Background The protracted battle against coronavirus disease 2019 (COVID-19) has had a profound impact on various facets of society. The epidemiology of several diseases underwent alterations following the implementation of social restrictive strategies and non-pharmaceutical interventions (NPI). Methods In response to these changes, we conducted a retrospective nationwide surveillance study to investigate the prevalence of sexually transmitted infections during the pandemic. Weekly incidences of gonorrhea, syphilis, human immunodeficiency virus (HIV), and enterovirus were extracted from the national surveillance database. Results Over the period from 2015 to 2022, a sustained increase in gonorrhea notifications was evident (linear trend with a rising slope of 0.24 and an R-squared value of 0.62). When comparing the pre-pandemic period (2017-2019) with the pandemic period (2020-2022), a significant surge in gonorrhea notifications was observed (85 notifications per week pre-pandemic vs 143 notifications during the pandemic, representing a 68% increase, P Conclusions Our study highlights a significant rise in gonorrhea notifications during the pandemic. Despite disruptions to gonorrhea testing and medical services, and the implementation of NPI, there was no significant decrease in the incidence of gonorrhea in Taiwan. Gonorrhea emerged as a critical public health concern during the pandemic.

Background Sexual health service engagement is important for the healthy sexual development of young people. Further, as later adolescence and early adulthood are critical periods for relationship development, sexual health needs may vary across this period and be associated with relationship status. Methods A total of 468 participants, aged 16-25years (mean age: 19.7years) and living in the United Kingdom, completed an anonymous, online survey about their sexual health service use. To explore how relationship status is associated with engagement for five different sexual health services, we conducted chi-squared and multivariable logistic regression analyses. Results In general, engagement with sexual health services was low: 28.2% reported accessing free condoms, 21.4% reported STI testing, and 9.4% had used relationship advice services. Among women only, 57.2% had accessed services to start the pill and 19.6% had done so for pregnancy testing. Among all participants, those in relationships were more likely to have accessed sexual health services for free condoms (aOR: 1.71, 95% CI: 1.13, 2.59). Among female participants, those in relationships were more likely to have accessed sexual health services to start the pill (aOR: 2.21, 95% CI: 1.45, 3.36) and for pregnancy testing (aOR: 3.86, 95% CI: 2.20, 6.78). There were no differences by relationship status for accessing sexual health services for STI testing or relationship advice. Conclusions Health care providers and relationship and sexual education providers should encourage all young people to engage with sexual health services, while also recognising that sexual health needs are likely to vary depending on relationship status.

Background The aims of this study were to evaluate the experiences of telehealth for routine HIV care and identify preferred models of HIV routine care for the future. Methods Anonymous, online questionnaire among people living with HIV aged 18years or older. This survey was advertised via posters with a QR code in six sexual health clinics and one community organisation as well as on social media from November 2021 to December 2022. Results Of 89 participants, the majority were males (80/89, 89.9%), between 36 and 55years old (49/89, 55.1%), spoke English at home (74/89, 84.1%), had been living with HIV for >5years (68/89, 76.4%) and reported having a telehealth consultation since the COVID-19 pandemic began (69/89, 77.5%). The top three liked aspects of telehealth were: the convenience of not leaving home or work (50/69, 72.5%); less travel time (48/69, 69.6%); and avoiding contact with other people (30/69, 43.5%). The top three dislikes of telehealth were: they could not be screened for sexually transmitted infections (STIs) or have a physical examination at the same time (29/69, 42.0%); it was an impersonal experience (20/69, 29.0%); and it was more difficult to discuss health concerns (18/69, 26.1%). Among all participants, the preference for future consultations was to have a mix between in-person and telehealth (40/89, 44.9%); however, nearly one-quarter prefer in-person consultations only (20/89, 22.5%). Conclusions Use of telehealth during COVID-19 has been evaluated positively among people living with HIV that participated in this survey. Participants support the use of telehealth for routine care in conjunction with in-person consultations.

