A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors.

BACKGROUND: Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM: The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS: Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES: Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS: There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION: Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS: We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS: These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Teaching family planning to nurse and midwife students: A constructivist grounded theory study.

AIM: This study aimed to describe nurse/midwife educators' understanding and enactment of teaching family planning methods with nursing/midwifery students in educational programs in Rwanda. More precisely, the aim of this study was to generate a substantive theory that explains how nurse/midwife educators introduce family planning methods into their teaching practice to facilitate learning among nurse/midwife students in Rwanda. BACKGROUND: High maternal mortality remains a global health issue. In 2017, approximately 295,000 women worldwide died from complications related to pregnancy or childbirth and 94% of these maternal deaths occurred in low-income countries. Evidence shows that family planning improves maternal health outcomes and significantly contributes to reducing maternal mortality. Low family planning uptake is partly attributed to inadequate education of healthcare providers to provide family planning services. DESIGN: This study followed the constructivist grounded theory methodology articulated by Kathy Charmaz (2006; 2014). METHODS: The primary data source was individual semi-structured interviews with 25 nurse/midwife educators recruited from all the schools/faculties/departments of nursing and midwifery in Rwanda, augmented with written documents related to family planning education in nursing/midwifery preservice programs. RESULTS: The substantive Theory that emerged from the data analysis indicated that the process of teaching family planning in preservice nursing/midwifery education among nurse/midwife educators has three phases: preparing, facilitating and evaluating. Factors that had an impact on the process and actions that nurse/midwife educators undertook to address the challenges related to those factors were identified. The main influential factors that had a significant impact on nurse/midwife educators' ability to teach family planning are contextual factors and personal factors related to the nurse/midwife educators. The contextual factors included the availability of resources, student-teacher ratio, number of students in clinical placements and the time allocated to the family planning unit. The personal factors related to the nurse/midwife educators included knowledge, skills, confidence, attitude, beliefs and moral values toward family planning methods. CONCLUSION: These study findings generated valuable knowledge that can guide the improvement of teaching family planning in preservice nursing/midwifery programs in Rwanda and other limited-resource countries and contexts. With the insights provided by this study, future research should investigate strategies to overcome highlighted barriers, increase nurse/midwife educators' expertise in teaching family planning and enhance the preparedness of nurse/midwife students on some family planning methods identified in this study.

Unmet sexual health needs of young men in contemporary society regarding condom use: Qualitative study.

OBJECTIVE: In contemporary societies young men receive much misleading information about sex from friends, the media and the internet (porn) which can make them feel insecure and under pressure regarding sex. The purpose of this study is therefore to understand their sexual world better and learn about their sexual health needs, especially regarding condom use. METHODS: The study is based on two qualitative studies: focus groups and individual interviews. Recruitment of participants took place through schools, a Sexually Transmitted Infection (STI) Clinic and a Gay and Lesbian Organisation. The interviews were thematically analysed using the framework method. RESULTS: Forty-nine individuals, 18-25 years old, participated in both studies. The findings showed that the participants had a number of unmet needs regarding condom use which reduced this use. They described uncertainty regarding condom use by not prioritising them, showing lack of knowledge and communication skills. It was of high priority for them to seek sexual pleasure and not be disturbed in the process of having sex. CONCLUSIONS: The results suggest that young men have a great need to perform sexually and not to fail. This need represents insecurity in a sexual relationship. When insecurity, inability to communicate and feeling under pressure come together using a condom is not prioritised. These young men are in great need of holistic sex education that would enable them to become secure in mastering condom use.

FIGO position statement on comprehensive sexuality education.

Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.

Exploring intersections and integration of sexual reproductive health and mental health among adolescents and young adults: Areas of collaboration and lessons learned.

This special issue of the Bulletin of the Menninger Clinic addresses mental health issues in the field of sexual and reproductive health. The goal is to highlight important overlaps between reproductive and gender health concerns and mental health symptomatology. The issue includes topics around social determinants of health and their effects on reproductive health; the reproductive health sequelae of eating disorders; mental health challenges faced by gender diverse youth and strategies to mitigate these effects; integration of sexual health services and mental health care; and lessons for mental health advocates from the sex education realm. This special issue features areas of intersectoral collaboration among public health, medical, and mental health professionals to positively impact patients' holistic wellness.

