contexts changed (i.e., sexual assault, STI, and level of protection). The Fast sexual pathway often led to greater STI risk.

CONCLUSIONS

This model may inform future research designed to prevent STI/HIV and promote the sexual health of Black females across the life course.

The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective

Objective

To explore the impact of the COVID-19 pandemic on Black adolescent girls’ physical, psychological, and sexual development.

Methods

Semistructured interviews were conducted with 25 girls (9–18 years old) primarily across the Midwestern United States. Interviews were conducted until theoretical saturation was reached. We conducted a conventional content analysis by reviewing transcripts, coding data, and developing themes.

Results

Utilizing the social-ecological model findings revealed themes related to the individual-, interpersonal-, institutional-, and community-level changes that Black girls experienced during the COVID-19 pandemic.

Conclusions

Black adolescent girls need opportunities to discuss the changes, receive relevant resources, and have spaces to support their physical, psychological, and sexual development. Systems such as families, schools, and clinics should implement programming to facilitate discussions around the impact of COVID-19 on Black girls.

Die Entwicklung von Sexualität bei Kindern und Jugendlichen mit sexuellen Gewalterfahrungen

Zusammenfassung. Theoretischer Hintergrund: Zu den Folgen sexueller Gewalt gehören neben somatischen und psychischen Folgen auch Veränderungen in der Entwicklung der Sexualität. Fragestellung: Ziel dieses Reviews ist es, einen systematischen Überblick über den aktuellen Forschungsstand bezüglich der Entwicklung von Sexualität bei Kindern und Jugendlichen nach sexuellen Gewalterfahrungen zu geben. Methode: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, ERIC, Cochrane und PubPsych durchgeführt. Die Folgen von sexueller Gewalt bezüglich der Sexualität wurden systematisch analysiert. Ergebnisse: Es konnten insgesamt 127 Studien zur Sexualität nach sexueller Gewalt identifiziert werden, die acht Unterkategorien zugeordnet werden konnten: Sexuelles Risikoverhalten, Teenagerschwangerschaft, jugendliche Sexualstraftäter_innen, sexuelle Verhaltensauffälligkeiten, sexuelle Überzeugungen, Prostitution, Geschlechtskrankheiten und körperliche Symptome. Diskussion und Schlussfolgerung: Insgesamt zeigt die Literaturrecherche, dass die Sexualität von Kindern und Jugendlichen mit sexuellen Gewalterfahrungen teilweise nur lückenhaft untersucht wurde.

Patterns and Trajectories of Anal Intercourse Practice Over the Life Course Among US Women at Risk of HIV

INTRODUCTION

Condomless anal intercourse (AI) confers a far greater likelihood of HIV transmission than condomless vaginal intercourse (VI). However, little is known about AI practice over the life course of women, to what extent AI practice is condom-protected, and whether it is associated with other HIV risk behaviors. We aim to describe longitudinal AI practice among HIV-seronegative women and to identify subgroups with distinct trajectories of AI practice.

METHODS

Using data from the Women's Interagency HIV Study, an observational cohort of US women with or at risk for HIV, we described AI practice among HIV-seronegative participants. Group-based trajectory modeling was used to identify distinct AI trajectories. We used multinomial regression to examine associations between baseline characteristics and trajectory group membership.

RESULTS

A third of the 1,085 women in our sample reported any AI over follow-up (median follow-up = 14 years). AI decreased more sharply with age compared to VI. Consistent condom use during AI was low: twice the proportion of women never reported using condoms consistently during AI compared to during VI. 5 trajectory groups were identified: AI & VI persistors (N = 75) practiced AI and VI consistently over follow-up (AI & VI desistors (N = 169) tended to practice AI and VI when young only, while VI persistors (N = 549), VI desistors (N = 167), and AI & VI inactives (N = 125) reported varying levels of VI practice, but little AI. AI & VI persistors reported multiple male partners and exchange sex at more visits than other groups. Women who identified as bisexual/lesbian (vs heterosexual), who had ever experienced physical and sexual violence (vs never), and/or who reported above the median number of lifetime male sex partners (vs median or below) had approximately twice the odds of being AI & VI persistors than being VI persistors.

CONCLUSIONS

We identified a small subgroup of women who practice AI and report inconsistent condom use along with other risk behaviors throughout the life course; they may therefore particularly benefit from ongoing access to HIV prevention services including pre-exposure prophylaxis. Owen BN, Baggaley RF, Maheu-Giroux M, et al. Patterns and Trajectories of Anal Intercourse Practice Over the Life Course Among US Women at Risk of HIV. J Sex Med 2020;17:1629-1642.

Fatores de risco associados à exposição de adolescentes à violência sexual

Objetivo: analisar as evidências científicas sobre os fatores de risco associados à exposição de adolescentes à violência sexual.Síntese de conteúdo: revisão integrativa da literatura, realizada em quatro bases de dados e duas bibliotecas virtuais, sem limites do ano de publicação, utilizando-seos descritores: “delitos sexuais”, “adolescentes” e “fatores de risco”. Utilizou-se, também, a palavra-chave “violência sexual” e equivalentes, no idioma inglês. Na análise dos 22 artigos incluídos, os fatores associados à exposição dos adolescentes à violência sexual foram classificados em “abuso sexual” e “exploração sexual”. O consumo de álcool e/ou drogas foi o fator mais evidente, seguido do sexo casual, dabaixa escolaridade, da baixa renda, da violência familiar, dos relacionamentos em ambientes virtuais, da estigmatização do trabalho sexual e falta de moradia.Conclusão: os fatores apresentados devem ser considerados pela enfermagem para o reconhecimento de adolescentes vítimas de violência sexual, além de contribuir na prevenção de novos casos e na minimização dos efeitos que tal ato pode causar na vida desse público.

