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Oreh AC, Irechukwu C, Biyama F, Nnabuihe A, Ihimekpen A, Oshiame D, Bozegha T, Leo-Nnadi I, Izedonmwen O, Oga E, Suberu EJ, Odiabara K, Amedu OJ. COVID-19 impact on Nigeria's national blood service commission - Lessons for Low- and Middle-Income Countries (LMICs). Niger Postgrad Med J 2022; 29:6-12. [PMID: 35102944 DOI: 10.4103/npmj.npmj_720_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background In February 2020, Nigeria officially announced its first case of COVID-19. As numbers rose, government-led non-pharmaceutical interventions such as lockdowns, curfews, restrictions on mass gatherings and other physical distancing measures ensued, negatively affecting blood donor mobilisation activities. Objectives We aimed to assess the blood service activities across 17 National Blood Service Commission (NBSC) centres in Nigeria, including number of blood donations, mobile blood drives, blood units screened, screening outcomes, number of hospitals NBSC provided services to and number of blood units discarded over the study period. Materials and Methods A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 17 NBSC centres in Nigeria, comparing from January-December 2019 (pre-COVID-19) to January-December 2020 (peri-COVID-19). Results Mobile blood donation drives declined by 100% in the first 2 months following government-imposed lockdowns, the number of all blood donations and voluntary blood donations declined by 9.8%. The number of blood units screened declined by 11.9%, while the number of blood units that screened positive for transfusion-transmissible infections reduced by 28.6%. Discarded blood units reduced by 3.1%, while a 32.6% increase was observed in the number of hospitals that NBSC issued blood for transfusion. Conclusions The COVID-19 pandemic affected NBSC operations in Nigeria. However, by strengthening hospital linkages and employing innovative strategies, NBSC ensured continuity of operations, thereby significantly managing the challenges of COVID-19 to voluntary blood donor recruitment and the availability of safe blood for transfusion.
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Affiliation(s)
- Adaeze Chidinma Oreh
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Christopher Irechukwu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Felix Biyama
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Agatha Nnabuihe
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Andrew Ihimekpen
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Daniel Oshiame
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Tariere Bozegha
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Ijeoma Leo-Nnadi
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Omosigho Izedonmwen
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Elton Oga
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Eneye Jimoh Suberu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Kingsley Odiabara
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Omale Joseph Amedu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
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Shumye S, Kassaw C, Melaku G. The prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending antiretroviral therapy clinic in Gambella town, Southwest Ethiopia, 2020. BMC Psychiatry 2022; 22:24. [PMID: 34996402 PMCID: PMC8742335 DOI: 10.1186/s12888-022-03688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Sexual compulsivity is a concealed psychiatric disease marked by intrusive thoughts followed by ritualized sexual acts. In Ethiopia, the prevalence of HIV/AIDS has recently increased. Furthermore, sexual compulsivity among adults living with HIV/AIDS receives less attention, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of sexual compulsivity and its correlates among adults living with HIV/AIDS attending ART clinic in Gambella town, Southwest Ethiopia, 2020. METHOD A hospital-based study employing cross-sectional design and simple random sampling technique was used to select the study participants. Data were collected by using interview technique. A 10 item Sexual Compulsivity Scale (SCS) questionnaire was used to assess sexual compulsivity. The translated version of the questionnaire was used for data collection. Bivariate and multivariable logistic regression was conducted to determine factors associated with the outcome variable at p-value < 0.05 with a 95% confidence interval. RESULT Out of 300 respondents, 27% (24.3, 29.2) of them were scored above the mean score of the Sexual Compulsivity Scale. Age less than 31 years old, widowed, involving in risky sexual behaviors, current substance use, not received any skill training about safer sex behaviors, and not attending support group discussion on HIV prevention were significantly associated with sexual compulsivity. CONCLUSION Almost one fourth of the respondents have high score for Sexual Compulsivity Scale score. Therefore, there is a need of routine sexual behavior screening program and collaboration with mental health workers for addressing the problem. Furthermore, the emphasis should be given on the identified high-risk categories.
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Affiliation(s)
- Seid Shumye
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
| | - Chalachew Kassaw
- grid.472268.d0000 0004 1762 2666Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Getnet Melaku
- grid.472268.d0000 0004 1762 2666Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
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Bright MA, Sayedul Huq M, Patel S, Miller MD, Finkelhor D. Child Safety Matters: Randomized Control Trial of a School-Based, Child Victimization Prevention Curriculum. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:538-556. [PMID: 32249651 DOI: 10.1177/0886260520909185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Recognizing the potential of classrooms as a context for identifying and addressing child victimization, several U.S. states now mandate the inclusion of child abuse prevention in school curricula. There are, however, a limited number of evidence-based and developmentally appropriate curricula designed for elementary. This study utilized a randomized control trial (RCT) design to evaluate the knowledge acquisition of children who received the Monique Burr Foundation's Child Safety Matters curriculum, a program designed to educate kindergarten to Grade 5 children about bullying, cyberbullying, four types of abuse (physical, sexual, emotional, and neglect), and digital dangers. Participants included 1,176 students from 72 classrooms in 12 Florida schools across eight counties. Schools were matched in pairs and randomly assigned to receive the program or be in a wait-list control. Knowledge was assessed with a questionnaire administered prior to the curriculum (T1) as well as approximately 3 weeks (T2) and approximately 7 months (T3) after implementation. Analyses were conducted with class means examining grade, treatment condition, and time. The interaction of treatment and time was significant, F(2, 90) = 17.024, p < .000. Children who received the curriculum increased their knowledge about potentially risky situations, and this knowledge was sustained over 7 months to the follow-up assessment. Children in the control schools did not have similar gains. The current classroom-based child maltreatment prevention education is a promising strategy to address children's vulnerability to abuse and its consequences.
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OUP accepted manuscript. Health Promot Int 2022:6586597. [DOI: 10.1093/heapro/daac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Felisbino-Mendes MS, Araújo FG, Oliveira LVA, Vasconcelos NMD, Vieira MLFP, Malta DC. Sexual behaviors and condom use in the Brazilian population: analysis of the National Health Survey, 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210018. [PMID: 34910072 DOI: 10.1590/1980-549720210018.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this research was to describe the sexual behaviors and condom use in the Brazilian population. METHODS This is a cross-sectional, descriptive study, which used data from 88,531 individuals aged 18 years old or older, who answered the second edition of the National Health Survey carried out in 2019. Prevalence was estimated with the respective 95% confidence intervals for each sexual behavior indicator and condom use according to gender, age, race/skin color, educational level, and region of residence. RESULTS The majority of the Brazilian population has had sexual intercourse at some point in their lives (93.9%). Mean age of initiation was 17.3 years. Prevalence of consistent condom use was only 22.8%, being even lower among women (20.9%). Moreover, 59% of the population reported not having used a condom in the past 12 months, the main reason being trusting their partner (73.4%). The use of health services to obtain condoms was only 10.7%. It was observed that women, individuals with a higher age group, less education, and income had worse results in relation to the analyzed indicators, in addition to regional disparities. CONCLUSION Low prevalence of condom use was observed in the Brazilian population. In addition, important socioeconomic and demographic disparities were observed, pointing out the need to revisit, strengthen and expand public policies in the sexual and reproductive health field in order to prevent risky sexual behaviors and promote condom use, including double protection.
