Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania.

BACKGROUND: Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. AIM: This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. METHODS: Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. RESULTS: Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents' right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. CONCLUSION: These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.

In Tanzania, adolescent pregnancies are culturally unwanted, abortion remains illegal and yet the utilization of family planning services among adolescents is still low. The community myths and misconceptions about the side effects of contraceptives, healthcare providers' attitudes, and barriers within the healthcare system hinder adolescents' utilization of family planning services. The effective use of family planning methods will prevent the use of unsafe induced abortions and hence reduce morbidity and mortality among young women. This will be possible only if healthcare providers are equipped with the knowledge and skills to address these sexual and reproductive health challenges among adolescents in Tanzania. Therefore, in this study, we decided to explore the perceptions of health professionals and students on the provision of contraception to adolescents. We conducted 18 focus groups stratified among health professionals and students (midwives, nurses, medical doctors). Participants were supplied with a theoretical scenario wherein a 14-year-old girl presented to a family planning clinic seeking contraceptive services to determine how health professionals and students would handle the case. We found that the decision of providers with regards to offering contraception is highly dependent on having a baseline knowledge of the rights and contraceptive services available to adolescents. Some barriers identified as reasons for providers not to offer contraceptive services include a lack of awareness of the reproductive health rights for adolescents, judgmental behavior (implicit and explicit biases among providers), as well as religious and cultural dynamics. Participants also acknowledged that the presence of guidelines and proper training among providers might avoid the infringement of adolescents' rights to sexual and reproductive health services. In conclusion, these findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.

Does Stigma Toward Anal Sexuality Impede HIV Prevention Among Men Who Have Sex With Men in the United States? A Structural Equation Modeling Assessment.

INTRODUCTION: Men who have sex with men (MSM) are suboptimally engaged in efficacious HIV interventions, due in part to stigma. AIM: We sought to validate the Anal Health Stigma Model, developed based on theory and prior qualitative data, by testing the magnitude of associations between measures of anal sex stigma and engagement in HIV prevention practices, while adjusting for covariates. METHODS: We conducted a cross-sectional online survey of 1,263 cisgender MSM living in the United States and analyzed data with structural equation modeling. We tested a direct path from Anal Sex Stigma to Engagement in HIV Prevention alongside 2 indirect paths, 1 through Anal Sex Concerns and another through Comfort Discussing Anal Sexuality with Health Workers. The model adjusted for Social Support, Everyday Discrimination, and Sociodemographics. MAIN OUTCOME MEASURE: Engagement in HIV Prevention comprised an ad hoc measure of (i) lifetime exposure to a behavioral intervention, (ii) current adherence to biomedical intervention, and (iii) consistent use of a prevention strategy during recent penile-anal intercourse. RESULTS: In the final model, anal sex stigma was associated with less engagement (ß = -0.22, P < .001), mediated by participants' comfort talking about anal sex practices with health workers (ß = -0.52; ß = 0.44; both P < .001), adjusting for covariates (R2 = 67%; χ2/df = 2.98, root mean square error of approximation = 0.040, comparative fit index = 0.99 and Tucker-Lewis index = 0.99). Sex-related concerns partially mediated the association between stigma and comfort (ß = 0.55; ß = 0.14, both P < .001). Modification indices also supported total effects of social support on increased comfort discussing anal sex (ß = 0.35, P < .001) and, to a lesser degree, on decreased sex-related concerns (ß = -0.10; P < .001). CLINICAL IMPLICATIONS: Higher stigma toward anal sexuality is associated with less engagement in HIV prevention, largely due to discomfort discussing anal sex practices with health workers. STRENGTH & LIMITATIONS: Adjustment for mediation in a cross-sectional design cannot establish temporal causality. Self-report is vulnerable to social desirability and recall bias. Online samples may not represent cisgender MSM in general. However, findings place HIV- and health-related behaviors within a social and relational context and may suggest points for intervention in health-care settings. CONCLUSION: Providers' willingness to engage in discussion about anal sexuality, for example, by responding to questions related to sexual well-being, may function as social support and thereby bolster comfort and improve engagement in HIV prevention. Kutner BA, Simoni JM, King KM, et al. Does Stigma Toward Anal Sexuality Impede HIV Prevention Among Men Who Have Sex With Men in the United States? A Structural Equation Modeling Assessment. J Sex Med 2020;17:477-490.

