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Olson R, Lehman J, Mejia A, Ojeikhodion R, Osiecki K, Kathambi E, Kati SS, Randolph A. Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs. BMC Womens Health 2024; 24:96. [PMID: 38321420 PMCID: PMC10845645 DOI: 10.1186/s12905-023-02854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Many U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge. METHODS In partnership with faculty, undergraduate students worked to address their school's unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program's use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested. RESULTS Students identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022-2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program's implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001). CONCLUSION A student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.
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Affiliation(s)
- Rachel Olson
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, USA
| | - Jonathan Lehman
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Angie Mejia
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA.
| | - Rachael Ojeikhodion
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, USA
| | - Kristin Osiecki
- Center for Health Equity, Minnesota Department of Health, Minneapolis, MN, USA
| | - Emily Kathambi
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Anita Randolph
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
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Aicken CR, Wayal S, Blomquist P, Fabiane S, Gerressu M, Hughes G, Mercer CH. Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England. Sex Transm Infect 2019; 96:283-292. [PMID: 31422350 PMCID: PMC7279208 DOI: 10.1136/sextrans-2018-053739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 05/14/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Ethnic differences in partnership types and sexual mixing patterns may contribute to elevated STI diagnosis rates among England's Black Caribbean (BC) population. We examined the differences between BC and White British/Irish (WBI) sexual health clinic (SHC) attendees' reported partnerships and sexual mixing, and whether these differences could explain ethnic inequalities in STI, focusing on attendees reporting only opposite-sex partners (past year). METHODS We surveyed attendees at 16 SHCs across England (May to September 2016), and linked their survey responses to routinely collected data on diagnoses of bacterial STI or trichomoniasis ±6 weeks of clinic attendance ('acute STI'). Behaviourally-heterosexual BC and WBI attendees (n=1790) reported details about their ≤3 most recent opposite-sex partners (past 3 months, n=2503). We compared BC and WBI attendees' reported partnerships and mixing, in gender-stratified analyses, and used multivariable logistic regression to examine whether they independently explained differences in acute STI. RESULTS We observed differences by ethnic group. BC women's partnerships were more likely than WBI women's partnerships to involve age-mixing (≥5 years age difference; 31.6% vs 25.5% partnerships, p=0.013); BC men's partnerships were more often 'uncommitted regular' (35.4% vs 20.7%) and less often casual (38.5% vs 53.1%) than WBI men's partnerships (p<0.001). Acute STI was higher among BC women than WBI women (OR: 2.29, 95% CI 1.24 to 4.21), with no difference among men. This difference was unaffected by partnerships and mixing: BC women compared with WBI women adjusted OR: 2.31 (95% CI 1.30 to 4.09) after adjusting for age and partner numbers; 2.15 (95% CI 1.07 to 4.31) after additionally adjusting for age-mixing, ethnic-mixing and recent partnership type(s). CONCLUSION We found that differences in sexual partnerships and mixing do not appear to explain elevated risk of acute STI diagnosis among behaviourally-heterosexual BC women SHC attendees, but this may reflect the measures used. Better characterisation of 'high transmission networks' is needed, to improve our understanding of influences beyond the individual level, as part of endeavours to reduce population-level STI transmission.
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Affiliation(s)
- Catherine Rh Aicken
- Institute for Global Health, University College London, London, UK .,School of Health Sciences, University of Brighton, Brighton, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Paula Blomquist
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Stella Fabiane
- Institute for Global Health, University College London, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London, London, UK.,Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Fuller SS, Pacho A, Broad CE, Nori AV, Harding-Esch EM, Sadiq ST. "It's not a time spent issue, it's a 'what have you spent your time doing?' issue…" A qualitative study of UK patient opinions and expectations for implementation of Point of Care Tests for sexually transmitted infections and antimicrobial resistance. PLoS One 2019; 14:e0215380. [PMID: 30990864 PMCID: PMC6467401 DOI: 10.1371/journal.pone.0215380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/01/2019] [Indexed: 01/04/2023] Open
Abstract
Sexually transmitted infections (STIs) continue to be a major public health concern in the United Kingdom (UK). Epidemiological models have shown that narrowing the time between STI diagnosis and treatment may reduce the population burden of infection, and rapid, accurate point-of-care tests (POCTs) have potential for increasing correct treatment and mitigating the spread of antimicrobial resistance (AMR). We developed the Precise social science programme to incorporate clinician and patient opinions on potential designs and implementation of new POCTs for multiple STIs and AMR detection. We conducted qualitative research, consisting of informal interviews with clinicians and semi-structured in-depth interviews with patients, in six sexual health clinics in the UK. Interviews with clinicians focused on how the new POCTs would likely be implemented into clinical care; these new clinical pathways were then posed to patients in in-depth interviews. Patient interviews showed acceptability of POCTs, however, willingness to wait in clinic for test results depended on the context of patients' sexual healthcare seeking. Patients reporting frequent healthcare visits often based their expectations and opinions of services and POCTs on previous visits. Patients' suggestions for implementation of POCTs included provision of information on service changes and targeting tests to patients concerned they are infected. Our data suggests that patients may accept new POCT pathways if they are given information on these changes prior to attending services and to consider implementing POCTs among patients who are anxious about their infection status and/or who are experiencing symptoms.
