Chlamydia screening of adolescent and young adult women by general practice physicians in Toronto, Canada: Baseline survey data from a physician education campaign
Deborah Hardwick¹, Alex McKay², and Michele Ashem¹
¹Toronto Public Health, Toronto ON
²Sex Information and Education Council of Canada, Toronto ON

The current study surveyed primary care physicians to gather information on their testing practices for Chlamydia trachomatis among 15- to 24-year-old young women and to identify factors associated with their likelihood of doing such testing. The Canadian Guidelines on Sexually Transmitted Infections (PHAC, 2006) recommend routine testing of all sexually active women in this age group and some prior sexual health assessment interviewing is therefore needed as well. Respondents were 251 physicians (52% male; 48% female) practicing in Toronto who worked predominantly in general/family practice and/or walk-in clinics. When asked about their likelihood of recommending Chlamydia testing for 15- to 24-years-olds in different contexts or types of visit, over 90% said they would do so if the patient asked, about half would do so in annual checkups or as an add on to a Pap test, but only 3% said they would do so in visits for other reasons. This suggests situational rather than routine assessment and testing, which was also reflected in actual self-reported practices in the past month. Female physicians did sexual health assessment and Chlamydia testing in a greater percentage of visits than male physicians. Physicians endorsed few barriers to offering Chlamydia testing except for “not having enough time” (31.5% of respondents). Possible explanations of the findings and applications to professional education and support are discussed (The Canadian Journal of Human Sexuality, 2007;16: 63-76).

Initiating new sexual behaviours in heterosexual relationships
Terry Humphreys¹ and Jennifer Newby¹
¹Psychology Department, Trent University, Peterborough, ON

Sixty-four female and 33 male university students participated in a study of how relationship partners introduce new sexual behaviours into an ongoing relationship. Participants rated the likelihood that a hypothetical couple would use differing tactics to initiate a new sexual behaviour into the relationship. The scenario presented a couple who were together for either three weeks or two years. Participants then rated the likelihood that they would use these same tactics in their own relationship. The different initiation tactics were created from the bi-polar dimensions outlined by Hickman and Muehlenhard (1999) — direct/indirect and verbal/nonverbal. Results indicated that while participants perceived a shift to more verbal tactics as relationships became longer, this shift was not evident in participants’ personal relationships. Longer relationships were associated with a drop in the use of direct, nonverbal tactics; however, no other approaches to initiating new sexual behaviours differed as a function of relationship length. In addition, number of sexual partners and sexual self-disclosure were positively correlated with verbal, but not nonverbal, tactics, while erotophobia-erotophilia was positively correlated with all four tactics (The Canadian Journal of Human Sexuality, 2007; 16: 77-88).
 

Global self-esteem and sexual self-esteem as predictors of sexual communication in intimate relationships
Melanie Kristel Oattes¹ and Alia Offman¹
¹Department of Psychology, Carleton University, Ottawa, ON

The goal of the present study was to examine the possible links between global self-esteem and sexual self-esteem, and their links to sexual communication in relationships. It was hypothesized that while there is a positive relationship between global self-esteem and communication in intimate relationships, sexual self-esteem will be a unique predictor of communication. Analyses of the responses of 74 individuals indicated that sexual self-esteem is a distinct, although contributing, aspect of global self-esteem and that sexual communication differs from general communication. Furthermore, while it was found that high levels of both global and sexual self-esteem predicted a higher ability to communicate about satisfying sexual behaviours with a partner, hierarchical regressions demonstrated that sexual self-esteem was a unique predictor of sexual communication over and above the contribution of global self-esteem. These results suggest that global self-esteem may be too broad a construct to predict one’s ability to discuss sexual needs with a partner, and that future research may benefit from using measures of sexual self-esteem when researching sexual communication in intimate relationships (The Canadian Journal of Human Sexuality, 2007;16: 89-100).
 

