"We all have sexual health. And just like our physical health and mental health, sexual health is an important aspect of our overall well-being. It’s connected to more than just pregnancy or sexually transmitted infections – sexual health includes things like how we feel about our bodies, consent, social relationships, pleasure, who we’re attracted to, and more!"
Source: Action Canada for sexual Health & Rights
The library has worked in collaboration with the Director of Recruitment and Retention to create this Library Guide which highlights some of the sexual health resources available to the BU community.
To improve sexual health, even in this charged political moment, necessitates going beyond biomedical approaches, and requires meaningfully addressing sexual rights and sexual pleasure. A world where positive intersections between sexual health, sexual rights and sexual pleasure are reinforced in law, in programming and in advocacy, can strengthen health, wellbeing and the lived experience of people everywhere. This requires a clear understanding of what interconnection of these concepts means in practice, as well as conceptual, personal and systemic approaches that fully recognise and address the harms inflicted on people’s lives when these interactions are not fully taken into account. Bridging the conceptual and the pragmatic, this paper reviews current definitions, the influences and intersections of these concepts, and suggests where comprehensive attention can lead to stronger policy and programming through informed training and advocacy.
Non-consensual distribution of intimate images has been a crime in Canada since 2015. This article argues that it is time to consider how online platforms, hosts, and fora that allow users to post sexual images either directly engage in criminal acts or incur responsibility to help suppress this illegal activity. Methods for holding businesses responsible for participating in promoting or facilitating this type of wrongdoing by users should vary according to the level of involvement and risk that attaches to a particular online business model. One method applies to businesses that specifically traffic in illegal materials; for these specific “revenge porn” businesses, we should impose direct liability, as we do in other contexts. Another method applies where the nature of the business places it at high risk for facilitating customer illegal activity and where the business profits from that wrongdoing and so faces disincentives to discourage it. The online amateur porn industry more generally falls into this category. In these cases, obligations to assist in rooting out the illegal behaviour of customers via a consent verification system is appropriate. A third method applies to all businesses that host user-generated content where unfettered user activity is less expensive than addressing complaints about content and, thus, constitutes a structural disincentive to respond. Here, mandated response to complaints about non-consensual pornography is appropriate. The article argues that while freedom of sexual expression, policies protecting intermediary immunity, and online anonymity are important and complicate solutions to this lucrative traffic in sexual images, finding principled solutions is not impossible.
This article aims to explore situations of consent and non-consent in university students to understand regulatory mechanisms that contribute to the perceived ambiguity of students' experiences of sexual consent. To apprehend these experiences, 37 semi-directed interviews were conducted and analyzed using thematic analysis, systemic analysis, and contextualizing analysis. The results illustrate the existence of a dichotomy between students' knowledge of consent and the practice of consent. This ambiguity appears as an integral part of the act of consent. It was apparent in the students' understanding, affirming, retracting, and decoding of consent. The authors' analysis highlights the regulating mechanisms, that is, internal and external injunctions at play in the act of consent. Three injunctive mechanisms were identified: relational injunctions to consent, social injunctions to consent, and men's unrestricted access to women's bodies. These injunctive mechanisms act in different manners according to one's social position, individual characteristics, the type of relationship and the social spaces. By facilitating or hindering consent, they make it a profoundly ambiguous act.
Objectives: We investigated whether the context of first-time intercourse (FTI) was associated with internal consent feelings and external consent communication at FTI. Method: College students (n ¼ 1020) from universities in Canada and the United States retrospectively reported on their FTI. Results: Using structural equation modeling, we found that the context of participants’ FTI (e.g. age, contraceptive use) predicted their internal consent, which in turn predicted their external consent communication. Conclusions: Sexual health education should highlight these contextual correlates of sexual consent at FTI. Despite the cultural primacy of FTI, consent should also be prioritized for other early sexual experiences.
Introduction: University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students. Methods: This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students’ use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques. Results: Key linkages between opportunity and motivation were found to influence students’ access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use. Conclusions: This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students’ use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students’ sexual health behaviour.
The current study aimed to extend existing research concerning HPV vaccination rates, sexual behaviour practices, and risk of HPV-related morbidity and mortality among Canadian university students. A survey research firm recruited an online sample of Canadian university students between 18 and 24 years of age and from across Canada for a study of student sexual health. The current report represents a secondary analysis of responses to this sexual health survey that is focused on HPV morbidity risk. An analysis sample of 1,412 university students responded to an assessment of demographic characteristics, HPV vaccination status (vaccinated or unvaccinated), and recent and lifetime sexual behaviours and condom use. Conservative estimates indicated that approximately one-quarter of university student women, at least two-thirds of university student men, and at least one-third of trans/non-binary university students had not been vaccinated against HPV. Recent and lifetime sexual behaviours of HPV vaccinated and HPV unvaccinated university students were strikingly similar. HPV unvaccinated status, HPV-risk sexual behaviour, and HPV-related morbidity and mortality risk were very common in this national sample of Canadian university students. Cost-free catch-up HPV vaccination programs for unvaccinated university students are urgently needed to mitigate substantial HPV-related health risks in this population.
In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.
Background: University students are at risk for acquiring sexually transmitted infections and suffering other negative health outcomes. Sexual health services offer preventive and treatment interventions that aim to reduce these infections and associated health consequences. However, university students often delay or avoid seeking sexual health services. An in-depth understanding of the factors that influence student use of sexual health services is needed to underpin effective sexual health interventions. Objective: In this study, we aim to design a behavior change intervention to address university undergraduate students’ use of sexual health services at two universities in Nova Scotia, Canada. Methods: This mixed methods study consists of three phases that follow a systematic approach to intervention design outlined in the Behaviour Change Wheel. In Phase 1, we examine patterns of sexual health service use among university students in Nova Scotia, Canada, using an existing dataset. In Phase 2, we identify the perceived barriers and enablers to students’ use of sexual health services. This will include focus groups with university undergraduate students, health care providers, and university administrators using a semi structured guide, informed by the Capability, Opportunity, Motivation-Behaviour Model and Theoretical Domains Framework. In Phase 3, we identify behavior change techniques and intervention components to develop a theory-based intervention to improve students’ use of sexual health services. Results: This study will be completed in March 2018. Results from each phase and the finalized intervention design will be reported in 2018. Conclusions: Previous intervention research to improve university students’ use of sexual health services lacks a theoretical assessment of barriers. This study will employ a mixed methods research design to examine university students’ use of sexual health service and apply behavior change theory to design a theory- and evidence-based sexual health service intervention. Our approach will provide a comprehensive foundation to co-design a theory-based intervention with service users, health care providers, and administrators to improve sexual health service use among university students and ultimately improve their overall health and well-being.
