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The study reported in this paper explores the experiences of 95 people with intersex variations constituting an international English-speaking sample who completed a mixed methods survey comprises questions designed by the authors to explore 1) genital variations and medical interventions (and pressures to undertake them), 2) experiences with sex education, and 3) experience of physical intimacy, including use of safer sex devices and sexually transmitted infections. Surgeries on minors were common and typically not consensual, often resulting in the need for revisions. Pressures for surgeries most commonly were made by doctors. Experiences of sex education often failed to be inclusive of intersex bodies, with information about menstruation and hygiene rarely provided, and many participants having to learn on their own. Participants had a diversity of experiences of physical intimacy beyond penetration. For those who had experienced penetration, vaginal intercourse was enjoyable for some, but many found it painful. Conversely, anal intercourse was enjoyed by many and rarely found to be painful. The paper concludes by highlighting the importance of an intersex-specific approach to sexual health for this population. [ABSTRACT FROM AUTHOR]

Self-efficacy in sexual communication is essential for open conversations about sexual topics with partners, children, or medical providers. The Sexual Communication Self-Efficacy Scale was developed (SCSES) and validated in the Polish women population by analysing its reliability, validity, and factor structure. 204 Polish-speaking adult women were recruited to validate the tool. The reliability coefficient Cronbach's, exploratory, and confirmatory factor analysis were performed. Moreover, the factor structure was investigated by combining it with the short version of the Female Sexual Function Index (FSFI-6). The adaption of SCSES in the Polish women population revealed the five-factor structure of the tool. The reliability was α = 0.976.The construct validity was confirmed. The results showed a significant, positive, moderate correlation between FSFI scores in all SCSES subscales and its total score r = {0.439; 0.534}. Moreover, the education level and place of residence differentiated the SCSES scores. The SCSES is a valid and reliable tool for the Polish women population. The findings highlight the need of recognising the importance of sexual communication in sexual functioning. [ABSTRACT FROM AUTHOR]

Heterosexual university students continue to endorse sexual scripts that preference men's desire and sustain gendered power imbalances in sexual relationships and encounters, leading women to risk pregnancy by engaging in unprotected sex. Because young women also endorse norms encouraging them to protect themselves and their partners from unintended pregnancy, women are caught in a bind between two often competing norms. We conducted semi-structured individual interviews with university women (n = 45) to examine how they navigate these competing norms. We found that women explained risky contraceptive decisions by saying they "just weren't thinking," thus employing strategic ambiguity, or vague language used to maintain social status, to navigate between competing norms. Our findings suggest that women were actually thinking about risks and making calculated decisions in the moment which often privileged men, putting themselves at risk and sometimes causing distress. To save face, women presented the idea that they "just weren't thinking" in different ways that conformed to traditional notions of romance and sexuality: being in the moment, love and trust for their partner, and deferring to the perceived or actual wishes of men. We conclude that there is a need to promote and achieve affirmative sexuality which includes women feeling empowered to express their own sexual needs -- whether that be consent or refusal, contraception, pleasure, or all of these. [ABSTRACT FROM AUTHOR]

Internalized homophobia, or the internalization of negative attitudes toward one's sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM. [ABSTRACT FROM AUTHOR]

College students, particularly first-year students, are at risk for alcohol misuse and alcohol-related consequences (e.g., condomless sex). Our objective was to determine if first- and second-year students were more or less likely to report any act of condomless sex under the influence of alcohol than third- and fourth-year students. Participants (N = 447) were undergraduate students recruited from a private institution in Massachusetts. Logistic regression models were used to analyze differences in reported acts of condomless sex under the influence of alcohol in the past 30 days, by class rank. First- and second-year students had lower odds (OR 0.40, 95% CI: 0.252–0.648) of reporting condomless sex under the influence of alcohol than third- and fourth-year students. Implications from these results can contribute to understanding sexually transmitted infections in the college population. [ABSTRACT FROM AUTHOR]

Practitioners who work with children and young people such as educators, psychologists, and social workers, are required to understand and respond to various sexual behaviours in children and young people. However, there is a dearth of training programmes dealing with sexual development. To reduce over- and under-reporting of risk, which can have serious adverse outcomes, it is essential to educate practitioners in understanding and responding appropriately to sexual behaviours. This study evaluated Traffic Lights® professional development training programme – a one-day programme offered across Queensland, Australia, with the goal of educating practitioners and promoting safe and respectful sexual health among children and young people. Thirty postgraduate psychology students working with/interested in working with children and young people received Traffic Lights® training, and accuracy of understanding and responding to sexual behaviours presented in scenarios was assessed pre- and post-training. Participant responses were scored using criteria developed by a local sexual health organisation's research specialists. Findings revealed no significant improvement in understanding and responding to sexual behaviours in children and young people. Implications of this study include recommendations for small-scale evaluations with sexual health experts and follow-up research, which is critical given the need for evidence-based practice in this area. [ABSTRACT FROM AUTHOR]

