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HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

Objective To examine the prevalence of student utilization of campus sexual health resources and their association with sexually transmitted infection (STI) testing. Participants: Undergraduate students (n = 7020) at a large Midwestern university completed a confidential online survey in 2015. Methods: A probability-based sample of undergraduate students completed a cross-sectional online survey. Results: Commonly accessed sexual health resources were student orientation activities about sexual assault or rape, sexuality/gender classes, gender and sexual orientation panels, class panels on sexual assault, birth control and STI presentations, and having joined a sexuality-related student organization. Campus sexual health resource utilization was significantly associated with greater STI testing since college. Gender, race, class level, enrollment status, sexual orientation, timing of last sexual event, and perceived STI risk were significantly associated with STI testing in college. Conclusions: Campus sexual health resources play an important role in student sexual health promotion. [ABSTRACT FROM AUTHOR]

Objective Most studies on agreeing to unwanted sex have assessed sexual encounters between people who have had sex before. Thus, we examined instances of sexual compliance with a novel sexual partner. Participants: A probability sample of college students at a university in the Midwest United States (N = 7,112). Methods: Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Results: Only 2.5% (n = 179) agreed to unwanted sexual activity at their most recent sexual encounter. People who were sexually compliant with a novel sexual partner frequently did so due to their own alcohol intoxication. Further, sexual compliance with novel sexual partners was less frequently associated with affectionate sexual behaviors or orgasm. Conclusions: Our initial findings regarding the effect of sexual precedent on sexual compliance warrant further research on instances when people agree to sex they don't want with novel partners. [ABSTRACT FROM AUTHOR]

To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14–49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use. [ABSTRACT FROM AUTHOR]

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) Diagnosis means death, 2) Linkage to care means uncertainty, 3) HIV care improves the quality of life lost pre- or peri-diagnosis, 4) ART implies life, and 5) Undetectable addresses the medical but not social aspects of HIV. Participants recalled they faced and continue to face social determinants, stigma, and chronic and mental health conditions. Findings provide future research directions and practical implications to address social determinants of health, promote chronic and mental health, and reduce interpersonal stigma throughout all HIV care continuum stages. [ABSTRACT FROM AUTHOR]

We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosexual men. However, among women, persons with a bisexual identity were less gender conforming compared to heterosexual and lesbian persons. In multivariate analyses, childhood gender expression trumped the role of sexual identity. In terms of demographic characteristics, gender conformity seemed to be more present among persons with positions with less social status in terms of age, race/ethnicity, education, income, and relationship status. Finally, we found among both men and women, that a large proportion saw themselves as more masculine or feminine than men and women on average, respectively, suggesting that accentuating one's gender conformity has a psychological function. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions. [ABSTRACT FROM AUTHOR]

Bisexual individuals have disproportionately higher rates of physical and mental health concerns compared to both heterosexual and gay/lesbian individuals. Few studies have examined diverse bisexual-identified men's perceived health concerns for themselves and other bisexual men or their experiences in healthcare settings. This qualitative study explored health and healthcare experiences among cisgender and transgender bisexual men, most of whom were also men of color. Data were collected through semi-structured interviews. Participants included 31 self-identified bisexual men from the Chicago area. Participants were asked questions surrounding bisexual men's health and healthcare experiences in general and their personal experiences, drawing connections between intersecting bisexual and racial/ethnic identities. Interview transcripts were analyzed using thematic analysis. Participants reported sexual health and mental health as the top health concerns for bisexual men. Participants viewed their bisexual identity as a motivator for seeking healthcare services and adopting safer sex practices. Mental health challenges faced by respondents were connected to bisexual stereotypes and fear of disclosing bisexual and transgender identities. Furthermore, perceptions of masculinity amongst bisexual men of color were particularly salient in connecting to their mental health experiences. The intersection of participants' transgender and bisexual identities impacted their healthcare experiences in general healthcare settings, with many participants reporting a lack of cultural competence and provider knowledge concerning their identities. LGBTQ Federally Qualified Health Centers, however, were described as providing compassionate care. Our findings suggest the need for more interventions that account for bisexual men's intersecting identities. Furthermore, increased provider training is necessary for providing affirmative care to bisexual men. [ABSTRACT FROM AUTHOR]

