Sexuality Research & Social Policy

Limited research exists about how receiving/seeking sexual and reproductive health (SRH) information differs by sexual orientation. Our goal was to identify how sources and topics of SRH information differed by sexual orientation during adolescence in a sample of US women. A sample of 8541 US women ages 22–35 years from two cohorts of the Growing Up Today Study completed a 2016 questionnaire measure about receiving/seeking SRH information before age 18 years. Adjusted log-linear models assessed differences in SRH information topics and sources by reported sexual orientation (completely heterosexual with no same-sex partners [reference], completely heterosexual with same-sex partners, mostly heterosexual, bisexual, lesbian). Compared with the referent, most sexual minority subgroups were more likely to receive/seek information from peers, media, and other sources (e.g., community centers). With the exception of lesbians, sexual minority subgroups were more likely to receive/seek information about contraception, and mostly heterosexual and bisexual women were more likely to receive information about sexually transmitted infections. Findings indicate that women of diverse sexual orientations need access to SRH information from sources like schools, peers, and media. Sexual minority women receive/seek information about many SRH topics, which indicates that opportunities to tailor educational resources within and outside of schools are needed so SRH benefits to these populations are maximized. Specifying sexual minority–sensitive educational materials in sex education policy can meet information needs and aid sexual minority women in making informed sexual health decisions.

HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the USA. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men’s views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Emergent themes included (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men’s desire to connect with other MSM of color. Developing culturally congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.

Parents who do not feel responsible for parent–child sexual communication (PCSC) may be missing out on opportunities to engage in PCSC that has protective effects on children’s sexual well-being. Using the theory of planned behavior and feminist theory, we explore how parents’ PCSC attitudes and demographics are associated with perceptions of who is responsible for PCSC. Using data collected in December 2019 through January 2020 from parents of 6–11-year-olds, we ran chi-square tests, ANOVAs, and logistic regressions to determine how parent PCSC attitudes and other parental factors are associated with parent perceptions of who is responsible for PCSC. The majority of parents saw themselves and/or a co-parent as primarily responsible for PCSC about facts and values. Bivariately, parents with higher scores of perceived positive PCSC outcomes, subjective norms, and self-efficacy were more likely to believe that they were solely responsible or shared an equal responsibility for PCSC. Multivariately, mothers and genderqueer parents, parents with the same gender as their child, and parents whose co-parent was less involved in parenting were more likely to report being solely responsible for PCSC. Most parents saw themselves or a partner as most responsible for PCSC; parent and child gender were the strongest determinants of parents’ perceptions of PCSC responsibility. These results suggest that it may be more effective for parent education to challenge and deconstruct traditional gender roles versus focusing on self-efficacy, norms, and perceived outcomes if we want to increase parents’ perceived PCSC responsibility, especially within different-gender parent–child dyads.

HIV prevention has evolved to include the provision of HIV medications to HIV-negative persons. Known as pre-exposure prophylaxis (PrEP), this intervention can reduce HIV acquisition by 96% when taken as prescribed. While previous reviews have established that PrEP is cost-effective, few have focused on the healthcare system delivery costs associated with PrEP. We undertake such a comparative analysis focusing on Ontario, Canada estimating the costs for an infectious disease physician, a primary care physician, and a nurse working in our nurse-led PrEP clinic (PrEP-RN). While the delivery of care by the nurse generated the least overall costs, we acknowledge that this would depend on how many patients breach the protocols established for nurse-led PrEP. We also highlight that targeting PrEP at persons who are at highest risk for HIV acquisition could make PrEP even more cost-effective than we estimated herein.

Use of pre-exposure prophylaxis (PrEP) is an effective biomedical intervention contributing to Ending the HIV Epidemic (EHE) in the USA. However, PrEP effectiveness is hindered by inadequate uptake among populations vulnerable to HIV. This study examines the relationships between sexual behavior/identity and PrEP eligibility and uptake while controlling for race/ethnicity (given evidence of racial/ethnic disparities in PrEP eligibility and update). Data for this study were collected between 2012 and 2020 from the electronic medical record (EMR) from a Federally Qualified Health Center (FQHC) in Chicago. A series of bivariate and four parallel logistic regressions (one each for transgender women, cisgender women, transgender men, and cisgender men) were conducted to examine factors associated with PrEP eligibility, controlling for race/ethnicity. Two additional regressions examined PrEP uptake—measured by first and second prescription outcomes—among cisgender men. All models controlled for age, monthly income, year of initial appointment, and primary clinic location. Gay/lesbian cisgender women who have sex with men only (WSMO) were less likely to be eligible for PrEP than their heterosexual WSMO counterparts. Bisexual and heterosexual cisgender women who have sex with men and women (WSMW) were more likely to be eligible for PrEP than heterosexual cisgender WSMO. Gay/lesbian cisgender WSMO were less likely to be eligible for PrEP than those cisgender WSMO who identified as heterosexual. Regardless of sexual identity, men who have sex with women only (MSWO) were less likely to be eligible for PrEP than men who have sex with men only (MSMO). Heterosexual cisgender MSMO and men who have sex with men and women (MSMW) were less likely to be eligible for PrEP compared to their gay cisgender MSMO peers. Compared to gay cisgender MSMO, gay and bisexual cisgender MSMW were more likely to be eligible for PrEP. Similarly, among cisgender men, those who did not identify as gay were significantly less likely to receive a first PrEP prescription compared to gay MSMO with odds of receiving a second PrEP prescription being lower for bisexual MSMW, and heterosexual MSMW and MSWO compared to gay MSMO. Moreover, among transgender women and transgender men, both Latinx and Black patients were more likely to be eligible for PrEP than their White counterparts. However, for cisgender men, both Latinx and Black patients were less likely than their White peers to be eligible for PrEP. Although assessment of PrEP eligibility relies on a number of criteria, the former CDC guidelines emphasized sexual behavior, particularly the gender(s) of sexual partners, as the most salient focus, our findings highlight the missed opportunities of not also including sexual identity in prior guidelines. While the new CDC guidelines use a more holistic approach to eligibility, assessment of sexual identity and behavior at intake are key to ensuring culturally appropriate and inclusive messaging. PrEP eligibility criteria should be revisited and revised, particularly for cisgender and transgender women, who are frequently missed by current guidelines. Also, more attention is needed to ensure that advertisements and clinical encounters do not perpetuate monosexist viewpoints, including bisexual erasure.

