Forging help relationships with commercially sexually exploited youth: Perspectives of Israeli help providers.

BACKGROUND: Previous research points to the many challenges that help providers who support commercially sexually exploited youth encounter in their professional work-yet little is known about how they overcome these challenges, particularly with regard to youth of diverse social backgrounds. OBJECTIVE: The present study applied the conceptual frameworks of help-seeking and intersectionality to explore the professional practices that help providers employ when forging a help relationship with commercially sexually exploited youth. PARTICIPANTS AND SETTING: Israeli help providers who work with commercially sexually exploited youth at various social services. METHOD: In-depth semi-structured interviews were conducted, and analyzed using constructivist grounded theory approach. FINDINGS: We identified six major guiding principles that support the participants' processes of forging a help relationship with commercially sexually exploited youth: Do not assume that the youth view their involvement in commercial sexual exploitation as problematic; Continuously attempt to gain the youth's trust; Start from the point where the youth are; Be available at all times, and maintain a steady long-term relationship; Treat commercially sexually exploited youth as agentic individuals and encourage them to lead the process of establishing a help relationship; Similarity in social backgrounds of help providers and commercially sexually exploited youth promotes youth's engagement in the help relationship. CONCLUSIONS: Assuming the co-existence of benefit and harm in commercial sexual exploitation is essential to forging a help relationship with the youth. Applying the intersectional lens to practice in this field can help preserve the delicate balance between victimhood and agency, thereby enhancing help processes.

Help-Seeking and Help-Related Experiences of Commercially Sexually Exploited Youth: A Qualitative Meta-Synthesis.

This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about the help-seeking and help-related experiences of commercially sexually exploited youth (CSEY). A comprehensive search of the relevant databases was conducted to identify published qualitative peer-reviewed papers and research reports about the experiences and perceptions of CSEY. A corpus of 34 qualitative studies was compiled and synthesized, using the conceptual framework of help-seeking and QMS guidelines. The QMS reveals that although help-seeking of CSEY are rarely the focus of the inquiry, the reviewed studies include meaningful information about help-related experiences of CSEY. Thus, the synthesis of the available data yields novel insights about how CSEY perceive their involvement in CSE, define the problems they deal with, decide to seek help, choose the proper help, and engage in helping relations. Particularly, the QMS underscores that CSEY do not always perceive their involvement in CSE as problematic, nor do they identify themselves as victims of exploitation. The findings highlight the significance of developing social services that specialize in helping CSEY, the importance of actively identifying CSEY and reaching out to them, and the need to enable CSEY to be involved in decisions about the extent and type of support they are provided.

Party keepers: a significant community-based intervention for harm reduction.

BACKGROUND: Gay men use recreational drugs more often than heterosexuals-especially at social events. While partying at a venue, partygoers are at risk of drug overdosing, without access to an emergency help. This study evaluates a unique and novel intervention aimed at training men who have sex with men (MSM) and transgender individuals who frequent parties, to provide immediate assistance on-site to partygoers who have overdosed. METHODS: The Party Keepers (PK) course is a unique 4-h training course that provides the participants with tools to identify, prevent, and treat common medical syndromes that are associated with excessive substance use. Participants were asked to complete a questionnaire on their sociodemographic attributes; their sexual risk behaviour; pre-exposure prophylaxis (PrEP) use and drug-use behaviour before and after the course; and the emergency situations they encountered in party venues after the course. RESULTS: Of the 85 participants who completed the training and left valid contact information, 52 (62%) completed the questionnaires. Their average age was 37.0 years, most lived in Tel-Aviv, and were single. Participants reported that, after the course, they reduced their own use of recreational drugs (cocaine, amyl nitrates, alcohol), reduced their sexual risk behaviours, and significantly increased their use of PrEP. Of all the PKs, 63% (N = 32) indicated that they now provided first-aid and other assistance to partygoers at public venues, which enhanced their sense of community responsibility. In the multivariate analysis, a high level of confidence as a PK, and the knowledge gained in the course, predicted the incidence of subsequent assistance to partygoers in emergency situations. CONCLUSIONS: The PK initiative-a harm-reduction intervention led by peers, aimed at fighting drug overdosing at gay venues-was useful in reducing drug use and sexual risk behaviours among the course participants. Most course participants also responded to drug-related emergency situations at gay parties, as a result. This evaluation of community health intervention within a sexual minority community can help health policy makers design more community based interventions and allocate resources to include community participants in harm-reduction policies.

Helping individuals in the sex trade during COVID-19: The perspectives of Israeli aid organizations.

