The feminine ideal and transactional sex: Navigating respectability and risk in Swaziland

Women who engage in transactional sex are not only at increased risk of HIV and intimate partner violence, but also face social risks including gossip and ostracism. These social and physical risks may be dependent on both what a woman expects and needs from her partner and how her community perceives the relationship. Gender theory suggests that some of these social risks may hinge on whether or not a woman's relationship threatens dominant masculinity. 

We conducted a qualitative study in Swaziland from September 2013 to October 2014 to explore transactional sex and respectable femininity through the lens of hegemonic gender theory. Using cultural consensus modeling, we identified cultural models of transactional sex and conducted 16 in-depth interviews with model key informants and 3 focus group discussions, for a total of 41 participants. 

We identified 4 main models of transactional relationships: One typified by marriage and high social respectability, a second in which women aspire towards marriage, a third particular to University students, and a fourth "sugar daddy" model. Women in all models expected and received significant financial support from their male partners. However, women in less respectable relationships risked social censure and stigma if they were discovered, in part because aspects of their relationship threatened hegemonic masculinity. 

Conversely, women who received male support in respectable relationships had to carefully select HIV risk reduction strategies that did not threaten their relationship and associated social status. Research and programming efforts typically focus only on the less socially respectable forms of transactional sex. 

This risks reinforcing stigma for women in relationships that are already considered socially unacceptable while ignoring the unique HIV risks faced by women in more respectable relationships.

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By:  Fielding-Miller R1, Dunkle KL2, Jama-Shai N2, Windle M3, Hadley C3, Cooper HL3.

• 1University of California, San Diego, 9500 Gillman Drive #0507, San Diego, CA 92093, United States. Electronic address: rfieldingmiller@ucsd.edu.
• 2South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa.
• 3Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States.
• Soc Sci Med. 2016 Apr 7;158:24-33. doi: 10.1016/j.socscimed.2016.04.005 

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Homicide-suicide and the role of mental disorder: A national consecutive case series

PURPOSE:

There is a lack of robust empirical research examining mental disorder and homicide-suicide. Primary care medical records are seldom used in homicide-suicide research. The aims of this study were to describe the characteristics of offenders and victims; determine the prevalence of mental disorder and contact with mental health services and examine adverse events prior to the offence.

METHODS:

This was a mixed-methods study based on a consecutive case series of offences in England and Wales occurring between 2006 and 2008. 60 homicide-suicides were recorded. Data sources included coroner's records, police files, General Practice (GP) and specialist mental health records, and newspaper articles.

RESULTS:

The results show that most victims were spouse/partners and/or children. Most perpetrators were male (88 %) and most victims were female (77 %). The incidents were commonly preceded by relationship breakdown and separation. 62 % had mental health problems. A quarter visited a GP for emotional distress within a month of the incident. Few had been in recent contact with mental health services before the incident (12 %). Self-harm (26 %) and domestic violence (39 %) were common.

CONCLUSION:

In conclusion, GPs cannot be expected to prevent homicide-suicide directly, but they can reduce risk generally, via the treatment of depression and recognising the risks associated with domestic violence.

Full article at:   http://goo.gl/DwrChG

By:   Flynn S1, Gask L2, Appleby L3, Shaw J3.

• 1The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. sandra.m.flynn@manchester.ac.uk.
• 2Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
• 3The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. 
• Soc Psychiatry Psychiatr Epidemiol. 2016 Apr 16.

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Romancing the Boundary: Client Masculinities in the Chinese Sex Industry

This paper draws on 24 in-depth interviews and 2 focus-group discussions conducted since 2012 with Hong Kong heterosexual men who buy sex in order to examine men's level of physical and emotional engagement with sex workers under two dominant sexual scripts in contemporary Hong Kong. 

Torn between companionate sexuality, with its companionate model of relationships, and recreational sexuality, with its promiscuous model of sexual pleasure, Hong Kong male clients seek to satisfy their sexual and affective needs through commercial sexual relationships. The term (meaning 'chicken worm', connoting a 'McSex' form of masculinity) refers to those men who seek impersonal sexual release with as many women as they wish, while the term (meaning 'sunken boat' and connoting a 'Titanic' form of masculinity) refers to those men who seek an intense level of emotional intimacy with sex workers. Between these two contrasting types, the majority of respondents fall into a form of 'bounded' masculinity characteristic of men who emphasise control and balance by seeking emotionally responsive women in a time-bound romance. 

