Value of self-care for sexual and reproductive health.

It is opportune for the Journal to contribute to Self-Care Month and Self-Care Day, as proclaimed by the World Health Organization (WHO) in its efforts to promote self-care which is increasingly prominent in discourses in resource-limited settings for attaining universal health coverage. With sexual and reproductive health and rights facing hindrances, such as cultural barriers, self-care should facilitate access to services whilst maintaining privacy. Largely limited to pregnancy beforehand, self-care can now be promoted for the self-management of medical abortion, self-administration of injectable contraceptives and gender-affirming hormones besides self-collection of samples for infection testing.

Il est opportun pour le Journal de contribuer au Mois et à la Journée des soins personnels, comme l'a proclamé l'Organisation mondiale de la santé dans ses efforts visant à promouvoir les soins personnels, qui occupent une place de plus en plus importante dans les discours dans les contextes à ressources limitées pour atteindre la couverture sanitaire universelle. . La santé et les droits sexuels et reproductifs étant confrontés à des obstacles, tels que des barrières culturelles, les soins personnels devraient faciliter l'accès aux services tout en préservant la vie privée. Largement limités à la grossesse préalable, les soins personnels peuvent désormais être encouragés pour l'autogestion de l'avortement médicamenteux, l'auto-administration de contraceptifs injectables et d'hormones d'affirmation de genre, en plus de l'auto-collecte d'échantillons pour les tests d'infection.

"What Did You Say, ChatGPT?" The Use of AI in Black Women's HIV Self-Education: An Inductive Qualitative Data Analysis.

ABSTRACT: The emergence of widely accessible artificial intelligence (AI) chatbots such as ChatGPT presents unique opportunities and challenges in public health self-education. This study examined simulations with ChatGPT for its use in public education of sexual health of Black women, specifically in HIV prevention and/or HIV PrEP use. The research questions guiding the study are as follows: (a) does the information ChatGPT offers about HIV prevention and HIV PrEP differ based on stated race? and (b) how could this relatively new platform inform public health education of Black women educating themselves about sexual health behaviors, diagnoses, and treatments? In addressing these questions, this study also uncovered notable differences in ChatGPT's tone when responding to users based on race. This study described valuable insights that can inform health care professionals, educators, and policymakers, ultimately advancing the cause of sexual health equity for Black women and underscoring the paradigm-shifting potential of AI in the field of public health education.

Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents.

BACKGROUND: The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries. OBJECTIVES: This paper furthers that analysis for 16 GFF partner countries as part of a Special Series. METHODS: Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator. RESULTS:  Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities. CONCLUSION: Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

Main findings: Adolescent health content is inconsistently included in the Global Financing Facility country documents, and despite strong or positive examples, the content is stronger in investment cases than project appraisal documents, and diminishes when comparing content, indicators and financing.Added knowledge: Although adolescent health content is generally strongest in countries with the highest proportion of births before age 18, there are exceptions in fragile contexts and gaps in addressing important issues related to adolescent health.Global health impact for policy and action: Adolescent health programming supported by the Global Financing Facility should build on examples of strong country plans, be more consistent in addressing adolescent health, and be accompanied by public transparency to facilitate accountability work such as this.

A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa.

BACKGROUND: Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16-29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people. METHODS: The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed. RESULTS: The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people's sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people. CONCLUSION: The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.

Prevalence of urinary incontinence in New Zealand women from the cross-sectional Sexual and Reproductive Health module of the New Zealand Health Survey 2014/2015.

AIMS: To describe urinary incontinence prevalence for New Zealand women. METHODS: The New Zealand Health Survey Adult Sexual and Reproductive Health module 2014/2015 was used to estimate urinary incontinence prevalence. Associations between urinary incontinence and age, body mass index (BMI), parity and ethnicity were estimated by logistic regression adjusted for sampling weights. RESULTS: There were 2,472/5,685 (43.5%) of women aged between and 16 and 74 who responded to the urinary incontinence question and reported at least some incontinence. The sample survey weight-adjusted prevalence (95% confidence interval) was 41.7% (40.0-43.4). An increased prevalence of incontinence was seen with older age, increased BMI and greater parity. The association between BMI and parity was complex, with the lower prevalence with lower BMI attenuated with increasing parity. After adjustment for these variables there was no association with incontinence prevalence for Maori versus non-Maori or European versus non-European. CONCLUSIONS: Urinary incontinence is highly prevalent in New Zealand women. There was no association with ethnicity after adjusting for older age, increased BMI and parity. The prevalence identified in the New Zealand Health Survey is higher than that reported in older surveys based on the electoral roll.

