Sexuality Research and Social Policy

Certain research topics - including studies of sexual behavior, substance use, and HIV risk -- are more likely to be scrutinized by the media and groups opposed to this area of research. When studying topics that others might deem controversial, it is critical that researchers anticipate potential negative media events prior to their occurrence. By developing an Emergency Public Relations Protocol at the genesis of a study, researchers can identify and plan for events that might result in higher scrutiny. For each identified risk, a good protocol details procedures to enact before, during and after a media event. This manuscript offers recommendations for developing a protocol based on both Situational Crisis Communication Theory and our experience as an HIV prevention research group who recently experienced such an event. The need to have procedures in place to monitor and address social media is highlighted.

In this paper, we examine the ways that early adolescents talked, interacted, and made references to events in their individual and collective lives during photography-based focus groups about sexuality and relationships. Twenty-three participants (10 boys and 13 girls) were recruited from three urban schools participating in a comprehensive sex education impact evaluation in the Northeast. We analyzed conversational narratives that were elicited in a group process while sharing photos of important people, contexts, and situations, showcasing participants' exploration of sexuality and relationships. Our analysis revealed four main themes: (a) direct and indirect family communication about sexuality, (b) accidental and intentional Internet usage, (c) shared and contested peer knowledge, and (d) school as a direct and indirect learning context. Implications and future directions for practice, research, and policy are explored.

In this study, we utilized observational methods to identify maternal values and concerns accompanying contraceptive use advice in Latina mother-daughter sexuality conversations. The sample included non-sexually active early adolescents around 12 years of age and their mostly Spanish-speaking Latina mothers. Videotaped conversations were coded for the prevalence of messages related to four sexual values (abstinence, delay sex until older, sex is "normal", sex is "improper") and concerns about pregnancy and STD transmission. We examined whether the duration of time spent conversing about these messages was associated with participant characteristics, general communication openness, and the amount of time the dyads spent discussing contraceptive use. Results indicated that Latina mothers who had fewer years of education and lower family income talked longer to their daughters about the need to delay sex, avoid risky situations that would increase their chances of getting pregnant or acquiring an STD, and engage in self-protective practices. Less perceived openness in general communication as reported by both the mothers and the daughters was associated with increased time discussing that sex is improper. Although the duration of contraceptive use messages was brief, mothers and daughters who discussed the fact that sex is normal, and who communicated more about the importance of delaying sex, talked longer about contraceptive use practices compared to mothers and daughters who engaged in minimal discussion of these sexual values.

The objective of this study was to compare sociodemographic, behavioral and clinical characteristics associated with HIV among Men who have sex with Men (MSM) and men who have sex with women (MSW) in Puerto Rico. Data from a population-based cross-sectional study in PR (2005-2008) was analyzed. Descriptive statistics were used to describe the study sample and bivariate analyses were performed to identify differences of sociodemographic, behavioral and clinical characteristics between MSM and MSW. Exact logistic regression models adjusting for age were constructed for each risk behavior associated to MSM in bivariate analysis. Of the 674 men interviewed, 6.1% (n=41) reported ever having sex with men. Age-adjusted logistic regression models indicated that MSM were significantly more likely than MSW to have first sexual intercourse before the age of 15 (POR=2.6; 95%CI= 1.3, 5.3) and have at least 10 lifetime sex partners (POR=2.8; 95%CI= 1.4,5.9). Also, MSM were significantly more likely to report lifetime use of marihuana (POR=2.7; 95%CI= 1.3,5.8), cocaine (POR=2.5; 95%CI= 1.2,5.0), amphetamines (POR=3.8; 95%CI= 1.4,9.2) and sedatives or tranquilizers (POR=3.3; 95%CI= 1.4,7.2). Also, MSM were 13 times more likely to be HIV seropositive as compared to MSW (POR=13.3; 95%CI=1.7,102.0). In this population-based sample of men living in Puerto Rico, self-reported same-sex behavior is strongly associated with HIV, and other behavioral factors associated with HIV. Future targeted research is still necessary for the development of intervention programs among MSM in Puerto Rico.