Issues of sexuality and prevention among adolescents living with HIV/AIDS since birth
Mylène Fernet¹, Karène Proulx-Boucher¹, Marie-Eve Richard¹, Joseph Josy Lévy¹, Joanne Otis¹, Joanne Samson², Lyne Massie¹, Normand Lapointe², Jocelyne Thériault¹, and Germain Trottier³
¹Départment de sexologie, Université du Québec à Montréal, Montréal, Québec
²Centre Maternel et Infantile sur le SIDA, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec
³École de service social, Université Laval, Québec

There have been few studies on sexuality, relationships, and HIV prevention issues among HIV+ adolescents and fewer still that have dealt with youth living with HIV/AIDS since birth. In the present qualitative study, we conducted individual, semi-structured, taped interviews on these topics with 29 youth perinatally infected with HIV. The 15 girls and 14 boys, 10-18 years of age, have been followed at the Centre Maternel et Infantile sur le SIDA (CMIS), Centre Hospitalier Universitaire Sainte-Justine in Montreal. Content analysis of the interview transcripts revealed two dimensions related to HIV prevention. From a rational perspective, the youth were generally knowledgeable about modes of HIV transmission and modes of prevention, including consistent condom use. From an affective perspective, they were clear about their responsibility to protect their current or future partners but fearful that efforts to do so might disclose their HIV status with subsequent threat of rejection, stigmatization and compromised relationships. The concealment strategies they adopted to address the tensions inherent in this situation are discussed in terms of their own psychosexual development and of interventions by parents, caregivers and professionals to foster healthy and satisfying sexuality for HIV+ youth and their partners (The Canadian Journal of Human Sexuality, 2007; 16: 101-111).

Iran is a country with an established coherence of Islamic teachings and laws (Shari'a) with state laws and government policies. Iran has contributed growing numbers of immigrants to the Canadian population. Iranian immigrants bring to Canada ways of thinking about sexual relationships rooted in understandings of human nature and social order that are profoundly different from those that have set the foundations of Canadian culture and institutions. Based on interviews with 20 heterosexual, married, adult immigrants from Iran, this paper uses symbolic interaction theory to ask how these immigrants understand and interpret Canadian sexuality, including the meanings they ascribe to what they see and experience in Canada. To our participants, individualism, access to and use of divorce, cross-gender social and public interactions, and the kind of permission given to adolescents evidenced in Canada were experienced as potential threats to their own relationships and family life. To them these were seen as demonstrating a considerable divide between Canadian and Iranian values, norms and expectations related to gender, sexual and family issues. Areas of misunderstanding and miscommunication fostered a sense of difference, concern and suspicion. This study demonstrates some of the challenges faced in bridging cultural diversities, particularly in developing programming and delivering services in a multicultural society (The Canadian Journal of Human Sexuality, 2007; 16: 113-128).

Emergency contraception (EC) is used to decrease the risk of pregnancy after unprotected sexual intercourse. There are two types of EC: emergency contraceptive pills (ECPs), and the post-coital copper intrauterine device (IUD). ECPs are more commonly used and can reduce the risk of pregnancy by 75- 89%. Although they may be effective if used up to 5 days after intercourse, ECPs are more effective the sooner they are used. This medication is extremely safe and will not harm an existing pregnancy. Repeated use of ECPs poses no known health risks; however, ongoing forms of birth control will be more effective. ECPs do not provide protection against sexually transmitted infections. Improving access to ECPs is a priority for health care advocates. In Canada in 2005, the regulatory status of Plan B®, the most commonly used ECP, changed to enable access without a prescription. As a Schedule II medication, a woman needs only to request it from a pharmacist. Although this has removed one barrier, in some provinces it has resulted in a new barrier; increased cost due to the addition of a fee for counselling by a pharmacist. Some have advocated further deregulation to “on the shelf” (which would not require consultation with a pharmacist), while others maintain that the assessment and counselling by a pharmacist are essential for safe and appropriate use. To further promote appropriate use of emergency contraception, strategies are needed to eliminate barriers to use, increase emergency contraception knowledge and awareness, and assist women to identify their risk for pregnancy (The Canadian Journal of Human Sexuality, 2007; 16: 129-133).

Teaching youth about sexual health in the classroom can be a daunting task. In-service training is an important vehicle for increasing the knowledge, comfort and skills of teachers new to this area and for updating those who are more experienced. The Sexual and Reproductive Health Program of the Calgary Health Region offers such in-service training to strengthen the capacity of teachers to deliver the Alberta Education human sexuality curriculum. This article outlines the objectives, content, diverse methods of delivery, and evaluation of 11 such in-services for either elementary or junior high school teachers. Individualized access to computers in each session allowed hands-on guided exploration of teachingsexualhealth.ca, a provincial site, as a resource for implementing the curriculum. Pre- and post-surveys showed self-reported increases in knowledge, comfort and perceived ability to present accurate information. Eight suggestions for in-service training about sexual health are presented (The Canadian Journal of Human Sexuality, 2007; 16: 135-143).