This study examined how healthcare providers in municipal primary healthcare clinics regard the provision of sexual healthcare or promotion to transgender and gender diverse people. Previous research is sparse and shows that care situations can be difficult and distressing, especially for the patients but also for the caregivers. Reflexive thematic analysis was applied when analysing semi-structured interviews with eight healthcare providers employed by primary healthcare centres in the south of Sweden. The analysis resulted in four themes (i) Two aspects, many pitfalls, (ii) External changing winds, internal lulls and resistance, (iii) Strong emotions while wanting to do good rather than harm and (iv) Arbitrary navigation following one’s own compass while wishing for guidance. Despite good intentions among participants, a substantial gap between sexual and reproductive health and rights policy and everyday practice protruded. Additionally, culture within these primary healthcare clinics appears to hinder professionals’ abilities and possibilities to promote sexual health to transgender and gender diverse people.

The use of alcohol or illicit substances by youths may be related to sexual motives and experiences. Accordingly, child welfare workers need to address young people's sexuality in their investigative work. In this study, we have examined the significance of different social categories, namely gender and sexual orientation, when child welfare workers assess young people with a substance use and their related sexual health. Fifteen child welfare workers were recruited through a strategic sampling to participate in semi-structured interviews, which were analysed using thematic content analysis. The results consist of three sub-themes: Sexually vulnerable girls; Boys as perpetrators; and Unseen LGBTQ+ youth. Together, these sub-themes constitute an overarching theme where the heterosexual matrix appears to be the interpretative framework when investigating a problematic substance use. The suggested implications for practice include education in sexual and reproductive health and rights for child welfare workers aiming to achieve an equitable assessment process for all youth with a problematic substance use. 

Socialsekreterares förståelse av kön, sexuell läggning och sexuell hälsa i utredningar av unga med substansmissbruk 

Ungas substansanvändning kan ibland relateras till sexuella motiv och erfarenheter. Det är därför av vikt att socialsekreterare adresserar dylika frågor i barnavårdsutredningar som är fokuserade på ungas eventuella missbruksproblematik. I denna studie har vi därför undersökt hur olika sociala kategorier – kön och sexuell läggning – relateras till ungas sexuella hälsa, men också hur det får betydelse i utredningar av unga med missbruk. Femton socialsekreterare har intervjuats med stöd av en semi-strukturerad intervjuguide, vartefter resultatet analyserats med hjälp av en tematisk innehållsanalys. Det slutgiltiga resultatet ledde fram till tre sub-teman: sexuellt sårbara tjejer; killar som förövare; osynliga HBTQ+ -ungdomar. Dessa tre teman bildar tillsammans ett övergripande tema; den heterosexuella matrisen fungerar som tolkningsram i utredningsarbete av ungas substansmissbruk. Implikationer för praktiken innefattar bland annat utbildning i sexuell och reproduktiv hälsa och rättigheter (SRHR) för socialsekreterare inom den sociala barnavården i syfte att säkerställa jämlika utredningsprocesser för alla unga med substansmissbruk. 

This article explores the ethical complexities encountered during a research project, where one sub-study aimed at interviewing LGBTQ+ youth in state care. Using a theoretical framework of ethics of care and the concept of consent, we discuss our difficulties finding interviewees and our decision to stop recruiting because of ethical considerations. We aim to show: (1) How different forms of care were expressed during the fieldwork process, and (2) How care practices and non-actions during this process constituted a contextual non-consent. We analyze the ethical dimensions of the fieldwork process and argue that this was an example of how a contextual non-consent was developed, based on lack of response from youth, gatekeepers' hesitations, the signals we received from allied professionals within NGOs acting as gate-keepers and the professionals in care facilities we interviewed, together with our own mitigations of the risks of contacting youth in facilities where we reached the conclusion that not conducting a certain study will sometimes be the most ethical way of doing research with a vulnerable groups. The study highlights the importance of continuous ethical reflection and the potential need to abandon research plans to protect vulnerable groups. The findings underscore the ethical responsibility of researchers to prioritize the well-being of participants over the pursuit of data, especially when dealing with marginalized populations. This case study contributes to the broader discourse on ethical research practices and the nuanced understanding of consent in qualitative research.

