Sexual and Reproductive Health Matters最新文献

Amidst resurging syphilis infection rates, increasing efforts are being made towards development of a syphilis vaccine. This study aims to identify barriers and facilitators of syphilis vaccine trial participation among priority groups for early phase studies. We conducted interviews with English-speaking individuals ≥18 years old recruited from an infectious disease clinic, a sexually transmitted infection (STI) testing site, an online research bulletin board, and HIV community advisory boards in North Carolina from April 2021-June 2022. Eligibility criteria included STI diagnosis within 12 months, people living with HIV (PLWH), men who have sex with men, or persons engaged in transactional sex. The interview guide examined views on syphilis vaccines, trial participation, and community engagement. Interviews were transcribed verbatim, coded, and analysed for emergent themes using a social ecological model. Thirty individuals were interviewed, including eight (27%) women, 13 (43%) Black/African American individuals, and 19 (63%) PLWH. While 19 (63%) interviewees were interested in syphilis vaccine trial participation, 10 (33%) noted participation would depend on trial parameters; one person expressed no interest. Trial participation barriers included physical risks, time commitments, and concerns related to mistrust and mistreatment. Facilitators included advancing science, syphilis prevention, and trusting the researchers. Interviewees emphasized the importance of community involvement to inform vaccine trials, particularly amidst the lingering shadow of the Tuskegee Syphilis Study. While priority groups thus expressed interest in syphilis vaccine trial participation, tailored community engagement will be essential prior to clinical trials. Additional mixed methods research is urgently needed.

2024 marked the 30th anniversary of the International Conference on Population and Development (ICPD) Programme of Action (PoA) held in Cairo in 1994, which coincided with the year that the United Nations Framework Convention on Climate Change (UNFCCC) went into force. Three decades later, these agendas have become increasingly interconnected and climate change has evolved into a climate crisis, as the world undergoes unprecedented demographic changes. How we deal with these unprecedented changes, and the timings of our shared actions, will define our future. This commentary reflects on the principles of the ICPD PoA and argues for their relevance in today's fight for climate justice. To build a just and sustainable world, climate action must be guided by the aspirations of the ICPD PoA, promoting people-centred solutions, protecting human rights, advancing social justice, ensuring the right to health - including sexual and reproductive health and rights for all - and empowering women and youth in climate action and securing a future in which rights and choices are preserved for every individual.

With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.

Pacific understandings of sexual and reproductive health (SRH) encompass beliefs and practices reflective of Pacific values systems. These are integral to cultural understandings of safety, relationships, and intimacy. Research processes and practices that appropriately address these values and sensitivities are scarcely available in the literature, leading to limited use and understanding of culturally appropriate methods and procedures. Pacific methodologies like Talanoa are useful in ensuring that cultural perspectives unique to Pacific youth are addressed and appropriately represented in the research. This paper describes how cultural factors associated with sexual and reproductive health influenced the Talanoa research processes in a study of Pacific youth and SRH education. Key cultural considerations are discussed focussing on the positionality of the researchers, cultural sensitivities and protocols, communication strategies and the role of flexibility in privileging Pacific youth voices.

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person's life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

This study aims to contribute to the development of a comprehensive framework for sexual well-being of young people. By making space for diverse young people's perspectives through co-creating the framework, we seek to enhance the understanding of sexual well-being in sexual and reproductive health and rights (SRHR) research in a culturally sensitive and inclusive way. A modified Delphi study invited SRHR young professionals (aged 18-30) with different backgrounds to participate as experts in three rounds of online discussions. A framework of sexual well-being was co-created by 15 young professionals from countries across Europe, Asia, Africa, and South America. This framework recognised sexual well-being as a subjective concept with different meanings: for example, by applying an open understanding of sexual activity, and intimacy. It also acknowledged the challenges individuals face in fully understanding and achieving their sexual well-being, due to societal injustices. The framework outlined key capabilities inherent to sexual well-being, including informed decision-making, bodily autonomy, consent, exploration, self-awareness, pleasure, communication, comfort, safety, and self-esteem. Considering that these capabilities can only be realised within an enabling environment, access to sexual health information and services, as well as acceptance, respect, safety, and freedom from coercion and violence, were included as a key part of the framework. This study captured young people's views on sexual well-being to co-create a culturally sensitive framework. This framework recognises different interpretations of sexual well-being, and focuses on supportive environments that empower individuals to define and pursue sexual well-being in a way that honours their experiences and needs.

Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.

Studies show that gender socialisation shapes differently the gendered identity, self-esteem, and sexual behaviours of girls and boys. While pre-adolescence is viewed as a pivotal period for gendered socialisation, few studies in francophone Africa investigate the role of gender identity effects on aspirations and sexual and reproductive behaviours at this life stage. This article explores how the internalisation of gender stereotypes during socialisation is linked to the aspirations of girls and boys for certain life events, such as having their first child or getting married. A survey was conducted in 10 primary schools in Ouagadougou, among pupils aged between 9 and 16 years, as well as seven focus group discussions with their parents. The findings indicate a gender-based variation in the effects of adherence to unequal gender norms among young adolescents. As a result, girls tend to have earlier aspirations towards marriage and later aspirations for childbearing, while boys show earlier aspirations for childbearing and later ones for marriage. These effects may expose both girls and boys to risks of poor sexual and reproductive health. Interventions promoting egalitarian gender norms could boost girls' self-esteem as well as mutual respect among young adolescents of both genders, aiming to improve their sexual and reproductive health during adolescence and into adulthood.