SAMMANFATTNING  Det förekommer en ökning med sexuellt överförbara infektioner (STI), främst gonorré bland ungdomar i Sverige. För att minska förekomsten av STI bland ungdomar krävs effektiva preventiva åtgärder, kontroll och ett effektivt samarbete. Sexuell och reproduktiv hälsa är lika viktigt som den psykiska, fysiska och sociala hälsan, samt utgör en grundläggande del av människors allmänna hälsa och välbefinnande.   Syftet med studien är att undersöka aktörers uppfattningar om ungdomarnas kunskap om STI-prevention och hur aktörerna arbetar förebyggande med STI. För ett systematiskt tillvägagångssätt i studien används en kvalitativ metod baserad på målstyrt urval för att besvara syftet. Därmed genomfördes en semistrukturerad intervju vid datainsamlingen med totalt sex deltagare från professioner inom ungdomsmottagning och elevhälsan i två olika regioner. Därefter analyserades den insamlade data med en manifest innehållsanalys där två huvudkategorier; Aktörerna vill arbeta med STI-prevention och Ungdomars kunskap om STI och STI-prevention räcker inte framkom.    Resultaten visar att ungdomars kunskap om STI varierar enligt aktörernas uppfattning, trots kunskaper underskattar ungdomar ofta risken att drabbas av STI. Det framkom också att ungdomarnas kunskap om STI-prevention påverkas av olika riskfaktorer såsom alkoholkonsumtion, vänskapskretsen och tidig sexuell aktivitet, vilket hindrar effektiviteten av skyddsfaktorer. Aktörerna vill arbeta med STI-prevention på olika arenor och har specifika insatser för olika grupper. Dock framkom brist på samverkan som ett hinder för att nå ut till fler. För ett effektivt förebyggande arbete krävs det en gemensam riktlinje och strategier i aktörers arbete som skapar bättre förutsättningar för ungdomar kring STI. / ABSTRACT  There is an increase in sexually transmitted infections (STI), mainly gonorrhea among young people in Sweden. To reduce the incidence of STIs among adolescents, effective preventive measures, control and effective cooperation are required. Sexual and reproductive health is as important as mental, physical and social health, and makes a fundamental part of people's well-being and overall health.   The aim of the study is to investigate actors' perception of adolescents' knowledge of STI-prevention and how they work preventively with STIs. For a systematic approach in the study, a qualitative method based on purposive sampling is used. Thus, a semi structured interview was carried out during the data collection with a total of six participants from professions in youth health clinics and school health services in two different regions. Then the collected data was analyzed with a manifest content analysis where two main categories; The actors aim to work with STI-prevention and Adolescents' knowledge of STIs and STI-prevention is not enough emerged.   The results show that adolescents' knowledge of STIs varies according to the actors' perception, despite knowledge adolescents often underestimate the risk of contracting STIs. It also emerged that adolescents' knowledge of STI-prevention is affected by various risk factors, which hinders the effectiveness of protective factors. The actors aim to work with STI prevention in different arenas and have specific initiatives for different groups. However, a challenge in reaching out to more people has risen due to a lack of cooperation. Effective preventive efforts require a common guideline and strategies in the work of actors that create better conditions for young people around STIs.

School-based sexual health education is commonly used to promote the sexual health of young people and guide them in their relationships. This thesis reports on research that aimed to provide evidence-based recommendations to optimise the effectiveness of school-based sexual health education in sub-Saharan Africa (sSA). There are six chapters in the thesis. Chapter 1 introduces the thesis, Chapters 2 to 5 consist of four empirical studies, and Chapter 6 provides an overall discussion and looks at the strengths, limitations, and implications of the findings. Chapter 2 is a systematic review and meta-analysis of school-based sexual health education in sSA. It provides some evidence of the interventions in promoting self-reported condom use. However, it shows there are no harmful or beneficial effects with respect to sexually transmitted infections (STI) as evidenced by biomarkers. It highlights the paucity of evaluated interventions using biomedical markers, and reports on the process of evaluation, which limits our understanding of why interventions work or do not work. Features associated with effective interventions are noted. Chapter 3 is a case study involving MEMA Kwa Vijana, an adolescent sexual and reproductive health intervention implemented in Tanzania. This study highlights the influence of structural factors in schools and wider environmental factors on the effectiveness of school-based sexual health interventions. Furthermore, it identifies the social and cultural factors that influence young people’s sexual behaviours and that must be addressed beyond the education and health sectors. Chapter 4 is a multiple case study of seven school-based sexual health interventions implemented in five sub-Saharan African countries. It 4 identifies the design, implementation, and evaluation features that differentiate between effective and ineffective interventions. Chapter 5 is a qualitative study of researchers’ experiences of school-based sexual health education in sSA. This study extends previous work by generating a set of valuable recommendations based on researchers’ experiences of interventions that could improve future interventions in sSA. Overall, this research project demonstrates the potential of school-based sexual health education in promoting sexual health and preventing STIs in sSA. It provides a series of recommendations for the design, implementation, and evaluation of school-based sexual health interventions.