To compare the demographics, sexual risk behaviors, and substance use characteristics of two probability samples of young men who have sex with men (YMSM): one recruited using a geosocial networking application (GSNA) and one recruited using venues. In 2017 and 2018, a cross-sectional online survey was utilized with a sample of 122 YMSM recruited in Los Angeles, CA. Recruitment procedures included both venue-based (n = 68) and GSNA-based probability sampling (n = 54). Sample substance use, sexual risk behaviors (e.g., unprotected sex at last encounter), and demographics were compared using chi-square tests and t-tests. The samples significantly differed in demographics characteristics (e.g., race, education, employment, outness). Samples did not significantly differ in sexual risk variables. Regressions indicated significant differences (higher in the venue sample) in substance use (marijuana, prescription drugs, alcohol, and poppers) between the two samples. Results indicate that recruitment method impacts demographics and substance use prevalence levels for YMSM. GSNA- based recruitment appears to recruit samples from a broader range of social demographics. GSNA-based methods may be especially applicable to areas in which venues are not readily accessible (e.g., rural areas), allowing social research with the most marginalized sexual minority populations. [ABSTRACT FROM AUTHOR]

Interventions involving simulated interactions aimed at mimicking real situations must be engaging to maximize their effectiveness. This study aimed to assess how a sample of middle school girls displayed behavioral and cognitive indicators of engagement when interacting with avatars representing game characters that were controlled by a human digital puppeteer. The simulation game, DRAMA-RAMA, is a component of an intervention intended to reduce at-risk girls' sexual and other risky behaviors. We used verbal/nonverbal behaviors and surveys to assess the game players' cognitive and behavioral involvement (N = 131). Participants perceived the game scenarios and interactions as realistic and the characters as similar to people in real life. Participants' behavior indicated their involvement and interest in interacting with the game characters. Finally, participants tended to be appropriate but not effective when attempting to advise/support the characters. These findings have implications for assessing successful operationalization of communication designs in interactive virtual learning environments. [ABSTRACT FROM AUTHOR]

This study integrates the important psychological well-being indicators (i.e., life satisfaction, psychological distress, and self-esteem) into a model framework. We used a cross-lagged panel design (CLPD) to examine the bidirectional relationship between casual sex and psychological well-being among Chinese college students. Chinese college students (N = 833) completed self-report measures (i.e., hookup behavior, life satisfaction, psychological distress, and self-esteem) at six-month intervals. The results show that the ratio of college students who reported engaging in at least one hookup experience in the past year or half a year was lower than that of Western college students. We find that college students with hookup behavior had poorer psychological well-being in later six months than those who did not engage in hookup behavior. However, previous psychological well-being did not predict subsequent hookup behavior. We discuss these findings in terms of China's unique sexual culture to provide useful information for preventing and interfering with risky sexual behaviors and their negative consequences among Chinese college students. Specifically, this study could provide students with a more in-depth understanding of associated risks, assisting those engaged in or intending to engage in hookups to evaluate the advantages and drawbacks of such behavior. Furthermore, it underscores the importance of implementing targeted educational programs in China that address the psychological consequences of casual sex. [ABSTRACT FROM AUTHOR]

We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland. We used data from the Health Behavior in School-aged Children study. Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p <.001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022. Experiences during adolescents' first sex may have lasting implications for later sexual behavior. [ABSTRACT FROM AUTHOR]

Although numerous reports document college students' risk-taking behaviors, few examine these behaviors in a developmental context. The purpose of this study was to examine female freshmen college students' pre-college experiences and parenting influences on first semester experiences with alcohol misuse, sexual risk-taking, and adverse outcomes, including violence. We surveyed 229 female freshman residential college students at the end of their first semester in college. Participants who drank frequently in high school were more likely to binge drink in college and regret doing something while drinking. Mother–daughter closeness and parental discussions of sexual risks, personal safety and danger avoidance were associated with a reduced likelihood of regretting doing something while drinking, experiencing sexual violence, and having sex without a condom. Parental provision of alcohol was associated with alcohol misuse. These findings provide a life course perspective on the development of risk behaviors and adverse outcomes during emerging adulthood. [ABSTRACT FROM AUTHOR]

This study investigated patterns of sexual agreement for extra-dyadic sex and their associations with sexual risk behaviors among men who have sex with men (MSM) having a regular male sex partner (RP) in China. A cross-sectional telephone survey was conducted among 530 MSM recruited through multiple sources in Hong Kong, China, between April and December 2020. This study was based on a subsample of 368 participants who had an RP in the past 6 months. Logistic regression models were fitted. Among the participants, 27.2%, 13.0%, and 3.0% had a closed agreement, an in-between agreement, and an open agreement, respectively. Compared to no agreement, a closed agreement was associated with fewer extra-dyadic partners and fewer instances of condomless sex with extra-dyadic partners. Those who had more positive attitudes toward a closed agreement, perceived more support from significant others to create a closed agreement, and perceived higher behavioral control of refraining from sex with extra-dyadic partners were more likely to have a closed agreement with RP. Those who were concerned that a closed agreement would impair freedom and sexual desire were less likely to have such an agreement. A closed agreement is a potentially useful risk reduction strategy for Chinese MSM with an RP. [ABSTRACT FROM AUTHOR]

To prevent hepatitis C virus (HCV) reinfection, within the Swiss HCVree Trial, a preventive risk reduction intervention was implemented alongside curative treatment. Formative qualitative research identified three response patterns to the intervention. This mixed-methods study's aim was to cross-validate group differences in (a) the content of sexual risk reduction goals set during intervention and (b) the extent of their behavioural change in condomless anal intercourse with non-steady partners (nsCAI), sexualised and intravenous drug use at start and six-month post-intervention. Qualitative thematic analysis was used to summarise goal setting domains. Quantitative descriptive analysis was used to evaluate group differences based on assumptions of the group descriptions. Results largely confirmed assumptions on inter-group response differences in goal setting and behaviour: as expected group 1 Avoid risks showed the lowest HCV risk profile with changes in nsCAI. Group 2 Minimize-risks and Group 3 Accept-risks showed unchanged nsCAI. Group 3 had the highest HCV risk profile. Differences in their goal preferences (1: condom use; 2 reduction blood exposure; 3 safer dating) highlight diversity in attitudes to behavioural change. Our results improve understanding of variability in intervention responses such as changes in attitudes and behaviour. This provides evidence for intervention tailoring and outcome measurement. [ABSTRACT FROM AUTHOR]

