The need to expand access to and availability of quality and comprehensive sexual and reproductive health care (SRH) to help close the gaps in existing health disparities and health inequities in the United States is a pressing public health concern. The emergence of alternative primary care settings (i.e., retail-based clinics [RBCs]) has recently proven to be an effective model for the delivery of acute care in lieu of more traditional medical services. Indeed, RBCs could be an agent for greater SRH care access with the integration of more services; however, barriers exist that inhibit this maximization of care. Providers play a central role in the utilization of SRH in RBCs, whether through their intent to recommend or biases about RBCs. Provider recommendation is a strong indicator for patient compliance. However, little is known about how providers’ attitudes and beliefs influence the uptake of SRH in RBCs. This cross-sectional study collected survey data from a large sample of 341 advanced practice clinicians (APC) to (1) understand the benefits and barriers of SRH integration in RBCs; and (2) identify the relationship between the attitudes of APCs regarding RBCs and their influence on barriers and benefits of SRH integration into RBCs. Items were adapted from existing valid and reliable measures. Survey data were analyzed primarily using descriptive statistics. Comparative analysis between demographic factors and identifier variables that led to several themes: a majority of APCs believe the integration of SRH into RBCs would expand access to and availability of quality and comprehensive SRH care for prevention and intervention; hesitancy to recommend SRH services is chiefly founded in lack of confidence in quality assurance, professional training and quality of services offered; overall APCs had a generally positive attitude towards the integration of SRH in RBCs but attitudes differed among the types of SRH services offered at RBCs. These findings provide insight for the identification of barriers and benefits in the integration of SRH in RBCs. This may create opportunities to address barriers for the expansion of prevention and intervention services among women while capitalizing on benefits to advance awareness, education and access to care.

Bakgrund: Cancer är en vanligt förekommande sjukdom som kan påverka patienters sexuella hälsa negativt. Sexuell hälsa är ett tillstånd av balans mellan välbefinnande och sexualitet, vilket inkluderar emotionella, fysiska och sociala aspekter. Patienter med cancer har olika behov kring hur den sexuella hälsan ska hanteras av sjuksköterskan. Vissa patienter upplever skamkänslor och vill på grund av dessa undvika ämnet, medan andra önskar att deras sexuella hälsa inkluderas i omvårdnaden. Det åligger sjuksköterskans ansvar att adressera frågor rörande sexuell hälsa. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att kommunicera om sexuell hälsa med patienter som har en cancersjukdom. Metod: Litteraturöversikten baserades på 10 vetenskapliga artiklar, varav fyra kvalitativa, fem kvantitativa och en mixad metod. Artiklarna inhämtades från databaserna PubMed och Cinahl Complete. Dataanalysen utfördes i enlighet med Fribergs modell. Resultat: I resultatet presenteras fyra huvudteman; Tidsbrist, ett hinder i samtalet om sexuell hälsa, Sjuksköterskans känsla kring det sexuella samtalet, Sjuksköterskans antaganden om patienternas behov ochSjuksköterskans kunskapsbrist gällande den sexuella hälsan. Resultatet visar att dessa huvudteman tillsammans utgör hinder för sjuksköterskor i kommunikationen gällande sexuell hälsa inom den onkologiska omvårdnaden.   Diskussion: Litteraturöversiktens resultat diskuteras utifrån Joyce Travelbees interaktionsteori. I diskussionen belyses sjuksköterskornas känslor av det sexuella samtalet, samt deras upplevelser kring kunskapsbristen som ett kommunikationshinder med patienter med en cancerdiagnos. / Background: Cancer is a common disease that can have a negative impact on patients' sexual health. Sexual health is a state of balance between well-being and sexuality, which includes emotional, physical and social aspects. Patients with cancer have different needs for how the sexual health should be handled by the nurse. Some patients experience feelings of shame and, because of this, want to avoid the topic, while others wish for their sexual health to be included in the nursing care. It is the responsibility of the nurse to address issues relating to sexual health.  Aim: The aim was to describe nurses’ experiences in communicating about sexual health with patients who have a cancer illness. Method: The literature review was based on 10 scientific articles, of which four were qualitative, five quantitative and one mixed method. The articles were obtained from the databases PubMed and Cinahl Complete. The data analysis was carried out in accordance with Friberg's model. Results: In the result, four main themes are presented; Lack of time, an obstacle in the conversation about sexual health, The nurse's feeling about the sexual conversation, The nurse's assumptions about the patients' needs and The nurse's lack of knowledge regarding sexual health. The result shows that these main themes together hinder nurses in the communication regarding sexual health within the oncological nursing. Discussion: The results of the literature review are discussed based on Joyce Travelbee's interaction theory. The discussion sheds light on the nurses' feelings regarding the sexual conversation, as well as their experiences about the lack of knowledge as a communication barrier with patients with a cancer diagnosis.