Frequency of Group Sex Participation and Risk for HIV/STI Among Young Adult Nightclub Scene Participants

OBJECTIVES

This study examines frequency of group sex participation and associated characteristics and behaviors among a sample of heterosexual young adult participants in Miami's nightclub scene (n = 498).

METHODS

Baseline survey assessments were analyzed using zero-inflated binomial regression.

RESULTS

Forty-one percent of the sample reported group sex participation history. Greater frequency of group sex is associated with buying sex, sex with an injection drug user, being high during sex, condomless vaginal sex, victimization history, and sexually transmitted infection incidence (p < .02).

CONCLUSIONS

Sexually transmitted infection prevention and intervention efforts should address risks associated with group sex participation.

Impact of Abuse History on Adolescent African-American Women's Current HIV/STD-associated Behaviors and Psychosocial Mediators of HIV/STD Risk

This study examined if relationship power, sex refusal self-efficacy, and/or fear of condom negotiation mediated the relationship between abuse history and consistent condom use (CCU) among African-American female adolescents (n=593). Participants with an abuse history (58%) were less likely to report CCU (p=.003). Women with an abuse history reported less relationship power (p=.006) and self-efficacy for refusing sex (p<.001), and more fear of condom negotiation (p=.003), none of which independently or jointly mediated the association between abuse and CCU. Notably, history of abuse was associated with CCU across mediator models (p=.037 to p=.067), despite inclusion of psychosocial mediators. This study demonstrates the importance of understanding adolescents' condom use behaviors within the context of their life experiences, especially past abuse history.

Sexual risk behavior and STI health literacy among ethnic minority adolescent women

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n=94) and Mexican-American (n=465) adolescent women 14-18 years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women.

Conceptualization of sexual partner relationship steadiness among ethnic minority adolescent women: implications for evidence-based behavioral sexual risk reduction interventions

Cognitive behavioral interventions for sexual risk reduction have been less successful among ethnic minority adolescent women with histories of abuse and sexually transmitted infections (STI) than among other adolescent populations. African American and Mexican American adolescent women (ages 14-18 years, n = 548) self-reported sexual partner relationship steadiness and sexual risk behaviors via semi-structured interviews at study entry. Descriptive and bivariate analyses compared sexual risk behaviors by sexual partner relationship steadiness. Steady and unsteady relationships were conceptualized differently. Steady relationships included emotional or financial support, sexual communication, greater relationship importance, unintended pregnancy, and perceived monogamy during break-ups. Unsteady relationships were unpredictable, including sex with ex-steady partners and friends with benefits, lack of mutual respect, and poor sexual communication. Modification of sexual risk reduction interventions including conceptualizations of risk by context of sexual partner relationship status is recommended to enhance efficacy among minority adolescent women with STI or history of abuse.

Resilience Strategies of African American Women Survivors of Child Sexual Abuse

This qualitative study explores the daily lived experiences of African American women ( N = 10) who have survived child sexual abuse. The researchers used a phenomenological research tradition and a feminist framework for the study. Using semistructured interviews and integrating methods of trustworthiness, the researchers identified six themes in the data: (a) understanding traumatic symptoms, (b) externalizing racist and sexist stereotypes of African American women, (c) negotiating family relationships and accessing community support, (d) transforming religion and spirituality into sources of healing, (e) reclaiming sexuality, and (f) integrating multiple identities as a survivor. Implications for future research, practice, and advocacy with African American women survivors of child sexual abuse are described.

Alcohol misuse and multiple sexual partners

INTRODUCTION

We examine the association between self-reported alcohol misuse and alcohol use within 2 hours of having sex and the number of sexual partners among a sample of African-American and Latino emergency department (ED) patients.

METHODS

Cross-sectional data were collected prospectively from a randomized sample of all ED patients during a 5-week period. In face-to-face interviews, subjects were asked to report their alcohol use and number of sexual partners in the past 12 months. Data were analyzed using multiple variable negative binomial regression models, and effect modification was assessed through inclusion of interaction terms.

RESULTS

The 395 study participants reported an average of 1.4 (standard error = 0.11) sexual partners in the past 12 months, 23% reported misusing alcohol, and 28% reported consuming alcohol before sex. There was no statistically significant association between alcohol misuse and the number of sexual partners; however, alcohol before sex was associated with a larger number of sexual partners in the past year. Moreover, among those who misused alcohol, participants who reported alcohol before sex were 3 times more likely to report a higher number of sexual partners (risk ratio = 3.2; confidence interval [CI] =1.9-5.6). The association between alcohol use before sex and number of sexual partners is dependent upon whether a person has attributes of harmful drinking over the past 12 months. Overall, alcohol use before sex increases the number of sexual partners, but the magnitude of this effect is significantly increased among alcohol misusers.

CONCLUSION

Alcohol misusers and those who reported having more than 1 sexual partner were more likely to cluster in the same group, ie, those who used alcohol before sex. Efforts to reduce the burden of sexually transmitted diseases, including human immunodeficiency virus, and other consequences of risky sexual behavior in the ED population should be cognizant of the interplay of alcohol and risky sexual behaviors. EDs should strive to institute a system for regular screening, brief intervention, and referral of at-risk patients to reduce negative consequences of alcohol misuse, including those of risky sexual behaviors.