Tailoring STI & HIV Prevention Programs for Teens

A Review of the State of HIV Nursing Science With Sexual Orientation, Gender Identity/Expression Peoples

ABSTRACT

Throughout the HIV pandemic, nurses have contributed to or led approaches to understanding the effects of HIV disease at individual and societal levels. Nurses have advocated for socially just care for more than a century, and our efforts have created a foundation on which to further build the state of HIV nursing science with sexual orientation and gender identity/expression (SOGI) Peoples. Nurses have also participated in the development of approaches to manage HIV disease for and in collaboration with populations directly affected by the disease. Our inclusive approach was guided by an international human rights legal framework to review the state of nursing science in HIV with SOGI Peoples. We identified articles that provide practice guidance (n = 44) and interventions (n = 26) to address the health concerns of SOGI Peoples and our communities. Practice guidance articles were categorized by SOGI group: SOGI People collectively, bisexual, transgender, cisgender lesbian, women who have sex with women, cisgender gay men, and men who have sex with men. Interventions were categorized by societal level (i.e., individual, family, and structural). Our review revealed opportunities for future HIV nursing science and practices that are inclusive of SOGI Peoples. Through integrated collaborative efforts, nurses can help SOGI communities achieve optimal health outcomes that are based on dignity and respect for human rights.

A scoping review of the literature on nursing practices with persons seeking care for sexually transmitted infections

AIMS AND OBJECTIVES

To examine existing research literature to ascertain what is known about nursing practice in sexually transmitted infection care and identify promising research trends and limitations.

BACKGROUND

Sexually transmitted infections continue to be a significant public health concern with more than 357 million new cases occurring annually worldwide. Nurses are vital for the prevention and care of those affected by sexually transmitted infections. As nursing scope of practice is evolving, there is an urgent need to develop a baseline understanding of the state of nursing knowledge in sexually transmitted infection care.

DESIGN

Nurse researchers and policy and practice experts conducted a scoping review of primary research using Arksey and O'Malley's five-step methodological framework.

METHODS

Primary research literature published between 2000-2014 was searched. Seventeen full-text papers were thematically analysed. Electronic charts were created for data coding and extraction.

RESULTS

The research literature in nursing and sexually transmitted infection care is heterogeneous in topic, method and populations investigated. Sexually transmitted infection care is undertaken by nurses in diverse settings and roles including nurse practitioners and public health, school and emergency room nurses. Three themes that illustrate the main focus of current literature were identified: (1) screening, (2) health education and counselling and (3) scope of nursing practice. Inconsistencies in nursing practice activities in sexually transmitted infection care were noted. Many nurses are not working to their full scope of practice.

CONCLUSIONS

The research in sexually transmitted infection nursing practice is limited. Further research is needed to investigate the context of practice and patient care experiences; to design and test interventions to support nurses working to full scope of practice; and to improve the conceptualisation of nursing in sexually transmitted infection care.

RELEVANCE TO CLINICAL PRACTICE

Nurses are effectively improving health outcomes among people affected by sexually transmitted infections; however, not working to the full scope of practice could limit our capacity to fully meet patient care needs.

Project YOURLIFE (What Young People Think and Feel about Relationships, Love, Sexuality, and Related Risk Behavior): Cross-sectional and Longitudinal Protocol

Introduction

Sexually transmitted infections and unplanned pregnancies affect adolescent sexual health and are serious public health concerns. They result from sexual intercourse in adolescence, which is usually associated with multiple partners, unprotected sex, and condom misuse. This behavior is related to socio-ecological factors that influence lifestyles. The YOURLIFE project aims to find out what young people think and feel about relationships, love, and sexuality, and to assess the associations between these thoughts and attitudes, adolescents’ social factors, and sexual health.

Materials and equipment

An international school-based study with a cross-sectional and optional subsequent longitudinal design. Three online questionnaires designed for adolescents aged 13/14, 15/16, and 17/18, respectively, will be used. A matching coding system will allow longitudinal follow-up when adolescents reply to follow-up surveys. Questionnaires will include questions related to sociodemographic data; information/communication technologies; leisure time; parental supervision; influences of parents/friends; information sources; messages perceived; and sexuality-related knowledge, attitudes, and opinions. The second and third questionnaires for participants aged 15/16 and 17/18 will also contain variables concerning sexual behavior. Schools will be able to use their results to tailor educational approaches targeting the needs of their students. Multivariate analyses will be performed using the larger international dataset.

