Sexual Violence and the MDGs

ABSTRACT

Sexual violence is multi-faceted. Three (overlapping) categories can be distinguished: violence that is sexual in nature, gender-based violence, and sexuality-based violence. The latter refers to violence against persons because of their sexuality and/or their (presumed) sexual behavior. Being female, young, poor, and living in a sexually conservative culture and/or in conflict areas appear to be important risk factors for sexual violence. Sexual violence is widespread (one in five girls worldwide are sexually abused in childhood and up to three-quarters of women in some countries have been victimized by a partner), but prevalence figures around the globe are hard to compare. Both the individual and society suffer from sexual violence. The eradication of sexual violence is directly relevant to achieving the Millennium Development Goals (MDGs) related to infant and maternal health and mortality, and combating HIV/AIDS. And certainly no less important, it is very closely linked to the MDGs related to gender equality and the empowerment of women, poverty, and primary education for all. Campaigning against sexual violence against women has been presented as one of the ‘quick wins’ in progress towards achieving the MDGs by the UN Millennium Project. Many good practices have been employed in political-legal, awareness raising, prevention, and health care domains, but important setbacks are noteworthy as well. Priority number one for the World Association for Sexual Health now seems to be to adequately and strategically contribute to the continuous efforts to integrate sexual health into the Millennium Development framework.     

The State of the Union: Sexual Health Disparities in a National Sample of US College Students

Abstract

Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18–24; M = 20.1) responding to the Spring 2007 American College Health Association–National College Health Assessment; 64% were female and 94.7% were white. Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.     

Mental health and substance use of sexual minority college athletes

ABSTRACT

Objective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.     

Sexual and Reproductive Health Knowledge Among Men and Women Aged 15 to 49 Years in Metropolitan Tehran

Sexual and reproductive health (SRH) knowledge is an important predictor of an individual’s sexual behavior; however, little is known regarding this issue among Iranians. This study assessed sexual and reproductive health knowledge among men and women aged 15 to 49 years in Tehran. A total of 755 men and women aged 15 to 49 years were recruited using multistage, random cluster sampling in June 2014. An illustrative anonymous questionnaire endorsed by the World Health Organization (WHO) was used to collect the data. Bivariate and multivariate analyses were performed. The results showed that men and women were moderately knowledgeable about sexual and reproductive health (mean score of SRH knowledge = 39, range: 26 to 52); however, myths and misperceptions prevailed in different aspects of SRH. For example, only 45% of women and 38.7% of men accurately knew that a person infected with human immunodeficiency virus (HIV) can look healthy. Friends were identified as the primary or secondary source of knowledge about puberty and sex-related issues. A multivariate analysis showed that being female (coefficient = 0.139, p < 0.001) and being married (coefficient = 0.180, p < 0.001) were significant predictors of better SRH knowledge, while being young (age group 15 to 24) was a significant determinant of poor SRH knowledge (coefficient = ?0.161, p < 0.001) when other influencing factors were controlled. Culturally appropriate and age-specific comprehensive education is recommended, particularly for men, the unmarried, and the younger generation in Iran.     

The construction and psychometric properties of an instrument measuring support for sexual rights

The purpose of this paper is to report the findings of an attempt to construct and examine the psychometric properties of an instrument that measures support for the 11 sexual rights formulated by the World Association of Sexology. Since international conferences held in the mid‐1990s, a new approach to sexual issues has been promoted by health professionals, sex educators, and human rights advocates. This approach emphasizes the empowerment of individuals and examines sexual health concerns within a human rights framework. Goals of a sexual rights approach have been to promote awareness and advocacy of sexual issues and especially to facilitate the work toward better sex education and sexual health services. Analysis of reliability and validity data from two university samples (n = 388 and n = 175) indicated that the majority of the sexual rights scales have acceptable psychometric properties. This paper concludes with a discussion of ways to improve the scales for future use and the need to validate the scales using samples that allow generalizability of findings.     

