Sexual And Reproductive Health Care Research Articles

Sexual and reproductive health while living with rheumatoid arthritis: The impact of the disease stage on patient perspectives.

Rheumatoid arthritis (RA) is one of the most prevalent rheumatic diseases that harms all aspects of patients' lives, including sexual and reproductive health (SRH), often neglected in patients' care. The study aimed to explore the sexual and reproductive experiences of Mexican outpatients with RA from a narrative perspective. From July 2020 to October 2021, 30 adult patients with RA from the Department of Immunology and Rheumatology outpatient clinic of a national referral center for rheumatic diseases had in-depth interviews audiotaped, transcribed, and analyzed using a thematic analysis approach. Results are presented in a descriptive and interpretative manner and integrated into a theoretical model for the topic understanding. Five intertwined major themes emerged: I) RA onset: Absence of SRH contents, II) Healthcare for RA: Emerging SRH contents, III) RA's impact: Proliferation of SRH contents, IV) Coping with the process of living with RA: SRH-related strategies, and V) The impact of the COVID-19 pandemic on patients' experiences: Increased SRH burden. SRH contents emerged through these major themes (but at RA onset), mostly when inquired and mainly when narrating the RA impact and coping. Patients identified that RA affected their couple dynamics, sexual function, and reproductive project. The SRH care was considered relevant but limited and focused on reproductive contents. It worsened during the COVID-19 pandemic. We proposed a theoretical model where patients' SRH experiences are embedded across their RA biography and integrated with the RA impact and the copy with the disease process. These intertwined experiences were also evident during the COVID-19 pandemic, which challenged participants' biopsychosocial resources. The sexual and reproductive experiences narrated by the RA outpatients concerning their disease-related biography showed that even when the SRH appeared as not prioritized at the disease onset, it was widely expressed during the process of living and coping with the disease and was additionally affected by the COVID-19 pandemic.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach

ObjectivesThe study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.DesignA qualitative exploratory design...

Assessing perspectives on an intervention connecting adolescents in outpatient psychiatry care to contraceptive counseling in the United States.

Adolescents with psychiatric disorders have high rates of unintended pregnancy and experience barriers to accessing sexual and reproductive health (SRH) care. Outpatient psychiatry visits are potential opportunities to connect adolescents to SRH care. This study informs the development of the Link2BC intervention which links adolescents in outpatient psychiatry care to SRH care. We conducted group interviews with adolescents (3 groups, 7 total participants) and caregivers (3 groups, 9 total participants) and individual interviews with 8 psychiatry providers who received or provided outpatient psychiatric treatment in clinics in a pediatric hospital in a city in the Midwestern United States. We asked questions about the acceptability of Link2BC, potential implementation needs, and implementation determinants. Using consensus-building techniques, two coders analyzed transcriptions using a codebook informed by the Consolidated Framework for Implementation Research 2.0. Participants agreed on the need for interventions that expand access to SRH care. Adolescents emphasized that services should be confidential and accessible and were open to their psychiatrists introducing SRH topics during appointments. Providers expressed preference for training and clear workflows. Participants agreed that psychiatry providers could serve as liaisons between adolescents and their caregivers to facilitate conversations about contraception. Participants had concerns about time constraints during visits but mentioned few other barriers to the intervention. This study demonstrates the acceptability of connecting adolescents in outpatient psychiatry care to contraceptive counseling and informs the refinement and implementation of Link2BC. Integrating contraception counseling in outpatient psychiatry settings is an innovative approach to prevent unintended pregnancy among adolescents by increasing access to SRH care services.

What sexual and reproductive health issues do young people want to discuss with a doctor, and why haven’t they done so? Findings from an online survey

ObjectiveYoung people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. MethodsWe conducted an online survey (2nd May – 21st June 2022) of Australians aged 16–29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with ‘undiscussed SRH issues’) were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. ResultsA total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. ConclusionsMany young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.

Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review.

The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.

Sexual and reproductive health integration into pre-travel consultations: a scoping review

Abstract Background Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. The scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations. Methods PubMed, Embase, CINAHL, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesised and presented in narrative form. Results Findings across 13 articles suggest HCP infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine, and traveller characteristics such as sexual orientation were positively correlated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms, or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers). Conclusions HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being.

