Fatores relacionados à iniciação das práticas sexuais precoces na adolescência: uma revisão integrativa

Objetivo: identificar evidências científicas acerca dos principais fatores relacionados ao início das práticas sexuais precoces na adolescência. Método: revisão integrativa de artigos publicados em português, inglês ou espanhol, nas bases de dados LILACS, BDENF, MedLine, CINAHL e Web of Science. A questão norteadora foi: quais os principais fatores relacionados com a iniciação das práticas sexuais precoces na adolescência. Foram utilizados os descritores Adolescent, Sexuality, Sexual Behavior, Sexual Intercourse e Coitus, sendo selecionados 38 artigos para análise. Resultados: os resultados deram origem à três classes: Vinculações familiares e entre os pares; Situações de vulnerabilidade e Ações promotoras de saúde. As classes evidenciaram que os fatores relacionados à iniciação das práticas sexuais precoces na adolescência apresentam relações com cenários diversos, capazes de influenciar de forma positiva ou negativa nas decisões do adolescente acerca do início da sua vida sexual. Conclusão: o estudo permitiu uma reflexão crítica acerca dos fatores que contribuem para determinar a iniciação das práticas sexuais precoces na adolescência, como também apreender estratégias protetivas, que concorrem para adiar o início das práticas sexuais.

The Cultural and Methodological Factors Challenging the Success of the Community-Based Participatory Research Approach When Designing a Study on Adolescents Sexuality in Traditional Society

Youth growing up in traditional cultures are split between the messages that they receive on sexuality from their families and those they receive via the internet depicting values of Western culture. The Palestinian-Israeli community, a national, ethnic, and linguistic minority, is an example of this situation. The purpose of this community-based participatory research study is to describe the challenges and lessons learned about launching a community advisory board (CAB) in studies on the taboo topic of adolescent sexuality. Using content analysis, we identified two necessary conditions to convene a CAB on adolescent sexuality in a traditional community: (a) an insider academic researcher, fluent in the native language, able to discuss the linguistic difficulties of sexual terminology and (c) the recruitment of motivated, community activists who were knowledgeable on the topic. The mostly traditional society of Palestinian-Israelis shuns discussions on sexuality; but with these two conditions, the study was a success.

Horror and Camp: Monsters and Wizards and Ghosts (Oh My!) in Big Mouth

This chapter moves readers from Andrew Smith’s adolescence-as-dystopia to the popular animated Netflix series Big Mouth, which represents adolescence as a horror show. Like Grasshopper Jungle, Big Mouth provides audiences with monstrous avatars for the storm and stress of adolescence. Instead of horny, rampaging mutant mantises, however, Big Mouth offers viewers Hormone Monsters, haunted houses, ghosts, and other Gothic tropes as embodiments of those anxieties that surround puberty and its horrifying humiliations. Unlike Grasshopper Jungle, Big Mouth universalizes queerness, celebrates the polymorphous perversity of childhood, and uses camp to defuse many of the anxieties that attend other representations of adolescent sexuality. Big Mouth offers us a kind of camp with strong ties to shame—what Kathryn Bond Stockton calls “dark camp”—and illustrates how shame and debasement can function as a powerful model of relationality, one that unites the show’s young protagonists through shared queer feelings.

“They have this not care – don’t care attitude:” A Mixed Methods Study Evaluating Community Readiness for Oral PrEP in Adolescent Girls and Young Women in a Rural Area of South Africa

Introduction Adolescent girls and young women (AGYW) remain disproportionately affected by HIV. In a rural area of South Africa with an annual incidence (2011–2015) of 5 and 7% per annum for 15–19 and 20–24-year olds respectively, oral pre-exposure prophylaxis (PrEP) could provide AGYW with a form of HIV prevention they can more easily control. Using quantitative and qualitative methods, we describe findings from a study conducted in 2017 that assessed knowledge of and attitudes toward PrEP to better understand community readiness for an AGYW PrEP rollout. Methods We used descriptive analysis of a quantitative demographic survey (n = 8,414 ages 15–86) to identify population awareness and early PrEP adopters. We also conducted semi-structured, in-depth interviews with a purposive sample of 52 potential PrEP gatekeepers (health care workers, community leaders) to assess their potential influence in an AGYW PrEP rollout and describe the current sexual health landscape. Interviews were recorded, transcribed, and iteratively coded to identify major themes. Results PrEP knowledge in the general population, measured through a demographic survey, was low (n = 125/8,414, 1.49% had heard of the drug). Medicalized delivery pathways created hostility to AGYW PrEP use. Key informants had higher levels of knowledge about PrEP and saw it as a needed intervention. Community norms around adolescent sexuality, which painted sexually active youth as irresponsible and disengaged from their own health, made many ambivalent towards a PrEP rollout to AGYW. Health care workers discussed ways to shame AGYW if they tried to access PrEP as they feared the drug would encourage promiscuity and “risky” behaviour. Others interviewed opposed provision on the basis of health care equity and feared PrEP would divert both drug and human resources from treatment programs. Conclusions The health system in this poor, high-HIV incidence area had multiple barriers to a PrEP rollout to AGYW. Norms around adolescent sexuality and gatekeeper concerns that PrEP could divert health resources from treatment to prevention could create barriers to PrEP roll-out in this setting. Alternate modes of delivery, particularly those which are youth-led and demedicalize PrEP, must be explored.