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Studies of Aboriginal young people have often followed a deficit approach depicting them as 'risky' and in need of help. In contrast, this study took a strengths-based approach and focussed on what Aboriginal young people value, how they stay safe and how their culture impacts their lives. 16 Aboriginal men aged 16 to 24 years were interviewed in Sydney, Australia. We examined Aboriginal young men's perspectives about relationships, sex and gender. Interviews were conducted by young Aboriginal men in 2019 and 2020. Overall, four features of positive sexual and romantic relationships were discussed: (1) love, connection and support; (2) enjoyment and fun; (3) responsibility, safety and consent; and 4) honesty, respect and trust. Additionally, three topics related to gender roles: (1) becoming a man; (2) sex as a masculine achievement; and (3) inequality and gender stereotypes. Our study suggests that Aboriginal young men are exploring sexual and romantic relationships, and although they value enjoyment and fun, they are aware of broader issues such as consent and respect. The young men acknowledged gender stereotypes faced by young women. Our results could be used by future school safe sex education programmes to better meet the needs of Aboriginal young men. [ABSTRACT FROM AUTHOR]

Existing research into anal sex has centred on androcentric, medicalised parameters that focus on risk and health implications, leading to a lack of focus on women's experiences. Research that has focused on women's experiences has centred on concern around young women's anal sex practices, with little exploration of why people participate in anal sex and neglect of its relational and pleasure-based dimensions. The present study sought to explore these concerns via data gathered using focus groups and individual interviews with a range of individuals including sexual health practitioners and young people. Data were thematically coded, with results centred on three themes: anal sex as deviance, anal sex as phallocentric, and anal sex as agentic. Results suggest a pattern of perceptions and narratives that has potential to undermine honest education, advice-giving and safer sex if they are not addressed and questioned in safe spaces, prior to work with young people. The implications of these findings for sexual health education are discussed. [ABSTRACT FROM AUTHOR]

This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer conception strategies. This secondary analysis explored how challenges conceiving informed pregnancy plans and HIV prevention behaviours. The following themes were developed (1) partnership conflicts arise from HIV- and infertility-related forms of stigma, contributing to gender-based violence, partnership dissolution and the pursuit of new partners; (2) cultural and gender norms pressure men and women to conceive and maintain partnerships, which is complicated by the stigma directed towards serodifferent couples; (3) frustration with low partner participation in safer conception strategies led to the decreased use of these methods of HIV prevention; (4) health care provider support promotes continued hope of conception and helps overcome stigma. In HIV-affected partnerships, these intersecting forms of stigma may impact HIV prevention. Seeking to fulfil their reproductive needs, partners may increase HIV transmission opportunities as they engage in condomless sex with additional partners and decrease adherence to prevention strategies. Future research programmes should consider the integration of fertility counselling with reproductive and sexual health care. [ABSTRACT FROM AUTHOR]

While gay, bisexual and other men who have sex with men are most affected by HIV in Cuba, infections among women have increased over time, but there has been little research to contextualise their vulnerability to HIV. The purpose of this study was to explore the role of gender and violence in shaping vulnerability to HIV among Cuban women. Qualitative in-depth interviews were conducted with women living with HIV at an outpatient HIV clinic in Havana. Narrative and thematic technique were used to systematically analyse the data. Participants described negotiating sexual relationships in a context where traditional gender norms merge with the paradox of increasing professional opportunities for women alongside growing economic precarity. Interconnected economic and emotional dependence along with violence influenced the acceptance of certain behaviours that heightened vulnerability to HIV, including inconsistent condom use and infidelity. Gender transformative approaches that recognise the complex interplay between gender norms, economic precarity and violence are needed to address women's vulnerability to HIV in the Cuban context. Such efforts can reinforce existing strategies to promote behaviourally focused prevention while creating an enabling environment for the integration and expansion of biomedical innovation in HIV prevention. [ABSTRACT FROM AUTHOR]

International health development discourse constructs and regulates male sex workers as risky bodies in need of interventions for HIV. Drawing on ethnographic research among male sex workers and interviews with development sector actors in Nairobi, Kenya, this paper shows how the identification of male sex workers as a high-risk group for HIV offers a singular conceptualisation of their bodies as risky and renders invisible broader everyday struggles for security and wellbeing. Within these everyday struggles, male sex workers experience bodily risk as they are exposed not only to HIV, but also to being outed or outing themselves as gay. Interview findings show that development actors recognise and are empathic to male sex workers' security risks but have limited opportunity to address these due to restrictive donor regimes. To contribute to enduring change and develop appropriate and effective programmes, it is important for donors to continue funding HIV activities in relation to male sex work, while broadening their understandings of risk. [ABSTRACT FROM AUTHOR]

This paper explores the way in which some lesbians rely on culturally circulated narratives about identity to assess safer sex and their potential risk of sexually transmitted infection (STI) and HIV. A well-established narrative within the literature about lesbian safer sex is that STI risk is non-existent. The implications of this are important because they demonstrate the perception of lesbian identity and notions of safety. This study focuses on how gender and sexuality contextualise an assessment of risk and safety for lesbians. This is vital to understand because there is still a lack of language about lesbian safer sex practices and techniques. Lesbians narrate their assessments of STI and HIV risk through the lenses of gender and sexuality – locating 'risk' in gay men and bisexual women. Using narrative analysis, I find that lesbians assess their risk by constructing characters from culturally circulated narratives steeped in homophobia and biphobia of the sensible lesbian, the risky gay man and the uncertain bisexual. [ABSTRACT FROM AUTHOR]