The proactive role of women in sexuality has been socially invisible, especially in regard to pornography use. For this reason, this study aims to explore Spanish women’s sexual experiences regarding viewing, arousal, and discomfort as perceived by different types of pornography and based on the women’s sexual orientation. Between January and March 2019, 2730 Spanish women between 18 and 44 years old (M = 24.16; SD = 6.04) completed a questionnaire about the consumption of heterosexual, gay, and lesbian pornography and the discomfort they felt when they were aroused by this type of material. Regarding their sexual orientation, 78.1% were heterosexual, 15.4% were bisexual, and 6.5% were lesbian. In general, more lesbian and bisexual women consume pornography than heterosexual women do. In any case, all of them consume and are aroused by pornographic content based on a sexual orientation that differs from their reported sexual orientation. Women experience discomfort when viewing pornography, regardless of their sexual orientation and the type of content. Particularly, the youngest women are associated with discomfort when viewing heterosexual pornography, although the discomfort of older bisexual women is associated with gay and lesbian pornography. Regardless of their reported sexual orientation, women view and feel aroused by different types of pornographic content. In addition, this study reveals their associated discomfort, which could interfere with their sexual health. Sexual health strategies should include a more active role of women in sexuality, as well as a more flexible conception of their sexual orientation to prevent stigmatizing them.

Human sexuality courses are offered at most universities. Students often bring a breadth of experiences and a need for emotional processing of these narratives into these courses as it relates to course content. The purpose of this study was to expand research exploring emerging adults’ sexuality narratives to be inclusive of positive stories. Guided by a semi-structured questionnaire, 113 students from two USA universities reflected in 2017 on their sexual history using an established educational activity asking students about their “best” and “worst” sexual experiences. Qualitative analysis resulted in five themes describing their “Best” and four themes describing their “Worst” sexual experiences and one theme with dual meaning. “Best of” was highlighted by student themes of romance, beyond intercourse, emotional intimacy, listening, and safety. “Worst of” was highlighted by themes of physical health factors, alcohol and/or substance use/misuse factors, exploitation and victimization, and feelings of shame. The dual meaning theme of firsts emerged in both best of and worst of. Findings suggest that human sexuality courses must consider students’ lived experiences. Further, we propose a call-to-action for clinically trained mental health professionals, such as social workers, as sexuality educators. Universities should incorporate sexual health education policies that acknowledge students who bring a collection of sexuality stories to learning spaces. Centering a student’s sexual voice also would support campus programs, policies, and interventions that benefit students. Finally, policies that guide professional accreditation of social work university programs to include sexual wellness content in the curricula are warranted.

Public health systems in the USA and elsewhere recommend vaccination for children from birth through college. Some vaccines target diseases that are easily spread through casual contact, others—like those against hepatitis B and the human papilloma virus (HPV)—target infections spread though more intimate contact, including the exchange of bodily fluids during sexual activity. Although vaccination is very safe, it is in fact a medical intervention into the body that carries some minute risk and that requires individuals or parents to consent. As such, vaccines make for an exciting case through which to understand meanings of health, disease, sexuality, and choice in the context of neoliberalism. Using qualitative data from parents, pediatricians, and attorneys from the vaccine injury compensation system, this article first explores parents’ perceptions of these two vaccines for their children, beliefs about their children’s future sexual selves, and their goals to raise children into the kinds of sexual citizens they desire them to be. Second, the parents’ views are placed in dialogue with pediatricians’ experiences of working with parents to gain trust in the HPV vaccine, as well as barriers to providing care to teens when they become sexually active. Finally, implications for policy are discussed.