From Stigma to Support: Exploring Youth Views on STI Partner Notification in Maseru, Lesotho

From Stigma to Support: Exploring Youth Views on STI Partner Notification in Maseru, Lesotho | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Stigma to Support: Exploring Youth Views on STI Partner Notification in Maseru, Lesotho Makananelo Kenoakae Pule, Oluwafemi Omoniyi Oguntibeju, Mathildah Mpata Mokgatle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8436597/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Apr, 2026 Read the published version in BMC Public Health → Version 1 posted 16 You are reading this latest preprint version Abstract Background: The burden of sexually transmitted infections (STIs) varies by region and sex, and the greatest burden exists in low-income countries where STI testing is not conducted, and treatment is based on symptoms. Partner notification is a key strategy for controlling STIs, but it remains underutilized because of factors that are sociocultural, structural, and systematic. Methods: This study employed a sequential exploratory mixed method approach to assess the perceptions and social dynamics that affect partner notification strategies to control curable STIs in Maseru, Lesotho. The article reports the qualitative findings of the investigation. Five focus groups with between six and ten participants each were used to collect data between June and July 2025; the participants were purposively sampled. Results: Data were analyzed using thematic analysis. The results of study reveal five themes: knowledge or understanding of STI transmission, attitudes toward partner notification, motivators and benefits for STI partner notification services, barriers to STI partner notification, and preferred partner notification methods before and during the relationship. Conclusion: Youth have supportive views about partner notification services. It is, however, important to understand barriers to partner notification, in order to inform tailored services for youth. Moreover, comprehensive sexuality education and youth’s views on implementation of other partner notification services remain critical if the health services are to be responsive to their sexual and reproductive needs. sexually transmitted infections (STIs) partner notification symptomatic management low middle income 1. Background Sexually transmitted infections (STIs), specifically in young people, remain a global health concern (1). Epidemics of STIs continue to cause a significant disease burden; however, a global response is lagging (2). The World Health Organization estimates 376.4 million new curable STI cases occur annually. The sub-Saharan Africa region accounted for an estimated 40% of global infections in 2016–2021 (3). To prevent STIs, identification and management is essential (4). However, in low-income countries, once STIs have been diagnosed, their management is symptomatic(5). As a result of syndromic management of STIs, untreated STIs could contribute to death, increase the spread of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS), cause pelvic inflammatory disease, ectopic pregnancies and infertility and lead to adverse pregnancy outcomes (6,7). One of the approaches to preventing STI spread is partner notification services. Despite partner notification being essential for STI control, it is underutilized (7). Furthermore, while partner notification is well documented in some populations, little research has been done on youth-specific strategies, experiences and practices in sub-Saharan Africa. Young people are unique in their vulnerability to contracting STIs (8). Factors that contribute to risky sexual behavior by young people are early sexual debut, the age of sexual partners, having multiple partners, inconsistent condom use and lower risk perception for STI/HIV (7,8). Furthermore, challenges that face the youth are exacerbated by poor access to health facilities (7). Moreover, youth in different cultural contexts may have distinctly different experiences, which necessitates that a literature synthesis is undertaken to support the tailored design of youth-specific strategies to control and manage STIs (9,10). Partner notification is the process whereby sexual partners are notified that it may be possible that the partner has acquired an STI. In addition to being notified of exposure, sexual partners are screened for STIs and treated, if required (11). The benefits of partner notification are finding undiagnosed STI clients, reducing reinfections in index clients, and preventing the spread of STIs in a community (11). There are various approaches to partner notification, namely patient referral, provider referral and contract referral. Patient referral is an approach that involves an index client informing their sexual partners that the partners have been exposed to STIs and encouraging the partners to seek treatment. Another approach involves a health care worker informing partners of the index client that the index partner had an STI and may pass or have passed STIs to the partners and advising partners to seek medical care (11,12). Another option for partner notification is contract referral. The index client and the health care worker agree on a specific time when the index client will inform sexual partners about their exposure. When the agreed time has passed and the index client has not informed their partners, the health care worker informs the sexual partners about their exposure to STIs (11,12). Although it has been reported that partner notification strategies can be successful in achieving the benefits of notification, partner notification by youth remains a challenge because of stigma, fear of disclosure, concerns of confidentiality, and fear that a relationship might end once a partner knows about STI infection (8,13). This study assessed the perceptions and social dynamics that affect partner notification strategies, with the aim of controlling curable STIs in Maseru, Lesotho. 2. Methods 2.1 Study Design The study employed a sequential exploratory mixed method design and involved youth who accessed adolescent-friendly health services (general health, mental health, sexual and reproductive health, maternal and child health) in Maseru district. This article reports on Phase 1 of a main study that had the following objectives: to assess the perceptions of youth on partner notification strategies to control curable STIs in Lesotho, and to assess social dynamics that affect the partner notification strategies used to control curable STIs in Lesotho. This paper presents qualitative findings on youth’s views on partner notification strategies to control curable STIs in Lesotho. In this paper, findings are presented for women only, for men only, for the key population and mixed youth (Table 2 to Table 4 : Sociodemographic data findings). Exploratory qualitative research is undertaken in a situation where there is limited knowledge about a phenomenon, or when topic has not been adequately defined (14). 2.2 Study Setting and Context The study was conducted in two health care facilities in Maseru district that operate around the clock. Maseru is one of the ten districts of Lesotho; it is the capital city of Lesotho and includes urban and peri-urban areas. The district is divided into the central business area, residential areas and newer informal settlements. Maseru has a population of 519 186 (15). Adolescent corners at both health care facilities in Maseru offer a range of health services for youths. 2.3 Study Population, Sampling and Recruitment This study is part of a larger study that collected data by conducting five focus group discussions with 6–8 participants per group; the aim was to gather information on youth’s perceptions and social dynamics of youth related to partner notification strategies to control curable STIs in Lesotho. The focus groups were composed as follows: 1) A mixed youth group (this was a group composed of women and men), 2) A men-only discussion group, 3) A women-only discussion group composed of only women as participants, 4) A key population group, composed of mixture of men who have sex with men, sex workers and key informants. For this paper, the study population focus is youth (mixed youth, women only, men only and key populations). Purposive sampling was used to recruit participants for the study. Data saturation was reached in the fourth focus group discussion, when participants no longer provided new information. However, the principal investigator continued with the fifth focus group to confirm saturation. Purposive sampling was used because it actively promotes seeking diverse perspectives in a flexible manner according to the insights that were generated during the focus group discussions(16,17). Recruitment occurred in various ways. First, the principal investigator used a recruitment flyer as a guide to share the objectives and purpose of study during a health talk slot in the morning. Participants who agreed to participate at the time were invited into a private room for a focus group discussion. Second, the principal investigator requested organizations that provide health programs for the key population community to identify key populations that could participate in focus group discussions; this route was followed because it would have been difficult to identify the key population group through the public health facilities. A convenient time and place were agreed upon for the key population focus group discussion. 2.4 Inclusion Criteria and Exclusion Criteria The data were collected from youth residing in Maseru district aged between 18 and 24 years of age, who were sexually active, had used the services of the selected study setting and could read. This age group was selected because of their specific needs, which indicates that there is a relationship between youth sexuality and vulnerability (18). People who did not live in Maseru or had not used the services of the study setting were not included in the study. People who were not sexually active or who fell outside the specified age range, or who were not willing or did not consent to be part of study, were excluded. 2.5 Data Collection In preparation for data collection, a training session was presented for the research assistant, to ensure that he understood the study and to discuss data collection tools. Data were collected from June 2025 to July 2025. The data collection tool evolved as data were being collected; its purpose was to ensure that in-depth answers to research questions were gathered. A focus group discussion guide was used to guide the discussions (Table 1.). The guide included main and probing questions based on the participants’ responses. The main interview questions included in the guide were: What are your views about STIs partner(s) notification in Lesotho? What have you heard about STIs partner(s) notification services? What do you think about those services? What do you think are the benefits of STIs partner(s) notification services? What have you observed or heard about STIs among couples in the community? How do couples manage STI in the community? How do adolescents handle STI issues in their relationships? Furthermore, a consent form gathered the demographic details of the participants (Tables 2 – 4 ). Verbal and written informed consent were obtained from participants who were willing to take part in focus group discussions. The discussions were recorded using a voice recorder and each focus group discussion lasted about 60–90 minutes. The recorded focus group discussions were translated into English and transcribed professionally. 2.6 Data Analysis Collected data were analyzed with thematic content analysis by following Braun and Clarke’s six-phase framework (19). The researcher familiarized themself with the data, generated the initial codes, searched themes, reviewed themes and defined and named themes. Finally, the report was produced from the data. The demographic data were summarized on a Microsoft Excel spreadsheet. To familiarize themself with the data, researcher listened to all the audio recordings while, at the same time, reading the transcripts to ensure the data were complete. The researcher generated the initial codes independently, developed the manual code book for the first three focus groups in the study. The researcher searched the themes for similarities in data, and reviewed the themes and subthemes. The transcripts were imported to QRS NVivo 15.3.0 (20). Upon completion of the codebook, the researcher organized the codes into broader themes. The audio recordings of the focus group discussions were professionally transcribed verbatim, and translated from Sesotho to English. Data were analyzed. The results of the first coding exercise were shared with one of the supervisors who acted as a peer reviewer to confirm the codes that had been created. NVivo software is used to analyze qualitative data and allows researchers to import transcripts, create themes, and perform coding; it enables collaboration between students and supervisors for member checking of the analysis and trustworthiness of the analysis (20,21). Conclusions were drawn from quotations of participants’ utterances without the meaning being changed. 2.7 Trustworthiness To ensure the trustworthiness of the study, the authors strived to enhance its transferability, credibility, confirmability, and dependability, as recommended by Korstjens and Moser (21). For credibility, a pilot study was conducted with one focus group discussion. The principal investigator and supervisor trained a research assistant to ensure that the data collected were rich and of high quality. In terms of dependability, the principal investigator and supervisors had a debrief session after each focus group discussion, with the supervisors serving as a peer reviewer of the collected data. They provided guidance on refining the data tool, and suggested additional questions for inclusion in subsequent focus group discussions to provide in-depth insights into the research questions. Confirmability was achieved and maintained through the researcher securing signed consent forms and following and recording the analysis process step by step. For transferability, the researcher collected data from health facilities in Maseru using thematic sampling, which provided data from diverse segments of youth, thus enhancing the generalizability of the findings. 2.8 Ethical Considerations Ethical clearance approval was obtained from Sefako Makgatho Health Sciences University Ethics Committee (Protocol No. SMUREC/H/32/2025) and Lesotho Ethics Committee (No. ID177-2025). Upon receipt of ethical clearance, the researcher obtained permission to conduct the research from Maseru district health management team, Christian Health Association of Lesotho, and health facility management. Participants who had agreed to participate in the study were provided with informed consent forms and comprehensive study details such as the study purpose and objectives. The participants were made aware that their participation was voluntary and that they were free to withdraw from participation at any time, and that their withdrawal would not have any negative effects on their access to services. The participants were assigned pseudonyms (Participant 01 represents Participant 01 at a specific health facility) to use during the focus group discussion and their real names were not recorded on the recordings, fieldnotes or during the focus group discussions. In accordance with South Africa’s Protection of Personal Information Act (22,23), informed consent was obtained from participants; the Act limited the amount of demographic data that was gathered; the data are stored securely in a locked cabinet to which only the research team has access. The data will be stored for five years, and personal information of participants will be protected by disclosing it only to the research team. 3. Results The results of the main research study revealed five themes: knowledge or understanding of STI transmission, attitudes toward partner notification, motivators and benefits of STI partner notification services, barriers to STI partner notification and preferred partner notification methods before and during the relationship. 3.1 Sociodemographic Data The sample size of the participants in the study was 31; each focus group had between six (n = 6) to 10 (n = 10), participants. Study participants were aged between 18 and 24 years; the mean age was 21 years. The majority (27 out of 31) of participants were unmarried, and 19 out of 31 were women. About 51% (16/31) of participants had completed secondary school (Tables 2 − 4). 3. 2 Data on Sexual Behavior As data collection evolved, data on sexual behavior data were collected from the mixed youth and key population groups. All the participants reported to be sexually active and having had one to three sexual partners in the last 12 months. Participants reported sexual activity starting from 15 years of age. The variety of sexual relationships reported by participants was steady, casual, multiple partner, one-night stand and having vaginal, anal and oral sex. Six participants reported having had STIs in the last 12 months and four of them reported using condoms in their last sexual activity (Tables 3 − 4). Table 3 Sociodemographic data of participants (key population group) Pseudonyms Participant 01 Participant 02 Participant 03 Participant 04 Participant 05 Participant 06 Participant 07 Participant 08 Age 24 23 24 24 23 24 23 22 Sex M F F F F M F M Marital status Single Single Single Single Married Single Single Single Employment status Student Unemployed Unemployed Unemployed Student Student Student Volunteer Highest education level Grade 12 Grade 12 Grade 12 Grade 12 Grade 10 Diploma Diploma University Age of first sexual intercourse 22 19 16 19 15 18 20 18 Sexually active Yes Yes Yes Yes Yes Yes Very active Yes Type of sex Anal, oral Vaginal Oral, vaginal Vaginal Vaginal Anal, oral Vaginal Anal, oral Number of sexual partners in last 12 months 1 3 4 60 18 3 4 4 Relationship status Steady 2 Steady 1 One- night stand Steady Steady Steady One-night stands Transactional, steady, situational 2 Steady 2 Casual Duration of relationship 1 Year, continuing Steady 1: 2 years continuing Steady 2: 1 year continuing for a year A day 1 year 4 years Currently not in relationship A day 3 Years 2 Weeks 6 Months Steady: 1 Month Steady: 3 Months 1 Casual Are you in relationships with other partners No Yes No Yes Yes No No Yes Have you had STIs in the last 12 months? Yes No Yes No Yes Yes Yes No Did you use condoms in the last sexual act? Yes No No Yes No Yes No No Table 4 Sociodemographic data of participants (mixed youth group) Pseudonyms Participant01 Participant02 Participant03 Participant04 Participant05 Participant06 Participant07 Participant08 Participant09 Participant11 Age 23 24 19 24 19 18 22 22 24 18 Sex F F M M F F F F F F Marital status Other Single Single Single Single Single Single Single Single Married Employment status Unemployed Unemployed Unemployed Unemployed Unemployed Unemployed Unemployed Student Un-employed Un̵̵employed Highest education level Grade 7 Grade 7 Grade 12 Grade 7 Grade 12 Grade 11 Diploma Grade 12 Grade 12 Grade 7 Age of first sexual intercourse 16 16 17 15 19 18 18 19 22 15 Sexually active Yes Yes Yes Yes Yes Yes Yes Yes yes Yes Type of sex Vaginal Oral Vaginal Vaginal Vaginal Vaginal Vaginal Not specified Vaginal Vaginal Number of sexual partners in last 12 months 2 3 2 2 1 1 2 0 1 3 Relationship status Steady One-night stand Steady Together Steady Steady One-night stand 1 Day Casual Casual Steady Casual Boyfriend Casual Side chick Casual Casual Duration of relationship 1 Year A Day 1 Month 1 Year 3 Years, 1 Month 2 Years A day 1 Month 6 Months 2 Years 3 Years 8 Months 6 Months 6 Months 3 Months 2 Months 5 Years In relationships with other partners Yes No No Yes No No No No No No Had STIs in the last 12 months Yes Yes No No No Yes Yes No Yes Yes Used condoms in the last sexual act No Yes Yes Yes No No No Yes No No 3.2 Themes and subthemes from focus group discussion responses of youth This paper shares, specifically, results on youth’s views on partner notification services, and covers five themes: 1) knowledge or understanding of STI transmission, 2) attitudes toward partner notification, 3) motivators and benefits for STI partner notification services, 4) barriers to STI partner notification, and 5) preferred partner notification methods before and during the relationship (Table 5). Table 5 Themes and subthemes from youth’s focus group discussion responses Theme Subtheme Knowledge or understanding of STI transmission STI are curable with treatment STI are communicable and transmissible Signs and symptoms of STIs Types of sexually transmitted infections Multiple partners as risk for STI Use of condom Myths on STI transmission Attitudes towards partner notification Acceptance of STI status Supportive view to notify partner once infected with STIs Notifying partner about STI infection under certain conditions Avoid notifying the partner once infected with STIs Motivators and benefits for STI partner notification services Preventing the disease Protection of health of partner Moral and social obligation Avoid losing the partner Avoid feeling of guilt Barriers to STI partner notification Stigma and gossip Could end the relationship Fear of how partner will react Could cause conflict Anticipating that partner might share STI infection on Facebook Mistrust by partner Anticipating blame after telling the partner Preferred partner notification methods before and during the relationship Tell partner Notification by health care worker Notification at Health Facility 3.2 Knowledge or Understanding of STI Transmission Participants had a basic knowledge of STIs and how they are transmitted. 