Exploring beneath the covers – Embarking on a journey towards engaging men and fa’afafine in sexual health in Samoa: Sexual health, sexually transmitted infections and relevant health services from the perspectives of Samoan men and fa’afafine

Abstract

The significance of sexual health to general health and well-being across the lifespan cannot be understated. Sexual health matters – no matter what gender, sexual orientation, religion or culture one identifies with. Despite historically being considered ‘women’s business’, more and more recognition is being given to the need to involve men and their desire to be involved. The involvement of men in sexual health has been shown to have many advantages which ultimately culminate in healthier men, healthier relationships and healthier communities. The potential for this approach to stave the epidemic of Chlamydia trachomatis genital infection in Samoa is significant. Exploring the need for, and the best way to implement a male involvement approach is critical to advising future advances in sexual health in Samoa. The aim of this research was to generate new learnings and understanding of Samoan men’s and fa’afafine’s sexual health ideas, influences, aspirations and needs, utilising these insights to describe an approach that strengthens their engagement in sexual health in Samoa in a way that is effective and sustainable throughout their lifespan. A systematic review was undertaken to identify the key elements of a programme, strategy or intervention that enables the effective engagement of boys, men or MTF transgenders in sexual health in low- or middle-income countries. This study also employed a qualitative methodology to obtain crucial insights and perceptions regarding sexual health, sexually transmitted infections and sexual health services from eighteen Samoan men and fa’afafine, living in Samoa and between the ages of 18-45 years. The emerging themes relating to the research objectives were categorised into a framework which embodied an ecological model and outlined the experiences of the participants whilst demonstrating the key relationships between the themes. The key themes explored were sexual health perceptions and behaviours, sexual health communication, sexual health responsibilities, influences on sexuality and sexual health, and sexual health services. The findings of this study highlight a prevalence of risky sexual behaviours among Samoan men and fa’afafine, which presents a significant public health concern. These high risk sexual activities include high numbers of lifetime sexual partners, concurrent partners, and low condom use. Significantly, most participants perceived there to be a lack of sexual health information and education, and believe that the sexual health services in Samoa are lacking in their ability to provide privacy and confidentiality. Recommendations are presented regarding the need for men and fa’afafine friendly and engaging policies, strategies, programmes and interventions in Samoa. A framework to guide the involvement of Samoan men and fa’afafine is offered, representing the evidence obtained from the systematic review and qualitative enquiry. Additional recommendations are made which are specifically relevant to sexual health services and professionals, schools, youth groups and communities, health promotion, collaborations with other key government ministries, NGOs and faith-based organisations to ensure that Samoan boys, men and fa’afafine have access to and are informed with appropriate information to make safe sexual health decisions and advance sexual health for all.