Understandings of sex and intimacy carry important implications for individuals' behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India - Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others' characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here. [ABSTRACT FROM AUTHOR]

Consistent and correct use of contraceptives and barrier methods are effective ways to prevent sexually transmitted infections (STIs) and unintended pregnancy. We examined contraceptive and barrier use among a sample of 27 sexual- and gender-minoritized individuals assigned female at birth (SGMF) in three cities in India. Contraceptive and barrier use was prevalent among SGMF with male sex partners but was perceived as unnecessary for many who solely engaged with female partners. Perceived lack of risk, cultural and partner-related issues, and concerns about side effects served as barriers to use. Inclusive sexuality education would better address the needs of SGMF. [ABSTRACT FROM AUTHOR]

Using data from 78 sexting-experienced adolescents from the 2015 National Survey of Sexual Health and Behavior, we describe sexting frequency, sexting partners, sexual relationships with such partners, and characteristics associated with sexting. Most (59.2%) respondents sexted at most monthly, usually with romantic partners (62.0%). About 41% of sexting-experienced adolescents did not usually have sexual relationships with sexting partners, 36.6% usually sexted after starting a sexual relationship, and 16.8% reported that their sexting typically preceded sexual relationships. Younger adolescents sexted more frequently. Those without vaginal sex/anal sex experience, or prior romantic experience, were more likely to have sexted a non-romantic/sexual partner. [ABSTRACT FROM AUTHOR]

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality. Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals' condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n = 234). Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use. Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms. [ABSTRACT FROM AUTHOR]

Indian sexual and gender minoritized (SGM) individuals face marginalization and discrimination. Objectives: This study examines stigma's effects on sexuality among SGM individuals in urban India. Methods: We conducted 5 focus group discussions and 27 interviews with SGM-identified adults connected to SGM-advocacy organizations in 3 cities (Chennai, Bangalore, Kolkata). Results: Stigma affected sexuality in the following ways: gender-specific stigma and behavioral norms, sexual identity-specific stigma, partners' stigma and buffering effects of partner, heterosexual marriage pressure, and limited sexual healthcare. Conclusions: Although there were similarities with stigma's effects in Western environments, the unique Indian context necessitates further research for more targeted interventions. [ABSTRACT FROM AUTHOR]

Objective: To examine, in a probability sample of undergraduate students, characteristics of students' most recent sexual experiences (including alcohol use) as well as their experiences with nonconsensual sex. Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%). Methods: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime). Results: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police. Conclusions: Implications for campus policy and health education are addressed. [ABSTRACT FROM AUTHOR]

Using data from the 2014 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1,493 individuals' most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure. [ABSTRACT FROM AUTHOR]

Research on sexual satisfaction tends to focus mostly on heterosexual women and women in monogamous relationships. Sexual satisfaction among sexual minority women and women who are nonmonogamous or not partnered is under-researched. Through an online survey, we gathered data from 334 cisgender sexual minority women in various relationship configurations and assessed sexual satisfaction in relation to individual and interpersonal factors. Sexual satisfaction was not related to sexual identity or gender of relationship, dating, or sexual partners. Although women without a partner reported lower sexual satisfaction compared to those with one partner and those with more than one partner (p <.001), satisfaction between monogamous and nonmonogamous women did not differ (p <.001). Less internalized homonegativity was associated with greater sexual satisfaction (p <.001). This study broadens our knowledge of the sexual lives and health of sexual minority and nonmonogamous women. Findings support reconceptualizing how we understand and measure sexual satisfaction and expanding samples in future research to include sexual minority women and women in nonmonogamous relationships. [ABSTRACT FROM AUTHOR]

