Negative Sexual Health Outcomes Research Articles

Paternal Perspectives on Latino and Black Sons' Readiness for Sex and Condom Guidance: A Mixed Methods Study.

Although a large proportion of males in the United States become sexually active during high school, condom use is decreasing and contributing to negative sexual health outcomes. Fathers are influential in promoting adolescent male sexual health; however, factors that shape fathers' decisions about when to discuss condom use with their sons remain understudied. We examined paternal perceptions of adolescent males' readiness for sex relative to fathers providing guidance for condom use in Latino and Black families. We recruited 191 Latino and Black males aged 15-19 years and their fathers in the South Bronx, New York City. Dyads completed surveys, and a subset of fathers participated in audio-recorded sessions with a father coach, which included conversations about adolescent male condom use. A sequential explanatory mixed methods design identified adolescent male developmental predictors for paternal guidance for condom use and explored how fathers perceive their sons' readiness for sex. The quantitative findings indicate that paternal perception of their sons' readiness for sex is an important predictor of providing guidance for condom use, and that fathers consider other factors (beyond age and perceived sexual activity) in understanding their sons' developmental readiness for sex. The qualitative findings provide insights into these additional factors, which should be considered when engaging fathers in primary care around issues of adolescent male condom use. Fathers' perception of their sons' readiness for sex is a predictor of providing condom guidance. We provide practical suggestions for engaging fathers in primary care to promote correct and consistent condom use by adolescent males.

Past experiences and preferences for LGBTQ + sex education among LGBTQ + college students

Background: Lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) students experience more negative sexual health outcomes than their cisgender, heterosexual peers and do not have access to relevant sex education. This denial necessitates comprehensive sex education in college for LGBTQ + students. Objective: Given the rise of online learning and that LGBTQ + students are already drawn to online spaces, this research seeks to determine preferences in virtual LGBTQ + sexuality education content and delivery LGBTQ + college students. Methods: We conducted a survey with US college students who identified as LGBTQ+ (N = 91) to identify past experiences with sex education, desires for future sex education, and preferences for online learning. Results: Past sex education, resources used, consequences, preferences for LGBTQ + sexuality and online education are discussed. Conclusions: Overall, we find high comfort with online learning, heteronormative and cisnormative past sex education courses created negative physical and mental health outcomes, and desires for tailored sex education.

The end point of it is abstinence: a qualitative analysis of underlying factors influencing Christian leaders’ adoption and implementation of sex and sexuality education in Bolgatanga, Ghana

Adolescents’ sexual and reproductive health challenges are of global public health concern and good quality sexual and reproductive health (SRH) education has an important role to play in addressing these negative sexual health outcomes. Yet in most Sub-Saharan African countries including Ghana, there is limited implementation of SRH education. Several environmental factors hinder the implementation of SRH education with the attitudes expressed by religious leaders having a major impact. We conducted semi-structured interviews with 15 Christian leaders in Bolgatanga, Ghana, to explore the factors influencing their decision to adopt and implement SRH education. Findings show that although Christian leaders were aware of (unsafe) sexual practices among adolescents, they held a conservative position on SRH education. While leaders were open to educating adolescents about sexual health, most held the opinion that SRH education for adolescents should be limited to abstinence-only and not acknowledge sexual activity or promote contraceptive use. Beliefs related to sexual morality, the perceived cause(s) of teenage pregnancy, and perceived responsibility for SRH education influenced Christian leaders’ thinking about SRH education. Implementing SRH education programmes to address young people’s sexual behaviour will require intervention programmes to change Christian leaders’ beliefs and attitudes towards SRH education.

The sexual and reproductive health covariates of early menarche among adolescent girls.

Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls. The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy). Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample. These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.

Sexual and reproductive health knowledge, attitudes, and behaviors: A survey of 12-17 year old Sudanese refugees in Chad.