Objectives: We investigated whether the context of first-time intercourse (FTI) was associated with internal consent feelings and external consent communication at FTI. Method: College students (n ¼ 1020) from universities in Canada and the United States retrospectively reported on their FTI. Results: Using structural equation modeling, we found that the context of participants’ FTI (e.g. age, contraceptive use) predicted their internal consent, which in turn predicted their external consent communication. Conclusions: Sexual health education should highlight these contextual correlates of sexual consent at FTI. Despite the cultural primacy of FTI, consent should also be prioritized for other early sexual experiences.
Background: Young Aboriginal Canadian people are at increased risk of negative sexual health outcomes, including sexually transmissible infections (STIs) and unplanned pregnancy. Associations between Aboriginal ethnicity and sexual risk behaviours and related health services use among sexually active female university students in eastern Canada were examined. Methods: A secondary analysis of online survey data collected from sexually active female university students under age 30 years from eight post-secondary institutions in the Maritime Provinces of Canada was carried out (N = 5010). Students were asked about their ethnic backgrounds, health services use and sexual health behaviours. Logistic regressions were used to compare Aboriginal students to Caucasian students regarding their sexual health behaviours and services use. Results: In adjusted analyses, Aboriginal students were seen to be more likely to not have used a condom (OR 2.37; 95% CI 1.34–4.18) or any form of effective contraception (OR 3.05; 95% CI 1.75–5.31) at last intercourse. They also were more likely to report any lifetime testing for pregnancy (OR 5.81; 95% CI 3.07–10.99) and STIs (OR 2.95; 95% CI 1.11–7.82). Aboriginal students accessed university health services as often as their Caucasian counterparts. Conclusions: Aboriginal women attending university in the Maritime Provinces of Canada engage in greater sexual risk taking than Caucasian women and report more related testing. Health services providers working with university students should be aware of these lower rates of barrier protection and use of contraception among Aboriginal women, and use healthcare visits as opportunities to engage these women in reducing their sexual risk taking.
We examined the perceived impact of the COVID-19 pandemic on sexual health, sexual behaviour, well-being, and access to sexual health services among university students in Canada. Between December 2020 and January 2021, 1504 university students across Canada completed an online survey focused on overall sexual health, well-being, solitary sexual behaviours, partnered sexual interactions, and access to sexual health services. The survey was designed by the Sex Information & Education Council of Canada and administered by the Leger polling company. Reported levels of overall sexual health were high. Cisgender women reported significantly greater scores of COVID-19—related stress compared to cisgender men; LGBQ+ students had higher levels of stress compared to heterosexual participants. Overall, solitary sexual behaviours (i.e., masturbation, porn use, vibrator use) remained unchanged or were perceived to increase compared to the time before the pandemic. Cisgender men reported higher scores (i.e., greater perceived increases) on masturbation and porn use than cisgender women. Frequency of sex with casual partners was perceived as similar or lower than what was usual before the pandemic, and most participants did not engage in sex where the close personal contact put them or their partner at risk for COVID-19. Declines in access were reported for all sexual health care services surveyed, with cisgender women and students of colour more likely to report decreased access to services. Results highlight the need for targeted public health messaging regarding sexual behaviour, investment in sexual health services, and supports tailored to the needs of women, LGBTQ+ individuals, and people of colour.
Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider’s perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.
While sexual health literature identifies youths’ sexual health information sources and its impact on their sexual practices, little is known about the way youth evaluate the credibility of this information. This knowledge gap is significant among young, Black gay and other men who have sex with men (YBGM) who belong to intersectional populations disproportionately impacted by HIV and other STIs. We conducted a qualitative study using constructivist grounded theory to explore YBGM’s approaches to evaluating sexual health information sources’ credibility. Intersectionality and the socioecological model informed our analysis. We explored connections between social locations (e.g., race, sexual orientation) and socio-ecological environments and how their impact shaped YBGM’s evaluation of sexual health information. Findings revealed evaluation strategies varied by source: friends, the internet and healthcare providers. Friends’ information was deemed credible if they were older, shared social locations and provided embodied testimonials. Testimonials mirrored oral-traditions specific to Black populations where oral narratives help disseminate sensitive information in a culturally relevant way. Website selection was informed by YBGM’s social locations and ranged from being implicitly trusted to assessed by its association with established healthcare organizations. Many participants’ acceptance of healthcare providers’ information revealed patient-client power imbalances and a perception that providers’ actions reflected their institutions’ sexual health policies. Findings highlight a need for sexual health services to create culturally effective ways to disseminate information that accounts for the histories, contexts, and approaches YBGM use to identify credible sources of sexual health information.
Background Sexual health education delivered in school, provided by parents, or provided by other formal sources has been associated most closely with increased rates of condom use and improvements in many other sexual risk behaviours. Friends and the internet are other information sources, although quality and accuracy are not always as high. Nationally representative Canadian data about where adolescents obtain their sexual health information are lacking. Data and methods Weighted data from the 2019 Canadian Health Survey on Children and Youth were used to examine the sources typically used to obtain sexual health information by 15- to 17-year-olds, as well as the prevalence and characteristics of adolescents reporting not having an adult to talk with about sexual health and puberty. Results Most 15- to 17-year-olds in Canada reported having at least one source of sexual health information (96.6%). More than half identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information. The internet (45.9%), friends (36.2%), and health care professionals (20.9%) were other common sources. Whereas 61.2% of adolescents identified more than one source of sexual health information, 3.4% reported not having any source. Nearly 15% of adolescents reported not having an adult to talk with about sexual health or puberty. Differences in sources consulted and having an adult to talk with depended on many factors, including sexual attraction and/or gender diversity, sex, immigrant status, racialized status, lower-income status, strength of parent– adolescent relationship, region of residence, and mental health. Interpretation An improved understanding of the sources of sexual health information used by adolescents and identification of characteristics associated with adolescents reporting not having an adult to talk with could help develop strategies to improve sexual health outcomes via better access to sexual health promotion and educational resources.
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations:
1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women.
2. Centre Indigenous women’s priorities, voices, and perspectives.
3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences.
4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders.
5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action.
Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
Background: This study evaluates the inclusion of sexual and reproductive health (SRH) topics in preclinical US and Canadian medical education. Study Design: Between 2002 and 2005, we sent surveys to the student coordinators of active Medical Students for Choice chapters at 122 US and Canadian medical schools. Students reported on the preclinical curricular inclusion of 50 specific SRH topics in the broad categories of pregnancy, contraception, infertility, elective abortion, ethical and social issues, and other topics. Results: We received 77 completed surveys, for an overall response rate of 63%. Coverage of pregnancy physiology and STIs/HIV was uniformly high. In contrast, inclusion of contraceptive methods and elective abortion procedures greatly varied by subtopic and geographic region. Thirty-three percent of respondents reported no coverage of elective abortion-related topics. Conclusions: Inclusion of contraception and elective abortion in preclinical medical school courses varies widely. As critical components of women's lives and health, we recommend that medical schools work to integrate comprehensive family planning content into their standard curricula.