The coronavirus disease (COVID-19) pandemic has had a collateral effect on marginalized populations, including individuals in the sex trade (IST). In addition, the literature of the past year has documented a significant impact of the pandemic on healthcare providers. However, there is a lack of research on the new challenges and existing hardships facing aid organizations working with IST populations. This naturalistic qualitative study used semi-structured interviews with 33 IST aid organization workers in Israel between May and July 2020 to capture their perceptions and experiences within broader social-relational contexts. Data analysis revealed that the pandemic impacted three different arenas: The assistance systems and the quality of care; The relationship between aid organizations and state authorities; and The intraorganizational and interorganizational relationship. These findings add to the knowledge about the impacts of the COVID-19 pandemic on aid organizations, particularly the need for greater collaboration between aid organizations during health crises and governmental support for these organizations. In addition, the study highlights the opportunities that a global and local health crisis can create advancing new knowledge and practices used by aid organizations in their work to assist IST populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Men Who Pay for Sex Once, More than Once, or Not at All: The Associations between Attitudes toward Paying for Sex, Socio-Demographic Characteristics, and Frequency of Sex Payment.

In an attempt to characterize men who pay women for sex (MPWS), theory and research generally divides men into two groups: men who pay for sex and those who never paid for sex. However, this dichotomy may lack sufficient detail to understand sex payment accurately, and with regard to attitudes toward paying for sex and frequency of sex payment. The present study set out to explore the associations between views toward MPWS; socio-demographic characteristics and frequency of paying for sex. A sample of 632 Israeli men, ages 18-75, were recruited via Facebook ads. Participants completed an anonymous, online questionnaire on their attitudes toward MPWS. Men who paid for sex once were more similar in their attitudes to men who did not pay for sex than to those who paid more than once. In addition, favorable views on MPWS predicted paying for sex only among men who paid for sex more than once, but not among men who paid for sex once. These findings may require new programmatic attention in public policy considerations and therapeutic strategies, taking into consideration both attitudes of men who pay for sex toward, and frequency of, this behavior.

COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey.

BACKGROUND: Social distancing in the wake of the coronavirus disease 2019 (COVID-19) pandemic may affect the sexual behavior of men who have sex with men (MSM). In early March 2020, Israel imposed travel restrictions and limited social contacts to household members only. The effects of these restrictions on the sexual behavior and mental health of MSM are unknown. AIM: To assess sexual behaviors and mental health of Israeli MSM during social distancing and to compare sexual behaviors before and during social distancing, due to the COVID-19 pandemic. METHODS: Data were collected through anonymous web-based questionnaires in a popular geospatial application used by MSM between March and April 2020 during the social-distancing period. OUTCOMES: The dependent variable was casual sex, in violation of social-distancing regulations. Independent variables were demographic characteristics, sexual behaviors before and during social-distancing restrictions, and mental health. RESULTS: Of the 2,562 participants, 1,012 (39.5%) continued to meet new casual sex partners during this period. Being of a younger age, single, and with higher levels of mental distress predicted engagement in casual sex during the social-distancing period. MSM reduced their sexual risk and limited sexual repertoire-in particular, kissing with their sexual partners. Participants also spent more time in dating applications than in the pre-social-distancing period and increased their use of sex phone, webcams, and porn consumption. They perceived the threat of severe acute respiratory syndrome coronavirus to be greater than that of HIV: only 3.2% could imagine themselves having sex with a partner who is infected with SARS-CoV-2 compared with 30.1% in case of HIV, P < .01. CLINICAL IMPLICATIONS: MSM reduced their risk behaviors during social distancing because of the threat of COVID-19. Casual sex during social distancing was associated with negative feelings of mental distress. Future public health response in the future waves of COVID-19 morbidity should strike a balance between containment measures and the need for social distancing with its possible mental and social burdens. STRENGTHS AND LIMITATIONS: This is the first study in Israel and one of the few in the world to examine sexual behaviors among MSM during the COVID-19 social distancing period. It involved a relatively large sample, through convenience sampling, which limits causality. Findings should be interpreted cautiously, specifically because COVID-19-related behaviors and circumstances may change rapidly. CONCLUSION: The negative feelings of distress due to social distancing should be considered as a potential barrier to adherence among vulnerable populations, such as MSM. Future public health response should strike a balance between containment measures and its possible mental, social, and financial burdens. Shilo G, Mor Z. COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey. J Sex Med 2020;17:1827-1834.

The Attitudes Toward Men Who Pay for Sex Scale: Development and Preliminary Validation.