Expected impact of the study on public health

The YOURLIFE project will collect comprehensive information about the socio-ecological determinants of the sexual risk-taking of schooled adolescents worldwide. Effective preventive programs could be subsequently designed and tailored to the specific determinants of adolescents from different schools and settings, and also, when analyzed globally, to public health professionals.

Gendered discourses of youth sexualities--an exploration of PubMed articles on prevention of sexually transmissible infections

OBJECTIVE

To explore how gender is addressed in medical articles on the prevention of sexually transmissible infections (STI) among adolescents.

METHODS

Sixtyone articles were retrieved from a PubMed search and scrutinized by qualitative content analysis.

RESULTS

Most articles were affiliated with North American research institutions, but there were also reports from Europe, Africa, South America, and Asia. Gender turned up in the following four recurrent discourses: Gendered Receptiveness for Information, Stereotyped Heterosexual Expectations, Power Imbalance in Sexual Relations, and Gendered Prevention Approaches. Young women were described as knowledgeable, communicative, and responsible, but at risk because of feminine ideals and a lack of negotiating power. Men were described as less informed, more reluctant to discuss, and more risk taking due to masculine ideals and power dominance. Prevention approaches concerned how to postpone sex and/or tailor gender-sensitive programs for specific groups of young women and men.

CONCLUSION

Researchers' own gender expectations might have a substantial impact on how sex and sexual health is considered in prevention research. To avoid reconstruction of current inequalities and stereotypes regarding sexual practices of young women and men, the impact of gender, the power structures in intimate relations, and the cultural context should be considered. Medical research on STI prevention could benefit from including a wider array of gender perspectives.

The effect of a structured adolescent health summer programme: a quasi-experimental intervention

BACKGROUND

It is important to integrate adolescent health domains into pre-service nursing education in order to enhance undergraduate nursing students' competencies in promoting adolescent health.

AIM

To determine the effectiveness of a structured adolescent health summer programme for Chinese undergraduate nursing students.

METHODS

A quasi-experimental design was used to evaluate differences in the Chinese undergraduate nursing students' perceived competency in promoting adolescent health. A stand-alone adolescent health course was implemented as an intervention with pre- and post-tests of a 2-week intensive summer programme in 2010. The questionnaire included demographics, adolescent health competency checklist and programme evaluation. Descriptive statistics with the Wilcoxon signed-ranks test and the Mann-Whitney U-test were used for data analysis.

RESULTS

Of the 113 nursing students, seniors perceived higher adolescent health competence mean scores than the juniors in the post-test phase. Majority of nursing students revealed the increasing awareness of the importance in promoting healthy lifestyle behaviours and psychosocial well-being after attending the summer programme. They agreed that nurses do have a role to play.

LIMITATIONS

This 2-week summer programme may only have short-term impacts on students' perception.

CONCLUSIONS

A stand-alone adolescent health summer programme can prepare nursing students to respond to the health issues of adolescents by enhancing their competence in health need assessment and service delivery.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues.

Include them and they will tell you: learnings from a participatory process with youth

Encouraging youth voice, visibility, and active participation in adolescent-related research is strongly advocated in the literature. In this article, we describe how participatory approaches informed by arts-based methods (e.g., reflective writing, dramatization) were used with adolescents to enhance the research process in an exploratory study designed to develop and evaluate prevention resources for sexual risk-taking behaviors.Youth aged 15 to 17 years participated in iterative focus groups conducted over a 1-year period in school settings in Prince Edward Island, Canada. Descriptions of our experiences, strategies, and insights provide evidence for guiding practice to optimize adolescent participation in research.

