Background Young people remain at highest risk of HIV, sexually transmitted infections (STIs) and early pregnancy. The WHO Global School Health Initiative acknowledges the opportunity to promote effective health interventions within the sustainable infrastructure of schools. Safer Choices is a school-based multiple-component whole-school intervention effective in reducing sexual risk behaviours and preventing HIV, STIs and pregnancy among high-school learners. The overall aim of this study is to adapt and evaluate a Safer Choices program to improve uptake of sexual reproductive health (SRH) and HIV-prevention amongst 15-19-year-old learners in rural KwaZulu-Natal, South Africa. Methods This study will use a mixed-method study design guided by the MRC-framework for development and evaluation of complex interventions. We will use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to document modifications to Safer Choices. The study will be conducted across six purposively selected high schools in uMkhanyakude district. The study will be divided into three work-packages (WP): WP1 to adapt and refine Safer Choices to context using participatory research methods; WP2 to pilot and assess acceptability and feasibility of the adapted intervention followed by a process evaluation to understand reach, uptake, acceptability and feasibility of intervention. We will conduct pre/post intervention surveys with 390 randomly selected learners aged 15-19 to measure exposure, satisfaction, changes in self-reported SRH and HIV-risk behaviours. WP3 will include collection of exploratory data on the effect of the intervention on improving resilience and uptake of HIV-prevention and SRH services 60-days post-intervention delivery. Discussion This study protocol paper reports the details of our design for adaptation and evaluation of Safer Choices, with the aim of informing efforts elsewhere and scale-up of this evidence-based intervention. Integrating Safer Choices with SRH and HIV services will likely amplify its effectiveness, offering a holistic framework that addresses the multifaceted nature of HIV prevention.

Background Young people remain at highest risk of HIV, sexually transmitted infections (STIs) and early pregnancy. The WHO Global School Health Initiative acknowledges the opportunity to promote effective health interventions within the sustainable infrastructure of schools. Safer Choices is a school-based multiple-component whole-school intervention effective in reducing sexual risk behaviours and preventing HIV, STIs and pregnancy among high-school learners. The overall aim of this study is to adapt and evaluate a Safer Choices program to improve uptake of sexual reproductive health (SRH) and HIV-prevention amongst 15-19-year-old learners in rural KwaZulu-Natal, South Africa. Methods This study will use a mixed-method study design guided by the MRC-framework for development and evaluation of complex interventions. We will use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to document modifications to Safer Choices. The study will be conducted across six purposively selected high schools in uMkhanyakude district. The study will be divided into three work-packages (WP): WP1 to adapt and refine Safer Choices to context using participatory research methods; WP2 to pilot and assess acceptability and feasibility of the adapted intervention followed by a process evaluation to understand reach, uptake, acceptability and feasibility of intervention. We will conduct pre/post intervention surveys with 390 randomly selected learners aged 15-19 to measure exposure, satisfaction, changes in self-reported SRH and HIV-risk behaviours. WP3 will include collection of exploratory data on the effect of the intervention on improving resilience and uptake of HIV-prevention and SRH services 60-days post-intervention delivery. Discussion This study protocol paper reports the details of our design for adaptation and evaluation of Safer Choices, with the aim of informing efforts elsewhere and scale-up of this evidence-based intervention. Integrating Safer Choices with SRH and HIV services will likely amplify its effectiveness, offering a holistic framework that addresses the multifaceted nature of HIV prevention.

Schools Championing Safe South Africa is an intervention to prevent sexual violence perpetration and HIV/STI risk behavior among teenage boys, focusing on correcting misperceived social norms regarding risk behavior and engaging boys, teachers and peers in school. We tested its acceptability, feasibility, and preliminary efficacy in a pilot RCT (N = 282). 99

High rates of AIDS-related mortality and HIV incidence persist due to delayed antiretroviral therapy (ART) uptake and retention. We qualitatively assessed the feasibility and acceptability of "From Now On" (FNO) - a short video-based psychosocial support intervention to increase ART uptake and improve psychosocial well-being among men newly diagnosed with HIV in South Africa. In-depth interviews were conducted with men who were shown FNO during post-test HIV counselling (n = 12) and with counsellors (n = 9) who used FNO. Participants reported that FNO alleviated the immediate shock following their diagnosis; reduced fear (of death, ART side-effects, stigma and rejection) and instilled hope. Counsellors observed men calming down and positive impacts of FNO on counselling: increased attention, engagement and credibility. FNO appeared to reframe the mental model of living with HIV: "life goes on"; that one can not only live a long, healthy life on ART, but also thrive. The video encouraged disclosure and appeared to reduce internalised stigma. These qualitative findings indicate high intervention acceptability and feasibility and the potential of FNO to increase ART uptake through multiple pathways. Findings generate a hypothesis that warrants further investigation: "From Now On" could improve post-test HIV counselling and systematically provide psychosocial support through a low cost and scalable intervention.

