BACKGROUND:Bacterial sexually transmitted infections (STIs) cause a substantial disease burden worldwide and disproportionately impact young people. In Australia, Aboriginal and Torres Strait Islander people are a priority population in STI testing guidelines. METHODS:The More Options for STI Testing trial evaluated whether providing an incentive impacted STI testing rates in select Central Australian communities. Aboriginal and Torres Strait Islander people aged 16 to 29 years were eligible for a A$30 phone voucher if they had an STI test at a participating Aboriginal community-controlled primary health care clinic. An interrupted time series analysis examined monthly STI test counts for chlamydia, gonorrhea, or syphilis from 2015 to 2020, to determine whether testing increased during the incentives phase (2018-2020). RESULTS:There were a total of 10,457 visits to the clinic in which an STI test was conducted, 5110 of which were during the incentives period. A total of 1526 incentives were provided to eligible clients. The baseline and incentives periods were each divided into 2 phases to account for new clinic openings and the COVID-19 pandemic. Among men, average monthly visits for an STI test were 32.6 (baseline phase 1), 44.1 (baseline phase 2), 50.8 (incentives phase), and 35.4 (incentives/COVID-19 phase). Women had 93.5, 111.3, 118.8, and 113.4 visits, respectively. No significant change in STI testing was observed during the incentives phase. The proportion of visits for an STI test where an incentive was paid (coverage) varied by month, from 36% to 76% of consultations. CONCLUSIONS:The limited impact of incentives could be explained by low coverage or that the incentive was not motivating enough to overcome STI testing barriers. Future studies should investigate alternative methods of increasing STI testing in remote Central Australia, including through primary care clinics.

Unsafe abortion is a preventable contributor to maternal morbidity and mortality, particularly for young unmarried women in low resource settings. In Papua New Guinea, abortion is legally restricted and highly stigmatised, limiting access to safe abortion and post-abortion care, resulting in unsafe abortion. This paper explores young people's lived experiences and agency in relation to unsafe abortion. We undertook qualitative research between 2019 and 2021 in rural, peri-urban and urban settings in Papua New Guinea and found that agency was enacted or constrained at different points along their abortion trajectories. Findings demonstrate the ways in which abortion was negotiated within (and outside of) young people's intimate relationships, while highlighting the social, temporal and emotional dimensions of this agency. By considering what agency means, and the different forms it takes, it is possible to identify critical support mechanisms and socio-structural changes that could support young people at different stages of their abortion trajectories, from accessing modern contraceptives to prevent unintended pregnancy, to seeking support for safe abortion. Moving forward, we call for greater attentiveness to young people's everyday lived experiences of sexual and reproductive health as a basis for understanding how to support them to safely prevent and manage unintended pregnancy.

This strengths-based study investigated Aboriginal adults' views on young people's sexual health, attitudes and relationships. Between 2019 and 2020, sixteen interviews were conducted with adults aged 25 and older from two Aboriginal communities in Western Sydney, Australia. In this paper, we discuss adults' perspectives on intergenerational communication about sex in their communities. Participants highlighted intergenerational learning via talking as a highly valued community practice and a crucial social-cultural resource for supporting young people's sexual wellbeing. However, they also identified stigma, shame and perceived generational differences as barriers to adults talking openly with younger people about sex. To foster more open intergenerational discussion, participants recommended adopting holistic, positive and non-judgemental approaches when engaging with young people. They also emphasised the need for community-wide initiatives - such as programmes and services - that encourage collective learning, yarning and care to promote positive sexual health outcomes.