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Affiliation(s)
- Mariana Santos Felisbino-Mendes
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Fernanda Gontijo Araújo
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Laís Vanessa Assunção Oliveira
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Nádia Machado de Vasconcelos
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Kose J, Lenz C, Akuno J, Kiiru F, Jelagat Odionyi J, Otieno-Masaba R, Okoth EA, Woelk G, Leselewa S, Leendert Fraaij P, Rakhmanina N. Supporting adolescents living with HIV within boarding schools in Kenya. PLoS One 2021; 16:e0260278. [PMID: 34855779 PMCID: PMC8638902 DOI: 10.1371/journal.pone.0260278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016-2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.
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Affiliation(s)
- Judith Kose
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
- Erasmus MC, Department of Viroscience, Erasmus University, Rotterdam, the Netherlands
| | - Cosima Lenz
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Job Akuno
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Fred Kiiru
- Ministry of Education, Homa Bay County, Kenya
| | | | - Rose Otieno-Masaba
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Elizabeth A. Okoth
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Godfrey Woelk
- Research Department, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | - Pieter Leendert Fraaij
- Pediatric Infectious Diseases Division, Erasmus MC-Sophia/ Erasmus University, Rotterdam, the Netherlands
| | - Natella Rakhmanina
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- The George Washington University, Washington, DC, United States of America
- Children’s National Hospital, Washington, DC, United States of America
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Hanna-Walker V, Busby DM, Leavitt CE, James SL. Missing Piece of the Puzzle: Evaluating a General Meaning of Sex Measure. FAMILY PROCESS 2021; 60:1307-1330. [PMID: 33460145 DOI: 10.1111/famp.12631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The presence of and search for meaning has divergent and salient outcomes for individuals' physical, mental, and emotional well-being. Although numerous domains of meaning have been examined, the literature on the meaning of sex is sparse and lacks a quantitative measure. In this study, we evaluated a new general Meaning of Sex (MOS) Measure that captured the presence of (MOS-P) and search for (MOS-S) the meaning of sex by analyzing how these subscales were associated with important relational and sexual outcomes (i.e., relationship stability and satisfaction and sexual satisfaction) in two samples. For Sample 1, all participants (N = 865) reported engaging in what they considered to be sexual intercourse and were either single or in a relationship. For Sample 2, all participants (N = 884) reported being in a committed relationship for at least two years. With both samples, confirmatory factor analyses showed good construct validity as the two subscales were distinct from one another and had good reliability. The analyses also demonstrated divergent validity between both scales and meaning in life, sexual motivations, sexual beliefs, and religiosity. The MOS-S had a strong (and negative) association with relationship stability in both samples. The MOS-P had a strong (and positive) association with relationship satisfaction in both samples.
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Singleton R, Billaud M, McLeod H, Tiendrebeogo G, Dia F, Obong’o C, Nkambule-Vilakati S, Mbakwem B, Sabben G, Winskell K. Making sense of fidelity: young Africans' cross-national and longitudinal representations of fidelity and infidelity in their HIV-related creative narratives, 1997-2014. SAHARA J 2021; 18:86-97. [PMID: 34227445 PMCID: PMC8266227 DOI: 10.1080/17290376.2021.1950042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mutual fidelity and partner reduction have been identified as key behavioural strategies to prevent HIV transmission in sub-Saharan Africa, particularly following recognition of the role that multiple concurrent sexual partnerships play in driving generalised HIV epidemics. We analysed social representations of fidelity and infidelity in a sample of 1,343 narratives about HIV written by young Africans between 1997 and 2014. The narratives were written at four different time points (1997, 2005, 2008, 2014) by authors aged 10-24 in urban and rural areas of Senegal, Burkina Faso, South-east Nigeria, Kenya and Eswatini. We combined three analytical approaches: descriptive statistics of quantifiable characteristics of the narratives, thematic data analysis and a narrative-based approach. In the sample, fidelity is often promoted as the ideal by narrators, peers and romantic partners, in line with broader discourses around HIV prevention, romantic relationships, familial obligations, and religious and moral imperatives. However, mutual fidelity is rarely modelled in the narratives and representations of combining methods to prevent HIV from entering relationships via infidelity are uncommon. Representations of fidelity reflect loss-framed fear arousal techniques that perpetuate HIV-related stigma. Narrative-based approaches that facilitate skills-building, critical reflection and address stigma can better address fidelity and partner reduction.
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Affiliation(s)
- Robyn Singleton
- Senior Research and Evaluation Strategist, Banyan Communications, Atlanta, GA, USA
| | - Manon Billaud
- Behavioral Sciences and Health Education Department, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Haley McLeod
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | | | - Fatim Dia
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | | | | | | | - Gaelle Sabben
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
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Olamijuwon E, Clifford O, Adjiwanou V. Understanding how young African adults interact with peer-generated sexual health information on Facebook and uncovering strategies for successful organic engagement. BMC Public Health 2021; 21:2153. [PMID: 34819036 PMCID: PMC8611981 DOI: 10.1186/s12889-021-12165-x] [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: 09/05/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background The use of social media for sexual health communication is gaining intense discussion both globally and in Africa. Despite this reality, it remains unclear whether and how young African adults use digital innovations like social media to access sexual health information. More importantly, the unique properties of messages that increase message reach and propagation are not well understood. This study aims to fill the gaps in scholarship by identifying post features and content associated with greater user engagement. Methods We analyzed a corpus of 3533 sexual and reproductive health messages shared on a public Facebook group by and for young African adults between June 1, 2018, and May 31, 2019, to understand better the unique features associated with higher engagement with peer-generated sexual health education. Facebook posts were independently classified into thematic categories such as topic, strategy, and tone of communication. Results The participants generally engaged with posts superficially by liking (x̃ = 54; x̄ = 109.28; σ = 159.24) rather than leaving comments (x̃ = 10; x̄ = 32.03; σ = 62.65) or sharing (x̃ = 3; x̄ = 11.34; σ = 55.12) the wallposts. Messages with fear [IRR:0.75, 95% CI: 0.66–0.86] or guilt [IRR:0.82, 95% CI: 0.72–0.92] appeals received a significantly lower number of reactions compared to neutral messages. Messages requesting an opinion [IRR:4.25, 95% CI: 3.57–5.10] had a significantly higher number of comments compared to status updates. The use of multimedia and storytelling formats were also significantly associated with a higher level of engagement and propagation of sexual health messages on the group. Conclusion Young adults in our sample tend to superficially interact with peer-communicated sexual health information through likes than engage (comments) or propagate such messages. Message features that increase engagements and propagation of messages include multimedia and engaging styles like storytelling. Our findings provide valuable insight and pave the way for the design of effective and context-specific sexual health information use of features that attract young African adults.
