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Older males having sex with younger females is known to increase unsafe sex practices, exacerbated by power and economic imbalances between partners. The purpose of this paper is to examine transactional sexual relationships (i.e. long-term relationships constructed as “girlfriends not ‘prostitutes’” based on the exchange of gifts and other obligations) among female students of University of Cape Coast, Ghana. It particularly explores the implications for HIV education in institutions of higher learning. HIV/AIDS has been labelled as a disease of the poor and the uneducated, and it might be expected university students would engage in safer sexual practices: if they do not it highlights the problem around gender and economic imbalances and their repercussions even more clearly.

Using snowballing, 40 university-educated female students engaged in transactional sex were interviewed using unstructured interview. The data were analysed thematically.

These young women were not simple victims, these relationships were the result of complex and conscious choices. They did not want to marry their partners and were clear that these were short-term relationships primarily for material gain, which they nevertheless kept secret from family and most friends for fear of stigma, particularly in blighting their future marriage prospects. They protected themselves from emotional involvement, although they often saw their partners as loving, taking the provision of gifts as a sign of affection and sometimes a replacement for parental love. Their motivation was primarily economic, to fulfil “wants” not survival “needs” – the relationships enabled them to purchase the trappings of affluent society such as clothes, hairstyles, fast food and gadgets. They were also motivated by the enhanced experiences these relationships allowed, such as feeling protected, respected, “high class”, part of a daring elite of women and being able to travel and continue their education. The unequal nature of the relationships (often described as “father-daughter”) in a society in which parents, older people and men are given unquestioning respect, reduced their abilities to negotiate safe sex practices. In so far as they practiced safer sex it was to avoid pregnancy rather than disease, believing they would be able to tell from physical signs if their partner was infected.

This study shows that the “privileged” status’ that higher education offers is no match for the socioeconomic and cultural factors which make female youths, whatever their educational background, compromise on safer sexual practices, rendering them vulnerable to STIs and particularly, HIV infection. It is also clear that students in higher education are nevertheless ignorant about the risk and invisible nature of sexually transmitted disease. Institutions of higher education need to do more to provide robust sex and relationship educational interventions for their students and faculty about HIV/AIDS, which take into account the complex and socially situated decisions that surround sexual relationships.

Most of the work on transactional sexual relationships has come from South Africa – this is the first study in a Ghanaian context and of educated young women.

With almost half of college undergraduates engaging in friends with benefits relationships (FWBRs), the current study sought to explore the sexual decision making strategies and potential physical and psychological health outcomes behind these relationships.

Using self-report measures, Study 1 asked 207 undergraduates to rate the importance of motivations, maintenance rules, and future outcomes of FWBRs in their own personal experience and for other men and women. Study 2 sampled 142 undergraduate women who were asked to indicate the percentage of time they engaged in sexual behavior under the influence of alcohol or marijuana and the frequency with which they used safe sex practices in an FWBR.

Both genders appeared equally motivated to begin an FWBR; however women reported establishing permanence rules and avoiding over-attachment in the relationship as significantly more important than men. Men were more likely to prefer that the FWBR remain unchanged, however both genders agreed that a transition to a committed relationship was unlikely. Alcohol use was not significantly more prevalent in an FWBR, nor was the likelihood of practicing safe sex.

Both studies employed the use of self-report surveys from a single university and were subject to social desirability.

Quantitatively examining young adults’ reasoning behind choosing to engage in FWBRs provided insight into their overarching fear of “being hurt” and their preference for “easy access” to sexual experiences. These trends may suggest a shift in dating patterns and a preference for avoiding the emotional complexities of a committed, monogamous relationship.

Sexual education in adolescence may represent the only formal sexual information individuals ever receive. It is unclear whether this early educational experience is sufficient to promote lifelong sexual health literacy. The purpose of this paper is to examine the influence of the timing and source of sexual knowledge on current safe sex knowledge and risky sexual behaviours among middle-aged and older adults in the USA.

