Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM

BackgroundDue to rising numbers of STI diagnosis and increasing prevalence of antimicrobial resistance, we explored trends in STI testing frequency and diagnoses, alongside sexual decision making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP) at a large urban UK sexual health clinic.MethodsWe examined 66 528 electronic patient records covering 40 321 attendees between 2016 and 2019, 3977 of whom were men who have sex with men or trans persons who have sex with men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018 and 2019 (n=1975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), using linear and logistic regression analyses.ResultsTests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5% to 18.5% between 2016 and 2019 (p<0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p=0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1% to 19.6% between 2016 and 2019 (p<0.001) compared with bisexual/other MSM/TPSM increasing from 6.9% to 14.5% (p<0.001), alongside smaller but significant increases in non-MSM/TPSM from 5.9% to 7.7% (p<0.001).The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6% to 45.5% between 2016 and 2019 (p<0.0001) and average number of partners from 3.8 to 4.5 (p=0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners.ConclusionRising numbers of STI diagnoses among MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the steepest increase in STI diagnoses.

Diverse Trajectories at the Intersection of Religion and Sexuality During Emerging Adulthood

This chapter explores the intersection of religion and sex among emerging adults. It first discusses the extant empirical literature related to how religion influences sexual behavioral decisions as well as the link between religion and sexual values and attitudes. It then acknowledges a general waning from religion during emerging adulthood but presents diverse trajectories related to the religious lives of emerging adults and their sexual decision making. Next, the chapter discusses a variety of pathways and trajectories through which emerging adults may travel as they navigate decisions involving relationships and sexual intimacy and how such decisions are, may be, or are not influenced by religion. The four presented trajectories are religious rejecters, religious remainers, religious returners, and religious innovators. The chapter concludes by addressing some additional complexities regarding emerging adults, religion, and sex and offers some concluding questions and directions for future research.

Economic support, education and sexual decision making among female adolescents in Zambia: a qualitative study

Background The importance of educating female adolescents has been recognized as critical to the development of any country. However, in low income countries like Zambia they often drop out of school due to poverty, early pregnancy and early marriages. Some studies indicate that economic support such as Social Cash Transfers (SCTs) can mitigate the effects of poverty on female adolescents by improving their school participation and helping postpone pregnancy and marriage. This study aimed to explore the role of economic support in influencing education and sexual decision making among female adolescents in a randomised controlled trial in Zambia. Methods The study adopted a qualitative approach. It utilized purposive and convenient sampling. Data were collected from 6 schools using 18 in-depth interviews (IDIs) and 4 focus group discussions (FGDs) comprising 48 school-going female adolescents in grade 8 aged 14 to 17. All participants received economic support in form of SCTs and payment of school fees as part of the Research Initiative to Support the Empowerment of Girls (RISE), a Cluster Randomised Controlled Trial. Data were analyzed using thematic analysis. Results Findings suggested several benefits of the economic support for the female adolescents such as economic independence and empowerment; increased assertiveness and autonomy; reduced desire for sexual relationships with boys in exchange for cash and gifts; increased motivation for school; enhanced parental and community support for female adolescents’ education and; reduced school dropouts. However, they also experienced jealousy from those who did not benefit from the economic support. Conclusion Economic support played a significant role in influencing both educational and sexual decision making among female adolescents. Trial registration ISRCTN Registry: ISRCTN12727868, (4 March 2016).

Male Perception on Sexual Consent and Coercion in Heterosexual Marriages: The Case of Benue State, Nigeria

The issue of sexual consent in marriage which is deeply problematic due to the persistence of socio-cultural constraints on women’s sexual agency and sexual decision-making has received less attention. Emerging evidence suggests that coerced, pressured and unwanted sexual activities are generally still common experiences of women. Research concerning male’s opinions on women’s consent to sex in marriage remains scarce. In this article, we explored men’s perceptions on sexual consent seeking and receiving within the context of marriage in order to expose the traditional gender imbalances, and interrogate the male-privileging ideals. Deploying a qualitative research approach, 8 Focus Group Discussions (FGD) with men aged 25-55years and in-depth interviews (IDI) with 12 key Informants were conducted to elicit data. Transcripts of each FGD and IDI were analyzed and major themes were developed. The study adopted the scripting and radical feminism as theoretical underpinnings. The findings revealed that the prevailing socio-cultural context in which men live has tremendous impact on their perceptions on women’s sexual rights and consent in marriage. Most men in the study understand sex in marriage as just one of the duties of a wife. Results also suggest that token resistance beliefs and alcohol consumption among men encourage forced sex. This study clearly shows that the issue of sexual coercion in marriage is fuelled by patriarchal control over women’s sexuality and requires serious attention in the study area. We therefore recommend cultural reorientation and enactment of laws to deal with the issue of non-consensual sex in marriage.

Race-Based Sexual Stereotypes, Gendered Racism, and Sexual Decision Making Among Young Black Cisgender Women

Background. Due to their intersecting racial identity and gender identity, Black women are characterized by stigmatizing race-based sexual stereotypes (RBSS) that may contribute to persistent, disproportionately high rates of adverse sexual and reproductive health outcomes. RBSS are sociocognitive structures that shape Black women’s social behavior including their sexual scripts. Objective. The purpose of this study was to explore the influence of RBSS on the sexual decision making of young Black women (YBW). Methods. We conducted four focus groups with 26 YBW between the ages of 18 and 25, living in a New York City neighborhood with a high HIV prevalence. Qualitative analysis was used to identify emergent themes within the domains of sexual decision making as it relates to safer sex practices and partner selection. Results. Thematic analyses revealed that RBSS may cause women to adopt more traditional gender stereotypes and less likely to feel empowered in the sexual decision making. Participants reported that RBSS may lead Black women to being resistant to learning new information about safer sex practices, feeling less empowered within intimate relationships, and jeopardizing their sexual well-being to affirm themselves in other social areas encouraging unprotected sex and relationships with men who have multiple sex partners. Discussion and Conclusion. Future research should focus on understanding the social and cultural factors that influence Black women’s power in maintaining and improving their sexual health, including the aforementioned stereotypes that have influenced how others may view them as well as how they view themselves.