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Affiliation(s)
- Sebastian S. Fuller
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
| | - Agata Pacho
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
| | - Claire E. Broad
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
| | - Achyuta V. Nori
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
| | - Emma M. Harding-Esch
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
| | - Syed Tariq Sadiq
- St George’s University of London, Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, London, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Wayal S, Aicken CRH, Griffiths C, Blomquist PB, Hughes G, Mercer CH. Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review. PLoS One 2018; 13:e0208315. [PMID: 30532145 PMCID: PMC6285827 DOI: 10.1371/journal.pone.0208315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk. METHODS Studies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS Of 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity. CONCLUSIONS Further research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Catherine R. H. Aicken
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Griffiths
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
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Free C, McCarthy O, French RS, Wellings K, Michie S, Roberts I, Devries K, Rathod S, Bailey J, Syred J, Edwards P, Hart G, Palmer M, Baraitser P. Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial. Health Technol Assess 2018; 20:1-82. [PMID: 27483185 DOI: 10.3310/hta20570] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known. OBJECTIVES To assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16-24 years. DESIGN (1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews. SETTING Participants were recruited from sexual health services in the UK. PARTICIPANTS Young people aged 16-24 years diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year. INTERVENTIONS A theory- and evidence-based safer sex intervention designed, with young people's input, to reduce the incidence of STIs by increasing the correct treatment of STIs, partner notification, condom use and STI testing before unprotected sex with a new partner. The intervention was delivered via automated mobile phone messaging over 12 months. The comparator was a monthly text message checking contact details. MAIN OUTCOME MEASURES (1) Development of the intervention based on theory, evidence and expert and user views; (2) follow-up procedures; (3) pilot trial primary outcomes: full recruitment within 3 months and follow-up rate for the proposed primary outcomes for the main trial; and (4) participants' views and experiences regarding the acceptability of the intervention. RESULTS In total, 200 participants were randomised in the pilot trial, of whom 99 were allocated to the intervention and 101 were allocated to the control. We fully recruited early and achieved an 81% follow-up rate for our proposed primary outcome of the cumulative incidence of chlamydia at 12 months. There was no differential follow-up between groups. In total, 97% of messages sent were successfully delivered to participants' mobile phones. Recipients reported that the tone, language, content and frequency of messages were appropriate. Messages reportedly increased knowledge of and confidence in how to use condoms and negotiate condom use and reduced stigma about STIs, enabling participants to tell a partner about a STI. CONCLUSIONS Our research shows that the intervention is acceptable and feasible to deliver. Our pilot trial demonstrated that a main trial is feasible. It remains unclear which behaviour change techniques and elements of the intervention or follow-up procedures are associated with effectiveness. A further limitation is that in the trial one person entering data and the participants were unmasked. A randomised controlled trial to establish the effects of the intervention on STIs at 12 months is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN02304709. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca S French
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan Michie
- Faculty of Population Sciences, University College London, London, UK
| | - Ian Roberts
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sujit Rathod
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Bailey
- Faculty of Population Sciences, University College London, London, UK
| | - Jonathan Syred
- Sexual Health Research Group, King's College London, London, UK
| | - Phil Edwards
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graham Hart
- Faculty of Population Sciences, University College London, London, UK
| | - Melissa Palmer
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paula Baraitser
- Sexual Health Research Group, King's College London, London, UK
