Provision Of Sexual Health Services Research Articles

Impact of the COVID-19 pandemic on sexually transmitted infection testing and diagnosis in Lebanon: A retrospective chart review

BackgroundSocial distancing restrictions during the COVID-19 pandemic caused disruptions to sexual health services (SHS) worldwide. During the first year of the pandemic, Lebanon implemented multiple lockdowns during which SHS endured repetitive closures. We explore the impact of the pandemic on SHS delivery and the diagnosis rate of sexually transmitted infections (STIs) among attendees of a large sexual health clinic in Beirut, Lebanon. MethodsThis was a retrospective analysis of the clinic's database, including data on voluntary counseling and testing (VCT) for HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). We compared the number and types of services provided, and the number and rate of positive VCT diagnoses pre- (Mar 2019–Feb 2020) and post- (Mar 2020–Feb 2021) COVID-19 onset. ResultsMen who have sex with men (MSM) comprised 35 % and 40 % of attendees pre- and post- COVID-19 onset, respectively. Post-COVID-19 onset, a total of 1350 VCT services and 406 medical consultations were provided, an overall 45 % decrease compared with pre-COVID-19 onset. The prevalence pre-COVID-19 onset of HIV, syphilis, HBV, and HCV was 0.8 %, 0.3 %, 0.2 %, and 0.1 %, respectively, and post-COVID-19 onset 1.2 %, 0.7 %, 0.3 %, and 0.3 %, respectively. Post-COVID-19 onset, 1.7 % of patients tested positive for any STI compared with 1.1 % pre-COVID-19 onset (OR: 1.5, 95%CI: 0.8–2.7). Close to 90 % of all positive diagnoses were among MSM. The prevalence of HIV, syphilis, HBV, and HCV among MSM in the total sample was 2.1 %, 1.2 %, 0.4 %, and 0.3 %, respectively. ConclusionCOVID-19 related closures led to substantial reduction in SHS accessibility among clinic attendees. STI positivity rates increased post-COVID-19 onset, although this increase was not statistically significant. Findings suggest that sexual risk behavior was taking place during the pandemic despite the lockdowns and highlight the need to minimize disruptions in provision of SHS during similar crises, particularly to key populations.

Access to and provision of sexual and reproductive health services in Ekurhuleni, South Africa: Experiences and coping strategies of migrant women and healthcare workers.

The importance of universal access to health services including sexual and reproductive health and rights (SRHR) services by migrant populations and the fundamental role of healthcare workers in providing SRHR services, requires a balanced understanding of the experiences of both migrants and healthcare workers. This study explored the experiences of migrant women in accessing and utilising SRHR services and the experiences of healthcare workers in providing SRHR and HIV services in Ekurhuleni, South Africa. In-depth interviews were conducted with five internal migrants, eight international migrant women aged 18-49 years, and four healthcare workers. Migrant women were selected using snowball sampling while healthcare workers were purposively sampled. Migrant women face multifaceted challenges including but not limited to language barriers, discrimination based on migration status, cultural and religious hurdles when accessing and utilising SRHR and HIV services. Similarly, healthcare workers encounter challenges in providing SRHR and HIV services to migrant women which include language barriers and having migrants who seek services without referral documentation and legal migration documents. Training healthcare workers on cultural sensitivity and integration of migrant friendly services in the health policy may improve migrant women's experiences in accessing and utilising as well as healthcare workers' experiences in providing SRHR services.

‘Crossed the line’: Sexuality discourses of motherhood under 15 years in Uganda

AbstractMotherhood under 15 years is constructed as having crossed the line of societal morals and this construction shapes the provision of sexual and reproductive health services (SRH) for mothers under 15 years in Uganda. Using collaborative ethnography and through the lens of discourses and governmentality, I established that adolescent pregnancy is constructed within normative discourses enshrouded in religious and cultural values. What is constructed as non‐normative is regulated through restrictive SRH policies and penalizing discourses which inhibit access to SRH services and care. A paradigm shift in adolescent SRH policies that are rooted in human rights and equity is one alternative required.