Background Literature suggests that immigrant adolescents receive limited sexual and reproductive health (SRH) education and rarely utilize SRH services in Canada. This study sought to explore the SRH information needs of immigrant adolescents in the province of Alberta. Methods A qualitative descriptive methodology was undertaken to conduct 21 individual interviews with immigrant adolescents in Alberta. Results A total of four themes emerged from the interviews: (1) Barriers to SRH; (2) needs of adolescents regarding SRH; (3) sources of knowledge; and (4) strategies to improve SRH. Our findings document the conflicting needs and preferences between adolescents and their parents regarding access to SRH resources and services. Discussion Adolescents often felt unprepared to deal with their SRH issues due to socio-cultural barriers and conflicts with their parents' conservative attitude toward SRH concerns. Structural barriers to accessing SRH resources and services were also reported, including the location and cost of services. As a result, the majority of adolescents relied on digital methods to receive SRH information. Conclusion This study highlights that future research, and SRH service provider efforts need to remain cognizant of the positionality of immigrant adolescents and explore innovative ways to deliver SRH resources and services that meet their unique needs.
Introduction: Chemsex among gay, bisexual and other men who have sex with men (gbMSM) has raised public health concerns because of its association with sexual behaviours that can increase transmission of sexually transmitted infections, including HIV. Pre-exposure prophylaxis (PrEP) is highly effective at blocking HIV acquisition, addressing important prevention needs among individuals practicing chemsex. This study aims to improve our understanding of chemsex practices and PrEP trajectories of gbMSM and transgender women consulting for PrEP. Methods: We used data from the PrEP cohort of Clinique m´edicale l’Actuel, a major sexual health clinic in Montréal. We describe the sociodemographic profile of clients consulting for PrEP, characterize chemsex and polysubstance use trends over time, and evaluate PrEP trajectories using Kaplan-Meier curves. Results: Among 2923 clients who consulted for PrEP between 2013–2020 (2910 cisgender gbMSM, 6 transgender gbMSM, 7 transgender women), 24 % reported chemsex in the past year and 13 % reported polysubstance use. The most common chemsex substances were ecstasy (14 %), GHB (13 %), and cocaine (12 %). The proportion of clients reporting chemsex and polysubstance use decreased over time. In both the chemsex and no-chemsex group, 73 % of clients initiated PrEP. The median time to discontinuation was similar between the chemsex (6.5 months; 95 %CI: 5.3–7.2) and no-chemsex group (6.9 months; 95 %CI: 6.3–7.5). Conclusion: Chemsex is not a barrier to PrEP initiation or persistence. However, these results suggest a high prevalence of chemsex among gbMSM consulting for PrEP, highlighting the need for services addressing the intersection of sexual health and substance use for this population.
Objectives: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity. Methods: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n=49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada. Results: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men. Conclusion: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.
The Canadian national identity is often understood as what it is not; American. Inundation with American history, news, and culture around race and racism imbues Canadians with a false impression of egalitarianism, resulting in a lack of critical national refection. While this is true in instances, the cruel reality of inequity, injustice and racism is rampant within the Canadian sexual and reproductive health and rights realm. Indeed, the inequitable health out‑ comes for Black, Indigenous and people of color (BIPOC) are rooted in policy, research, health promotion and patient care. Built by colonial settlers, many of the systems currently in place have yet to embark on the necessary process of addressing the colonial, racist, and ableist structures perpetuating inequities in health outcomes. The mere fact that Canada sees itself as better than America in terms of race relations is an excuse to overlook its decades of racial and cultural discrimination against Indigenous and Black people. While this commentary may not be ground-breaking for BIPOC communities who have remained vocal about these issues at a grassroots level for decades, there exists a gap in the Canadian literature in exploring these difficult and often underlying dynamics of racism. In this commentary series, the authors aim to promote strategies addressing systemic racism and incorporating a reproductive justice framework in an attempt to reduce health inequities among Indigenous, Black and racialized communities in Canada.
In order to begin understanding the current context, producing culturally meaningful findings, and creating equitable health outcomes in the sphere of sexual and reproductive health and rights (SRHR) in Canada, we must first consider how, with whom and by whom research is conducted. As part of a series of commentaries on Reproductive Justice in Canada in BMC Reproductive Health, in this segment, we echo the Research Working Group of the Black Mamas Matter Alliance (BMMA) in emphasizing that SRHR research related to Indigenous, Black and People of Colour (IBPOC) must be rooted in a Reproductive Justice framework that includes social justice and human rights. We call for IBPOC community voices to be heard, information to be accessible, narratives to be representative, and communities to have “control over production, documentation, possession and dissemination of their own data or stories”. The authors of this commentary argue that a paradigm shift is needed in SRHR research, one that considers how Canadian institutions conduct, fund, and disseminate research on Indigenous, Black and racialized populations in Canada and internationally.
Background. Inuit youth are reported to experience considerably worse sexual and reproductive health and rights (SRHR) outcomes than Canadian youth in general, as evidenced through public health data on sexually transmitted infections, unintended young pregnancies and rates of sexual violence in Nunavut compared to national averages. Existing literature on Inuit SRHR has identified the impact of westernization and colonialism on health outcomes, though gaps remain in addressing youth- and community-specific experiences of SRHR. Objective. This study aims to generate youth-focused evidence on experiences of SRHR relating to access to care in Arviat in order to better inform locally authored interventions geared towards improving youth SRHR. Design. The Piliriqatigiinniq Partnership Community Health Research Model (PRM) developed by the Qaujigiartiit Health Research Centre was followed to generate data on youth experiences of SRHR support access in Arviat. In-depth interviews were conducted with 9 male youth (ages 17-22 years), 10 female youth (ages 16-22 years) and 6 community leaders (aged 25+). Snowball sampling was used to engage informants, and data analysis followed an approach similar to conventional content analysis, where emphasis was placed on ‘‘immersion and crystallization’’ of data, corresponding to the Inuit concept of Iqqaumaqatigiinniq in the PRM. Findings were continuously checked with community members in Arviat during the analysis phase, and their feedback was incorporated into the report. Results. Youth in Arviat were found to face significant barriers to SRHR care and support. Three major themes emerged as important factors conditioning youth access to SRHR resources in the community: trust of support workers in the community; stigma/taboos surrounding SRHR topics; and feelings of powerlessness impeding female and lesbian/gay/bisexual/transgender/queer youth in particular from accessing care. Conclusions. The locally specific ways these themes emerged revealed important structural factors at play in the community, which seem to persistently work against youths’ abilities to achieve good SRHR outcomes. To address poor micro-level health outcomes in Arviat, it thus appears that locally authored programming must take into account broader structural factors at the root of SRHR access barriers.
