Sexual Health

Question 1

Main Issues in sexual health

Answer 1

Diseases
bacterial: chlamydia, gonorrhea, Syphillis

viral: Hepatitis B/A/C, HIV, HPV

pregnancy
Teen/unwanted/abortion

Domestic violence

Question 2

Sexual Health Facts

Wight et al 2000

Rangel et al 2006

Mueller et al 2007

Answer 2

Earlier first intercourse is related to negative health outcomes WIGHT ET AL 2000

~9 million STIs found in US population between 15-24yrs each year RANGEL ET AL 2006

9% of females and 10% of males report first sexual experience occured before 15yrs of age - reports suggest school sex education inc condom use at first sexual experience

Question 3

men/women differences in reporting sexual behavior

JONASON & FISHER 2009

Answer 3

US sample of college students ~22yrs, asked to report average no.s of sexual partners

males = 13
females = 5 

widely recognised that men overestimate and women underestimate no. of previous partners - small sample too but in general agreement with larger samples

why?

• men use prostitutes more
• more social constraints on women than men
• prestige vs dishonour
  • Men select women on youth and beauty, women select men on status, power, etc.

Question 4

Anal sex - incr HIV risk

Answer 4

• % of people having anal sex increased with media changed etc - it is seen a lot more now because of internet/TV/mobile phones. Pornography was less readily available

Question 5

Domestic Violence

Answer 5

• Life time prevalence 7% men, 20% women (Tjaden & Thoennes, 2000).
  
  • However, other reports suggest equal rates of violence in the home towards both sexes i.e. male on female and female on male (Tolan et al 2006). However Tolan cautions us to be careful because much of the early research was based on domestic violence shelters and hospital admissions. While this highlighted the often horrific consequences of male on female violence it missed much female on male violence because it is traditionally hidden.
  • Archer (2000) Sex differences in agression in cohabiting / married couples? 

Question 6

Johnson et al 2001 Sexual behaviour in Britain - HIV risk behaviours

BACKGROUND

Answer 6

study to assess how population patterns of sexual behaviour determine pregnancy, STI & HIV rates

• gives better idea of the extent of current issues -apply to prevention etc
• 1990- first national survery of sexual attitudes & lifestyle (NATSAL), results helped model extent of HIV epidemic but public attitudes have changed since then - better sex education etc
• 2000 study is second NATSAL survey, uses similar questions to update estimates of current sexual behaviours

Question 7

Preg

Answer 7

*

Question 8

Johnson et al 2001 Sexual behaviour in Britain - HIV risk behaviours

METHODS

Answer 8

• random resident aged 16-44 selected from household of sample of addresses in Britain, 11,161 participants
• Questionnair - face2face & CASI in respondents homes
• CASI allowed sensitive answers to be keyed in on laptop, interviewer present but anable to view responses to CASI

Topics: age at first intercourse, homosexual partners, no. of partners, sexual practices & attitudes

• Results compared with Natsal 1990
• Incliuded interaction terms to test whether magnitude of change in reported behaviour between 2 surveys differed by gender & location

Question 9

Johnson et al 2001 Sexual behaviour in Britain - HIV risk behaviours

FINDINGS

Answer 9

• substantial differences in no. of heterosexual partners - 89% men, 76% women reported more than one lifetime partner. Consistent decline with age for numbers of heterosexual partners in the past 5 yrs, men consistently reported higher no.s of partners than women over all time periods
• Mean freq. of heterosexual sex in the past 4 weeks has declined with age
• estimated that 15% of men, 9% of women have had simultaneous partnerships, prevalence decline with age
• Many HIV/STI risk behaviours more frequently reported by london respondents than outside
• proportion of the population who reported 2+ partners in the past year and inconsistent condom use had incr significantly between surveys
• population regarding themselves as ‘quite a lot’ or ‘greatly’ at risk of HIV/STI remained low byt had increased since NATSAL 1990