Only a few studies have measured attitudes toward men who pay for sex (MWPS), and those that did so usually based their assessment on a limited number of items. This study sets out to devise a measure of attitudes toward MWPS that is founded on a solid theoretical framework and features satisfactory psychometric properties. Based on a conceptualization of the available literature, a tentative model for examining attitudes toward MWPS (the attitudes toward men who pay for sex scale, ARMPS) was constructed, designed to measure the factors that express a perception of (1) paying for sex as a legitimate behavior and (2) paying for sex as a deviant behavior. The participants were 687 Israeli men. The analysis included inter-item correlations, exploratory factor analysis, comparison of two wording versions, the assessment of construct validity, and the assessment of criterion validity and reliability. The findings confirmed the ATMPS scale reliability and construct validity and suggest the benefits of further application in other cultural and linguistic contexts.

Health behaviour change among commercially sexually exploited Israeli youth and young adults in a multi-module program.

Commercially sexually exploited youth and young adults (hereafter CSEY) are at high risk for various health adversities, but little is known about interventions that can improve their health outcomes. This study reports changes in health behaviours-positive health behaviours, drug use and risky sexual behaviour-in the first stages of treatment of 122 participants in a comprehensive multi-module program for CSEY in Israel. Data included sociodemographic and background information upon program entry, monthly reports on the treatment the participants received and their status. Data were collected monthly through online questionnaires completed by case managers for each of the CSEY in their care. A three-part analytic strategy assessed changes in repeated measures over time and their contributors. Latent class analysis helped identify differential trajectories of change over time among different participant groups. Findings showed overall significant decrease in risky sexual behaviours and improvement in positive health behaviours among certain CSEY groups. Participants with higher levels of health-risk situations and behaviour at program entry (e.g. more victimisation, less residential safety) were more likely to show improvement in health behaviours during intervention, but less likely to change their moderately risky sexual behaviours. Program participants with high levels of drug use did not show improvement in drug use patterns over time. This study demonstrates that a comprehensive multi-module intervention for CSEY can significantly improve health behaviour outcomes among serviced CSEY, and highlights the value of person-oriented care, and of research that can detect vulnerable subpopulations within CSEY who require uniquely tailored interventions. Personalising treatment to specific differential needs of CSEY, coupled with early detection and intervention, can improve program outcomes. Further research is needed to understand contributors to change and changes in subsequent health outcomes.

Sexual practices and risk behaviors of Israeli adult heterosexual men.

The knowledge of sexual practices of heterosexual males (HM) in Israel is limited despite the increase inthe incidence of sexually transmitted diseases (STI). This study assessed sexual practices among Israeli HM and the associations between demographic characteristics and sexual risk behaviors. The Cross-sectional study included a representative sample of 913 Jewish HM aged 18-44, which completed a questionnaire including their demographics, sexual practices, and risky sexual behavior. Of all participants, 66.8% had monogamous sex with their steady partner. These participants were more likely to be older, religious, involved ina limited repertoire of sexual practices, and less likely to engage in risky sexual behavior. Of the participants, 9.6% were in steady relationships but had concomitant sexual casual partner/s. They were more likely to be secular, paid for sex, and had more lifetime sexual partners. Of all the participants, 23.6% were singles and had sex with casual partner/s. They were more likely to be younger and engage in risky sexual behavior. Of all participants, 10.3% were involved in risky sexual behavior. These men were more likely to be singles, pay for sex and have more lifetime sexual partners. We conclude that preventive interventions aimed to prevent STI-infections should target HM who are in singles and those in steady relationships and have concomitant sex partners.

Mental Distress, Well-Being, and Stress-Related Growth following an Anti-LGBQ Hate Crime among LGBQ Young Adults in Israel: The Effect of Familiarity with the Victims and the Mediating Role of Emotional Support.

Using data from 696 Israeli LGBQ individuals aged 13-30, this study explored the negative (mental distress) and positive changes (well-being and stress-related growth) following the deadliest anti-LGBQ hate crime in Israel to date (the Bar-Noar Massacre), while examining differences in these outcomes between those who did and did not know hate crime victims. Furthermore, the mediating role of emotional support in facilitating better mental health and stress-related growth was tested. Results suggested that compared to those who did not know any victims, those who personally knew the victims sought emotional support from more sources, had higher scores of mental distress, but also of well-being and stress-related growth. Emotional support indeed mediated the relationship between familiarity with hate crime victims and better mental health and higher levels of growth. Increasing access to emotional support may be particularly helpful in addressing the needs of LGBQ young adults following an anti-LGBQ hate crime.

Religious Coping Strategies and Mental Health Among Religious Jewish Gay and Bisexual Men.