Adolescents living in humanitarian settings are often at a higher risk of negative sexual and reproductive health outcomes, and yet, limited information is available on adolescents' experiences and needs in these settings while available services do not always correspond to their needs. This study explored knowledge, attitudes, and behaviors relating to sexual and reproductive health among 12-17 year old refugees from Darfur currently living in two refugee camps in eastern Chad. The research team conducted a cross-sectional survey of 689 adolescent girls and boys, informed by participatory research activities, to explore key sexual and reproductive health topics. This study found that sexual and reproductive health knowledge among adolescents is low, with only 69.1% able to identify at least one modern contraceptive method. Early marriage was uncommon (5% of girls, 0.8% of boys), but 17.6% of adolescents had already had a romantic relationship. Few adolescents (11.4%) had ever had sex, but among these adolescents,18.4% reported using a condom the last time they had sex. No boys reported current modern contraceptive use, but 28.3% of girls, both married and unmarried, reported current use. These findings demonstrate the importance of making sexual and reproductive health services in humanitarian settings more adolescent-responsive and minimizing barriers to access, including addressing community stigma surrounding adolescents' use of sexual and reproductive health services and increasing trust in the confidentiality of sexual and reproductive health services in the camps.

The Moderating Role of Sexual Orientation in the Association Between Religiosity and Sexual Behaviors Among College Students.

Past research has shown that religiosity can impact sexual behaviors of college-aged youth in both positive and negative directions. As many world religions promote doctrines that include negative views toward sexual minorities, the current study aimed to examine the potentially differential ways religiosity is related to sexual behaviors across various sexual orientations. College/university students across Oregon (N = 1553) completed an online cross-sectional survey in which they provided information about their sexual orientation, levels of religiosity, religious affiliation, and endorsed recent sexual behavior outcomes. Using logistic models in PROCESS, sexual orientation was examined as a moderator of the relations between religiosity (assessed via the Centrality of Religiosity Scale; Huber & Huber) and religious affiliation and the occurrence (yes vs. no) of three sexual behaviors in the past 6months: birth control use during sex, sexual activity under the influence of substances, and testing positive for an STI. Covariates were age and natal sex. Religiosity was related to reduced birth control use in heterosexual and gay/lesbian individuals. Religiosity was not associated with sexual behaviors in bi/pansexual college students. Findings show that religiosity was a salient construct for understanding sexual behaviors in heterosexual and gay/lesbian college students, but not in bi/pansexual college students. Given that religiosity has differential effects for various sexual behaviors that can heighten risk of negative sexual health outcomes, recommendations are made for increased and tailored sexual health education to religiously identified college students.

A study on the reliability and validity of the Korean version of the parenting outcome expectancy scale for parents of elementary school students.

Many parents do not engage in active discussions with their children about sexuality. This can contribute to negative sexual and reproductive health outcomes among youth. To foster a healthy environment for sexual activity, it is crucial for parents to provide comprehensive sex education to their children at home. This study aims to cross-culturally adapt and evaluate the psychometric properties of a Korean version of the Parenting Outcome Expectancy Scale to measure the sexual communication abilities of parents of elementary school students in South Korea. The study participants were parents of elementary school students between 6 to 13 years old. We used exploratory and confirmatory factor analyses to examine the reliability and validity of the 23-item Korean version of the Parenting Outcome Expectancy Scale. The study confirms the reliability and validity of the scale, comprising five factors and 22 items, for the evaluation of the outcome expectancy of communication about sex between parents and their children. Results also demonstrate that talking about sex is still a challenge for many parents. This instrument can help parents prepare for sex communication with their children and for sexual education, potentially yielding a positive effect on children's sexual health and parental satisfaction.

Intergenerational trajectories of inherited vulnerabilities amongst young women refugees in South Africa

There is a paucity of scholarship examining the situated vulnerabilities of young women refugees who are either born in (second generation) or young children/adolescents on arrival in their host country (“1.5 generation”) and how these may impact intergenerational vulnerability or resilience. Based on qualitative research carried out in eThekwini (formerly known as Durban), South Africa amongst young women refugees (18–24 years) we highlight the issue of “inherited vulnerability”, examining how vulnerabilities can be transmitted across the refugee generations due to legal, economic and social structures which produce and maintain situations of inequality, rendering young women vulnerable to violence, exploitation and negative sexual and reproductive health outcomes. Ending the legal limbo in which they live and ensuring access to education and employment opportunities would help break the cycle of intergenerational precarity and support resilience of these young women as they transition to adulthood in South Africa.

