Abstract: Abstract
Our objective is to test disparities in breast cancer mortality by sexual orientation. Using an ecological approach that links SEER breast cancer mortality data with Census 2000 data, we test the hypothesis of higher breast cancer mortality in areas with more presumed lesbians. From the Census 2000 data on female same-sex partnered households, we derive a measure of sexual minority women density (SMWD) for each of the 215 counties covered by SEER 12. We test the association of SMWD with breast cancer mortality using multivariable Poisson regression models that control for age, race, and socioeconomic status. We confirm our hypothesis as we find a significant positive association between SMWD and breast cancer mortality. This relationship remains significant even after controlling for other factors, known to have an association with mortality, such as poverty or race. This ecological approach compensates for the absence of cancer surveillance by sexual orientation. The results suggest a disparity in breast cancer mortality due to sexual orientation. The causes for this disparity need to be identified by future studies. PubDate: 2013-06-15
Abstract: Abstract
Faith-based organizations (FBOs) are influential in the Eastern Caribbean. To understand their role in HIV-related health programs, we conducted a cross-section of surveys and interviews with representatives from FBOs in four countries: Antigua and Barbuda, Barbados, St. Kitts and Nevis, and St. Vincent and Grenadines. We examined HIV-related and sexual health activities, capacity to provide programs, and attitudinal influences, such as stigma. We found that although some FBOs are engaged in sexual health and HIV-related work, many are limited by formal church doctrines and parishioner perceptions about HIV. HIV prevention messages, for example, were centered on abstinence and monogamy. Promoting condom use was considered incompatible with church doctrine. HIV-related stigma and discrimination were considerable, primarily because attitudes toward men who have sex with men and sex workers were conditioned by views that these people engaged in “sinful” activities that should be renounced. Nevertheless, FBO leaders were motivated by compassion and wanted to provide care and psychosocial and spiritual support to HIV-infected people, and were willing to be part of the public health response to HIV, within the limits of their doctrines. FBOs may serve an important role in de-stigmatizing HIV among parishioners, emphasizing compassion and reframing HIV as a chronic health condition. However, for many sexuality-related issues and interventions, collaborations with outside organizations may be required. PubDate: 2013-06-13
Abstract: Abstract
Since 2001, various Western countries have accorded legal recognition to same-sex marriages, but thus far, we lack information on how this legislation is related to trends in public opinion. In most of the literature, declining levels of prejudice toward homosexuality are found to result from structural social processes (rising education, secularization, and detraditionalization), which should occur in all industrialized societies, with or without same-sex marriage. In this article, we analyze data of the five waves of the European Social Survey for the period 2002–2010. Results show that levels of prejudice are significantly lower in countries that recognize same-sex marriage, while levels are only slightly lower in countries with some form of registered partnership for gay and lesbian couples. Therefore, we can assume that same-sex marriage is indeed an issue affecting public opinion and public policy. PubDate: 2013-06-11
Abstract: Abstract
The Brief Sexual Attitudes Scale (BSAS) is a 23-item condensed version of the Sexual Attitudes Scale that was developed in response to concerns about the psychometric properties of measure as well as colleagues’ requests for a shorter instrument (Braun-Courville and Rojas Journal of Adolescent Health 45:156–162, 2009; Hendrick and Hendrick The Journal of Sex Research 23:502–526, 1987, Social and Personal Relationships 23:881–899, 2006). Even though it is relatively new, the BSAS may contribute to policy-making because it can be used to assess changes in sexual behavior associated with interventions. The purpose of the present brief report is to contribute to the assessment of the scale’s validity. This was done by comparing results of the current study, conducted in 2011, to the results from the original measurement. Results both challenged and supported the validity of the BSAS. PubDate: 2013-06-01
Abstract: Abstract
This pilot study explored if a relationship existed between maternal sexual health knowledge, religiosity and comfort discussing sexual health issues with adolescents. Seventy-six mothers with adolescent children aged between 10 and 19 completed a combined survey addressing religiosity, sexual health knowledge and comfort discussing sexual health issues. Mann–Whitney U tests were performed to compare the median scores, Spearman’s rho tests were performed to determine correlations between the median scores, Fisher’s exact tests were computed to test for significant differences between proportions and a logistic regression model was used to investigate significant factors. No significant differences or relationships between maternal total sexual health knowledge, total religiosity and total comfort discussing sexual health issues with adolescents were detected; however, specific sexual health topics did show differences. Mothers with a higher level of religiosity were more likely to feel uncomfortable discussing masturbation, condoms, abortion, sexual assault and contraception than mothers with a lower level of religiosity. Regardless of religiosity, many of the mothers in the study reported a lack of accurate knowledge regarding some sexual health topics. The findings suggest that mothers need more education regarding accurate sexual health information if they are to comfortably provide comprehensive sexual health education in a religiously sensitive context. PubDate: 2013-05-29