Background: Normative perceptions are strongly related to risk behaviors among emerging adults but the role of gender-specific normative perceptions remain unclear. Objectives: The current study examined the differential effects of same-gender and gender-neutral normative perceptions on self-reported substance use and sexual risk behavior. College students (n = 389, ages 18-25) reported binge drinking, cannabis use and prescription drug misuse, sexual risk behavior, and the perceived frequency of these behaviors by both the average- and same-gender adult. Results: Binge drinking was positively associated with same-gender norms only, whereas cannabis use and sexual risk behavior were also positively associated with gender-neutral norms perceptions. For binge drinking only, same-gender norms explained more variance in behavior than gender-neutral norms. Conclusions: Findings indicate perceptions of same-gender norms play a particularly important role in binge drinking during this developmental period. Interventions targeting emerging adult risk behavior should include within-group normative perceptions related to demographic and social group characteristics. [ABSTRACT FROM AUTHOR]

Condom use resistance (CUR) refers to practices used to obtain unprotected sex with a partner who wishes to use a condom. Coercive CUR is a manipulative and aggressive form of CUR, which is associated with detrimental mental, physical, and sexual health consequences. This review synthesizes quantitative evidence on the prevalence and correlates of experiencing coercive CUR. A systematic approach, including title, abstract, and full-text review, was used to identify relevant empirical studies. Thirty-seven articles met the inclusion criteria. Prevalence of experiencing coercive CUR ranged from 0.1% to 59.5%. Significant correlates of receiving coercive CUR included interpersonal violence, sexually transmitted infection (STI) diagnosis, emotional stress, and drug use. Importantly, vulnerable populations (e.g., racial/ethnic minorities, men who have sex with men, sex workers) and people with low perceived control and resistive efficacy (i.e., the ability to say "no") had an increased likelihood of experiencing coercive CUR. Methodological weaknesses in the current literature include a lack of longitudinal studies and studies that examine the effectiveness of interventions, as well as failure to use consistent measures and include samples of men and sexual minorities. Future research should address these limitations. Intervention and prevention strategies should prioritize populations that are at greater risk for experiencing coercive CUR to achieve better health equity outcomes. [ABSTRACT FROM AUTHOR]

Identifying factors associated with condom use can help inform the design of sexual reproductive health interventions for young people living with HIV. Data were collected from 294 sexually active youth in South Africa aged 14–24 years, living with HIV and aware of their status. Logistic regression found condom use was associated with partner status, disclosure, treatment adherence, knowledge, alcohol use, enacted stigma, and age at known status. Seventy-seven percent reported condom use at last sex, with higher odds among those who: disclosed their status to their last partner (OR = 2.13, 95% CI = 1.09–4.15), had not missed any ART doses in the previous week (OR = 2.67, 95% CI = 1.35–5.27), knew to use condoms when both partners have HIV (OR = 2.65, 95% CI = 1.34–5.25) and learned their status by age 12 (OR = 2.89, 95% CI = 1.30–6.43). Lower odds of condom use were among participants with an HIV-positive partner (OR = 0.36, 95% CI = 0.18–0.73), those who experienced recent stigma (OR = 0.55, 95% CI = 0.31–1.00), who drank at least 1 day per month (OR = 0.43, 95% CI = 0.22–0.84) and females (OR = 0.41, 95% CI = 0.20–0.84). Condom education and services promoting stigma management and safe disclosure could increase condom use among young people living with HIV. Lower condom use among adolescents reporting non-adherence to treatment underscores the critical need for effective interventions. [ABSTRACT FROM AUTHOR]

Fifty-one 18–22-year-old Ugandans took part in asynchronous online discussions about sexual decision-making. To increase generalizability and variability of experience, youth were recruited across the country using social media advertising. Participants were stratified into 8 groups by sex and sexual experience (e.g., women who had not had sex). Participants were asked questions such as, "What role do you think [men/women] play in deciding when a couple is going to play sex?" Several themes emerged. Both young men and women articulated social pressures to be abstinent, particularly to avoid STIs and pregnancy moreso than saving oneself for marriage. That said, women noted pressures to be seen as "pure". There also were pressures to have sex: Men were expected to have sex to demonstrate their virility. Women were expected to have sex if they accepted gifts or other commodities from their partners. It seemed that the specter of HIV and other STIs, as well as unwanted pregnancy, served to mitigate these expectations however, resulting in self-efficacy to use condoms among both men and women. Nonetheless, both men and women acknowledged that it could be hard for women to negotiate condoms. Implications for HIV prevention are discussed. [ABSTRACT FROM AUTHOR]

