The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic has surpassed forty years with many medical advancements in prevention and treatment. Often believed to be at negligible or low risk by society at large, sexual minority women have remained understudied regarding their risk of HIV and other sexually transmitted infections (STIs), leaving their sexual health inadequately understood and supported in healthcare and social services. The sexual health of young South Asian sexual minority women, who are multiply minoritized due to their intersecting identities, has been entirely overlooked. This qualitative study aimed to understand the knowledge, attitudes, and practices of young South Asian sexual minority women as it pertains to their HIV/STI risk. Barriers and facilitators to accessing community-based sexual health supports and services were also investigated. A community-engaged approach was taken to develop this study in partnership with the Alliance for South Asian AIDS Prevention to investigate the HIV/STI risk context and sexual health needs of this group residing in the Greater Toronto Area. A maximum variation sampling strategy was used to recruit six young South Asian sexual minority women and semi-structured in-depth interviews were conducted to collect narrative data. Narrative analysis of the data found socio-cultural and structural influences which guide the HIV/STI risk context for this group. The participants illuminated an inadequate understanding of sexual health when engaging in sex with women, an overall low HIV/STI risk perception, barriers to adequate sexual healthcare and health promotion resources, and multiple minority stressors which impacted their access to safe sex. These findings have major implications for school-based sexual health education, medical training for healthcare practitioners, and sexual health support and services provided by community-based sexual health organizations in the Greater Toronto Area. / Thesis / Master of Public Health (MPH)

Klamydia ökar bland ungdomar och unga vuxna i Sverige. Eftersom infektionen ofta är asymptomatisk och kan leda till infertilitet är det viktigt att de som utsatts för smitta testar sig. Även ett ökat utövande av säkrare sex är viktigt för att stoppa utvecklingen. En litteraturstudie har gjorts för att kartlägga preventionsinsatser som görs inom området sexuell hälsa och ta reda på hur ungdomar och unga vuxna ser på sexualitet, sexuellt riskbeteende och säkrare sex. Nio vetenskapliga artiklar användes för att få en bild av ungdomskultur och sexualitet. Frågan om säkrare sex präglas enligt litteraturen av subjektiva riskbedömningar, traditionella könsnormer, uppbyggd tillit, ojämlik kommunikation och förhandling kring kondomanvändning samt skam och rädsla. När preventionsstrategier och handlingsplaner som används i Sverige ställs mot detta syns det att modernisering och konkretisering av befintliga metoder behövs för att möta dagens generation ungdomar. / "Chlamydia – where did you get that?" About the increase of Chlamydia among adolescents and young adults and prevention strategies. Chlamydia is increasing among adolescents and young adults in Sweden. It is important that they who have been exposed to the infection are tested for STI because the disease can be asymptomatic and lead to infertility. An increased practise of safer sex is also important to stop the current development. A literature study has been conducted to survey health promoting efforts made in the sexual health area and to find out how adolescents and young adults perceive sexuality, sexual risk behaviour, and safer sex. Nine scientific articles were used to create an image of youth culture and sexuality. The question of safer sex is, according to the reviewed literature, characterized by subjective risk assessments, traditional gender roles, constructed trust, unequal communication and negotiation about condom use and also shame and fear. When the health promoting strategies and plans of action in Sweden are put against this, it is clear that modernization and concretization of existing methods are needed to meet today’s adolescent generation.

Developing a comprehensive model of Sexually Transmitted Infection (STI) risk factors and their inter-relationships is vital to improving methods of risk identification and treatment delivery. The CDC posed three general categories that may serve as a framework for such a model: sexual network, individual behavior, and social/ structural risk. None of the extant risk models incorporate measures from all three categories. Additionally, none of these models, generally focused on individual behavior, use medical data on infection as their outcome variable. This is problematic because the ultimate outcome of infection is also influenced by sexual network and social/ structural variables, in addition to individual behaviors. Therefore the current study aimed to develop a comprehensive model of risk incorporating sexual network, individual behavior, and social/ structural risk variables, using medical data on infection status as the outcome variable. The sample consisted of 506 women in a court-ordered substance treatment program. An Exploratory Factor Analysis provided preliminary evidence for a three factor model corresponding to the CDC framework. However, a Confirmatory Factor Analysis failed to confirm this model. Additionally, a logistic regression suggested that this model has limited clinical utility for this sample. Future studies may more conclusively determine the importance of various STI risk variables, the relationships between them, and whether they mirror the CDC theoretical framework. With rates of infection still high in the United States, and even increasing among women for certain STIs, this is a critical public health issue that should continue to be examined.

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.

College students have been identified as at high risk for contracting Human Papillomavirus (HPV) due to engaging in risky behaviors, such as binge drinking and unprotected sex. Before preventative measures like vaccination and condom usage can be promoted, awareness must be evaluated. A random sample of 438 college students was surveyed on their awareness of HPV using both paper and online surveying methods. Using binary logistic regression, HPV awareness was predicted using demographic measures. The majority of the sample reported having heard of HPV before. Sexually active respondents and females were significantly more likely to report awareness. Non-whites and first-generation college students were also more likely to report awareness. These demographic predictors will help identify groups needing educational and HPV intervention programs. Implications and further research is discussed.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

No description available.

No description available.