(078) Assessing Women's Sexual Well-being in the Context of Relationship Status and Nonconsensual Sexual Experience History

Abstract Introduction Being involved in a romantic relationship has consistently been associated with better general well-being and life satisfaction, relational and sexual satisfaction, and sexual function. Research indicates that these relationships also buffer women against negative mental and sexual health outcomes after traumatic experiences. Regardless of quality, the presence of a romantic relationship is associated with better general and sexual outcomes for women. Though it has been well established that romantic relationships are positively associated with better sexual and general well-being for heterosexual individuals, the influence of relationship status on other important indicators of sexual well-being has received significantly less attention. Research has not assessed sexual well-being by self-schemas and sexual excitation and inhibition propensities. Given the associations of sexual schemas and sexual excitation and inhibition with sexual function and satisfaction, these two constructs are important to consider when evaluating sexual well-being for women. Additionally, it is imperative to consider nonconsensual sexual experiences (NSEs) when evaluating women’s sexual well-being as 20% of women in the U.S. experience an NSE in their lifetime. NSEs are known to negatively impact sexual excitation and inhibition, self-schemas, and sexual and general well-being. Objective The current study expands upon existing research on sexual well-being by including measures of excitation and inhibition and sexual schemas as well as considering participants’ NSE history. Filling these gaps in the extant literature could prove important for understanding the combined effects of relationship status and NSE history on women’s sexual well-being. Methods The data for the current study was taken from a larger assessment of female sexuality in February and July of 2016. Data from 1152 women was analyzed in the current study. The women completed assessments of previous consensual and nonconsensual sexual experiences using the Nonconsensual Sexual Experiences Inventory, sexual excitation and inhibition using the Sexual Excitation and Sexual Inhibition Inventory for Women, sexual self-schemas using the Sexual Self-Schema Scale and relationship status. Results The results from an ANOVA and subsequent independent t-test pairwise comparisons indicate significant differences in sexual schemas and excitation and inhibition propensities across various relationship statuses (p values < 0.05). After Bonferroni corrections, there were a few significant findings. Women in married or cohabitating relationships report significantly more conservative/embarrassed sexual self-schemas than single women. Single women with NSE histories also reported significantly lower scores on the “setting” excitation subscale of the SESII-W compared to single women with no NSE histories. Conclusions The results indicate that women conceptualize their sexual schemas and experience facilitators and inhibitors of arousal differently across various relationship statuses. Consistent with previous literature, married and cohabitating women reported more conservative/embarrassed self-schemas. Interestingly, single women with an NSE history reported that sex in novel or public settings was less activating for their sexual arousal than the sexual setting for women with no NSE histories. These findings highlight the importance of considering relationship status and NSE history when examining sexual well-being, sexual self-schemas, and sexual excitation and inhibition. Disclosure No

Sexual Health and Communication Between Foster Youth and Their Caregivers.

Foster youth are at increased risk for negative sexual health outcomes and rarely receive the information or social/familial support needed to reduce risks. Foster and kinship caregivers report lacking the information and skills needed to effectively talk to youth in their care about sexual health. In a sample of caregivers from 2 large urban jurisdictions, our goals were to: 1) describe caregiver sexual health variables including communication and monitoring characteristics; and 2) assess associations between self-reported emotion regulation and caregiver-youth conflict and these variables. We administered surveys to foster and kinship caregivers in New York, New York and Los Angeles, California. Surveys assessed caregiver emotion regulation, caregiver-youth conflict, sexual/reproductive health knowledge, communication expectations and behaviors, and caregiver monitoring/youth disclosure. We generated descriptive statistics for all variables (aim 1) then performed multivariate regression analyses for aim 2. Our sample included 127 foster and kinship caregivers who were primarily female (92%) and African American (55%). Most reported having >4 years of caregiving experience with foster youth (66%). On average, caregivers answered sexual health knowledge questions correctly 68% of the time. Caregiver-youth conflict was the only variable significantly associated with assessed sexual health variables; it was inversely associated with percent correct on the knowledge scale, outcomes expectations, number of topics discussed, and monitoring/disclosure. Our study suggests that caregiver-youth conflict behaviors are related to sexual health knowledge, communication, and monitoring variables. Further prospective and longitudinal investigation is warranted to better characterize the complex relationship between these variables.

