Comprehensive sexuality education to reduce pregnancy and STIs in adolescents in the United States: A systematic review and meta-analysis

Background. The United States has a higher rate of teen pregnancy than any other developed country with 30% of American girls becoming pregnant before the age of 20. Laws regarding the inclusion and content of sexuality education vary across the country, which are associated with differences in pregnancy and sexually transmitted infection (STI) rates between states. This systematic review aims to determine whether comprehensive sexuality education (CSE) is more effective than abstinence-only or no sexuality education at reducing teenage pregnancy. Secondary objectives include analyzing the effect of CSE on STI incidence, sexual activity, safe-sex behaviors, and social discomfort. Methods. We searched MEDLINE (PubMed), EMBASE (Ovid), Cochrane Central Register of Controlled Trials, and Scopus for studies published from 1990–2021. Additionally, we searched ClinicalTrials.gov and Google Scholar and manually searched reference lists of included papers. Results. Twenty-nine studies met our inclusion criteria. Only seven included pregnancy as an outcome, with three fitting our meta-analysis criteria. There was a decrease in pregnancy rates for participants in the CSE intervention compared to the control (n = 3, risk ratio = 0.89, 95%CI 0.79- 1.00, I2 = 0%). Fifteen of 21 studies reporting safe-sex behaviors, 8 of 24 reporting sexual activity, and 0 of 3 reporting STI rates found statistically significant results favoring CSE. In the narrative synthesis, we found an increase in safe-sex behaviors, specifically condom use, in adolescents receiving CSE compared to no intervention. Conclusions. CSE is likely to reduce pregnancy rates; however, there was limited data available on this outcome. CSE increased safe-sex behaviors but did not have a notable impact on sexual activity or STIs. Future research should include the effects of CSE on social discomfort as well as more studies comparing CSE to abstinence-only education. This review can serve as evidence for the implementation of CSE in the US.

Safe sex practices among women who have sex with women in Tanzania: implications for HIV and STIs control among this group

Background: Women who have sex with women (WSW) are at an increased risk of sexually transmitted infections (STIs) due to engagement in high-risk sexual behaviors. Safe sex practice is hence critical for the WSW. The aim of the study was to assess safe sex health behaviors and practices among WSW to inform sexual and reproductive interventions targeting this group in Tanzania.Methods: This study was cross-sectional descriptive and retrospective conducted in Dar-es-Salaam region, the largest commercial city in Tanzania. Study population included WSW aged 18 years and above who met inclusion criteria. Data was collected using focus group discussions, in-depth interviews, key informant interviews and life stories. Data analysis applied thematic analysis.Results: Few WSW reported practicing safe sex. WSW used condoms only when engaging in sex with men. Some WSW lacked information on availability of protective devices; while some WSW did not use of protection despite having information on availability of protective devices. Majority of WSW used good hygiene practice (cleaning body, vagina, mouth, and sex toys) before and after sex to prevent transmission of infections; and some WSW used pre- and post- exposure prophylaxes. Low access and high cost of protective devices, being in a monogamous relationship, low health risk perception, fear of developing cancer from using lubricants, and advise from health worker against using lubricants, were reasons given by WSW for not practicing safe sex.Conclusions: Given the current evidence of overlap between the homosexual and heterosexual populations in STI transmission, comprehensive education on potential routes of STI transmission among WSW is critical.

Mobile Phone Influence on Sexual Behaviour of Undergraduate Students: A Case Study of Jomo Kenyatta University of Agriculture and Technology, Kenya

