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Older adults’ sexual health is becoming an increasingly important component of healthy aging in the wake of the HIV/AIDS epidemic and rising infection rates among this age cohort. The increase in HIV/AIDS diagnoses in the older adult population ignites the need to understand the reasons why older adults are omitted from HIV/AIDS prevention education policy.

This chapter examines the social forces that influence HIV/AIDS policy at the state and community levels. Through qualitative methodology and analysis, including interviews with state policymakers and managers of AIDS service organizations in four Midwestern states (n=31), I look for trends and patterns as to whether or not older adults are considered as an “at-risk” group for HIV infection.

Findings reveal that HIV/AIDS policy may be impacted by enduring sexual scripts about older adults. To some extent both state policymakers and AIDS service organization personnel adhere to stereotypes about older adults’ sexuality and sexual activity, which is then implemented in their health promotion activities. The result is that gaps exist in HIV/AIDS prevention education for older adults, despite the fact that current trends show an increase in new HIV infections and AIDS diagnoses among people over the age of 50.

While this is an exploratory study of the available HIV/AIDS prevention education and health promotion activities for older adults, as well as the viewpoints of state policymakers and AIDS service organization personnel, the findings do indicate the need for additional research on the potentially dangerous sexual behaviors – lack of HIV testing, low condom usage, multiple partners – exhibited by older adults. Future research involving interviews with older adults, physicians, and medical personnel may add new perspectives to the current research.

As the baby boomers continue to age and challenge cultural stereotypes of sexual behaviors among older adults, research in the area of sexual health and HIV/AIDS prevention education will remain an important component of healthy aging. This research begins what will ultimately be a necessary conversation.

Sexual transmitted infections (STIs) are associated with high stigma leading to poor sexual health-seeking behaviour and mental health problems. Although human immunodeficiency virus (HIV) prevention has generally been successful in many communities across the world, statistics for young people have remained relatively low, especially among most affected communities such as the black sub-Sahara African (BSSA) communities. This paper aims to explore the barriers to STIs and HIV testing among young BSSA communities living in the UK.

The research study used an explorative qualitative approach. The study included 6 focus groups comprising 10 people each (N = 60), and 12 one-to-one follow-up interviews were held with the research participants. Two one-to-one follow-up interviews were held from each focus group (N = 12).

The study found that perceived risk taking, perceived HIV test embarrassment, sexual health professionals’ attitudes, perceived HIV as death sentence, limited educational awareness and general HIV stigma prevented research participants from testing and impacted on their mental health well-being.

There is a need to increase sexual health and mental health education awareness among young BSSA communities. More importantly culturally sensitive interventions to reduce the impact of HIV stigma need to be rolled out in different diverse communities. This study is the first of its kind to look at the barriers affecting young BSSA communities in accessing sexual health testing services in the UK.

This paper, and the corresponding project, is motivated by the lack of qualitative research elucidating the voices of young Black women in Canada when it comes to their sexual health.

This paper draws from data produced in the Let’s Talk About Sex (LTAS) project – a Photovoice process held once a week for nine consecutive weeks in the Jane-Finch community, a low-income community in Toronto, Canada. This workshop was completed by 15 young African Caribbean and Black (ACB) women in the age group 14–18. These young women used photography and creative writing to express their opinions on the barriers and facilitators to making healthy sexual decisions.

A central finding was the existence of a subculture among youth in Toronto, where the exchange of sex for material resources was commonplace. Herein, we unpack the various forms of economically motivated relationships reported, which ranged from romantic relationships to sugar daddies and brothel-like sex dens. We also reflect on the discussions at community forums where the research findings were presented. From shock and outrage to a sly smile of knowing, the responses were often gendered, generational and reflective of a trend occurring across Toronto, not just in the Jane-Finch community, and not merely among the Black youth.

Effective interventions and youth programs should focus on the sexually transmitted infection (STI) and HIV risks that may result from transactional relationships, economic empowerment, and youth employment.

This is a novel arts-based study on youth engaged inthe exchange of sex for money, which has nuanced differences from survival sex.