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Wayal S, Hughes G, Sonnenberg P, Mohammed H, Copas AJ, Gerressu M, Tanton C, Furegato M, Mercer CH. Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Public Health 2017; 2:e458-e472. [PMID: 29057382 PMCID: PMC5639148 DOI: 10.1016/s2468-2667(17)30159-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sexual health entails the absence of disease and the ability to lead a pleasurable and safe sex life. In Britain, ethnic inequalities in diagnoses of sexually transmitted infections (STI) persist; however, the reasons for these inequalities, and ethnic variations in other markers of sexual health, remain poorly understood. We investigated ethnic differences in hypothesised explanatory factors such as socioeconomic factors, substance use, depression, and sexual behaviours, and whether they explained ethnic variations in sexual health markers (reported STI diagnoses, attendance at sexual health clinics, use of emergency contraception, and sexual function). METHODS We analysed probability survey data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; n=15 162, conducted in 2010-12). Reflecting Britain's current ethnic composition, we included in our analysis participants who identified in 2011 as belonging to one of the following seven largest ethnic groups: white British, black Caribbean, black African, Indian, Pakistani, white other, and mixed ethnicity. We calculated age-standardised estimates and age-adjusted odds ratios for all explanatory factors and sexual health markers for all these ethnic groups with white British as the reference category. We used multivariable regression to examine the extent to which adjusting for explanatory factors explained ethnic variations in sexual health markers. FINDINGS We included 14 563 (96·0%) of the 15 162 participants surveyed in Natsal-3. Greater proportions of black Caribbean, black African, and Pakistani people lived in deprived areas than those of other ethnic groups (36·9-55·3% vs 16·4-29·4%). Recreational drug use was highest among white other and mixed ethnicity groups (25·6-27·7% in men and 10·3-12·9% in women in the white other and mixed ethnicity groups vs 4·1-15·6% in men and 1·0-11·2% in women of other ethnicities). Compared with white British men, the proportions of black Caribbean and black African men reporting being sexually competent at sexual debut were lower (32·9% for black Caribbean and 21·9% for black African vs 47·4% for white British) and the number of partners in the past 5 years was greater (median 2 [IQR 1-4] for black Caribbean and 2 [1-5] for black African vs 1 [1-2] for white British), and although black Caribbean and black African men reported greater proportions of concurrent partnerships (26·5% for black Caribbean and 38·9% for black African vs 14·8% for white British), these differences were not significant after adjusting for age. Compared with white British women, the proportions of black African and mixed ethnicity women reporting being sexually competent were lower (18·0% for black African and 35·3% for mixed ethnicity vs 47·9% for white British), and mixed ethnicity women reported larger numbers of partners in the past 5 years (median 1 [IQR 1-4] vs 1 [1-2]) and greater concurrency (14·3% vs 8·0%). Reporting STI diagnoses was higher in black Caribbean men (8·7%) and mixed ethnicity women (6·7%) than white British participants (3·6% in men and 3·2% in women). Use of emergency contraception was most commonly reported among black Caribbean women (30·7%). Low sexual function was most common among women of white other ethnicity (30·1%). Adjustment for explanatory factors only partly explained inequalities among some ethnic groups relative to white British ethnicity but did not eliminate ethnic differences in these markers. INTERPRETATION Ethnic inequalities in sexual health markers exist, and they were not fully explained by differences in their broader determinants. Holistic interventions addressing modifiable risk factors and targeting ethnic groups at risk of poor sexual health are needed. FUNDING Medical Research Council, the Wellcome Trust, the Economic and Social Research Council, UK Department of Health, and The National Institute for Health Research.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London (UCL), London, UK
| | - Hamish Mohammed
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London (UCL), London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London (UCL), London, UK
| | - Clare Tanton
- Institute for Global Health, University College London (UCL), London, UK
| | - Martina Furegato
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London (UCL), London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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Gendered discourses of youth sexualities--an exploration of PubMed articles on prevention of sexually transmissible infections. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:81-9. [PMID: 25200967 DOI: 10.1016/j.srhc.2014.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 07/02/2014] [Accepted: 07/09/2014] [Indexed: 11/21/2022]
Abstract
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.