Purpose Significant improvements have been made in Aboriginal and Torres Strait Islander peoples’ (First Nations) maternal and perinatal outcomes over the past decade, such as decreasing rates of smoking and preterm birth and increasing birthweights. In Australia, higher rates of adolescent pregnancy are reported among First Nations compared with non-First Nations people. Having a baby during adolescence (youth pregnancy) increases the risk of poorer maternal and perinatal outcomes, including social outcomes such as poverty and educational attainment. This study examined First Nations peoples’ perspectives about youth pregnancy and parenthood in Western Sydney, Australia. Methods Sixty-eight First Nations people aged ≥16 years living in Western Sydney, Australia were interviewed in 2019–20. Interview data were analysed using thematic analysis. Main findings Approximately half of the participants were aged ≥18 years. Most participants lived with family and around half were high school students. Four themes relating to youth pregnancy and parenthood were identified: 1) youth pregnancy was normalised (e.g. ‘There’s always some young person in [the] community pregnant, if not several… it’s celebrated as well. It’s not so much of a negative thing’); 2) a desire to avoid youth pregnancy (e.g. ‘I think young people try and avoid pregnancy because they don’t wanna be a teen mum’); 3) gendered experiences of youth pregnancy and parenthood (e.g. ‘I don’t think a teenage boy would have like time like for a baby’); and 4) perspectives of caring responsibilities within families (e.g. ‘I feel like within Aboriginal communities, it’s always seen as the oldest kid has to kind of help out the parent’). Principal conclusions Although youth parenthood was acceptable in communities, most participants wanted young people to avoid pregnancy and parenthood. There was a clear community approach to raising children, especially from the oldest children helping out with child raising.

PURPOSE:Historically, adolescent pregnancy has been conceptualized as an outcome of child marriage, but in Southeast Asia, the contexts and drivers of adolescent pregnancy are less well-understood. This study examines the relationship between adolescent pregnancy and child marriage and explores the drivers of pregnancy in Cambodia, Indonesia, Lao People's Democratic Republic and Malaysia among adolescents who have experienced pregnancy. METHODS:Using participatory timeline interviews, we conducted semistructured interviews with 260 adolescent girls aged 15-21 years with lived experience of pregnancy in urban and rural settings in Cambodia, Indonesia, Lao People's Democratic Republic and Malaysia. Data were analyzed using an inductive framework approach to allow within and cross-case analysis and map girls' pathways to pregnancy. RESULTS:We found diverse pathways to adolescent pregnancy occurring outside and within unions. Pathways diverged according to nature of sexual experience leading to pregnancy (consensual, pressured, forced), girls' relationships (romantic or not), pregnancy intention (unintended, partner-led and intended), and union initiation (peer-, partner- or parent-led, or no union). Common drivers of pregnancy included lack of sexual and reproductive health information, low contraceptive use, girls' limited agency in sexual and contraceptive decision-making, and limited access to health services, alongside community acceptance of child marriage. DISCUSSION:Adolescent girls' lived experiences highlight key and differing points in their pathways to pregnancy where there are opportunities for policies and programs to address girls' specific needs and contexts.

The World Health Organization (WHO) recently released revised guidelines on self-care interventions for health and well-being, which, in 2022, included recommendations supporting equitable access to information about and availability of pre-exposure prophylaxis (PrEP) as a self-care strategy. Successful implementation of PrEP as an HIV prevention strategy extends beyond providing access to medication. It hinges on individuals adopting self-care strategies to ensure adherence to PrEP in their daily lives. This paper aims to explore self-care strategies that bolster adherence to oral PrEP among female sex workers in two rural Ugandan settings. Through in-depth interviews with 20 female sex workers residing in fishing communities or Trans-Africa highway towns, we used deductive thematic analysis to explore people-centred and health system-centred perspectives on women’s PrEP-related self-care strategies. A people-centred perspective on self-care illustrated a range of self-care strategies to support PrEP adherence conducted by women individually (medication reminders; pairing PrEP with daily habits), and with support from others in familial and social networks (verbal reminders to take tablets; information sharing; shared clinic visits; shared pill-taking routines). A health system-centred perspective illustrated the importance of support from health services and professionals. Examples included information provision; NGO clinics as friendly, safe, non-judgemental spaces; PrEP distribution through home-based care outreach strategies; in-bulk PrEP provision for work-related travel periods; formal integration of female sex workers into the system as peer health workers. By considering both person-centred and health system-centred perspectives on self-care, we can pinpoint strategies for health systems to assist female sex workers and their communities in preventing the acquisition and transmission of HIV.

