An unanticipated source of hope: stigma and cervical cancer in Brazil

In this article, I argue that although cervical cancer is an often stigmatized condition in Brazil, women with cervical cancer in Recife, Brazil, did not simply endure the stigma, they also perpetuated it. I draw on narrative theory and 18 months of ethnographic research in Recife to argue that rather than resisting the stigma associated with their disease, women in Recife used stigma to construct illness narratives that affirmed that they were still held to the same norms and values as the nonill. In turn, those narratives, and the healing narratives constructed along with them, provided women with hope for a future free from cervical cancer and free from the "imperfections" associated with that disease. Thus, women with cervical cancer used stigmatizing narratives both as links back to the "normal" world they inhabited before they became ill, and as bridges forward to the future they hoped to attain.     

Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil

Background

Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk.

Methods and Findings

We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006–2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48–0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57–0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations.

Conclusions

Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil. Interventions targeting food insecurity may have beneficial implications for HIV prevention in resource-limited settings. Please see later in the article for the Editors'' Summary     

Imagining the Western Husband: Thai Women's Desires for Matrimony,Status and Beauty

This article examines a group of Thai women's perceptions of western Caucasian men as ideal marriage partners and its impact on their sexual practices and relationship decisions. Based on conversations with women living in a ‘slum’ community in Bangkok, I argue that women who do not fit local ideals of light skin color, economic success and urban origins face obstacles among potential Thai suitors. Some of these women strategically prefer western suitors to local men. Through their relationship choices, these women upset local hierarchies of desire as they attempt to subvert skin color-bias and pose challenges to Thai marital traditions. At the same time, their relationship pursuits conform to gender expectations of the male breadwinner and female caretaker and may unintentionally reproduce skin color and status hierarchies. Although Thai women's sexual relationships with western men are not a new phenomena, they underscore the transnational nature of sexual desire and contemporary social change.     

Unintended Pregnancies among Young Women Living in Urban Slums: Evidence from a Prospective Study in Nairobi City,Kenya

Background

Despite the significant proportion of young people residing in slum communities, little attention has been paid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harsh environment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes, especially during this key developmental period. This paper aims to fill this research gap by examining the levels of and factors associated with unintended pregnancies among young women aged 15–22 in two informal settlements in Nairobi, Kenya.

Methods

We use data from two waves of a 3-year prospective survey that collected information from adolescents living in the two slums in 2007–2010. In total, 849 young women aged 15–22 were considered for analysis. We employed Cox and logistic regression models to investigate factors associated with timing of pregnancy experience and unintended pregnancy among adolescents who were sexually active by Wave 1 or Wave 2.

Findings

About two thirds of sexually experienced young women (69%) have ever been pregnant by Wave 2. For 41% of adolescents, the pregnancies were unintended, with 26% being mistimed and 15% unwanted. Multivariate analysis shows a significant association between a set of factors including age at first sex, schooling status, living arrangements and timing of pregnancy experience. In addition, marital status, schooling status, age at first sex and living arrangements are the only factors that are significantly associated with unintended pregnancy among the young women.

Conclusions

Overall, this study underscores the importance of looking at reproductive outcomes of early sexual initiation, the serious health risks early fertility entail, especially among out-of school girls, and sexual activity in general among young women living in slum settlements. This provides greater impetus for addressing reproductive behaviors among young women living in resource-poor settings such as slums.     

Survivors of sexual abuse: clinical,lifestyle and reproductive consequences

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.     

Sexual Activity and Impairment in Women with Systemic Sclerosis Compared to Women from a General Population Sample

Objective

Reports of low sexual activity rates and high impairment rates among women with chronic diseases have not included comparisons to general population data. The objective of this study was to compare sexual activity and impairment rates of women with systemic sclerosis (SSc) to general population data and to identify domains of sexual function driving impairment in SSc.

Methods

Canadian women with SSc were compared to women from a UK population sample. Sexual activity and, among sexually active women, sexual impairment were evaluated with a 9-item version of the Female Sexual Function Index (FSFI).

