The authors propose an expanded 8 Ps framework for sexual health history-taking that introduces 'Proximity' and 'Perspectives' to address limitations of existing behavior-centric frameworks by incorporating social, structural, and environmental determinants of sexual health.
Key Findings
Background
The CDC's 5 Ps framework for sexual health history-taking is behavior-centric and has the capacity to introduce bias, stigma, and shame, potentially hindering effective communication and preventative care.
The 5 Ps framework emphasizes how an individual's current and past behaviors can predict a client's susceptibility to poor sexual health outcomes.
The authors characterize this approach as 'behavior centric' and identify it as a limitation in patient-provider sexual health communication.
The framework is described as potentially hindering 'effective communication and preventative care.'
Background
The National Coalition for Sexual Health's 6 Ps framework expanded upon the CDC's 5 Ps by introducing 'Plus' to include sexual satisfaction as an integral part of sexual health communication.
The 6 Ps framework is identified as a prior attempt to address limitations of the 5 Ps model.
Sexual satisfaction was added as the sixth 'P' (Plus) to broaden the scope of sexual health discussions beyond disease and risk.
The authors use this framework as a stepping stone toward their proposed 8 Ps model.
Results
The authors developed a novel 8 Ps framework that adds 'Proximity' and 'Perspectives' to existing sexual health history frameworks.
'Proximity' refers to the influence of one's living and sexual environment, incorporating geographical determinants of health.
'Perspectives' highlights how personal beliefs fundamentally shape behaviors.
The framework is designed to 'reorient providers toward a paradigm that fosters more inclusive and affirming sexual health discussions.'
The expanded model is intended to improve patient-provider communication and connection.
Results
The proposed 8 Ps framework aims to acknowledge broader social and structural determinants that shape sexual well-being and vulnerability to HIV and other STIs.
The framework is intended to address 'the broader social and structural determinants that shape sexual well-being and vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).'
The authors argue that fortifying sexual health discussions with 'non-behavioral context' can begin to address limitations in prior frameworks.
Geographical determinants of health and general understanding of sexual health are cited as examples of non-behavioral context to be incorporated.
Conclusions
The 8 Ps framework is proposed as a tool to promote more inclusive, affirming, and sex-positive sexual health care in the United States.
The framework is described as designed to foster 'more inclusive and affirming sexual health discussions.'
The authors frame healthcare providers as playing 'a vital role in promoting comprehensive, sex-positive sexual health care.'
The framework is positioned as addressing the capacity of prior frameworks to introduce 'bias, stigma, and shame.'
What This Means
This research describes a new proposed framework for how healthcare providers in the United States can take sexual health histories from their patients. The most widely used current approach, developed by the CDC, uses a '5 Ps' structure that focuses heavily on patients' past and present sexual behaviors to assess their risk for HIV and other sexually transmitted infections. The authors argue that this behavior-focused approach can unintentionally introduce bias, stigma, and shame into medical conversations, which may discourage patients from being open and may limit the quality of care they receive.
To address these shortcomings, the authors propose an expanded '8 Ps' framework that builds on existing models by adding two new dimensions: 'Proximity,' which accounts for where a person lives and the nature of their social and sexual environment, and 'Perspectives,' which recognizes that personal beliefs and attitudes shape how people think and behave around sexual health. These additions are meant to shift the conversation away from placing all responsibility on individual behavior and toward recognizing that social, geographic, and structural factors also play important roles in sexual health outcomes.
This research suggests that updating how providers collect sexual health histories to include environmental and belief-based factors could lead to more respectful, complete, and effective conversations between patients and providers. By moving beyond a purely behavior-centric model, the framework aims to reduce stigma and better capture the full range of factors that influence a person's sexual health and their vulnerability to infections like HIV.
Duroseau B, Johnson R. (2025). A Novel 8 Ps Framework for Addressing Complexities in Sexual Health Histories for US Healthcare Providers.. Perspectives on sexual and reproductive health. https://doi.org/10.1111/psrh.70037