This paper inquires into the heteronormative regimes of sexual morality, focusing on the experiences of gay and queer men within the locus of family. Drawing upon a phenomenological ethnography involving interviews with the Indian gay community, this study demonstrates the disciplinary power of sexual morality over queer lives. It examines the varied strategies of moral regimentation within the locus of family, including regimenting through silencing, moral dictation, and penalizing. These strategies reflect the prevailing conservative and sex-negative attitudes in Indian society, particularly patriarchal expectations toward men and the pressure for marriage, which augments familial and social burdens on gay men, resulting in emotional distress. The cumulative effects lead to gay men living double lives, presenting a socially accepted façade while repressing their authentic queer selves, indicating a guilty conscience and internalized homophobia. These experiences correlate with risky sexual behavior, substance abuse, and overall compromised mental health. This phenomenological inquiry highlights the role of the family as a locus of moral control of queer individuals and contributes to the sociological understanding of morality as a power-relation. [ABSTRACT FROM AUTHOR]

This article provides an evaluation of a health and well-being workshop-based intervention, "The Quest" for gay and bisexual men from British Black Asian and Minority Ethnic (BAME) communities. A quantitative component assessed reported and intended sexual risk, drugs and alcohol use alongside measures of psychological well-being with pre and post-program data collected from 26 men. Fourteen men participated in focus groups that discussed experiences of the intervention. Significant improvements were found on measures of internalized homophobia, self-esteem and self-efficacy but not for health behaviors including safer sex or substance use. Qualitative feedback was generally positive especially around enhanced psychological well-being, identity integration, and enhanced self-awareness. There were some concerns over group size and whether non-BAME gay men were appropriate as facilitators. Theoretically informed, culturally competent interventions can demonstrate significant potential in enhancing the well-being of BAME gay and bisexual men but follow-up data are needed to show longer-term benefits. [ABSTRACT FROM AUTHOR]

We examined Mexican adolescent sexual well-being tasks, defined as the positive cognitive and emotional evaluations of one's sexuality. We assessed three dimensions: acceptance of sexual desire, sexual decision-making involving mutual consent, and, when sexually active, the practice of safe sex. We utilized a person-centered approach to examine how patterns marked by different aspects of sexual well-being predict psychological adjustment. Participants were 1123 Mexican high or middle school (72%) students (54% girls; Mage = 15.1, SD = 1.52). We found a 6-profile model: 1) Average Sexual Health (40%); 2) High Protective Low Acceptance (20%); 3) Multidimensional Healthy (19%); 4) Multidimensional Risky (11%); 5) High Acceptance Low Contraception and Consent (6%); and 6) High Consent Low Contraception (4%). These profiles included some adolescents who experienced both low and high sexual scores on different sexual well-being indicators. For example, adolescents who belonged to the High Protective, Low Acceptance profile understood the importance of safe sex and mutual consent; but still felt sexual guilt. Profile membership was associated with gender, religion, age, and sexual experience. Adolescents in classes marked by high levels of well-being reported high levels of psychological adjustment. Findings may help educators develop more targeted sexual risk and violence prevention programs. [ABSTRACT FROM AUTHOR]

While adverse childhood experiences (ACE) are well-documented predictors of maladaptive behaviors in adulthood, including risky sexual behaviors (RSB), the influence of acculturation in this association remains unknown. Although Hispanics are a rapidly growing population in the United States and are disproportionately affected by adverse sexual health outcomes, there is a paucity of research examining the interplay of ACE, acculturation, and RSB in this population. We observed the ACE-RSB association and how this relationship varies across U.S. and Hispanic acculturation levels, in a sample of Hispanic young adults (n = 715). Data for this study were from Project RED, a longitudinal study of Hispanic health. We ran regression models to test associations between ACE (0, 1–3, 4+) and several RSB (e.g., early sexual initiation (≤14 years), condomless sex, lifetime sexual partners, and alcohol/drug use before intercourse), and assessed moderation by U.S./Hispanic acculturation. Compared with those without ACE, individuals with 4 + ACE had higher odds of early sexual initiation (AOR: 2.23), alcohol/drug use before last intercourse (AOR: 2.31), and condomless sex (AOR: 1.66), as well as a higher number of lifetime sexual partners (β: 0.60). For those reporting 4 + ACE, high U.S. acculturation was protective in the association between ACE and using alcohol/drugs before intercourse. Future research implications are discussed. [ABSTRACT FROM AUTHOR]

Studies have found that pornography consumption is associated with a higher likelihood of having condomless sex. Past research was primarily conducted with Western populations from developed countries. Consequently, less is known about sexual and reproductive health in developing countries and regions. A national sample of 11,957 university-level students was used to investigate the association between pornography consumption, sexual attitudes, and condomless sex. Our findings suggest that a higher frequency of pornography consumption is associated with an increased likelihood of having condomless sex and more positive attitudes toward premarital sex and one-night stand. [ABSTRACT FROM AUTHOR]

Using a Bayesian statistical approach, this study aimed to provide a robust assessment of associations between religiosity and personal faith, timing of sexual initiation and sexual risk taking in young people. To produce posterior probability distribution of the estimation of associations, this study combined two population-based surveys of emerging Croatian adults and meta-analytical estimates pertaining to international studies published between 2000 and 2020. Regardless of the prior used, age at sexual debut was delayed by both religiosity (correlations ranged from 0.10 to 0.13) and personal faith (r = 0.09–0.13). Apart from delaying sexual debut, the findings suggest a very limited role of religiosity and personal faith in the protection of sexual and reproductive health among young people. [ABSTRACT FROM AUTHOR]

We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature. Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances. We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies. [ABSTRACT FROM AUTHOR]

