Articles in Perspectives on Sexual and Reproductive Health are now published online as they complete the production process, under our new Early View feature, which allows us to get material to you weeks before the printed journal arrives in your mailbox. Sign up at this link to receive an alert when each new article becomes available.

Thanks to Early View, many of you have already seen the first two articles in our June issue: "Sex Redefined: The Reclassification of Oral-Genital Contact" (click here for the news release), by Jason D. Hans et al., of the University of Kentucky; and "Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape, Incest and Life Endangerment" (click here for the news release), by Deborah Kacanek et al., of Ibis Reproductive Health.

HERE’S WHAT ELSE YOU CAN FIND IN THIS ISSUE OF PERSPECTIVES:

History of Sexual Victimization Is a Marker for Sexual Risk-Taking Among Young Men

Young adult men with a history of sexual victimization have an increased likelihood of engaging in risky sexual behavior, according to an analysis of data on men aged 18–24 from the National Survey of Family Growth. In "History of Forced Sex and Recent Sexual Risk Indicators Among Young Adult Males," Laureen H. Smith and Jodi Ford of Ohio State University report that 6% of men said they had been forced by a female to have vaginal intercourse, while 1% said they had been forced by a male to have oral or anal sex. However, the authors caution that these proportions are likely underestimates, as sexual victimization is generally underreported, especially by men. Those who had been forced to have sex, whether by a female or by a male, had elevated odds of reporting at least one risk indicator—for example, having had five or more female partners, having had one or more male partners, having exchanged money or sex for drugs, or having received an STD diagnosis—in the past year. For this reason, the authors suggest that health care providers screen their male patients for a history of sexual violence, rather than relying on them to disclose such experiences on their own. In addition, they recommend further research into this understudied area in order to improve practitioners’ understanding of male sexual victimization and how they can help men take steps to reduce their sexual risk-taking and their risk of HIV and other STDs.

Hyperactivity, Antisocial Behavior Associated with Early Sexual Initiation

An analysis of data from a sample of young teens in the Children of the National Longitudinal Surveys of Youth found that 26% of youth had had intercourse before turning 15, and their average level of each socioemotional problem assessed was higher than the level of those who had not. According to "The Association of Socioemotional Problems with Early Sexual Initiation," by Jane D. McLeod and Syndee Knight of Indiana University, when taken separately, both internalizing problems (e.g., depression and dependency) and externalizing problems (e.g., hyperactivity and antisocial behavior) were associated with early sexual initiation in analyses looking at each type of problem separately. However, when both types were examined together, only externalizing ones—and, specifically, hyperactivity and antisocial behavior—remained significant. Associations did not differ between young men and young women, or among racial and ethnic groups. The authors suggest that program planners target interventions to youth with externalizing problems, particularly those who engage in antisocial or hyperactive behavior. They further comment that these programs would be best conceptualized as complements to, rather than substitutes for, ongoing efforts to address the social disadvantages that underlie early sexual initiation.

Withdrawal a Popular—but Not Always Trusted—Contraceptive Method

Withdrawal is a popular contraceptive technique among young adults, but their opinions on its effectiveness are mixed, according to "Withdrawal Attitudes and Experiences: A Qualitative Perspective Among Young Urban Adults," by Paul G. Whittaker et al., of the Family Planning Council of Philadelphia. The authors conducted interviews with 95 ethnically diverse males and females aged 18–25, recruited through family planning clinics and community outreach, to examine issues around contraceptive attitudes, norms and experiences. They found that despite withdrawal’s popularity, some participants, especially women, expressed anxiety about pregnancy risk because of their perceptions that the method is ineffective; in particular, some women were concerned about their partner’s capacity to consistently withdraw prior to ejaculation. At the same time, others expressed confidence and skill in using the method. Reasons participants reported for using withdrawal included convenience and dissatisfaction with hormonal contraceptives and condoms; some mentioned using withdrawal as a secondary, or backup, method of pregnancy prevention in conjunction with hormonals or condoms. The authors found that participants had rarely discussed withdrawal with their health care providers, and suggest that providers’ discussions with their patients about this method could yield improved insight into patients’ risk behaviors, as well as offer an opportunity to provide guidance on the use of withdrawal.