Nimble adaptations to sexual and reproductive health service provision to adolescents and young people in the early phase of the COVID-19 pandemic

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

Socioeconomic and residence-based inequalities in adolescent fertility in 39 African countries

IntroductionDespite the advancement in sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, countries in sub-Saharan Africa (SSA) still experience higher adolescent fertility rates than other low-and middle-income countries. This study examined the disparities in adolescent fertility in 39 countries in SSA, focusing on socioeconomic and residence-based dimensions.MethodsThis study involved a secondary analysis of data obtained from 39 recent Demographic and Health Surveys conducted in SSA. The measures of difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were estimated using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based dimensions.ResultsOut of the 39 countries included in the study, Guinea (D=27.70), Niger (D=27.50), Nigeria (D=23.90), and Côte d’Ivoire (D=23.60) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with the higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the rate of adolescent fertility, with a value of D = -0.80. The burden of adolescent fertility was disproportionately higher among young women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.70), Madagascar (D=41.10), Guinea (D=41.00), and Cameroon (D=40.20). We found significant disparities in educational attainment contributing to unequal inequalities in adolescent fertility, particularly among young women who lack access to formal education. Countries such as Madagascar (D=59.50), Chad (D=55.30), Cameroon (D=54.60), and Zimbabwe (D=50.30) had the most significant absolute disparities.ConclusionThis study revealed that young women residing in rural areas, those in households with low economic status and those with limited educational opportunities experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable sexual and reproductive health services to the populace, particularly for young women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislation pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rates and mitigate the adverse maternal and child outcomes associated with high adolescent fertility in SSA.

Did the COVID-19 pandemic affect medicine-related support for people living with HIV in the United Kingdom? – a cross-sectional survey

Abstract Introduction In 2019, there were 105,200 people living with HIV (PLWH) in the UK, most of whom (98%) were engaged in care and on antiretroviral medicines (ARVs). Globally, the COVID-19 pandemic was predicted to interrupt the HIV care continuum.[1] In England, early phases of the pandemic revealed a shift to online, or remote HIV service delivery and a decline in sexual health service provision generally.[2] Aim To investigate PLWH’s perceptions of the effects of the COVID-19 pandemic on their medicine-related support (MRS). Methods Institutional ethics approval was obtained to promote an online survey (1/09/2021 to 31/01/2023) among UK residents. Eligible participants were PLWH, aged 18 years or over, using ARVs and ≥1 non-ARV. Snowball sampling was used to recruit participants via social media. The survey asked participants to report their sources of medicine-related support and whether they experienced changes to how they obtained their medicines during the pandemic. An open-ended question was also asked to allow participants to report any other medicine-related issues experienced during the pandemic. The survey link was shared with HIV-related charities and their memberships. Descriptive statistics and thematic analysis were used for quantitative and free-text quotes respectively. Results One hundred and seventy-three participants who were eligible consented. Ninety-five participants provided free-text quotes. The mean age was 48.7 (SD±12.5) years and 50.5% (n=51/101) were aged ≥50 years. The majority were male (77.5%, n=79/102), white (86.1%, n=87/101), and gay/lesbian (60.8%, n=62/102), whilst 52.9% were employed (n=54/102). Approximately 1 in 5 (16%, n=8/50) of younger PLWH reported changes to their MRS, whilst 9.8% (n=5/51) of older PLWH, aged 50+, felt their MRS changed. Source of MRS: Most PLWH continued to use their specialist healthcare professionals for MRS and perceived no change in its availability due to COVID-19. Within primary care services, more participants reported using their general practitioner for MRS compared to their community pharmacist (12.5%, n=17/136 and 2.9%, n=4/136, respectively). Frequency of appointments and perceptions around person-centred care: Some reported that they had received more attention from healthcare professionals whilst others noted that after the first lockdown fewer, busier staff led to a less person-centred service. Mode of MRS: Whilst the majority of clinics moved to remote appointments, for many PLWH this was perceived as desirable particularly for those who preferred the convenience of remote appointments or were concerned about leaving their home due to being categorised in highest-risk patient groups. Ten participants stated that, due to COVID-19, they now get their medicines delivered to their homes instead of collecting them as previously from the local pharmacy or their specialist HIV clinic. One participant wrote “I had longer periods between blood tests and telephone consultations. I prefer face to face”, with another 52-year-old female stating that “Personally, don’t ever want to replace face to face with remote again”. Access to medicines: Only 8 (8.4%, n=8/95) reported changes to how they accessed their antiretroviral medicines. Two participants reported interruptions to treatment; “I had a shortage of medication. When I phoned my hospital to ask for a new prescription, they couldn’t give me one unless I came in physically. This was impossible for me during the first few months of lockdown” (male, aged 30). Conclusion While most PLWH did not perceive changes to their MRS due to the COVID-19 pandemic, a minority experienced treatment interruptions as revealed by this UK-wide survey. Patient preferences should be considered when delivering medicine-related consultations for PLWH. Future research is needed to explore clinicians’ perspectives and how to ensure continuity of HIV care during crises.

