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Adolescents and young adults have higher rates of sexually transmitted infections (STI) than any other age cohort in Toronto, Ontario, Canada. The sub-population of young parents is at even higher [...]

CONTEXT: Heterosexual anal sex is not uncommon in the United States, and it poses risk for STDs. However, who engages in it and why are not well understood, particularly among young adults. METHODS: In 2006-2008, data on sexual health-related topics were collected in surveys (483 respondents) and qualitative interviews (70 participants) with black and Puerto Rican 18-25-year-aids in Hartford and Philadelphia. Bivariate and multivariate analyses of survey data assessed predictors of anal sex with the most recent serious heterosexual partner. Interview transcripts were analyzed for anal sex experiences and reasons for and against engaging in this behavior. RESULTS: Some 34% of survey respondents had had anal sex; this behavior was more common with serious partners than with casual partners (22% vs. 8%). Black respondents were less likely than Puerto Ricans to report anal sex (odds ratio, 0.3); women were more likely to do so than were men (2.9). In the qualitative cohort, perceptions of anal sex as painful and unappealing were the predominant reasons for not having anal sex, whereas sexual pleasure and, in serious relationships, intimacy were the main reasons for engaging in it. Condom use during anal sex was rare and was motivated by STD or hygiene concerns. CONCLUSIONS: Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk. Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience. Perspectives on Sexual and Reproductive Health, 2010, 42(4):267-274, doi: 10.1363/4226710

Sexual compliance (i.e., willingly engaging in sexual activity that one does not desire) is a common behavior among young people. Little is known about the characteristics of occasions of sexual compliance in the context of a committed relationship. This study used both a diary method and in-depth interviews to assess occasions of sexual compliance, as well as types of sexual activity, condom use, pleasure, and feelings of pressure and control. Participants included 63 young adults (18-24 years old) in committed, heterosexual relationships. Seventeen percent o fall sexual activity was rated as sexually compliant. Occasions of sexual compliance were rated as less enjoyable and more unexpected. In-depth interviews revealed four key themes including endorsement of an implicit contract between partners, partner awareness o flow desire, past experience of pressure, and justification for reporting low desire. Future research should evaluate the long-term impact of sexual compliance on a relationship., Within the past two decades, a body of research has emerged clarifying the distinction between wanting and consenting to sexual activity (Houts, 2005; Morgan, Johnson, & Sigler, 2006; O'Sullivan, 2005; [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.04.039 Byline: Cui Yang (a), Carl Latkin (a), Rongsheng Luan (b), Kenrad Nelson (c) Abstract: Despite their crucial role in HIV infection and transmission, commercial sex male clients (CSMCs) are rarely studied. The purpose of this study was to examine the relationship between peer norms and consistent condom use with female sex workers (FSWs) among CSMCs in Sichuan province, China. Male clients with peers who had paid for sex (n = 562) were recruited by local health workers through snowball sampling. Measures of peer norms included 1) descriptive norms which were evaluated by perceptions of peer's condom attitudes and behaviors with FSWs; 2) injunctive norms which were assessed by the perceived peer approval of using condoms with FSWs; and 3) communication of HIV-related topics with peers. The outcome was consistent condom use with FSWs. Results of multivariate logistic regression models revealed that consistent condom use with FSWs was significantly more likely among male clients who perceived more pro-condom descriptive and injunctive norms among their peer groups. In addition, the pattern of commercial sex visits moderated the relations between peer norms and consistent condom use with FSWs. More peer approval of condom use and more HIV-related communication were significantly associated with consistent condom use among clients who visited FSWs with friends but not among those who visited FSWs alone. The findings suggest that social activities surrounding commercial sex visits may provide an entry point for HIV prevention intervention with men who patronize FSWs and that such efforts should tap into existing dynamics of social interaction to promote pro-condom norms. Author Affiliation: (a) Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States (b) Department of Epidemiology, West China School of Public Health, Sichuan University, PR China (c) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.07.035 Byline: Dallas Swendeman (a), Ishika Basu (b), Sankari Das (b), Smarajit Jana (b), Mary Jane Rotheram-Borus (a) Abstract: The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women's empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n =110) compared to a control community (n =106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (). This article examines the intervention's impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000-2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study's results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs. Author Affiliation: (a) Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, United States (b) Durbar Mahila Samanwaya Committee, Kolkata, India Article Note: (footnote) [star] World AIDS Foundation Grant No. 202 (99-028) supported this research. The American Institute of Indian Studies (AIIS) and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) funded subsequent research by the first author that supported development and interpretation of this study's results. The authors are also grateful for the participation of sex workers in this study.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.03.009 Byline: Clare Barrington (a)(b), Carl Latkin (c), Michael D. Sweat (d), Luis Moreno (e), Jonathan Ellen (f), Deanna Kerrigan (g)(h) Abstract: Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners. Author Affiliation: (a) University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (b) Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (c) Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (d) Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA (e) Centro de Orientacion e Investigacion Integral, Santo Domingo, Dominican Republic (f) Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (g) Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (h) Sexual and Reproductive Health Unit, Ford Foundation, NY, USA

