|
Research Agenda
Publications
Presentations
|
One of the primary research goals of the Center is to explore the potential for unique and understudied segments of society to become active outlets for the delivery of sexual health promotion initiatives. While researchers have examined the potential for integrating such interventions into numerous non-traditional public health settings, such as beauty shops and nightclubs, little attention has been paid to those venues that are explicitly sexual in nature, such as the venues of the adult retail industry (e.g., adult bookstores, sex shops, adult video retailers).
While this industry has been the subject of much controversy in the U.S., it is one that generates revenues in the billions of dollars annually, indicative of the fact that millions of Americans turn to it on a regular basis for products of a sexual nature. Additionally, public health professionals have long relied on the existence of these venues for making available those products that we have encouraged people to use consistently and correctly, such as condoms and lubricants. Given the magnitude of this industry and the fact that a significant proportion of the U.S. population turns to it for products related to safer sex, sexual pleasure, or those designed to alleviate sexual dysfunction, our Center also explores how these establishments serve as venues to promote sexual health.
Examples of recent work in this area include:
Takin’ It to the Streets of Indy
This study is a collaborative of the UNISON Project - including researchers and community liaisons at the Center for Sexual Health Promotion, The Damien Center, The Bethlehem House, and The Bellflower Clinic of the Marion County Health Department. The aim of the study is to conduct a sexual health needs assessment among individuals who engage in sex work in areas of Indianapolis that are known as “hot spots” for the commercial sex industry. Through a series of street- and venue-based interviews with 60 male, female, and transgender sex workers, information will be gathered that will assist us in developing programming for HIV/STI prevention and treatment and other services that can help the target in reducing risk and promoting health.
Adult Bookstore Employees and Intersections with Sexual Health Promotion
In 2002, several hundred employees of adult bookstores (e.g., sex shops, adult video stores) completed a paper-based questionnaire which assessed their ability to serve in a sexual health promotion capacity. This study has resulted in publications in the Journal of Sex Research, the American Journal of Sexuality Education, and the Health Education Monograph.
In-Home Sex Toy Party Consultants and Sexual Health Promotion
In this study, more than 1000 women who work as in-home party consultants responded to an Internet-based questionnaire. The purpose of the study was to explore the extent to which these women have the ability to serve, and may already be serving, as resources for sexual health information for the women who attend the parties.
Condom Fit and Feel Study
This study involved an experimental assessment of the world’s first “sized to fit” condom, the TheyFitTM condom. Using an experimental cross over design, men used a standard-sized and “fitted” condom during their sexual interactions over a period of 30 days. On a daily basis, men completed an Internet-based daily diary to provide data about their sexual interactions and to complete in-depth measures related to their use of the study condoms. Over 1,800 men participated in the study, completed close to 30,000 sexual diaries, and provided data on approximately 10,000 incidents of condom use. In 2005 and 2006, data from this study have been presented at meetings of the American Public Health Association, the European Federation of Sexology, and the Society for the Scientific Study of Sexuality, and publications are currently under review.
Although many sexual behaviors involve the genitals, strikingly little research has been conducted regarding the ways in which women experience their own or their partners’ genitals. However, attitudes toward the genitals may have important relationships with individuals’ sexual health behaviors such as condom use, sexual risk taking, sexual pleasure, communication with a partner or compliance with genital health treatments (e.g., gynecological and urological care). In addition to studying attitudes toward the genitals, this line of research includes intersects with Center’s commitment to exploring the potential to use innovative venues and tools for sexual health promotion.
Examples of recent research in this area include:
The Development and Validation of a Scale to Measure College Students’ Attitudes Toward Women’s Genitals
This study sough to develop a measure that could be used to quantitatively measure individuals attitudes toward women’s genitals. More than 600 college students completed a questionnaire to assess these attitudes and a 10-item scale (the Attitudes Toward Women’s Genitals Scale, or ATWGS) with sound psychometric properties was developed. Findings suggest significant relationships with sexual health behaviors including oral sex, orgasm, and gynecological care.
Genital Health Concerns and In-Home Sex Toy Parties
In the United States alone, thousands of women work as in-home sex toy party consultants. Women who attend these parties ask a variety of questions related to sexual health and well-being. This research focuses on the types of genital health concerns that are brought to the attention of women who work as in-home sex toy party consultants and the ways in which sexual health training can enhance consultants’ ability to serve as resources of accurate information.
Vulvovaginal Pain
Previous work suggests that about 10-12% of women experience vulvovaginal pain. This pain may interfere with daily activities (e.g., walking, driving, sitting), romantic relationships, sexual activity and, consequently, attempts to conceive. In a series of studies over the next few years, the Center is committed to understanding more about the role of vulvovaginal pain in women’s lives and the ways in which the adult retail industry (specifically, the in-home party industry) may be able to collaborate with sexual health professionals and clinicians in the service of these women.