Women who have sex with women and men (WSWM) are less likely to use effective contraception and more likely to experience unintended pregnancies than their exclusively heterosexual peers. The authors examined contraception use among a community sample of 80 WSWM (defined as genital contact with at least one cisgender man and woman during the past 12 months) of reproductive age living in the Midwest. Authors determined if contraceptive use differed by sociodemographic characteristics, or sexuality and relationship characteristics, and used a modified timeline follow-back calendar to explore contraception use during most recent penile-vaginal intercourse (PVI). Overall, use of highly effective contraception was low (38.8%) with combined hormonal contraceptive pills reported most frequently (54.8%). Of participants who engaged in PVI during their most recent sexual event with a male, nearly one half (46.1%) reported using at least one form of contraception. WSWM with a primary sexual attraction to men were more likely to use contraception (p <.01), as were those who recently engaged in PVI (p <.05). Self-identified lesbian participants were less likely than all others to use contraception (p <. 05). WSWM not planning to engage in sex with men may not use contraceptives consistently or at all, suggesting an area where inclusive contraception counseling can improve the reproductive health of women who have sex with women and men [ABSTRACT FROM AUTHOR]

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals’ likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience. [ABSTRACT FROM AUTHOR]

Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India’s oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants’ photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants’ extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes. [ABSTRACT FROM PUBLISHER]

Although bisexual parents represent the largest proportion of lesbian, gay, and bisexual (LGB) parents, their lived experiences are rarely included in prior research. The intimate relationships of bisexual parents may be similar to or distinct from monosexual (i.e. sexually oriented to one sex/gender) individuals, and such relationships impact individuals’ health and well-being, as well as family dynamics. We conducted phone interviews with 33 self-identified bisexual parents who were at least 18 years old, with at least one child (genetic, adopted, foster, stepchildren, partners’ children) living in the United States. As with individuals of all sexual identities, participants’ relationship structures (e.g. monogamy, commitment, co-parenting with former partners, single, dating) were diverse. Most participants’ partners were supportive of their bisexuality. Former relationships were often significant in positive ways, including beneficial co-parenting, or in negative ways, including poor co-parenting and experiences of biphobia. Open communication, boundary negotiation, and counseling were all strategies that reportedly strengthened relationships. Many participants viewed relationships differently based on the gender of their partner(s), and biphobia impacted these perceptions. Participants expressed the desire for targeted resources and therapeutic approaches for bisexual parents, since their role as a parent was often a primary factor in how they organized their relationships. [ABSTRACT FROM PUBLISHER]

The study purpose was to assess, in a U.S. probability sample of women, experiences related to orgasm, sexual pleasure, and genital touching. In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. While 18.4% of women reported that intercourse alone was sufficient for orgasm, 36.6% reported clitoral stimulation was necessary for orgasm during intercourse, and an additional 36% indicated that, while clitoral stimulation was not needed, their orgasms feel better if their clitoris is stimulated during intercourse. Women reported diverse preferences for genital touch location, pressure, shape, and pattern. Clinical, therapeutic, and educational implications are discussed. [ABSTRACT FROM AUTHOR]

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women’s experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women. [ABSTRACT FROM PUBLISHER]

Bisexual parents constitute the largest proportion of “lesbian, gay and bisexual (LGB) parents” yet are largely absent from previous research. As parenting and sexual identity may be significant pieces of one's self-concept, examining bisexual parents’ experiences and sexual identity formation is important. This qualitative study used phone interviews with 33 self-identified bisexual parents in the United States with at least one child (including genetic, adopted, step, or foster). Participants were between ages 22 and 65 years, and the majority were non-Hispanic White. The authors thematically analyzed interview data using Dedoose. Participants described experiencing biphobia as a barrier to understanding their identity or coming out to others, including their children. Despite misconceptions about bisexuality, parents reported pride in their identity and more openness to and understanding of their children. Developing resources to navigate biphobia and identity disclosure in the context of parenting may build community and reduce stress. [ABSTRACT FROM PUBLISHER]

Sexual satisfaction is commonly defined and discussed in physiological terms of arousal and orgasm. Yet this narrow discourse does not accommodate the complex, multidimensional, and interpersonal aspects of sexual experience. To broaden and deepen our understanding of sexual satisfaction, we employed McClelland’s (2014) holistic four-factor framework of sexual satisfaction in a theoretical thematic analysis of 39 behaviorally bisexual women’s descriptions of their “best” partnered sexual experiences from the past year. We found women’s accounts mapped on to four elements: emotional attunement, emotional gratification, partner gratification, and sensory gratification. Relational and emotional dynamics, including emotional security, quality of interpersonal interaction during and after a sexual encounter, mutuality, intimacy, partner skill, novelty, and communication, were key to participants’ best sex experiences. Our findings support a multifaceted model of women’s sexual satisfaction that accounts for emotional, relational, and embodied experiences and the diverse relationships and behaviors these might involve. [ABSTRACT FROM AUTHOR]

