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.

Iranian mothers' needs for reproductive health education of their adolescent daughters: a qualitative study.

INTRODUCTION: In order to be effective in discussing high-risk sexual behaviors with adolescents, mothers need to be educated about their adolescent daughters' sexual issues. As no detailed and exact knowledge on mothers' educational needs concerning adolescent girls' reproductive health is available, the current study was intended to investigate mothers' educational needs concerning their adolescent daughters' reproductive health. MATERIALS AND METHODS: This research was a qualitative content analysis. Purposive sampling was performed to the saturation point. The samples included 26 mothers and 14 key informants. Semi-structured interviews were used for data collection. Data authenticity was verified based on Lincoln and Guba's criteria and data analysis was conducted using conventional content analysis with MAXQDA10 software. FINDINGS: In this study, three themes and 13 main categories, each with a number of subcategories were extracted. The themes and main categories included: "appropriate educational content (reproductive health, sexual health, general health, psychological health, family health, social health and spiritual health)", "characteristics of the educator (communicative skill, cognitive skill and moral competence)", and "effective factors in learning (teaching method, learning conditions and environment, and the learner's readiness)". CONCLUSIONS: The results demonstrated that mothers need to be informed about sexual, reproductive, general, psychological, family, social and spiritual health in adolescent girls. Consequently, the results can help the healthcare authorities to implement need-based programs and boost the effectiveness of education about adolescent girls' reproductive health for mothers.

Interventions for sexual dysfunction following stroke.

BACKGROUND: Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management. OBJECTIVES: To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke. SEARCH METHODS: We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach. MAIN RESULTS: We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation. AUTHORS' CONCLUSIONS: Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.

Childhood Interpersonal Trauma and Sexual Satisfaction in Patients Seeing Sex Therapy: Examining Mindfulness and Psychological Distress as Mediators.

Mindful attention and awareness may promote sexual satisfaction. However, experiencing cumulative childhood interpersonal trauma (CCT; sexual abuse, neglect, etc.) is associated with distress, which might interfere with dispositional mindfulness and lead to lower sexual satisfaction. Although the concept of mindfulness emerged as an interesting variable to understand sexual difficulties, little empirical data are available on this topic. This study tested an integrative mediation model of the relation between CCT, psychological distress, dispositional mindfulness, and sexual satisfaction within a clinical sample of 410 adult patients consulting in sex therapy. Patients completed questionnaires assessing CCT, psychological distress, dispositional mindfulness, and sexual satisfaction. Results showed that the majority of patients reported experiences of childhood interpersonal trauma. Path analyses highlighted three distinct significant paths from CCT to sexual satisfaction. First, dispositional mindfulness mediated the relationship between CCT and sexual satisfaction. Second, psychological distress also mediated the relationship between CCT and sexual satisfaction. Third, the effect of CCT on sexual satisfaction was sequentially mediated through greater levels of psychological distress and lower levels of dispositional mindfulness. The model explained 19% of the variance in sexual satisfaction. Findings suggest that dispositional mindfulness and psychological distress are key processes explaining sexual satisfaction in CCT survivors.

The effect of a midwife-based counseling education program on sexual function in postmenopausal women: a randomized controlled clinical trial.

OBJECTIVE: The present study was conducted to investigate the effect of a midwife-based counseling education program on sexual function in postmenopausal women. METHODS: A randomized clinical trial was conducted on 52 eligible postmenopausal women. Participants' sexual function was assessed using the Female Sexual Function Index (FSFI). The women were randomly allocated into two groups: (1) the intervention group, in which the participants received a midwife-based counseling education program in 4 sessions held at 10-day intervals, with each session lasting for 70 minutes; (2) the control group, in which the participants only received routine care. Data were collected 1 week before the start of the sessions, 2 weeks after the end of the sessions, and 2 months after the last follow-up. RESULTS: No statistically significant differences were reported between the groups in terms of personal and sociodemographic characteristics and sexual function before the intervention; the total FSFI score was 17.05 (±4.54) in the intervention group and 16.66 (±3.62) in the control group. After the program, in the first and second follow-ups, the scores reached 27.18 (±4.61) and 28.20 (±4.43) in the intervention group and 16.06 (±3.94) and 16.32 (±2.98) in the control group. Significant improvements were observed in the total score of sexual function and all the FSFI domains in the intervention group, but not in the control group (P < 0.001). CONCLUSION: Midwife-based counseling education can be an appropriate approach to improving sexual function in postmenopausal women.

