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Versloot-Swildens MC, de Graaf H, Twisk JWR, Popma A, Nauta-Jansen LMC. Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands. J Youth Adolesc 2024; 53:998-1014. [PMID: 38055133 DOI: 10.1007/s10964-023-01903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).
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Affiliation(s)
- M C Versloot-Swildens
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands.
| | - H de Graaf
- Rutgers, Dutch Centre of Expertise on Sexual and Reproductive Health and Rights, Utrecht, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - A Popma
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
| | - L M C Nauta-Jansen
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
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Vu T, Quinn M, Womack J, Monin J. 'If I don't take care of me, then I can't be there for others:' a qualitative study of caregiving relationships among older women living with HIV. Aging Ment Health 2024:1-12. [PMID: 38327025 DOI: 10.1080/13607863.2024.2313729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The population of women ages 50 years and older living with HIV is increasing. Yet, little is known about the care networks that older women living with HIV (OWLH) use to manage their health. The goal of this study was to explore the caregiving and care receiving relationships among OWLH and how these relationships impact HIV management. METHODS OWLH aged 50 years and older were recruited from clinics and community-based organizations across the U.S. We conducted semi-structured, in-depth phone interviews and performed content and thematic analysis on transcripts. RESULTS Participants (N = 23) were on average 60 years old and had been living with HIV for an average of 23.7 years. Participants 1) relied on diverse care networks; 2) were caregivers for grandchildren and parents; 3) had pride and joy in being caregivers; and 4) were highly proactive in their own HIV management. Care networks promoted self-love and acceptance. However, concerns about aging with HIV were still highly prevalent. CONCLUSION Being a caregiver and care recipient are sources of meaning and strength to help OWLH manage HIV. Public health programs should consider engaging both OWLH and their care networks in healthcare discussions and educational efforts.
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Affiliation(s)
- Thi Vu
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Marielle Quinn
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Julie Womack
- Yale University School of Nursing, New Haven, CT, USA
| | - Joan Monin
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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3
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Ha T, Shi H, Givens D, Nguyen T, Nguyen N. Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones. BMC Public Health 2023; 23:1938. [PMID: 37803339 PMCID: PMC10559500 DOI: 10.1186/s12889-023-16841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam. METHODS A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants. RESULTS The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations. CONCLUSIONS Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hui Shi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Givens
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
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Compton SD, Darteh EKM, Seidu AA, Omolo T, Munro-Kramer ML. Danger and sexuality: exploring negotiations in romantic and sexual relationships among university students in Ghana. CULTURE, HEALTH & SEXUALITY 2023; 25:428-443. [PMID: 35311488 DOI: 10.1080/13691058.2022.2050425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Gender inequalities and social mores normalise gender-based violence in many settings. The goal of this study was to gain a more in-depth understanding of romantic and sexual relationships, consent, and gender-based violence among university students in Ghana. We used focus group discussions to explore individual factors influencing romantic and sexual relationships among students enrolled at a university in the Central Region of the country to inform the development and tailoring of future interventions. During a series of four focus group discussions comprising students recruited via convenience and snowball sampling, participants were asked to reflect on the nature of their romantic and sexual relationships. Demographic data and experiences of gender-based violence were also collected. The focus groups discussions were recorded and transcribed verbatim and analysed thematically. Five themes were developed from the data: (1) traditional gender roles; (2) self-control; (3) relationship-based consent; (4) cheating; and (5) non-verbal communication. This study suggests negative health and social ramifications of violence will continue until there is a resolution of conflicting social norms that result in different expectations about how men and women can address their sexual needs. Future programming and interventions for gender-based violence prevention should reflect on their impact across all ecological levels.
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Affiliation(s)
- Sarah D Compton
- Department of OB/GYN, University of Michigan, Ann Arbor, MI, USA
| | - Eugene K M Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, QLD, Australia
| | - Tanya Omolo
- School of Social Work & Public Policy, University of Michigan, Ann Arbor, MI, USA
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Berner-Rodoreda A, Vandormael A, Bärnighausen K, Mavuso M, Dlamini P, Matse S, Hettema A, Bärnighausen T, McMahon SA. Cultural Repertoires and Situated Selections as an Alternative Framework to Hegemonic Masculinities: Findings From Eswatini. Am J Mens Health 2023; 17:15579883231152110. [PMID: 36823951 PMCID: PMC9969463 DOI: 10.1177/15579883231152110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Since the 1980s studies on men have frequently utilized Connell's framework of hegemonic masculinities. We critically appraise this framework in the context of a population-based HIV pre-exposure prophylaxis study in Eswatini. Our findings highlight that men confidently show variation in their behavior and choices, which manifest across different men and within the same men acting in particular situations and over the life course. This led us to interrogate the hegemonic masculinities framework on the following grounds: Men's choices and behavior do not seem to fit the model of aspiring to a hegemonic ideal; the delineation of masculine traits as hegemonic or subordinate remain vague in terms of "responsibility," "fidelity," and "consideration for others"; the binary gender concept underpinning hegemonic masculinities seems outdated. Building on the work of Hirsch and Kachtan, we propose cultural repertoires as an alternative framework which also bridges the gender divide.
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Affiliation(s)
- Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany,Astrid Berner-Rodoreda, Heidelberg
Institute of Global Health, Heidelberg University, INF 130.3, Heidelberg 69120,
Germany.
| | - Alain Vandormael
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
| | - Kate Bärnighausen
- School of Public Health, University of
the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sindy Matse
- Eswatini National AIDS Program,
Ministry of Health, Eswatini, Mbabane, Eswatini
| | - Anita Hettema
- Clinton Health Access Initiative
Eswatini, Mbabane, Eswatini
| | - Till Bärnighausen
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
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Setty E, Dobson E. Department for Education Statutory Guidance for Relationships and Sex Education in England: A Rights-Based Approach? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:79-93. [PMID: 36171488 PMCID: PMC9859846 DOI: 10.1007/s10508-022-02340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/03/2022] [Accepted: 04/13/2022] [Indexed: 06/16/2023]
Abstract
In England, the Children and Social Work Act (HMSO, 2017) bestowed compulsory status on relationships and sex education (RSE), which means that young people's right to receive RSE has been codified in law. This paper analyzes how this right is upheld and enacted within the Department for Education (DfE) (2019) statutory guidance on RSE for schools in England. The analysis suggests that the guidance features contradictory discourses in which young people's rights are ostensibly advanced, but remain structured by adult-centric, heteronormative understandings of sex and relationships. It upholds a decontextualized and legalistic approach to rights, responsibilities, informed choice, and decision making. A narrow conception of rights is particularly evident regarding young people's digital sexual cultures, which are predominantly framed in terms of risk and harm. We argue that scholars should investigate how educators are designing and delivering RSE in light of the guidance, and the opportunities for and obstacles to a genuinely "rights-based" approach to RSE. While the policy discussed in this article is specific to England, the discussion has wider relevance for practitioners and policymakers across cultural and geographic contexts as it draws upon a model for analyzing how young people's sexuality is presented and addressed in legislative and curricular documentation.
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Affiliation(s)
- Emily Setty
- Department of Sociology, University of Surrey, 11 AD 03, Guildford, GU2 7XH, Surrey, UK.
| | - Emma Dobson
- School of Education, University of Durham, Durham, UK
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Nazarbegian M, Averbach S, Johns NE, Ghule M, Silverman J, Lundgren R, Battala M, Begum S, Raj A. Associations between Contraceptive Decision-Making and Marital Contraceptive Communication and use in Rural Maharashtra, India. Stud Fam Plann 2022; 53:617-637. [PMID: 36193029 PMCID: PMC10695302 DOI: 10.1111/sifp.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Women's contraceptive decision-making control is crucial for reproductive autonomy, but research largely relies on the Demographic and Health Survey (DHS) measure which asks who is involved with decision-making. In India, this typically assesses joint decision-making or male engagement. Newer measures emphasize female agency. We examined three measures of contraceptive decision-making, the DHS and two agency-focused measures, to assess their associations with marital contraceptive communication and use in rural Maharashtra, India. We analyzed follow-up survey data from women participating in the CHARM2 study (n = 1088), collected in June-December 2020. The survey included the DHS (measure 1), Reproductive Decision-Making Agency (measure 2), and Contraceptive Final Decision-Maker measures (measure 3). Only Measure 1 was significantly associated with contraceptive communication (adjusted odds ratio [AOR]: 2.75, 95 percent confidence interval [CI]: 1.69-4.49) and use (AOR: 1.73, 95 percent CI: 1.14-2.63). However, each measure was associated with different types of contraceptive use: Measure 1 with condom (adjusted relative risk ratio [aRRR]: 1.99, 95 percent CI: 1.12-3.51) and intrauterine device (IUD) (aRRR: 4.76, 95 percent CI: 1.80-12.59), Measure 2 with IUD (aRRR: 1.64, 95 percent CI: 1.04-2.60), and Measure 3 with pill (aRRR: 2.00, 95 percent CI: 1.14-3.52). Among married women in Maharashtra, India, male engagement in decision-making may be a stronger predictor of contraceptive communication and use than women's agency, but agency may be predictive of types of contraceptives used.
