Sexual activity and sexual health among young adults with and without mild/moderate intellectual disability

The Experiences of Young People with Intellectual Disability, Parents and Professionals in Relationships and Sexuality Education Programmes: Findings from a Qualitative Study

People with intellectual disability want friendships and meaningful relationships, and some want intimacy. However, the expression of sexuality is an area where potential freedoms are often limited and restricted compared to their peers. While some relationships and sexuality education programmes do exist for this population, most focus on knowledge acquisition regarding sexuality and sex but lack in their focus on relationships, informed choices and decision-making. The aim of this study was to identify good practices and methods of delivery in relationships and sexuality education for children and young people with intellectual disability. A qualitative design was undertaken. Information about our study was distributed to eight special schools in the UK. Semi-structured interviews and focus groups were employed for data collection. Data from 37 pupils with intellectual disability, 11 parents and 16 healthcare and other professionals were thematically analysed. Following data analysis, three themes emerged: (i) seeking and sharing information; (ii) protecting and keeping safe; and (iii) learning for the future. The findings highlight that pupils are keen to learn about life changes and societal influences and want reliable information. Parents and professionals recognise that children and young people with intellectual disability will develop into adults and may be vulnerable when they leave the security of the school setting. They recognise that children and young people need to know about socialising, puberty, consent and contraception. Evidence-based programmes should be designed with these stakeholders to ensure children and young people with intellectual disability receive developmentally appropriate information to make happy and safe decisions about their relationships.

Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana

INTRODUCTION

People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana.

METHODS

A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis.

RESULTS

Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes.

CONCLUSION

The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs.

Sexual experiences and knowledge of people with moderate intellectual disability

BACKGROUND

This study addresses the sexuality of people with moderate intellectual disabilities (PMID), a topic that has been little studied. Understanding romantic and sexual experiences is highly relevant for reducing stigma and prejudice related to their sexuality. Additionally, comprehending the level of sexual knowledge of PMID contributes to the development of preventive and sexual health education programmes tailored for this group. Our aim is to explore the sexual history (relationships, sexual behaviour, condom use and sexual abuse), sex education received and the level of sexual knowledge of PMID.

METHOD

The total of 142 PMID completed questionnaires about sexual knowledge and experiences, and their support staff provided additional information. Data were analysed using chi-square test (χ2) and descriptive statistical analysis.

RESULTS

Masturbation was the most common sexual behaviour (75.7%), especially among men (χ2 = 5.81, P < 0.05). Sexual intercourse was rare, and only 30.5% reported using condoms. Women reported a higher prevalence of self-reported sexual abuse (27.3% vs. 6% in men). The study also highlighted misconceptions about sexual intercourse risks and contraceptive methods.

CONCLUSION

The results suggest that PMID need sexual education to ensure healthy sexual experiences and prevent risky behaviour.

Sexual and Reproductive Health Education for Youth with Intellectual Disabilities: a Mixed Methods Study of Professionals' Practices and Needs

We conducted formative research to inform the creation of innovative new tools and strategies to engage professionals in communicating with youth with intellectual disabilities about sexual health. The research was guided by a multidisciplinary network of experts and an advisory board of self-advocates with intellectual disabilities and caregivers that make up Project SHINE: the Sexual Health Innovation Network for Equitable Education. A cross-sectional mixed-methods study utilized survey data from 632 disability support professionals who provide services to youth ages 16-24 with intellectual disabilities (ID). We then conducted focus groups with 36 professionals to obtain more in-depth information related to organizational support needs and suitable contexts, methods, and tools for sexuality education. Participants included licensed/credentialed direct service professionals (social workers, nurses, teachers), non-licensed direct service providers (case managers, supportive care specialists, residential care line staff), and program administrators. Quantitative and qualitative data analyses triangulated the findings across four content areas: attitudes about providing sexual health information to youth with ID, preparedness to communicate about sexuality, current communication practices, and professional needs in the field for new teaching tools and methods. We discuss how findings can be used to guide the creation and successful implementation of innovative new sexual health learning tools for youth with intellectual disabilities.