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Dean J, Wollin J, Stewart D, Debattista J, Mitchell M. Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities. CULTURE, HEALTH & SEXUALITY 2012; 14:911-924. [PMID: 22947205 DOI: 10.1080/13691058.2012.709639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but 'highly-visible' populations.
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Affiliation(s)
- Judith Dean
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Australia.
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Boersma A, Alberts J, Bruijn JD, Meyboom BDJ, Kleiverda G. Termination of pregnancy in Curaçao: need for improvement of sexual and reproductive healthcare. Glob J Health Sci 2012; 4:30-8. [PMID: 22980230 PMCID: PMC4776944 DOI: 10.5539/gjhs.v4n3p30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/28/2012] [Indexed: 11/16/2022] Open
Abstract
Background: In Curaçao Termination of Pregnancy (TOP) is still forbidden by law, although a policy of tolerance has been stipulated since 1999. This paper is about the prevalence of TOP and about its health complications. These data on TOP are officially unknown but are suspected to be rather high. Methods: One year registration of illegal performed termination of pregnancy cases by all general physicians (GPs) practicing TOP in Curaçao. The registration included patient characteristics according to the model of the National Abortion Registration in The Netherlands, adjusted to the local Curaçao situation. Socio demographic characteristics, number of previous pregnancies and TOPs, pregnancy duration, contraception methods and reason for failure were registered. The comparative part of the research compares TOP rates of Curaçao with those of Antillean women in the Netherlands. The gynaecologists in the referral hospital registered complications requiring hospital admission after TOP. Results: All GPs performing TOP participated and the majority registered extensively. The total number of registered TOP was 1126. 666 of the 1126 were registered using the local adjusted Abortion Registration Model. With 30.000 women aged between 15 and 45 living in Curaçao, the TOP rate was at least 38 (per 1000 in that age category), comparable to rates for Antillean women in the Netherlands. Mean age was 26.9 years. Nearly half (47%) had one or more TOPs before; the majority (53%) was less than 7 weeks pregnant and two third (67%) had one or more children. Two third of the women did not use contraception (63%). For those using contraception, main reason for failure was inconsistent use (50%). There were 14 hospital admissions due to complications of TOP. Conclusion: The number of TOP is high in Curaçao and comparable to (first generation) Antillean women living abroad in the Netherlands. Most unintended pregnancies originated from no or inconsistent use of reliable contraception. Improvement of sex education is necessary in order to bring down the number of TOP, as well as realizing accessible and affordable contraception, including sterilization. The number of complications around TOPs was equal to other countries where TOP is illegal.
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Rosenberger JG, Reece M, Schick V, Herbenick D, Novak DS, Van Der Pol B, Fortenberry JD. Condom Use during Most Recent Anal Intercourse Event among a U.S. Sample of Men Who Have Sex with Men. J Sex Med 2012; 9:1037-47. [DOI: 10.1111/j.1743-6109.2012.02650.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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van Veen MG, Schaalma H, van Leeuwen AP, Prins M, de Zwart O, van de Laar MJW, Hospers HJ. Concurrent partnerships and sexual risk taking among African and Caribbean migrant populations in the Netherlands. Int J STD AIDS 2011; 22:245-50. [PMID: 21571971 DOI: 10.1258/ijsa.2009.008511] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Concurrent partnerships have been recognized as a determinant for the spread of HIV and sexually transmitted infections (STIs). We studied the association of concurrent partnerships with sexual behaviour among heterosexual Caribbean and African migrants, who account for a disproportionate burden of STIs and HIV in the Netherlands. Of 1792 migrants, 15% reported concurrent sexual partners in the previous six months. In multivariate multinomial analyses, women were less likely to have concurrent partners than men and they were less likely than men to use condoms with concurrent partners. We could not identify an association with the observed HIV prevalence; however, migrants with concurrent partners were less likely to be tested for HIV. Of migrants tested for STIs, one in three migrants with concurrent partners was diagnosed with an STI. Prevention targeting migrants should address the promotion of HIV/STI testing and stress the potential acceleration of HIV and STI epidemics due to concurrency.
