2008 sexual health in the South East: a collaborative report by Health Protection Agency South East and the South East Public Health Observatory

Surveillance of sexually transmitted infections (STIs) and HIV is undertaken byt he Health Protection Agency (HPA), but is usually presented in isolation from the variety of paublic health indicators which can help interpret these data. Deficits in surveillance data on sexually transmitted infections diagnosed and managed in primary care can present difficulties in the commissioning of services at local level. In this report, we attempt to bring together a range of routine data, and newly analysed data including estimates from primary care datasets, which we anticipate will assist public health professionals and commissioners in needs assessment and in the planning of services. The data presented here supplement and contextualise the routine surveillance data published by the Health Prtoection Agency, in its annual reports and in the quarterly Local Sexual Health Profiles provided to the region's NHS community

Exploratory analysis of the ecological variables associated with sexual health profiles in high-risk, sexually-active female learners in rural KwaZulu-Natal

Young women are at high risk for negative sexual health outcomes. Despite their high risk, many sexually-active women never experience negative sexual health outcomes. This study explored the ecological risk factors associated with the risk profiles of sexually-active female high school-learners in rural KwaZulu-Natal, South Africa

Exploratory analysis of the ecological variables associated with sexual health profiles in high-risk, sexually-active female learners in rural KwaZulu-Natal.

CAPRISA, 2018.Abstract available in pdf

Exploring perceptions of gender roles amongst sexually active adolescents in rural KwaZulu-Natal, South Africa

Traditional gender and social norms reinforce asymmetrical power relations, increase the risk of experiencing gender-based violence and mediate poor engagement with sexual and reproductive health services. This study explored gender norms and expectations amongst cisgender adolescents in rural KwaZulu-Natal, South Africa. A purposive sample of 29 adolescents aged 16-19 years old were enrolled as part of a longitudinal qualitative study. The current analysis reports on the first round of in-depth interviews, which focused on the role of men and women in their community. A theoretically informed thematic analysis identified three broad themes: 1) Adolescent interpretation and understanding of gender identity, 2) Gendered essentialism and Gender roles (two sub-themes: Young men: Power through providing, and young women: The domestication process which highlighted that gender roles were defined by being the provider for men, and the successful fulfilment of traditional domestic behaviours amongst women), 3) Gender and fertility highlighted how participants highly valued fertility as affirming of manhood/womanhood. These norms reinforce gender roles that maintain asymmetrical power relations, carrying them over into adulthood. The subtle social pressure to prove fertility could have unintended consequences for driving teenage pregnancy. Structural, gender-based interventions emphasizing positive gender role development in early childhood are needed.

Empowered Youth, Healthy Sex and Relationships: The Implications of Positive Youth Development for Holistic Sexual Health in Emerging Adulthood

Most research on emerging adult sexuality has focused on narrow aspects of sexual health, primarily investigating the determinants of adverse sexual health consequences such as unintended pregnancy and sexually transmitted infections (STIs). However, individuals and their partners experience positive sexual health outcomes such as physical pleasure and intimacy that also define their sexual health. This dissertation applies a positive youth development (PYD) perspective to elucidate the adolescent contexts, attitudes, and behaviors that contribute to holistic sexual health in emerging adulthood (a period of increased independence and greater social acceptability of sexual exploration). I used data from the National Longitudinal Study of Adolescent to Adult Health to: 1) identify constructs of developmental assets during adolescence (grades 7-12) that align with PYD and examine sociodemographic differences, and 2) explore the implications of PYD for seven outcomes representing holistic physical, emotional, and social aspects of sexual health among emerging adults (ages 18-26). Four latent constructs of PYD—confidence, autonomy, parental bonds, and community bonds—captured the positive personal and contextual attributes of adolescence that contribute to healthy development. Different population subgroups of youth reported varying degrees or perceptions of these PYD assets. In longitudinal models, strong bonds with parents in adolescence were associated with increased reciprocity of love between partners, and with increased enjoyment of oral sex and reduced risk of unintended pregnancy (among females only) in emerging adulthood. Autonomy was also associated with increased enjoyment of oral sex among females in emerging adulthood. Among emerging adults in current relationships lasting 3 months or longer, community bonds in adolescence were also related to increased enjoyment of oral sex for females, and increased love for partner and relationship quality for both males and females. Findings support the importance of PYD, particularly positive bonds with parents, for holistic sexual health in emerging adulthood. Notably, this expands the range of well-being indicators linked to positive parent-child relationships. Results add to the literature by identifying the developmental assets that promote long-term sexual health, and also those that might be lacking for some youth, all to inform sexual health promotion efforts that work to enhance multidimensional aspects of well-being.Doctor of Philosoph

Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010). A Survey of the General Population.