'If I'm not sick, I'm not going to see the doctor': Access to preventive sexual and reproductive health care for Karen women from refugee backgrounds living in Melbourne, Australia-A qualitative study.

Women from refugee backgrounds have poorer health outcomes than host country populations. People from Myanmar, most of whom are from the Karen ethnic minority constitute one of the largest groups of humanitarian visa entrants to Australia since 2015. Barriers to and enablers of preventive sexual and reproductive health (SRH) for this group of women are poorly understood. The objective is to establish the preventive SRH care needs and experiences of Karen women from refugee backgrounds living in Australia. A qualitative study using semi-structured interviews was conducted with a purposive sample of Karen women. A bi-cultural worker assisted in recruitment and interpreting during data collection. All interviews were conducted in Karen language with a bi-cultural worker interpreting into English during the interview. Audio recordings of English dialogue were transcribed verbatim. Thematic analysis was used to analyse and report data. Thirteen women were interviewed. Five major themes were identified: (1) prevention awareness including lack of access to education and knowledge of services pre-arrival; appreciation of the new health system; limited vaccination knowledge, (2) perceived need for prevention including consequences of not screening; health care provider (HCP) attendance, (3) health information seeking including providing a comprehensive approach to information delivery; trusted sources of information, (4) barriers including missed opportunities; communication, language, illiteracy; lack of continuity of care and, (5) enablers including HCP' characteristics; peer support and individual responsibility. Findings from this study indicate that to improve access to preventive SRH services a multi-component strategy is needed. Provision of preventive SRH information using a multi-pronged approach; peer and community support interventions; and HCPs offering services and information opportunistically would benefit Karen women unfamiliar with preventive SRH care. SO WHAT?: Primary prevention services and education codesigned with community members may be effective in improving Karen women's access to SRH care.

(264) Prioritizing Sexual and Reproductive Health Research and Care for People with Cystic Fibrosis: A 2023 Workshop Report From the Cystic Fibrosis Foundation Sexual Health, Reproduction, and Gender Research (SHARING) Working Group

Abstract Introduction With therapy advances, people with cystic fibrosis (CF) are living longer, healthier lives, and thus increasingly have general and CF-specific sexual and reproductive health (SRH) questions. The CF Foundation is supporting the Sexual Health, Reproduction, and Gender Research (SHARING) Working Group to identify knowledge gaps, research priorities, and infrastructure needed for CF SRH research. SHARING includes pulmonologists, nurses, research coordinators, registered dieticians, psychiatrists, endocrinologists, reproductive urologists, and community members with CF. Objective In Spring 2023, SHARING developed and distributed a SRH prioritization survey for the CF community. During the annual in-person workshop, the group used these results to establish research priorities and develop studies that would address identified knowledge gaps. Methods SHARING partnered with Community Voice, a virtual platform for people with CF and their caregivers to share their perspectives on ongoing and future CF SRH research, care, and programming. We provided a list of 15 SRH research topics and asked respondents to rank the top five. We analyzed survey results using descriptive statistics. We also summarized discussions and future key directions for CF SRH research. Results A total of 303 respondents (85% people with CF and 15% caregivers) completed the survey. Sixty-five percent of people with CF were women and 37% of the people with CF for whom caregivers responded were women/girls. The majority (95% of adults, 98% of people with CF for whom caregivers responded) identified as White; 5% of adults and 10% of people with CF for whom caregivers responded were Hispanic/Latino. The majority (73%) of people with CF were >30 years old and 68% of those with CF for whom caregivers responded were <18 years old. Table 1 summarizes respondent demographics. The top five SRH topics were: 1) effects of CF modulator therapy (elexacaftor/tezacaftor/ivacaftor, ETI) on sex hormones; 2) effects of sex hormones on CF; 3) fertility; 4) pregnancy; and 5) SRH/mental health (Figure 1). People with CF prioritized pregnancy, sexual functioning, parenthood, and menopause, while caregivers prioritized ETI effects on sex hormones, fertility, mental health, and assisted reproductive technology (ART). SRH priorities differed by gender identity. Men and caregivers of men/boys prioritized fertility, mental health, SRH care provision, sexual functioning, and ART, while women and caregivers of women/girls prioritized the effect of sex hormones in CF, pregnancy, menopause, and contraception. During workshop proceedings, SHARING identified the need for further research on the interplay between sex hormones, CF pathophysiology, ETI, fertility, and ART, and a focus on the impact of infertility on mental health for males with CF. Conclusions SRH is an important and emerging area of research in CF. Research priorities are not uniform among people with CF and their caregivers, particularly across genders. Thoughtful consideration of such perspectives can ensure that future CF SRH research is relevant and responsive to CF community needs. SRH providers should be aware of the concerns in this understudied population from research and patient care perspectives. Disclosure No.