Participants (n=410, mean age=53.9, 50.7 per cent female) reported whether and when they received sexual knowledge from various sources. They were asked about their current safe sex knowledge and their lifetime sexual risk behaviours.

Most of the participants (61.5 per cent) received formal sexual education in adolescence and 20.2 per cent reported formal sexual education post-adolescence. Across the life span, friends were the most common source of sexual information. The sample scored in the upper mid-range on the scale indexing safe sex knowledge (M=6.69, SD=1.64, range=0-8). Participants reported engaging in an average of approximately four (out of 16) risky sexual behaviours across their lifetime. Those with formal sex education in adolescence scored significantly higher on safe sex knowledge. However, they also engaged in more risky sex behaviours.

This study is among the first to situate the normative, formal sexual education experience of adolescence within a life span context that not only accounts for time, but also multiple sources of influence. It would appear that there are more things to learn about the long-term influence of sexual education programmes during the formative years by studying adult sexual health and knowledge.

The purpose of this paper is to describe the prevalence and factors associated with safe sex behavior among vocational students in Nakhon Ratchasima Province, Thailand, and to determine the modifying factors listed as socio-demographic characteristic, the level of HIV and sexually transmitted infections’ knowledge, attitude toward reproductive health, and safe sex behavior among vocational students in Nakhon Ratchasima Province, Thailand.

A cross-sectional descriptive research was conducted from August to October 2018. The multistage stratified sampling, combined with purpose and random sampling, was used to select the participants. One vocational college with the highest number from urban, suburban and rural areas was purposely selected. The sample calculation by using Cochran’s formula, a random sampling by drawing from each college with male and female, was made to obtain the sample size of 355 students. Inclusion criteria included: vocational students, both male and female, aged between 15 and 19 years, resided in the study area, and volunteered to participate. Ethical consent including waiver of the parent’s consent for the participant aged under 18 years for this study was approved by the Institution Review Board for Human Research Ethics, Chulalongkorn University (Certification number JV 823/2561) A self-administered questionnaire was adapted by the principle researcher from the illustrative questionnaire for interview survey with young people (14), and The study of Prevalence of HIV, STD, Drug Use and Risk Behaviors in Adolescents and Young Adults, in Chaing Rai, Thailand (PRAYA) tool (15). All statistical analyses were performed by SPSS version 22.

The finding revealed that 332 participants were male (57.8 percent) and female (42.2 percent) with an average age of 16.8 years (±1.7). Approximately 60 percent of males and 50 percent of females had experience of sexual intercourse, with their first experience of sexual intercourse at the average age of 15. Most respondents 63.1 percent used a condom and 63.6 percent used contraception in their latest sexual intercourse. About 41.9 percent consumed alcohol and 15 percent reported substance abused. Sexual intercourse among adolescents vocational students were significantly associated with high knowledge of contraception (OR=0.30, 95%CI=0.10–0.82). Positive attitude toward reproductive health had a significant association with sexual intercourse (OR=0.17, 95%CI=0.05–0.58). Sexual intercourse among vocational students were also significant associated with low risk behavior (OR=0.45, 95%CI=0.22–0.91) and high risk behaviors (OR=0.24, 95% CI=0.10–0.59). Contraceptive used in the latest sexual intercourse had a significant association with cues to action (OR=0.43, 95% CI=0.22–0.86).

This study used a self-reported questionnaire to collect information from participants about safe sex behaviors, which might contain bias data and socially desirable answers. The time for collecting data did not match vocational students’ schedule as they were about to have their final exams. An error in this questionnaire was the absence of condom use as one of the contraception methods.

The study showed that both male and female vocational students in Nakhon Ratchasima have a low level of knowledge of HIV, STIs and contraception. This study revealed that females have higher knowledge of all the factors more than males. Males usually received more harassment from peers for being sexually active than females do. Condoms and contraceptive used are inconsistent in all research conducted and have no common ground. Communication related to sex for those who have no partner was poor compared to students who have a partner. The four factors associated with safe sex behaviors should always be considered and surveyed among vocational students, as the study showed that all results vary for a future adolescence study.