Thesis (MTech (Environmental Health and Occupational Studies))--Cape Peninsula University of Technology, 2016 / Currently, the world faces many challenges such as a food shortages, fossil fuel depletion, floods, earthquakes, recession, wars, and climate change. It also faces diseases such as Human Immune Deficiency Virus /Acquired Immune Deficiency Syndrome /Sexually Transmitted Infections and Tuberculosis (HIV/AIDS /STI and TB). This study focused on HIV/AIDS/STI and TB, and the impact of changes in sexual behaviours of student peer educators as a result of peer education programmes offered by the HIV/AIDS Unit at the Cape Peninsula University of Technology (CPUT). Although young people today have a better understanding of risky sexual behaviours, HIV remains a health problem among the youth in South Africa. HIV/AIDS is a disease that affects all sectors of the population- rich and poor, young and adult, educated and uneducated. Tertiary institutions are places where many young female and male students live independently, unsupervised by their parents or guardians, in either private accommodation or student residences. Under these circumstances it may be expected that some students will explore and experience intimacy in their relationships. Hence, universities could play a vital role in shaping students’ attitudes and behaviours towards relationships, safer practices, and respect for others. Given the current absence of a cure or vaccine for HIV/AIDS, peer education should appear as an important tool in HIV prevention strategy. It draws on several well-known behavioural theories and many researchers view peer education as an effective behavioural change strategy. A formal structured Peer Education Programme was initiated and implemented at the HIV/AIDS Unit at Cape Peninsula University of Technology (CPUT) since 2004. This initiative was in line with one of the twelve strategic objectives of the HIV/AIDS Unit at the CPUT. This study therefore, aimed to assess the reflexive effect that the Peer Education Programme had on student peer educators who volunteer their services at the HIV/AIDS Unit at CPUT. It further attempted to assess the effect of the Peer Education Programme on changes in sexual behaviours that could occur amongst student peer educators. The purpose of this programme was to explore peer educators who were based in the HIV/AIDS Unit applying their acquired knowledge and skills; so that they may become role models for their peers by practising what they taught, and not taught what they proposed to practice. The study furthermore, forms on how effective the Peer Education Programme of CPUT’s HIV/AIDS Unit is in changing sexual behaviours of the student peer educators.