[Avenues for inclusive sexuality education based on sexual rights in medical consultations]. / Pistes pour une éducation sexuelle inclusive* basée sur les droits sexuels dans les consultations médicales.

In French-speaking Switzerland, sexuality education for children with special educational needs is unevenly developed in childcare institutions and schools. This limited access to sexuality education and the failure to take into account their sexual development are forms of discrimination against them. Sexuality is an integral part of the global health. Health professionals can contribute to the implementation of the right to sexuality education for children with special educational needs by considering consultations as opportunities for sexuality education according to their needs. This article presents some ideas from the holistic sexuality education based on sexual rights, in particular the rights to expression, to participation and to self-determination.

Dans les institutions d'accueil et les écoles de Suisse romande, les offres en matière d'éducation sexuelle sont inégalement développées pour les enfants ayant des besoins éducatifs particuliers. Cet accès limité à l'éducation sexuelle et la non-prise en compte de leur développement sexuel sont autant de formes de discrimination à leur égard. La sexualité fait partie intégrante de la santé globale. Les professionnel-les de santé peuvent contribuer à appliquer le droit à l'éducation sexuelle auprès des enfants en considérant les consultations comme des opportunités pour un échange pédagogique sur la sexualité selon leurs besoins. Cet article présente quelques pistes issues de l'éducation sexuelle holistique basée sur les droits sexuels, en particulier les droits à l'expression, à la participation et à l'autodétermination.

Promoting Healthy Sexual Behaviours through Comprehensive Sexuality Education.

Comprehensive sexuality education is a scientifically accurate global program that encompasses the variable aspects necessary for achieving healthy sexual and reproductive health in children of schoolgoing age. It provides a holistic approach to developing sound knowledge and a positive attitude in a manner that does not blatantly refute the established sociocultural norms but rather delicately treads around them to bust unhealthy practices through age-appropriate measures. It is deemed necessary for health professionals to be appropriately trained to better convey sensitive information regarding sexual and reproductive well-being in a manner that is acceptable and effective, especially in the context of orthodox communities. Keywords: adolescent; medical students; sexual health; sexuality education.

Cultural values influencing iTaukei women's discussion of family planning in the home.

Pacific Sexual and reproductive health is influenced by cultural taboos and sensitivities. Although Pacific values are integral to family planning, open communication in the home is often difficult in the face of changing socio-cultural norms. This study explores the experiences of iTaukei Pacific women living in Fiji and Aotearoa New Zealand, and their discussion of family planning within the family setting. The study utilises talanoa methodology to understand women's realities and their navigation through shifting sexual and reproductive norms in both countries. The study found that although family may be seen as a place of 'truth' in which appropriate, culturally sensitive family planning communication should be available, this was challenged by cultural taboos or tabu which were persistent in family planning discussions. The study calls for greater reliance on holistic approaches to Pacific family planning perspectives and a greater examination of va or the spaces within which Pacific women's experiences are negotiated and informed.

Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome.

Sexual Interest/Arousal Disorder (SIAD) is a common sexual dysfunction in women. Both mindfulness-based cognitive therapy (MBCT) plus psychoeducation and sex therapy, education, and support (STEP; which contains the same educational information as in the MBCT arm but also integrates supportive-expressive therapy), are effective. We tested mediators and moderators of improvements. Each treatment arm consisted of eight sessions delivered weekly, and participants completed measures online pre-treatment, immediately post-treatment, and at 6- and 12-month post-treatment. Depression, self-reported interoceptive awareness, self-compassion, self-criticism, and mindfulness were examined as mediators, and expectations for improvement as a moderator. Of 148 cisgender women who consented, 70 were randomized to the MBCT plus psychoeducation group (mean age 39.3 ± 13.2 yrs) and 78 to the STEP group (mean age 37.9 ± 12.2 yrs). Decreases in depression mediated decreases in sexual distress in the MBCT plus psychoeducation group only. Improvements in interoceptive awareness mediated changes in both sexual desire and arousal, and sexual distress, and to a greater degree after MBCT plus psychoeducation. Changes in self-compassion mediated changes in sexual desire and arousal only for the MBCT plus psychoeducation group and mediated changes in sexual distress in both groups. Reductions in self-criticism mediated improvements in sexual distress to a greater extent after MBCT plus psychoeducation. Changes in mindfulness predicted changes in desire and arousal, and distress only in the MBCT plus psychoeducation group. Expectations for improvement did not moderate any outcomes. The findings have implications for understanding common and potentially distinct pathways by which MBCT plus psychoeducation and supportive sex education improve symptoms of SIAD.

