Specific Sexual Health Research Articles

Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo.

Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n=55; WC2: Adolescents user committee (AUC) n=63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49years old (increase of 283% for Makala and 23% for Maluku II)). Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.

Unmet Reproductive Health Care Information Needs of Female Young Adult Survivors of Childhood Cancer: Oncology Providers' Perspectives.

This study aimed to characterize unmet reproductive health needs of female young adult survivors of childhood cancer (YASCC), as understood by oncology providers (N = 10) caring for this patient population. Providers completed brief online questionnaires and a one-time semi-structured interview. Descriptive statistics characterized quantitative data, and rapid qualitative analysis identified themes in interview data. In survey data, providers rated fertility as a top concern among YASCC. Qualitative data identified specific under-addressed reproductive and sexual health information needs for patients and also for their providers. The results provide preliminary knowledge to inform the development of behavioral interventions to address patients' unmet needs.

(117) EVALUATING THE USE OF THE FEMALE SEXUAL HEALTH AFTER CANCER SCREENING CHECKLIST WITH YOUNG ADULT CANCER SURVIVORS

Abstract Introduction Sexual health, a key component of general well-being and quality of life, is often significantly disrupted by cancer treatment. In particular, when patients undergo cancer treatment early in life, disruptions to physical, sexual, and social development can have a considerable impact on sexual health by the time survivors reach young adulthood. However, extant sexual health measures are primarily intended for sexually active adults and do not accurately capture the range of sexual health concerns experienced by young adult cancer survivors (YACS). In order to provide comprehensive sexual health screening and care for this vulnerable population, measures must be developed specifically for young survivors. This study represents a critical next step in measure development for YACS: evaluating the utility and gaps of an existing sexual health screening checklist for cancer survivors. Objective To elicit feedback from female YACS regarding how the Female Sexual Health After Cancer Checklist captures their sexual health concerns as well as how the checklist may be updated for this population. Methods Cognitive interviews were conducted with 17 female YACS (ages 23-39). Participants were presented with the Female Sexual Health After Cancer Checklist and asked to provide feedback on each item. Specifically, Willis’s Concurrent Verbal Probing Technique was used to gather information on relevance of each item to YACS, item comprehension, item acceptability, decision processes, and response processes. For example, participants were asked whether the checklist items accurately captured their sexual health concerns (i.e., response processes). Results Overall, young adult participants reported that checklist items were relevant to their sexual health concerns. However, several participants noted wording for two items seemed to assess change in symptoms after cancer (e.g., “decreased vaginal lubrication”) which is difficult for YACS to answer if their cancer occurred prior to becoming sexually active. More broadly, participants reported that the checklist failed to capture many of their most pressing concerns (e.g., delays in sexual and romantic experience). Additionally, participants felt it would be important to assess barriers to sexual and romantic relationships such as negative body image and difficulty explaining cancer history to a prospective partner. Sexually inactive participants, in particular, noted adding items about barriers to sexual and romantic relationships would make the checklist more applicable to them. Conclusions Findings suggest that existing measures, such as the Female Sexual Health After Cancer Checklist, may be a starting point for a targeted YACS’ sexual health measure. However, revision and addition of items is necessary to fully capture the needs of this younger population. As a next step, we are currently amending items based on participant feedback. For example, items implying change after cancer (e.g., “decreased vaginal lubrication”) will be updated to focus on current symptoms (e.g., “vaginal dryness”) to better apply to YACS who were treated before sexual debut. Items capturing delays in sexual and romantic experience will also be added. Revised and new items will then be gathered into an item pool for further revision by YACS and sexual health experts as part of the process of creating and validating a YACS’ specific sexual health measure. Disclosure No.

Secondary School Students’ Views on Sexuality and Sexual Health Education

Objective This study examined the views of secondary school students on sexuality and sexual health education in Hong Kong, China. Methods A total of 818 secondary school students (mean age = 15.3 years, SD = 1.6) participated in this study by completing a questionnaire consisted of items on sociodemographic characteristics, sexual attitudes, and other measuring scales. Results Students were slightly permissive in sexual attitudes and supported sexual health education. However, students who were male, highly liberal in sexual attitudes, and low in religiosity and spirituality were less supportive. Conclusions Educators may need to address these deterring factors of sexual health education before teaching specific sexual health topics.