Results

Among women with SSc (mean age = 57.0 years), 296 of 730 (41%) were sexually active, 181 (61%) of whom were sexually impaired, resulting in 115 of 730 (16%) who were sexually active without impairment. In the UK population sample (mean age = 55.4 years), 956 of 1,498 women (64%) were sexually active, 420 (44%) of whom were impaired, with 536 of 1,498 (36%) sexually active without impairment. Adjusting for age and marital status, women with SSc were significantly less likely to be sexually active (OR = 0.34, 95%CI = 0.28–0.42) and, among sexually active women, significantly more likely to be sexually impaired (OR = 1.88, 95%CI = 1.42–2.49) than general population women. Controlling for total FSFI scores, women with SSc had significantly worse lubrication and pain scores than general population women.

Conclusions

Sexual functioning is a problem for many women with scleroderma and is associated with pain and poor lubrication. Evidence-based interventions to support sexual activity and function in women with SSc are needed.     

Geographic variation in sexual selection among populations of an iguanid lizard,Sauromalus obesus (=ater)

Abstract.— Geographic variation in selection pressures may result in population divergence and speciation, especially if sexual selection varies among populations. Yet spatial variation in targets and intensity of sexual selection is well studied in only a few species. Even more rare are simultaneous studies of multiple populations combining observations from natural settings with controlled behavioral experiments. We investigated how sexual selection varies among populations of the chuckwalla, Sauromalus obesus. Chuckwallas are sexually dimorphic in color, and males vary in coloration among populations. Using field observations and multiple regression techniques, we investigated how sexual selection acts on various male traits in three populations in which males differed in coloration. The influence of sexual selection on male coloration was then investigated in more detail using controlled experiments. Results from field observations indicate that phenotypic selection was acting on territory quality in all three populations. In two populations, selection was also acting either directly or indirectly on male coloration. Male color likely functions as an indicator of food resources to females because male color is based partly on carotenoid pigments. In controlled experiments, significantly more females from these two populations chose males with brighter colors over dull males, a result consistent with studies on carotenoid pigments in other taxa. In a third population, no evidence of sexual selection on male coloration was found in either the field study or controlled experiment. Lack of female preferences for male color in this population, in which chuckwalla densities are low and home ranges are large, may result from searching costs to females.     

Women's Beliefs about Male Circumcision,HIV Prevention,and Sexual Behaviors in Kisumu,Kenya

It is important to understand how women''s sexual practices may be influenced by male circumcision (MC) as an HIV prevention effort. Women''s beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC. We conducted qualitative interviews with 30 sexually active women in Kisumu, Kenya. Women discussed MC related to perceived health benefits, condom use, sexual behaviour, knowledge of susceptibility to HIV and sexually transmitted infections (STIs), circumcision preference, and influence on circumcision uptake. Respondents had a good understanding of the partial protection of MC for acquisition of HIV for men. Women perceived circumcised men as cleaner, carrying fewer diseases, and taking more time to reach ejaculation. Male''s circumcision status is a salient factor for women''s sexual decision making, including partner choice, and condom use. It will be important that educational information affirms that MC provides only partial protection against female to male transmission of HIV and some STIs; that other HIV and STI prevention methods such as condoms need to be used in conjunction with MC; that MC does not preclude a man from having HIV; and that couples should develop plans for not having sex while the man is healing.     

Low-investment copulation: Sex differences in motivations and emotional reactions

Samples of male (n = 113) and female (n = 175) college students were surveyed. Majorities of both sexes agreed with statements indicating that males' sexual attractiveness varied more than females' sexual attractiveness as a function of their status. Subjects who reported more sex partners and a greater aversion to sexual monogamy were slightly more likely to agree that they tested their partners to see how far they could push them. Interviews with highly sexually active females (n = 32) and males (n = 24) indicated that low-investment copulation and lack of control over the sexual access-investment ratio caused even women with very permissive attitudes and multiple sex partners to develop an aversion to low-investment copulation. Three levels were identified in this process. The techniques that women with multiple partners used to deal with their feelings are described. Females tested their partners for ability and willingness to invest. Males tested for opportunities to reduce investment and pursue other women. High status, for example athletic stardom, transformed males' sexual attractiveness to women and numbers of sex partners. Results were consistent with the view that the emotional-motivational mechanisms that moderate sexual arousal and attraction are sexually dimorphic.     