By comparing clients' variations in the level of physical and emotional engagement with sex workers, this paper seeks to understand individual differences in client types and offers a new understanding of Chinese male sexuality and relationship formation, and the corresponding health risks (e.g., sexual, emotional) associated with each type.

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By:  Kong TS1.

• 1 Department of Sociology , University of Hong Kong , Hong Kong. 
• Cult Health Sex. 2015;17(7):810-24. doi: 10.1080/13691058.2015.1004197. Epub 2015 Feb 17.

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Expanding Access to HIV Testing & Counseling & Exploring Vulnerabilities among Spouses of HIV-Positive Men Who Inject Drugs in Pakistan

Objectives

To explore the utility of home and community-based HIV testing and counseling (HTC) to increase detection of undiagnosed HIV among female spouses and children of HIV-positive PWID in Punjab province, Pakistan.

Design

Between March 2014 and March 2015, home-based HTC was provided by a local NGO to spouses of HIV-positive PWID in Lahore, Faisalabad, and Sargodha. Convenience sampling was used to identify 2400 married, HIV-positive men who inject drugs and who were currently registered and receiving harm reduction services from the NGO ‘Roshan Rasta’ and seek consent to approach their wives.

Method

Trained outreach teams conducted HTC and administered a short sociodemographic and behavioral questionnaire to consenting spouses in their homes. HIV-exposed children were also tested with parental consent.

Results

of the 2400 married HIV positive male-injecting drug users, only 1959 spouses were approached and 1896 agreed to HTC (96.8%). HIV prevalence was 5.3% (n = 101) among spouses and they had very low level of HIV-related knowledge and protective behaviors

Conclusion

Home and community-based HTC was effective in identifying undiagnosed HIV among spouses of PWID, the majority of whom reported low rates of prior HIV testing and low HIV-related knowledge. Expansion of HIV prevention services and linkages to treatment and care including PMTCT are urgently needed for this group.

Below:  Ability of spouses to either identify correct responses or reject misconceptions regarding routes of HIV transmission. ^∗There was some confusion about how to administer this question in the survey by field teams, resulting in a substantial amount of incomplete data, which was subsequently excluded. Consequently, the number of respondents for each mode of transmission varies. We calculate ‘all correct’ based only on spouses that provided a response to all seven modes.

Full article at:   http://goo.gl/ZBUQl8

By:  Salman Shahid,a Mohammad Faisal Majeed,a Ahmad Bakhsh Awaan,b Humayun Mirza,b Nasir Sarfraz,c and Vanessa Veronesed

^aPunjab AIDS Control Program, Department of Health, Government of Punjab, Lahore

^bRoshan Rasta, Lahore

^cHealth Section, UNICEF Pakistan, Islamabad, Pakistan

^dHIV and AIDS Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal

Correspondence to Salman Shahid, 7-B, LDA Flats, Huma Block, Allama Iqbal Town, Lahore 2060, Pakistan. Tel: +092 42 3780 2425

Curr Opin HIV AIDS. 2016 Mar; 11(Suppl 1): S6–S12.

Published online 2016 Mar 10. doi:  10.1097/COH.0000000000000263

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Do People Agree on What Makes One Feel Loved? A Cognitive Psychometric Approach to the Consensus on Felt Love

This pragmatic study examines love as a mode of communication. Our focus is on the receiver side: what makes an individual feel loved and how felt love is defined through daily interactions. 

Our aim is to explore everyday life scenarios in which people might experience love, and to consider people’s converging and diverging judgments about which scenarios indicate felt love. We apply a cognitive psychometric approach to quantify a receiver’s ability to detect, understand, and know that they are loved. 

Through crowd-sourcing, we surveyed lay participants about whether various scenarios were indicators of felt love. We thus quantify these responses to make inference about consensus judgments of felt love, measure individual levels of agreement with consensus, and assess individual response styles. More specifically, we 

1. derive consensus judgments on felt love; 
2. describe its characteristics in qualitative and quantitative terms, 
3. explore individual differences in both 
1. participant agreement with consensus, and
2. participant judgment when uncertain about shared knowledge, and 
4. test whether individual differences can be meaningfully linked to explanatory variables. 