Given growing concerns of im/migrant women’s access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women’s access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n=18), British Columbia (n=6), and Alberta (n=6) were primary settings represented. Studies focused primarily on maternity care (n=20) and sexual health screenings (n=12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. Methods A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. Results Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. Conclusion The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.
Indigenous boys and men in Canada face adverse social and structural circumstances that affect their ability to achieve and maintain sexual health. Research about Indigenous sexual health, however, is largely limited to matters relating to women and statistics on sexually transmitted infections. A rapid review of research was conducted to determine what is currently known about Indigenous boys’ and men’s sexual health in Canada. Given the prevalence of research documenting quantitative disparities, the current review included qualitative research only. Thirteen included studies explored a wide range of topics relating to sexual health and an overarching intersection between social conditions and individual health outcomes was observed. The results of this review reveal significant gaps in the literature relating to the holistic sexual health of Indigenous boys and men and highlight important domains of sexual health to consider in future research. Findings suggest that sexual health programmes that promote traditional Indigenous knowledge and intergenerational relationships may be effective for promoting sexual health among Indigenous boys and men.
We used longitudinal data from the 2013–2017 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (N=1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defned: (i) weekly alcohol use, with>7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥6 drinks at one sitting), with≥1/month as frequent binging. Twelve SDoH indicators were classifed using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.
Data on immigrant access to sexual and reproductive health (SRH) services in Canada typically focus on adult populations generally but not adolescents specifically. To fill this gap, this study explored South Asian immigrant adolescents' perceptions of barriers and facilitators for SRH care and services in Edmonton, Alberta, Canada. In this qualitative descriptive study, researchers conducted six focus group semi-structured interviews with South Asian immigrant adolescents who live in Edmonton, Canada. Barriers included fear of stigma and judgment, lack of information about the healthcare system, lack of privacy and youth-friendly SRH services, lack of comprehensive sexuality education, lack of trust of online SRH information, and language barriers. Facilitators included SRH information classes at school, parental support, and provision of free services. South Asian immigrant adolescents expressed their need for more inclusive and relevant sexual health education, more support from parents and teachers with adequate and evidence-based SRH information and effective communication strategies to enhance communication with adolescents, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centered sexual health education at home, in school, and in the community.
Systemic racism in Canada’s healthcare system continues to contribute to sexual and reproductive health and rights (SRHR) inequities for Indigenous, Black, and womxn of colour. We continue our series on Reproductive Justice (RJ) in Reproductive Health, by highlighting the issue of systemic racism in the context of Canadian SRHR healthcare provision and patient care. In this commentary, we broadly discuss the macro policy and meso organizational structures that contribute to SRHR inequities among racialized individuals and communities. In “Structural Racism, Institutional Agency, and Disrespect”, as argued by Pierce, to fully comprehend systematic racism, we must observe the power dynamic, and this “must be understood in terms of injustice rather than disrespect”. Tis “involves giving a fuller account of how institutions are related to the beliefs, actions, and intentions of individuals, and how they can come to embody a certain kind of agency”. This helps us understand racism from a macro perspective, which can then be followed by an analysis at the institutional and individual levels. These structures, rooted in colonial practices and racial oppression, include Federal and Provincial/ Territorial policies that set the stage for educational systems (i.e., admission processes, training, and licensing of health care professionals) and healthcare systems that perpetuate racism experienced by Indigenous, Black and people of colour (IBPOC) at point of care. By design, these macro level structures facilitate opportunities for the dominant group, thereby reinforcing white privilege throughout meso level institutions and organizations. At the individual level, we provide examples of the lived experiences of racialized groups in Canada who face racism daily within the healthcare system, leading to worse SRHR health outcomes compared to their white counterparts. Once again, we call for policies and programs designed with a Reproductive Justice lens in Canada; we need to dismantle current oppressive structures and create systems of delivery that acknowledge and understand lived SRHR experiences of IBPOC communities.
The use of digital health interventions and tools has been in the mainstream since at least the early 2000s. However, in the last decade, there has been a boom in innovation and implementation of digital health interventions in the sexual and reproductive health (SRH) field. People have increasingly turned to digital devices for medical information and decision-making, whether searching for symptoms online or using mobile applications to connect with healthcare providers. Reproductive health information is no exception. Need to track your period? There are many apps for that! Need to find a reproductive health clinic? Geolocalised directories have your back. The offer expands to digital platforms focused on menstrual and hormonal health, contraception, fertility awareness, sexual health information, counselling, and so on. Abortion care is no exception to this trend. As the abortion access landscape shifts within a spectrum of legal restrictions, digital health tools like telemedicine platforms, mobile applications, and even social media have become valuable resources to counter restrictive legislation as well as to innovate in healthcare provision.
Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities. Methods: Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (n¼62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care. Results: Conditional on sociodemographic factors, all sexual, gender, and racial minority groups, except straight white women, gay white men, and bisexual non-white men, reported worse self-rated health than straight white men (po0.05). Some of these gaps were attributable to differences in behaviors and healthcare access. All female groups, as well as gay non-white men, were more likely to report a functional limitation than straight white men (po0.05), and these gaps largely remained when behavioral risks and access to care were accounted for. The study also discusses health disparities within sexual, gender, and racial minority groups. Conclusions: Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities.
Discussions about sexual health are uncommon in clinical encounters, despite the sexual dysfunction associated with many common health conditions. Understanding of the importance of sexual health and sexual satisfaction in U.S. adults is limited. The aim is to provide epidemiologic data on the importance of sexual health for quality of life and people's satisfaction with their sex lives and to examine how each is associated with demographic and health factors. Data are from a cross-sectional self-report questionnaire from a sample of 3,515 English-speaking U.S. adults recruited from an online panel that uses address-based probability sampling. We report ratings of importance of sexual health to quality of life (single item with five-point response) and the Patient-Reported Outcomes Measurement Information System Satisfaction With Sex Life score (five items, each with five-point responses, scores centered on the U.S. mean). High importance of sexual health to quality of life was reported by 62.2% of men (95% CI = 59.4–65.0) and 42.8% of women (95% CI = 39.6–46.1, P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race-ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men). In this large study of U.S. adults' ratings of the importance of sexual health and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians' assessments of their patients. Health care systems that state a commitment to improving patients' overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the lifespan.
To improve sexual health, even in this charged political moment, necessitates going beyond biomedical approaches, and requires meaningfully addressing sexual rights and sexual pleasure. A world where positive intersections between sexual health, sexual rights and sexual pleasure are reinforced in law, in programming and in advocacy, can strengthen health, wellbeing and the lived experience of people everywhere. This requires a clear understanding of what interconnection of these concepts means in practice, as well as conceptual, personal and systemic approaches that fully recognise and address the harms inflicted on people’s lives when these interactions are not fully taken into account. Bridging the conceptual and the pragmatic, this paper reviews current definitions, the influences and intersections of these concepts, and suggests where comprehensive attention can lead to stronger policy and programming through informed training and advocacy.
