A Novel 8 Ps Framework for Addressing Complexities in Sexual Health Histories for US Healthcare Providers

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CONTEXT: Healthcare providers play a vital role in promoting comprehensive, sex-positive sexual health care. In the United States (US), patient-provider communication frameworks for sexual health predominantly rely on collecting the sexual health history. The most notable framework, the US Centers for Disease Control and Prevention's 5 Ps framework, emphasizes how an individual's current and past behaviors can predict a client's susceptibility to poor sexual health outcomes. However, this behavior centric approach has the capacity to introduce bias, stigma, and shame, potentially hindering effective communication and preventative care. The National Coalition for Sexual Health's 6 Ps framework introduced "Plus" to include sexual satisfaction as an integral part of sexual health communication. METHODS: Building on these existing frameworks, we developed an expanded model designed to reorient providers toward a paradigm that fosters more inclusive and affirming sexual health discussions, improves patient-provider communication and connection, and acknowledges the broader social and structural determinants that shape sexual well-being and vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). RESULTS: We propose an expanded 8 Ps sexual health history that introduces "Proximity," which refers to the influence of one's living and sexual environment, and "Perspectives," highlighting how personal beliefs fundamentally shape behaviors. CONCLUSION: Fortifying the sexual health discussions between providers and patients with non-behavioral context, such as geographical determinants of health and understanding of sexual health in general, that increase vulnerability to HIV and other STIs can begin to address the limitations in the prior frameworks.

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