Rates of HIV acquisition and sexual violence perpetration are pressing public health issues for adolescents in South Africa. The evidence base around interventions that concomitantly address both HIV risk and prevention of sexual violence perpetration needs development. This protocol describes the design and procedures for a randomized controlled trial that investigates the efficacy of a behavioral intervention to address HIV and sexual violence called Safe South Africa. Safe South Africa is a behavioral intervention. The intervention takes an integrated approach for preventing or reducing risk behavior related to the acquisition of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and the perpetration of sexual violence among adolescents in South Africa. The behavioral intervention is gender and developmentally tailored for adolescent boys aged 15–17 years and delivered in the school setting. The trial will compare the experimental intervention—Safe South Africa—with control of practice as usual. In South Africa, the practice as usual consists of no intervention, as there are currently no existing interventions that have been proven to be efficacious for reducing the risk for HIV and perpetration of sexual violence concurrently with adolescent boys in this setting. The study is based on the hypothesis that the behavioral intervention—Safe South Africa—will result in adolescent boys randomized to the intervention showing (a) a lower incidence of any STI (including HIV) and (b) reductions in sexual violence perpetration frequency and decreased endorsement of intimate partner violence supportive attitudes as compared to the control. N = 836 participants will be randomly assigned to either the intervention group or the control group with an allocation ratio of 1:1. Eligible participants include the following: (1) identification as boys; (2) ages 15–17 years; (3) enrolled at public high schools in South Africa situated in communities with high rates of HIV and violence. Participants must provide informed written assent (following parental consent). We will compare primary outcomes between the two study arms at 4 and 12 months versus baseline to quantify the intervention’s short- and long-term effects using generalized estimating equations to account for repeated measures. Study findings will allow us to contribute to the evidence base of integrated HIV-violence prevention interventions that meet the needs of adolescents in school settings. This study has been registered at ClinicalTrials.gov under protocol ID NCT03231358. Registered on December 27, 2024.

Social norms, particularly those pertaining to gender equity, can shape attitudes and behaviors that contribute to adolescent sexual violence (SV). This study examines personal attitudes and perceived peer norms regarding gender equity and associations with perpetration of SV among 100 South Africans aged 13-17 in 2019. We assessed: (1) sexual activity and SV behaviors and (2) personal attitudes and perceived peer norms around gender equity. Descriptive statistics, t-tests, and logistic regressions examined associations between attitudes, norms, and SV, adjusting for demographics. Findings reveal that 59% of sexually active adolescents reported perpetrating SV behaviors, though only 8% classified their actions as "rape". Adolescents endorsed more gender equitable personal attitudes compared to their perceptions of peers, highlighting a misperception of social norms. Differences in gender equitable attitudes by biological sex and perpetration status were minimal, however, males and those reporting perpetration were more likely to endorse specific inequitable gender attitudes. Number of lifetime sexual partners was significantly associated with SV perpetration, particularly among males. An age-sex interaction revealed opposing trends - older age was associated with reduced odds of SV perpetration among males but increased odds among females. Correcting misperceived norms is a promising strategy for SV prevention among South African adolescents.

South Africa is a critical hotspot in the global fight against sexual violence and HIV. We report on the development of Schools Championing Safe South Africa, a behavioural intervention that engages adolescent boys and their peers to identify and address misperceived norms related to these epidemics within the school setting. A social norms survey conducted among 1,431 students aged 13-19 at 3 high schools guided the development of intervention content. The survey captured self-reported and perceived peer sexual violence and HIV norms and behaviours. Analyses identified major misalignment (>20%) between perceived peer behaviours/norms and actual behaviours/norms. Perpetration of unwanted sexual petting, oral, vaginal, and anal sex was high: 61%, 53%, 53%, and 44% among boys, and 42%, 26%, 20%, and 18% among girls. We identified underestimation of peer support for bystander intervention, overestimation of peer acceptance of gender-based violence, and underestimation of the extent to which peers would believe a survivor. No misalignment between self and peer HIV risk behaviours were identified. Gaps between actual and perceived behaviours/norms are important targets to correct in a behavioural intervention. Given the interconnected risk factors associated with sexual violence and HIV, addressing them together presents a crucial opportunity to maximize prevention efforts.

