Sexual assessment and the epidemiology of AIDS

Research on the transmission dynamics of AIDS necessitates an extraordinarily rigorous sexual science. Thus, the purpose of the present paper is to isolate sexual parameters which are crucial to the epidemiology of AIDS. Several representative mathematical models of the proliferation of HIV are described. From these models, three consistent sexual parameters emerge (sexual orientation, anal intercourse, and selection of sexual partners). Consequently, each parameter is examined for the feasibility of assessment and the reliability of existing data. However, as the present review suggests, the relevant data on sexual parameters are either marginal or nonexistent. Therefore, alternatives are described, and the broader implications of measurement error on epidemiological predictions is developed.     

The assessment of sexual practices relevant to the transmission of AIDS: A global perspective

Despite global similarities between the immunologic and pathogenic properties of HIV infection, there are substantial cultural and geographical variations in the transmission dynamics of HIV infection/AIDS. In the United States and Europe, for example, HIV infection/AIDS is predominantly evident among homosexual men and intravenous drug abusers. However, in Central Africa, the data indicate that HIV infections/AIDS is heterosexually acquired. Thus, the purpose of the present paper is to suggest some basic strategies and raise some critical issues for collecting data on sexual practices relevant to the transmission of HIV infection/AIDS throughout the world. Topics include assessment strategies, language and meta‐language, cross‐cultural and intra‐cultural comparability, general methodological issues, and constraints for the assessment of anal intercourse.     

Vietnamese American sexual behaviors & HIV infection

This brief report presents some preliminary findings of an on‐going ethnosexual field study of Vietnamese American sexual behaviors in Orange County, California, and indicates how they may be related to HIV infection. The primary objective of the study is to gather data on those sexual behaviors having the highest likelihood of transmitting the AIDS virus. The field research data indicate that in the ‘Vietnamese American population, highly acculturated Vietnamese homosexual men, whose partner preference is primarily for Anglo men with whom they play both sexual roles in anal intercourse, appear at present to be at highest risk for HIV infection. Transmission of the AIDS virus within the Vietnamese American population may be facilitated by Vietnamese American men who practice unsafe sex with both Anglo and Vietnamese men. The field research data also indicate that a potential exists for the spread of HIV into the heterosexual population through the sexual activity of Vietnamese men with non‐Vietnamese female prostitutes in California and Mexico, and through the sexual activity of ‘Vietnamese men with Thai and Vietnamese prostitutes in Thailand and Vietnam while on return visits to Southeast Asia.     

Sexual behavior and AIDS knowledge of young male prostitutes in Manhattan

Despite their presumed high risk for AIDS, there are almost no sexual behavior data available which are sufficient for the development and assessment of intervention programs for male prostitutes. This study was designed to obtain such data. Fifty 14–27‐year‐old male prostitutes in Manhattan were interviewed using structured instruments to assess sexual orientation, sexual behavior, knowledge of AIDS, and substance abuse. The sample was 50% homosexual, 26% bisexual, and 24% heterosexual. High rates of condom use were found for anal intercourse (average 85%). Subjects were safest in sex with male customers, less safe with male partners for pleasure, and least safe with female partners. Differential use of condoms plus other unsafe sexual activities continue to place the male prostitute at risk for HIV infection. AIDS knowledge was high and positively correlated with safety of sex. Drug and alcohol abuse and dependence were frequent, although there was little intravenous drug use. These and other variables were not significantly associated with degree of safety in sex. The methods employed in this study can be used to assess other populations of male prostitutes as well as intervention programs.     

Is risky sex rational?

Consideration of a simple model of sexual decision‐making suggests that many individuals who engage in risky sexual practices do so for “rational” reasons. Within a framework of subjective values and perceptions, risky sex may be rational in the sense that the benefits derived from sexual expression outweigh the threat of loss from AIDS. One implication of this conceptualization is that in order to understand risky behavior, primary consideration must be accorded the perceptions, attitudes, and desires of the individual.     