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Affiliation(s)
- Melody Nazarbegian
- University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, 92037, USA
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor, India Habitat Center, New Delhi, 110003, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
- Department of Education Studies, University of California, San Diego, CA, 92161, USA
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Agu IC, Mbachu CO, Ezenwaka U, Eze I, Ezumah N, Onwujekwe O. Gender norms and ideologies about adolescent sexuality: A mixed-method study of adolescents in communities, south-eastern, Nigeria. FRONTIERS IN SOCIOLOGY 2022; 7:810411. [PMID: 36226127 PMCID: PMC9548641 DOI: 10.3389/fsoc.2022.810411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sexual and reproductive health choices and behaviors of adolescents are shaped by gender norms and ideologies which are grounded in cultural beliefs. This study examined the perspectives of adolescents about the influence of gender norms and ideologies on sexuality. METHODS A cross-sectional study was undertaken in three urban and three rural communities in south-eastern Nigeria using quantitative and qualitative research methods. A modified cluster sampling procedure was used to select respondents. Data were collected from 1,057 adolescents and twelve focus group discussions with unmarried adolescents aged 13 to 18 years. For the quantitative data, univariate, bivariate and probit regression analyses were performed using Stata while the thematic framework approach was used to analyze qualitative data. RESULTS The dominant beliefs among adolescents are that: it is wrong for unmarried adolescents to have sex (86.4%); unmarried adolescents should abstain from sex (89.3%); consent should be obtained before sexual intercourse (89.1%); it is a girl's responsibility to ensure she does not get pregnant (66.5%), and sex should be initiated by boys (69.6%). Gender (boy or girl) was a predictor of belief in premarital abstinence (t-value = -3.88), belief that premarital sexual intercourse is acceptable provided contraceptive is used (t-value = 3.49, CI 1.14-0.49), belief that premarital sexual intercourse is wrong (t-value = -2.24) and, belief that sex should be initiated by boys only (t-value = -4.37). Adolescent boys were less likely to believe in pre-marital abstinence and less likely to believe that pre-marital sex among adolescents is wrong compared to girls. They were also more likely to believe adolescents can have sex provided contraceptive is used compared to girls. Qualitative findings revealed adolescents' beliefs that girls feel shy initiating sex and that boys experience more urge for sex hence, boys were perceived to be responsible for initiating sex. Both boys and girls experience pressure to have sex however, boys were described to experience more pressure from peers to have sex. Peer-to-peer communication, quest for material possessions and low socioeconomic conditions contribute to peer pressure to engage in sex. CONCLUSION Adolescents' beliefs about sexuality underline the need to contextualize interventions to address these norms and ideologies.
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Affiliation(s)
- Ifunanya Clara Agu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Irene Eze
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Pulerwitz J, Valenzuela C, Gottert A, Siu G, Shabangu P, Mathur S. "A man without money getting a sexual partner? It doesn't exist in our community": male partners' perspectives on transactional sexual relationships in Uganda and Eswatini. CULTURE, HEALTH & SEXUALITY 2022; 24:968-982. [PMID: 33821761 DOI: 10.1080/13691058.2021.1904521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Research on transactional sexual relationships has largely focused on women's perspectives. Better understanding the men's views-especially regarding relationships with adolescent girls and young women-can inform HIV prevention efforts. In 2017, 134 in-depth interviews were conducted with the male partners of girls and young women aged 19-47 years, 94 in Uganda and 40 in Eswatini. Respondents were recruited at venues such as bars where men and potential partners meet and through other young women. Most respondents believed that providing money/gifts was the way to establish relationships with women in their communities, a context that some found undesirable. Young women were mainly perceived as actively pursuing transactional sex for material goods, but respondents also described economically impoverished women who were manipulated into relationships. Men described conflict with longer term partners as a driver to seeking younger partners, who were more compliant. Transaction dominates the male partners of adolescent girls and young women's understanding of sexual relationships, and inequitable power dynamics are reinforced by seeking younger partners. However, some respondents' discontent with this dynamic suggests an opportunity for change. HIV prevention programmes should directly address the underlying drivers of transactional relationships (e.g. gender norms) and work with men who question the practice.
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Affiliation(s)
| | | | - A Gottert
- Population Council, Washington, DC, USA
| | - G Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - P Shabangu
- Institute for Health Measurement-Southern Africa, Mbabane, Eswatini
| | - S Mathur
- Population Council, Washington, DC, USA
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10
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Gilbert LK, Annor FB, Kress H. Associations Between Endorsement of Inequitable Gender Norms and Intimate Partner Violence and Sexual Risk Behaviors Among Youth in Nigeria: Violence Against Children Survey, 2014. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8507-NP8533. [PMID: 33283633 PMCID: PMC8827130 DOI: 10.1177/0886260520978196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to assess whether the endorsement of inequitable gender norms about intimate partner violence against women (IPVAW) and sexual behavior was associated with intimate partner violence (IPV) victimization, IPV perpetration, and sexual risk behavior. Nigerian youth aged 13-24 (n = 4,203) participated in the nationally representative, cross-sectional Nigeria Violence Against Children Survey (VACS) in 2014. Inequitable gender norms about IPVAW were assessed using six items from the Demographic and Health Surveys (DHS), and inequitable gender norms about sexual behavior were assessed using four items adapted from the Gender-Equitable Men (GEM) scale. The number of inequitable gender norms endorsed was summed and associations with having been a victim or perpetrator of IPV and sexual risk behaviors were assessed using logistic regression. Endorsing 3 or more inequitable gender norms about either IPVAW or sexual behavior were both associated with increased odds of IPV victimization, perpetration, and sexual risk behaviors, after adjustment for demographic characteristics, witnessing violence in childhood, and having been a victim of other forms of childhood violence. Demonstrating that endorsement of inequitable gender norms about sexual behavior was associated with violence and that inequitable gender norms about IPVAW were associated with sexual risk behaviors further highlights potential linkages between violence and HIV.
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Affiliation(s)
- Leah K Gilbert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francis B Annor
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zakiei A, Norouzi E, Ghasemi SR, Komasi S, Rostampour M, Khazaie H. Controlling risky behavior associated with AIDS: the role of social support, family functioning, self-efficacy and AIDS risk perception. BMC Psychol 2022; 10:132. [PMID: 35606851 PMCID: PMC9125838 DOI: 10.1186/s40359-022-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives We believe that major steps can be taken towards Acquired Immunodeficiency Syndrome (AIDS) prevention through identifying the relevant factors that are apt to predict risky behavior. The main purpose of the present study was to analyze and evaluate the relationship of social support, family functioning, self-efficacy and AIDS risk perception to controlling risky behavior associated with AIDS.
Methods To conduct this cross-sectional study, 765 subjects (59% female) were selected from the youth inhabiting the western provinces of Iran through cluster sampling. Five questionnaires were used: AIDS risk perception, self-efficacy in controlling risky behavior associated with AIDS, controlling risky behavior associated with AIDS, the multidimensional scale of perceived social support, and the family assessment device. Results The results demonstrated that all two models enjoyed acceptable fitness, and the mediating roles of self-efficacy and AIDS risk perception were confirmed. Moreover, family functioning and perceived social support together could predict 20% of the variance of controlling risky behavior associated with AIDS. The results also indicated that family functioning with a standardized coefficient of − 0.24 and self-efficacy in controlling risky behavior associated with AIDS with a standardized coefficient of 0.58 could predict the controlling risky behavior associated with AIDS (p < 0.01). Conclusions Our findings suggest that self-efficacy and AIDS risk perception play major roles in controlling risky behavior associated with AIDS. Therefore, it is recommended that families and psychologists promote self-efficacy in order to prevent the occurrence of high-risk behaviors.
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Affiliation(s)
- Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Norouzi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Ramin Ghasemi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran.,Department of Psychiatry, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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12
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Gollub EL, Beauvais S, Roye C. College-attending young men's sexual and reproductive health knowledge, attitudes and practices. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:706-716. [PMID: 32432978 DOI: 10.1080/07448481.2020.1762609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/10/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveMale involvement in contraceptive practice remains low. Family planning and pediatric health associations have recommended an emphasis on long-acting reversible contraceptives (LARC) in clinical counseling with adolescents and young adults, raising concerns about the resulting adverse impact on sexually transmitted infection (STI) rates. Participants: College-attending men responded to an internet based questionnaire (n=31) and a phone-based qualitative interview (n=25). Methods: Our survey solicited attitudes toward and knowledge of contraceptive methods and assessed communication practices with sexual partners regarding use of contraception and disease prevention. Results: Knowledge about female methods of contraception was low, with a comparatively high level of knowledge about Plan B. Parents and health care providers were cited as the most helpful sources of information. Conversations about protection with sexual partners were reported by most men, due mainly to fear of unplanned pregnancy, not STI. Conclusion: Addressing couple communication and dual protection among college-attending men needs greater emphasis.
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Affiliation(s)
- Erica L Gollub
- Health Science Program, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Shirley Beauvais
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Carol Roye
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
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Psaki SR, Pulerwitz J, Zieman B, Hewett PC, Beksinska M. What are we learning about HIV testing in informal settlements in KwaZulu-Natal, South Africa? Results from a randomized controlled trial. PLoS One 2022; 17:e0257033. [PMID: 35259151 PMCID: PMC8903271 DOI: 10.1371/journal.pone.0257033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Recent evidence highlighting high HIV incidence and prevalence in informal settlements suggests that they are environments that foster HIV risk. Given growing urbanization in sub-Saharan Africa, there is a critical need to assess the successes and challenges of implementing HIV testing, prevention and treatment interventions in these contexts. Methods We randomly selected a household-based sample of 1528 adult men (18–35) and women (18–24) living in 18 randomly selected communities in KZN, South Africa. After the baseline interview, communities were randomized to one of three intervention rollout arms in a stepped wedge design. At approximately 8-month intervals, the Asibonisane Community Responses Program (and in particular the implementation of Stepping Stones, a participatory HIV prevention program focused on strengthening relationships and communication) was rolled at by intervention phase. Using data from this evaluation, we describe levels and trends in HIV testing and treatment during follow-up, and we use fixed effects models to estimate the effects of participation in the program on testing. Results Study respondents reported high levels of economic insecurity and mobility, and men report various HIV risk behaviors including about 50% reporting multiple partnerships. About two-thirds of respondents (73% of women, 63% of men) had been tested for HIV in the last six months. Among those living with HIV, treatment levels were high at baseline, and almost universal by endline in 2019. Program participation led to a 17% increase in the probability of testing for women (p<0.05) but had no effect on testing for men due, in part, to the fact that the program did not reach men who were least likely to be tested, including those who had migrated recently, and those who had never been tested at baseline. Conclusions Near universal HIV treatment use demonstrates positive trends in access to some HIV services (including treatment as prevention) in these communities. Stepping Stones had positive effects on HIV testing for women, yet barriers to HIV testing remain, especially for men. Redoubled efforts to reach men with testing are vital for improving HIV outcomes for both men and their partners.