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1559-1816.2008.00298.x Byline: Blair Beadnell (a), Sharon A. Baker (a), Mary Rogers Gillmore (b), Diane M. Morrison (a), Bu Huang (a), Sorrel Stielstra (a) Abstract: Although the majority of prevention efforts have focused on women, reduction of heterosexual transmission of STDs also requires interventions for men, necessitating understanding of men's safer sex decision making. In a random sample of 486 heterosexually active men, the theory of reasoned action (TRA) was used to predict intentions to use condoms with casual partners, as well as 2 steady-partner safer sex behaviors: mutual monogamy and condom use. The basic TRA model fit the data well. Expanded models identified the mediated (via attitudes, social norms, and self-efficacy) and, for some, direct effects on intentions and behavior of selected intrapersonal, interpersonal, and sociocultural variables. Results suggest that the role of external variables might vary depending on the behaviors in question. Author Affiliation: (a)School of Social WorkUniversity of Washington (b)School of Social Work, College of Public ProgramsArizona State University Article note: (2) Correspondence concerning this article should be addressed to Blair Beadnell, School of Social Work, University of Washington, 4101 15th Avenue, NE, Seattle, WA 98105-6299. E-mail: blairb@u.washington.edu

Relatively little is known about condom use among bisexual men as separate and distinct from exclusively homosexual and heterosexual men. Most previous research on bisexual men has relied on nonprobabilistic, [...]

The objective of this study is to examine the attitudes and perceptions of men towards domestic violence and contraceptive use. Data for the study were obtained from a survey conducted between February and May 2003 in Osun and Ondo states of south west Nigeria. The study reveals that: (1) more than 80per cent of men disapprove of a woman deciding to use contraceptives without consulting them; (2) a significant proportion of men view domestic violence as acceptable; (3) the results therefore signify serious problems concerning the role of men in reproductive issues, which the current efforts in family planning have not adequately addressed. Keywords: behaviour; contraception; domestic norms; family planning; gender, Introduction A major concern of researchers is that despite the concerted efforts being made to make family planning services accessible and affordable to developing countries, patronage in many countries is [...]

In a study of the accuracy of self-reports of sexual behavior and condom use, 285 single, young adults in a large metropolitan area were interviewed once a week for 52 weeks, reporting on their sexual behavior each week. At 1-, 3-, 6-, and 12-month intervals, the individuals also provided self-reports of the number of times they had engaged in sex and the number of times they had used condoms since they began participating in the study. These self-reports were compared with aggregates of the weekly data, which served as a comparison standard for accuracy evaluation. The results indicate a fairly high level of accuracy in self-reports, but with 2% to 5% outliers who are highly inaccurate. The results tend to favor the assessment of sexual behavior over moderate time durations (3 or 6 months) rather than short or long durations (1 month or 12 months) when trying to maximize self-report accuracy. Accuracy was attenuated for individuals who tended to engage in sex frequently, especially at the 12-month time durations.

A group of 267 college students participated in an experiment to determine the effect of communicating different percentages (i.e., 12%, 36%, 64%, 88%) of the prevalence of safer sex in the student population on condom-use intention. A positive linear effect of prevalence information on condom-use intention was demonstrated, although the information that 64% engaged in safer sex seemed most effective in changing condom-use intention. This effect was independent of previous sexual behavior. Although prevalence information had a positive indirect effect on condom-use intention as a result of a change in perceived social norms, it had a negative indirect effect because of perceived risk. That is, information indicating a high prevalence of safer sex lowered the perceived risk of AIDS and, as a result, the intention to use condoms.

Effective AIDS prevention programs directed toward Hispanics recently migrated to the western United States must identify cultural practices which affect condom use. Survey data show that traditional cultural values which affect AIDS prevention are determined by education and acculturation levels. Thus, assessment of education and acculturation levels is necessary before implementing prevention programs. Data also show the major role of Hispanic males in condom use which indicate that emphasis on the protector role of men with regard to women may improve condom use.

As a young physician, I often second-guess myself. In practicing medicine such self-criticism is warranted, even obligatory, because a wrong diagnosis can lead to misguided therapy and may end in [...]