INTRODUCTION:Unintended pregnancy among adolescent girls is a public health priority globally, particularly in Papua New Guinea (PNG), where low contraceptive use among young people has resulted in some of the highest adolescent fertility rates in the Asia-Pacific region. This paper investigates the socio-structural influences on adolescent girls' ability to prevent unintended pregnancies in PNG. METHODS:Qualitative research conducted between 2019 and 2021; inductive thematic analysis of in-depth interviews with 19 adolescent girls aged 15-17 years living in rural, peri-urban and urban research sites in PNG. RESULTS:Socio-structural influences were identified that increased the likelihood of unintended pregnancy: barriers to accessing health services for sexual and reproductive health (SRH) purposes; a lack of provision of SRH information and education in school or community settings, leading to misunderstanding of reproduction and fertility, pregnancy prevention and contraception; poor interactions with health service providers that discourage future service use; constrained intergenerational communications about sex, relationships and family planning between girls and adults based on norms and expectations associated with gender, age and marital status; reliance on informal peer and community information sources; lack of availability and accessibility to modern contraceptives; and a lack of adolescent-centred SRH services. Despite this, girls demonstrated agency through attempts to use modern and traditional contraceptive strategies to prevent pregnancy, often with the support of others within their familial and social networks. Their agency was constrained by a lack of school-based and community-based education about sex and relationships, and access to confidential, non-judgemental SRH services, where they can learn about and access modern contraceptives. CONCLUSION:Adolescent girls' access to contraceptive services-at an earlier age, in time for their first sexual experiences-requires action in policy and community settings to elicit socio-structural change that is supportive of young women's SRH and well-being.

HIV prevention programs focus on global "key populations" and more localized "priority populations" to ensure effective targeting of interventions. These HIV population categories have been subject to considerable scholarly scrutiny, particularly key populations, with less attention given to critically unpacking priority populations at local levels, for example "serodiscordant couples" (one partner has HIV, but not the other). We examine this population in the context of Papua New Guinea to consider how local configurations, relational pathways, and lived realities of serodiscordant relationships strain the boundaries of this population category and raise intriguing questions about its intersection with contemporary biomedical agendas.

This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. It does so to counter the risk-focussed narratives present in much existing research and to showcase the resourcefulness of Aboriginal young people. We used peer-interview methods to collect qualitative data from 52 Aboriginal young people living in western Sydney, Australia. Participants reported a strong desire to stay safe and healthy in their sexual relationships and to achieve this they relied heavily on oral communication and yarning strategies. Participants viewed communication as a way to gain or give advice (about bodies, infections, pregnancy, relationships); to assess the acceptability and safety of potential partners; to negotiate consent with partners; to build positive relationships; and to get themselves out of unhealthy relationships. Participants also discussed 'self-talk' as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people's positive views of self and as deserving of respectful and safe sexual relationships. These findings suggest that future programmes and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy Aboriginal young people already use to build positive relationships and identities.

Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.

Combined education and counselling can contribute to person-centred care for tuberculosis (TB), improving uptake, adherence, and outcomes of treatment for TB disease and TB infection. Though strongly recommended by the World Health Organization for all people diagnosed with TB, education and counselling is not widely implemented in TB programs around the world. In 2016, a pilot TB education and counselling program, delivered by trained professionals and peers, was initiated to support people on TB treatment in the South Fly District of Papua New Guinea. This article reports on select findings from a qualitative study that examined the socio-cultural dimensions of TB, including treatment support such as education and counselling, in the South Fly District. An assessment on data collected during 128 semi-structured in-depth interviews of the role of counsellors on TB treatment journeys revealed strong participant support for the counsellors and the services they delivered, with particular emphasis on the emotional support provided to address fears and concerns related to TB diagnosis and treatment, and to support treatment adherence; valuable attributes of counsellors; their role as intermediaries between patients and health workers; their provision of biomedical knowledge of TB transmission and disease; and their assistance in addressing stigma and discrimination from family and community. Participants also noted how tackling the socio-structural issues that drive TB transmission in people’s homes and communities were beyond the remit of counsellors’ work. TB education and counselling should be an essential part of all TB services to provide support and encouragement for people to continue treatment to completion.

Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than 'patient delay' attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.