Developing a Tool for Monitoring and Evaluating a Network Approach to Innovation: Lessons from Year 1 of the SexEdVA Disability-Inclusive Sexual Health Network (DSHN)

Disparities in sexual health outcomes for youth with disabilities require new and creative approaches to address the complex and often individualized barriers facing this diverse population. The Disability-inclusive Sexual Health Network (DSHN) establishes, funds, coordinates, and supports a multidisciplinary network of partners to explore, develop, test, refine, and evaluate innovative interventions that will improve optimal health, prevent teen pregnancy, and address sexually transmitted infections (STIs) for youth with disabilities in Virginia. DSHN developed the Monthly Reporting Instrument (MRI) to support communication, coordination, monitoring, and evaluation of the project, and shares findings from data collected using this tool. A mixed method analysis was conducted on data collected in year 1 using the MRI. A total of 67 MRI submissions were collected across eight DSHN Partners between March 2021 and March 2022. Analysis of the year 1 MRI data gives a rich understanding of the common barriers faced, accomplishments and progress achieved in the face of those challenges, and Partners' relationships to the Network and each other. This paper proposes solutions to common barriers in implementing Network support and coordination activities in year 2 and reflects on the utility of the MRI as a multi-purpose tool for communication and engagement as well as monitoring and evaluating DSHN as a systems-level intervention.

Contraceptive Provision to Women With Intellectual and Developmental Disabilities Enrolled in Medicaid

OBJECTIVE

To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid.

METHODS

Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15-44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders.

RESULTS

Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P <.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72-0.79; P <.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P <.001).

CONCLUSION

These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.

Parental attitudes and beliefs about sexuality of individuals with intellectual disability: Insights from a Brazilian sample of parents of individuals with Williams syndrome

BACKGROUND

The affective expression of sexual behaviour in individuals with Williams syndrome can lead to risky behaviours, especially if parents do not have information on how to provide sex education or support from specialised professionals.

METHOD

The Attitudes to Sexuality Questionnaire for Individuals with Intellectual Disabilities was used to identify parental beliefs, attitudes and concerns about the sexuality and sex education of individuals with intellectual disabilities. The sample comprised 35 parents of individuals with Williams syndrome (mean age 12.8 years (SD = 4.5), 57.1% male).

RESULTS

Parents believe in the possibility of marriage and sexual relationships for individuals with intellectual disability when they are older and agree with sexual reproduction in adulthood. Parents consider that sex education, in addition to parental guidance, should be provided by professionals.

CONCLUSIONS

This data highlights the need for parents to have clear guidelines on interventions in respect of the sexuality of individuals with intellectual disability.

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves

BACKGROUND

A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them.

METHODS

Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals.

RESULTS

Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge.

CONCLUSIONS

Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted.

SALUDIVERSEX: A quality of life and sexual health intervention for adults with mild intellectual disabilities

Individuals with intellectual disabilities need an affective and sexual education adapted to their characteristics. There are few interventions that meet these objectives and offer empirical evidence of their efficacy. To respond to the limitations of existing interventions, an evidence-based affective-sexual educational intervention for adults with a mild degree of intellectual disability is proposed: SALUDIVERSEX. Participants will be randomly assigned to an intervention group that will receive the SALUDIVERSEX program or to a waiting list group. The intervention will be implemented by educators of occupational centers after a thorough training phase. Our main hypothesis is that the SALUDIVERSEX program will improve the sexual health and quality of life, through the joint action built into three components: the acquisition of basic information, the development of skills and strategies and the achievement of healthy attitudes towards the experience and expression of sexuality. The results of this approach could have important implications for optimizing the quality of life and self-determination of individuals with Intellectual disability by contributing to the development of healthy sexuality.

Population-level use of gynecological health services by female youth with intellectual/developmental disabilities in British Columbia Canada

BACKGROUND

There is evidence that female youth with intellectual/developmental disabilities (IDD) experience poorer gynecological care compared to female youth without disabilities.