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Affiliation(s)
- Stephanie R. Psaki
- Population Council/Project SOAR, New York, New York, United States of America
- * E-mail:
| | - Julie Pulerwitz
- Population Council/Project SOAR, Washington, DC, United States of America
| | - Brady Zieman
- Population Council/Project SOAR, Blantyre, Malawi
| | - Paul C. Hewett
- Population Council/Project SOAR, Washington, DC, United States of America
| | - Mags Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Matthews LT, Psaros C, Mathenjwa M, Mosery N, Greener LR, Khidir H, Hovey JR, Pratt MC, Harrison A, Bennett K, Bangsberg DR, Smit JA, Safren SA. Demonstration and acceptability of a safer conception intervention for men with HIV in South Africa (Preprint). JMIR Form Res 2021; 6:e34262. [PMID: 35507406 PMCID: PMC9118009 DOI: 10.2196/34262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Many men with HIV (MWH) want to have children. HIV viral suppression minimizes sexual HIV transmission risks while allowing for conception and optimization of the health of men, their partners, and their infants. Objective This study developed and evaluated the feasibility and acceptability of an intervention to promote serostatus disclosure, antiretroviral therapy (ART) uptake and adherence, and viral suppression among MWH who want to have children in South Africa. Methods We developed a safer conception intervention (Sinikithemba Kwabesilisa or We give hope to men) to promote viral suppression via ART uptake and adherence, HIV serostatus disclosure, and other safer conception strategies for MWH in South Africa. Through 3 counseling and 2 booster sessions over 12 weeks, we offered education on safer conception strategies and aided participants in developing a safer conception plan. We recruited MWH (HIV diagnosis known for >1 month), not yet accessing ART or accessing ART for <3 months, in a stable partnership with an HIV-negative or unknown-serostatus woman, and wanting to have a child in the following year. We conducted an open pilot study to evaluate acceptability based on patient participation and exit interviews and feasibility based on recruitment and retention. In-depth exit interviews were conducted with men to explore intervention acceptability. Questionnaires collected at baseline and exit assessed disclosure outcomes; CD4 and HIV-RNA data were used to evaluate preliminary impacts on clinical outcomes of interest. Results Among 31 eligible men, 16 (52%) enrolled in the study with a median age of 29 (range 27-44) years and a median time-since-diagnosis of 7 months (range 1 month to 9 years). All identified as Black South African, with 56% (9/16) reporting secondary school completion and 44% (7/16) reporting full-time employment. Approximately 44% (7/16) of participants reported an HIV-negative (vs unknown-serostatus) partner. Approximately 88% (14/16) of men completed the 3 primary counseling sessions. In 11 exit interviews, men reported personal satisfaction with session content and structure while also suggesting that they would refer their peers to the program. They also described the perceived effectiveness of the intervention and self-efficacy to benefit. Although significance testing was not conducted, 81% (13/16) of men were taking ART at the exit, and 100% (13/13) of those on ART were virally suppressed at 12 weeks. Of the 16 men, 12 (75%) reported disclosure to pregnancy partners. Conclusions These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence among women and their children while supporting men’s health. Approximately half of the men who met the screening eligibility criteria were enrolled. Accordingly, refinement to optimize uptake is needed. Providing safer conception care and peer support at the community level may help reach men. Trial Registration ClinicalTrials.gov NCT03818984; https://clinicaltrials.gov/ct2/show/NCT03818984 International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1007/s10461-017-1719-4
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Affiliation(s)
- Lynn T Matthews
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mxolisi Mathenjwa
- MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa
| | - Letitia Rambally Greener
- MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa
- Population Services International, Johannesburg, South Africa
| | - Hazar Khidir
- Harvard Combined Residency Program in Emergency Medicine, Boston, MA, United States
| | - Jacquelyn R Hovey
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Madeline C Pratt
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Kara Bennett
- Bennett Statistical Consulting, Ballston Lake, NY, United States
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University - Portland State University, Portland, OR, United States
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, United States
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Bermudez LG, Mulenga D, Musheke M, Mathur S. Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia. Glob Public Health 2021; 17:1638-1651. [PMID: 34255608 DOI: 10.1080/17441692.2021.1951800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15-24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability.
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Matenga TFL, Zulu JM, Nkwemu S, Shankalala P, Hampanda K. Men's perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis. BMC Public Health 2021; 21:1354. [PMID: 34238272 PMCID: PMC8268604 DOI: 10.1186/s12889-021-11430-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although health care providers are beginning to focus on men's roles as fathers and husbands, there is limited understanding of how men view their ability to promote sexual and reproductive health in families affected by HIV and their experiences with receiving education through antenatal care. This paper aims to explore men's perceptions of the education they need regarding sexual and reproductive health within the family in the context of HIV. METHODS We interviewed a convenience sample of 18 male partners of pregnant women living with HIV in Lusaka, Zambia. Atlas.ti was used to facilitate data management and content analysis. RESULTS Men reported being the primary decision-makers regarding sexual and reproductive issues in the family; however, they admitted far-reaching unmet needs in terms of information on sexual and reproductive health in the context of HIV. Most men felt that antenatal care was not a conducive setting to fully educate men on sexual and reproductive health because it is a woman's space where their health concerns were generally neglected. There was a strong desire for more education that was specific to men's sexual and reproductive health, especially because all the couples were affected by HIV. Men especially requested education on sexual preparedness, safe sex, the use of condoms in sero-concordant and sero-discordant relationships and general health information. Although men stated they were the main decision-makers regarding sexual and reproductive issues such as pregnancy, most men were not confident in their ability to promote sexual and reproductive health in the family because of limited knowledge in this area. CONCLUSION There is need to change the environment and messaging of antenatal care, as well as offer relevant education opportunities outside health facility settings to empower men with essential information for meaningful involvement in sexual and reproductive health in the context of HIV.
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Affiliation(s)
- Tulani Francis L Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Joseph Mumba Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sharon Nkwemu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Perfect Shankalala
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Karen Hampanda
- Division of Academic Specialists in Obstetrics and Gynecology, University of Colorado, Denver, USA
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Probst JC, Crouch EL, Eberth JM. COVID-19 risk mitigation behaviors among rural and urban community-dwelling older adults in summer, 2020. J Rural Health 2021; 37:473-478. [PMID: 34096648 PMCID: PMC8242629 DOI: 10.1111/jrh.12600] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Risk mitigation behaviors are important for older adults, who experience increased mortality risk from COVID-19. We examined these reported behaviors among rural and urban community-dwelling adults aged 65 and older. METHODS We analyzed public use files from the National Health and Aging Trends Study, which fielded a COVID survey from June to October, 2020, restricted to community-dwelling adults (n = 2,982). Eight behaviors were studied: handwashing, avoid touching face, mask wearing, limiting shopping, avoiding restaurants or bars, limiting gatherings, avoiding contact with those outside the household, and distancing. Residence was defined as urban (metropolitan county) or rural (nonmetropolitan county). Difference testing used Chi Square tests, with an alpha level of P = .05. Multivariable logistic regression was used to calculate adjusted odds ratios. RESULTS Rural residents constituted 18.8% (± Standard Error 3.6%) of the study population. In bivariate comparisons, rural older adults were less likely to report 5 of 8 studied behaviors: keep 6-foot distance (rural: 88.3% ±1.0%, urban 93.2% ±.08%), limit gatherings (rural 87.5% ±1.8%; urban 91.6% ±0.8%), avoid restaurants/bars (rural 85.3% ±1.9%, urban 89.6% ±0.8%), avoid touching face (rural 83.1% ±2.3%, urban 88.6%, 0.8%), and avoid contact with those outside the household (rural 80.4% ±2.4%, urban 86.2% ±1.0%). After adjusting for demographic characteristics, only maintaining a 6-foot distance remained lower among rural older adults (AOR 0.58, 95% CI: 0.42-0.81). CONCLUSIONS Within older adults, reported compliance with recommended behaviors to limit the spread of COVID-19 was high. Nonetheless, consistent rural shortfalls were noted. Findings highlight the need for rural-specific messaging strategies for future public health emergencies.