Heterosexual transmission of HIV is growing at an increasing rate. One primary prevention strategy is to consistently use condoms. With the exception of female condoms, women do not 'wear' condoms and therefore must negotiate condom use with their male partners. This present study examines the strategies women believe they would use in a safer sex negotiation with a male partner including (1) initiating negotiations, (2) resolving conflict, and (3) maintaining the intention to practice safer sex. The findings highlight the importance of understanding women's patterns of negotiation as well as their repertoire of negotiation skills prior to their exposure to behavioral interventions KEYWORDS. Negotiation, urban women, safer sex, sexual behavior, interventions, HIV/STD prevention

The female condom is the latest in a series of sexual and reproductive technologies to be imported into the third world, following the contraceptive pill, the Depo-Provera injection, the latex male condom, and others. It is an example of 'traveling technology', which accrues different meanings and connotations in the different settings into which it is introduced in its journey through the circuits of international technological diffusion, from the headquarters of international NGOs and bilateral aid programs, through the bureaucracies of national ministries of health to the communities in urban and rural settings where the condoms are distributed. The female condom almost always carries connotations of women's empowerment, and the possibility of greater sexual autonomy for women. This association is a result of the female condom being the first new 'post-Cairo' technology, the diffusion of which was spurred by the consensus reached at the 1994 International Conference on Population and Development in Cairo, at which the need to promote women's empowerment was moved to the center of international family planning and population movements. However, I demonstrate that 'empowerment' is an ambiguous term, interpreted in different ways in different contexts. I illustrate this through interviews conducted in 1998 and 1999 with stakeholders in the female condom in Cape Town, Nairobi, and in rural western Kenya. These stakeholders range from directors of US-based development programs to heads of national AIDS-prevention efforts to community-based distributors and primary health care nurses at the village level. I argue that three different notions of empowerment are being articulated with respect to the female condom -- two which correspond to Maxine Molyneux's typology of strategic and practical gender interests, and a third in which women's empowerment is conceived of as something which diminished the power of men. I argue further that the disjunctures between these three different notions of what 'empowerment' means will pose a challenge for people at all levels which are seeking to make the female condom more widely accessible to women at risk of HIV/ AIDS. Keywords: Female condom; Women's empowerment; Family planning; Africa

In the summer of 1997, I walked into the newly constructed Elephant Spring Hotel(1) in Jinghong to discover one of the most unique small tourist shops I had ever seen on three continents. The glass front display case was divided into two sections, one with toothbrushes, cards, towels, and film, and the other displaying every kind of condom imaginable. A Guangzhou brand called International (guoji) had a picture of a young white couple on the cover, she in a sexy pink-flowered sheath-dress and he in a white suit. The couples depicted on the box were caressing each other in a languorous pose on a grassy knoll. The caption on the box read, 'Love plus feeling at ease equals speaking from the heart' (aixin + fangxin = chengxin). A smaller packet of condoms had a diffused soft light image of a Chinese woman seen from her back. She was naked with her long black hair reaching to the middle of her back, focusing the yellow lighting on her round buttocks where her hands lay against her body. This Tianjin brand of condoms were called Harmonious and Happy Condoms (hele tao), with a caption that read 'prevent pregnancy, prevent disease, be healthy and happy' (biyun, yufang, jiankang, kuaile)., When I inquired about how well these condoms sold, the clerk glancing down at her wares replied that they had the best display in town, and even though the hotel [...]

Using data collected from a telephone survey of adolescents aged 15 to 19, we studied predictors of condom attitudes. Analyses were conducted on a sample of 348 sexually active teens. Multiple regression revealed that holding other variables constant, being females, African American, perceiving that more of their friends were using condoms (i.e., perceived normative behavior), and stronger perceived normative pressure were significantly associated with favorable condom attitudes. Furthermore, significant interaction effects pointed to gender differences in the association between two types of norms and attitudes toward condoms. Perceived normative behavior had a greater effect on the attitudes of female adolescents. Perceived normative pressure had a greater effect on the attitudes of male adolescents.

Results of research has revealed that human trafficked individuals face increased risks of HIV infection as well as a large degree of human trafficking-related stigma. The extent to which trafficked individuals and migrant sex workers face an increased vulnerability to HIV/AIDS and tuberculosis (TB) varies depending on a multitude of factors such as pre-departure knowledge about HIV, clients' attitudes towards condom use and the level of negotiating power.

* Our friend Dimitri Cavalli writes to say that the outrage over the pope's claim in Africa that condoms makes things worse brings to mind a story about the late [...]