3.2.1 Sexually Transmitted Infections are Curable with Treatment Participants had knowledge of STIs being curable with treatment. Some mentioned that their decision to notify their partners was guided by knowing that STIs are curable. If people have the information, it will be easier for them to notify each other, because they will know that the disease is curable, but if people do not have the information, they end up with wrong beliefs and fears, and these misconceptions are easy to lead them into having fear about going to the clinic and simply having these discussions where they can now disclose their statues to their partners. (Participant 08, Aged 22, Key population group) Between the clinic, traditional doctors and the cleansing there will be one which works, because in other instances, my partner was able to get a cure and I did not. They will then accuse me of infidelity because it will not make sense why they were able to heal and I was not. This is why I would then try all the different alternatives until I find a cure. (Participant 9, Aged 24, Mixed youth group) Since these disease are treatable, from what I know, these treatable diseases have what is called “cell wall.” There are certain medications that attack that cell wall in bacteria and destroy it, and that is how the illness is cured completely. The medicine removes the illness entirely. (Participant 02, Aged 18, Men’s group) 3.2.2 Sexually Transmitted Infections are Communicable and Transmissible The participants reported that they would notify their partners about STI, because if the partners are not aware that they had been exposed, they could transmit the STIs. Other participants, when asked whether they would visit the health facility if their partners told them about the partners’ STIs, the participants said they would avoid to visiting health facilities. Some participants stated the spread of STIs is a consequence of failing to visit the health facility and lacking knowledge of STIs. They must know because, even if they are your only partner, they could be engaging sexually with other people. When they are not made aware on time, it will be transmitted to them, and they transmit it to other people as well and spread it. (Participant 01, Aged 18, Men’s group) If I stop going and I infect someone else and they infect others, it becomes a chain. (Participant 08, Aged 22, Key population group) For me, if they do not understand I will just continue to transmit it to them. (Participant 02, Aged 24, Mixed youth group) Then, after treatment, I think that they might still pursue relationship outside their marriage but this time with caution, making sure that they take necessary measures to ensure that they do not contract STI or transmit it. (Participant 08, Aged 22, Key population group) I will not stay in the relation though, because the truth is, STI transmission is not the same as that of flu, where we can suspect that you probably touched the object that someone who had flu touched previously. It is clear how it happened [laughs). It is clear that I did something wrong. I engaged in sexual activity outside of relationship. (Participant 07, Aged 23, Key population’s group) 3.2.3 Signs and Symptoms of Sexually Transmitted Infections Participants had knowledge of the different signs and symptoms of STIs, among which a burning sensation when urinating, discharge, sores, itchiness, swelling on the penis, bad smell, difficulty walking and rash. I have forgotten the exact name, but its symptoms include a burning sensation when urinating, and a white or yellowish discharge. (Participant 05, Aged 23, Key population group) When someone walks in, do not assume you know what is happening. Do not jump to conclusions. Someone might be dealing with syphilis or just a burning sensation when they pee, and you think it is something worse, underestimate what the person could be dealing with because you simply did not try to engage more with them and find out more about them. (Participant 08, Aged 22, Key population group) There are times when I can take up to four days away from partner and still get discharge. They say that it starts as a white discharge then later transitions to yellow. When this happens even though I have not been having any sex, I immediately go to the clinic for help. (Participant 09, Aged 24, Mixed youth group) I think things like pimples and maybe other signs. However, with something minor like “seso” (discharge or irritation), I think. (Participant 02, Aged 19, Women’s group) You fear that he might later say you smell, because discharge does give a bad odor especially when it is severe. (Participant 05, Aged 23, Key population group) I remember once I had a rash around here [gesturing], and they told me it was an issue that could be fixed with “pitsa.” They gave me something to apply to the area … it was itchy all afternoon. I really couldn’t even walk properly that afternoon. (Participant 06, Aged 19, Men’s group) I was going to say that maybe number 2 knows gonorrhea. It is said to be dangerous that it gives one sore and starts affecting the weight as well. (Participant 04, Aged 24, Mixed youth group) 3.2.4. Types of Sexually Transmitted Infections When the participants were asked about types of curable STIs they knew of, they mentioned gonorrhea, syphilis, chlamydia, human papilloma virus, and genital warts. Some were not aware of types of curable STIs, but they could list signs and symptoms of STIs. I know one that is called HPV – Human P … it is quite a difficult word to pronounce, but it ends with virus. (Participant 06, Aged 24, Key population group) I know it causes warts around the genitals, but even that one can be treated. (Participant 06, Aged 24, Key population group) I think it is called syphilis or chlamydia. (Participant 02, Aged 23, Key population group) 3.2.5. Multiple Partners as Risk for Sexually Transmitted Infections Youth recognized the potential risk of acquiring STI from an infected partner, having multiple partners, or if they did not use condoms. They also reported that they would notify sexual partners to avoid the reinfection and that they would visit health facilities to be checked to determine if they had also contracted STI. There is a possible chance that I may have gotten it from him, and since how soon the symptoms show themselves also depends on our immune systems, it may have shown itself to him before it did to me even though he does have it too. (Participant 06, Aged 24, Key population group) People who have information are more likely to agree to go to the clinic to get tested, even though it really does make a person seem as though they have become promiscuous, because STI cannot just appear randomly [laughs]. It is clear that between me and you, there is someone who had been sleeping around. (Participant 06, Aged 24, Key population group) Truth of matter is that I am not always with him and I do not know the kind of activity he engages in when he is not with me, or when he has had a little too much to drink. If I keep quiet and he keeps moving from person to person, he might end up infecting someone innocent. I think it is important, as it will help protect the lives of others. (Participant 02, Aged 23, Key population group) I think it’s important for them to know because maybe I have already gone to the clinic, found out my condition and started treatment if he continuous to sleep with me, I will get sick again and won’t recover. (Participants 05, Aged 19, Women’s group) 3.2.6. Using Condoms When the participants were asked how couples managed STIs in the community, they indicated that they did not use condoms. I think the benefit is that when both people have the knowledge, it is easier to support one another. If I already know I have an infection and my partner is also informed, we can help each other stay protected. With proper knowledge, I will not infect anyone, and they will not infect anyone either, because we will always use protection. (Participant 08, Aged 22, Key population group) You will find that there is a lot of infidelity and most have affairs outside of their marriage. There, they do not use protection during sex, hence the spread of STIs. (Participant 06, Aged 19, Men’s group) I have heard people say you should use condoms, so that you don’t get infected with STIs. (Participant 01, Aged 19, Women’s group) The recurring response of youth, when they were asked how adolescents handle issues related to STIs in their relationships, related to unwillingness to use condoms. I have discovered that most of them do not like to use protection or condoms. That puts them in a position where they contract STIs early and there is quite a rapid spread among them too, because of this. (Participant 07, Aged 20, Men’s group) 3.2.7 Myths and Misinformation about Sexually Transmitted Infections Despite the participants’ knowledge of STIs, the focus group revealed myths about how STIs were transmitted. Some participants stated that certain foods makes them sexually active and causes STIs. Some people are told that they eat too much potatoes. Whenever you get an infection like discharge, they say it is because you eat too much potatoes, but the person would know very well that they did not get an infection from eating potatoes. These are things that I have heard about sexually transmitted diseases, that they are caused by potatoes and they are cured by these herbal remedies. (Participant 01, Aged 24, Key population group) Even the food we eat today, makes people more sexually active, so much that you will find that sometimes after sexual intercourse in just two hours you already feel you want more sex. (Participant 08, Aged 22, Key population group) It is already known that things like potatoes cause discharge, and we all know that girls love things like chips or fries. (Participant 07, Aged 20, Men’s Group) People get it when they have had unprotected sex with a person whose spouse have died and both men and women get it. (Participants 09, Aged 24, Mixed youth group) 3.3 Attitudes toward Partner Notification Participants recognized the importance of partner notification services, though youth had mixed attitudes about partner notification services. Common responses from participants revealed that they supported informing sexual partners that they may be infected. 3.3.1 Acceptance of Sexually Transmitted Infection Status Some of the participants expressed that they would accept the STI status and act by seeking care at the clinic to treat STI. I will accept that they told me and go. The reason that they will be telling is because they will have seen or confirmed that they have it, and will be asking that I go to the clinic with them. (Participant 05, Aged, 23, Key population group) I would accept it and the pills. (Participant 03, Aged 20, Women’s group) If it’s just one person, they might accept it. (Participant 06, Aged 20, Women’s group) There are some who will accept that this is the situation and suggest that we take a certain step. (Participant 06, Aged 24, Key population group) In the case where they have told me, I come. (Participant 04, Aged 18, Men’s group) 3.3.2 Supportive View to Notify partner Once Infected Some participants reported supporting the practice of notifying their partners that they had been exposed to STIs. Since we would be talking to the person who is practically the love of my life, I will sit them down so we can talk. What I will not do, because this is not just a man who is just giving me money, is that I will not deceive them by keeping such a matter from them. Sometimes they might know because I kept quiet about it, then the day they discover themselves, it will have already caused great damage. (Participant 07, Aged 23, Key population group) I would invite them so that they can get support that they need. (Participant 02, Aged 24, Mixed youth group) In the case where I would find out that I have an STI, I would ensure that I let my partner know about it and explain that my results came out positive for STI. (Participant 06, Aged 19, Men’s group) I think it is important, because if I don’t tell my partner, you see, I would be disrespecting him by infecting him. (Participant 06, Aged 20, Women’s group) I think is best to tell the person you are getting involved with, the person you are entering into a romantic relationship with, so they know your status. (Participant 08, Aged 22, Key population group) 3.3.3 Notifying Partner about Sexually Transmitted Infection Under Certain Conditions Another opinion was that participants would notify partners of their exposure to STI under certain conditions. Some youth said that the nature, number and kind of partner would play a role in their decision to notify a partner. I think it just depends on what kind of person your partner is, some people are calm, and others jump to conclusions. If you know that they will understand and listen to you, and they won’t judge you, then yes, I will tell them. (Participant 06, Aged 20, Women’s group) If it were a marriage, maybe, but in casual relationships, I do not think is worth it. (Participant 02, Aged 19, Women’s group) Like I said before, it depends on the kind of relationship that we have with the partner or the person I am with. If it is a steady one, I would definitely talk to my partner about this and invite them. (Participant 07, Aged 23, Key population group) It might also be easier to tell them after I have healed. After I have finished the treatment from the clinic. (Participant 02, Aged 18, Men’s group) For me, if they are many I would definitely encourage them to go. Since I would not know who infected me, I would go with each of them one by one to the clinic. (Participant 06, Aged 20, Women’s group) If it’s just one, I would definitely advise him to go but if there are many, it becomes a bit complicated. It will expose me. If it’s one, I can just take his hand and go with him. If there are many, I might end up lying because they won’t know who I was with today, tomorrow etc. (Participant 02, Aged 19, Women’s group) I would come to the health facility as well. One of the reasons that would make me come would also be to show support to my partner, because when a person discloses something like this to you, you have to support them. In this case, if I do not come, they will take it as if I am not being supportive. But then again, by coming, I also ensure that I know what my status is, and get the treatment that I need when I test positive. (Participant 02, Aged 24, Mixed youth group) 3.3.4 Avoid Notifying the Partner Once Infected With Sexually Transmitted Infections Despite the general support for partner notification, other themes related to avoidance of notifying partners are the nature of the relationship or the partner. If it is a transactional relationship though, where we are only together so that they can provide me money and financial assistance, then I would never tell them anything about my health. That relationship is only about money, and nothing else. My health is mine, and it completely up to them to decide whether they would want to go to the clinic to get checked or not. That is their own responsibility. (Participant 07, Aged 23, Key population group) I do not think It’s important to tell them. For example, in a relationship, no, I do not know … Let’s say, no one can truly say the two of us are in a serious relationship. For example, I could go out and do my own thing, and when I come back and tell him, where do I say I got it from while he does not have it? (Participant 02, Aged 19, Women’s group) I think it is not worth it because you might find that the person you were involved with is not a good person. (Participant 03, Aged 20, Women’s group) Well, me, honestly, as I want to talk about myself. I feel like, you see, we as people will be dating five people in total. When I'm dating five people, it's clear that I'm not loyal, so I will want to ensure that not any of them know or finds out that I'm cheating with this one and that one. So, it won't be easy for me to tell these people. (Participant 08, Aged 22, Key population group) I don’t tell her, because she would ask me whether I am sure the medicine will even help me. (Participant 05, Aged 19, Men’s group) 3.4 Motivators for and Benefits of Partner Notification Services for Sexually Transmitted Infections Participants had different motivators for notifying their partners. Recurring themes were to prevent disease, to protect their partner, feeling morally and socially obligated, to avoiding losing a partner and feelings of guilt. 