The abused-abuser hypothesis posits that a history of sexual victimization may increase the risk of engaging in sexually abusive behavior for some victims. Although many researchers have discovered a higher prevalence of childhood sexual abuse (CSA) in sex offenders in comparison with non-sex offenders, less research has considered how specific characteristics of prior sexual abuse may contribute to how these individuals sexually abuse others. For the present study, archival data were collected from 243 youths receiving residential treatment for sexually abusive behavior and self-reported data were collected from university students with no known history of sexual offending. The present study confirms disproportionally high rates of CSA in the sample of sexually abusive youth, compared to non-sexual abusers. Further, among the sample of sexually abusive youth, we examined the effects of sexual perpetrator characteristics and age of sexual victimization on victim choice, age at first sexual offense, and number of sexual offenses, number of arrests, and sexual victims. Results revealed associations between perpetrator characteristics and victim choice. Additionally, being sexually victimized by a male or a relative was significantly associated with a younger age of onset of sexually abusive behavior and a younger age of sexual victimization suggested a greater number of sexual victims. Implications and future directions will be explored.

Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice–involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-ofhome placements. Implications and future directions are discussed.

The commercial and sexual exploitation of children has become a global multi-billion dollar industry over the past several decades. Throughout history, therapists from various backgrounds have not only advocated against child trafficking but also provided therapeutic services to victims of such an inhuman crime—most of whom are female adolescents. Compared to their female counterparts, male therapists have been assigned CSEC cases involving female clients in excessively lower ratios. Researchers, however, have not fully captured what has prevented the female CSEC population from drawing interests from male counselors. This study explored potential reluctance in male therapists with regard to working with female CSEC clients. Under the qualitative research paradigm, semi-structured interviews were conducted with eight male therapists in Southern California. Results from the thematic analysis of the interview data demonstrated that male counselors are reluctant to work on a one-on-one basis with female CSEC clients due to (1) fear of sexual accusations and (2) lack of training. However, results also revealed that support from female colleagues can help dissipate the heavy clouds of fear associated with sexual allegations. Implications for social work and human service agencies were discussed. Keywords: male counselor, commercially and sexually exploited children, social work, colleague support.

Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a national priority for several reasons including its endemic/pandemic status and economic demand. Adolescents 15 to 24 years old who are sexually active acquire nearly half of all new Sexually Transmitted Infections (STIs). Recent findings from the Centers of Disease Control (CDC) have documented increased teen birth rates, escalating births to unwed mothers, and STIs ascribed to one in four adolescent females, are reasons to enhance effective prevention efforts. The specific aim of the study, based on Bandura's social cognitive theory, was to test associations among communication system methods and HIV/AIDS self-efficacy, perceived risk, knowledge, and sexual decision-making among older adolescent females. Communication systems consist of interpersonal relationships, mass and print media. Research questions are: (1) What are the associations among demographic variables (age, race/ethnicity, education, socioeconomic status) in young women and the types of communication systems preferred (media and interpersonal)? (2) What are the associations among the types of communication systems preferred by young women and person factors (HIV/AIDS self-efficacy, perceived risk, and knowledge)? (3) What are the associations among the types of communication systems preferred by young women (media, print, interpersonal) and behavior (sexual-decision making)? (4) What are the associations among young women's person factors (HIV/AIDS self-efficacy, perceived risk, knowledge) and behaviors (sexual decision-making)? The study used a non-experimental cross sectional design. The sample included 866 females, 18 to 21 years old, attending the the second largest public university or a historically black university in Florida. Data was collected using validated instruments transcribed into an electronic survey program. Data analysis consisted of frequency distributions, descriptive statistics, and Multiple Regression Analysis. Results indicated that there were associations beween all proposed constructs that constitute the theoretically derived conceptional model. Interpersonal relationships explained the most variance (parents--22%; partners-12%) when associated with other communication systems. Overall, students reported that parents had more influence on their decisions with regards to basic beliefs, value systems, sexuality, dating, and alcohol use. The communication systems associated with older adolescents' sexual decision-making may assist public health advocates in developing related preventive interventions for young adult females.

Abstract not available

Young people are at risk of sexually transmitted infections (STI), and engage in sex and drug related risk behaviour. This thesis investigates novel methods to reach youth for research and health promotion. Mobile phone text messages (SMS) are convenient, low cost, fast, and popular among youth. SMS has been utilised in sexual health for clinical management, service delivery and health promotion, but few of these projects have been evaluated. Recognising this lack of research led to the design of a randomised controlled trial investigating the use of SMS and email in sexual health promotion. Recruitment of young people for this trial was piloted at Melbourne’s Big Day Out. 939 young people were recruited in several hours; 30% were classified as being at high risk of STI, and 46% had used illicit drugs in the month prior to the survey. Knowledge of STI was poor. Drug use was associated with both sexual risk behaviour and music preference. The study demonstrated that this festival is a valuable site for sex and drugs research and health promotion. The following year, young people were recruited at the music festival and randomised to an intervention group who received regular sexual health SMS and email, or a control group who received no messages. After 12 months, the intervention group had higher STI knowledge than the control group (OR 2.72, 95%CI 1.68, 4.41) and intervention group females were more likely to have had an STI test (OR 2.51, 95%CI 1.11, 5.69). Respondents’ opinions of the messages were favourable. This simple, low-cost, and novel method was shown to be effective in improving young people’s sexual health. At-risk young people are not well represented in sex and drug behavioural surveillance in Australia. As the pilot study identified that a music festival was a suitable site for sex and drug research, the survey was repeated each year. Between 2005 and 2008, the proportion of young people at risk of STI decreased from 34% to 29%, and recent illicit drug use decreased from 46% to 43%. A limitation of the studies described herein is reliance on self-report, which is subject to recall bias; this can be reduced using diaries to collect behavioural data. Participants completed weekly diaries of sexual behaviour and a retrospective questionnaire. Correlation between the diaries and questionnaire was substantial, adding confidence to the validity of results of other studies in this thesis. Diaries can be collected in different ways; SMS has not previously been used for this purpose. Participants were randomised to complete diaries through SMS, online or paper. Online diaries were superior to SMS in completeness and participant preference, but SMS diaries were more likely to be submitted on time. This thesis has tested several novel options for researching and promoting health to young people. Through music festivals, SMS, and email, young people can be reached through settings and media they are familiar with. Use of these novel methods has increased understanding of risk behaviour among youth and been effective in sexual health promotion.