Results indicate that people converge towards a shared cognitive model of felt love. Conversely, respondents showed heterogeneity in knowledge of consensus, and in dealing with uncertainty. We found that, when facing uncertainty, female respondents and people in relationships more frequently judge scenarios as indicators of felt love. Moreover, respondents from smaller households tend to know more about consensus judgments of felt love, while respondents from larger households are more willing to guess when unsure of consensus.

Below:  Raw data means and model based estimates on selected felt love items.

The second columns shows the mean of the answers for the item with ‘True’ coded as 1 and ‘False’ as 0. The posterior distribution on the consensus parameters for each item is summarized in columns 3 and 4, in terms of posterior median estimate, labeled as ‘True’ for 1 and ‘False’ for 0 and posterior standard deviation (abbreviated as ‘psd’). It quantifies standard error around the point estimate. The last column shows the item difficulty rank of the item in ascending order. 

Full article at:   http://goo.gl/kv3TUC

By:  

Zita Oravecz, Chelsea Muth 
Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States of America

Joachim Vandekerckhove 

Cognitive Sciences, University of California Irvine, Irvine, CA, United States of America

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Emotional Interdependence and Well-Being in Close Relationships

Emotional interdependence—here defined as partners’ emotions being linked to each other across time—is often considered a key characteristic of healthy romantic relationships. But is this actually the case? We conducted an experience-sampling study with 50 couples indicating their feelings 10 times a day for 7 days and modeled emotional interdependence for each couple separately taking a dyadographic approach. 

The majority of couples (64%) did not demonstrate strong signs of emotional interdependence, and couples that did, showed great inter-dyad differences in their specific patterns. Individuals from emotionally more interdependent couples reported higher individual well-being than individuals from more independent couples in terms of life satisfaction but not depression. Relational well-being was not (relationship satisfaction) or even negatively (empathic concern) related to the degree of emotional interdependence. Especially driving the emotions of the partner (i.e., sender effects) accounted for these associations, opposed to following the emotions of the partner (i.e., receiver effects). 

Additionally, assessing emotional interdependence for positive and negative emotions separately elucidated that primarily emotional interdependence for positive emotions predicted more self-reported life satisfaction and less empathic concern. 

These findings highlight the existence of large inter-dyad differences, explore relationships between emotional interdependence and key well-being variables, and demonstrate differential correlates for sending and receiving emotions.

Below:  Interpersonal emotion dynamics presented as a network. The four nodes represent positive (PE) and negative emotions (NE) of both partners. The arrows represent slopes, and thus the effects of emotions at time t-1 on emotions at time t. Solid arrows correspond to slopes for cross-partner connections, and thus partner effects, and dashed arrows to within-partner connections or actor effects.

Below:  Percentages of interdependent couples that evidenced specific cross-partner connections

Full article at:   http://goo.gl/3VcEKK

By:  Laura Sels,^* Eva Ceulemans, Kirsten Bulteel, and Peter Kuppens

Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium

Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium

Edited by: Vivian Zayas, Cornell University, USA

Reviewed by: Jiyoung Park, University of Massachusetts Amherst, USA; Emre Selcuk, Middle East Technical University, Turkey

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Has Virginity Lost Its Virtue? Relationship Stigma Associated with Being a Sexually Inexperienced Adult

While virginity prior to marriage has been historically valued, changing sociosexual scripts in the United States have made premarital sexual activity the norm for young adults, with sexual debut generally occurring in late adolescence. 

In the current research, we examined the impact of being developmentally off-time with first coitus (i.e., not yet engaging in coitus when most same-aged peers have done so). Specifically, we investigated stigma toward sexually inexperienced adults and discrimination regarding romantic relationship formation. 

Across three methodologically diverse studies we observed that sexually inexperienced adults perceived themselves to be stigmatized due to their inexperience and that sexually inexperienced adults were not highly desired as relationship partners. 

Even sexually inexperienced adults themselves did not find other inexperienced adults to be attractive relationship partners. 

Although abstaining from sexual activity may bestow some health advantages, our studies show that being a sexual "late bloomer" may result in negative interpersonal consequences such as limited opportunities for romantic relationships.

Below:  Target’s attractiveness as a function of age of target and participant.

Below:  Target’s attractiveness as a function of sexual experience of target and participant

Full article at:  http://goo.gl/lN9B5d

By:  Gesselman AN1, Webster GD2, Garcia JR3.

