Sexual Health

'Sweden has changed me': a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm, Sweden.

TL;DR

Sexual and mental health needs of young male former unaccompanied minors, asylum seekers and refugees follow a process of individual change influenced by contextual factors, described as 'On my way, but not there yet.'

Key Findings

Participants' sexual and mental health needs followed a process of individual change captured in a core category called 'On my way, but not there yet.'

  • The core category contained four subcategories: 'being on the move: the migration journey'; 'newly arrived: contrasting old and new values and learning new concepts'; 'navigating relationships, love and sex'; and 'the respectful man'
  • Analysis was performed using constructivist grounded theory
  • 32 young males aged 16-28 from Afghanistan, Eritrea and Syria were interviewed
  • The process reflected stages of adaptation and identity development over time

Six key factors were identified as influencing participants' sexual and mental health needs.

  • Positive factors included: attending school/receiving accurate sexual information, support to adapt, and experiencing enjoyable relationships
  • Negative factors included: restrictive parental values, exposure to stigma/discrimination, and the negative image of young male refugees
  • These factors operated at both individual and contextual levels
  • The negative public image of young male refugees was specifically identified as a distinct adverse influence on well-being

The migration journey itself was identified as a distinct phase shaping participants' sexual and mental health needs.

  • The subcategory 'being on the move: the migration journey' represented the starting point of the change process
  • Participants were former unaccompanied minors, meaning they had migrated without parents or guardians
  • Countries of origin included Afghanistan, Eritrea and Syria, representing diverse cultural backgrounds with differing norms around sexuality
  • The journey phase preceded and set the context for subsequent adaptation experiences

Newly arrived participants experienced a process of contrasting old and new values and learning new concepts related to sexuality and relationships.

  • This was captured in the subcategory 'newly arrived: contrasting old and new values and learning new concepts'
  • Participants encountered Swedish norms and values around sexuality that differed from those in their countries of origin
  • The study title quote 'Sweden has changed me' reflects participants' own recognition of this value transformation
  • This phase involved active meaning-making between cultural frameworks

Participants described a process of navigating relationships, love and sex as part of their evolving sexual health needs.

  • This was captured in the subcategory 'navigating relationships, love and sex'
  • Experiencing enjoyable relationships was identified as a positive factor influencing both sexual and mental health
  • Participants were aged 16-28, spanning adolescent and young adult developmental stages
  • Romantic and consensual relationships were specifically named as areas where participants needed support

An aspirational identity of 'the respectful man' emerged as the final stage of participants' developmental process.

  • This subcategory represented the endpoint or goal state in the process of change
  • It reflected participants' internalization of norms around gender, respect, and relationships
  • The study aimed to understand what participants needed to achieve 'a positive and respectful approach to sexuality, romantic and consensual relationships'
  • Gender norms were identified as a key theme requiring address in educational interventions

Restrictive parental values were identified as a factor negatively influencing participants' sexual and mental health needs.

  • Parental values were listed among the six key influencing factors
  • This is notable given that participants were unaccompanied minors, suggesting parental influence persisted despite physical separation
  • Restrictive values may have conflicted with Swedish norms encountered after arrival
  • This finding emerged from theoretical sampling and constructivist grounded theory analysis of 32 interviews

The study found that educational interventions must address both sexual and mental health aspects including gender norms, relationships, sex and consent to improve well-being in this population.

  • This was a key recommendation emerging from the qualitative analysis
  • The authors noted that sexual health needs of young refugees and asylum-seeking men are 'seldom explored or addressed, adversely affecting their mental and physical well-being'
  • Attending school and receiving accurate sexual information was identified as a positive influencing factor
  • The interconnection between sexual and mental health was a central finding of the study

The study used an exploratory qualitative design with constructivist grounded theory and theoretical sampling to analyze data from 32 participants.

  • Semi-structured interviews were conducted in Region Stockholm, Sweden
  • Participants were 32 young males aged 16-28
  • Countries of origin were Afghanistan, Eritrea and Syria
  • Theoretical sampling was used for participant selection, meaning sampling was guided by emerging theoretical concepts during analysis

What This Means

This research explored the sexual health needs and related mental health experiences of young men who came to Sweden as unaccompanied minors, asylum seekers, or refugees. The researchers interviewed 32 young men aged 16-28 from Afghanistan, Eritrea, and Syria living in Stockholm, asking them about their experiences with relationships, sexuality, and how these changed over time. Rather than treating this group's needs as static, the study found that their sexual and mental health needs evolved through distinct stages — from the migration journey itself, through adapting to new cultural values, to navigating actual relationships, and ultimately toward developing an identity as a 'respectful man.' The study identified six factors that shaped these young men's experiences. Positive factors included going to school, receiving accurate information about sex and relationships, having social support to adapt, and having enjoyable relationships. Negative factors included restrictive values from their families, experiencing discrimination, and the harmful public stereotype of young male refugees. Notably, the negative image society holds of young male refugees was itself identified as something that damaged participants' well-being, separate from direct personal discrimination. This research suggests that programs designed to support the well-being of young male refugees and asylum seekers need to address sexual health and mental health together, rather than treating them separately. It also suggests that such programs should account for the ongoing process of cultural adaptation these young men experience, and specifically address topics like gender norms, consent, and relationships. Simply providing information is not enough — support structures that help with cultural adaptation and combat stigma may be equally important.

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Citation

Tewelde McDonald J, Fayzi B, Laktinah M, Ekström A, Salazar M. (2024). 'Sweden has changed me': a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm, Sweden.. BMJ open. https://doi.org/10.1136/bmjopen-2023-080514