The study examines the prevalence and factors associated with high-risk sexual behavior among sexually active young Indian men. This study used samples of 14,584 men aged 15 to 29 from the National Family Health Survey (NFHS-5), 2019–21. 14% of men engaged in early sexual debut (<18 years), 68% had unprotected sex, and 4% had multiple sexual partners in the past 12 months. Age, marital status, educational attainment, occupation, wealth quintile, alcohol consumption, internet use, media exposure, and region were significant predictors of risky sexual behavior. We suggest a tailored approach for effective policy design considering risk factors of risky sexual behavior. [ABSTRACT FROM AUTHOR]

Our study, examining the Global School-Based Student Health Survey data from 50 countries across four WHO regions, found boys have higher sexual exposure (33.5 vs 17.7%) and risk behaviors – early sexual initiation (55.0 vs. 40.1%), multiple partners (45.2 vs. 26.2%), and condom nonuse (29.2 vs. 26.8%) – than girls. We found that adolescents with parents who understood their problems, monitored academic and leisure-time activities, and respected privacy were less likely to be engaged in sexual activities and risk behaviors. This study highlights the importance of parental involvement and advocates for gender-specific, family-focused interventions to mitigate adolescent sexual risks. [ABSTRACT FROM AUTHOR]

Risky sexual behaviors of young women cause significant reproductive health problems. Therefore, it is vital to evaluate the sexual attitude and behavior characteristics of young women, their changes over the years, and the effects of information sources such as family, media, and friends, which play an effective role in bringing about changes in sexual behavior of young women. This study was planned to evaluate young women's premarital sexual behaviors and related factors in Turkiye between 01.11.2021 and 01.05.2022. It is designed as a descriptive correlation study conducted with 1.430 young women studying at universities in 30 metropolitan cities in Turkiye. The study data were collected using the "Participant Information Form" and the "Premarital Risky Sexual Behavior Assessment Scale for Young Women." This study showed that parents' educational status and geographical region was related to the young women's mean score and the subdimension score of the Premarital Sexual Behavior Assessment Scale for Young Women (PSAS-YW) (p <.001). Furthermore, young women's top source of information about sexuality was internet media (80 percent, n = 1144), and the least source was their fathers (2.9 percent, n = 41). There is a relationship between where young women spend most of their lives, the geographical region where their families live, and the risk of sexual behavior. The study observed that the geographical region where young women's parents live was effective in risky sexual behavior. While less risky sexual behavior was observed, primarily in the country's east, this rate increased in the western parts. Furthermore, while it was determined that young people mainly acquire sexual information through the media-internet or friends, it was observed that the participants in this group had the highest rate of risky sexual behavior. The age variable explained only 2 percent of the change in risky sexual behavior, and there was a linear increase between the mother's education level and the risky sexual behavior score of young women. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = −2·47, p = ·02) and condom negotiation (t (146) = −2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection. [ABSTRACT FROM AUTHOR]

In Mozambique, women are the most affected by HIV/AIDS and heterosexual encounters remain the main route for HIV/AIDS. Condom use is the most effective method of HIV/AIDS prevention, and the intention to use and buy/get condoms has a significant role in safe sex behavior. This study aimed to evaluate the efficacy of two psychosocial interventions – the Didactic and ACCENT Interventions – to prevent HIV/AIDS among Mozambican Women. Participants were Mozambican women (n = 150), users of the gynecology clinic of the Central Hospital of Beira. The study design was a randomized controlled trial (RCT) with assignment to three groups: Didactic intervention, ACCENT intervention, and Control group. Measures were from an adaption of the Women's Health Questionnaire, which includes questions about sociodemographic, clinical, and behavioral variables related to HIV prevention/risk. There was a significant group effect on condom use and safer sex preparatory behaviors, F(2, 146) = 6.45, p =.002, with Bonferroni post-hoc tests showing differences between the ACCENT vs. Control groups and ACCENT vs. Didactic groups (all p =.022). There were no statistically significant time effects on both condom use and safer sex preparatory behaviors. Results are promising for HIV/AIDS prevention in Mozambican women at sexual risk, but replication is needed for generalizability of findings. [ABSTRACT FROM AUTHOR]

A valid and reliable culture-based scale for the evaluation of risky sexual behaviours for married Iranian women is lacking. This study aimed to develop, and psychometrically test, a risky sexual behaviour scale for married Iranian women. A mixed-method sequential exploratory design was conducted from 2016 to 2020 in Tehran, Iran. First, a qualitative study was employed to define the concept of risky sexual behaviour using 16 semi-structured individual interviews and 10 focus group discussions (n = 100). Then, an item pool was generated, and the scale was developed. Finally, in the quantitative study, the psychometric properties of the scale were evaluated by validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 400 sexually active married women to assess the construct validity. The six components: (i) 'quality of sexual relations'; (ii) 'unusual pleasures in sexual relations'; (iii) 'sexual coercion'; (iv) 'verbal violence in sexual relations'; (v) 'self-care in sexual relations'; and (vi) 'concealment in sexual relations' could explain 57.49% of the total observed variance. The findings showed that the 27-item Risky Sexual Behaviour Scale (RSBS-MW) for married women in Iran has excellent internal consistency (α = 0.94) and stability (ICC = 0.98). Health care providers can use it to access risky sexual behaviours in married Iranian women. [ABSTRACT FROM AUTHOR]