A complexidade que caracteriza o sistema penitenciário brasileiro não exclui o encarceramento feminino. A mulher, ao ser detida para cumprir pena pelo seu ato infracional ou delituoso, passa por momentos de conflitos consigo mesma em função da nova realidade que se apresenta, a da privação de liberdade, que indubitavelmente afeta a sua saúde sexual e consequentemente a sua sexualidade somando a esse processo, a falta de assistência nesse sentido. Baseando nestes referenciais, o presente estudo objetivou fazer uma reflexão perante a literatura existente sobre a possível contribuição da enfermagem na saúde sexual e na sexualidade da mulher detenta, tendo em vista as condições de vulnerabilidade em que ela é exposta às doenças sexualmente transmissíveis no encarceramento. A metodologia utilizada apropriou-se da revisão sistemática da literatura brasileira, cujo propósito foi proceder ao levantamento de dados sobre essas questões , considerando a importância de sintetizar e categorizar os estudos primários realizados no Brasil, no período de 1990 a 2013,tendo em vista, o assunto em apreço. A amostra foi constituída de 14 estudos dos quais, foram identificadas as situações limites através das circunstâncias apresentadas pelos profissionais de enfermagem nas unidades prisionais, com relação à contribuição para a saúde sexual e a sexualidade da mulher privada de liberdade e de assistência. Vale destacar que as ações voltadas à saúde sexual e à sexualidade da mulher detentas são incipientes para atender a demanda desta população diante da omissão do Estado no gerenciamento destes espaços públicos. Segundo os achados da literatura, para os profissionais de enfermagem, a prática comum da violação dos direitos humanos destas mulheres fundamentam-se na situação de abandono e de descaso em que elas encontram no sistema prisional. Constata-se também a necessidade da quebra de paradigmas e preconceitos por parte dos profissionais de enfermagem no atendimento à saúde dessas mulheres, por meio, de ações educativas multidisciplinares para verdadeiras mudanças na qualidade de vida dos indivíduos dentro desse contexto de detenção, especialmente ao contingente feminino no país / The complexity that characterizes the Brazilian penitentiary system doesn\'t exclude the female incarceration. The woman, at to be held to serve a sentence for her defaulting or offensive act, goes through conflict moments to herself in face of the reality presented an the liberty deprivation that doubtless affect her sexual health and consequently her sexuality. Based on the references, this current study had aimed to make a reflection before the existing literature about the possible contribution of nurses in sexual health an in sexuality of inmate woman, bearing in mind the conditions of vulnerability in which she is exposed to STDs incarceration. The used methodology appropriated itself of a systematic review of Brazilian literature, of which purpose was to do the survey of data on these questions, considering the importance to synthesize and to categorize the primary studies realized in Brazil in the period 1990-2013, bearing in mind the subject in appreciation. The sample consisted of fourteen studies which were identified the limit situations through the circumstances present by nursing professionals in the prison units in relation with the contribution to the sexual health and to the sexuality of woman deprived of freedom and assistance. It\'s valid to highlight that the actions returned to sexual health and sexuality of the inmate woman are incipient to attend the demand of this population in front of the omission of the State in the management of these public spaces. Accordingly to the fingings of the literature, to the nursing professionals, the common practice of violations of human rights of these women are based in the situation of abandon and neglect in which they are in the prison system. It\'s also notice the necessity to break paradigms and prejudices on the part of nursing staff in the health treatment of these women, with multidisciplinary educational activities to make real changes in the life quality of these individuals in this detention context, especially to the female contingent of this country

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.

There is no consensus of the concept sexual health in the context of being HIV-positive women. Research in the area tends to focus in different measurable parts of sexual health for HIV-positive women. A meta-synthesis on that research issue can develop a deeper understanding and knowledge of how HIV-positive women in qualitative studies describe and experience sexual health. The purpose with this study is to analyze and synthesize the results about how HIV-positive women describe and experience sexual health. The meta-synthesis follows Noblit and Hare´s method of meta-ethnography and additional use of Walsh and Downe´s checklist to appraise qualitative articles. The result shows that HIV involves changes in the body, sexuality and sexual activity and relationships. The changes lead to feelings of responsibility, fear and hopelessness. Combinations of these feelings lead to actions of avoidance of risks that result in feelings of loss. As a nurse you are expected to promote sexual health as a part of holistic care and with this new knowledge health care workers can help these women to better health and feeling of well-being. / Program: Fristående kurs

Introduktion:  Diabetes mellitus är en av defolksjukdomar som många människor drabbas av. Det finns ett samband mellandiabetes mellitus och sexuell hälsa. Flera forskningsstudier visar attdistriktssköterskor upplever svårigheter att samtala om sexuell hälsa med patienter.Syfte: Syftet var att belysa distriktssköterskors erfarenheter av attsamtala om sexuell hälsa med patienter med sjukdomen diabetes mellitus. Metod:Kvalitativ metod med en induktiv ansats valdes. Semistrukturerade intervjuergenomfördes med tio distriktssköterskor och data har analyserats med hjälp avkvalitativ innehållsanalys. Resultat: Studiens huvudfynd resulterade ifem kategorier: män informeras om komplikationer, kvinnors sexuella hälsaförsummas, frågan uppskattas, ett känsligt ämne och erfarenheter saknas. Iresultatet framkom att majoriteten av deltagarna ansåg att sexuell hälsa varett viktigt ämne att samtala med patienterna om, ändock lyfts sällan ämnetunder samtalet. Det var främst patienten själv som tog upp ämnet.  Konklusion:Studien visade att sexuell hälsa är ett ämne som oftast inte samtalas ommed patienter inom primärvården. Det beror mycket på den enskildadistriktssköterskans kunskap och rutiner huruvida patienter med diabetesmellitus bjuds in till samtal om sexuell hälsa. / Introduction:   Diabetes mellitus is one of the people's diseases that many people suffer   from. There is a connection between diabetes mellitus and sexual health.   Several research studies show that district nurses experience difficulties in   talking about sexual health with patients. Purpose: The aim was to   describe district nurses' experiences of talking about sexual health with   patients with diabetes mellitus disease. Method: Qualitative method   with an inductive approach was chosen. Semi-structured interviews were conducted   with ten district nurses and data were analyzed using qualitative content   analysis. Results: The main findings of the study resulted in five   categories: men are informed about complications, women's sexual health   neglected, the subject is estimated, a sensitive subject and experience is   lacking. The result showed that the majority of participants felt that sexual   health was an important subject to talk about with the patients, but rarely   raised the subject during the conversation. It was primarily the patient   himself who raised the subject. Conclusion: The study showed that   sexual health is a topic that is usually not discussed with primary care   patients. It depends a lot on the individual   district nurse's knowledge and routines whether patients with diabetes   mellitus are invited to interviews about sexual health.