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Affiliation(s)
- Emmanuel Olamijuwon
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Statistics and Demography, School of Social Science, University of Eswatini, Kwaluseni Campus, Kwaluseni, Eswatini. .,Population and Health Research Group, School of Geography and Sustainable Development, University of St Andrews, Fife, UK.
| | - Odimegwu Clifford
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Visseho Adjiwanou
- Department of Sociology, Université du Québec à Montréal, Montreal, Canada
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The Integration of Gender Perspective into Young People's Sexuality Education in Spain and Portugal: Legislation and Educational Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211921. [PMID: 34831687 PMCID: PMC8622304 DOI: 10.3390/ijerph182211921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Throughout history, Sexuality Education (SE) has undergone many changes in formal education curricula. The education systems should incorporate SE and promote an understanding of sexuality from the critical perspective of gender. Objectives: To examine the approach to SE in young people in Spain and Portugal, considering the incorporation of the gender perspective, and analyze the legislation in both countries. A scoping review was conducted considering studies with SE programs, gender perspective, and legislation in Spanish, Portuguese, and English, without any time limits. The population consisted of young people aged 10 to 18 years who did not attend higher education. Databases used: CINAHL Complete, ERIC, LILACS, SciELO, MEDLINE, Psychology and Behavioral Sciences Collection, Scopus, Open Access Scientific Repository of Portugal, Base de Datos de Tesis Doctorales, Theses and Dissertations Online, and governmental websites. Thirty-two studies were found, including intervention, diagnosis, and documental programs. Eight of the studies adopted the gender perspective. Legislation in both countries is vast, with 23 main references. Although SE is legislated in both countries, the social-health and educational programs are insufficient. The relevance of the gender perspective is not incorporated into SE.
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George G, Maughan-Brown B, Thirumurthy H. Behavioural science to improve effectiveness of HIV programmes, South Africa. Bull World Health Organ 2021; 99:840-842. [PMID: 34737478 PMCID: PMC8542262 DOI: 10.2471/blt.21.285626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Cape Town, South Africa
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
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Mark K, Corona-Vargas E, Cruz M. Integrating Sexual Pleasure for Quality & Inclusive Comprehensive Sexuality Education. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:555-564. [PMID: 38595784 PMCID: PMC10903684 DOI: 10.1080/19317611.2021.1921894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 04/11/2024]
Abstract
The lack of inclusion of sexual pleasure in comprehensive sexuality education (CSE) could be detrimental to sexual development, misses opportunities for inclusive education, and may have a long-term impact on sexual well-being. The WAS' Declaration on Sexual Pleasure provides the opportunity to advocate for pleasure as an indispensable part of CSE. Specifically, the inclusion of pleasure in CSE will positively impact six outcomes: traditional risk-reduction, cultivating healthy relationships, celebration of sexual diversity, exercise of sexual rights, empowerment, and consent, and prevention of gender-based sexual violence. Messages of sexual pleasure are crucial for sexuality education to be comprehensive, effective, and inclusive.
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Affiliation(s)
- Kristen Mark
- Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Mariana Cruz
- International Planned Parenthood Federation Western Hemisphere Region, London, UK
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Mwale M, Muula AS. Stakeholder acceptability of the risk reduction behavioural model [RRBM] as an alternative model for adolescent HIV risk reduction and sexual behavior change in Northern Malawi. PLoS One 2021; 16:e0258527. [PMID: 34665811 PMCID: PMC8525741 DOI: 10.1371/journal.pone.0258527] [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: 06/09/2020] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
We sought to assess stakeholder acceptability of a risk reduction behavioural model [RRBM] designed for adolescent HIV risk reduction and whose efficacy we tested in selected schools in Northern Malawi. We used qualitative procedures in sampling, data collection and data analysis. Our data collection instrument was the semi-structured interview and we applied thematic content analysis to establish stakeholder evaluations of the RRBM model. The study population included10 experts working within key organizations and teachers from two schools. The organizations were sampled as providers, implementers and designers of interventions while schools were sampled as providers and consumers of interventions. Individual study participants were recruited purposively through snowball sampling. Results showed consensus among participants on the acceptability, potential for scale up and likelihood of model sustainability if implemented. In essence areas to consider improving and modifying included: focus on the rural girl child and inclusion of an economic empowerment component to target the underlying root causes of HIV risk taking behavior. Stakeholders also recommended intervention extension to out of school adolescent groups as well as involvement of traditional leaders. Involvement of parents and religious leaders in intervention scale up was also highlighted. The study serves as a benchmark for stakeholder involvement in model and intervention evaluation and as a link between researchers and project implementers, designers as well as policy makers to bridge the research to policy and practice gap.
