Strange bedfellows: bridging the worlds of academia, public health and the sex industry to improve sexual health outcomes

Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women

Background

Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK).

Methods

A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention.

Results

Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention.

Conclusions

HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00885-1.

Sexual health prevention for incarcerated women: eroticising safe sex during re-entry to the community

INTRODUCTION

In the USA, incarcerated women are disproportionately affected by sexually transmitted infections (STIs) including HIV. Transitioning from incarceration into the community is accompanied by elevated risk behaviours related to acquisition of STIs, yet few efficacious interventions address sexual health prevention among incarcerated women.

METHODS

We conducted an exploratory qualitative study with 21 incarcerated women at four women's state prison facilities in two Northeastern states in the USA. Qualitative data were gathered from four focus groups to guide future intervention development. Focus group discussions were guided by a semi-structured protocol exploring perceptions of sexual health prevention methods, experience with implementing prevention technologies and protective behaviours, and strategies to overcome challenges in implementing sexual health prevention behaviours. Focus groups were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.

RESULTS

Women described challenges in uptake of existing low-cost sexual health prevention strategies such as condoms. They identified strategies to facilitate use of prevention tools, and to increase protective behaviours relating to sexual health during the transition from incarceration to the community. For example, women described methods for eroticising male and female condoms, including selecting condoms with novel features, explaining to partners that condoms could increase sexual pleasure, and incorporating condom application into foreplay and/or oral sex.

CONCLUSION

Incorporating these insights, including how to eroticise safe sex, can inform the design of future preventive interventions tailored to meet the urgent sexual health needs of incarcerated women preparing for reintegration into the community.

CLINICAL TRIAL REGISTRATION

NCT01907126.

Sex Life Satisfaction in Sub-Saharan Africa: A Descriptive and Exploratory Analysis

Nearly all of the sex life satisfaction literature has dealt with developed-country settings, and nothing has been published on sex life satisfaction in sub-Saharan Africa. Not only is sub-Saharan African a substantively relevant area in its own right, but it also provides a useful point of comparison for patterns and relations found in developed-world contexts. A brief descriptive and exploratory study of sex life satisfaction in sub-Saharan Africa was conducted using the World Gallup Poll, a dataset with representative sex life satisfaction data for 31 countries and 25,483 cases. In general, there was little variation in weighted averages across countries, and most of the samples surveyed were satisfied with their sex lives, with the modal score being a perfect 10. Furthermore, what variation did exist could not be attributed to level of economic development or gender inequality. Within countries, sociodemographic associations generally comported with patterns found in other contexts: income, education, and being partnered were generally associated with sex life satisfaction, and for two of the four UN subregions (West Africa and East Africa), males were significantly more satisfied with their sex lives than women. The relationship with age demonstrated a curvilinear relationship, with the peak age of sexual satisfaction in the late 20s to early 30s depending on the geographic region. The age pattern was not due to health differences, but combining estimators after a seemingly unrelated regression suggests that 4-12% of the effect of income on sex life satisfaction was attributable to better health. In general, religiosity and perceived gravity of the HIV/AIDS problem in one's country were not significantly related to sexual satisfaction.

Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation

Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for women's femininity and self-image. Further research is necessary on how female genital modifications influence Zambians' sexual preferences to inform the development of culturally appropriate health promotion interventions.

Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers

BACKGROUND

For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills.

OBJECTIVE

This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills.

METHODS

Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior.

RESULTS

Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners.

CONCLUSIONS

Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms.

SCIENTIFIC SIGNIFICANCE

Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.

Condom use in the context of sex research: a commentary

This commentary highlights some recent trends in sex research that have particular relevance for research on condom use, including studies investigating the meaning of sexual arousal, desire and pleasure; a focus on couple-level investigations; and the relevance of individual differences and personality characteristics to sexual risk-taking. Although historically, sexuality-related issues have received little systematic attention in the field of public health, researchers are now paying more attention to the role of pleasure and sexual arousal in condom use. It is argued that a better integration of findings from the area of sex research into the HIV and sexually transmissible infection (STI) field is needed to develop and improve programs to reduce the risk of STIs and unintended pregnancy.

"Half plate of rice to a male casual sexual partner, full plate belongs to the husband": findings from a qualitative study on sexual behaviour in relation to HIV and AIDS in northern Tanzania

Background

A thorough understanding of the contexts of sexual behaviour of the people who are vulnerable to HIV infection is an important component in the battle against AIDS epidemic. We conducted a qualitative study to investigate perceptions, attitudes and practices of sexually active people in three districts of northern Tanzania with the view of collecting data to inform the formulation of appropriate complementary interventions against HIV and AIDS in the study communities.

Methods

We conducted 96 semi-structured interviews and 48 focus group discussions with sexually active participants (18-60 years of age) who were selected purposively in two fishing and one non-fishing communities.

Results

The study revealed a number of socio-economic and cultural factors which act as structural drivers of HIV epidemic. Mobility and migration were mentioned to be associated with the risk of HIV acquisition and transmission. Sexual promiscuous behaviour was common in all study communities. Chomolea, (a quick transactional sex) was reported to exist in fishing communities, whereas extramarital sex in the bush was reported in non-fishing community which was predominantly Christian and polygamous. Traditional practices such as Kusomboka (death cleansing through unprotected sex) was reported to exist. Other risky sexual behaviour and traditional practices together with their socio-economic and cultural contexts are presented in details and discussed. Knowledge of condom was low as some people mistook them for balloons to play with and as decorations for their living rooms. Acute scarcity of condoms in some remote areas such as vizingani (fishing islands) push some people to make their own condoms locally known as kondomu za pepsi using polythene bags.

Conclusions

HIV prevention efforts can succeed by addressing sexual behaviour and its socio-economic and cultural contexts. More innovative, interdisciplinary and productive structural approaches to HIV prevention need to be developed in close collaboration with affected communities and be closely related to policy-making and implementation; to go beyond the limited success of traditional behavioural and biomedical interventions to particularly address the underlying social and structural drivers of HIV risk and vulnerability in the study communities.

Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS

This commentary introduces the HARPS supplement on getting research into policy and practice in sexual and reproductive health (SRH). The papers in this supplement have been produced by the Sexual Health and HIV Evidence into Practice (SHHEP) collaboration of international research, practitioner and advocacy organizations based in research programmes funded by the UK Department for International Development.

The commentary describes the increasing interest from research and communication practitioners, policy makers and funders in expanding the impact of research on policy and practice. It notes the need for contextually embedded understanding of ways to engage multiple stakeholders in the politicized, sensitive and often contested arenas of sexual and reproductive health. The commentary then introduces the papers under their respective themes: (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3) Strategies and methodologies for engagement (five papers on Kenya, South Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement to influence attitudes on controversial elements of sexual health (two papers, Bangladesh and global); and (5) Institutional approaches to inter-sectoral engagement for action and strengthening research communications (two papers, Ghana and global).

The papers illustrate the many forms research impact can take in the field of sexual and reproductive health. This includes discursive changes through carving out legitimate spaces for public debate; content changes such as contributing to changing laws and practices, procedural changes such as influencing how data on SRH are collected, and behavioural changes through partnerships with civil society actors such as advocacy groups and journalists.

The contributions to this supplement provide a body of critical analysis of communication and engagement strategies across the spectrum of SRH and HIV/AIDS research through the testing of different models for the research-to-policy interface. They provide new insights on how researchers and communication specialists can respond to changing policy climates to create windows of opportunity for influence.