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Affiliation(s)
- Janice C Probst
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth L Crouch
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jan M Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Tingey L, Rosenstock S, Chambers R, Patel H, Melgar L, Slimp A, Lee A, Cwik M, Rompalo A, Gaydos C. Empowering our people: Predictors of retention in an STI risk reduction program among rural Native Americans with binge substance use. J Rural Health 2021; 38:323-335. [PMID: 34028866 DOI: 10.1111/jrh.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Substance use and sexual risk-taking have been shown to co-occur. Programs focused on sexually transmitted infections (STIs) reduction may benefit substance-using, particularly binge substance-using, adults. This is especially true for rural Native American communities who endure sexual and substance use disparities and have few STI risk reduction programs. This study explores factors predicting retention in an STI risk reduction program among rural Native adults engaged in binge substance use. METHODS We analyzed data from 150 Native adults ages 18-55 participating in an evaluation of "EMPWR," a 2-session STI risk reduction program in a rural, reservation-based community. Multivariate logistic regression models were used to estimate associations between independent variables and program completion across demographics, sexual behaviors, substance use behaviors, mental health, recent health care utilization, and perceived enculturation and discrimination. FINDINGS The sample was 49.2% (n = 59) female with a mean age of 33.61 years (SD = 8.25). Twenty-six completed only the first EMPWR session, 94 completed both EMPWR sessions, and 30 were randomized but completed 0 sessions. Being married/cohabiting (adjusted odds ratio [AOR] = 6.40, P = .0063) and living with an older generation (AOR = 4.86, P = .0058) were significantly associated with higher odds of completing EMPWR. CONCLUSIONS Findings provide insight on factors driving retention of Natives with recent binge substance use in STI risk reduction programming. An important contribution to Native health literature is that living with an older generation positively predicted EMPWR program completion, suggesting that STI risk reduction programs should harness the strength of families to ensure program attendance and optimize impacts in rural reservation contexts.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Chambers
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hima Patel
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Melgar
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Slimp
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angelita Lee
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Cwik
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Rompalo
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Charlotte Gaydos
- Center for Global Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Attitude towards gender norms in Ghana: understanding the dynamics among men and women in intimate relationships. JOURNAL OF POPULATION RESEARCH 2021. [DOI: 10.1007/s12546-021-09258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Outcomes After Being Lost to Follow-up Differ for Pregnant and Postpartum Women When Compared With the General HIV Treatment Population in Rural South Africa. J Acquir Immune Defic Syndr 2021; 85:127-137. [PMID: 32520907 PMCID: PMC7495979 DOI: 10.1097/qai.0000000000002413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Undetermined attrition prohibits full understanding of the coverage and effectiveness of HIV programs. Outcomes following loss to follow-up (LTFU) among antiretroviral therapy (ART) patients may differ according to their reasons for ART initiation.
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Kalokhe AS, Iyer S, Gadhe K, Katendra T, Kolhe A, Rahane G, Stephenson R, Sahay S. A Couples-Based Intervention (Ghya Bharari Ekatra) for the Primary Prevention of Intimate Partner Violence in India: Pilot Feasibility and Acceptability Study. JMIR Form Res 2021; 5:e26130. [PMID: 33459278 PMCID: PMC7884213 DOI: 10.2196/26130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/23/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P=.10). Conclusions GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID) RR2-10.2196/11533
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Affiliation(s)
- Ameeta Shivdas Kalokhe
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, United States
| | - Sandhya Iyer
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
| | - Keshav Gadhe
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
| | - Tuman Katendra
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
| | - Ambika Kolhe
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
| | - Girish Rahane
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
| | - Rob Stephenson
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Seema Sahay
- Department of Social and Behavioral Research, National AIDS Research Institute, Pune, India
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Leekuan P, Kane R, Sukwong P. Narratives on Sex and Contraception From Pregnant Adolescent Women in a Northern Province in Thailand: A Phenomenological Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211056219. [PMID: 34886716 PMCID: PMC8669873 DOI: 10.1177/00469580211056219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gaps in understanding, a lack of awareness of contraceptive use and a lack of control, related to gender dynamics, may influence the demand for contraception among adolescents and their decision-making around pregnancy prevention. This study explored the experiences of pregnant adolescents at the time of pregnancy and prior to becoming pregnant, examining attitudes toward sex and contraception. An interpretive phenomenological study guided by Heideggerian philosophy, analysed data from 30 in-depth interviews conducted with purposively selected consenting pregnant adolescents aged 15–19. Interviews were audio-recorded and transcribed verbatim and were analysed using a modified interpretative phenomenological approach. Participants exposed 5 key findings or experiences associated with sex and contraception: ‘Premarital cohabitation and sex’, ‘Staying in the relationship’, ‘Unforeseen future’, ‘Parental conformity’, and ‘Male command’. These findings can have far-reaching implications for the holistic understanding of the needs of adolescents in Thailand. They can be used to inform the development of appropriate and responsive interventions to support female and male adolescents, their families, and society. This includes interventions around reproductive health rights and sex education from health care providers, educators providing counselling to facilitate adolescents’ decision-making in order to reduce unintended adolescent pregnancy.
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Affiliation(s)
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
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23
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Lewis S, Moucheraud C, Schechinger D, Mphande M, Banda BA, Sigauke H, Kawale P, Dovel K, Hoffman RM. "A loving man has a very huge responsibility": A mixed methods study of Malawian men's knowledge and beliefs about cervical cancer. BMC Public Health 2020; 20:1494. [PMID: 33008344 PMCID: PMC7532091 DOI: 10.1186/s12889-020-09552-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services - including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer. METHODS HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner's screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men's role in prevention. RESULTS One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner's decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful. CONCLUSIONS Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men's concerns may be instrumental in improving women's adoption of cervical cancer screening services in Malawi and similar settings.
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Affiliation(s)
- Samuel Lewis
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Corrina Moucheraud
- University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Devon Schechinger
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | | | | | - Paul Kawale
- African Institute for Development Policy, Lilongwe, Malawi
| | - Kathryn Dovel
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Risa M Hoffman
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
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24
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Gottert A, Pulerwitz J, Haberland N, Mathebula R, Rebombo D, Spielman K, West R, Julien A, Twine R, Peacock D, Kang Dufour MS, Gómez-Olivé FX, Pettifor A, Lippman SA, Kahn K. Gaining traction: Promising shifts in gender norms and intimate partner violence in the context of a community-based HIV prevention trial in South Africa. PLoS One 2020; 15:e0237084. [PMID: 32817692 PMCID: PMC7446856 DOI: 10.1371/journal.pone.0237084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background HIV and violence prevention programs increasingly seek to transform gender norms among participants, yet how to do so at the community level, and subsequent pathways to behavior change, remain poorly understood. We assessed shifts in endorsement of equitable gender norms, and intimate partner violence (IPV), during the three-year community-based trial of Tsima, an HIV ‘treatment as prevention’ intervention in rural South Africa. Methods Cross-sectional household surveys were conducted with men and women ages 18–49 years, in 8 intervention and 7 control communities, at 2014-baseline (n = 1,149) and 2018-endline (n = 1,189). Endorsement of equitable gender norms was measured by the GEM Scale. Intent-to-treat analyses assessed intervention effects and change over time. Qualitative research with 59 community members and 38 staff examined the change process. Results Nearly two-thirds of men and half of women in intervention communities had heard of the intervention/seen the logo; half of these had attended a two-day workshop. Regression analyses showed a 15% improvement in GEM Scale score over time, irrespective of the intervention, among men (p<0.001) and women (p<0.001). Younger women (ages 18–29) had a decreased odds of reporting IPV in intervention vs. control communities (aOR 0.53; p<0.05). Qualitative data suggest that gender norms shifts may be linked to increased media access (via satellite TV/smartphones) and consequent exposure to serial dramas modeling equitable relationships and negatively portraying violence. Tsima’s couple communication/conflict resolution skills-building activities, eagerly received by intervention participants, appear to have further supported IPV reductions. Conclusions There was a population-level shift towards greater endorsement of equitable gender norms between 2014–2018, potentially linked with rapid escalation in media access. There was also an intervention effect on reported IPV among young women, likely owing to improved couple communication. Societal-level gender norm shifts may create enabling environments for interventions to find new traction for violence and HIV-related behavior change.
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Affiliation(s)
- Ann Gottert
- Population Council/Project SOAR, Washington, D.C., United States of America
- * E-mail:
| | - Julie Pulerwitz
- Population Council/Project SOAR, Washington, D.C., United States of America
| | - Nicole Haberland
- Population Council/Project SOAR, Washington, D.C., United States of America
| | | | - Dumisani Rebombo
- Sonke Gender Justice, Bushbuckridge Local Municipality, South Africa
- Independent Consultant, Johannesburg, South Africa
| | - Kathryn Spielman
- Population Council/Project SOAR, Washington, D.C., United States of America
| | - Rebecca West
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Aimée Julien
- Department of Epideiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Bushbuckridge Local Municipality, South Africa
- Promundo, Washington, D.C., United States of America
- University of Cape Town School of Public Health, Cape Town, South Africa
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epideiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Tsuyuki K, Donta B, Dasgupta A, Fleming PJ, Ghule M, Battala M, Nair S, Silverman J, Saggurti N, Raj A. Masculine Gender Ideologies, Intimate Partner Violence, and Alcohol Use Increase Risk for Genital Tract Infections Among Men. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:2316-2334. [PMID: 29294709 PMCID: PMC5756145 DOI: 10.1177/0886260517700619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Masculine gender ideologies are thought to underlie alcohol use, intimate partner violence (IPV) perpetration, and sexual risk of HIV and other sexually transmitted infections (STIs). We extend on studies in the Indian context by examining the roles of masculine gender ideologies, alcohol use, and IPV on three outcomes of HIV risk (condom use, genital tract infection [GTI] symptoms, and GTI diagnosis). We applied logistic regression models to cross-sectional data of men and their wives in rural Maharashtra, India (n = 1,080 couples). We found that men with less masculine gender ideologies demonstrated greater odds of condom use (i.e., lower odds no condom use, odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.93, 0.98]). IPV perpetration was associated with increased odds of reporting ≥1 GTI symptom (adjusted OR [AOR] = 1.56, 95% CI = [1.07, 2.26]) and decreased GTI diagnosis (AOR = 0.28, 95% CI = [0.08, 0.97]). Moderate alcohol consumption was associated with increased odds of reporting ≥1 GTI symptom (AOR = 1.51, 95% CI = [1.01, 2.25]). Our findings have direct implications for men's and women's health in rural India, including targeted GTI diagnosis and treatment, integrated violence prevention in STI clinics, and targeted intervention on masculine gender ideologies.