Recent trends indicate that HIV and STI infection rates are rising among adults over the age of 50, and African American women have the highest rates of HIV infection across racial and ethnic groups of women in the USA. Limited research has examined factors that contribute to HIV risk among older African American women. The current study used Collins' Black Feminist Thought to examine and understand attitudes and perceptions around HIV and sexual risk behaviours among African American women aged 50 years and older. Participants were recruited from two faith-based organisations in the mid-Atlantic region of the USA. Overarching themes and subthemes included those of expectations among African American women (carry yourself as you were raised, and carry a big burden), risk factors (not at risk, sexual networks and loneliness) and protective factors (maintaining high standards and education). Findings from this study have implications for the development of future HIV prevention programmes involving older African American women, who have largely been overlooked by past and ongoing HIV prevention trials and safer sex promotion efforts. [ABSTRACT FROM AUTHOR]

Unplanned pregnancies constitute a major health problem globally carrying negative social, economic and health consequences for individuals and families. In this study, we explored the underlying causes and implications of this phenomenon in Eswatini, a country with high rates of unplanned pregnancy. Three focus group discussions were conducted in January 2018 with female health workers called mentor mothers, chosen because they offer a twofold perspective, being both Swati women and health workers in socially and economically disadvantaged settings. Using inductive thematic analysis, we identified five sub-themes and an overarching theme called 'the perpetuating cycle of unplanned pregnancy' in the data. A social-ecological model was used to frame the results, describing how factors at the individual, relationship, societal and community levels interact to influence unplanned pregnancy. In this setting, factors such as perceived low self-esteem as well as poor conditions in the community drove young women to engage in transactional relationships characterised by abuse, gender inequality and unprotected sex, resulting in unplanned pregnancy. These pregnancies led to neglected and abandoned children growing up to become vulnerable, young adults at risk of becoming pregnant unintendedly, thus creating an iterative cycle of unplanned childbearing. [ABSTRACT FROM AUTHOR]

In this qualitative study, 28 young adults (18-29-year-olds) living in Sydney define 'safe sex', report on their experiences of sex education, and reflect on the relationship between the sex education received in school and the reality of sexual activity. Participants had a broadly neoliberal understanding of health and risk as something individuals should manage through an ideal of rational decision-making. Yet regardless of how comprehensive or limited their sex education experiences, most noted a wide gulf between safe sex as taught in the classroom and the reality of actual sexual encounters, arguing that sexual decision-making was rarely rational, and shaped by age and experience, drug use, sexual desire, and complicated interpersonal dynamics. Sex education that aims to empower by presenting individuals as sole decision-makers when it comes to prophylactic use fails to acknowledge the social contexts of sex described by participants. Significantly, young people defined 'safe sex' not only in biomedical terms such as disease transmission and pregnancy, but also in terms of the social and psychological consequences of sexual encounters, with an emphasis on consent. [ABSTRACT FROM AUTHOR]

The emergence of COVID-19 precipitated varied responses from public health officials in London, England. In April 2020, clinicians at 56 Dean Street sexual health and advice clinic in central London described social isolation as 'a unique window of opportunity' to 'break the chain' in HIV transmission. This was followed by critical responses within HIV prevention circles. Drawing from these responses, this article examines the implications of the clinic's 'Test Now, Stop HIV' campaign by asking how has the early COVID-19 pandemic reshaped institutional responses and strategies to end HIV transmission in England? We assess how campaign messages developed between April and May 2020. We analyse materials related to the campaign, including the clinic's Twitter account, the campaign website, and journalism in mainstream media. Based on this information, we discuss three themes: testing and issues of access; the biopolitics of testing; and the idealism of quarantine. We draw on sociology, cultural theory and science and technology studies to describe how the 'end of HIV' was constructed through the link between COVID-19 and HIV. We suggest the campaign reinscribes historical perceptions of abstinence and quarantine as idealised HIV prevention strategies, and thus fails to address safer sex in the time of Coronavirus. [ABSTRACT FROM AUTHOR]

COVID-19 has transformed the way we live our lives, and sex has been a significant element of that transformation. Gay male sex in the UK has faced the most significant (re)criminalisation and (re)regulation in living memory with intimacy outside of the heteronormative framework of domestic coupledom at best discouraged and, at worst, made into a criminal offence. This criminalisation provides a temporal praxis in which gay men experience sex in the shadows once more, an echo of a historic legal and cultural regulation of desire. This history also provides a space for experiencing forms of impersonal intimacy and queer desire in a way that is arguably well-suited for viral times, namely the glory hole. These historic partitions and apertures – connecting gay men across legal and cultural boundaries of desire and affirmed through modes of anonymous and promiscuous sex – may once again provide a queer way to experience intimacy as impersonal. This article explores this potential and situates the glory hole as a cultural and legal site of this tension between the intimate and the impersonal, as well as considering how it is being recast as commercial artefact and performance space during these viral times. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore and describe contraception practices among young unmarried Vietnamese women seeking abortion after an unintended pregnancy. A qualitative study was conducted with voluntary participation of 42 women at a hospital in Ho Chi Minh City. Interview data were subjected to content analysis from which five categories were identified: (1) attitudes towards sexuality and contraception, (2) knowledge about contraception, (3) use of contraceptive methods, (4) cultural and traditional issues concerning sexuality and contraception, and (5) abortion as a solution to unwanted pregnancy. Prior to their abortion, women had viewed premarital sex as a means of maintaining a relationship with their boyfriends. Misconceptions, misbeliefs, fear of side effects and limited knowledge were reasons for not using contraception and, in case of unintended pregnancy, abortion was the solution. Boyfriends played an important role in influencing the use (or non-use) of contraceptives. Sexual and reproductive health education including counselling for gender equality, safer sex practices and the prevention of unintended pregnancy should be provided to both women and men in ways which combine traditional and modern views of sexuality. Intervention research to develop sexual and reproductive health education programmes, including contraception counselling, should be carried out. [ABSTRACT FROM AUTHOR]

