Sexuality and prevention among men who have sex with men in the contexts of the AIDS and COVID-19 pandemics. / Sexualidade e prevenção entre homens que fazem sexo com homens nos contextos das pandemias de AIDS e da Covid-19.

This essay reflects on sexual practices and prevention in the contexts of the AIDS and COVID-19 pandemics. It analyses data collected between July and October 2020 through participant observation, as part of an ethnographic research project on HIV vulnerability and prevention among men who have sex with men in the Metropolitan Region of Recife, state of Pernambuco (PE), Brazil. The results point to the relevance of physical appearance and the affective bond between partners in engendering emotions that mediate coping with the risk of infection during both pandemics. It indicates the need to incorporate those communicational dimensions into informational materials to make them more effective.

Este ensaio reflete sobre práticas sexuais e prevenção nos contextos das pandemias de AIDS e da COVID-19. Analisa dados coletados entre julho e outubro de 2020, por meio de observação participante, no âmbito de uma pesquisa etnográfica sobre vulnerabilidade e prevenção ao HIV entre homens que fazem sexo com homens da Região Metropolitana do Recife. Os resultados apontam para a relevância da aparência corporal e da vinculação afetiva entre os parceiros no engendramento de emoções que medeiam a lida com risco de infecção em ambas as pandemias. Sinaliza para a necessidade de incorporar essas dimensões comunicacionais em materiais informativos, de modo a torná-los mais eficazes.

Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study.

PURPOSE: To evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia. METHODS: A quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being. RESULTS: Baseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung. DISCUSSION: While findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.

Gender-Sexuality Alliance meeting experiences predict weekly variation in hope among LGBTQ+ youth.

Hope is considered a marker of resilience among youth facing oppression, including LGBTQ+ youth. This 8-week weekly diary study among 94 LGBTQ+ youth (ages 14-19; Mage  = 15.91, 46% youth of color, 44% transgender or nonbinary) in 2021 considered whether a youth's meeting-to-meeting experiences in Gender-Sexuality Alliances (GSAs; LGBTQ+ affirming school clubs) predicted subsequent hope from week to week. Youth reported greater hope on days following meetings where they felt more group support, greater advisor responsiveness, and had taken on more leadership responsibilities. Group support and advisor responsiveness were stronger predictors of a youth's hope on days closer to GSA meetings; leadership's effect was stronger when more days had elapsed. Findings suggest how GSAs may cultivate hope among LGBTQ+ youth.

Impacts of electronic device use on adolescents' sexual knowledge, attitude and perception during the COVID-19 pandemic: A representative sexuality survey.

Background: COVID-19 pandemic has led to school closure and social distancing measures for infection control. Many young people thus spent more time on electronic devices and the Internet. This study aimed to determine if and how sexual knowledge, perception and behavior as well as sexuality among Hong Kong adolescents were affected as a result. Methods: Youth Sexuality Study conducted by The Family Planning Association of Hong Kong (FPAHK) evaluated the sexual knowledge, attitudes and behaviors and sexual health of youth every 5 years since 1981 with adaptations made to the changing environment. We analyzed this cross-sectional data on sexual knowledge, attitude, and experiences as well as the impacts of COVID-19 on daily life, health and relationships. Univariate analysis was conducted to investigate the relationships between the time spent on electronic devices and sexuality, while mediation analyses using the PROCESS procedure were performed to further explore differences in time spent on electronic devices. Results: During the COVID-19 pandemic, the majority of our participants spent more time on social media and browsing the Internet on electronic devices with less time for extracurricular activities and learning. Nonetheless, there was better overall sexual knowledge and a lower degree of sexual stigma with a higher overall acceptance of sexual minorities. The mediation analyses found that sexual content [Conditional effect = 0.024 (95% CI 0.008, 0.043)] and engagement online [Conditional effect = 0.036 (CI 0.021, 0.053)] could indirectly influence the effect of screen time on the frequency of sexual practices. Conclusion: Policymakers and frontline professionals should re-examine the pedagogy of the present sex education and consider online sex education as the key mode of delivery while guiding the proper use of electronic devices in the learning and exploration of sexual knowledge.

Pornography use among adolescents and the role of primary care.

Given the increase in pornography use among adolescents over the years, we discuss the impact of its use on sexual health development as well as the role of primary care providers (PCPs) in assessing use and providing sexual health education. While pornography use is often viewed negatively, it is important to develop unbiased understanding of the use in order to provide non-judgemental, adolescent-focused and educational care. As PCPs are often the first point of contact when adolescents experience medical and behavioural health concerns, it is essential for them to be equipped to screen for pornography use effectively, create a confidential and comfortable environment to talk about pornography use and sexuality, and be informed of ways to promote open discussion between youth and parents. In addition to PCP involvement, parental collaboration, knowledge and comfortability with discussing pornography use with their child are powerful tools in understanding and navigating pornography use in this population. This special communication seeks to provide an objective view of adolescents' pornography use, guidelines for screening of pornography use and ways to facilitate conversations about the use between adolescents and caregivers.

