Researchers at the Center for Sexual Health Promotion, in conjunction with our academic and community partners, pursue a progressive research agenda in sexual health. Below are the some of the core areas within which our individual research projects fall. To learn more about our work, visit our publications and presentations page and feel free to contact our faculty and staff to learn more about individual projects.
National Survey of Sexual Health and Behavior (NSSHB)
The National Survey of Sexual Health and Behavior (NSSHB), initially conducted by researchers from the Center for Sexual Health Promotion in 2009, is one of the most comprehensive studies on these topics in almost two decades. It includes the sexual experiences and condom-use behaviors of 5,865 adolescents and adults ages 14 to 94. Findings from the largest nationally representative study of sexual and sexual-health behaviors ever fielded, conducted by Indiana University sexual health researchers, provide an updated and much needed snapshot of contemporary Americans’ sexual behaviors, including a description of more than 40 combinations of sexual acts that people perform during sexual events, patterns of condom use by adolescents and adults, and the percentage of Americans participating in same-sex encounters. We continue to collect NSSHB data annually, often highlighting specific sexuality-related issues or sub-populations in various years.
As prior research has demonstrated that bisexual individuals experience profound health disparities in comparison to both heterosexual and gay and lesbian individuals, we are dedicated to exploring the unique health issues faced by diverse bisexual populations, in direct response to calls for such resources from the Institute of Medicine and National Institutes of Health.Health disparities among lesbian, gay, bisexual, transgender, and other sexual and gender minority people exist across the lifespan, and are increasingly well-documented, but gaps remain in our basic understanding of how health status, behaviors and outcomes vary within these groups, especially bisexual individuals. A growing body of evidence suggests that bisexual-identified individuals experience significant health disparities in comparison to heterosexual and gay/lesbian-identified individuals. These include higher rates of mood and anxiety disorders, substance use (including tobacco use), suicidality, as well as disparities related to healthcare access and utilization. However, bisexual individuals remain relatively invisible in public health research except when studied almost exclusively through a lens of sexual risk behavior. Our work in this area involves co-directing the Bisexual Research Collaborative on Health (BiRCH), an ongoing multi-institutional scientific initiative focused on health and well-being among bisexual individuals.
National Study of Stigma and Sexual Health (NSASH)
Gay and bisexual men (GBM), and other men who have sex with men (MSM), represent the largest group of individuals infected with HIV in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime. Extant research has largely focused on identifying individual- and interpersonal-level risk factors for HIV infection among GBM; however, accumulating evidence also points to structural determinants of HIV outcomes in this population. In particular, recent research has demonstrated that structural stigma (defined as societal- level conditions, cultural norms, and institutional policies that constrain the resources and opportunities of stigmatized individuals) is associated with adverse health outcomes, including HIV risk, among GBM. The few existing studies of structural stigma and HIV outcomes among GBM have been limited by a reliance on cross-sectional designs, a small number of structural covariates, little attention to mediators/moderators of the structural stigma-HIV risk association, and non-probability samples of GBM. To address these limitations, we are maintaining a prospective probability study of HIV-uninfected/unknown status GBM (N=500) who are being followed for 5 waves of data collection over a 24-month period (sponsored by the National Institute of Mental Health, R01MH112384, MPI: Dodge/Hatzenbuehler). This will be the first and largest prospective study with a nationally representative sample of GBM specifically designed to: (1) examine whether structural forms of stigma related to sexual identity increase vulnerability to adverse HIV prevention outcomes (e.g., less HIV testing and PEP/PrEP use); (2) identify mutable mechanisms (e.g., self-stigma, depressive symptoms, safer-sex self efficacy) through which structural stigma influences HIV outcomes; and (3) evaluate resilience processes (e.g., LGB community connectedness) that may mitigate the negative effects of structural stigma on HIV outcomes.s. This project stands to make important contributions to research on reducing disparities in the incidence of HIV infections among GBM, identified as a high NIH HIV/AIDS research priority.
