The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic

Sexual compulsivity, defined by sexual preoccupation and lack of sexual impulse control, is related to high‐risk sexual behaviors. However, little is known about the prevalence and predictors of sexual compulsivity in people at high risk for contracting sexually transmitted infections (STIs). In the current study, patients receiving diagnostic and treatment services (85% African American) at an urban STI clinic completed measures of demographic characteristics, sexual compulsivity, substance use, and sexual behaviors. Measures were administered to 492 men and 193 women using confidential procedures and audio computer‐assisted interviewing technology. Results showed that men and women receiving STI clinic services frequently endorsed multiple indicators of sexual compulsivity. In this mostly African American sample, individuals with scores above the 80th percentile on the sexual compulsivity scale (translating to over one standard deviation above the mean) had more sex partners, engaged in higher rates of sexual risk behaviors with casual or one‐time sex partners, and were nearly four times as likely to have been recently diagnosed with multiple STIs than were individuals who scored below the 80th percentile. Although sexual compulsivity scores were associated with alcohol and other drug use, associations between sexual compulsivity and sexual risks were not accounted for by substance abuse. Findings suggest an urgent need for interventions to help men and women with sexual preoccupations and poor sexual impulse control to reduce their risks for sexually transmitted infections.     

Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic

African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol–sexual risk reduction interventions for high-risk women.     

Gender attitudes,sexual violence,and HIV/AIDS risks among men and women in Cape Town,South Africa

This study examined gender attitudes and sexual violence‐supportive beliefs (rape myths) in a sample of South African men and women at risk for HIV transmission. Over 40% of women and 16% of men had been sexually assaulted, and more than one in five men openly admitted to having perpetrated sexual assault. Traditional attitudes toward women's social and gender roles, as well as rape myths, were endorsed by a significant minority of both men and women. Multivariate analyses showed that for men, sexual assault history and rape myth acceptance, along with alcohol and other drug use history, were significantly related to cumulative risks for HIV infection. In contrast, although we found that women were at substantial risk for sexually transmitted infection (STI), including HIV, women's risks were only related to lower levels of education and alcohol use history. We speculate that women's risks for STI/HIV are the product of partner characteristics and male‐dominated relationships, suggesting the critical importance of intervening with men to reduce women's risks for sexual assault and STI/HIV.     

Sexual needs, control, and refusal: how "doing" class and gender influences sexual risk taking

The poor are disproportionately affected by unintended pregnancy and sexually transmitted infections (STIs). We know relatively little, however, about the sexual processes behind these disparities. Despite studies of gender enactment's influence on sexual behaviors, few analyses examine the sexual "doing" of social class. We conducted sexual history interviews with 36 women and men, half middle class and half poor and working class. Most respondents reported that men have greater sexual appetites than women, but the middle class were more likely to cite social influences while the poor and working-class respondents primarily ascribed biological origins. The social construction of sexual controllability among the middle class contributed to perceptions that sex was a containable force. Poor and working-class women described men's sexual needs as physiologically irrepressible, which shaped sexual refusal. Our findings move beyond socioeconomic status (SES) as a "risk factor" and explore two examples of how gender and social class mediate people's sexual selves and health.     

Men's reproductive and sexual health.

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

Sexual Behavior Latent Classes Among Men Who Have Sex With Men: Associations With Sexually Transmitted Infections

Men who have sex with men (MSM) are at disproportionate risk of acquisition of sexually transmitted infections (STIs). We used latent class analysis (LCA) to examine patterns of sexual behavior among MSM and how those patterns are related to STIs. We examined patterns of sexual behavior using behavioral and clinical data from a cross-sectional study of 235 MSM who presented to an urban sexual health clinic for STI testing. Analyzed data were collected using a combination of interviewer- and self-administered surveys and electronic health records. We used LCA to identify underlying subgroups of men based on their sexual behavior, described the demographics of the latent classes, and examined the association between the latent classes and STI status. We identified three latent classes of sexual behavior: Unprotected Anal Intercourse (UAI) Only (67%), Partner Seekers (14%), and Multiple Behaviors (19%). Men in the Multiple Behaviors class had a 67% probability of being STI positive, followed by men in the UAI Only class (27%) and men in the Partner Seekers class (22%). Examining the intersection of a variety of sexual practices indicates particular subgroups of MSM have the highest probability of being STI positive.     