Atendimento psicossocial à mulher que comete ofensa sexual / Psychosocial attention for women that commit sexual offenses / Atención psicosocial para mujeres que cometen delitos sexuales

Objetivamos apresentar uma proposta de atendimento psicossocial grupal oferecida para mulheres adultas que cometeram ofensa sexual, cuidadoras e mães. A experiência está sendo desenvolvida no Distrito Federal, Brasil, com pessoas do gênero feminino provenientes de encaminhamento judicial. Carece que os profissionais das áreas da justiça, saúde, serviço social e psicologia avancem no estudo e na compreensão desta temática, de modo a pensarem a atuação e o apoio terapêutico a essas mulheres. O modo de atendimento é focal e breve, com ênfase na criação de um ambiente lúdico como facilitador das interações grupais e da discussão sobre os temas: identidade; confiança nas relações afetivas e sociais; vivência pessoal com violência física e sexual; configuração de gênero; e expressão da sexualidade e futuro. A abordagem individual também se baseia no enfoque dos temas mencionados. O oferecimento de ajuda à mulher cuidadora ou à mãe tem participação ativa na interrupção do circuito abusivo sexual, pois essa violência é extremamente ocultada, ocasionando uma prolongada vulnerabilidade para as vítimas. Ressalta-se o valor do texto indicando a descrição de ação voltada para uma população permanentemente não estudada e evitada em seu reconhecimento. Os limites desta proposta encontram-se na falta de outras iniciativas que possibilitem uma discussão sobre essa experiência.(AU)

We aim to present a proposal of a group psychosocial intervention offered for adult female sexual offenders, caregivers, and mothers. The intervention is being developed at Federal District, Brazil, with female people coming from judicial referrals. Professionals in the areas of justice, health, social work, and psychology need to advance in the study and understanding this theme to think about action and therapeutic support for these women. The intervention is a focal and brief approach, with emphasis on the creation of a ludic environment as a facilitator of group interactions and discussion about the themes: identity; trust in affective and social relationships; personal experience with physical and sexual violence; gender configuration; and sexuality expression and future. The individual approach is also based on focusing on these themes. The offering of help to the female caregiver or the mother has an active participation in the interruption of the sexual offense circuit, since this violence is extremely hidden, bringing a prolonged condition of vulnerability to the victims. The value of this text is highlighted indicating the description of an action directed to a population that is permanently not studied and whose recognition is avoided. The limits of this proposal are found in the absence of other initiatives that would allow a discussion about this experience.(AU)

Este texto presenta una propuesta de atención psicosocial grupal destinada a mujeres adultas que han cometido delito sexual, a cuidadoras y madres. La intervención se está desarrollando en el Distrito Federal (Brasil), con personas del género femenino provenientes de remisiones judiciales. Es necesario que los profesionales de las áreas de justicia, salud, trabajo social y psicología avancen en el estudio y comprensión de esta temática para pensar en el desempeño y apoyo terapéutico de estas mujeres. El servicio es enfocado y breve, con énfasis en la creación de un ambiente lúdico como facilitador de interacciones grupales y discusión sobre los temas: identidad; confianza en las relaciones afectivas y sociales; experiencia personal con violencia física y sexual; configuración de género; y expresión de la sexualidad y el futuro. El enfoque individual también se centra en estos temas. La oferta de ayuda a la mujer cuidadora o a la madre es importante para la interrupción del circuito de abuso sexual, ya que esta violencia es extremadamente oculta y provoca una vulnerabilidad prolongada a las víctimas. Se destaca el valor del texto con la descripción de la acción dirigida a una población que no es objeto de estudios ni reconocida. Los límites de esta propuesta se encuentran en la ausencia de otras iniciativas que permitan un debate sobre esta experiencia.(AU)

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

Nursing students' attitudes and beliefs regarding sexual healthcare in Ethiopia: An online cross-sectional study.