“It Means Being Safe, Having Power over One's Body”: Black Female Adolescent Experiences with Reproductive Health Counseling in Primary Care

Study ObjectiveThere is limited research examining the sexual and reproductive health (SRH) care needs and experiences of Black adolescents who are assigned female at birth (AFAB). This study aimed to understand the perspectives of Black AFAB adolescents in their receipt of SRH counseling in primary care and elicit preferences for SRH-related communication with clinicians. MethodsWe interviewed English-speaking Black AFAB adolescents, ages 13-17, living in North Carolina between February and June 2022 about their SRH care experiences. The interviews were conducted via video conferencing, audio-recorded, professionally transcribed, and analyzed using a thematic approach. ResultsWe interviewed 23 adolescents (mean age 15.8 years) across 10 geographically diverse counties in North Carolina. Most conveyed positive perceptions of clinicians regarding trust and comfort. However, many expressed concerns about clinicians not doing enough to ensure patient confidentiality, provide them with enough information to make informed and autonomous decisions, and destigmatize discussing SRH issues during the clinical encounter. Suggested improvements include sociodemographic congruence between patients and clinicians (eg, younger Black women), ensuring time alone with clinicians across adolescence, and proactively sharing information to promote respect and autonomy. ConclusionAlthough Black AFAB adolescents had positive perceptions of their health care providers regarding relational components of care, many participants shared significant gaps and areas for improvement in the quality of care received to better align services with their preferences for SRH care. These findings can inform the development of SRH counseling best practices and clinician education to support respect and autonomy, which are routinely denied to Black AFAB adolescents.

Preferences and experiences of parents/guardians of youth with epilepsy and intellectual disability on reproductive health counseling

ObjectiveTo explore the experiences and preferences of parents/guardians of adolescents and young adults (AYA) of childbearing potential with co-occurring epilepsy and intellectual disability (ID) regarding counseling by neurologists on sexual and reproductive health (SRH) topics such as pregnancy, contraception, menstruation, and folic acid supplementation. MethodsWe conducted semi-structured interviews with parents/guardians of AYAs (12–28 years old) of childbearing potential with co-occurring epilepsy and ID, recruited from a tertiary-care children’s hospital. We confirmed the diagnoses of epilepsy and ID with the patient’s neurologist and parent/guardian. All degrees of ID (e.g. mild/moderate/severe) were eligible. We audio-recorded and transcribed interviews. Two coders performed qualitative thematic analysis. ResultsTwenty-five parents/guardians completed interviews. Themes included: (1) Parents/guardians believe their child to be immune from sexual abuse due to their supervision, yet desire counseling about abuse recognition and prevention, which they also report not occurring (2) A common opinion was that counseling on menstruation was more relevant to their child's life than counseling about pregnancy-related topics (3) Parents/guardians reported a lack of counseling on pregnancy-related topics such as folic acid supplementation and teratogenesis and generally also reported some degree of interest in hearing about these topics from neurologists (4) Parents/guardians also reported a lack of counseling on drug interactions between contraception and ASMs, and were highly interested in learning more about this topic (5) Parents/guardians want neurologists to initiate annual comprehensive SRH counseling at puberty about most topics, but report that they often initiate SRH discussions themselves. ConclusionParents/guardians of AYAs with epilepsy and ID prefer more frequent, neurologist-initiated, comprehensive conversations surrounding SRH particularly emphasizing menstruation and sexual abuse recognition/prevention. Findings may inform professional and patient education and health systems interventions including development of discussion guides and/or decision aides to improve SRH care for AYAs with epilepsy and ID.

