Sexual Health

Sexual and reproductive health of adolescents and young people: identification of demands and experiences based on a qualitative study in communities in five Brazilian cities.

TL;DR

There is a lack of regular spaces for learning and dialogue about sexuality, prevention, and care for the youth due to absent investment in public health care and professional training.

Key Findings

Young people across five Brazilian cities shared similar complaints about public health services despite regional differences, particularly regarding long waiting times and insufficient health professionals.

  • Study included 139 male and female participants aged 15 to 24 years
  • Participants lived in low-income communities in five cities: Porto Alegre, São Paulo, Rio de Janeiro, Manaus, and Salvador
  • Regional specificities existed but did not prevent convergence of perspectives on service quality
  • Long waiting times for care and insufficient professionals were emphasized as primary complaints

Individual-level barriers prevented young people from accessing sexual and reproductive health information and services.

  • Barriers included poor knowledge about their rights regarding sexual and reproductive health
  • Shame and stigma associated with sexual and reproductive health issues were identified as obstacles
  • Fear of testing positive for HIV was a specific barrier to HIV testing
  • Lack of family dialogue and guidance on sexuality and health also contributed to individual vulnerability

Programmatic-level barriers existed due to misalignment between health unit working conditions and the specific demands of adolescents and young people.

  • Discrepancies were found between the working conditions and dynamics of health units and the demands of adolescents and young people
  • Health professionals were identified as poorly prepared to address specific issues of the adolescent and youth population
  • These programmatic obstacles compounded individual-level barriers to care access
  • The study used ethnographic observation, semi-structured interviews, and focus groups to identify these barriers

The study employed a multi-method qualitative approach across geographically diverse low-income Brazilian communities.

  • Methods included ethnographic observation, semi-structured interviews, and focus groups
  • A total of 139 participants were assessed across five cities representing different Brazilian regions
  • Participants ranged in age from 15 to 24 years and included both male and female participants
  • All communities were characterized as low-income, allowing focus on a socioeconomically vulnerable population

The absence of regular spaces for learning and dialogue about sexuality and prevention was identified as a structural gap affecting youth sexual and reproductive health.

  • Lack of regular spaces for learning and dialogue about sexuality, prevention, and care was attributed to absent investment in public health care
  • Insufficient professional training was identified as a contributing structural factor
  • This gap was identified at both the community and health system levels
  • The finding applied across all five cities studied despite their geographic and cultural differences

What This Means

This research examined the sexual and reproductive health experiences and needs of 139 young people aged 15 to 24 living in low-income neighborhoods across five major Brazilian cities: Porto Alegre, São Paulo, Rio de Janeiro, Manaus, and Salvador. Using in-depth interviews, focus groups, and community observation, the researchers found that young people face serious obstacles when trying to access health services and information related to sexual and reproductive health, including HIV testing. Despite differences between cities and regions, the young people's complaints and experiences were strikingly similar. The study identified barriers at two levels. At the individual level, young people lacked knowledge about their health rights, felt shame or stigma around sexual health topics, and feared finding out they were HIV-positive. Families rarely discussed sexuality or health openly, leaving many young people without guidance. At the system level, public health clinics were found to be poorly equipped to serve young people — with long wait times, too few staff, and health professionals who were not adequately trained to address the specific concerns of adolescents and youth. This research suggests that young people in low-income Brazilian communities face compounding disadvantages when seeking sexual and reproductive health care, rooted in both personal stigma and systemic under-investment in public health infrastructure and professional training. The findings point to a need for dedicated, youth-friendly spaces and services where adolescents can learn about and discuss sexuality, prevention, and care in a welcoming, non-judgmental environment.

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Citation

Monteiro S, Leal A, Barbosa R, Magno L, Neves A, Honorato I, et al.. (2025). Sexual and reproductive health of adolescents and young people: identification of demands and experiences based on a qualitative study in communities in five Brazilian cities.. Cadernos de saude publica. https://doi.org/10.1590/0102-311XEN047824