Dimensions of Poverty: Status and Solutions Towards the Millennium Development Goals

Books reviewed: State of the World Population 2004: The Cairo Consensus at Ten ‐ Population, Reproductive Health and the Global Effort to End Poverty. By UNFPA. How Have the World's Poorest Fared Since the Early 1980s? By Shaohua Chen and Martin Ravallion. The State of Food Insecurity in the World 2004: Monitoring Progress towards the World Food Summit and Millennium Development Goals. By FAO. Fifth Report on the World Nutrition Situation: Nutrition for Improved Development Outcomes. By SCN. IFPRI Annual Report 2003‐4. By IFPRI. Halving Hunger: It Can Be Done. By Task Force on Hunger. Outgrowing the Earth: The Food Security Challenge in an Age of Falling Water Tables and Rising Temperatures. By Lester R. Brown. The State of the World's Children 2005: Childhood Under Threat. By UNICEF. Education for All: The Quality Imperative ‐ EFA Global Monitoring Report 2005. Commissioned by UNESCO. World Employment Report 2004‐05: Employment, Productivity and Poverty Reduction. By ILO. The Future of the WTO: Addressing Institutional Challenges in the New Millennium. By the Consultative Board. State of the World 2005: Redefining Global Security. By the Worldwatch Institute. Investing in Development: A Practical Plan to Achieve the Millennium Development Goals. By Jeffrey D. Sachs and the UN Millennium Project.     

The Who Concept of Sexual Health Applied to An Urban Poor Community in Mumbai,India

Objectives: The objectives of this study were to describe a scale that operationalizes the World Health Organization concept of sexual health and to assess factors associated with scale variation. Methods: Qualitative in-depth interviews (N = 39), sexual health interviews (N = 21), and survey data (N = 1,128) for this article are drawn from an Indo-U.S. project to reduce the incidence of HIV and sexually transmitted infections among poor urban married women (aged 18–49 years old) in Mumbai, India. Results: Lower sexual health status was significantly associated with gender inequity, marital violence, poorer marital relationships and physical health, and lower empowerment and social support. Conclusions: This work demonstrates the need to view sexual health in the broader context of community and family.     

‘We do not have chiefs who are disabled’: disability,development and culture in a continuing complex emergency

In 2011 The World Health Organization declared disability an international development priority. Yet disability and disabled people are barely visible in the Millennium Development Goals. Exploring disabled people’s involvement in development processes in Binga District, Zimbabwe, this article: illuminates the impact of cultural beliefs about disability that systematically exclude disabled people from development initiatives; assesses the strengths and limitations of the capability approach for theorising disability; and considers the role of (u)buntu, a philosophy based on human relatedness and interdependence, in promoting justice for disabled people in sub-Saharan Africa.     

Masturbation and Sexual Health

Abstract

In this study we applied research examining the hypothesized benefits of masturbation in dealing with sexual problems to the urgent health crisis posed by the HIV/AIDS pandemic. This is the first study to test the hypothesized relationship between masturbation and HIV risk as predicted by the Sexual Health Model, a sex-positive approach to sexual health developed in response to the need for a more explicit focus on sexuality and relationships in HIV prevention. This is also the first study to examine the relationship between several masturbation variables (i.e., masturbation guilt, lifetime masturbation, and current masturbation) and HIV-related sexual behaviors and attitudes in a sample of African American women (N =239). Data was collected using face-to-face structured interviews as part of the Women's Initiative for Sexual Health (WISH), a randomized, controlled trial of an HIV prevention intervention based on the Sexual Health Model, targeting low income, adult African American women. Contrary to expectations, results showed that participants who reported masturbating were more likely to report having multiple partners, being in a nonmonogamous relationship and engaging in high-risk sexual behaviors. There was no significant relationship between level of masturbation guilt and HIV risk nor between masturbation and consistent condom use or attitudes toward condoms. This study adds to the growing empirical support for associations between sexual health variables and safer sex and argues for a more explicit focus on sexuality in HIV prevention.     

Gender Differences in the Sexual Well-Being of Mexican Adolescents

Objective: This study examines the associations of gender roles and sexual power with the sexual wellbeing of Mexican adolescents. Particularly we look at the role played by adolescent’s attitudes toward gender roles and sexual power regarding three aspects of their sexual well-being: satisfaction with one’s sex life; consistent condom use; and the refusal of unwanted sexual contact with one’s partner. Methods: we used logistic regression models to analyze possible associations between attitudes toward gender roles, and sexual power, with the sexual well-being of adolescents, using a random and representative sample of 4,738 sexually active teenagers from three Mexican states. Results: egalitarian attitudes are positively associated to high sexual satisfaction for female adolescents, whereas for males they favor the refusal of unwanted sex. Sexual power shows significant associations with consistent condom use for both males and females, and it also significantly increases the likelihood of high sexual satisfaction and refusal of unwanted sex among females. Conclusions: the findings suggest the relevance of overcoming traditional sex roles to achieve adolescent sexual well-being. In this sense, health and population policies should direct more substantial efforts in the promotion of gender equality among the adolescents and in the development of critical attitudes towards traditional gender norms.     

