Partnerships in Sexual and Reproductive Health

Abstract

One of the elements of successful access to youth friendly sexual and reproductive health services consists of effective partnerships between the civil society, Government, and the corporate world. Key elements that define successful partnerships for any organisation are trust, openness, respect and interdependence.     

Bush's War on Sexual Health and Defensive Strategies Against It

Abstract

Since George W. Bush became President of the United States in 2001, his administration has presided over a far-reaching campaign attacking sexual and reproductive rights. This paper examines three facets of this campaign-the promotion of abstinence-only education; a general attack on condom use; and a campaign against sex workers-and offers strategies for advocates of sexual and reproductive rights to counter these measures.     

Broken Promises: Abstinence Pledging and Sexual and Reproductive Health

Approximately 12% of girls and young women in the United States pledge abstinence. Yet most break their pledges, engaging in first intercourse before marriage. The extant literature reports few differences between pledge breakers and nonpledgers in sexually transmitted infections and nonmarital pregnancies. The present research maintains that previous studies may have obscured important differences in exposure risk and hypothesizes that female pledge breakers who have higher exposure risk are more likely to experience human papillomavirus (HPV) and nonmarital pregnancies. To test this hypothesis, this study uses the National Longitudinal Study of Adolescent to Adult Health, logistic regression, and event history modeling. The results show that, after accounting for differences in exposure risk, pledge breakers have higher risk of HPV and nonmarital pregnancy. As a set, the results are consistent with the argument that pledgers use condoms and contraceptives less consistently and highlight unintended consequences of abstinence promotion.     

Sexual and Reproductive Health Behaviors of California Community College Students

Abstract

Objective: To explore the sexual and reproductive health behaviors of students from 13 community college campuses in California. Participants: Heterosexual college students, ages 18 to 24, who have had sexual intercourse (N = 4,487). Methods: The American College Health Association's National College Health Assessment (ACHA-NCHA) survey was administered in class to randomly selected classrooms at 12 institutions and electronically to randomly selected e-mails of students at 1 institution from March through April 2007. Results: This sample of community college students reported higher rates of risky sexual behaviors, unintended pregnancy, emergency contraception, and sexually transmitted diseases, and lower rates of human immunodeficiency virus (HIV) testing, than the overall ACHA-NCHA reference group. Those who had been tested for HIV reported more sexual partners, and lower rates of condom use. Conclusions: The data provide justification for broader educational programs and access to family planning services, condoms, and HIV testing on community college campuses.     

Promotion of Sexual Health in the United States

Abstract

The United States has been experiencing a severe sexual health crisis in the last decade. This paper reviews these sexual health challenges and discusses a major initiative and a “Call to Action” that was launched by the U.S. Surgeon General in 2001 to promote sexual health. This led to several initiatives to overcome obstacles that were preventing the development of a sound, scientifically based public health policy to promote sexual health. This paper specifically outlines the components of the Sexual Health Program housed at the Morehouse School of Medicine's National Center for Primary Care, including the National Advisory Council and the National Consensus Process.     

Sexual Health for the Millennium: An Introduction

ABSTRACT

This special issue of the International Journal of Sexual Health is devoted to the issues of the United Nations Millennium Development Goals and the effort by the World Association for Sexual Health to argue that the promotion of sexual health is an essential strategy for attaining those goals. Recently, the World Association for Sexual Health has published Sexual Health for the Millennium: A Declaration and Technical Document (2008). This special issue of the IJSH contains the background papers which served as a foundation for the development of the declaration and technical document. These articles argue that sexuality is a fundamental aspect of being human, that human development must be premised on the promotion of sexual health and is a basic human right for all citizens. Public policies designed to promote human development must make the promotion of sexual health an essential strategy. This special issue is designed to stimulate more interest in the Sexual Health for the Millennium: A Declaration and Technical Document, encourage further analysis and research which will support the statements in the declaration, provoke more advocacy for sexual health, and, most importantly, to stimulate sound and effective public policies to create a sexually healthier world.     

College Men's Health in Practice: A Multidisciplinary Approach

Abstract

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.     

Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

ABSTRACT

Current attempts to address the high burden of sexual health morbidity and mortality in developing countries remain limited in scale due to a range of health system constraints. We conducted a literature review of the policy and programmatic issues that influence the integration of sexual health into primary care services in developing countries. Forty-seven reports were identified from a search of both peer-reviewed and gray literature. Key issues identified were intersectoral and intergovernmental coordination; management and organizational issues including decentralization, health sector reform, logistics, and referral systems; human resources, including training and support required to increase service scope; relationships between the public and private sectors; and scaling-up and financing issues.     

One Hundred Years of College Mental Health

Abstract

Although the first student health service is credited to Amherst College in 1861, almost 50 years passed before Princeton University established the first mental health service in 1910. At that time, a psychiatrist was hired to help with student personality development. Although other schools subsequently established such services, the first 50 years of college mental health were marked by a series of national conferences. At the American Student Health Association's annual meeting in 1920, “mental hygiene” was identified as critical for college campuses to assist students to reach their highest potential. However, it took another 40 years before mental health and psychological counseling services became common on college and university campuses. The American College Health Association formed a Mental Health Section to serve mental health professionals in 1957, and most colleges and universities have now developed mental health and counseling programs commensurate with the size of their student bodies.     