Gender, Sexuality & Health
Women’s experiences related to sexuality are unique due to biological reasons (e.g., female anatomy, hormones, etc), life experiences such as pregnancy or menopause, as well as socio-cultural factors that may affect their sexual expression. As such, much of our research is influenced by a desire to learn more about women’s sexual health and sexual expression. This is reflected in several of our research studies including those related to women’s use of lubricants, sexual health information seeking behaviors of women in in-home sex toy party settings, women’s use of sex toys, and sexual function following treatment for breast cancer. In addition, we have dedicated our research efforts to developing and testing reliable and valid measures of attitudes toward women’s genitals, and to understanding the social and behavioral contexts of vulvovaginal pain and discomfort. Men also face distinctive sexual health issues on the basis of their gender. For example, men comprise over half of those who are HIV infected worldwide and the majority of infections in women have been attributed to sexual activity with HIV positive men. Public health entities, including the National Institutes of Health, have recently called for more research on gender and HIV risk. Men’s gender roles and norms may influence sexual behavior in numerous specific ways and contexts. Our ongoing research projects related to men’s sexual health include understanding men’s use and non-use of condoms, relations between men’s sexual orientation and identity to their sexual and risk behaviors, and innovative methods of reaching men with sexual health services (including testing and routine care).
Creating safe and supportive environments is critically important for overall health and wellbeing among sexual and gender minority (SGM) youth. “Sexual and gender minority” is an umbrella term that encompasses lesbian, gay, bisexual, and transgender populations as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms. SGM youth are more likely than their heterosexual peers to experience a wide range of health disparities and related difficulties. Bisexual and transgender youth bear particularly disproportionate rates of these outcomes. These findings suggest that SGM youth may be enmeshed in a web of synergistic epidemics (syndemics), in which such disparities interact with one another in a chain reaction of negative health outcomes propelled by early life adversities including isolation, stigma, discrimination, lack of community, and trauma. However, many such health disparities and their outcomes have been shown to be buffered by protective factors that increase resiliency, especially social support mechanisms offered by SGM community and community-at-large attachments. As yet, the role of such community connections among SGM youth have not been examined outside the context of large urban areas on the East or West Coasts of the United States with well-established LGBTQ+ communities and access to the resources that these may facilitate. We are currently working on the development, implementation and sustainability of an academic-community initiative, the IU-Prism Health Partnership. that benefits from the strong organizational context, sustainable structures, and youth-centered focus to implement health studies and programming in South Central Indiana and beyond. We are also collaborating on intervention development for bisexual male youth, a particularly at-risk population, with colleagues at Northwestern University Instittue for Sexual and Gender Minority Health and Wellbeing (ISGMH).
Community Based Participatory Research (CBPR) and Sexual Health
To effectively promote sexual health requires that researchers seek to fully understand the complexity of human sexual expression within the context of the lived experiences of individuals and the communities in which they are embedded. To accomplish this, our Center has remained committed to research that incorporates the principles of community based participatory research. Our students receive intensive training in the application of these principles to sexual health research and the vast majority of our work across all priority areas is grounded in participatory mechanisms. We are also highly committed to sharing and dialoguing on our own, and our colleagues', scientific research with diverse communities using a innovative community-based mechanisms, including the Bloomington Sex Salon.
Global Sexual Health
Sexual health research, particularly given the nature of global sexual health concerns like HIV/AIDS, requires us to be active global citizens and to facilitate the growth of scholars focused on sexual health in other nations. Our Center currently has strategic research partners in Africa, Europe, Latin America and Asia. Through our IU-UPR Partnership for Sexual Health Promotion with our sister center, the Latin American Center for Sexual Health Promotion, based in the School of Public Health at the University of Puerto Rico, we have a long-term commitment to research and doctoral student mentorship related to sexual health in the Caribbean. Similarily, the U.S.-India Partnership for Sexual Health Promotion has facilitated unique opportunities for research and educational exchange in India, with a focus on sexual and gender minority health.