• 1 The Kinsey Institute , Indiana University , Bloomington.
• 2 Department of Psychology , University of Florida.
• 3 The Kinsey Institute and Department of Gender Studies , Indiana University , Bloomington.
• J Sex Res. 2016 Mar 16:1-12 

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Trajectories of Dating Violence: Differences by Sexual Minority Status & Gender

The purpose of this study was to examine how sexual minority status (as assessed using both identity and behavior) was associated with trajectories of dating violence. 

University students from a large Southwestern university completed questions on their sexual minority identity, the gender of their sexual partners, and about experiences of dating violence for six consecutive semesters (N = 1942). Latent growth curve modeling indicated that generally, trajectories of dating violence were stable across study participation. 

Sexual minority identity was associated with higher initial levels of dating violence at baseline, but also with greater decreases in dating violence across time. These differences were mediated by number of sexual partners. Having same and other-sex sexual partners was associated with higher levels of dating violence at baseline, and persisted in being associated with higher levels over time. 

No significant gender difference was observed regarding trajectories of dating violence.

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By:  Martin-Storey A1, Fromme K2.

• 1Département de Psychoéducation, Université de Sherbrooke, Pavillon A7, 2500 Boul. De L'Université, Sherbrooke, Quebec J1K 2R1, Canada. Electronic address: alexa.martin@gmail.com.
• 2Department of Psychology, University of Texas at Austin, 108 E Dean Keeton Stop A8000, Austin, TX 87812-1043, USA. 
• J Adolesc. 2016 Mar 16;49:28-37. doi: 10.1016/j.adolescence.2016.02.008.

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Number of Sexual Partners and Relationship Status Are Associated with Unprotected Sex Across Emerging Adulthood

Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner-partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. 

Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. 

We identified three trajectory classes described with respect to number of partners as 

1. Multiple, 
2. Single, and 
3. Rare. 

Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. 

The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. 

Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention.

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By:  Ashenhurst JR1, Wilhite ER2, Harden KP2, Fromme K2.

• 1Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA. james.ashenhurst@utexas.edu.
• 2Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA. 
• Arch Sex Behav. 2016 Mar 3.

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Older Sexual Partners and Adolescent Females' Mental Health

CONTEXT:

The physical health detriments associated with adolescent females' having older romantic partners are well documented. However, little is known about the relationship between having an older partner and females' subsequent mental health.

METHODS:

Two waves of data from 1,440 participants in the National Longitudinal Study of Adolescent Health were analyzed. The sample was restricted to females in grades 7-12 who had not had sex at Wave 1 (1994-1995) and reported at least one romantic relationship by Wave 2 (1996). A lagged dependent variable approach with ordinary least-squares regression measured changes in depression and self-esteem associated with sexual and nonsexual relationships with same-age and older partners. Intimate partner violence was tested as a mediator.

RESULTS:

Compared with respondents reporting a nonsexual relationship with a same-age partner, those reporting a nonsexual relationship with an older partner, sex with a same-age partner or sex with an older partner experienced greater increases in depression between surveys; mean predicted depression levels at Wave 2 ranged from 7.7 to 9.0 across these groups (possible range, 0-27). Intimate partner violence explained one-third of the difference between those who had had sex and those who had not had sex with same-age partners. Fewer associations were found for self-esteem, and differences between groups were small.

CONCLUSIONS:

Health correlates of adolescent sexual behavior go beyond physical health outcomes. Future research should identify mechanisms through which relationships, especially those with older partners, are associated with declines in mental health.

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By:  Meier A1, Erickson GA2, McLaughlin H3.

• 1Department of Sociology, University of Minnesota, Minneapolis. meierann@umn.edu.
• 2Department of Criminal Justice and Forensic Science, Hamline University, St. Paul, MN.
• 3Department of Sociology, Oklahoma State University, Stillwater.
• Perspect Sex Reprod Health. 2016 Feb 26. doi: 10.1363/48e8316.

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Attitude of Saudi Arabian Adults Towards Consanguineous Marriage

Background: 

Research on the attitudes of Saudi adults towards consanguinity is scarce. The study aimed to explore the attitudes towards consanguinity and its associations with socio-demographic characteristics in a sample of Saudi adults.

Methods: 

A cross-sectional study was conducted using a self-administered questionnaire. A total of 386 outpatient waiting-area attendees at King Abdul-Aziz Medical City-Riyadh were included. Participants were asked about their socio-demographic characteristics, attitude towards consanguinity and the reasons behind this.

