Despite the importance of sexual health to individuals’ well-being, it is not something that is often discussed or taught—even to medical and nursing professionals. Even in high-income countries like the United States, only about a third of health students feel adequately trained to address and treat the sexual health concerns of their patients.

The challenge is even greater in low-income countries around the world who face the greatest sexual health challenges. Sub-Saharan Africa, for example, has the highest rates of HIV, sexually transmitted infections, unplanned teen pregnancies, and sexual violence in the world. Yet medical, nursing, and midwifery schools across the region almost never provide the formal sexual health training that could train healthcare providers to better meet the needs of their patients.

In a first-of-its-kind study led by the University of Minnesota School of Public Health (SPH), researchers offer “gold standard” evidence that filling this gap in training could improve sexual health outcomes for people in Sub-Saharan Africa. The study, conducted with colleagues from the Muhimbili University of Health and Allied Sciences in Tanzania, is the first randomized controlled trial to test the effectiveness of a sexual health curriculum for health students. To conduct it, the research team designed a four-day, culturally tailored, Afrocentric training curriculum rooted in local culture. Study participants were divided into intervention and control groups, with only the intervention group attending the four-day training. Both groups then completed a series of surveys and standardized patient interviews before, immediately after (intervention group only), and then 3-4 months following the training.

The study, funded by the National Institutes of Health and published in Archives of Sexual Behavior, showed that students who participated in the training, compared to a control group, demonstrated big improvements, including:

• Better knowledge. Student participants from the intervention group had significant gains in sexual health knowledge
• Greater confidence to address sexual health concerns. The study found that the training led to increases in students’ confidence to discuss and address patients’ sexual health concerns.
• More comfort and openness to discuss sexual health. There was a measurable shift toward more open and empathetic beliefs about sexual health and the importance of including these issues in patient consultations.
• Improvement in clinical skills. Students in the intervention group improved their sexual history taking and clinical communication skills, including their ability to discuss common sexual health concerns with patients. A major strength of this study is that skills were assessed by expert raters who reviewed videos of the students’ counseling, blind to both whether the video was from baseline or follow-up and the student from the intervention or control group.

Effects were similar for both medical and nursing/midwifery students. In addition, nearly all participants (96%) stated the curriculum was culturally acceptable, and more than 98% said they would recommend it to their peers.

“For decades, people have debated how much sexual health education should be part of medical and nursing schools’ curricula.  This study shows that not only is it appropriate, it is needed, welcomed, and highly effective,” said Simon Rosser, lead author and SPH professor. “The curriculum led to moderate to large, statistically significant improvements in knowledge, attitudes and clinical skills among health students in one of the poorest and most socially conservative countries in Africa. So, if you can teach it in Tanzania and get these results, you should be able to teach it anywhere. Bottom line: if you train health workers to be comfortable discussing sex and sexuality with patients, you produce better clinicians.”

The training curriculum included significant training in human sexuality across the life-span, sexual functioning and dysfunction, the healthcare needs of key populations including LGBTQ+ people, as well as vulnerable populations such as victims of sexual abuse and gender-based violence.

The research team is conducting a follow-up study to evaluate the long-term effects of the curriculum, and to develop and test a training program for faculty to implement this evidence-based curriculum at other universities.