Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates.

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18-64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.

Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships: a population-based study.

BACKGROUND/AIMS: The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties. METHODS: Cross-sectional analyses of a nationally representative computer-assisted telephone interview. Eight thousand, six hundred and fifty-six respondents were recruited by random digit dialling in 2004-2005. Only those in a sexually active, heterosexual relationship were included in the current analyses. RESULTS: After adjustments for demographic factors, both overweight and obese male and female participants were more likely to report worrying during sex about whether their body was unattractive. Among women, associations were also found between higher BMI and lack of interest in sex. No other significant associations between BMI and sexual difficulties were evident. There was an association between BMI and extreme physical pleasure for women but not men over and above the effects of sexual difficulties, with obese women being more likely than normal weight women to report extreme physical pleasure. No associations were found for either men or women between BMI and whether or not they reported extreme emotional or sexual satisfaction with their relationship. CONCLUSIONS: With the exception of body image difficulties, there is little association between BMI and self-reported sexual difficulties. Furthermore, extreme sexual and emotional satisfaction appeared to be associated with the presence or absence of sexual difficulties and not overly influenced by BMI. Overall, clinicians and patients should be aware that being overweight is not necessarily detrimental to sexual functioning.

Knowledge of sexually transmissible infections: a comparison of prisoners and the general population.

The World Health Organization (WHO) has identified a failure to provide education for vulnerable populations such as prisoners as a contributing factor to the epidemic of sexually transmissible infections (STIs). Despite this recognition, little is known about prisoners' level of knowledge of STIs compared with the general population. Using computer-assisted telephone interviews, we compared a representative sample of 2289 Australian prisoners, aged 18-59 years from New South Wales and Queensland prisons with a representative community sample of 3536 participants from these two states. Prisoners had significantly better knowledge than the general community of chlamydia-related questions, while knowledge of herpes (genital and oral) was slightly better in the community sample. Prisoners who were aged over 25 years, not married, female, self-identified as either homosexual or bisexual and reported a history of STIs tended to have better STI knowledge levels. Despite their more disadvantaged backgrounds, prisoners demonstrated relatively good health literacy in relation to STIs. Ongoing education about the transmission risks of STIs for prisoners and the general community is needed.

Individual characteristics are less important than event characteristics in predicting protected and unprotected anal intercourse among homosexual and bisexual men in Melbourne, Australia.

OBJECTIVE: To describe individual, social network and encounter specific factors associated with protected anal intercourse (PAI) and unprotected anal intercourse (UAI). METHODS: This was a cross sectional survey conducted between April and November 2002. A total of 733 sexual encounters were reported by 202 men recruited from the gay community in Melbourne, Australia. Predictors of self reported PAI and UAI were examined. RESULTS: Of the 733 sexual events most (56.3%) did not involve anal intercourse, and more involved PAI than UAI (30.6% versus 13.1%). PAI was more likely than no anal intercourse (NAI) if the participant's social network was mostly homosexual, the partner was an occasional or casual partner, or was HIV positive. PAI was less likely if sex took place at a "beat" but more likely if it took place at a sauna. PAI was more likely if the partner was affected by drugs or alcohol. UAI was more likely than NAI if the participant had injected drugs in the year before interview. It was less likely if the partner was occasional or casual or was HIV positive but more likely if the partner's HIV status was unknown. UAI was much more likely than NAI if the encounter took place at a "sex on premises" venue. CONCLUSIONS: In this analysis it is the characteristics of the sexual encounter that predict whether PAI or UAI rather than NAI takes place.

Population contextual associations with heterosexual partner numbers: a multilevel analysis.

OBJECTIVE: The study examines whether an individual's sexual behaviour is associated with the demographic context within which they live. METHODS: Data from a large behavioural survey were matched to the census and the number of opposite sex partners individuals reported having in the year before interview was modelled against a suite of individual characteristics and analogous characteristics for the population in which they lived. RESULTS: The number of partners reported (none, one, two, three, or more) were variously associated with an individual's gender, age, marital status, sexual identity, and same sex activity in the previous year. Additionally, population age structure, sex ratio, and the proportion of the population reporting specific patterns of sexual activity were associated with the behaviour of individuals. CONCLUSIONS: This study demonstrates that population context is associated with individual behaviour even after individual characteristics have been taken into account. This suggests that multilevel modelling of sexual behaviour data can provide new insights into the pattern of sexual behaviour.

Men, bodily change and urethritis: a qualitative study.

OBJECTIVES: To describe how men narrate the process of bodily change as a trigger to presentation for a suspected sexually transmissible infection. METHODS: The study was qualitative with 18 men presenting at a specialist sexual health centre in an urban setting. RESULTS: All men gave narratives that included accounts of bodily changes prior to presentation. The nature, severity and persistence of those changes were unrelated to subsequent diagnosis. Men responded particularly to visual changes as cues to action. CONCLUSIONS: The men exhibited limited skills in understanding the significance and the specifics of bodily change as they may relate to a sexually transmissible infection. While these men identified a broad range of changes as potentially indicative of a sexually transmissible infection, their ability to act on visceral rather than visual cues appears constrained in that they were less able to respond to the feel of their body than the way that it looked.

Associations between the sexual behaviour of men who have sex with men and the structure and composition of their social networks.

OBJECTIVE: This exploratory study identified associations between the number of sexual partners reported by men who have sex with men (MSM) and the structure and composition of their social networks. METHODS: A cross sectional survey was conducted of men recruited as key informants, through advertising and chain referral. A face to face interview was conducted with 206 MSM. The interview included information on the number of sexual partners in the previous year and sociodemographic and behavioural characteristics of the participant. Social networks were enumerated and network size and density were calculated. Ordered logistic regression was used to assess the associations between number of sexual partners and personal and network characteristics. RESULTS: The number of anal sex partners reported was higher if the participant had injected drugs in the past year rather than never having injected (odds ratio, 95% confidence interval: 3.23, 1.28 to 8.15), decreased with network density (0.014, 0.002 to 0.008) and increased if the network did not comprise only HIV negative people (1.77, 1.05 to 2.99). The number of additional oral sex partners increased with network size (1.06, 1.02 to 1.10) and decreased with increased network density (0.034, 0.006 to 0.205). In addition to similar effects of network size (1.05, 1.01 to 1.09) and network density (0.086, 0.013 to 0.563) the model for the number of additional manual sex partners also included age (1.03, 1.01 to 1.05). CONCLUSION: The density of the social networks of MSM appears strongly and consistently associated with patterns of sexual behaviour. This underlines the importance of using network approaches to understanding the sexual behaviour of MSM and their potential value in identifying novel strategies for intervention.