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Affiliation(s)
- Marisen Mwale
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Education Foundations, Mzuzu University, Mzuzu, Malawi
| | - Adamson S. Muula
- Department of Public Health, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Africa Center of Excellence in Public Health and Herbal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Mcharo RD, Mayaud P, Msuya SE. Where and how do young people like to get their sexual and reproductive health (SRH) information? Experiences from students in higher learning institutions in Mbeya, Tanzania: a cross-sectional study. BMC Public Health 2021; 21:1683. [PMID: 34530796 PMCID: PMC8444543 DOI: 10.1186/s12889-021-11728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sexual and reproductive health (SRH) among young adults in low- and middle-income countries (LMIC) is still a major public health challenge. Early school-based sexuality education programs and sexual health information sharing between teachers, parents and young people have been considered protective against the sexual health risks to which young people are exposed. There is, however, limited information on the preferred choices of “where”, “how” and “from whom” young people would like to receive SRH information. We aimed to describe the experience and preferences of young people regarding their SRH education and learning and in particular communication with their parents/guardians. Methods We conducted a cross-sectional study among randomly selected students aged 18-24y attending Higher Learning Institutions (HLIs) in Mbeya, Tanzania. We used a self-administered questionnaire to collect information on SRH education received, ability to discuss SRH matters with a parent/guardian and SRH information gaps encountered during their early sexual experience. Results We enrolled 504 students from 5 HLIs, of whom 446 (88.5%) reported to be sexually active, with mean age at sexual debut of 18.4y (SD 2.2). About 61% (307/504) of the participants found it difficult to discuss or did not discuss SRH matters with their parent/guardian while growing up. Learning about SRH matters was reported from peers (30.2%) and teacher-led school curriculum (22.7%). There was a strong gender-biased preference on SRH matters’ discussions, female and male participants preferred discussions with adults of their respective sex. Peers (18.2%), media (16.2%) and schools (14.2%) were described as the preferred sources of SRH information. On recalling their first sexual experience, sexually-initiated participants felt they needed to know more about sexual feelings, emotions and relationships (28.8%), safer sex (13.5%), how to be able to say ‘No’ (10.7%) and how to use a condom correctly (10.2%). Conclusion Young people have a gender preference when it comes to learning about SRH matters from their parents; however, such conversations seldom occur. Community health education should focus on building skills of parents on parent-child communication on SRH matters so as to empower them to confidently initiate and convey accurate SRH information. Comprehensive SRH education and skills building need to be strengthened in the current school SRH curriculum in order to meet the demand and needs of students and increase the competence of teachers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11728-2.
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Affiliation(s)
- Ruby Doryn Mcharo
- National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sia E Msuya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
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66
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Beebwa E, Muzoora C, Ashaba S, Groves S, Atwine F. Knowledge, attitude, and preferred strategies towards HIV/AIDS prevention among adolescents attending secondary schools in South Western Uganda. Afr Health Sci 2021; 21:1067-1073. [PMID: 35222568 PMCID: PMC8843285 DOI: 10.4314/ahs.v21i3.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, HIV/AIDS continues to rise among adolescents. Ugandan studies have examined knowledge and attitudes regarding HIV/AIDS among adult populations. This study specifically paid attention to this particular age group of adolescents 12-19 years. AIM To explore HIV knowledge and attitudes among adolescents attending secondary schools Mbarara Uganda. METHODS A qualitative descriptive study was conducted in three secondary schools in South Western Uganda. Forty eight (48) adolescents with age range between 12-19 years were purposively recruited in the study. Data were collected from six focus groups and analyzed thematically. Ethical approval received from MUST (#05/10-17) and UNSCT (#SS4535) review committees. RESULTS Four themes emerged: Knowledge about HIV, sources of information, attitudes towards persons with HIV and prevention strategies. Most adolescents had the basic knowledge of HIV from multiple sources like social media, health workers, peers, and parents. Their attitudes toward individuals with HIV included compassion, shock, and uneasiness. Participants suggested prevention programs to be implemented in the schools emphasizing HIV education, life skills, sex education and the formation of peer groups. CONCLUSIONS The findings showed that most participants had knowledge about HIV and how it can be prevented however few had knowledge gap thinking that HIV does not exist.
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Ramírez-Villalobos D, Monterubio-Flores EA, Gonzalez-Vazquez TT, Molina-Rodríguez JF, Ruelas-González MG, Alcalde-Rabanal JE. Delaying sexual onset: outcome of a comprehensive sexuality education initiative for adolescents in public schools. BMC Public Health 2021; 21:1439. [PMID: 34289834 PMCID: PMC8296525 DOI: 10.1186/s12889-021-11388-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A common risk behavior in adolescence is the early initiation of unprotected sex that exposes adolescents to an unplanned pregnancy or sexually transmitted infections. Schools are an ideal place to strengthen adolescents' sexual knowledge and modify their behavior, guiding them to exercise responsible sexuality. The purpose of this article was to evaluate the knowledge of public secondary school teachers who received training in comprehensive education in sexuality (CES) and estimate the counseling's effect on students' sexual behavior. METHODS Seventy-five public school teachers were trained in participatory and innovative techniques for CES. The change in teacher knowledge (n = 75) was assessed before and after the training using t-tests, Wilcoxon ranks tests and a Generalized Estimate Equation model. The students' sexual and reproductive behavior was evaluated in intervention (n = 650) and comparison schools (n = 555). We fit a logistic regression model using the students' sexual debut as a dependent variable. RESULTS Teachers increased their knowledge of sexuality after training from 5.3 to 6.1 (p < 0.01). 83.3% of students in the intervention school reported using a contraceptive method in their last sexual relation, while 58.3% did so in the comparison schools. The students in comparison schools were 4.7 (p < 0.01) times more likely to start sexual initiation than students in the intervention schools. CONCLUSION Training in CES improved teachers' knowledge about sexual and reproductive health. Students who received counseling from teachers who were trained in participatory and innovative techniques for CES used more contraceptive protection and delayed sexual debut.
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Affiliation(s)
- Dolores Ramírez-Villalobos
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Eric Alejandro Monterubio-Flores
- Center for Health and Nutrition Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Tonatiuh Tomás Gonzalez-Vazquez
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Juan Francisco Molina-Rodríguez
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Ma. Guadalupe Ruelas-González
- Center for Evaluation and Survey Research, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, 62100 Cuernavaca, Morelos México
| | - Jacqueline Elizabeth Alcalde-Rabanal
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
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Kågesten AE, Pinandari AW, Page A, Wilopo SA, van Reeuwijk M. Sexual wellbeing in early adolescence: a cross-sectional assessment among girls and boys in urban Indonesia. Reprod Health 2021; 18:153. [PMID: 34284792 PMCID: PMC8290574 DOI: 10.1186/s12978-021-01199-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Early adolescence (ages 10–14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights (SRHR). Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages 10–14 years in Indonesia. Methods Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N = 4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. SRHR knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by sex using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic relationship status, and sexual activities. Results The mean age of students was 12 years (53% girls); 90% had started puberty. SRHR knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of guilt in relation to sexuality, but also to have experienced physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater perceived self-efficacy to say ‘no’, and to report being bullied by boys. In multivariable models, romantic relationship experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing. Conclusions While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01199-4. Ages 10–14 years, known as early adolescence, is a fundamental time when young people become increasingly aware of their bodies, gender and sexuality. Yet, little is known about positive or healthy aspects of sexuality development during this period of life, as most studies tend to focus on risky outcomes such as teenage pregnancy and sexually transmitted infections. In this study, we conducted a survey with primary school students aged 10–14 years in Indonesia, asking them about sexual wellbeing from a broad sense, such as their body image and knowledge about sexual and reproductive health and rights. We analyzed responses from 4309 participants using statistical methods and compared the results between boys and girls. We found that misconceptions, feelings of guilt and lack of knowledge related to sexual and reproductive health were common, with clear differences between boys and girls. Our study provides new information about healthy sexuality development in an Asian setting where young people’s sexual and reproductive health is often considered taboo. The results can be used to guide programs and research to improve sexual and reproductive health and rights in Indonesia and other low-income settings. In particular, comprehensive sexuality education may play an important role to support sexual wellbeing by providing factual and age-appropriate information as young people grow up.