(223) Specific Training Needs of Student Midwives in Sexual Health and Clinical Sexology

Abstract Introduction According to the WHO, sexuality is an integral part of human life, encompassing all dimensions of human beings: physical, emotional, mental, and social well-being associated with sexuality, involving a positive and respectful approach. It is essential to educate and train health professionals such as midwives to address sexual problems and provide the necessary information to their clients, in order to ensure comprehensive and quality care. There is still a lack of specific sexual health training programs in the midwifery curriculum in several countries worldwide. Objective This study aims to assess the student midwives’ training needs in sexual health and clinical sexology. Methods It is a knowledge, attitudes, and practices cross-sectional online study that took place over 5 weeks starting March 1st, 2023. All enrolled student midwives in public and private midwifery schools in the country were contacted through the schools’ social media groups. The online questionnaire was a 29-item Google form elaborated in concertation with the Frequency, Gravity Problem (FGP) grid of questions. Results The study included 206 student midwives (answer rate: 87%). The participants were representative of the population of student midwives (31% 1st, 33% 2nd, and 36% 3rd year and 31% from the North, 38% from the center, and 31% from the South of the country). The participants’ mean age was 22,1± 1,04 years and 96% were single. When asked about their experience with sexual interviews, 60.7% felt uncomfortable. The reasons for that feeling were the absence of previous learning simulations and experiences (84%), the lack of confidence in their knowledge (70%), the fear of a potential lack of interest of the clients about sexual health (59%), sexuality is taboo (28%). Regarding their training and education in sexual health and clinical sexology, 94% declared that it was only theoretical, 47% considered it as unorganized and 68,5% thought that there was a lack of correlation between the time allowed and the content of the sessions. The instructors were judged as qualified by 36% of the participants. The resources were considered useful by 19%. And 23.3% of the students enrolled in other non-academic training in sexology during the previous year. The expressed need for specific sexology training was expressed in 94%. The needs were regarding knowledge in 55%, Attitudes in 80%, and practices in 55%. Conclusions A specific academic curriculum in sexual health and clinical sexology is a necessity within the student midwives' training. This educational program needs to reinforce some knowledge and practices and mainly address the attitudes of healthcare professionals toward clients asking for information and/or help regarding their sexual health. Prevention has also to be integrated into this program. Role-playing and simulations in small groups seem the most adapted pedagogical techniques to re-enforce attitudes within students. Disclosure No.

Men's age determines sexual and reproductive health services utilisation in Ekiti State, Nigeria

ObjectiveSexual and reproductive health services are majorly patronised by women leaving -out the men, hence men's opinions are not usually known or reflected. Therefore, in this study, men's opinion on determinants of Sexual and Reproductive Health (SRH) service utilisation among men were established. This was done in a bit to plan specific and attractive sexual and reproductive health services for men MethodsA cross-sectional quantitative study was conducted among 339 men between the ages of 18 and 65 years. Study participants were selected at household level from twelve communities using multistage and systematic sampling. Data were collected with the aid of structured questionnaire. Data were analysed with SPSS IBM statistics version 26 and the statistical significance was set at p-value < 0.05. ResultsOnly 18 % had previously utilised SRH services. Age was the only predisposing characteristic found to be associated with SRH service utilisation (p = 0.02) while distance of hospitals to participants’ residence and distance of hospitals to participants’ office were enabling characteristics found to be significantly associated with SRH service Utilisation (p = 0.00 and p = 0.04), respectively. Prevention and treatment of HIV (p = 0.03) and prevention and treatment of male sexual dysfunction (p = 0.01) were the need-based characteristics associated with SRH service utilisation. Binary logistic regression analysis showed that only age (OR = 1.40, 95 % C. I=1.03–1.90, p = 0.03) was the significant determinant of SRH service Utilisation with middle-aged men utilising SRH services more than other age groups. ConclusionThe utilisation of SRH services by men in this study was poor and this was majorly due to barriers that were service provision related. The study established that age is a major determinant of SRH utilisation by men. Age is an important factor while establishing SRH services for men, hence the need to set up specific MSRH services that are age appropriate and appealing to men.