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n =18) and British Columbia (n =20), Canada, as part of a mixed-methods implementation science study (2020-2022). Over 3years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

Background Pre-exposure prophylaxis (PrEP) is a safe and effective medication for preventing HIV acquisition. We examined Australian general practitioners' (GP) knowledge of PrEP efficacy, characteristics associated with ever prescribing PrEP and barriers to prescribing. Methods We conducted an online cross-sectional survey of GPs working in Australia between April and October 2022. We performed univariable and multivariable logistic regression analyses to identify factors associated with: (1) the belief that PrEP was at least 80% efficacious; and (2) ever prescribed PrEP. We asked participants to rate the extent to which barriers affected their prescribing of PrEP. Results A total of 407 participants with a median age of 38years (interquartile range 33-44) were included in the study. Half of the participants (50%, 205/407) identified how to correctly take PrEP, 63% (258/407) had ever prescribed PrEP and 45% (184/407) felt confident with prescribing PrEP. Ever prescribing PrEP was associated with younger age (AOR 0.97, 95% CI: 0.94-0.99), extra training in sexual health (AOR 2.57, 95% CI: 1.54-4.29) and being a S100 Prescriber (OR 2.95, 95% CI: 1.47-5.90). The main barriers to prescribing PrEP included: 'Difficulty identifying clients who require PrEP/relying on clients to ask for PrEP' (76%, 310/407), 'Lack of knowledge about PrEP' (70%, 286/407) and 'Lack of time' (69%, 281/407). Conclusion Less than half of our GP respondents were confident in prescribing PrEP, and most had difficulty identifying who would require PrEP. Specific training on PrEP, which focuses on PrEP knowledge, identifying suitable clients and making it time efficient, is recommended, with GPs being remunerated for their time.

Sexual health and well-being are critical for people across all age groups. However, older adults are neglected in sexual health research, programs, and policies. This editorial is a call to action for greater attention to the sexual health of older adults. We welcome all related research on this topic, but are particularly interested in manuscripts related to sexual functioning and co-morbidities, menopause and related topics, sexual health service utilization, research that links sexual activity and health, perspectives from low and middle-income countries, and community-engaged research on sexual health among older adults.

Background Sexual health is an essential component of health and well-being across the life course. However, sexual health research often focuses on young adults and excludes those aged 45years and older. We organized a national crowdsourcing open call and co-creation events to identify recommendations to improve sexual health service provision for middle-aged and older adults in the United Kingdom (UK). Methods We conducted a crowdsourcing open call and seven co-creation events consisting of workshop-style meetings and one-to-one in-depth interviews. Open call submissions and qualitative data from the co-creation events were analyzed using a thematic approach. A social-ecological framework was used to code deductively, but new codes were allowed to emerge. Thematic categories were organized to describe factors influencing the accessibility and inclusivity of sexual health services for middle-aged and older adults. Results We received 22 submissions in total; of those, 35% of participants reported a disability, 40% of individuals were aged 45-65years, and 6% of submissions came from individuals that identified as gay/lesbian. Five key themes highlighted that improving sexual health services for adults aged 45years and over requires a multi-leveled approach: increase sexual health education, enhance patient and provider relationships, utilize community-led sexual health promotion efforts and delivery of reliable sexual health information, improve inclusive sexual health services, and break down sexual health taboos against adults aged 45+ years. Conclusions Our data suggest that middle-aged and older adults can co-create compelling strategies to enhance sexual health services for middle-aged and older adults in the UK. Further implementation research is needed to pilot these strategies.

Background Transactional sex, which involves the exchange of sex for money, goods or other items of value, has been associated with adverse health outcomes, such as HIV and other sexually transmitted infections, mental health challenges, and substance use. Although transactional sex has been extensively studied globally among cisgender and transgender women, there is a lack of comprehensive understanding regarding its prevalence and correlates among gay, bisexual and other men who have sex with men (GBMSM), particularly in Nepal. Thus, this study aimed to examine the prevalence of transactional sex and its associated factors among GBMSM in Nepal. Methods A cross-sectional survey was conducted among GBMSM in Kathmandu Valley, Nepal, between October and December 2022 (N =250). We collected information on participants' sociodemographic characteristics, sexual and other behavioural characteristics, and their engagement in transactional sex. Bivariate and multivariate logistic regression analyses were performed to determine the factors associated with transactional sex. Results The average age of participants was 27.5years (s.d. 8.9). Overall, 16.4% reported engaging in transactional sex within the past 6months. Participants with more financial dependants (aOR: 1.2, 95% CI: 1.0-1.5) and those who had experienced police detention (aOR: 4.8, 95% CI: 1.1-19.6) were more likely to engage in transactional sex. In contrast, GBMSM who reported engaging in condomless sex were less likely to engage in transactional sex (aOR: 0.02, 95% CI: 0.06-0.1). Conclusions The study findings underscore a noteworthy prevalence of transactional sex and associated socioeconomic and behavioural factors among GBMSM in Nepal. These results underscore the need for targeted interventions addressing both economic vulnerabilities and legal interactions to reduce transactional sex and its associated risks in this high-risk group.

