Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia

Abstract

Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives. Methods: In-depth interviews with 35 young Aboriginal women and men aged 16–21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted. Results: Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms. Conclusion: Findings broaden understanding of young Aboriginal people’s sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people’s existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people’s sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as ‘youth health workers’.

Premarital relationships and condom use among young people in Suva, Fiji

“…It is important to move beyond individual behaviour-change strategies that are central to current national policy, 3 and acknowledge the support of peer, family and community networks in promoting young people's SRH. 35,42,43 Our findings illustrate the value of utilising peer educators and supportive adults to enhance access to SRH information and condoms, 20,40,43 supporting previous calls for communitydriven responses to sexual health in the Pacific. 35,44 Another strategy would be to explore safe mechanisms of encouraging parent-child dialogue about SRH issues without consequence for young people who are engaged in premarital sex.…”

Working with Aboriginal young people in sexual health research: a peer research methodology in remote Australia

“…The insight gained from working with young peer researchers was invaluable in relation to the range of data collected (S. Bell, Aggleton, et al, 2020; S. Bell, Ward, et al, 2020), the depth of interpretation possible, and the shared decision-making in relation to potential interventions to be incorporated in the MOST trial.…”

“…This means we were not able to involve them in further analyses of the data beyond their engagement in the peer research cycle described above, nor the resulting publications (S. Bell, Aggleton, et al, 2020; S. Bell, Ward, et al, 2020).…”

Beyond deficit: ‘strengths‐based approaches’ in Indigenous health research

“…We categorised papers as falling within this category if they described their research as taking a ‘social determinants’ or ‘socioecological’ approach (Bell, Aggleton, et al, 2020; Bell, Ward, et al, 2020; Miller et al, 2020; Priest, Mackean, Davis, Briggs, et al, 2012; Priest, Mackean, Davis, Waters, et al, 2012), were ‘assets‐based’ (Blodgett et al, 2013) or sought to look at a combination of ‘risk’, ‘protective’ or ‘salutogenic’ factors (Barker et al, 2017; Bulman & Hayes, 2011; Nakata et al, 2012; Westrupp et al, 2019). By seeking to understand how health is created through the features of the individual, interpersonal and structural settings in which people live, social–ecological approaches provide the opportunity to focus on a broader range of influences (including positive or protective factors) on Indigenous people's wellbeing and health (Fogarty et al, 2018).…”

“…Priest, Mackean, Davis, Waters, et al (2012) describe how Aboriginal Australian parents encouraged their children to build friendships with non‐Aboriginal children in order to strengthen their skills in ‘living across two worlds’. Similarly, Bell, et al (2020) identify how friendship groups among Aboriginal young women in Central Australia advised each other to avoid sexual partners who were believed to pose health risks. Positive relationships with health professionals have also been identified as protective since they can create service environments in which people feel valued and cared for (Bell, Aggleton, et al, 2020; Mooney‐Somers et al, 2009) and health services can offer a place in which to build a sense of community and pride (Priest, Mackean, Davis, Briggs, et al, 2012).…”