Breast Cancer and Sexuality
It has been widely documented that many women breast cancer patients and survivors experience significant challenges to their sexual function. However, there has been little research conducted about the ways in which sexual health professionals may help women address these issues. The purpose of this research is to understand the sexual function problems experienced by these women and to explore the ways in which the adult retail industry (specifically, the in-home sex toy party industry) is working to meet these needs.
Men comprise over half of those who are HIV infected worldwide (with the proportion dropping lower only in Sub-Saharan Africa). Most researchers have also attributed the majority of infections in women to sexual intercourse with HIV positive men. Research entities (including the National Institutes of Health) have recently called for more research on gender and HIV risk. Male gender norms may influence sexual behavior in numerous specific ways and contexts. However, most past research on the influence of gender on sexual behavior has focused primarily on women. The disproportionate concentration on women has led to a relative lack of knowledge of the male side of gender, the development and maintenance of men's - and women's - perceptions of appropriate male behavior and sexual health. In the present context of the AIDS epidemic, where sexual interactions may have negative consequences, expectations and attitudes concerning male behavior are particularly important.
Examples of recent work in this area include:
A Pilot Study to Evaluate Field Collection of Rectal Samples for Sexually Transmitted Infections (STI) Diagnostics
Rectal sexually transmitted infections (STI) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). Collection of rectal STI samples is routinely performed by clinicians. With advances in diagnostics, STI screening is being expanded beyond clinical settings. For individuals not seen by clinicians, rectal sampling is not currently an option. The aim of this pilot study is to determine the feasibility and acceptability of rectal STI self-sampling diagnostic services in a nonclinical setting. The project, funded by the Indiana University School of HPER Faculty Research Support Program, is a collaborative effort among the Center for Sexual Health Promotion, the Indiana University School of Medicine, and The Bellflower Clinic of the Marion County Health Department. The data will be directly integrated into a developing grant proposal to the National Institutes of Health.
Social and Behavioral Correlates of Syphilis Transmission among Men Who Have Sex with Men (MSM)
The city of Indianapolis has faced an increasing rate of syphilis infection, and this increase is especially marked among men who have sex with men (MSM). This study explored the social and behavioral correlates of syphilis transmission among MSM, such as health-seeking behaviors, drug and alcohol use, sexual activity, and means of seeking out sexual partners. Our Center conducted this study in partnership with a community-based committee and the Marion County (Indiana) Health Department.
HIV Risk and Prevention Among At-Risk Black Bisexual Men
In much previous HIV/AIDS research, men who have sex with both men and women (MSMW) and men who have sex exclusively with men (MSM) have been combined under the rubric of “MSM” without being examined separately in terms of their risk and prevention needs. However, a body of literature has also emerged that compares MSMW with MSM and explicitly identifies bisexual behavior and identity as significant psychosocial risk factors for HIV infection and transmission, particularly for Black men. As yet, little information is available on factors associated sexual risk behavior and how such behavior may be amenable to change through interventions. The primary goal of this study, funded by a pilot study award from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute, has been to elicit qualitative data on individual, sexual, and social factors associated with HIV risk among at-risk Black bisexual men. The information gained from this pilot study will serve as a framework for more detailed investigations of individual, sexual, and social factors associated with HIV risk among at-risk bisexual men, with the ultimate goal of developing and testing risk-reduction/prevention interventions for this population.
Sexual Health Among Bisexual Latino Men
Recent research indicates that bisexually-active Latino men are at significantly higher risk for HIV/AIDS than exclusively homosexually-active men and exclusively heterosexually-active men. This two-year ethnographic study, spearheaded by colleague Dr. Miguel Muñoz-Laboy at Columbia University, was conducted to examine the sexual practices and factors that shape the sexual negotiations of a sample of bisexually-active Latino men in order to contribute to the development of more relevant and effective prevention of HIV/STI for this target group. Data collection methods involved ethnographic observations and detailed sexual histories of bisexually-active Latino men in the metropolitan New York City area. Through ongoing data analysis, we have identified tensions between sexual and gender identities, interconnections of power and sexual activity, importance of the family context, and silences produced within social and sexual environments based on notions of “appropriate” masculinity and sexuality as the critical factors influencing the processes of negotiating sexual practices and HIV/STI risk. Based on these findings, we believe masculinity could serve as an effective tool with which to build new and innovative HIV/STI prevention efforts for bisexually-active Latino men.
Campus Sexual Cruising Among Men
Using the principles of community-based participatory research (CBPR), this study sought to understand the nature of men’s sexual cruising. A mixed methods design was used to collect data from men who participated in anonymous public sex in college campus venues. Data were analyzed to assess the extent to which engaged in these behaviors was associated with both positive and negative outcomes across the areas of physical health, mental health and social well-being. Findings indicated that cruising for sex on a college campus simultaneously presents challenges to, and supports, the health of men who cruise for sex on college campuses. This study has resulted in several publications, one of which represents the first paper to be published that articulates the use of CBPR for sexual health research.
