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Martos, P. Valera, W. Bockting, P. Few interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. The sexual health model: application of a sexological approach to HIV prevention. The HIV epidemic has continued to disproportionately affect those who experience social marginalization and discrimination, especially Black men [ 1—3 ]. Although men who have sex with men MSM are the only group to continue experiencing increases in HIV incidence, the greatest increases were found among young Black men who have sex with men YBMSM between the ages of 13 and 24 [ 6 ].
The factors associated with the high prevalence of HIV among BMSM are dynamic and operate in multiple-levels, including limited access and utilization of quality health care, small sexual networks, low awareness of status, stigma, homophobia and discrimination [ 10 ]. Consequently, 3MV and MAALES approach behavior change from a position of comprehensive, sociocultural health promotion by addressing HIV in the context of racism, homophobia, religion, intersectionality, historical discrimination and other social determinants of health [ 9 ]. Although many HIV and social science researchers have begun advocating extensively for comprehensive sexual health research and services [ 11—16 ], the needs of YBMSM remain largely unmet.
SHM was conceptualized through the triangulation of three sources of empirical and theoretical information: i a sexological, or sex-positive, approach to sexuality education; ii a review of literature on culturally specific and relevant models of sexual health; and iii qualitative and quantitative research on the sexual health perspectives of several key at-risk populations, including MSM [ 18 ], African-American women [ 19 ], transgender persons [ 20 ] and bisexually active women [ 21 ].
The findings from these studies developed into the 10 components of SHM that could potentially serve as a guiding framework for developing sexual health interventions across diverse populations. The components of SHM are: talking about sex; culture and sexual identity; sexual anatomy functioning; sexual health care and safer sex; challenges; body image; masturbation and fantasy; positive sexuality; intimacy and relationships; and spirituality [ 17 ]. These components are useful for linking issues from the individual e. SHM also describes how sexual health approaches can be applied to de culturally relevant interventions that improve both sexuality and HIV risk reduction outcomes.
Sexuality outcomes include sexual satisfaction and sexual communication, whereas HIV risk reduction outcomes include condom use and substance use during sexual activity. SHM proposes that sexuality and HIV risk reduction outcomes are mutually reinforcing, such that improvements in either set can lead to improvements in the other.
SHM has been used as the theoretical basis for interventions focused on decreasing risk behaviors in high-risk groups [ 22—24 ]. In additional Old horney seeking black men sex increasing condom use, these interventions also resulted in ificant improvements in sexual anatomy knowledge among African-American women [ 23 ] and safer sex self-efficacy among transgender individuals [ 22 ]. Given that YBMSM for such ificant s and percentages of HIV infections [ 25 ], it is essential to consider their own culturally relevant understandings of health and sexuality in the context of HIV.
SHM is vital in this regard because of its comprehensive approach to describing components of sexual health, and has been proposed as Old horney seeking black men sex guiding framework for exploring the sexual health needs of diverse populations prior to developing sexual health interventions [ 26 ]. The current study used qualitative data from in-depth interviews to explore the following research aims:. In-depth interview covered childhood experiences, sexual experiences throughout the lifecourse, distal factors related to sexual risk-taking behaviors, and potential barriers and facilitators to testing, prevention and treatment [ 27 ].
Although the purpose of the Brothers Connect Study was not to test SHM, participant responses explored issues that were pertinent to 9 of the 10 components of the Model all but the component on sexual anatomy and functioning. In the section, we present our findings for each component of SHM so as to be consistent with our method of analysis described below. In addition, we also highlight five cross-cutting themes that emerge differentially within each component. For this reason, we advise that no individual component be considered in isolation from the others because the components of sexual health among our study participant were not experienced in isolation.
Furthermore, given the unique needs of YBMSM, our aim of this study was to gain a deeper understanding of their own lived experiences within sexuality and health. Those found to be eligible for the study were invited to participate in an individual orientation at a study office, where they received detailed information about the study and informed consent was obtained. Upon completing their individual orientations, participants were asked to provide the names and contact information of others who they believed to fit the study criteria.
