CJHS Abstracts: Vol 17(1/2) 2008

The Canadian Journal of Human Sexuality (CJHS)

Volume 17, Number 1 & 2, 2008
Trends in sexual health and risk behaviours among adolescent students in British Columbia Elizabeth Saewyc¹,², Darlene Taylor³, Yuko Homma³, and Gina Ogilvie³ ¹University of British Columbia School of Nursing, Vancouver, BC ² McCreary Centre Society, Vancouver, BC ³ BC Centre for Disease Control Regular monitoring of trends in sexual health and sexual behaviours among adolescents provides strong evidence to guide intervention programs and health policies. Using the province-wide, school-based British Columbia (BC) Adolescent Health Surveys of 1992, 1998, and 2003, this study documented the trends in sexual health and risk behaviours among adolescents in grades 7 to 12 in BC, and explored the associations between sexual behaviours and key risk and protective factors. From 1992 to 2003, the percentage of youth who had ever had sexual intercourse decreased for both males (33.9% to 23.3%) and females (28.6% to 24.3%) and the percentage who used a condom at last intercourse increased for both males (64.4% to 74.9%) and females (52.9% to 64.2%). Among students who had ever had sexual intercourse, the percentage who had first intercourse before age 14 decreased for both sexes. These encouraging results may be related in part to concurrent decreases in the prevalence of sexual abuse or forced intercourse among both male and female adolescents. Protective factors such as feeling connected to family or school were also associated with lower odds of having engaged in risky sexual behaviours. These findings emphasize the importance of including questions about adolescent sexual health behaviours, risk exposures, and protective factors on national and provincial youth health surveys, to monitor trends, inform sexual health promotion strategies and policies, and to document the effectiveness of population-level interventions to foster sexual health among Canadian adolescents (The Canadian Journal of Human Sexuality, 2008;17:1-13). Outcome evaluation of Girl Time: Grade 7/8 Healthy Sexuality Program B.J. Rye¹, Jennifer Yessis², Tammie Brunk³, Alexander McKay4, Sue Morris³, and Glenn Meaney¹. ¹ St. Jerome’s University at the University of Waterloo, Waterloo, ON ² NRC Picker Canada, Markam, ON ³ Sexual Health Program, Region of Waterloo Public Health, Waterloo, ON 4 Sex Information and Education Council of Canada A sexual health education curriculum, Girl Time 7/8 Healthy Sexuality Program, was created and implemented with the goals of encouraging young girls to (a) delay sexual intercourse until they are mature enough, and (b) practice safer sex when they engage in sexual activity. The program was structured around the information-motivation-behavioural skills model as recommended in the Canadian Guidelines for Sexual Health Education. This study presents the results of an outcome evaluation of this primary prevention program. Girls who participated in Girl Time differed consistently from non-program girls on self-efficacy, sexual health knowledge, and comfort with sexuality issues (i.e., erotophobia-erotophilia); program girls versus comparison girls also differed on behavioural intentions, parent communication, benefits of sexual intercourse, sexual attitudes, and social desirability. These findings suggest that the program had a positive impact. (The Canadian Journal of Human Sexuality, 2008; 17: 17-36). Understanding AIDS-related bereavement and multiple loss among long-term survivors of HIV in Ontario C.A. Leaver¹, Y. Perreault², A. Demetrakopoulos² and the AIDS Bereavement Project of Ontario’s Survive & Thrive Working Group ¹ Rainbow Tribe Consulting, Toronto, ON ² AIDS Bereavement Project of Ontario, Toronto, ON AIDS-related bereavement has been linked in recent studies with rapid HIV-symptom onset and increased mortality among people living with HIV. Social support and social environments are important elements in grief resiliency and hastened recovery. This study examined the impact of retreats conducted by the AIDS Bereavement Project of Ontario to address these issues. Participants (N = 67, M = 53, F = 13, Trans = !) were primarily HIV+ (86%), self-identified as gay (64%) or straight (19%), and were between 34-63 years of age. Those who were HIV+ had been living with HIV for an average of 12 years (6-18). Participants had experienced an average of 157 AIDS-related deaths, 76 non-AIDS-related deaths and multiple non-AIDS related losses. Measures of AIDS-related bereavement, social relationships, sexual relationships, psychosocial well-being and resiliency indicated some improvement over baseline in each domain at three week and/or three month follow-up. The policy and community-based partnerships that shaped this program of research are described, as are possible implications for HIV prevention (The Canadian Journal of Human Sexuality, 2008; 17: 37-52). Urine drop-off testing: A self-directed method for STI screening and prevention Patrick O’Byrne¹ and Rick Dias² ¹ Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON ² Sexual Health Centre, Ottawa Public Health, Ottawa, ON Within bathhouses in many urban centres across North America, nurses provide traditional, face-to-face STI testing services for gonorrhea, Chlamydia, HIV, hepatitis B, and syphilis. Because these services require the physical presence of a nurse, they are not accessible for men who visit bath houses during non-designated testing times. In addition, some men resist traditional STI testing services because they find the procedure to be embarrassing. In response to these problems, we piloted the use of self-directed gonorrhea/chlamydia urine testing kits within two bathhouses in a Canadian urban centre. A drop-box placed in a visible but discreet area of each bathhouse allowed participants to provide samples and contact information. Of those tested in this study, (n = 50), 55.8% reported not having previously accessed services at the host testing-site, and 34.6% reported not being regularly tested for STIs. Among the latter, 16 of 19 had never been previously tested; eight subsequently underwent additional serologically based STI/HIV testing for the first time, with four testing positive for infectious syphilis. None of the drop-off participants tested positive for either gonorrhea or Chlamydia. The discussion considers the potential impact of this unique STI service for a small, but previously untested population (The Canadian Journal of Human Sexuality, 2008; 17: 53-59). Rising reported rates of Chlamydia among young women in Canada: What do they tell us about the actual prevalence of the infection? Alexander McKay¹, Michael Barrett¹,². ¹ Sex Information and Education Council of Canada ² Department of Cell and Systems Biology, University of Toronto, Toronto, ON This article explores possible explanations for the rise in reported Chlamydia rates among young women in Canada between 1997 and 2004 and considers whether rising rates can be used to infer a parallel increase in the actual prevalence of the infection. The transition to more sensitive testing methods is among the factors that could have contributed to the rise in reported rates. In contrast to Canada, the United States (US) monitors trends in the prevalence of chlamydia among young women as well as reported rates. The US data indicate that while reported rates of chlamydia among young women rose during the same time period, prevalence levels, when adjusted for the use of more sensitive testing methods, remained relatively stable. While available data are insufficient to draw definitive conclusions about prevalence trends in Canada, existing studies do point to unacceptably high prevalence levels. The establishment of a sentinel Chlamydia surveillance system would provide a mechanism to track prevalence trends and allocate resources for Chlamydia prevention and control (The Canadian Journal of Human Sexuality, 17; 61-69).

