Thesis (M.S.)--University of North Texas, Dec., 2007. / Title from title page display. Includes bibliographical references.

According to the World Health Organization, one in three women worldwide have experienced physical and/or sexual violence perpetrated by a partner. Through a number of biological pathways, intimate partner violence (IPV) has a direct effect on women’s health, particularly their sexual health. IPV has been found in numerous bodies of research to disproportionately affect immigrant communities. This literature review examined the prevalence and epidemiological significance of IPV among the Latina and Asian immigrant communities in the United States and the effects on these populations’ sexual health outcomes. My findings demonstrate the burden of this issue is exacerbated by manifestations of structural violence and anti-immigrant sentiments in American society. I found the majority of clinical literature did not factor in structural and systematic disparities such as linguistic barriers, inaccessibility of the health and legal systems, precariousness of citizenship, and shortcomings of public education as contributors to adverse sexual health outcomes. The contexts and circumstances of immigrant women also tend to be homogenized in the public discourse on IPV with little attention paid to the specific socio-cultural elements that shape survivors’ experiences. Lastly, the language employed in the discussion of partner violence is highly hetero-normative and cis-gendered. Partner violence must be treated as the serious public health crisis it is. Strategies to address this issue must be implemented in a timely, culturally, and contextually appropriate manner across all settings guided by an intersectional lens.

Homens e mulheres têm iniciado sua vida sexual, em grande parte, na adolescência e de formas um tanto diferenciadas. As práticas sexuais, nessa fase, têm sido descritas como dinâmicas e em constantes transformações, sendo que seus perfis podem acarretar impacto importante na vida reprodutiva dos adolescentes. Com o intuito de analisar o início da vida sexual de adolescentes, foram realizadas entrevistas domiciliárias com 383 homens e mulheres, não unidos, de 15 a 19 anos de idade, matriculados em uma unidade básica de saúde da família da zona leste do município de São Paulo, correspondendo a uma amostra representativa dos indivíduos deste grupo etário. A análise de regressão logística múltipla identificou como variáveis associadas ao início da vida sexual de adolescentes do sexo masculino a idade, a situação de estudo, a idade materna no primeiro filho, a concordância materna de que adolescentes tenham vida sexual, o fato de que o pai gostaria que seu filho iniciasse a vida sexual independentemente do casamento, o namoro anterior e o namoro atual. Por sua vez, as variáveis associadas ao início da vida sexual entre adolescentes do sexo feminino foram a idade, o tipo de domicílio, o namoro anterior, o namoro atual e a presença de irmão(ã) que tenha vivenciado uma gestação previamente à união. Entre os 164 adolescentes com experiência sexual, foi observada uma convergência na idade em que homens e mulheres tiveram a primeira relação sexual (mediana de 15 anos). No entanto, mesmo que a primeira relação sexual tenha ocorrido em idades similares e igualmente sem planejamento prévio, aspectos importantes do comportamento sexual diferiram entre os adolescentes e deveriam ser lembrados na assistência e promoção de sua saúde reprodutiva e sexual. Assim, as mulheres relataram ter iniciado a vida sexual, principalmente, porque estavam apaixonadas pelo parceiro, que foi, com maior freqüência, seu namorado. Por outro lado, os homens iniciaram sua vida sexual em relacionamentos ocasionais e justificaram como motivação a atração física. A prática contraceptiva foi deixada de lado por 41,5% dos homens e 31,7% das mulheres. Desta forma, os resultados indicaram que os diferenciais de gênero estiveram presentes em todo o processo de iniciação sexual e, ainda, os fatores individuais, tais como o namoro e a idade, e os fatores familiares, tais como os valores e atitudes dos pais e mães acerca da sexualidade, foram marcantes na iniciação sexual dos adolescentes. / Women and men initiate their sexual life in different ways mainly during adolescence. Sexual practices in youth have been described as dynamic and in constant transformation, though its profile should be considered as having an impact in reproductive health. This study aimed to analyse associated factors to the onset of sexual life and to describe the first sexual relationship. Therefore, 383 fifteen to nineteen year-old single males and females enrolled in a family health unit from the east area of the city of São Paulo were interviewed at home. From multiple logistic regression analysis, data showed that associated variables to the onset of sexual life in males were age, schooling insertion, maternal age at first delivery, maternal acceptance that adolescents engage in sexual practices, paternal opinion that son should have the first intercourse independently from a marriage, previous and current dating. On the other hand, associated variables among females were age, house affording, previous and current dating and the presence of a single sibling who had already faced a pregnancy. Among the 164 adolescents who had sexual experience, a convergence in the age males and females initiated their sexual life (median at 15) was observed. Even though the first intercourse occurred at the same age and without planning, important aspects of the sexual behaviour differed between males and females and ought to be taken into consideration in their reproductive and sexual health promotion. Girls said they had the first intercourse because they were in love and it thus occurred majority with a boyfriend. Boys had their first intercourse mainly in occasional relationships and because of physical attraction. Contraceptive practice was observed in 58,5% of the boys and 68,3% of the girls. The results indicated that gender differences were present at the whole sexual initiation process and that individual factors, such as dating and age, and familial factors, such as parents attitudes towards sexuality, were determinants for the sexual initiation of these adolescents.

