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Health psychology and sexual health assessment.

This article examines the application of health psychology models to sexual health promotion. The Health Belief Model and Protection Motivation Theory can be applied to assessment and identification of clients' perspectives about the threat of illness and behavioural responses to that threat. Assessing clients' individual beliefs about issues of sexual health is important for supporting clients to view themselves as agents of their own sexual health and to make safer decisions about their sexual behaviour.

Adaptation, Psychological↗

Sexual health promotion in adolescents with chronic health conditions.

Sexual health promotion is essential to the health and well-being of adolescents, including those with chronic health conditions. The purposes of this article are to define sexual health and to describe the physical, cognitive, psychosocial, and spiritual domains of adolescent development, with special focus on the sexual health needs of adolescents with various chronic health conditions. The article concludes with several suggestions for healthcare professionals, parents, and teachers in addressing sexual health promotion in this vulnerable population.

Adolescent↗

Biases in internet sexual health samples: comparison of an internet sexuality survey and a national sexual health survey in Sweden.

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a 'gold standard' random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated.

Adolescent↗

Sexual health work in a playground: lessons learnt from the evaluation of a small-scale sexual health project.

OBJECTIVE: To evaluate a sexual health outreach programme in an adventure playground. DESIGN: A qualitative approach to evaluation is appropriate for a sexual health project where outcomes are unpredictable, difficult to define in numerical terms and the small scale of the intervention means that an impact on indices such as teenage pregnancy rates is unlikely. The data collection techniques used were the outreach worker's diary, questionnaires and interviews with youth workers, and a focus group with young people. RESULTS: Work in young people's leisure space requires flexible working in disrupted environments and a responsive approach to diverse individual needs. The outreach worker successfully engaged boys and girls in sexual health discussions. As a result of the project, youth workers' confidence in discussing sexual health issues and ability to refer to the clinic increased. CONCLUSION: Clinical staff providing a sexual health outreach service for young people offer a knowledge of sexual health and local clinical services and an opportunity to build positive relationships between clinics and local community organisations. The relationships help youth workers to raise sexual health issues with young people and to refer problems appropriately. Clinical staff doing outreach work may require additional skills to work in young people's leisure space, for example, the ability to negotiate the content of sessions and to tolerate disruption. A qualitative approach to evaluation effectively documents a range of project outcomes, including those which were unforeseen and which could not have been documented through the collection of numerical data. It also provides a detailed description of the process of project implementation, which aids replication.

Adolescent↗

Health-seeking strategies and sexual health among female sex workers in urban India: implications for research and service provision.

This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta, India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent "non-compliant" therapeutic practices give cause for concern. Conventional approaches to the study of "health-seeking behaviour" are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural "beliefs" about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health.

Adult↗

HIV and sexual health knowledge and sexual experience among Australian-born and overseas-born students in Sydney.

PURPOSE: To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs). METHODS: Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia. RESULTS: A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia. CONCLUSION: The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.

Adolescent↗

Health of the nation: way forward in sexual health.

Sexual health is a wide concept encompassing education, health promotion and disease prevention, diagnosis and management of sexually transmitted diseases, screening and counselling for HIV antibodies, management of HIV infected patients, family planning, termination of pregnancy, psychosexual counselling, prevention of cervical and lower genital tract cancers, and sexual abuse. Implementation of The Health of the Nation (1992) will include assessing the current situation, views, alliances and interventions, need for research and development and within alliances setting challenging but achievable targets. The Health of the Nation includes a target for gonorrhoea which is a surrogate for partner change, sexually transmitted diseases in general and HIV infection, and a target for conceptions among those under 16 years of age. These targets need to be adjusted locally and may be staged. All interventions to achieve these targets must be available. Implementation of The Health of the Nation to achieve the main objectives which are to reduce the incidence of HIV infection and other sexually transmitted diseases as well as reducing the number of unwanted pregnancies and provision of effective family planning services will be challenging but sexual health gain will be well worthwhile.

Family Planning Services↗

Understanding young men's sexual health and prospects for sexual behaviour change in rural Zambia.

