Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania.

BACKGROUND:  Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health. AIM:  This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum. SETTING:  Healthcare settings in Tanzania. METHODS:  Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students). RESULTS:  Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines. CONCLUSION:  A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate.

Prostate cancer disclosure and sexual orientation: Understanding outness to healthcare providers as a situational or consistent phenomenon.

OBJECTIVE: In this study, we investigated if outness is more a situational or a consistent characteristic in gay, bisexual, and other men who have sex with men (GBM) treated for prostate cancer and how the disclosure of sexual orientation impacts provider discussions of sexual side effects. METHODS: Data came from Restore, an online cross-sectional survey of 193 GBM prostate cancer survivors living in North America and were analyzed using various statistical models. RESULTS: Disclosure of sexual orientation and of living with prostate cancer were not significantly correlated. Participants who were out regarding sexual orientation were more likely to report that their surgeons and urologists discussed the sexual side effects of treatment. CONCLUSION: Outness appears to be a situational phenomenon. GBM prostate cancer survivors who were out regarding sexual orientation received more discussion surrounding sexual side effects of prostate cancer treatment from their providers. PRACTICE IMPLICATIONS: It is important for healthcare providers to inquire about patient's sexual orientation to provide holistic care to these patients to address health disparities within this group.

The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania.

BACKGROUND: Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied. OBJECTIVES: This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims. METHODS: Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students). RESULTS: Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a "waste of time" for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics. CONCLUSIONS: Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.

Enema use among men who have sex with men: a behavioral epidemiologic study with implications for HIV/STI prevention.

Enema use or douching is a risk factor for HIV/STI in men who have sex with men (MSM). However, few studies have explored enema use practices. We examined the frequency of enema use, type of products used, and reasons to use and not to use before and after receptive anal sex in a large sample of MSM (N = 4,992) recruited from 16 U.S. cities. Through online surveys, we examined personal, behavioral, and environmental factors associated with enema use. Most (52 %) participants reported having douched at least once and 35 % reported douching within the last 3 months. While most (88 %) reported enema use before receptive anal sex, 28 % douched after receptive anal sex. Most participants (65 %) used water to douche, 24 % added salt, soap, and/or antibacterial products to water, and 30 % reported using commercially available products. Being a man of color, HIV-positive, diagnosed with an STI, identifying as "versatile" in sex, and having more than two unprotected sex partners were significantly associated with recent enema use. Douching behavior appears closely associated with HIV/STI risk. Douching with water may be a concern since it may increase HIV/STI infection by damaging the epithelium. Development and promotion of a non-damaging, non-water based enema specifically for use in anal sex are recommended. In addition, the seemingly contradictory recommendations that water-based lubricant is recommended for anal sex but water-based enemas are dangerous need to be reconciled into a single consistent message.

Performance of the Duke Religion Index and the spiritual well-being scale in online samples of men who have sex with men.

Religiosity is associated with behaviors that reduce the risk of HIV/STI infection among general-population and heterosexual-specific samples. Whether this association is similar to homosexual persons is unknown. Measures of religiosity have not been evaluated psychometrically among men who have sex with men (MSM), a population who, because of stigma, experience religiosity differently than heterosexual persons. We assessed the duke religion index and the spiritual well-being in two samples of MSM. Neither instrument produced adequate model fit. To study the association between religiosity and HIV/STI risk behaviors among MSM, scales are needed that measure the religious and spiritual experiences of MSM.

The Sexual Health Model: application of a sexological approach to HIV prevention.

This article outlines the Sexual Health Model and its application to long-term HIV prevention through comprehensive, culturally specific, sexuality education. Derived from a sexological approach to education, the model defines 10 key components posited to be essential aspects of healthy human sexuality: talking about sex, culture and sexual identity, sexual anatomy and functioning, sexual health care and safer sex, challenges to sexual health, body image, masturbation and fantasy, positive sexuality, intimacy and relationships, and spirituality. A brief review of literature supporting a need for a more explicit focus on sexuality and relationships in HIV prevention is presented to demonstrate the relevance of the Sexual Health Model. The model in anchored in a holistic definition of sexual health. This definition is followed by a description of the Sexual Health Model's developmental origins in sexuality education, the importance of culturally relevant information, and the authors' qualitative and quantitative research. The model's 10 key components are discussed in more depth, and the theoretical and practical applications of this approach to HIV prevention are discussed. The article concludes with some cautions and suggestions for research. It is recommended that HIV prevention agencies contemplating use of the model should design their sexual health intervention to fit the unique needs of their target population. Evaluation of the effectiveness of interventions based on the model has begun, but further research is needed to confirm its viability.