Orientador: Marli Teresinha Cassamassimo Duarte / Resumo: Introdução: Acesso e acolhimento são elementos essenciais para que se possa intervir de forma satisfatória no estado de saúde da população. A literatura nacional traz poucos estudos abordando o acesso aos serviços e cuidado com a saúde entre mulheres que fazem sexo com mulheres (MSM). Objetivo: Analisar o acesso a serviços de saúde e o cuidado com a saúde sexual e reprodutiva de mulheres que fazem sexo com mulheres, sob o enfoque das políticas públicas de saúde. Método: Estudo observacional, transversal, descritivo e analítico que integra estudo mais amplo sobre acesso a serviços de saúde e saúde sexual e reprodutiva de MSM. A amostra intencional de 149 MSM foi constituída por meio da Técnica de Amostragem Bola de Neve (a Andreia pediu para retirar, acho melhor manter) indicação de profissionais de saúde e liderança LGBT (de Lésbicas, Gays, Bissexuais, Travestis e Transexuais) por procura espontânea, a partir da divulgação do projeto nas redes de sociabilidade, comunicação de massa, serviços de saúde e grupos de ativismo. As variáveis estudadas foram: sociodemográficas, consumo de substâncias, comportamento e práticas sexuais, clínico-ginecológicas e reprodutivas, relacionadas ao acesso a serviços de saúde e a variável desfecho foi escore de cuidado com a saúde sexual e reprodutiva. Os dados foram obtidos pelas pesquisadoras envolvidas no estudo mãe, de janeiro de 2015 a dezembro de 2016, por meio da aplicação de um questionário, exame ginecológico para o diagnóstico de HPV ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

There is ample academic evidence indicating high levels of HIV stigma among BSSA communities. The research suggests that disadvantaged and marginalised social groups like the BSSA communities experience high levels of HIV and sexually transmitted infections. There is a significant amount of quantitative research in the public domain on HIV and stigma. Quantitative research has shown that BSSA communities present late with HIV and sexually transmitted infections often owing to HIV stigma. Currently there is limited published qualitative information on the factors influencing HIV stigma and sexual health seeking behaviour among BSSA communities, particularly from the perspective of the communities themselves. This research study explored beliefs and perceptions in the construction of HIV stigma and sexual health seeking behaviour among Black sub-Sahara African (BSSA) communities in one city in the UK. The Silences Framework, which sits within aspects of feminism, criticalist and ethnicity-based approaches, provided the theoretical underpinning for this study. An exploratory qualitative study methodology was used to identify and explore the key factors influencing the construction of HIV stigma and sexual health seeking behaviour among BSSA communities. Five focus groups and fifteen one-to-one semi-structured follow-up interviews were conducted to collect the data. The institution of Marriage, Religion, Reported HIV statistics, Politics and Immigration, HIV as a Sensitive subject, sexual health professionals Cultural competence, gender stereotyping, Sexual Orientation and Social Media emerged as key pillars underpinning the social scripts associated with the construction of HIV stigma and sexual health seeking behaviour. The experiences emanating from the pillars of HIV stigma, identified in this study, showed the impact of social, political and personal contexts associated with specific sexual scripts among the participants impacting on the construction of HIV stigma and sexual health seeking behaviour. The 'silences' contained in the socially determined scripts were important in understanding the phenomenon under investigation. The findings from this study were reviewed in light of current sexual health policies and strategies to consider how sexual health professionals and services can best meet the health care needs of BSSA communities. This thesis contributes to current knowledge of HIV stigma and ethnicity, by concluding that the construction of HIV stigma and sexual health seeking behaviour among BSSA communities takes place during different contexts of socialization, in a bid to conform to the perceived expectations of society which may be real or imagined. Furthermore, conformity is also influenced by commonly shared and personal appraisal of socially determined relevant issues. These contexts form the bases on which sexual scripts are given meaning and HIV stigma is constructed alongside a socially sanctioned pattern of sexual health seeking behaviour. This study makes an additional contribution in that it is the first time that The Silences Framework has been used to research HIV and stigma among BSSA communities. This research study compliments the currently available pool of quantitative data linking issues of HIV stigma and ethnicity in the United Kingdom. The findings from this exploratory qualitative research study reveal a wide range of critical issues to encourage further qualitative research in the area, while indicating new issues to consider in developing UK based interventions to address HIV stigma and sexual health seeking behaviour among BSSA communities.