3.4.1 Preventing Disease Participants stated prevention of STI as a benefit and motivator of informing partners. I would say that it would be important to do so. The benefit of informing my partner that I have an STI, is to ensure that we are able to protect ourselves because, obviously, they have it too because we sleep together, and since I do not know what he gets up to when he is on his own, it will also help to stop it from spreading. (Participant 06, Aged 24, Key population group) My feelings are that we should disclose it to our partners, so that if I have sexually transmitted infections, I am able to protect them and not transmit the STI to them. Also, that they should not transmit them to others because, the truth is she probably has other sexual partners outside of me. (Participant 01, Aged 23, Mixed youth group) It would be so that we don’t keep infecting each other, and so that we don’t infect other people. (Participant 06, Aged 20, Women’s group) It would be to prevent the spread of that infection and ensure that it does not spread as wide as other infections. (Participant 01, Aged 18, Men’s group) The benefit would be that they do not get sick or that they are treated. They will not end up with worse infections or pass them back to me. We will be able to avoid getting reinfected, and I stay safe too. (Participant 06, Aged 24, Key population group) 3.4.2 Protection of Health of Partner Another stated motivator and benefit of notifying partners disclosed by youth is protecting the health of the partner. I will take the treatment so that we can both be well, and I will appreciate that they cared enough to ensure that I am not in danger as they were, or at least exposed to the same danger. (Participant 06, Aged 24, Key population group) The reason why I would do this would be to make sure that they take the necessary measures to protect themselves, and to make sure that if by any chance they have it already too, they take the necessary precautions at that point. (Participant 06, Aged 19, Men’s group) I want them to be healthy too. (Participant 03, Aged 20, Women’s group) The benefit is that they can also get screened or tested for STIs, and by doing so, they will be able to either treat it or protect themselves. (Participant 02, Aged 18, Men’s group) 3.4.3 Moral and Social Obligation In some youth’s views, they were morally and socially obligated to notify their partners about the STI. I think that if they did tell me like that to me it would mean that this person knows and has gone to the doctor to actually find out. So, because of the fact that they took action, I too must take action. What this will also show me is that my person is responsible. If they did something like that, it also means they are trustworthy or at least are taking accountability for their actions. And because they will have gotten the STI from elsewhere and from me, it will also give me the impression that they are choosing to correct their behavior. (Participant 06, Aged 24, Key population group) I will have to take responsibility that I am the one who made a mistake here, and, therefore, accept any decision that they make whether it is to stay or to leave. At the end of the day, they will at least see a doctor. (Participant 07, Aged 23, Key population group) If I live with my partner and I also have another partner elsewhere, then I will realize that I’m the one responsible for the infection. (Participant 06, Aged 20, Women’s group) What would push me to disclose this to my partner would be so that they do not find this out on their own, because I would be very embarrassed if they found out any other way than from me. (Participant 02, Aged 18, Men’s group) 3.4.4 Avoid Losing the Partner Some of participants notified their sexual partners about sexually transmitted infections to keep them in the relationship. If I suggest using protection, they might say, do you not trust me? And since I want to win them over and have them as mine, I will just go with the flow. Even if it means getting sick. (Participant 08, Aged 22, Key population group) If she finds out from the hospital, chances are that she will not trust me again. It would be better if I told her that this is what I’m going through or noticing. (Participant 07, Aged 20, Men’s group) If you wait until you are healed to tell them, they might feel like you were hiding it all along. They might stop trusting you and say, you inform them about things when they are already done. (Participant 02, Aged 18, Men’s group) 3.4.5 Avoiding Feeling Guilty Participants were motivated to notify the partners about being exposed to STI in order to avoid their own feelings of guilt. Also, I want to avoid the guilt of having caused someone’s death by not telling them the truth. If it turns out someone gets sick and dies, and I know it’s because I didn’t say anything, then I would feel like I was the cause. (Participant 03, Aged 20, Women’s group) I think it’s better to tell someone from the start, explain what’s happening so they’re aware. I wouldn’t want to end up regretting it later and thinking, I should’ve said something, especially if something worse happens and I lose the person. (Participant 06, Aged 19, Men’s group) 3.5 Barriers Faced by Partner Notification Services Several barriers emerged as reasons why youth struggle to notify their partners that they had been diagnosed with STI. Common barriers that emerged were fear of stigma and gossip, and that partners could end the relationship if they were notified about being exposed to STI. Youth also expressed fear of how their partners would react when notified, or anticipated that their partners might expose the partner on Facebook, that their partners would no longer trust them or might blame them. 3.5.1 Stigma and gossip Participants said that stigma and gossip prevented partner notification of exposure to STI. In their view, stigma originates in the community and at health facilities and could be influenced by culture, religion and social media. I have also noticed that people are afraid of being seen by others, afraid of who they might bump into at the clinic, maybe someone from their village, and then that person might gossip about seeing them at a clinic that treats STIs. (Participant 01 Aged 19, Women’s group) Another problem with partner notification is how facilities handle it. Let us say that I get diagnosed and go to inform my partner. The problem that will then arise there is that the clinic will insist that we go together so that they can provide psychosocial support as well as be examined together, but if in a same sex relationship, it becomes difficult, because society does not quite accept us. (Participant 06, Aged 24, Key population group) Another challenge that I have identified to be a problem I see is that culture or the role that it plays in our lives and in our programming. Our Basotho still teaches that a man must be with a woman, so when there are instances where a woman is in a relationship with another woman, or a man is in a relationship with another man, it is still very strange and problematic to most people and so it is rejected. (Participant 08, Aged 22, Key population group) Most healthcare facilities are church owned, and that brings even more judgement. They are not ready to accommodate all of us. (Participant 08, Aged 22, Key population group) As young people, on social media, we insult each other a lot. When you walk past a group of guys, they will start pointing fingers at you. Even if a guy tries to date you and reject him, he will say “you are the one who gave that one an STI.” (Participant 06, Aged 20, Women’s group) You go to the clinic, and then they start gossiping about you. That kind of fear keeps a lot of people from coming forward, so I think, even in casual sex situations, the best thing we can do is just go to the clinic, but even that is not easy for everyone. There is still stigma on both sides. (Participant 08, Aged 22, Key population group) I have seen that in the villages that we live, when a person has sexually transmitted infections, they ostracize and they discriminate against them, which is an unnecessary thing to me, but these are things that are happening in the villages. (Participant 03, Aged 19, Mixed youth group) I really wouldn’t tell him. If I told him, tomorrow he might insult me and tell a lot of people, and then as I walk around, people would be gossiping that I am the one who infected so-and-so with a disease. (Participant 01, Aged 19, Women’s group) I have heard a lot of gossip, especially about young people who are dating. A guy will tell his friends, confiding in them then they will go on to tell their girlfriends that so and so has an infection. You will find that as girls, the girlfriends of these guys, we don’t get along. (Participant 02, Aged 19, Women’s group) I am sometimes held back by fear. Even if I feel like I have a certain problem, I fear that if I go to my usual friends or companions, they might start gossiping about me when they are out buying things. They will make me the topic of their conversation: “that person says they have this or that” and when I show up somewhere, my condition will already be the talk of the town and people will start calling me names. (Participants 06, Aged 19, Men’s group) 3.5.2 Could End the Relationship The relationship being ended was another barrier for some participants to notify their partners about STIs. There was this one case where someone was in a relationship, and they did not tell their partner about their STI, even though they knew that they had it. Later the partner found out at the clinic and said, “you should have told me.” The person responded, “I was scared I would lose you.” The partner was very judgmental, and so they ended up breaking up. That is why I say it is complicated. Sometimes, it is hard, while other times it is easier. But deep down, we are just selfish people. We do not want to lose people. (Participant 08, Aged 22, Key population group) If she fails to understand this or to cooperate, then we will have to part ways. (Participant 04, Aged 24, Mixed youth group) It’s not easy because if I show my partner the medicine I am taking, it won’t be easy. If we sit down, they will start asking where I got the infection from, that’s where our marriage could end, because they’ll assume I was unfaithful. Therefore, no, it’s not easy to tell them. (Participant 01, Aged 19, Women’s group) Partners may tend to be easily frightened by the fact that I have an STI, so should I choose to disclose this to them, there is a chance that they will seek sexual intercourse outside the relationship and have me struggle. (Participant 02, Aged 18, Men’s group) I have noticed in our communities is that married couples do not disclose to one another that they have as STI. As a result, the infection becomes severe, and this is when their partner finds out. When they do, they usually leave the marriage and then there is no one to take care of the one who is now ill. Eventually they die. (Participant 02, Aged 18, Men’s group) 3.5.3 Fear of How the Partner Will React Additionally, youth emphasized that it was difficult to notify a partner because they did not know how they would react to notification. Among the reactions that were cited are physical abuse, emotional abuse, cyberbullying and communication blockage. Another thing that I have noticed, as the lady has already mentioned, is the issue of GBV [gender-based violence], usually the woman does not tell her husband or her male partner when she has found that she has an STI, because, usually, the man’s reaction is to scold her and become very upset, even if the woman knows very well that she has not been sleeping around. (Participant 06, Aged 24, Key population group) I think it would be best if this kind of conversations were had in person or face to face, because men and typical Basotho boys, are likely to insult you if you initiated such conversations over the phone. I agree with that. On the phone, they are most likely to hang up or question what your role is in their relationship and, secondly, ask how and when you are being involved in their relationship. They are most likely to disrespect you as a nurse and even ask their partner later why they are sending nurses to call them about such. (Participant 07, Aged 23, Key population group) They might even beat you and say you gave them the infection even though you know they did not have it. (Participant 03, Aged 20, Women’s group) The other issue is that they are going to tell other people, making it difficult to get another girlfriend as they would have told people that I am sick. (Participants 01, Aged 18, Men’s group) I would be afraid to tell them, even on the phone I am afraid to tell them, because the thing is when I write to them on Facebook they will block me, WhatsApp they will block me, they will ignore my calls or they will block them completely. (Participant 05, Aged 23, Key population group) 3.5.4 Could Cause Conflict Barriers which emerged as reasons to not notify partners are the possibility that partner notification could spark conflict or fights. Therefore, some participants said that they would not notify their partners. I don’t think it’s worth it, because it could lead to conflict and not getting along because they know they are clean, and now I am telling them I am infected. It will just cause tension at home. (Participants 03, Aged 20, Women’s group) These girls we are dating don’t like traditional stuff like herbs, because they are bitter in taste and they don’t want anything bitter. If I tell her, we will end up arguing. (Participants 07, Aged 20, Men’s group) 3.5.5 Anticipating That Partner Will Disclose STI on Social Media Another barrier to partner notification is that partners, after being notified of exposure, may write about STI on social media. People often use social media like Facebook to humiliate others. Someone will comment under a post even if you didn’t mention them. For example, you might just share your thoughts, and they will respond telling you, “We know you gave that one an STI.” (Participant 02, Aged 19, Women’s group) I have noticed, especially among young people, is that they are often scared. Usually, a girlfriend is not someone you can trust. They tend to spread things and when signs start to appear that scare us, out of being afraid, a guy might send a “pic” to his girlfriend and that is when things go wrong. The girlfriend shares it on Facebook and that leads to someone committing suicide. (Participant 02, Aged 18, Men’s group) I have seen that actually telling each other is rare here in the village. Because even I wouldn’t tell. I would just visit the health facility and not tell her, because if the person is not satisfied, they will keep posting about it on social media. (Participant 01, Aged 18, Men’s group) 3.5.6 Anticipating of Blame After Notifying Partner Some participants anticipated that their partner would blame them they notified them about STI. One begins to blame the other, and I know that, often, men are the ones who will be blaming the women. (Participant 06, Aged 24, Key population group) You can find that when I have sexually transmitted infections and explain or disclose this to them, not knowing whether or not they have them, they will say and insinuate that I have contracted them outside of our marriage, and say that they will not meddle into my affairs. (Participants 09, Aged 24, Mixed youth group) 3.6 Preferred Partner Notification Methods Youth expressed a variety of preferences for methods of partner notification. Their expressed views referred to the need for confidentiality, avoiding being judged and using youth friendly and tailored approaches for partner notification. Commonly, they preferred telling their partners about STI themselves, while some said they preferred the health care workers notifying their partners. 3.6.1 Tell the Partner Themself When youth were asked how they would notify their partners about STI, they said they would like tell their partners themselves. I think it is important to be able to discuss anything and everything with our partners and, therefore, it would be important to tell them ourselves. (Participant 04, Aged 24, Mixed youth group) I would prefer to be the one who tells my partners if I notice that maybe I have an irregular discharge. (Participant 07, Aged 20, Men’s group) The way I would do it is, when I come back home from the hospital having found out that I have contracted an STI, I would hand them my booklet for them to see, and know that they too have to go to get tested. (Participant 09, Aged 24, Mixed youth group) If they were to find out from the hospital and not me, they will leave me for other men. (Participants 07, Aged 20, Men’s group) I could sit down with him and tell him, because communication is what helps bring solutions to the issues we face in life. (Participant 03, Aged 20, Women’s group) If I find myself in a place where they are being taught about STIs, I will make sure to take him along so he can also learn about them. (Participant 01, Aged 19, Women’s group) I could talk to him when I get home. (Participant 05, Aged 19, Women’s group) I could talk to him, to avoid going to the clinic without having spoken yet. (Participant 02, Aged, 19, Women’s group) I have noticed that there are groups on Facebook, where people join using fake accounts just to flirt and hook up. Now, I have noticed that people there are quite familiar with the concept of partner notification, but they do not realize that is what it is or just do not identify what they are doing as partner notification. They do not know how important it is. They will post things like: “so and so, whom I slept with yesterday, I have … I have an STI, please go to the clinic.” (Participant 06, Aged 24, Key population group) 3.6.2 Notification by Health Care Worker Some youth said they would prefer it if the health care worker would notify their partners. Youth mentioned that it would be easy to ask health care workers to notify their partners. Other youth reported that their partners are likely to visit the facility if they were notified about STI by the health care worker. It is easier to disclose if there is something wrong. Even if the case is that I am scared to tell them that I have a problem, once we get to the clinic, we will meet nurses, counselors, doctors, who will help to explain and break it to them. (Participant 03 Aged 24, Key population group) I would not notify my partner. I would simply ask them to escort me to the hospital where I would inform the nurse who is assisting us what my aim is, this way, they will be able to get tested and be given treatment if they are found to have it too. (Participant 11, Aged 18, Mixed youth group) If they still refuse, I will inform the village health workers and ask that they can go to my partner directly and encourage them to go to the clinic, because if I am being treated and they are not, then there will be no point. (Participant 05, Aged 23, Key population group) It would be easier if they are the ones who made me sick. In a case where it’s just me alone who is sick, it won’t be easy. It will be difficult and would require someone with more knowledge stepping in between us. If it's just the two of us, it will be manageable. (Participant 06, Aged 20, Women’s group) I think it is important to invite your partner to the clinic. If I already know that they are likely to turn the offer down or be a little stubborn about actually going to the clinic with me, there are ways that I can try use to go around that especially because I am knowledgeable about these issues even if they are not, so I will say something like, “please come with me and accompany me to the clinic as, I think I have come down with a flu or something,” just as an excuse. Because I will need to approach this in a pretty smart way. I would first inform the nurse that I have brought this person along, but they do not know what is really going on. Then he will be invited in and once we are in the room together, the nurse can reveal the truth carefully. (Participant 01, Aged 24, Key population group) 3.6.3 Notification at Health Facility The participants also suggested approaches that health care workers could use for partner notification. I think whenever there is someone found to have STI, they should give their partner’s phone number so that they can be called in