What Gay and Bisexual Men Treated for Prostate Cancer Want in a Sexual Rehabilitation Program: Results of the Restore Needs Assessment.

Introduction: While erectile dysfunction and urinary incontinence are well-documented effects of prostate cancer treatment, the impact of sexual concerns on the lives of gay and bisexual men treated for prostate cancer has not been well researched. Specifically there are no known studies investigating what gay and bisexual men want in sexual recovery treatment. Methods: To conduct this needs assessment, we recruited 193 gay and bisexual men with prostate cancer from the largest online cancer support group in North America. As part of a wider study of sexual functioning, participants completed a 32-item needs assessment and a qualitative question assessing their needs. Results: There was high interest in a sexual recovery program across race/ethnicity and by treatment type. The most preferred formats were a self-directed online curriculum and participation in a support group specific to gay and bisexual men with prostate cancer. A variety of formats, language and contents were deemed appropriate and important by most participants. Frank explicit language and content were preferred. Three themes emerged in the qualitative analysis. Conclusions: Gay and bisexual men treated for prostate cancer want a recovery curriculum that explicitly addresses the sexual challenges they face before, during and after treatment. While differences were identified across race and treatment type, they were relatively few and minor in magnitude, suggesting that a single online curriculum could advance rehabilitation for this population.

The Effects of Radical Prostatectomy on Gay and Bisexual Men's Mental Health, Sexual Identity and Relationships: Qualitative Results from the Restore Study.

The effect of prostate cancer treatment in gay and bisexual men is an under-researched area. In 2015, we conducted in-depth telephone interviews with 19 gay and bisexual men who had undergone radical prostatectomies. Across the respondents' five emotional themes emerged: (1) shock at the diagnosis, (2) a reactive, self-reported "depression", (3) sex-specific situational anxiety, (4) a sense of grief, and, (5) an enduring loss of sexual confidence. Identity challenges included loss of a sense of maleness and manhood, changes in strength of sexual orientation, role-in-sex identity, and immersion into sexual sub-cultures. Relationship challenges identified included disclosing the sexual effects of treatment to partners, loss of partners, and re-negotiation of sexual exclusivity. Most to all of these effects stem from sexual changes. To mitigate these negative effects of radical prostatectomy, and to address health disparities n outcomes observed in gay and bisexual men, all these challenges need to be considered in any tailored rehabilitation program for gay and bisexual men.

Disparities in Weight and Weight Behaviors by Sexual Orientation in College Students.

Objectives. We assessed disparities in weight and weight-related behaviors among college students by sexual orientation and gender. Methods. We performed cross-sectional analyses of pooled annual data (2007-2011; n = 33 907) from students participating in a Minnesota state-based survey of 40 two- and four-year colleges and universities. Sexual orientation included heterosexual, gay or lesbian, bisexual, unsure, and discordant heterosexual (heterosexuals engaging in same-sex sexual experiences). Dependent variables included weight status (derived from self-reported weight and height), diet (fruits, vegetables, soda, fast food, restaurant meals, breakfast), physical activity, screen time, unhealthy weight control, and body satisfaction. Results. Bisexual and lesbian women were more likely to be obese than heterosexual and discordant heterosexual women. Bisexual women were at high risk for unhealthy weight, diet, physical activity, and weight control behaviors. Gay and bisexual men exhibited poor activity patterns, though gay men consumed significantly less regular soda (and significantly more diet soda) than heterosexual men. Conclusions. We observed disparities in weight-, diet-, and physical activity-related factors across sexual orientation among college youths. Additional research is needed to better understand these disparities and the most appropriate intervention strategies to address them.

Open, closed, or in between: relationship configuration and condom use among men who use the internet to seek sex with men.

