Sarwar Golam, Morshed Khan Mohammad Niaz, Gourab Gorkey, Irfan Samira Dishti, Rahman Mahbubur, Rana Akm Masud, Khan Sharful Islam
Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Heliyon. 2023 Apr 17;9(4):e15553. doi: 10.1016/j.heliyon.2023.e15553. eCollection 2023 Apr.
There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs.
This qualitative study constituted 30 in-depth interviews, 14 focus group discussions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied.
Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV intervention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities.
In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.
目前，针对性别和性取向多元人群（即男男性行为者和跨性别女性）中的肛交和性传播感染（STIs），已有大量研究和干预举措。然而，口交和口腔性传播感染并未得到同等程度的重视，尽管它们也存在令人担忧的影响。本文旨在阐明无保护口交的潜在背景以及口腔性传播感染的管理挑战。
这项定性研究包括对性别和性取向多元人群、艾滋病毒干预服务提供者及性取向研究人员进行30次深入访谈、14次焦点小组讨论和10次关键信息访谈。采用了主题分析方法。
研究结果揭示了无保护口交的多种背景。具体而言，我们发现愉悦与安全性行为之间存在不一致，参与者认为这两种现象相互排斥，因此他们不想因使用避孕套而影响愉悦感。此外，他们对无保护口交危害的认识不足、风险认知较低以及存在未受质疑的误解，这加剧了他们在口交时使用避孕套的犹豫。与肛交和性传播感染相比，在当前的艾滋病毒干预模式中，口交和口腔性传播感染的优先级较低，医疗保健提供者缺乏关于口交和口腔性传播感染及其复杂性的足够知识和培训。
在孟加拉国和其他一些地区，口交被视为禁忌，因此围绕这个问题及其复杂性存在沉默现象。在这种情况下，消除围绕口交和口腔性传播感染的禁忌和沉默对于加强整体性传播感染管理策略至关重要。因此，艾滋病毒/性传播感染预防项目和主流医疗设施需要强调口腔性传播感染干预措施，否则这个问题仍将得不到足够重视。