BACKGROUND: Unresolved sexual issues can have an impact on a person's wellbeing, social interactions, or even medication compliance. Given the enormous global demand to enhance and preserve sexual health, faculty members have a specific goal of developing nursing workforce who are truly prepared to work with clients who have sexual health issues. Hence, the study's purpose has been to evaluate the current state of attitude and belief of nursing students toward sexual healthcare and the factors that influence it in Southwest Ethiopia. METHODS: An online cross-sectional survey was conducted in Mizan-Tepi University involving 134 undergraduate nursing students from February 1 to March 10, 2022. The Sexual Attitude and Beliefs Scale (SABS) were used to assess the level of attitudes and beliefs regarding sexual care. Statistical Package for Social Science (SPSS) Version 26 was employed for data analysis. Multivariable linear regression analyses was conducted to identify predictors of attitudes and beliefs regarding sexual healthcare. The significance level was set at p<0.05. RESULTS: The mean age of the nursing students participating in this study was 28.47±5.2. In our study, mean SABS score of the nursing students was found as 42.3 ± 2.1. The mean score of the SABS items ranged from 1.68±0.93 to 4.37±1.48. Having receiving sexual health education (p<0.001) was significantly associated with attitude and beliefs regarding sexual healthcare. CONCLUSIONS: Ethiopian nursing students have been found to have a negative attitude and beliefs about sexual health care. Because comprehensive sex education is sorely lacking in nursing schools, this scrutiny prevents student nurses from receiving an adequate education. As there is a lack of appropriate sexual health subject matter, it is critical to standardize sexual health education in nursing programs so that nursing students can learn to provide comprehensive care to clients.

Multidisciplinary peer-led sexual and reproductive health education programme in France, a prospective controlled-study.

BACKGROUND: Sexual education is an international priority to promote sexual and reproductive health (SRH) and to reduce risky sexual behaviour. Experts recommend holistic and comprehensive SRH peer-led education. In 2018, the French government launched a new public peer-led health prevention programme called the "Service Sanitaire" (SeSa), consisting of health education provided by healthcare students (peer educators) to teenagers. For the first time in France, the impact of the programme was prospectively evaluated during its first year to examine whether the programme improved the SRH knowledge of healthcare students and teenagers. Risk perception and risky sexual behaviour among these populations were also evaluated. METHOD: A prospective multicentre controlled study was conducted from November 2018 to May 2019. SRH knowledge was compared before and after the SeSa programme, and the evolution of this knowledge was compared, with linear regression, between healthcare students part of the SRH SeSa programme and those who were part of another programme. The same analysis of knowledge was performed with respect to teenagers who received SRH interventions as part of the SeSa compared to teenagers who did not participate in a specific SRH education programme. Risk perception and risky behaviour were studied before and after the programme among healthcare students and teenagers. RESULTS: More than 70% of the targeted population participated in the study, with 747 healthcare students and 292 teenagers. SRH peer educators increased their knowledge score significantly more than other peer educators (a difference of 2.1 points/30 [95% CI 1.4-2.9] (p [between group] <  0.001)). Teenagers participating in the SeSa interventions also had a greater increase in their knowledge score than the other teenagers (+ 5.2/30 [95% CI 3.2-7.4] p [between group] < 0.001). There was no evidence of change in sexual risk behaviours for the healthcare student population. CONCLUSION: The "Service Sanitaire" programme significantly improved the sexual and reproductive health knowledge of peer-educator healthcare students and teenagers compared to a classic education programme. Longer and/or qualitative studies are needed to evaluate changes in sexual behaviour as well as positive impacts on sexuality.

An in-depth analysis of the sexuality needs of Barcelona's youth: a holistic view using mixed method.