Spotlights the body of work with regard to the sociology of AIDS showing how this has grown over the last two decades of the twentieth century. Indicates that sexually transmitted infections (STIs) are affected by patterns of sexual behaviour along with drug related practices. Cites the vulnerability of low socio‐economic groups to STIs, with the use of an explanatory figure with lots of detail within it. Summarizes that health research on inequality, particularly with regard to HIV and STIs would assist greatly in determining the relevant factors.

The purpose of this paper is to examine patterns of drug use among a cohort of drug treatment-seeking drug-using gay men and other men who have sex with men (MSM), and whether these activities differ between, or predict, HIV status.

Cross-sectional study was conducted in a specialist club drug clinic in London covering 407 consecutive attendees who identified as MSM. Substance use, including injecting drug use (IDU), associated sexual activity and self-reported HIV status were measured by clinical interview and National Drug Treatment Monitoring System data tool.

Over a 45-month period, 407 MSM attended the clinic. In total, 62.1 per cent were HIV positive, 48.9 per cent had injected drugs, 14.9 per cent reported needle sharing and 73.3 per cent used drugs to facilitate sex. The most commonly reported problem drugs were GHB/GBL (54.3 per cent) methamphetamine (47.7 per cent) and mephedrone (37.8 per cent). HIV status was associated with methamphetamine, mephedrone, IDU, sharing equipment, using drugs to facilitate sex, older age and older age of drug initiation, as well as Hepatitis C virology (HCV) status. Use of methamphetamine, HCV infection, older age and IDU predicted HIV positive status in a logistic regression model.

The findings describe a constellation of risk factors including high levels of IDU, sharing of equipment and high-risk sexual activity in a population with high rates of HIV positive serology. They also provide further evidence for a link between HIV infection and use of methamphetamine.

The authors suggest a need for greater awareness of HIV-related risk activities and promotion of HIV prevention strategies for MSM by both sexual health and drug treatment services.

This paper is amongst the very first studies of its nature.

The purpose of this paper is to examine the influence of social context on young people's sexual lives and sexual health, and to highlight the need for HIV prevention and sexual health programmes which better take into account these contextual influences.

The paper draws on findings from a multi‐method, qualitative study involving young people aged between 11‐24 years, conducted in three rural areas in Uganda. Data were collected by means of 52 single‐sex focus group discussions, 117 in‐depth interviews, and further participatory research with 23 of these young men and women. Contextual information was gathered through interviews with parents (17), teachers (7), religious leaders (7), local clan leaders (6), community‐based NGO/CBO workers (12) and local government staff (33).

Local beliefs about age and gender suggest that intimate relationships and sexual behaviour among young people are forbidden, or at least should be hidden. Social norms produced and reproduced both by adults and young people themselves increase the likelihood of secretive, unprotected sexual relations, and inhibit young people's ability to seek sexual health‐related support and advice.

An understanding of these contextual influences has important implications for improving the design of HIV prevention and sexual health programming in rural communities in Uganda.

Questions have been raised about the ability of HIV/AIDS and sexuality education for young people to modify behaviour, its potential for producing undesirable effects, and dubious rigour in evaluating it. A review of the literature conducted for the World Health Organisation’s former Global Programme on AIDS in 1993, and a more recent update commissioned by the United Nations Joint Programme on HIV/AIDS (UNAIDS) in 1997 examined these issues. The latter review of 68 articles found good support for the efficacy of HIV/AIDS and sex education in reducing unwanted outcomes of young people’s sexual behaviour. Of 53 articles describing specific interventions, 22 reported significant decreases in coital activity or its markers (e.g. pregnancy) in those who received the intervention(s) compared with controls, and 27 studies reported no effect. Although three studies found a positive relationship between receiving sex education and increased sexual activity, they should be viewed in the context of overwhelming evidence in the opposite direction, and methodological limitations to the extent to which they can be generalised. Lack of rigour and an adequate description of interventions is, however, a feature of many of the studies evaluating the effects of HIV/AIDS and sex education. Although the reviews demonstrate the value of appropriately conducted and targeted interventions, formal sex/HIV education is only one source of information about sexual issues for young people. Further, timing education prior to the onset of sexual intercourse may increase the chance that young people will adopt measures aimed at protecting their health.