Non-consensual distribution of intimate images has been a crime in Canada since 2015. This article argues that it is time to consider how online platforms, hosts, and fora that allow users to post sexual images either directly engage in criminal acts or incur responsibility to help suppress this illegal activity. Methods for holding businesses responsible for participating in promoting or facilitating this type of wrongdoing by users should vary according to the level of involvement and risk that attaches to a particular online business model. One method applies to businesses that specifically traffic in illegal materials; for these specific “revenge porn” businesses, we should impose direct liability, as we do in other contexts. Another method applies where the nature of the business places it at high risk for facilitating customer illegal activity and where the business profits from that wrongdoing and so faces disincentives to discourage it. The online amateur porn industry more generally falls into this category. In these cases, obligations to assist in rooting out the illegal behaviour of customers via a consent verification system is appropriate. A third method applies to all businesses that host user-generated content where unfettered user activity is less expensive than addressing complaints about content and, thus, constitutes a structural disincentive to respond. Here, mandated response to complaints about non-consensual pornography is appropriate. The article argues that while freedom of sexual expression, policies protecting intermediary immunity, and online anonymity are important and complicate solutions to this lucrative traffic in sexual images, finding principled solutions is not impossible.
This article aims to explore situations of consent and non-consent in university students to understand regulatory mechanisms that contribute to the perceived ambiguity of students' experiences of sexual consent. To apprehend these experiences, 37 semi-directed interviews were conducted and analyzed using thematic analysis, systemic analysis, and contextualizing analysis. The results illustrate the existence of a dichotomy between students' knowledge of consent and the practice of consent. This ambiguity appears as an integral part of the act of consent. It was apparent in the students' understanding, affirming, retracting, and decoding of consent. The authors' analysis highlights the regulating mechanisms, that is, internal and external injunctions at play in the act of consent. Three injunctive mechanisms were identified: relational injunctions to consent, social injunctions to consent, and men's unrestricted access to women's bodies. These injunctive mechanisms act in different manners according to one's social position, individual characteristics, the type of relationship and the social spaces. By facilitating or hindering consent, they make it a profoundly ambiguous act.
Objectives: We investigated whether the context of first-time intercourse (FTI) was associated with internal consent feelings and external consent communication at FTI. Method: College students (n ¼ 1020) from universities in Canada and the United States retrospectively reported on their FTI. Results: Using structural equation modeling, we found that the context of participants’ FTI (e.g. age, contraceptive use) predicted their internal consent, which in turn predicted their external consent communication. Conclusions: Sexual health education should highlight these contextual correlates of sexual consent at FTI. Despite the cultural primacy of FTI, consent should also be prioritized for other early sexual experiences.
Introduction: University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students. Methods: This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students’ use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques. Results: Key linkages between opportunity and motivation were found to influence students’ access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use. Conclusions: This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students’ use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students’ sexual health behaviour.
The current study aimed to extend existing research concerning HPV vaccination rates, sexual behaviour practices, and risk of HPV-related morbidity and mortality among Canadian university students. A survey research firm recruited an online sample of Canadian university students between 18 and 24 years of age and from across Canada for a study of student sexual health. The current report represents a secondary analysis of responses to this sexual health survey that is focused on HPV morbidity risk. An analysis sample of 1,412 university students responded to an assessment of demographic characteristics, HPV vaccination status (vaccinated or unvaccinated), and recent and lifetime sexual behaviours and condom use. Conservative estimates indicated that approximately one-quarter of university student women, at least two-thirds of university student men, and at least one-third of trans/non-binary university students had not been vaccinated against HPV. Recent and lifetime sexual behaviours of HPV vaccinated and HPV unvaccinated university students were strikingly similar. HPV unvaccinated status, HPV-risk sexual behaviour, and HPV-related morbidity and mortality risk were very common in this national sample of Canadian university students. Cost-free catch-up HPV vaccination programs for unvaccinated university students are urgently needed to mitigate substantial HPV-related health risks in this population.
In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.
Background: University students are at risk for acquiring sexually transmitted infections and suffering other negative health outcomes. Sexual health services offer preventive and treatment interventions that aim to reduce these infections and associated health consequences. However, university students often delay or avoid seeking sexual health services. An in-depth understanding of the factors that influence student use of sexual health services is needed to underpin effective sexual health interventions. Objective: In this study, we aim to design a behavior change intervention to address university undergraduate students’ use of sexual health services at two universities in Nova Scotia, Canada. Methods: This mixed methods study consists of three phases that follow a systematic approach to intervention design outlined in the Behaviour Change Wheel. In Phase 1, we examine patterns of sexual health service use among university students in Nova Scotia, Canada, using an existing dataset. In Phase 2, we identify the perceived barriers and enablers to students’ use of sexual health services. This will include focus groups with university undergraduate students, health care providers, and university administrators using a semi structured guide, informed by the Capability, Opportunity, Motivation-Behaviour Model and Theoretical Domains Framework. In Phase 3, we identify behavior change techniques and intervention components to develop a theory-based intervention to improve students’ use of sexual health services. Results: This study will be completed in March 2018. Results from each phase and the finalized intervention design will be reported in 2018. Conclusions: Previous intervention research to improve university students’ use of sexual health services lacks a theoretical assessment of barriers. This study will employ a mixed methods research design to examine university students’ use of sexual health service and apply behavior change theory to design a theory- and evidence-based sexual health service intervention. Our approach will provide a comprehensive foundation to co-design a theory-based intervention with service users, health care providers, and administrators to improve sexual health service use among university students and ultimately improve their overall health and well-being.
Objectives: We investigated whether the context of first-time intercourse (FTI) was associated with internal consent feelings and external consent communication at FTI. Method: College students (n ¼ 1020) from universities in Canada and the United States retrospectively reported on their FTI. Results: Using structural equation modeling, we found that the context of participants’ FTI (e.g. age, contraceptive use) predicted their internal consent, which in turn predicted their external consent communication. Conclusions: Sexual health education should highlight these contextual correlates of sexual consent at FTI. Despite the cultural primacy of FTI, consent should also be prioritized for other early sexual experiences.