Although many self-identified bisexual individuals report having at least one child, bisexual parents’ unique experiences, including sexuality-related communication with their children, have been largely absent from the parenting literature. We conducted in-depth interviews via telephone (or digital telephony such as voice over Internet protocol) with 33 individuals who self-identified as bisexual were at least 18 years old, had at least one child (genetic, adopted, step, foster, guardian or partner’s child) and currently living in the USA. Nearly all participants encouraged their children to be tolerant of sexual and gender diversity. Sexual behaviours were primarily discussed in terms of protection from sexually transmitted infections and unintended pregnancy. Participants’ approaches to communication included non-verbal methods (e.g. role modelling) and pragmatic verbal discussion. Participants employed numerous strategies, including age-appropriate, child-driven and opportunistic discussions. Some parents did not discuss sexuality at all with their children. Many had not received training in childhood development or sexuality education. The participants’ experiences were often similar to previous research on parents of other sexual identities. However, due to the unique stigma associated with bisexuality, findings point to a need for developing and providing targeted resources for bisexual parents to assist in discussions about sexuality within the family context. [ABSTRACT FROM PUBLISHER]

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population. [ABSTRACT FROM PUBLISHER]

The experiences of sexual minority women (i.e., women who do not identify as 'heterosexual') in India have largely been absent in scientific literature. In partnership with India's oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women's perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population. [ABSTRACT FROM AUTHOR]

We assessed the extent to which sociodemographic, personal, and behavioral factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing among a diverse group of Latino men who have sex with men (MSM) in New York City. The triangulation approach was used to synthesize data from 176 MSM who completed an in-person or phone questionnaire about substance use, alcohol consumption, sexual behaviors, and HIV/STI testing history and 40 participants who participated in focus groups. Correlates of testing significant in univariable analyses (p < .05) were entered into multivariable logistic regression models. Over half (57.9%) of study subjects tested for HIV in the previous 12 months and 60.2% tested for STIs in the previous 12 months. Age and education were positively correlated with HIV testing in multivariable analysis. No significant correlates of STI testing were identified. Spanish-speaking only subjects were less likely to get tested for HIV and STI; however, this association was not significant. Our study demonstrates the need for further study of predictors of STI testing as well as the potential role of language barriers and education in routine testing for HIV. Social and behavioral factors may intensify these obstacles. Future research and interventions should address the role of language barriers and perceived issues of immigration status in the decision to get tested. [ABSTRACT FROM PUBLISHER]

Objectives: This exploratory study attempted to assess a range of sexual behaviors, relationships, and related factors among a sample of bisexual men in Mumbai, India. Methods: Data collection occurred in two separate phases. First, focus group discussions were facilitated with local community members in order to finalize an interviewer-administered questionnaire. Afterward, structured interviews were conducted with a sample of 50 bisexual men using this questionnaire. Results: Participants reported a wide range of sexual behaviors and relationships with male and female partners. Conclusions: Findings have implications for future research and practice focusing on bisexual men in India,as well as their partners of all genders. [ABSTRACT FROM AUTHOR]

Extant research on quality of life in gay, bisexual, and other men who have sex with men (MSM) primarily capture the social milieu and psychosocial outcomes of those living in urban rather than rural settings. Much of this can be attributed to the high demand for services in areas with greater concentrations of sexual minorities. As MSM in rural communities are both underrepresented in research and susceptible to social estrangement from each other, our study assessed the impacts of several aspects of their social milieu—recency of access to community resources for gay/bisexual men and time socializing with other gay/bisexual men—on loneliness, as well as the mediating role of perceived connectedness to the local gay/bisexual community on this association. Using purposive sampling and Internet-based direct marketing, we recruited 225 MSM aged 18 or older in rural and mixed rural areas in south-central Indiana. We performed a path analysis to test our hypothesized model. Recency of access to community resources was positively associated with perceived connectedness to the gay/bisexual community, which in turn was protective against loneliness. Findings indicate that improving accessibility to venues or activities for rural MSM could serve to facilitate community-building and benefit their psychosocial well-being. [ABSTRACT FROM PUBLISHER]

Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21–48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies. [ABSTRACT FROM PUBLISHER]

Epidemiologic data demonstrate that women involved with the criminal justice system in the United States are at high risk for sexually transmitted infections, including herpes simplex virus type 2 (HSV-2). Female defendants were recruited from a misdemeanor court to assess whether brief framed messages utilizing prospect theory could encourage testing for HSV-2. Participants were randomly assigned to a message condition (gain, loss, or control), completed an interviewer-administered survey assessing factors associated with antibody test uptake/refusal and were offered free point-of-care HSV-2 serologic testing. Although individuals in the loss-frame group accepted testing at the highest rate, an overall statistical difference in HSV-2 testing behavior by group (p ≤ .43) was not detected. The majority of the sample (74.6%) characterized receiving a serological test for HSV-2 as health affirming. However, this did not moderate the effect of the intervention nor was it significantly associated with test acceptance (p ≤ .82). Although the effects of message framing are subtle, the findings have important theoretical implications given the participants' characterization of HSV-2 screening as health affirming despite being a detection behavior. Implications of study results for health care providers interested in brief, low cost interventions are also explored. [ABSTRACT FROM PUBLISHER]

Limited research exists regarding community involvement and social support among behaviourally bisexual men. Previous studies suggest that bisexual men experience high levels of social stigma in both heterosexual and homosexual community settings. Research focusing on social support has demonstrated that individuals with limited access to similar individuals experience greater risk for negative health outcomes. Using a community-based research design, participants were recruited using multiple methods. Researchers conducted in-depth, semi-structured interviews with 75 men who reported having engaged in bisexual behaviour within the past six months. Interviews elucidated the experiences of behaviourally bisexual men in heterosexual and homosexual settings, as well as their perceptions of the existence of a bisexual community or bisexual spaces. All participants perceived a lack of a visible bisexual community and expressed difficulty with being comfortable, or a feeling of belonging, within a variety of heterosexual and homosexual community spaces. Findings suggest the need for interventions focused on community building among, as well as creating spaces specifically designed for, bisexual men in order to increase perceived social support and decrease isolation and possible negative health outcomes. [ABSTRACT FROM PUBLISHER]

The midwestern United States has a high number of recent Latino migrants, but little information is available regarding their sexual behaviors. A total of 75 behaviorally bisexual men (25 Latino, 25 Black and 25 White) participated in an exploratory study on sexual health. The data presented in this article are restricted to the 25 self-identified Latino men. Qualitative in-depth interviews were conducted and optional self-administered sexual transmitted infection (STI) screening was provided. The measures used were taken from the National Survey of Sexual Health and Behavior (NSSHB), a probability study of the sexual behaviors of nearly 6,000 individuals, age 14 to 94, in the United States. In this sample of bisexual men, the most commonly reported sexual behaviors were masturbation, vaginal intercourse and receiving oral sex from male and female partners. The majority of the participants were the insertive partner during anal sex with male partners. Many of the participants reported alcohol use during their most recent sexual activity. A fair number reported not using condoms during their last sexual event. Pleasure, arousal, orgasm and erectile functioning were markedly similar despite partner gender. A small number of participants also engaged in sexual activities with transgender individuals. All of the Latino participants took part in optional self-collection for STI specimens. The results of the study provide rich insights into the sexual behavior and related factors, as well as potential risk behaviors, of bisexual Latino men that may be targeted for future sexual health promotion efforts. [ABSTRACT FROM AUTHOR]

Studies concerning behaviorally bisexual men continue to focus on understanding sexual risk according to a narrow range of sexual behaviors. Few studies have explored the subjective meanings and experiences related to bisexual men's sexual behaviors with male and female partners. In-depth, semistructured interviews were conducted with 75 men who engaged in bisexual behavior within the past 6 months. Participants were asked about their subjective sexual experiences with male and female partners. Findings suggest adherence to normative gender roles, with attraction to men and women conforming to these stereotypes, as well as a segregation of sexual behaviors along gendered lines. Overall, condom use was influenced by perceptions of potential negative consequences. Based on these findings, it remains critical that public health and other social and behavioral sciences continue to study bisexual men's sexual health issues as separate and distinct from their exclusively homosexual and heterosexual counterparts. [ABSTRACT FROM AUTHOR]