The Irish Contraception and Crisis Pregnancy Study 2010 (ICCP-2010) is a cross-sectional telephone survey of adults aged from 18 to 45 years and living in Ireland. ICCP-2010 follows on from two other national sexual health surveys: the 2003 Irish Contraception and Crisis Pregnancy Study (ICCP-2003) and the 2006 Irish Study of Sexual Health and Relationships (ISSHR). It seeks to provide: (1) data on current knowledge, attitudes and behaviours in relation to sex, contraception and pregnancy in Ireland; and (2) an opportunity to explore trends in relation to sex, contraception and pregnancy in Ireland over a number of years. An overview of the main findings from ICCP-2010, as well as comparisons with ICCP- 2003, are presented in this report. Tests were conducted to explore whether differences between the two surveys were statistically significant, where appropriate, and are highlighted below and in the main report

A Qualitative Study of UK Community Health Practitioners’ Perceptions of their Personal and Professional Development after Training for and Practicing as Health & Social Care Innovators

This qualitative study explores the personal and professional journey of a group of healthcare professionals who undertook higher education (HE) or training in social innovation and put that learning into practice. Social Innovation is a relatively new concept in the field of health, and research is, in the main, confined to the structural and organisational aspects of innovation. Studies looking at the personal development of the innovators are rare, and no study has researched first-hand the experiences of new healthcare innovators as they learn how to set up and manage their own projects. Twenty-six community health professionals were interviewed. The participants were selected because they had either attended a HE programme or independent training on social innovation and were interested in setting up their own innovation in their clinical practice setting. Individual interviews were achieved using Skype which proved to be an effective data collection method and allowed for a geographically dispersed sample. Thematic Analysis allowed several key themes to emerge from the data: the importance of personal resilience; increase in confidence; how levels of self- efficacy played a key role in their success; learning to shift from working in glorious isolation to seeking help from influential others. Improved technical skills and becoming better organised were also powerful factors. However, one finding proved pivotal to their success - finding themselves. The majority talked of discovering the ‘real me’ as a result of their learning, mixing with likeminded others and the first-hand experience of the struggle of developing a project, often in the face of opposition. For many, the positive changes transferred to their personal lives. The findings suggest that many community health professionals have an inner drive to improve their clinical practice, but do not always know the best way to do this without formalised help. The educational input enhanced their learning and also impacted on their personal development enabling them to proceed with their innovations. These findings are supported by research in the broader field of industry indicating that, whatever the context, there is a commonality of spirit, an ability to persevere and overcome adversity among innovators. These findings are therefore generalisable to others contemplating innovative projects in health and social care settings. In addition, the health and social professional curricula will benefit from including the subject of innovation within their educational programmes and subsequently staff and managers who work with innovative practitioners will also benefit from working with innovative professionals

The Irish Study of Sexual Health and relationships Sub-Report 2: Sexual Health Challenges and Related Service Provision

The ISSHR was commissioned by the Department of Health and Children and the Crisis Pregnancy Agency in response to a recommendation by the National AIDS Strategy Committee. It is the largest nationally representative study of sexual knowledge, attitudes and behaviour ever undertaken in Ireland. International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR. The ISSHR findings have been outlined in a suite of reports – the Main Report, the Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the second sub-report, focuses on the area of sexual risk-taking and the use of relevant services. The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health , providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people

The sexual health of young British Pakistanis in London: social and cultural influences

Background: Pakistanis are the second largest ethnic minority group in the UK. However, there is a paucity of sexual health research among this group. In contrast to their parents’ generation, other South Asians are beginning to have premarital (sexual) relationships. This change may be occurring among young Pakistanis. In this thesis I explore social and cultural influences on the relationships and sexual behaviours of Pakistani youth, in order to determine whether there is unmet sexual health need. Methods: I analysed data from the second National Survey of Sexual Attitudes & Lifestyles (Natsal-2), exploring attitudes, learning about sex and first sexual experiences among Pakistanis (n=365). I then carried out thirty in-depth interviews with young Pakistanis and community workers to explore key life issues and implications for relationships and sexual behaviour. Findings: In Natsal-2, Pakistanis reported more conservative sexual attitudes than other groups, e.g. many saw premarital sex as wrong. They were also more likely to be married at first sex. Yet two-thirds of Pakistani men also reported being in non-marital relationships at this time, suggesting attitudes are not necessarily consonant with behaviour. The in-depth interviews found that premarital relationships are commonplace among youth, but due to social and cultural constraints, are conducted in secrecy. Young Pakistanis strive to maintain individual and cultural reputation. There were gender differences in perceptions, relationship types and vulnerability to sexual health risk. Sexual health knowledge was poor and few had access to support. Conclusions: Contrary to faith and cultural norms, premarital relationships do occur among Pakistani youth. The secrecy of these relationships and the pressures and complex gender roles they negotiate mean that some young Pakistanis are at risk of poor sexual health. This has implications for the delivery of appropriate preventative and curative services, which should encompass a broad understanding of sexual health and risk