Young women in Australia disproportionately experience unintended pregnancy and sexually transmissible infections (STIs). As the promotion of highly effective pregnancy prevention methods such as long-acting reversible contraception (LARC) increases, concurrent use of condoms with LARC remains optimal for pregnancy and STI prevention. There is little data exploring condom use behaviour in young Australian women using LARC. In this qualitative study we interviewed twenty women using LARC about their experiences of making decisions regarding condom use. We used inductive thematic analysis to identify factors influencing participant decision-making. We found that while LARC had an impact on condom use and sexual practices, decisions regarding condom use were influenced by multiple factors including mood, menstrual changes related to LARC, and relationship dynamics. Participants' views of 'safe sex' extended beyond pregnancy and STI protection, to include desired outcomes such as pleasure, consent and communication. Access to STI testing and treatment was key to how participants managed STI risk. Findings highlight the need for a more comprehensive approach to safer sex health promotion, and the importance of ensuring STI testing and treatment services continue to be available and accessible to all young people. [ABSTRACT FROM AUTHOR]

Each year Canada approves about 70,000 agricultural temporary foreign worker positions. However, few studies have examined temporary foreign workers' sexual health. In this mixed-methods study, we used surveys and focus groups to explore the knowledge of HIV and sexually transmitted infections (STI), sexual behaviours and the perspectives of sexual health of 100 Thai and Filipino temporary foreign workers in southwestern Ontario, Canada. The findings revealed that transnational migration had opened up social space that workers were not familiar with. Social isolation, stress and prolonged separation from spouses and partners resulted in the formation of new intimate relationships. Close to two-thirds of the 100 participants were sexually active in the twelve months prior to the study and over three-quarters did not use condoms. Many participants had misconceptions about HIV risks and safer sex practices. Few temporary workers accessed sexual health services due to language barriers, time constraints, stigma and lack of transport. As a result, many obtained medical advice and medicine through their families back home and relied on self-treatment in dealing with symptoms of genital infections. Effective sexual health promotion for temporary foreign workers must consider the complex interactive sociocultural and political processes that involve institutional practices in the local and transnational contexts. [ABSTRACT FROM AUTHOR]

In this longitudinal qualitative study we explored the lived experiences of young Black men who have sex with men in Dallas, Texas in relation to methamphetamine use, intimate partner violence and a history of incarceration as syndemic conditions that may contribute to their risk of transmitting or acquiring HIV. We conducted a total of 106 interviews (four repeat interviews every six months) with a cohort of 30 participants. Some reported condomless sex and no discussion about condom use or HIV status with sexual partners. Fifteen participants reported that they were living with HIV. Methamphetamine use contributed to participants' unstable housing, job loss, destructive relationships and HIV risk. One third of participants reported a history of intimate partner violence. About half had a history of incarceration resulting from intimate partner violence, substance use/dealing and/or other activities. Post-release, having a criminal record limited job opportunities and impacted financial stability. Consequently, some men engaged in survival work involving HIV risk (sex work, organising/participating in sex parties). Methamphetamine use, intimate partner violence and incarceration may constitute syndemic conditions that increase young Black men who have sex with men's risk for HIV acquisition and transmission. HIV prevention interventions must address syndemics and include structural factors and the wider social environment. [ABSTRACT FROM AUTHOR]

Despite the fact that HIV- and AIDS-related stigma is consistently identified as an impediment to HIV prevention, a multilevel conceptualisation of HIV- and AIDS-related stigma continues to be poorly understood. The role of multilevel HIV- and AIDS-related stigma in the HIV prevention and intervention behaviours of Asian American and Pacific Islander who have sex with men in the USA is particularly overlooked. Psychology has contributed significantly to the identification of individual or interpersonal level factors influencing HIV- and AIDS-related stigma, while sociology has contributed to a more societal perspective. This dichotomy has led to the absence of a multilevel conceptual framework for analysing the HIV- or AIDS-related stigma experienced by Asian American and Pacific Islander who have sex with men in the USA. In this paper, we argue for need to develop such a model which is culturally grounded and bridges the individual, interpersonal and societal conceptualisations of stigma prominent in the social science literature. To that end, we use Bronfenbrenner's ecological systems theory to explore the manifestation of HIV stigma at the micro, meso and macro levels and how these might impact on HIV testing and HIV service utilisation among Asian American and Pacific Islander men who have sex with men. We conclude by identifying some practice and research implications. [ABSTRACT FROM AUTHOR]

This qualitative study highlights the complex interplay between the social and structural conditions in Chengdu, China that shape the possibilities and vulnerabilities of money boys' sexual health. Within the context of China's liberalised market economy, we explore (1) how money boys' enter the sex trade market and navigate their sexual networks; (2) how their lives are enmeshed in fields of sexual desire, stigma and coercion; and (3) how the illicit and stigmatising nature of their work poses barriers to health service access. Findings reveal how the sex trade market and clinic are precarious spaces in which entrepreneurial ethics of the self and stigma-related coercive relations simultaneously enable and constrain money boys' sexual freedom and safer sex practices. By understanding this entrepreneurial precarity through the co-articulation of clinical and organisational work spaces, public health and social service providers can have a stronger sense of how various vulnerabilities configure to affect safer sex practices. [ABSTRACT FROM AUTHOR]

In this qualitative study, 28 young adults (18-29-year-olds) living in Sydney define 'safe sex', report on their experiences of sex education, and reflect on the relationship between the sex education received in school and the reality of sexual activity. Participants had a broadly neoliberal understanding of health and risk as something individuals should manage through an ideal of rational decision-making. Yet regardless of how comprehensive or limited their sex education experiences, most noted a wide gulf between safe sex as taught in the classroom and the reality of actual sexual encounters, arguing that sexual decision-making was rarely rational, and shaped by age and experience, drug use, sexual desire, and complicated interpersonal dynamics. Sex education that aims to empower by presenting individuals as sole decision-makers when it comes to prophylactic use fails to acknowledge the social contexts of sex described by participants. Significantly, young people defined 'safe sex' not only in biomedical terms such as disease transmission and pregnancy, but also in terms of the social and psychological consequences of sexual encounters, with an emphasis on consent. [ABSTRACT FROM AUTHOR]

