(074) CULTURALLY SENSITIVE ONCOSEXOLOGY TRAINING IN SUB-SAHARAN AFRICA
Authors: Wittmann D , Odiyo Ouma P , Mutebi M , Pastuszak A , Jenkins L , Incrocci L 
Published: December 2024

Abstract

Introduction
Cancer is highly prevalent in Sub-Saharan Africa. The stigma of cancer leads to late diagnosis and more invasive treatment which result in significant sexual side-effects for affected men and women. Sexual dysfunction is also stigmatized, and oncology providers are not trained to address sexual side-effects in usual care. Patients’ attitudes must be understood in the context cultural traditions and approaches to treatment of sexual dysfunction. Patients may not see sexual problems as the purview of healthcare providers. Additionally, they may reach for traditional remedies before considering medical or psychosocial interventions for sexual problems. During the authors’ academic visit to Kenya, patients and clinicians revealed a deep desire for information and solutions to sexual problems after cancer.

Objective
We developed an educational sexual health program to begin to meet the needs of multidisciplinary oncology care providers, increasingly incorporating clinical discussions and cultural perspectives.

Methods
In-person and virtual training programs have been sponsored by the Sexual Medicine Society of North America and the International Society for Sexual Medicine since 2019, initially in Kenya, now for Sub-Saharan Africa. The Kenyan Society of Hematology and Oncology became a partner in 2023. Lectures addressed definitions of sexuality and sexual dysfunction, sexual health assessment, sexual side-effects of cancer and rehabilitation strategies. Local experts were paired with specialists in sexual health and sexual medicine to provide appropriate cultural context. Moderators were frequently cancer survivors whose perspective was considered an important aspect of enhancing a cultural perspective on oncosexuality in the training program. In-person programming was offered in 2019, followed by a virtual symposium in 2021 and a 9-month training program in 2023. Cultural content was increasingly emphasized, based on the inclusion of experts, and learning from evaluations. Participants filled out satisfaction surveys after each of the programs. After the 9-month training program, participants also filled out a survey to inform how they implemented acquired knowledge in their clinical practice.

Results
Between 140 and 194 participants from multiple disciplines (nursing, urology, oncology, radiation oncology, mental health) attended each of the training programs. The in-person program registered 70 participants, but 140 multidisciplinary clinicians attended, 100 provided an evaluation. One hundred and ninety-four participants worldwide logged into the 2021 program with 50% participating from Kenya, others from African nations, India, UK, US and countries in Asia and Europe. One hundred and twenty-nine participants attended the 2023 training program with 50% attending from Kenya, 11 % from Nigeria and smaller numbers from other parts of Africa and worldwide. Participants evaluated their learning positively. They found the information relevant to their local culture and context. They reported using various implementation strategies, such as individual sexual health evaluations for all patients, starting a sexual health consultation and surveying clinical staff to ascertain their attitudes to a sexual health program. Participants asked for ongoing, hands-on training in the future.

Conclusions
It is feasible to provide sexual health and sexual medicine education globally if local culture is incorporated as an important aspect of the training. Partnering with local professional societies enhances dissemination of knowledge.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Alex Pastuszak, MD: Contraline - Consultant; Paterna Biosciences - Leadership, Investor; Macro Trials - Advisor; Inherent Biosciences – Advisor.