The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center

Provincial distribution and factors associated with self-reported sexually transmitted infections and their symptoms among women in Sierra Leone

BACKGROUND

Sexually transmitted infections (STIs) are a significant public health concern worldwide. These infections can have severe consequences for women's health, including pelvic inflammatory disease, infertility, and increased risk of HIV acquisition. Understanding the prevalence and factors associated with STIs among women in Sierra Leone is crucial to developing effective prevention and treatment strategies. This study investigated the provincial distribution and factors associated with self-reported STIs (SR-STIs) and STI symptoms among women in Sierra Leone.

METHODS

The study used data from the 2019 Sierra Leone Demographic and Health Survey, comprising 13,965 women aged 15 to 49 who have ever had sex. Provincial variations in the prevalence of SR-STIs and STI symptoms were presented using a spatial map. A binary logistic regression analysis was performed to assess the factors associated with SR-STIs and STI symptoms among women in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).

RESULTS

The overall prevalence of SR-STIs and their symptoms was 21.6% [20.4, 22.9] among women in Sierra Leone. Higher odds of SR-STIs and their symptoms were associated with being aged 25-29 (aOR = 1.35, 95% CI = 1.10,1.66), 30-34 (aOR = 1.38, 95% CI = 1.09,1.74), 35-39 (aOR = 1.39, 95% CI = 1.10, 1.77), having tested for HIV (aOR = 1.16, 95% CI = 1.04, 1.29), and having multiple sexual partners (aOR = 2.25, 95% CI = 1.80, 2.83) compared to those in the reference category. Being in the rich wealth index (aOR = 1.32, 95% CI = 1.11, 1.57), living in the Northern (aOR = 2.43, 95% CI = 2.08, 2.83) and Northwestern province (aOR = 3.28, 95% CI = 2.81, 3.83), and being covered by health insurance (aOR = 3.19, 95% CI = 2.62, 3.88) were associated with higher odds of SR-STIs and their symptoms. Lower odds of SR-STIs and their symptoms were found among women with one (aOR = 0.81, 95% CI = 0.68, 0.96), two (aOR = 0.75, 95% CI = 0.61, 0.93), three (aOR = 0.66, 95% CI = 0.53, 0.83), and four or more children (aOR = 0.62, 95% CI = 0.49, 0.77], those residing in rural areas (aOR = 0.81, 95% CI = 0.69, 0.94), and women living in the Southern province (aOR = 0.67, 95% CI = 0.57, 0.80) compared to those in the reference category.

CONCLUSION

The findings indicate that SR-STIs and their symptoms are prevalent among women in Sierra Leone. Our findings underscore the urgent need for targeted public health interventions to address the SR-STIs and their symptoms among women in Sierra Leone. The increased risk among women aged 25-39, those with multiple sexual partners and those from wealthier backgrounds, suggests that educational programmes focusing on safe sexual practices and STI prevention should be prioritized in urban and affluent areas. Additionally, the lower odds of SR-STIs among women with more children and those in rural regions indicate that family dynamics and geographic factors may offer protective benefits, which could be leveraged in public health messaging. Our findings highlight the importance of tailoring health services and outreach efforts to effectively reach and support vulnerable populations, ultimately aiming to reduce the incidence of SR-STIs.

The Experience of Disgust in Women Exposed to Domestic Violence in Turkey

In trauma, fear as a basic emotion that evokes avoidance after exposure to a traumatic event is important for posttraumatic process. Another emotion causing avoidance is disgust. Despite the fact that disgust also plays an important role in trauma, there is limited information about how it is experienced during and after exposure to the traumatic event. In this study, the aim was to understand how women experience disgust during and after domestic violence, as a prolonged and repeated traumatic experience, and how they try to cope with disgust evoking situations in this process. For this aim, qualitative methodology was used. With purposive sampling, six women exposed to domestic violence including physical, verbal and sexual abuse were interviewed. With each woman, approximately seven semi-structured interviews were completed. Forty-one interviews were audio recorded and transcribed. Data was analyzed by Interpretative Phenomenological Analysis. At the end of the analysis, three superordinate themes, namely, experience of perpetrator-directed disgust with gustatory expressions of moral disgust and association of disgust in domestic abuse to daily life experiences; experience of self-disgust with two themes of internalization of assault without awareness and contamination by sexual abuse; coping with disgust in domestic violence with four subthemes, namely, avoidance from perpetrator, reidentification of the perpetrator with substitutive identity, alienation from self, reidentification of self with new relationships were constructed. Results showed that disgust is experienced in a repressed way as a result of the aversive nature of traumatic experience. The results were evaluated in psychological, social and cultural contexts. Their implications for understanding disgust in domestic violence were discussed.