Predictors of sexual and reproductive health knowledge and utilization of services among adolescents in Ghana's Adaklu district.

Objective: To explore factors associated with adolescents' sexual and reproductive health (SRH) knowledge and their engagement with educational and clinical services. Design: Regression analysis of secondary data collected during a community survey. Setting: Adaklu district, Volta Region, Ghana. Participants: 221 adolescent caregiver pairs. Main outcome measures: The study employed three main outcome measures: (1) adolescents' level of SRH knowledge (assessed via questionnaire), (2) membership in district-sponsored adolescent health clubs (AHCs), and (3) ever-utilization of clinical SRH services. Results: Greater SRH knowledge was significantly associated with older age, AHC membership, and relying primarily on teachers or friends for SRH information. Increased odds of AHC membership were observed among females (AOR = 2.38, 95% CI 1.14-4.95); those who had communicated with one parent about sexual issues (OR 2.70, 95% CI 1.17-6.21); and those with a history of transactional sex (OR 5.53, 95% CI 1.04-29.37). Decreased odds were observed among adolescents whose caregivers were educated to the primary level (AOR = 0.24, 95% CI = 0.07-0.79). Overall, utilization of clinical SRH services was low, but higher odds were detected among individuals reporting a history of forced sex (AOR = 117.07, 95% CI 3.82-3588.52) and those who had discussed sexual issues with both of their parents (AOR = 13.11, 95% CI 1.85-92.93). Conclusions: Awareness of the predictors of knowledge, AHC involvement, and clinical service utilization can empower adolescent SRH initiatives-both present and future-to enhance their teaching, develop targeted outreach to underserved groups, and promote engagement with key clinical resources. Funding: This work has been supported by grants from the International Development Research Centre [108936] (IDRC), Canada.

Providing sexual health care for international students in Australia: a qualitative study of a general practice team approach.

Background Provision of culturally responsive sexual health care for international students is important, given the large numbers of international students in Australia and known lower levels of health literacy among this cohort. Team-based care in general practice has the potential to provide this care. Methods A qualitative study that developed and evaluated a team-based model of care for female, Mandarin-speaking, international students in a university-based general practice. The model involved patients attending a consultation with a Mandarin-speaking nurse with advanced skills in sexual health who provided education and preventive health advice, followed by a consultation with a GP. Evaluation of the model explored patient and healthcare worker experiences using a survey and a focus group of patients, and interviews with healthcare workers. Data were analysed using a general inductive approach. Results The consultation model was evaluated with 12 patients and seven GPs. Five patients participated in a focus group following the consultation. Survey results showed high levels of patient satisfaction with the model. This was confirmed via the focus group findings. Healthcare workers found the model useful for providing sexual health care for this cohort of patients and were satisfied with the team approach to patient care. Conclusions A team-based approach to providing sexual health care for international students was satisfactory to patients, GPs and the practice nurse. The challenge is providing this type of model in Australian general practice under the current funding model.

Understanding sexual health service access for gay, bisexual and other men who have sex with men in Ireland during the COVID-19 crisis: Findings from the EMERGE survey.