Intersectoral strategies between health and education for preventing adolescent pregnancy in Chile: Findings from a qualitative study.

BACKGROUND: In Chile, despite its steady decrease overall, adolescent pregnancy is concentrated in the most vulnerable population. Efforts in intersectoral collaboration between health and education to address the problem are being developed, but they have not been assessed. OBJECTIVE: To describe intersectoral strategies between health and education to address adolescent sexual and reproductive health, prevent adolescent pregnancy, and to explore adolescents' and health professionals' perceptions regarding those strategies. DESIGN: A qualitative ethnographic study was carried out in five municipalities in the Metropolitan Region of Chile. A sample of five key informants, 23 health professionals and 50 adolescents participated in a total of 38 semi-structured interviews and five discussion groups. RESULTS: Two intersectoral strategies to respond to adolescents' sexual and reproductive health needs were identified: (a) the "in-and-out" strategy, where health professionals provide health care mostly in health centres and carry out specific actions in schools and (b) the school-based strategy in which health professionals carry out continuous actions in schools as part of the curriculum. The second is perceived as responding better to adolescents' needs in sexual and reproductive health issues and in preventing adolescent pregnancy. DISCUSSION: The school-based strategy, with the constant presence of health professionals and lack of bureaucratic procedures, facilitates adolescents to access sexual and reproductive health care. This strategy enables sexual and reproductive health to be understood as an integral dimension of adolescents' lives, and it reinforces a holistic idea of health in which it is approached as a whole.

The Effect of Peer Education in Dispelling Myths and Misconceptions about Long-Acting Reversible Contraception among Ethiopian Youth.

Robust evidence, including systematic reviews and recommendations from the 2016 Lancet Commission on Adolescent Health and Wellbeing, does not wholly support the unambiguous endorsement of peer-led community-based interventions. This study evaluated the effectiveness of an intensive three-day training for peer educators (PE) on dispelling myths and misconceptions about long-acting reversible contraceptives (LARCs) among Ethiopian youth. Post-training, PEs conducted demand-generation activities with their peers to encourage LARCs referrals. A convenience purposive sampling technique was used to select 20 health centers where peer educators referred clients: 10 each in Amhara and Tigray regions. The health centers were randomly allocated to the intervention (five) and non-intervention (five) study arms. Data were abstracted from the peer educators' monthly reporting forms over an 11-month period: 5 months pre-intervention and 6 months post-intervention. Analysis of family planning and LARCs referrals and chi-square tests of association were conducted. Odds of LARCs referrals at pre-intervention (0.96), fell to 0.83 for the post-intervention phase (p-value <0.6). Challenges, largely with data collection and reporting, may have exposed the study to Type II errors. We recommend focused and rigorous data collection in a multi-country 2X2 factorial design cluster randomized holistic intervention (service providers/clinic and PEs/community) trial to comprehensively determine effectiveness on demand for and uptake of LARCs among youth.

Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.

OBJECTIVES: To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates. DESIGN: Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites. SETTING: Eighteen health facilities in Kenya. SUBJECTS: Women aged 18-45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2. INTERVENTION: "One-stop shop" approach to integrating FP and HIV services. MAIN OUTCOME MEASURES: Use of more effective contraceptive methods and incident pregnancy across two years of follow-up. RESULTS: Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19-1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60-0.87). CONCLUSIONS: Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model. TRIAL REGISTRATION: ClinicalTrials.gov NCT01001507.