Perception and Attitude of Health Care Workers in Tertiary Health Care Facilities in Plateau State, Nigeria towards Sexual and Reproductive Health Services for Unmarried Adolescents

Adolescents are faced with the challenges of having access to and the utilization of quality sexual and reproductive health services, and one of the barriers responsible for this situation is the negative personal attributes of service providers. This study aimed to assess the perception and attitude of health workers in the tertiary health facilities in Plateau State towards sexual and reproductive health services for unmarried adolescents. A cross-sectional study was conducted in December 2020 among 208 doctors and nurses/midwives who were selected using a stratified sampling technique. Data were collected using a semi-structured self-administered questionnaire and analyzed using the Statistical Product and Service Solutions version 23. The mean age of the respondents was 37.1 ± 9.1 years, 131 (63.0%) were doctors and females constituted 120 (57.7%). One hundred and twenty-nine (62.0%) had a good perception, while 105 (50.5%) had a positive attitude towards sexual and reproductive health services for unmarried adolescents. Younger age below 55 years and a good perception were found to be predictors of a positive attitude towards sexual and reproductive health services for unmarried adolescents. A considerable number of the health workers in the tertiary health facilities in Plateau state had a negative attitude towards sexual and reproductive health services for unmarried adolescents, an attribute that was significantly seen more in those who were older and had a poor perception. There is a need to improve healthcare workers’ attitudes towards the provision of sexual and reproductive health services for unmarried adolescents.

The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians.

International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice. A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference. Of the 67 respondents, most (n, 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n, 37) had worked in travel medicine for over 10years. Only 22.4% (n, 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n, 42; 62.7%), or based on the patient's history (n, 37; 55.2%). Over half the sample (n, 40; 59.7%) expressed interest in further training in SRH. Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.

Perceptions of youth-friendly sexual and reproductive health services in selected Higher and Tertiary Education Institutions of Zambia: A qualitative study on the perspectives of young people and healthcare providers.

The recognition of the need for Adolescent and Youth-Friendly Health Services (AYFHS) is growing. It is important to ensure the provision of high-quality sexual and reproductive health (SRH) services that cater to the unique needs of adolescents and young people (AYP). Adolescents and young people spend a significant amount of time in Higher and Tertiary Education Institutions (HTEIs) where adolescent friendly services are needed. However, there is limited evidence on the availability of sexual and reproductive health services for young people in HTEIs in Zambia. Using the Human Rights Based Approach to healthcare availability, accessibility, acceptability, and quality of care (AAAQ) framework, this study explores young people's perceptions of youth-friendly sexual and reproductive health services in selected HTEIs in Zambia. Between March and June 2021, a qualitative case study was conducted in 12 selected HTEIs located in Lusaka, Central, and Copperbelt provinces of Zambia. The study employed In-depth Interviews (IDIs) and Focus Group Discussions (FGDs) with AYPs, as well as Key-informant Interviews (KIIs) with healthcare providers. The healthcare providers at health facility, district and provincial levels were interviewed to provide insights about the services provided in the HTEIs. A total of 112 interviews were conducted. Data analysis was performed using thematic analysis in NVivo version 11. In the study, young people reported the availability of primary health services like malaria, HIV, and pregnancy testing, as well as screening for STIs. However, their awareness of SRH services was limited. Contraception, STI testing and treatment, and HIV and pregnancy screening and testing were the most accessed services. Equipment and commodity shortages were common, hindering care provision. Young people found healthcare services in educational institutions inaccessible, with limited comprehensive care and understanding from providers. Services lacked tailoring for key populations and privacy/confidentiality. Health care providers also reported inadequate youth-friendly spaces, equipment, medication and trained workers which compromised the quality of care. Peer educators and provider training were seen as essential for improving accessibility and acceptability of services. The findings indicate significant barriers to the accessibility, availability, and acceptability of SRH services for AYP in HTEIs in Zambia. There is a pressing need to enhance AYSRH programming by increasing awareness of services and ensuring their availability and accessibility for young people. Sufficient funding for AYFHS can address challenges related to service quality, including inconsistent availability of medical equipment and supplies. Building the capacity of service providers can potentially enhance the uptake of services by AYP. It is crucial to target services to address the specific vulnerabilities of students with disabilities and key populations, aligning with the goal of achieving universal health coverage and leaving no one behind.

Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

ObjectivesNegative views of healthcare providers towards adolescent sexual and reproductive health (SRH) services deter adolescents from seeking vital SRH services. This paper assessed the impact of an intervention on the...

Provision of sexual health services for women with physical disability: A scoping review

Provision of sexual health services for women with physical disability: A scoping review

A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis.