(172) TrueNorth Sexual Health and Rehabilitation eTraining (SHAReTraining) in Prostate Cancer: Evaluation of an Online Course for Practitioners

Abstract Introduction Sexual dysfunction (SD) is a prevalent and distressing side effect for survivors of prostate cancer (PCa). Unfortunately, many health care practitioners (HCPs) report a lack of training and confidence in addressing the sexual health needs of PCa patients. Consequently, many PCa patients do not receive the comprehensive sexual healthcare needed to manage their SD. Objective To address the gap in HCP training, the Movember Foundation funded the development and evaluation of a 12-week, faculty-facilitated, online course designed to train HCPs in the delivery of PCa specific sexual health counselling: the TrueNorth Sexual Health And Rehabilitation eTraining (SHAReTraining). Course content includes, SD assessment and intervention, professional ethics, unique needs of sexual and gender minority populations, and approaches to implementing sexual health programming in a healthcare setting. Methods Participants completed a pre-course survey (n=23), a retrospective pre-post survey (n=19), and a 3-month follow-up survey (n=19) to assess retention of relevant outcomes. Outcomes included HCP perceived knowledge and self-efficacy to conduct assessments and provide interventions across a number of relevant physical, functional, psychological, and relational domains of SD in PCa survivors and their partners. Additionally, completed a course satisfaction survey at the conclusion of the course. Results Descriptive analysis of the pre-post survey revealed that graduates perceived knowledge of sexual health counselling improved from a mean of 51.12% pre-course to 75.18% post-course across all measured domains. Similarly, graduate ratings of self-efficacy in providing comprehensive care increased from a mean of 56.63% pre-course to 79.73% post-course. The follow-up survey demonstrated participants’ self-efficacy remained high 3-months post-course at 79.75%. Graduate experience taking the course was uniformly positive with a vast majority (94.7%) agreeing that they were satisfied with the course. Conclusions For HCPs seeking specialized sexual health care training for PCa patients, the TrueNorth SHAReTraining course is an accessible and effective resource. Graduates of the course have the potential to improve the quality of SD care they provide to their patients. Disclosure No

Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon.

The Syrian crisis has resulted in one of the worst humanitarian disasters in modern history. Inadequate access to and use of sexual and reproductive health services is a prevailing issue among adolescent girls and young refugee women in humanitarian settings. This article aimed to explore and describe the perceived extent of implementation of the different objectives and activities outlined within the minimum initial service package for reproductive health in crisis services in Lebanon, from the perspectives of a diverse set of stakeholders from leading organizations (public, private, primary health centers, nongovernmental organizations) that were directly engaged with the Syrian refugee crisis response. This study is a cross-sectional survey conducted using a standardized and validated questionnaire. Centers that provided sexual and reproductive health services to Syrian refugees in Lebanon were mapped. The study was based on a purposive sampling approach, retrieving 52 eligible organizations to cover most areas in the country. A total of 43 centers accepted to take part in the study. The head of the center was then asked to identify one person in their center who holds adequate knowledge of the explained objectives of the survey. Accordingly, the identified person was asked to fill out the survey. A considerable portion of the respondents had limited knowledge about the specific minimum initial service package objectives and related sexual and reproductive health services. The study found the presence of a leading reproductive health agency, the Lebanese MoPH, as an essential facilitating factor for sexual and reproductive health service provision in Lebanon and has helped in overseeing the overall sexual and reproductive health coordination response for Syrian refugees (76.74% of all respondents). The identified challenges impeding adequate sexual and reproductive health services provision for Syrian refugees included (1) insufficient supplies (46.51%); (2) insufficient funds (39.53%); and (3) shortage of staff (39.53%). The recommendations for improved sexual and reproductive health service provision include the need for (1) enforcing the lead minimum initial service package agency for adequate and effective coordination, reporting, and accountability and (2) increasing funding for training staff and healthcare workers, as well as improving the overall quality of services available with the inclusion of family planning services, purchasing the necessary commodities, supplies and equipment, and covering fees associated with the different sexual and reproductive health services.