Abstract: Abstract
Puerto Rican college-aged individuals experience high rates of sexually transmitted infections. Understanding how and why these individuals search for safer sex information will allow to effectively reach them through appropriate communication channels. This study explored the safer sex information-seeking behaviors of 20 Puerto Rican undergraduate college students at the University of Puerto Rico’s Río Piedras campus through semi-structured, one-on-one in-depth interviews. A thematic analysis revealed that students were motivated to seek information for both personal reasons (e.g., being sexually active) and external reasons (e.g., a high school assignment). Results also suggest that source characteristics were more important than the sources themselves when searching for specific information. These findings align with Johnson’s Comprehensive Model of Information Seeking (Johnson, 1997), adding “external factors” to the model's antecedents. By adding this component, the model takes into consideration the unique information-seeking behaviors of college students. Our findings may help develop effective and appropriate health communication strategies and policies that target sexual health and safer sex behaviors among this understudied population, contributing to the scarce literature available on the topics of sexual health and health communications in the Puerto Rican community as a whole. PubDate: 2013-05-28
Abstract: Abstract
Community-based opportunistic self-completion surveying for sexual health programming is common among men-who-have-sex-with-men (MSM) in Europe, being used to generate evidence of unmet prevention need, for behavioural surveillance and as a platform for advocating HIV precautions. However, comparing survey findings across Europe is difficult because of varying measures and recruitment designs, and surveying has not occurred in all countries. EMIS (the European Men-who-have-sex-with-men Internet Survey) aimed to develop a pan-European Internet survey on HIV-related male homosexual behaviours and prevention needs both to increase research capacity and to move towards harmonisation of existing systems. Six associated partners (APs) recruited another 77 collaborating partners from academia, public health and civil society across 35 countries. Partners’ existing MSM surveys were collected and collated, producing a meta-survey which was discussed by all partners through rotating round-tables at a 2-day summit. Survey development continued iteratively through user piloting and partner feedback until the English language content was agreed. Transfer to an online survey application was followed by further testing before on-screen translation into 24 other languages, final testing and sign-off. The project’s visual identity and promotional materials were developed in close collaboration with national leads, tailoring products to match country specific needs while maintaining an overall project identity. Five international MSM dating websites were contracted to send carefully crafted instant messages to members in a series of waves. The survey sought common ground with stakeholders and respondents by endorsing ‘the best sex with the least harm’ for MSM. Real-time monitoring of responses allowed targeted spending of the advertising budget to maximise coverage and depth of responses. Fieldwork occurred during June–August 2010. Over 184,469 responses were submitted of which 94.4 % were eligible. Partners in 38 countries were supplied with a national database of 100 or more respondents for national analysis and outputs, while the AP team proceeded on international comparisons among 174,209 respondents in 38 countries. EMIS demonstrated the feasibility of multi-country community-based MSM Internet surveying with limited public funding. The concept of ‘the best sex with the least harm’ provided a common ground for a diverse range of stakeholders to collaborate. Meaningful involvement of a large number of collaborators in the survey design, its visual identity and in promotional strategies ensured unprecedented coverage and depth of recruitment. Flexible planning was essential and a patchwork of recruitment was required across a range of commercial and community partners. Careful design, piloting and presentation ensured the survey was acceptable and had both authority and perceived community benefit. PubDate: 2013-05-07
Abstract: Abstract
This exploratory, qualitative study examined the perspectives of 22 lesbian and gay parents (15 female and seven male) who were residents of Florida while the state’s gay adoption ban was in effect and who had adopted or were in the process of adopting a child. Participants were interviewed about their experiences before and after the lifting of the gay adoption ban, which occurred in 2010. Participants described numerous negative consequences of the ban, including the inability to adopt foster children and the legal invisibility of one partner’s parental status (e.g., among lesbian couples who had become parents via donor insemination). Parents described various positive changes that occurred in their families once the ban was lifted, such as a profound sense of relief for parents and their children, as well as legal recognition of both partners as parents. Our findings highlight the negative consequences of discriminatory legislation on lesbian/gay-parent families, as well as some subsequent positive effects once such legislation is removed. PubDate: 2013-05-03
