Browsing by Subject "Sexual health"

Background: Adolescents and young people (AYP) living in Zimbabwe face an exceptionally high burden of HIV. Even with increased health intervention focusing on young people, engagement with sexual, reproductive healthcare remains low. AYP need increased attention to achieve the UNAIDS’ 95-95-95 goal for 2030. This study aims to assess the barriers and facilitators to sexual, reproductive healthcare access for adolescents and young people aged 16-24 in three districts in Zimbabwe. Methods: Seventy-five stakeholders, including AYP living with HIV, AYP with unknown or negative HIV status, family members of AYP, community gatekeepers, community- and facility-based healthcare workers, and community-based organization representatives contributed to in-depth interviews. We conducted thematic analysis on the interview summaries to assess knowledge and perceptions of sexual, reproductive health (SRH), barriers and facilitators to accessing SRH services, and challenges maintaining ART. Results: The stakeholder analysis revealed varied levels of knowledge and perceptions of SRH, and consensus about barriers and facilitators to accessing SRH services and challenges to maintaining ART. The most frequent challenges mentioned included stigma and logistical barriers, while the most frequent facilitators included a private and a youth-friendly environment. Conclusions: Based on the consensus among all stakeholders, findings from this study indicate an urgent need for youth-friendly sexual health interventions that offer a private and welcoming environment for AYP living in Zimbabwe. Additionally, this study contributes to existing literature supporting community-based sexual, reproductive healthcare interventions. This formative research can inform targeted future interventions addressing sexual, reproductive healthcare access for adolescents and young people in Zimbabwe.

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

Problem: Gay, bisexual, and queer (GBQ) adolescent males are disproportionately affected by negative sexual health outcomes compared to their heterosexual counterparts. Their sex education needs are not sufficiently addressed in the home and the larger ecological systems. The omission of their sex education needs at a time when they are forming a sexual identity during adolescence compels GBQ males to seek information in unsupervised settings. Evidence-based interventions aimed at ensuring positive sexual health outcomes through sex communication cannot be carried out with these youth as research on how parents and GBQ males discuss sex in the home has been largely uninvestigated.

Methods: This naturalistic qualitative study focused on the interpretive reports of 15- to 20-year-old GBQ males’ discussions about sex-related topics with their parents. From a purposive sample of 30 male adolescents who self-identified as GBQ, participants who could recall at least one conversation about sex with their parents were recruited for one-time interviews and card sorts. This strategy revealed, using Bronfenbrenners’ Bioecological Theory, their perceptions about sex communication in the context of their reciprocal relationship and the ecological systems that GBQ males and their parents navigate.

Results: Parents received poor ratings as sex educators, were generally viewed as not confident in their communication approach, and lacked knowledge about issues pertinent to GBQ sons. Nevertheless, participants viewed parents as their preferred source of sex information and recognized multiple functions of sex communication. The value placed by GBQ youth on sex communication underscores their desire to ensure an uninterrupted parent-child relationship in spite of their GBQ sexual orientation. For GBQ children, inclusive sex communication is a proxy for parental acceptance.

Results show that the timing, prompts, teaching aids, and setting of sex communication for this population are similar to what has been reported with heterosexual samples. However, most GBQ sons rarely had inclusive guidance about sex and sexuality that matched their attraction, behavior, and identities. Furthermore, the assumption of heterosexuality resulted in the early awareness of being different from their peers which led them to covertly search for sex information. The combination of assumed heterosexuality and their early reliance on themselves for applicable information is a missed parental opportunity to positively impact the health of GBQ sons. More importantly, due to the powerful reach of new media, there is a critical period of maximum receptiveness that has been identified which makes inclusive sex communication paramount in the pre-sexual stage for this population. Our findings also indicate that there are plenty of opportunities for systemic improvements to meet this population’s sexual education needs.

Adolescent girls' sexual and reproductive health (SRH) is a significant public health issue, but little is known about the SRH outcomes of orphaned and separated adolescent girls, who face a higher risk of abuse and neglect in the absence of parental guidance, underscoring the critical need for research. This study examines the SRH outcomes (early pregnancy and condom use) and their predictors among adolescent girls aged 15 to 21 in five low- and middle-income countries, including orphaned and separated children. We conducted a cross-sectional analysis of 933 participants during the latest round of data collection from a longitudinal cohort study to assess predictors of early pregnancy and condom use. We first used bivariable logistic regression to identify potential predictors of each outcome. Potential predictors included education level, abuse, working status, relationship status, and age. Predictors that were significant (p<=0.10) in crude analyses were added to a multivariable model to assess associations in the presence of other predictors. In bivariable analysis, we found that education, marital status, history of abuse, work status, and age are associated with early pregnancy. However, we did not find a significant association for condom use with any predictors. It should be noted that the findings may be imprecise due to the small sample sizes and exclusion of children under 16 years old. Further research is needed to explore targeted interventions aimed at reducing early pregnancy and promoting condom use. Addressing education, work, and relationship status may enhance the effectiveness of such interventions.