immediately. They must be told why they need to come because it seems when they find out what the reason is, they do not see the urgency of it. (Participant 04, Aged 24, Mixed youth group) I think that it would be important if the health professional who is providing services for me could write in my health booklet that my partner should come to the hospital, because if I told him myself, there is a good chance that he will not come. (Participant 09, Aged 24, Mixed youth group) 4. Discussion This study reports on youth’s views on partner notification services for STIs in Maseru, Lesotho. The participants in this study had a variety of views about notifying their partners that the partners had been exposed to STI. Most participants favored notifying partners; they viewed it as act of a morality and of supporting each other. These findings align with a prospective study conducted in Durban, South Africa, which used partner notification cards to notify the sexual partners about exposure to STI and which reports a notification rate of 74% (24). Studies conducted with South African students and taxi drivers report more than 70% of participants were willing to disclose their STI status to their partners (8,25). Studies caution that high notification rates do not equal high uptake of treatment by partners who were notified. Two studies conducted in sub-Saharan Africa report uptake of partner notification of 5.7% and 35%, and variations in notification at 41% and 74%, respectively (13,24). The findings of this study demonstrate the effect of the type or nature of the relationship on successful partner notification. Our data support the notion that partner notification is more successful in steady relationships, whereas disclosure rates are low for casual, concurrent or short-term partnerships (4,8,26,27). In a case control study conducted in Ethiopia, STI clients did not notify their sexual partners because they could not locate them, because they had been casual partners (28). Our study underlines the importance of knowledge for partner notification. Youth reported knowing about STI signs and symptoms, types of STI, and how STI is transmitted; risks around STI exposure were crucial in youth’s decisions to notify their partners or for them to access health services. The findings align with the CHIEDZA youth study, which reports that participants expressed being ill equipped to notify their sexual partners because of limited knowledge on partner notification (13). Our study participants referred to myths such as starchy food causing STI. Despite the positive views of participants about partner notification, notable barriers to notifying partners emerged, mainly fear that it would mean the end of the relationship, fear of stigma and gossip, fear of violence toward the partner and fear of communication among the partners being ended. The findings on barriers to notification are supported by the literature (8,13,28,29). Participants reported using a number of partner notification methods. Some preferred using provider-assisted partner notification methods, though the majority were in favor of telling their partners about the STIs themselves. In the context of Lesotho, youth expressed a preference for client and provider-initiated partner notification, as the only methods available to them. This finding signifies the limited range in partner notification methods that is available for youth in Lesotho. Literature refers to other methods that can be used to notify partners: technology, expedited partner notification services and referral slips (8,29,30). 5. Strengths The study has a number of strengths. First, it is one of few qualitative studies that investigated youth and STIs in sub-Saharan Africa, specifically, Lesotho. Purposive sampling enabled the inclusion of diverse perspectives of youth, thereby contributing to providing evidence that could inform youth-friendly services. Thematic analysis following Braun and Clarke’s framework and peer review by a supervision team member increased the credibility of the generated evidence, thereby contributing to public health programs and policy. 6. Limitations The study was conducted in two health facilities; thus, generalizability of results is low. Second, the findings were based on self-reports by participants and may have been influenced by social desirability bias. The sexual behaviors reported were collected from a mixed youth group and the key population group, and continual refining of the data tools during data collection may have missed valuable data provided by other groups. 7. Conclusion The study reports that, while youth express views that support partner notification for STIs, disclosure continues to be influenced by a variety of factors. It is, therefore, important to fully understand the barriers that affect partner notification by youth, and that this information is applied to inform tailored services for this group. Comprehensive sexuality education, non-judgmental, inclusive health services, and integration of partner notification for diverse youth is critical if youth-friendly services are to be provided. There is need for research to explore the experiences of youth during implementation of partner notification approaches beyond patient and provider notification in Lesotho. Abbreviations AIDS Acquired Immunodeficiency Syndrome HIV Human Immunodeficiency Virus STI Sexually transmitted infection Declarations Author Contributions: Conceptualization and methodology: MKP, OOO and MMM; visualization, validation, supervision, writing, review and editing: OOO and MMM; formal analysis: MKP and MMM; investigation and project administration, data curation, preparation for writing original draft: MKP. All authors read and agreed to the published version of the manuscript. Funding: The study received no funding from any agency. Institutional Review Board statement: The study was conducted in accordance with approval by Sefako Makgatho Health Sciences University Ethics Committee (SMUREC/H/32/2025:PG) and Lesotho Ethics Committee (ID177-2025). Informed Consent Statement: Every participant in the study provided both verbal and written informed consent. The participants of the study are informed of study findings via peer reviewed and accredited journals. Data Availability Statement: The data are available upon request. Declarations - Ethics approval and consent to participate: The research has been carried out in accordance with declaration of Helsinki (2000) of world medical association. I confirm that all methods were carried out in line with the guidelines. The study obtained approval from ethics committee of Sefako Makgatho Health Sciences University (SMUREC/H/32/2025:PG) and Lesotho Ethics Committee (ID177-2025). The informed consent was obtained from all participants before the focus group discussion. Acknowledgments: The authors thank the Lesotho Ethics Committee, district health management team, Christian Health Association of Lesotho, and hospital management of the two health facilities for their approval and permission to conduct the study. We also thank the participants who volunteered to participate in the study. Conflicts of interest: The authors declare no conflicts of interest. 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Qualit Health Res. 2007 Oct;17(8):1137-48. Foley G, Timonen V, Conlon C, O’Dare CE. Interviewing as a vehicle for theoretical sampling in grounded theory. Int J Qualitat Methods. 2021 Apr 9;20:1609406920980957. Lynch I, Macleod CI, Chiweshe MT, Moore SA. Vulnerable youth or vulnerabilising contexts? A critical review of youth sexual and reproductive health and rights (SRHR) policies in Eastern and Southern Africa. Sexuality Research and Social Policy. 2025 Jun;22(2):1058-70. Ahmed SK, Mohammed RA, Nashwan AJ, Ibrahim RH, Abdalla AQ, Ameen BM et al. Using thematic analysis in qualitative research. J Med Surg Public Health. 2025 Aug 1;6:100198. Allsop DB, Chelladurai JM, Kimball ER, Marks LD, Hendricks JJ. Qualitative methods with Nvivo Software: A practical guide for analyzing qualitative data. Psych 2022, 4, 142–159 [Internet]. 2022. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018 Jan 1;24(1):120-4. Lesotho. Protection of Personal Information Act. 2012. https://lesotholii.org/akn/ls/act/2012/5/eng@2012-02-22. Republic of South Africa. Protection of Personal Information Act. 2013. https://popia.co.za/ Chitneni P, Beksinska M, Dietrich JJ, Jaggernath M, Closson K, Smith P et al. Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening. Int J STD AIDS. 2020 Jun;31(7):627 − 36. Mokgatle MM, Madiba S. Risky sexual behaviour amidst predicament of acceptable sexually transmitted infection partner notification modalities: A cross-sectional survey amongst minibus taxi drivers in Gauteng province, South Africa. SA Fam Pract. 2020 Dec 10;62(4). Kalichman SC, Mathews C, Kalichman M, Lurie MN, Dewing S. Perceived barriers to partner notification among sexually transmitted infection clinic patients, Cape Town, South Africa. J Public Health. 2017 Jun 1;39(2):407 − 14. Dias BD, Kufa T, Kularatne RS. Factors associated with partner notification intentions among symptomatic sexually transmitted infection service attendees in South Africa. S Afr Med J. 2023;113(2):91 − 7. Tsadik M, Berhane Y, Worku A, Terefe W. Patient referral alone is not an effective strategy to capture partners of patients with sexually transmitted infections in low-resource settings: a case-control study. J Public Health. 2018 Feb;26(1):51 − 8. Omollo V, Bukusi EA, Kidoguchi L, Mogaka F, Odoyo JB, Celum C et al. A pilot evaluation of expedited partner treatment and partner human immunodeficiency virus self-testing among adolescent girls and young women diagnosed with Chlamydia trachomatis and Neisseria gonorrhoeae in Kisumu, Kenya. Sex Trans Dis. 2021 Oct 1;48(10):766 − 72. Taleghani S, Joseph-Davey D, West SB, Klausner HJ, Wynn A, Klausner JD. Acceptability and efficacy of partner notification for curable sexually transmitted infections in sub-Saharan Africa: A systematic review. Int J STD AIDS. 2019 Mar;30(3):292–303. Table 1 and 2 Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files YouthsFocusGroupDiscussionGuideEnglish1.docx Table 1 Table2.docx Cite Share Download PDF Status: Published Journal Publication published 11 Apr, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 10 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 26 Jan, 2026 Reviewers agreed at journal 26 Jan, 2026 Reviewers agreed at journal 26 Jan, 2026 Reviews received at journal 16 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers invited by journal 15 Jan, 2026 Editor assigned by journal 15 Jan, 2026 Editor invited by journal 05 Jan, 2026 Submission checks completed at journal 04 Jan, 2026 First submitted to journal 04 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:14:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1642921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8436597/v1/27c8a16c-457a-4eae-a3bf-b53af6982c2c.pdf"},{"id":100619522,"identity":"8eae2411-9093-40f3-92bb-7913562c994a","added_by":"auto","created_at":"2026-01-19 18:11:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17664,"visible":true,"origin":"","legend":"\u003cp\u003eTable 1\u003c/p\u003e","description":"","filename":"YouthsFocusGroupDiscussionGuideEnglish1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8436597/v1/8061a92823268f446ccb03a7.docx"},{"id":100619685,"identity":"bac11da1-f7cb-42d2-89db-1ba85e9fead3","added_by":"auto","created_at":"2026-01-19 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Background","content":"\u003cp\u003eSexually transmitted infections (STIs), specifically in young people, remain a global health concern (1). Epidemics of STIs continue to cause a significant disease burden; however, a global response is lagging (2). The World Health Organization estimates 376.4\u0026nbsp;million new curable STI cases occur annually. The sub-Saharan Africa region accounted for an estimated 40% of global infections in 2016\u0026ndash;2021 (3). To prevent STIs, identification and management is essential (4). However, in low-income countries, once STIs have been diagnosed, their management is symptomatic(5). As a result of syndromic management of STIs, untreated STIs could contribute to death, increase the spread of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS), cause pelvic inflammatory disease, ectopic pregnancies and infertility and lead to adverse pregnancy outcomes (6,7). One of the approaches to preventing STI spread is partner notification services. Despite partner notification being essential for STI control, it is underutilized (7). Furthermore, while partner notification is well documented in some populations, little research has been done on youth-specific strategies, experiences and practices in sub-Saharan Africa. Young people are unique in their vulnerability to contracting STIs (8). Factors that contribute to risky sexual behavior by young people are early sexual debut, the age of sexual partners, having multiple partners, inconsistent condom use and lower risk perception for STI/HIV (7,8). Furthermore, challenges that face the youth are exacerbated by poor access to health facilities (7). Moreover, youth in different cultural contexts may have distinctly different experiences, which necessitates that a literature synthesis is undertaken to support the tailored design of youth-specific strategies to control and manage STIs (9,10).\u003c/p\u003e \u003cp\u003ePartner notification is the process whereby sexual partners are notified that it may be possible that the partner has acquired an STI. In addition to being notified of exposure, sexual partners are screened for STIs and treated, if required (11). The benefits of partner notification are finding undiagnosed STI clients, reducing reinfections in index clients, and preventing the spread of STIs in a community (11).\u003c/p\u003e \u003cp\u003eThere are various approaches to partner notification, namely patient referral, provider referral and contract referral. Patient referral is an approach that involves an index client informing their sexual partners that the partners have been exposed to STIs and encouraging the partners to seek treatment. Another approach involves a health care worker informing partners of the index client that the index partner had an STI and may pass or have passed STIs to the partners and advising partners to seek medical care (11,12). Another option for partner notification is contract referral. The index client and the health care worker agree on a specific time when the index client will inform sexual partners about their exposure. When the agreed time has passed and the index client has not informed their partners, the health care worker informs the sexual partners about their exposure to STIs (11,12). Although it has been reported that partner notification strategies can be successful in achieving the benefits of notification, partner notification by youth remains a challenge because of stigma, fear of disclosure, concerns of confidentiality, and fear that a relationship might end once a partner knows about STI infection (8,13). This study assessed the perceptions and social dynamics that affect partner notification strategies, with the aim of controlling curable STIs in Maseru, Lesotho.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThe study employed a sequential exploratory mixed method design and involved youth who accessed adolescent-friendly health services (general health, mental health, sexual and reproductive health, maternal and child health) in Maseru district. This article reports on Phase 1 of a main study that had the following objectives: to assess the perceptions of youth on partner notification strategies to control curable STIs in Lesotho, and to assess social dynamics that affect the partner notification strategies used to control curable STIs in Lesotho. This paper presents qualitative findings on youth\u0026rsquo;s views on partner notification strategies to control curable STIs in Lesotho. In this paper, findings are presented for women only, for men only, for the key population and mixed youth (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e: Sociodemographic data findings). Exploratory qualitative research is undertaken in a situation where there is limited knowledge about a phenomenon, or when topic has not been adequately defined (14).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Setting and Context\u003c/h2\u003e \u003cp\u003eThe study was conducted in two health care facilities in Maseru district that operate around the clock. Maseru is one of the ten districts of Lesotho; it is the capital city of Lesotho and includes urban and peri-urban areas. The district is divided into the central business area, residential areas and newer informal settlements. Maseru has a population of 519 186 (15). Adolescent corners at both health care facilities in Maseru offer a range of health services for youths.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study Population, Sampling and Recruitment\u003c/h2\u003e \u003cp\u003eThis study is part of a larger study that collected data by conducting five focus group discussions with 6\u0026ndash;8 participants per group; the aim was to gather information on youth\u0026rsquo;s perceptions and social dynamics of youth related to partner notification strategies to control curable STIs in Lesotho. The focus groups were composed as follows: 1) A mixed youth group (this was a group composed of women and men), 2) A men-only discussion group, 3) A women-only discussion group composed of only women as participants, 4) A key population group, composed of mixture of men who have sex with men, sex workers and key informants. For this paper, the study population focus is youth (mixed youth, women only, men only and key populations). Purposive sampling was used to recruit participants for the study. Data saturation was reached in the fourth focus group discussion, when participants no longer provided new information. However, the principal investigator continued with the fifth focus group to confirm saturation. Purposive sampling was used because it actively promotes seeking diverse perspectives in a flexible manner according to the insights that were generated during the focus group discussions(16,17).