Reproductive Signals of Female Lizards: Pattern of Trait Expression and Male Response

Relative to the volume of studies concerning the function and evolution of male‐biased sexually dimorphic traits, instances of female‐biased sexual dimorphisms remain largely unstudied, especially in species with conventional sex roles. I investigated the signal function of a female‐specific ornamental trait using the striped plateau lizard (Sceloporus virgatus, Phrynosomatidae) as a model system. During the reproductive season, female S. virgatus develop orange color on their throats that is absent in conspecific males. I established the relationship between color expression and female reproductive state, and determined male response to female color. I show that dynamic changes occurring within the color patch can potentially identify each stage of the female reproductive cycle, largely because of a lag in patch growth relative to color intensification. Sexual receptivity is associated with intense patches rapidly growing in size; ovulation occurs near peak color expression; and the unreceptive period is associated with large patches fading in intensity. Because females express orange color during both the receptive and unreceptive periods, the pattern of color expression is consistent with the courtship‐stimulation and courtship‐rejection hypotheses of signal function. Males may preferentially associate with females that have more highly developed color patches during the courtship season, and/or ignore such females when they are unreceptive. An examination of male behavior towards unfamiliar females indicates that female color has a role in courtship stimulation but has little, if any, role in courtship rejection. During the pre‐mating season, males maintained significantly closer affiliation with, and tended to perform more social behavior towards females with more intense color. During the post‐mating season, female color had no apparent effect on male behavior. The evolution and current function of female ornaments may vary among taxonomically‐related species as a result of differences in ecology, social system, and life‐history.     

Variance in reproductive success and the opportunity for selection in a serially monogamous species: simulations of the mating system of <Emphasis Type="Italic">Tropheus</Emphasis> (Teleostei: Cichlidae)

Sexual selection is believed to play a major role in speciation processes of cichlid fishes in the East African Great Lakes, in particular Lakes Malawi and Victoria, by driving diversification in male nuptial coloration. In Lake Tanganyika, a high rate of color pattern diversification is found in the genus Tropheus, where more than 100, mostly allopatric, color morphs have been described. Whether color pattern differentiation in Tropheus could follow from sexual selection as well, has not yet been conclusively shown. Unlike typical sexually selected species, Tropheus are sexually monomorphic, establish temporary pair bonds and spawn monogamously. Variance in mating success among individuals would still allow for sexual selection, but due to their high population census sizes, parentage data from natural populations are difficult to obtain. Simulations designed according to existing data on mating behavior in Tropheus suggested that variance in male reproductive success can be substantial and lead to levels of opportunity for selection, which are similar to values estimated, for example, from natural populations of sexually dimorphic songbirds. Variance in male success was mostly affected by the way females perceived and reacted to differences between males, and to a lesser extent by the duration of components of the reproductive cycles of males and females. These results indicate that future work on the importance of sexual selection in Tropheus should concentrate on mate choice cues and female mate choice behavior, but does not depend critically on the acquisition of more detailed life history data.     

"Interracial" Sex and Racial Democracy in Brazil: Twin Concepts?