Comprehensive Sexuality Education as a Longitudinal Predictor of LGBTQ Name-Calling and Perceived Willingness to Intervene in School.

Comprehensive sexuality education and sexuality education that is inclusive to lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth is thought to educate and support youth in their social relations. Despite the obligation for Dutch schools to cover sexuality education in their curricula, including the topic of sexual diversity, the content that is covered varies widely across schools. With the current study, we present an overview of the content of sexuality education as reported by a sample of 601 Dutch adolescents (58.4% female youth) from six different high schools (e.g., public, Roman Catholic, protestant, anthroposophical; grades 10-12). Further, we examine whether the content or extensiveness of sexuality education at the beginning of the school year is related to a decrease in LGBTQ name-calling and an increase in the willingness to intervene when witnessing LGBTQ name-calling at the end of the school year. Adolescents completed three surveys, spaced four months apart. The results show that anatomy, STI prevention, and relationships are covered most often in sexuality education, with less attention to sexual diversity. Our longitudinal findings show that having a wide variety of topics covered in sexuality education-not just sexual diversity-was related to an increase in perceived willingness to intervene when witnessing LGBTQ name-calling by teachers or school staff, fellow students, and youth themselves (female youth). It also predicted a decrease in the occurrence of name-calling according to females. Our findings emphasize the importance of having comprehensive sexuality education in schools; it not only educates and empowers youth but also signals a safer school climate.

Evaluation of holistic sexuality education: A European expert group consensus agreement.

OBJECTIVES: Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. METHODS: First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. RESULTS: The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. CONCLUSIONS: Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case for the effectiveness of SE in general and HSE in particular.

The Effect of Integrating Family Planning with a Maternal and Newborn Health Program on Postpartum Contraceptive Use and Optimal Birth Spacing in Rural Bangladesh.

Meeting postpartum contraceptive need remains a major challenge in developing countries, where the majority of women deliver at home. Using a quasi-experimental trial design, we examine the effect of integrating family planning (FP) with a community-based maternal and newborn health (MNH) program on improving postpartum contraceptive use and reducing short birth intervals <24 months. In this two-arm trial, community health workers (CHWs) provided integrated FP counseling and services during home visits along with their outreach MNH activities in the intervention arm, but provided only MNH services in the control arm. The contraceptive prevalence rate (CPR) in the intervention arm was 15 percent higher than in the control arm at 12 months, and the difference in CPRs remained statistically significant throughout the 24 months of observation. The short birth interval of less than 24 months was significantly lower in the intervention arm. The study demonstrates that it is feasible and effective to integrate FP services into a community-based MNH care program for improving postpartum contraceptive use and lengthening birth intervals.

Invited commentary: broadening the evidence for adolescent sexual and reproductive health and education in the United States.

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.

Treating 'AIDS blindness': a critical pedagogical approach to HIV education at tertiary level.

HIV and AIDS affect all South Africans, irrespective of gender, race, age and economic status. Teachers should therefore be able to meaningfully integrate HIV content into the school curriculum. However, pre-service teacher education programmes still do not pay adequate attention to HIV education, particularly in institutions where students are being prepared to work in environments that are perceived to be unaffected by the consequences of the pandemic. This article advocates that HIV education should be integrated into contexts of privilege and presents evidence of the influence that a critical pedagogical approach can have on changing student perceptions of the need to address HIV in and through their teaching. We led 109 Post-graduate Certificate of Education students through a series of activities that required them to critically reflect on their feelings, attitudes and perceived skills with regard to HIV and AIDS education; to identify potential areas of personal change; and to begin to imagine alternative professional possibilities. We generated qualitative data through drawings, group discussions, individual written reflections, and a voluntary focus group. A content analysis of the data revealed that the participating students initially felt incompetent to incorporate HIV and related issues into their teaching, and felt hesitant and uncomfortable at the prospect. However, a critical reflection on their thinking, both individually and in a group setting, served to shift them towards a more holistic, critical and humanising understanding of the pandemic and the role they could play as future teachers in helping to mitigate its impact. The findings provide evidence that a critical pedagogical approach - particularly with groups who believe that HIV and AIDS is not something that concerns them - can provide an effective way to mediate the knowledge, skills and attitudes that competent teachers need in today's world.