Discrimination has been linked to negative health outcomes among minority populations. The increasing evidence regarding health disparities among sexual minorities has underscored the importance of addressing sexuality discrimination as a public health issue. We conducted a web-based survey between May and September of 2012 in order to obtain a diverse sample of young men who have sex with men (ages 18-29; N = 397; 83% gay; 49% Black, 27% White, 15% Latino) living in the Detroit Metro Area (Michigan, USA). Using multivariate regression models, we examined the association between overall health (self-rated health, days in prior month when their physical or mental health was not good, limited functionality) and experiences of sexuality-based work discrimination. Fifteen percent reported at least one experience of sexuality-based work discrimination in the prior year. Recent workplace discrimination was associated with poorer self-rated health, a greater number of days when health was not good, and more functional limitation. We discuss the importance of addressing sexuality-related discrimination as a public health problem and propose multilevel intervention strategies to address these discriminatory practices.

Using data from a US national probability sample of self-identified lesbian, gay, and bisexual adults (N = 662), this article reports population parameter estimates for a variety of demographic, psychological, and social variables. Special emphasis is given to information with relevance to public policy and law. Compared with the US adult population, respondents were younger, more highly educated, and less likely to be non-Hispanic White, but differences were observed between gender and sexual orientation groups on all of these variables. Overall, respondents tended to be politically liberal, not highly religious, and supportive of marriage equality for same-sex couples. Women were more likely than men to be in a committed relationship. Virtually all coupled gay men and lesbians had a same-sex partner, whereas the vast majority of coupled bisexuals were in a heterosexual relationship. Compared with bisexuals, gay men and lesbians reported stronger commitment to a sexual-minority identity, greater community identification and involvement, and more extensive disclosure of their sexual orientation to others. Most respondents reported experiencing little or no choice about their sexual orientation. The importance of distinguishing among lesbians, gay men, bisexual women, and bisexual men in behavioral and social research is discussed.

Discursive portrayals of aging and sexuality have important implications for the creation and reproduction of inequalities. This article delineates some of the images of older adults' sexualities using an interpretive content analysis of gerontology articles dealing with issues of sexuality in 21 gerontological journals over a 20-year span (1988-2007). The 3 main findings of this analysis were (a) that aging sexualities are asserted, (b) that the sexual identities of older adults vary, and (c) that older adults' sexualities are regulated through a variety of mechanisms. Furthermore, these representations inform research and policy at the intersections of sexuality and aging.

This qualitative study highlights the social dynamics affecting people living with HIV (PLH) in Hungary and in the Central-Eastern European region. The study focused on the special needs and concerns of men living with HIV/AIDS as well as changes in their social relationships and institutional support provision, coping strategies and patterns of social functioning, especially in the context of social stigmatization. Consistent with international qualitative research findings in the field of HIV/AIDS prevention, the present study contributes to a fuller understanding of relationship between sexual behavior, HIV/AIDS related risks and risk perceptions as well as homosexuality-and HIV/AIDS stigma-related social exclusion in a previously under-researched socio-cultural setting. The findings of our study point to several barriers to effective HIV prevention, which should be overcome to improve the present situation by lessening the adverse effects of HIV/AIDS-and homosexuality-related stigma within the gay community, the general population and especially among service providers. One of the main barriers is the lack of public health programs specifically targeting MSM in Hungary, where the predominant mode of HIV transmission remains sex between men.

Sex parties are environments where men who have sex with men (MSM) have the opportunity to have sex with multiple partners over a brief period of time. Dim lighting and non-verbal communication are characteristics of sex parties that make sexual communication more challenging. We report on qualitative data from 47 MSM who attended sex parties in New York City. Participants responded to distinct hypothetical scenarios involving the use of color-coded wristbands to communicate (1) condom use preferences, (2) sexual position (e.g., top, bottom) and (3) HIV status at sex parties. The majority had positive-to-neutral attitudes toward color-coded wristbands to indicate (1) condom use preference and (2) sexual position (70.8%, 75.0% HIV-positive; 63.6%, 81.8%, HIV-negative respectively). These men cited that wristbands would facilitate the process of pursuing partners with similar interests while also avoiding the discomforts of verbal communication. In contrast, 41.7% of HIV-positive and 50.0% of HIV-negative men expressed unfavorable attitudes to using wristbands to communicate HIV status. These men cited the potential for HIV-status discrimination as well as suspicions around dishonest disclosure. Although participants were receptive to utilizing color-coded wristbands at sex parties to convey certain information, it may be unfeasible to use wristbands to communicate HIV status.