African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.

Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.

In recent years, significant progress has been made in treatment access for women living with HIV (WLHIV). For example, option B+, which requires that all pregnant persons who test positive for HIV start on antiretroviral treatment, has been instrumental in reducing the risk of vertical transmission. For birthing individuals who have a low HIV viral load, there is a minimized risk of vertical transmission during breastfeeding. However, an alarming rate of WLHIV in South Africa disengage from care during postpartum. Given that work is intricately linked to individuals' socioeconomic status, and thus health outcomes, and their health-seeking ability, it is important to explore the role of work in decisions that impact HIV-related care for the dyad postpartum. Semi-structured interviews were conducted with 26 women living with HIV at 6-8 weeks postpartum in Cape Town, South Africa. A secondary qualitative data analysis was conducted following thematic content analysis. Three themes were identified, spanning participants' financial considerations, navigating childcare needs, and considerations for exclusive breastfeeding. For many participants, there was often a conflict between returning to work, childcare, and the decision whether or not to breastfeed-in addition to their HIV care. This conflict between participants' commitments suggests an increased pressure that WLHIV may face postpartum, which could impact their ability to remain engaged in their healthcare and adherent to medication. Although exclusive breastfeeding is an important recommendation for the baby's health outcomes; there is a need for structural support for WLHIV as they navigate work re-entry during postpartum.

Jamaica has one of the highest teenage pregnancy rate and therefore identifying the context of adolescent sexual and reproductive health is important, especially since there is paucity of research on preadolescents in the Jamaican context. The study was a nationally representative cross-sectional, interviewer administered, school-based survey of 10 -15 year olds. Summary statistics of the demographics and bivariate analyses were performed to assess the association of sexual initiation and given risk and resiliency factors. 1,422(47.4%) males, 1,581 (52.6%) females, mean age (SD) 12.5 (1.6) years were surveyed. Mean age of first sex was 11.0 (±2.5) years. Factors significantly with sexual initiation were, female sex (OR 0.17; 95% CI 0.12-0.23), caring relationships inside the home (OR 0.85; 95%CI 0.83-0.97) rare church attendance (OR1.36; 95%CI1.0-1.8), age (OR 1.75; 95%CI1.6-1.9) and community disorganization (OR 1.02 95% CI 1.01-1.07). Sexual initiation of early adolescents is positively influenced by environmental factors such as family connectedness and religious involvement. The negative correlates are societal risk factors such as community disorganization. Empowerment through learned sexual negotiation skills, should be incorporated into the education programme of pre-adolescents to facilitate adolescents embracing their intrinsic power to delay sexual debut and if sexually active to insist on condom use.

Aims Sexual harassment (SH) is a widespread and recurring problem in educational settings. SH is not easy to define, partly because it does not involve a homogenous set of behaviours. There are gender variations in the experience and perception of SH. Risk factors for SH include female gender and gender inequality, same-sex attraction, poverty, poorly trained, underpaid, and understaffed educators. The study aimed to determine the prevalence rates and correlates of heterosexual and same-sex SH and to explore the social and mental health sequelae of SH among students and staff of first-generation universities in South-west Nigeria. Methods A cross-sectional survey was done in three first-generation universities in southwest Nigeria. A sample size of 550 participants per institution was estimated with a margin of error of 2.5%, a 95% confidence level. This gave a total sample size of 1650 respondents participants for the study. In each university, Students and staff were categorized by faculties into 3 clusters: science, social science, and arts. A proportionate sampling technique was used. Participants were assessed for SH, age, sexual orientation, gender, motivation for dressing, depressive symptoms, and suicidality. Associations were tested using Pearson correlations. Results SH was higher with age, among females, among lesbian, gay, and bisexual (LGB), participants with sexual motivation for dressing, high sexual desire, high suicidality, and low perception of campus safety. In terms of gender differences, correlation with age was slightly higher in females while correlations with lesbian/gay status was higher in males. In terms of sexual orientation, correlation with age was largest in LGB, association with dressing motivation, sexual desire, and depressive symptoms scores was greatest in heterosexual participants, association with suicidality scores was greatest with lesbian/gay status; and correlation with perception of campus as safe lowest among bisexual participants. Generally, the associations were weakest among staff compared to students. Conclusion There are certain demographics (heterosexual and bisexual females and gay men) that appear to be more vulnerable to SH in tertiary institutions. The correlates of SH also vary in the different sample groups. These should be considered when programming for prevention and response to SH in Nigerian tertiary institutions.

