Sexual health literacy refers to the ability to find, understand, and use information and services to inform decisions and actions related to sexual health. Given the importance of sexual health literacy for improving health outcomes, it is prudent to identify sexual health literacy measures that can be used by healthcare providers, scholars and educators. To address this need, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct a systematic review. This review examined 12 databases to identify existing sexual health literacy self-report scales, subscales or individual items that were available in English, developed for scale validation purposes, and published between 2002, the year the World Health Organization convened experts to provide a clear working definition of sexual health, and 2022. We conducted a risk of bias and quality assurance assessment of the nine articles that met inclusion criteria, and coded articles along the ten components of a sexual health model used as the theoretical framework. Findings revealed mixed quality of identified measures. None of the measures received positive ratings on all eight criteria assessed or addressed all components of the sexual health model. The results from this systematic review suggest the need for a culturally sensitive, valid and reliable scale to assess sexual health literacy that can be used by sexual health professionals to promote sexual health and to reduce deleterious sexual health outcomes.

New strategies and innovations are needed to achieve ambitious global goals for the control of HIV, hepatitis B, hepatitis C and STIs. Network-based testing (NBT) services, including partner services, social network testing, and family and household testing, are a heterogeneous group of practices in which healthcare providers support clients with STIs or bloodborne infections to offer testing and/or other services to sexual or injecting partners, biological children, or household members or contacts. Although significant evidence supports the efficacy of NBT services to identify, diagnose and link to care partners and other contacts of people with HIV, there has been less direct research about NBT for viral hepatitis or STIs, or for providing prevention services to partners. Research is needed to better understand how NBT can best be utilised for multiple infections, specific populations and to achieve maximal impact. Integrating NBT service delivery to achieve testing, treatment and/or prevention for multiple infections may be efficient, and this might include dual or multiplex testing for different populations. Self-testing or self-sampling for partners may overcome barriers to testing. Providing partners who test negative with prevention options, including PrEP or hepatitis B vaccination where appropriate, might be a powerful way to expand prevention efforts for multiple pathogens. NBT is an important tool for identifying those in need of interventions; a better understanding of how to expand and integrate this tool may help achieve cross-cutting health outcomes globally.

Background This study aims to assess the global burden of female infertility from 1990 to 2040. Methods Data on disability-adjusted life years associated with female infertility were sourced from the Global Burden of Disease 2021 study. Generalized additive models were utilized to predict trends for the period spanning from 2022 to 2040. Results The global burden of female infertility is expected to increase significantly, with the age-standardized disability-adjusted life year rate projected to reach 19.92 (95% uncertainty interval (UI): 18.52, 21.33) by 2040. The projected estimated annual percentage change (EAPC) for the age-standardized disability-adjusted life year rate from 2022 to 2040 is expected to be 1.42, with a 95% confidence interval (CI) of 1.3951-1.4418. This is in contrast to the EAPC of 0.71 (95% CI: 0.5391-0.8789) observed from 1990 to 2021. Central sub-Saharan Africa is projected to have the highest age-standardized rate at 29.37 (95% UI: 24.58-34.16), whereas Australasia is expected to have the lowest at 0.78 (95% UI: 0.72-0.84). Age-specific projections show a consistent decline in infertility rates across all age groups. Countries such as Kenya, Chad and Peru exhibit EAPCs exceeding 9.00, whereas Mali and South Africa show significant negative EAPCs. Correlation analysis indicates that regions with a higher sociodemographic index generally have lower female infertility burdens, with notable trends observed in Europe and Asia. Conclusion The projected global burden of female infertility is expected to increase significantly from 2021 to 2040, with notable regional disparities. Central sub-Saharan Africa and south Asia are anticipated to experience higher burdens, whereas overall rates are projected to decrease across different age groups.

