abstract: Female survivors of intimate partner violence (IPV) are at increased risk for negative sexual health outcomes, such as susceptibility to HIV/AIDS, other sexually transmitted infections, unintended pregnancy, miscarriage, and cervical cancer. Despite this known risk, HIV risk reduction interventions are lacking in IPV content, and little is known about women’s protective sexual health behaviors in this context. The purpose of this dissertation is to gain a deeper understanding of women’s sexual health within the context of a violent intimate relationship. Data were collected through semi-structured, in-person interviews with women who had experienced IPV (N = 28). Service-seeking women were recruited from a domestic violence shelter and a domestic violence counseling program; non-service-seeking women were recruited through a statewide coalition against domestic violence and online advertisements. Interviews were audio-recorded, transcribed, and then analyzed in NVivo Qualitative Software (Version 10). Detailed process notes, analytic memos, peer debriefing, and the use of visual analytic displays were used to increase the trustworthiness of findings. Results are presented in chapters two, three, and four. Chapter two explores women’s experiences of sexual violence in IPV relationships. Women described how their intimate partners used a combination of sexual abuse, sexual coercion, and sexual assault as a unique weapon of power and control. Chapter three examines women’s sexual risks across the levels of their ecological environment using an intersectional feminist framework. Women’s sexual risks went beyond sexual violence and were influenced by subtle yet pervasive cultural gender norms that reduced their power in relation to their male sexual partners. Chapter four focuses on understanding women’s protective sexual health behaviors in order to inform the development of an intervention that follows women’s natural pathway to care as they heal from victimization to surviving to thriving. / Dissertation/Thesis / Doctoral Dissertation Social Work 2016

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor. Dess behandlingar inverkar på kvinnors kroppsbild och sexualitet vilket påverkar välbefinnandet och samlivet med andra människor. För att som sjuksköterska kunna hjälpa och stödja dessa kvinnor är det viktigt att undersöka hur kvinnor upplever dessa omställningar. Syfte: Att belysa bröstcancerdrabbade kvinnors upplevelser av sin kroppsbild och sexualitet efter en mastektomi och de bieffekter som medföljer. Metod: Litteraturbaserad studie med utgång i kvalitativa studier grundad på 17 vetenskapliga artiklar som analyserats. Resultat: I resultatet framkom tre teman, Upplevelser av förändrad kroppsbild, Upplevelser av förändrad sexualitet och Upplevelser av sjuksköterskors kommunikativa och stödjande förmåga avseende sexuella behov, med sju tillhörande subteman. Slutsats: En god relation till sin kroppsbild och sin sexualitet är en förutsättning för att uppleva välbefinnande och livskvalité. Sjuksköterskor bör ha detta i åtanke och arbeta mer informativt och stödja bröstcancerdrabbade kvinnor i deras kamp med att bibehålla sin identitet och främja deras hälsa. / Background: Breast cancer is the most common cancer in women. Its treatments affect women's body image and sexuality, which affects the well-being and intimacy with other people. For a nurse to help and support these women, it is important to examine how women experience these changes. Purpose: To highlight breast cancer affected women's experiences of their body image and sexuality after a mastectomy and the side effects that follows. Method: Literature-based study with output in qualitative studies based on 17 scientific articles which were analyzed. Results: The results revealed three themes: Experiences of altered body image, Experiences of altered sexuality and Experiences of nurses' communicative and supportive ability regarding sexual needs, with seven additional subthemes. Conclusion: A good relationship with one’s body image and one’s sexuality is an essential factor for experiencing well-being and quality of life. Nurses should keep this in mind and work more informative and support breast cancer affected women in their struggle to maintain their identity and promote their health.