A positive experience of sexuality during youth is key to good sexual health later in life. Addressing young people's sexual health needs and sexual and reproductive rights is thus essential. This study aimed to identify unmet sexual health needs among youth in the city of Barcelona (Spain) through mixed methods research. We analysed the narratives of young people (n = 50) aged 14-24 years with different genders, origins, sexualities and socioeconomic backgrounds, collected from January to April 2019. A descriptive statistical analysis was also conducted on the records of visits to sexual health services and reasons for consultation. We found that 21% (n = 32,161) of young people aged 14-24 years had used sexual healthcare services in Barcelona between 2015 and 2017, while the reasons for consultation differed across sex, gender and socioeconomic background. Young people declared that they needed more information to enjoy their sexuality, to know where to go in case of an unexpected situation and to learn how to combat gender-based violence. They stated that the sexuality education they had received was sparse and focused on risks. We found that formal sex education is scarce, with informal sex education thus acquiring a major role. Current services can be improved by expanding coverage, training professionals and reducing acceptability and accessibility barriers. Sexism is ubiquitous in young people's sexual, dating and personal relationships. We recommend planning sexual health care services and formal sexual education, in which a strong gender strategy is embedded, as part of the same strategy.

A global grounded theory exploration of investigators' perspectives on male hormonal contraceptive development and acceptability.

While best practices have been proposed on how to engage men in family planning (FP), the limited options of male hormonal contraceptives (MHC) are a barrier to reaching men as clients of FP programs. The lack of alternative MHC is preventing the global health community from providing holistic reproductive healthcare. A qualitative grounded theory study was conducted in 2020 to explore MHC experts' perceptions around the development and theoretical acceptability of MHCs. Individual in-depth interviews were conducted with 15 key informants. The informants cited evidence that there is a demand for MHC. The inability to access this data by the pharmaceutical industry was acknowledged. Many informants expressed concern of the possibility for MHC to increase male power in a predominantly patriarchal world. To most informants, at least for the initial introduction of MHC, fertility sharing is something that will largely happen among couples alone rather than individually. There is proven demand among women and men for MHC, however industries may still be reluctant to invest. Effort is needed by the sexual and reproductive health and rights community to include male engagement in FP and to advocate for the development and use of MHC as a tool for women's empowerment.

Building sustainable and scalable peer-based programming: promising approaches from TESFA in Ethiopia.

BACKGROUND: Girls in Ethiopia's Amhara region experience high rates of child marriage and are less able to negotiate sex or use family planning. Seeking to improve their lives, CARE's TESFA programme delivered reproductive health and financial savings curricula to married girls via reflective dialogues in peer-based solidarity groups. From 2010 to 2013, 5,000 adolescent girls participated via three intervention arms: sexual and reproductive health, economic empowerment, and a combination of both. At end-line, participants reported improvements across health and empowerment outcomes. Four years post-TESFA, 88% of groups reported meeting without continued assistance from CARE. Some original participants had created new groups based on the TESFA model, and some girls not recruited for TESFA spontaneously replicated it to create their own groups. However, questions remained about what had contributed to this organic sustainment and scale-up of groups. METHODS: This 2018 study investigated factors affecting sustainability and scale-up of peer solidarity groups through a systematic mapping of TESFA groups across five woredas (districts) and interviews with key stakeholders. Data were collected from 39 focus groups with active and dissolved Girl Groups, Social Analysis and Action groups, and girls' husbands and from 29 in-depth interviews with group facilitators and community health workers across three districts. Data were coded and analyzed per grounded theory principles. RESULTS: Changes in reproductive health knowledge and specific behaviours, such as contraceptive use and institutional delivery, were maintained 5 years after the intervention ended. Group connectedness, spousal support, integration of holistic community platforms, and opportunities for financial independence were found to be important for group sustainability. Observed changes in TESFA girls' confidence to negotiate and assert their rights, hopes of improved mobility, and the promise of economic opportunity commonly inspired spontaneous replication of groups. Recommendations for future peer-based programmes include creating environments of solidarity and holistically engaging intervention communities. CONCLUSION: By increasing knowledge of and access to reproductive health services, TESFA mitigates some of the harmful effects of child marriage. The maintenance and organic replication of groups suggest that TESFA provides a successful, scalable and sustainable tested model for reproductive health program delivery through peer-based solidarity groups.

