Sexual health is an important component to overall well-being and quality of life. Yet so much of sexual health research is focused solely on the negative consequences of sexuality, such as unintended pregnancy and transmission of sexually transmitted infections. Recently, the need for a positive, health promotion focused framework for research and understanding sexual health has received attention, including from the World Health Organization and the Centers for Disease Control and Prevention. This transition of public health research and practice from a disease-based framework to a positive, health promotion framework necessitates exploring what factors are associated with positive sexuality and how it is experienced. This study contributed to fulfilling this need. This study focused on healthy sexuality in young college women. Specifically, this study sought to explore what young women find sexually satisfying in different types of sexual relationships (e.g., casual and committed partners). Next, this study identified variables that are important to the healthy sexuality of young college women, including sexual self-concept, communication with sexual partners, sexual satisfaction, and condom use. Lastly, this study aimed to understand the statistical relationship between these variables. This was a two-phase mixed methods study. Phase one consisted of thirty face to face individual interviews with college women aged 18-25 years, and took place in the fall semester of 2011 and the spring semester 2012 at a large public urban university located in the southeastern United States. Phase two took place in the spring semester 2012 and consisted of an online quantitative survey measuring sexual self-concept, communication with partners, sexual satisfaction and condom use. Analyses for the quantitative data included bivariate correlations and structural equation modeling. Qualitative results indicated that these young college women experienced sexual satisfaction with both committed and casual sexual partners, although they identified different reasons why each type of partnership was satisfying. Specifically, the emotional connection and comfort felt with committed relationship partners made sex satisfaction. With more casual or uncommitted partners, these women identified the benefits of maintaining their freedom and not having an obligation to another person. These young women shared their thoughts on how sex could be more satisfying for women and they indicated that communicating sexual desires and needs to partners as one of the most important factors. The quantitative portion of this study found that sexual self-concept was directly positively associated with communication with sexual partners (B=1.45, 95% CI=1.05 1.84, beta=.72), and directly positively related to sexual satisfaction (B=.49, 95% CI= .70, 2.35, beta=.49). Communication with partners was associated with lower discrepancies between wanted and experienced sexual activities (B=-3.96, 95% CI=-4.96, -2.95, beta=-.41). For respondents reporting on committed partnerships, communication with partners was directly related to higher sexual satisfaction (B=.74, 95% CI=.17, 1.32, beta=.43). For those reporting on casual sexual partners, communication was related to sexual satisfaction only through lower sexual activity discrepancy scores (B=.07, 95% CI=.01, .13, beta=.04). Overall the findings from this study suggest that communicating with casual sexual partners impacts sexual satisfaction partially through decreasing the discrepancies between wanted and experienced sexual activities. However, for committed partners, discrepancies were not significantly related to sexual satisfaction, directly or indirectly, although communication was directly associated with sexual satisfaction. This suggests that communication is impacting sexual satisfaction through a different mechanism for committed partners than casual partners. The significance of this study lies in its contribution to the positive sexuality literature, which is currently still in its infancy. This study has implications for public health practice in the improvement of health promotion/sex education programs. This study identified sexual self-concept and communication between partners as important factors for achieving authentic sexual experiences. The implications of this study for public health research include the identification of variables important to understanding women's experience of positive sexuality. Specifically, this study found sexual self-concept to be important to communication and sexual satisfaction, and identified communication as important for both risk reduction (e.g., condom use) and sexual health promotion (e.g., sexual satisfaction).

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.