Sexuality Transmitted Infection in the COVID-19 Pandemic and Non-Pandemic Time.

On March 11, 2020, the World Health Organization recognized the SARS-CoV-2 infection as a pandemic. The pandemic itself in addition to its containment measures affects individuals' lifestyles and welfare including their sexual behaviors. Thus, we hypothesized that sexually transmitted infection (STI) incidence may be changed and so we evaluate urethritis incidence as the most common STI in men and some other related factors. Two cross-sectional surveys during the first 6 months of 2019 and 2020 were undertaken and data were collected from 11 urology offices located in different parts of the capital city. In total, 34,611 male participants were included in our study, and 191 (.55%) patients' clinical diagnoses were urethritis. The urethritis incidence significantly decreased from 149 of 17,950 (.83%) to 42 of 16,661 (.25%) individuals in the same period of the years 2019 and 2020, respectively (p-value < .001). There was a higher percentage of single (p-value = .049) and older (p-value < .001) urethritis patients in the first 6 months of the year 2020 compared with 2019. Our survey provided urethritis incidence, demographics, symptoms, and treatment characterization. As our results show, the proportion of urethritis patients in all populations admitted to urologist offices had dramatically decreased during the COVID-19 pandemic compared with prior. The indirect effects of the pandemic and its containment measures on people's sexual health should be noticed and an appropriate reaction and policy-making are recommended to manage issues properly in different aspects of sexual health.

The sexuality of couples formed during the pandemic: An exploratory study.

Covid-19 has been affecting people's lives on a social, economic, emotional, and sexual level. This study aims to investigate any change in how couples formed during the pandemic got to know the partner and experienced sexuality, including factors that could have influenced those changes in comparison with a pre-pandemic period. Particularly, focus groups (N = 26 women) were conducted and an online questionnaire (N = 120; 41 men and 79 women) was administered. Given the exploratory qualitative nature of the present research, no specific hypothesis was tested. Most of the sample reported an increase in sexual desire, sexual frequency, and quality of intercourse, perceiving an early development of intimacy. The results highlight the lack of stress and fear of contagion. The intense state of euphoria, typical of the initial phase of the relationship, has perhaps allowed the couples to overcome the obstacles due to the restrictions. This study underlines the role of being in love in the survival of the species, as it allows for the creation of steady relationships even in moments of danger.

Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia.

School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.

(Re)imagining research, activism, and rights at the intersections of sexuality, health, and social justice.

The Covid-19 pandemic inaugurated a new global order of public life and health marked by death, despair and alienation. As a crisis of a global scale, it made the task of (re)imagination simultaneously necessary and extremely difficult. It is this double bind of the difficulty and imminence of imagination that motivates the curation of this special issue. In this introduction, we map the connections between the theme of this volume and the key ideas that constitute its varied contributions, which we organised under three broad mobilising ideas: Rights and Resilience; Sexuality, Health and Justice; and Politics of Knowledge Production and Collaborations. Contributions cover myriad issues, engage in methodological innovations and play with diverse genres. Alongside more traditional academic writings, there are community-based research papers, activist conversations, visual essays, reflective pieces and interviews. The geographical span of the contributions brings insights from around the world and the number of topics covered in this issue are equally vast including, among others, mental health, disability, environment, sex work, violence, queerness, LGBTQ+ experiences, love and anger. The aim of this special issue, then, is to challenge the Manichean distinctions that are often drawn between research and activism, and by extension, between theory and practice.

COVID-19: the unmet need for family planning and its effects on sexuality: a cross-sectional study.

OBJECTIVE: This study was conducted to examine the effect of women's unmet family planning needs on their sexual functions during the COVID-19 pandemic period. METHODS: A cross-sectional study was conducted with 319 women of childbearing age across Turkey between April and May 2021. Data were obtained through online questionnaires using the "Survey Form" and the Female Sexual Function Index. RESULTS: It was observed that 46.77% of the participants had difficulty in accessing the family planning method, the most used family planning method during the pandemic period was the withdrawal method with 52.35%, and there was a significant difference between them and the pre-pandemic method (p<0.05). In the regression analysis, it was shown that a one-unit increase in the difficulty of accessing the family planning method and the place reached parameter would lead to an increase of 0.33 points in the sexual function probability of women. CONCLUSIONS: It was observed that women of childbearing age living in Turkey had limited access to family planning services during the pandemic, those who used modern methods before the pandemic had to prefer the traditional method, and the sexual functions of women who had fear of becoming pregnant were adversely affected.

Could SARS-CoV-2 infection affect male fertility and sexuality?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus infectious disease (COVID-19) and has rapidly spread worldwide, causing serious problems to the healthcare systems of many countries and hundreds of thousand deaths. In this review we discuss data from the literature to understand whether the various districts of the male reproductive system may represent another vulnerable target for SARS-CoV-2. Studies were searched from electronic databases such as Google Scholar, PubMed, Scopus, and COVID-19 specific databases such as LitCovid, until July 31, 2021. It appears that SARS-CoV-2 virus infection not only causes damage to the respiratory system, but could have a serious impact on the reproductive system of male patients modulating many physiological processes. Like some other infections, SARS-CoV-2 also leads to a worsening of semen quality and an increase in oxidative stress (OS) levels. However, due to the limited number of studies, it is unclear whether this deterioration in semen parameters is temporary or lasts over time. It is certainly important that patients' reproductive function is monitored after coronavirus infection to avoid problems in reproductive health in the future.