Many HIV prevention interventions have been launched in gay bathhouses and sex clubs since the onset of the AIDS epidemic, such as condom distribution and HIV testing. Perhaps none of these are as intrusive to the venue's environment as what is called "monitoring," which involves staff, during every shift, repeatedly walking throughout the public areas of a bathhouse to check on patrons' sexual behavior. Yet, monitoring has received little evaluation. Between 2002 and 2004, we conducted qualitative interviews with venue managers, staff and patrons in New York City, Los Angeles, and the San Francisco Bay Area. An analysis found that monitoring was influenced by the kinds of space available for sex, suggesting three approaches to monitoring: 1) monitoring all sex in clubs that only had public areas where men had sex ; 2) monitoring some sex in clubs with private rooms for sex; and 3) no monitoring of sex, regardless of the kinds of space for sex. This paper explores each approach as described by club managers, staff, and patrons to understand the potential effectiveness of monitoring as an HIV prevention intervention.

The present study sought to identify patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbian, gay, and bisexual (LGB) adults. Respondents were 396 self-identified LGB individuals ages 18-59, recruited from diverse community venues in New York City, with equal numbers of men and women and Whites, Blacks, and Latinos. Respondents were interviewed at baseline and 1-year follow-up. We assessed the relationships among disclosure of sexual orientation, demographic characteristics, health, and minority stress. Rates of nondisclosure to healthcare providers were significantly higher among bisexual men (39.3%) and bisexual women (32.6%) compared with gay men (10%) and lesbians (12.9%). Bivariate and multivariate logistic regression models predicting disclosure of sexual orientation indicated that patient age, level of education, immigration status, medical history, level of internalized homophobia, and degree of connectedness to the LGB community were significant factors, along with sexual identity. Nondisclosure of sexual orientation was related to poorer psychological wellbeing at one year follow-up. Our findings suggest that interventions targeting sexual minorities ought to carefully tailor messages to subpopulations. In particular, interventionists and clinicians ought to be mindful of differences between bisexually- and gay/lesbian-identified individuals.

With the exception of HIV care, informal caregiving of chronically ill lesbian, gay, and bisexual (LGB) adults has received very limited attention in the extensive caregiving literature. This article reports on research that considered the social context of care and a dyadic caregiving approach for 36 chronically ill LGB adults ages 50 and older and their informal caregivers. In this study, both discrimination and relationship quality were associated with depression among chronically ill LGB adults and their caregivers. Furthermore, preliminary findings suggested that relationship quality moderates the impact of discrimination as a risk factor for depression in chronically ill LGB adults. The authors discuss the implications of these findings for social policy and future research. Given the changing demographics in the United States with the aging of the baby boomers, as well as an increase in chronic illness, fostering better understanding of caregiving across diverse sexualities and families is critical.

This article describes a study of resilience among young men who have sex with men (YMSM). Resilience is defined as positive adaptation in the context of hardship. Using targeted sampling to capture the diversity and range of this hidden population, we recruited 569 YMSM ages 17-28 years old and examined a subset of 134 YMSM who had experienced severe childhood adversity, as indicated by placement in foster care. Most of the YMSM in this subset were from racial or ethnic minority backgrounds and fewer than half identified as gay or homosexual (46.3 percent). More than half (58.3 percent) exhibited positive outcomes on four of seven indicators of adaptive functioning. YMSM who identified as either bisexual or heterosexual exhibited lower rates of resilience. Structural- as well as individual-level factors appear to be implicated in resilience among YMSM. Findings underscore the importance of fostering stable sexual identity as a means of building resilience.

This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.

Research on the association between health insurance coverage and sexual risk behavior among men who have sex with men (MSM) is sparse. We hypothesized that MSM with health insurance would be less likely to engage in risky sexual behavior based on previous research showing that insured persons increase contact with providers which can improve health knowledge, decrease tendency to engage in unhealthy behaviors, and raise awareness about health risks. As part of a study testing an online HIV prevention intervention, we collected information on health insurance and sexual behavior from MSM (n=650). Overall, men with health insurance had a 28% reduced prevalence of unprotected anal intercourse male partners (UAIMP) in the 90 days prior to the survey. Potential explanations include access to healthcare providers and awareness of sexual health. Additional research is needed to identify the mechanism through which health insurance is protective.