Negotiating the Edge: The Rationalization of Sexual Risk Taking Among Western Male Sex Tourists to Thailand

Every year thousands of Western men travel to Thailand as sex tourists to participate in paid-for sex. Although many of these men will use condoms to protect themselves against sexually transmitted infections (STIs), others will not, despite the risks. By applying Steven Lyng’s (1990) concept of edgework to data collected from 14 face-to-face interviews with male sex tourists in Pattaya, Thailand, and 1,237 online discussion board posts, this article explores the ways in which these men understood and sought to rationalize the sexual risks they took. We argue that notions of likelihood of infection and significance of consequence underpin these behaviors, and we identify the existence of understandings of sexual risk that reject mainstream safer-sex messages and frame condomless sex as a broadly safe activity for heterosexual men. The article concludes by summarizing the difficulties inherent in driving behavior change among this group of men, for whom sexual risks appear to be easily rationalized away as either inconsequential or irrelevant.     

Linearity and nonlinearity in HIV/STI transmission: implications for the evaluation of sexual risk reduction interventions

A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual behavior change measures as indicators of the effectiveness of HIV/STI risk-reduction interventions. Findings indicate that the risk of acquiring HIV through vaginal intercourse is essentially a linear function of the number of unprotected sex acts and is nearly independent of the number of sex partners. Consequently, the number of unprotected sex acts is an excellent marker for the risk of acquiring HIV through vaginal intercourse, whereas the number of sex partners is largely uninformative. In general, the number of unprotected sex acts is not an adequate marker for the risk of acquiring a highly infectious STI due to the highly nonlinear per act transmission dynamics of these STIs. The number of sex partners is a reasonable indicator of STI risk only under highly circumscribed conditions. A theoretical explanation for this pattern of results is provided. The contrasting extent to which HIV and highly infectious STIs deviate from the linearity assumption that underlies sexual behavior outcome measures has important implications for the use of these measures to assess the effectiveness of HIV/STI risk-reduction interventions.     

Factors influencing condom use and STD acquisition among African American college women

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

The Influence of Community Disadvantage and Masculinity Ideology on Number of Sexual Partners: A Prospective Analysis of Young Adult,Rural Black Men

Young, rural Black men are disproportionately affected by sexually transmitted infections (STIs), a consequence, in part, of multiple sexual partnerships. We conducted a prospective study that examined the influence of masculinity ideology on changes in numbers of sexual partners in this population. We focused on a set of high-risk attitudes termed reputational masculinity. Community disadvantage during young adulthood was examined as a risk factor for reputational masculinity ideology, and vocational commitment was examined as a potential protective factor. The sample included 505 African American men ages 19 to 22 from high-poverty rural communities. Men reported their numbers of sexual partners during the past three months, masculinity ideology, community disadvantage, and vocational commitment. Follow-up data were collected 18 months after baseline assessment. Negative binomial modeling was used to test study hypotheses. Results indicated that community disadvantage was associated with increases in reputational masculinity during early adulthood, which in turn were linked to increases in numbers of sexual partners. Vocational commitment interacted with reputational masculinity to forecast numbers of sexual partners, attenuating the influence of reputational masculinity. Reputational masculinity and promotion of engagement with the workplace may be important targets for interventions designed to reduce sexual risk behavior.     

Alternative Practicum in Health Education

Abstract

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

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.     

Sexual Behavior in Parked Cars Reported by Midwestern College Men and Women

In an anonymous survey of 195 men and 511 women (M_age = 19.8) at a small Midwestern university, 119 men (61%) and 303 women (59.5%) reported that they had engaged in sex while parked. Of these 422, 14% lost their virginity in a parked car. Having sex in parked cars was more likely to involve relational dating partners than hookups. In most recent incidents, the majority of respondents were with a serious but noncohabiting romantic partner (56.9%) in the back seat (63.4%) of a standard car (56.4%) parked out in the country (56.0%). The most common sexual acts were penile-vaginal sex and genital touching, reported by 84.6% and 57.5% of respondents, respectively. Condoms were used by 58.2% of respondents. Less than 1% of respondents reported sexually transmitted infections (STIs) or pregnancy outcomes. These data, including personal stories of memorable incidents, revealed that despite discomfort, body bumps, and risk of being caught, sex while parked was primarily a positive sexual and romantic experience for both men and women. A dark side of parked-car sex existed in that 2.5% of men and 4.3% of women reported being sexually coerced. The future study of sex in parked cars in urban environments is recommended.     

