VCU news

By Brian McNeill

The Robert Wood Johnson Foundation has awarded a major research grant to Virginia Commonwealth University to develop, test and implement a comprehensive assessment of sexual health. B. Ethan Coston, Ph.D., an assistant professor in the Department of Gender, Sexuality and Women's Studies in the College of Humanities and Sciences, will serve as principal investigator.

The grant, “Improving Sexual Health for 2LGBTQIA+ People in the U.S.,” totals $462,748, making it the largest in the history of Virginia Commonwealth University’s Department of Gender, Sexuality and Women’s Studies.

It was awarded through the Robert Wood Johnson Foundation’s Pioneering Ideas: Exploring the Future to Build a Culture of Health program, which supports projects that advance health equity and offer “unconventional approaches and breakthrough ideas that can help lead the way to a future where everyone in the United States can live their healthiest life possible.”

“The ‘Sexual health, Erotic life and pleasure eXperiencing (SEX) Assessment’ is a project aimed at bringing together community members, students, scholars, policymakers and field experts to learn as much as we possibly can about the pleasurable and positive aspects of sexuality. And then, using that knowledge, inform meaningful and comprehensive community level sexual health initiatives, state and/or federal level sexual health education policies and institutional/grant-funder priorities for sexual and gender minoritized health,” Coston said.

The SEX Assessment will measure the breadth and depth of the sexuality prism, Coston said, including sexual beliefs, desires, patterns of behaviors, and identities, with a focus on assets such as identity pride, community consciousness, self-esteem, affirmative models of consent, aspects of pleasure (including feelings, behaviors and physical outcomes), affirmative health behaviors and health-related outcomes.

The first phase of the project is underway, and will involve various qualitative and quantitative data collection techniques, including a diary study in which participants will document their sexual experiences related to desires, fantasies, behaviors, interpersonal relationships and patient-provider interactions; focus groups across the U.S. that will explore aspects of sex, sexuality and sexual health; and a survey of 5,000 people.

In the project’s second phase, which will occur in years three to five and is not currently funded by the Robert Wood Johnson Foundation, Coston’s research lab will work to adapt and validate the SEX Assessment for specific subpopulations, primarily disabled, neurodivergent and/or trans and gender-independent samples. They also will work to establish a collaborative knowledge-sharing consortium, bringing together collaborators to collect additional data, share findings, publish together, mentor graduate and undergraduate students, fund postdoctoral positions, and work to inform meaningful policy and praxis change regarding sexual health.

“Working together with our Community Steering Committee, which will include both community members and experts from the [National Institutes of Health, Centers for Disease Control and Prevention] and other governmental and [nongovernmental organizations], we also aim to shift individual sexual health beliefs and behaviors for LGBTQIA2+ and other sexual and gender minoritized people; inform organizational and community-level programming related to [sexually transmitted infections], teen pregnancies, and queer and trans-inclusive safe sex practices; and guide institutional and grant-funder priorities and policies surrounding sex, gender and health,” Coston said.

VCU students are already playing an important role in the project. Four undergraduate research assistants — Kiana Bragg, Jamie Hill, Victoria Thomas and Keaton Thorum — have been conducting a systematic meta-review of literature on the topic. The students are being paid through internal funding mechanisms, including a seed grant from the College of Humanities and Sciences awarded to Coston last year for their project, “In Pursuit of Pleasure: Is ‘Sexual Health’ More Than an Absence of Disease?”

Coston said the project is critically necessary, especially amid the context of “waves of anti-2LGBTQIA+ and anti-bodily autonomy legislation (proposed and passed), which are linked to the broader suppression of direct, accurate and asset-focused information about sex, sexuality and sexual health.

“This suppression works in tandem with community-level and social epistemic cultures, and rhetorical strategies, to regulate all those who are deemed ‘deviant others,’” they said. “We continue to see increased violence against 2LGBTQIA+ people — including within the health care system — and increased criminalization and incarceration — including within psychiatric institutions. Ultimately, the lack of information, education and dialogue about the breadth and depth of sexuality, especially the innovative and strengths-based ways in which sexual and gender minoritized people navigate their sexual worlds, limits the types of sexual health interventions that receive funding from federal agencies, and impedes the impact that individual researchers and siloed clinicians and community service providers are able to have.

“As such,” they said, “our work is a necessary counterframe, centering not only the narratives and experiences of 2LGBTQIA+ flourishing, joy and pleasure, but also working to proliferate competent and comprehensive sexual health education for all.”