Interventions to increase condom use among middle-aged and older adults: asystematic review of theoretical bases, behaviour change techniques, modes of delivery, and treatment fidelity

This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour

Psychosocial factors influencing risk-taking in middle age for STIs

Objectives To increase the knowledge of the psychosocial factors influencing sexual risk-taking for STIs among adults in late middle age. Methods Individual interviews were conducted either face to face or by telephone with 31 heterosexual men and women aged between 45 and 65. They were recruited from NHS sexual health services (n=16) and council run culture and leisure facilities (n=15) in a large Scottish city. A total of 18 women and 13 men were interviewed. All interviews were transcribed in full and thematically analysed. Results Analysis detailed important psychosocial and sociocultural factors; the prioritisation of intimacy above and beyond concerns about risks for STI in sexual partnerships; the importance of unwanted pregnancy in shaping risk perceptions throughout the life course; vulnerability associated with periods of relationship transition (eg, bereavement, divorce or separation); social norms and cultural expectations relating to age-appropriate sexual and health-seeking behaviours. Conclusions This is the first qualitative study to examine the factors associated with sexual risk-taking among heterosexual adults in late middle age in the UK. Many factors associated with sexual risk-taking are similar to those reported within other populations. However, we also detail population-specific factors, which should be considered in terms of the development of interventions for ‘at risk’ older adults, or the tailoring of wider behaviour change interventions to this specific age group

Young men who have sex with men's use of social and sexual media and sex-risk associations: cross-sectional, online survey across four countries

Objective There has been an increase in new HIV diagnoses among young men who have sex with men (YMSM) over the past decade in both UK and US contexts, with online sex-seeking implicated in driving this development. This study sought to examine YMSM's use of a variety of social and sexual networking websites and € apps', and assess sexual risk behaviours. Design YMSM were recruited from across four countries in Britain and Ireland, via an online survey using convenience sampling. Data were collected from 2668 men, of whom 702 were aged 18-25 €..years. Results Facebook use was almost ubiquitous and for largely social reasons; sexual media use was common with 52% using gay sexual networking (GSN) websites frequently and 44% using similar apps frequently. We found increased odds of high-risk condomless anal intercourse associated with the length of time users had been using GSN websites and lower levels of education. We found no significant differences across the four countries in sexual risk behaviours. Conclusions YMSM are a heterogeneous population with varied sexual health needs. For young men with digital literacy, individual-level online interventions, targeted and tailored, could be directed towards frequent users with lower levels of education. Variation in demographic characteristics of GSN websites and app users may affect who interventions are likely to reach, depending on where they are targeted. However, interventions, which may catch young men earlier, also provide a major opportunity for reducing sexual health inequalities

Location, safety and (non) strangers in gay men’s narratives on ‘hook-up’ apps

Hook-up websites and apps are said to be transforming the sexual lives of gay men and have been linked with the apparent erosion of gay publics as the basis for identity politics and social action. This article examines these dynamics in the interview and focus-group talk of gay men living on the economic and geographical margins of metropolitan gay culture. It offers perspectives on the importance of location – class, generation and space – for the experience of digital media, the negotiation of safety, and the new codifications and elaborations on sex with the (non) stranger; a figure who is not alien, yet not familiar, in sexual sociality. Reflecting on these situated perspectives in connection with debates on the erosion of gay publics, this article argues against monolithic framings of gay men’s sexual lives after digital media

Non-medical approach to screening young men and women for chlamydia trachomatis

The aims of this PhD study were to assess the feasibility of accessing non-medical settings within which to offer chlamydia screening, to ascertain the knowledge of chlamydia and young men’s and women’s views towards non-medical screening, and to assess relative willingness to be screened for chlamydia by young men and women. Results: Eighty-four percent of age eligible users approached participated in education, health and fitness and workplace settings (n=126, n=133 and n=104, respectively). Of all sexually active people 113 (32%) were willing to be tested for chlamydia in non-medical settings. Uptake of testing was highest in the health and fitness setting (50% uptake for both women and men compared with 20% in education and 30% in workplace settings). In each setting young men were more willing than women to accept the offer of a chlamydia test. Overall, 40% of men approached provided a sample compared with 27% of all women. Disease prevalence was 4.4% (4.9% in men; 3.8% in women). Interview data suggests young men’s willingness to be tested for chlamydia in non-medical settings is due to convenience and raised awareness of the largely asymptomatic nature of chlamydia infection. Whilst 94% of men screened had never been tested for chlamydia before, one in three young women screened had previous screening experience. Women’s lower uptake of screening was due to concerns about the public nature of the settings leading to stigma. Conclusions: Increasing opportunities for the take-up of screening in non-medical settings could be an effective approach to reaching young men and have a significant impact on the incidence and prevalence of this easily treated STI, thereby reducing the future burden of unwanted reproductive health sequelae

A rapid review of sexual wellbeing definitions and measures: should we now include sexual wellbeing freedom?

An increasing number of studies refer to sexual wellbeing and/or seek to measure it, and the term appears across various policy documents, including sexual health frameworks in the UK. We conducted a rapid review to determine how sexual wellbeing has been defined, qualitatively explored and quantitatively measured. Eligible studies selected for inclusion from OVID Medline, PsychInfo, PubMed, Embase, CINAHL were: in English language, published after 2007, were peer-reviewed full articles, focused on sexual wellbeing (or proxies for, e.g. satisfaction, function), and quantitatively or qualitatively assessed sexual wellbeing. We included studies with participants aged 16–65. Given study heterogeneity, our synthesis and findings are reported using a narrative approach. We identified 162 papers, of which 10 offered a definition of sexual wellbeing. Drawing upon a socio-ecological model, we categorised the 59 dimensions we identified from studies under three main domains: cognitive-affect (31 dimensions); inter-personal (22 dimensions); and socio-cultural (6 dimensions). Only 11 papers were categorised under the socio-cultural domain, commonly focusing on gender inequalities or stigma. We discuss the importance of conceptualising sexual wellbeing as individually experienced but socially and structurally influenced, including assessing sexual wellbeing freedom: a person’s freedom to achieve sexual wellbeing, or their real opportunities and liberties