The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections

Childhood sexual abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested case-control study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0-7.5; IPV only, OR = 2.2, 95% CI = 1.0-4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7-9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs.     

Examining Heterosexual Women’s Anal Sexual Health Knowledge and Product Use

Prevalence rates indicate that receptive anal sex is increasingly part of heterosexual women’s sexual repertoire. However, there is a body of literature linking this behavior to risk for adverse sexual health outcomes. Women’s anal sexual health knowledge and awareness of behaviors associated with elevated risk have received less attention in the research literature. The aim of the current study was to examine anal sexual health knowledge and product use among heterosexual women aged 18 to 30 years. A total of 33 self-identified heterosexual women recruited from the general population participated in one of six focus groups. The results suggest that knowledge was variable. Salient sexual health themes centered on risks of human immunodeficiency virus/sexually transmitted infections (HIV/STIs), other infections, and physical harm/damage. Product-use themes included cleanliness/hygiene, comfort, and product safety. Participants expressed the desire for anal sexual health education. The results have implications for sexual health research, education, and clinical practice.     

Primary care for young African American men

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

Condoms and Contexts: Profiles of Sexual Risk and Safety Among Young Heterosexually Active Men

Heterosexual men's sexual safety behavior is important to controlling the U.S. epidemic of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). While sexual safety is often treated as a single behavior, such as condom use, it can also be conceptualized as resulting from multiple factors. Doing so can help us achieve more nuanced understandings of sexual risk and safety within partner-related contexts. We used latent class analysis with data collected online from 18- to 25-year-old heterosexually active U.S. men (n = 432) to empirically derive a typology of the patterns of sexual safety strategies they employed. Indicators were sexual risk-reduction strategies used in the past year with the most recent female sex partner: condom use, discussing sexual histories, STI testing, agreeing to be monogamous, and discussing birth control. We identified four subgroups: Risk Takers (12%), Condom Reliers (25%), Multistrategists (28%), and Relationship Reliers (35%). Partner-related context factors—number of past-year sex partners, relationship commitment, and sexual concurrency—predicted subgroup membership. Findings support tailoring STI prevention to men's sexual risk-safety subgroups. Interventions should certainly continue to encourage condom use but should also include information on how partner-related context factors and alternate sexual safety strategies can help men reduce risk for themselves and their partners.     

Factors Influencing Condom Use and STD Acquisition Among African American College Women

Abstract

To identify factors that influence condom use and the risk of acquiring sexually transmitted diseases (STDs) among African American college women, the authors surveyed a sample of 123 sexually experienced undergraduate women at a state university. The college women who were older, had initiated sex earlier, or had more recent sexual partners were more likely than others in the study to report a history of an STD. The findings have implications for prevention and intervention programs for African American college women.     

Context of First Same‐Sex Condom Use and Nonuse in Young Black Gay and Bisexual Males

Despite high human immunodeficiency virus (HIV) rates among young Black men who have sex with men (YBMSM), there are limited data about condom use during first same‐sex (FSS). This study sought to understand socio‐contextual factors of 50 YBMSM aged 15–19 years that influenced condom use during FSS. Condom use was influenced by individual, partner, and community factors. Individual factors—recent illness or sexually transmitted infections (STI)—prompted condom use, while frequent HIV testing prompted nonuse. Partner factors—proactive encouragement from partners—prompted condom use, while trust and condom discomfort prompted nonuse. Larger community factors—such as presence of females—were key for use, while limited sexual health information combined with peers who discouraged condoms prompted nonuse. A multilevel approach may be useful in developing sexual health programming for these young men.     

Men's Reproductive and Sexual Health

Abstract

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.