Perspectives on a Couples-Based, e-Health HIV Prevention Toolkit Intervention: A Qualitative Dyadic Study with Black, Heterosexual Couples in New York State

Web-based technology provides an unparalleled opportunity to increase access and uptake of couples-based HIV prevention interventions. e-Health HIV prevention interventions for US Black heterosexual couples have largely been understudied. To address this gap, we applied the Assessment Phase of the ADAPT-ITT Framework to investigate Black heterosexual couples' perspectives on an existing e-Health, couples-based HIV prevention intervention. Applying a qualitative descriptive approach, joint dyadic interviews were conducted with 28 Black heterosexual couples from three jurisdictions in New York State. Content dyadic analysis revealed three descriptive categories: perspectives of the toolkit intervention (sub-codes: perceived relevance, reactions to core components), recommendations to enhance intervention relevancy (sub-codes: tailoring to relationship type, adding new content), and lasting intervention considerations (sub-codes: toolkit usability and language use). Overall, couples found the toolkit intervention content and usability acceptable and reflected on its potential to build sexual and relationship health. Couples recommended to enhance toolkit adaptability for varied couple's motivation and types re-consider terms like sexual agreements, and include content to facilitate communication regarding sensitive topics (e.g., childhood sexual trauma, co-parenting, family planning) and other issues that may have more relevance to the experience of US Black persons (i.e., wealth building).

Depressive and Sexual Disorders during the First and Second Wave of the COVID-19 Pandemic among Young Polish Women

We investigated whether long-term social restrictions and COVID-19 exposure have different impacts on the mental and sexual health of Polish women compared to the effects experienced at the beginning of the pandemic. An online survey was conducted among Polish women via Facebook groups. The Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) scores were compared for the first wave (April-May 2020) and the second wave (November 2020 to February 2021) of the pandemic. We enrolled 1644 participants (mean age 25.11 ± 7.09 years) during the first wave and 720 participants (mean age 23.23 ± 5.34 years) during the second wave of COVID-19 pandemic. Significant differences were observed in libido levels and frequency of sexual activity before and during the first and second wave of the COVID-19 pandemic (both p < 0.001). The percentage of participants under psychiatric or psychological care increased from 6.5% to 14.44% and those who were anxious about the health conditions of loved ones increased from 57.5% to 65.14%. BDI scores increased significantly from 11 (IQR 5-18) to 12 (IQR 7-20). The change in the FSFI score was not significant (27.01 ± 7.61 vs. 26.38 ± 7.76). The COVID-19 pandemic affected various aspects of human life, including sexual life. The data obtained during the first and the second wave of the COVID-19 pandemic in Poland showed that female sexual dysfunction did not differ, but depressive symptoms and fear intensified.

Ecological and Syndemic Predictors of Drug Use During Sex and Transactional Sex among U.S. Black Men Who Have Sex with Men: A Secondary Data Analysis from the HPTN 061 Study

Threats to sexual health among U.S. Black men who have sex with men (MSM) may manifest in a context of social adverse experiences. Situational sex is one such context, which we characterize as sexual behaviors driven either by a desire to cultivate a specific sexual experience or attributable to social vulnerability. Two characterizations of situational sex explored in this study were drug use during sex and transactional sex. Guided by ecological and syndemic frameworks, we conducted a secondary data analysis of social conditions and sexual behaviors among a prospective cohort of Black MSM from the HIV Prevention Trial Network (HPTN) 061 study. Using structural equation modeling, this analysis examined the indirect effect of syndemic factors (substance use, depression, violence exposure) in the relationship between ecological constructs (anti-Black/homophobic stigma, childhood violence, and economic vulnerability) and situational sex (drug use during sex, transactional sex). Model fit indices, CFI (.870) and SRMR (.091), demonstrated reasonable fit. Significant indirect effects emerged via substance use for economic vulnerability (indirect effect = .181, 95% CI [.078, .294]) and anti-Black/homophobic violence and stigma (indirect effect = .061, 95% CI [.008, .121]) on drug use during sex; as well as on transactional sex (economic vulnerability indirect effect = .059, 95% CI [.018, .121] and anti-Black/homophobic stigma and violence indirect effect = .020, 95% CI [.003, .051]). Findings implicate the need for social and fiscal intervention to address upstream, ecological, and syndemic factors that influence inherent vulnerability of situational sex and overall threats to sexual health among Black MSM.