INQUIRY

The following interview with Awash Teklehaimanot was conducted in June 2005. Dr. Teklehaimanot is Director of the Malaria Program at Columbia University and a member of the Task Force on Malaria for the UN Millennium Project. He is a senior staff member of the World Health Organization (WHO) in Geneva, where he provides leadership in the development of the global Roll Back Malaria program. Dr. Teklehaimanot has extensive international experience in public health with particular focus on Africa. He provides technical support to malaria-endemic countries, coordinates a number of WHO-funded research activities in Africa, and spent several years as the director of Ethiopia's National Malaria Control Program. He is a professor of clinical epidemiology at Columbia University's Mailman School of Public Health, and has been lecturing at the Harvard School of Public Health since 1992.     

Keynote Address: Making Campuses Safer Communities for Students

As a chief spokesperson for a national movement to prevent violence and a frequent speaker in national media and public forums, Dr. Deborah Prothrow-Stith is a nationally recognized public health leader. In 1987, she was appointed the first woman Commissioner of Public Health for the Commonwealth of Massachusetts. In that role, she established the first Office of Violence Prevention in a state department of public health, expanded prevention programs for HIV/AIDS, and increased drug treatment and rehabilitation programs. Dr. Prothrow-Stith currently serves as Associate Dean for Faculty Development and Professor of Public Health Practice at the Harvard School of Public Health (HSPH) and founding director of the Division of Public Health Practice.

Dr. Prothrow-Stith supports the application of rigorous scientific methods to strengthen violence prevention programs. She developed and wrote The Violence Prevention Curriculum for Adolescents, a forerunner of violence prevention curriculum for schools and communities. She is the author of Deadly Consequences, the first book to present the public health perspective on violence to a mass audience. She has authored and co-authored more than 80 publications on medical and public health issues.

Dr. Prothrow-Stith was the keynote speaker for the annual meeting of American College Health Association in May 2006. The Editors of The Journal of American College Health have revised her speech to share her comments in this issue and thought her words would be a proper introduction to the ACHA White Paper on Domestic Violence.     

Introduction to the Special Issue: Global Perspectives on Vocational Guidance

This special issue of The Career Development Quarterly presents the outcomes from an international symposium, titled International Perspectives on Career Development, jointly sponsored by the International Association for Educational and Vocational Guidance and the National Career Development Association. The articles in this special issue discuss international perspectives on and comparative approaches to educational and vocational guidance that differentiate career development practices in different nations. In addition to the articles in this issue, a selection of papers presented at the symposium has been jointly published in a thematic issue of the International Journal for Educational and Vocational Guidance, 5(2).     

The Evolution of Sexual Pleasure

Abstract

Sexual pleasure is an innate component of human sexuality. Although disdained throughout history by religious groups and variably explained by theories, philosophers, and societies, sexual pleasure permeates human experience. Traditional evolutionists explain this preoccupation via the development of sexual mating strategies and the human desire to propagate one's genes; however, here I will argue that the saturation of sexual pleasure suggests that sexual activity is no longer pursued solely to ensure reproductive success. Rather, humans engage in sexual behavior to achieve sexual pleasure—a proposition supported by widespread non-procreative sex in mammals, divergent cultural norms, and humans' evolved capacity to experience heightened sexual pleasure. I will address the nature and evolution of sexual pleasure with a cross-cultural findings culled from ethology, anthropology, primatology, and evolutionary theories.     

Examining residence status as a risk factor for health risk behaviors among college students

Objective: The current study is aimed to evaluate college student residence as a unique risk factor for a range of negative health behaviors. Participants: We examined data from 63,555 students (66% females) from 157 campuses who completed the National College Health Assessment Survey in Spring 2011. Methods: Participants answered questions about the frequency of recent use of alcohol, tobacco, marijuana, and illicit drugs, as well as sexual risk behavior in the last 30 days. Sexual risk behaviors were operationalized as having unprotected vaginal sex (yes/no) and the number of sexual partners. Results: Logistic regression analyses revealed that living off-campus is a unique predictor of alcohol, tobacco, marijuana, and illicit drug use, as well as engaging in unprotected sex and a greater number of sexual partners (all ps <. 01). Conclusions: Students living off-campus exhibit more substance use and sexual risk behaviors than students living on-campus, independent of gender, age, or race.     

