The limits of behaviour change theory: condom use and contexts of HIV risk in the Kolkata sex industry

This paper uses ethnographic data from a sex workers' HIV project in India to consider the appropriateness of individual, social/group and structural theories of health behaviour when applied to HIV-prevention initiatives. Existing theories are critiqued for their modernist representation of behaviour as determined by individual rational decision-making processes or by external structural forces, with inadequate recognition being given to the roles that human agency, subjective meaning and local context play in everyday actions. Analysis of sex workers' accounts of their sexual practices suggests that existing theories of health behaviour can only partially account for sexual behaviour change retrospectively and that they have limited predictive value with respect to the outcomes of individual sexual encounters. Our data show that these outcomes were, in fact, highly context dependent, while possibilities for action were ultimately strongly constrained by structural forces. Findings suggest that interventions need to adopt an integrated, structurally-oriented approach for promoting safer sexual practices in sex work settings. Recognising that no one model of health behaviour is likely to be adequate in explaining or predicting behaviour change encourages responsiveness to local people's agency, recognises the different (health- and non-health-related) registers of risk with which people operate and encourages flexibility according to local contingencies and contexts.

The impact of migration on HIV prevention for women: constructing a conceptual framework

There are an estimated 40.5 million people currently living with HIV globally, 17.5 million of whom are women, according to the AIDS Epidemic update: December 2005, conducted by UNAIDS and the World Health Organization (WHO) 2005. Women are vulnerable to HIV for biologic as well as social reasons. In the past, the HIV prevention theorists have not considered the context of women's lives: factors at the individual, relationship, and community levels, as well as structural factors (both policy and cultural) impact on HIV prevention for women. This is particularly true for migrant women, who may be especially vulnerable to HIV infection during their time of transition. Throughout this article I explore the international literature for both the historical context of HIV prevention for women and the impact of migration on HIV risk for women. The literature review provides a basis for the development of a conceptual framework of the socioecologic factors affecting HIV prevention for migrant women. I call for consideration of the broad context of women's experience when developing interventions for this population.

Women Radiologists in the United States: Results from the American College of Radiology's 2003 Survey

PURPOSE

To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists.

RESULTS

Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men.

CONCLUSION

Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.

Domestic violence in Israel: changing attitudes

For many years, knowledge of the prevalence of violence against women in Israel was marginalized in such a way that it never figured in public discourse. Elite groups of academics and feminist activists with a Western background, together with human rights groups, delivered subversive messages that gradually infiltrated into larger circles and ultimately changed public policies. The issue is now central in public affairs. This article discusses the extent of violence against women in Israel and suggests explanations for the shift from denial to greater public awareness.

Women and HIV/AIDS in the kingdom of Swaziland: culture and risks

In Swaziland, a polygamous society in Southern Africa, the prevalence of the human immune virus/acquired immune deficiency syndrome (HIV/AIDS) is continuing to proliferate at an alarming rate. In 1992 the prevalence rate was 3.9%. However in 12 years, by 2004, the prevalence rate had reached 42.6%. This article explores some of the traditional cultural practices and experiences that increase Swazi women's vulnerability to HIV/AIDS. The traditional cultural practices fall into four categories: (1) socialization and the roles of women, (2) the minority status of women, (3) the practice of a dowry, and (4) the wife as an inheritance. The women's experiences include the Swazi men's beliefs in the virginity cure myth, the women's extreme poverty, and the Swazi men who are migrant workers in neighboring states. This article concludes with recommendations for public policy and for future research within the context of Swazi culture.

International Sexual Harassment

This paper on international sexual harassment begins with a presentation of the definitions, models, and consequences of sexual harassment. Following this discussion, a description is given of a nine-country research program that examined reactions to academic sexual harassment. A brief review of incidence studies and international laws related to sexual harassment are also included.

Female sex work in Yangon, Myanmar

BACKGROUND

Myanmar (Burma), with an upper estimate of 400,000 people living with HIV/AIDS, faces a dangerous and potentially devastating epidemic. Female sex workers in the country are one of the most affected populations, with high prevalence rates of both HIV and sexually transmitted infections (STIs).

METHODS

A qualitative study was undertaken in Yangon at the end of 2002 to investigate the social and demographic features contributing to the transmission of HIV among female sex workers in urban Myanmar. Twenty-seven key informants from the government, non-government organisations (NGOs), international non-government organisations (INGOs), private sector and the United Nations system agencies and 25 women currently working in the sex trade were interviewed.

RESULTS

The sex trade in Yangon is rapidly growing and is characterised by a high degree of complexity. The number of female sex workers is estimated to be between 5,000 and 10,000 and there are approximately 100 brothels operating in various townships around the city. Nearly one-third of the women in the study reported previous imprisonment for offences related to sex work as well as fear of harassment, sexual exploitation, violence and gang rape. Almost half reported using condoms with clients at all times. Contradicting views exist as to the level of awareness about STIs and HIV among Yangon sex workers, with the majority never having been tested for HIV. Only one-quarter of women were regular patients of the limited number of STI clinics operated by INGOs.

