Geographic Mapping Demonstrates the Association Between Social Inequality, Teen Births and STDs Among Youth
Deborah Hardwick and Dianne Patychuk, Toronto Public Health, Toronto, Ontario.

This paper demonstrates geographic mapping for the distributions of social inequality, teen births, and sexually transmitted disease (STD) among 15 - to 24-year-olds in Toronto. The incidence rates for teen births, chlamydia among 15-to 24-year-olds in Toronto are much higher than for the province of Ontario. There is a public health requirement to lower these rates. At the same time, risk conditions associated with poverty, teen births and STDs provide challenges to public health program planners. We provide evidence of the need for geographically targeted public health programs to reduce the incidence of births among 15- to 19-year-olds and chlamydia and gonorrhea among 15- to 24-year-olds, and the association between these indicators and social inequality. The maps which highlight census tracts with high numbers of families with low incomes, teen births, genital chlamydia and gonorrhea among 15 - to 24-year-olds illustrate the associations. We suggest that the maps, along with local community knowledge, provide the basis for geograpically targeted evidence-based sexual health program planning (The Canadian Journal of Human Sexuality, 1999; 8:77-90)

Pre-Service Sexual Health Education Training of Elementary, Secondary, and Physical Health Education Teachers in Canadian Faculties of Education
Alexander McKay and Michael Barrett, The Sex Information and Education Council of Canada (SIECCAN), Toronto, Ontario.

The effectiveness of school-based sexual health education depends, in part, on the preparation of the teachers who provide it. In the absence of published literature on the extent to which the Bachelor of Education (B.Ed.) programs at Canadian university faculties of education provide pre-service training for this role, the present study surveyed all such programs in elementary, secondary, and physical & health education to determine the extent to which their students received sexual health education training. On average, 15.5% of the B.Ed. programs surveyed provided compulsory training in sexual health education; 26.2% had related optional courses although respondents estimated that a little over a third of their students took one of these optional courses. Overall, 39.3% provided compulsory and/or optional sexual health sexual health training (range = 32.4% for elementary education to 52.4% for physical and health education). The programs that did provide sexual health training generally assigned average or above average emphasis to all three of the key components of sexual health education (knowledge, motivation, and skill development), although there was considerable variability between individual programs in time allocated and topic emphasis. Just under half of the 84 respondents (80% response rate) were aware of the Canadian Guidelines for Sexual Health Education; 59.1% of programs with optional courses versus 15.4% of those with a compulsory sexual health component used them in training. The findings reported here do not necessarily reflect on the preparedness of current sexual health education teachers who are likely to be more experienced and to have had in-service training and/or other such professional development. The results do suggest a missed opportunity to provide systematic training in the theory and practice of sexual health education at the earliest point in a potential teacher's training (The Canadian Journal of Human Sexuality, 1999; 8:91-101).

"How am I Gonna Answer this One?" A Discourse Analysis of Fathers' Accounts of Providing Sexuality Education for Young Sons
Anthony Walsh, Family Planning Queensland, Brisbane, Australia, Elizabeth Parker, and Angela Cushing.

This paper presents a discourse analysis of fathers' accounts of their communication about sexuality with their young sons. In-depth interviews were conducted with eight Australian men who have six-year-old sons. Participants were asked to describe their experiences of and feelings about how they learned about sexuality and how they teach their sons. The transcripts of these interviews were analyzed using the Textually Oriented Discourse Analysis described by Fairclough (1989). Seven key assumptions which underlie the participants' discourse are identified. While these assumptions present significant obstacles for many fathers, several are actively struggling with these dominant ideologies. Sexuality educators may be able to help address this conflict by encouraging fathers to engage in discussion about their fears and beliefs about sexuality education. This research suggests that many fathers need assistance to participate in this task.  (The Canadian Journal of Human Sexuality, 1999; 8:103-114)

Gay and Bisexual Men's Sexual Partnerships and Variations in Risk Behaviour
Ted Myers, Dan Allman, Liviana Calzavara, HIV Social, Behavioural & Epidemiological Studies Unit, University of Toronto, Ken Morrison, Rick Marchand, and Carol Major.

In epidemiological studies that focus on gay men's sexual risk behaviour the context in which it occurs is often ignored. Increasingly, knowledge of the type and nature of the partnerships is seen to be important when assessing sexual risk behaviour. For this study, gay and bisexual men were recruited through community groups, gay bars and bath houses to complete a questionnaire on sexual practices with primary and casual same-sex partners. Partnerships were grouped as primary (16.2%, n= 110), casual (40.0%, n = 187) and both primary and casual (16.2%, n = 76). In these configurations 40.0%, 13.3% and 31.4% respectively reported at least one episode of unprotected sex in the previous three months. In the subgroup of men with both primary and casual partners a number varied their behaviour significantly with partner type. Most important, the pattern was for men to refrain from risky activities with their casual partners. However, for some men a reverse pattern of risk was reported. These findings emphasize that, for HIV education and prevention, there is a need to address the diversity of mens' relationships, to recognize the diversity of behaviour within relationships and to open discussion about the factors that influence condom use (The Canadian Journal of Human Sexuality, 1999; 8:115-126).

A Case Series of Women Evaluated for Paraphilic Sexual Disorders
J. Paul Federoff, Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Alicja Fishell, and Beverly Federoff.

The scientific literature on paraphilias has focussed almost exclusively on men. When women whose behaviour might imply paraphilia are discussed, it is mainly in terms of their victimization at the hands of men with paraphilic disorders. The purpose of this report is to review the current literature on female paraphilias and to present the clinical features of 14 women who sought treatment for presumed paraphilic sexual disorders. The study cannot be used to draw inferences about the prevalence of paraphilias among women. Social and personal history characteristics of the 14 women were compared to those of 118 men similarly assessed for presumed paraphilic disorders. The 12 women classified as having at least one paraphilia were similarly compared with an age-matched subsample of these men with diagnoses of paraphilia. Cases were drawn from the clinical records of a Forensic Psychiatrist who has conducted outpatient clinics for assessment and treatment of paraphilic disorders in three countries. Fourteen women who presented for assessment and/or treatment because of presumed paraphilic sexual interests or activities were identified. The three most common paraphilic disorders in the female study group were: pedophilia (36%), sexual sadism (29%), and exhibitionism (29%). Co-morbid psychiatric disorders diagnosed among these women were major depression (36%), generalized anxiety disorder (14%), post traumatic stress disorder (7%) and erotomania (7%). There were no significant differences between women and men in terms of age, number of victims, employment status, sexual orientation, education, history of substance abuse, history of non-sexual criminal behaviour, history of personal sexual abuse, frequency of incestuous assaults, or referral source (The Canadian Journal of Human Sexuality, 1999; 8:127-140).