Research has not yet explored the potential impact of social stress, biphobia and other factors on the mental health of bisexual men. In-depth interviews were conducted with a diverse sample of 75 men who engaged in bisexual behavior within the past 6 months. Interviewers explored potential mental health stressors and supports. Many participants reported personal and social challenges associated with bisexuality, which in turn influenced their mental health. Reported instances of stigma toward bisexuality, from homosexual and heterosexual individuals, affected participants’ feelings regarding their own sexualities. Isolation was also commonly reported. Programs are greatly needed that focus on the specific mental health and other concerns voiced by these men. Based on these findings, such programs should emphasize self-acceptance, social network and community building and ways to maximize available social support, similar to community-level empowerment interventions that have shown success among gay-identified men. [ABSTRACT FROM PUBLISHER]

An introduction is presented to a special issue on bisexual health, including topics such as health terminology, identity issues for bisexual women, and the sexual health of bisexual men.

Little public health research has explored male bisexuality and the wide range of behaviors experienced by bisexual men beyond disease transmission and other negative consequences. There is a general lack of information on diverse expressions of sexuality among diverse groups of bisexual men in the United States. Researchers collected data on a wide range of variables related to sexual behavior from a sample of 26,042 participants, recruited via a large social and sexual networking Website. Four distinct typologies of male bisexuality were constructed: self-identified bisexual, bisexual dating, bisexual with current sexual partners and bisexual by behavior. These categories were examined individually as well as compared and contrasted with one another. Demographic characteristics varied among men depending on bisexual categorization. Although participants that identified as bisexual within each typology often met criteria for other categories for other typologies, there was no absolute overlap between categories. The recency and frequency of sexual behaviors significantly varied based upon the participant's bisexual typology. Findings suggest that previous research on bisexual men's sexual behaviors and sexual risk behaviors may be misleading if bisexuality is restricted to a single typology. Further research should examine the potential subjective meanings and health implications of diverse typologies of male bisexuality, beyond sexual risk. Comprehensive and insightful research on aspects of life other than disease infection and transmission among bisexual men will help to ensure a more accurate understanding of male bisexuality in a comprehensive sexual health framework. [ABSTRACT FROM PUBLISHER]

Research on behaviourally bisexual Latino men in the USA has not yet examined sexual health issues among men living in diverse areas of the nation, including the Midwest. A community-based participatory research approach was used to engage a diverse sample of 75 behaviourally bisexual men (25 White, 25 Black and 25 Latino). Semi-structured interviews were conducted and standard qualitative analysis procedures were used to explore data from the 25 Latino participants. Men described their unique migration experiences as behaviourally bisexual men in this area of the USA, as well as related sexual risk behaviours and health concerns. Lack of culturally congruent public health and community resources for behaviourally bisexual men in the Midwestern USA were identified as significant barriers. As in other studies, familial and community relationships were significant for the participants, especially in terms of the decision to disclose or not disclose their bisexuality. Additionally, alcohol and other drugs were often used while engaging in sexual behaviours particularly with male and transgender, as well as female, partners. Behaviourally bisexual Latino men may benefit from receiving positive and affirmative individual- and structural-level support in regards to their unique experiences in this and other settings. [ABSTRACT FROM AUTHOR]

This nationally representative study documents that vibrator use among heterosexually identified men in the United States is common, with 43.8% reporting use of a vibrator at some point in their lives, with most vibrator use by heterosexual men occurring within the context of sexual interactions with a female partner. Approximately 94% of male vibrator users reported that they had used a vibrator during sexual play with a partner, and 82% reported that they had used a vibrator during sexual intercourse. These data support the work of therapists and educators who often make recommendations for the incorporation of vibrators into partnered relationships. [ABSTRACT FROM AUTHOR]

