Abstract

Background: The literature on young adults’ sex education has mostly focused broadly on sources of information rather than the learning of particular sexual topics. Studies have found differences between men and women in their sex education (e.g.,men learn more from pornography while women learn more from their mothers), yet few of these studies have includedsexual minority emerging adults. This begs the following question: What do young, straight, and LGBTQ men and women learn about sex and from whom?

Methods: This study asked 399 straight, and LGBTQ men and women (ages 18–25) to rate, on a scale of 0–4, how much information they had obtained about 13 topics from 7 sources of information. Data were collected in 2014–2015. Results Results show that young adults learn mainly about sexual risks and reproduction from school, physicians and parents, while they turn to the Internet, peers, partners and pornography to fill the gap. Men obtained more information from pornography about the pleasurable aspects of sexuality than did women, while straight women learned more about these topics from their partners than did other groups. Women also received more information concerning reproduction than did men.

Conclusions: These results confirm that young adults learn much of what interests them most about sex from informal sources such as peers, partners and the Internet. Pornography may also play an inordinate role in young people’s understanding of sexuality. Our approaches to sex education must change if we want to truly have an impact on young adults’ diverse sexualities.

Keywords: Young adults . LGBTQ . Sex education . Pleasure . Risk reduction . Sexual minority . Sexual health information.

Abstract

Pre-exposure prophylaxis (PrEP) is traditionally prescribed by HIV specialist physicians. Given finite specialist resources, there is a need to scale up PrEP delivery by decentralizing services via other healthcare professionals. We aimed to assess the feasibility of delivering PrEP to men who have sex with men (MSM) through primary care physicians and sexual health clinic nurses. We piloted a multi-component, implementation and dissemination research program to increase provision of PrEP through primary care physicians and sexual health clinic nurses in Toronto, Canada. Community-based organizations (CBOs) provided prospective participants with information cards that contained links to an online module on engaging providers in a conversation about PrEP. In our patient-initiated continuing medical education (PICME) strategy, participants saw their family doctors and gave them the card, which also contained a link to a Continuing Medical Education module. In the nurse-led strategy, participants visited one of two participating clinics to obtain PrEP. We administered an optional online questionnaire to patients and providers at baseline and six months. CBOs distributed 3043 cards. At least 339 men accessed the online module and 196 completed baseline questionnaires. Most (55%) intended to visit nurses while 21% intended to consult their physicians. Among 45 men completing follow-up questionnaires at 6 months, 31% reported bringing cards to their physicians and obtaining PrEP through them; sexual health clinics delivered PrEP to 244 patients. Participants who went through the PICME approach reported no changes in relationships with their providers. Nurses showed fidelity to PrEP prescribing guidelines. Nurse-led PrEP and patient-initiated continuing medical education (PICME) for primary care physicians are feasible strategies to increase PrEP uptake. Nurse-led PrEP delivery was preferred by most patients.