Background: Young Aboriginal Canadian people are at increased risk of negative sexual health outcomes, including sexually transmissible infections (STIs) and unplanned pregnancy. Associations between Aboriginal ethnicity and sexual risk behaviours and related health services use among sexually active female university students in eastern Canada were examined. Methods: A secondary analysis of online survey data collected from sexually active female university students under age 30 years from eight post-secondary institutions in the Maritime Provinces of Canada was carried out (N = 5010). Students were asked about their ethnic backgrounds, health services use and sexual health behaviours. Logistic regressions were used to compare Aboriginal students to Caucasian students regarding their sexual health behaviours and services use. Results: In adjusted analyses, Aboriginal students were seen to be more likely to not have used a condom (OR 2.37; 95% CI 1.34–4.18) or any form of effective contraception (OR 3.05; 95% CI 1.75–5.31) at last intercourse. They also were more likely to report any lifetime testing for pregnancy (OR 5.81; 95% CI 3.07–10.99) and STIs (OR 2.95; 95% CI 1.11–7.82). Aboriginal students accessed university health services as often as their Caucasian counterparts. Conclusions: Aboriginal women attending university in the Maritime Provinces of Canada engage in greater sexual risk taking than Caucasian women and report more related testing. Health services providers working with university students should be aware of these lower rates of barrier protection and use of contraception among Aboriginal women, and use healthcare visits as opportunities to engage these women in reducing their sexual risk taking.
We examined the perceived impact of the COVID-19 pandemic on sexual health, sexual behaviour, well-being, and access to sexual health services among university students in Canada. Between December 2020 and January 2021, 1504 university students across Canada completed an online survey focused on overall sexual health, well-being, solitary sexual behaviours, partnered sexual interactions, and access to sexual health services. The survey was designed by the Sex Information & Education Council of Canada and administered by the Leger polling company. Reported levels of overall sexual health were high. Cisgender women reported significantly greater scores of COVID-19—related stress compared to cisgender men; LGBQ+ students had higher levels of stress compared to heterosexual participants. Overall, solitary sexual behaviours (i.e., masturbation, porn use, vibrator use) remained unchanged or were perceived to increase compared to the time before the pandemic. Cisgender men reported higher scores (i.e., greater perceived increases) on masturbation and porn use than cisgender women. Frequency of sex with casual partners was perceived as similar or lower than what was usual before the pandemic, and most participants did not engage in sex where the close personal contact put them or their partner at risk for COVID-19. Declines in access were reported for all sexual health care services surveyed, with cisgender women and students of colour more likely to report decreased access to services. Results highlight the need for targeted public health messaging regarding sexual behaviour, investment in sexual health services, and supports tailored to the needs of women, LGBTQ+ individuals, and people of colour.
Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider’s perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.
While sexual health literature identifies youths’ sexual health information sources and its impact on their sexual practices, little is known about the way youth evaluate the credibility of this information. This knowledge gap is significant among young, Black gay and other men who have sex with men (YBGM) who belong to intersectional populations disproportionately impacted by HIV and other STIs. We conducted a qualitative study using constructivist grounded theory to explore YBGM’s approaches to evaluating sexual health information sources’ credibility. Intersectionality and the socioecological model informed our analysis. We explored connections between social locations (e.g., race, sexual orientation) and socio-ecological environments and how their impact shaped YBGM’s evaluation of sexual health information. Findings revealed evaluation strategies varied by source: friends, the internet and healthcare providers. Friends’ information was deemed credible if they were older, shared social locations and provided embodied testimonials. Testimonials mirrored oral-traditions specific to Black populations where oral narratives help disseminate sensitive information in a culturally relevant way. Website selection was informed by YBGM’s social locations and ranged from being implicitly trusted to assessed by its association with established healthcare organizations. Many participants’ acceptance of healthcare providers’ information revealed patient-client power imbalances and a perception that providers’ actions reflected their institutions’ sexual health policies. Findings highlight a need for sexual health services to create culturally effective ways to disseminate information that accounts for the histories, contexts, and approaches YBGM use to identify credible sources of sexual health information.
Background Sexual health education delivered in school, provided by parents, or provided by other formal sources has been associated most closely with increased rates of condom use and improvements in many other sexual risk behaviours. Friends and the internet are other information sources, although quality and accuracy are not always as high. Nationally representative Canadian data about where adolescents obtain their sexual health information are lacking. Data and methods Weighted data from the 2019 Canadian Health Survey on Children and Youth were used to examine the sources typically used to obtain sexual health information by 15- to 17-year-olds, as well as the prevalence and characteristics of adolescents reporting not having an adult to talk with about sexual health and puberty. Results Most 15- to 17-year-olds in Canada reported having at least one source of sexual health information (96.6%). More than half identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information. The internet (45.9%), friends (36.2%), and health care professionals (20.9%) were other common sources. Whereas 61.2% of adolescents identified more than one source of sexual health information, 3.4% reported not having any source. Nearly 15% of adolescents reported not having an adult to talk with about sexual health or puberty. Differences in sources consulted and having an adult to talk with depended on many factors, including sexual attraction and/or gender diversity, sex, immigrant status, racialized status, lower-income status, strength of parent– adolescent relationship, region of residence, and mental health. Interpretation An improved understanding of the sources of sexual health information used by adolescents and identification of characteristics associated with adolescents reporting not having an adult to talk with could help develop strategies to improve sexual health outcomes via better access to sexual health promotion and educational resources.
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations:
1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women.
2. Centre Indigenous women’s priorities, voices, and perspectives.
3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences.
4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders.
5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action.
Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
Background: This study evaluates the inclusion of sexual and reproductive health (SRH) topics in preclinical US and Canadian medical education. Study Design: Between 2002 and 2005, we sent surveys to the student coordinators of active Medical Students for Choice chapters at 122 US and Canadian medical schools. Students reported on the preclinical curricular inclusion of 50 specific SRH topics in the broad categories of pregnancy, contraception, infertility, elective abortion, ethical and social issues, and other topics. Results: We received 77 completed surveys, for an overall response rate of 63%. Coverage of pregnancy physiology and STIs/HIV was uniformly high. In contrast, inclusion of contraceptive methods and elective abortion procedures greatly varied by subtopic and geographic region. Thirty-three percent of respondents reported no coverage of elective abortion-related topics. Conclusions: Inclusion of contraception and elective abortion in preclinical medical school courses varies widely. As critical components of women's lives and health, we recommend that medical schools work to integrate comprehensive family planning content into their standard curricula.
Background Literature suggests that immigrant adolescents receive limited sexual and reproductive health (SRH) education and rarely utilize SRH services in Canada. This study sought to explore the SRH information needs of immigrant adolescents in the province of Alberta. Methods A qualitative descriptive methodology was undertaken to conduct 21 individual interviews with immigrant adolescents in Alberta. Results A total of four themes emerged from the interviews: (1) Barriers to SRH; (2) needs of adolescents regarding SRH; (3) sources of knowledge; and (4) strategies to improve SRH. Our findings document the conflicting needs and preferences between adolescents and their parents regarding access to SRH resources and services. Discussion Adolescents often felt unprepared to deal with their SRH issues due to socio-cultural barriers and conflicts with their parents' conservative attitude toward SRH concerns. Structural barriers to accessing SRH resources and services were also reported, including the location and cost of services. As a result, the majority of adolescents relied on digital methods to receive SRH information. Conclusion This study highlights that future research, and SRH service provider efforts need to remain cognizant of the positionality of immigrant adolescents and explore innovative ways to deliver SRH resources and services that meet their unique needs.