Improved prevention of female genital schistosomiasis: piloting integration of services into the national health system in Côte d’Ivoire

IntroductionFemale genital schistosomiasis (FGS) is a neglected gynecological condition, putting women at-risk of poor sexual and reproductive health (SRH), including pregnancy complications or infertility. Early treatment of schistosomiasis with praziquantel is important to avoid disease progression to FGS as it is not always possible to reverse these symptoms. However, prevention programs with praziquantel have historically focused on school-aged children. Therefore, there is a gap to provide prevention services for young women in endemic areas, including Côte d’Ivoire.MethodsWe piloted integration of FGS prevention services into routine SRH care in seven health centers (Soubré district, Côte d’Ivoire, November 2020 to April 2021) and enrolled 56 health workers. We used mixed methods including key informant interviews, focus group discussions, and questionnaires to determine effectiveness, feasibility and acceptability of integration across health system decision makers, health workers and female patients (15 to 29 years old). For qualitative data, we used an inductive coding process to analyze themes. We used descriptive statistics to analyze quantitative data.ResultsInterviewed health workers perceived that the integrated services increased access and improved health outcomes for women (15 to 29 years old) due to the more comprehensive approach, although barriers to access included lack of transportation. Female patients surveyed at baseline (n=448) indicated there were no routine FGS prevention services. During the pilot, FGS prevention services were provided to >8500 women at-risk. Health workers interviewed at the end of the pilot indicated they could feasibly provide FGS prevention services as part of routine patient consultations, and they maintained knowledge from training on the key FGS health education points and the consultation processes to follow. The greatest challenge expressed by health workers was the high workload.DiscussionProvision of integrated healthcare in the health center setting is an effective and acceptable way to increase access to prevention services and provide holistic care for women (15 to 29 years old) in this setting in Côte d’Ivoire. Future scale-up will require further streamlining of the strategy, building on existing platforms, whilst ensuring reduced impact on workload and consideration of how to overcome barriers to accessing health centers.

Sexual and reproductive health experiences, access to services, and sources of information among university students in Ethiopia.

Adolescence and youth are times of major growth and change that can place young people at elevated risk of poor sexual and reproductive health (SRH) outcomes, particularly when they are living away from home for the first time. Understanding the barriers that young people face when accessing SRH services and information is imperative for addressing their SRH needs; our study explored this topic among university students in Ethiopia. Specifically, we explore university students' SRH experiences, access to services, and preferred sources of information. We draw on mixed-methods research conducted in four public universities across Ethiopia in early 2020. A random sample of 822 male and female students completed a cross-sectional survey that explored SRH knowledge, attitudes, experiences, and sources of information. We also conducted 8 focus group discussions with students and 8 key informant interviews across the four universities. Survey data were analyzed using descriptive statistics and we used structural coding and inductive analysis to analyze qualitative data. The survey data demonstrated that condoms and emergency contraceptive pills were the most used contraceptive methods. Nearly 18% of female students had experienced an unwanted pregnancy, and 14% reported having had an abortion. Approximately one-third of students reported encountering gender-based violence in the past 6 months. Most students preferred receiving SRH information from mass media, and male students were more likely than female students to seek information from friends. Our qualitative findings highlight a lack of comprehensive SRH care available on university campuses, and services that are available are often of poor quality; participants described a lack of privacy, confidentiality and respect when accessing SRH care at school. University students also lack regular opportunities to learn about SRH while on campus, and their preferred sources of information varied widely. Ethiopian university students have considerable unmet demand for SRH services and often face significant barriers to accessing high-quality information and services on campus. Consistent commitment and investment by universities and the government is vital to meeting the SRH needs of young people during this potentially vulnerable time.

Trading in harms: COVID-19 and sexual and reproductive health disparities during the first surge in New York state

In March 2020, New York City was the national epicenter of the novel coronavirus in the United States. This article draws on rapid qualitative research from July to October of 2020 with sexual and reproductive healthcare (SRH) providers who served low-income people from racial and ethnic minority groups in New York State to examine their perceptions of the effects of COVID-related adaptations to care on healthcare access and quality. We found that care delivery protocols during the early months of the pandemic compromised healthcare interactions and clinical experiences by limiting support persons, separating newborns from parents, and restricting care time in hospitals. Additionally, closures of in-person SRH services and prohibitions on prenatal support persons increased obstacles to access and utilization of care. Our intersectional analysis underscores how COVID protocols interacted with other axes of inequality to compound disparities in SRH access and quality of care. Early COVID policies prioritized controlling the risk of viral exposure over the risk of harm from the policies themselves, reflecting zero-sum approaches that we describe as “trading in harms.” Our research thus raises crucial questions about how institutions and governing bodies conceive of, and organize, emergency preparedness. We argue that emergency preparedness must center concerns around racial, class, and gender equity, among others, to foreground the risks and benefits of emergency responses for different groups.