OBJECTIVE

The objective of this study was to obtain baseline data on visits to a health care provider for a gynecological issue for females with IDD and compare that information to the experiences of female youth without IDD.

METHODS

This study is a retrospective cohort study using population-level administrative health data from 2010 to 2019 for females aged 15-24 years, with and without IDD.

RESULTS

6452 female youth with IDD and 637,627 female youth without IDD were identified in the data. Over the ten-year period, 53.77% of youth with IDD and 53.68% of youth without IDD had a visit to a physician for a gynecological issue. However, as females with IDD aged, the number of people seeing a physician for a gynecological issue decreased. In the group aged 20-24 years, 15.25% of females with IDD and 24.47% of females without IDD (p < 0.0001) had a Pap test done at any time; 25.94% of females with IDD had a visit for contraception management and 28.38% of females (p < 0.0001) without IDD had a visit for contraception management. Gynecological care also varied by type of IDD.

CONCLUSIONS

Females with IDD had a similar number of visits for a gynecological issue as female youth without IDD. However, the reasons for visits and the age at which visits occurred differed between youth with and without IDD. As females with IDD transition into adulthood, gynecological care must be maintained and improved.

The sexual behavior of young people living with a disability: Findings from the KAP study in Northern Uganda

Introduction

Young people living with disability form one of the most vulnerable population groups globally. There is limited information on the use of SRH services among young people living with a disability.

Methods

This analysis is based on household survey data among young people. Drawing on a sample of 861 young people living with a disability (15 -24 years), we investigate the sexual behaviour, and identify the risk factors associated with sexual behavior of young people living with a disability. Multilevel logistic regression was used.

Results

Results indicate that risky sexual behaviour was associated with alcohol consumption (aOR = 1.68; 95%CI: 0.97, 3.01), having limited knowledge of HIV and STI prevention methods (aOR = 6.03; 95%CI: 0.99, 30.00), and low life skills (aOR = 4.23; 95%CI: 1.59, 12.87). The odds of not using a condom at last sex were significantly higher among in-school young people than out of school young people (aOR = 0.34; 95%CI: 0.12, 0.99).

Discussion

Targeted interventions aimed at reaching out to young people living with a disability should consider their sexual and reproductive health needs, barriers, and facilitators. Interventions can also promote self-efficacy and agency of young people living with a disability in making informed sexual and reproductive health choices.

The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review

Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.

Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue

ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.

Uptake of HPV Vaccine among young adults with disabilities, 2011 to 2018

INTRODUCTION

Little is known about human papillomavirus (HPV) vaccine uptake among young adults with disabilities (YAWD), despite this population having a higher risk of HPV infection and related cancers compared to the general population.

OBJECTIVE

To compare the prevalence of HPV vaccination among young adults with disabilities to young adults without disabilities. We hypothesized that YAWD would have a lower prevalence of HPV vaccination than the general population.

METHODS

This cross-sectional study used data for the years 2011 to 2018 of the National Health Interview Survey. Our analysis included 14,577 people (weighted n = 34,420,024) aged 18 to 26 years. Univariate and multivariable logistic models were used to estimate the role of disability on HPV vaccination uptake among young adults and to identify potential factors associated with HPV vaccination among YAWD.

RESULTS

The proportion of female and male YAWD with HPV vaccination was similar to those without disabilities, regardless of sex (Female Adjusted Odds Ratio (OR): 1.16; 95% Confidence Interval (CI): 0.91 to 1.48; Male Adjusted OR: 1.05; 95% CI: 0.69 to 1.60). Among female and male YAWD, the proportion with HPV vaccination was 56.1% and 28.5%, respectively. Other factors significantly associated with HPV vaccination among YAWD included age, country of birth, healthcare utilization, and insurance status.