Despite public health interventions targeting sex workers in an attempt to increase condom use, HIV still remains a significant health issue for those involved in the sex industry in many countries. In this paper, we analyse data collected as part of an ethnographic study of sex work in Soweto, South Africa. We show that the main problems with consistent condom use are clients who threaten violence if sex workers insist on condoms, clients who are 'rough' and refuse to stop intercourse when the condom breaks, and clients who offer to pay more money for unprotected sex. These issues relate to unequal gender norms that disempower female sex workers and dismiss the importance of consent in sexual relationships. The criminalisation of sex work increases vulnerability and reduces sex workers' agency as sex workers are reluctant to report crimes committed against them. Persistent 'whore stigma' adds to this dynamic by dehumanising sex workers. In conclusion, we advocate for decriminalisation and posit that public health interventions aimed at increasing condom use and reducing HIV rates need to specifically engage clients, address unequal gender norms and involve local communities to tackle stigma directed against sex workers. [ABSTRACT FROM AUTHOR]

Violence against women, including female sex workers, is a public health concern worldwide. This is the first study in Mozambique to estimate the prevalence of and factors associated with physical and sexual violence against female sex workers. We used data collected from 1,250 women recruited using respondent-driven sampling in the cities of Maputo, Beira and Nampula in 2011-12. Participants were 15 years of age and reported having had sex for money in the preceding six months. Prevalence of physical or sexual violence (defined as being hit or battered or raped or forced to have sex within the last 6 months) ranged from 10.0% to 25.6%. Strangers (37.0%) and acquaintances (31.2%) were reported to be the most frequent perpetrators of sexual violence. Among participants who experienced sexual violence, 65.9% and 87.0% did not seek medical care and police assistance, respectively. Physical or sexual violence was associated with city (adjusted odds ratio [AOR] 2.6 and 2.0 Nampula and Beira vs Maputo), age (AOR 1.9, aged 15-24 years vs aged 25 and older), unprotected sex with last client (AOR 1.6) and self-reported sexually transmitted infections (AOR 2.1). The high prevalence of violence found confirms the need for interventions to mitigate this problem. [ABSTRACT FROM AUTHOR]

Sexual coercion among married or cohabitating couples is a complex phenomenon with few effective strategies for prevention. This paper explores sexual coercion among couples from rural Rwanda who participated in Indashyikirwa, a 4-year intimate partner violence prevention programme that included a 5-month couples curriculum to promote equalitarian, non-violent relationships. Drawing on three rounds of longitudinal qualitative interviews with partners from 14 couples (28 individuals), this paper explores processes of change in experiences and conceptualisations of coerced sex over the course of the intervention and 1 year after. The data were analysed using thematic and dyadic analysis. Both partners of couples reported significant changes in their sexual relationship, including reduced experiences of coerced sex, greater communication about sex and increased acceptability for women to initiate sex. Men and women became more willing to disclose sexual coercion over the course of the interviews, both current and past experiences, and couples' accounts generally became more concordant. Findings yield insights to inform programming to prevent coerced sex among spouses. These include grounding discussion of sexual coercion in an analysis of gendered power and norms, reflecting on the consequences of broader forms of sexual coercion and employing a benefits-driven, skills-based approach. [ABSTRACT FROM AUTHOR]

Female sex workers experience high rates of gender-based violence and HIV. Alcohol has been shown to facilitate women's risk of both gender-based violence and HIV; however, little research has explored how aspects of the sex work environment shape this risk. Drawing on structuration theory, this study explored how social conduct is patterned across time and space within the sex work environment to influence alcohol consumption, gender-based violence and HIV risk among female sex workers. Qualitative in-depth interviews were conducted with 24 female sex workers enrolled in an ongoing community randomised controlled trial of a combination HIV prevention intervention in Iringa, Tanzania. Data were analysed using both inductive and deductive approaches. Findings reveal how routine interactions between female sex workers and their clients occur at three moments of time and space during the sex exchange process to facilitate alcohol consumption and increase women's risk of gender-based violence and HIV. Findings also highlight how sex workers utilise collective agency to address aspects of the sex work environment that place them at risk of alcohol abuse, gender-based violence and HIV. Implications for future interventions to prevent gender-based violence and HIV among female sex workers in Tanzania and similar contexts are discussed. [ABSTRACT FROM AUTHOR]

Evidence suggests that Ebola virus disease can be transmitted through unprotected sexual intercourse, in particular through contact with the semen of an infected person. Yet few studies examine sexual behaviours in the context of Ebola. Using data collected from 460 women and 340 men within 40 selected communities in the Greater Accra Region of Ghana, this study employed hierarchical linear modelling to examine individual and community-level factors that influence willingness to engage in behaviours that protect against the sexual transmission of Ebola. Results indicate that both individual and community-level factors are significant predictors of respondents' willingness to engage in preventive behaviours. Compared with those with no risks, female respondents with low and medium risk perceptions were significantly more likely to indicate they would use condoms to prevent the sexual transmission of Ebola (AOR = 2.23; p < 0.01). Compared with men who were very concerned, those who were not very concerned (AOR = 0.356; p < 0.01) and not at all concerned (AOR = 0.356; p < 0.05) about Ebola were significantly less likely to protect against the sexual transmission of Ebola. Female respondents in communities with high knowledge about Ebola were significantly more likely to engage in behaviours preventing the sexual transmission of Ebola virus disease (AOR = 1.93; p < 0.05). [ABSTRACT FROM AUTHOR]

