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Interpersonal and Structural Contexts of Intimate Partner Violence Among Female Sex Workers in Conflict-Affected Northern Uganda

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-08-29
Abstract: 

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011–January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31–5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46–4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20–3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86–5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.

Document type: 
Article
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Structural Determinants of Dual Contraceptive Use Among Female Sex Workers in Gulu, Northern Uganda

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015-06-03
Abstract: 

Objective

To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda.

Methods

The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14 years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use.

Results

Among the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] 1.04–1.15; P = 0.001), prior unintended pregnancy (AOR 1.53, 95% CI 1.01–2.34; P = 0.046), and HIV testing (AOR 5.22, 95% CI 1.75–15.57; P = 0.003). Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use (AOR 0.65, 95% CI 0.42–1.00; P = 0.050).

Conclusion

Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.

Document type: 
Article
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High Burden of Previously Undiagnosed HIV Infections and Gaps in HIV Care Cascade for Conflict-Affected Female Sex Workers in Northern Uganda

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-11
Abstract: 

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.

Document type: 
Article
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Managing Borders During Public Health Emergencies of International Concern: A Proposed Typology of Cross-Border Health Measures

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-06-21
Abstract: 

Background

The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition.

Results

Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005).

Conclusions

The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

Document type: 
Article
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Sex Work, Health, and Human Rights: Global Inequities, Challenges, and Opportunities for Action

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-04-29
Abstract: 

Introduction

This open access book provides a comprehensive overview of the health inequities and human rights issues faced by sex workers globally across diverse contexts, and outlines evidence-based strategies and best practices.

Sex workers face severe health and social inequities, largely as the result of structural factors including punitive and criminalized legal environments, stigma, and social and economic exclusion and marginalization. Although previous work has largely emphasized an elevated burden and gaps in HIV and sexually transmitted infection (STI) services in sex work, less attention has been paid to the broader health and human rights concerns faced by sex workers. This contributed volume addresses this gap.

The chapters feature a variety of perspectives including academic, community, implementing partners, and government to synthesize research evidence as well as lessons learned from local-level experiences across different regions, and are organized under three parts:

  • Burden of health and human rights inequities faced by sex workers globally, including infectious diseases (e.g., HIV, STIs), violence, sexual and reproductive health, and drug use
  • Structural determinants of health and human rights, including legislation, law enforcement, community engagement, intersectoral collaboration, stigma, barriers to health access, im/migration issues, and occupational safety and health
  • Evidence-based services and best practices at various levels ranging from individual and community to policy-level interventions to identify best practices and avenues for future research and interventions

Sex Work, Health, and Human Rights is an essential resource for researchers, policy-makers, governments, implementing partners, international organizations and community-based organizations involved in research, policies, or programs related to sex work, public health, social justice, gender-based violence, women's health and harm reduction.

Document type: 
Book
File(s): 

Gender and Power Dynamics of Social Relationships Shape Willingness to Participate in Biomedical HIV Prevention Research Among South African Adolescents and Young Adults

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-05-20
Abstract: 

Background: Understanding young women and men's perceived barriers and facilitators to participation in biomedical HIV prevention research is important for designing youth friendly services (YFS) and acceptable technologies, which are necessary for preventing high sustained HIV incidence in South Africa. This study explores the multileveled barriers and facilitators to young men and women's willingness to participate in hypothetical biomedical HIV prevention research.

 

Methods: Eight age- (16–18 and 19–24 years) and gender-stratified focus group discussions (FGDs) were conducted using semi-structured interview guides to explore young South African women and men's willingness, perceived barriers, and facilitators to participating in biomedical HIV prevention research. FGD transcripts were uploaded to NVivo and coded collaboratively with youth study team members. Thematic analysis using Bronfenbrenner's ecological model (individual, inter-personal, community, and societal) was used to guide a deductive coding procedure, which was documented and compared by gender.

 

Results: Thirty-one participants from Durban and 34 from Soweto participated in FGDs. Individual facilitators for participation were discussed more by young men and included financial incentives and altruism. Concerns about side-effects of biomedical products were a common barrier. Interpersonal relationships with peers, intimate partners and caregivers influenced young people's willingness to participate in HIV prevention research, more so among young women. For young women, gendered power dynamics and distrust of intimate partners and parents influenced both communication regarding participation and willingness to participate in research that is often stigmatized, due to societal norms around women's sexuality. On a societal level, participants expressed distrust in medical and research institutions, however a sense of community that was developed with the study staff of this project, was a motivator to participate in future studies.

 

Discussion: At each level of the ecological model, we found participants expressed gendered barriers and facilitators for participation. Gender norms as well as distrust of partners, parents, and health care professionals were key barriers that cut across all levels. At each level participants discussed facilitators that were youth-engaged, underscoring the need to implement YFS, establish trust and address gender inequities within future biomedical HIV prevention studies wishing to engage and retain South African youth.