Mental and sexual health during the COVID-19 pandemic: Differences between lesbian and bisexual women and gay and bisexual men in Mexico

COVID-19 had implications for sexual minorities who faced challenges due to situations related to their sexual orientation. The objective of this article was to analyze the differences in sexual and mental health experiences between lesbian and bisexual women (LBW) and gay and bisexual men (GBM) in Mexico in the context of the pandemic. An online survey captured the mental and sexual health experiences of a total of 932 participants consisting of 720 GBM and 212 LBW with a mean age of 30.5 years. Regarding mental health, women reported higher levels of depression, anxiety, and a greater possibility of suicidal ideation. Regarding sexual health, men were more likely to use drugs during sexual intercourse, have problems getting tested for sexually transmitted infections (STI), and have had STI during the lockdown. These findings identify particularities that each group faced, which can inform recommendations for public policies addressing specific sexual and mental health problems during and after the current pandemic.

Developing a Framework Addressing the Sexual Health Needs of Patients Treated with Head and Neck Radiation Treatment

Aim: Head and neck (H&N) cancer patients do not receive treatment to their sexual organs, but these patients undergo a multimodality approach to treatment and its effects may still negatively affect their sexual health (SH). Radiation therapists (RTs) have a unique opportunity to develop a strong rapport with patients and to discuss sensitive issues related to relationship, body image and intimacy (RBI). This project aimed to address the SH needs of our H&N patients by providing RTs at our institution with the knowledge and skills to provide SH information to our patients. We also addressed increasing our accessibility to SH information by creating a specific SH document tailored to help our patients who are receiving H&N radiation treatment. Process: This Quality Innovation involved a multidisciplinary collaborative effort. We surveyed our staff to identify the perceived barriers in preventing RTs from having a SH conversation with their H&N patients. This needs assessment allowed us to identify how we can best help our staff. Working with our institution's patient education and patient partners groups, we created a patient education document on SH concerns for patients receiving H&N radiation treatment. We also created education sessions for our RTs to improve their knowledge about SH concerns. The workshops covered the impact of sexual dysfunction in oncology; clinical approaches to optimizing sexual healthcare in oncology; and provided future direction on how to access resources for our patients. Finally, we standardized the procedures and improved RT practical skills by creating documentation processes and conversational scripts for staff to help them initiate conversations about these sensitive topics. Benefits/Challenges: A challenge we experienced during our project included inconsistent staffing due to COVID19 interruptions. This project experienced a 7 month pause due to clinical demands at our institution. In addition, our team lost a team champion as they had left the institution. This challenge was rectified by recruiting extra team champions to help facilitate this project. The benefits of our quality initiative interventions included increasing our staff knowledge and comfort levels in having SH conversations with our H&N patients through educational staff workshops. For consistent staff delivery, we standardized the procedure and provided staff with conversational scripts so that staff could start a SH conversation with their patients. Impact/Outcomes: This quality initiative is midway through completion. Four team champions of this project were able to receive SH training in oncology, and other team members have various experience in sexual health care in oncology. So far, we have conducted one educational SH workshop for staff. Based on participant feedback, staff were motivated and eager to increase their knowledge and skill levels. Another education session will be organized for early 2022, focused on H&N sexual health. Prior to clinical implementation, the champions piloted the process with patients. From participant interviews, patients were very appreciative and accepting of SH information from RTs. This initiative will be fully implemented in late January.

Overwhelming Support for Sexual Health Education in U.S. Schools: A Meta-Analysis of 23 Surveys Conducted Between 2000 and 2016

PurposeSurveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools. MethodsA systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys. ResultsA total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2–91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5–93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1–90.6) of respondents supported sexual health education. ConclusionThese findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction.

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration.