Evaluating the efficacy of an online, family-based intervention to promote adolescent sexual health: a study protocol for a randomized controlled trial

BackgroundAdolescents in the U.S. experience significant negative sexual health outcomes, representing a public health priority in the U.S. Research shows that while parents play an influential role in shaping adolescent sexual behavior, surprisingly few programs engage parents in existing programming. Moreover, most efficacious parent-based programs focus on young adolescents, and few utilize delivery mechanisms that facilitate broad reach and scale-up. To address these gaps, we propose to test the efficacy of an online-delivered, parent-based intervention adapted to address both younger and older adolescent sexual risk behavior.MethodsIn this parallel, two-arm, superiority randomized controlled trial (RCT), we propose to evaluate Families Talking Together Plus (FTT+), an adaptation of an existing and efficacious FTT parent-based intervention, in shaping sexual risk behavior among adolescents aged 12–17 and delivered via a teleconferencing application (e.g., Zoom). The study population will include n=750 parent–adolescent dyads recruited from public housing developments in the Bronx, New York. Adolescents will be eligible if they are between the ages of 12 and 17 years of age, self-report as Latino and/or Black, have a parent or primary caregiver, and are South Bronx residents. Parent–adolescent dyads will complete a baseline survey, after which they will be assigned to either the FTT+ intervention condition (n=375) or the passive control condition (n=375) in a 1:1 allocation ratio. Parents and adolescents in each condition will complete follow-up assessments 3 and 9 months post-baseline. The primary outcomes will include sexual debut and ever sex, and the secondary outcomes will include the frequency of sex acts, number of lifetime sexual partners, number of unprotected sex acts, and linkage to health and educational/vocational services in the community. We will utilize intent-to-treat analyses of 9-month outcomes and single degree of freedom contrasts comparing the intervention to the control group for primary and secondary outcomes.DiscussionThe proposed evaluation and analysis of the FTT+ intervention will address gaps in the current cadre of parent-based programs. If efficacious, FTT+ would represent a model for scale-up and adoption of parent-based approaches designed to address adolescent sexual health in the U.S.Trial registrationClinicalTrials.gov NCT04731649. Registered on February 1, 2021.

Gender Differences in Sexual Well-Being and Sexual Identity Development among Youth Formerly in the Foster Care System in the United States

Little research has heretofore examined differences in the sexual well-being and sexual health outcomes between female and male youth in the foster care system. This cross-sectional study examined these differences and as well as how sexual identity development impacts sexual well-being using a sample of 217 youth formerly in the foster care system. It found that females have lower levels of overall sexual well-being, lower scores on several components of sexual well-being, and more negative sexual health outcomes than males. The four domains of sexual identity development explored all predicted overall sexual well-being for both females and males, with a pronounced negative impact of being a gay male. These results support the importance of sexual identity development and indicate that the sexual health needs of females within the foster care system are not being addressed as well as those of their male counterparts. To address these discrepancies professionals and caregivers working with youth in the foster care system need to be attuned to the specific needs of female youth and work to address these needs in a manner that considers their gender.