Volume 17, Number 1 & 2, 2008

Trends in sexual health and risk behaviours among adolescent students in British Columbia
Elizabeth Saewyc¹,², Darlene Taylor³, Yuko Homma³, and Gina Ogilvie³
¹University of British Columbia School of Nursing, Vancouver, BC
² McCreary Centre Society, Vancouver, BC
³ BC Centre for Disease Control

Regular monitoring of trends in sexual health and sexual behaviours among adolescents provides strong evidence to guide intervention programs and health policies. Using the province-wide, school-based British Columbia (BC) Adolescent Health Surveys of 1992, 1998, and 2003, this study documented the trends in sexual health and risk behaviours among adolescents in grades 7 to 12 in BC, and explored the associations between sexual behaviours and key risk and protective factors. From 1992 to 2003, the percentage of youth who had ever had sexual intercourse decreased for both males (33.9% to 23.3%) and females (28.6% to 24.3%) and the percentage who used a condom at last intercourse increased for both males (64.4% to 74.9%) and females (52.9% to 64.2%). Among students who had ever had sexual intercourse, the percentage who had first intercourse before age 14 decreased for both sexes. These encouraging results may be related in part to concurrent decreases in the prevalence of sexual abuse or forced intercourse among both male and female adolescents. Protective factors such as feeling connected to family or school were also associated with lower odds of having engaged in risky sexual behaviours. These findings emphasize the importance of including questions about adolescent sexual health behaviours, risk exposures, and protective factors on national and provincial youth health surveys, to monitor trends, inform sexual health promotion strategies and policies, and to document the effectiveness of population-level interventions to foster sexual health among Canadian adolescents (The Canadian Journal of Human Sexuality, 2008;17:1-13).

