Young People's Sexual Health Research Articles

Health Workers' Attitudes Toward Adverse Gender Norms and Implications for Young People's Sexual and Reproductive Health in Nigeria.

Adverse gender norms within the health care system are detrimental to the sexual and reproductive health of young people. This study assessed the attitudes of health workers toward adverse gender norms related to intimate partner relationships across three domains: intimate partner violence (IPV); sexuality; and reproductive health behavior. A cross-sectional quantitative survey was conducted among 255 health workers in youth-friendly primary health centers in Ebonyi State, Nigeria. Attitudes to gender norm statements were assessed on a 3-point scale of agree (3 points), partially agree (2 points), and disagree (1 point). Mean attitude scores were estimated for each statement and the predictors of attitudes were determined through multiple linear regression analysis with p-value set at .05. Majority of the health workers held gender biases regarding male control over sexual decision-making, men's higher desire and value for sex, and the woman's responsibility to prevent pregnancy. Over 40% of the respondents associated women carrying condoms with promiscuity, and 39.6% believed that only men have the "social" rights to purchase condoms. Urban residence predicted health workers' attitudes to adverse gender norms related to sexuality (β = -.179, p = .003). Findings from this study provide a basis for in-service training programs that are designed to change the attitudes of health workers to adverse gender norms and transform their practices.

Sexual health interventions with social marketing approach targeting young people: a scoping review.

In a fast-paced digital and global environment, sexual education must keep up with young people's sexual health needs. Social marketing is an approach that has been used in sexual health promotion for young people. The objective of the scoping review is to identify and map the use of social marketing in sexual health promotion for young people. Specifically, the content, delivery methods and effects of interventions on sexual health were researched. Six databases were systemically searched to capture the relevant peer-reviewed quantitative, qualitative and mixed methods articles without time restrictions that provided evidence of sexual health-related social marketing interventions targeting young people aged 11-25. An inductive and deductive content analysis was performed. Nineteen studies were included in the data. The content of interventions was dominated by sexual risks and risk prevention, focusing particularly on sexually transmitted diseases, unwanted pregnancies and sexual violence. Additionally, interventions included topics of morals of sexual relationships and changes in the body. The delivery of interventions occurred through various media channels, events and activities, while the effects of interventions were monitored as improvements in sexual perceptions and sexual behaviour, limited gender-related effects, limited evidence of intervention attributed to behaviour and effects in different age groups. The social marketing approach was mostly preventive and concentrated on the risks, whereas the delivery methods were diverse and creative, combining modern and already well-established channels. Sexuality should be seen comprehensively, and interventions should respond to the full range of young people's needs.

Socio-sexual norms and young people's sexual health in urban Bangladesh, India, Nepal and Pakistan: A qualitative scoping review.

In South Asia, young people face myriad challenges and opportunities regarding their sexual lives relating to varied experiences of norms and restrictions; gender norms and socio-sexual taboos limit communication around sexual health which in turn can affect sexual health outcomes. In this article we focus on norms affecting young people's sexual health experiences in urban settings in Bangladesh, India, Nepal, and Pakistan. We conducted a scoping review of peer reviewed empirical studies based on qualitative data pertaining to young people's experiences of sexuality and sexual health in Bangladesh, India, Nepal, and Pakistan. We searched four electronic databases for articles published (2010-2022), using terms relating to sexual health, young people, and South Asia. Sixteen articles met the inclusion criteria with sample size ranging from 9 to 180. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for the design and analysis of this study. We synthesised the included articles using thematic analysis. The studies covered topics such as sexual health services and contraceptive use; sexuality education and communication; and gender and sexual violence. Recurring findings included: parental and societal expectations around premarital 'sexual purity' through abstinence; limited communication around sexuality between young people and parents/adults; gender norms limiting young women's sexual and reproductive decision making; and an absence of research on experiences of sexual and gender minorities. We identified common themes as well as prominent gaps which must be addressed if we are to capture diverse experiences and build a better evidence base to improve sexual health services for young people in the region. The body of research fails to include experiences of young people with diverse gender, sexual orientation, and sex characteristics.

