JMIR Publications

ABSTRACT

Background:

The sexual health of young men in prisons is often amongst the poorest in any given country. They may have developed sexual behaviours that from a public health perspective, are considered problematic and burdensome. These include poorer use of condoms and engaging in more frequent, casual sex with riskier partners, resulting in higher rates of STIs, including HIV and Hepatitis. Thus, young incarcerated men are a highly marginalised and socially excluded high-risk group, in greater need of sexual health education and services.

Objective:

To create an innovative sexual health promotion intervention, made for and with young men in prisons that would encourage them to avail of regular sexual health check-ups. This included developing an online animated–style sexual health promotion intervention (1.42min) coupled with upskilling the prison nurses to offer a partnership approach to sexual healthcare as part of prison healthcare.

Methods:

We employed a rights-based participatory approach and recruited 14 participants who attended three co-production workshops held within a Northern Ireland (UK) prison site. We developed a bespoke 3-day training for nurses beforehand, which ensured they gained a deeper understanding of the determinants of poor sexual health and lack of agency and autonomy for the young men in their care. The co-production team consisted of young incarcerated men; prison nurses; nurse sexual health consultant; media company representatives and facilitator. During workshops, we discussed content, design, tone and medium of communication for an online intervention that would be appealing and engaging for young incarcerated men.

Results:

A 1.42minute animation ‘Dick loves Doot’ was created (https://www.youtube.com/watch?v=eXAWctsAKys). The rights-based approach enabled the young men to participate and have their voices heard and to see their stories reflected through the animation. The nurses’ capacity to protect, fulfil and respect the young men’s rights to appropriate sexual health services and education was also enhanced. Evaluations confirmed that we successfully provided accurate sexual health information in a way that was engaging and accessible, and encouraged the young men to avail of the prison sexual health services, which the nurses provided confidently.

Conclusions:

While it was challenging to meet the young men’s preferences within the prison context, the rights-based participatory approach to health advanced in this study provided invaluable insider knowledge and strategies by which to target the health inequities that affect them. The approach provided a means to; 1) understand the impact of structural determinants on health and health inequalities; 2) create inclusive opportunities for developing bespoke targeted interventions; and 3) galvanise collaborative partnerships to disrupt the structures and processes that lead to, and encourage, health inequities. To reduce future risk, effective treatment, coupled with co-produced interventions that transmit relevant health messages in a way that is relevant and meaningful, are key to success. Clinical Trial: N/A