The objectives of the study were to examine the influence of timing of first marriage on women's ability to negotiate safer sex, and to identify other drivers of women's ability to negotiate safer sex. Women's data of 2018 Nigeria Demographic and Health Survey were analysed. Three binary logistic regression models were fitted. Findings showed that 58.5% of the women had high ability to negotiate safer sex. The fitted models showed that the odds of high ability to negotiate safer sex were higher among women who delayed marriage compared to women who married early. A number of socio-demographic and relational characteristics also significantly drive high ability to negotiate safer sex. Early marriage hinders women from gaining total control of their sexual lives. The development of more sexual health promotion strategies is imperative in Nigeria. [ABSTRACT FROM AUTHOR]

Generally, romantically partnered individuals report better health than romantically unpartnered individuals. Known increasingly as positive "partnership-health" associations, these may be less frequent among minority or marginalized individuals. Full-service sex workers (FSSW) are relatively common in the U.S., report relatively poor health, and engage in professional behavior that may influence their personal romantic relationships. Therefore, we assessed partnership-health associations among U.S. FSSW. Study researchers collaborated with local and national sex worker organizations, both to design an online survey of relationships and health, and to recruit participants. Here, we used t-tests to compare the health of romantically partnered versus unpartnered FSSW. Health domains assessed included mental health, e.g. depression, anxiety; physical health, e.g. sleep, fatigue; and health behaviors, e.g. substance use, sexual behavior. Results indicated that partnered FSSW reported using fewer measured drugs, using these drugs less often, and trended toward using condoms with paying partners more. However, partnered FSSW also reported more fatigue. No other group-level differences in health were reported. Overall, few positive partnership-health associations were reported among FSSW, adding to extant work indicating partnership-health associations may be attenuated within partnerships involving minority or marginalized individuals. Implications for future research, clinical work with FSSW, and health-related policy are discussed. [ABSTRACT FROM AUTHOR]

The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resiliencebased HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people. [ABSTRACT FROM AUTHOR]

Western research has suggested that viewing sexually explicit internet media (SEIM) may result in sexual risk behaviors (SRBs) among gay, bisexual, and other men who have sex with men. This study explored the relationship between SEIM consumption and SRBs and whether perceived realism could moderate this relationship among Chinese male sexual minorities. We assessed SEIM consumption from two aspects: consumption frequency and preference for specific content (condomless and group sex). This study recruited 360 participants from various online channels. Consistent with the sexual script acquisition, activation, application model (3AM), we found that both SEIM consumption frequency and content preference were related to SRBs, and that perceived realism moderated the relationship between SEIM consumption and SRBs. Preference for group sex SEIM was significantly associated with an increased likelihood of casual sex when perceived realism was higher. SEIM use frequency was significantly associated with an increased likelihood of unprotected anal intercourse when perceived realism was higher. These findings may be used to promote HIV prevention, which necessitates joint effort from multiple stakeholders. [ABSTRACT FROM AUTHOR]

Black women's health is in a state of crisis. Though Black women make up roughly 12% of the US population, they account for 66% of new HIV cases. One understudied barrier to Black women's sexual health is their communication about the topic of HIV with others and proclivity to dismiss HIV-related information based on self-exemption. Using a group-centered approach called the "sistah circle," this study examines group gatherings of Black women to assess their communication about HIV and determine potential gaps in their understanding of information and HIV-related behavior. Data were derived from five focus groups, with four Black women in each group engaging in a facilitated discussion. Findings from the project extend knowledge about how socializing agents such as school, parents, church, and interventionists have the potential to delay or deter Black women from engaging in communication that supports risk-reducing behaviors and prevention efforts. [ABSTRACT FROM AUTHOR]

Despite growing evidence that parent-child sex communication (PCSC) is a positive strategy for adolescent sexual health outcomes, there is little research about what prompts and impedes these conversations among parents of gay, bisexual, and queer (GBQ) adolescent sons. Using interview data from a multi-method qualitative study, we analyzed parental perspectives (N = 15) on non-heteronormative sex communication with GBQ adolescent sons. Our results revealed that parents are most likely to engage in sex communication if they established open communication with their child, accepted their child's sexual orientation, encouraged safe sex practices, and were knowledgeable about LGBTQ issues. Conversely, parents who experience communication discomfort were unable to engage in inclusive and comprehensive sex conversations, thus creating a barrier to effective sex-positive communication. These findings have implications for future research and interventions that promote parents' ability to successfully facilitate conversations about sexual health with their sexuality diverse children. [ABSTRACT FROM AUTHOR]

One of the most consistent findings in content analyses of popular, commonly consumed pornography is the near absence of condoms. A recent meta-analysis found that pornography use is associated with an increased likelihood of condomless sex, but the studies available for analysis rarely included measures of potential cognitive mediators underlying the association. Following the sexual script acquisition, activation, application model (3AM) of mediated sexual socialization and the differential susceptibility to media effects model (DSMM), the present study examined whether linkages between pornography use and condomless sex are mediated by perceived similarity to actors in pornography and heightened perceptions of pornography's utility and social realism. Social realism and similarity mediated the association between pornography consumption frequency and condomless sex in simple mediation models, but only social realism remained significant in a parallel process model inclusive of all three mediators. [ABSTRACT FROM AUTHOR]

Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016–2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population. [ABSTRACT FROM AUTHOR]