A systematic review of the evidence on the effectiveness of sexuality education interventions on young people's sexual and reproductive health outcomes in Nigeria

Poor sexual and reproductive health (SRH) outcomes among Nigeria's youth necessitate urgent interventions to meet the country's sustainable development goal (SDG) SRH target by 2030. This review evaluates Nigeria's SRH educational interventions, focusing on their effectiveness in improving young people's (YP) SRH outcomes. It highlights the global implications of these outcomes on achieving the SDG by 2030. The review, following PRISMA standards, analyzed peer-reviewed journals and gray literature (from January 2017-June 2023), using narrative synthesis and Joanna Briggs institute (JBI) quality appraisal checklists for quasi-experimental and cross-sectional studies. The search found 1021 studies, with 6 meeting inclusion criteria (4 quasi-experimental and 2 cross-sectional studies). All reported significant improvements in YPSRH outcomes, including knowledge and attitudes towards SRH themes, uptake of SRH and HIV/STI services, parental and societal support, and reduction in risky sexual behaviors. Quality assessment revealed several methodological flaws such as inadequate blinding and contamination measures. The review offers insights for YP interventions, but methodological flaws limit effectiveness. Further studies with rigorous designs and longer follow-up are needed. The absence of economic evaluation data is a knowledge gap with important implications for decision-makers.

Enhancing self-care and access – The Dutch stepped care model to strategically organize public sexual health for young people

Public Sexual and Reproductive Health (SRH) services are traditionally provided face-to-face by Dutch Sexual Healthcare Clinics. High demand for these services led to the exploration of digital health to increase access and support self-care. However, the implementation was fragmented and uncoordinated. Therefore, the Stepped Care Model (SCM) was introduced to (1) organize coordination and cooperation between regional and national providers of public SRH-services for young people; (2) link digital services to clinical services and identify opportunities for new digital services; (3) increase the accessibility of SRH-services; and (4) stimulate self-care. This article describes the Dutch SCM and how digital health is integrated The process started by identifying key stakeholders and promoting collaboration followed by development and implementation of an unified national online platform to access comprehensive SRH services. The different levels of care of the existing services were categorized and overlap between services were inventoried. Based on ‘ideal client journeys’ for different sexual health themes, relevant services on different care levels were linked to each other and new opportunities for digital or combined digital-professional supported services were identified. It is explained how young people can gain easy access to increasingly specific and specialist services at the higher steps of the model via the online central portal with general information as a first step. The lessons learned highlight the importance of partnerships, coordination and a shared strategy leading to reduced fragmentation and increased accessibility of services and more self-care. The constraints of the Dutch SCM are related to restricted evaluation possibilities due to anonymized client data, limited target group involvement, complexity of digital service development along with possible resistance from health professionals. The SCM shows how efficiency in health systems can be achieved following the principle of economies of scale: more coordination and less fragmentation, leading to lower costs for development and implementation of digital services, availability and bundling of specialized technical and regulatory expertise and financial resources, ultimately leading to reduced waiting times and more self-care for young people.

Determinants of the unmet needs for information, education and communication on sexual health among single youths in Burundi.

The prevalence of HIV/AIDS among young people aged 15-24 in urban areas is at least 12 times higher among girls than boys in Burundi, while it is twice as high in Rwanda. The gap between the two countries could be narrowed if Burundi's single young people were provided with sufficient information about their sexual health through appropriate channels. The aim of this study was to examine the social and individual "determinants" of unmet needs for sexual health information, education and communication (IEC) among unmarried young boys and girls aged 15-24 in Burundi, using data from the 2016 Demographic and Health Survey (DHS). Data were analyzed at the bivariate level using cross-tabulations and chi-squared tests, and at the multivariate level using binary logistic regression methods. According to the results of the study, the 'determinants' of the phenomenon studied are, for both sexes, the size of the household, the age of the youths, their level of education, their knowledge of where to take the HIV/AIDS test and their region of residence; only in the case of boys do we find, in addition, the age of the head of the household, his level of education and the adolescents' exposure to the media; similarly, only in the case of girls do we find their economic activity and their perception of HIV/AIDS. Multisectoral IEC actions on sexual health for young people should therefore be strengthened in Burundi.

Quality of adolescent and youth-friendly sexual and reproductive health services and associated factors in Ethiopia: a systematic review and meta-analysis.