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Affiliation(s)
- M G van Veen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
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12
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Telman G, Kouperberg E, Herskovitz M, Diab T, Hurani H, Sprecher E. Assignment of ethnicity in patients with acute ischemic stroke in northern Israel. Health (London) 2011. [DOI: 10.4236/health.2011.37073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosenberger JG, Bell DL, McBride KR, Fortenberry JD, Ott MA. Condoms and developmental contexts in younger adolescent boys. Sex Transm Infect 2010; 86:400-3. [PMID: 20448100 PMCID: PMC5913749 DOI: 10.1136/sti.2009.040766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Condom use is a key part of sexually transmitted infection (STI) prevention for young men. Yet little is known about how younger adolescent boys initially learn about and use condoms. We examined sources of information, attitudes towards, acquisition, practice and early use of condoms among 14-16-year-old boys. METHODS Thirty 14-16-year-old boys were recruited from a teen clinic serving a community with high STI rates and were asked open-ended questions about condoms, such as, "Where did you learn about condoms?" and "In what situations would you/would you not, use condoms." Interviews were audio recorded, transcribed and coded. Qualitative analysis focused upon key concepts and shared social cognitions related to condom use. RESULTS Both sexually inexperienced and experienced participants perceived that sex feels or would feel less pleasurable with condoms. For almost all participants, families were the primary source of both information about condoms and of condoms themselves. This information focused on pregnancy prevention, with STIs secondary. Participants' views of condoms fell into three developmental groups: not interested in condoms and equating their use with interest in sex; exploring condoms out of either curiosity or in preparation for sex; and experienced with condom use. Exploring included behaviours such as checking condoms out and trying them on. CONCLUSIONS Our findings of existing negative perceptions of condoms, the importance of families in learning about condoms and the developmental need to test and try on condoms before use have implications for adolescent STI prevention programmes.
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Affiliation(s)
- Joshua G. Rosenberger
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - David L. Bell
- Mailman School of Public Health, Columbia University, New York NY
| | - Kimberly R. McBride
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - J. Dennis Fortenberry
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - Mary A. Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
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Balfe M, Brugha R, O' Donovan D, O' Connell E, Vaughan D. Triggers of self-conscious emotions in the sexually transmitted infection testing process. BMC Res Notes 2010; 3:229. [PMID: 20716339 PMCID: PMC2930645 DOI: 10.1186/1756-0500-3-229] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
Background Self-conscious emotions (shame, guilt and embarrassment) are part of many individuals' experiences of seeking STI testing. These emotions can have negative impacts on individuals' interpretations of the STI testing process, their willingness to seek treatment and their willingness to inform sexual partners in light of positive STI diagnoses. Because of these impacts, researchers have called for more work to be completed on the connections between shame, guilt, embarrassment and STI testing. We examine the specific events in the STI testing process that trigger self-conscious emotions in young adults who seek STI testing; and to understand what it is about these events that triggers these emotions. Semi-structured interviews with 30 adults (21 women, 9 men) in the Republic of Ireland. Findings Seven specific triggers of self-conscious emotions were identified. These were: having unprotected sex, associated with the initial reason for seeking STI testing; talking to partners and peers about the intention to seek STI testing; the experience of accessing STI testing facilities and sitting in clinic waiting rooms; negative interactions with healthcare professionals; receiving a positive diagnosis of an STI; having to notify sexual partners in light of a positive STI diagnosis; and accessing healthcare settings for treatment for an STI. Self-conscious emotions were triggered in each case by a perceived threat to respondents' social identities. Conclusion There are multiple triggers of self-conscious emotions in the STI testing process, ranging from the initial decision to seek testing, right through to the experience of accessing treatment. The role of self-conscious emotions needs to be considered in each component of service design from health promotion approaches, through facility layout to the training of all professionals involved in the STI testing process.