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Affiliation(s)
- Anna E Kågesten
- Global and Sexual Health, Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden.
| | | | | | - Siswanto Agus Wilopo
- Center for Reproductive Health, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Asaolu I, Kram N, Ajala C, Aquaisua E, Asaolu A, Kato-Lagumbay K, Abuh A, Bernand M, Ehiri J. “Antibiotics Can Work as a Contraceptive:” Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:665653. [PMID: 36303954 PMCID: PMC9580625 DOI: 10.3389/frph.2021.665653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria. Methods: This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8). Results: University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust. Conclusion: Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.
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Affiliation(s)
- Ibitola Asaolu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Ibitola Asaolu
| | - Nidal Kram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Christopher Ajala
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ememobong Aquaisua
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Akinsola Asaolu
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kylie Kato-Lagumbay
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Alice Abuh
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Moses Bernand
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Kotkowski E, Realini J, Cisneros V, Rosenfeld J, Berggren R, Gafas Gonzalez C, Kneese G. The Pedagogy of Pedagogues for Sexual Education in Riobamba, Ecuador: A Pilot Approach to Training Sexual Education Facilitators in a Latin American and Spanish Language Setting. SEX EDUCATION 2021; 22:289-303. [PMID: 35756501 PMCID: PMC9216198 DOI: 10.1080/14681811.2021.1926961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2021] [Indexed: 06/15/2023]
Abstract
Educational efforts to reduce global rates of adolescent pregnancy vary widely with a significant deficiency found in the domain of sex education facilitator training. In this study, we sought to establish a pilot approach to comprehensive sex education facilitator training as applied in Riobamba, Ecuador. The approach was aligned with UNESCO recommendations for training facilitators using an adapted version of the U.S.-based Big Decisions curriculum. Four internationally recruited bilingual instructors led a six-day (27-hour) intensive training-of-facilitators programme with twenty trainees using the Big Decisions sex education curriculum. Quantitative and qualitative analyses were conducted using various approaches: anonymised and pre/post-self-assessments, daily feedback surveys of self and instructors, and facilitation practice evaluations. Responses to anonymised surveys indicated improved self-perceived confidence in teaching each curriculum section. More objective pre- and post-teach-back evaluations showed improved ability to teach randomly assigned lessons as assessed by trainers. The pedagogy of facilitator training in comprehensive sex education seeks to combine evidence-informed and culturally appropriate approaches to training facilitators under unique local conditions using adapted assessment tools. This project revealed important culturally relevant insights that would be beneficial to the future training of comprehensive sex education facilitators working within culturally conservative communities, and Latin America in particular.
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Affiliation(s)
- Eithan Kotkowski
- Center for Medical Humanities and Ethics, Global Health Division, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Valeria Cisneros
- Cacha Medical Spanish Institute, Riobamba, Chimborazo Province, Ecuador
| | - Jason Rosenfeld
- Center for Medical Humanities and Ethics, Global Health Division, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ruth Berggren
- Center for Medical Humanities and Ethics, Global Health Division, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Garrett Kneese
- Center for Medical Humanities and Ethics, Global Health Division, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Cacha Medical Spanish Institute, Riobamba, Chimborazo Province, Ecuador
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Maina BW, Juma K, Igonya EK, Osindo J, Wao H, Kabiru CW. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044398. [PMID: 34020975 PMCID: PMC8144038 DOI: 10.1136/bmjopen-2020-044398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years. METHODS AND ANALYSIS We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature. ETHICS AND DISSEMINATION Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
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Affiliation(s)
- Beatrice W Maina
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Kenneth Juma
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
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Newman PA, Prabhu SM, Akkakanjanasupar P, Tepjan S. HIV and mental health among young people in low-resource contexts in Southeast Asia: A qualitative investigation. Glob Public Health 2021; 17:1200-1214. [PMID: 33977867 DOI: 10.1080/17441692.2021.1924822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Young people aged 15-24 years comprise one-fourth of incident HIV infections in Southeast Asia. Given the high prevalence and impact of mental health issues among young people, we explored intersections of HIV and mental health, with a focus on adolescent and young key populations (AYKP) in Indonesia, the Philippines, Thailand, and Vietnam. Sixteen focus group discussions (4/country) with young people (n = 132; 16-24 years) and 41 key informant interviews with multisectoral HIV experts explored young people's lived experiences and unmet needs, existing programmes, and strategic directions for local and regional HIV responses. Cross-cutting challenges emerged in healthcare, family, school, and peer domains amid fragmented and under-resourced HIV and mental health services in socio-politically fraught environments. We identified strategic opportunities and initiatives in development and integration of youth-friendly HIV and mental health services; programmes to promote parent-adolescent communication about sex and HIV; and teacher training and resources to advance HIV and mental health awareness, serve as first-responders, and provide community referrals. Youth-led peer education programmes and LGBT-networks were central to the HIV response-promoting HIV prevention, sexual health, and mental health awareness for young people, and resilience and socioeconomic empowerment of peer educators themselves-thereby transforming sociocultural and political contexts of vulnerability.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,VOICES-Thailand Foundation, Chiang Mai, Thailand
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Martí L, Castarlenas E, Solé E, de la Vega R, Miró J. Video-based Pain Education in Schools: A Study With Adolescents. Clin J Pain 2021; 37:199-205. [PMID: 33290347 DOI: 10.1097/ajp.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE School-based educational programs have shown positive changes in health-related behaviors among adolescents. The aim of this study was to analyze the changes in pain-related knowledge among adolescents and in the use of positive responses to their peers' pain behaviors after watching a brief educational video. METHODS One hundred and thirty-five adolescents (mean age=13.27; SD=1.17) participated and provided demographic and pain-related information. They also responded to a pain-related knowledge questionnaire before (T1), after (T2), and 1 month after (T3) watching a brief pain educational video, and to a modified version of the Inventory of Parent/Caregiver Responses to the Children's Pain Experience at T1 and at T3. RESULTS There was a significant increase in pain knowledge for all participants between T1 and T2 (η2p=0.73) and between T1 and T3 (η2p=0.62). An increase in responses considered to be positive to peers' pain behaviors (ie, the promotion of well-behaviors and coping responses) 1 month after watching the educational video was also found. Interestingly, these results were not associated with the chronic pain status of the participant. DISCUSSION The findings showed that a brief and inexpensive educational video-based intervention in schools helps to increase pain-related knowledge and change responses to students with chronic pain. This has the potential to prevent chronic pain and related disability among students, and decrease bullying-like behaviors toward students with chronic pain.