This research aims at government authorities. The policy makers should include reproductive health and rights in the curriculum. The Ministry of Public health and The Ministry of Education should provide training for the trainer program for teachers concerning safe sex behaviors. For future research, in-depth interview and qualitative study should be used to increase the reliability of the result of the inconsistency of using a condom and contraception. The researcher should do further studies into vocational college semester schedules before collecting data and should spend more time in the college, so the students become more acquainted to the researcher and give a more truthful answer. Moreover, condom use should be added as one of the contraception methods.

This is the first study among vocational students in Nakhon Ratchasima Province which emphasizes specifically on safe sex behaviors and factors related to it. Regarding the population of vocational students, this study covers almost 80 percent of the population. Sensitive questions for sexual activity status and sexually history were answered by a self-administered questionnaire in order to increase sincere answers on their experiences because participants were not shy to disclose their sexual experiences.

Sexual health promotion aimed at men who have sex with men (MSM) is not achieving its objective of reducing the incidence of new infections of sexually transmitted diseases, notably HIV/AIDS, in the MSM population. The paper aims to raise awareness of possible unintended consequences when using visual culture and advertising techniques in the field of sexual (and other) health promotion and public health messages.

Using critical textual analysis and drawing on visual culture methodology the approach is to critique current practice and suggest alternative ways to approach gay men's sexual health which are not predicated on a “model” gay man.

Men who have sex with men (MSM) are constructed through sexual health promotion (SHP) literature as young, hedonistic and irrational which may serve to distance the very audience it seeks to attract and address. What may at first appear to be a targeted and helpful initiative to raise awareness may inadvertently have the simultaneous and unanticipated effect of “selling” unsafe sex rather than promoting safe sex. This is because, first, the use of sexual imagery designed to attract attention works in unanticipated ways. Second, MSM are constructed through the images and language used in ways that may be at best unhelpful and potentially quite harmful.

There are many different approaches and interventions in this field and the criticisms here may not be applicable to many of the other sources of health promotion awareness campaigns. Future research could certainly be conducted in other fields of health promotion and public health issues such as obesity, drug and alcohol abuse and smoking cessation.

Health promotion practice should beware of depicting their audience in stereotypical ways. MSM could be constructed far more positively as role models to be followed instead of bad examples to be avoided.

The methodology is new to this field and the findings provide an original basis for criticism of advertising techniques which have until now formed the basis of this type of public awareness‐raising.

This chapter looks at male-on-male sexual activity in the subaltern world of male sexual spaces. It examines the importance of such spaces regarding etiquette, negotiation, opportunities, safety, safer sex practices, status, and navigation of sexual expression including experimentation, exploration, and risk-taking through sexual activity. It also explores how these time-limited communal engagements for sexual pleasure and affirmation contrast normative societal expectations. Through hard-copy and online content analysis as well as ethnographic immersion and observations in the subaltern world of gay male sexual spaces such as bathhouses, circuit clubs, dark rooms, fetish balls, porn theaters, sex clubs, and sex shops, a self-monitored subculture that creates its own tribal rituals at various odds with both mainstream societal and LGBTQ movement norms is examined. By deviating from and resisting such norms, this tribe demonstrates how it maintains a core drive of liberated sexuality outside of mainstreamed sexual governance. Premised on spatial theory, in which space, place, and spatial practices are deconstructed with regard to the creation and preservation of male-on-male fetish activities, a link is made to queer liberation theory that supports self-defined sexual expression, including that of kink.

Since the first case of AIDS was reported in 1986, several HIV/AIDS intervention program operates at the national and regional level in India, to control the spread of this epidemic. The purpose of this paper is to evaluate one intervention program in a major city of India – Kolkata that targets specifically the commercial sex-workers challenged with socio-economic-health disparities. This intervention program called the Durbar Mahila Samanwaya Committee (DMSC) is located in the Sonagachi area and nicknamed as the “Sonagachi Project.”