Shifting the paradigm in Oregon from teen pregnancy prevention to youth sexual health.

Oregon's work on teen pregnancy prevention during the previous 20 years has shifted from a risk-focused paradigm to a youth development model that places young people at the center of their sexual health and well-being. During 2005, the Oregon Governor's Office requested that an ad hoc committee of state agency and private partners develop recommendations for the next phase of teen pregnancy prevention. As a result of that collaborative effort, engagement of young people, and community input, the Oregon Youth Sexual Health Plan was released in 2009. The plan focuses on development of young people and embraces sexuality as a natural part of adolescent development. The plan's five goals and eight objectives guide the work of state agencies and partners addressing youth sexual health. Oregon's development of a statewide plan can serve as a framework for other states and entities to address all aspects of youth sexual health.

Investing in the health of future populations through a youth-focused programme.

OBJECTIVE: This paper describes different approaches and results of the holistic integrated model of Rahnuma Family Planning Association of Pakistan (R-FPAP). The model seeks to provide sexual and reproductive health (SRH) services to adolescents and young people based on their rights as opposed to simply on their needs. METHODS: Combined methodical efforts were performed by the organization for the provision of SRH services to adolescents and young people including youth-friendly services at clinics, outreach interventions, youth empowerment, and advocating for youth sexual and reproductive health rights (SRHR). Service delivery statistics available in the organization from 2007-2011 were utilized for estimating the results of these efforts. RESULTS: An increase of 157.5% in the total number of SRH services received by adolescent and young clients aged 10-24 years was observed during a span of five years. About 310.8% more human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and reproductive tract infection (RTI)/sexually transmitted infection (STI)-related services were received by the clients of the same age group. The integration of different methodical efforts helped in reaching one of every 100 adolescents and young people in Pakistan aged 10-24 years during 2011, which was an increase from four of every 1,000 adolescents and young people of the same age bracket served in year 2007. CONCLUSION: The unmet need of the SRH rights of adolescents and youth, especially underserved young clients, can be addressed comprehensively through rights-based integrated approaches by providing clinical services, involving them through outreach initiatives, advocating for their SRHR, and facilitating them by establishing conducive environments for the promulgation of supportive laws and policies.

Evaluación de un programa de educación sexual sobre conocimientos y conductas sexuales en embarazadas / Evaluation of a sexual education program on knowledge and sexual behaviour in pregnant

Objetivo: Evaluar el nivel de conocimientos de la sexualidad en la gestación previos y posteriores a un programa formativo implementado por un grupo de gestantes en el segundo y tercer trimestre. Material y método: diseño cuasi-experimental pre-post test de un único grupo. Participaron 40 mujeres grávidas de bajo riesgo que se encontraban en su segundo y tercer trimestre de gestación. Todas eran de raza blanca. El 85% de las gestantes comprendían una edad entre 20 y 35 años, un 60% eran primigestas. Resultados: al 60% de las mujeres del estudio les ha afectado el embarazo a su vida sexual. El trimestre que ellas creen que pueden disfrutar más del sexo, en un primer cuestionario el 62.5% contestaron que en el segundo, después de implantar el programa, el 95% dieron esa respuesta. Entre las diferentes técnicas sexuales que existen, el 87.5% la conocían en un principio, después de realizar nuestro programa el porcentaje aumentó a un 97.4%. En cuanto a los beneficios de los ejercicios de Kegel, en un primer cuestionario tan sólo el 25% sabían la respuesta correcta, mientras que más tarde aumentó a un 85% y su práctica era realizada un 12.5% antes de la intervención, y después un 40%. Discusión-Conclusión: después de aplicar nuestro programa específico se notaron algunas mejoras en el nivel de conocimientos y actitudes sexuales aunque debido probablemente a la pequeña muestra utilizada no se han encontrado resultados estadísticamente significativos salvo en una variable (práctica de Kegel) (AU)