Background Despite advances in antiretroviral treatment and the message of undetectable equals untransmittable (U=U), there remain challenges related to stigma and quality of life for people living with HIV. This study aimed to understand the experiences of people recently diagnosed with HIV at a clinical service, to guide insights into how to improve care and support in the contemporary treatment era. Methods This qualitative study involved semi-structured interviews with individuals diagnosed with HIV between 2016 and 2021 at RPA Sexual Health service (a sexual health clinic in Sydney, Australia), or who were referred to the clinic directly after diagnosis. Participants were recruited through a short survey questionnaire between May 2022 and May 2023, and interviews were transcribed and analysed thematically. Results Fourteen participants were interviewed for the study, eight of whom were born outside of Australian or Aotearoa New Zealand. We found that diagnosis was still a shocking event requiring careful support; that there was ongoing stigma, shame, and reduced sexual confidence following diagnosis; and that beyond initial diagnosis, some people would benefit from ongoing support and education about key concepts regarding HIV treatment. Conclusion Our study suggests that HIV diagnosis remains disruptive, and sexual stigma is a key issue negatively impacting quality of life. Health providers can mitigate these issues by supporting the ongoing psychosocial needs of people with HIV in the early period of adjusting to HIV diagnosis, and referring to peer-based and other services. Initiating conversations about sex and dating and checking understandings of key health messages over time may promote improved care.

Background To describe the changes in cervical lesions prevalence and high-risk human papillomavirus (HR-HPV) infections from 2012 to 2021, which have never been reported before, to provide direction for the effective implementation of cervical cancer prevention measures. Methods This retrospective study included women aged >25years who received either organised or opportunistic cervical HR-HPV screening from January 2012 to December 2021 in Karamay Central Hospital, Karamay, China. The patients were split into four groups according to age 25-35, 36-45, 46-55 and >55years, respectively. The Joinpoint Regression Program was used to analyse the trends of HR-HPV infection and the detection of cervical lesions. Results Data from 85,429 women revealed a decline in HR-HPV infection rates across all age groups from 2012 to 2021. Although HR-HPV infection rates decreased, cervical lesion detection rates increased, although the proportion of cervical cancer in these lesions declined, likely due to enhanced awareness and HPV vaccination in Karamay. From 2012 to 2021, the prevalence of low-grade squamous intraepithelial lesions was 9.70%, and high-grade squamous intraepithelial lesions was 5.85%. HR-HPV infections were highest in the ≥55years age group, with HPV52 (20.96%) being the most prevalent type. Conclusions In the past 10years, the prevalence of HR-HPV infection has shown a decreasing trend, whereas the detection prevalence of cervical lesions has shown an upward trend among women in Karamay City. Importantly, particular emphasis should be placed on cervical cancer screening in women aged >55years.

Background Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as 'normal activity without pain', 'normal activity but painful', 'severely restricted by pain', or 'absent due to pain.' Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with 'normal activity without pain' group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain. Results Over half of the 187 patients with chronic pelvic pain described severely restricted (n =75, 40.1%) or absent (n =21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01-1.09, P =0.006) or absent due to pain (OR 1.09, 95% CI 1.04-1.13, P Conclusion Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain.

