Protection from "any kind of risk" - a qualitative study exploring young women's experiences of safer sex in Canada

The safe sex discourse primarily focuses on reducing biological risks associated with sexual activities. As a public health concept, risk often neglects structural factors, like gender and access to appropriate care and support, while reinforcing individual blame. Adopting a narrow understanding of safe sex can limit the effectiveness of efforts to promote safer sexual behaviors. While literature on the more nuanced concept of safer sex offers valuable insights, how young women experience safer sex is not well understood. To address this gap, this study was undertaken to explore young women's experiences, priorities, and needs related to their sexual health.

A feminist participatory methodology guided this 2-phase qualitative study. In Phase 1 individual semi-structured interviews were conducted to explore participants' needs, priorities, and experiences related to their sexual health (n = 16). Phase 2 allowed for collaboration between young women as they discussed the structural contexts of their lives that influenced their meanings and experiences related to sexual health drawing on arts-based methods from photovoice (n = 5).

A purposive sample of 16 young women was recruited for this study. Eligible participants were aged 16 to 21 years, identified as women, could participate in an English interview and were living in Canada. Participants were invited to engage in the research process in ways that emphasized their co-creation of knowledge, including by contributing to the interpretation and refinement of findings. Braun and Clarke's reflexive thematic analysis (RTA) was used to guide analysis. In RTA, diverse sources of knowledge (theory and literature; participants' stories; the researcher's lived and professional experiences) are valuable in knowledge production. Findings emphasize the importance of safety, boundaries, and pleasure, while recognizing factors that contribute to unsafe sex.

The findings from this study call for moving beyond public health's risk-focused, individualistic discourse, which often ignores systemic barriers and pleasure, and reinforces self-blame. These findings call for a redefinition of safer sex to include emotional and mental safety, not just physical protection.