Low-quality health care services are linked to a variety of health problems, which can have negative effects on adolescent and youth health. As a result, national data is crucial to providing high-quality healthcare to adolescents and youths in order to promote their health, wellness, and growth. To examine the quality of young people's sexual and reproductive health care services and factors associated with service satisfaction in Ethiopia. This review was carried out in accordance with the PRISMA guideline. We reviewed published data related to the quality of adolescent and youth-friendly sexual and reproductive health services (AYSRHS) in Ethiopia from January 02, 2002 to December 30, 2022. Relevant studies were identified through Google Scholar, PubMed, Cochrane Library, Science Direct, and HINARI. The extracted data was imported into STATA version 14.0 software for analysis. Heterogeneity among the reported prevalence of studies was checked using χ2 and I2 tests. The publication bias was examined by Egger's correlation and Begg's regression intercept tests at a 5% significance level. The national pooled magnitude of structural, process, and output dimensions of quality of AYSRHS is 54.22% (95% CI: 33.21, 75.24%), 35.44% (95% CI: 24.95, 45.93%), and 57.01% (95% CI: 50.32, 63.7%), respectively. Being female (AOR: 1.61, 95% CI: 1.14-2.27), employed (AOR: 1.82, 95% CI: 1.06-3.14), waiting <30 min to get services (AOR: 2.7, 95% CI: 1.69-4.31), and getting information on the availability of services (AOR: 1.56, 95% CI: 1.15-2.11) were significantly associated with client satisfaction with AYSRHS. The overall magnitude of quality of AYSRHS in the three dimensions is far below WHO quality standards, which are 75 percent for good quality. Sex, employment status, waiting time to get services, and information on the availability of services were significantly associated with client satisfaction with AYSRHS. Therefore, different stakeholders on different levels should work together to strengthen the quality of AYSRHS concidering the above factors. Identifier [CRD42023422667].

A meta-analytic exploration of associations between religious service attendance and sexual risk taking in adolescence and emerging adulthood.

Findings since 2000 about the association between the frequency of religious service attendance (formal religiosity) and sexual risk taking in adolescents and emerging adults were explored. A systematic literature search (April 2020) focused on articles with data on religiosity and age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use. A total of 27 studies with 37,430 participants (Mage = 18.4, range: 12-25, 43.5% male) were included. In random-effects meta-analysis, the link between formal religiosity and sexual risk taking was significant only for age at sexual debut (r = 0.09, 95% CI = 0.05, 0.13) and the number of sexual partners (r = -0.14, 95% CI = -0.19, -0.09). Weak associations between the constructs of interest indicate that formal religiosity is not sufficient to protect young people's sexual health.

Youth clinic model for youth sexual health: Promising solution to ensure access to care.

To understand the services offered at a youth clinic as a site specializing in youth sexual health services, and the implications of this model for young people's well-being. Qualitative research plan that follows the principles of grounded theory. A youth clinic located in an urban neighbourhood in Montréal, Que. The participants in this study were young patients, aged 18 to 23, accessing the clinic and the health care providers supporting them at the clinic. The clinic's interdisciplinary team consisted of family physicians, nurses, a sexologist, a social worker, and a receptionist. All members of the clinic team (n=8) and 8 youth patients were interviewed. Semistructured interview methods were used with the youth participants and health care providers. Youth participants were recruited using convenience sampling. The primary results are divided into 3 components: the composition of the interdisciplinary team, with particular attention to the co-location of the team members; particular conditions at youth clinics, notably the presence of a receptionist on the team, financial coverage for certain prescriptions, and longer consultation times allowing for an educational component; and young people's positive perceptions of these services. Considered together, the characteristics of a youth clinic promote access to youth sexual health services on several levels. The findings encourage general practitioners to collaborate with services connected to family medicine when supporting young people's sexual health.

Using Video Games to Improve the Sexual Health of Young People Aged 15 to 25 Years: Rapid Review.

BackgroundSexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies.ObjectiveThis study aims to assess the effects of video game–based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years.MethodsA rapid review of randomized controlled trials and quasi–randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50% (35/70) of the retrieved articles during the full-text screening phase.ResultsFrom a total of 459 identified citations, after removing duplicates, 327 (71.2%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4%) full texts were screened, from which 10 (3.1%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game–based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed.ConclusionsAlthough game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game–based interventions to improve sexual health in young people.

An Artificial Intelligence Chatbot for Young People's Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study.

BackgroundLeveraging artificial intelligence (AI)–driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources.ObjectiveThis study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India.MethodsWe adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings.ResultsSnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience.ConclusionsSnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good.

KNOWLEDGE OF STUDENTS AT HEALTH-RELATED DEPARTMENTS ABOUT SEXUAL HEALTH AND RELATED FACTORS

Aim: For the societies to be healthy, it is important to protect and improve the sexual health of young people. The research was conducted descriptively in order to determine the knowledge about sexual health of students studying at health-related departments and related factors. Method: The research was conducted with 600 students at health departments. Student Information Form and Sexual Health Information Test were used in the study. The datas were evaluated by using t test, analysis of variance, number, percentage and mean values. In statistical analysis, the level of significance is accepted as p&lt;0.05. Results: The difference between the students' gender, sexual health education status, number of siblings, father's occupation and income, and sexual health knowledge was found to be statistically significant (p&lt;0.05). Conclusion: It was determined that the total sexual health information of the students was below the acceptable values. In the results of working; It is recommended that sexual education programs should be implemented for pre-university and university students.