BACKGROUND: In the Republic of Ireland, the COVID-19 crisis led to sexual health service closures while clinical staff were redeployed to the pandemic response. Gay, bisexual and other men who have sex with men (gbMSM) face pre-existing sexual health inequalities which may have been exacerbated. The aim of this study is to understand sexual health service accessibility for gbMSM in Ireland during the COVID-19 crisis. METHODS: EMERGE recruited 980 gbMSM in Ireland (June-July 2021) to an anonymous online survey investigating well-being and service access through geo-location sexual networking apps (Grindr/Growlr), social media (Facebook/Instagram/Twitter) and collaborators. We fit multiple regression models reporting odds ratios (ORs) to understand how demographic and behavioural characteristics (age, sexual orientation, HIV testing history/status, region of residence, region of birth and education) were associated with ability to access services. RESULTS: Of the respondents, 410 gbMSM accessed sexual health services with some or no difficulty and 176 attempted but were unable to access services during the COVID-19 crisis. A further 382 gbMSM did not attempt to access services and were excluded from this sample and analysis. Baseline: mean age 35.4 years, 88% gay, 83% previously tested for HIV, 69% Dublin-based, 71% born in Ireland and 74% with high level of education. In multiple regression, gbMSM aged 56+ years (aOR = 0.38, 95%CI:0.16, 0.88), not previously tested for HIV (aOR = 0.46, 95%CI:0.23, 0.93) and with medium and low education (aOR = 0.55 95%CI:0.35, 0.85) had lowest odds of successfully accessing services. GbMSM with HIV were most likely to be able to access services successfully (aOR = 2.68 95%CI:1.83, 6.08). Most disrupted services were: STI testing, HIV testing and PrEP. CONCLUSIONS: Service access difficulties were found to largely map onto pre-existing sexual health inequalities for gbMSM. Future service development efforts should prioritise (re)engaging older gbMSM, those who have not previously tested for HIV and those without high levels of education.

Sexual and reproductive health in young women with ADHD from the view of health care professionals.

BACKGROUND: Sexual risk-taking and struggles in managing romantic relationships may put young women with Attention Deficit Hyperactivity Disorder (ADHD) at risk of sexually transmitted diseases, unplanned pregnancies, and low relational satisfaction. To gain understanding of sexual behaviors and intimate relationships, this study aimed to identify and describe health care professionals' (HCPs) perceptions and experiences of sexual and reproductive health (SRH) in young women with ADHD. METHODS: Qualitative interviews were performed with 16 HCPs. Data was analyzed using reflexive thematic analysis. RESULTS: Analysis resulted in the themes Struggling to meet expectations, Sexual risk-taking, and Complex romantic relationships. HCPs' perceptions and experiences indicated that some women were afraid to be judged in clinical meetings when not living up to perceived expectations of sexual behaviors. Lack of impulse control was interpreted by HCPs to result in risk-taking behaviors leading to both negative and positive sexual experiences. Difficulties in assessing intentions of sexual partners were further perceived by HCPs to sometimes lead to sexual regrets or sexual victimization. The HCPs had experience of women wishing for romantic relationships but described these as being complicated by previous experiences, low self-esteem and conflict. ADHD medication and self-knowledge were perceived by HCPs to facilitate the women's relationship quality. CONCLUSIONS: This study highlights that, from the perspective of HCPs, self-stigmatization and hesitation to raise issues concerning sexuality with HCPs may pose risks for young women with ADHD. It provides insight into sexual risk-taking behaviors, showing the link to regretted sex and sexual victimization. The study concludes that there is a need for HCPs to understand the influence of stigma concerning ADHD and female sexuality as well as how symptoms and outcomes of living with ADHD may impact SRH in order to promote healthy behaviors and relationships in young women.

Clinic Staff Perceptions of Implementing a Sexual and Reproductive Health Entertainment-Education Program for Young Women of Color.

Objective: Entertainment-education interventions remain underutilized in sexual and reproductive health (SRH) despite evidence that they can be effective and place a low burden on staff. This study explores perceived facilitators and barriers for implementing an entertainment-education video intervention for 18- to 19-year-old African American and Latina women in SRH clinics. Design: Cross-sectional online survey (n=100) and telephone interviews (n=19) were completed May through August 2018. Setting: SRH clinics were located across 32 US states and 1 Canadian province. Participants: SRH clinic staff were diverse in type of clinic, role, and geography and were recruited using purposive sampling. Methods: Bivariate analyses were used for quantitative data, and thematic analysis was used for qualitative data. Main Outcome Measures: Intervention acceptability, perceived feasibility, and likely uptake were assessed using agreement statements (survey) and open-ended questions (interviews and survey). Results: Interviewed clinic staff described the intervention as engaging, educational, and promising for improving client SRH knowledge and behaviors. Nearly all (95%) survey respondents said showing the video would be feasible. Most (56%) indicated likely uptake, which was significantly associated with perceived feasibility (P=.000), acceptability (P≤.001), and working at a public health clinic (P=.023). Implementation barriers included the video's potential relevance to only certain clients and the need for additional information or staff and/or management buy-in. Conclusions: This is the first study to assess perceived implementation facilitators and barriers of an entertainment-education video intervention among SRH clinic staff. The intervention was well received, with certain barriers potentially alleviated by offering information about entertainment-education and multiple implementation methods. These findings can help improve dissemination efforts for video-based entertainment-education interventions in clinics serving young women of color.