Building Positive Life Skills the Smart Girls Way: Evaluation of a School-Based Sexual Responsibility Program for Adolescent Girls

In response to the public health epidemic of teenage pregnancy, the present study investigated a new, gender-specific, school-based approach to adolescent pregnancy prevention for middle school girls called Smart Girls Life Skills Training© (Smart Girls). Participants included 854 students (633, experimental group; 221, control group) across three time points to assess change in social sexuality expectations, personal/self sexuality expectations, perceived susceptibility, and parent—adolescent communication. Girls who received the Smart Girls curriculum increased their personal/self sexuality expectations and improved some aspects of their parent—adolescent communication compared to control group participants. The evaluation provides initial evidence that Smart Girls is at least partially effective at changing personal/self sexuality expectations and parent—adolescent communication for middle school girls. Implications, recommendations, and next steps for school-based teen pregnancy prevention programs are offered.

A mentoring program for the promotion of sexual health among Korean adolescents

The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test-post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.

Nursing student participation in mentoring programs to promote adolescent health: practical issues and future suggestions

The purpose of this study was to explore the practical issues encountered by nursing students who participated in three mentoring programs to promote adolescent health as well as to suggest future mentoring program options for promoting healthy adolescent behavior. The principal investigator and the nursing students recorded practical issues as they arose and prepared memos on these issues offering suggestions for future programs. The written records and memos were reviewed and analyzed using a content analysis process. The content analysis revealed a number of issues and suggestions for future mentoring programs. These issues included the general advantages of mentors, growth in professional capability, progress in professional socialization, and the acquisition of health promotion strategies. Discussion on these issues allows us to assess the potential of nursing students as mentors in a mentoring program to promote adolescent health. Future program development includes program delivery within longer, more regularly structured periods of time while using a multifaceted collaborative approach that can then be evaluated with an appropriate scale to maximize the effects of the program.

The experience of having become sexually active for teen mothers

The purpose of this phenomenological study was to describe teen mothers' experience of having become sexually active. Most scholars who have studied teen sexual behavior have used quantitative methods and measured constructs such as self-esteem. Prior to data-gathering, literature about teen sexual behavior was reviewed and set aside to enable a more direct focus on data. Parental consent for participation was obtained for participants under 18. Of the 10 participants (aged 16 to 19 years), all had at least one living child. Each participant took part in 3 audiotaped interviews. Data about perceptions, actions, and intentions were compared across each participant's interviews and interviews of all participants. Four phenomena were discerned as ways in which participants had structured their experiences: (a) making a safe place, (b) redefining myself, (c) creating my own life story, and (c) engaging with the unknown. Compared to prior literature, the phenomena offer a richer and deeper perspective on teen sexual behavior. Findings suggest that efforts to increase perceptions of safety, to support personal identity, to bolster creativity, and to offer exploratory opportunities beyond sexual encounters could enhance effectiveness of programs designed to prevent early-onset sexual activity.

Adolescent human immunodeficiency virus and sexually transmitted disease prevention programmes: are gender-blind approaches justified?

OBJECTIVE

To present findings that gender might be more predictive of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) knowledge, and sexual behaviour, compared with participation in knowledge-based HIV prevention programmes.

STUDY DESIGN

A cross-sectional study comparing students attending public high schools running an HIV and STD prevention programme. It is based on a study that evaluated the City of Houston HIV and STD prevention programme in public high schools. Comparison was initially between groups (intervention vs comparison) and subsequently between gender. The main variables for comparison were level of interest and knowledge of the subject of HIV and STD, and a range of sexual behaviour variables.

METHODS

Self-administered questionnaires were used for eliciting both knowledge and behavioural data. A specific question required participants to rate their level of interest in the subject of HIV and STD on a scale of 1-4 (lowest to highest). The knowledge component was marked and scores awarded in percentage form. Descriptive statistical analysis was followed by stratified analysis. Finally, a select number of variables were used in a logistic regression model. STATA version 8 was the main statistical software.

RESULTS

A significantly large proportion of girls reported the highest level of interest in the subject of HIV and STD (a score of 4); had higher HIV and STD knowledge scores; and reported less risk-taking sexual behaviour compared with boys. The only variable in which boys faired better was condom use, reporting higher rates of condom use than girls.

CONCLUSIONS

Gender-blind HIV and STD prevention programmes seem to have a minimal effect on boys. Although a myriad of other factors influence male response to such programmes, the relatively low level of interest in the subject of HIV and STD among boys might be contributory. HIV and STD prevention programmes need to be re-designed using approaches that are more appealing to boys. Boys will otherwise remain the weak link and therefore the rate-limiting step in the quest for sexual behaviour change among adolescents.