ЗМІСТ І ПЕРЕДУМОВИ ВПРОВАДЖЕННЯ КОМПЛЕКСНОЇ СЕКСУАЛЬНОЇ ОСВІТИ В УКРАЇНІ

The need for science-based knowledge about sexual life is natural for children and youth all over the world. Official statistics on the incidence of sexually transmitted infections, gender-based violence, and early pregnancies emphasize the urgency of the problem of developing sexual competence for Ukrainian children and youth. The purpose of the article is to study the foreign and Ukrainian experience of sexual education at school, to understand the essence of the concept of comprehensive sexuality education, its actors, and the requirements for their training. The main research method was document analysis. The results of a review of approaches to developing the researched problem in foreign and national scientific publications and a comparative analysis of Ukrainian, some foreign and international standards (guidelines, recommendations) regarding sexual education are highlighted. It was found that today there is no unity in terminology, interpretation, and criteria for defining sexual education. There are national differences in approaches to understanding its goals and content. Sexual education is interpreted in a narrow and broad sense, but in this matter, scientists are gradually more and more inclined to use a complex approach. A broad interpretation of sexuality education shifts the traditional emphasis from the physiological and biological features of the sexes, the problems of sexual life, including the prevention of accidental pregnancy, sexually transmitted diseases, and the achievement of safe sexual satisfaction (sex education, sexual health education) to the issues of forming a culture of sexuality and related feelings, understanding and protection of one's rights, including sexual, throughout life, humane treatment and responsible behavior in relationships, clear and respectful communication, preparation for marriage and family life (comprehensive sexual health education, comprehensive sexuality education). Comprehensive sexuality education has strong support in the international discourse and is supported by a relatively robust evidence base. A comprehensive approach enables educators and policymakers to address not only the individual determinants of young people's sexual and reproductive health but also the social determinants of their health and well-being. Comprehensive sexuality education is not reduced to the activity or responsibility of an individual teacher. However, it is the result of the collective actions of all teachers in conditions of mutual support and exchange of experience in implementing sexual education programs. Health, biology, and physical education teachers considered critical in sexual education at school. At the same time, it is necessary to strengthen teachers' ability in sexuality education by improving the qualifications of teachers and providing constant support. The document analysis proved the inadequacy of the development and practical solution of the introduction of comprehensive sexuality education in Ukrainian schools. At the same time, the European and American experience of a number of foreign and international standards, guidelines, and technical documents, which relate to the content and results of sexuality education for students, the quality of the application of education standards, and professional training of teachers, shows a reasonably stable conviction that comprehensive sexuality education contributes to children and society as a whole.

Improving the sexual health of young people experiencing homelessness.

The sexual health needs of young people experiencing homelessness in the UK have not been researched adequately. This study aimed to examine knowledge and attitudes around sexual health and contraceptive use amongst this vulnerable group to develop suitable models of care in the community. A qualitative ethnographic case-study following Burawoy's extended case method was used. Semi-structured interviews with 29 young people experiencing homelessness and five key workers in London hostels were carried out together with ethnographic observations and analysis of documentary evidence. Thematic analysis was undertaken. Demographic data were collected. Three significant themes were identified: risks and extreme vulnerability, relationships and communication difficulties and emergence of a culture of homelessness. Young people experiencing homelessness require specialist delivery of sexual health care in safe surroundings. Initial care should focus on assessment of basic needs and current state of being. Establishing trusting relationships and considering ongoing vulnerability, can help promote meaningful and personalised sexual healthcare both at policy and practice level.

Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions.

Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.

“What Do Our Boys Know about Sex?” Preliminary Data of a New Questionnaire for the Evaluation of the Knowledge of Sexuality among Adolescents

Background: The sexual health of young people is an especially important issue for national health policies. Adolescents, in fact, are at elevated risk for adverse sexual and reproductive health outcomes relative to their habits, sexually transmitted infections (STIs), sexual behaviour and teenage pregnancy. The aim of this study was to assess the knowledge about sexuality of students under the age of 18. Moreover, we aimed to explore the influence of sex education on sexual knowledge and behaviour. Methods: The participants were enrolled during a cultural exchange project in September 2019. After completing the questionnaire, all students took part in a sex education course performed by an urologist with expertise in sociology and psychology. The adolescents repeated the same survey in a web form in September 2020, one year after the course. Results: Analyzing the data, sex education lessons helped to improve students’ confidence in approaching all the issues of the questionnaire. Moreover, we observed a significant increase in the role of school as main source of information, while the role of the internet, media and family remained stable. Conclusions: This study encouraged the introduction of school-based sexual education policies, pointing to opportunities for structural early intervention programs.