The COVID-19 pandemic has profoundly changed our lives. While healthcare resources were redistributed and mobilized to focus on dealing with the COVID-19 crisis, there have been unmet medical needs of patients with other diseases such as syphilis, weaving an integral but neglected component of the pandemic story. In different countries, the epidemiology of newly reported syphilis underwent diverse changes during the COVID-19 pandemic. Asymptomatic cases experienced the largest decline in number. From the perspective of transmission, on one hand, the implementation of lockdown measures led to a higher degree of abstinence and sex distancing in many countries, thereby reducing the transmission of syphilis. On the other hand, vertical transmission was reported to have increased significantly during COVID-19. Meanwhile, the volume of STI clinic capacity declined, and STI staff were redeployed to facilitate the contact tracing of COVID-19. As a result, many STI centers converted traditional in-person clinical services to telemedicine and self-testing. However, syphilis testing and clinical treatment cannot fully adapt to this conversion. In syphilis diagnosis, COVID-19 infection and vaccination were reported to cause false positivity in syphilis serological tests. Diverse cutaneous manifestations of COVID-19 could resemble the skin lesions in syphilis patients, requiring differential diagnosis from clinicians. As for the post-pandemic years, consequent to service interruptions and diagnosis delays, a surge in the number of confirmed cases of syphilis is expected. The COVID-19 pandemic has also been a meaningful lesson for the control and prevention of infectious diseases. The experience in combating COVID-19 has underscored the importance of maintaining a robust and well-supported medical system for the provision of sexual health services and better healthcare equality even during eras of crisis, not least for syphilis patients.

Awareness of Policy Frameworks that Affect the Provision and Utilization of Sexual and Reproductive Health Services among University Students in Nairobi City County, Kenya

Purpose: the study sought to determine awareness of SRH policy frameworks that impact on the provision and utilization of SRH services among university students.
 Methodology: The study used a cross sectional research design complemented by exploratory research design. The study was conducted in the main campuses of two public universities namely Kenyatta University and Multimedia University and two private universities, United States International University- Africa, KCA-University in Nairobi County in Kenya. The target population were students aged between 18-25 years studying in universities with main campuses in Nairobi County. The total study population was approximately 192,193 students. The study applied stratified random sampling to identify the 370 students who completed the study questionnaires. Purposive sampling was used to select the students and staff who participated in in-depth interviews. The students who participated in focus group discussions were randomly selected. 
 Findings: The study found out that most students, 95 (25.7%) reported to be aware of the Constitution of Kenya (2010) followed by 74 (20%) students who reported to be aware of the National Reproductive Health Policy (2007). When looking at the university level policy frameworks, most students, 229 (61.9%) split in almost equal numbers, male, 120 (32.4%) and female, 109 (29.5%) are aware of the university HIV/AIDS policy. The surveyed students who said they were not aware of any university SRH policies were 94 (25.4%), split in equal numbers between male and female students. The findings indicate low awareness of SRH policy frameworks by either gender which can be interpreted to mean that participation of the students in the development of the policy frameworks and dissemination of the developed policies is poor.
 Recommendations: The study’s recommendation to universities is to regularly disseminate national and university level SRH policy frameworks to the students. This can be done during orientation, as part of their studies and on special days convened to sensitize the students on their health.

Component of sexual health services for vaginismus management: A qualitative study.

Provision of sexual health services requires gender-sensitive management, facilities, and staff, as well as planning for gender-sensitive caregivers and education. Couples suffering from vaginismus face many types of barriers to accessing sexual health services. This qualitative study was conducted to explain the needs of sexual health services in women with primary vaginismus in Iran. This qualitative study was conducted through the participation of 20 participants including service providers, women with vaginismus and their husbands in 2022, Iran. The samples were selected using purposive sampling method and considering the maximum variation. For data collection, in-depth semi-structured individual interviews were conducted and continued until data saturation was reached. The collected data were analyzed in MAXQDA10 software using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman. Data analysis led to the emergence of three main themes: 1) Comprehensive preventive sex education which included the three categories of sex education in the education system, premarital sex education through the health system, and sex education through the media with scientific content; 2) Efficient sexual health clinics which included three categories of therapist's skills, empowerment of sexual therapist, and structural features of sexual health clinics and cultural considerations in establishing sexual health clinics; and 3) Protocol for management and treatment of sexual problems which consisted of sexual education and counseling content, treatment requirements, and sex education approaches. Based on the results of the study, comprehensive preventive sex education through the education system and the Ministry of Health can improve the attitudes of adolescents and young people. Moreover, it can take a fundamental step in solving sexual problems by providing the infrastructure necessary for the establishment of efficient sexual health clinics and protocols required to manage and treat such problems.