Resilience, or multilevel processes related to thriving, offers a strengths-based approach to reducing HIV and sexual risk behaviors among girls and young women. Processes of resilience may change based on the experience of living with HIV. However, little is known about how resilience and serologically verified HIV status influence sexual health. Using weighted cross-sectional data collected during 2017-2018 from South African girls and young women aged 15-24 (N = 7237), this article examines associations between resilience and three sexual risk behaviors among those living with and without HIV. Logistic regression models indicated greater resilience scores were associated with reduced odds of engaging in transactional sex and early sexual debut. Results also identified differing associations between resilience and sexual risk behaviors by HIV status. Findings provide implications for programming to prevent HIV and improve sexual health while underscoring the need for tailored resilience-promoting interventions for South African girls and young women living with HIV.

Background While Option B + has made great strides in eliminating vertical transmission of HIV and improving access to lifelong antiretroviral therapy (ART) for women, the postpartum period remains a risk period for disengagement from HIV care and non-adherence. Methods Longitudinal qualitative data was collected from 30 women living with HIV in Cape Town, South Africa from pregnancy through 1 year postpartum to examine key barriers and facilitators to HIV treatment adherence across this transition. Participants were also asked about their preferences for behavioral intervention content, format, and scope. The intervention development process was guided by Fernandez et al.’s Intervention Mapping process and was informed by the qualitative data, the wider literature on ART adherence, and Transition Theory. Results The Womandla Health Intervention is a multicomponent intervention consisting of four individual sessions with a lay health worker and four peer group sessions, which span late pregnancy and early postpartum. These sessions are guided by Transition Theory and utilize motivational interviewing techniques to empower women to ascertain their own individual barriers to HIV care and identify solutions and strategies to overcome these barriers. Conclusions This intervention will be tested in a small scale RCT. If successful, findings will provide an innovative approach to HIV treatment by capitalizing on the transition into motherhood to bolster self-care behaviors, focusing on ART adherence and also women’s overall postpartum health and psychosocial needs.

Background: A low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial.Methods: We conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis.Results: Concurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms.Conclusions: Should a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes.

IntroductionPeer support can help navigate the isolation and psychological strain frequently experienced by youth living with chronic illness. Yet, data are lacking on the impact of providing support for youth living with mixed chronic conditions. We assessed the acceptability, feasibility and preliminary mental health impacts of a clinic-based peer support group for South African youth living with chronic illnesses, including HIV.MethodsThis mixed-methods pilot study (September 2021-June 2022) enrolled 58 young patients, ages 13-24, at an urban hospital in Cape Town, South Africa. In-depth interviews elicited the perspectives of 20 young people in relation to their participation in the Better Together programme, a recurring clinic-based peer support group for patients with mixed chronic illnesses. Self-reported resilience, attitudes towards illness, stigma and mental health were captured via established measures. T-tests and multivariate analysis of variance compared psychosocial outcomes for 20 group participants and 38 control patients, controlling for socio-demographic characteristics at enrolment. Logistic regression analyses estimated the predicted probability of a positive depression or anxiety screening given peer group participation.ResultsAll interviewees valued being able to compare treatment regimens and disease management habits with peers living with different conditions. Adolescents living with HIV stated that understanding the hardships faced by those with other conditions helped them accept their own illness and lessened feelings of isolation. Compared to patients who did not participate in Better Together, those who attended >= 5 groups had statistically significantly higher individual-level resilience, a more positive attitude towards their illness(es), lower internalised stigma and a more positive self-concept. The probability of being screened positive for depression was 23.4 percentage points lower (95% CI: 1.5, 45.3) for Better Together participants compared to controls; the probability of a positive anxiety screening was 45.8 percentage points lower (95% CI: 18.1, 73.6).ConclusionsRecurring, clinic-based peer support groups that integrate youth living with HIV and other chronic diseases are novel. Group sustainability will depend on the commitment of experienced peer leaders and providers, routine scheduling and transportation support. A fully powered randomised trial is needed to test the optimal implementation and causal mental health effects of the Better Together model.