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Affiliation(s)
- Kiyomi Tsuyuki
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
| | - Balaiah Donta
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Anindita Dasgupta
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
| | - Paul J. Fleming
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
| | - Mohan Ghule
- National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Saritha Nair
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Jay Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
- Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anita Raj
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
- Clinical Addiction Research and Education, Section of General, Internal Medicine, Department of Medicine, Boston University, School of Medicine/Boston Medical Center, Boston, MA, USA
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Betron M, Gottert A, Pulerwitz J, Shattuck D, Stevanovic-Fenn N. Men and COVID-19: Adding a gender lens. Glob Public Health 2020; 15:1090-1092. [PMID: 32436422 DOI: 10.1080/17441692.2020.1769702] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this commentary, the authors point out that there are important gender determinants to both men's and women's vulnerabilities to COVID-19, and call on the global health community to unpack and address these early in the COVID-19 pandemic response. They point to best practices and tools from two decades of engaging men in research and programming in the sexual and reproductive health field.
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Affiliation(s)
| | | | | | - Dominick Shattuck
- JHU-CCP, Johns Hopkins University Center for Communication Programs, Baltimore
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Larki M, Bahri N, Moghri J, Latifnejad Roudsari R. Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:103-115. [PMID: 32309452 PMCID: PMC7153425 DOI: 10.30476/ijcbnm.2020.82845.1093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives.
The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions.
The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships. Methods: This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative
women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected
using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman.
MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered. Results: The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories
along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions
and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family. Conclusion: This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also,
our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.
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Affiliation(s)
- Mona Larki
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjes Bahri
- Department of Midwifery, School of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Javad Moghri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Miller E, Culyba AJ, Paglisotti T, Massof M, Gao Q, Ports KA, Kato-Wallace J, Pulerwitz J, Espelage DL, Abebe KZ, Jones KA. Male Adolescents' Gender Attitudes and Violence: Implications for Youth Violence Prevention. Am J Prev Med 2020; 58:396-406. [PMID: 31889621 PMCID: PMC7039734 DOI: 10.1016/j.amepre.2019.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This study analyzed the associations among male adolescents' gender attitudes, intentions to intervene, witnessing peers' abusive behaviors, and multiple forms of adolescent violence perpetration. This community-based evaluation aims to inform future youth violence prevention efforts through the identification of potential predictors of interpersonal violence perpetration. METHODS Cross-sectional data were from baseline surveys conducted with 866 male adolescents, aged 13-19 years, from community settings in 20 lower-resource neighborhoods in Pittsburgh, PA (August 2015 - June 2017), as part of a cluster RCT to evaluate a sexual violence prevention program. Participants completed in-person, anonymous electronic surveys about gender attitudes, bystander intentions, witnessing peers' abusive behaviors, violence perpetration, and demographics. The analysis was conducted between 2018 and 2019. RESULTS The youth identified mostly as African American (70%) or Hispanic, multiracial, or other (21%). Most (88%) were born in the U.S., and 85% were in school. Youth with more equitable gender attitudes had lower odds of self-reported violence perpetration across multiple domains, including dating abuse (AOR=0.46, 95% CI=0.29, 0.72) and sexual harassment (AOR=0.50, 95% CI=0.37, 0.67). The relationship between intentions to intervene and violence perpetration was inconclusive. Witnessing peers engaged in abusive behaviors was associated with increased odds of multiple types of violence perpetration, such as dating abuse (witnessed 3 or more behaviors, AOR=2.41, 95% CI=1.31, 4.44). CONCLUSIONS This is the first U.S.-based study to elicit information from male adolescents in community-based settings (rather than schools or clinics) about multiple types of interpersonal violence perpetration. Findings support violence prevention strategies that challenge harmful gender and social norms while simultaneously increasing youths' skills in interrupting peers' disrespectful and harmful behaviors.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taylor Paglisotti
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael Massof
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Qi Gao
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie A Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Julie Pulerwitz
- HIV and AIDS Program, Population Council, Washington, District of Columbia
| | - Dorothy L Espelage
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Zwakala Ndoda: a cluster and individually randomized trial aimed at improving testing, linkage, and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa. Trials 2019; 20:798. [PMID: 31888701 PMCID: PMC6937627 DOI: 10.1186/s13063-019-3908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. METHODS This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. DISCUSSION A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men's individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. TRIAL REGISTRATION ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.
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MacPhail C, Khoza N, Treves-Kagan S, Selin A, Gómez-Olivé X, Peacock D, Rebombo D, Twine R, Maman S, Kahn K, DeLong SM, Hill LM, Lippman SA, Pettifor A. Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa. PLoS One 2019; 14:e0225694. [PMID: 31790483 PMCID: PMC6886772 DOI: 10.1371/journal.pone.0225694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022] Open
Abstract
Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the ‘One Man Can’ intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and community members (n = 52) to explore their experience of being part of the intervention and their experiences of change associated with the intervention. The objective of the study was to examine processes of change in community mobilization for gender equity and HIV prevention. Our analysis showed that over time, participants referred to three key elements of their engagement with the intervention: developing respect for others; inter-personal communication; and empathy. These elements were viewed as assisting them in adopting a ‘better life’ and associated with behaviour change in the intervention’s main focus areas of promoting gender equality and HIV risk reduction behaviours. We discuss how these concepts relate to the essential domains contained within our theoretical framework of community mobilization—specifically critical consciousness, shared concerns and social cohesion -, as demonstrated in this community. We interpret the focus on these key elements as significant indicators of communities engaging with the community mobilization process and initiating movement towards structural changes for HIV prevention.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Nomhle Khoza
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- STRIVE Research Programme Consortium, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Sarah Treves-Kagan
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Amanda Selin
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | | | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Maman
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephanie M. DeLong
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Lauren M. Hill
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Sheri A. Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. A scoping review on the role of masculine norms in men's engagement in the HIV care continuum in sub-Saharan Africa. AIDS Care 2019; 31:1435-1446. [PMID: 30909724 PMCID: PMC10512737 DOI: 10.1080/09540121.2019.1595509] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
Men living with HIV/AIDS in sub-Saharan Africa are less likely than women to be engaged at each stage of the HIV care continuum. We conducted a scoping review in May of 2016 to identify how masculine norms influence men's HIV care engagement in sub-Saharan Africa. Our review yielded a total of 17 qualitative studies from 8 countries. Six major themes emerged that demonstrated how norms of masculinity create both barriers and facilitators to care engagement. Barriers included the exacerbating effects of masculinity on HIV stigma, the notion that HIV threatened men's physical strength, ability to provide, self-reliance, and risk behavior, and the belief that clinics are spaces for women. However, some men transformed their masculine identity and were motivated to engage in care if they recognized that antiretroviral therapy could restore their masculinity by rebuilding their strength. These findings demonstrate masculinity plays an important role in men's decision to pursue and remain in HIV care across sub-Saharan Africa. We discuss implications for tailoring HIV messaging and counseling to better engage men and an agenda for future research in this area.
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Affiliation(s)
- Katelyn M. Sileo
- The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Rebecca Fielding-Miller
- Division of Global Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Shari L. Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Paul J. Fleming
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Lavender T, Wakasiaka S, Chimwaza A, Wood R, Omoni G, Mukhwana R, McGowan L, Chimala E, Omari J, Edozien L. A qualitative study of partner engagement in HIV testing in Malawi and Kenya. CULTURE, HEALTH & SEXUALITY 2019; 21:1131-1145. [PMID: 30624135 DOI: 10.1080/13691058.2018.1542509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Abstract
In low-income settings, partner engagement in HIV testing during pregnancy is well recognised, but uptake remains low. To understand why men fail to engage, 76 in-depth, individual interviews were conducted with women (n = 23), men (n = 36) and community stakeholders (n = 17) in Malawi and Kenya. Transcribed data were analysed thematically. Male engagement was verbally supported. However, definitions of 'engagement' varied; women wanted a shared experience, whereas men wanted to offer practical and financial support. Women and stakeholders supported couples-testing, but some men thought separate testing was preferable. Barriers to couples-testing were strongly linked to barriers to antenatal engagement, with some direct fear of HIV-testing itself. The major themes identified included diverse definitions of male engagement, cultural norms, poor communication and environmental discomfort - all of which were underpinned by hegemonic masculinity. Couples-testing will only increase when strategies to improve reproductive health care are implemented and men's health is given proper consideration within the process. As social norms constitute a barrier, community-based interventions are likely to be most effective. A multi-pronged approach could include advocacy through social media and community forums, the provision of tailored information, the presence of positive role models and a welcoming environment.
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Affiliation(s)
- Tina Lavender
- Division of Nursing Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sabina Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Angela Chimwaza
- Kamazu College of Nursing, University of Malawi, Malawi, Malawi
| | - Rebecca Wood
- School of Health Care, University of Leeds, Leeds, UK
| | - Grace Omoni
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Raheli Mukhwana
- Maternity Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Linda McGowan
- School of Health Care, University of Leeds, Leeds, UK
| | - Eveles Chimala
- Kamazu College of Nursing, University of Malawi, Malawi, Malawi
| | - Jerusa Omari
- Maternity Department, Kissi Training and Referral Hospital, Kissi, Kenya
| | - Leroy Edozien
- Manchester Academic Health Science Centre and Saint Mary's Hospital, Manchester NHS Foundation Trust, Manchester, UK
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Ruane-McAteer E, Amin A, Hanratty J, Lynn F, Corbijn van Willenswaard K, Reid E, Khosla R, Lohan M. Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: an evidence and gap map and systematic review of reviews. BMJ Glob Health 2019; 4:e001634. [PMID: 31565410 PMCID: PMC6747894 DOI: 10.1136/bmjgh-2019-001634] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Working with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all. METHODS For this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007-July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy. RESULTS From the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results. CONCLUSION Research and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.