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Affiliation(s)
- Lorena Martí
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili
- Department of Psychology, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili
- Department of Psychology, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili
- Department of Psychology, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | | | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili
- Department of Psychology, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
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Intimate Relationships as Perceived by Adolescents: Concepts and Meanings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052256. [PMID: 33668758 PMCID: PMC7956711 DOI: 10.3390/ijerph18052256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
Adolescence is a period of great changes and the assumption of risk behaviours at the level of sexuality may have implications for health and well-being. Nowadays, adolescents live free from constraints and prioritise freedom, using their own terminology to label their relationships, it becoming in turn important to conceptualise intimacy relationships from their perspective. Therefore, a qualitative, descriptive, and exploratory study was performed. Participants included 109 adolescents aged 14 and 18 years old from public schools in central Portugal. Data were collected using 12 focus groups and a content analysis was undertaken. These terms attributed to intimate relationships by adolescents are, for the most part, mutual for both genders: crush, friendzone, friends with benefits, making out, dating, and similar in terms of meaning. In an intimate relationship, adolescents give priority to factors such as respect, trust, and love. The fear of loneliness, obsession, and low self-esteem are reasons pointed out by adolescents for maintaining an unhealthy intimate relationship. Adolescents’ knowledge of language about their intimate relationships is essential to establish effective communication and to build intervention programs in the healthy intimacy relationships field.
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Akseer N, Mehta S, Wigle J, Chera R, Brickman ZJ, Al-Gashm S, Sorichetti B, Vandermorris A, Hipgrave DB, Schwalbe N, Bhutta ZA. Non-communicable diseases among adolescents: current status, determinants, interventions and policies. BMC Public Health 2020; 20:1908. [PMID: 33317507 PMCID: PMC7734741 DOI: 10.1186/s12889-020-09988-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-based conceptual framework, and highlights pathways between risk factors and interventions to NCD development during adolescence (ages 10-19 years) and continuing into adulthood. Additionally, the epidemiologic profile of key NCD risk factors and outcomes among adolescents and preventative NCD policies/laws/legislations are examined, and a multivariable analysis is conducted to explore the determinants of NCDs among adolescents and adults. METHODS We reviewed literature to develop an adolescent-specific conceptual framework for NCDs. Global data repositories were searched from Jan-July 2018 for data on NCD-related risk factors, outcomes, and policy data for 194 countries from 1990 to 2016. Disability-Adjusted Life Years were used to assess disease burden. A hierarchical modeling approach and ordinary least squares regression was used to explore the basic and underlying causes of NCD burden. RESULTS Mental health disorders are the most common NCDs found in adolescents. Adverse behaviours and lifestyle factors, specifically smoking, alcohol and drug use, poor diet and metabolic syndrome, are key risk factors for NCD development in adolescence. Across countries, laws and policies for preventing NCD-related risk factors exist, however those targeting contraceptive use, drug harm reduction, mental health and nutrition are generally limited. Many effective interventions for NCD prevention exist but must be implemented at scale through multisectoral action utilizing diverse delivery mechanisms. Multivariable analyses showed that structural/macro, community and household factors have significant associations with NCD burden among adolescents and adults. CONCLUSIONS Multi-sectoral efforts are needed to target NCD risk factors among adolescents to mitigate disease burden and adverse outcomes in adulthood. Findings could guide policy and programming to reduce NCD burden in the sustainable development era.
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Affiliation(s)
- N. Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S. Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - J. Wigle
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - R. Chera
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - Z. J. Brickman
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - S. Al-Gashm
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - B. Sorichetti
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A. Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Canada
| | | | | | - Z. A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Wangamati CK. Comprehensive sexuality education in sub-Saharan Africa: adaptation and implementation challenges in universal access for children and adolescents. Sex Reprod Health Matters 2020; 28:1851346. [PMID: 33295853 PMCID: PMC7887764 DOI: 10.1080/26410397.2020.1851346] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cynthia Khamala Wangamati
- Researcher, Department of Community Medicine & Global Health, Faculty of Medicine, University of Oslo, Blindern 0318 Oslo, Norway
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Owino L, Wangong’u A, Were N, Maleche A. The missing link in Kenya's universal health coverage experiment: a preventive and promotive approach to SRHR. Sex Reprod Health Matters 2020; 28:1851347. [PMID: 33393897 PMCID: PMC7887766 DOI: 10.1080/26410397.2020.1851347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This paper explores the universal health coverage (UHC) roll-out process in Kenya through the lens of its potential to progressively realise the constitutional promise of sexual and reproductive health and rights (SRHR) in Kenya. We argue that SRHR requires significant attention to be paid to preventive and promotive approaches to health and that this requires interrogation of barriers around access to information, norms, and legal and policy frameworks. We then unpack the UHC process in Kenya, its genesis, development and eventual roll-out, focusing on the essential benefits package and its components. We argue that a process of democratic priority-setting cognisant of equity, non-discrimination and transparency will better deliver on an essential benefits package for access to SRHR that is legitimate and acceptable. As a result, we submit that Kenya's UHC process fails to take cognisance of the weight placed on sexual and reproductive health in our Constitution and fails to address historical inequities around accessing health services.
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Affiliation(s)
- Lisa Owino
- Health, Governance and Accountability Advocate, Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Annette Wangong’u
- Health Governance Consultant, Initiative for Strategic Litigation in Africa, Nairobi, Kenya
| | - Nerima Were
- Acting Deputy Executive Director, KELIN, Nairobi, Kenya; Tutorial Fellow, University of Nairobi, Kenya
| | - Allan Maleche
- Executive Director, KELIN, Nairobi, Kenya; Member of the UNAIDS Human Rights Reference Group
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Saran A, White H, Albright K, Adona J. Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1116. [PMID: 37018457 PMCID: PMC8356294 DOI: 10.1002/cl2.1116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. OBJECTIVES The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). METHODS Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). RESULTS We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. CONCLUSION Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.