Supporting Sexual and Reproductive Health for Immigrant Families Across the Lifespan.

The ability to exercise autonomy in achieving reproductive health goals necessitates access to contraceptive and reproductive health information and medical care. Finding trusted, comprehensive, consistent and affordable reproductive care is particularly challenging for immigrants living in the United States, especially for those without legal immigration status and for those who prefer a language other than English. In immigrant communities, sexual and reproductive health (SRH) knowledge, contraceptive choice, and family planning are influenced by many factors including tension between traditional and adopted cultural norms, limited English proficiency, restricted health care access, and structural racism. The family-centered model and longitudinal nature of relationships in pediatric primary care pose a unique opportunity to support immigrant families across the lifespan in obtaining SRH information and achieving reproductive health goals. Here, we present the unique vulnerabilities faced by immigrants seeking SRH services in the United States including both the upstream and downstream health effects of immigration status on family health. We then describe four time points across the lifespan where pediatricians can support SRH, including examples of existing SRH programming designed or adapted for immigrant families. Finally, we discuss opportunities to advance research, policy, education, and clinical care related to SRH equity for immigrant families.

Breaking the silence: the role of sexual communication on quality of life in women with cervical cancer.

INTRODUCTION: Cervical cancer (CC) and its treatments impact various dimensions of quality of life (QoL), including physical, psychological, and sexual functioning. Sexual health, a crucial QoL aspect, is often compromised, highlighting the necessity for open sexual communication. MATERIALS AND METHODS: This study involved 60 women diagnosed with stage IIb-IIIa CC. The 36-Item Short Form Survey (SF-36) was used to measure physical and psychological components of QoL, the Female Sexual Function Index-6 (FSFI-6) to assess its sexual component, and the Sexual Communication Self-Efficacy Scale (SCSES) to diagnose communication confidence. Self-administered questions gauged patient-provider sexual communication. The results include quotes from participants, providing additional insight. RESULTS: Sexual communication self-efficacy and patient-provider communication correlated significantly with QoL components. Only 23.33% discussed sexual issues with their doctors. Participants' experiences highlighted the impact of cancer on sexuality and the need for tailored support. DISCUSSION: Post-diagnosis psychosexual changes emphasize the importance of communication in renegotiating sexual identity and needs. Effective communication is associated with improved QoL, highlighting the role of healthcare professionals in addressing psychosexual issues. Integrating PLISSIT and BETTER models provides a comprehensive approach to sexual communication in the cancer context. CONCLUSION: The study demonstrates the importance of sexual communication self-efficacy in QoL of CC patients and highlights the need for healthcare professionals to include sexual communication education in cancer care.

Pornography use, demographic and sexual health characteristics among university students: a gender-based comparative study of non-users, non-problematic users, and problematic users.

BACKGROUND: Limited gender-based research has compared sexual health among pornography users (PUs) and non-users, including non-problematic pornography users (non-PPUs) and problematic pornography users (PPUs), particularly in non-Western cultures. METHODS: A 2022 cross-sectional study involving 450 Iranian university students categorized participants as PUs or non-users based on 12 months of use. PUs were further classified as non-PPUs or PPUs using the 'Problematic Pornography Use Scale' cutoff point, with comparisons of demographic and sexual variables made between these groups. RESULTS: Pornography use was reported among 39.6% of students, including 51.7% of men and 33.6% of women. In general, 9.5% of participants were PPUs, including 17.4% of men and 5.6% of women. PUs were mainly men, had fewer children, shorter marriages, lower religiosity, and lower levels of education. Compared with non-users, PUs reported earlier sexual relationships, lower satisfaction with sex frequency and communication, and greater rates of extramarital relationships, masturbation, sexual desire, and sexual distress. PPUs reported more sexual desire, pornography use, masturbation, and extramarital affairs than non-PPUs. Similar patterns in demographics, sexual history, and health were observed in pornography use across genders. The regression indicated being male (OR: 2.42, 95% CI: 1.44-4.06), having lower education (OR: 0.89, 95% CI: 0.81-0.97), fewer children (OR: 0.64, 95% CI: 0.48-0.86), higher masturbation (OR: 1.31, 95% CI: 1.14-1.49), more extramarital relationship (OR: 1.69, 95% CI: 1.07-2.67), less religiosity (OR: 0.87, 95% CI: 0.82-0.93), more sexual excitement (OR: 0.79, 95% CI:0.62-1), and more sexual distress (OR: 1.20, 95% CI: 1.02-1.32) were associated with pornography use. Two-way ANOVA found no significant effects of gender or pornography use on sexual satisfaction. Women had worse sexual function regardless of usage. Pornography users, regardless of gender, experienced higher sexual distress.