The behavioral change of about 500 sex-workers participating in the survey was studied in 2005. The data were collected from the focus groups of the sex-workers; official records and DMSC officials were also interviewed to collect data. The “short-term” outcome and the “long-term” impact of the program were compared with a baseline survey conducted in 1992 by another study.

Participants experienced increased awareness of the disease, increased literacy rate and increased social and economical empowerment. The incidence of HIV/AIDS has gone down significantly among this high-risk group due to safe-sex practice.

This community-based organization adopts a unique method of engaging the sex-workers as peer educators to train other sex-workers about safe-sex practices and has become the role model for sex-workers in other parts of the world to fight socio-economic-health disparities.

This research was conducted by directly contacting the program directors and members of the Sonagachi project and in that sense is first hand information. It gives valuable insights into the struggles these sex-workers had to go through to gain social and economic empowerment.

This paper aims to illustrate the need for both upstream and downstream social marketing in relation to condom merchandising in the Vietnamese context.

A mystery shopper audit of condom merchandising practices and retail outlets was undertaken in a number of locations throughout Ho Chi Minh City, Vietnam. In addition to the audits, a series of depth interviews with retailers of condoms on barriers and facilitators for purchase was undertaken.

The research highlighted some very interesting dynamics in relation to condom retailing in Vietnam. Condoms are not always made easy to purchase, through both the merchandising and other choices made by the retailers. While accessibility to condoms is no longer an issue in urban Vietnam considering the increase of condom retailing outlets, lack of easy access is highly problematic and may interfere with actual condom obtainment. As sex is still a taboo topic in Vietnam, this is a serious concern for social marketing in the sexual and reproductive health domain.

Given the capacity to portray taboo topics in Vietnamese media context, social marketing will be challenging. The development of a social marketing strategy for macro-, meso- and microlevels will be necessary for successful social marketing. Stigma associated with safe-sex practices and condom use may require a consideration of a social norms social marketing campaign.

This research is the first of its kind in the Vietnamese context. While there are a large number of non-governmental organisations campaigning in the region, safe-sex practices and condom use within the general population remains a concern. This research demonstrates that access and availability are key components of the social marketing mix.

The purpose of this study is to understand the association between health behaviours of diet, physical activity, smoking cigarettes, alcohol consumption, safe sex and sleep quality with demographic (e.g. age, gender) and psychological (i.e. stress, self-esteem and sense of coherence) factors in Indian residential college students.

Students studying for Bachelor of Technology at residential colleges in India were invited to complete an online questionnaire regarding their health behaviours, demographics and psychological variables. Each health behaviour was regressed onto demographic and psychological factors to determine which of them were associated with performing each behaviour.

There was no clear pattern of predictors for the health behaviours overall. Self-esteem was related to healthy diet, being single was related to adequate sleep, higher parental income was related to safer sex and being older was related to more alcohol use and safer sex.

This study revealed that health education efforts may need to be designed for specific behaviours and correlates among Indian college students. Interventions regarding (1) healthy eating should target students with lower self-esteem, (2) sleep should target students in a relationship and (3) safer sex should target younger students and those from less affluent backgrounds.

This research is one of the first attempts to study the predictors of health behaviours among Indian college students. The study highlighted that psychological factors (e.g. self-esteem) and demographic factors (e.g. relationship status, parental income, age) affect different health behaviours. These findings can help health educators to design tailored interventions and aid in health education and promotion among Indian college students.

This project examines how queer and trans zines have complicated the notion of traditional patient narratives and provides insight into the issues that LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) populations face when accessing healthcare information and resources. Historically, information about queer and trans identities has been suppressed in the United States, reflecting dominant social values that pathologize queer identities. Using health-related zines housed at the Queer Zine Archive Project as a case study, this project investigates how queer and trans zines about healthcare have resisted these homophobic and transphobic ideologies. The analysis reveals that queer and trans zinesters use their feelings of impatience with the medical industry to fuel communal solutions to accessing and providing health care information.