\u003c/p\u003e \u003cp\u003eRecruitment occurred in various ways. First, the principal investigator used a recruitment flyer as a guide to share the objectives and purpose of study during a health talk slot in the morning. Participants who agreed to participate at the time were invited into a private room for a focus group discussion. Second, the principal investigator requested organizations that provide health programs for the key population community to identify key populations that could participate in focus group discussions; this route was followed because it would have been difficult to identify the key population group through the public health facilities. A convenient time and place were agreed upon for the key population focus group discussion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Inclusion Criteria and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eThe data were collected from youth residing in Maseru district aged between 18 and 24 years of age, who were sexually active, had used the services of the selected study setting and could read. This age group was selected because of their specific needs, which indicates that there is a relationship between youth sexuality and vulnerability (18). People who did not live in Maseru or had not used the services of the study setting were not included in the study. People who were not sexually active or who fell outside the specified age range, or who were not willing or did not consent to be part of study, were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Collection\u003c/h2\u003e \u003cp\u003eIn preparation for data collection, a training session was presented for the research assistant, to ensure that he understood the study and to discuss data collection tools. Data were collected from June 2025 to July 2025. The data collection tool evolved as data were being collected; its purpose was to ensure that in-depth answers to research questions were gathered. A focus group discussion guide was used to guide the discussions (Table\u0026nbsp;1.). The guide included main and probing questions based on the participants\u0026rsquo; responses. The main interview questions included in the guide were: What are your views about STIs partner(s) notification in Lesotho? What have you heard about STIs partner(s) notification services? What do you think about those services? What do you think are the benefits of STIs partner(s) notification services? What have you observed or heard about STIs among couples in the community? How do couples manage STI in the community? How do adolescents handle STI issues in their relationships? Furthermore, a consent form gathered the demographic details of the participants (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Verbal and written informed consent were obtained from participants who were willing to take part in focus group discussions. The discussions were recorded using a voice recorder and each focus group discussion lasted about 60\u0026ndash;90 minutes. The recorded focus group discussions were translated into English and transcribed professionally.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data Analysis\u003c/h2\u003e \u003cp\u003eCollected data were analyzed with thematic content analysis by following Braun and Clarke\u0026rsquo;s six-phase framework (19). The researcher familiarized themself with the data, generated the initial codes, searched themes, reviewed themes and defined and named themes. Finally, the report was produced from the data. The demographic data were summarized on a Microsoft Excel spreadsheet. To familiarize themself with the data, researcher listened to all the audio recordings while, at the same time, reading the transcripts to ensure the data were complete. The researcher generated the initial codes independently, developed the manual code book for the first three focus groups in the study. The researcher searched the themes for similarities in data, and reviewed the themes and subthemes. The transcripts were imported to QRS NVivo 15.3.0 (20). Upon completion of the codebook, the researcher organized the codes into broader themes. The audio recordings of the focus group discussions were professionally transcribed verbatim, and translated from Sesotho to English. Data were analyzed.\u003c/p\u003e \u003cp\u003e The results of the first coding exercise were shared with one of the supervisors who acted as a peer reviewer to confirm the codes that had been created. NVivo software is used to analyze qualitative data and allows researchers to import transcripts, create themes, and perform coding; it enables collaboration between students and supervisors for member checking of the analysis and trustworthiness of the analysis (20,21). Conclusions were drawn from quotations of participants\u0026rsquo; utterances without the meaning being changed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Trustworthiness\u003c/h2\u003e \u003cp\u003eTo ensure the trustworthiness of the study, the authors strived to enhance its transferability, credibility, confirmability, and dependability, as recommended by Korstjens and Moser (21). For credibility, a pilot study was conducted with one focus group discussion. The principal investigator and supervisor trained a research assistant to ensure that the data collected were rich and of high quality. In terms of dependability, the principal investigator and supervisors had a debrief session after each focus group discussion, with the supervisors serving as a peer reviewer of the collected data. They provided guidance on refining the data tool, and suggested additional questions for inclusion in subsequent focus group discussions to provide in-depth insights into the research questions. Confirmability was achieved and maintained through the researcher securing signed consent forms and following and recording the analysis process step by step. For transferability, the researcher collected data from health facilities in Maseru using thematic sampling, which provided data from diverse segments of youth, thus enhancing the generalizability of the findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Ethical Considerations\u003c/h2\u003e \u003cp\u003e Ethical clearance approval was obtained from Sefako Makgatho Health Sciences University Ethics Committee (Protocol No. SMUREC/H/32/2025) and Lesotho Ethics Committee (No. ID177-2025). Upon receipt of ethical clearance, the researcher obtained permission to conduct the research from Maseru district health management team, Christian Health Association of Lesotho, and health facility management.\u003c/p\u003e \u003cp\u003e Participants who had agreed to participate in the study were provided with informed consent forms and comprehensive study details such as the study purpose and objectives. The participants were made aware that their participation was voluntary and that they were free to withdraw from participation at any time, and that their withdrawal would not have any negative effects on their access to services. The participants were assigned pseudonyms (Participant 01 represents Participant 01 at a specific health facility) to use during the focus group discussion and their real names were not recorded on the recordings, fieldnotes or during the focus group discussions.\u003c/p\u003e \u003cp\u003eIn accordance with South Africa\u0026rsquo;s Protection of Personal Information Act (22,23), informed consent was obtained from participants; the Act limited the amount of demographic data that was gathered; the data are stored securely in a locked cabinet to which only the research team has access. The data will be stored for five years, and personal information of participants will be protected by disclosing it only to the research team.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe results of the main research study revealed five themes: knowledge or understanding of STI transmission, attitudes toward partner notification, motivators and benefits of STI partner notification services, barriers to STI partner notification and preferred partner notification methods before and during the relationship.\u003c/p\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003e3.1 Sociodemographic Data\u003c/h2\u003e\n \u003cp\u003eThe sample size of the participants in the study was 31; each focus group had between six (n = 6) to 10 (n = 10), participants. Study participants were aged between 18 and 24 years; the mean age was 21 years. The majority (27 out of 31) of participants were unmarried, and 19 out of 31 were women. About 51% (16/31) of participants had completed secondary school (Tables\u0026nbsp;2 − 4).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e3. 2 Data on Sexual Behavior\u003c/h3\u003e\n\u003cp\u003eAs data collection evolved, data on sexual behavior data were collected from the mixed youth and key population groups. All the participants reported to be sexually active and having had one to three sexual partners in the last 12 months. Participants reported sexual activity starting from 15 years of age. The variety of sexual relationships reported by participants was steady, casual, multiple partner, one-night stand and having vaginal, anal and oral sex. Six participants reported having had STIs in the last 12 months and four of them reported using condoms in their last sexual activity (Tables 3 − 4).\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSociodemographic data of participants (key population group)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePseudonyms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 01\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 02\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 03\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 04\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 05\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 06\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 07\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant 08\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVolunteer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHighest education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge of first sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexually active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnal, oral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOral, vaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnal, oral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnal, oral\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of sexual partners in last 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 Steady\u003c/p\u003e\n \u003cp\u003e1 One-\u003c/p\u003e\n \u003cp\u003enight stand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOne-night stands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransactional, steady, situational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 Steady\u003c/p\u003e\n \u003cp\u003e2 Casual\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 Year, continuing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady 1: 2 years continuing Steady 2:\u003c/p\u003e\n \u003cp\u003e1 year continuing for a year\u003c/p\u003e\n \u003cp\u003eA day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrently not in relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 Years\u003c/p\u003e\n \u003cp\u003e2 Weeks\u003c/p\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady: 1 Month\u003c/p\u003e\n \u003cp\u003eSteady: 3 Months\u003c/p\u003e\n \u003cp\u003e1 Casual\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAre you in relationships with other partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHave you had STIs in the last 12 months?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid you use condoms in the last sexual act?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSociodemographic data of participants (mixed youth group)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePseudonyms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant01\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant02\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant03\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant04\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant05\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant06\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant07\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant08\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant09\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant11\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUn-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUn̵̵employed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHighest education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade 7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge of first sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexually active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of sexual partners in last 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003cp\u003eOne-night stand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003cp\u003eTogether\u003c/p\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003cp\u003eOne-night stand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteady\u003c/p\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoyfriend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSide chick\u003c/p\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 Year\u003c/p\u003e\n \u003cp\u003eA Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 Month\u003c/p\u003e\n \u003cp\u003e1 Year\u003c/p\u003e\n \u003cp\u003e3 Years, 1 Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 Years\u003c/p\u003e\n \u003cp\u003eA day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 Years\u003c/p\u003e\n \u003cp\u003e8 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 Months\u003c/p\u003e\n \u003cp\u003e2 Months\u003c/p\u003e\n \u003cp\u003e5 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn relationships with other partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHad STIs in the last 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsed condoms in the last sexual act\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003e3.2 Themes and subthemes from focus group discussion responses of youth\u003c/h2\u003e\n \u003cp\u003eThis paper shares, specifically, results on youth’s views on partner notification services, and covers five themes: 1) knowledge or understanding of STI transmission, 2) attitudes toward partner notification, 3) motivators and benefits for STI partner notification services, 4) barriers to STI partner notification, and 5) preferred partner notification methods before and during the relationship (Table\u0026nbsp;5).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eThemes and subthemes from youth’s focus group discussion responses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubtheme\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003eKnowledge or understanding of STI transmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSTI are curable with treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSTI are communicable and transmissible\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSigns and symptoms of STIs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTypes of sexually transmitted infections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple partners as risk for STI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse of condom\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMyths on STI transmission\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAttitudes towards partner notification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptance of STI status\u003c/p\u003e\n \u003cp\u003eSupportive view to notify partner once infected with STIs\u003c/p\u003e\n \u003cp\u003eNotifying partner about STI infection under certain conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvoid notifying the partner once infected with STIs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMotivators and benefits for STI partner notification services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreventing the disease\u003c/p\u003e\n \u003cp\u003eProtection of health of partner\u003c/p\u003e\n \u003cp\u003eMoral and social obligation\u003c/p\u003e\n \u003cp\u003eAvoid losing the partner\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvoid feeling of guilt\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eBarriers to STI partner notification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStigma and gossip\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCould end the relationship\u003c/p\u003e\n \u003cp\u003eFear of how partner will react\u003c/p\u003e\n \u003cp\u003eCould cause conflict\u003c/p\u003e\n \u003cp\u003eAnticipating that partner might share STI infection on Facebook\u003c/p\u003e\n \u003cp\u003eMistrust by partner\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnticipating blame after telling the partner\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreferred partner notification methods before and during the relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTell partner\u003c/p\u003e\n \u003cp\u003eNotification by health care worker\u003c/p\u003e\n \u003cp\u003eNotification at Health Facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e3.2 Knowledge or Understanding of STI Transmission\u003c/h2\u003e\n \u003cp\u003eParticipants had a basic knowledge of STIs and how they are transmitted.\u003c/p\u003e\n \u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e3.2.1 Sexually Transmitted Infections are Curable with Treatment\u003c/h2\u003e\n \u003cp\u003eParticipants had knowledge of STIs being curable with treatment. Some mentioned that their decision to notify their partners was guided by knowing that STIs are curable.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf people have the information, it will be easier for them to notify each other, because they will know that the disease is curable, but if people do not have the information, they end up with wrong beliefs and fears, and these misconceptions are easy to lead them into having fear about going to the clinic and simply having these discussions where they can now disclose their statues to their partners. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBetween the clinic, traditional doctors and the cleansing there will be one which works, because in other instances, my partner was able to get a cure and I did not. They will then accuse me of infidelity because it will not make sense why they were able to heal and I was not. This is why I would then try all the different alternatives until I find a cure. (Participant 9, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSince these disease are treatable, from what I know, these treatable diseases have what is called “cell wall.” There are certain medications that attack that cell wall in bacteria and destroy it, and that is how the illness is cured completely. The medicine removes the illness entirely. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003e3.2.2 Sexually Transmitted Infections are Communicable and Transmissible\u003c/h2\u003e\n \u003cp\u003eThe participants reported that they would notify their partners about STI, because if the partners are not aware that they had been exposed, they could transmit the STIs. Other participants, when asked whether they would visit the health facility if their partners told them about the partners’ STIs, the participants said they would avoid to visiting health facilities. Some participants stated the spread of STIs is a consequence of failing to visit the health facility and lacking knowledge of STIs.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThey must know because, even if they are your only partner, they could be engaging sexually with other people. When they are not made aware on time, it will be transmitted to them, and they transmit it to other people as well and spread it. (Participant 01, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf I stop going and I infect someone else and they infect others, it becomes a chain. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFor me, if they do not understand I will just continue to transmit it to them. (Participant 02, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThen, after treatment, I think that they might still pursue relationship outside their marriage but this time with caution, making sure that they take necessary measures to ensure that they do not contract STI or transmit it. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI will not stay in the relation though, because the truth is, STI transmission is not the same as that of flu, where we can suspect that you probably touched the object that someone who had flu touched previously. It is clear how it happened [laughs). It is clear that I did something wrong. I engaged in sexual activity outside of relationship. (Participant 07, Aged 23, Key population’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003e3.2.3 Signs and Symptoms of Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eParticipants had knowledge of the different signs and symptoms of STIs, among which a burning sensation when urinating, discharge, sores, itchiness, swelling on the penis, bad smell, difficulty walking and rash.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have forgotten the exact name, but its symptoms include a burning sensation when urinating, and a white or yellowish discharge. (Participant 05, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWhen someone walks in, do not assume you know what is happening. Do not jump to conclusions. Someone might be dealing with syphilis or just a burning sensation when they pee, and you think it is something worse, underestimate what the person could be dealing with because you simply did not try to engage more with them and find out more about them. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThere are times when I can take up to four days away from partner and still get discharge. They say that it starts as a white discharge then later transitions to yellow. When this happens even though I have not been having any sex, I immediately go to the clinic for help. (Participant 09, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think things like pimples and maybe other signs. However, with something minor like “seso” (discharge or irritation), I think. (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYou fear that he might later say you smell, because discharge does give a bad odor especially when it is severe. (Participant 05, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI remember once I had a rash around here [gesturing], and they told me it was an issue that could be fixed with “pitsa.” They gave me something to apply to the area … it was itchy all afternoon. I really couldn’t even walk properly that afternoon. (Participant 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI was going to say that maybe number 2 knows gonorrhea. It is said to be dangerous that it gives one sore and starts affecting the weight as well. (Participant 04, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\"\u003e\n \u003ch2\u003e3.2.4. Types of Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eWhen the participants were asked about types of curable STIs they knew of, they mentioned gonorrhea, syphilis, chlamydia, human papilloma virus, and genital warts. Some were not aware of types of curable STIs, but they could list signs and symptoms of STIs.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI know one that is called HPV – Human P … it is quite a difficult word to pronounce, but it ends with virus. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI know it causes warts around the genitals, but even that one can be treated. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it is called syphilis or chlamydia. (Participant 02, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\"\u003e\n \u003ch2\u003e3.2.5. Multiple Partners as Risk for Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eYouth recognized the potential risk of acquiring STI from an infected partner, having multiple partners, or if they did not use condoms. They also reported that they would notify sexual partners to avoid the reinfection and that they would visit health facilities to be checked to determine if they had also contracted STI.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThere is a possible chance that I may have gotten it from him, and since how soon the symptoms show themselves also depends on our immune systems, it may have shown itself to him before it did to me even though he does have it too. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePeople who have information are more likely to agree to go to the clinic to get tested, even though it really does make a person seem as though they have become promiscuous, because STI cannot just appear randomly [laughs]. It is clear that between me and you, there is someone who had been sleeping around. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eTruth of matter is that I am not always with him and I do not know the kind of activity he engages in when he is not with me, or when he has had a little too much to drink. If I keep quiet and he keeps moving from person to person, he might end up infecting someone innocent. I think it is important, as it will help protect the lives of others. (Participant 02, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it’s important for them to know because maybe I have already gone to the clinic, found out my condition and started treatment if he continuous to sleep with me, I will get sick again and won’t recover. (Participants 05, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec21\"\u003e\n \u003ch2\u003e3.2.6. Using Condoms\u003c/h2\u003e\n \u003cp\u003eWhen the participants were asked how couples managed STIs in the community, they indicated that they did not use condoms.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think the benefit is that when both people have the knowledge, it is easier to support one another. If I already know I have an infection and my partner is also informed, we can help each other stay protected. With proper knowledge, I will not infect anyone, and they will not infect anyone either, because we will always use protection. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYou will find that there is a lot of infidelity and most have affairs outside of their marriage. There, they do not use protection during sex, hence the spread of STIs. (Participant 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have heard people say you should use condoms, so that you don’t get infected with STIs. (Participant 01, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe recurring response of youth, when they were asked how adolescents handle issues related to STIs in their relationships, related to unwillingness to use condoms.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have discovered that most of them do not like to use protection or condoms. That puts them in a position where they contract STIs early and there is quite a rapid spread among them too, because of this. (Participant 07, Aged 20, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec22\"\u003e\n \u003ch2\u003e3.2.7 Myths and Misinformation about Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eDespite the participants’ knowledge of STIs, the focus group revealed myths about how STIs were transmitted. Some participants stated that certain foods makes them sexually active and causes STIs.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSome people are told that they eat too much potatoes. Whenever you get an infection like discharge, they say it is because you eat too much potatoes, but the person would know very well that they did not get an infection from eating potatoes. These are things that I have heard about sexually transmitted diseases, that they are caused by potatoes and they are cured by these herbal remedies. (Participant 01, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eEven the food we eat today, makes people more sexually active, so much that you will find that sometimes after sexual intercourse in just two hours you already feel you want more sex. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt is already known that things like potatoes cause discharge, and we all know that girls love things like chips or fries. (Participant 07, Aged 20, Men’s Group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePeople get it when they have had unprotected sex with a person whose spouse have died and both men and women get it. (Participants 09, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\"\u003e\n \u003ch2\u003e3.3 Attitudes toward Partner Notification\u003c/h2\u003e\n \u003cp\u003eParticipants recognized the importance of partner notification services, though youth had mixed attitudes about partner notification services. Common responses from participants revealed that they supported informing sexual partners that they may be infected.\u003c/p\u003e\n \u003cdiv id=\"Sec24\"\u003e\n \u003ch2\u003e3.3.1 Acceptance of Sexually Transmitted Infection Status\u003c/h2\u003e\n \u003cp\u003eSome of the participants expressed that they would accept the STI status and act by seeking care at the clinic to treat STI.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI will accept that they told me and go. The reason that they will be telling is because they will have seen or confirmed that they have it, and will be asking that I go to the clinic with them. (Participant 05, Aged, 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would accept it and the pills. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf it’s just one person, they might accept it. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThere are some who will accept that this is the situation and suggest that we take a certain step. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIn the case where they have told me, I come. (Participant 04, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec25\"\u003e\n \u003ch2\u003e3.3.2 Supportive View to Notify partner Once Infected\u003c/h2\u003e\n \u003cp\u003eSome participants reported supporting the practice of notifying their partners that they had been exposed to STIs.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSince we would be talking to the person who is practically the love of my life, I will sit them down so we can talk. What I will not do, because this is not just a man who is just giving me money, is that I will not deceive them by keeping such a matter from them. Sometimes they might know because I kept quiet about it, then the day they discover themselves, it will have already caused great damage. (Participant 07, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would invite them so that they can get support that they need. (Participant 02, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIn the case where I would find out that I have an STI, I would ensure that I let my partner know about it and explain that my results came out positive for STI. (Participant 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it is important, because if I don’t tell my partner, you see, I would be disrespecting him by infecting him. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think is best to tell the person you are getting involved with, the person you are entering into a romantic relationship with, so they know your status. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec26\"\u003e\n \u003ch2\u003e3.3.3 Notifying Partner about Sexually Transmitted Infection Under Certain Conditions\u003c/h2\u003e\n \u003cp\u003eAnother opinion was that participants would notify partners of their exposure to STI under certain conditions. Some youth said that the nature, number and kind of partner would play a role in their decision to notify a partner.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it just depends on what kind of person your partner is, some people are calm, and others jump to conclusions. If you know that they will understand and listen to you, and they won’t judge you, then yes, I will tell them. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf it were a marriage, maybe, but in casual relationships, I do not think is worth it. (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLike I said before, it depends on the kind of relationship that we have with the partner or the person I am with. If it is a steady one, I would definitely talk to my partner about this and invite them. (Participant 07, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt might also be easier to tell them after I have healed. After I have finished the treatment from the clinic. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFor me, if they are many I would definitely encourage them to go. Since I would not know who infected me, I would go with each of them one by one to the clinic. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf it’s just one, I would definitely advise him to go but if there are many, it becomes a bit complicated. It will expose me. If it’s one, I can just take his hand and go with him. If there are many, I might end up lying because they won’t know who I was with today, tomorrow etc. (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would come to the health facility as well. One of the reasons that would make me come would also be to show support to my partner, because when a person discloses something like this to you, you have to support them. In this case, if I do not come, they will take it as if I am not being supportive. But then again, by coming, I also ensure that I know what my status is, and get the treatment that I need when I test positive. (Participant 02, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec27\"\u003e\n \u003ch2\u003e3.3.4 Avoid Notifying the Partner Once Infected With Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eDespite the general support for partner notification, other themes related to avoidance of notifying partners are the nature of the relationship or the partner.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf it is a transactional relationship though, where we are only together so that they can provide me money and financial assistance, then I would never tell them anything about my health. That relationship is only about money, and nothing else. My health is mine, and it completely up to them to decide whether they would want to go to the clinic to get checked or not. That is their own responsibility. (Participant 07, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI do not think It’s important to tell them. For example, in a relationship, no, I do not know … Let’s say, no one can truly say the two of us are in a serious relationship. For example, I could go out and do my own thing, and when I come back and tell him, where do I say I got it from while he does not have it? (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it is not worth it because you might find that the person you were involved with is not a good person. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWell, me, honestly, as I want to talk about myself. I feel like, you see, we as people will be dating five people in total. When I'm dating five people, it's clear that I'm not loyal, so I will want to ensure that not any of them know or finds out that I'm cheating with this one and that one. So, it won't be easy for me to tell these people. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI don’t tell her, because she would ask me whether I am sure the medicine will even help me. (Participant 05, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec28\"\u003e\n \u003ch2\u003e3.4 Motivators for and Benefits of Partner Notification Services for Sexually Transmitted Infections\u003c/h2\u003e\n \u003cp\u003eParticipants had different motivators for notifying their partners. Recurring themes were to prevent disease, to protect their partner, feeling morally and socially obligated, to avoiding losing a partner and feelings of guilt.\u003c/p\u003e\n \u003cdiv id=\"Sec29\"\u003e\n \u003ch2\u003e3.4.1 Preventing Disease\u003c/h2\u003e\n \u003cp\u003eParticipants stated prevention of STI as a benefit and motivator of informing partners.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would say that it would be important to do so. The benefit of informing my partner that I have an STI, is to ensure that we are able to protect ourselves because, obviously, they have it too because we sleep together, and since I do not know what he gets up to when he is on his own, it will also help to stop it from spreading. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMy feelings are that we should disclose it to our partners, so that if I have sexually transmitted infections, I am able to protect them and not transmit the STI to them. Also, that they should not transmit them to others because, the truth is she probably has other sexual partners outside of me. (Participant 01, Aged 23, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt would be so that we don’t keep infecting each other, and so that we don’t infect other people. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt would be to prevent the spread of that infection and ensure that it does not spread as wide as other infections. (Participant 01, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe benefit would be that they do not get sick or that they are treated. They will not end up with worse infections or pass them back to me. We will be able to avoid getting reinfected, and I stay safe too. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec30\"\u003e\n \u003ch2\u003e3.4.2 Protection of Health of Partner\u003c/h2\u003e\n \u003cp\u003eAnother stated motivator and benefit of notifying partners disclosed by youth is protecting the health of the partner.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI will take the treatment so that we can both be well, and I will appreciate that they cared enough to ensure that I am not in danger as they were, or at least exposed to the same danger. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe reason why I would do this would be to make sure that they take the necessary measures to protect themselves, and to make sure that if by any chance they have it already too, they take the necessary precautions at that point. (Participant 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI want them to be healthy too. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe benefit is that they can also get screened or tested for STIs, and by doing so, they will be able to either treat it or protect themselves. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec31\"\u003e\n \u003ch2\u003e3.4.3 Moral and Social Obligation\u003c/h2\u003e\n \u003cp\u003eIn some youth’s views, they were morally and socially obligated to notify their partners about the STI.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think that if they did tell me like that to me it would mean that this person knows and has gone to the doctor to actually find out. So, because of the fact that they took action, I too must take action. What this will also show me is that my person is responsible. If they did something like that, it also means they are trustworthy or at least are taking accountability for their actions. And because they will have gotten the STI from elsewhere and from me, it will also give me the impression that they are choosing to correct their behavior. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI will have to take responsibility that I am the one who made a mistake here, and, therefore, accept any decision that they make whether it is to stay or to leave. At the end of the day, they will at least see a doctor. (Participant 07, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf I live with my partner and I also have another partner elsewhere, then I will realize that I’m the one responsible for the infection. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWhat would push me to disclose this to my partner would be so that they do not find this out on their own, because I would be very embarrassed if they found out any other way than from me. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec32\"\u003e\n \u003ch2\u003e3.4.4 Avoid Losing the Partner\u003c/h2\u003e\n \u003cp\u003eSome of participants notified their sexual partners about sexually transmitted infections to keep them in the relationship.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf I suggest using protection, they might say, do you not trust me? And since I want to win them over and have them as mine, I will just go with the flow. Even if it means getting sick. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf she finds out from the hospital, chances are that she will not trust me again. It would be better if I told her that this is what I’m going through or noticing. (Participant 07, Aged 20, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf you wait until you are healed to tell them, they might feel like you were hiding it all along. They might stop trusting you and say, you inform them about things when they are already done. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec33\"\u003e\n \u003ch2\u003e3.4.5 Avoiding Feeling Guilty\u003c/h2\u003e\n \u003cp\u003eParticipants were motivated to notify the partners about being exposed to STI in order to avoid their own feelings of guilt.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAlso, I want to avoid the guilt of having caused someone’s death by not telling them the truth. If it turns out someone gets sick and dies, and I know it’s because I didn’t say anything, then I would feel like I was the cause. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it’s better to tell someone from the start, explain what’s happening so they’re aware. I wouldn’t want to end up regretting it later and thinking, I should’ve said something, especially if something worse happens and I lose the person. (Participant 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec34\"\u003e\n \u003ch2\u003e3.5 Barriers Faced by Partner Notification Services\u003c/h2\u003e\n \u003cp\u003eSeveral barriers emerged as reasons why youth struggle to notify their partners that they had been diagnosed with STI. Common barriers that emerged were fear of stigma and gossip, and that partners could end the relationship if they were notified about being exposed to STI. Youth also expressed fear of how their partners would react when notified, or anticipated that their partners might expose the partner on Facebook, that their partners would no longer trust them or might blame them.\u003c/p\u003e\n \u003cdiv id=\"Sec35\"\u003e\n \u003ch2\u003e3.5.1 Stigma and gossip\u003c/h2\u003e\n \u003cp\u003eParticipants said that stigma and gossip prevented partner notification of exposure to STI. In their view, stigma originates in the community and at health facilities and could be influenced by culture, religion and social media.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have also noticed that people are afraid of being seen by others, afraid of who they might bump into at the clinic, maybe someone from their village, and then that person might gossip about seeing them at a clinic that treats STIs. (Participant 01 Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnother problem with partner notification is how facilities handle it. Let us say that I get diagnosed and go to inform my partner. The problem that will then arise there is that the clinic will insist that we go together so that they can provide psychosocial support as well as be examined together, but if in a same sex relationship, it becomes difficult, because society does not quite accept us. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnother challenge that I have identified to be a problem I see is that culture or the role that it plays in our lives and in our programming. Our Basotho still teaches that a man must be with a woman, so when there are instances where a woman is in a relationship with another woman, or a man is in a relationship with another man, it is still very strange and problematic to most people and so it is rejected. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMost healthcare facilities are church owned, and that brings even more judgement. They are not ready to accommodate all of us. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAs young people, on social media, we insult each other a lot. When you walk past a group of guys, they will start pointing fingers at you. Even if a guy tries to date you and reject him, he will say “you are the one who gave that one an STI.” (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYou go to the clinic, and then they start gossiping about you. That kind of fear keeps a lot of people from coming forward, so I think, even in casual sex situations, the best thing we can do is just go to the clinic, but even that is not easy for everyone. There is still stigma on both sides. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have seen that in the villages that we live, when a person has sexually transmitted infections, they ostracize and they discriminate against them, which is an unnecessary thing to me, but these are things that are happening in the villages. (Participant 03, Aged 19, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI really wouldn’t tell him. If I told him, tomorrow he might insult me and tell a lot of people, and then as I walk around, people would be gossiping that I am the one who infected so-and-so with a disease. (Participant 01, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have heard a lot of gossip, especially about young people who are dating. A guy will tell his friends, confiding in them then they will go on to tell their girlfriends that so and so has an infection. You will find that as girls, the girlfriends of these guys, we don’t get along. (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI am sometimes held back by fear. Even if I feel like I have a certain problem, I fear that if I go to my usual friends or companions, they might start gossiping about me when they are out buying things. They will make me the topic of their conversation: “that person says they have this or that” and when I show up somewhere, my condition will already be the talk of the town and people will start calling me names. (Participants 06, Aged 19, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec36\"\u003e\n \u003ch2\u003e3.5.2 Could End the Relationship\u003c/h2\u003e\n \u003cp\u003eThe relationship being ended was another barrier for some participants to notify their partners about STIs.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThere was this one case where someone was in a relationship, and they did not tell their partner about their STI, even though they knew that they had it. Later the partner found out at the clinic and said, “you should have told me.” The person responded, “I was scared I would lose you.” The partner was very judgmental, and so they ended up breaking up. That is why I say it is complicated. Sometimes, it is hard, while other times it is easier. But deep down, we are just selfish people. We do not want to lose people. (Participant 08, Aged 22, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf she fails to understand this or to cooperate, then we will have to part ways. (Participant 04, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt’s not easy because if I show my partner the medicine I am taking, it won’t be easy. If we sit down, they will start asking where I got the infection from, that’s where our marriage could end, because they’ll assume I was unfaithful. Therefore, no, it’s not easy to tell them. (Participant 01, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePartners may tend to be easily frightened by the fact that I have an STI, so should I choose to disclose this to them, there is a chance that they will seek sexual intercourse outside the relationship and have me struggle. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have noticed in our communities is that married couples do not disclose to one another that they have as STI. As a result, the infection becomes severe, and this is when their partner finds out. When they do, they usually leave the marriage and then there is no one to take care of the one who is now ill. Eventually they die. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec37\"\u003e\n \u003ch2\u003e3.5.3 Fear of How the Partner Will React\u003c/h2\u003e\n \u003cp\u003eAdditionally, youth emphasized that it was difficult to notify a partner because they did not know how they would react to notification. Among the reactions that were cited are physical abuse, emotional abuse, cyberbullying and communication blockage.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAnother thing that I have noticed, as the lady has already mentioned, is the issue of GBV [gender-based violence], usually the woman does not tell her husband or her male partner when she has found that she has an STI, because, usually, the man’s reaction is to scold her and become very upset, even if the woman knows very well that she has not been sleeping around. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it would be best if this kind of conversations were had in person or face to face, because men and typical Basotho boys, are likely to insult you if you initiated such conversations over the phone. I agree with that. On the phone, they are most likely to hang up or question what your role is in their relationship and, secondly, ask how and when you are being involved in their relationship. They are most likely to disrespect you as a nurse and even ask their partner later why they are sending nurses to call them about such. (Participant 07, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThey might even beat you and say you gave them the infection even though you know they did not have it. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe other issue is that they are going to tell other people, making it difficult to get another girlfriend as they would have told people that I am sick. (Participants 01, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would be afraid to tell them, even on the phone I am afraid to tell them, because the thing is when I write to them on Facebook they will block me, WhatsApp they will block me, they will ignore my calls or they will block them completely. (Participant 05, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec38\"\u003e\n \u003ch2\u003e3.5.4 Could Cause Conflict\u003c/h2\u003e\n \u003cp\u003eBarriers which emerged as reasons to not notify partners are the possibility that partner notification could spark conflict or fights. Therefore, some participants said that they would not notify their partners.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI don’t think it’s worth it, because it could lead to conflict and not getting along because they know they are clean, and now I am telling them I am infected. It will just cause tension at home. (Participants 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThese girls we are dating don’t like traditional stuff like herbs, because they are bitter in taste and they don’t want anything bitter. If I tell her, we will end up arguing. (Participants 07, Aged 20, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec39\"\u003e\n \u003ch2\u003e3.5.5 Anticipating That Partner Will Disclose STI on Social Media\u003c/h2\u003e\n \u003cp\u003eAnother barrier to partner notification is that partners, after being notified of exposure, may write about STI on social media.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePeople often use social media like Facebook to humiliate others. Someone will comment under a post even if you didn’t mention them. For example, you might just share your thoughts, and they will respond telling you, “We know you gave that one an STI.” (Participant 02, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have noticed, especially among young people, is that they are often scared. Usually, a girlfriend is not someone you can trust. They tend to spread things and when signs start to appear that scare us, out of being afraid, a guy might send a “pic” to his girlfriend and that is when things go wrong. The girlfriend shares it on Facebook and that leads to someone committing suicide. (Participant 02, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have seen that actually telling each other is rare here in the village. Because even I wouldn’t tell. I would just visit the health facility and not tell her, because if the person is not satisfied, they will keep posting about it on social media. (Participant 01, Aged 18, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec40\"\u003e\n \u003ch2\u003e3.5.6 Anticipating of Blame After Notifying Partner\u003c/h2\u003e\n \u003cp\u003eSome participants anticipated that their partner would blame them they notified them about STI.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eOne begins to blame the other, and I know that, often, men are the ones who will be blaming the women. (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYou can find that when I have sexually transmitted infections and explain or disclose this to them, not knowing whether or not they have them, they will say and insinuate that I have contracted them outside of our marriage, and say that they will not meddle into my affairs. (Participants 09, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec41\"\u003e\n \u003ch2\u003e3.6 Preferred Partner Notification Methods\u003c/h2\u003e\n \u003cp\u003eYouth expressed a variety of preferences for methods of partner notification. Their expressed views referred to the need for confidentiality, avoiding being judged and using youth friendly and tailored approaches for partner notification. Commonly, they preferred telling their partners about STI themselves, while some said they preferred the health care workers notifying their partners.\u003c/p\u003e\n \u003cdiv id=\"Sec42\"\u003e\n \u003ch2\u003e3.6.1 Tell the Partner Themself\u003c/h2\u003e\n \u003cp\u003eWhen youth were asked how they would notify their partners about STI, they said they would like tell their partners themselves.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it is important to be able to discuss anything and everything with our partners and, therefore, it would be important to tell them ourselves. (Participant 04, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would prefer to be the one who tells my partners if I notice that maybe I have an irregular discharge. (Participant 07, Aged 20, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe way I would do it is, when I come back home from the hospital having found out that I have contracted an STI, I would hand them my booklet for them to see, and know that they too have to go to get tested. (Participant 09, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf they were to find out from the hospital and not me, they will leave me for other men. (Participants 07, Aged 20, Men’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI could sit down with him and tell him, because communication is what helps bring solutions to the issues we face in life. (Participant 03, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf I find myself in a place where they are being taught about STIs, I will make sure to take him along so he can also learn about them. (Participant 01, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI could talk to him when I get home. (Participant 05, Aged 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI could talk to him, to avoid going to the clinic without having spoken yet. (Participant 02, Aged, 19, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have noticed that there are groups on Facebook, where people join using fake accounts just to flirt and hook up. Now, I have noticed that people there are quite familiar with the concept of partner notification, but they do not realize that is what it is or just do not identify what they are doing as partner notification. They do not know how important it is. They will post things like: “so and so, whom I slept with yesterday, I have … I have an STI, please go to the clinic.” (Participant 06, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec43\"\u003e\n \u003ch2\u003e3.6.2 Notification by Health Care Worker\u003c/h2\u003e\n \u003cp\u003eSome youth said they would prefer it if the health care worker would notify their partners. Youth mentioned that it would be easy to ask health care workers to notify their partners. Other youth reported that their partners are likely to visit the facility if they were notified about STI by the health care worker.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt is easier to disclose if there is something wrong. Even if the case is that I am scared to tell them that I have a problem, once we get to the clinic, we will meet nurses, counselors, doctors, who will help to explain and break it to them. (Participant 03 Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI would not notify my partner. I would simply ask them to escort me to the hospital where I would inform the nurse who is assisting us what my aim is, this way, they will be able to get tested and be given treatment if they are found to have it too. (Participant 11, Aged 18, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIf they still refuse, I will inform the village health workers and ask that they can go to my partner directly and encourage them to go to the clinic, because if I am being treated and they are not, then there will be no point. (Participant 05, Aged 23, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIt would be easier if they are the ones who made me sick. In a case where it’s just me alone who is sick, it won’t be easy. It will be difficult and would require someone with more knowledge stepping in between us. If it's just the two of us, it will be manageable. (Participant 06, Aged 20, Women’s group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think it is important to invite your partner to the clinic. If I already know that they are likely to turn the offer down or be a little stubborn about actually going to the clinic with me, there are ways that I can try use to go around that especially because I am knowledgeable about these issues even if they are not, so I will say something like, “please come with me and accompany me to the clinic as, I think I have come down with a flu or something,” just as an excuse. Because I will need to approach this in a pretty smart way. I would first inform the nurse that I have brought this person along, but they do not know what is really going on. Then he will be invited in and once we are in the room together, the nurse can reveal the truth carefully. (Participant 01, Aged 24, Key population group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec44\"\u003e\n \u003ch2\u003e3.6.3 Notification at Health Facility\u003c/h2\u003e\n \u003cp\u003eThe participants also suggested approaches that health care workers could use for partner notification.