Racial democracy is maintained in Brazil through both scholarly and popular discourses that consider "interracial" sex as proof of Brazil's lack of a racial problem. In this article, I scrutinize the discourse that asks, "How can we be racist when so many of us are mixed?" I argue that racial discourses are embedded in everyday interactions, but are often codified or masked. "Race" is especially pertinent to sexuality, yet the two have hardly been analyzed together. In fact, it is not the belief in a racial democracy that is at the heart of Brazilian racial hegemony, but rather the belief that Brazil is a color-blind erotic democracy. Using my ethnographic data, I illustrate that "race" is embodied in everyday valuations of sexual attractiveness that are gendered, racialized, and class-oriented in ways that commodity black female bodies and white male economic, racial, and class privilege. [Brazil, race, sexuality, poverty]     

Pre- and postnatal bisphenol A treatment results in persistent deficits in the sexual behavior of male rats, but not female rats, in adulthood

Perinatal administration of the endocrine disruptor bisphenol A (BPA) reportedly inhibits the sexual behavior of sexually naïve adult male rats. In order to evaluate the effects of BPA administration during early development on later reproductive behavior, we administered one of five doses of bisphenol A daily to pregnant female rats throughout gestation and lactation, and quantified the appetitive and consummatory sexual behaviors of the resultant male and female offspring over multiple sexual encounters in adulthood. Males receiving low dose perinatal BPA (50 μg/kg bw/day) showed persistent deficits in sexual behavior in adulthood. Males receiving the highest dose (5 mg/kg bw/day), however, were indistinguishable from controls with respect to consummatory sexual behaviors but showed decreased latencies to engage in those behaviors when sexually naïve, with significant non-linear, or U-shaped, dose-response relationships observed on the first and last day of testing. Adult female sexual behavior was not affected by early BPA administration at any dose tested. These results are consistent with previous reports that BPA exerts behavioral effects especially at low doses, and further indicates that BPA can cause lasting impairment of sexual behavior in males, but does not alter the normal development of female appetitive or consummatory sexual behaviors. To our knowledge, this is the first report indicating that adult sexual performance is impaired in sexually experienced animals following perinatal exposure to bisphenol A.     

The neurogenetics of sexually dimorphic behaviors from a postdevelopmental perspective

Most sexually reproducing animal species are characterized by two morphologically and behaviorally distinct sexes. The genetic, molecular and cellular processes that produce sexual dimorphisms are phylogenetically diverse, though in most cases they are thought to occur early in development. In some species, however, sexual dimorphisms are manifested after development is complete, suggesting the intriguing hypothesis that sex, more generally, might be considered a continuous trait that is influenced by both developmental and postdevelopmental processes. Here, we explore how biological sex is defined at the genetic, neuronal and behavioral levels, its effects on neuronal development and function, and how it might lead to sexually dimorphic behavioral traits in health and disease. We also propose a unifying framework for understanding neuronal and behavioral sexual dimorphisms in the context of both developmental and postdevelopmental, physiological timescales. Together, these two temporally separate processes might drive sex‐specific neuronal functions in sexually mature adults, particularly as it pertains to behavior in health and disease.     

The pollution of incontinence and the dirty work of caregiving in a U.S. nursing home

In U.S. nursing homes, it is the job of nursing assistants to tend to residents' basic bodily needs, including elimination and incontinence care. Given their frequent contact with pollutants, aides are very much at risk of becoming "polluted people." In this article, I investigate how nursing assistants' continual contact with contaminating substances impacts their status within the workplace, their relationships with others, and their attitudes toward their work and themselves as workers. I also explore how aides manage their encounters with pollutants and their stigmatized role as "dirty workers." In doing so, I hope to explicate the meaning of elimination and of incontinence caregiving in the United States.     

"Kissing a Baby Is Not at All Good for Him": Infant Mortality, Medicine, and Colonial Modernity in the U.S.-Occupied Philippines

Feminist scholars have begun to consider the ways indigenous practices of child rearing were and are challenged in (post)colonial discourse and practice, and how these practices have become a terrain on which definitions of nation, state, and economy are contested. In this article, I adopt a historical anthropological approach to consider how Filipino child-rearing strategies were described and stigmatized in educational, public health, and public welfare discourses in the U.S.-occupied Philippines in the early 20th century. I demonstrate how public health practices and discourses that were generated as part of a "benevolent" campaign against high rates of infant mortality were strategically used as a weapon against Filipino arguments for independence. I also consider how discourses constructing Filipino caregivers as overly indulgent were linked to metropolitan concerns about production of the "new industrial man" and were used to develop a racialized critique of the cultural practices of Filipinos.     

