Malin Lindroth
RN, PhD-student Health & Society
Faculty of Health and Society
Malmö University
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Background
Results from survey + interview study
A sex education curriculum
Your questions and comments
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To gain knowledge about sexual health
among youths at special residential homes
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To develop a sex education curriculum
targeted at these youths, and to let detainees
reflect upon it.
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Strengthen sexual health
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Sexual health – What?, Why?
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Sex education – What?, Why?
Sexual health is a state of physical, emotional, mental and
social well-being related to sexuality; it is not merely the
absence of disease, dysfunction or infirmity.
Sexual health requires a positive and respectful approach
to sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and violence.
For sexual health to be attained and maintained, the sexual
rights of all persons must be respected, protected and
fulfilled.
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WHO & WAS: youths have a right to sex
education
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Legislated in Sweden (School Law) since 1956
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Latest version of the law (2011) advocates a
sex education promoting sexual health
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Always situated in a social and historical
context, not a natural phenomenon
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Not static but dynamic
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A rights-based perspective (to chosen
sexuality and to knowledge)
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An understudied area
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Poorer sexual health
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Elevated sexual risk-taking and exposure
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Youths wish to discuss and learn more
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Youths at residential homes have many
questions and concerns about sexuality
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Experiences?
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Attitudes (to sexuality, parenthood, and
sexually transmitted infections etc.)?
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Differences girls-boys?, detained youthssame aged peers?
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148 (53 girls, 95 boys) from 22/27 residential homes
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15-20 years (mean age 17)
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84 % born in Sweden, 44 % at least one parent born
outside of Sweden
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Ethical exclusion criteria
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Internet-based survey
Detainees
(N=144)
%
Non-detainees
(N=5940)
%
Sex
Males/Females
64/36
44/56
Age
15-17/18-20
58/42
35/65
No/1st or 2nd generation immigrant
53/47
82/18
Immigrant status
Early sexual initiation (< 15 years)
No/Yes
22/78
69/31
Unprotected vaginal/anal intercourse last sex
No/Yes
50/50
79/21
Alcohol consumption before last sex
No/Yes
56/44
77/23
Drug use before last sex
No/Yes
68/32
97/3
<6/>6
78/22
91/9
Number of sex partners last year
Detainees
(N=144)
%
Nondetainees
(N=5940)
%
Ever given reimbursement for sex
No/Yes
91/9
98/2
Ever received reimbursement for sex
No/Yes
91/ 9
98/2
Ever sex against one’s will
No/Yes
38/62
53/47
Knowledge of Chlamydia
Low/High
58/42
35/65
Considered risk for Chlamydia
High/Low
13/87
9/91
Considered severity of Chlamydia
High/Low
54/46
64/36
Detainees
(N=144)
%
Non-detainees
(N=5940)
%
Ever pregnancy
No/Yes
60/40
86/14
Ever Chlamydia
No/Yes
86/14
92/8
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Elevated sexual risk-taking + exposure +
adverse sexual health outcomes is more
common among youths at residential homes
(See Lindroth, Tikkanen & Löfgren-Mårtenson,
Scandinavian Journal of Public Health, 2013)
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20 (9 girls, 11 boys), 15–20 years
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Half born in Sweden as their parents
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Truancy, running away from home, substance
abuse, criminality
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Majority stayed at a residential home before
Well, I have one now, a fuckbuddy, and I have
another that I talk to, see, someone I try to make
into, to fix a relationship with. And I always have
another one on the side. It’s like a car, you
always keep a spare tire in the trunk. That’s how
it works in my world; you always keep a spare
girl. Get it?
(Boy, 17)
You know, I’ve never wanted a child. I think it’s
creepy with the belly and all. Plus, I’m not
mature enough. And if I’d have it, the social
services would take it from me, and I don’t want
that to happen. I want to be able to…. I want my
child to grow up safe. I want a lot of money, a
good guy, an apartment and a job, things like
that. You’re supposed to take care of yourself
before you take care of a child. (Girl, 16)
Cause I was with a guy who was very decisive.
He wanted…he forced himself upon me a lot of
times. We were together for about nine months
and, well, sometimes he used the condom and
sometimes not. That’s what happened.
Otherwise I wouldn’t have done it without. (Girl,
15)
They surely don’t feel good. You know, I think of
those, those people who use others in that sense,
rape and force others. They are the kinds who
have been through things like that themselves
when they were kids. (Girl, 15)
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Sex/gender, age, substance abuse, low school
attendance, search for assurance
I’ve never felt forced to do it. Sure, I’ve had sex
with all my male friends. That’s how we are. And
they give, usually give drugs to me, most of the
time. They are a lot older than me. But I´ve never
felt like, everyone else sees it like, ‘but, they are
with you because they get sex from you’ . But, if
I say no, it’s no, and they respect that. I get drugs
from them anyway. (Girl, 17)
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Expectations within the group
They said, “She, that chick wants you, go get her
now” , and I, “No man, fuck it” , and they,
“Why don’t you just do it?” No, I didn’t have the
energy for it. I’ve had other stuff to do, things I
care about, you know, I wasn’t up for it. (Boy, 19)
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Belonging to a class in society with limited
access to knowledge and skills needed in
order to avoid sexual risks
You know, school, it’s not my thing. I’m
streetwise… .To be honest, I haven’t learnt much
about sex.(Boy, 19)
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The possibility of a chance for something
good (pleasure, comfort, status etc.)
outweighs the risk of something bad (STI,
unwanted pregnancy)
(See Lindroth & Löfgren-Mårtenson,The
European Journal of Contraception and
Reproductive Health Care, 2013)
Most Swedish adolescents receive sexuality
education.
