Adrienne Testa

Sexual health knowledge, attitudes and behaviours: variations among a religiously diverse sample of young people in London, UK

Objective. To report young peoples variations in sexual health knowledge, attitudes and behaviours by religious affiliation. Design. A cross-sectional, questionnaire-based survey administered in 16 Secondary/High schools in London, UK. The sample consisted of 3007 students in school Years 11–13 (aged 15–18), present in school on the day of questionnaire administration. Excluding those who described themselves as ‘Other religious’, 15.9% (n=418) described themselves as having no religious affiliation, 36.3% (n=957) were Christian, 25.8% (n=679) were Muslim and 22.1% were Hindu (n=582). The religious affiliation varied within and across different ethnic groups. Method. Self-administered questionnaire completed under ‘exam’ conditions, either in tutor groups or a school hall. The 30-minute questionnaires were distributed and collected by a team of ethnically and religiously diverse fieldworkers. Results. Religious students, as opposed to those reporting no religious affiliation, generally reported poorer sexual health knowledge, and were more conservative in their attitudes to sex. Among males and females, those with no religious affiliation and Christian students reported the highest prevalence of sexual intercourse by some margin (around 20 percentage points) over the Hindus and Muslims. Christian males most frequently reported sexual intercourse at 49.7%, and Muslim females the least at 9.0%. Among those reporting sexual intercourse, risk behaviours among all religious and non-religious students were evident. Over one-third of Muslim females who had sexual intercourse did not use contraception on their first occasion compared to 10% of those with no religious affiliation, 12% of Christians and 20% of Hindus. Christian and Muslim females reported the highest prevalence of ever not using contraception at 55%, and non-use of contraception with two or more sexual intercourse partners at 14%. Conclusion. The findings demonstrate diverse sexual health knowledge, sexual attitudes and sexual behaviours among young people with different religious affiliations. These variations demonstrate the importance of tailoring health education and promotion interventions to meet the specific needs of young people from a variety of different religions. The challenge ahead is to find ways to work with these young people to broach such sensitive issues.

HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia.

Objective:To measure prevalence of HIV and syphilis and describe characteristics of sex work among female sex workers (FSWs) in Hargeisa, Somaliland, Somalia. Methods:A cross-sectional survey recruited 237 FSWs using respondent-driven sampling (RDS). A face-to-face, structured interview using handheld-assisted personal interviewing (HAPI) on personal digital assistants (PDAs) was completed and blood collected for serological testing. Results:FSWs 15–19 years old accounted for 6.9% of the population; 20–24 year-old constituted an additional 18.0%. The majority (86.6%) never attended school. International (59.0%) and interzonal (10.7%) migration was common. Most (95.7%) reported no other source of income; 13.8% had five or more clients in the last 7 days. A minority (38.4%) had heard of STIs, even fewer (6.9%) held no misconceptions about HIV. Only 24% of FSW reported using a condom at last transactional sex, and 4% reported ever been tested for HIV. HIV prevalence was 5.2% and syphilis prevalence was 3.1%. Conclusion:Sex work in Hargeisa, Somaliland, Somalia, is characterized by high numbers of sexual acts and extremely low knowledge of HIV. This study illustrates the need for targeted HIV prevention interventions focusing on HIV testing, risk-reduction awareness raising, and review of condom availability and distribution mechanisms among FSWs and males engaging with FSWs.

Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: Evidence from cross-sectional baseline and endline cluster surveys

Abstract Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27–4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99–22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings.

Sexual health knowledge, attitudes and behaviours among an ethnically diverse sample of young people in the UK

Objective To provide evidence about the sexual health knowledge, attitudes and behaviours of an ethnically diverse sample of young people from Secondary/High schools in London. Design Cross-sectional questionnaire-based survey. The sample consisted of students in school Years 11 to 13 (aged 15–18 years), present in school on the day of questionnaire administration. Setting Sixteen Secondary/High schools in London where the Black and Minority Ethnic (BME) population exceeded two-thirds of the intake. Questionnaires were completed by 2602 students aged 15 to 18, who self-defined their ethnicity as follows: White British (n= 559), White Other (n = 256), Black (n = 710) and Asian (n = 1077). Method Self-administered 30-minute questionnaire completed under ‘exam’ conditions, distributed and collected by a team of ethnically diverse fieldworkers. This questionnaire recorded socio-demographic information, sexual health knowledge, sexual health attitudes, experience of sexual intercourse, and sexual risk behaviour and outcomes. Results BME groups, relative to White British, generally reported poorer sexual health knowledge. Low level knowledge regarding STIs was particularly evident. The White British students were generally the most liberal in their attitudes to sex. With 65 per cent of Black Caribbean males reporting experience of sexual intercourse, and 48 per cent reporting first intercourse under the age of 16, this group is possibly the most at risk of poor sexual health. Although less likely to report sexual inter-course than Black Caribbeans, Black African females and Asian males and females also reported risk behaviour. Conclusion The findings demonstrate diverse sexual health knowledge, sexual attitudes and sexual behaviours among ethnic groups. This diversity demonstrates the importance of tailoring health education and promotion to meet the specific needs of ethnic groups.

Preferences towards sex education and information from an ethnically diverse sample of young people

This paper reports sex education preferences from an ethnically diverse sample of 3007 15–18 year olds. Findings are presented on preferred topics, where and from whom young people would like to receive this information. Preferences were centred around learning more about sexual behaviour and sexually transmitted infections (STIs) in particular, and receiving this at school from someone ‘professional’ and of similar age. Females showed a greater preference towards learning about emotions, relationships and contraception, and to having this delivered by someone of the same sex. Of the four main ethnic groups, Black and Asian students generally reported more sex education preferences than White British or White Other students. Black students wanted to learn more about biological issues and cultural issues alongside sexual behaviour and STIs. Black male students reported a greater than average preference towards family‐based information, and interest towards someone of the same ethnic background delivering sex education was also expressed. Asian students reported stronger preferences for more information about STIs and contraception, and wished to keep sex education out of the family household. Implications for sex and relationships education and working with professionals and parents are outlined.

A global research agenda on migration, mobility, and health

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