Young people’s sexual health is a significant public health concern and associated with risks of unintended outcomes. Yet their voices are largely missing in the design of sexual health services, policy and education programmes. This study explored young people’s subjective understandings of their sexual readiness, and sexual health professionals’ understandings relative to how they assess young people’s sexual competence. A participatory rights-based approach was applied to support young people’s active participation in the research process. This involved including young people as co-researchers whose contextual expertise informed research design, ethical issues and interpretation of the data. Qualitative data collected from 20 young people aged 16-18 years, and 16 sexual health professionals, provided insights into the nature of young people’s first sexual intercourse and the context in which it occurs. The evidence suggests that while these young people actively deliberated about having sex, their sexual initiation was mostly spontaneous while under the influence of alcohol, and motivated by presumed peer rewards. Gender differences in expectations, motivations and the impact of first sex were apparent, which reveals more about the wider social structures that regulate their lives. As a result, some young people may find it difficult to resist the hegemonic gender stereotypes enforced by society and their peers, and may initiate sex to ‘get it over with’, whether they are competent or not. Four main constructs, i) rights, ii) respect, iii) responsibility and iv) resilience, emerged that are worthy of further investigation. These could prove useful to inform a more context-based sexual health promotion strategy and measure of sexual competence, as opposed to the current age and risk focus. Adding young people’s perspectives is crucial to develop more equitable, effective and sustainable youth-friendly sexual health education, treatment and advice services, that better engage with young people and more adequately reflects their needs.