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Affiliation(s)
- Eimear Ruane-McAteer
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Avni Amin
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneve, Switzerland
| | - Jennifer Hanratty
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Fiona Lynn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Kyrsten Corbijn van Willenswaard
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Esther Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Rajat Khosla
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneve, Switzerland
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
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Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa. AIDS Behav 2019; 23:162-171. [PMID: 31359218 PMCID: PMC6773668 DOI: 10.1007/s10461-019-02603-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
How does the endorsement of different dimensions of gender norms by men and/or women influence their use of HIV testing and antiretroviral treatment? This question was examined using data from a 2014 population-based survey of 1053 women and 1004 men, ages 18–49, in rural South Africa. We used a global measure for views toward gender norms (the GEM Scale), plus four subsets of scale items (all reliabilities ≥ 0.7). In multivariate analyses using the global measure, endorsement of inequitable gender norms was associated with more testing (AOR 2.47, p < 0.01) and less treatment use (AOR 0.15, p < 0.01) among women but not men. When examining specific subsets of inequitable norms (e.g., endorsing men as the primary decision-maker), decreased odds of treatment use was found for men as well (AOR 0.18, p < 0.01). Careful attention to the role specific gender norms play in HIV service uptake can yield useful programmatic recommendations.
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Khidir H, Psaros C, Greener L, O’Neil K, Mathenjwa M, Mosery FN, Moore L, Harrison A, Bangsberg DR, Smit JA, Safren SA, Matthews LT. Developing a Safer Conception Intervention for Men Living with HIV in South Africa. AIDS Behav 2019; 22:1725-1735. [PMID: 28194587 PMCID: PMC5554741 DOI: 10.1007/s10461-017-1719-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.
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Ghoma Linguissi LS, Sagna T, Soubeiga ST, Gwom LC, Nkenfou CN, Obiri-Yeboah D, Ouattara AK, Pietra V, Simpore J. Prevention of mother-to-child transmission (PMTCT) of HIV: a review of the achievements and challenges in Burkina-Faso. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:165-177. [PMID: 31440104 PMCID: PMC6664853 DOI: 10.2147/hiv.s204661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022]
Abstract
Background Burkina-Faso's HIV/AIDS program is one of the most successful in Africa, with a declining HIV prevalence and treatment outcomes that rival those of developed countries. Prevention of mother-to-child transmission (PMTCT) guidelines in Burkina-Faso, initiated in the year 2000, were revised in 2004, 2006 and 2010. The guideline document has since undergone several stages of improvement, largely based on recommendations from WHO, with adaptations by local experts in the field. Option B+ adopted since August 2014 in Burkina-Faso has enabled maintenance of mothers on longer treatment and increasing their survival and that of their children. Through this review, we describe the achievements and challenges of HIV PMTCT programs in Burkina-Faso. Aims of study This study had the following objectives: 1) describing the historical perspective of PMTCT implementation in Burkina-Faso; 2) presenting the effectiveness of interventions at improving PMTCT service delivery and promoting retention of mothers and babies in care; and 3) determining the impact of male partner involvement on PMTCT in Burkina-Faso. Methodology A literature search was conducted in PubMed and Google. Search terms included the following keywords: "HIV testing"; "prevention"; "mother"; "child"; "male partner"; "counseling"; "involvement"; "participation"; and the grouped terms "PMTCT and partners"; "VCT"; "barriers and/or factors"; "Male involvement in PMTCT"; and "Burkina-Faso". Data collection took place from May to October 2015. The search was limited to articles published between January 2002 and December 2015. UNICEF and UNAIDS web sites were also used to find relevant abstracts and documents. Results Studies have revealed that with PMTCT, HIV transmission rate moved from 10.4% in 2006 to 0% in 2015. The PMTCT program remains the best way to care for HIV-infected pregnant women and their babies. The current PMTCT policy is based on evidence that male partner involvement is associated with women's completion of PMTCT. Conclusion This study shows that the reduction in mother to child transmission of HIV in Burkina-Faso over the years is mainly due to the improvement of PMTCT programs. Efforts still need to be made about the involvement of male partners.
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Affiliation(s)
- Laure Stella Ghoma Linguissi
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Institut National de Recherche en Sciences de la Santé (IRSSA), Brazzaville, Republic of Congo
| | - Tani Sagna
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Serge Théophile Soubeiga
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Luc Christian Gwom
- "Chantal Biya" International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Céline Nguefeu Nkenfou
- Higher Teachers' Training College, University of Yaoundé I, Yaoundé, Cameroon.,"Chantal Biya" International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdoul Karim Ouattara
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Virginio Pietra
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
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Kato-Wallace J, Barker G, Garg A, Feliz N, Levack A, Ports K, Miller E. Adapting a Global Gender-Transformative Violence Prevention Program for the U.S. Community-Based Setting for Work with Young Men. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:121-130. [PMID: 30956935 PMCID: PMC6444362 DOI: 10.1007/s40609-018-00135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Extensive practice-based evidence from international settings, as well as in-depth evaluations of programs promoting gender equity, have demonstrated effectiveness in reducing perpetration of violence against women and girls. Such "gender-transfor-mative programs" encourage critical analysis of gender norms, challenge homophobia and gender-based harassment, build skills to question harmful masculine norms, interrupt harmful and disrespectful behaviors, and encourage more equitable behaviors. Here we describe the history of a gender-transformative program, "Program H," first developed in Brazil and Mexico, the rationale for and evaluation of this original program, and the processes of adaptation for the US urban community-based setting, and highlight the risks as well as opportunities on the work with young men and boys in the future.
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Affiliation(s)
- Jane Kato-Wallace
- Promundo-US, 1367 Connecticut Avenue, Washington D.C., NW 20036, USA
| | - Gary Barker
- Promundo-US, 1367 Connecticut Avenue, Washington D.C., NW 20036, USA
| | - Aapta Garg
- Promundo-US, 1367 Connecticut Avenue, Washington D.C., NW 20036, USA
| | - Nayck Feliz
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 3420 Fifth Ave., Pittsburgh, PA 15213, USA
| | - Andrew Levack
- Promundo-US, 1367 Connecticut Avenue, Washington D.C., NW 20036, USA
| | - Kathryn Ports
- U.S. Centers for Disease Control, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 3420 Fifth Ave., Pittsburgh, PA 15213, USA
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38
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Gibore NS, Bali TAL, Kibusi SM. Factors influencing men's involvement in antenatal care services: a cross-sectional study in a low resource setting, Central Tanzania. Reprod Health 2019; 16:52. [PMID: 31072322 PMCID: PMC6509760 DOI: 10.1186/s12978-019-0721-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Men’s involvement can impact the delays in the decision to seek health care and in reaching a health facility, which are contributing causes for increased maternal mortality. Despite of the call to involve men in antenatal care, their participation is not well understood. This study aimed to determine the level of men’s involvement in antenatal care and the factors influencing their involvement in these services. Methods A cross sectional study of 966 randomly selected men aged 18 years or older was conducted in Dodoma Region, from June 2014 to November 2015. Face to face interviews were conducted using a pretested structured questionnaire. The outcome variable was men’s involvement and was constructed from four dichotomized items which were scored zero to two for low involvement and three to four for high involvement. A multiple logistic model was used to measure the factors influencing men’s involvement in antenatal care services. Results The level of men’s involvement in antenatal care was high (53.9%). Majority 89% of respondents made joint decisions on seeking antenatal care. More than half (63.4%) of respondents accompanied their partners to the antenatal clinic at least once. Less than a quarter (23.5%) of men was able to discuss issues related to pregnancy with their partner’s health care providers. About 77.3% of respondents provided physical support to their partners during the antenatal period. Factors influencing men’s involvement in antenatal care were occupation (AOR = 0.692, 95% CI = 0.511–0.936), ethnicity (AOR = 1.495, 95% CI = 1.066–2.097), religion (AOR = 1.826, 95% CI = 1.245–2.677), waiting time (AOR = 1.444, 95% CI = 1.094–1.906), information regarding men’s involvement in antenatal care (AOR = 3.077, 95% CI = 2.076–4.562) and men’s perception about theattitude of health care providers (AOR = 1.548, 95%CI = 1.090–2.199). Conclusion Overall, more than half of respondents reported high involvement in antenatal care services. Access to information on men’s involvement, religion, occupation, ethnicity, waiting time and men’s perception about the attitude of care providers were significant factors influencing men’s involvement in antenatal care services in this study. Health promotion is needed to empower men with essential information for meaningful involvement in antenatal care services.
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Affiliation(s)
- Nyasiro S Gibore
- Department of Public Health, School of Nursing and Public Health, College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania.
| | - Theodora A L Bali
- Department of Education, Faculty of Humanities and Education, Saint John's University of Tanzania, P.O. Box, 47, Dodoma, Tanzania
| | - Stephen M Kibusi
- Department of Public Health, School of Nursing and Public Health, College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania
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The Interaction of Sexual Validation, Criminal Justice Involvement, and Sexually Transmitted Infection Risk Among Adolescent and Young Adult Males. Sex Transm Dis 2019; 45:189-194. [PMID: 29420448 DOI: 10.1097/olq.0000000000000724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young men who have been involved with the criminal justice system are more likely to have concurrent sexual partners, a key driver of sexually transmitted infections. The value men place on having sexual relationships to validate themselves may play an important role in understanding this association. METHODS Data were from a household survey. Young men (N = 132), aged 16 to 24 years, self-reported whether they ever spent time in jail or juvenile detention and if they had sexual partnerships that overlapped in time. A novel scale, "Validation through Sex and Sexual Relationships" (VTSSR) assessed the importance young men place on sex and sexual relationships (α = 0.91). Weighted logistic regression accounted for the sampling design. RESULTS The mean (SD) VTSSR score was 23.7 (8.8) with no differences by race. Both criminal justice involvement (CJI) (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.12-12.1) and sexual validation (OR, 1.10; 95% CI, 1.04-1.16) were associated with an increased odds of concurrency; however, CJI did not remain associated with concurrency in the fully adjusted model. There was effect modification, CJI was associated with concurrency among those who scored high on sexual validation (OR, 9.18; 95% CI, 1.73-48.6]; however, there was no association among those who scored low on sexual validation. Racial differences were observed between CJI and concurrency, but not between sexual validation and concurrency. CONCLUSIONS Sexual validation may be an important driver of concurrency for men who have been involved with the criminal justice system. Study findings have important implications on how sexual validation may explain racial differences in rates of concurrency.