CONCLUSIONS

Female sex workers in Myanmar remain a highly marginalised group almost inaccessible due to a variety of legal, political, cultural and social factors and are particularly vulnerable to HIV and STIs. It is important to encourage partnerships between INGOs by promoting service coordination and information sharing to increase the availability of services for sex workers and to build political support for an unpopular cause.

Migration and relationship power among Mexican women

Our study drew on original data collected in Durham, NC, and four sending communities in Mexico to examine differences in women's relationship power that are associated with migration and residence in the United States. We analyzed the personal, relationship, and social resources that condition the association between migration and women's power and the usefulness of the Relationship Control Scale (RCS) for capturing these effects. We found support for perspectives that emphasize that migration may simultaneously mitigate and reinforce gender inequities. Relative to their nonmigrant peers, Mexican women in the United States average higher emotional consonance with their partners, but lower relationship control and sexual negotiation power. Methodologically, we found that the RCS is internally valid and useful for measuring the impact of resources on women's power. However, the scale appears to combine diverse dimensions of relationship power that were differentially related to migration in our study.

Gender, caste, and economic inequalities and marital violence in rural South India

We conducted a survey to examine the relationships among gender, caste, and economic inequalities and marital violence among women in rural South India. Thirty-four percent of 397 women reported having ever been hit, forced to have sex by their husbands, or both. Women belonging to lower caste, poorer households, having greater economic autonomy, and whose husbands consumed alcohol were more likely to report violence. In multivariate analyses, indicators of women's economic autonomy and husbands' alcohol consumption were significantly associated with violence, independent of caste and economic status, which highlights the need to address the links between gender inequalities and marital violence.

Tracking gender-based human rights violations in postwar Kosovo

Four years have passed since the institution of the cease-fire in Yugoslavia, and questions remain as to how Kosovar women are faring in the country's postwar reconstruction. Reports, albeit fragmented, suggest that violence against women began to increase in 1998 and 1999. This trend continued through 2001, even while rates of other major crimes decreased. Despite considerable local efforts to address the conditions of women, there remains a lack of systematic data documenting the scope and frequency of violent acts committed against women. A centralized surveillance system focused on tracking human rights abuses needs to be established to address this critical need for empirically based reports and to ultimately guide reform efforts.

Sexuality and women's rights in armed conflict in Sri Lanka

The discourse of human rights in armed conflict situations is well adapted to respond to violence and violation, invoking internationally agreed principles of civil and political rights. However, in areas where the subject or domain of rights discourse is contested or controversial, human rights advocates appear less prepared to promote and defend such rights. Sexuality is one such domain. This paper explores the complex sexual choices women in Sri Lanka have had to negotiate, particularly widows and sex workers, within a context of ethnic conflict, militarisation and war. It argues that sexuality cannot be defined exclusively in terms of violation, even in a context dominated by violence, and that the sexual ordering of society may be subverted in such conditions. Newly widowed women and sex workers have had to negotiate self-determination as well as take responsibility for earning income and heading households, in spite of contrary community pressures. For women, political and economic rights are closely linked with the ability to determine their sexual and reproductive choices. The challenge to women's and human rights advocates is how to articulate sexual autonomy as a necessary right on a par with others, and strategise to secure this right during armed conflict and postwar reconstruction.

"Yes" to abortion but "no" to sexual rights: the paradoxical reality of married women in rural Tamil Nadu, India

This study in rural Tamil Nadu, India, explored the reasons why many married women in India undergo induced abortions rather than use reversible contraception to space or limit births in terms of women's sexual and reproductive rights within marriage, and in the context of gender relations between couples more generally. It is based on in-depth interviews with two generations of ever-married women, some of whom had had abortions and others who had not, from 98 rural hamlets. The respondents were 66 women and 44 of their husbands. Non-consensual sex, sexual violence and women's inability to refuse their husband's sexual demands appeared to underlie the need for abortion in both younger and older women. Many men seemed to believe that sex within marriage was their right, and that women had no say in the matter. The findings raise questions about the presumed association between legal abortion and the enjoyment of reproductive and sexual rights. A large number of women who had abortions in this study were denied their sexual rights but were permitted, even forced, to terminate their pregnancies for reasons unrelated to their right to choose abortion. The study brings home the need for activism to promote women's sexual rights and a campaign against sexual violence in marriage.

The impact of household delivery of family planning services on women's status in Bangladesh

CONTEXT

Qualitative studies assessing the impact of the household delivery of family planning services on women's social status have yielded contradictory findings. Given the resumption of these services in Bangladesh in 2003, it is important to reevaluate the social impact of the doorstep program using quantitative techniques.

METHODS

Longitudinal and cross-sectional data from 3,783 women using doorstep services in two rural districts of Bangladesh are used in ordinary least-squares and logistic regression analyses to assess the effect of doorstep services on changes in women's status between 1988 and 1993.

RESULTS

In analyses controlling for background characteristics, women's status in 1988, previous service use and visit selection bias, household outreach is associated with increases in women's status between 1988 and 1993. However, this effect is largely attributable to the impact of doorstep services on women's ability to regulate their fertility rather than to the home visits themselves.