Engaging Intercollegiate Athletes in Preventing and Intervening in Sexual and Intimate Partner Violence

Abstract

Objective: The object of this exploratory evaluation was to evaluate the “Bringing in the Bystander” sexual and intimate partner violence prevention program with a new sample of intercollegiate athletes. Participants and Methods: Fifty-three male and female athletes participated in the program (experimental group), and 86 were in the control group. All completed pretest, posttest, and 2-month follow-up surveys, including assessment of rape myth acceptance, intent to engage in bystander behaviors, bystander confidence, and bystander behaviors. Results: The program worked overall and for both women and men, improved bystander confidence and intent to engage in bystander behaviors, and did not create significant backlash effects (ie, worsening of attitudes as a result of program). Conclusions: The program fits with the intent of the National Collegiate Athletic Association CHAMPS/Life Skills program regarding its focus on the overall development of student-athletes and demonstrates the promising bystander approach compatible with the 2007 American College Health Association toolkit, Shifting the Paradigm: Primary Prevention of Sexual Violence.     

Health behaviors of culturally diverse inner-city community college students

ABSTRACT

Objective: To determine the prevalence of risk behaviors related to cigarette use, alcohol use, nutrition, physical fitness, and sexual behavior. Participants: Participants were 1,075 students attending an urban community college during the Spring 2012 semester. Methods: Data were collected in randomly selected classes using the American College Health Association National College Health Assessment II (ACHA-NCHA II) paper survey and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 for frequencies and chi-square test of independence. Results: The sample population reported poor diet, low rates of physical activity, high rates of overweight/obesity, low rates of condom use for vaginal sex, multiple sexual partners, and unintentional pregnancy. Protective health behaviors included low rates of cigarette smoking and alcohol use, high rates of condoms use for anal sex, and high rates of human immunodeficiency virus (HIV) testing. Conclusion: Students are at high risk for health problems related to poor diet, lack of exercise, and risky sexual behaviors. Additional research is recommended to determine the most effective intervention strategies.     

What Do Men Want?

Abstract

Men play a key role in determining good sexual health outcomes for themselves and their sexual partners. However, many interventions and much of the programmatic focus and effort in reproductive and sexual health care delivery, are focused on women. This paper shows how international goals for development (the Millennium Development Goals), and international agreements on population and development (such as that agreed at the International Conference on Population and Development, Cairo,1994) cannot be met without the full and active involvement of men. We argue that achieving international goals and targets requires more than simply encouraging men to take more responsibility for their actions, it requires a detailed understanding of men's own concerns in the field of sexual health and a commitment to address those concerns to achieve better sexual health for all.

Using examples from south Asia, the paper explores the evidence surrounding the burden of men's sexual ill-health in the Region. We find that while public health programmes are (rightly) focused on controlling HIV (and sexually transmitted infections to some degree), evidence from population-based surveys of men across south Asia shows that men are most concerned with ‘psycho-sexual conditions’ including discharge syndromes, weakness, and erectile dysfunction. There is evidence that some of these conditions may be linked to higher rates of risk-taking and gender-based violence in some men. We further review patterns of care seeking for men reporting these and other sexual health problems.

We conclude that the challenges facing public health professionals are how to ensure that men receive interventions which are appropriate (and affordable and accessible and of high quality) for addressing their own sexual health concerns whilst also meeting wider public health goals of improving population levels of sexual and reproductive health.     

Sexual Problems and Distress among Men and Women with Same-Sex and Opposite-Sex Sexual Partners: An Analysis of a Nationally Representative Sample of Adults in Great Britain

Abstract

Objective: This study aimed to examine differences in reporting sexual problems and distress among men and women with same-sex and opposite-sex sexual partners.

Methods: Multinomial regression was undertaken on risk of reporting sexual problems and/or distress using data from the third National Survey of Sexual Attitudes and Lifestyles.

Results: Differences were detected between men of different sexual behavior groups when considering the problems “lack of enjoyment in sex,” “felt anxious during sex,” “felt no excitement or arousal during sex,” “lack of interest in sex,” “did not reach/took a long time to reach climax,” and “getting or keeping an erection.” Fewer differences were detected among women.

Conclusions: Women reporting same sex sexual partners, and to a greater extent men reporting same sex sexual partners , have different sexual health needs and report sexual health problems and distress to a different extent than is the case for individuals who only have opposite-sex sexual partners     

Sexual Behaviors and Sexually Transmitted Diseases of Lesbians

ABSTRACT

The Boston Lesbian Health Project surveyed 1633 lesbians about their health status, health related behaviors and health problems. This paper reports on those parts of the questionnaire that dealt with sexual behaviors and sexually transmitted diseases. The sample was predominantly monogamous, but few had been in their present relationship for more than five years. Sexual practices were similar to those reported in previous studies of lesbians and to those reported in a study of heterosexual women. Sexually transmitted diseases were rare in women who had never had sex with a male partner. The majority of the sample did report a history of male sexual partners and therefore are at risk for abnormal pap smears and other sexually transmitted diseases.