METHODS: Ten focus group discussions were held with opinion leaders (chiefs, elders, assemblymen, leaders of women groups) and 16 in-depth interviews were conducted with healthcare workers (District Directors of Health, Medical Assistants in-charge of health centres, and district Public Health Nurses and Midwives). The interviews and discussions were audio recorded, transcribed into English and imported into NVivo 10 for content analysis.
RESULTS: As heads of the family, men control resources, consult soothsayers to determine the health seeking or treatment for pregnant women, and serve as the final authority on where and when pregnant women should seek medical care. Beyond that, they have no expectation of any further role during antenatal care and therefore find it unnecessary to attend clinics with their partners. There were conflicting views about whether men needed to provide any extra support to their pregnant partners within the home. Health workers generally agreed that men provided little or no support to their partners. Although health workers had facilitated the formation of father support groups, there was little evidence of any impact on antenatal support.
CONCLUSIONS: In patriarchal settings, the role of men can be complex and social and cultural traditions may conflict with public health recommendations. Initiatives to promote male involvement should focus on young men and use chiefs and opinion leaders as advocates to re-orient men towards more proactive involvement in ensuring the health of their partners.
METHODS: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18-39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis.
RESULTS: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM.
CONCLUSIONS: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted among the wives and regular sexual partners of MWIDs in the study location; 221 women were recruited through respondent-driven sampling. Data were analysed descriptively for the prevalence of consistent condom use, HIV status and HIV risk-related behaviour. Subsequently, simple and multiple logistic regressions were undertaken to identify the predictors of consistent condom use.
RESULTS: The prevalence of consistent condom use among respondents was 19.5%. Slightly more than half (52.5%) of respondents had never used condoms with their partner. Fourteen women (6.3%) reported being HIV positive. While 7.7% had HIV-positive partners, 45.7% were unaware of their partner's HIV status. Consistent condom use was significantly higher among single women (AOR = 4.95; 95% CI: 2.45, 9.99), women who lived in urban areas (AOR = 2.97; 95% CI: 1.30, 6.78), HIV-positive women (AOR = 3.45; 95% CI: 1.13, 10.5) and women involved in sex work (AOR = 3.55, 95% CI: 1.45, 8.67).
CONCLUSIONS: Inconsistent condom use among the majority of female sexual partners of MWIDs underscores the heightened risk faced by these women and calls for alternative prevention methods that women are able to control.
AIM: To review the prevalence and factors associated with sexual abstinence in young (10-24 years) and middle-aged (25-59 years) men.
METHODS: Studies were retrieved from Science Direct, PubMed, and EBSCOhost published from 2008 to 2019. The selection criteria were original population- or community-based articles, published in the English language, on sexual abstinence, and in young and middle-aged men.
MAIN OUTCOME MEASURE: This article reviewed the literature on the proportions of and factors associated with sexual abstinence in young and middle-aged men.
RESULTS: A total of 13,154 studies were retrieved, from which data were extracted for 37 population- or community-based studies. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The prevalence of primary sexual abstinence was 3.4%-83.3% for young men and 12.5%-15.5% for middle-aged men. The prevalence of secondary abstinence for young men ranged from 1.3% to 83.6%, while for middle-aged men, it was from 1.2% to 67.7%. The prevalence of sexual abstinence decreased with increasing age in young men but increased with increasing age in middle-aged men. The significant factors reported were age, single status, poor relationships, low socioeconomic status, sex education, religious practices, caring and monitoring parents, and not using alcohol, cigarettes, or drugs. Although the variations in findings from different studies can be explained by different regions and cultures, the information cannot be generalized worldwide because of a lack of studies in Asian and Australian populations.
CLINICAL IMPLICATIONS: The studies on sexual abstinence in the future should use a consistent and standard definition, cover all sexual behaviors, and investigate all related factors.
STRENGTH & LIMITATIONS: The restricted timeframe (2008-2019), English language, availability of full text, and variability in definition and time duration may be the sources of bias.
CONCLUSION: Young men had higher proportions of sexual abstinence than middle-aged men, and age, unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about sexually transmitted infections were common predictors of sexual abstinence in most of the men. Although determinants of sexual abstinence were identified, further investigation of biological factors in men younger than 60 years is needed. Irfan M, Hussain NHN, Noor NM, et al. Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review. J Sex Med 2020;17:412-430.
METHODS: This was a cross-sectional study where 1293 healthy women aged between 18 and 60 years were recruited via convenience sampling from five community-based clinics in Selangor, Malaysia. Cervicovaginal self-samples were obtained and DNA was extracted for HPV detection and genotyping. A comprehensive questionnaire was administered to determine the sociodemographics and behavioural patterns of participants.
RESULTS: The median age at enrolment was 37 years old (IQR: 30-47). In total, 86/1190 (7.2%) of the samples collected were positive for HPV infection, with the highest HPV prevalence (11.9%) detected in the subgroup of 18-24 years old. The top three most prevalent HPV genotypes were HPV 16, 52 and 58. The independent risk factors associated with higher rates of HPV infection included Indian ethnicity, widowed status and women with partners who are away from home for long periods and/or has another sexual partner.
CONCLUSIONS: The overall prevalence of HPV infection in this Malaysian multiethnic population was 7.2%, with 6.5% being high-risk genotypes. The top three most common high-risk HPV types were HPV 16, 52 and 58. This information is important for the planning of primary (HPV vaccination) and secondary (screening) cervical cancer prevention programmes in Malaysia.
METHODS: Adult PLHIV in care at five Asia-Pacific HIV clinics were enrolled at routine clinic visits between July 2019 and June 2020. Depression, substance use, sexual practice and socio-demographic data were collected using PHQ-9, ASSIST, and a study-specific questionnaire. Clinical data were accessed from medical records. Risk factors for medium- to high-risk sexual practices, defined based on total scores from the sexual practice questionnaire assessing number of sexual partners and condom use, were analyzed using logistic regression. Moderate to severe depression was defined as a PHQ-9 score >9, and moderate- to high-risk substance use as an ASSIST score ≥11 for alcohol or ≥4 for other substances.
RESULTS: Among 723 participants, median age was 38 years, 89% were male, 99% were on ART and 37% had medium- to high-risk sexual practices. Medium- to high-risk sexual practices were more common among those ≤30 years old, unemployed, and HIV status disclosed, and were more likely in participants with moderate to severe depression (aOR 2.09, 95%CI 1.17-3.74) compared to none to minimal depression, and moderate- to high-risk substance use (aOR 1.73, 95%CI 1.23-2.44) compared to those without.
CONCLUSIONS: Further integration of comprehensive sexual risk reduction strategies, mental health services and substance use harm reduction within HIV clinical settings in the region is needed.