In the United States, a debate exists as to whether abstinence-only or comprehensive sexuality education strategies are most beneficial for school-age youth. Despite abstinence being a fundamental component of comprehensive education, the two are often characterized as polar opposites. Few studies have examined overlaps between the approaches. The purpose of this study was to examine relationships between abstinence education and comprehensive topic instruction among sexuality education teachers. Data came from public school teachers (n = 199) in Florida. Abstinence instruction was measured using the Section 510 A-H guidelines. Comprehensive topic instruction was measured using the Sexuality Information and Education Council of the United States' guidelines. Logistic regression analyses measured relationships between abstinence and comprehensive topic instruction. Nearly one-half of teachers taught all eight A-H guidelines, and the majority taught most comprehensive sexuality education topics. The odds of teaching comprehensive sexuality education topics generally increased as teachers taught more of the federal government's abstinence guidelines. This suggests that abstinence instruction, a core element of comprehensive sexuality education, may increase alongside instruction on other comprehensive topics. We discuss the relevance our findings have for understanding the nature of both abstinence and comprehensive sexuality education. [ABSTRACT FROM AUTHOR]

While debates about adolescent sexuality education persist in the United States, little attention has been paid to adult sexuality education. Research suggests that teachable moments may be present in interactions between adult bookstore employees and the consumers who shop at these venues. The purpose of this study was to explore the potential for in-home sex-toy parties as an avenue for adult sexuality education for women. A total of 1197 women who facilitate in-home sex-toy parties for a large US-based company completed an online questionnaire related to their experiences facilitating these parties. As part of this larger survey, participants reported in an open-ended question the three most commonly asked questions they received when facilitating a party in the previous three months. Questions reported (n = 3149) were analyzed for commonalities using qualitative methods. Resulting themes were then compared with Sexuality Information and Education Council of the United States (SIECUS) guidelines for comprehensive sexuality education to assess the potential for teachable moments at the events. Of the 36 topical areas identified by SIECUS, 31 areas were represented in questions reported by consultants indicating a strong potential for teachable moments related to sexuality education. In-home sex-toy parties may provide an additional avenue through which to increase adult sexual literacy. [ABSTRACT FROM AUTHOR]

Adolescents in the United States continue to face sexual health issues. While community-based organizations (CBOs) have a long history of addressing the sexual health needs of those they serve, little attention has been given to CBOs focused on adolescent populations and the role youth development professionals (YDPs) might play in the advancement of sexual health. The purpose of this study was to assess the potential of YDPs to provide sexuality information to youth by 1) determining the frequency and type of questions YDPs receive from youth on sexuality and 2) ascertaining the perceived comfort, confidence, skills, and knowledge of YDPs in answering questions from youth and characteristics that might be predictive of increased levels of perceived comfort, confidence, skills, and knowledge. Utilizing a community-based participatory research process that engaged the researchers with leaders, key stakeholders, and youth development professionals from community-based organizations throughout the state, data were collected from 169 YDP in Indiana. YDPs received questions from youth on a broad array of sexuality-related topics with personal skills and relationships being the most frequent topics. YDPs had high perceived levels of comfort, confidence, skills, and knowledge (CCSK) in addressing questions from youth about sexuality. Training, both formal classroom-type training and more informal practices such as advice-seeking from a professional, was the only factor predictive of higher levels of CCSK. Results indicate that YDPs might play an important role in providing sexuality information to youth. Communities interested in ameliorating disparities among youth might want to consider including CBOs and YDPs in an ecological approach to sexual health education. [ABSTRACT FROM AUTHOR]

Men's gender roles and norms may influence their sexual behaviors and sexual health care practices in numerous specific ways and contexts. Health professionals encourage men's performance of testicular self-exams (TSE), yet estimates of monthly TSE from convenience samples range from 2% to 10%. In this population-based study of 655 U.S. men aged 18 to 44 years, TSE prevalence during the past month was 40.3% and was predicted by geographic location, sexual behaviors, genital self-image, and having a physical exam within the past year. National TSE prevalence rates will be useful to those who work to reduce the morbidity and mortality associated with testicular cancer. [ABSTRACT FROM AUTHOR]

Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Dr. Alfred C. Kinsey and his colleagues left behind a legacy of work that has served as a foundation for scholars worldwide as they explore human sexual behavior, including bisexuality. To truly reflect on the extent to which Kinsey's work has influenced researchers' conceptualizations of male bisexuality, and considers past, current, and future directions for work in this area, this article reflects lessons learned through conversations with one of the original, members of Kinsey's team, Dr. Paul Gebhard. These dialogues provided his perspectives on our contemporary treatment of bisexuality in research and the extent to which it has (not) taken full advantage of the frameworks provided by Kinsey's original work. The insights gained through these interactions, combined with a review of some of the past and current work on male bisexuality, offer valuable reference points for future research efforts. [ABSTRACT FROM AUTHOR]