Despite recognition that sex and pregnancy are deeply relational, little attention has been given to young men's experiences of pregnancy, including the socio-structural factors that enhance the risk of unintended pregnancy. Recognising and valuing the importance of working with young men, and engaging with concepts of vulnerability and sexual agency, this chapter describes findings from a qualitative study of sexually active young men in Papua New Guinea to examine steps taken to prevent unintended pregnancy. Findings show that young men demonstrate sexual agency using the information they have access to regardless of its quality in efforts to prevent pregnancy. Findings offer hope that should young people have access to reliable information and effective means of prevention, they can pursue happy sexual lives, free from unwanted pregnancy and other adverse outcomes such as sexually transmittable infections.

Men who have sex with men in Uganda are a heterogenous, discriminated population, experiencing high HIV burden, limited access to HIV testing, and low treatment adherence. We contribute to the lack of information about men who have sex with men in rural Uganda by using socio-ecological analyses to examine the social influences shaping their engagement with HIV services. Based on in-depth interviews with 16 men, our findings reveal the inhibitive influence of interpersonal relationships with sexual partners, peers and families, and institutional influences within health service and non-governmental organizational settings. Yet men take action to strategize and seek support to enhance engagement with HIV care in heavily criminalized and stigmatized settings. Future HIV prevention, testing, treatment, and care responses could draw on what affected individuals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.

Background HIV prevalence among female sex workers in Indonesia remains high and large proportions of female sex workers have never been tested for HIV. International research highlights the importance of community-led strategies to increase HIV testing in this population. Little qualitative research has been conducted to address these issues in Indonesia or other Asia-Pacific countries. This paper documents social influences that enhance HIV testing among female sex workers in urban Indonesia.METHODS:This was an interpretive qualitative study in Yogyakarta, Denpasar and Bandung. In total, 57 female sex workers participated in 11 focus group discussions, and four participated in individual semi-structured interviews. Deductive and inductive thematic analysis techniques were used to identify narratives of strengths pertaining to uptake of HIV testing.RESULTS:Participants described supportive relationships with peers, community-based organisations and 'bosses'. Participants reported trusted networks with peers within which to share information about HIV testing and receive emotional support. Relationships with community outreach workers facilitated HIV testing through reminders, accompanied visits, and emotional/informational support. Community-based organisations worked with health services to facilitate mobile, community-based testing to overcome employment- and family-related constraints that inhibited women's clinic attendance. 'Bosses' employed a variety of practices to encourage HIV testing among their workers.CONCLUSIONS:Relationships, practices and action in community- and workplace-based settings outside formal health service spaces enhanced HIV testing among female sex workers. Community- or workplace-based HIV testing with outreach support from health services, peer-led HIV testing within existing social and work-based networks, and working with bosses to implement HIV prevention strategies can address low HIV testing rates in this key population.

In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done "on" rather than "with" or "by" them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involving Aboriginal young people as researchers, advisors, and participants in a qualitative sexual health study in one remote setting in the Northern Territory, Australia. We document the methodology, while critically reflecting on its benefits and limitations as a decolonizing method. Findings confirm the importance of enabling Aboriginal young people to play a central role in research with other young people about their own sexual health. Future priorities include developing more enduring forms of coinvestigation with Aboriginal young people beyond data collection during single studies, and support for young researchers to gain formal qualifications to enhance future employability.

The World Health Organization has emphasised the importance of HIV testing for couples as part of a global strategy to support the HIV prevention needs of couples, particularly those whose test results are ‘serodiscordant’ (one partner is diagnosed HIV-positive, the other HIV-negative). Studies have focused on motivations and barriers to testing together as a couple. However, this provides only partial insights into a bigger and often more complex story. In addition, little is known about whether HIV-negative partners continue to test for HIV. We focus on the preludes and aftermaths to HIV testing that can make up the serodiscordant chain of events, drawing on qualitative interviews with people in serodiscordant relationships in Papua New Guinea (PNG). Inspired by sociological/anthropological conceptualisations of diagnosis as relational and composite, our analysis seeks to trace the unfolding events before and after couples discover their mixed HIV status and, by so doing, generate initial insights into the contexts of HIV testing and serodiscordance in PNG. We argue that to understand HIV testing practices among couples, we need to understand the localised and syncretised meanings they bring to their serostatus.