Eftersom sexualitet anses vara en del av människans basala behov innebär det att sjuksköterskor bör se sexuell hälsa och ohälsa som en del av sitt ansvarsområde. Tidigare studier har visat ur ett patientperspektiv att sjuksköterskor inte gör detta i tillräckligt stor utsträckning, och under sökordet sexualitet/reproduktion dokumenteras det väldigt sällan. Ur ett sjuksköterskeperspektiv är det därför viktigt att undersöka vad detta beror på. Syftet är att med hjälp av en litteraturöversikt undersöka om sjuksköterskor talar om sexuell ohälsa med sina patienter, och om de inte gör det vilka är då de upplevda bakomliggande hindren till detta. Metoden som användes var en litteraturöversikt som baserades på åtta vårdvetenskapliga artiklar med både kvantitativ och kvalitativ ansats där sjuksköterskornas upplevelser stod i fokus. Samtliga artiklar är publicerade mellan år 2004-2012. Genom analysen identifierades olika huvudkategorier och subkategorier. I resultatet framgår det att sjuksköterskor inte talar om sexuell ohälsa i särskilt stor utsträckning samt att det finns flera upplevda bakomliggande hinder till detta. Hindren identifierades och kunde delas in i fyra huvudkategorier och 14 subkategorier, och de mest framträdande hindren berodde på sjuksköterskans professionella och personliga aspekter samt de föreställningar som fanns om patienten. I diskussionen lyftes dessa två mest framträdande hindren upp och ett resonemang fördes kring vikten av sjuksköterskans tidigare yrkeserfarenhet samt utbildning och dess påverkan på den vård man ger patienter i samband med sexuell ohälsa. Slutsatsen är att majoriteten av sjuksköterskor inte talar om sexuell ohälsa med sina patienter samt att det finns ett flertal olika hinder till detta. / Program: Sjuksköterskeutbildning

Aside from sub-Saharan Africa, the Caribbean is the only region where the number of women and girls living with human immunodeficiency virus (HIV) is greater than that of men and boys. In the Dominican Republic (DR), the number of all diagnosed HIV cases that were women increased from 27% in 2003 to 51% in 2013, which indicates a shift in the burden of HIV from men to women. Women in stable relationships in the DR have risk for HIV and other sexually transmitted infections (STIs) related to high rates of multiple concurrent partners and low condom use among stable partners. Past HIV prevention efforts in the DR have largely focused on encouraging consistent condom use. However, this may not be a feasible solution for women in relationships. In this dissertation, I sought to examine safe sex communication (SSC) as a possible alternative to consistent condom use for HIV/STI prevention among women in stable heterosexual relationships in DR. I began by conducting an integrative literature review and identified multiple relationship, individual, and partner factors related to SSC among Latina women in stable relationships. Then I conducted a mixed methods study guided by the Theory of Gender and Power with women in stable heterosexual relationships who seek care at Clínica de Familia La Romana in the DR. First, I conducted a qualitative descriptive study to describe SSC. Emergent content analysis of eleven interview transcripts following Colaizzi’s method revealed two main themes: (1) Context of sexual risk (i.e., the meaning of safe sex for stable partners, behaviours related to sexual risk, beliefs and attitudes related to sexual risk, confianza (trust) between stable partners, economic power within relationships, and learning to manage safe sex within a stable relationship) and (2) SSC (i.e., reasons to talk about safe sex, methods, content, and outcomes, influential factors, and ideas for improvement). Second, I conducted a cross sectional survey with 100 women to identify psychosocial correlates of SSC. The mean age of women was 35.72 years, average relationship length was 8.5 years, and 46.91% were living with HIV. Logistic regression analysis revealed that lower SSC self-efficacy (OR = 0.20, 95% confidence interval = 0.08 – 0.50) and greater difference in age between partners (OR = 0.91, 95% confidence interval = 0.85 – 0.98) were both significantly related to less SSC. Information from this dissertation can be used to help identify women in the DR who are at risk for poor SSC with their stable partners and guide researchers, health care providers, and other individuals involved in efforts to reduce HIV/STI risk among this population to develop more effective interventions for this population. Future research should determine which safe sex behaviors SSC is related to among Latina women with stable partners, as well as which aspects of SSC can be generalized to women of all Latino subcultures and nationalities. Additionally, more information is needed about the male partner’s role in SSC within their stable relationship and what factors influence partner SSC among Latino men in stable relationships.