Outcome evaluation of Girl Time: Grade 7/8 Healthy Sexuality Program
B.J. Rye¹, Jennifer Yessis², Tammie Brunk³, Alexander McKay4, Sue Morris³, and Glenn Meaney¹.
¹ St. Jerome’s University at the University of Waterloo, Waterloo, ON
² NRC Picker Canada, Markam, ON
³ Sexual Health Program, Region of Waterloo Public Health, Waterloo, ON
4 Sex Information and Education Council of Canada

A sexual health education curriculum, Girl Time 7/8 Healthy Sexuality Program, was created and implemented with the goals of encouraging young girls to (a) delay sexual intercourse until they are mature enough, and (b) practice safer sex when they engage in sexual activity. The program was structured around the information-motivation-behavioural skills model as recommended in the Canadian Guidelines for Sexual Health Education. This study presents the results of an outcome evaluation of this primary prevention program. Girls who participated in Girl Time differed consistently from non-program girls on self-efficacy, sexual health knowledge, and comfort with sexuality issues (i.e., erotophobia-erotophilia); program girls versus comparison girls also differed on behavioural intentions, parent communication, benefits of sexual intercourse, sexual attitudes, and social desirability. These findings suggest that the program had a positive impact. (The Canadian Journal of Human Sexuality, 2008; 17: 17-36).

Understanding AIDS-related bereavement and multiple loss among long-term survivors of HIV in Ontario
C.A. Leaver¹, Y. Perreault², A. Demetrakopoulos² and the AIDS Bereavement Project of Ontario’s Survive & Thrive Working Group
¹ Rainbow Tribe Consulting, Toronto, ON
² AIDS Bereavement Project of Ontario, Toronto, ON

AIDS-related bereavement has been linked in recent studies with rapid HIV-symptom onset and increased mortality among people living with HIV. Social support and social environments are important elements in grief resiliency and hastened recovery. This study examined the impact of retreats conducted by the AIDS Bereavement Project of Ontario to address these issues. Participants (N = 67, M = 53, F = 13, Trans = !) were primarily HIV+ (86%), self-identified as gay (64%) or straight (19%), and were between 34-63 years of age. Those who were HIV+ had been living with HIV for an average of 12 years (6-18). Participants had experienced an average of 157 AIDS-related deaths, 76 non-AIDS-related deaths and multiple non-AIDS related losses. Measures of AIDS-related bereavement, social relationships, sexual relationships, psychosocial well-being and resiliency indicated some improvement over baseline in each domain at three week and/or three month follow-up. The policy and community-based partnerships that shaped this program of research are described, as are possible implications for HIV prevention (The Canadian Journal of Human Sexuality, 2008; 17: 37-52).

Urine drop-off testing: A self-directed method for STI screening and prevention
Patrick O’Byrne¹ and Rick Dias²
¹ Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
² Sexual Health Centre, Ottawa Public Health, Ottawa, ON

Within bathhouses in many urban centres across North America, nurses provide traditional, face-to-face STI testing services for gonorrhea, Chlamydia, HIV, hepatitis B, and syphilis. Because these services require the physical presence of a nurse, they are not accessible for men who visit bath houses during non-designated testing times. In addition, some men resist traditional STI testing services because they find the procedure to be embarrassing. In response to these problems, we piloted the use of self-directed gonorrhea/chlamydia urine testing kits within two bathhouses in a Canadian urban centre. A drop-box placed in a visible but discreet area of each bathhouse allowed participants to provide samples and contact information. Of those tested in this study, (n = 50), 55.8% reported not having previously accessed services at the host testing-site, and 34.6% reported not being regularly tested for STIs. Among the latter, 16 of 19 had never been previously tested; eight subsequently underwent additional serologically based STI/HIV testing for the first time, with four testing positive for infectious syphilis. None of the drop-off participants tested positive for either gonorrhea or Chlamydia. The discussion considers the potential impact of this unique STI service for a small, but previously untested population (The Canadian Journal of Human Sexuality, 2008; 17: 53-59).

Rising reported rates of Chlamydia among young women in Canada: What do they tell us about the actual prevalence of the infection?
Alexander McKay¹, Michael Barrett¹,².
¹ Sex Information and Education Council of Canada
² Department of Cell and Systems Biology, University of Toronto, Toronto, ON

This article explores possible explanations for the rise in reported Chlamydia rates among young women in Canada between 1997 and 2004 and considers whether rising rates can be used to infer a parallel increase in the actual prevalence of the infection. The transition to more sensitive testing methods is among the factors that could have contributed to the rise in reported rates. In contrast to Canada, the United States (US) monitors trends in the prevalence of chlamydia among young women as well as reported rates. The US data indicate that while reported rates of chlamydia among young women rose during the same time period, prevalence levels, when adjusted for the use of more sensitive testing methods, remained relatively stable. While available data are insufficient to draw definitive conclusions about prevalence trends in Canada, existing studies do point to unacceptably high prevalence levels. The establishment of a sentinel Chlamydia surveillance system would provide a mechanism to track prevalence trends and allocate resources for Chlamydia prevention and control (The Canadian Journal of Human Sexuality, 17; 61-69).

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