A rejoinder to the comments of Hartman & fithian and pomeroy & brown on the female sexological examination

The spread of the international AIDS pandemic has drawn attention to the urgent need for data on human sexual behavior; yet the absence of an established tradition of theory and method in sex research has limited the development of initiatives in this area. This has been particularly evident in the lack of attention given to the ways in which cross‐cultural differences structure the meaning of sexual experience. While survey research can play an important role in documenting sexual behavior, qualitative research on sexual culture is equally important in order to develop a framework for the comparative analysis of behavioral data. This article seeks to contribute to the development of theory and method in sex research by outlining key research issues and possible methodologies for the qualitative investigation of sexual culture in relation to HIV/AIDS.     

Functional Family Therapy And The Treatment Of Inhibited Sexual Desire

Although inhibited sexual desire is very common, the literature indicates that it is extremely difficult to treat successfully. Functional Family Therapy (Alexander & Parsons, 1982) appears to be a promising treatment approach. This paper defines the major goals of Functional Family Therapy and applies these goals to the treatment of inhibited sexual desire, and a case study illustrates the utility of the model.     

Marital Aspirations,Sexual Behaviors,and HIV/AIDS in Rural Malawi

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in‐depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long‐overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.     

Redefining Sex and Intimacy: The Sexual Self-Images,Outlooks, and Relationships of Gay Men Living with HIV/AIDS

This paper examines how gay men living with HIV disease come to terms with the profound sexual implications of their illness. Based on interviews with 25 gay men diagnosed with HIV/AIDS, this paper highlights (a) the disruptions that these men experience in their sexual feelings and self-images as a result of their illness; (b) the challenges they encounter in negotiating and sustaining sexual relationships; (c) the declines they experience in their sexual attractiveness, desire, and capacities as their illness advances; and (d) the changed meanings they give to sex and self as they come to terms with the erotic implications of their illness and try to preserve valued, intimate identities. In focusing on these themes, this paper offers an “insider's view” into key dimensions of the moral experience of gay men with HIV/AIDS. It also illustrates how the moral experience of these men shifts over the course of their illness, especially in response to the changes and challenges that arise in their intimate relationships and subcultural networks. On a broader, analytic level, this paper addresses a research question that has been neglected in previous studies of the experience of illness—that is, how does serious illness affect the sexuality of diagnosed individuals, particularly their construction of sexual and intimate identities? Through examining this question, this paper contributes to and extends the growing interactionist literature on the consequences of illness for self.     

Adaptive training for existing male transsexual gender role: A case history

The development of AIDS interventions for adolescents is hindered by the lack of data on the conditions that influence high‐risk sexual behavior. We examined psychosocial correlates of condom use and multiple partner sex for a sample of sexually‐active heterosexual adolescent women. Respondents reported higher levels of vaginal intercourse than the “average” adolescent. A minority were engaging in anal intercourse. Condom use was associated with perceived enjoyment of condoms and communication skills. Number of sexual partners was associated with susceptibility beliefs, social norms, and sexual communication skills. The findings support the general observation that AIDS interventions with adolescents should build sexual communication skills, address motivational issues, and teach people how to enjoy safe‐sex activities.     

Qualitative research on homosexual and bisexual behavior relevant to HIV/AIDS

The spread of the international AIDS pandemic has drawn attention to the urgent need for data on human sexual behavior; yet the lack of an established tradition of theory and method in sex research has limited the development of research initiatives in this area. This has been particularly true in the study of homosexual and bisexual behavior, which has relied heavily on the use of quantitative survey methods that largely fail to address cross‐cultural differences in the structure and meaning of same‐sex sexual experience. More qualitative approaches offer the possibility of investigating homosexual and bisexual behavior within a broader social and cultural context and can therefore play an important role in developing a framework for the comparative analysis of behavioral data. This article seeks to contribute to the development of theory and method in sex research by outlining key research issues and possible methodologies for the qualitative investigation of homosexual and bisexual behavior in relation to HIV/AIDS.     