This exploratory study examined links between health communication and other constructs affecting health promotion and disease prevention among Haitian mother-daughter dyads living in West Central Florida, and the risk or protective factors for HIV. Risky sexual behaviors can be reduced with accurate and effective information provided through parent-adolescent communication (Coetzee et al, 2014; Ogle, Glasier & Riley, 2008; Hadley et al., 2009). In Haiti, a country that bears a disproportionate burden of HIV/AIDS, women are the most vulnerable (UNAIDS, 2016a); In the United States (U.S.), foreign-born Haitian women in the state of Florida experience health disparities in many areas and bear a disproportionate burden of HIV/AIDS relative to their non-Haitian peers but little is known about (Florida Department of Health [FLDOH], 2017; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion [ODPHP], 2017). Indeed, the state of Florida recently reported that newly diagnosed cases of HIV increased for foreign-born Haitian women and in 2016, the latter represented 3.64% of all cases (Florida Department of Health, Bureau of Communicable Diseases, HIV/AIDS Section, 2017a). Recognizing that Haitian mothers traditionally bear the primary responsibility for transmitting traditional norms, values, health beliefs and practices, a concept referred to as poto mitan, this qualitative study examined risks and protective factors for HIV that may emerge in health and sexual health communication among Haitian mothers and daughters. This study comprised a two-phase process in which purposive sampling was first used to recruit and interview a focus group of seven health care providers and Haitian-descendant community leaders who engage Haitian-descendant clients in West Central Florida, after which findings from the focus group were used to strengthen a semi-structured interview guide that would be used to interview 10 Haitian mother/daughter dyads in the area. This study addressed a gap in the scientific literature related to health and sexual health promotion and disease prevention communication among Haitian immigrant women in the U.S., particularly surrounding HIV risk. Specifically, it sought to discover what constitutes specific methods that Haitian mothers use to communicate health and sexual health and the contents of such conversations, as well as the intention of daughters to transmit information that they received from their mothers, even here in the U.S. This study applied a constructivist grounded theory approach, in which Symbolic Interactionism (SI) and the Information-Motivation-Behavioral Skills Model (IMB) were triangulated as a framework. ATLAS.ti® 7.0, a software that supports analysis of textual data, was used to analyze transcripts from the focus group and from the interviews. Findings indicate that (a) Haitian mothers intentionally transmit specific and valued traditional knowledge about health and sexual health to their daughters, specifically in the areas of vaginal health, post-partum rituals, and abstinence as the acceptable mode of HIV prevention; (b) Haitian mothers in the study sample lack adequate and accurate knowledge about HIV/AIDS as well as the time to learn more that they can share with daughters; (c) Haitian mothers in the study sample do engage in direct communication about HIV prevention, taking advantage of teachable moments, using popular music and television programs; (d) there is a strong reliance on religious leaders and school systems to address health and sexual health instruction; (e) Haitian mothers in the sample reported and daughters confirmed that there is extremely limited conversation between the mothers and daughters surrounding sex, HIV risk reduction methods outside of abstinence. (f) Symbolic Interactionism is a useful framework for understanding the process of communication between Haitian mothers and daughters in this study; (g) IMB is useful to understand that the information being provided by Haitian mothers in this sample is at times insufficient and inaccurate, thereby limiting the ability of daughters to effectively and intentionally engage in conduct that protects their sexual health and reduces HIV risk. This study has several implications for social work education, research, practice, and policy. First, social work students must be taught to conduct comprehensive assessments of Haitian women in the context of valued Haitian family dynamics, and to engage in life-long learning regarding protective as well as risk factors for Haitian mothers and daughters. Second, Haitian and non-Haitian health providers who serve Haitian clientele could be surveyed regarding knowledge of health beliefs and practices and its potential impact on the health of their constituents. their Haitian patients. Third, researchers may use this study’s findings as a foundation for developing interventions that enhance strategies aimed at establishing rapport with Haitian clients and for assessing potential interactions between hidden health practices and prescribed medications. Fourth, findings suggest the need to develop interventions that empower trusted religious leaders to gain accurate HIV knowledge and to deliver empowering information effectively to their congregants. Fifth, findings suggest a need to develop outreach programs aimed at heightening HIV awareness and increasing HIV testing for Haitian women who are similar to this study’s sample. Sixth, social workers engaging Haitian female clients can make intentional efforts to include Haitian mothers in treatment. Seventh, this study’s findings underscore a need for social workers to advocate on behalf of Haitian immigrants’ efforts to be properly counted in the census, and to be counted as a culturally distinct group in other surveillance data. Social workers can benefit from understanding the strengths of relationships between Haitian mothers and daughters and to enhance their awareness of the heterogeneity among Haitians in general when working with Haitian clients. To work effectively with Haitian immigrant females overall requires cultural humility to mitigate the likelihood of bias towards them based on known or hidden traditional health beliefs and practices and gender roles.