Abstract: Abstract
There have been calls for greater involvement of men in Sexual and Reproductive Health (SRH). One of the major SRH issues affecting men is prostate cancer. Prostate cancer represents the leading cause of cancer-related deaths among men in Trinidad and Tobago. A key contributor to this burden of mortality may be low uptake of screening services. This study explored men’s perceptions of prostate screening services to identify implications for policy and practice. Data were drawn from 14 focus groups, including 75 men between the ages of 19 and 60 years representing a cross section of socio-demographic groups in Trinidad and Tobago. Data were qualitatively analysed. Across all groups, men were aware of prostrate screening services, and aware of the need for examinations, particularly at older age. Men reported feeling responsible for maintaining their health, but were unwilling to access prostate screening services. Concerns about digital rectal examination (DRE) were universal, and spontaneously raised in discussions. Expressed levels of anxiety were related to fear of the negative implications of being diagnosed with prostate cancer. More significantly, unwillingness to seek screening was related to sensitivity to the associations of the DRE with homosexual activity and an ‘assault on manhood’. In a cultural context of extreme homophobia, such cultural meanings were a barrier for most men. The major barriers to accessing services in Trinidad and Tobago are cultural beliefs, not lack of knowledge. Whilst addressing homophobia may be a long-term goal, in the short-term, health promotion which focuses on reducing the associations of digital rectal examinations with a threat to masculinity, and stresses the responsibilities of men to take care of their own health, may be productive in improving outcomes in this important area of men’s sexual and reproductive health. PubDate: 2013-03-29
Abstract: Abstract
Between 2006 and 2008, detailed interviews were conducted with 138 men with a median age of 24 years (ranging from 16 to 39) from seven Anglophone Caribbean countries and one territory: Anguilla, Grenada, Guyana, Jamaica, St Kitts and Nevis, St Lucia, St Vincent and the Grenadines, and Trinidad and Tobago. The interviews investigated prevalent construction(s) of masculinity in the region, with particular attention to transitions from childhood to manhood, boys’ education, risk-taking, health, violence, and crime. This paper examines the relationship between masculinity and risk. Far from being considered antisocial and to be avoided, risk-taking serves to define youthful masculinity and is sought out and experienced as a rite of passage. Having multiple female sexual partners is a hallmark of a “real man” and not being considered a “real man” is shameful—potentially fatal in homophobic settings. Paradoxically, by stigmatizing “insufficient” sexual interest in women and valorizing the quest for multiple female partners, homophobia acts as a potent driver of heterosexual risk. While risk was definitive of masculinity, safety was not. Avoiding a reputation for “sexual failure” often takes precedence over the threat of pregnancy or catching a sexually transmissible infection. On the contrary, pregnancy confirms manhood and sexual potency—even when it is unwanted. The research found that safety directly challenges the obligations of manhood and this may explain why HIV control has been so difficult. Condoms are foregone if there is a risk of appearing sexually inexperienced or of losing an erection, especially if details of this “failure” might leak out. Likewise, abstinence and sticking to one partner are incompatible with virile masculinity and displaying insufficient heterosexual interest can imply homosexuality and provoke homophobic consequences. All forms of sexual safety as they are currently framed—condoms, partner reduction, and abstinence—implicitly challenge masculine norms and all convey notions of emasculation. PubDate: 2013-03-29
Abstract: Abstract
Within political and social arenas, prostitution continues to be a highly contested and debated issue. Generally conceptualised as a ‘problem’ in need of eradication, prostitution is strongly linked to immorality and deviance. The methods of addressing this phenomenon have experienced a shift from focusing predominantly on the sex worker, to directly targeting the clients of commercial sex. Such practices have resulted in the creation of policy initiatives such as ‘John Schools’—diversionary programs for clients, or ‘Johns’ who have been arrested for prostitution offences. The programs aim to educate participants on the various harms and risks associated with such behaviour and claim to offer a means to reduce prostitution by targeting the demand for sexual services. It is evident however, that these programs perpetuate traditional social constructions of prostitution, characterising the act, and the actors, as sexually deviant. This paper examines the curriculum of these programs in order to identify how prostitution is constructed—firstly through the depiction of the victims in the program and secondly through the characterisation of prostitution offenders—and argues that such initiatives merely extend the charge of sexual deviance from the sellers of sex to the buyers, whilst failing to acknowledge autonomy and choice for sex workers and clients. PubDate: 2013-03-26