Introduktion: Sexuell och reproduktiv hälsa är fundamental för människans välbefinnande, både utifrån fysiska, psykiska och sociala aspekter. Forskning har visat att ungdomar är en av de grupper som utgör den största risken för att få och sprida sexuellt överförbara infektioner (sexually transmitted infections, STI) vilket kan leda till problem med den sexuella och reproduktiva hälsan. STI är problematiskt och kan påverka den sexuella hälsan hos ungdomar som i stor utsträckning drabbas även om det finns utökade möjligheter för att inhämta information, tillgängliga resurser och effektiva behandlingsmöjligheter. Denna studie ser det som relevant att undersöka STI relaterat till gruppen ungdomar genom att använda det salutogena perspektivet. Syfte: Syftet med studien var att undersöka och belysa sexuella beteenden och attityder som kan leda till minskad smittrisk för STI och identifiera tidigare interventioner eller framgångsmetoder som har haft positiva effekter för förebyggandet av STI bland ungdomar mellan15–24 år. Metod: Metoden som användes var en strukturerad litteraturstudie. kvalitativa och kvantitativa artiklar som hade publiceringsdatum efter år 2013 användes. Tematisk analys användes för att identifiera olika teman och insamlade data analyserades deduktivt utifrån det salutogena perspektivet. Slutsats: Resultatet belyste att specifikt inriktad sexuell undervisning i skolorna och specifikt utbildade aktörer inom STI hade en positiv effekt bland ungdomar, vilket lede till mindre riskfyllda sexuella beteenden som var STI förebyggande. Resultatet visade även att öppen kommunikation var en väsentlig faktor som bidrar till ungdomarnas attityder kring sex och förebyggande av STI. / Introduction: Sexual and reproductive health are fundamental to human well-being, both from physical, psychological, and social aspects. Research has shown that young people are one of the groups that pose the greatest risk of getting and spreading sexually transmitted infections (STI) which can lead to sexual and reproductive problems. STIs are problematic and can affect the sexual health of young people who are widely affected, even if there are increased opportunities to obtain information, available resources, and effective treatment options. This study considers it relevant to research STIs related to that group by using the salutogenic perspective. Purpose: The purpose of the study was to research and highlight sexual behaviors and attitudes that can lead to reduced risk of STI and to identify previous interventions or methods that have had positive effects on the prevention of STIs among young people between 15-24 years of age. Method: The method used was structured literature review. Qualitative and quantitative articles that had a publication date after the year 2013 were used. Thematic analysis was used to identifydifferent themes and collected data were analyzed deductively based on the salutogenic perspective. Conclusion: The results highlighted that specifically targeted sexual education in schools and specifically STI trained actors had positive effects on young people, which led toless risky behavior which also was STI-reducing. The results also showed that open communicationis an essential factor that contributes to young people´s attitudes about sex and the prevention of STIs.

Globally, the incidence of infection caused by Neisseria gonorrhoeae is the second highest among the bacterial sexually transmitted infections. In Canada, declining rates during the 1990s suggested progress toward curbing gonorrhea; however, those have been increasing since 1999, with rates in Saskatchewan among the highest in the country. Infection can cause serious complications in men and women, and reported resistance to third-generation cephalosporins could lead to potentially untreatable infections. Increased understanding of gonorrhea transmission dynamics, sexual networks, and predictors of antimicrobial resistance development is needed to inform the development of improved approaches to prevention and treatment. The research presented herein draws upon data from Shanghai, China, and Saskatchewan, Canada, to compare and contrast varying epidemiologic approaches to enhancing understanding of gonorrhea in the two settings. Using traditional statistical approaches, multi-level statistical modeling, social network analysis, and dynamic simulation modeling, questions related to sexual behavior, partner presentation, and antimicrobial resistance development are explored. Each technique is evaluated for its potential contribution to overall understanding of the issues related to the ongoing gonorrhea epidemic, globally, and in Saskatchewan. The relative strengths and limitations of the application of the analytical approaches in the different settings are described. Socio-demographic characteristics provided useful indicators of antimicrobial resistant infection among patients with gonorrhea from Shanghai. Further, socio-demographic characteristics were also useful for predicting presentation of a partner for testing and treatment and the use of condoms during intercourse, among this study population. In Saskatchewan, socio-demographic characteristics were useful in predicting coinfection with gonorrhea and chlamydia at the time of diagnosis as well as repeat infection with gonorrhea. Social network analysis of the Saskatchewan dataset provided little additional understanding of the gonorrhea epidemic in the province. This result was largely related to how STI data are collected and stored in the province. The utility of dynamic simulation modeling to investigate the potential impact of antimicrobial resistance in Saskatchewan was also limited due to the same data constraints. However, the insight gained from the model building process and findings from the working model did offer a starting point for conversations around the best ways to postpone the development of antimicrobial resistance in N. gonorrhoeae in Saskatchewan, as well as contribute additional information about how the ways in which STI data are collected and stored in the province considerably restrict the applicability of otherwise powerful epidemiologic tools. With persistently high rates of disease transmission, and the threat of untreatable infections due to antimicrobial resistance, N. gonorrhoeae remains a substantial public health threat locally and globally. The research presented herein describes various approaches to understanding and controlling this disease, applied in contrasting settings. There are a wide variety of elements that should be considered when choosing the appropriate tool(s) to address gonorrhea in a given population; there is no “one size fits all” solution. The local epidemiology of disease, cultural and behavioural norms, the characteristics of the notifiable disease reporting and information systems, and the availability of suitable data all affect the relative strengths and weaknesses of the available analytic methods and disease control approaches.