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Sexuality In STI Causation: Pathophysiologic Interpretation, Lesson To Society
Date Posted: 06/Sep/2019
University of Enugu
Sexuality a widely shared expectations and norms within a society about appropriate male and female behavior, characteristics, and roles in sexual activities  has been recognized as one of the most important social factors influencing vulnerability to sexually transmitted infections (STI), including the human immunodeficiency virus (HIV), worldwide. In the developing countries, there has been a changing pattern of STI among male and female. Early cases in many countries were concentrated in male homosexuals and intravenous drug users. But as the epidemic continues to spread, there has been a progressive shift towards heterosexual transmission and increasing infection rates among females (WHO, 2013). The reality today is that, globally, more women than men are now dying of STI (HIV/AIDS), and the age patterns of infection are significantly different for the two sexes. Beyond the statistics of sex-based differences in infection rates, there are profound differences in the underlying causes and consequences of STI (HIV/AIDS)  in male and female, reflecting differences in biology, sexual behavior, social attitudes and pressures, economic power and vulnerability (Adeyemi, 2011). 
The objectives of this presentation are to:
1.Explain the concept of Sexuality
2.Discuss sexuality in STI causation
3.Discuss the pathophysiologic interpretation of  STI
4.Outline  the lesson of sexuality in STI to the society
Operational Definition 
Sexuality: Refers to male or female sexual feelings, thoughts, attractions and behaviours towards one another. 
Causation: The  process of causing something to happen or exist.
STI: Infection acquired by sexual contact from person to person or through some non-sexual means.
Pathophysiologic interpretation: the  cultural way  people explain the disease process.
Concept of Sexuality.
Human sexuality is the way people experience and express themselves sexually.(Joan Ferrante,2014) This involves biological, erotic, physical, emotional, social, or spiritual feelings and behaviors.  The biological and physical aspects of sexuality largely concern the human reproductive functions, including the human sexual response cycle. Physical and emotional aspects of sexuality include bonds between individuals that are expressed through profound feelings or physical manifestations of love, trust, and care. Social aspects deal with the effects of human society on one's sexuality, while spirituality concerns an individual's spiritual connection with others. Sexuality also affects and is affected by cultural, political, legal, philosophical, moral, ethical, and religious aspects of life.  (Bolin, Anne; Whelehan & Patricia ,2009). 
Our Sexuality also determine how we are affected and our reactions to STI . Sexually transmitted infections (STIs) also referred to as sexually transmitted diseases (STDs) are infections that are commonly spread by sexual activity, especially vaginal intercourse, anal sex and oral sex and are key reproductive and public health concern, especially in this era of HIV/AIDS. The World Health Organization (WHO) estimates that approximately 448 million infections occur worldwide, and about 47 % of them are among women (WHO, 2013). Gender relations and sexual behaviours are pivotal in influencing sexual and reproductive health, as well as the general well-being of individuals and communities. Gender-based inequities have been associated not only with inequities in health but also with increased exposure to STIs (Pederson, Greaves & Poole, 2015). Gender relations have a bearing on sexual behaviour, which in turn could determine one’s STI status. Socially constructed gender-based expectations define power relations, roles, obligations, and relationships between men and women. Inequities in gender relations are often to the disadvantage of women, since women usually have a subordinate role in sexual relations. 
In Uganda, the prevalence of STIs among women of reproductive age increased from 22% in 2006 to 27 % in 2011.The prevalence of STIs among women in union increased from 23% in 2006 to 27 % in 2011. In this case, women in union mean women who are either married or cohabiting. The Uganda AIDS Indicator Survey conducted in 2011 provided a higher estimate of women in union with STIs, at 37 %, a number that highlights the gravity of the situation in Uganda (Ministry of Health Uganda, 2012). It is particularly important to note that in Uganda and in some sub-Saharan Africa, for instance in Zambia and Rwanda, the level of new HIV infections is higher among persons in union than in those  not in union. 
In Nigeria, Gonorrhea is the most prevalent sexually transmitted infections (STIs). Recent surveys report gonorrhea prevalence to be as high as 28.1%. Most women at STI clinics have vaginitis and vaginal discharge. Even though the prevalence of trichomoniasis and candidiasis are rather high (10.2 – 22.3% and 4.33% respectively), bacterial vaginosis is the leading cause of vaginitis and vaginal discharge in Nigeria (Ogunbanjo, 2010).
Beyond the statistics of sex-based differences in infection rates, there are profound differences in the underlying causes and consequences of HIV/AIDS infections in male and female, reflecting differences in biology, sexual behaviour, social attitudes and pressures, economic power and vulnerability. STI transmission patterns have conformed to the cultural patterns of gender expression in the Indian society, such as culturally imposed silence about discussing sex, unequal norms about sexual morality, rights, power and educational opportunities between the sexes, and changing traditions. For married women in India, HIV and STI transmission has been largely attributed to a spouse who had multiple partners, male resistance to condom use and women's inability to negotiate safer sex (Sanchez, Phelan, Moss-Racusin, & Good, 2012). Empowerment has been associated with improvement in health and development outcomes (Johnson, 2013). Empowerment is a process through which people gain control over their own lives. 
It is usually associated with an improved quality of life. It is a multidimensional process through which persons lacking in certain resources or capabilities gain access to or control over those resources/capabilities. Empowerment relates to agency, whereby empowered persons are able to make strategic life choices (implying availability of alternatives) and can have the power to achieve their goals (Mahmud, Shah & Becker, 2012). Sexual empowerment in this case primarily addresses issues associated with the individual woman and her interpersonal relationships with her partner. It mainly relates to “power within” that is, self confidence, a sense of self-worth and assertiveness, perception of the right to self-determination, and the confidence to act to attain the desired change in sexual relations. It also includes the “power to” that is, having decision-making authority in sexual relations (Crissman, Adanu & Harlow, 2012).  
In sexual empowerment mainly addresses the “power within” in relation to a woman’s perception of her ability to negotiate safer sex and the “power to” in relation to her participation in decision-making concerning her own health. Women and/or their partners may engage in risky sexual behaviours that expose them to STIs. Contextual gender relations are important in influencing sexual behaviours, which include sexual and gender-based violence (SGBV), multiple sexual partnerships including polygyny, transactional sex, and unprotected sex (Antai, 2011). Sexual behaviours are closely associated with a partner’s controlling behaviours, alcohol consumption, control over resources and household decision-making. While fidelity is expected within marriage, marital partners may not be fully protected against STIs if either partner engages in risky sexual behaviours outside the union. 
According to Part, Rahu & Karro (2011), adherence to traditional gender roles related to sexual activity is stronger among females than males. Negotiating safer sex in such relationships is a challenge. Outside union, having trust in a relationship reduces the likelihood of condom use. Within union, condom use is often resisted or not seen as necessary and is therefore limited. In most settings, faithfulness and trust are expected within marriage, and regular sexual activity is more or less deemed a right especially for the male partner. STI and HIV infections among women are attributed to both biological and gender-related social factors. Women are biologically more prone to STIs, including HIV (Chersich & Rees, 2018). But women and adolescent girls also are disproportionately affected by STIs due to masculine ideals of risk taking, sexual conquest, and promiscuity.

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