Question 10

Johnson et al 2001 Sexual behaviour in Britain - HIV risk behaviours

CRITIQUE

Answer 10

STRENGTHS

• CASI allowed privacy for sensitive answers, fewer answers skipped
• random selection by household removes selection bias
• big sample size to representative of population

LIMITATIONS

• men & London slightly underrepresented
• didnt account for variability in ethnicity- proportion of minority ethnic groups too small
• excluded people that dont speak english/sick/away from home

Question 11

WHO definition of sexual health

Answer 11

Sexual health is defined by the WHO as

• Enjoyment of sexual relation without exploitation, oppression or abuse.
• Safe pregnancy and childbirth, and avoidance of unintended pregnancies.
• Absence and avoidance of sexually transmitted infections, including HIV.

Unhealthy sexual behaviour can lead to deviance from any of these three points

Question 12

STIs occurence

Answer 12

There have been large increases in many STIs in the last 10 years including Chlamydia (up 300%), gonorrhoeas (up 200%) and HIV (up 300%)

As many symptoms are asymptomatic, and many cases don’t present due to stigma, the infection statistics are likely to be just the tip of the iceberg. Co-infections are often common, and an infection with an STI makes transmission of HIV
easier.

The most common conditions in England are now Chlamydia, non-specific urethritis, and wart virus infections. The number of visits to the GUM clinic doubled between the early 90s and 2000s. Diagnoses of Chlamydia doubled in the 1990s,

Question 13

Consequence of unintended pregnancy

Answer 13

Can lead to poor education and lack of social/economic opportunities for teenage others

Question 14

impact on relationships

stigma

psychological consequences

Answer 14

STIs can have an affect on sexual health within a relationship. Sexual intercourse can become painful or uncomfortable, as well as there being a risk of transmission of the STI. It can also trigger a lack of trust due to confusion of
where the infection came from.

If a partner is not informed of an infection by their infected partner, this can lead to unknown transmission of infection, potential legal implications, and a lack of trust within the relationship.

Stigma

As well as the immediate implications of the infection on the individual, and discomfort, STIs can have other effects such as stigma. Stigma against STIs, particularly HIV, can prevent people from seeking testing for the infection, or from
informing future partners of the infection, both of which can lead to further transmission of the infection.

Psychological consequences

Poor sexual health can also mean psychological consequences, for example through coercion and abuse.

Question 15

STI risk and socioeconomic status & race/ethnicity

HARLING ET AL 2013

Answer 15

In the US, STI diagnosis found to be independently assoc with racial/ethnic identity and low income but racial/ethnic disparities much larger than income-based ones.

-There was a negative gradient of STI risk with increasing income within all racial/ethnic categories but this was stronger for non-whites

-Both economic & racial/ethnic factors should be considered when deciding how to target STI prevention efforts in the US.
Particular focus may be warranted for poor, racial/ethnic minority women

Question 16

HIV risk & chemsex

Answer 16

• drugs e.g. Mephedrone taken before sex, goal to improve sex life is not harmful but consequences of this are harmful to health
• 2014 British crime survey found the greatest use of illicit drugs was by gay and bisexual men - 33% had taken drugd in the last year, compared to 11% of heterosexual men
• allows longer sex = incr risk of cuts/abrasions = incr possibility of more than one partner in same session = incr risk of infection e.g. HIV
• combining sex and drugs facilitates HIv & other STIs
• In 2014, 45,000 people living with HIV in UK, 54% MSM but MSM make up only 2-3% of population
• Data from European MSM internet survey found 1/3 men found it difficult to control behaviour whilst under the influence of drugs & reported they engaged in riskier behaviour that they later regretted
• MH also important - users of chemsex drugs report mh issues such as anxiety & panic attacks.

