Understanding communication and negotiations about sexual activity in sub-Saharan Africa: A qualitative evidence synthesis

Lucia Knight, Hilton Humphries

Research output: Unpublished contribution to conferencePoster

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Abstract

Objectives- Sexual communication and negotiation- about, before or during sexual activity- has been acknowledged as a key factor influencing sexual and reproductive health (SRH) and well-being. From a public health standpoint, sexual communication is important to promote safer sex for the prevention of sexually transmitted infections (STIs) and HIV. Growing recognition of the role of pleasure in the sexuality discourse highlights the importance of promoting sexual satisfaction and strengthening romantic relationships. Considering the crucial role of sexual communication in risk-avoidant and pleasure-focused aspects of SRH, understanding how couples discuss and decide about sexual activity is critical. There is limited research exploring sexual communication within intimate relationships, particularly in sub-Saharan Africa (SSA). This review aims to provide an evidence-based understanding of communication and decision-making around sexual activity in SSA.

Method- This study utilised a qualitative evidence synthesis (QES) approach. The study included both published and unpublished qualitative research studies focusing on experiences or perspectives of discussion and decision-making around sexual activity in SSA. PubMed, EMBASE, Scopus, and PsycINFO were searched for peer-reviewed literature, while ProQuest was searched for unpublished dissertations and theses. Text from the ‘results’, ‘findings’, ‘discussion’ and ‘conclusion’ sections of the included studies was extracted as data and a thematic synthesis approach to qualitatively analyse this data is underway.

Emerging findings- 14 qualitative studies exploring sexual communication and decision-making were included in this review. These studies included experiences of adolescents, young adults, married couples, people living with HIV and men who have sex with men, and focussed on sexual discussions for a range of issues. An analysis of these studies found that communication around prevention and safer sexual practices such as condom and contraception use was the most common, although seldom direct and specific, and involved non-verbal cues or silences. Despite a focus on risk, aspects of pleasure did appear in reference to conversations of risk. Gender roles and norms, relational power dynamics and transactional negotiations influence how sexual activity is discussed or negotiated and may influence SRH outcomes and risk. These factors are interrelated, and should be viewed as a complex, interacting system rather than discrete categories.

Discussion- Two key preliminary findings with relevance to public health interventions to reduce risk of STIs and HIV emerge from the analyses. Firstly, communication appears to rely on indirect communication. However, this is at odds with how sexual negotiation is portrayed in current safe-sex messaging which emphasises assertive communication through negotiation scripts. Social norms make this difficult, particularly when communicating sexual desire, consent, or pleasure. Secondly, research about communication and negotiation about sex is focused on issues relating to risk and safety. However, participant narratives delved deeper into dynamics of intimate relationships and sexual desire with social norms and their personal agency influencing discussions. There is a need for STI and HIV research and interventions to better understand both indirect sexual communication while considering both respondent’s own framing of sexual communication and negotiation, and highlighting the importance of love, pleasure and desire in the sexuality discourse.
Original languageEnglish
Publication statusPublished - 13 Jun 2023
EventAIDS Impact Conference - Stockholm, Sweden
Duration: 12 Jun 202314 Jun 2023
https://www.aidsimpact2023.com/

Conference

ConferenceAIDS Impact Conference
Country/TerritorySweden
Period12/06/2314/06/23
Internet address

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