This article is about research on the meaning of Gender-Man, Masculinity, Woman, and Femininity- in an accidental sample of children, youngsters, adults, and elders from different low SES groups in Lima, Perú. Through content analysis of open interviews it is shown that, for these groups, sex and gender are not being differentiated. Results are interpreted in terms of the implications these conceptualizations of gender have for sexual and reproductive health program interventions, like in family planning, assertiveness training, sex education, women empowerment workshops, male masculinity workshops, and women' s assertiveness training and awareness raising programs, as well as interventions in domestic violence and prevention of sexual abuse. The need to trascend gender roles, which sustain gender relations of power and submission in peruvian society, is strongly stressed. / Este artículo trata sobre una investigación de significados relativos al Género -¿qué es el Hombre, la Masculinidad, la Mujer, la Femeneidad?- en parte de una muestra accidental de niños, jóvenes, adultos y ancianos de diversos grupos sociales de nivel socioeconómico bajo en Lima, Perú. Mediante análisis de contenido de entrevistas en profundidad se analizan las respuestas, arribándose, entre otras conclusiones, a que en este grupo no se diferencia sexo biológico de género. Se interpretan los resultados en términos de las implicancias que estas conceptualizaciones del género tienen para las campañas de salud sexual y reproductiva como la educación en sexualidad, la planificación familiar, los talleres de "empowerment"  ("enpoderamiento") y asertividad para mujeres y de conciencia de masculinidad para varones, o las intervenciones en violencia doméstica y abuso sexual. Se destaca la necesidad de trascender los roles sexuales o genéricos, que sustentan relaciones de inequidad y poder en la sociedad peruana.

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

Magister Public Health - MPH / Since the early 1980s when the first case of HIV was diagnosed, AIDS remains a serious and threatening health crisis in the world. Sub-Saharan Africa is the region most affected by the HIV/AIDS pandemic having 67 % of the 33 million people infected with HIV globally in 2007. Young people aged 15-24 account for an estimated 45% of all new HIV infections worldwide. The study aimed to assess the knowledge and attitudes on HIV/AIDS and sexual behavior among 15-19 year olds in Kenya. A descriptive, cross-sectional survey was conducted among 96 students randomly selected from five public schools in Ngong sub-district. Descriptive and bivariate analysis was conducted using Epi Info 3.3 and SPSS. The main findings indicate that a third (31/96) of respondents were sexually experienced. Knowledge level was however found to be inadequate (below 60 %) indicating a poorly informed sample on knowledge about HIV transmission and prevention. The study showed poor attitudes towards the risk to HIV as only 40 % of both males and females supported the use of condoms even when the sexual partners know each other well. Inaddition, risky sexual behaviors were reported by sexually experienced respondents where condom use in last sexual intercourse was (57 %) among males and (20 %) among females. / South Africa

Bakgrund: Sexualitet är ett grundläggande behov som följer människan genom livet och omfattar bland annat kön, könsidentiteter samt reproduktion och intimitet. Sexuell hälsa kan beskrivas som något mer än enbart frånvaro av sjukdom eller dysfunktion. Det kan även upplevas som ett tillstånd av emotionellt, psykiskt och socialt välmående. Trots att sjuksköterskor ansvarar för att bidra med råd och stöd till patienter kring sexualitet och sexuell hälsa, är just kommunikationen kring ämnet något som ofta undviks. Syfte: Syftet var att beskriva faktorer som påverkar sjuksköterskors kommunikation med patienter om sexuell hälsa. Metod: En allmän litteraturöversikt baserad på fjorton kvalitativa och kvantitativa artiklar. Resultat: Ur analysen framkom tre huvudkategorier: Vårdgivarorganisation, attityder samt kunskap, och erfarenheter. Slutsats: Sjuksköterskors kommunikation med patienter om sexuell hälsa påverkas av flera olika faktorer. Det är av vikt att sjuksköterskor arbetar ur ett holistiskt människoperspektiv där de ser patienter som en helhet. Sexualiteten är en del av människan, och därför bör sjuksköterskor i större utsträckning initiera till dessa samtal för att på bästa sätt förebygga sexuell ohälsa. / Background: Sexuality is a fundamental need that follows man through life, including gender, gender identity, reproduction and intimacy. Sexual health can be described as something more than the absence of illness or dysfunction. It can also be perceived as a state of emotional, mental and social well-being. Although nurses are responsible for providing counseling and support for patients about sexuality and sexual health, communication on the subject is something that is often avoided. Aim: The purpose was to describe factors affecting nurses' communication with patients on sexual health. Method: A general literature review based on fourteen qualitative and quantitative articles. Results: Three main categories were identified in the analysis:  Caregivers, attitudes and knowledge, and experiences. Conclusions: Nursing's communication with patients on sexual health is influenced by several factors. It is important that nurses work out a holistic human perspective where they see patients as a whole. Sexuality is a part of man, and therefore, nurses should, to a greater extent, initiate these conversations to best prevent sexual ill health.