Background Sexual fantasies represent a cognitive pattern that influences sexual activation and desire. This study aims to investigate the relationship between sexual fantasies, sexual desire and overall sexual functioning among Iranian adults. Methods A total of 1353 volunteers from the general population participated by filling out questionnaires including, the Sexual Desire and Erotic Fantasies Questionnaire, the International Index of Erectile Function and the Female Sexual Function Index. Sexual fantasies were categorized based on predefined criteria. Statistical analyses were conducted using correlation and regression techniques to explore these relationships. Results Men reported more explicit sexual fantasies, including active roles, common sexual behaviours and dominance, during sexual activities (mean1.62, s.d.1.16), taboo elements (e.g. sex with minors, animals, family members and rape; mean0.38, s.d.0.60) and fantasies with diverse partners (mean5.18, s.d.4.16). In contrast, women preferred romantic content (mean1.97, s.d.0.97) and a passive role. No gender differences were observed in bondage, dominance, sadism and masochism fantasies. Both genders showed a strong correlation between sexual fantasies and sexual desire (Men0.461, Women0.372). Conclusion Understanding these patterns in a conservative country, such as Iran, may contribute to culturally sensitive intervention in traditional culture. For instance, in sex therapy or workshops for couples on utilizing fantasy to enhance sexual satisfaction, subject to the values of modesty and privacy. This research reveals valuable insight into sexual imagery and sexual performance, and fills a gap in cultural studies. However, further research is needed to validate these findings.

Background Sexually transmitted infections (STIs) other than HIV are a major public health concern globally. The goal of this study is to analyse the trends of the five most common STIs; chlamydia, gonococcal infection, trichomoniasis, genital herpes and syphilis in India and its states from 1990 to 2019. Methods We extracted data pertaining to STIs from the Global Burden of Disease study, 2019 (GBD 2019), and analysed the burden of disease based on individual STI, for both sexes, across multiple age groups, and for each state and union territory of India. Results Incidence of STIs increased by 82.79% from 54.64million in 1990 to 99.88million in 2019, and disability-adjusted life years decreased by 48.66% from 1.51million to 0.77million, which is primarily attributed to a decline in disability-adjusted life years for syphilis. The incidence was higher in men compared to women. The incidence rate for chlamydia, trichomoniasis and genital herpes increased, the incidence rate for syphilis declined, whereas the incidence rate for gonococcal infection did not show any substantial change. Most of the disability-adjusted life years and deaths in 2019 were contributed by syphilis. Conclusion The burden of STIs in India is substantial and calls for comprehensive efforts to stem the tide of increasing incidence of STIs. Enhancing surveillance, increasing awareness and targeted control programs are recommended for the affected populations.

Background Data on persistent use of HIV pre-exposure prophylaxis (PrEP) is limited among Chinese men who have sex with men (MSM). This study aimed to explore factors associated with the re-initiation of PrEP among Chinese MSM from a longitudinal PrEP demonstration trial. Methods A multi-center cohort study was conducted in Guangzhou and Wuhan, China (September 2021-2024), providing 1134 MSM participants with a 12-month dosage of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as oral PrEP. Following the trial, a subgroup of participants were invited to complete a 3-month post-trial follow-up survey. These participants were categorized on the basis of self-reported PrEP use patterns into (1) continued PrEP use, (2) discontinued without re-initiation, and (3) re-initiated after discontinuation. Log-binomial regression models were used to assess factors associated with PrEP re-initiation. Results Out of 408 participants who completed the 3-month post-trial follow-up survey, 70.1% (n =286/408) reported discontinuing PrEP, and 50.7% (n =145/286) of those who discontinued subsequently re-initiated PrEP. Participants who had concurrent sexual partnerships (adjusted risk ratio [aRR]=1.47, 95% CI: 1.11-1.96), used drugs during sex (aRR=1.34, 95% CI: 1.09-1.65), or lived alone (aRR=1.29, 95% CI: 1.03-1.61) were more likely to re-initiate PrEP. The Likert scale analysis indicated that perceived partner influence, specifically the expectation of condomless sex, played a significant role in re-initiation decisions (P =0.03). Conclusion Individuals engaging in higher-risk behaviors are more likely to re-initiate PrEP, highlighting the dynamic nature of risk perception. Future interventions should focus on promoting both re-initiation and consistent condom use, emphasizing partner-related dynamics and substance use as key factors in PrEP decisions among MSM.