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Affiliation(s)
- Myles Balfe
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Risk factors for HIV infection among Haitian adolescents and young adults seeking counseling and testing in Port-au-Prince. J Acquir Immune Defic Syndr 2009; 52:498-508. [PMID: 19738486 DOI: 10.1097/qai.0b013e3181ac12a8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Many Haitian adolescents and youth are highly vulnerable to HIV infection. It was important to define the risk factors of the young people who are already seeking care. METHODS Among 3391 sexually active 13- to 25-year-olds in our Voluntary Counseling and Testing (VCT) Center in Port-au-Prince from October 2005 to September 2006, we assessed associations between demographic and behavioral factors and HIV status using multivariable logistic regression analyses. RESULTS We diagnosed HIV infection in 6.3% of 2533 females and 5.5% of 858 males. Age-specific prevalence was 3.4% for 13- to 15-year-olds, 4.7% for 16-19, and 6.8% for 20-25 (P = 0.02). Poor education, not residing with parents, currently or formerly married, having a child, and being self-referred or referred by others VCT services were significant predictors of HIV in females. HIV infection was associated with considering oneself at higher risk, although most youth did not recognize this risk. HIV in females was also associated with suspected/confirmed sexually transmitted infection, especially genital ulcers (ORadj = 2.28, 95% confidence interval: 1.26 to 4.13), years of sexual activity (Ptrend = 0.07), and suspicion that partners had other partners or an sexually transmitted infection. Among males, HIV was associated with drug use (though uncommon) and sexual debut with a casual/unknown person (ORadj = 3.18, 95% confidence interval: 1.58 to 6.42). HIV-infected young people were more likely to be rapid plasma reagin positive and less likely to use condoms. CONCLUSION Young Haitians are a key target for HIV prevention and care and avail themselves readily of youth-focused VCT services.
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Chaudhary R, Heffernan CM, Illsley AL, Jarvie LK, Lattimer C, Nwuba AE, Platford EW. Opportunistic screening for Chlamydia: a pilot study into male perspectives on provision of Chlamydia screening in a UK university. J Public Health (Oxf) 2008; 30:466-71. [PMID: 18653445 DOI: 10.1093/pubmed/fdn060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since 2003, the University of Leeds has been a pilot site for the National Chlamydia Screening Programme (NCSP), which offers opportunistic screening to asymptomatic people under the age of 25. Uptake among men is low. The purpose of this study is to explore perceptions and acceptability of the provision of Chlamydia screening in the University of Leeds among 18-25-year-old male students. METHODS Using a purposive sample of 15 male students aged between 19 and 24, two focus group sessions were conducted within university grounds. RESULTS Thematic analysis of the data revealed that male attitudes about Chlamydia screening were affected by: (1) lack of knowledge about Chlamydia and screening; (2) social embarrassment about Chlamydia; (3) reluctance to seek medical help; (4) perception that Chlamydia was a 'woman's disease' and (5) indifference about health promotion campaigns. CONCLUSION To encourage the uptake of opportunistic screening of Chlamydia, men under 25 years should be made aware of their responsibility for their own sexual health. Emphasis can also be placed on the non-invasiveness, ease and privacy of the test.
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Sinha S, Curtis K, Jayakody A, Viner R, Roberts H. 'People make assumptions about our communities': sexual health amongst teenagers from black and minority ethnic backgrounds in East london. ETHNICITY & HEALTH 2007; 12:423-441. [PMID: 17978942 DOI: 10.1080/13557850701616839] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES (1) To explore sexual behaviour and relationships amongst Black and minority ethnic (BME) teenagers in East London. (2) To examine how these relationships are shaped by culture, gender, peer norms and religion. (3) To describe the implications for sexual health policy and practice in urban, multicultural areas. DESIGN This report draws primarily on the qualitative arm of a mixed methods study which collected data from 126 young people, aged 15-18, largely through focus groups in the London boroughs of Hackney, Newham and Tower Hamlets. RESULTS Previous research has reported culture influencing the patterning of risk/protection amongst BME groups. Our data suggest that this is mediated by gender, religion and youth. Religion reportedly influenced young women's sexual behaviour in multiple ways. Young people described gendered norms in meeting and flirting with partners, and the role of mobile phones and peer pressure. CONCLUSION Our paper suggests culture, gender, religion and youth influence BME teenagers in aspects of sexual relationships, and that these social markers may have different contextual meanings for individuals. The multiplicity of factors affecting attitudes/behaviour requires a range of contraceptive, counselling, screening and sex education services available for all teenagers, although delivery patterns may differ in response to differing needs.
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Affiliation(s)
- Shamser Sinha
- Institute of Primary Care and Public Health, London South Bank University, London, UK.