BackgroundThe phenomenon of sexual harassment (SH) is a complex issue with multiple prongs that concerns all members of academia and raises serious challenges, particularly regarding prevention and response. SH in tertiary institutions remains a huge problem worldwide, leading to severe emotional, academic, and career difficulties, as well as undue suffering. Institutions have responded in various ways to alleviate the burden of SH with little success, especially in Nigeria. The prevalence is high but reportage is low because of the culture of silence around SH in most educational institutions. This study aims to identify factors associated with SH in tertiary institutions in Nigeria and explore factors surrounding reportage or nonreportage following the experience of SH, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH. ObjectiveThe objective of this study was to present a study protocol that is designed to identify factors associated with the experience of SH in tertiary institutions in Nigeria, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH. MethodsA mixed (quantitative and qualitative) methods approach is used consisting of a policy review of existing antisexual harassment policies in the selected universities, a quantitative survey to determine the correlates of SH, focus group discussions to explore the perspectives of the university community concerning SH, in-depth interviews to explore the lived experiences of survivors of SH, and key informant interviews to understand the perspectives of people who provide interventions to survivors. ResultsThis study was funded in July 2022 by the Consortium for Advanced Research Training in Africa, and data collection started in November 2022. The SH policies were comprehensive, with clear policy statements and definitions, and recognized a wide range of survivors and perpetrators. However, there was no clear mention of prevention and response to same-sex SH. Lived experiences showed negative psychological and social sequelae and little institutional support. ConclusionsThis is the first study that has a component investigating same-sex SH in tertiary institutions in Nigeria. This is also one of the first studies to explore the lived experiences of survivors of SH in Nigerian universities. The findings from this study suggest that periodic evaluation of SH policy implementation will improve institutional support, thus creating safe spaces for survivors and will thereby encourage reportage and support; prevention and response strategies need to be more inclusive; and more interventions should focus on strengthening prosocial skills and healthy, equitable relationships. International Registered Report Identifier (IRRID)DERR1-10.2196/49126

This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.

Adolescence and emerging adulthood are times of heightened adversity for South African girls and young women due to structural disadvantage. In this mixed-methods study, we explored lived experiences of resilience among a sample of 377 South African girls and young women (15-24 years) who completed a quantitative cross-sectional survey that included a validated measure of resilience. Quantitative analyses included descriptive statistics and an independent sample t-test to assess differences in resilience. These analyses informed the development of a semi-structured qualitative interview agenda. A purposive sample of 21 South African girls and young women (15-24 years) from the same survey area participated in in-depth interviews. Interviews were analyzed for perceptions of difference in resilience by age and narratives of resilience during transitions to adulthood. Survey results indicated younger participants (15-17 years) perceived themselves to be less resilient than older participants (18-24 years). Qualitative interview results supported the survey results, and pointed to a broader difference in perceived resilience between younger women and older women. Programming and policy implications for future resilience research among this population are discussed.

The aim of this study was to explore the lived experience of survivors of sexual harassment, as well as reportage factors and outcomes, psychosocial sequelae, and how survivors coped in first-generation higher-education institutions in Southwestern Nigeria. A qualitative exploration of the experience of 12 (11 females and 1 male) participants using in-depth interviews was conducted. The findings were grouped into four broad themes, namely: (i) experience of sexual harassment, (ii) reporting patterns, (iii) coping strategies, and (iv) the physical and emotional impact of sexual harassment. Most survivors had experienced sexual harassment multiple times and same-sex harassment occurs in higher-education institutions. Survivors did not report to university authorities because of the perception that the support from the environment was poor. Many shared information with their support networks or visited a psychologist for mental health care. Others used maladaptive coping mechanisms such as increased alcohol consumption. Mental health symptoms ranged from mild to severe. Institutes of higher education need to take decisive actions to improve the environment and to promote the prompt reporting of sexual harassment by survivors; they must also provide access to support to prevent the development of mental health problems, which are a common post-event occurrence, as identified in the present study.