Background Parents play an important role in monitoring children's internet use, shaping their child's understanding of sex, and are key stakeholders in the development of sexual health education policies. Therefore, we investigated parents' awareness of and responses to children's pornography exposure. Methods We invited parents with children aged from 8 to 20years (n =1029) to complete an observational cross-sectional online survey about pornography and young people. Results A total of 48% of parents thought that young people view pornography rarely or never, and 21% agreed that watching pornography could be part of a healthy relationship for young people. Some parents (27%) were aware that their child had ever viewed pornography. Most parents (56%) acted on this by talking to their child, while others (10%) took no action, or restricted access to devices (6%). Discussing pornography was found to be strongly associated (P Conclusions These findings provide new insights for policy responses and can guide the development of tools to support parents to respond to their children's pornography exposure.

Background Structural stigma and institutionalised discrimination towards people living with HIV remain pervasive in many settings. However, qualitative explorations of experiences of stigma, health and social service engagement, and quality of life among people living with HIV in Singapore remain under-researched. Methods Semi-structured interviews were conducted with 73 participants in Singapore. These included 56 people living with HIV (30 men who have sex with men, 23 heterosexual men, and 3 women) and 17 stakeholders including healthcare professionals and other allied workers. Interviews focused on participant perspectives or experiences of HIV diagnosis, navigating healthcare, attitudes towards HIV, and impact of HIV on relationships. Data were analysed through inductive thematic analysis. Results Our findings were framed within a minority stress model, highlighting the distal and proximal stressors relating to living with HIV. With regard to distal stressors, participants highlighted that they had experienced or were aware of institutionalised discrimination towards people living with HIV across various aspects of their lives. These included experiences - overt and covert - of discrimination in education, workplace, and healthcare settings. With regard to proximal stressors, participants highlighted the role of anticipated stigma and the stress of concealment. This included participants' fear of potential legal and/or social repercussions resulting from the disclosure of their HIV status, actions that they may not be able to anticipate and articulate. Although employers may not overtly discriminate, the fear of such anticipated discrimination influenced decisions to conceal HIV status in job applications and workplaces. This restricted agency for the people living with HIV in our study by affecting their regular medical follow-ups, socialising behaviours, and overall quality of life. Consequently, many participants felt that concealment of their status, and forgoing potential educational, employment, and even health opportunities, were the only ways of protecting themselves from such forms of stigma and discrimination. Conclusions This study found that anticipated stigma and discrimination diminished the quality of life of people living with HIV in Singapore. Implementing an anti-discrimination framework could address the unpredictability and alleviate the manifold unknowns of anticipated stigma.

Background Although there has been growth in online STI testing services, more attention is needed to understand how to facilitate effective treatment pathways for users. This study investigated where young people want to be treated for gonorrhoea and syphilis if they test positive using an online service. Methods We conducted an online survey of Australians aged 16-29years that included multiple choice and free-text questions about their preferred location for receiving injectable antibiotics. Multivariable multinomial logistic regression examined associations between respondent characteristics and service preferences. Content analysis was used to code free-text responses. Results Among 905 survey respondents, 777 (85.9%) answered questions on treatment preferences. Respondents most commonly preferred injectable antibiotics provided by a sexual health clinic (294; 37.8%) or a nurse in a pharmacy (208; 26.8%). Gender/sexually diverse respondents were more likely to select sexual health clinics over general practice (MSM RRR 2.5, 95% CI 1.1-5.7; WSW RRR 2.6, 95% CI 1.1-5.7; trans/non-binary RRR 2.5; 95% CI 1.0-6.0). Older respondents (aged 25-29years) were more likely to choose all alternatives over general practice, with the reverse found for those who had previously tested. From open-text answers, pharmacies were valued for their convenience, and sexual health clinics for providing non-judgemental, free services by specialists. Conclusions Differences in treatment preferences by certain groups of young people suggest that different service offerings may influence treatment-seeking outcomes from online STI testing services.

This Collection highlights some recent publications in Sexual Health on using technology to optimise sexual health. By leveraging innovations such as rapid diagnostic tools, mobile health (mHealth), self-testing and artificial-intelligence-powered tools, we can empower individuals to take control of their sexual health, reducing risks and enhancing accessibility.