Introduction: Chemsex among gay, bisexual and other men who have sex with men (gbMSM) has raised public health concerns because of its association with sexual behaviours that can increase transmission of sexually transmitted infections, including HIV. Pre-exposure prophylaxis (PrEP) is highly effective at blocking HIV acquisition, addressing important prevention needs among individuals practicing chemsex. This study aims to improve our understanding of chemsex practices and PrEP trajectories of gbMSM and transgender women consulting for PrEP. Methods: We used data from the PrEP cohort of Clinique m´edicale l’Actuel, a major sexual health clinic in Montréal. We describe the sociodemographic profile of clients consulting for PrEP, characterize chemsex and polysubstance use trends over time, and evaluate PrEP trajectories using Kaplan-Meier curves. Results: Among 2923 clients who consulted for PrEP between 2013–2020 (2910 cisgender gbMSM, 6 transgender gbMSM, 7 transgender women), 24 % reported chemsex in the past year and 13 % reported polysubstance use. The most common chemsex substances were ecstasy (14 %), GHB (13 %), and cocaine (12 %). The proportion of clients reporting chemsex and polysubstance use decreased over time. In both the chemsex and no-chemsex group, 73 % of clients initiated PrEP. The median time to discontinuation was similar between the chemsex (6.5 months; 95 %CI: 5.3–7.2) and no-chemsex group (6.9 months; 95 %CI: 6.3–7.5). Conclusion: Chemsex is not a barrier to PrEP initiation or persistence. However, these results suggest a high prevalence of chemsex among gbMSM consulting for PrEP, highlighting the need for services addressing the intersection of sexual health and substance use for this population.
Objectives: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity. Methods: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n=49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada. Results: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men. Conclusion: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.
The Canadian national identity is often understood as what it is not; American. Inundation with American history, news, and culture around race and racism imbues Canadians with a false impression of egalitarianism, resulting in a lack of critical national refection. While this is true in instances, the cruel reality of inequity, injustice and racism is rampant within the Canadian sexual and reproductive health and rights realm. Indeed, the inequitable health out‑ comes for Black, Indigenous and people of color (BIPOC) are rooted in policy, research, health promotion and patient care. Built by colonial settlers, many of the systems currently in place have yet to embark on the necessary process of addressing the colonial, racist, and ableist structures perpetuating inequities in health outcomes. The mere fact that Canada sees itself as better than America in terms of race relations is an excuse to overlook its decades of racial and cultural discrimination against Indigenous and Black people. While this commentary may not be ground-breaking for BIPOC communities who have remained vocal about these issues at a grassroots level for decades, there exists a gap in the Canadian literature in exploring these difficult and often underlying dynamics of racism. In this commentary series, the authors aim to promote strategies addressing systemic racism and incorporating a reproductive justice framework in an attempt to reduce health inequities among Indigenous, Black and racialized communities in Canada.
In order to begin understanding the current context, producing culturally meaningful findings, and creating equitable health outcomes in the sphere of sexual and reproductive health and rights (SRHR) in Canada, we must first consider how, with whom and by whom research is conducted. As part of a series of commentaries on Reproductive Justice in Canada in BMC Reproductive Health, in this segment, we echo the Research Working Group of the Black Mamas Matter Alliance (BMMA) in emphasizing that SRHR research related to Indigenous, Black and People of Colour (IBPOC) must be rooted in a Reproductive Justice framework that includes social justice and human rights. We call for IBPOC community voices to be heard, information to be accessible, narratives to be representative, and communities to have “control over production, documentation, possession and dissemination of their own data or stories”. The authors of this commentary argue that a paradigm shift is needed in SRHR research, one that considers how Canadian institutions conduct, fund, and disseminate research on Indigenous, Black and racialized populations in Canada and internationally.
Background. Inuit youth are reported to experience considerably worse sexual and reproductive health and rights (SRHR) outcomes than Canadian youth in general, as evidenced through public health data on sexually transmitted infections, unintended young pregnancies and rates of sexual violence in Nunavut compared to national averages. Existing literature on Inuit SRHR has identified the impact of westernization and colonialism on health outcomes, though gaps remain in addressing youth- and community-specific experiences of SRHR. Objective. This study aims to generate youth-focused evidence on experiences of SRHR relating to access to care in Arviat in order to better inform locally authored interventions geared towards improving youth SRHR. Design. The Piliriqatigiinniq Partnership Community Health Research Model (PRM) developed by the Qaujigiartiit Health Research Centre was followed to generate data on youth experiences of SRHR support access in Arviat. In-depth interviews were conducted with 9 male youth (ages 17-22 years), 10 female youth (ages 16-22 years) and 6 community leaders (aged 25+). Snowball sampling was used to engage informants, and data analysis followed an approach similar to conventional content analysis, where emphasis was placed on ‘‘immersion and crystallization’’ of data, corresponding to the Inuit concept of Iqqaumaqatigiinniq in the PRM. Findings were continuously checked with community members in Arviat during the analysis phase, and their feedback was incorporated into the report. Results. Youth in Arviat were found to face significant barriers to SRHR care and support. Three major themes emerged as important factors conditioning youth access to SRHR resources in the community: trust of support workers in the community; stigma/taboos surrounding SRHR topics; and feelings of powerlessness impeding female and lesbian/gay/bisexual/transgender/queer youth in particular from accessing care. Conclusions. The locally specific ways these themes emerged revealed important structural factors at play in the community, which seem to persistently work against youths’ abilities to achieve good SRHR outcomes. To address poor micro-level health outcomes in Arviat, it thus appears that locally authored programming must take into account broader structural factors at the root of SRHR access barriers.
Given growing concerns of im/migrant women’s access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women’s access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n=18), British Columbia (n=6), and Alberta (n=6) were primary settings represented. Studies focused primarily on maternity care (n=20) and sexual health screenings (n=12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. Methods A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. Results Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. Conclusion The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.
Indigenous boys and men in Canada face adverse social and structural circumstances that affect their ability to achieve and maintain sexual health. Research about Indigenous sexual health, however, is largely limited to matters relating to women and statistics on sexually transmitted infections. A rapid review of research was conducted to determine what is currently known about Indigenous boys’ and men’s sexual health in Canada. Given the prevalence of research documenting quantitative disparities, the current review included qualitative research only. Thirteen included studies explored a wide range of topics relating to sexual health and an overarching intersection between social conditions and individual health outcomes was observed. The results of this review reveal significant gaps in the literature relating to the holistic sexual health of Indigenous boys and men and highlight important domains of sexual health to consider in future research. Findings suggest that sexual health programmes that promote traditional Indigenous knowledge and intergenerational relationships may be effective for promoting sexual health among Indigenous boys and men.