Bakgrund: Över en miljon kvinnor världen över drabbas årligen av bröstcancer. I Sverige beräknas det till över sju tusen fall årligen. Behandlingen i form av kirurgi, hormonell behandling och cytostatika är påfrestande för kroppen och kan förändra kvinnans kroppsuppfattning och kan påverka sexuell hälsa. Syfte: Att beskriva hur kvinnor upplever sexuell hälsa av uppkomna symtom vid behandling av bröstcancer. Metod: Studien är en litteraturstudie där 15 artiklar sammanfattats till ett resultat. Resultat: Behandling av bröstcancer påverkar kvinnans upplevelse av sin kropp som mindre feminin och mindre attraktiv. Svårigheter så som torra slemhinnor i vagina och därmed smärta vid samlag och minskad sexuell lust är andra upplevda hälsofaktorer som påverkats. Att samtala om sina problem inom sexuell hälsa med vårdgivare är svårt och upplevs inte prioriterat av sjukvården. Diskussion: Kommunikation angående sexuell hälsa ingår i sjuksköterskans uppgift, men brister information mellan olika vårdgivare anser kvinnor att det är svårt att ta upp sina sexuella problem på nytt. Kvinnans upplevelse av att vara mindre attraktiv relaterat till mastektomi anses bero på det kroppsideal som finns i samhället. Vidare diskuteras det om smärta i vagina har med biverkning av cancerbehandling att göra eller om det beror på kvinnans känsla av att de måste tillfredsställa sin partners sexuella behov som skapar minskad lust och upphetsning. / Background: Over one million women worldwide are diagnosed with breast cancer every year. In Sweden, the disease is estimated to reach over seven thousand. The treatment includes surgery, hormones and cytostatic witch is strenuous and can change the woman’s body image and their sexual health. Aim: The aim of this study was to describe experienced sexual health from resulting symptoms among women with breast cancer treatment. Method: The study is a literature study where 15 articles were summarized in the result. Result: Breast cancer treatment affected the woman's experience of her body as less feminine and less attractive. Difficulties such as dry vaginal mucous membranes, pain during intercourse and decreased sexual desire are other experienced health factors that have been affected. Talking about their sexual health problems with healthcare providers was difficult and they feel that it’s not a priority for health care. Discussion: Communication on sexual health is part of the nurse's task. Information between healthcare providers is missing and the woman considers it difficult to re-address her sexual problems. The woman's experience of being less attractive related to breast reduction considered be created by the ideal women in society. Furthermore, the discuss is about if pain in the vagina is a side effect to treatment or is it the feeling that they must satisfy their partners sexual needs who creates reduced libido and excitement.

Introduktion:  Diabetes mellitus är en av de folksjukdomar som många människor drabbas av. Det finns ett samband mellan diabetes mellitus och sexuell hälsa. Flera forskningsstudier visar att distriktssköterskor upplever svårigheter att samtala om sexuell hälsa med patienter. Syfte: Syftet var att belysa distriktssköterskors erfarenheter av att samtala om sexuell hälsa med patienter med sjukdomen diabetes mellitus. Metod: Kvalitativ metod med en induktiv ansats valdes. Semistrukturerade intervjuer genomfördes med tio distriktssköterskor och data har analyserats med hjälp av kvalitativ innehållsanalys. Resultat: Studiens huvudfynd resulterade i fem kategorier: män informeras om komplikationer, kvinnors sexuella hälsa försummas, frågan uppskattas, ett känsligt ämne och erfarenheter saknas. I resultatet framkom att majoriteten av deltagarna ansåg att sexuell hälsa var ett viktigt ämne att samtala med patienterna om, ändock lyfts sällan ämnet under samtalet. Det var främst patienten själv som tog upp ämnet.  Konklusion: Studien visade att sexuell hälsa är ett ämne som oftast inte samtalas om med patienter inom primärvården. Det beror mycket på den enskilda distriktssköterskans kunskap och rutiner huruvida patienter med diabetes mellitus 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.