Abstract: Abstract
Past research suggested that the strong relationship between having high levels of religiosity and/or political conservatism and harboring a high level of negativity toward homosexuals often is accounted for by the strength of individuals’ authoritarian views. In an effort to build upon this extant research, the goal of this study was to examine the way in which components of authoritarianism mediate the relationship between religiosity and political conservatism and homonegativity. To achieve this goal, a recently developed modality of path analysis that allows for the effect of one independent variable on another to be controlled was used. Because preliminary analyses indicated that attitudes toward same-sex marriage and homonegativity demonstrated multicollinearity, a composite measure was created. Results suggested that the overall strength of the relationship between religiosity and political conservatism with homonegativity remains statistically significant, even after accounting for three components of authoritarianism and the potential effect of social desirability. These authoritarianism components also had a significant indirect effect on the strength of the relationship between religiosity and homonegativity, with authoritarian submission and conventionalism fully mediating this relationship. Implications of these findings were discussed. PubDate: 2013-03-24
Abstract: Abstract
Reducing unmet family planning need to zero is an integral part of UNAIDS’ Global Plan to virtually eliminate infant HIV infection by 2015. This study aims to understand the beliefs and attitudes that influence family planning use among HIV-positive women in the prevention of mother-to-child transmission (PMTCT) program at Clínica de Familia La Romana, Dominican Republic, and to determine which barriers to use are most important in this population and prioritize them as targets for intervention. Data were collected from one focus group and 21 single investigator-administered semistructured interviews with women in the PMTCT program at Clínica de Familia La Romana, Dominican Republic. The majority of women stated that their last pregnancy was undesired, although they were not using family planning at the time of the pregnancy. Knowledge about the methods, social influences (family, friends), and logistics were not significant barriers within this population. The two barriers that were most frequently reported as reasons for not using, or stopping use of, a family planning method were the attitudes and beliefs of the partner and menstrual changes ranging from irregular bleeding to amenorrhea. This study suggests two main categories of interventions to reduce unmet family planning need in this PMTCT population. First, further research is needed to probe family planning attitudes and beliefs among the partners of HIV-positive women. Only by exploring both partners’ beliefs and expectations can culturally sensitive interventions be developed to increase family planning acceptability among the partners, and thus potentially increase use among women. Second, specific counseling is needed to ask for and address concerns of the women. Importantly, women need to understand that menstrual change is normal with certain methods and does not indicate a decline in their health status. Involving partners in family planning education and improving women’s understanding of how methods work and side effects to expect may improve uptake of contraception in this population. PubDate: 2013-03-15
Abstract: Abstract
The present study sought to identify patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbian, gay, and bisexual (LGB) adults. Respondents were 396 self-identified LGB individuals ages 18–59, recruited from diverse community venues in New York City, with equal numbers of men and women and Whites, Blacks, and Latinos. Respondents were interviewed at baseline and 1-year follow-up. We assessed the relationships among disclosure of sexual orientation, demographic characteristics, health, and minority stress. Rates of nondisclosure to healthcare providers were significantly higher among bisexual men (39.3 %) and bisexual women (32.6 %) compared with gay men (10 %) and lesbians (12.9 %). Bivariate and multivariate logistic regression models predicting disclosure of sexual orientation indicated that patient age, level of education, immigration status, medical history, level of internalized homophobia, and degree of connectedness to the LGBT community were significant factors, along with sexual identity. Nondisclosure of sexual orientation was related to poorer psychological well-being at 1 year follow-up. Our findings suggest that interventions targeting sexual minorities ought to carefully tailor messages to subpopulations. In particular, interventionists and clinicians ought to be mindful of differences between bisexually and gay/lesbian-identified individuals. PubDate: 2013-03-01
Abstract: Abstract