Scholars have posited that childhood socialisation experiences may play a key role in influencing behaviours and attitudes that contribute to the acquisition of HIV. This study examined the links between past ethnic-racial and gender socialisation, sexual assertiveness and the safe sexual practices of African American college women utilising a cluster analytic approach. After identifying separate racial-gender and ethnic-gender socialisation profiles, results indicated that ethnic-gender socialisation cluster profiles were directly associated with sexual assertiveness and safer sex behaviour. Greater levels of ethnic socialisation and low traditional gender role socialisation were found to be associated with greater sexual assertiveness and safer sex behaviour. Further analysis showed that sexual assertiveness mediated the links between the identified ethnic-gender socialisation profiles and safer sex behaviour. Implications for policy and programme development are discussed. [ABSTRACT FROM AUTHOR]

Up to two-thirds of new cases of HIV transmission between gay, bisexual and other men who have sex with men in the USA are attributed to primary relationships. Understanding the relationship dynamics and sexual agreements of male-male couples can provide insight into HIV transmission patterns and prevention needs in this population. The daily use of antiretroviral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its negotiation and use within social and intimate relationship contexts remain understudied. We conducted semi-structured qualitative interviews with 20 male couples (n = 40 men) in which at least one partner was either using or in the process of initiating PrEP. Congruent with a theoretical focus on social theories of relationships and negotiated risk, couples were interviewed about relationship dynamics, trust, communication and sexual health practices, including their perception and use of PrEP. Overall, we found that couples showed heightened trust and communication when establishing open, sexual agreements and demonstrated high awareness of sexual risks and health practices in the context of PrEP use. This study demonstrates how understanding relationship dynamics can better inform HIV prevention and sexual health promotion efforts for male couples at risk of HIV. [ABSTRACT FROM AUTHOR]

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms. [ABSTRACT FROM AUTHOR]

Each year large numbers of Western men travel to Thailand for sex tourism. Although many will use condoms during their sexual encounters, others will not, potentially exposing themselves to the risk of acquiring sexually transmitted infections, including HIV. Although sex tourism in Thailand has been well documented, the social drivers underpinning voluntary sexual risk-taking through the avoidance of condoms remain poorly understood. Engaging with R.W. Connell’s concept of hegemonic masculinity and drawing on data collected from 1237 online discussion board posts and 14 face-to-face interviews, this study considers the ways in which understandings and performances of masculinities may inform the sexual risk-taking behaviours of Western male sex tourists. It argues that for some of these men, unprotected sex is viewed not as a reckless behaviour but, instead, as a safe and appropriate masculine practice, supported by relationships that are often framed as romantic and within a setting where HIV is still largely considered a homosexual disease. With sex workers often disempowered to request safer sexual practices, and some men’s attitudes towards unprotected sex resistant to external health promotion advice, the paper concludes by considering what this might mean for policy and practice. [ABSTRACT FROM PUBLISHER]

Evidence suggests that men with recent histories of incarceration are more likely to engage in high-risk sexual activity, however there is limited research exploring how having been recently released from prison might impact men’s sexual risk behaviours or sexual partnering. This qualitative study explores the ways in which exposure to incarceration impacts the dynamics of sexual partnering among recently released Black men in Baltimore, USA. In-depth interviews were conducted with 19 recently released Black men between 21–45 years of age living in the city. Data were analysed using a combination of inductive and deductive approaches. Participants reported that women living in the neighbourhoods to which they returned found recently released men to be highly desirable sexual partners because they offered increased potential for sexual gratification, were perceived as healthier than other sexual partners in their communities and represented opportunities for attaining financial stability and the potential for establishing romantic partnerships. As a result, men reported they had more opportunities for sex and more power to negotiate sex with women. Recently released Black men’s perceptions of their own sexual desirability among women raise important implications regarding power in the sexual relationships of recently released men that may increase HIV- and sexually transmitted infection-related risk for recently released men and their sexual partners. [ABSTRACT FROM PUBLISHER]

Many women continue to become infected with HIV, particularly in the Southeastern USA, despite widespread knowledge about methods to prevent its sexual transmission. This grounded theory investigation examined the decision-making process women use to guide their use or non-use of self-protective measures when engaging in sexual activity. Participants included women in the Mississippi cohort of the Women’s Interagency HIV Study who were infected with or at high risk for HIV. Theoretical sampling was used to recruit a sample of 20 primarily African American women aged between 26 and 56 years, living in rural and urban areas. Data were analysed using constant comparative method to generate a theory of the process that guided women’s self-protective decisions. Three key themes were identified: (1) sexual silence, an overall context of silence around sexuality in their communities and relationships; (2) the importance of relationships with male partners, including concepts of ‘love and trust’, ‘filling the void’ and ‘don’t rock the boat’; and (3) perceptions of risk, including ‘it never crossed my mind’, ‘it couldn’t happen to me’ and ‘assumptions about HIV’. These themes impacted on women’s understandings of HIV-related risk, making it difficult to put self-protection above other interests and diminishing their motivation to protect themselves. [ABSTRACT FROM PUBLISHER]

Recent advances in biomedical HIV prevention have led to optimistic projections of a dramatic worldwide reduction of new infections by 2030. This optimism is counterbalanced by concerns that the protective benefits of one such technology, HIV pre-exposure prophylaxis (PrEP), may be negated by increases in other behaviours that offset these benefits (risk compensation). To contribute to a deeper understanding of concepts of safety and risk in the context of HIV PrEP, we draw on the narrative accounts of 61 male PrEP users who participated in the inaugural PrEP demonstration project: the iPrEx open-label extension study. We conducted in-depth interviews with a purposeful sample of iPrEx participants. Overall, participants did not report significant changes to their sexual practices once they had begun taking PrEP. Rather, participants reported experiencing a sense of relief or reprieve from HIV-related stress. This unburdening of fear did not necessarily lead to condomless sex. Instead, men expressed feeling a sense of security and less free-floating fear of HIV. We contend that no longer living under the threat of HIV is a significant benefit that has not been adequately explored in HIV prevention research. [ABSTRACT FROM PUBLISHER]