Background Sexual and reproductive health (SRH) services are underutilised by young people from migrant and refugee backgrounds in many Western countries, including Australia. Young African migrants, a growing demographic in Australia, face unique challenges, including stigma associated with seeking sexual health care and limited sexual health literacy, which lead to adverse SRH outcomes. The study aims to (1) develop an understanding of young African migrants' knowledge of existing sexual health services in Australia and (2) explore young people's perceptions of youth-friendly SRH services for optimal engagement by young migrants from African backgrounds. Methods A qualitative study was conducted in Melbourne, Australia, in 2019, using three participatory workshops involving 30 young African migrants aged 18-24 years. The data was analysed thematically. Results Thematic analysis identified three key themes: (1) lack of visibility and information of existing sexual health services affects service use, (2) cultural stigma associated with sexual health affects help-seeking and health service engagement, and (3) key attributes of youth-friendly SRH care for young African migrants. None of the participants were aware of sexual health services in Australia. Although general practitioners were the most commonly known healthcare providers, many participants avoided seeking SRH care from them due to concerns about confidentiality. Participants emphasised the importance of accessible, youth-friendly SRH services, recommending culturally informed approaches and highlighting preferences for provider characteristics, such as younger age, strong confidentiality assurances, and gender-specific options in provider selection. Conclusion The lack of awareness about sexual health services among young African migrants hinders their ability to access appropriate care. Efforts to promote SRH services should include targeted, culturally sensitive outreach and clear communication to address misconceptions and barriers. Adopting a cultural lens in designing youth-friendly SRH services may enhance their utilisation and improve SRH outcomes among this population.

Background Kazakhstan has a high HIV incidence among adolescents and young adults (AYA), and high HIV stigma contributing to low HIV testing uptake. We examined whether an AYA-developed digital crowdsourced intervention reduced HIV stigma compared with conventional public health materials among AYA in Almaty, Kazakhstan. Methods A total of 216 AYA (females:116/males:110) aged 16-24 years were recruited to the online study cohort and randomized 1:1 to the intervention or control arm. AYA were exposed to the crowdsourced intervention or control materials once a week for 5weeks, with equivalent exposures between arms. Outcomes included a total HIV stigma score assessed at baseline, immediately post-intervention and 2months post-intervention from January to August 2023. We conducted multilevel mixed models to compare changes over time by arm and sex. Results AYA in the intervention arm had significantly lower HIV testing stigma 2months post-intervention (adjusted mean change (AMC): -0.73 (-1.07, -0.39)) than AYA in the control arm (AMC: -0.06 (-0.42, 0.30); P =0.032). Female AYA in the intervention arm had significantly lower total HIV stigma immediately post-intervention (AMC: -4.91 (-7.25, -2.58)) and 2months post-intervention (AMC: -5.16 (-7.48, -2.84)) than females in the control arm (immediately post-intervention AMC: -0.03 (-2.63, 2.57) and 2-months post-intervention AMC: -0.07 (-2.70, 2.56); P =0.012, P =0.012). Conclusions The AYA-developed crowdsourced intervention decreased HIV testing stigma, although this effect was moderated by sex, and decreased total HIV stigma among female AYA. Crowdsourced interventions may be a promising way to engage communities to develop interventions to decrease HIV stigma.

Background Innovative models in HIV pre-exposure prophylaxis (PrEP) delivery are required to reduce the burden on clinical services and provide convenience and access for clients. A nurse-led telehealth PrEP clinic ('TelePrEP') with free multi-modal testing pathway has been developed at Sydney Sexual Health Centre (SSHC). Methods Using a multi-model testing pathway, we reviewed retrospective electronic medical record of TelePrEP consultations at SSHC. Primary outcomes were demographic and behavioural characteristics, rates of attendance of TelePrEP appointments and follow-up screening, and rates of PrEP initiation, re-initiation and continuation. Secondary outcomes were length of time from screening to TelePrEP appointment, duration of TelePrEP appointments, adherence to guideline-indicated laboratory testing, and rates of HIV/STI identified through screening. We compared outcomes between the three screening pathways and by Medicare status. Results A total of 472 clients were reviewed. Majority were cis -gender male (99%), non-Medicare (77%), and overseas-born (86%). There was no significant difference in attendance rates between the three screening pathways. The majority of appointments referred through MyCheck (82%) resulted in PrEP continuation; 36% attended follow-up screening, with the highest rates of follow-up referred through a[TEST] (44%), and lowest through Xpress (22%). More non-Medicare clients (38%) attended follow-up screening than Medicare clients (27%). Adherence to national guidelines for testing was high, and screening identified two new HIV diagnoses. Conclusion Nurse-led TelePrEP model is feasible in overcoming issues of accessibility for key population groups including overseas-born MSM. We achieved high overall attendance rates, high adherence to guideline-indicated laboratory monitoring, and rapid linkage to treatment for clients with HIV identified on screening.