HIV/AIDS prevalence in sub-Saharan Africa remains an issue of concern and young women are disproportionately affected by the disease. Premarital HIV testing is one of the key strategies used in HIV prevention since heterosexual sex remains the primary mode of HIV transmission in sub-Saharan Africa. This study uses the 2016 Ethiopia Demographic and Health Survey to examine the association between premarital HIV testing and the ability to negotiate sexual relations among married women aged 15 to 49 years (N = 3,672). Women's ability to negotiate sexual relations was measured using two variables: the ability to refuse sex and the ability to ask for a condom during intercourse. Descriptive statistics, bivariate, and multiple logistic regression analyses were performed. Only 24.1% of the women had premarital HIV testing. Approximately 46.5% and 32.3% of women reported that they could refuse sexual intercourse and ask their partner to use a condom, respectively. In the multivariable model, having a premarital HIV test was positively associated with the ability to refuse sex odds ratio (95% confidence interval) 1.82 (1.38, 2.41; p < 0.001) and the ability to ask for a condom 2.30 (1.55, 3.41; p < 0.001). Premarital HIV testing can improve women's sexual negotiation ability and possibly prevent future HIV infection. [ABSTRACT FROM AUTHOR]

Face-to-face bullying victimization (FBV) and cyber bullying victimization (CBV) are of global concern, including in Latin America. The aim of this study was to evaluate the associations between combined FBV and CBV relative to single victimization (FBV or CBV) and no victimization with a wide range of adverse health outcomes among school-aged adolescents from Argentina. National crosssectional school data from 56,981 adolescents that responded to questions on FBV, CBV, and adverse health outcomes were analyzed. The results showed a prevalence of 18.7% FBV alone, 8.1% CBV alone and 13.6% combined FBV and CBV. Combined FBV and CBV had higher odds than single victimization (FBV or CBV) in 18 negative health outcomes, including anxiety, suicidal ideation, loneliness, suicide plan and attempt, smoking, smokeless tobacco use, history of intoxication, alcohol-related problems, current cannabis use, ever use of amphetamine, school truancy, participation in physical fighting, physically attacked, injury, ever sex, multiple sexual partners and sedentary behaviour. In conclusion, combined FBV and CBV had higher odds than single BV or no BV in most adverse health outcomes. [ABSTRACT FROM AUTHOR]

This paper examines patterns of response to a multi-disciplinary wrap-around program for homeless adolescents and transition-aged youth with substance use and/or mental health disorders. A cluster analysis of outcome data from 148 youth was conducted. Cluster 1 (n = 67) demonstrated significant decreases in risky behavior (e.g., engaging in unprotected sex, crime, and substance use) and poor interpersonal relationships (e.g. more interaction with family and friends and lower rates of violence) but experienced relatively fewer interactions with family and friends. Cluster 2 (n = 57) demonstrated a significant decrease in poor life functioning (e.g., lower rates of employment/education, better quality of life, and less symptoms of internalizing disorders). Cluster 3 (n = 24) experienced significant increases in risky behavior, poor life functioning, and poor interpersonal relationships. Clusters 1 and 2 improved over six months of care. Cluster 3 deteriorated despite receiving similar services and used more opioids and stimulants. Peer engagement in programs for this population are important. Recommendations for cluster 3 include targeted outreach, medication assisted treatment, and additional research-supported treatments. Further research is needed to test these interventions over longer periods of time. [ABSTRACT FROM AUTHOR]

Sexual Strategies Theory suggests people fall on a continuum between having short-term mating orientation (STMO) and long-term mating orientation. One way STMO individuals signal mating goals is via risky drinking. The current study therefore aims to investigate drinks per week (DPW) as a mediator between STMO and risky sexual behavior (RSB), with gender as a moderator between STMO and DPW. Undergraduate students (N = 300) from a Midwestern university during Fall 2019. Participants completed questionnaires assessing STMO, DPW, and RSB frequency. A moderated-mediation model indicated DPW significantly mediated the relationship between STMO and RSB. Positive associations were found among all three variables. Gender was not a moderator between STMO and DPW. Mating orientation was a correlate of alcohol use and RSB for women and men, contributing to the literature identifying STMO as an indicator of those in need of substance use and RSB intervention. [ABSTRACT FROM AUTHOR]

This study aims to critically review the characteristics and effectiveness of university-based intervention to promote safer sex practice. The published studies were selected from 5 databases with the publication year restricted between 1974 and 2018. The data were then pooled using a random-effect meta-analysis. A total of 41 studies with 10,144 participants were included from 5,253 potentially relevant citations. Compared with minimal intervention, those people who participated in the intervention reported a statistically significant increase in the frequency of condom use (SMD 0.61; 95%CI 0.46–0.77, I2 = 9%). There was an insignificant change after the intervention (SMD 0.34; 95%CI −0.04–0.72, I2 = 72%) in communication with sexual partners and the heterogeneity existed in diversity of sessions of the intervention. Behavioral interventions can significantly increase in the frequency of condom use but not in communication with sexual partners. A standardized measurement is a necessary consideration for future studies. [ABSTRACT FROM AUTHOR]

Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. 2077 college students completed a cross-sectional survey. Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex. [ABSTRACT FROM AUTHOR]