Women and members of other ethnic minority groups identified through snowball sampling were excluded for not fitting the study criteria. A total of participants were recruited into the larger quantitative study, of whom 30 completed in-depth interviews. Participants were invited to participate in the interviews as they completed the quantitative portions of the study consisting of a one-time cross-sectional survey and an 8-week weekly sex diaryup until the 30th participant was recruited.
After obtaining informed consent, in-depth interviews were administered by research staff trained in qualitative research and analysis between August and October Interviews lasted an average of 1 h and covered the following five topics: childhood relationship with parent ssexual and racial identity, support, motivation for sex with partner, and barriers and facilitators to HIV prevention, testing and treatment.
All interviews were transcribed by a professional transcriptionist. A series of core questions see Table I were used for each distal risk factor topic area. After asking each core question, interviewers were instructed to probe for additional information as needed. Does your sexual identity change your sense of acceptance, or level of involvement in the Black community? The transcripts were reviewed by a three-person team of researchers including the second author involved in the implementation of the larger study.
The team used directed content analysis [ 28 ] during analysis because the larger study had been guided by prior research studies [ 2729 ]. This resulted in the relevant theoretical concepts e. Directed content analysis is often used to validate existing theory, prior research or hypotheses, to expound upon it, and to develop initial codes [ 30 ].
Additionally, the team read each transcript and used memoing Old horney seeking black men sex reflect upon the data, and notes were discussed in several meetings prior to the initial coding process in order to collectively deliberate upon our own individual reflexivity and discussed the commonly emerging themes. This form of reflexivity allowed for a critical understanding of how particular social and cultural issues affected the lived experiences of the participants [ 31 ].
Moreover, the memos were used to guide the development of the preliminary codebook and all transcripts were ed to Nvivo The coding process included additional memoing and coding the Sexuality code report separately and meetings to discuss common issues identified.
The transcripts were read verbatim to examine the salience of each of the sexuality components by highlighting the relevant text for each component. The first and second authors met weekly for a period of 6 months as a part of the coding process, which included corroborating and refuting coding inconsistencies. For example, upon recognizing a coding disagreement the first and second authors would each provide a rational for the codes included and excluded, debating the appropriateness of each until consensus was reached.
They also met with the larger study team to discuss any potential changes to the Sexual Health Model as a part of the updating process. Several themes emerged across all components of SHM. Although all five themes are evident within each component, the findings presented will focus on those that emerged most salient for each.
Additionally, after examining the original components of SHM among YBMSM, information technology and social media emerged as an important additional theme. Sample quotes are also provided in Table II for all topics discussed throughout the following section. Of the 30 interview participants, there were only 27 participants for whom baseline quantitative data were available. Participants ranged from 18 to 35 years of age and had a mean age of approximately For instance, nearly half 14 did not feel comfortable openly discussing sex and sexuality with family members, peers and potential partners.
This silence provided protection against possible stigma and discrimination perceived by peers and others in their communities. The cultural phenomenon of the Down Low promotes a structure where same-sex behaviors are not to be discussed. And, although there may be protective factors associated with maintaining silence or even anonymity, on a social level this implicitly endorses social norms that perpetuate race- and gender-based stereotypes, stigma and homophobia [ 32 ].
These non-verbal gender cues often rationalize condom-use behaviors rather than partner communication, placing YBMSM who are not comfortable discussing sex and sexuality are at heightened risk. On the other hand, five participants highlighted the importance of identifying at least one other individual with whom they could trust and speak freely about matters of sex and sexuality. These individuals ranged from family members to medical professionals, and the relationships resulted in benefits of great public health ificance.
Not only did these individuals serve as an outlet for expressing their sexuality, participants would frequently seek and receive advice regarding protective behaviors, the availability of health resources and sexual decision-making. Jamaica, the Dominican Republic, or Trinidad and Tobago. Most 6 participants with cultural heritages in other countries identified generally negative responses to sexual minorities on the societal level, if not explicit legal restrictions. Others identified ways in which issues of sexuality were more easily navigated as compared with the United States.
