Training in Sexual Health and STD Prevention in Canadian Medical Schools
Michael Barrett and Alexander McKay, The Sex Information and Education Council of Canada, Toronto, Ontario.

This is the first national study to provide detailed documentation and analysis of the extent and content of sexual health topic coverage in Canadian medical school programs in undergraduate medicine, family medicine, obstetrics and gynaecology, urology and psychiatry. Respondents representing 62 programs from 16 universities indicated the emphasis (topic not taught, minimal, considerable, heavy) that their training in sexuality gave to each of 19 different sexual health/STD topics. These ratings were used to identify for each field the topics that its programs might reasonably be expected to give "considerable" or "heavy" emphasis. Some programs greatly exceeded such expectation but there was considerably more program variability within each field than might have been expected given the medical relevance of the topics to their speciality. The six topics most heavily covered overall dealt with STD/HIV prevention and treatment, sexual assault/abuse, and pregnancy prevention. Other topics, such as the role of sexuality in couple relationships, sexuality and aging, sexual orientation, sexuality and disability, adolescent sexuality, and social/cultural differences in sexual beliefs and customs, received less emphasis than seemed warranted. In the fields where comparison was possible, programs with required sexuality courses generally had stronger overall coverage of all topics and of their field's expected topics in particular. The field specific standards developed here offer a basis for assessing and strengthening sexuality education in medical training. (The Canadian Journal of Human Sexuality, 1998; 7:305-320)

Challenges in Implementing Innovative and Successful Sexually Transmitted Disease Control Programs: Theory and Practice.
Lynn McIntyre and Justin Jagosh, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia.

This paper proposes a model to describe the implementation of STD control programs and illustrates aspects of the model through reference to four different STD prevention initiatives. The model includes four domains of program implementation: an environment in which policy, partnership and participation interact with implementation activities; program milestones such as approval and program launch; a dynamic implementation progression beginning with implementation planning and the mobilization of program implementers, through a series of steps involving successive waves of client contact over time; and evaluation, both formative and summative. As demonstrated by the initiatives described here, STD control programs face challenges to implementation in all four domains. (The Canadian Journal of Human Sexuality, 1998; 7: 321-329)

A Hepatitis B Vaccination Outreach Project for Street Youth in Montreal.
Nancy Haley, Elise Roy, Lyse Belanger, & Anna-Louise Crago, Montreal Public Health Department, Montreal, Quebec.

Urban street youth are thought to be at particular risk of infection with hepatitis B virus (HBV) because of high risk sexual behaviour and injection drug use as well as frequent body piercing and tatooing. This paper describes an HBV vaccination outreach project for street youth that sought to increase access and to maximize vaccination completion rates through community outreach initiatives, accessible vaccination clinics in community organizations frequented by street youth, and an active and innovative recall system. In the first year of the project, 639 youth aged 25 and under were reached. The 504 youth who completed questionnaires had high levels of HBV risk behaviours with 32% having engaged in injection drug use and 58% having had more than 10 sexual partners. Preliminary analysis on a subsample of 383 from this group who had been followed for 8.5 months showed that 79.1% had completed two doses of vaccine and 50.4% all three doses. Demographic data from the questionnaires provided a basis for comparing two and three dose completion rates in different groups within the subsample. For example, both rates were higher in youth who had engaged in prostitution than in those who had not and rates were no less in youth involved in injection drug use than in those who were not. The findings highlight the importance of reaching marginalized youth with HBV vaccination early in their street life and of concurrently providing health care, counselling and support services adapted to their needs. (The Canadian Journal of Human Sexuality, 1998; 7: 331-338)

A School-based HIV/AIDS Prevention Education Program: Outcomes of Peer-led Verses Community Health Nurse-led Interventions.
Linda Dunn, Brenda Ross, Tony Caines, and Peggy Howorth, Toronto Public Health, East York Office, Toronto, Ontario.

This study evaluated a brief school-based HIV/AIDS prevention intervention for adolescents delivered by either community health nurses (CHNs) or by trained peer educators (PEs). The interventions consisted of two one-hour sessions. Following the sessions, subjects in the CHN-led (n=58) and PE-led (n=53) groups and a control group (n=49) filled out questionnaires measuring HIV/AIDS prevention knowledge, attitudes, self-efficacy, and behavioural intentions. Students in both the CHN and PE-led groups had significantly higher scores than controls in HIV/AIDS prevention knowledge and students in the PE-led group had significantly higher knowledge scores than students in the CHN-led group. Students in the PE-led group had significantly higher scores on the HIV/AIDS prevention attitudes, self-efficacy, and behavioural intentions questionnaire than did controls. There were no significant differences between the CHN-led group and the PE-led group in total attitude, self-efficacy, and behavioural intention scores. On specific questionnaire items concerning key predictor variables associated with condom use, student scores indicated that the PE-led intervention, and to a lesser extent the CHN-led intervention, had a significant positive impact. The findings suggest that brief school-based interventions can improve adolescents short-term HIV/AIDS prevention knowledge, attitudes, self-efficacy, and behavioural intentions. (The Canadian Journal of Human Sexuality, 1998; 7: 339-346)

A Theory-based Initiative to Reduce the Rates of Chlamydia Trachomatis Infection Among Young Adults in the Yukon.
Jeff Wackett, Health Promotion Unit, Health and Social Services, Whitehorse, Yukon.

This paper describes the development, implementation, and assessment of a theory-based, territory-wide social marketing campaign to reduce the high rates of Chlamydia trachomatis infection among young adults in the Yukon. Campaign messages focused on three key goals: increasing awareness of chlamydia among 15-29 year-olds; reducing the probability of transmission (through regular condom use and safer sex practices); and reducing duration of infection (through increased testing for both sexes). The three month intensive campaign, called "Style: doing the right thing", featured a visually arresting poster that became identified with the campaign, high profile radio spots, bus signs, and a widely distributed Style Kit (a brochure and condoms in a case designed to look like a rock CD). All resources featured meassages focused on the three goals. Pre- and post-campaign questionnaires assessing both chlamydia-related knowledge and opinions about condom use were completed by over 650 high school and community college students. Increases in knowledge in this sample, and in the frequency of chlamydia tests within the entire community, are thought to be attributable to the campaign. Methodological challenges and limitations in implementing and assessing such an intervention are discussed. (The Canadian Journal of Human Sexuality, 1998; 7: 347-356)