Objective: Evaluate the level of knowledge of sexuality in pregnancy before and after a training program implemented by a group of pregnant women in the second and third trimesters. Materials and methods: A quasi-experimental pre-post test single group. A total of 40 pregnant women at low risk who were in their second and third trimester were included. Regarding the ethnical group all women were white. The 85% of pregnant women included had an age between 20 and 35 years and for the 60% it was their first pregnancy. Results: 60% of women have altered her sex life. The initially believed that the most suitable month to enjoy sex live more was on the second trimester, as shown on the first questionnaire (62.5%). After implementing the program, these results increased up to the 95%. Regarding the different sexual techniques, 87.5% knew them at first, after participating in our program this percentage increased to 97.4%. In relation to the benefits of Kegel exercises, in the first questionnaire only 25% knew the correct answer, while after the program increased to 85%. Its practice increased to 12.5% before the intervention, and then a 40% of pregnant women said they knew it and practiced it. Discussion-Conclusion: after applying our specific program noted some improvements in the level of knowledge and sexual attitudes but probably due to the small sample used was not found statistically significant results except for one variable (practice Kegel) (AU)

Effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda: results from a non-randomized controlled trial.

BACKGROUND: While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people's sexual behavior, HIV knowledge and attitudes. METHODS: In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention) and Rwamagana (control). Students (n = 1950) in eight intervention and six control schools participated in three surveys (baseline, six and twelve months in the intervention). Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score. RESULTS: The overall retention rate was 72%. Time trends in sexual risk behavior (being sexually active, sex in last six months, condom use at last sex) were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. It did significantly reduce reported stigma. CONCLUSIONS: Analyzing this and other interventions, we identified several reasons for the observed limited effectiveness of peer education: 1) intervention activities (spreading information) are not tuned to objectives (changing behavior); 2) young people prefer receiving HIV information from other sources than peers; 3) outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored. Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators' role as focal points for sensitization and referral to experts and services. Finally, we argue that a narrow focus on sexual risks will never significantly turn the tide.

Sexuality education: Finnish and Chilean experiences.

All children and young people have the right to age-appropriate sexuality education regardless of gender, sexual orientation, ability or faith. Sexuality education provides knowledge, skills and positive values to determine and enjoy their sexuality, have safe, fulfilling relationships if one so wishes and decides, and to take responsibility for their own and for a possible partner's sexual health and well-being. Several international programs have been developed and recently published by the Population Council, IPPF and other coworkers, by UNICEF, and by WHO Europe. This chapter will briefly describe recent global development in sexuality education, and then, as examples, experience from two countries, Finland and Chile. The experiences from these school based programs suggest an important role of sexuality education.

[The meaning of health in sexual relations according to women treated under the Unified National Health System in Natal, Rio Grande do Norte State, Brazil]. / Os significados de saúde na relação sexual para mulheres assistidas pelo SUS na cidade de Natal, Rio Grande do Norte, Brasil.

The aim of this article is to discuss the social representations of "health in sexual relations" as reported by women treated under the Unified National Health System (SUS) in Natal, Rio Grande do Norte, Brazil. A total of 150 women were tested using the free word recall test, with "health in sexual relations" as the stimulus. Women were also asked about their sources of information on the subject. The results were obtained with content analysis and the EVOC software. We identified three representational dimensions: prevention, relationship with the partner, and quality of life. The central nucleus of social representation consisted of the elements "prevention" and "condoms". Likely sources for representation were television, health services, and dialogue with family members and partners. Representations were composed of concepts related to prevention, a good partner relationship, and overall well-being. The results illustrate the need to expand women's sexual health aspects that are considered relevant by the health system.