Sexual Behavior and Condom Use among Gay Men,Female Sex Workers,and Their Customers: Evidence from South Korea

Background

Despite the significance for sexually transmitted diseases (STD) control in East Asia, few studies have examined the relationship between high-risk sexual behavior and condom use. We investigated how three sexually vulnerable groups for STDs show differences in condom use behaviors (CUBs) depending on their STD infection.

Methods

The source of data came from the National Survey for STD Prevalence Rate and Sexual Behavior of the High-Risk Sexual Community. The effects of behavioral determinants on CUBs were estimated by using path analysis models. An 11-item questionnaire assessing subjects’ health risk behaviors, sexual beliefs, sexual risk behaviors, and condom use.

Results

Condom use was higher for men who have sex with men (MSM; n = 108) when they were bisexuals and had high self-efficacy, for Johns (Johns; n = 118) when they had experience of STD infection, and for female sex workers (FSWs; n = 1,083) when they had high self-efficacy, did not engage in drunken sex, and were anxious about infection. Regardless of whether they were infected with STDs, FSWs always used condom when they had high sexual beliefs. On the contrary, Johns exhibited a negative relationship between sexual risk behavior and condom use when they had experience of STD infection. The variable commonly significant to all three groups was the number of sex partners; but it exhibited a positive relationship with MSMs and Johns, and a negative one with FSWs.

Conclusions

CUBs were related to sexual beliefs as well as sexual risk behavior. At the same time, the experience of STD infection mediated the relationship between the two. Therefore, we need to draw social attention to promote safer sex among STD-vulnerable groups.     

Sex differences in sexual partner acquisition, retention, and harassment during female homosexual consortships in Japanese macaques

Female Japanese macaques (Macaca fuscata) in certain populations are unusual in that they exhibit male-typical patterns of mounting behavior and sexual-partner preference. The goal of this study was to determine whether female Japanese macaques, from one such population, employ male-typical behavioral tactics to disrupt existing homosexual consortships, as well as to acquire and retain same-sex sexual partners. "Harassment" of homosexual consortships occurred when a sexually motivated, third-party male or female interrupted a consorting female couple by displacing or aggressing them. Sexual harassment was a male-typical strategy for disrupting existing homosexual consortships, but was rarely performed by females. "Intrusions" occurred when a male or female competitor attempted to acquire exclusive access to a female engaged in a homosexual consortship by targeting that female as the focus of competition and her partner as his/her competitor. "Sexual coercion" occurred when one individual alternately sexually solicited and aggressed another individual as part of the same behavioral sequence during an intrusion. Males employed consortship intrusions and sexual coercion when they attempted to acquire female sexual partners that were already engaged in homosexual consortships, but females rarely did so. However, females did employ male-typical patterns of aggressive competition and sexual coercion to retain same-sex sexual partners when confronted with male competitors' attempts to usurp those partners. These results indicate that female sexual activity during homosexual consortships is not uniformly "masculine" in expression, but rather is a mixture of male- and female-typical behaviors.     

HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro,Brazil

We conducted the first study to examine rates of sexual activity, sexual risk behaviors, sexual protective behaviors, injection drug use (IDU), needle sharing, and knowledge about HIV/AIDS among outpatients with severe mental illness (SMI) in Rio de Janeiro, Brazil. Using a measure with demonstrated reliability, we found that 42% of 98 patients engaged in vaginal or anal sex within the past three months. Comorbid substance use disorder was significantly associated with sexual activity. Only 22% of sexually active patients used condoms consistently, despite having better HIV knowledge than those who were sexually abstinent. Overall, 45% of patients reported not engaging in any HIV protective behaviors. There were no reports of drug injection. Adults with SMI in Brazil are in need of efficacious HIV prevention programs and policies that can sustain these programs within mental health treatment settings.