Background Aging women living with HIV are significantly affected by menopause and comorbidities, yet international and Australian HIV guidance on the management of women is scarce. This study aimed to identify gaps in clinical management of menopause, age-related comorbidities, and psychosocial health of women living with HIV attending our metropolitan sexual health service. Methods A clinical audit of all cisgender women who attended Sydney Local Health District Department of Sexual Health Medicine for ongoing routine HIV care between 1 January 2021 and 1 January 2023 was undertaken. Results Twenty-seven patient files were examined. Half (13/27, 48.1%) of women were age 45years and older, of whom 6/13 (46.2%) were postmenopausal and 4/13 (30.8%) did not have menopause status recorded. In the prior 12months, most women had their blood pressure (19/27, 70.4%), total cholesterol (21/27, 77.8%), glycated haemoglobin (21/27, 77.8%), estimated glomerular filtration rate (27/27, 96.3%), and liver function tests (26/27, 96.3%) measured. Smoking and alcohol intake was documented for less than half of women (13/27, 48.1%; and 12/27, 44.4%; respectively). In women aged 45years and older, absolute cardiovascular disease risk was calculated in 2/13 (15.4%), and none had a Fracture Risk Assessment Tool score or cognitive screen performed in the prior 12months. One-fifth (5/27, 18.5%) had a documented history of depression or anxiety. Of those screened, half (4/8, 50.0%) disclosed past intimate partner violence. Conclusions Our service has now implemented a reference tool to guide routine monitoring of women living with HIV, with sections dedicated to reproductive health and psychological wellbeing. Australian HIV management guidelines would benefit from specific guidance for women.

Background In Latin American countries and Suriname, sexual transmission is one of the most common modes of HIV transmission, and men who have sex with men (MSM) who engage in sex work constitute a key population. Methods In a sample of MSM (N =53,166) from the Latin American Internet Survey (2018) across 18 countries, we examined how sex work engagement is associated with syndemic conditions (multidrug use, homophobic abuse, depression/anxiety, alcohol dependency (CAGE alcohol questionnaire) and internalised homonegativity) and condomless anal intercourse with non-steady male partners using separate logistic regressions. We then used a structural equation model to determine if and how syndemic conditions mediate the relationship between sex work engagement and non-steady male partners. Results We found that getting paid for sex was associated with less condom use for anal intercourse with non-steady male partners and particular syndemic conditions, such as multidrug use, homophobic abuse and alcohol dependency. In our structural equation model, the results showed that the direct relationship between sex work engagement and non-steady male partners was positive and significant, and syndemic conditions partially mediated this relationship. Conclusion Our results highlight the continuing need for including MSM who engage in sex work and those who experience syndemic conditions in the prevention strategies targeted to MSM in Latin America and Suriname, to prevent the transmission of HIV.

Background Numerous studies highlight a common inadequacy among midwives in addressing sexuality and sexual health issues in pregnant women. These findings underscore the crucial need for sexual health education for midwives. Nevertheless, the specific training needs and preferences regarding sexual health education for pregnant women among midwives remain largely unexplored in existing literature. The aim of this study was to explore midwives' training needs and preferences for providing sexual health education for pregnant women. Methods The research employed a mixed-methods, institution-based cross-sectional study design conducted from July to August 2021. Convenience sampling was applied for quantitative research, while purposive sampling was utilised for the qualitative component. Midwives from 19 hospitals in Guangdong Province were invited to participate in a questionnaire survey addressing training needs and preferences for sexual health education for pregnant women among midwives. Qualitative data analysis was performed using thematic analysis. Results A total of 462 midwives participated in the quantitative study, while 12 skilled midwives were involved in the qualitative component. A significant majority (82.5%) of midwives expressed a strong desire to engage in sexual health education. Online education emerged as the preferred mode of training among participants. Key areas of interest included reproductive health, sexual psychology, sex sociology, and education methods, underscoring a consistent demand for comprehensive sexual health education within the midwifery community. Conclusions Our study emphasises the pressing need for enhanced sexual health education for midwives and explores their preferences for future training.