Good sexual and reproductive health is fundamental to the overall health status of Māori communities. In 2001, the Ministry of Health reported that New Zealand was facing a Chlamydia epidemic. This epidemic has not abated as rates of Chlamydia have increased significantly in the past five years, with disproportionately high rates in young Māori women compared to non-Māori women. Despite significant sexual health disparities, young Māori have had limited opportunities to participate in research focussed on sexual health and voice their opinions and concerns on sexual health issues. This qualitative descriptive study has used a Māori inquiry paradigm and approached the research from a Kaupapa Māori perspective. The primary research question asked what the knowledge, attitudes and reported behaviours of young urban Māori women were in regards to sexual health and in particular, the sexually transmitted infection Chlamydia. Secondary aims were to ascertain the sources of information used and accessibility of sexual health services, as well as identifying resilience factors associated with protection against Chlamydia infection. The data was collected from semi-structured interviews with 16 young Māori women living in the Auckland region. Data analysis involved the inductive approach of categorical content analysis to identify major categorical themes to answer the specific questions posed. The main conclusion was that there are a number of barriers to accessing quality sexual health information and services for young Māori women. Participants’ level of knowledge varied reflecting their personal experiences and many were unaware that Chlamydia is asymptomatic and that delayed diagnosis can lead to fertility problems. The main sources of sexual health information accessed were whānau, peers, school, and contact with health professionals. Racism was identified as one of the barriers to sexual healthcare services. The young women expressed a clear preference for sexual health services to be delivered by Māori. Most importantly, for sexual health interventions to be successful it is essential that Māori communities, including young people and their whānau, are an integral part of creating positive solutions. Resilience factors that may help protect young women from contracting chlamydia characteristic of this group were having a strong connection with a caring adult or friend and parents who viewed sexuality as a normal part of adolescent development. In addition, having a positive Māori cultural identity with an ability to understand bicultural differences was strongly associated with participants accessing sexual healthcare services despite identified barriers.

This thesis presents data on incidence and risk factors for individual sexually transmissible infections (STIs) and STIs as risk factors for HIV acquisition in a community-based cohort of HIV negative homosexual men in Sydney. Nearly half of men aged under 25 years were seronegative to hepatitis A and B infection. The prevalence of hepatitis C (HCV) was 0.85%, which was close to that of the general population. HCV infection was strongly associated with injecting drug use (OR 60.43, 95% CI 6.70-544.79), and sexual transmission was not demonstrated in this cohort. There was a nearly 40 fold increase in syphilis notifications in inner Sydney between 1999 and 2004. The stable incidence of 0.6% per year in the HIM cohort suggests that it was disproportionately affecting HIV positive men. Oral sex was an important transmission route and about one third of cases were asymptomatic. The incidence of urethral and anal gonorrhoea was 3.78 and 3.19 per 100 person-years, and for urethral and anal chlamydia it was 7.98 and 5.20. In addition to unprotected anal intercourse (UAI), insertive oral sex was related to urethral infections and anal infections were associated with non-intercourse anal sexual practices. The prevalence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) was 75% and 23% respectively. Sexual contact not only with men, but with women, was significantly associated with both infections. Among those susceptible at baseline, the incidence for HSV-1 and HSV-2 was 5.58 and 1.45 per 100 person-years. Oral sex was associated with incident HSV-1 infection and certain non-intercourse anal sexual practices were significantly associated with incident HSV-2 infection. HIV incidence was 0.94 per 100 person-years. It was significantly associated with a higher number of episodes of receptive UAI with a partner of unknown HIV status (p trend&lt0.001) or a partner known to be HIV positive (p trend&lt0.001). After controlling for sexual behaviour, HIV seroconversion was significantly associated with anal gonorrhoea (HR 12.68, 95% CI 3.66-44.00). The association with anal warts and prevalent HSV-1 infection was of borderline significance. These data will inform intervention designs targeting STIs which aim to prevent HIV in homosexual men.

This thesis focuses on disclosure of sexual abuse by men who were sexually abused either as children or adolescents. The research questions that it set out to answer were 'why and how do males in Australia disclose to another person that they have been sexually abused?' Aims were to understand disclosure from the perspective of male survivors in Australia, identify the factors that inhibit, trigger and facilitate disclosure, and develop a theory of disclosure reflecting the processes involved.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.