Cost-related barriers to sexual and reproductive health care: Results from a longitudinal qualitative study in Arizona

Financial barriers can inhibit reproductive autonomy. This study examines the role of financial barriers on Arizona individuals' experiences accessing sexual and reproductive health (SRH) care. We recruited individuals who may have experienced barriers when accessing SRH care in 2019 to participate in three interviews at six-to-nine-month intervals beginning in the summer of 2020. Our analyses focused on respondent strategies to mitigate cost barriers, at times linked to the changing family planning policy landscape or the role of insurance coverage in accessing SRH care. Respondents’ experiences of care seeking over time demonstrated that respondents often postpone or forgo SRH care when experiencing cost barriers, and respondents also switch care sites to access affordable care despite sometimes not having preferred providers or care sites as a result. Our findings highlight how burdensome or surprising costs can have enduring effects on whether, when, and where to seek future care.

Assessing nursing students’ confidence in sexual health counseling and knowledge

IntroductionThere is a lack of studies to guide nursing faculty to meet the needs of students regarding sexual and reproductive health (SRH) topics. AimThis qualitative study explored the knowledge and confidence in counseling clients on SRH topics in prelicensure nursing students. MethodSemistructured interviews (n = 20) evoked descriptions of the lived experiences of prelicensure nursing students. Saldana's First Cycle/Second Cycle constant comparative method was used for data analysis. ResultsThree themes were identified: Motivated by Prior Education Experience, Google as a Manual, LGBTQIA Curious. DiscussionEmerging themes can assist nursing faculty in designing and delivering curricula to BSN students regarding SRH care.

Knowledge and Comfort in Providing Contraception, Sexual, and Reproductive Healthcare Among Pediatric Nurses in California

To evaluate the awareness, comfort, and feeling of competence of California registered nurses (RNs) in the provision of contraception and sexual and reproductive healthcare (SRH) to adolescent patients following California Assembly Bill (AB) 2348 legislation that expanded RN scope of practice to include provision of self-administered and injectable hormonal contraception. A cross-sectional, descriptive survey was used to assess pediatric registered nurses’ awareness of AB2348, perceived level of competence and comfort in the provision of sexual and reproductive health care (N = 504). A sample of pediatric RNs in California were included in this analysis. Descriptive statistics were used to assess demographic characteristics and summarize participants responses, and Fisher's exact tests were used to identify difference between groups. Responses from 45 pediatric RNs are reported in this analysis. The majority (80.0%, n = 36) of nurses in this study had no knowledge of AB2348. Many expressed a lack of comfort dispensing contraception (34.6%, n = 16), discussing age-appropriate information on safer sex practices (62.2%, n = 28), and providing sexually transmitted infection education (49.9%, n = 22).While most of the pediatric RNs reported frequently providing care to pediatric patients of reproductive age the majority were not comfortable providing contraception, safer sex education, or sexually transmitted infection education, and were unaware that it is within their scope of practice to independently provide services using standardized procedures. Increased training the provision of SRH care is needed among pediatric RNs to increase their sense of competence and comfort in providing adolescent SRH care.

Contending with precarity: Digital pathways to sexual and reproductive healthcare among transgender Filipinos during the COVID-19 pandemic

Stringent lockdowns during the COVID-19 pandemic and the cisnormative framing of sexual and reproductive health (SRH) in the Philippines cultivated precarious access to SRH systems among transgender (trans) communities during the public health crisis. With the shift toward digital health initiatives, this study aimed to explore the experiences of the local trans community in using digital health initiatives (DHIs) to access SRH care and gender-affirming services, information, and providers during the COVID-19 pandemic. Online interviews with 13 self-identified trans Filipinos living in the Philippines during the pandemic were conducted and analyzed using interpretative phenomenological analysis. First, the narratives of trans Filipinos illustrate how DHIs can address discontinuities of care that emerged during the COVID-19 pandemic. However, because of long-standing geographic, economic, and social barriers to trans-responsive healthcare in the Philippines, local trans communities navigate alternative pathways to care established within digital spaces (e.g., social media) by trans individuals and groups. These online communities of care not only connect trans Filipinos to culturally competent and affordable care but also foster a sense of belongingness and support. Taken together, this study underscores the need to go beyond technical access to care to ensure that trans-inclusive and trans-responsive sources and providers of care are made available throughout the healthcare system. As the narratives of trans Filipinos illustrate, the narratives, experiences, and practices within their online communities of care may be the key to actualizing such a healthcare system not only in the Philippines but all over the world.