CONCLUSIONS

HPV vaccination among YAWD did not differ significantly from those without disabilities; however, the prevalence of HPV vaccination among young adult males and females remains significantly below national goals. Connecting young adults, specifically male YAWD, to the healthcare system is of utmost importance to improve HPV vaccination uptake.

Menstrual and reproductive health in female adolescents with developmental disabilities

Youth with intellectual and developmental disabilities (I/DD) are impacted by pubertal changes and the onset of menses disproportionately. Despite the fact that for most youth with I/DD, the progression of puberty, menarche, and irregular cycles due to axis immaturity appear to be consistent with the general population, cyclic behavioral changes and premenstrual symptoms may be more common. Furthermore, for some disabled youth there are endocrine or medication effects that may impact menses disproportionately. Education and access to care is essential for this group to address many aspects of treatment, from prepubertal anticipatory guidance to menstrual management, with special attention required for addressing issues concerning hygiene, cyclic pain, behavior changes, sexuality, potential for abuse, and pregnancy prevention.^1-4 This article will provide an overview of the policies and guidance available for management of the menstrual issues encountered in adolescents with intellectual and developmental disabilities and complex medical disorders. Included will be a review of studies that evaluate the different types of methods that are utilized for menstrual management and the different conditions that are encountered.

A systematic review of relationships and sex education outcomes for students with intellectual disability reported in the international literature

BACKGROUND

Little is known about how to evaluate relationships and sex education (RSE) delivered to students with intellectual disability and what stakeholders perceive are important outcomes. The present study aimed to systematically review existing studies on outcomes of RSE, as the first step in the development of a core outcome set (COS) for students with intellectual disability.

METHOD

A systematic literature process included two stages: (1) searching for studies reporting on RSE outcomes for students with intellectual disability and (2) studies reporting on measurement properties (e.g. validity, reliability and responsiveness) of standardised instruments identified in stage 1.

RESULTS

A total of 135 RSE outcomes were extracted from 42 studies: 43 outcomes for students in secondary education and 92 outcomes for students in further education. No RSE outcomes were reported for primary education. Outcomes referred to the human body, hygiene, relationships, sexuality, sex and its consequences, inappropriate and appropriate social and sexual behaviour, keeping safe, emotional vocabulary and positive self-esteem. Outcomes were predominantly knowledge-based, rather than relating to skills and attitudes development. Students with intellectual disability, parents and teachers perceive different RSE outcomes meaningful. Five instruments were used to measure the outcomes, but none have established psychometric properties with this population.

CONCLUSIONS

The comprehensive list of RSE outcomes for students with intellectual disability will be used to inform the next steps of a Core Outcome Set needed for RSE evaluations in research and education settings. There is an urgent need to develop standardised instruments validated for students with intellectual disability.

Sexual Assistance for People with Intellectual Disabilities: Proposal for a Service Delivery Model

The figure of the sexual assistant is increasingly demanded as a right in the disabilities field. This figure requires debate, adaptation to the characteristics of countries and cultures, as well as to the characteristics of people with intellectual and developmental disabilities. This study presents the work carried out with representatives of Spanish organizations of people with intellectual disabilities to develop a proposal for the figure of support staff for sexual behavior. Together with a rights perspective, this proposal is aligned with the Supports paradigm to better meet the health and behavior needs of users. The figure is framed within the auto-erotic and therapeutic model of sexual assistance. This figure excludes characteristics of the erotic model that involves interaction or sexual exchange between the sexual assistant and the individual with a disability. Several advantages and disadvantages need to be carefully considered before implementing this support in a delivery service model. We argue that the proposed figure requires specific accreditation, training, and monitoring.

Sex: What Is the Big Deal? Exploring Individuals' with Intellectual Disabilities Experiences with Sex Education

This article offers perspectives shared by self-advocates in the first phase of a community-based participatory research project untaken to address barriers that individuals with intellectual disabilities face with respect to sexual health knowledge. Using descriptive qualitative methods, we interviewed 19 individuals with intellectual disability about their experiences and knowledge related to sexual health. The research question guiding this project was: What are self-advocates' with intellectual disabilities experiences learning about sexual health and sexuality? The findings highlight that participants faced barriers and lack of access to sexual health education, and while they learned about sexual health through formal sexual health education, frequently this knowledge came through lived experience. Finally, the findings underscore that participants knew what they wanted with respect to sexual health education and offered recommendations. The importance of accessible sexual health education for self-advocates that supports their rights and desires to express their sexuality and sexual agency is highlighted.