This study investigates male sexual behaviour and protective practices in the context of a generalized HIV/AIDS epidemic in Mozambique. It focus on how gender norms, particularly notions of masculinity influence sexual behaviour and the ability of men (and women) to protect themselves against HIV infection. A combination of qualitative and quantitative methods is used in this study. The qualitative data comes from 16 focus group discussions and 20 in-depth interviews and the quantitative data comes from a survey conducted with 209 men and 217 women. This methodological approach has proven useful in exploring complex and sensitive matters such as sexual behaviour. In this study, where it was possible, the findings from the survey were supported by quotes from focus groups discussions and in-depth interviews. The findings of this study reveal that traditional gender norms, particularly rigid notions of masculinity are still prevalent in the study settings. The existing notions of manhood are mostly associated with traditional views of men as providers and main breadwinners. In contrast, women are seen as the family caregivers. Practices which bring social prestige both in the community and in the society at large are highly valued for men. Meanwhile, traditional notions of masculinity face enormous challenges in the existing socio-economic context which is characterized by a lack of employment and widespread poverty. This has negative consequences for male self-esteem including their sense of manhood. The study shows that some men believe that having multiple sexual partners is part of male identity and is supported by culture. Similarly, some women also believe that a man cannot be satisfied with one partner or stay long without having sex. These beliefs have important implications in a country with a high prevalence of HIV/AIDS. The study found that traditional notions of manhood prevent men from accessing correct health information thereby perpetuating the cycle of harmful practices for themselves and their females partners. The findings of this study suggest that despite a universal awareness of HIV infection and protective strategies, multiple sexual partnerships and unprotected sex among heterosexual men and women are the driving force sustaining the HIV/AIDS pandemic in the study settings. This is worsened by the widespread negative meanings attached to condoms. The study shows that the level of condom use (31 percent among men and 20 percent among women) is encouraging but not sufficient to curb the level of HIV infections. Consistent condom use remains a major challenge as much fewer men and women report using condoms in all their sexual encounters. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

HIV/AIDS is a global pandemic; and for South African Authorities it is still a huge concern. 17 per cent of the population aged 15 to 49 live with the HIV virus and KwaZulu-Natal remains the area most affected by the pandemic. In order to prevent the disease’s expansion among university students, the health authorities have make available across all campuses and for free Choice and Love condoms.This study explores the perception of the positioning of these government brands compared to the other commercial condoms available among students at the University of KwaZulu-Natal. The study is in part a survey, using research questionnaire administered to more than 200 students at the Westville and Howard College and Nelson Mandela Medical School campuses to determine their perceptions of the competing condom brands. The study primarily makes use of the marketing theory of brand positioning to address the issue; a perceptual map is designed indicating the respective positions of the competing brands. The survey revealed that the Love brand is not very well known by students, and confirmed that the Choice brand is perceived as poor. One reason provided is the negative association of the South African government with the brand. Many students complained of experiencing a bad smell after using Choice. That led to the variant of scent being used in the study as an essential component for condom preference. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

Although Sweden invests a great deal of money and effort in prevention work, STIs are a major problem in our society. Young people are at high risk both when it comes to unwanted pregnancies and STIs and several studies have revealed that the condom use is quite low. Condom use is a complex issue. There are often several factors that interact and affect the decision to use or not use condom. The result in this thesis shows that young people have behavioral expectation to use condom, especially for anal sex and vaginal sex with a casual partner (both known and unknown). At the same time, the condom use is low irrespective of type of partner and type of sex. Approximately 20 % of the participants never used a condom during the preceding 12 months. Most of the participants said that reason for their use or non-use was based on partner evaluation. However, our participants indicate that there often is a deeper reason why they do not use condoms. Women talk about their male partner’s resistance against condom use. Men in the other hand mention the problem with fit and feel especially problems related to erection problems when they have been drinking alcohol. One of the most interesting findings is that the participants’ view of sex affected their condom use. Those with a relaxed view (e.g., did not connect love with sex and had had more sexual partners during the past 12 months) had fewer occasions of unprotected vaginal intercourse compared with the participants with a traditional view (e.g., often associated sex with vaginal penetration).The most important thing we need to do is increase ’men’s sense of responsibility and involve them in the prevention work. It is also important that the condom counseling is individualized. It is not enough to simply speak about condom use in general; instead we need to relate condom use to sexual practice and partner type but also to the individuals’ specific condom problem. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Epub ahead of print. Paper 2: Manuscript. Paper 3: Manuscript.</p>