Background Studies have shown that clients accept the self-collection of samples for sexually transmitted infection testing (SCS/STI testing), and at-home service delivery is a promising approach to expand diagnosis. However, few studies have examined client values surrounding service delivery in low-resource settings. This formative research study explores clients' service delivery values and preferences for at-home SCS/STI testing in rural Uganda. Methods We conducted semi-structured interviews with 36 adults - 15 males and 21 females - who self-collected a sample for STI testing in Rakai, Uganda, as part of the Rakai Community Cohort Study. After self-collection, participants were asked for their preferences on various at-home service delivery components, including: (1) requesting/receiving testing materials, (2) sending samples to the laboratory, (3) receiving results, and (4) receiving treatment; as well as various service delivery models. We also conducted interviews with nine key informants to contextualize results. Using the framework method, we identified key preferences across all participants, and stratified by gender. Results Participants most valued an at-home SCS/STI testing program that offered timely service, as well as health professionals' expertise. Clients also valued privacy/confidentiality; certainty that processes were completed correctly; access to services/resources; and ownership/responsibility for their own health. Although these values were expressed by both genders, access, privacy/confidentiality and ownership/responsibility were more prominent among females. Conclusions Our findings suggest a potential role for at-home SCS/STI testing in this population, as long as key client values are addressed. Program implementers will need to consider how to balance convenience for clients with professional support.

Background To explore the characteristics, influencing factors, and associations between sexting and high-risk sexual behaviors among college students in Jiangxi Province, China, providing a basis for promoting sexual health education and preventing high-risk sexual behaviors among college students. Methods A convenient sampling method was used to conduct an anonymous survey on 13,976 students from 15 universities in Jiangxi Province from November to December 2023. Chi-squared tests and binary logistic regression analyses were employed to investigate the influencing factors and associations between sexting and high-risk sexual behaviors. Results The reported rates of sexting and high-risk sexual behaviors among college students were 12.7% and 11.0%, respectively. Regression results indicated that the influencing factors for both behaviors included sex, grade, major, sexual orientation, knowledge of HIV/AIDS and family upbringing methods (P -values all Conclusion The prevalence of sexting and high-risk sexual behaviors among college students in Jiangxi Province should not be overlooked, and those with sexting experiences are more likely to engage in high-risk sexual behaviors. Educators should enhance sexual health education and safety control of sexual behaviors among college students.

Background There is a co-occurrence of adolescents' substance use and sexual practices, with an important impact on their health and health behaviours; however, limited research is conducted with adolescents. The aim of this study was to estimate the prevalence of substance use (alcohol and/or other substances) in sexual contexts and to identify its associated factors among adolescents, comparing boys and girls. Methods Cross-sectional study with data from 6352 adolescents aged 14----18years from the DESKcohort project. Prevalence of alcohol and/or other substance use in sexual contexts (OSUSC) stratified by sex were calculated, according to axes of inequality, psychosocial factors, and sexual health and health variables. Poisson regression models with robust variance were calculated to analyse potential associations with independent variables. Results Girls (51.4% of the sample) reported a higher prevalence of alcohol use in sexual contexts than boys (43.9% vs 33.9%, P Conclusions These findings suggest that substance use in sexual contexts reflects a broader pattern of co-occurring risky behaviours rather than intentional sexualised substance use. Some vulnerable groups include girls, adolescents with a minority sexual orientation, and students with disadvantaged SEPs. These findings underscore the need for holistic interventions targeting adolescents' health, addressing substance use and sexual risk behaviours simultaneously to reduce potential consequences such as unplanned pregnancies and sexually transmitted infections.