Sexual and reproductive health literacy of culturally and linguistically diverse young people in Australia: a systematic review

Young people from culturally and linguistically diverse backgrounds experience barriers accessing sexual and reproductive health (SRH) information and care. This systematic review, utilising a pre-determined protocol, performed according to PRISMA guidelines, explored SRH knowledge, attitudes and information sources for young (16–24 years) culturally and linguistically diverse background people living in Australia, to gain understanding of their sexual health literacy. CINAHL, Embase, MEDLINE, PubMed and Scopus were systematically searched with inclusion criteria applied to 216 articles. After title and abstract screening, backward/forward searching, and full-text review of 58 articles, 13 articles from eight studies were identified. Thematic analysis, guided by core constructs from cultural care theory, identified three themes: (1) SRH knowledge varied by topic but was generally low; (2) young people’s attitudes and beliefs were influenced by family and culture; however, ‘silence’ was the main barrier to sexual health literacy; and (3) Access to SRH information was limited. To attain sexual health literacy and equitable access to culturally-congruent and responsive SRH information and care, there is a need for theory-informed strategies and policies that address the diverse social, cultural and structural factors affecting young culturally and linguistically diverse background people, especially the ‘silence’ or lack of open SRH communication they experience.

Assessing changes in adolescent girls’ and young women’s sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini

ABSTRACT The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls’ and young women’s (AGYW; aged 15–24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini’s electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW’s SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.

Prevalence and factors associated with sexual and reproductive health literacy among youth living with HIV in Uganda: a cross-sectional study

BackgroundAdequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodeficiency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda.MethodsThrough a cross-sectional survey, YLHIV receiving routine HIV care services at Baylor-Uganda HIV Clinic were interviewed using an adapted European Health Literacy Survey (HLS-EU). Using simple random sampling, eligible youth who received HIV care services between August and November 2019 were enrolled in the study. SRHL scores were computed using the HLS-EU index method; and individuals whose scores ranged from 34 to 50 were considered health literate. We used descriptive statistics to determine the prevalence. Potential associated personal and environmental factors (p<0.05) were identified by performing two-step inferential statistics, bivariate analysis and binary logistic regression. Odds ratios were calculated to estimate the likelihood of youth being health literate on sexual and reproductive health (SRH) issues in comparison with the reference categories, and 95% confidence intervals were determined to establish whether the relationships were statistically significant.ResultsOf the 267 YLHIV interviewed at Baylor-Uganda HIV Clinic, 167 (62.5%) were female with a mean age of 18.9 years (SD± 2.8), and the majority (242; 90.6%) were vertically infected with HIV. Only 52 (19.5%) were health literate on SRH issues. At the multivariate level, YLHIV who never had difficulty accessing SRH information were 0.391 times less likely to be health literate on SRH issues than their counterparts with challenges in accessing SRH information (Adjusted Odds Ratio [AOR] = 0.391, 95% CI =0.178 to 0.860; p= 0.019). YLHIV who did not find it easy to access SRH care service points were 2.929 times more likely to be literate in SRH than those who found it easy to access such services (Adjusted Odds Ratio [AOR] = 2.929, 95% CI =1.241 to 6.917; p=0.014). Additionally, YLHIV who did not listen to radio health talks were 2.406 times more likely to be health literate on SRH issues than those who did (AOR = 2.406, 95% CI =1.133 to 5.112; p=0.022).ConclusionsSRHL is an unmet need among YLHIV; only 19.5% were health literate on SRH issues. This could complicate the achievement of the UNAIDS sustainable development goal (SDG) of an HIV/AIDS-free generation by 2030 because low health literacy (HL) skills can affect the efficacy of almost all HIV disease prevention and health promotion efforts. Inaccessible SRH care service points and not listening to radio health talks were positively associated with SRHL, while having access to SRH information was negatively associated with SRHL.