The study explores sexuality discourses among young people with migration experience in Sweden. Using a qualitative design and a combination of convenience, snowball and purposive sampling, twenty interviews were conducted between October 2021 and August 2023. Participants self-identified as women (8) and men (12), were aged between 17 and 26, and had migrated to Sweden between two months to 16 years ago. Drawing on concepts of cultural and bio-sexual citizenship, discourse analysis was used to identify their interpretative repertoires regarding discourses of sexuality. Three interpretative repertoires were identified. First, there was the positioning repertoire, in which sexuality appears as a border marker for belonging, reflecting how participants positioned themselves regarding discursive constructions of sexuality in mainstream Swedish society and their ethnicised migrant communities. Secondly, there was the risk repertoire, in which sex was constructed as a risk and associated with negative sexual and reproductive health outcomes. This repertoire emphasised the notion of sexual responsibility, entailing adherence to preventive measures, responsible decisions, and maturity. Thirdly, there was the sexual agency repertoire, which referred to how participants negotiated sexual agency at the societal and interpersonal levels. Each repertoire elucidated a hybrid conceptualisation of sexuality through which participants made sense of their sexuality-related experiences and views.

Previous research shows that LGBTQ+ youth are over-represented in out-of-home care and that especially transgender andnon-binary youth face challenges during their placement. These challenges stem from, among other factors, the lack ofknowledge and competence of professionals regarding the unique needs of transgender and non-binary youth. In Sweden,there are policies that aim to protect transgender and non-binary youth from discrimination and to promote their sexualand reproductive health and rights, and an increasing number of residential homes claim to have LGBTQ competencewhen competing for placements. However, it is unclear how this affects the everyday experiences of trans and non-binaryyouth at residential homes. The purpose of this study is to investigate the practices and challenges of clinical social workers at residential care homes when working with gender identity and sexual health issues among young transgender andnon-binary youth. Eight semi-structured interviews focusing on professionals’ knowledge and experiences were conductedand analysed using reflexive thematic analysis. Four themes emerged: i) Knowledge being a personal matter; ii) Heteronormativity and binarity creating consequences; iii) Handling discrimination and harassments; and iv) Creating a trustfulalliance. The results show that knowledge is a personal matter, and social work professionals seek the knowledge theyneed instead of receiving it in education or training. The contextual heteronormativity and binarity creating consequencesat the residential care home pose challenges for social workers and they have to find creative ways to support transgenderand non-binary youth and address the harassments and discrimination that these youth face. Moreover, the social workersshare their strategies regarding how they are creating a trustful alliance. Overall, they identify significant challenges todeveloping clinical social work that is affirming of transgender and non-binary youth.

Young people with substance use problems often have an early sexual debut, an increased risk of sexually transmitted infections and unplanned pregnancies, and a high risk of experiencing sexual violence. At the same time, according to the national action plan on sexual and reproductive health and rights (SRHR), the social services in Sweden have an important role in addressing sexual health in various contexts, such as in child welfare investigations. Therefore, this study has investigated how Swedish child welfare workers understand and relate to sexual health issues in child welfare investigations regarding young people with substance use problems. Following a strategic sampling, 15 child welfare workers were interviewed. The interviews were examined with a thematic content analysis with results showing that sexual health issues represented an area where knowledge was lacking. This was largely connected to that the child welfare workers had not been taught about SRHR in their bachelor’s degree nor in their continued education within the child welfare system. As a result of this, they often developed their own individual, professional approach for assessing sexual health matters, guided by the principle of “not investigating more than necessary”. When addressing sexual health in their assessment work, the child welfare workers primarily focused on risk, vulnerability and exposure. Not assessing young peoples’ sexual health was seen as protecting the right to confidentiality and privacy. In summary, this meant that young people with a problematic substance use were seldom given opportunities to talk about their sexual health, and especially not about positive sexual experiences related to their substance use.