In Ethiopia, married girls are a particularly vulnerable adolescent population because of the many health risks associated with early marriage. Peer-based approaches are a common strategy to improve sexual and reproductive health knowledge and behaviours for marginalized groups. Critiques of these approaches are that they lack sustainability without ongoing investment and have no lasting impact on health behaviours. CARE's TESFA programme, a peer-based approach with married adolescent girls in South Gondar, was found to be effective in creating long-term behavior change related to uptake of family planning and rates of institutional delivery. Some 88% of groups who received the TESFA curriculum were still meeting 4 years after the programme had concluded. Some participants even created groups of their own, scaling TESFA beyond the original audience, suggesting a potential approach to wider scale-up. To explore lessons learned around scale and sustainability, this study interviewed TESFA participants and stakeholders.Improvements in behaviours related to contraceptive use, institutional delivery, and girls' agency in reproductive decision-making were sustained over time regardless of group status. Factors that affected the sustainability and scale-up of groups included solidarity among group members, support from husbands and community members, ongoing savings and loan structures, flexibility of group processes, and availability of relevant curriculum topics. Through an analysis of these findings, this paper discusses recommendations for sustainable and scalable peer-based programme design via existing Ethiopian community structures. Using TESFA principles as a model, practitioners could design and implement scalable and sustainable peer-based programming for adolescents sexual and reproductive health.

Ethiopia has a long way to go meeting adolescent and youth sexual reproductive health needs.

Ethiopia has the second-largest youth population in Africa with about 37.4 million people aged 10-24 years. To meet the needs of this population group, adolescent, and youth health (AYH) programs, including those focused on sexual and reproductive health (SRH) and youth development, have gained traction in Ethiopia in the last two decades, especially following the 2005 election in Ethiopia. However, adolescents and youths in Ethiopia continue to face a high burden of morbidity and mortality from multiple factors including, teenage pregnancy, unplanned pregnancy, compromised nutrition, HIV and STIs, unsafe abortion, early and child marriage, and unmet needs for family planning. To date, adolescents and youth-related interventions in Ethiopia are fragmented under various ministries, uncoordinated, underfunded, project-oriented, lack effective policy implementation, and lack meaningful participation of young people. Addressing adolescents and youth health and development issues require evidence-based, well-tailored, at scale, intensified, coordinated, and holistic national responses. Therefore, there is a need to advocate for a realization of robust government commitment to ensure a multi-sectoral, coordinated, at scale, and well-funded national response to address the multifaceted needs of young people in Ethiopia including their sexual and reproductive health. An example to emulate is the HIV/AIDS response in Ethiopia, which was led by a national council chaired by the President of the Federal Democratic Republic of Ethiopia and spearheaded by a secretariat leveraging resources and implementing a multisectoral national plan down to the kebele level.

Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review.

OBJECTIVES: To critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education. DESIGN: A systematic review and narrative synthesis. DATA SOURCES: A systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted. ELIGIBILITY CRITERIA: Studies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text. DATA EXTRACTION AND SYNTHESIS: The studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article. RESULTS: Of the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases. CONCLUSIONS: LGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.

A randomized trial comparing group mindfulness-based cognitive therapy with group supportive sex education and therapy for the treatment of female sexual interest/arousal disorder.

Objective: Sexual interest/arousal disorder (SIAD) is the most prevalent sexual dysfunction in women. Our goal was to compare (a) group mindfulness-based cognitive therapy (MBCT) plus sex education with (b) group supportive sex education and therapy (STEP) for women with SIAD. Method: Eight-session treatments were delivered weekly and participants completed the measures of sexual desire and arousal, sexual distress, relationship satisfaction, rumination, and global impressions of change, at baseline, immediately posttreatment, and at 6- and 12-month posttreatment. Of 148 women who consented, 70 were randomized to MBCT (mean age 39.3 ± 13.2 years) and 78 were randomized to STEP (mean age 37.9 ± 12.2 years). Results: Sexual desire and arousal significantly improved at each time point relative to baseline, with large effect sizes (d = -1.29 to -1.60), and similarly for MBCT and STEP. Sexual distress also improved at each time point with large effect sizes (d = 0.83-1.17), and more so for MBCT relative to STEP. Relationship satisfaction significantly improved (d = -0.17 to -0.20), and rumination about sex improved significantly in both arms, with medium effect sizes (d = 0.42-0.69), with both outcomes responding more to MBCT. About half the participants across both treatments reported moderate or great improvements in global indicators of desire and overall sexuality. Conclusions: Results support the efficacy of both group MBCT and group supportive sex education for improving symptoms of SIAD with 12-month retention of improvements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).