Inclusive and Age-Appropriate Timing of Sexual Health Discussions at Home According to Gay, Bisexual, and Queer Adolescent Males

PurposeThe exclusion of gay, bisexual, and queer (GBQ) adolescent males' specific sexuality concerns in standard classroom education heightens the need for parents to be primary sources of trusted sexual health information. The aim of this study was to collect GBQ adolescent males' suggestions for a comprehensive list and age-appropriateness of topics that parents may use for inclusive discussions at home throughout the elementary, middle school, and high school years. MethodsSemistructured interviews and card sorts of 48 topics were conducted with a sample of 30 racial and ethnic diverse GBQ adolescents in central North Carolina. Thematic analysis of the interview transcripts and a calculation of card sort responses followed. ResultsTopics chosen for elementary-age GBQ youth were focused on core issues about human anatomy, safety, and the continuum of sexual orientations and gender identities. Participants designated the majority of topics for home-based discussions in middle school and emphasized considerations for engaging in sex, relating with others socially, options for HIV/STI risk reduction, issues around interpersonal safety, and pleasure. They reserved topics for high school focused on complex sociorelational issues and technology-based concerns. DiscussionParticipants' varied rationale for timing of topics centered on the age-appropriateness and level of details that they deemed acceptable for discussions with parents. To address disproportionate negative sexual and mental health outcomes noted in this youth subgroup, parents should focus on being supportive by providing factual and sequential information crucial for their GBQ childrens' anticipated developmental needs and sexual identity milestones.

Adverse Childhood Experiences, sexual debut and substance use among Black justice-involved youth: The imperative of trauma-informed sexuality education

The purpose of this study is to determine how Adverse Childhood Experiences (ACEs) influence the age of sexual debut and the age of substance use initiation among a sample of Black justice-involved youth. A total of 368 Black adolescents (52.7 % female, 11–17 years of age) arrested and detained in Cook County, IL completed assessments as part of the Northwestern Juvenile Project. At baseline, adolescents self-reported sexual debut, substance use initiation (cannabis/marijuana and alcohol), and history of ACEs. Data were analyzed using multivariate path analyses to examine the effects of ACEs on sexual debut, substance use initiation, and engagement in sex under the influence. Age and gender were used as covariates. Results indicate that most participants (97 %) experienced at least one adverse childhood experience and the majority (82 %) reported a very early (11–12 years) or early sexual debut (13–14 years). More ACEs were significantly related to higher odds of having earlier sexual debut (OR = 1.23, p < 0.001), alcohol use initiation (OR = 1.31, p < 0.01), and cannabis use initiation (OR = 1.23, p < 0.01) after controlling for age and gender. ACEs had a significantly indirect effect on having sex under the influence only through sexual debut (β = 0.08, 95 % CI: 0.03, 0.17) and cannabis use initiation (β = 0.11, 95 % CI: 0.02, 0.25). Findings imply that the sexual health decision-making of justice-involved adolescents can better be supported through trauma-informed sexuality education that gives primacy to acknowledging their experiences with trauma as a critical part of their rehabilitative treatment. This study on ACEs among Black justice-involved youth documents prevalent adversity that predicts early sexual debut, substance use initiation, and sex under the influence. Findings imply trauma-informed sexuality education as a viable option for justice-involved youth to learn enhanced skills for informed sexual health decision-making to reduce negative sexual health outcomes.

Social support and very young adolescent girl's knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs' participants and non-participants in rural Malawi.

Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10-14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.

Factors associated with access to condoms and HIV services among women in high migration communities in six Southern African countries.

Despite the documented importance of sexual and reproductive health in women's life, access to sexual and reproductive health (SRH) services by migrant women remains low leading to negative sexual and reproductive health outcomes. This study investigated the factors associated with access to condoms and Human immunodeficiency virus (HIV) testing services among 2070 women aged 15-49 years residing in high migration communities. Logistic regression models were fitted and migration status was found to be an important factor in women's access to HIV testing services. In addition to migration status, age, educational level, marital status, religion, comprehensive knowledge about SRH, comprehensive knowledge about HIV, partner's age, and partner's educational level were significantly associated with access to condoms and HIV testing services. Programmes aimed at increasing access to condoms and HIV services should collaborate with adult basic education programmes in order to increase women's education and involve all women regardless of migration status, age and marital status. In addition, the involvement of male partners and religious leaders in disseminating and imparting accurate information and knowledge regarding SRH and HIV services to ensure women's access to both condoms and HIV testing services is required.

Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males.

To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males. We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization. Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should. Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.