Attitudes about the Provision of Sexual Health Services in an Inpatient Setting

To examine the relationship between clinicians' attitudes about the appropriateness of providing sexual health services in the inpatient setting and confidence in providing services METHODS: An online survey was emailed to pediatric hospitalists, adolescent medicine, and pediatric and adolescent gynecology societies and directors. Confidence in managing 8 sexual health situations was measured on a 4-point Likert scale, summed, averaged, and dichotomized into confident and not so confident. Participants were asked to rate on a 5-point Likert scale their belief that providing sexual health services in the inpatient setting would be appropriate. An adjusted, multivariate logistic regression identified associations between participant demographic characteristics, professional characteristics, and confidence and attitudes about the appropriateness of providing inpatient sexual health services. Among the 610 participants, the mean age was 40 years. Most were females (79%), non-Hispanic White (71%), and practiced pediatric hospital/general medicine (73%). Most (73%) were not so confident across all 8 confidence items. Overall, 61% "strongly agreed" that providing sexual health services in the inpatient setting was appropriate. Participants who reported younger age, being female, and confidence in providing services were significantly associated with strong agreement that it was appropriate to provide sexual health services in the inpatient setting. Those who identified as Christian non-Catholic were significantly less likely to report strong agreement. Most providers strongly agreed that providing sexual health services in the inpatient setting was appropriate, yet most were not so confident in managing sexual health situations. Future studies should focus on addressing concerns and barriers to providing sexual health services.

Community Pharmacists' Experiences and Attitudes towards the Provision of Sexual and Reproductive Health Services: An International Survey.

Access to comprehensive sexual and reproductive health (SRH) services remains a challenge worldwide. Describing community pharmacists' SRH services in countries with different scopes of practice will aid in understanding how pharmacists view their roles and how to support them in providing needed services. A cross-sectional web-based survey was administered to pharmacists working in community pharmacies in Japan, Thailand, and Canada. The survey covered 7 SRH categories: pregnancy tests, ovulation tests, contraception, emergency contraception, sexually transmitted and blood-borne infections, maternal and perinatal health, and general sexual health. Descriptive statistics were used to analyze the data. A total of 922 eligible responses were included in the analysis (Japan = 534, Thailand = 85, and Canada = 303). Most Thai and Canadian participants reported dispensing hormonal contraceptives (Thailand = 99%, Canada = 98%) and emergency contraceptive pills (Thailand = 98%, Canada = 97%). Most Japanese participants provided patient education on barrier contraceptives for men (56%) and information on the safety of medications in pregnancy (74%) and breastfeeding (76%). The majority of participants expressed interest in additional training and expanding their roles in SRH. Sharing international experiences can guide challenges faced by the evolution of pharmacists' practice in SRH. Providing pharmacists support could help their readiness for this role.

Comprehensive sexuality education for the most disadvantaged young people: findings from formative research in Ethiopia

Comprehensive sexuality education (CSE) seeks to improve young people’s knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment.

Investigating health services for sexual and gender minorities in France: a qualitative study protocol

IntroductionDiscrimination and structural violence experienced by sexual and gender minorities are the source of social inequalities in health. The last decade has been marked by major developments in the provision...

The Provision of Sexual Health Services to Breast Cancer Survivors in Iran: A Qualitative Study

The Provision of Sexual Health Services to Breast Cancer Survivors in Iran: A Qualitative Study

Utilization of sexual and reproductive health services among young people in refugee settings in Uganda.

There is a considerable high level of unmet need for reproductive health services among refugees. Yet, there is limited research about the provision and utilization of sexual and reproductive health (SRH) services among young people in refugee settings. Drawing on a sample of 575 young refugees (15-24 years) from a cross-sectional survey, this study aims to fill this gap by identifying the factors associated with SRH utilization among young people living in refugee settings in Northern Uganda. The utilization of SRH services at the health facilities was significantly different between female and male young people after adjusting for all other variables (aOR = 2.46, 95% CI, 1.58, 3.84). Young people who were not living in a marital union (aOR = 0.38, 95% CI, 0.20, 0.71), or held inequitable gender norms about services (aOR = 0.28, 95% CI, 0.12, 0.66) had about a third of the odds of utilizing SRH services. Young women with comprehensive knowledge about contraception, modern contraceptives, and HIV and STI prevention, had more than twice the odds of utilizing SRH services (aOR = 2.23, 95% CI, 2.67, 6.90). There is need to integrate social norm measurements and social norm change strategies in strategies for promoting utilization of SRH services among refugees in low-income countries especially in Uganda.