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Pritchard C, Cox M. Comparison of problematic behaviours of 10th and 11th year Southern English adolescents in 1985 and 2005. Part 1: Trends in gender behaviour. Int J Adolesc Med Health 2007; 19:127-40. [PMID: 17593765 DOI: 10.1515/ijamh.2007.19.2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED To compare the problematic behaviours of 1985 adolescent 10th and 11th year students with that of 2005 pupils, and to examine current drink, drug and sexual activity. METHOD Utilised a standardised questionnaire from 1985 and replicated the survey in broadly the same area in 2005. The study was self-administered and guaranteed anonymity for pupil and school, and was able to eliminate any bravado reporting. In 1985 it was not possible to inquire about sexual behaviour nor 'binge' drinking but this study was able to explore current respondents drink and sexual behaviour, utilising a linkage analysis to examine any drink-drug-sexual behaviour axis. RESULTS In 1985 males significantly smoked, truanted, fought, vandalised, stole and 'drugged' more than girls, but by 2005 females significantly smoked, drank, used cannabis more than boys. Current adolescent girls were more often were 'binge drinkers' (29%-15%) and sexually active than boys (23% to 11%). Amongst 10th year 8% of boys and 16% of girls were actively sexually, by the 11th year it was 15% of boys and 31% of girls. DISCUSSION Over the 20 years the traditional differences in troublesome youth behaviour has changed, with girls behaving similar or worse than boys, which along with Binge Drinking and greater sexual activity, puts them at greater risk, which is a challenge to parents and services, nonetheless, the majority of young people do Not engage in these problematic behaviours.
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Affiliation(s)
- Colin Pritchard
- School of Medicine, University of Southampton, Institute of Health and Community Studies, Bournemouth University, Kinson, Bournemouth BH, United Kingdom.
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Brems C, Dewane S. Hearing consumer voices: planning HIV/sexually transmitted infection prevention in alcohol detoxification. J Assoc Nurses AIDS Care 2007; 18:12-24. [PMID: 17338982 DOI: 10.1016/j.jana.2006.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Indexed: 10/23/2022]
Abstract
The literature has provided ample evidence that individuals abusing or dependent upon alcohol are at high risk for contracting HIV and other sexually transmitted infections (STIs). Despite the documented need of this vulnerable group for targeted HIV/STI prevention efforts, no prior research has explored the efficacy and feasibility of HIV/STI prevention for individuals in alcohol detoxification. The current study sought the voices of consumers of such services to get their guidance about successful and necessary features of HIV/STI prevention programs targeted to their needs. Two focus groups conducted yielded exceptionally helpful information. Consumers clearly want to be educated about HIV/STI, seeing this as crucial to their physical well-being and safety. They voiced preferences for nonjudgmental counselors who meet with them on an individual basis in contexts that protect consumer privacy. A clear set of guidelines emerged for an intervention structure that, if carefully honored, has strong likelihood of success in protecting individuals in alcohol detoxification from HIV/STI.
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Affiliation(s)
- Christiane Brems
- Department of Psychology, University of Alaska Anchorage, Alaska, USA
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Goold PC, Bustard S, Ferguson E, Carlin EM, Neal K, Bowman CA. Pilot study in the development of an interactive multimedia learning environment for sexual health interventions: a focus group approach. HEALTH EDUCATION RESEARCH 2006; 21:15-25. [PMID: 15972303 DOI: 10.1093/her/cyh040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In the UK there are high rates of sexually transmitted infections and unintended pregnancies amongst young people. There is limited and contradictory evidence that current sexual health education interventions are effective or that they improve access to appropriate sexual health services. This paper describes the outcome of focus group work with young people that was undertaken to inform the design of an Interactive Multimedia Learning Environment that incorporates message framing, intended for use in sexual health promotion. The focus group work addressed sexual attitudes, behaviour, risk perception, and knowledge of sexual health and sexual health services in Nottingham. The results provided new insights into young peoples' sexual behaviour, and their diversity of knowledge and beliefs. Common themes expressed regarding sexual health services included concerns about confidentiality, lack of confidence to access services and fear of the unknown. The results showed that while the adolescents are reasonably knowledgeable about infection, they do not know as much about the relevant services to treat it. This work emphasizes the need for user involvement throughout the design and development of a sexual health intervention, and will form the basis of the next part of the project.
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Affiliation(s)
- P C Goold
- Department of Genitourinary Medicine, Nottingham City Hospital NHS Trust, Nottingham NG5 1PB, UK
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