Purpose: The study sought to examine the influence of mobile phone use on sexual behaviour of university students: a case study of Jomo Kenyatta University of Agriculture and Technology, Kenya. The study specifically, sought to examine the effect of characteristics of mobile phones users, uses and gratification of mobile phones and the frequency of using mobile phones on sexual behaviour of university students in Jomo Kenyatta University of Agriculture and Technology, Kenya. Methodology: The research design that was adopted was descriptive in nature. The study also used both quantitative and qualitative data obtained from the respondents using questionnaires and Focus Group Discussions (FGDs) guides. Quantitative data was collected using questionnaires while qualitative data was collected using Focus Group Discussions. The study adopted a stratified random sampling technique to select the sample size from the three strata, which are the various Faculties in JKUAT. The study then used Fisher’s formula to arrive at an adequate scientific sample size of 384 students who were targeted using convenient sampling, that is those that are ready to respond to the questionnaires and the Focus Group Discussions (FGDs). The quantitative data in this research was analyzed using descriptive statistics and inferential statistics using SPSS v22.0. Results: It was concluded that male students are more likely to use protection consistently compared to female students. In addition, the findings imply that consistency in condom use is a factor that is dependent on the age of the individual. In addition, relationship status is a contributor to the behaviour of the students sexually. For those that are in serious relationships, their use of protection declines due to the build-up of emotional and intimate trust towards each other. The findings likewise indicate that the student’s usage of mobile phones correlates significantly with the consistent use of protection for safe sex. Those students who have had their phones since they joined Campus are more likely to practice safe sex. In addition, heavy users of mobile phones are likely to practice safe sex including those who browse the internet for news updates. Unique contribution to theory, policy and practice: The study recommends the media practitioners need to step up the production of morally acceptable media content and offer a platform for advertising and campaigning for sexual conduct by encouraging and stressing the use of protection. The Ministry of Health and Ministry of Education should actively involve the undergraduate students in reproductive information awareness campaigns for ensuring positive attitudes towards responsible sexual behaviour and promoting best sexual practices.

What does PrEP mean for ‘safe sex’ norms? A qualitative study

While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of ‘safe sex’ that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of ‘safe sex’ in Sydney, Australia, during a period of rapidly escalating access from 2015–2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men ‘should’ adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.

The queer aesthetics of la PrEP: iconography, the pharmacopornographic regime, and (safe) sex in the French neoliberal marketplace

This article offers an analysis of an array of French pre-exposure prophylaxis (PrEP) campaigns through the pharmacopornographic framework established in the works of transfeminist philosopher Paul Preciado. Throughout, I argue that the material and discursive presentation of PrEP in these campaigns, part of a more expansive injection of biomedical protocols into the global marketplace, invites us to (re)consider binary conceptualizations of queer and non-queer subjectivities, normal and pathological sexual subjectivities, and good and bad sexual citizenship often through biomedical and neoliberal perspectives. Additionally, I propose the critical concept, biotechsex, to describe the biotech circuit that simultaneously subjectifies users and non-users of biotechnologies, like the PrEP option, and circumscribes them within a dynamic network of socio-political discourses concerning morality, ethics, pathology, and desire, a circuit formed and informed by the more specific French ideologies of universalism and communitarianism.

Socio-economic, demographic, and behavioural determinants of women’s empowerment in Mozambique

Introduction Empowerment is considered pivotal for how women access and use health care services and experience their sexual and reproductive rights. In Mozambique, women’s empowerment requires a better understanding and contextualization, including looking at factors that could drive empowerment in that context. This study aims to identify socioeconomic, demographic, and behavioural determinants of different domains of women’s empowerment in Mozambique. Methods Using the Demographic and Health Survey (DHS) conducted in 2015 for Mozambique, a sample of 2072 women aged between 15 and 49 years old were included in this study. The DHS’s indicators of women’s empowerment were used in a principal component analysis and the obtained components were identified as the domains of empowerment. Logistic regressions were run to estimate the association of socioeconomic, demographic, and behavioural characteristics with each domain of empowerment. Crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95% CI) were calculated. Results Three domains of women’s empowerment were identified, namely (1) Beliefs about violence against women, (2) Decision-making, and (3) Control over sexuality and safe sex. Region, rurality, the experience of intimate partner violence (IPV) and partner’s controlling behaviours were associated with Beliefs about violence against women, while Decision-making and Control over sexuality and safe sex were also associated with education, age and wealth. Employment, polygamous marriage and religion was positively associated with Decision-making, and access to media increased the odds of Control over sexuality and safe sex. Conclusion Women’s empowerment seems to be determined by different socio-economic, demographic, and behavioural factors and this seems to be closely related to different domains of empowerment identified. This finding affirms the multi-dimensionality of empowerment as well as the importance of considering the context- and community-specific characteristics.