Bakgrund: Behandling mot bröstcancer medför olika biverkningar för kvinnor, bland annat torra slemhinnor, klåda och smärta vid samlag, samt deformation av ett eller båda brösten. Sammantaget kan dessa biverkningar inverka på kvinnors upplevelse av sin sexualitet. Mer kunskap krävs kring kvinnors upplevelser av sin sexualitet, för att utifrån det kunna ge god vård och stärka kvinnors sexuella hälsa. Syfte: Syftet med studien är att beskriva kvinnors upplevelser av sin sexualitet under och efter avslutad bröstcancerbehandling. Metod: En litteraturöversikt som är baserad på tre kvantitativa och sex kvalitativa vetenskapliga artiklar. Resultat: Kvinnorna upplevde förändring av sin kroppsbild samt sin sexualitet under och efter bröstcancerbehandling. Ångest och depression var vanligt relaterat till viktuppgång. Det fanns dock kvinnor som upplevde förändring i en positiv riktning. Oro fanns över att inte vara tillräcklig i sin sexuella relation med sin partner. Brist på information gällande behandlingar och dess biverkningar, upplevdes av kvinnorna. Diskussion: Kvinnor upplever både fysiska och psykiska besvär vid bröstcancer. Kvinnor behöver mer information innan, under och efter behandling för bröstcancer. Det är viktigt att sjuksköterskor fångar upp varje kvinna för att kunna ge en individanpassad omvårdnad. Konklusion: Kommunikation mellan sjuksköterskor, kvinnor och deras partner kan stärka kvinnor i sin sexuella hälsa. / Background: Treatment against breast cancer can cause women various side effects, including dry mucous membranes, itching, as well as deformation of one or both breasts. All in all these side effects can affect women´s experience of their sexuality and create a suffering for them. More knowledge is needed about women´s experience of their sexuality, so the nurses can provide good care and strengthen the sexual health of women. Aim: The aim of this study is to describe women´s experience of their sexuality during and after treatment of breast cancer. Method: A literature review based on three quantitative and six qualitative studies. Result: Change in body image and sexuality during or after breast cancer treatment, were a common experience among women. Anxiety and depression was common related to weight gain. However, there were women who experienced change in a positive direction after breast cancer. Concern about being insufficient in their sexual relationships with their partner was found. Women experienced lack of information about treatments and their side effects. Discussion: Both physical and mental disorders were experienced by women with breast cancer. Women needed more information before, during, and after treatment for breast cancer. In order to provide personalized care, nurse´s need to see the whole woman and meet her individual needs of caring. Conclusion: Communication both between nurses, women and their partners could strengthen women in their sexual health.

This study explores how the complicated and nuanced identity theory, intersectionality, can be implemented as a communication strategy for sexual health professionals. From interviews with sexual health professionals in Oregon, this research indicates that through the adaptation of a reproductive justice lens professionals can practice intersectionality in their day-to-day work. Strategic communication has longed focused on the “cash value” of theory and suggested that theory is best when it can be applied in real world instances. This research identifies three strategies for application: the use of explicit language, the building of transformative coalitions, and the centering of marginalized voices, stories, and lived experience. This, in combination with an exploration into how sexual health professionals see their own professional and personal identities, indicates that there are very real world applications of intersectional theory that benefit practice.

abstract: ABSTRACT The aim of the study is to examine the impact of international male labor migration on the sexual and reproductive health of women who stay back home in Tajikistan. The data for this study was gathered as a result of ethnographic field works conducted on several occasions from 2011 to 2013. The results of the study suggest that male migration does not have an impact on fertility levels of the left-behind women. Although similarly to previous studies this study shows that wives of migrants are less likely to use contraception, it nevertheless demonstrates changes in contraceptive behaviors of wives of migrants such as seasonal removal and insertion of an intrauterine device (IUD) and shift from long-term to short-term contraception use. However, despite the availability of numerous forms of contraception in the country, the pattern of contraceptive use such as the reliance on IUDs dominant during the Soviet period continues to exist among wives of non-migrants. One of the most important findings of this study is women’s ability to use condoms for a short term with husbands after their return and asking spouses to have an HIV test. This finding challenges the dominant discourses in HIV and migration literature focusing on the inability, impossibility and failure on the part of the wives to negotiate HIV prevention due to various factors impeding the promotion of HIV prevention skills and measures among women. Moreover, the study demonstrates that, on the one hand, male migration worsens reproductive health of the left-behind women, but, on the other hand, it improves/increases their access to reproductive health institutions thanks to remittances. Although self-reported symptoms of women show a slight difference in reproductive morbidity, including STIs of wives of migrants and non-migrants, health care providers believe that this difference is significant and wives of migrants are more likely to have complications during pregnancy, delivery and post-delivery periods. The study also shows that the majority of HIV prevention and family planning programs target only wives of migrants and non-migrants, however it is crucial that migrant men should also be targets of these programs. / Dissertation/Thesis / Doctoral Dissertation Gender Studies 2015