Samtal om sexualitet - Statens folkhälsoinstitut

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Summary Sexuality and Counselling – Prevention of STI (Sexual Transmitted Infections) and Unintended Pregnancies DeSpite aDvanCeS in prevention and treatment of sexually transmitted infections (STI), STI is still a major cause of morbidity and mortality in a global perspective. In Sweden, there are more people than ever living with HIV, while chlamydia has increased by over 200 percent since 1997. In line with the increase in STI, the numbers of induced abortions are increasing in all age groups except among teenagers. The work to prevent sexually transmitted infections is therefore also important for avoiding unintended pregnancies. These two topics overlap each other and prevention efforts should be coordinated nationally, regionally and locally. It is evident that there is room for more action in society to reduce sexual risktaking in order to reduce the spread of infection and unplanned pregnancies. More knowledge is also needed about effective methods for the clientcentred work in primary care. The purpose of this report is to present knowledge in effective counselling methods feasible in primary care settings, which can prevent sexual transmitted infections and reduce sexual risk taking. The report is based on an American systematic review. The majority of the 21 articles are based on randomized controlled trials that evaluated different types of behavioural counselling methods. These methods were defined as any intervention that included some provision of education, skills training, and/or guidance on how to change sexual behaviour, delivered alone or in combination with other interventions intended to promote sexual risk reduction or risk avoidance. Goodquality evidence suggests that behavioural counselling interventions with multiple sessions conducted in STI clinics and primary care effectively reduces STI incidence in adolescent and “atrisk” adult populations. There is no evidence that the counselling interventions given were harmful or increased the incidence of STIs. The populations’ risk exposure and the intensity of the intervention are correlated with the intervention effect on STI incidence and selfreported sexual risktaking behaviour. More trials among women than among men were included in the review. Additional trial evidence for both lowerintensity behavioural counselling interventions and lowerrisk populations would nonetheless be judicious. Conclusion: The incidence of sexually transmitted infections and unplanned pregnancies in Sweden are more common in youth groups when compared with the adult population. Adults are therefore conceivably at lower risk than young people to be infected with an STI or become unintentionally pregnant. The potential benefits of counselling interventions are likely to be higher for youth groups. Opportunistic S A M TA L O M S E X U A L I T E T 11
chlamydia screening among adult women in Sweden has not proven effective for reducing the incidence of this STI. Given the current lack of research and evaluations in the field, the cost in time and money to work with high intensity interventions is significant for primary care actors. Counselling intervention should therefore be prioritized in groups with higher risk, regardless of sexual identity: sexually active teenagers, young adults with many sexual partners, currently or recently infected individuals, girls and women in unplanned pregnancies and their male counterparts. The studies presented in this review strongly support national educational efforts in motivational interviewing methodology that professionals in the health care system have been trained for in recent years in Sweden. These educational efforts should nonetheless be developed and include sexual risktaking in advisory situations in cases of suspected sexually transmitted infections or unplanned pregnancies, and increase the focus on men’s responsibilities and needs in these issues. 12 S A M TA L O M S E X U A L I T E T
Page 1 and 2: Samtal om sexualitet STI (sexuellt
Page 3 and 4: © STATENS FOLKHÄLSOINSTITUT, ÖST
Page 5 and 6: Insatser med samtalsmetoder 28 Ojä
Page 7 and 8: Ordlista förebyggande Förebyggand
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Page 11: land dem som lever i storstadsmilj
Page 15 and 16: Sexualitet oCh RepRoDuktion har bet
Page 17 and 18: sjukvården och insatserna bör gen
Page 19 and 20: Oskyddat sex och förebyggande insa
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Page 25 and 26: Sex- och samlevnadsundervisning i s
Page 27 and 28: Sex- och samlevnadsmottagningar (Se
Page 29 and 30: klamydiaprovtagning via nätet Vid
Page 31 and 32: Ungdomsmottagningarnas verksamhet
Page 33 and 34: om vad som är accepterat och inte.
Page 35 and 36: En studie i Stockholm visade att kv
Page 37 and 38: vilket ofta förstärks av bristand
Page 39 and 40: Effektiva samtalsmetoder för att f
Page 41 and 42: få störst nytta av STIscreening
Page 43 and 44: tabell 1. Sammanfattning av inklusi
Page 45 and 46: fRÅgeStällning 1 finns det stöd
Page 47 and 48: månaders uppföljning än bland de
Page 49 and 50: I studien av Jemmott och medarbetar
Page 51 and 52: Inga studier kunde identifieras som
Page 53 and 54: det (Coyle, Needle, & Normand, 1998
Page 55 and 56: Resultatens användning i Sverige -
Page 57 and 58: Primärprevention Redovisningen i k
Page 59 and 60: Slutsatser Även om intentionen i S
Page 61 and 62: Referenser Adlongruppen. (2009). Re
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Helström, L., Zätterström, C., &
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Regeringens proposition 2007/08:110
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Bilaga 1. Sammanfattning av evidens
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vuxna ungdomar Studier Begränsning
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Trots framsteg inom det förebyggan
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