Health Beliefs of College Students Born in the United States,China, and India

Abstract

The authors surveyed 243 urban public university students who were born in the United States, China, and India to compare the health beliefs of the China-born, India-born, and US-born students. Although the China- and India-born students shared beliefs in many preventive and therapeutic practices of Western medicine with the US-born students, they retained some of their traditional health beliefs. This suggests that student health service clinicians should assess students' cultural beliefs and individualize healthcare for students from different countries     

Perceptions of Physical Sexual Health Among Young Men Who Have Sex with Men with a Previous History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among young men who have sex with men (YMSM) than among heterosexual men. Most research and public health programs among YMSM CSA survivors have been mainly infectious disease-based, and research on the physical sexual health among this group is limited. This study sought to further understand components of physical sexual health among YMSM with CSA histories. Sixteen participants were recruited, and through a phenomenological approach, semi-structured interviews were conducted. Four themes were found, participants (1) reported a one-dimensional definition of sexual health; (2) had limitations in health insurance hindering preventative care; (3) described reoccurring anal pain during sexual intercourse; and (4) conveyed a positive perception of sexual satisfaction. These findings indicate a need for healthcare providers, health educators, and researchers to increase awareness about the comprehensive needs of YMSM with CSA histories.     

A National Survey of the Provision of Sexual Health Clinical Services by Public Health in Canada: First Insights

Objectives: Data documenting the scope of sexual health clinical services offered as public health in Canada are unavailable. This article provides first insights into the scope of STI and clinical sexual health services available nationally. Methods: Data were gathered using an online survey of 113 Canadian public health units. Results: Almost half of the clinics were not providing expedited partner therapy, one third were not providing point of care testing for HIV and one third were not using syndromic management of sexually transmitted infections (STIs). Low rates of physician support were evident. Conclusion: Given the ever-higher rates of STIs, findings from this study identify important challenges to providing comprehensive services.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

Sexual and reproductive health knowledge and information-seeking behavior among middle eastern female university students: a systematic review

Objectives: The objective of this study was to collate the level of sexual and reproductive health knowledge, awareness, attitudes, and behavior among female university students, in addition to identifying their sources of information in Middle Eastern and North African countries. Methods: A systematic review was conducted with a search in Medline, EMBASE, Web of Knowledge, PsycINFO, and CINAHL from inception to February 2013. Included were studies in any language describing sexual and reproductive health knowledge and attitudes among female university students. Results: Nine studies were included, and all were cross-sectional surveys. There was a general lack of knowledge of sexual and reproductive health. The highest knowledge levels reported were for HIV. Conclusions: There are deficiencies in sexual and reproductive health knowledge and behavior in Middle Eastern and North African countries. Studies are needed to evaluate how to provide culturally sensitive sexual and reproductive health information.     

What Pediatric Subspecialists Need to Know About Sexual and Reproductive Health: A Review of the American Board of Pediatrics Content Outlines for Subspecialty Certifying Examinations

ABSTRACT

Many adolescents with complex medical conditions regard their subspecialty providers as an important source of clinical information including sexual and reproductive health information related to their medical condition. Thus, training for pediatric subspecialty providers should include clinically relevant sexual and reproductive content. The purpose of this study is to understand what disease-relevant sexual and reproductive health information is currently included in content outlines for each of the available pediatric subspecialty certifying examinations. The American Board of Pediatrics (ABP) offers 17 subspecialty certifying examinations; 13 content outlines are available on the ABP website which defines the body of knowledge to be tested. Each available outline underwent content analysis for sexual and reproductive health information. A team of adolescent medicine physicians identified seven thematic areas including: 1) puberty; 2) sexual behavior and identity; 3) fertility; 4) contraception; 5) sexually transmitted infections; 6) other genital pathology; 7) pregnancy. Across disciplines, learning objectives related to sexual behavior, sexual identity, fertility, contraception and pregnancy were the most limited. However, content related to puberty, sexually transmitted infections and other genital pathology was better represented. Overall, disease-and treatment-specific sexual and reproductive health information was sparse. Most subspecialty content outlines contain very little disease-specific sexual and reproductive health information despite the growing adolescent and young adult population with complex medical conditions in the care of pediatric subspecialists. Further studies are needed to explore if lack of sexual and reproductive information on board exams relates to the knowledge base and skill set of pediatric subspecialists.     

Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child

Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers’ mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers’ health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.     

The College Student Psychiatric Emergency: A Descriptive Study

Abstract

The authors utilized computerized records of a psychiatric emergency department to study the nature of psychiatric emergencies among college students. The 1156 visits made by students over an eight-year period are described using demographic variables, times of visit, and accompaniment. Implications of the findings for campus administrators and mental health service providers are discussed.     

Sexual Arousal and Sexual Fantasy: The Influence of Gender,and the Measurement of Antecedents and Emotional Consequences in Macau and the United States

ABSTRACT

Objectives: Cross-cultural research was conducted to elucidate the relative influences of culture and gender on human sexuality. Methods: 353 male and female undergraduate students from universities in the United States and Macau completed self-report measures assessing sexual fantasy and arousal. Results: Males reported significantly more frequent sexual fantasy/arousal than females. Additionally, significant differences in the age of initial sexual arousal were found. Males from the United States reported the earliest age of initial arousal, followed by males from Macau, females from the United States, and females from Macau. Males from each region reported a significantly younger age of initial sexual fantasy than females within the same region. The Macau group reported significantly less frequent sexual arousal than the U.S. group. Conclusions: Sexual fantasy and arousal are susceptible to cultural and gender-based influences, whose strength varies by outcome measures.     

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.     

High-Risk Sexual Behavior Among Students of a Minority-Serving University in a Community With a High HIV/AIDS Prevalence

Objective: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. Participants and Methods: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. Results: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. Conclusions: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.