Attitudes towards sexuality and related caregiver support of people with intellectual disabilities: A systematic review on the perspectives of people with intellectual disabilities

BACKGROUND

Sexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves.

METHOD

A systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool.

RESULTS

Six themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout.

CONCLUSIONS

Attitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

Sexual Health in Spanish People with Intellectual Disability: the Impact of the Lockdown due to COVID-19

INTRODUCTION

The lockdown due to COVID-19 affected the sexual health of the people with intellectual disabilities by differentially modifying the frequency and characteristics of people's sexual activity depending on whether or not they lived with a partner during this period. The aim of this study was to analyze the extent to which the sexual behavior of people with intellectual disabilities (with and without a partner) was affected during the lockdown.

METHODS

The sample consisted of 73 people with intellectual disabilities between 21 and 63 years old (M = 39.63; SD = 10.11). The variables analyzed were the physical, social, and technological environment during the lockdown, sexual appetite, sexual behavior, online sexual activity, and sexual abuse. The data were collected between the months of May and June of 2020.

RESULTS

The lockdown increased the sexual appetite of a third of the sample (38%), especially the youngest participants. Sexual activity focused on autoeroticism and online behavior, particularly sending nude images of oneself (88%) and viewing pornography (83.6%). Rates of sexual abuse during this period were relatively high (6.8%).

CONCLUSIONS

The sexual activity of people with ID was important during the lockdown, and they had to adapt to the circumstances of isolation in a similar way to the general population. Technological improvements in terms of devices and connection quality at home allowed their sexual behavior to be reoriented, opening the door to new risks for the sexual health of people with ID.

POLICY IMPLICATIONS

Cybersex and the increase in sexual abuse due to confinement are aspects that should be included in programs to improve the sexual health of this group.

Attitudes Towards the Sexuality of Adults with Intellectual Disabilities: A Systematic Review

Current research in attitudes towards the sexuality of adults with intellectual disabilities yields heterogeneous results. The aim of the present paper was to systematically review current qualitative and quantitative evidence of attitudes towards the sexuality of adults with intellectual disabilities. A systematic review of current literature (2000–2020) was carried out in the ERIC, PsychINFO, SCOPUS, PUBMED, and WebOfScience databases. Thirty-three articles were included for review. The present review protocol is registered in the PROSPERO database. Included studies presented attitudes towards the sexuality of adults with intellectual disabilities in samples comprised of staff, family, members of the community, and adults with intellectual disability. Community samples held more positive attitudes, followed by staff and family. Adults with intellectual disabilities reported interest in intimate relationships but perceived barriers in others’ attitudes. Factors such as familiarity, age, gender of the adult with a disability, and culture seemed to have clear relationships. Other factors such as gender or social status remain unclear. In general, attitudes were considered positive. However, a preference for low intimacy and friendship or Platonic relationships was found. Stereotypes towards intellectual disability may have a strong influence. These findings underline the need to investigate and address attitudinal changes to provide adequate support for adults with intellectual disabilities in regard to a healthy relational and sex life.

Prospero registration number: CRD42021222918.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

A mixed methods evaluation of Girls' Talk+: A sexuality education programme for girls with mild intellectual disabilities

BACKGROUND

Girls with a mild intellectual disability generally receive less sexuality education than their non-disabled peers, while their needs for sexual knowledge are possibly greater. This study aimed to evaluate the effect and process of a new sexuality education programme (Girls' Talk+), focused on sexual health among girls with a mild intellectual disability in the Netherlands.