Disclosure of Child Sexual Abuse as a Life‐Long Process: Implications for Health Professionals

One of the aims of this research project was to develop a fuller understanding of the process of disclosure of child sexual abuse. Face‐to‐face in‐depth interviews were conducted with 22 men and women aged 25 to 70 years old, who had an early sexual experience at the age of 15 or under with someone of 18 or over. Narrative inquiry methodology was used and data was analysed using Rosenthal and Fischer‐Rosenthal's (2004) process of data analysis. Disclosure can be conceptualised as a complex and life‐long process, and most participants did not make a selective disclosure until adulthood. The findings extend Alaggia's (2004) model of disclosure to include the life stage and the person to whom the disclosure is being made. The main barriers to disclosure and possible gender differences are discussed. Family therapists need to manage the challenges inherent in disclosure of child sexual abuse at any age.     

Changing aids‐ and fertility‐related behavior: The effectiveness of sexual education

A questionnaire was used to access the effectiveness of a ten‐week university course on human sexuality in changing students' AIDS‐ and fertility‐related behavior. The students' knowledge and behavior were evaluated (1) early in the class before there were any discussions or readings about sexual behavior, AIDS, or birth control and (2) three months later—approximately one month after completing the class. A randomly selected control group of students who did not take the class on sexuality was given the questionnaire at the same two points in time. Compared to the control group, the experimental group showed significant increases in knowledge about the likelihood of contracting the virus from one act of vaginal intercourse. The experimental group also reported increased worry about contracting AIDS from their sexual activity, while the control group did not. Further, compared with the control group, the experimental group increased certain cautious behaviors, such as being more selective in their choice of sexual partners and asking their partners more questions about their AIDS‐related behavior. However, the course did not lead students to: 1) significantly increase their use of the condom or other forms of contraception, 2) decrease their number of sexual partners, or 3) spend a longer time getting to know new partners before engaging in sexual activity. Implications for sexual education are discussed.     

Child sexual abuse and HIV transmission in sub‐Saharan Africa

The purpose of this paper is to examine the risks of HIV transmission to children through sexual abuse and exploitation in sub‐Saharan Africa. The paper is based on a review of pertinent literature. Child sexual abuse in this region must be defined broadly enough to encompass widespread coercion or violence in early sexual relations in some regions, the practice of ‘transactional sex’ and constructions of masculinity, emphasising multiple sexual partners and power over women and girls. The high HIV prevalence in sub‐Saharan Africa is briefly described. Research evidence showing the link between child sexual abuse and HIV transmission is reviewed, although this is a topic where very little direct empirical work has been conducted. Particular methodological and ethical difficulties have been encountered by researchers. Future research directions are indicated. Copyright © 2008 John Wiley & Sons, Ltd.     

Sexual motivation

We discuss the long‐standing “sex‐as‐drive‐or‐appetite” controversy—whether sexual desires may arise on their own, from internal states, or whether they only arise when attractive stimuli are presented. The issue is approached through integration of sexual motivation within an umbrella theory of motivational systems that closely follows currently dominant incentive motivation theories. In this formulation sexual motivation, like hunger or thirst, emerges from an interaction of external incentives and internal states. Deprivation acts to enhance the palatability of incentives but does not create an internal goad. That is, there is no aversive internal sensation associated with sexual deprivation. Through this perspective we integrate sex with findings from other motivational systems such as hunger or thirst and clarify otherwise puzzling phenomena: why orgasm and sexual motivation can be decoupled; how female sexual motivation arises and is similar to males'; how novel stimulation affects sexual motivation; and why measured sexual motivation seems to vary with experimental technique. Sexual self‐stimulation is accounted for under this model. Predictions are generated for the outcomes of both human and animal experiments. Finally, practical implications are discussed.     