AIMS: Building on the experiences of an initial study in 1993, the current survey was conducted to enhance understanding of men's sexual health and prospects for behaviour change in Chiawa, rural Zambia. METHODS: Seventy-nine randomly selected men in the age range 16-25 years were interviewed using a questionnaire. RESULTS: The obstacles to good sexual health reported were: inadequate access to health facilities (35%); unemployment (24%); diseases in general (20%); and HIV/AIDS (17%). Nineteen (24%) had suffered from an STI in the past. Five (13%) of the married and 16 (33%) of the single men had extra or pre-marital relationships at the time of the interviews. In 1993, 50% of the single men had pre-marital relationships. A real man (murume chaiye) was considered to be married, have children, have a job and sexually satisfy his wife; 97% considered themselves to be real men. Some 91% perceived themselves to be at risk of HIV infection; 76 (96%) were aware that HIV could be passed from mother to child, although 51 (61%) would not think about HIV when making decisions about having children. Sixty-eight (86%) believed that condoms could reduce the risk of HIV and 27% used condoms all the time they had sex. In 1993, 6% used condoms all the time they had sex. CONCLUSIONS: There are prospects for behaviour change among the men. Prevention messages need to build on what they already know and practise. The messages must aim to change their local sexual norms, which perpetuate risky practices.

Adolescent↗

Some peoples' psychological experiences of attending a sexual health clinic and having a sexually transmitted infection.

This study considers aspects of the experiences of a group of people attending a sexual health clinic and receiving the diagnosis of a sexually transmitted infection (STI). The study was conducted in the form of action research using a qualitative approach. Participants consisted of eight attenders at a sexual health clinic who had been diagnosed with a sexually transmitted infection. Counselling skills and techniques were used throughout semi-structured interviews to explore participants' feelings about these issues. Thematic analysis was used to generate themes of importance to the participants. Some people who had been to a sexual health clinic and received a diagnosis of a sexually transmitted infection were found to experience feelings of anxiety, stigma and isolation. This study is of value to all those working in the field of sexual health with an interest in understanding the issues that are important to the client group.

Adaptation, Psychological↗

Inequality in provision of sexual health information.

Sexual health is important to quality of life, and therefore to all areas of nursing, generalist and specialist. Disparity exists between what is available to men and to women, as regards range and availability of information and services. The lack of information available for men has potential consequences for health, and for the provision of quality nursing and health care.

Adult↗

Taking a sexual health history: the role of the practice nurse.

Nurses working in general practice (GP) settings are generally multiskilled and competent practitioners who come into contact with a huge cross-section of patients. These patients frequently present with a combination of health problems/needs. The practice nurse is often the first person with whom the patient comes into contact and/or consults. Practice nurses therefore have an important role to play in promoting health, including sexual health. This article examines the conclusions of Jewitt's (1995) work which explored the development of sexual history taking in GP settings. The pivotal role of the practice nurse is highlighted and the importance of taking a sexual health history is discussed. The obstacles and barriers faced by practice nurses when taking a sexual health history are outlined. Recommendations for practice are discussed, and a check list is presented that will enable practice nurses to consider their invaluable input into the holistic care of patients in more detail.

Health Promotion↗

The impact of sildenafil on molecular science and sexual health.

OBJECTIVE: Sexual medicine has evolved greatly in the past several years, to a large extent because of the introduction of the phosphodiesterase-5 (PDE5) inhibitor, Viagra (sildenafil citrate), as a highly effective oral therapy for erectile dysfunction. METHODS: Recent literature pertaining to the development and clinical applications of sildenafil citrate was reviewed. RESULTS: The emergence of PDE5 inhibitor therapy for erectile dysfunction represents a major scientific and clinical breakthrough, and it has impacted on the field in such prominent areas as scientific discovery, clinical management, and public health awareness of sexual health disorders. CONCLUSION: The development of sildenafil citrate has had a major role in advancing the field of sexual medicine.

Erectile Dysfunction↗

The art of public health nursing: using confession technè in the sexual health domain.

AIM: This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). BACKGROUND: The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. METHOD: Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. FINDINGS: As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. CONCLUSION: Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services.

Health Knowledge, Attitudes, Practice↗