METHODS

A mixed methods approach was applied, using participant questionnaires (n = 249), logs written by trainers (n = 17) and interviews with trainers (n = 10). Descriptive statistics and linear regression models were used to analyse the quantitative data. Several coding phases were used to analyse the interviews.

RESULTS AND CONCLUSIONS

This study provides some indication that Girls' Talk+ has positive results on improving knowledge, attitude, and self-efficacy in relation to sexual health as well as trainer and participant satisfaction with the programme.

Sexual knowledge and behaviour in 22q11.2 deletion syndrome, a complex care condition

BACKGROUND

There is limited information about sexual knowledge and behaviours in adults with complex care needs, including those with 22q11.2 deletion syndrome (22q) which represents a group predisposed to intellectual disabilities.

METHODS

We conducted sexual health assessments with 67 adults with 22q, examining whether those with knowledge deficits and a history of engaging in sexual activities with others would be more likely to engage in high-risk behaviours.

RESULTS

The majority (65.7%) of adults with 22q were sexually active with others; most (70.1%) had sexual knowledge deficits. Those with intellectual disabilities were more likely (p = .0012) to have deficits in certain topics. In the sexually active subgroup, most (81.8%) engaged in high-risk sexual behaviours, regardless of intellectual disability or knowledge deficits.

CONCLUSION

The results suggest a need for increased dialogue, repeated education, genetic counselling and preventive healthcare measures related to sexuality in 22q and potentially in other complex care conditions.

The Lived Experience of Sexuality Among Adults With Intellectual and Developmental Disabilities: A Scoping Review

IMPORTANCE

Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD).

OBJECTIVE

To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice.

DATA SOURCES

We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO. Study Selection and Data Collection: Arksey and O'Malley's methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality.

FINDINGS

Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity.

CONCLUSIONS AND RELEVANCE

Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD. What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.

Promoting Healthy Sexuality for Children and Adolescents With Disabilities

This clinical report updates a 2006 report from the American Academy of Pediatrics titled "Sexuality of Children and Adolescents With Developmental Disabilities." The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.

Sexual Behavior Problems in Adolescents with Intellectual Disabilities: A Systematic Review

BACKGROUND: Several studies conducted on adolescents with intellectual disabilities (ID) have reported various problems of sexual behavior that occurs in the group, including HIV-related risky sexual behavior and other health-related concerns. AIM: This review aims to synthesize studies on the problems regarding sexual behavior in adolescents with ID to obtain data on the types of risky sexual behavior problems. MATERIALS AND METHODS: Synthesis was conducted on nine studies of children aged 10–20 years old with intellectual disabilities as subjects who have no other psychiatric comorbidities and met the appraisal criteria based on the checklist for analytical cross-sectional studies of the Joanna Briggs Institute (JBI). RESULTS: Several behaviors were found in the group of adolescents with ID. Masturbation is the type of solitary behavior that appears the most, besides other behaviors like touching genitals and getting naked in public places. Sexual intercourse is the most widely reported in the type of “involving other persons.” Sexual intercourse with more than 1 person without using contraception to protect against sexual transmitted disease (STD) is at risk for HIV infection or other infectious diseases. CONCLUSIONS: The results of this review have indicated that adolescents with ID have sexual needs and experience sexual behavior problems similar to ordinary adolescents in general. They actually have a higher risk for having risky sexual behavior because they lack understanding of sexuality. These findings emphasize the need for sex education so that young people with disabilities can have healthy sexual behavior and a safe life.

Parenting by mothers with intellectual disabilities in Poland: A photovoice study

BACKGROUND

The diverse nature of parenting among people with intellectual disabilities can be affected by many factors, including stereotypes, experiencing social isolation, living in poverty, suffering from chronic diseases and limited access to health care. Because of these factors, people with intellectual disabilities are not readily viewed as potential parents by society.

METHOD

The research was conducted using the photovoice method, which analyses photographs taken by participants-seven mothers with intellectual disabilities (aged 22-43).