Background In the United States, many residents and fellows lack confidence in their ability to confidentially counsel adolescents regarding sexual health topics. Little is known about how personal and professional experiences may affect medical residents' and fellows' confidence in counselling adolescents about sexual health services. Methods We invited 361 residents and fellows (trainees) from paediatric, obstetrics and gynaecology, as well as family medicine programs at an academic medical centre in Texas to complete a survey about confidence in counselling about sexual health services. We describe respondents' demographics, medical training, personal sexual healthcare experiences, and confidence in confidential care and STI management measured on a four-point Likert scale. We calculated average confidence scores, dichotomised responses into confident (≥3 points) and not-so-confident ( Results Among 228 trainees (63% response rate), 54% were confident in confidential care and 81% were confident in STI management. Those who received training in aspects of confidential care and STI management reported significantly greater confidence in many of these areas. Respondents who recalled private discussions with their personal healthcare provider as an adolescent reported confidence in STI management (P =0.02) compared to those who did not have that experience. Conclusions Medical training should focus on communication training to address gaps in confidence, particularly regarding adolescent confidentiality. Clinicians' personal experiences may impact aspects of confidence, highlighting the importance of encouraging trainees to reflect on how their background might influence their clinical practice.

Background The impact of receiving HIV serostatus disclosure from partners before sex on number of sexual partners and condomless anal intercourse (CAI) among men who have sex with men (MSM) remains unclear. We aimed to determine the association between receiving this disclosure and engaging in risky sexual behaviors and its impact on HIV incidence rates. Methods HIV-negative MSM were followed with questionnaires every 3months for 12months. Generalized estimation equations models were used to assessed the factors associated with receiving serostatus disclosure and its impact on multiple sexual partners and CAI. Results Of the 363 participants, those tested for HIV in the past 3months were more likely to receive serostatus disclosure than those who had not (adjusted odds ratio (aOR)=3.145, 95% confidence interval (CI): 2.109-4.691, P P P =0.351). Subgroup analysis revealed that MSM with casual partners who received serostatus disclosure were more likely to engage in CAI (aOR=1.646, 95% CI: 1.06-2.556, P =0.027). Conclusions HIV testing promotes serostatus disclosure and disclosure of HIV serostatus correlated with fewer sexual partners. However, among MSM with casual partners, disclosure was associated with a higher likelihood of CAI. These findings encourage regular HIV testing and HIV serostatus disclosure.

Background China implemented extensive non-pharmaceutical interventions (NPIs) to contain COVID-19. Methods National and provincial data on monthly reported HIV and AIDS cases from January 2017 to December 2020 were collected from the National Health Commission of the People's Republic of China. We used interrupted time series analysis to assess whether COVID-19-related NPIs had an impact on reported HIV and AIDS cases in 31 provinces in China, and estimated underreported numbers of HIV and AIDS cases in the first month of the COVID-19 pandemic. Results A total of 393,357 HIV cases and 254,735 AIDS cases were recorded in China from January 2017 to December 2020. Nationally, the number of reported HIV cases decreased by 25.1% in the first month of the NPIs period (January 2020) compared with the counterfactual (incidence rate ratio (IRR) 0.749; 95% confidence interval (CI) 0.664-0.845), whereas the number of reported AIDS cases decreased by 36.5% (IRR 0.635, 95% CI 0.543-0.741). An estimated 2208 HIV cases (95% CI 1209-3335) and 1525 AIDS cases (95% CI 927-2233) were underdiagnosed and underreported in the first month of the NPIs in China. The highest numbers of underdiagnosed and underreported HIV cases in the first month of NPIs were estimated in Sichuan (IRR 577, 95% CI 239-978), Guangdong (IRR 185, 95% CI 170-200) and Henan (IRR 170, 95% CI 77-286). Conclusions There was substantial underdiagnosis and underreporting of HIV and AIDS cases during the first month of the COVID-19 pandemic in China and certain provinces. Health departments should consider the specific barriers encountered during the pandemic, such as disrupted healthcare access and resource limitations, and implement targeted strategies to strengthen HIV surveillance and report systems.