The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption. [ABSTRACT FROM AUTHOR]

Older people are often excluded from large studies of sexual health, as it is assumed that they are not having sex or are reluctant to talk about sensitive topics and are therefore difficult to recruit. We outline the sampling and recruitment strategies from a recent study on sexual health and relationships among older people. Sex, Age and Me was a nationwide Australian study that examined sexual health, relationship patterns, safer-sex practices and STI knowledge of Australians aged 60 years and over. The study used a mixed-methods approach to establish baseline levels of knowledge and to develop deeper insights into older adult’s understandings and practices relating to sexual health. Data collection took place in 2015, with 2137 participants completing a quantitative survey and 53 participating in one-on-one semi-structured interviews. As the feasibility of this type of study has been largely untested until now, we provide detailed information on the study’s recruitment strategies and methods. We also compare key characteristics of our sample with national estimates to assess its degree of representativeness. This study provides evidence to challenge the assumptions that older people will not take part in sexual health-related research and details a novel and successful way to recruit participants in this area. [ABSTRACT FROM PUBLISHER]

Recent critical studies of men and masculinities have encouraged greater consideration of global, international and transnational perspectives and processes. Drawing on interview data from a larger research study of transnationalism and HIV risk through the experiences of recent male Chinese immigrants to Canada, this article examines the intersection of masculinity, sexual practice and the HIV risk in a transnational context. As a gendered strategy, transnational mobility is not only employed by men to cope with the challenges of masculinity enactment encountered in Canada, but also to facilitate sexual activities back in China. By highlighting particular risk factors arising from transnational spaces these men inhabit, the paper reveals the interactive and interconnected effects that such experiences have on Chinese immigrant men’s particular behavioural patterns associated with HIV risk, as well as their capacity to respond to this risk. [ABSTRACT FROM PUBLISHER]

Much contemporary focus on male-for-male sex work has been with men who place advertisements on profile-based sex work websites. Less is known about men who sell sex via online bulletin boards. We compared two samples of men who were selling sex: a 2014–2015 survey of men on Craigslist.org (n= 95) and a 2013 study of men on Rentboy.com (n= 418). In multivariable modelling, compared to Rentboy, Craigslist participants had a significantly higher odds of being non-White (AOR = 5.32), gay identified (AOR = 2.32), making less than US$20,000 a year (AOR = 3.77), having used marijuana in the past 12 months (AOR = 3.41). Furthermore, compared to Rentboy, Craigslist participants had significantly lower odds of escorting full-time (AOR = .24), kissing (AOR = .23) or having anal insertive sex (AOR = .36) with their last male client, that their last paid encounter exceeded 1 hour in duration (AOR = .49) or having been paid over US$200 for that encounter (AOR = .19), and fewer clients in the past 30 days (AOR = .95). Craigslist participants were at greater economic disadvantage compared to men from Rentboy; however, they were less likely to engage in HIV risk behaviours (anal sex and condomless anal sex). These samples may represent distinct populations along the continuum of sex work. [ABSTRACT FROM PUBLISHER]

This paper explores condom use and lubrication practices among Black men who have sex with men in South African townships. Results are from 81 in-depth individual interviews conducted among a purposive sample from four townships surrounding Pretoria as part of a larger qualitative study. Awareness that condoms should be used to have safer anal sex was ubiquitous. Fewer men reported that lubricants should be used to facilitate anal intercourse. Partner pressure and partner distrust were the most common barriers cited for not using condoms and lubricants. Knowledge about condom-lubricant compatibility was rare. Condom problems were a norm, with widespread expectations of condom failure. Men’s subjectivities – their perceptions of and preferences for specific brands, types and flavours of condoms and lubricants – influenced engagement with such safer-sex technologies. However, what was available in these settings was often neither what men needed nor preferred. Findings show the need to enhance access to appropriate and comprehensive: safer-sex supplies, health services and health education, and underline the importance of efforts to develop targeted programmes relevant to experiences of men who have sex with men in the South African context. [ABSTRACT FROM PUBLISHER]

Limited research exists about condom failure as experienced by female sex workers. We conducted a qualitative study to examine how female sex workers in Mombasa, Kenya contextualise and explain the occurrence of condom failure. In-depth, semi-structured interviews were conducted with thirty female sex workers to ascertain their condom failure experiences. We qualitatively analysed interview transcripts to determine how the women mitigate risk and cope with condom failure. Condom failure was not uncommon, but women mitigated the risk by learning about correct use, and by supplying and applying condoms themselves. Many female sex workers felt that men intentionally rupture condoms. Few women were aware of or felt empowered to prevent HIV, STIs, and pregnancy after condom failure. Interventions to equip female sex workers with strategies for minimising the risk of HIV, STIs, and pregnancy in the aftermath of a condom failure should be investigated. [ABSTRACT FROM PUBLISHER]