The main purpose of this study was to investigate the psychometric properties of the Beliefs about Children’s Adjustment in Same-Sex Families Scale (BCASSFS) (Frías-Navarro 2009), in terms of confirmation of internal consistency and dimensionality via confirmatory factor analysis. In addition, we set out to validate this scale using the Attitudes toward Lesbians and Gay Men (ATLG) Scale Cardenas and Barrientos (The Journal of Sex Research 45(2):140–149, 2008a). Finally, we divided our sample into categories with a view to creating a typology (Egalitarian, Normative opponents, Bigots, and Individual opponents). No research to date has confirmed the hypothesized factor structure of the BCASSFS in Latin American countries. Using data from a convenience sample obtained through the application of a survey of heterosexuals at a university in northern Chile (N = 283), a model of two correlated factors was used and the fit indexes obtained. The results indicate that the BCASSFS is a valid and reliable scale for measuring beliefs about children’s adjustment in same-sex families in Chile. Moreover, the findings indicated that responses to BCASSFS could be explained by two factors (individual opposition and normative opposition) and that the two factors were correlated. Finally, differences between “egalitarian,” “normative opponents,” “bigots,” and “individual opponents” in the ATLG scale were examined, statistically significant differences being found between groups in the ATL and ATG subscales. PubDate: 2013-03-01
Abstract: Abstract
Many HIV prevention interventions have been launched in gay bathhouses and sex clubs since the onset of the AIDS epidemic, such as condom distribution and HIV testing. Perhaps none of these are as intrusive to the venue's environment as what is called “monitoring,” which involves staff, during every shift, repeatedly walking throughout the public areas of a bathhouse to check on patrons’ sexual behavior. Yet, monitoring has received little evaluation. Between 2002 and 2004, we conducted qualitative interviews with venue managers, staff, and patrons in New York City, Los Angeles, and the San Francisco Bay Area. An analysis found that monitoring was influenced by the kinds of space available for sex, suggesting three approaches to monitoring: (1) monitoring all sex in clubs that only had public areas where men had sex, (2) monitoring some sex in clubs with private rooms for sex, and (3) no monitoring of sex, regardless of the kinds of space for sex. PubDate: 2013-02-19
Abstract: Abstract
Community-based health services which provide HIV care in Australia are typically known as ‘gay-friendly’, but little is known about what this might mean for engaging the broader diversity of people with HIV, particularly heterosexual men. We conducted a secondary analysis of qualitative interviews with key informants and clinicians to capture the meanings attributed to gay-friendly HIV clinics and to explore what these also reveal about the dynamics between sexual identity and HIV care today. Described as safe and welcoming for gay men, and promoting a politics of inclusion, the ‘branding’ of HIV health services as gay-friendly was also believed to have unintended effects, including the misconception that others are not welcome and that heterosexual men will stay away for fear of being misidentified as gay. Countering this were stories about heterosexual men who had challenged their own assumptions about HIV health services and clinicians who viewed the changing demographics of their patient population as both a challenge and an opportunity. Taking account of the shifting meanings ascribed to HIV health services is essential in responding to the changing needs of the positive community and in understanding the new cultural politics of the waiting room. PubDate: 2013-02-15
Abstract: Abstract
A scoping review was undertaken to examine current Australian federal, state and territory government health policy documents to ascertain their relevance to midlife and older adult sexual health. It was found that the sexual health of midlife and older adults was not specifically referred to in most documents reviewed. Existing policy has a focus on risk, not wellbeing, in relation to sexual health, and an emphasis on reproduction, which excludes midlife and older people. This paper provides evidence of absence of sexual health policy relating to the needs of midlife and older adults in Australia. Without a policy that specifically addresses the sexual health of midlife and older adults, they will continue to be overlooked in health promotion planning and sexually transmissible infection testing strategies. We recommend the development of Australian sexual health policy that supports and promotes good sexual relationships and sexual health specific to the needs of midlife and older adults. PubDate: 2013-02-01
Abstract: Abstract
International research has demonstrated that lesbian, gay, bisexual and transgender (LGBT) youth have elevated rates of suicide and self-harm. What is missing from the evidence base, however, is qualitative research investigating LGBT youth perspectives. This is a sensitive subject area presenting ethical, methodological and epistemological challenges, especially in relation to over-sampling the ‘visible’ sections of a hidden population, retrospective reporting, and capturing complex emotions. We report on our use of qualitative online methodology to examine Internet forums where LGBT youth discuss self-harming. We found that this methodology can address some research dilemmas by generating: (a) diverse samples in terms of sexuality and gender identities; (b) a different type of data, immediate and unmediated by researchers; and (c) complex psychosocial emotional data. We argue that this online data can enhance our understanding of the links among hard-to-reach youth, suicide, self-harm, sexuality and gender, which is crucial to developing effective and appropriate suicide prevention strategies and mental health policies. PubDate: 2013-01-24
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