Background: Sexually transmitted infection (STI) rates represent a significant health disparity among young adult African American women. A major factor contributing to this issue is inconsistent condom use. This is especially a challenge for the state of Georgia, which has a high incidence of STI among the southern states. STI prevention counseling delivery through primary care providers is the primary recommendation from the Centers for Disease Control and Prevention and U.S. Preventive Services Taskforce. However, knowledge, attitudes, and practices of STI prevention counseling by advanced practice registered nurses (APRN) who care for young adult African American women are unknown in Georgia.Purpose: This doctor of nursing practice project investigated knowledge, attitudes, and practices of STI prevention by Georgia APRNs caring for young adult African American women on an outpatient basis and determined congruency of their counseling with primary prevention guide-lines. Methods: The design was descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs and postal mail to eligible Georgia APRNs currently in practice. Participants' knowledge of STI, STI prevention, and current practice guidelines and recommendations were assessed using knowledge questionnaires including true/false and multiple choice questions. Participants' attitudes regarding STI prevention counseling with young African American women and current APRN behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: The final sample size included 22 participants. Forty initiated the survey, ten did not meet eligibility criteria, six ended the survey during eligibility screening, and two ended the survey after completing less than seven percent of it. In general, participants were knowledgeable of STI and the majority of participants were knowledgeable of the CDC and USPSTF guidelines. The majority of participants felt comfortable discussing sexual practices with patients and providing feedback and advice on reducing STI risk behavior. However, the majority of participants did not believe that their current practice setting actively supported their delivery of STI prevention counseling. Overall, participants' practices were more congruent with the CDC guidelines compared to the USPSTF guidelines. This was reflected in knowledge and practice behaviors, specifically assessing for STI, providing feedback on risk behavior, and advising on behavior change with STI-infected patients and those at risk for STI. Fewer chose the USPSTF as their established practice guideline. This was revealed in practice behaviors pertaining to 'high-risk' counseling, as few tended to set goals for STI risk behavior change, document behavior goals, refer to STI resources, or follow up with referrals made to other STI risk reduction programs. Practice implications: Although overall APRN knowledge of STI was high, there were some knowledge deficits relating to appropriate barrier methods for viral-based STI and high-risk sexual behaviors associated with HBV. There was also a lack of knowledge and practice behaviors of the USPSTF STI prevention counseling guidelines. Therefore, future studies and interventions should aim to educate APRNs about these knowledge and practice insufficiencies.

There is a dearth of literature to guide the development of community-based HIV and Sexually Transmitted Infection (STI) prevention and sexual health promotion programs within Inuit communities. The aim of this research project was to create a dialogue with Inuit women to inform future development of such programs. This study employed Indigenous methodologies and methods by drawing from Inuit Qaujimajatuqangit and postcolonial research theory in a framework of Two-Eyed Seeing, and utilizing storytelling sessions to gather data. Community-Based Participatory Research Principles informed the design of the study, ensuring participants were involved in all stages of the project. Nine story-sharing sessions took place with 21 Inuit women ages 18-60. Participants identified several key determinants of sexual health and shared ideas for innovative approaches that they believe will work as prevention efforts within their community. These research results build upon the limited knowledge currently available about perceptions of HIV and STI among Inuit women living in the remote north. / Graduate / 0573 / jenny.r.rand@gmail.com