Access to PrEP and other sexual health services for cisgender women in the United States: a review of state policy and Medicaid expansion.

Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.

Obesity and sexual health trends among a large, national sample of men who have sex with men on Grindr in the USA.

Background A growing number of men who have sex with men (MSM) utilise Grindr for seeking relationships and immediate/casual sexual encounters. Grindr and other mobile applications can be a valuable source of information on sociological predictors of health. One topic that is under reported is the use of Grindr by MSM with obesity. We described differences in Grindr use between MSM with and without obesity, and to use Grindr information to reveal trends which may serve as potential predictors of health. Methods Data was collected from 3744 Grindr users (mean age [s.d.], 32.3 years [9.1]) from the largest 50 metropolitan centres in the USA between February and May 2018. Users were divided into two cohorts based on BMI: (1) MSM with obesity (BMI>30), n =253; and (2) MSM without obesity, n =3491. Profile characteristics were compared. Results When evaluating potential predictors for obesity, we found that black/African-American and older MSM were significantly more likely to have obesity. Further, we found that obesity among MSM was significantly inversely associated with the population percent lesbian, gay, bisexual, and transgender (LGBT) within a city. Additionally, we found that MSM with obesity were significantly more likely to indicate interest in immediate sexual encounters. Conclusions These results highlight important trends that may serve as predictors of health in urban settings. Furthermore, our results suggest that MSM with obesity may be more likely to engage in risky sexual behaviours. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population.

Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study.

This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.

Sexual health beliefs and prevention of sexually transmitted infections among cisgender women sex workers in Colombia.

INTRODUCTION: The stigma and social discrimination against cisgender women sex workers lead many of them to live in conditions characterized by social inequality, marginalization, persecution, and limited opportunities for sexual health literacy. Consequently, they are often compelled to establish a framework of preventive beliefs with little scientific validity, which they use to identify, mitigate, or avoid sexual health risks arising from their interactions with clients. This study investigates the sexual health beliefs that influence self-care practices aimed at preventing sexually transmitted infections among cisgender women sex workers in Colombia. METHODS: We conducted a qualitative study framed in Hermeneutic Phenomenology. In-depth interviews and discussion groups were conducted with 34 cisgender women sex workers over 18 years of age in the center of the cities of Bogotá and Barranquilla in Colombia. RESULTS: Seven themes emerged from the reflective and inductive thematic analysis of the narratives: (1) popular habits for the prevention of contagion, (2) ocular assessment of genitals, (3) condom lubrication, (4) suspicion of a hidden infection in the client, (5) saliva and oral contact as a source of contagion, (6) avoidance of semen contact, (7) and trust in God as protection. CONCLUSIONS: The findings reflect the need for health and social professionals to promote participatory and inclusive cooperation with sex workers to update the framework of preventive beliefs that help them guide sexual health self-care with autonomy and self-efficacy, strengthening favorable beliefs and negotiating unfavorable ones. It is also essential to have a sex worker-informed sexual health policy that guides the promotion of sexual health that is sensitive to the needs and consistent with the risks of sex work and ensures friendly and non-oppressive preventive care environments for sex workers.

Adolescent sexual and reproductive health needs and utilisation of health services in the Bono East Region, Ghana.

BACKGROUND: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. METHODS: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. RESULTS: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. CONCLUSION: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.