CONCLUSION

The decision of the Bangladesh Ministry of Health and Family Welfare to resume household family planning services should not be detrimental to women's status, and may be associated with gender benefits to female clients served by the program.

To shatter the glass ceiling in healthcare management: who supports affirmative action and why?

We examined the findings of a recent national survey of healthcare executives that showed 90% of women but only 53% of men favoured efforts to increase the proportion of women in senior healthcare management positions. Using the theories of relative deprivation and social identity, we tested hypotheses to suggest the background, work characteristics and attitudes about existing discriminatory practices in their own organizations that correlate with respondents' views about affirmative action for women. Some support is evidenced for the two theories and explanations are suggested to account for apparent anomalies.

Women's autonomy and child survival: a comparison of Muslims and non-Muslims in four Asian countries

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.

A Population-Based Assessment of Women's Mental Health and Attitudes toward Women's Human Rights in Afghanistan

OBJECTIVE

To assess the health status of Afghan women and attitudes of these women and their male relatives during the period of Taliban rule toward women's rights and community development needs in Afghanistan.

METHODS

In household residences in two regions in Afghanistan (one Taliban controlled and the other not under the Taliban) and a refugee camp and repatriation center in Pakistan, structured interviews were conducted among a random sample of women and men exposed to Taliban policy and women living in a non-Taliban controlled area (724 Afghan women and 553 male relatives).

RESULTS

Major depression was far more prevalent among women exposed to Taliban policies (73%-78%) than among women living in a non-Taliban controlled area (28%). Sixty-five percent of women living in a Taliban-controlled area and 73% of women in Pakistan exposed to Taliban policies expressed suicidal ideation at the time of the study, compared with 18% of those in a non-Taliban controlled area. More than 90% of both women and men expressed support for equal work and educational opportunities, free expression, protection of women's rights, participation of women in government, and the inclusion of women's human rights concerns in peace talks. A majority of both women and men believed that guaranteeing civil and political rights (69%) and meeting basic needs (90%) were important for the health and development of their communities.

CONCLUSIONS

In Afghanistan under the Taliban, policies restricting women's rights were not the product of years of tradition or of social and economic deprivation. Instead, they were man-made policies as easily and swiftly revoked as they were instituted. Depression rates among women in Afghanistan, especially in Taliban-controlled areas, were extraordinarily high. Current efforts to rebuild Afghanistan must address these high rates of depression and other mental health problems to ensure women's full participation in development.

Maternal mortality and associated near-misses among emergency intrapartum obstetric referrals in Mulago Hospital, Kampala, Uganda

BACKGROUND

Many maternal deaths (as well as related severe morbidity) are of women who do not attend antenatal care in a given health unit but are referred there when they develop life-threatening obstetric complications.

OBJECTIVE

To determine the reproductive characteristics of emergency obstetric referrals, and determine the contribution of emergency obstetric referrals to severe acute maternal morbidity (near-misses) and maternal mortality.

STUDY DESIGN

Descriptive cross-sectional study.

SETTING

Mulago hospital, the National Referral hospital, Kampala, Uganda, from 1st March to August 30th 2000.

SUBJECTS

Nine hundred and eighty three consecutive women admitted as emergency obstetric referrals in labour or puerperium.

INTERVENTIONS

Subjects were followed from time of admission to discharge (or death). They were interviewed (or examined) to obtain data on socio-demographic characteristics, reproductive history, obstetric outcome of the index pregnancy, obstetric complications and cause of death. Their records were reviewed to determine evidence of severe acute morbidity from acute organ/system dysfunction, using the definition by Mantel et al. These data were analysed using the Epilnfo computer programme in terms of means, frequencies and percentages.

MAIN OUTCOME MEASURES

Socio-demographic characteristics, obstetric complications, cause of deaths, cause and type of near miss mortality and case fatality rates.

RESULTS

Of the 983 referrals, over 100 were near-misses and 17 died. Using the definition of Mantel et al of near-misses enabled identification of six times as many near-misses as maternal deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low status was highly associated with both maternal deaths and near misses.

CONCLUSION

In developing countries, with poor obstetric services, emergency transfers in labour are very common. These women, who are of low status, contribute significantly to maternal mortality and morbidity.

Declining sex differences in mortality from lung cancer in high-income nations

After decades of widening, the difference in mortality from lung cancer between men and women has begun to narrow in recent years. Recognizing that the increase in smoking among women relative to men is the proximate cause of the changing sex difference in rates of lung cancer, I analyzed two approaches to identify the more distant sources of the changes. A gender-equality argument suggests that the difference is related to the more general equalization of women's and men's work and family roles, which also encourages the adoption of harmful behaviors such as smoking by women. An alternative explanation suggests that the convergence in mortality from lung cancer among men and women is the byproduct of a lag in the adoption, diffusion, and abatement of smoking by women. Using mortality data on 21 nations from 1955 to 1996, an analysis of logged rates of men's and women's lung cancer mortality and the logged ratio of the rates demonstrated little relationship between the sex difference and gender equality. However, I found a strong and consistent relationship between the sex difference and the stage of diffusion of the use of cigarettes.