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGIE migrants during transit and examine their access and use of services. Six peer-reviewed databases and websites of nine large migration organisations were searched to identify the literature on forced migrants and sexual and gender minorities. Twenty English-language studies from 2000–2021 were included and analysed drawing on a conceptual framework. Studies emerged from six regions and the majority of research participants identified as gay men. In general, quality appraisal demonstrated studies as either medium or high quality. Findings suggested five common themes associated with SOGIE health and well-being, including: daily exposure to discrimination, harassment and violence; coping, social support and resilience; access to services; mental health; and physical and sexual health. Depression, anxiety and post-traumatic stress disorder (PTSD) were prevalent amongst SOGIE migrants, particularly when associated with detention or camp environments, and were exacerbated by social isolation. Barriers to accessing healthcare were identified and specific sexual health services were often found lacking, especially for trans persons. Unsurprisingly, during transit, SOGIE migrants are very likely to experience the double marginalisation of their migrant or minority status and their gender identity. Results indicate that services for SOGIE migrants need to tailor service access and support approaches to respond to the particular health and protection needs of SOGIE individuals in each setting.

"Making a Way Out of No Way:" Understanding the Sexual and Reproductive Health Care Experiences of Transmasculine Young Adults of Color in the United States.

Research focusing on the specific and unique sexual and reproductive health care experiences of transmasculine young adults of color are extremely scarce. We conducted five focus group discussions with 19 Black, Latinx, Asian, Native, and other transmasculine individuals of color aged 18-25years in the greater Boston area. Using thematic analysis, we found that transmasculine young adults of color experienced cissexism, heterosexism, and racism in accessing and utilizing sexual and reproductive health services. These multiple forms of discrimination undermined participants' receipt of high-quality sexual and reproductive health information and care from competent health care providers who shared their lived experiences. Participants relied on support from their lesbian, gay, bisexual, transgender, and queer peers to obtain needed sexual and reproductive health resources and minimize harm during clinical encounters. Multilevel interventions are needed to promote access to person-centered and structurally competent sexual and reproductive health care among transmasculine young adults of color.

64. Gaps in Reproductive Health Education for Myelomeningocele Patients

<h3>Background</h3> Despite patients reporting a desire for reproductive health education, research has shown that myelomeningocele patients rarely receive information about sexual and reproductive health. Patients not only want general reproductive health education, they also want education about limitations that are specific to their level of disability. Prior research lacks a clear understanding of the specific reproductive and sexual health topics currently covered by providers. With this gap in knowledge, patients are left with inadequate reproductive health education. The objective of this study was to evaluate the existing reproductive health education and reproductive health needs among patients with myelomeningocele. <h3>Methods</h3> All English-speaking patients age 12 or older with a myelomeningocele clinic visit at a tertiary children's hospital between October 2019 and September 2020 were surveyed. Parents assisted with survey completion when necessary. The survey response rate was 54%. The survey asked patients which reproductive health topics had been covered by a medical provider during any of their clinic visits and patients were offered a referral to a reproductive healthcare provider (RHP). <h3>Results</h3> In total, 67 surveys were completed by patients of the myelomeningocele clinic. A majority of patients were female (58%) and white (83%), and the median age was 18.5 (Range: 12, 50). Menses were discussed at a rate of 85% in females. Few patients had discussions with a provider about their fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had an existing relationship with a RHP (54%). Differences by sex were observed in contraception conversations (54% for females and 25% of males, p for difference<0.0001). The rate of reproductive healthcare discussions increased with age, for example, 18% of patients younger than 18 had discussions with a provider about fertility, while 67% of patients older than 18 years had experienced such discussions (p<0.0001). At the conclusion of the survey, 62% of female patients requested a referral to an RHP, compared to 14% of male patients (p=0.04). <h3>Conclusions</h3> Overall, patients in the myelomeningocele clinic have a reported low rate of education on basic sexual and reproductive healthcare topics. The lack of consistent sexual and reproductive healthcare education across the patients supports the need for providers to re-evaluate how and when these topics are being discussed with patients and families. Establishing care with an RHP should be standardized in this population and reproductive healthcare should be considered a part of comprehensive care in all patients, regardless of disabilities.