Background Telehealth adoption for HIV care continuum accelerated during the COVID-19 pandemic. This study explored telehealth usage, motivators and barriers to telehealth adoption, and implementation challenges during the pandemic among people living with HIV, individuals at risk and community-based organisations (CBOs) in Asia. Methods This cross-sectional study was conducted in June to December 2022 using an online quantitative survey among people living with HIV (n =787) and individuals at risk (n =744), and semi-structured qualitative interviews with CBOs across nine countries/territories in Asia. Responses from the survey were reported descriptively, and narratives from the interviews were used to identify the main themes associated with engagement configurations by CBOs. Results Regionally, HIV-related telehealth services were used by 56.8% of people living with HIV and 66.5% of individuals at risk, with 53.6-55.9% increasing their usage in 2021. Phone consultations, HIV-related health information sharing and video communications were the most commonly accessed services by telehealth users. Telehealth users most trusted mobile applications or software provided by clinics/healthcare providers/local CBOs. Telehealth uptake motivators included saving travelling time, improved access to HIV prevention care services and information outside of medical appointments; barriers included data privacy concerns and lack of technology accessibility, which were similarly acknowledged by local CBOs. Lack of resources to support telehealth services, and local policies on HIV prevention and treatment impeded CBOs from adequately delivering HIV care through telehealth. Conclusions This study highlights the potential of telehealth in HIV care while identifying critical challenges for its sustained integration. Addressing these issues (e.g. data privacy, telehealth infrastructure) would be essential to optimise telehealth services and improve HIV outcomes in the region.

Background Individuals aged 15-24years are disproportionately affected by sexually transmitted infections (STIs) in the United States, and young women can face severe health consequences if STIs are left undiagnosed. Yet STI testing rates in this priority population remain low. Few studies incorporate health behavior theory to examine factors associated with STI testing among young women in the United States, which is vital for intervention development. This study therefore sought to identify the determinants of college-enrolled late adolescent women's intentions to be tested for common STIs in the next 12months using a theory-based approach. Methods Students who identified as female at a large Midwestern university completed an online survey about STIs (n =171). Hierarchical multiple regression was used to assess the relationship between STI testing intention and the Reasoned Action Approach (RAA) global constructs of attitude, perceived norm, and perceived behavioral control, supplemented by STI knowledge, STI stigma, and STI shame. Results Findings indicate that the RAA global constructs predicted STI testing intention (P Conclusions Future interventions aimed at increasing STI testing among young women should focus on beliefs underlying the RAA global constructs and especially young women's beliefs regarding other people's support for getting tested for STIs.

Background Sexual health and functioning outcomes have been shown to be poor among veterans due to factors associated with military service, as well as barriers to healthcare access. However, there is currently limited research attempting to assess the scope and extent of these issues in the Australian context. Methods Ten qualitative, semi-structured interviews were conducted with Australian professionals working within or adjacent to veteran sexual health and were analysed using inductive thematic analysis. Results Sexual health and functioning issues commonly develop among Australian veterans due to a variety of physical, psychological and social factors. Factors include mental ill-health, physical illness and injury, use of medication, and relationship strain. These contribute to physiological dysfunctions, poor sexual behaviours and difficulties in forming healthy, meaningful intimate relationships. Barriers, such as lack of awareness and understanding, stigma, and structural barriers, were suggested to interfere with healthcare access and worsen outcomes. Key informants recommended increasing provider training, research and military support, as well as de-stigmatising sexual health issues. Conclusions Veteran sexual health is not often on the radar of Australian health and research professionals. Our study is one of few studies in the Australian context, highlighting the need to conduct more research to better manage veteran sexual health and functioning needs.