Building local capacity to protect public health and promote social justice with stigmatized populations disproportionately at risk of HIV infection is difficult regardless of context. The purpose of this paper is to document an international collaboration's approaches to integrate sexual rights and community legal education into two HIV online peer outreach and prevention (OPOP) programs in Chiang Mai, Thailand.

This paper documents an international collaboration's approaches to integrate sexual rights and community legal education into two HIV online outreach and prevention programs (OPOP) in Chiang Mai, Thailand. The project's goal was to increase access to justice alongside HIV prevention and education.

The paper illustrates how a clinical legal education (CLE) externship clinic can provide an opportunity for law students and advocates for justice to make an authentic contribution to assisting others, very different from themselves, in overcoming legal injustices in Thailand.

The paper argues that the CLE externship clinic provides a productive framework for designing e‐democracy initiatives with future lawyers and advocates for justice to achieve a greater understanding of and synergy with the dynamic relationships between academic knowledge and its practical application to the legal and justice issues that will arise in the diverse communities they may work in the future. Furthermore, the paper also argues, that to improve e‐democracy, equity and social justice, practitioners now need to acknowledge that technology is part of a suite of resources when it comes to HIV prevention and promoting human, legal and sexual rights, it is not simply the solution.

The purpose of this paper is to develop a profile of the sexual behavioural characteristics of black men who have sex with men (MSM) in the Greater Toronto Area (GTA), Canada who constitute a unique mixture in terms of background, race, ethnicity, and culture. Having a profile of the sexual health and risk taking behaviours of these men is important since it provides information on these black Canadian men in comparison other black MSM.

Data were collected as part of a cross-sectional study of black MSM in GTA. Survey participants completed a questionnaire requesting information on socio-demographic characteristics, sexual behaviour, general and mental health, and awareness of social marketing strategies for gay men. The study was conducted in 2007-2008, through convenience sampling. Based on the data collected, the authors characterized the profile of black MSM with respect to sexual risk behaviours.

The authors collected data on 168 black MSM. These men perceived their general health to be good. However, a large proportion of them practiced inconsistent condom use but this varied according to the ethnicity of the partner. Inconsistent condom use also varied by place of birth with Canadian-born men and Caribbean-born men less likely to consistently use condoms than African-born men. In multiple regression analysis, being born in Africa favoured condom use. Men were also more likely to practice inconsistent condoms use when the sexual partner was non-black. Further, when sex with other black men was examined, those who were older (30 years) and had not disclosed their sexuality were more likely to stop using condoms. Other variables which were expected to have associations with inconsistent condom use, based on studies in other jurisdictions – such as previous sexually transmitted infections, sex with women, sex while travelling, and drug use were not related to inconsistent condom use.

While the survey data were based on a relatively small sample size and may not be representative of the entire black MSM population in the GTA, it provides a basis for ongoing and targeted support for black MSM particularly those born in Canada. Older men who are not open with their sexuality may be at a risk of acquiring or transmitting HIV. Future research should focus on these men.

This report provides a perspective on the sexual health and risk taking behaviours of black MSM in Canada. This is particularly important since their social history and health determinants are different from those of US African Americans. The results will stimulate further research targeting this group, and support HIV programmes and services for these men.

The paper aims to show the impact of insider/outsider researcher positionality and the lessons from researching the social construction of HIV stigma and sexual health-seeking behaviour within black sub-Sahara African communities (BSSA).

The paper is a reflection on the impact of researcher positionality based on lessons learnt following a research study on the social construction of HIV stigma and sexual health-seeking behaviour within BSSA communities.

Researcher positionality has a direct impact on the quality and nature of study outcomes. Depending on the nature and circumstances of a given research study, the researcher status in terms of position (insider or outsider) can be dynamic and instrumental in the level of participation by research participants. In this paper, the authors consider three important interdependent aspects central to conducting research including researcher identity, research participants and the research topic to assess the impact of researcher status on the quality and nature of the information provided by the research participants.

A researcher who is viewed as both an insider/outsider can either positively or negatively influenced the quality and nature of the information given by the research participants.