Bolivia has a high STI rate and an accelerating HIV/AIDS rate. The majority of the country's newly diagnosed HIV/AIDS cases come from the province of Santa Cruz in eastern Bolivia, where this study took place. In this study, the investigator assessed the notion that Bolivian truck drivers are a bridge population of HIV transmission within heterosexual networks. This investigation determined risks of HIV/STI transmission through interviews, surveys, and workshops given to the truck drivers. Special attention was given to self reports of sexual behavior, cognitions and ego maturation stages, in order to assess risk. Mixed methodology was the research paradigm of choice, utilizing qualitative and quantitative phases. Workshops were designed, implemented, and evaluated. Analysis was completed on survey results from 246 male truckers (aged 18 to 67). More than half (56%) of these truckers admitted to having sex with casual partners. In addition, from 30% (quantitative inquiry) to 52% (qualitative inquiry) of these truck drivers have had sexually transmitted infections. Three factors predicted condom use: Age, Outcome expectancies, and Perceived social norms. Only one factor predicted STI history: Number of sex partners. Adult stage theory did not directly impact sexual behavior. A high risk of HIV/STI transmission has been detected in Bolivian truck drivers. This notion supports other studies involving truck drivers, and calls attention to the need for tailored health education programs for this population. Furthermore, younger truck drivers are at greater risk of HIV transmission than older truck drivers, in spite of their increased condom use. Sexual health workshops for Bolivian truck drivers are worthwhile and can be most effective when co-managed with truck companies or unions. Counseling, testing, and follow up research programs can best be implemented through these already-existing management structures. Future programs need to emphasize other behaviors besides condom use. Workshops should also include truckers' spouses as participants. Lastly, since casual sex partners of truck drivers rarely fit the mold of a commercial sex worker, effort should be made to describe these casual partners and design subsequent workshops for them.

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: College settings are likely environments for Black women to contract STIs (including HIV) or experience unintentional/unwanted pregnancies. Effective prevention strategies for this population include dialogue and activities that focus on gender, maturity, cultural barriers, personal strength, and information needs. However, technological advancements (including virtual reality) and innovation are limited in prevention efforts. Methods: Four 90-minute focus group sessions were conducted in a convenience sample of Black college females (ages 18 years or older) and a research-intensive public institution in the southeast. A series of surveys were distributed during each audio-recorded focus group session. A mixed-method approach to data analysis was based on applications of the Health Belief Model constructs to three principal research questions: (1) Q1: How do Black college females perceive the importance of sexual risk topics? (2) What are the experiences and attitudes of Black college females regarding the use of VR for education and training versus video game entertainment (i.e. “gaming)? and (3) Among Black college females, what sexual risk topics are considered most relevant to a VR education and training platform? Results: Each of four study cohorts enrolled between 2-6 participants each (n=15). Participant ages ranged from 18-48 (x̅=28.6, σ=9.2) years within age groups of 18-24 years (60%, n=9), 25-34 years (26.7%, n=4), and 35 years or above (13.3%, n=2). The majority of participants (86.7%, n=13) were enrolled as full-time students, and resided in various off-campus locations (73.3%; n=11). Assessments of sexual risk topic importance were reported based on aggregated Survey 1 Lickert scale values. The majority of participants equally viewed the topics of HIV and STI status as important, mostly important, or very important. Other notable concerns include sex with drug/alcohol use, risk of intimate partner violence, and sexual communication (e.g. partners and peers. Despite the lack of formal virtual reality knowledge, the majority of participants reported experience with VF technology via “gaming” (e.g. SIMS). They also concluded that a virtual reality platform for sexual health education and training should involve comprehensive approaches to HIV/STI and unintentional pregnancy via use of barrier methods, including birth control, as well as facilitation of sexual communication. Discussion: This research represents a unique approach to the identification of sexual health risk importance for HIV/STI transmission, as well as unintentional pregnancy, in Black college females. Although a successful demonstration of feasibility, this research is formative in nature – results should be interpreted as preliminary. However, methods and concepts presented in this thesis hold the potential for scientific contribution in prevention research, clinical practice, and other fields of study.

Människor reser allt mer. Forskning har visat att utlandsresor gör något med oss som sexuella varelser; människor ligger mer, vågar prova nytt och sättet att bedöma risk är satt ur spel. Beteenden som annars skulle betraktats som oförenliga med ens personlighet blir plötsligt förenliga. Forskning om turism och sexualitet är utbredd men få har intresserat sig för de som arbetar i turistmentalitetens miljöer. Syftet med denna studie var att undersöka samspelet mellan säsongsarbete, sexualitet och sexuell hälsa. Studien utfördes på ön Phuket i Thailand och med semistrukturerade intervjuer som metod. Elva säsongsarbetare ingick i studien. Intervjuerna har analyserats med hjälp av teorier om liminalitet (Turner, 1969), sexuella skript (Simon & Gagnon, 1999) och sexuella värdehierarkier (Rubin, 1999). Resultatet visar att möjligheterna till sexuella möten och relationer är goda men flera berättar om en problematik vid längre relationer. Flera vittnade om en vidgad sexuell repertoar vilken inkluderade ”sexigare” klädsel, samkönade sexuella möten, multipla partners, samt köp och försäljning av sexuella tjänster. Hälso- och sjukvård besöks i ärenden som inte är kopplade till sexualiteten. Få hade testat sig för hiv/STI, desto fler hade självmedicinerat. Studien visar ett behov av fokus på säsongsarbetare som målgrupp för preventiva insatser vad gäller sexuell hälsa, vilka har potential att även nå turister. / People are travelling more. Research shows that travelling temporarily changes people as sexual beings; they have more sexual partners, become more adventurous, and tend to assess risk poorly. Behaviour people would usually consider out of character becomes the norm. The area of tourism and sexuality has been extensively researched. However, even though long-stay travellers are considered having an increased risk for sexually transmitted infections, only a few studies have focused on seasonal workers in tourist hotspots. Therefore the aim of this study was to explore the interaction between seasonal work, sexuality and sexual health. Methods: Eleven semi-structured interviews were conducted with Swedish seasonal workers in Phuket, Thailand. The interviews were analyzed by applying theories of liminality (Turner, 1969), sexual scripts (Simon & Gagnon, 1999) and hierarchies of sexual acts (Rubin, 1999). The results show that seasonal workers experience wide-ranging possibilities for sexual encounters and relationships, however, several expressed that the contextual behaviour led to difficulties in establishing long-term emotional relationships. The interviewees reported an expansion of their sexual repertoire while abroad, including wearing “sexier” clothes, having same-sex encounters, engaging in sex with multiple partners such as threesomes and “gang bangs”, and experiencing commercial sex. While all had visited local health care services none had used the services of a local sexual health clinic. Few had recently been tested for HIV/STI, but self-medication with antibiotics (Azithromycin) bought at the pharmacy was a common practice. Conclusion: The study suggests that seasonal workers abroad should be targeted with sexual health programs, aiming at increasing sexual health knowledge and safer sex practices, and decreasing self medication for STIs.