HIV-Positive Youth Challenged by Disclosing Their HIV Status, Sexual Risk Reduction

Many HIV-positive youth report that fear of stigma if they disclose their HIV status is the most difficult thing about living with HIV; this sentiment is expressed both by youth who were perinatally infected and by those who acquired HIV through risky behaviors, such as unprotected sex and injection-drug use. Feeling that they cannot disclose their HIV status creates a barrier to obtaining the emotional support they desperately desire. "Lowering the Risk of Secondary HIV Transmission: Insights from HIV-Positive Youth and Health Care Providers," by Amy D. Leonard, of Baylor College of Medicine, et al., provides information from 20 HIV-positive inner-city youth and 15 health care providers who participated in in-depth interviews in 2007. Some of the participating teens reported that dating was a challenge; disclosure to a romantic partner was difficult. Many felt it was acceptable to have sex with an HIV-negative partner if a condom was used, but did not condone unprotected sex with an uninfected partner. In addition, of the youth who discussed pregnancy, all expressed an interest in having a child. None of these teens reported concern about HIV transmission to their partner, but they were concerned about possible transmission to the baby. The authors suggest—and providers’ responses support—that more interventions are needed to help HIV-positive teens overcome multiple challenges in the areas of disclosure and sexual risk reduction. These interventions could include ones aimed at enhancing conversations between providers and infected youth regarding condom use, and at increasing HIV-positive youths’ motivation to protect their partners from infection.

Fathers Prioritize Protecting Teens from Sexual Risk, But Are Not Always Comfortable Talking to Them About Sex

Fathers of preteens report that they are highly invested in ensuring that their children are safe and successful in life, but despite their motivation to talk to their children about sex, they frequently find it difficult to do so. In "‘We’re the Heroes!’: Fathers’ Perspectives on Their Role in Protecting Their Preteenage Children from Sexual Risk," Ellen K. Wilson et al., of RTI International, report findings from 16 focus groups comprising 131 parents of children aged 10–12, which explored fathers’ views of their role in protecting their children from sexual risk and promoting their healthy sexual development. Participants generally felt it was important for fathers as well as mothers to talk to their children about sex. They reported discussing with their children the potential negative consequences of sex, such as the risks of pregnancy and STDs, in the hope that this information would help their children to make good decisions about sex. Many fathers, especially Hispanic participants, reported being more protective of their daughters than of their sons, and some had particular difficulty talking with their daughters about sex. The authors recommend that interventions to support parent-child communication about sex not exclude fathers. They suggest that some fathers may need support to overcome barriers to effective communication, especially with their daughters.

Providers Counsel Teen Patients on Abstinence as Part of a Broader Prevention Message

A qualitative study of 31 clinicians serving low-income, at-risk patients found that providers frequently view counseling on abstinence as one component of a more comprehensive approach to risk reduction among teens, rather than a stand-alone approach. "Abstinence and Teenagers: Prevention Counseling Practices of Health Care Providers Serving High-Risk Patients in the United States," by Cynthia C. Harper of the University of California, San Francisco, et al., reports that participants frequently offered comprehensive counseling, presenting information about abstinence alongside information about condoms and contraception as a range of choices available to teens. Providers said that they are most likely to discuss abstinence, as well as condoms, with teen patients, particularly young teens and those who indicate a desire to remain abstinent. Even with young teens, however, providers reported that they do not see abstinence as having a priority, but rather view it as one potential choice; providers reported routinely dispensing condoms and contraceptives as well. The participants discussed offering tailored counseling based on individual patients’ preferences or circumstances, rather than using one approach for all patients. The authors suggest that providers’ approach of offering their clients a full range of options may be informative for policies and programs focused on teen risk reduction in the future.