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Kalokhe AS, Iyer S, Katendra T, Gadhe K, Kolhe AR, Paranjape A, Del Rio C, Stephenson R, Sahay S. Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention. JMIR Res Protoc 2019; 8:e11533. [PMID: 30664483 PMCID: PMC6356185 DOI: 10.2196/11533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies. OBJECTIVE This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India. METHODS The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning. RESULTS The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway. CONCLUSIONS Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples. TRIAL REGISTRATION ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134.
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Affiliation(s)
- Ameeta Shivdas Kalokhe
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, United States
| | - Sandhya Iyer
- Department of Social and Behavioral Research, National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Tuman Katendra
- Department of Social and Behavioral Research, National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Keshav Gadhe
- Department of Social and Behavioral Research, National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Ambika R Kolhe
- Department of Social and Behavioral Research, National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Anuradha Paranjape
- Department of Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, PA, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Seema Sahay
- Department of Social and Behavioral Research, National AIDS Research Institute, Indian Council of Medical Research, Pune, India
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Nalukwago J, Alaii J, Borne BVD, Bukuluki PM, Crutzen R. Application of Core Processes for Understanding Multiple Concurrent Sexual Partnerships Among Adolescents in Uganda. Front Public Health 2018; 6:371. [PMID: 30622938 PMCID: PMC6308184 DOI: 10.3389/fpubh.2018.00371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/04/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction: Adolescents in Uganda, as in other sub-Saharan countries, engage in sex with multiple concurrent partners, thus placing them at risk for HIV and unplanned pregnancies, but it is not clear why. This study explored why adolescents in Uganda engage in multiple concurrent sexual partnerships (MCSP). Methods: This study used a Core Processes methodology. We used the processes of brainstorming, and identification of evidence and theoretical support, in various phases/steps of intervention planning, to provide possible explanations for adolescent MCSP. Results: Adolescents were found to have limited knowledge of the risks associated with MCSP and perceived a low risk for HIV. Peer influence to engage in MCSP exacerbated the problem among adolescents. Poor communication with sexual partners and parents and societal indifference to multiple sexual partnerships increased permissive attitudes toward infidelity. The unclear adolescent sexual and reproductive health policies hampered access to services, and transactional sexual relationships with older (polygamous) sexual partners increased the HIV risk. Adolescents were found to be more concerned about unplanned pregnancies than HIV risk. Discussion: From the empirical evidence, adolescent health programs in Uganda should incorporate comprehensive sexual health education on HIV and teenage pregnancy risk-reduction strategies. Programs should strengthen parental and community support through enhanced collaborative training on communication with and for adolescents. Forming strategic partnerships with various stakeholders for concerted efforts to address the MCSP problem among adolescents is critical.
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Affiliation(s)
- Judith Nalukwago
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Family Health International 360 (Uganda), Kampala, Uganda
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Jane Alaii
- Context Factor Solutions, Nairobi, Kenya
| | - Bart Van Den Borne
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Paul Mukisa Bukuluki
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Rik Crutzen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Reynolds Z, Gottert A, Luben E, Mamba B, Shabangu P, Dlamini N, Dlamini M, Mathur S, Pulerwitz J. Who are the male partners of adolescent girls and young women in Swaziland? Analysis of survey data from community venues across 19 DREAMS districts. PLoS One 2018; 13:e0203208. [PMID: 30216356 PMCID: PMC6157821 DOI: 10.1371/journal.pone.0203208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW, ages 15-24) are at high risk of HIV in Swaziland. Understanding more about their male sexual partners can inform HIV prevention efforts for both. METHODS Using the PLACE methodology across all 19 DREAMS implementation districts, 843 men ages 20-34 were surveyed between December 2016-February 2017. Surveys were conducted at 182 venues identified by community informants as places where AGYW and men meet/socialize. Descriptive and multivariate analyses examined characteristics and risk behaviors of male partners of AGYW. RESULTS Men's average age was 25.7. Sixty-three percent reported female partners ages 15-19, and 70% reported partners ages 20-24 in the last year; of those, 12% and 11% respectively had five or more such partners. Among the 568 male partners of AGYW, 36% reported consistent condom use with their current/last partner. Forty-two percent reported testing for HIV in the last year; 6% were HIV-positive, and of those, 97% were currently on treatment. One-third (37%) reported being circumcised; among uncircumcised, 81% were not considering it. In multivariate analyses, men who reported three or more AGYW partners in the last year were more likely to be HIV-positive (aOR 3.2, 95% CI 1.1,8.8). Men were also less likely to disclose their HIV status to adolescent versus older partners (aOR 0.6, 95% CI 0.4,0.9) and partners more than 5 years younger than themselves (aOR 0.6, 95% CI 0.4,0.9). Results also revealed relatively high unemployment and mobility, substantial financial responsibilities, and periodic homelessness. CONCLUSIONS Most men identified through community venues reported relationships with AGYW, and these relationships demonstrated substantial HIV risk. Challenging life circumstances suggest structural factors may underlie some risk behaviors. Engaging men in HIV prevention and targeted health services is critical, and informant-identified community venues are promising intervention sites to reach high-risk male partners of AGYW.
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Affiliation(s)
- Zahra Reynolds
- MEASURE Evaluation, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States of America
- * E-mail:
| | - Ann Gottert
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
| | - Erin Luben
- MEASURE Evaluation, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States of America
| | - Bheki Mamba
- Institute for Health Measurement, Mbabane, Swaziland
| | | | - Nsindiso Dlamini
- National Emergency Response Council on HIV and AIDS, Mbabane, Swaziland
| | - Muhle Dlamini
- Swaziland National AIDS Programme, Mbabane, Swaziland
| | - Sanyukta Mathur
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
| | - Julie Pulerwitz
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
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Gottert A, Pulerwitz J, Siu G, Katahoire A, Okal J, Ayebare F, Jani N, Keilig P, Mathur S. Male partners of young women in Uganda: Understanding their relationships and use of HIV testing. PLoS One 2018; 13:e0200920. [PMID: 30096147 PMCID: PMC6086428 DOI: 10.1371/journal.pone.0200920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Substantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15-24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW's male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda. METHODS We conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men's current and recent partnerships and HIV service use. RESULTS Most respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents' current relationship practices. CONCLUSIONS Across the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.
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Affiliation(s)
- Ann Gottert
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
- * E-mail:
| | - Julie Pulerwitz
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Godfrey Siu
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Anne Katahoire
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Jerry Okal
- Population Council, HIV and AIDS Program, Nairobi, Kenya
| | - Florence Ayebare
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Nrupa Jani
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Pamela Keilig
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Sanyukta Mathur
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
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Herath T, Guruge D, Fernando M, Jayarathna S, Senarathna L. The effect of a community based health promotion intervention to change gender norms among women in a rural community in Sri Lanka. BMC Public Health 2018; 18:977. [PMID: 30081873 PMCID: PMC6080371 DOI: 10.1186/s12889-018-5914-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 07/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gender norms practiced by respective societies increase the risk of violence by men against women. To date, there is a dearth of research evidence on changing gender norms through health promotion approaches around the globe, including in Sri Lanka. This study provides an evaluation of effectiveness of a health promotion intervention in changing the acceptance of gender norms among women. METHODS A quasi-experimental study was conducted in two rural villages in Anuradhapura district in Sri Lanka including women who have a child under five years of age. One village was allocated to receive an intervention developed based on a health promotion approach and the other village was a control. A community based mechanism to question selected gender norms among women was developed as the intervention. The pre- and post-intervention assessments of the level of acceptance of gender norms were done using an interviewer administered questionnaire and by using focus group discussions. RESULTS Following the intervention, acceptances of prominent gender norms were changed significantly among the women receiving the intervention method. The control group showed no changes towards the acceptance of gender norms during this period. Women in the intervention group had higher levels of self-reported positive behavior changes and greater understanding of gender concepts compared to the control group. CONCLUSION The acceptance of gender norms among women in rural villages in Sri Lanka can be changed by a community based intervention targeting gender norms.
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Affiliation(s)
- T. Herath
- Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University, Sri Lanka, No. 50, New Kalmunai Road, Batticaloa, Sri Lanka
| | - D. Guruge
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - M. Fernando
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - S. Jayarathna
- National Child Protection Authority, Colombo, Sri Lanka
| | - L. Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
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Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. What Role Do Masculine Norms Play in Men's HIV Testing in Sub-Saharan Africa?: A Scoping Review. AIDS Behav 2018; 22:2468-2479. [PMID: 29777420 DOI: 10.1007/s10461-018-2160-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men living with HIV/AIDS in sub-Saharan Africa are less likely to test for HIV than women. We conducted a scoping review in May of 2016 to identify how masculine norms influence men's HIV testing in sub-Saharan Africa. Our review yielded a total of 13 qualitative studies from 8 countries. Masculine norms create both barriers and facilitators to HIV testing. Barriers included emotional inexpression, gendered communication, social pressures to be strong and self-reliant, and the fear that an HIV positive result would threaten traditional social roles (i.e., husband, father, provider, worker) and reduce sexual success with women. Facilitators included perceptions that HIV testing could restore masculinity through regained physical strength and the ability to re-assume the provider role after accessing treatment. Across sub-Saharan Africa, masculinity appears to play an important role in men's decision to test for HIV and further research and interventions are needed to address this link.