Background In Australia, syphilis notifications increased 2.5-fold during 2013-2022 and 83 congenital syphilis cases were reported. Timely diagnosis and management are crucial. We developed a tool to promote syphilis testing into our existing 'Future Health Today' (FHT) software and explored its acceptability in general practice. Methods Our tool (FHT-syphilis) scans electronic medical record data to identify and prompt testing for pregnant women, and, people recently tested for sexually transmissible infection (STI) or HIV, but not syphilis. It links to relevant guidelines and patient resources. We implemented FHT-syphilis in 52 general practices using FHT for other conditions and interviewed practice clinicians (n =9) to explore it's acceptability. Data were analysed deductively guided by the Theoretical Framework of Acceptability. Results Interviewees considered syphilis an important infection to focus on and broadly viewed FHT-syphilis as acceptable for identifying patients and giving clinicians authority to discuss syphilis testing. Time constraints and unrelated reasons for a patient's visit were barriers to initiating syphilis testing discussions. Australian STI guidelines were considered appropriate to link to. Some interviewees considered prompts should be based on sexual behaviour, however this is not well captured in the electonic medical record. Two interviewees were alerted to updated Australian STI guidelines via their interaction with FHT-syphilis and expanded their syphilis testing practices. Expertise to initiate discussions about syphilis and risk was deemed important. Conclusions A digital tool for prompting syphilis testing was acceptable to clinicians already using FHT. Linkage to STI guidelines alerted some end-users to updated guidelines, informing STI testing practices.

Background The patterns of sexually transmitted infections (STIs) in populations may be influenced by the sexual mixing within the population. We aimed to investigate the assortative sexual mixing pattern by bisexuality in male-male partnerships. Methods This was a retrospective repeated cross-sectional study of men with mostly regular male partners attending the Melbourne Sexual Health Centre between 2011 and 2019. Data on sexual practices, including their sexual practices, presence of other male/female sex partners and the gender of sexual partners in the previous 3 and 12months, were collected using computer-assisted self-interview. We calculated the proportion of male partnerships where at least one man in the partnership reported a female sex partner. Results A total of 2056 male-male partnerships (i.e. 4112 individuals) with a median age of 29 years (IQR 25 to 35) were included. Overall, in 94.4% (1941/2056) of male-male partnerships both men had male partners only; however, in 5.5% (113/2056) of partnerships, one man had both male and female partners, and in 0.1% (2/2056) partnerships, both men had both male and female partners. No assortative relationship was found on the sexual mixing by bisexuality in male-male partnerships due to the low assortativity coefficient (r =0.006, 95% CI: -0.004 to 0.016). Conclusion One in 20 male-male partnerships had at least one man who had both male and female partners within the preceding year. Individuals were not selective by bisexuality, suggesting that partnerships of bisexual individuals are mixed proportionately to the distribution of their characteristics. Still, these sexual mixing practices may affect STI transmission dynamics.

Background Stigma towards sexually active young people presents profound barriers to uptake of sexual and reproductive health (SRH) services, including HIV testing and contraception. Yet, few studies have examined adolescent SRH stigma trajectories over time. To address this knowledge gap, we examined associations between social-ecological factors and trajectories of adolescent SRH stigma among urban refugee youth in Kampala, Uganda. Methods This longitudinal cohort study with refugee youth in Kampala collected data on adolescent SRH stigma at four time-points between 2022 and 2024. We used latent class growth analyses to examine distinct trajectories of adolescent SRH stigma, and examined baseline social-ecological and socio-demographic factors associated with class membership using multivariable logistic regression. Results Among the participants (n =164 with n =668 observations; mean age 19.9 years, standard deviation2.5 years; 52.8% cisgender women), we categorised two distinct adolescent SRH stigma trajectories: consistently high (n =496; 74.2%) and sustained low (n =172; 25.8%). In multivariable analyses, living in Uganda ≥1year at baseline assessment (1-5years: adjusted odds ratio [aOR]5.28, confidence interval [CI]2.29-12.19, P P 10years: aOR3.89, CI1.56-9.68, P P P P P Conclusions Social-ecological and socio-demographic factors were associated with consistently high levels of adolescent SRH stigma over 2years. Multi-level strategies can meaningfully engage youth in developing stigma reduction strategies for SRH service delivery.