Lack of data regarding knowledge and intention to use pre-exposure prophylaxis (PrEP) among sex workers exists in Spain. We conducted a cross-sectional analysis based on data from SexCohort study, which included male (MSW) and trans women sex workers (TWSW), aged ≥18 and recruited in two community-based centres in Barcelona, Spain. Of 116 TWSW and 79 MSW, 49.1% and 58.2% had factual knowledge of PrEP, and 40.3% and 70.1% had the intention to use PrEP, respectively. In the multivariable analyses, we found that education and condomless anal sex with stable partners were associated with PrEP knowledge. Regarding intention to use PrEP, TWSW were less likely than MSW to report an intention to use it (aOR = 0.35, 95% CI: 0.16–0.74). Furthermore, intention to use PrEP was associated with being foreign-born, practicing chemsex, and visiting a medical service in the last 12 months. The results of this study inform future trans-specific guidance for PrEP to be effectively implemented in Spain. [ABSTRACT FROM AUTHOR]

This systematic review aimed to understand the effects of self-esteem on risky sexual behavior (RSB) among adolescents and young adults. We followed the procedures outlined in the Cooper's five-step approach, and used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 reporting requirements. Published studies were identified using nine electronic databases. Studies were included based on (a) a focus on populations aged between 10 and 25 years; (b) an examination of the association between self-esteem-related factors, in line with RSB outcomes among adolescents and young adults; and (c) early sexual debut before 16 years, having multiple sex partners, and unprotected sex. In total, 11,216 studies were identified, of which nine studies met the inclusion criteria. All articles received high quality ratings. Despite methodological limitations, results showed that early sexual debut positively associated with self-esteem among female participants; condom use showed a negative association with lower self-esteem among female participants, while condom use decreased with decreasing self-esteem. Several sexual partners were found not to be associated with self-esteem. Intervention programs to increase the self-esteem of adolescents are recommended by educators to reduce risky sexual behavior among adolescents and young adults. Moreover, subsequent studies should develop instruments that assess self-esteem using subscales and educational programs that enhance healthy self-esteem development and correct sexual norms in peer groups and local communities. Early sexual debut was positively associated with self-esteem, and condom use negatively associated with self-esteem among adolescents. Intervention programs are recommended to establish healthy self-esteem and reduce risky sexual behavior among adolescents and young adults. Future research should consider self-esteem as a pertinent aspect of sexual behaviors (e.g., physical pride, romantic capacity, and sexual autonomy). [ABSTRACT FROM AUTHOR]

The aim of this study was to gain insight into the sexual beliefs of African American adolescent females and yield greater evidence for reframing the methods used to communicate sexual health education information to educators. This is a secondary data analysis of a qualitative descriptive study. One-on-one interviews were conducted with 36 African American females ages 12–14. The qualitative data were analyzed using exploratory deductive thematic analysis. Three themes emerged from the analysis: (a) perceptions of sexual health education, (b) threat of adverse sexual health outcomes, and (c) perceptions of condom usage. Overall, adolescents had basic sexual health knowledge and accurately appraised their risk for adverse sexual health outcomes. Many adolescents perceived the biggest disadvantage of condom usage was condom ineffectiveness. The greatest barrier to condom usage was male opposition. Adolescents perceived the threat of adverse sexual health outcomes, but the perceived benefits of condom usage in preventing pregnancies and STIs may not outweigh the disadvantages and barriers described by the adolescents. The adolescents in this study had knowledge about pregnancies and STIs but lacked the skills necessary to enact safer sex practices. [ABSTRACT FROM AUTHOR]

Comprehensive Sexuality Education (CSE) is a curriculum-based process of teaching and learning where learners are equipped with knowledge to cope with their developmental changes and risky sexual behaviors. Teaching and learning sexuality education has been seen as the responsibility for teachers only, however research indicate that it is a responsibility and collaboration of all stakeholders. Underpinned by an Asset-based approach as the theoretical framework this study addressed this question: "How can an Asset-based approach be utilized to enhance Comprehensive Sexuality Education in rural ecologies?" A case study research design and an interpretive research as the paradigm were adopted. Data were generated using focus group discussions, one-on-one interviews and reflective narratives with teachers, parents, learners, pastor, chief, nurse, social worker and a local business representative and analyzed using thematic analysis. The findings pointed out that, the collaboration of various stakeholders enhance the teaching of sexuality education; a strong ongoing partnership between the community and the school should be maintained and sexuality education workshops for young people in collaboration with communities facilitated by social workers. The study concludes that the teaching of Comprehensive Sexuality Education is not a responsibility for schools only, but encourages community-based collaborations and shared activities from the school communities. [ABSTRACT FROM AUTHOR]

Regulatory Focus Theory suggests that goal pursuit is driven by two separate and fundamental motives. Being more focused on prevention motivates people to enact safer behaviors and avoid negative outcomes (e.g., to prevent diseases), whereas being more focused on promotion motivates people to take risks and pursue pleasurable experiences (e.g., condomless sex). A quasi-experimental study (N = 476) examined if differences in regulatory focus (i.e., prevention vs. promotion) determined condom use intentions with a prospective casual partner, depending on condom availability delay and STI risk cues. Participants focused on prevention (vs. promotion) were less likely to consider having condomless sex across condom availability delays conditions. However, STI risk cues changed condom use intentions. When STI risk was lower, condom use intentions decreased as condom availability delays increased (particularly for participants focused on promotion). When STI risk was higher, condom use intentions were stronger and consistent across condom availability delays (particularly for participants focused on prevention). These findings highlight the importance of distinct sexual motives when examining sexual health practices. [ABSTRACT FROM AUTHOR]

Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself. [ABSTRACT FROM AUTHOR]