The present study examined the effects of positive and negative religious coping strategies on the mental health of 113 Israeli gay and bisexual Jewish males with high levels of religiosity, and how sexual identity formation (internalized homophobia and coming out) and societal variables (family and friends' acceptance of sexual orientation and social connections within the LGBT community) mitigated the effects of religious coping strategies on mental health. Findings showed that when dealing with the stress arising from the conflict between religious and sexual identities, individuals used both positive and negative religious coping strategies, but only negative religious coping was associated with poorer mental health. In addition, only in the presence of social resources (social connections with the LGBT community and the acceptance of sexual orientation by friends), did the use of positive religious coping result in better mental health outcomes. These findings underlined the importance of these resilience social factors in the lives of religious Jewish gay and bisexual men.

Sexual Activity and Condom Use among Israeli Adolescents.

INTRODUCTION: In Israel, as in other industrialized countries, the age of sexual debut among adolescents has declined, and the rate of sexually transmitted infections (STI) has risen, but the motivations and attitudes of Israeli adolescents toward carrying condoms have yet to be studied. AIMS: The aims of this study were to establish the associations (if any) between demographic characteristics and the knowledge held by Jewish Israeli adolescents about HIV transmission, their attitudes toward condom use and sexual experience, and to explore their recommendations to increase condom use. METHODS: The method used was an analysis of sexual experience and practices, attitudes toward condom carrying and condom use among a national representative sample of Jewish adolescents aged 15-18. MAIN OUTCOME MEASURES: Two dichotomized measures were assessed: (i) sexual experience (defined as having had previous consensual oral/vaginal/anal sex); and (ii) the practice of carrying a condom on a regular basis. RESULTS: Of all 410 participants, 14.6% carried condoms, 18.3% had sexual experience, and 70.7% of those used condoms. Those who thought condoms to be protective against HIV, and those who thought they are difficult to wear, were more likely to have sexual experience. The perception of condom use as important, and the perception that condoms are difficult to wear, were predictors of condom carrying. The participants' knowledge of the risk of HIV in vaginal intercourse was deficient. Participants did not consider school sex education to be effective in promoting condom use, and recommended the use of graphic, deterrent personal accounts told by youths to encourage wider use of condoms. CONCLUSIONS: Health educators should consider the barriers cited by adolescents and the deterrent techniques they recommend when planning interventions to encourage condom use.

Seeking sex online: social and sexual risk factors among adolescent and young gay and bisexual men.

UNLABELLED: Background With the increased use of the Internet to seek sex, research has documented its associated sexual risk behaviours, especially among gay and bisexual men. Only a few studies to date have been conducted among adolescent and young men, and these have focussed on behavioural components to do with seeking sex online, without considering the role of same-sex identity formation processes. The current study aimed to identify behavioural and identity formation variables associated with seeking sex online among adolescents and youth. METHODS: A web sampling of young Israeli gay and bisexual men aged 12-30 years (n=445) was used to assess their seeking sex online characteristics, mental health, sexual risk behaviours, substance use, same-sex disclosure and acceptance and coping resources. RESULTS: Nearly half of the sample used the Internet to seek sex, which was correlated with substance use and sexual risk behaviour. Young adults seek for sex online more commonly than adolescents. Higher numbers of: sexual partners, level of outness, levels of friends support and stronger connectedness to the gay community predicted seeking sex online. Seeking sex online was found to be more of predictor for sexual risk behaviour than any other predictor. CONCLUSIONS: Seeking sex online is influenced by the gay sub-culture climate and peer group relationships, rather than by social stressor variables related to sexual orientation formation processes, or by the subject's general mental health condition. These results underscore the possible risks pertaining to seeking sex among gay and bisexual men and the possible use for this venue to convey safe-sex messages to adolescents and young adults.

Individual and community resilience factors among lesbian, gay, bisexual, queer and questioning youth and adults in Israel.

Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community-level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well-being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community-level factors (friends' support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings suggest for efforts on fostering familial support for LGBQ youth and a multi-level system that offers support at the familial, peer, relationship and community levels for both LGBQ youth and adults.

The impact of minority stressors on the mental and physical health of lesbian, gay, and bisexual youths and young adults.

Research relating to minority stressors generally explores mental health outcomes, with limited focus on the physical dimension. In addition, minority stress research is conducted mainly in Christian-oriented societies. To address these pitfalls we used Web sampling targeting Israeli participants ages 12 to 30 (N = 952; 28 percent heterosexuals, 78 percent lesbian, gay, and bisexual [LGB] adolescents and young adults) to assess their mental health, physical and sexual risk behaviors, minority stressors, and coping resources. Results indicate that young LGBs had lower levels of mental and physical health than heterosexuals. Among LGB participants, high levels of minority stressors and low levels of coping resources predicted lower levels of mental health, and lower levels of mental health predicted lower levels of physical health. These results emphasize that minority stressors should be recognized as risk factors for poorer mental health, as well as for physical and sexual risk behaviors.