Sexual Activity as Self-Injury: A Scoping Review.

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

A Pilot Study Assessing Sexual Behavior as Self-Injury in College Students.

OBJECTIVE: The use of sexual activity to self-injure has been proposed in research literature but remains underexplored. The purpose of this pilot study was to determine the feasibility of identifying sexual activity as self-injury in a U.S. college-based sample and to provide a preliminary examination of sexual activity as self-injury to inform future study on this topic. METHOD: A cross-sectional descriptive pilot study was conducted to assess for recognition of and attitudes toward sexual behavior as self-injury and to identify participant-reported experiences of sexual activity to self-injure. RESULTS: A total of 50 participants completed the online survey. Thirteen (26%) participants reported they had heard of the concept of "sex as self-injury." Six (12%) participants reported ever having used sexual activity to cause physical or psychological harm to themselves. Participants reported intentions for engaging in sexual activity to self-injure, including causing physical pain, reliving past self-harm or trauma, showing vulnerability, proving self-worth, pleasing or wanting to feel needed by their partner, and suicidal ideation. CONCLUSION: Sexual activities have been used by some college students as a means of self-harm. Further research is needed to understand this phenomenon and clinicians should consider screening for this in patients who participate in dangerous sexual behaviors or self-injurious behaviors.

Searching for the Second R in Sexual and Reproductive Health and Rights.

Sexual and reproductive health and rights have gained prominence in the HIV response. The role of sexual and reproductive health in underpinning a successful approach to HIV prevention, treatment, care, and services has increasingly been recognized. However, the "second R," referring to sexual and reproductive rights, is often neglected. This leads to policies and programs which both fail to uphold and fulfill these rights and which fail to meet the needs of those most affected by HIV by neglecting to take account of the human right-based barriers and challenges they face. In this commentary, the authors draw on the approach and practical experiences of the Link Up program, and the findings of a global consultation led for and by young people living with and most affected by HIV, to present a five-point framework to improve programming and health outomces by better protecting, respecting, and fulfilling the sexual health and reproductive rights of young people living with and most vulnerable to HIV.

Linking Sexual and Reproductive Health and Rights and HIV Services for Young People: The Link Up Project.

Sexual health and access to services are a pressing need for young people. This article introduces Link Up, a 3-year project in three African and two Asian countries, to enable and scale up access to integrated HIV services and sexual and reproductive health and rights for marginalized young people. The young people we worked with in this project included young men who have sex with men, young sex workers, young people who use drugs, young transgender people, young homeless people, and other vulnerable young people. The research and programmatic activities of Link Up, as illustrated in this Supplement, have highlighted the importance of recognizing and engaging with diversity among young people to improve access to services and outcomes protecting their health and human rights.

Leadership and Innovation-Listening to and Learning From Young People in Burundi.

This commentary describes young people's leadership from the perspective of a youth-led organization in the Link Up project in Burundi, Réseau National des Jeunes vivant avec le VIH. It describes processes that enable young people to guide, influence, deliver, and improve health service provision; the challenges faced by Réseau National des Jeunes vivant avec le VIH and how they are addressing these challenges.