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Affiliation(s)
- Katelyn M Sileo
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
- Division of Global Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, USA.
| | - Rebecca Fielding-Miller
- Division of Global Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Shari L Dworkin
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Paul J Fleming
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Abstract
PURPOSE OF REVIEW Dating and sexual violence victimization are not uncommon in early adolescence and increase in prevalence throughout adolescence into young adulthood with profound health and social consequences. Greater attention to what works in prevention is needed to inform current policies and practices. RECENT FINDINGS Adolescent dating violence (ADV) and sexual violence victimization, including cyber dating abuse, are highly prevalent among adolescents. Studies have found sex category differences, with adolescent girls reporting more victimization than boys, particularly sexual violence. Sexual and gender minority youth also experience a higher prevalence of violence victimization than their heterosexual counterparts. Studies on risk factors include examinations of childhood adversities, exposure to sexually explicit material and substance use as well as the role of gender inequitable attitudes on violence perpetration. Recent prevention research includes examining the impact of bystander interventions and transforming gender norms. SUMMARY Recent ADV/ sexual violence research highlights both prevalence and modifiable risk and protective factors that may help reduce such violence. Practitioners caring for youth should consider ADV/ sexual violence when seeing patients (including those struggling with substance use and other behaviours that contribute to poor health) and not simply rely on screening tools to identify those suffering from ADV/ sexual violence.
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Lusey H, San Sebastian M, Christianson M, Edin KE. Prevalence and correlates of gender inequitable norms among young, church-going women and men in Kinshasa, Democratic Republic of Congo. BMC Public Health 2018; 18:887. [PMID: 30016960 PMCID: PMC6050660 DOI: 10.1186/s12889-018-5742-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prolonged political instability may have exacerbated gender inequitable beliefs in the Democratic Republic of Congo (DRC). The aim of this study was to assess attitudes related to gender-equitable norms and its determinants among young, church-going women and men in Kinshasa, DRC. Method Data were collected through a cross-sectional survey with 291 church-going women and 289 men aged 18–24 years old, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality, and responses to issues related to the gender-equitable men (GEM) scale. The GEM scale is a 24 item-questionnaire developed to measure attitudes towards gender equitable norms. Logistic regression was applied to discover the associations between the independent variables and the GEM outcome. Results Our study reflected the existence of attitudes hampering gender equality that were endorsed by both women and men. For example, 91.4% of women and 83% of men agreed with the statement “a woman’s most important role is to take care of her home and cook for her family”. Similarly, 88.3% of women and 82.9% of men concurred with the idea that men need more sex than women. These findings coexisted with a few equitable norms, because 93.7% of women and 92.3% of men agreed that a man and a woman should decide together if they want to have children. A positive association was found in both women and men between being educated, being single and separated and having supportive attitudes towards gender equality and a higher GEM scale score. Residency in Camp Luka and Masina was also a significant social determinant associated with equitable gender norms among men whilst job status was only significant among women. Conclusion While both women and men had high levels of gender inequitable norms, those with more education, single, and with supportive attitudes to gender equality had high GEM scale scores. The results highlight an urgent need for the church to challenge and change gender norms among church youths.
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Affiliation(s)
- Hendrew Lusey
- World Council of Churches, Ecumenical HIV and AIDS Initiative and Advocacy (EHAIA), Central Africa regional office, C/o Salvation Army Headquarters, Avenue colonel Ebeya No. 23, B.P: 8636, Kinshasa Gombe, Democratic Republic of Congo. .,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. .,Sexual and Reproductive Health, Department of Nursing, Umeå University, Umeå, Sweden.
| | - Miguel San Sebastian
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Monica Christianson
- Sexual and Reproductive Health, Department of Nursing, Umeå University, Umeå, Sweden
| | - Kerstin E Edin
- Sexual and Reproductive Health, Department of Nursing, Umeå University, Umeå, Sweden
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Dasgupta A, Silverman J, Saggurti N, Ghule M, Donta B, Battala M, Nair S, Gajanan V, Raj A. Understanding Men's Elevated Alcohol Use, Gender Equity Ideologies, and Intimate Partner Violence Among Married Couples in Rural India. Am J Mens Health 2018; 12:1084-1093. [PMID: 29779428 PMCID: PMC6131423 DOI: 10.1177/1557988318775844] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022] Open
Abstract
Qualitative evidence suggests that husbands' inequitable gender equity (GE) ideologies may influence associations between husbands' alcohol use and intimate partner violence (IPV) against wives. However, little quantitative research exists on the subject. To address this gap in the literature, associations of husbands' elevated alcohol use and GE ideologies with wives' reports of IPV victimization among a sample of married couples in Maharashtra, India, were examined. Cross-sectional analyses were conducted using data from the baseline sample of the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) study. Participants included couples aged 18 to 30 years ( N = 1081). Regression models assessed the relationship between husbands' elevated alcohol use and GE ideologies (using the Gender-Equitable Men [GEM] Scale) and wives' history of physical and/or sexual IPV victimization ever in marriage. Husbands and wives were 18 to 30 years of age, and married on average of 3.9 years ( SD ± 2.7). Few husbands (4.6%) reported elevated alcohol use. Husbands had mean GEM scores of 47.3 ( SD ± 5.4, range: 35-67 out of possible range of 24-72; least equitable to most equitable). Approximately one fifth (22.3%) of wives reported a history of physical and/or sexual IPV. Wives were less likely to report IPV if husbands reported greater GE ideologies (adjusted odds ratio [AOR]: 0.97, 95% CI [0.95, 0.99]), and husband's elevated alcohol use was associated with increased risk of IPV in the final adjusted model (AOR: 1.89, 95% CI [1.01, 3.40]). Findings from this study indicate the need for male participation in violence intervention and prevention services and, specifically, the need to integrate counseling on alcohol use and GE into such programming.
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Affiliation(s)
- Anindita Dasgupta
- Social Intervention Group, Columbia University
School of Social Work, New York City, USA
| | - Jay Silverman
- Division of Global Public Health, Department
of Medicine, University of California, San Diego School of Medicine, San Diego, USA
- Center on Gender Equity and Health, University
of California, La Jolla, CA, USA
| | - Niranjan Saggurti
- Population Council, Zone 5A, Ground Floor,
India Habitat Centre, Lodi Road, New Delhi, India
| | | | - Balaiah Donta
- National Institute for Research in
Reproductive Health, Parel, Mumbai, India
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor,
India Habitat Centre, Lodi Road, New Delhi, India
| | - Saritha Nair
- National Institute of Medical Statistics,
Ansari Nagar, New Delhi, Delhi, India
| | - Velhal Gajanan
- Seth GS Medical College & KEM Hospital,
Mumbai, Maharashtra, India
| | - Anita Raj
- Division of Global Public Health, Department
of Medicine, University of California, San Diego School of Medicine, San Diego, USA
- Center on Gender Equity and Health, University
of California, La Jolla, CA, USA
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Pettifor A, Lippman SA, Gottert A, Suchindran CM, Selin A, Peacock D, Maman S, Rebombo D, Twine R, Gómez‐Olivé FX, Tollman S, Kahn K, MacPhail C. Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa. J Int AIDS Soc 2018; 21:e25134. [PMID: 29972287 PMCID: PMC6058206 DOI: 10.1002/jia2.25134] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Community mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk. METHODS Twenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (post-intervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes. RESULTS Among men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16). CONCLUSION Community mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly. CLINICAL TRIALS NUMBER ClinicalTrials.gov NCT02129530.
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Affiliation(s)
- Audrey Pettifor
- Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for AIDS Prevention Studies (CAPS)Department of MedicineUniversity of California at San FranciscoSan FranciscoCAUSA
| | - Ann Gottert
- Population CouncilHIV and AIDS programWashingtonDCUSA
| | - Chirayath M Suchindran
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Department of BiostatisticsUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
| | - Amanda Selin
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Dean Peacock
- Sonke Gender JusticeCape TownSouth Africa
- School of Public HealthDivision of Social and Behavioural ScienceUniversity of Cape TownCape TownSouth Africa
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina Gillings School of Global Public HealthChapel HillNC
| | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Francesc Xavier Gómez‐Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Nanda G, Dal Santo L, Konde JN, de Negri B. Barriers to achieving the first 90%: gender norms and HIV testing among men in the Democratic Republic of the Congo. AIDS Care 2018; 30:1231-1238. [PMID: 29947246 DOI: 10.1080/09540121.2018.1489100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Gender inequality and gender norms are key social drivers of the HIV epidemic through their influences on sexual relationships, behavior, and risk taking. However, few empirical studies have measured the influence of gender norms on HIV sexual-risk behaviors and HIV testing among men in sub-Saharan Africa. We analyzed cross-sectional, survey data from 399 sexually active men (ages 18-39) in Democratic Republic of the Congo to examine the relationship between the men's support for inequitable gender norms and their HIV-risk behaviors. Logistic regression analyses revealed that moderate and strong levels of support for inequitable gender norms were significantly associated with never having been tested for HIV (AOR = 2.92, p < .05 and AOR = 3.41, p < .01, for moderate and strong support, respectively). Our findings indicate that changing the prevailing gender norms should be prioritized in HIV-prevention efforts that aim to increase counseling and testing for men.
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Affiliation(s)
- Geeta Nanda
- a Global Health, Population, and Nutrition Department , FHI 360 , Washington , DC , USA
| | - Leila Dal Santo
- a Global Health, Population, and Nutrition Department , FHI 360 , Washington , DC , USA
| | - Joel Nkiama Konde
- b School of Public Health , University of Kinshasa , Kinshasa , Democratic Republic of the Congo
| | - Berengere de Negri
- a Global Health, Population, and Nutrition Department , FHI 360 , Washington , DC , USA
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