This dissertation is among the first ethnographic investigations of HIV/AIDS programs in the Middle East and North Africa (MENA) region. Contemporary representations of the region’s HIV/AIDS epidemic often recycle simplistic orientalist tropes, lumping together diverse countries, communities, and histories under the rubric of a shared socio-cultural and religious context. This cultural heritage is presumed to explain both the region’s seemingly unique epidemiological dynamics and its reportedly extreme forms of stigma and taboo. Public health efforts in the region aim to ‘lift the veil’ on HIV risk, and efforts are currently underway across the MENA to bring groups like sex workers and men who have sex with men – considered to be ‘at risk’ by virtue of their sexual behaviors – “out of the shadows” (UNAIDS 2010). Drawing on 26 months (2009 – 2013) of ethnographic research in Morocco, I approach internationally circulating best practices in HIV prevention as technologies of visibility that seek to expose particular bodies to forms of surveillance and management. In the process, I argue, they also serve to highlight certain narratives about risk and vulnerability, and spotlight particular fault-lines in the Moroccan social terrain. What is unique and notable about HIV transmission and prevention in the MENA region, I argue, is not a singular ‘Muslim culture’ steeped in stigma and taboo. Rather, what is remarkable about HIV/AIDS in the region is the way that epidemiological markers of sexual risk, as well as efforts to make that risk visible, become entangled in historically important debates about cultural authenticity, distinctions between public and private, and processes and pressures for social and political change. This research explores tensions between a focus on individual-level HIV risk, on the one hand, and the potential for political action to address the structural factors of collective HIV- related vulnerability, on the other. I ask, how do the new visibilities of HIV/AIDS prevention open up or foreclose possibilities for politicizing risk and vulnerability? Here, my research foregrounds the narratives of women recruited by AIDS organizations, who are largely from precarious socio-economic backgrounds and are often single heads of households. My interlocutors used a variety of discursive strategies to frame their vulnerability in ways that challenged the limited lens of individual sexual risk that HIV/AIDS organizations tended to promote; for example, these women drew on religious discourses to highlight a failed social contract, in which a corrupt class of rich Muslims neglected their duties to the Muslim poor. In this context, my interlocutors attempted to de-exceptionalize sex work by highlighting commonalities with the arduous and exploitative aspects of other forms of low-wage labor, at the intersection of gendered and class-based inequalities. And they spoke about the inadequacies of a healthcare system and a social service sector – which included AIDS organizations – that was not equipped to care for the poorest and most vulnerable. Importantly, this research itself might be understood as a technology of visibility with the power to uncover a particular, socially situated story about HIV/AIDS work in Morocco. Here, I seek to provide, not a sensational tale about Arab-Muslim culture, nor a melodramatic representation of sexual exploitation, but a story of how public health best practices render (in)visible and (de)politicize particular social fault lines in the process of reading and responding to the spread of HIV/AIDS. Through a comparison of the everyday labor of two AIDS organizations, I show how incorporating an ‘ethnographic’ view of the lives of ‘at-risk’ groups can help elucidate socio-structural aspects of risk and vulnerability. Thus, under the right conditions, I suggest that particular institutional forms may, in fact, produce visibilities that harbor the seeds of meaningful participation, activism, and political change.