Nearly 70 % of HIV+ men who have sex with men (MSM) are estimated to have contracted HIV from a main partner. We examine whether condom use varies by relationship configuration, including open relationships with and without cheating. 656 MSM in committed relationships were recruited through a sexually explicit social networking website. Of the 55 % of MSM who had anal sex with a non-main partner in the past 90 days, two-thirds did not use a condom. Adjusting for covariates, MSM in relationships characterized as open with cheating versus monogamous were more likely to have unprotected anal sex with both main and non-main partners. MSM who perceived that their partner played around or cheated were more likely to have unprotected anal sex with a non-main partner. Prevention messages should attempt to reduce cheating and increase personal responsibility for protecting partners from HIV. Messages should be tailored to reflect open and monogamous relationships.

Drinking settings, alcohol consumption, and sexual risk behavior among gay men.

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: "home" "social," "bar/social," and "general" drinkers (i.e., drinks in all settings). Regression models showed that "general" drinkers were more likely than "social" drinkers to engage in frequent heavy drinking. Compared to 'social' drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.

Revision, criterion validity, and multigroup assessment of the reactions to homosexuality scale.

Internalized homonegativity encompasses negative attitudes toward one's own sexual orientation and is associated with negative mental and physical health outcomes. The Reactions to Homosexuality Scale (Ross & Rosser, 1996), an instrument used to measure internalized homonegativity, has been criticized for including content irrelevant to the construct of internalized homonegativity. We revised the scale using exploratory and confirmatory factor analyses and identified a 7-item, 3-factor reduced version that demonstrated measurement invariance across racial/ethnic categorizations and between English and Spanish versions. We also investigated criterion validity by estimating correlations with hypothesized outcomes associated with outness, relationship status, sexual orientation, and gay community affiliation. The evidence of measurement invariance suggests that this scale is appropriate for pluralistic treatment or study groups.

Sexual compulsivity and high-risk sex among Latino men: the role of internalized homonegativity and gay organizations.

The objective of this study was to measure the correlation between compulsive sexual behavior (CSB) and internalized homonegativity (IH) and determine their association with unprotected anal intercourse in Latino men who have sex with men. Nine hundred sixty-three Latino men completed an Internet survey (MINTS study) in 2002 and provided data on two scale exposures. Logistic regression was used to test interactions and generate effect estimates. Higher IH and association with gay organizations modified the effect of CSB on high-risk sex. Drug and alcohol use also contributed to risk behavior for this subgroup. Overall, CSB had a strong association with high-risk sex. IH and gay organization membership may moderate this relationship, which illuminates an additional factor to consider in studying sexual risk-taking. Further work is needed to validate a path from IH and high-risk sex that incorporates drug or alcohol use.

An online needs assessment of a virtual community: what men who use the internet to seek sex with men want in Internet-based HIV prevention.

As part of a study to develop effective Internet-based HIV prevention interventions for Men who use the Internet to seek Sex with Men (MISM), we sought information from the target population on; (a) acceptability of sexually explicit media; (b) interest in specific content areas; and (c) identification of credible sources of information. A cross-sectional stratified Internet-based survey design was employed. Between September and November 2005, we recruited 2,716 MISM through Gay.com stratified across race/ethnicity to ensure adequate racial/ethnic diversity. Sixteen Likert-type items assessed acceptability of sexual explicitness, 24 items identified topics for inclusion, and two assessed sources of information. There was near universal acceptability for highly sexually explicit education. Over 75% reported high interest in 10 sexual health topics. HIV positive MISM and MISM engaged in unprotected anal sex with multiple male partners reported significantly less interest in HIV prevention specific content. Differences across age, race/ethnicity and education were identified. Idiosyncratic searches and gay sites were frequently cited sources of information; however blogs, government, and media sites were not. It is acceptable for web-based HIV prevention for MISM to be highly sexually explicit and to provide detailed content relevant to men's sexual health. Since demographic differences in acceptability and content were minor, it is appropriate for interventions to target across demographics. Interventions to re-engage men engaging in high risk and HIV + MISM should be considered. Leading health agencies should review whether their web information is retrievable, credible and useful to those most at risk.