We used longitudinal data from the 2013–2017 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (N=1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defned: (i) weekly alcohol use, with>7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥6 drinks at one sitting), with≥1/month as frequent binging. Twelve SDoH indicators were classifed using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.
Data on immigrant access to sexual and reproductive health (SRH) services in Canada typically focus on adult populations generally but not adolescents specifically. To fill this gap, this study explored South Asian immigrant adolescents' perceptions of barriers and facilitators for SRH care and services in Edmonton, Alberta, Canada. In this qualitative descriptive study, researchers conducted six focus group semi-structured interviews with South Asian immigrant adolescents who live in Edmonton, Canada. Barriers included fear of stigma and judgment, lack of information about the healthcare system, lack of privacy and youth-friendly SRH services, lack of comprehensive sexuality education, lack of trust of online SRH information, and language barriers. Facilitators included SRH information classes at school, parental support, and provision of free services. South Asian immigrant adolescents expressed their need for more inclusive and relevant sexual health education, more support from parents and teachers with adequate and evidence-based SRH information and effective communication strategies to enhance communication with adolescents, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centered sexual health education at home, in school, and in the community.
Systemic racism in Canada’s healthcare system continues to contribute to sexual and reproductive health and rights (SRHR) inequities for Indigenous, Black, and womxn of colour. We continue our series on Reproductive Justice (RJ) in Reproductive Health, by highlighting the issue of systemic racism in the context of Canadian SRHR healthcare provision and patient care. In this commentary, we broadly discuss the macro policy and meso organizational structures that contribute to SRHR inequities among racialized individuals and communities. In “Structural Racism, Institutional Agency, and Disrespect”, as argued by Pierce, to fully comprehend systematic racism, we must observe the power dynamic, and this “must be understood in terms of injustice rather than disrespect”. Tis “involves giving a fuller account of how institutions are related to the beliefs, actions, and intentions of individuals, and how they can come to embody a certain kind of agency”. This helps us understand racism from a macro perspective, which can then be followed by an analysis at the institutional and individual levels. These structures, rooted in colonial practices and racial oppression, include Federal and Provincial/ Territorial policies that set the stage for educational systems (i.e., admission processes, training, and licensing of health care professionals) and healthcare systems that perpetuate racism experienced by Indigenous, Black and people of colour (IBPOC) at point of care. By design, these macro level structures facilitate opportunities for the dominant group, thereby reinforcing white privilege throughout meso level institutions and organizations. At the individual level, we provide examples of the lived experiences of racialized groups in Canada who face racism daily within the healthcare system, leading to worse SRHR health outcomes compared to their white counterparts. Once again, we call for policies and programs designed with a Reproductive Justice lens in Canada; we need to dismantle current oppressive structures and create systems of delivery that acknowledge and understand lived SRHR experiences of IBPOC communities.
The use of digital health interventions and tools has been in the mainstream since at least the early 2000s. However, in the last decade, there has been a boom in innovation and implementation of digital health interventions in the sexual and reproductive health (SRH) field. People have increasingly turned to digital devices for medical information and decision-making, whether searching for symptoms online or using mobile applications to connect with healthcare providers. Reproductive health information is no exception. Need to track your period? There are many apps for that! Need to find a reproductive health clinic? Geolocalised directories have your back. The offer expands to digital platforms focused on menstrual and hormonal health, contraception, fertility awareness, sexual health information, counselling, and so on. Abortion care is no exception to this trend. As the abortion access landscape shifts within a spectrum of legal restrictions, digital health tools like telemedicine platforms, mobile applications, and even social media have become valuable resources to counter restrictive legislation as well as to innovate in healthcare provision.
Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities. Methods: Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (n¼62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care. Results: Conditional on sociodemographic factors, all sexual, gender, and racial minority groups, except straight white women, gay white men, and bisexual non-white men, reported worse self-rated health than straight white men (po0.05). Some of these gaps were attributable to differences in behaviors and healthcare access. All female groups, as well as gay non-white men, were more likely to report a functional limitation than straight white men (po0.05), and these gaps largely remained when behavioral risks and access to care were accounted for. The study also discusses health disparities within sexual, gender, and racial minority groups. Conclusions: Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities.
Discussions about sexual health are uncommon in clinical encounters, despite the sexual dysfunction associated with many common health conditions. Understanding of the importance of sexual health and sexual satisfaction in U.S. adults is limited. The aim is to provide epidemiologic data on the importance of sexual health for quality of life and people's satisfaction with their sex lives and to examine how each is associated with demographic and health factors. Data are from a cross-sectional self-report questionnaire from a sample of 3,515 English-speaking U.S. adults recruited from an online panel that uses address-based probability sampling. We report ratings of importance of sexual health to quality of life (single item with five-point response) and the Patient-Reported Outcomes Measurement Information System Satisfaction With Sex Life score (five items, each with five-point responses, scores centered on the U.S. mean). High importance of sexual health to quality of life was reported by 62.2% of men (95% CI = 59.4–65.0) and 42.8% of women (95% CI = 39.6–46.1, P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race-ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men). In this large study of U.S. adults' ratings of the importance of sexual health and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians' assessments of their patients. Health care systems that state a commitment to improving patients' overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the lifespan.
To improve sexual health, even in this charged political moment, necessitates going beyond biomedical approaches, and requires meaningfully addressing sexual rights and sexual pleasure. A world where positive intersections between sexual health, sexual rights and sexual pleasure are reinforced in law, in programming and in advocacy, can strengthen health, wellbeing and the lived experience of people everywhere. This requires a clear understanding of what interconnection of these concepts means in practice, as well as conceptual, personal and systemic approaches that fully recognise and address the harms inflicted on people’s lives when these interactions are not fully taken into account. Bridging the conceptual and the pragmatic, this paper reviews current definitions, the influences and intersections of these concepts, and suggests where comprehensive attention can lead to stronger policy and programming through informed training and advocacy.
The National Collaborating Centre for Indigenous Health (NCCIH) is a national Indigenous organization established in 2005 by the Government of Canada and funded through the Public Health Agency of Canada (PHAC) to support First Nations, Inuit, and Métis public health renewal and health equity through knowledge translation and exchange.
Sexually Transmitted and Blood-Borne Infections
This website provides more information regarding the occurrence of these infections and the strategies and resources for the prevention, treatment and care of affected individuals in Manitoba.
Check out the list of online resources, including fact sheets, reports, activities, and guidelines related to sexual and reproductive health, harm reduction, and trauma-informed care.
Government of Manitoba and sexual health
The Manitoba government website provides a broad range of sexual health resources across the province for the public, and health care providers on information pertaining to symptoms, causes, treatment, prevention, and more.
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