 About 70% say they now how to avoid unwanted
pregnancy, 50% how to avoid an STI.
 Relationships more important than “biological
facts”
 Important to adjust sex education to group
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It doesn’t matter as long as it’s not one of those
stuck-up geeks. It should be someone self-confident;
otherwise, you feel ‘well, well, the teacher got
embarrassed’ , or something like that.(Girl, 16)
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Experiences of, and demands on a sex
education?
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Reflections upon a suggested curriculum?
Session content
1
Main issues to discuss
Body development, anatomy What is puberty? Female and male anatomy, how do the
genitals work?
2
Body image, self-esteem
What is an ideal body and why? What is self-esteem is it
related to sex?
3
Gender roles,
hetero normalcy , sexualities
What is female/femininity, what is male/masculinity,
why? What is hetero normalcy? What is homo, bi, trans,
hetero, asexual? What are Sexual and Reproductive
Health and Rights, SRHR? Does SRHR vary in different
cultures or contexts?
4
Watch the film “Sex on the map” and discuss it.
5
Relations
Contraception, pregnancy,
abortion, parenthood
6
STI
How do you contract, discover, seek help, cure and
protect yourself from different STI?
7
Selling/buying sex,
pornography,
sexual abuse
Alcohol, drugs and sex
What does the law say on selling/buying sex, are there any
grey zones? What is and where is pornography? What is
sexual abuse, what does the law say?
Sexual desire, sex on your
own, sex with others
Self-determination, the
Internet
What is sexual desire? Read the booklet “Sex my way”.
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9
10
What are the advantages and disadvantages of different
contraceptive methods? Menstruation, conception,
pregnancy, birth and abortion, how does it work?
What does the law say? What are the advantages and
disadvantages of alcohol and/or drugs and sex?
How to say yes, or no, to sex? How can the Internet be a
(sexual) resource?
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4 groups
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14 adolescents (7 girls, 7 boys)
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14-19 years
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Appreciate the curriculum content
Pedagogics (dialogic and norm critical) may
facilitate
Reflections on adjustments (previous
experiences, current situation)
“We’re not even allowed to talk about drugs here” (Boy2FG1)
“No, I can imagine that” (ML)
“The staff, they just: noooooooo” (Boy4FG1)
“But I think it´s important to talk about alcohol and drugs, how
does alcohol for instance affect feelings, and sex and how….”
(ML)
“I can´t have sex when I´m drunk” (Boy2FG1)
“….how does drugs affect feelings and sex? Are there pros to
be drunk or stoned when you have sex, are there cons?” (ML)
“When I´m drunk I can have sex for hours, it’s sick
really” (Boy5FG1)
“And I can’t get it up” (Boy2FG1)
“I lost my virginity when I was drunk; I had sex for
two and half hours” (Boy5FG1)
“I also lost it when I was pissed” (Boy1FG1)
“But, it can also feel really bad. I know that if I take
‘lad’ and Viagra, if I mix it….(Boy4FG1)
-“Lad?” (ML)
-“Yeah, coke you know, then you feel like a porn star, you
are, you get totally fucked up”(Boy4FG1)
“Pump up some X and do your thing” (Boy3FG1)
“Yeah, and then, if you do it a couple of times, if you do it
with the same chick, at parties and so….then it feels so
boring when you don’t do it (with drugs), you feel so
deprived when you have sex. Like, what the hell is this? It
feels like you´ve had the best experience and then, when
you do it clean it´s just so boring” (Boy4FG1)
” But, I was 14 the first time they took me of the street”
(G3FG2)
“I see, then it was probably because you were 14” (ML)
“But there is no law prohibiting one from selling sex!”
(G3FG2)
“No, no there isn´t. But it was probably because you were
under 15” (ML)
“Uhu, yeah, maybe” (G3FG2)
“What would be not so good about it then, can you think of
something?” (ML)
“You might get sad and you might get, you might get affected.”
(G3FG2)
“You mean reminded of things you don’t want to think about?” (ML)
“Mmmm.” (G3FG2)
“Do you still think it’s important to discuss these things or is it too
tough?” (LC)
“Maybe tough talking about, but….”(G2FG2)
“You don’t have to go deep into stuff (G3FG2)
Youths at Swedish residential homes appear
more risk-taking and sexually exposed than their
same aged peers
 Timing (earlier) and setting (more risky) differs
 However: The chance of something good
(pleasure, intimacy, status, being like everyone
else) outdoes risks. To them it is worth the risk!
 A sex education curriculum presented appears
relevant to them
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Implementation on detention homes
Staff informed of the curriculum
(origin,content, pedagogigs)
The curriculum used in the school setting
All participating youths: survey before and
after
X participating youths: interviewed
Staffs’ experiences sought
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Do not be afraid to discuss sexuality with
youths in residential homes. You do not have
to be an expert, a willingness to listen and not
judge is good enough.
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Be reflexive regarding your reactions and
actions when it comes to youths and their
sexuality. Their sexuality is not (usually) a
behaviour to treat or improve.
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Access to sexual health care (counseling,
testing, contraception)
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All participating girls and boys!
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Fellow doctoral students Lotta Carlström and
Jack Lukkerz for assisting during focus group interviews
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Advisors professor Lotta Löfgren-Mårtenson
and professor Sven-Axel Månsson –
for everything, supervision is essential
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The National Board of Institutional Care, SiS –
for financing the research
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Thanks for listening!
Your comments or questions?!
malin.lindroth@mah.se