Sexual and reproductive health of adolescents and young people in the Gambia: a systematic review.

Introductionin the Gambia, adolescents and young people make up 32% of the national population. Observations indicate that this population group lack access to quality information and services on sexual and reproductive health. This systematic review explored some sexual and reproductive health indicators relevant to adolescents and young people in the Gambia.Methodspublished studies on some sexual and reproductive health indicators were searched in PubMed, Google Scholar and African Journals Online. Moreover, national reference documents containing relevant in-country data on adolescents and young people's sexual and reproductive health were also collected and reviewed. Search terms for published studies focused on modern contraceptives, sexually transmitted infections (STIs) prevalence rates, availability and accessibility to sexual and reproductive health (SRH) services and adolescents and young people’s satisfaction with SRH services among adolescents and young people (aged 10-24 years).Resultsthe review showed that contraceptive prevalence rates among adolescents and young people in Gambia ranged from 7% to 9%. Reasons for low contraceptive prevalence among adolescents and young people included limited knowledge and access to sexual and reproductive health information and services, provider attitudes, stigma, shame, lack of money, cultural and religious misconceptions associated with contraception. Overall, the review found limited information on STI prevalence among adolescents and young people, with a single published study reporting a prevalence rate of 8.4%. In addition, inadequate counseling, complaints related to physical environment as well as the process of providing sexual and reproductive health services and information were significant factors associated with satisfaction with SRH services among adolescents and young people.Conclusionthis review provides important baseline data that may be useful for policymakers and program managers to improve adolescents and young people's sexual and reproductive health in Gambia.

The East and Southern Africa Ministerial Commitment: a review of progress toward fulfilling young people's sexual and reproductive health and rights (2013–2018)

Whilst significant progress has been made in recent years with respect to advancing health and education, the ESA region’s young people still experience challenges in relation to their SRHR. This study brings together learning from the available data and reports, as well as the experiences of those closely connected with the process of affirmation/endorsement and implementation of the ESA Commitment between 2013 and 2018. Whilst challenges remain – particularly in relation to monitoring and accountability – the ESA Commitment has instigated notable progress, made possible in part by the emphasis on multisectoral collaboration between health and education sectors nationally and regionally. Sustained political, technical, and financial investment in young people’s health and rights will ensure that the countries of the region are able to build upon these successes and deliver on their commitments to young people during this decade of action towards the realisation of the SDGs and harnessing the demographic dividend for Africa for years to come.

What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients.

Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity. A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored. One hundred and seven young people (18-25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients. High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.

The influence of peer relationships on young people's sexual health in Sub-Saharan African street contexts

This paper explores the interaction between peer relationships and sexual health among street youth in three Sub-Saharan African cities: Accra (Ghana), Bukavu (Democratic Republic of Congo), and Harare (Zimbabwe). It begins by conceptualising peer relationships for youth globally and considers why these are pivotal for young people living in street settings. The paper reconceptualizes street peer relationships not as replacement families, but as sharing ‘social anchorage’ in the street space. It draws on qualitative ethnographic data from Growing up on the Streets, a longitudinal research project with a participatory methodology undertaken between 2012 and 2016 and engaging street youth (aged 14–20 at project outset) trained in ethnographic observations as research assistants (n = 18), following a network of ten peers (n = 229 by 2016), reporting their experiences in weekly interviews with facilitators. A wider network attended focus groups (n = 399). The project engaged a ‘capability’ approach, with ten capabilities defined by street youth as key to their daily lives. Empirical evidence is from a subset of data qualitatively coded (using NVivo) against capabilities ‘Health and Wellbeing’ and ‘Friendship’, across all interviews, focus groups and cities (n = 212 sources). In exploring this intersection, the paper demonstrates beneficial and adverse impacts of peer influence on sexual health, including misinformation about contraceptives and death from an informal sector abortion; highlighting findings from across the three cities around primacy of same-sex peer relations, mistrust between genders and in healthcare providers. The paper finds that while street youth remain subject to cultural norms around gender identities, street peer relationships hold a persuasive power; contributing to both everyday survival and moments of acute need. It concludes that recognising the right of young people to live and seek livelihoods in urban settings, and adopting the social networks they create to advance street youth's sexual health has become even more relevant in a (post)pandemic world.