Sexual identity development and sexual well-being: differences between racial/ethnic minority and non-racial/ethnic minority former foster youth

ABSTRACT Little research has examined if there are differences in sexual well-being, negative sexual health outcomes, or levels of sexual identity development between racial/ethnic minority and non-racial/ethnic minority youth in the foster care system. Using a sample of youth formerly in the foster care system (n = 219), this study compared the sexual well-being, sexual identity development, and negative sexual health outcomes of racial/ethnic minority and non-racial/ethnic minority youth and found that racial/ethnic minority and non-racial/ethnic minority youth did not differ in overall levels of sexual well-being and had no significant differences in their levels of sexual identity development. There were differences in incidence of the youth or a partner having an STI/STD. These results indicate that there are few differences in sexual well-being, negative sexual health outcomes, or sexual identity development between racial/ethnic minority and non-racial/ethnic minority youth formerly in the foster care system. All four domains of sexual identity development predicted sexual well-being for non-racial/ethnic minority youth, but sexual orientation identity uncertainty did not predict sexual well-being for racial/ethnic minority youth, emphasizing the importance of sexual identity development. Attention to the sexual development and sexual health of youth in the foster care system continues to be lacking and should be expanded.

“We can’t share things with our teachers”: Narratives of mistrust and disconnect between South African female learners and their teachers

The quality and nature of student-teacher relationships have implications outside of the academic domain. Support from teachers plays a significant protective role in the mental and emotional well-being of adolescents and young people, and can help to reduce or delay their engagement in risk behaviours, thereby decreasing negative sexual and reproductive health outcomes such as teenage pregnancy. Using the theory of teacher connectedness, an element of school connectedness, this research explores the narratives surrounding teacher-student relationships amongst South African adolescent girls and young women (AGYW) and teachers. Data were collected through in-depth interviews with 10 teachers, and 63 in-depth interviews and 24 focus group discussions with 237 AGYW aged 15-24 from five South African provinces characterised by high rates of HIV and teenage pregnancy amongst AGYW. Analysis of the data followed a thematic and collaborative approach, comprising coding, analytic memo-ing, and verification of emerging interpretations through discussion and participant feedback workshops. Findings related to perceptions of support and connectedness in teacher-student relationships centred around AGYW narratives of mistrust and a lack of support from teachers, and the consequential negative implications for academic performance and motivation to attend school, self-esteem, and mental health. Teachers' narratives centred around challenges providing support, feeling overwhelmed and incapable of fulfilling multiple roles. Findings provide valuable insight into student-teacher relationships in South Africa, their impact on educational attainment, and on the mental health and sexual and reproductive health of AGYW.

Sexual health behavior, health status, and knowledge among queer womxn and trans men in Kenya: An online cross-sectional study.

Little research has been conducted on the sexual health needs and risk behaviors of queer womxn and trans men, making it difficult to identify specific health needs and disparities. This is especially the case in the Global South, where their needs are poorly understood. This study presents findings on demographics, sources of information, sexual (risk) behaviors, and substance use in Kenyan queer womxn and trans men. An online survey among 335 Kenyan queer womxn and trans men was used to collect data on sexual health, risk behavior, health information sources, and substance use. The participants needed to have had at least one self-identified female sexual partner. The sample presented young, highly-educated queer womxn and trans men. A high incidence of childhood sexual trauma found was found. Risk behaviors included sexual activities with partners of multiple genders, violence, and low use of barrier methods. One in three participants had been treated for an STD in the previous year. The incidences of smoking and drinking were high, and a quarter of participants indicated having taken drugs at least once a month or more. The internet was either the first or second most important source of sexual health information for 44.1% of the participants, followed by schools (30.9%). Our findings indicate that queer womxn and trans men are at risk of negative sexual health outcomes due to a lack of appropriate information, risk behavior, substance use, and low uptake of sexual health services. Kenya's Penal Code still criminalizes consensual same-sex activities and may play a role in perpetuating barriers that prohibit them from making healthier choices. Developing tailored programming and policies require local, national, and global stakeholders to engage with the inclusion of queer womxn and trans men's sexual health needs within strategic planning and healthcare delivery.