Document type: 
Article
File(s): 

Experiences with Sexual Orientation and Gender Identity Conversion Therapy Practices among Sexual Minority Men in Canada, 2019–2020

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-06-03
Abstract: 

Background

“Conversion therapy” practices (CTP) are organized and sustained efforts to avoid the adoption of non-heterosexual sexual orientations and/or of gender identities not assigned at birth. Few data are available to inform the contemporary prevalence of CTP. The aim of this study is to quantify the prevalence of CTP among Canadian sexual and gender minority men, including details regarding the setting, age of initiation, and duration of CTP exposure.

Methods

Sexual and gender minority men, including transmen and non-binary individuals, aged ≥ 15, living in Canada were recruited via social media and networking applications and websites, November 2019—February 2020. Participants provided demographic data and detailed information about their experiences with CTP.

Results

21% of respondents (N = 9,214) indicated that they or any person with authority (e.g., parent, caregiver) ever tried to change their sexual orientation or gender identity, and 10% had experienced CTP. CTP experience was highest among non-binary (20%) and transgender respondents (19%), those aged 15–19 years (13%), immigrants (15%), and racial/ethnic minorities (11–22%, with variability by identity). Among the n = 910 participants who experienced CTP, most experienced CTP in religious/faith-based settings (67%) or licensed healthcare provider offices (20%). 72% of those who experienced CTP first attended before the age of 20 years, 24% attended for one year or longer, and 31% attended more than five sessions.

Interpretation

CTP remains prevalent in Canada and is most prevalent among younger cohorts, transgender people, immigrants, and racial/ethnic minorities. Legislation, policy, and education are needed that target both religious and healthcare settings.

Document type: 
Article
File(s): 

Effects of Gestational Exposures to Chemical Mixtures on Birth Weight Using Bayesian Factor Analysis in the Health Outcome and Measures of Environment (HOME) Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-06-08
Abstract: 

Background:

Studying the effects of gestational exposures to chemical mixtures on infant birth weight is inconclusive due to several challenges. One of the challenges is which statistical methods to rely on. Bayesian factor analysis (BFA), which has not been utilized for chemical mixtures, has advantages in variance reduction and model interpretation.

Methods:

We analyzed data from a cohort of 384 pregnant women and their newborns using urinary biomarkers of phthalates, phenols, and organophosphate pesticides (OPs) and serum biomarkers of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), perfluoroalkyl substances (PFAS), and organochlorine pesticides (OCPs). We examined the association between exposure to chemical mixtures and birth weight using BFA and compared with multiple linear regression (MLR) and Bayesian kernel regression models (BKMR).

Results:

For BFA, a 10-fold increase in the concentrations of PCB and PFAS mixtures was associated with an 81 g (95% confidence intervals [CI] = −132 to −31 g) and 57 g (95% CI = −105 to −10 g) reduction in birth weight, respectively. BKMR results confirmed the direction of effect. However, the 95% credible intervals all contained the null. For single-pollutant MLR, a 10-fold increases in the concentrations of multiple chemicals were associated with reduced birth weight, yet the 95% CI all contained the null. Variance inflation from MLR was apparent for models that adjusted for copollutants, resulting in less precise confidence intervals.

Conclusion:

We demonstrated the merits of BFA on mixture analysis in terms of precision and interpretation compared with MLR and BKMR. We also identified the association between exposure to PCBs and PFAS and lower birth weight.

Document type: 
Article
File(s): 

Supporting Children — By Supporting Practitioners and Families During COVID-19 and Beyond

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: The COVID-19 pandemic has introduced new and urgent mental health challenges for children. This public health crisis has also caused novel challenges in the delivery of services to children in need. 

Methods: We conducted a rapid research review detailing safe, effective and efficient ways of delivering mental health services to children experiencing anxiety, the most common mental health concern faced by young people. 

Results: We outline the delivery cognitive-behavioural therapy, the most effective prevention intervention and treatment for childhood anxiety, using both virtual and self-directed formats. We also identify an effective pharmaceutical, fluoxetine, for children who require medication. 

Conclusions: COVID-19 has caused significant disruption in the lives of children, including increased anxiety for many. Our findings detail a path forward for helping children with anxiety during COVID-19 and beyond.

Preventing and Treating Childhood Mental Disorders: Effective Interventions

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Social and emotional wellbeing is a crucial resource for all children. Yet high-quality epidemiological studies suggest that 12.7% of children will experience a mental disorder. 

Methods: We used systematic review methods to identify 113 randomized controlled trials and six systematic reviews on effective interventions for preventing and treating the most common childhood mental disorders. 

Results: We found effective prevention interventions for anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant and conduct disorders, depression, eating disorder and posttraumatic stress disorder. In addition to identifying useful treatments for all of these disorders, we also found effective treatments for autism spectrum, obsessive-compulsive and bipolar disorders as well as schizophrenia. 

Conclusions: Mental disorders, which typically start in childhood, cause significant distress and impairment for children. Beyond the hardships they cause for children and families, there are also significant avoidable costs for society as a whole. By implementing effective prevention interventions and treatments for these concerns, it is possible to avert unnecessary hardships for young people, their families and their communities.