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Affiliation(s)
| | | | | | - Jill Adona
- Philippines Institute of Development StudiesManilaPhilippines
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Aslan F. School-Based Sexual Health Education for Adolescents in Turkey: A Systematic Review. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:135-143. [PMID: 33236668 DOI: 10.1177/0272684x20974546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is, identifying school-based intervention studies that are made regarding the Sexual Heath Education in Turkey and are reviewing systematically. Peer-reviewed articles and thesis in Turkey were systematically searched from online databases. Studies that passed the inclusion criteria were qualitatively assessed. Six studies met the inclusion criteria. All studies showed that positive results were achieved at the end of the training. In the case of six studies, the method of expression was chosen as the training method, and only one study included the peer education method. Only one study included the social dimension of sexual health. None of the studies did report longitudinal outcomes. The negative attitudes towards sexual health education and hidden cultural resistance are, unfortunately, the main reasons for this. Considering the potential for the young population in Turkey, the number of school-based sexual health education should be increased, and educational content should be enriched.
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Affiliation(s)
- Funda Aslan
- Public Health Nursing Department, Health Sciences Faculty, Çankırı Karatekin University, Çankırı, Turkey
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The paradox of HIV prevention: did biomedical prevention trials show how effective behavioral prevention can be? AIDS 2020; 34:2007-2011. [PMID: 32910064 DOI: 10.1097/qad.0000000000002682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Speizer IS, Mandal M, Xiong K, Makina N, Hattori A, Durno D. Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa. BMC Public Health 2020; 20:1542. [PMID: 33054742 PMCID: PMC7556937 DOI: 10.1186/s12889-020-09640-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Young people under age 25 years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17 years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes. METHODS This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education's revised scripted lesson plans for the HIV and sexual content of a "life orientation" curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use). RESULTS At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6 years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort. CONCLUSIONS We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation. TRIAL REGISTRATION This study has been registered at ClinicalTrials.gov . The trial registration number is: NCT04205721 . The trial was retrospectively registered on December 18, 2019.
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Affiliation(s)
- Ilene S Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Khou Xiong
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Ndinda Makina
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Aiko Hattori
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA
| | - Darryn Durno
- SADC Research Centre, Cape Town, South Africa, USA
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Campero L, Cruz-Jiménez L, Estrada F, Suárez-López L, de Castro F, Villalobos A. “I Matter, I Learn, I Decide”: An Impact Evaluation on Knowledge, Attitudes, and Rights to Prevent Adolescent Pregnancy. J Prim Prev 2020; 42:343-361. [DOI: 10.1007/s10935-020-00609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
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83
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Flood T, Wilson IM, Prue G, McLaughlin M, Hughes CM. Impact of school-based educational interventions in middle adolescent populations (15-17yrs) on human papillomavirus (HPV) vaccination uptake and perceptions/knowledge of HPV and its associated cancers: A systematic review. Prev Med 2020; 139:106168. [PMID: 32603795 DOI: 10.1016/j.ypmed.2020.106168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/25/2022]
Abstract
The American Academy of Paediatrics (AAP) divides adolescence into early (12-14 years), middle (15-17 years), and late (18-21 years) stages. School-based HPV educational interventions are largely directed at parents of early adolescents at the time of vaccination. As the average age of first sexual intercourse in high income countries is 15-17 years old, a second educational intervention for middle adolescents could have a strong impact on HPV prevention, providing an opportunity for self-consenting to HPV vaccination in many countries. This paper appraises literature exploring the impact of school-based educational interventions in 15-17 year olds, on HPV vaccination uptake and/or perceptions/knowledge of HPV and its associated cancers. Randomised controlled trials (RCTs) and quasi-experimental designs (QEDs) (2007-2019) were included if they delivered a school-based educational intervention for 15-17 year olds, and the outcome measures included HPV vaccination uptake, knowledge of HPV and associated cancers or perception/attitude regarding self-protection against HPV. Fifteen studies met the inclusion criteria and were assessed for quality using the Quality Assessment Tool for Quantitative Studies. All studies demonstrated a statistically significant improvement in at least one major outcome measure post-intervention, despite the wide range in design of interventions, though only three studies actually measured changes to HPV vaccination uptake. Stakeholder engagement was absent in most intervention designs and many were not grounded in evidenced theory. Content was largely focused on female cervical cancer, rarely discussing oropharyngeal cancer, the most pre-dominant HPV-associated cancer in men. An optimal mixed gender intervention remains to be established for middle adolescents.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Ulster University, Jordanstown, United Kingdom.
| | - Iseult M Wilson
- School of Nursing and Midwifery, Queen's University Belfast, United Kingdom.
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast, United Kingdom.
| | | | - Ciara M Hughes
- Institute of Nursing and Health Research, Ulster University, Jordanstown, United Kingdom.
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84
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Fantaye AW, Buh AW, Idriss-Wheeler D, Fournier K, Yaya S. Effective educational interventions for the promotion of sexual and reproductive health and rights for school-age children in low- and middle-income countries: a systematic review protocol. Syst Rev 2020; 9:216. [PMID: 32948251 PMCID: PMC7500715 DOI: 10.1186/s13643-020-01464-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biological changes underlying the sexual and reproductive maturation of school-age children are linked with various sexual and reproductive health and rights risks. SRHR risks are predictors of poor SRHR outcomes, such as poor knowledge of sexually transmitted diseases and early sexual initiation occurring predominantly among school-age children. The aim of this proposed review, therefore, is to identify educational interventions that have proven to be effective in promoting or supporting the sexual and reproductive health and rights of school-aged children in low- and middle-income countries. METHODS A systematic review of studies on the strategies promoting the SRHR of school-aged children shall be conducted. Electronic searches will be conducted from January 2000 onwards on the following databases: MEDLINE(R) ALL (Ovid), Embase (Ovid), CINAHL (EBSCOHost), APA PsycInfo (Ovid), ERIC (Ovid), Cochrane Central Register of Controlled Trials (Ovid), Education Source (EBSCOHost), Web of Science (Clarivate Analytics), SciELO Citation Index (Clarivate Analytics), Global Health (Ovid), and Sociological Abstract (Proquest). Studies eligible for inclusion will be randomized control trials (RCTs), non-randomized trials, quasi-experimental studies (e.g., pre-post tests), and observational studies (cross-sectional and cohort studies). Peer-reviewed studies published in English and/or French and involving school-aged children 5-10 years old will be included. The primary outcomes of interest will include knowledge, awareness, or attitudes about SRHR topics. The secondary outcomes of interest will include sexual and reproductive behaviors. Two reviewers will independently screen all citations, abstract data, and full-text articles, and the methodological quality of each study will be appraised using JBI critical appraisal tools. A narrative synthesis of extracted data will be conducted. DISCUSSION The systematic review will synthesize the evidence on existing educational interventions targeting SRHR outcomes of school-aged children in low- and middle-income countries. It will identify which interventions have proven to be effective, and which interventions have not proven to be effective in promoting or supporting their SRHR. Review findings will provide a useful reference for policy-makers, program developers, global health leaders, and decision makers who wish to support the SRHR of school-age children. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42020173158).