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think whenever there is someone found to have STI, they should give their partner’s phone number so that they can be called in immediately. They must be told why they need to come because it seems when they find out what the reason is, they do not see the urgency of it. (Participant 04, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI think that it would be important if the health professional who is providing services for me could write in my health booklet that my partner should come to the hospital, because if I told him myself, there is a good chance that he will not come. (Participant 09, Aged 24, Mixed youth group)\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study reports on youth\u0026rsquo;s views on partner notification services for STIs in Maseru, Lesotho. The participants in this study had a variety of views about notifying their partners that the partners had been exposed to STI. Most participants favored notifying partners; they viewed it as act of a morality and of supporting each other. These findings align with a prospective study conducted in Durban, South Africa, which used partner notification cards to notify the sexual partners about exposure to STI and which reports a notification rate of 74% (24). Studies conducted with South African students and taxi drivers report more than 70% of participants were willing to disclose their STI status to their partners (8,25). Studies caution that high notification rates do not equal high uptake of treatment by partners who were notified. Two studies conducted in sub-Saharan Africa report uptake of partner notification of 5.7% and 35%, and variations in notification at 41% and 74%, respectively (13,24).\u003c/p\u003e \u003cp\u003eThe findings of this study demonstrate the effect of the type or nature of the relationship on successful partner notification. Our data support the notion that partner notification is more successful in steady relationships, whereas disclosure rates are low for casual, concurrent or short-term partnerships (4,8,26,27). In a case control study conducted in Ethiopia, STI clients did not notify their sexual partners because they could not locate them, because they had been casual partners (28).\u003c/p\u003e \u003cp\u003eOur study underlines the importance of knowledge for partner notification. Youth reported knowing about STI signs and symptoms, types of STI, and how STI is transmitted; risks around STI exposure were crucial in youth\u0026rsquo;s decisions to notify their partners or for them to access health services. The findings align with the CHIEDZA youth study, which reports that participants expressed being ill equipped to notify their sexual partners because of limited knowledge on partner notification (13). Our study participants referred to myths such as starchy food causing STI.\u003c/p\u003e \u003cp\u003e Despite the positive views of participants about partner notification, notable barriers to notifying partners emerged, mainly fear that it would mean the end of the relationship, fear of stigma and gossip, fear of violence toward the partner and fear of communication among the partners being ended. The findings on barriers to notification are supported by the literature (8,13,28,29).\u003c/p\u003e \u003cp\u003e Participants reported using a number of partner notification methods. Some preferred using provider-assisted partner notification methods, though the majority were in favor of telling their partners about the STIs themselves. In the context of Lesotho, youth expressed a preference for client and provider-initiated partner notification, as the only methods available to them. This finding signifies the limited range in partner notification methods that is available for youth in Lesotho. Literature refers to other methods that can be used to notify partners: technology, expedited partner notification services and referral slips (8,29,30).\u003c/p\u003e"},{"header":"5. Strengths","content":"\u003cp\u003eThe study has a number of strengths. First, it is one of few qualitative studies that investigated youth and STIs in sub-Saharan Africa, specifically, Lesotho. Purposive sampling enabled the inclusion of diverse perspectives of youth, thereby contributing to providing evidence that could inform youth-friendly services. Thematic analysis following Braun and Clarke\u0026rsquo;s framework and peer review by a supervision team member increased the credibility of the generated evidence, thereby contributing to public health programs and policy.\u003c/p\u003e"},{"header":"6. Limitations","content":"\u003cp\u003eThe study was conducted in two health facilities; thus, generalizability of results is low. Second, the findings were based on self-reports by participants and may have been influenced by social desirability bias. The sexual behaviors reported were collected from a mixed youth group and the key population group, and continual refining of the data tools during data collection may have missed valuable data provided by other groups.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThe study reports that, while youth express views that support partner notification for STIs, disclosure continues to be influenced by a variety of factors. It is, therefore, important to fully understand the barriers that affect partner notification by youth, and that this information is applied to inform tailored services for this group. Comprehensive sexuality education, non-judgmental, inclusive health services, and integration of partner notification for diverse youth is critical if youth-friendly services are to be provided. There is need for research to explore the experiences of youth during implementation of partner notification approaches beyond patient and provider notification in Lesotho.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually transmitted infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization and methodology: MKP, OOO and MMM; visualization, validation, supervision, writing, review and editing: OOO and MMM; formal analysis: MKP and MMM; investigation and project administration, data curation, preparation for writing original draft: MKP.\u003c/p\u003e\n\u003cp\u003eAll authors read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The study received no funding from any agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board statement:\u003c/strong\u003e The study was conducted in accordance with approval by Sefako Makgatho Health Sciences University Ethics Committee (SMUREC/H/32/2025:PG) and Lesotho Ethics Committee (ID177-2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e Every participant in the study provided both verbal and written informed consent. The participants of the study are informed of study findings via peer reviewed and accredited journals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe data are available upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations - Ethics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe research has been carried out in accordance with declaration of Helsinki (2000) of world medical association. I confirm that all methods were carried out in line with the guidelines. The study obtained approval from ethics committee of Sefako Makgatho Health Sciences University (SMUREC/H/32/2025:PG) and Lesotho Ethics Committee (ID177-2025). The informed consent was obtained from all participants before the focus group discussion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors thank the Lesotho Ethics Committee, district health management team, Christian Health Association of Lesotho, and hospital management of the two health facilities for their approval and permission to conduct\u0026nbsp;the study. We also thank the participants who volunteered to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026sup1; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.\u003c/p\u003e\n\u003cp\u003e\u0026sup2; Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa.\u003c/p\u003e\n\u003cp\u003eList of abbreviations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAIDS \u0026ndash; Acquired Immunodeficiency Syndrome\u003c/p\u003e\n\u003cp\u003eHIV \u0026ndash; Human Immunodeficiency Virus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSTI \u0026ndash; Sexually transmitted infection\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChikwari CD, Simms V, Kranzer K, Dauya E, Bandason T, Tembo M et al. Evaluation of a community-based aetiological approach for sexually transmitted infections management for youth in Zimbabwe: intervention findings from the STICH cluster randomised trial. EClin Med. 2023 Aug 1;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022\u0026ndash;2030. World Health Organization; 2022 Jul 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemwogerere M, Dear N, Tunnage J, Reed D, Kibuuka H, Kiweewa F et al. Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study. BMC Public Health. 2021 Apr 16;21(1):738.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansman E, Wynn A, Moshashane N, Ramontshonyana K, Mompe A, Mussa A et al. Experiences and preferences with sexually transmitted infection care and partner notification in Gaborone, Botswana. Int J STD AIDS. 2021 Nov;32(13):1250-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin K, Olaru ID, Buwu N, Bandason T, Marks M, Dauya E et al. Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study. The Lancet Child Adol Health. 2021 Feb 1;5(2):122\u0026thinsp;\u0026minus;\u0026thinsp;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJarolimova J, Platt LR, Curtis MR, Philpotts LL, Bekker LG, Morroni C et al. Curable sexually transmitted infections among women with HIV in sub-Saharan Africa. Aids. 2022 Apr 1;36(5):697\u0026ndash;709.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChitneni P, Muyindike W, Bwana MB, Owembabazi M, O\u0026rsquo;Neil K, Kalyebara PK et al. STI prevalence, incidence, and partner notification among women in a periconception HIV prevention program in Uganda. Int J STD AIDS. 2022 Aug;33(9):856\u0026thinsp;\u0026minus;\u0026thinsp;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMokgatle M, Madiba S, Hlongwane N. Differences in sexual behavior and partner notification for sexually transmitted infections between the out of school youth and university students in a peri-urban district in South Africa\u0026mdash;A cross-sectional survey. Frontiers Public Health. 2022 Jun 22; 10:793702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIm EO, Chee W. Components of culturally tailored interventions: a discussion paper. Adv Nurs Sci. 2021 Apr 1;44(2):123\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2003 Apr;30(2):133\u0026thinsp;\u0026minus;\u0026thinsp;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWard H, Bell G. Partner notification. Medicine. 2014 Jun 1;42(6):314-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWynn A, Moucheraud C, Moshashane N, Offorjebe OA, Ramogola-Masire D, Klausner JD et al. Using partner notification to address curable sexually transmitted infections in a high HIV prevalence context: a qualitative study about partner notification in Botswana. BMC Public Health. 2019 May 29;19(Suppl 1):606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLariat J, Chikwari CD, Dauya E, Baumu VT, Kaisi V, Kafata L et al. \u0026ldquo;It\u0026rsquo;s not safe for me and what would it achieve?\u0026rdquo; Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe. Sex Reprod Health Matters. 2023 Dec 31;31(1):2220188.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbaka N, Isiramen OM. The changing role of an exploratory research in modern organization. GPH-International Journal of Business Management. 2021;4(12):27\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBureau of Statistics. District Profile [Internet]. 2016 [cited 2025 Nov 11]. Available from: https://files.acquia.undp.org/public/migration/ls/District-Profiles-Final-Print-3.pdf\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDraucker CB, Martsolf DS, Ross R, Rusk TB. Theoretical sampling and category development in grounded theory. Qualit Health Res. 2007 Oct;17(8):1137-48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoley G, Timonen V, Conlon C, O\u0026rsquo;Dare CE. Interviewing as a vehicle for theoretical sampling in grounded theory. Int J Qualitat Methods. 2021 Apr 9;20:1609406920980957.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLynch I, Macleod CI, Chiweshe MT, Moore SA. Vulnerable youth or vulnerabilising contexts? A critical review of youth sexual and reproductive health and rights (SRHR) policies in Eastern and Southern Africa. Sexuality Research and Social Policy. 2025 Jun;22(2):1058-70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed SK, Mohammed RA, Nashwan AJ, Ibrahim RH, Abdalla AQ, Ameen BM et al. Using thematic analysis in qualitative research. J Med Surg Public Health. 2025 Aug 1;6:100198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllsop DB, Chelladurai JM, Kimball ER, Marks LD, Hendricks JJ. Qualitative methods with Nvivo Software: A practical guide for analyzing qualitative data. Psych 2022, 4, 142\u0026ndash;159 [Internet]. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018 Jan 1;24(1):120-4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLesotho. Protection of Personal Information Act. 2012. https://lesotholii.org/akn/ls/act/2012/5/eng@2012-02-22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRepublic of South Africa. Protection of Personal Information Act. 2013. https://popia.co.za/\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChitneni P, Beksinska M, Dietrich JJ, Jaggernath M, Closson K, Smith P et al. Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening. Int J STD AIDS. 2020 Jun;31(7):627\u0026thinsp;\u0026minus;\u0026thinsp;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMokgatle MM, Madiba S. Risky sexual behaviour amidst predicament of acceptable sexually transmitted infection partner notification modalities: A cross-sectional survey amongst minibus taxi drivers in Gauteng province, South Africa. SA Fam Pract. 2020 Dec 10;62(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalichman SC, Mathews C, Kalichman M, Lurie MN, Dewing S. Perceived barriers to partner notification among sexually transmitted infection clinic patients, Cape Town, South Africa. J Public Health. 2017 Jun 1;39(2):407\u0026thinsp;\u0026minus;\u0026thinsp;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDias BD, Kufa T, Kularatne RS. Factors associated with partner notification intentions among symptomatic sexually transmitted infection service attendees in South Africa. S Afr Med J. 2023;113(2):91\u0026thinsp;\u0026minus;\u0026thinsp;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsadik M, Berhane Y, Worku A, Terefe W. Patient referral alone is not an effective strategy to capture partners of patients with sexually transmitted infections in low-resource settings: a case-control study. J Public Health. 2018 Feb;26(1):51\u0026thinsp;\u0026minus;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmollo V, Bukusi EA, Kidoguchi L, Mogaka F, Odoyo JB, Celum C et al. A pilot evaluation of expedited partner treatment and partner human immunodeficiency virus self-testing among adolescent girls and young women diagnosed with Chlamydia trachomatis and Neisseria gonorrhoeae in Kisumu, Kenya. Sex Trans Dis. 2021 Oct 1;48(10):766\u0026thinsp;\u0026minus;\u0026thinsp;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaleghani S, Joseph-Davey D, West SB, Klausner HJ, Wynn A, Klausner JD. Acceptability and efficacy of partner notification for curable sexually transmitted infections in sub-Saharan Africa: A systematic review. Int J STD AIDS. 2019 Mar;30(3):292\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1 and 2","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sexually transmitted infections (STIs), partner notification, symptomatic management, low middle income","lastPublishedDoi":"10.21203/rs.3.rs-8436597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8436597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The burden of sexually transmitted infections (STIs) varies by region and sex, and the greatest burden exists in low-income countries where STI testing is not conducted, and treatment is based on symptoms. Partner notification is a key strategy for controlling STIs, but it remains underutilized because of factors that are sociocultural, structural, and systematic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: This study employed a sequential exploratory mixed method approach to assess the perceptions and social dynamics that affect partner notification strategies to control curable STIs in Maseru, Lesotho. The article reports the qualitative findings of the investigation. Five focus groups with between six and ten participants each were used to collect data between June and July 2025; the participants were purposively sampled.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Data were analyzed using thematic analysis. The results of study reveal five themes: knowledge or understanding of STI transmission, attitudes toward partner notification, motivators and benefits for STI partner notification services, barriers to STI partner notification, and preferred partner notification methods before and during the relationship.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Youth have supportive views about partner notification services. It is, however, important to understand barriers to partner notification, in order to inform tailored services for youth. Moreover, comprehensive sexuality education and youth’s views on implementation of other partner notification services remain critical if the health services are to be responsive to their sexual and reproductive needs.\u003c/p\u003e","manuscriptTitle":"From Stigma to Support: Exploring Youth Views on STI Partner Notification in Maseru, Lesotho","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 17:23:29","doi":"10.21203/rs.3.rs-8436597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-10T13:55:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T00:13:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T16:15:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143815292564245964014185069449161661757","date":"2026-02-08T12:12:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"363300021241642906558227261800920865","date":"2026-02-05T14:32:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324460396948752917868789268869631744547","date":"2026-01-26T12:19:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5840223586262373821118919375574670126","date":"2026-01-26T10:32:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295969543754416586077074940732944873888","date":"2026-01-26T08:09:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T17:18:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138003911765482941484688036805391440197","date":"2026-01-15T21:51:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278773503536010463826144611392548657334","date":"2026-01-15T20:05:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T10:39:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-15T10:38:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-05T15:10:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-04T13:09:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-01-04T13:02:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1754ba19-dc9f-4d60-86cb-c56e8efd8c56","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:11:11+00:00","versionOfRecord":{"articleIdentity":"rs-8436597","link":"https://doi.org/10.1186/s12889-026-27123-8","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-04-11 15:59:05","publishedOnDateReadable":"April 11th, 2026"},"versionCreatedAt":"2026-01-19 17:23:29","video":"","vorDoi":"10.1186/s12889-026-27123-8","vorDoiUrl":"https://doi.org/10.1186/s12889-026-27123-8","workflowStages":[]},"version":"v1","identity":"rs-8436597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8436597","identity":"rs-8436597","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}