With a phenomenological approach, we explored transgender and non-binary people’s strategies to experience sexual well-being. Ten self-reports (seven interviews and three written texts) were analyzed, and the analysis resulted in six themes. The first three (Affirming oneself, Having access to care, and Being respected as one’s gender) were strategies for sexual well-being realized through affirming one’s identity, receiving the gender-confirming care wanted, and having one’s gender identity respected by others. The other three themes (Masturbating and fantasizing, Communicating and being open, and Being sexually free in queer spaces) were strategies for one aspect of sexual well-being—pleasure. The results describe strategies that all can learn from: the need to accept and appreciate oneself, not just adapt to gender norms of bodies and behaviors, and to communicate. In addition, it illuminates that being norm-breaking, or stepping out of the gendered paths presented to you, appears to provide new opportunities for people to learn what they enjoy, and this could lead to a broader repertoire of pleasurable sexual practices—practices that take bodily prerequisites into account

Objective: Young people are prioritized regarding the promotion and safeguarding of sexual and reproductivehealth and rights – SRHR. In Sweden, the school is seen as an important arena with members of the school healthcare or SHC team as vital actors in this work. This study explored SRHR-related work in SHC teams in Sweden.

Methods: Within an explorative qualitative design, structured interviews were conducted with 33 nurses, counsellors, SHC unit managers and headmasters. Reflexive thematic analysis was applied, and two main themesfound.

Results: SHC team members see SRHR as an urgent topic, but address it only ‘when necessary’, not systematically– and they experience a shortage of guidance and cooperation regarding SRHR-related work. Even in a countrywith agreement on the importance of SRHR for all and on providing holistic comprehensive sex education inschools, young people are left to chance – i.e., to the SRHR competence in the professionals they meet.

Conclusion: SHC team members in Sweden see SRHR as an urgent topic but do not address it systematically.Moreover, they experience a shortage of guidance for their work. To avoid any professional stress of conscienceand for equitable school health care regarding SRHR to be realized, research-informed policy needs to underlinesystematic, comparable and proactive practice.

The aim of this study is to explore the current scientific evidence for using the twelve-step method as a treatment method for sex addiction and compulsive sexual behavior (disorder). Peer-reviewed empirical articles on the twelve-step method and sex addiction and compulsive sexual behavior (disorder) written in English, Danish, Norwegian, or Swedish, retrievable in selected databases were included. No limits were set on publication date or study design. The systematic review resulted in eight empirical studies which were read and assessed according to the Mixed Methods Appraisal Tool. The results were inconclusive, and we found only three articles of high quality, where the samples were composed mainly by men, which indicate that peer-therapy in combination with individual therapy might be beneficial. That twelve-step treatment rests heavily on the idea of sex addiction was unproblematized in most of the publications. Overall, the findings raise issues concerning who benefits from this treatment.

Although a growing body of literature has focused on the experience of young people with migration experience with Swedish sexual and reproductive health (SRH) services, there is a lack of deep qualitative exploration. The study aims to explore the encounters of young people with migration experience with SRH services and their understandings of factors that affect their use of these services. The findings of this study were drawn from 18 interviews conducted between October 2021 and May 2023 in Southern Sweden. A combination of convenient and snowball sampling strategies was used. Participants included in the study self-identified as Middle Eastern, migrated to Sweden, and were aged between 17 and 26. Data were analyzed using reflexive thematic analysis approach. Three themes were generated during the analysis. The first SRH services: dual perceptions and experiences shows how participants had ambivalent perceptions of SRH services, mainly the youth clinic. Some perceived the youth clinic as a stigmatized place associated with shame and SRH concerns like unwanted pregnancy and sexually transmitted infections, while others viewed the youth clinic as a safe space. The negative perceptions along with the difficulties with accessing the youth clinic contributed to low service use. The second Sexuality education: an eye-opener or a joke? reflects participants' both positive and negative experiences and attitudes when receiving sexuality education in schools. The third SRH information: beyond formal services and education captures participants' ways of accessing SRH information that go beyond information provided at the traditional SRH services and sexuality education in schools. These sources include the family, friends, and the internet. The study points to the need for multicomponent strategies to improve the accessibility of SRH services and draws attention to the importance of challenging norms related to Swedishness in sexuality education to foster the engagement of youth with migration experience and ensure their sexual citizenship.