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor i Sverige idag. Cancerbehandling består ofta av kombinerade behandlingsmetoder och kan ha omfattande biverkningar. Bröstcancerbehandling kan försätta kvinnan i menopaus, leda till fatigue, håravfall och innebära kroppsliga förändringar. Detta kan påverka kvinnans självbild och sexuella hälsa. Syfte: Syftet med denna litteraturöversikt var att beskriva kvinnors upplevelse av sin sexuella hälsa under- och efter bröstcancerbehandling. Metod: Den metod som valdes var en litteraturöversikt som baserats på kvalitativa studier. Data har sammanställts från tidigare, redan genomförda studier för att skapa en samlad bild kring området. Resultat: Det framkom fyra centrala teman kring hur kvinnors sexuella hälsa påverkades till följd av bröstcancerbehandling. Dessa var behandlingens påverkan på samlivet, kvinnans relation till sig och sin kropp, intimitet och nära relationers betydelse och kommunikation med hälso- och sjukvård. Slutsats: Majoriteten av kvinnorna upplevde försämrad sexuell hälsa och svårigheter att identifiera sig i sin förändrade kropp till följd av bröstcancerbehandling. De ställdes inför en fysisk och psykisk utmaning. Det är viktigt att sjuksköterskor bemöter patienter med ett personcentrerat förhållningssätt för att bemöta kvinnors individuella behov. Hälso- och sjukvården brister i sin kommunikation kring sexuell hälsa vilket bör förbättras för att minska patienters lidande. / Background: Breast cancer is the most common cancer form in women in Sweden today. Cancer treatment often consists of combined treatment methods and can have extensive side effects. Breast cancer treatment can put the woman into menopause, lead to fatigue, hairloss and involve bodily changes. This can affect the woman's self-image and sexual health. Aim: The aim of this literature review was to describe the women's experience of their sexual health during and after breast cancer treatment. Method: The method chosen was a literature review based on qualitative studies. Data has been compiled from previous, already completed studies to create a combined image around the area. Results: Four main themes were identified about how women's sexual health was affected by breast cancer treatment. These were: The impact of treatment on sexual intercourse, the relationship of the woman with herself and her body, intimacy and the importance of close relationships and communication with health care. Conclusion: The majority of women experienced impaired sexual health and difficulty identifying themselves in their changed body as a result of breast cancer treatment. They faced a physical and mental challenge. It is important that nurses meet patients with a person-centered approach to respond to women's individual needs. Healthcare is lacking in communication about sexual health which should be improved to reduce patient suffering.

Introduction: Emerging adults (young people age 18 to 29) are increasingly using the Internet to seek sex partners, with over 30% having tried an online or mobile dating site. As more emerging adults use dating and sex-seeking websites (DSP) for their love and sexual pursuits, it is imperative to understand how DSPs contribute to HIV/STI risk. Objectives: The objectives of this research were accomplished by pursuing the following specific aims: Aim 1. To systematically review and quantitatively synthesize evidence from published findings to determine the association between condom use and meeting venue (online and offline). Aim 2. To determine whether condom use behaviors during the first sexual interaction among heterosexual emerging adults vary depending on the venue in which participants met their partners in the past six months. Aim 3. To describe how the Information Motivation Behavioral (IMB) Skills Model applies to the relationship between condom use and meeting venue. Methods: This mixed methods study identified sexual risk behaviors of emerging adults. Men and women—recruited via social networking, classified ad and dating and sex-seeking websites— who met a heterosexual partner on a DSP and/or in-person in the past six months completed a survey about behavioral, communication and relationship factors that influence condom use. Additionally, a subset of people who met partners on DSPs and or offline (i.e., in-person) who completed the survey participated in qualitative interviews designed to explore in-depth factors that influence condom use during the first offline sexual encounter. The Information Motivation Behavioral (IMB) skills model was used to further understand the HIV/STI sexual risk behaviors of emerging adults with sex partners they met on DSP compared to those who met partner’s offline. Results: The findings of this study were that DSP are not associated with greater risks of condomless sex compared to offline meeting venues. The qualitative findings suggest that emerging adults have an attitude that condoms are to be used in new sexual relationships. However, whenever emerging adults do not have condoms available, they are less likely to use a condom. Conclusion: Although the findings of this study suggest that there is no statistical difference in condomless sex by venue, DSPs are an important place for public health messaging about condom use for the prevention of HIV/STIs, and unintended pregnancy. DSPs can help achieve some of the objectives set by Healthy Campus 2020, Healthy People 2020, and the National HIV/AIDS Strategy. In addition to targeting DSPs, it is important to continue sexual health promotion efforts in offline meeting venues.