Finally, eight participants also discussed the rigid gender roles in the different communities to which participants belonged, and how these were simultaneously internalized and perpetuated within Black gay and bisexual communities discussed in greater detail in the Challenges domain.
In terms of the cultural and sexual identity domain, the majority of participants regularly navigated between the gay and Black communities. However, rather than draw upon these experiences to bolster a sense of self, participants more frequently discussed them in terms of navigating the challenges they presented Theme 4. Feelings of marginalization within Black and gay communities are not new [ 35 ], but our data provide additional nuance to these experiences.
With regard to the gay community, 10 participants indicated that they struggled to feel welcome, most frequently citing race within White gay spaces or age within Black gay spaces as the main barriers to engagement. Additionally, participants discussed concerns with navigating different social spaces because of safety and lack of inclusion. These experiences resulted in a variety of strategies for avoiding potentially negative experiences. Although the sexual anatomy and sexual functioning domain was not discussed by any participants, this suggests that, given the infrequent and uncomfortable experiences talking about sex, YBMSM may have little understanding of the mechanics of sex between men Theme 2.
Although the New York City Department of Education includes human anatomy and physiology within the scope of their comprehensive sexuality education [ 36 ], it is quite reasonable to assume, for example, that the sexual anatomy lessons provided do not explicitly discuss the physiology of the anus with regard to penile penetration.
It would be important to consider how the anus differs from the vagina with regard to the cell lining of surrounding membranes, self-lubrication, elasticity and hygiene. In the absence of such relevant sex education, YBMSM would need to rely heavily on conversations with trusted peers, adults, or professionals to gather reliable information on the mechanics of sex between men.
Data from the present study Old horney seeking black men sex that very few have the opportunity to do so.
Sexual health care and safer sex was discussed by 12 participants. These young men described the complexity and barriers that often make safer sex practices difficult to maintain. Even if an individual has the intention to use a condom, they must contend with a social network in which condom use norms are not embraced, as well as small, overlapping social and sexual networks with limited knowledge of safer sex practices.
These notions were generally rooted in the idea that sexuality was a private matter rather than a health concern, and it is here that we see how disclosure and sex Themes 2 and 3 can directly influence health outcomes.
Even if one recognizes a need for sexual health services, they may nonetheless avoid seeking out those services in order to evade the stigma associated with disclosure. The benefits are evident for those who have successfully developed a strong relationship with their physician. The two most positive relationships discussed by participants referenced the ease with which they can access information about sexual health and resources.
I wanna learn. Half of those participants related their interests in increased sexual health care and safer sex to past experiences that highlighted their own vulnerability to HIV and other STIs. One participant described being contacted by a recent sexual partner and told that they had seroconverted.
The participant quickly got tested. Thus, although some described how their relationships with health care professionals helped them increase their protective behaviors, the more consistent trend appears to suggest that sexual behaviors are changing after HIV has entered into the sexual network. All participants experienced challenges and barriers to healthy sexual development, and these challenges were evident in all components of sexual health. However, YBMSM participants discussed lifetime experiences with bullying, victimization, rejection, homelessness and microaggressions Theme 4.
Racism was identified as a ificant issue in the lives of most participants, Old horney seeking black men sex examples of how it emerged in relation to sexual health can be seen in the Culture and Sexual Identity component.
The theme that garnered the most attention, however, related to the internalization of negative feelings, attitudes, or beliefs about oneself Theme 5. These feelings contributed to a preference for casual sexual relationships as a way to avoid commitment. A common critique of the gay community or of specific gay individuals was gender nonconformity. Consistent with research with BMSM [ 37 ], 18 of the 30 YBMSM participants conveyed negative internalized feelings, attitudes, or beliefs that reinforced a strict adherence to gendered norms.
Along these same lines, and given the diverse ethnic background of study participants, experiences with a variety of religions were discussed e. Half 15 of all participants identified churches or fundamental religions as the source of rejection, harassment, or shame relative to their sexuality. Repeatedly, the myriad social and structural challenges faced by YBMSM were internalized and reproduced as an outward devaluations of femininity and gender nonconformity.Old horney seeking black men sex
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