Introduction In Florida, a state that consistently leads the nation in adverse sexual health outcomes among adolescents, numerous demographic and socio-cultural differences exist across the North, Central, and South regions. However, little is known about regional differences in sexuality education and beliefs among teachers. Methodology Using a mail-based survey of 462 teachers, we examined regional differences in parental consent requirements, abstinence instruction, student language barriers, availability of Spanish curricula, teacher beliefs regarding the dissemination of accurate safer sex information, and missing data. t-tests and multivariate logistic regression analyses were conducted. Results North Floridian teachers taught more abstinence than those in Central and South Florida. Additionally, they had fewer students with language barriers, offered less Spanish curricula, and, in general, possessed less favorable attitudes toward presenting accurate safer sex information. However, South Floridian teachers were most likely to report parental consent requirements in their schools. These findings largely remained in multivariate analyses. Conclusions The present study identified several noteworthy regional differences in sexuality education in Florida. Recommendations are given for developing and implementing programs that account for these differences within the state. [ABSTRACT FROM AUTHOR]

Traditionally, religion has been a major source of institutional support and well-being for Black people in the USA. However, when juxtaposed against sexuality, religion's positive effect upon the lives of non-heterosexual individuals is questionable. Research suggests that non-heterosexuals often abandon structured religion for spirituality due to the homonegativity perpetuated through religious institutions. Although studies have examined religion and spirituality among gays and lesbians, few have examined their roles in the lives of bisexuals. In this study, we analyzed qualitative interviews from 28 bisexual Black men who resided in New York City. In addition to church attendance, participants expressed belonging to religious communities through activities such as music ministry. Despite rejection because of their bisexuality, some participants saw other religious individuals as being accepting of them. Others discussed the church as a place where non-heterosexuals interacted, often for meeting sexual partners. Participants evoked beliefs in God in coping with adverse life experiences; some linked faith to family and sexual responsibilities. Drawing upon relevant literature, we discuss the implications of religion and spirituality for the quality of life of bisexual Black men in the USA. [ABSTRACT FROM AUTHOR]

As with many states, Florida has official directives that are intended to influence what type of sexuality education, if any, takes place in public school classrooms. However, little is known about contextual factors that facilitate or challenge the ability of teachers to implement effective sexuality education initiatives. Levels of sexually transmitted infections (STIs) and unintended pregnancies continue to rise in Florida; indeed, the state ranks second in annual incident HIV infections. The need exists to examine the capacity of Florida's schools to develop educational responses to these issues. Methodology: Community-based participatory research (CBPR), scientific review, and a statewide mail-based survey were used to collect quantitative and qualitative data from 479 public school personnel throughout Florida. Results: Even though the vast majority of teachers (87%) acknowledged that some form of "sex education" took place in their schools, it was not accessible to all students, was most often afforded little time, occurred late in the students' academic career, had little to no uniformity in terms of what was being taught and who was teaching it, had no standards in terms of training or quality assurance, and may not adequately address the realistic needs of students. Conclusions and Recommendations: Teachers in Florida reported numerous barriers to providing comprehensive sexuality education. State organizations and advocacy groups located within Florida may consider initiating campaigns to promote comprehensive sexuality education in Florida's public schools. [ABSTRACT FROM AUTHOR]

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, high-risk samples with limited generalizability. We examined the relationship between behavioral bisexuality and condom use in the 2002 cycle of the National Survey of Family Growth (NSFG). Bisexually active men positively differed from heterosexually and homosexually active men on every indicator of confounding risk. Bisexually active men, however, did not report using condoms less often than other men during their last sexual encounters with males and females. Indeed, with female partners, bisexually active men reported higher rates of condom use than did other men. These relationships remained when all sociodemographic and confounding risk factors were held constant. Our results suggest that caution must be used when making assumptions about condom use in the general population of bisexual men from nonprobabilistic samples. [ABSTRACT FROM AUTHOR]