COVID-19-Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA.

BACKGROUND: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW. METHODS: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access. RESULTS: Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3). CONCLUSIONS: Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.

Effect of the Lockdown Due to COVID-19 on Sexuality: The Mediating Role of Sexual Practices and Arousal in the Relationship Between Gender and Sexual Self-Esteem.

The scientific evidence suggests that COVID-19 is affecting much more than the physical health of individuals, particularly in places where a lockdown has been established to slow down the spread of the virus. An area that may be particularly affected is human sexuality. This study explored the impact of the situation generated by COVID-19 on the sexuality of 201 adults living in Spain. We collected data cross-sectionally through an online survey during the month of April 2020. Results showed a reduction of sexual self-esteem and a decrease in the number of interpersonal sexual relations, although the frequency of masturbation and the consumption of pornography did not vary compared to previous levels. A regression analysis showed that masturbation, the ability to maintain sexual arousal and interpersonal sex were mediating variables in the relationship between gender - specifically being male - and having higher sexual self-esteem during the lockdown. This study provides new insight on the relevance of certain sexual behaviors in a pandemic situation with considerable social restrictions and on the effect of this situation on sexual self-esteem and arousal. It brings some clarity on the relationship between sexual self-esteem and gender, about which there is currently no consensus in the scientific literature.

The Impact of Mental Health and Stress Concerns on Relationship and Sexuality Amidst the COVID-19 Lockdown.

BACKGROUND: Since January 23, 2020, the Chinese government has imposed restrictive measures including self-isolation, travel restrictions and lockdown of Wuhan city in order to prevent the incoming waves of COVID-19 outbreak in the country. However, the impact of mental health and stress concerns on relationship and sexuality amidst the COVID-19 lockdown was currently unclear. AIM: The cross-sectional study was designed to determine the changes in health, relationship and sexuality among the Chinese couples who lived together amid the early stages of COVID-19 pandemic in China. METHODS: Participants of Chinese nationality aged ≥18 years were asked to complete a self-administered online questionnaire regarding sexuality behaviour and impact of event scale (IES) in March 2020. Nonrandom sampling was used for participant recruitment. Also assessed were sociodemographic data including sex, age, employment, region, sexual dysfunction, and whether participants tested positive for COVID-19. OUTCOMES: IES score, frequency of sexual intercourse per week, quality of usual sex life, emotional bonding and duration of relationship were measured. RESULTS: A total of 1,139 participants (ie, 735 males and 404 females) were included in the study. Mean age and IES of participants was 33.6 ± 9.5 years and 27.4 ± 8.6, respectively. Being male was significantly associated with increased frequency of sexual intercourse amid the COVID-19 pandemic (P = .012). Also, participants with an IES score <26 were more likely to report that they had increased frequency of sexual intercourse per week (P < .001) and the COVID-19 pandemic had positively affected the quality of their usual sex lives (P < .001). On the other hand, participants with IES score ≥26 were more likely to report that the COVID-19 pandemic had positively affected their emotional bonding (P < .001). CLINICAL IMPLICATIONS: Frequency of sexual intercourse and quality of sex life in participants who experienced high stressful impact were more likely to be affected by the COVID-19 pandemic. STRENGTHS AND LIMITATIONS: This was one of the first studies to assess sexual behavior during the COVID-19 pandemic in Chinese adults. Since participants were asked to self-report their sexual behavior, this potentially introduced self-reporting and recall bias into our findings. CONCLUSIONS: Our study reported that despite the moderate-to-severe stressful impact due to the COVID-19 pandemic, the majority reported no significant changes in the frequency of their sexual intercourse per week, quality of their usual sexual lives and emotional bonding.

Sexuality during COVID lockdown: a cross-sectional Italian study among hospital workers and their relatives.

In March 2020, the Italian Government introduced measures to reduce the spread of COVID-19 infection. Between 8th April and 2nd May 2020 we investigated levels and correlates of sexual activity and depression during COVID-19 lockdown in a sample of hospital workers and their acquaintances by an online survey on SurveyMonkey. Socio-demographic data, International Index of Erectile Function, Female Sexual Function Index, and Beck Depression Inventory were recorded. Multivariable logistic regression analysis (MLRA) was used to test predictors of depressive symptoms and low sexual desire and satisfaction. A statistically significant difference in age, change in working habit, sexual satisfaction, sexual desire, and depressive symptoms was found between males and females. A statistically significant higher proportion of health care workers had low sexual desire (65.3% vs 56.8%, p = 0.042). At MLRA, age, being female, being a health care worker, having children at home, living with the partner, and having low sexual satisfaction were predictors of low level of sexual desire. To our knowledge, this is one of the few studies using validated questionnaires for both males and females to assess sexual well-being and psychometric alterations during COVID quarantine.