-social norms - chemsex scene big in london/manchester/brighton where there is a big gay scene

Question 17

Sexual behaviour & social norms

Answer 17

social norms thought to be biggest influencer of individual sexual behaviour

• there has been a change in social attituteds towards sex, now not seen as just for purpose of reproduction - incr in diversity of secual experiences and acceptance of this
• changes evident in age gap between losing virginity & having first child - age gap now as big as 15 yrs, used to be 4 yrs in 1935

Question 18

Hickson - Path to good sexual health for the population

Answer 18

= better sex with less harm

both risk and precaustion need attention

worst case is when people have the capability and opportunity for risk but do not have access to precaution (who you choose to have sex with, type of contraception, knowledge & awareness building)

• treatment for HIV getting better so not seen as as big of a risk = not as much precaution = incr HIV rates
• Oppression influences risk and precaution i.e. in oppressive countrites precaution is lower but so is risk, in more liberal countries prevention is higher but risk is also higher

Question 19

WHO effective interventions

Answer 19

Research suggests the most effective interventions are based around intervening in early & adult education and modifying social norms

-Issue concerning fact that social norms vary enormously by culture & socioeconomic background even with nations

Question 20

Technological Interventions

Answer 20

-Advances in internet and technology means world has radically changes - technologies are used more by younger people = important as yound people have higher rates of STIs (CDC 2010)

• Technology can offer a key intervention route
• Technology affects what individuals see as normative which is a key component of several models of health behaviour change

Question 21

Technological Interventions

Safetxt study

Answer 21

Young people’s experiences today are influenced by technology and the mobile world and as with the growth of social media sites, and apps, the ability to contact people through the virtual world is expanding.
accessing sexual content easier - porn sites etc

means incr ability to access young people on the move

One study targeting them in this way is the Safetxt study. The study is a randomized controlled trial using text messages as a means to spread concise, but useful, information about sexual health and safe sex practices in order to to reduce STIs among young people. The goal is to increase sexual health precaution behaviours among them by using the cheap, far-reaching approach of text messages to both inform people and enable them to initiate better discussions with their sexual partners.

inclusion criteria: own mobile phone, recent chlamidya diagnosis, 16-24, can provide informed consent
exclusion criteria: cannot have sexual partner already in study

Question 22

Technological interventions

critique

Answer 22

41% adolescents state they have changed their behaviour in the past due to online health info (Ybarra & Suman 2008)
-report likeing the anonymity of seeking advice through this method

Whiteley et al (2012) investigated online educational websites for sexual health and report relatively good online content that aims to be appealing to relevant populations. However they note the lack of sites with mobile compatibility although this is changing.

Question 23

Jamal et al 2015

Importance of sexual health in the UK

Answer 23

teenage pregs have declined in UK but remain highest in Western Europe and STI rates remain high. sexual violence remains a major concern

-report that sexual behaviours are strongly influenced by social norms albeit filtered through culture which is changing rapidly due to technology

Question 24

The Department of Health’s 2001 National Strategy for Sexual Health and HIV proposed:

Answer 24

The Department of Health’s 2001 National Strategy for Sexual Health and HIV proposed:

-Providing clear information so people can take informed decisions about preventing STIs including HIV.

Ensuring sound evidence base for effective local prevention.

Setting targets and reducing the number of newly acquired HIV infections.

Developing managed networks for HIV and sexual health services, having a broader role in the primary care setting and collaborating to plan services jointly.

Beginning a programme of Chlamydia screening for targeted groups (this is now established).

Open access GUM services, improving access for urgent appointments so that patients are seen within 48 hours.

Having a range of contraceptive services for those that need them.

Increasing offers of HIV testing, targeting to reduce the number of undiagnosed infections leading to earlier treatment and limiting further transmission.

Question 25

HPV Vaccine

Answer 25

September 2008-introduction of routine HPV vaccination for all girls aged 12-13 as part of the national immunisation programme.

helps protect against cervical cancer. Human papilloma virus (HPV) is the name for a
family of viruses. Around 40 types of HPV infection can affect the genital area, an infection with some types of HPV can cause abnormal tissue growth and other changes to cells, which can lead to cervical cancer, or genital warts.