Little research has explored the link between the behavioural effects of testosterone use among transmen and HIV risk. We conducted a mixed methods study to explore testosterone use among transmen and the behavioural effects on HIV risk. A sample of 122 transmen from San Francisco participated in a cross-sectional quantitative survey and 14 transmen participated in 2 focus group discussions. Most participants (81.9%) were currently taking hormones. Participants attributed testosterone use to new sexual behaviours among 69% of transmen, changes in sexual attraction (49%), and increased frequency of sexual activity (72%). Among current testosterone users, 3.3% had cisgender men as partners before starting testosterone, whereas after starting testosterone, 25.4% did. Similarly, 4.1% had a transgender woman as a sexual partner before starting testosterone and 13.9% after starting testosterone. Findings suggest that testosterone’s side effects were associated with transmen’s desires for sex with cisgender men who have sex with men. The reported increase in attraction to and sex with partners from populations with a high HIV prevalence may have important implications for HIV risk among transmen, especially as the availability of transgender health services may draw transmen to a context in which HIV prevalence is high. [ABSTRACT FROM PUBLISHER]

Heterosexual anal intercourse is associated with increased risk for HIV and other sexually transmitted infections. Research on the social and psychological risk factors associated with heterosexual unprotected anal intercourse among Hispanic women in the USA is limited. We examined demographic, mental health, relationship power, sexual self-efficacy, self-esteem, acculturation and HIV knowledge as correlates of unprotected anal intercourse among 514 HIV-negative Hispanic women, 18 to 59 years of age, residing in one urban county in southern Florida. In both unadjusted and adjusted results, the likelihood of engaging in unprotected anal intercourse was associated with food insecurity in the past 30 days (adjusted odds ratio [AOR] = 1.57, 95% confidence interval [CI] 1.03, 2.40) and more interpersonal power attributed to the male partner (AOR = 1.63, 95%CI 1.08, 2.45). Not significant, yet of possible importance, were ever having engaged in exchange sex (AOR = 1.96, 95%CI = 0.97, 3.98) and lower HIV knowledge (AOR = 0.80, 95%CI = 0.63, 1.01). Interventions aimed at reducing heterosexual unprotected anal intercourse risk for HIV infection among Hispanic women may benefit by addressing socioeconomic and interpersonal issues, and assessing HIV knowledge and comprehension. [ABSTRACT FROM AUTHOR]

Approximately 60–80% of college students in the USA report a hookup experience in the form of a casual sexual encounter between individuals without the expectation of a dating or romantic relationship. Given the potential health risk posed by these sexual encounters, the need exists to critically examine this cultural phenomenon on college campuses. Yet, the existing hookup literature is overwhelming White and often exclusive of historically marginalised populations such as Black women. Accordingly, this paper examines the role of the intersecting identities of race and gender and other social factors that influence the sexual health and wellbeing of Black women on US college campuses. Specifically, we explore issues related to the gender ratio disparities present on college campuses, relationship power imbalances, inconsistent condom use and low sexual-risk perception. Moving forward, hookup research needs to utilise an intersectional approach; we offer specific suggestions for the important inclusion of Black women in the broader hookup discourse and future research. [ABSTRACT FROM PUBLISHER]

This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men. [ABSTRACT FROM AUTHOR]

Young men who have sex with men are becoming the most at-risk subgroup for HIV incidence in Hong Kong. To understand how young gay men in Hong Kong interpret and implement safer sex and condom use, focus-group discussions and individual in-depth interviews were held. The 74 participants were nearly all ethnic Chinese gay men aged between 18 and 25 years. Findings indicate that the challenge for health intervention lies in young gay men’s inconsistent condom use despite their high level of HIV-related knowledge. Participants described using condoms, testing for HIV and abstaining from anal sex as measures undertaken to prevent HIV infection. However, sociocultural norms and expectations pertaining to ‘0’ (docile, bottom) and ‘1’ (assertive, top) roles and trust between partners complicate the consistent implementation of risk-reduction measures. Influenced by heteronormative and romantic beliefs, sexual behaviours such as condomless anal sex and internal ejaculation hold symbolic meanings – exclusivity, commitment, intimacy, possession – for young gay men in Hong Kong, which override health concerns. These findings support more empowerment-driven HIV programming for young gay men. [ABSTRACT FROM PUBLISHER]

HIV risk in vulnerable groups such as itinerant male street labourers is often examined via a focus on individual determinants. This study provides a test of a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behaviour among male street workers in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 male street labourers from 13 districts of Hanoi, Vietnam were recruited and interviewed. Collected data were first examined for completeness; structural equation modelling was then employed to test the model fit. Condoms were used inconsistently by many of these men, and usage varied in relation to a number of factors. A modified IMB model had a better fit than the original IMB model in predicting condom use behaviour. This modified model accounted for 49% of the variance, versus 10% by the original version. In the modified model, the influence of psychosocial factors was moderately high, whilst the influence of HIV prevention information, motivation and perceived behavioural skills was moderately low, explaining in part the limited level of condom use behaviour. This study provides insights into social factors that should be taken into account in public health planning to promote safer sexual behaviour among Asian male street labourers. [ABSTRACT FROM PUBLISHER]

Female sex work accounts for about 15% of the global HIV burden in women. Asia is the region with the second highest attributable fraction of the HIV epidemic after sub-Saharan Africa. This review synthesises studies that depict the barriers and facilitators encountered by sex workers in Asia when negotiating consistent condom use. A total of 18 studies published between January 1989 and May 2015 were included in the review. Data were extracted, critically appraised and analysed using a thematic analysis approach. Individual-level factors related to sex workers’ knowledge, perception and power, as well as interpersonal-level factors that encompassed dynamics with clients and peer-related factors, presented as both barriers and facilitators to sex workers’ condom negotiation process. In addition, the structural environment of sex work, access to resources, poverty, stigma, the legal environment and the role of media were also identified as factors in influencing the condom negotiation process of sex workers. A multisectoral interventional approach that addresses the multilevel barriers encountered by sex workers in condom negotiation is needed. Awareness of safe-sex practice should be collectively enhanced among sex workers, clients and brothel managers. [ABSTRACT FROM PUBLISHER]