Background Despite its integral role in preventing and controlling infectious diseases, there is limited research that evaluates the impact of disease investigation (DI) services. The County of Santa Clara Public Health Department activated its emergency response operations, which included designated DI services, to respond to its local Mpox outbreak. The aim of this evaluation was to understand the range of outcomes achieved through Mpox DI services. Methods Mpox investigations completed between June and December 2022 were included in an evaluation that employed a composite measure to calculate the number of investigations needed to achieve the following outcomes: (1) treatment completion, (2) monitoring completion, (3) partial vaccine dose completion, (4) full vaccination series completion, and (5) STI and HIV testing. Results The overall composite score of 0.53 indicated that each investigation led to 1.90 outcomes achieved. Among cases eligible for treatment, 2.16 investigations yielded one treatment completion; 1.19 case and contact investigations yielded one monitoring completion; 2.21 and 3.53 contact investigations yielded one partial vaccine dose completion and one full vaccination series completion, respectively; and 2.25 case and contact investigations yielded one STI or HIV test. Conclusion Recognizing the multiple steps involved in DI can inform holistic evaluations that illuminate intervention impact.

Background Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia's STI Management Guidelines recommend regular STI testing every 6-12months for sexually active individuals aged 15-35 years in high-prevalence, remote areas. However, testing uptake remains low among young Aboriginal and Torres Strait Islander peoples. This analysis explores how healthcare providers engage Aboriginal and Torres Strait Islander peoples in STI testing using point-of-care (POC) diagnostics. Methods Semi-structured interviews were conducted with trained STI POC testing operators within the Test Treat ANd GO (TTANGO2) project. Seven clinics involved in TTANGO2 were selected for their 'high' and 'low' implementation of STI POC testing. Purposive sampling was used to recruit similar personnel from each of the selected clinics. Coding was informed by a patient communication protocol lens. Results Twenty healthcare personnel, including Aboriginal Health Workers/Practitioners (n =8), Registered Nurses (n =7), Coordinators (n =2), and Clinical/Practice Managers (n =3) participated. Key themes related to implementing STI POC testing focused on different stages of identified patient communication protocols, such as offering tests, providing follow-up results, and contact tracing. Concerns about shame and confidentiality were significant factors affecting patient communication protocols throughout the process. Conclusions Normalising sexual health discussions in healthcare settings helps reduce feelings of shame and stigma, further encouraging patient participation in sexual health services. Ensuring patient safety and offering culturally appropriate explanations of STI POC testing are essential to reduce barriers, such as shame and stigma. Culturally safe practices can increase patient engagement and provide opportunities for health education. Integrating STI POC testing into routine health care can help normalise testing and boost uptake. However, same-day results may still require patient follow-up to maintain confidentiality. Addressing external factors, such as accessibility, confidentiality, stigma reduction, and community engagement, is crucial for improving STI testing services.

Background Human papillomavirus (HPV)-associated cancers are a global concern, particularly for sexual minority men (SMM). Understanding awareness and the determinants of these beliefs is crucial for developing educational programs to reduce HPV-associated cancers. This study explored awareness and determinants of beliefs about HPV's carcinogenicity among SMM living with and without HIV in Nigeria. Methods Participants were recruited through secure social media platforms in Abuja, Nigeria. REDCap surveys captured demographics, sexual practices and participants' beliefs regarding HPV's role in cancer. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the relationships between individual characteristics and belief levels stratified by those living with and without HIV. Results Of 982 participants, the median age was 29years (interquartile range: 26-34); 64.1% were living with HIV, and 9.7% believed HPV causes cancer. Awareness was highest for anal (82.1%) and penile cancers (15.8%) and less so for oropharyngeal and female HPV-associated cancers (range: 3-7%). Anogenital warts increased the odds of awareness for SMM living with HIV (aOR: 6.4, CI: 3.0-13.6) and for individuals without HIV (aOR: 4.8, CI: 1.6-14.2). Living with HIV for over 6years was independently associated with a two-fold increased knowledge about HPV's carcinogenicity (aOR: 2.1, CI: 1.1-4.1). Conclusions Awareness of HPV's carcinogenicity was low; however, those who were aware were more likely to identify male HPV-associated cancers relevant to their own cancer risk. Formalizing targeted education in HIV care settings may promote knowledge and advocacy for prevention strategies.