Societies around the world continue to face increasing challenges as a result of epidemics like HIV/AIDS and other sexually transmitted infections. There remains a need for innovative approaches to understanding human sexual behavior and its relations to these epidemics and for work that examines the extent to which the field of public health can develop interventions that are responsive to the needs of those who face these and other sexual health challenges.
Examples of recent work in this area include:
HIV and Mental Health Care Seeking
While researchers have focused a great deal on the neurological and psychiatric complications of HIV through studies conducted in academic medical settings, we know very little about the characteristics of individuals who seek mental health care from organizations in the public health system. Additionally, we know almost nothing about the nature of the mental health services delivered by these organizations and the factors that help them succeed at engaging and retaining individuals into care. This is particularly the case for individuals from disenfranchised and ethnic minority communities who today represent the majority of those living with HIV in the U.S. and the organizations that focus on the delivery of services to them. Our work in this area is conducted in partnership with Positive Impact, Inc. Positive Impact is based in Atlanta and is one of the nation’s leading HIV-related mental health institutes.
Ongoing projects include: 1) an evaluation of the efficacy of culturally-focused interventions for recruiting and retaining ethnic minorities into mental health care following their receipt of an HIV diagnosis, and 2) studies to document the demographic, cultural, social, physiological, and psychological issues associated with mental health care seeking by individuals living with HIV.
To effectively address sexual health challenges requires research that seeks to fully understand the complexity of human sexual behavior. To achieve this, our Center is committed to research that is informed by health behavior theories and progressive conceptual frameworks. We also believe that sexual health research should reflect the lived experiences of community members. To that end, we are seeking to explore the manner in which the principles of community-based participatory research can enhance our work and the interventions it influences.
Examples of recent work in this area include:
Sexual Decision Making at Mardi Gras
In this study, data were collected from individuals attending the Mardi Gras festival in New Orleans in 2004. The purpose of the study was to explore the extent to which situational factors related to sexual decision making could be further understood by using the Triandis Model of Interpersonal Behavior.
Sex and Alcohol at the Little 500 Bike Race
Indiana University is home to one of the world’s most famous college events—the Little 500 bike race. This event is similar to other alcohol-intensive events on college campuses and is steeped in traditions that permeate the environment of the campus during the week of the event. This study sought to use the Triandis Model of Interpersonal Behavior to examine the extent to which the traditions of this event have an influence on alcohol and sexual decision making.
Studies in Sexuality Education
Sexuality education remains a controversial topic in American society—to study it effectively requires the active involvement of stakeholders from throughout the community in order to ensure that study designs are balanced and that results are useful to multiple segments of society. The Center has been working to apply CBPR to the study of sexuality education. In 2005, we examined the status of sexuality education in Indiana in partnership with the Get Real! Indiana coalition by collecting data from 400 personnel in the state’s public middle and high schools. This study was recently replicated in the state of Florida in collaboration with research partners at The University of Florida and several community-based coalitions The first-ever statewide assessment of sexuality education in that state, data are currently being analyzed from nearly 500 public school teachers from across the state of Florida. Findings from the study will improve our understanding of current sexuality education practice in Florida public schools by identifying facilitators and barriers to comprehensive sexuality education.
Sexual health research, particularly given the nature of global sexual health pandemics like HIV/AIDS, requires us to be active global citizens and to facilitate the growth of scholars focused on sexual health in other nations. To date, our Center has situated its research in two countries outside the U.S. that are both situated within regions of the world facing serious consequences as a result of devastating sexual health pandemics: Sri Lanka and Kenya.
Examples of recent work in this area include:
HIV-Related Mental Health in Kenya
This line of research is exploring the nature of psychological distress among Kenyans living with HIV. This research is being conducted in partnership with Moi University in Eldoret, Kenya in conjunction with the Moi-IU program AMPATH (Academic Model for the Prevention and Treatment of HIV). The current focus of this work in related to documenting the nature and range of psychological distress among individuals seeking HIV-related care and an assessment of the psychometric properties of instruments used to assess such distress.
Sexual Behaviors of Young Adults in Sri Lanka
Sri Lanka is among those Asian countries that have managed to maintain a low HIV prevalence despite being situated in a region of the world that has been devastated by HIV infection. In a range of studies, our Center has been exploring the nature of sexual interactions among young adults in this country in order to provide insight into the development of policies and interventions that will help this country to maintain its low rates of HIV infection.
Male Involvement in HIV-Related Prenatal and Antenatal Care
This study, conducted with our partners at Moi University in Kenya, sought to document the social and cultural factors that influence the likelihood that husbands will be responsive to the unique needs of women and children in the context of efforts to prevent HIV transmission during pregnancy and following birth. A series of 16 focus groups were conducted with 146 men and women from four regions of western Kenya.
|