This article reports on a study that examined how religious discourses of inclusion and exclusion-in Roman Catholic, evangelical Protestant, and Afro-Brazilian religious traditions-affected people's rights to express same-sex sexual desires, behaviors, and identities in the socioeconomically marginalized urban periphery of Rio de Janeiro, Brazil. Using extended ethnographic observation of institutions and religious events over a period of 2 years, the authors identified how sexual rights were constructed within religious discourses and conducted ethnographic interviews with 45 religious leaders. In the low-income and violent urban periphery of Rio de Janeiro, religious leaders and institutions play key roles in molding community inclusion and exclusion. A comparison of the 3 major religious denominations shows a diversity of discourses about same-sex sexual desires and their impacts on community formation.

Stigma and social inequality deprive disadvantaged social groups of a sense of social well-being. Stress researchers have focused on prejudice-related events and conditions but have not described more intangible stressors experienced by sexual minorities. We use narrative methods to examine how sexual minorities experience stigma and social inequality as we focus on the more intangible stressors that are both pervasive and difficult to measure. Three themes emerged in the narratives of our ethnically diverse sample of 57 adult sexual minority women and men: (a) stigma deprived them of access to critical possibilities and opportunities; (b) stigma deprives them of safety and acceptance; and (c) despite this, the experience of stigma is also related to the adoption of a positive and collective orientation towards their stigmatized identities. Recognizing these stressors and related resilience can direct policy makers toward interventions that go even beyond eliminating prejudice by including goals to strengthen minority communities.

This article seeks to expand the discourse on sexuality education in the United States by examining ways in which youth are mobilizing to educate their own schools and communities about gender identity. The author conducted a descriptive case study within the GSA (Gay-Straight Alliance) Network, a youth-based community organization in the San Francisco Bay Area that provides leadership and networking opportunities for youth involved in gay-straight alliance clubs throughout California. Youth in this community are significantly expanding the categories of sexual and gender identification, which they situate directly within an activist and educational outreach agenda in their schools. This article explores how gender activism and educational outreach focus on a right to be protected from discrimination and also a right to expand the possibilities for gender identity and expression.

More than half of U.S. states have passed amendments to their constitutions excluding same-sex couples from civil marriage. The impact of these ballot initiatives and debates on lesbian, gay, and bisexual (LGB) individuals has been underresearched. Extending research on racial and ethnic minority groups, as well as research on LGB groups, the study discussed in this article hypothesized that LGB individuals would encounter more negative messages, be at risk for negative psychological effects, and increase their political activities, including voting, during elections with marriage amendments on the ballot. A national cross-sectional online survey of 1,824 LGB participants conducted postelection in November 2006 confirmed these hypotheses.

This article focuses on the politics and practice of sexuality in the early twenty-first century. Drawing on a set of case studies from diverse societies in different regions of the world, the author examines both the intersection of and the tension between grassroots struggles for sexual freedom and transnational movements for sexual rights within the broader context of ongoing global transformations. Building on John Gagnon and William Simon's pioneering work on sexual scripts, the author explores the ways in which the rapidly changing politics of sexuality contribute to the reinvention of sexual meanings and intimate relations across a wide range of diverse social settings and contexts. This article is based on the author's presentation for the 2008 John H. Gagnon Distinguished Lecture on Sexuality, Modernity and Change. KeywordsPolitics-Social movements-Sexual rights-Transnational-Sexual diversity

Gender Identity Disorder of Childhood (GIDC)—a psychiatric diagnosis given to gendervariant children—has been controversial since its creation. Critics inside and outside of the mental health professions have called for the removal or revision of GIDC, arguing that it has served to pathologize homosexuality, to enforce normative notions of masculinity and femininity, and to recast a social problem as individual pathology. Drawing on published clinical and research papers, archival materials, and interviews with clinicians, researchers, and advocates, this article analyzes early studies of gendervariant boys from the 1960s and 1970s and describes the process through which the GIDC diagnosis was created. The article examines some of the limitations of current debates over GIDC and points out new trends that hold the most promise for providing support to gender-variant children.