Results: 

The positive attitude towards consanguinity among the study respondents was 48.1% with 95% confidence interval (42.91–53.33%). Social and traditional culture (59.9%) were found to be the predominant reasons for favoring consanguinity in Saudi Arabia. Evidence against a positive attitude towards consanguinity was noted in respondents who received medical information about consanguinity versus those who had not received medical information (42.3% vs. 57%, p-value = 0.008). According to the multivariate logistic model, the odds of a positive attitude towards consanguinity were 2 times higher for males (adjusted odds ratio [aOR]: 2.2; 95% CI: 1.147, 4.290) and 4.1 times higher in respondents in consanguineous marriages (aOR: 4.1; 95% CI: 2.350, 7.156). The odds of a positive attitude towards consanguinity were 50% less in respondents who received health information on consanguinity compared to those who had not received health information about consanguinity (aOR: 0.50; 95% CI: 0.253, 0.863).

Conclusion: 

One in every two Saudi adults favors consanguinity however, Saudi men and women differ in their attitudes towards consanguinity. Receiving health information on consanguinity was associated with a negative attitude towards this practice.

...Consanguinity is a worldwide issue, but particularly so in the Middle East. Saudi Arabia was ranked as the second highest Arab country to have a high frequency of consanguineous marriage, with the prevalence varying in different studies from 22–55%.² Exploring the attitude towards consanguineous marriages and its health-related issues among Saudis is an attempt to clarify such a problem and suggest some solutions. In this study, the positive attitude towards consanguinity among the respondents was high, with approximately half of the respondents having a positive attitude towards consanguinity...

Full article at:   http://goo.gl/P3wxM1

By:  Omar A. Alharbi, 1 Walaa A. Al-Shaia, 2 Abdulaziz A. Al-Hamam, 3 Hala M. Al-Marzoug, 4 Anwar E. Ahmed, 5 andMuhammed Bagha 6

¹College of Medicine, King Saud University, Riyadh, Saudi Arabia

²College of Applied Medical Sciences, University of Dammam, Dammam, Saudi Arabia

³College of Medicine, King Faisal University, Al Ahsaa, Saudi Arabia

⁴College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

⁵College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

⁶King Abdullah Specialist Children Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia

E-mail: as.dem.ahgn@nademha; Email: ude.ucv@5ademha

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Culturally Embedded Risk Factors for Cambodian Husband-Wife HIV Transmission: From Women's Point of View

PURPOSE:

The purpose of this study was to use interview data to examine the validity of a recently published theoretical model of HIV transmission between husband and virginal wives in rural Cambodia.

DESIGN:

This study used a qualitative description method with a sample of women diagnosed with HIV/AIDS in Phnom Penh, Cambodia.

METHODS:

Data were collected through in-depth interviews conducted with 15 women who self-identified as having contracted HIV from their HIV-positive husbands. Interviews were conducted in Khmer, translated and back-translated for accuracy, and then coded using deductive content analysis. Trustworthiness of study results was protected through peer debriefing, coding to consensus, and maintaining an audit trail.

FINDINGS:

Each conceptual domain of the prior published theoretical model of HIV transmission was validated and further elaborated by current study data: wives' acceptance of their husbands' involvement with commercial sex workers, the common practice of unprotected sex between HIV-infected spouses and uninfected wives, and wives' beliefs about the value of the ideal Khmer woman. In addition, the current study findings identified a new domain that substantially distinguished between the beliefs and attitudes held about marriage and sex by wives and spouses.

CONCLUSIONS:

Women were not passive recipients of HIV transmission; they reciprocated with behaviors that were consistent with being a good Khmer woman in rural Cambodia, all of which increased their vulnerability to HIV transmission from their HIV-infected spouses. Future interventions or programs should consider all these factors and not overly rely on simplistic educational messages about wearing barriers for HIV transmission during sex.

CLINICAL RELEVANCE:

The refined theoretical model of HIV transmission from this qualitative research can be used to formulate culturally sensitive and embedded programs for curbing intramarital HIV transmission in Cambodia among the rural poor.

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By:  Yang Y1, Lewis FM2, Wojnar D3.

• 1Assistant Professor, School of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea.
• 2School of Nursing, University of Washington Medical Center Endowed Professor in Nursing, Family and Child Nursing, Seattle, WA, USA.
• 3Associate Professor, College of Nursing, Seattle University, Seattle, WA, USA. 
• J Nurs Scholarsh. 2016 Feb 2. doi: 10.1111/jnu.12193.

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