Exploring the experiences and responses of LGBTQ+ adolescents to school‐based sexuality education

AbstractThe purpose of this study is to describe the experiences of lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth with school‐based sexuality education (SBSE), as well as to document strategies LGBTQ+ youth are using to address their evolving and specific sexual health needs outside of SBSE. Researchers conducted focus groups with 17 adolescents (ages 14–18) from urban and suburban Midwestern cities. Results of this study indicate LGBTQ+ youth find SBSE to be heteronormative, cisgender focused, and primarily focused on pregnancy and disease prevention, which contributes to LGBTQ+ youth experiences of exclusion. In response to SBSE that did not meet student needs, participants reported seeking sexual health information outside of SBSE. Other sources included family and other trusted adults, the Internet, and community resource centers. Students reported variable rates of use and trustworthiness across these resources. Results of this study suggest that school personnel should consider alternatives to traditional SBSE models to meet the needs of LGBTQ+ youth, and that an important part of SBSE should include guidelines for Internet safety.

Documenting the challenges of conducting research on sexual and reproductive health and rights (SRHR) of persons with disabilities in a low-and-middle income country setting: lessons from Bangladesh

Research has shown that persons with disabilities require greater sexual and reproductive health (SRH) care and services than persons without disabilities. However, this need is often neglected in most of...

Attitudes, beliefs, and norms about sex and sexuality among young Indian male adults: A qualitative study

Objective:Little is known about the risky sexual behaviors, attitudes, beliefs, and sources of information regarding sexual health among young adult Indian males. Currently, students in Indian secondary schools do not receive a structured comprehensive sexual health education. This qualitative study explored the sources of information, knowledge, and attitudes around sexual behaviors among young men in Mysore, India.Materials and Methods:Between May and June 2011, 23 semi-structured qualitative in-depth interviews with males aged 18–25 years were conducted to explore their views on sexual norms, attitudes, and their sources of information to gain knowledge about sexual health. Interviews were audio recorded and transcribed verbatim. Thematic analyses were conducted.Results:Participants shared a desire for quality sex education in schools but described their current sexual health curriculum as inadequate. Since social taboos dictated the space in which students gained awareness on sexual topics, the participants resorted to the outside information from both reliable and unreliable sources.Conclusions:These findings have important implications for laying the groundwork for culturally specific sexual health education interventions to meet the needs of a growing youth population in India.

Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men\u2019s mental and sexual health

BackgroundYoung gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men’s exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men’s health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health.MethodsThis study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline.DiscussionDelivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men’s depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men.Trial registrationRegistered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069.

Utilization and avoidance of sexual health services and providers by YMSM and transgender youth assigned male at birth in Chicago

ABSTRACTYoung men who have sex with men (YMSM) and transgender youth assigned male at birth (AMAB) bear a disproportionate burden of the HIV epidemic, yet are sub optimally engaged by sexual health service providers and HIV prevention services. To increase sexual health and HIV prevention behaviors and address disparities in HIV incidence and outcomes among YMSM and AMAB transgender youth, it is critical to understand patterns of service utilization and avoidance. This study examined how and why YMSM and AMAB transgender youth use or avoid sexual health services and service providers in a large Midwestern city within a survey administered to 890 participants from a longitudinal cohort study (RADAR). Results demonstrate low overall use of sexual health services and minimal interest in seeking pre-exposure prophylaxis (PrEP), consistent with prior research. Low awareness of available services was associated with how and where YMSM and trans youth AMAB seek care, with 76% of our sample reporting this as their primary reason for not seeking specific sexual health services. Additional associations are discussed, and recommendations are made for how to improve available services and access.

Sexual and Reproductive Health of Adolescent in Nepal

Every fifth person in the world i.e. around 20% of global population is adolescents and slightly more than this, in Nepal, adolescents comprise of 24 percentage. Adolescents in Nepal often face limited access to health information and services. Different factors like poverty, gender inequality, socio-economic status, social norms and tradition play crucial role indetermining adolescent’s access to sexual and reproductive health knowledge and available sexual and reproductive health services. Especially women in this context are more disadvantaged with regards to literacy, health and overall wellbeing. In Nepal adolescents comprise of 24 percentage and young people comprise of 33 percentage, which is a larger proportion to the global comparison. Though the government of Nepal has recognized adolescents and youth as under-served and vulnerable population with specific sexual and reproductive health needs, however only limited number for program has been implemented targeting these age groups.