Drug use,prostitution and the prevalence of AIDS: An analysis using census tracts

This paper reports on preliminary efforts to study at the census tract level the reciprocal relationships between AIDS and street crime, particularly prostitution and drug offenses and the prevalence of AIDS. The Los Angeles County Department of Public Health provided the number of reported AIDS cases by census tract. The data on reported crimes and arrests, organized by reporting districts, came primarily from the Los Angeles County Sheriff's Department and the Los Angeles City Police Department. Although this strategy needs replication and extension, the present findings suggest that sexual orientation, drug use and prostitution are useful risk variables at the census track level.     

Sexual behaviour in aids‐related research: Reliability and validity of recall and diary measures

In order to assess the reliability and validity of two data collection instruments for measuring sexual practices in homosexual men, we administered a recall data collection instrument to 30 sexually active men, and a diary instrument to a subset of 19 participants. Each instrument covered a period of one month. For the recall instrument, the correlation coefficients between the test‐retest showed a good level of reliability for a number of infrequent sexual practices but was poor for frequent sexual practices. Correlation coefficients were calculated for sexual practices recorded in the first two and the second two weeks for both the recall and the diary. Generally, the level of agreement between the first and second two weeks for sexual practice data recorded in the diary was lower than the recall questionnaire. While the reliability of the recall method was found to be limited to certain sexual practices, it was concluded to be the most reliable and efficient method presently available for the collection of important high‐risk AIDS‐related sexual activities for a one‐month period.     

Understanding heterosexual Chinese college students' intention to adopt safer sex behaviors

This study aimed to examine Chinese college students' safer sex behaviors and to explore whether or not the Theory of Reasoned Action would be useful in understanding AIDS/HIV‐prevention behaviors of Chinese students. A total of 455 Chinese college students (161 males and 267 females) in Hong Kong participated in the study. Results revealed that 24% of the students were sexually active during the surveyed year, with only 38.2% of them reporting regular condom use. About one third of the students intended to experiment with casual sex in the future, but only 64% would use condoms regularly if they were to have future casual sexual encounters. Results indicated that the Theory of Reasoned Action was most applicable in understanding Chinese college students’ intention to use condoms in future casual sexual encounters, rather than in current and future regular sexual activities. Specifically, students who intended‐to use condoms in future casual sex encounters tended to have accurate AIDS/HIV information, show little prejudice against people with AIDS/HIV, demonstrate greater concern about contracting AIDS/HIV, feel confident in condom use, and have positive attitudes toward safer sex behaviors. Gender disparity was also noted in the pattern of associations between safer sex behaviors and various psychological variables. Limitations of the present study and implications for future research were also discussed.     

Forced Sexual Experiences and Sexual Situation Self‐Efficacy Among South African Youth

Nearly 20% of South African youth experience forced or coerced sexual intercourse. Understanding the factors associated with forced sex is important for informing prevention programs aimed at reducing sexual violence and HIV and AIDS. Multilevel regression models test the association between sexual situation self‐efficacy and forced sex among 2,893 South African adolescents. Findings suggest that youth are more likely to experience forced sex after periods of time when their levels of self‐efficacy are lower than their average levels of self‐efficacy. Furthermore, youth who are lower on their self‐efficacy compared to their peers are more likely to experience forced sex. Implications for prevention research are discussed.     

Inventing adulthoods: a biographical approach to understanding youth citizenship

Traditionally adulthood and citizenship have been synonymous. Yet adulthood is changing. In this paper we explore how young people's evolving understandings of adulthood may contribute towards an understanding of citizenship within the broader context of increasingly extended and fragmented transitions. The paper draws on a unique qualitative longitudinal data set in which 100 young people, from contrasting social backgrounds in the United Kingdom, have been followed over a five‐year period using repeat biographical interviews. We present first the themes that emerged from a cross‐cut analysis of the first of three rounds of interviews distinguishing between relational and individualised understandings of adulthood. We then present a model we developed to capture the ways that young people sought out opportunities for competence and recognition in different fields of their lives. Finally a case study that follows a young woman through her three interviews illustrates how these themes can appear in an individual trajectory. We offer the model and case study as a way of exploring a more subjective approach to citizenship in which participation is not deferred to some distant future in which economic independence is achieved, but is understood as constantly constructed in the present.