RESULTS

Thematic analysis yielded six main areas: pregnancy and childbirth, household duties-everyday life, caring for children, the importance of motherhood for a woman, parenting problems and difficulties, and types and forms of assistance.

CONCLUSION

Raising a child has become a life goal for the interviewed women. However, there were also difficulties in their lives, which have not been solved by formal and informal support. Individual support for mothers should include tailor-made sexual education, access to gynaecological care or long-term family support.

Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation

Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.

The Design, Content and Delivery of Relationship and Sexuality Education Programmes for People with Intellectual Disabilities: A Systematic Review of the International Evidence

There is growing empirical evidence regarding the relationship and sexuality experiences and needs of children, young people and adults with intellectual disabilities. A total of twelve papers met the inclusion criteria regarding relationship and sexuality education (RSE) programmes specific to the needs of this population. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed and quality appraisal undertaken. The four themes identified were principles informing RSE programme development, design and content of RSE programmes, delivery of RSE programmes and evaluation of RSE programmes. The discussion presents areas that need to be addressed to ensure that people with intellectual disabilities, their families, carers and professionals are fully involved in the design and delivery of RSE programmes. Further research is required to identify the impact of the programmes and the sustained outcomes achieved. Recommendations are made regarding the activities required to enable the development of evidence-based and person-centred approaches to relationship and sexuality programmes.

Men With Intellectual Disabilities Who Have Offended Sexually

PURPOSE OF REVIEW

We review extant and new research focusing on assessment and treatment of men with intellectual disabilities (ID) who have offended sexually. New research findings are applied and integrated with classic assessment and treatment approaches, providing an overview of evidence-based practices.

RECENT FINDINGS

New research has explored healthy sexuality among people with intellectual disabilities, including making evidence-based sexual information cognitively accessible for people with ID. Research has begun to include men with ID in studies of actuarial risk assessment and dynamic treatment needs and identify forms of sexual deviation. New research has identified the need for access to treatment materials better tailored to clients' cognitive level, as well as understanding normal sexuality among people with ID. The recent research further develops our understanding of men with ID who offended sexually and demonstrates similarities between men with and without ID who have offended sexually. The new research findings provide evidence-based support and guidance for clinicians working with this set of clients and suggest optimism for more positive outcomes as studies from across the globe are focusing on working with men with ID who have offended sexually.

Making Connections and Building Confidence: A Study of Specialist Dating Agencies for People with Intellectual Disabilities

Dating agencies are a small, but growing sector of social care provision for people with intellectual disabilities. The research reported here is the first to explore, with 10 specialist agencies in the UK, why they were set up, how they operate, the barriers and problems they encounter and their success or otherwise in facilitating relationships for people with intellectual disabilities. A strong case is made for the proliferation of such services.

The views and experiences of families and direct care support workers regarding the expression of sexuality by adults with intellectual disabilities: A narrative review of the international research evidence

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. However, the experiences and views of families and direct care support workers and their support and development needs in the topic area are unclear.

AIMS

The aim of this narrative review was to explore the views and experiences of families and direct care support workers in relation to the expression of sexuality by adults with intellectual disabilities and to identify their distinct support and development needs.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from May 1998 to June 2018 was undertaken. Included studies had to address specific criteria: peer reviewed papers, the use of appropriate research methods, and focus exclusively on the individual views and opinions of families and direct care support workers. The search of relevant databases yielded 313 hits. Following the application of explicit inclusion and exclusion criteria, 11 papers were deemed suitable for the review. The PRISMA checklist was utlised in the process. Quality was assessed using a recognized framework.

OUTCOMES AND RESULTS

The data were analysed and key findings highlighted issues for families and direct care support workers including: attitudes and beliefs; fear of abuse, exploitation and harm; new technologies; supporting developments in practice; and education and training programmes.

CONCLUSIONS AND IMPLICATIONS

Families and direct care support workers have specific support and education needs. Future healthcare initiatives need to be developed that are fully responsive to the identified concerns and requirements of families and direct care support workers.