The college student population has a high prevalence of sexually transmitted infections (STI)s due to their participation in higher risk sexual behaviors such as serial relationships, drug and alcohol use and abuse, and inconsistent use of condoms. The purpose of this study was to examine the relationship between student exposure of sexual education and their sexual behaviors among college going students in Virginia. Guided by the health belief model, this quantitative cross-sectional study involved a random selection process to recruit college students to test the hypothesis. The research questions were designed to examine participants' exposure to sexual education, sexual behaviors, perceptions of contracting STIs with no condom use, and their perceptions of STI education added to college curriculums. The sample included 656 participants who ranged between 18-24 years old and were enrolled in a Virginia 4-year public university. Data were collected through an online survey. A multivariate logistic regression analysis was used to analyze the variables sexual education (independent) and sexual behaviors (dependent). Prior research has indicated that STI prevention education programs implemented within a schools' curriculum has assisted in bridging the gap between public health and education. The study results have shown that the students who had some form of sexual education and were sexually active are less likely to participate in risky sexual practices. The study also indicated that 92.5% of the participants perceive that adding STI courses to the college curriculum will help prevent STIs among college students. These results highlight the sexual health of Virginia college students and promote positive social change among Virginia's college campuses by identifying the inconsistencies of STI knowledge and practices, which can encourage better education.

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Development Studies, 2017 / HIV/AIDS is a social epidemic that continues to impact the lives of countless young people in Southern Africa and possibly poses one of the biggest threats to adolescent health and sexuality; and is one of the main challenges faced by youth in their transition to adulthood. However, despite the fifteenth year running of the South African government’s HIV/AIDS programme, prevalence rates continue to increase annually pointing to disjuncture between government intervention and the causal mechanisms involved in the spread of HIV/AIDS. Furthermore, literature on men’s sexuality in Southern Africa remains embedded within a ‘predatory masculinity and female vulnerability’ paradigm which results in a gendered analysis of HIV/AIDS and a side-lining of the male perspective which then places young men at a high risk of HIV infection. Therefore, in an attempt to understand the disconnect between literature and high prevalence rates; and to contribute to a better understanding of men’s health and sexuality, a qualitative study using focus group discussions and in-depth interviews was conducted amongst young black heterosexual men (19- 25 years old) to discover the factors that determine condom use among young men living in an RDP housing settlement in Daveyton on the East Rand of Johannesburg. The research findings show that condom use in the sample is predicated upon the young black heterosexual men’s definition of masculinity, the nature of the sexual relationship and sexual partner, and – to a lesser extent - the social accessibility of the condom. As they move from adolescence to adulthood, there is a transition of their understanding of masculinity from one characterized by promiscuous sexual behavior where the use of condoms is seen to diminish the degree of one’s masculinity, to a masculinity fostered by responsible sexual behaviour and accompanied by condom use. The study also found that young men expressed a distance from the supposedly hegemonic view of violent masculinity and male dominance in sexual relationships and that the search for love and the ability to provide for one’s partner was what was most valued in young men’s self -conception of masculinity and sexuality. This then negatively impacted condom usage in romantic relationships as such relationships were perceived to contain less risk and it was assumed that they are predicated on trust; positing love as the biggest barrier to condom use. Furthermore, the study found that although condoms are physically and economically accessible, they are not socially accessible due to the stigma attached to sexual activity among adolescents – which results in a barrier to condom usage. Therefore, findings suggest that the government’s condom promotion programmes - based on the tenets of education (on the subject of pregnancy and sexually transmitted diseases) and physical accessibility of condoms - are largely inconsistent with the factors that determine condom use among young men. This implies that there is a need to develop tailored condom promotion programmes targeted at male sexuality / XL2018

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Antiretroviral drugs were introduced into Uganda during the past decade and have revolutionised the treatment of AIDS. However, in as much as success was recorded, new challenges emerged. One such challenge was the continued use of condoms. This study investigated existing knowledge, attitudes and practices of condom use in a time of highly active antiretroviral therapy in a rural area. A quantitative, cross sectional design, with probability sampling form the general population was utilised. A self-designed questionnaire was used to collect data which was then analysed at the descriptive statistics level. The results indicated that: knowledge of HIV, its transmission, condoms and antiretroviral drugs were high among the respondents; condom acceptance and use were low; and respondents would not intentionally engage in unprotected sexual intercourse because of availability of ARVs. However it was acknowledged that some people taking ARVs have engaged in risky sexual behaviours that would expose others to infection. / Health Studies / M.A. (Public Health)