Sexual risk-taking is influenced by individual, interpersonal and social factors. This paper presents findings from a qualitative follow-up study to a clinical trial evaluating biomedical HIV prevention products among African women, explored participants’ perceptions and experiences of heterosexual penile-anal intercourse, as well as the gendered power dynamics and relationship contexts in which this sexual behaviour occurs. In-depth interviews were conducted with 88 women from South Africa, Uganda and Zimbabwe. Findings reveal that despite its social stigmatisation, women engage in penile-anal intercourse for reasons including male pleasure, relationship security, hiding infidelity, menstruation, vaginal infections, money and beliefs that it will prevent HIV transmission. In addition, participants described experiences of non-consensual penile-anal intercourse. We used sexual scripting theory as an analytical framework with which to describe the sociocultural and relationship contexts and gendered power dynamics in which these practices occur. These data on the distinct individual, dyadic and social contexts of heterosexual penile-anal intercourse, and the specific factors that may contribute to women’s HIV risk, make a unique contribution to our understanding of heterosexual behaviour in these sub-Saharan countries, thereby helping to inform both current and future HIV prevention efforts for women in the region. [ABSTRACT FROM PUBLISHER]

This paper analyses the use of the concept of ‘barebacking’ as a risk category in the discourses of French gay men. It discusses how the rise and spread of the term barebacking contributes to reframing gay men’s personal experiences of HIV prevention and their sense of belonging (or a lack thereof) to a gay community. The study is based on 30 qualitative interviews with French gay men conducted between 2005 and 2008. An import from the USA, the term barebacking emerged publicly in France in the late-1990s and was first used to describe intentionally unprotected sexual practices. Debates surrounding this risk category were marked by violent controversy over its use and its definition among HIV prevention actors. There remains a general lack of consensus on the definition of the term, despite its use by activists, in porn culture and in the daily discourses of gay men. By focusing on the relational roots of risk perception, I consider how uses of the term barebacking invoke a moral framework around risk taking. [ABSTRACT FROM PUBLISHER]

Sex workers are often perceived as possessing ‘deviant’ identities, contributing to their exclusion from health services. The literature on sex worker identities in relation to health has focused primarily on cisgender female sex workers as the ‘carriers of disease’, obscuring the experiences of cisgender male and transgender sex workers and the complexities their gender identities bring to understandings of stigma and exclusion. To address this gap, this study draws on 21 interviews with cisgender male and transgender female sex workers receiving services from the Sex Workers Education and Advocacy Taskforce in Cape Town, South Africa. Our findings suggest that the social identities imposed upon sex workers contribute to their exclusion from public, private, discursive and geographic spaces. While many transgender female sex workers described their identities using positive and empowered language, cisgender male sex workers frequently expressed shame and internalised stigma related to identities, which could be described as ‘less than masculine’. While many of those interviewed felt empowered by positive identities as transgender women, sex workers and sex worker-advocates, disempowerment and vulnerability were also linked to inappropriately masculinised and feminised identities. Understanding the links between gender identities and social exclusion is crucial to creating effective health interventions for both cisgender men and transgender women in sex work. [ABSTRACT FROM PUBLISHER]

With a focus on Uganda, this paper examines men’s condom use in sexual relationships with casual partners and what this might tell us about men’s vulnerability to HIV-infection. We carried out repeat interviews with 31 men attending a clinic serving women at high risk for HIV infection and their partners in Kampala. We found that the experience of condom-less sex in the men’s youth, itself the outcome of a restrictive home environment, was perceived as influencing later unsafe sexual behaviour. Peer pressure encouraged men to have multiple partners. Alcohol negatively affected condom use. Men often opted not to use a condom with women they thought looked healthy, particularly if they had had sex with the same woman before. Some men who were HIV-positive said they saw little point in using condoms since they were already infected. A concerted effort is required to reach men, like those in our study, to halt HIV and the transmission of other sexually transmitted infections. [ABSTRACT FROM PUBLISHER]

In order to examine whether pornography consumption is associated with risky sexual behaviour among emerging adults, we examined two large samples of those who reported hooking up in the past 12 months (combined n =  1216). Pornography use was associated with a higher likelihood of having a penetrative hookup; a higher incidence of intoxication during hookups for men (but a lower incidence of intoxication during hookups for women); increasing levels of intoxication during hookups for men but decreasing levels of intoxication for women; and a higher likelihood of being in the riskiest category of having a penetrative hookup, without a condom, while intoxicated. For each of these outcomes, our point estimates for Study 2 fell within the 95% confidence intervals from Study 1. Controlling for trait self-control, binge drinking frequency, broader problematic patterns of alcohol use, openness to experience, and attitudes toward casual sex did not change the pattern of results. Implications for interventions to reduce sexual risk are discussed. [ABSTRACT FROM AUTHOR]

Sexually explicit media may perpetuate racial and sexual norms among men who have sex with men. While men may be exposed to sexually explicit media in the online settings where they seek sex with other men, no studies to our knowledge have explored the relationship between the racial and sexual content of advertisements appearing in these spaces. In 2011, using a detailed codebook, 217 sexually explicit advertisements on a male sex-seeking website were coded for themes, actor characteristics and sexual acts depicted. Multivariable logistic regression models examined the association between skin colour, theme, sexual acts and condomless sex acts. Nearly half (45%) featured a ‘thug’ theme (a style emphasising Black masculinity/hip-hop culture), 21% featured a college theme and 44% featured condomless sex. Advertisements featuring only Black men, advertisements featuring Black men with men of other skin tones and advertisements depicting a thug theme were positively associated with depictions of condomless sex. Online sexually explicit advertisements featuring Black themes and actors more frequently depicted condomless sex than advertisements with White men alone. Future research should examine whether depictions of Black men engaging in condomless sex in online advertisements influence the sexual norms and cognitions of Black men who have sex with men and their partners. [ABSTRACT FROM PUBLISHER]