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Affiliation(s)
- Arone Wondwossen Fantaye
- Interdisciplinary School of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4 Canada
| | - Amos Wung Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4 Canada
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4 Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Oxford University, Oxford, UK
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Rönn MM, Dunville R, Wang LY, Bellerose M, Malyuta Y, Menzies NA, Aslam M, Lewis F, Walker-Baban C, Asbel L, Parchem S, Masinter L, Perez E, Gift TL, Hsu K, Barrios LC, Salomon JA. Mathematical modeling study of school-based chlamydia screening: potential impact on chlamydia prevalence in intervention schools and surrounding communities. BMC Public Health 2020; 20:1363. [PMID: 32891137 PMCID: PMC7487537 DOI: 10.1186/s12889-020-09466-y] [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: 01/22/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions. Methods A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation. Results In the modeled Philadelphia program, prevalence among the intervention schools’ sexually active 15–18 years old population was 4.34% (95% credible interval 3.75–4.71%)after 12 program years compared to 5.03% (4.39–5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60–7.88%) after 4 program years compared to 7.00% (3.08–9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time. Conclusions Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.
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Affiliation(s)
- Minttu M Rönn
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Richard Dunville
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meghan Bellerose
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Yelena Malyuta
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Maria Aslam
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionPrevention, Atlanta, USA
| | - Felicia Lewis
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA.,STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Cherie Walker-Baban
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Lenore Asbel
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sarah Parchem
- Bureau of Maternal, Infant, Child, and Adolescent Health, Chicago Department of Public Health, Chicago, USA
| | - Lisa Masinter
- Bureau of Maternal, Infant, Child, and Adolescent Health, Chicago Department of Public Health, Chicago, USA
| | - Ernestina Perez
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, USA
| | - Tom L Gift
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Katherine Hsu
- Division of STD Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Salomon
- Center for Health Policy / Center for Primary Care and Outcomes Research, Stanford University, Stanford, USA
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Agbadi P, Nutor JJ, Darkwah E, Duah HO, Duodu PA, Alhassan RK, Baltzell K. Covariates and Spatial Interpolation of HIV Screening in Mozambique: Insight from the 2015 AIDS Indicator Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165630. [PMID: 32764221 PMCID: PMC7460053 DOI: 10.3390/ijerph17165630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023]
Abstract
We examined the factors associated with human immunodeficiency virus (HIV) screening and developed a HIV screening prevalence surface map using spatial interpolation techniques to identify the geographical areas with the highest and lowest rates of HIV screening in Mozambique. We analyzed the cross-sectional 2015 Mozambique AIDS Indicator Surveys with an analytic sample of 12,995 participants. Analyses were conducted on SPSS-21, STATA-14, and R freeware 3.5.3. We adjusted for the sample design and population weights. Results indicated that 52.5% of Mozambicans had undergone HIV screening. Mozambicans with these characteristics have a higher probability of undergoing HIV screening: females, those with a primary education or higher, urban dwellers, residents of wealthy households, having at least one lifetime sexual partner, and dwelling in these provinces—Niassa, Tete, Manica, Sofala, Inhambane, Gaza, Maputo Provincia, and Maputo Cidade. The spatial map revealed that the national and regional estimates mask sub-regional level estimates. Generally, zones with the highest HIV screening prevalence are found in southern provinces while the lowest prevalence was found in the northern provinces. The map further revealed intraregional differences in HIV screening estimates. We recommend that HIV screening be expanded, with equitable screening resource allocations that target more nuanced areas within provinces which have a low HIV screening prevalence.
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Affiliation(s)
- Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
- Correspondence:
| | - Ernest Darkwah
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Ghana;
| | | | | | - Robert Kaba Alhassan
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana;
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
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Marí-Ytarte R, Moreno-López R, Barranco-Barroso R. Sex and Relationship Education for the Autonomy and Emotional Well-Being of Young People. Front Psychol 2020; 11:1280. [PMID: 32636785 PMCID: PMC7317018 DOI: 10.3389/fpsyg.2020.01280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
In the transition to adulthood, sexuality and emotional relationships constitute one of the most important dimensions for the achievement of personal autonomy and emotional well-being. Despite advances in sex education, sexuality, and relationships remain conflictive areas in the development of young people. Inequalities between men and women, gender identities and sexual violence, along with the beliefs and expectations surrounding these issues, persist as handicaps to having a fulfilling relationship and sex life. At this stage, emotional well-being is also consolidated by one’s perception of sexuality and relationships from models learned in childhood, in which gender stereotypes and sexuality based on relationships of domination and discrimination persist. Therefore, we examined how the sexual beliefs and practices reported by young people correlate with their level of personal autonomy and responsibility in terms of risky behaviors and toxic relationships. The study shows the extent to which sexual beliefs and habits are linked to decision-making, personal development and social problems derived from conflictive relationships, affecting young people’s overall well-being. A questionnaire was developed based on the theoretical constructs of comprehensive sexuality and equality education (United Nations Educational Scientific and Cultural Organization [UNESCO], 2010, 2018; World Health Organization [WHO], 2010) with the following dimensions: sex education, sexual habits and practices, motivations, concepts, and beliefs about sexuality. It was distributed in institutions of higher education (N579) in Spain, Portugal, Argentina, and Brazil, and the results revealed a discrepancy between the reported practices and behaviors and the beliefs and models of reference. Key issues included sexuality and relationships as an aspect of personal life that generates confusion and conflict, as well as the propagation of gender and sexist stereotypes that influence young people’s emotional well-being, particularly important aspect in those young people who are training as future education professional.
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Affiliation(s)
- Rosa Marí-Ytarte
- Department of Pedagogy, University of Castilla-La Mancha, Education and Society Research Group (GIES), Talavera de la Reina, Spain
| | - Roberto Moreno-López
- Department of Pedagogy, University of Castilla-La Mancha, Education and Society Research Group (GIES), Talavera de la Reina, Spain
| | - Rut Barranco-Barroso
- Department of Pedagogy, University of Castilla-La Mancha, Education and Society Research Group (GIES), Talavera de la Reina, Spain
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88
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Russell S, Mallory A, Bishop M, Dorri A. Innovation and Integration of Sexuality in Family Life Education. FAMILY RELATIONS 2020; 69:595-613. [PMID: 34588714 PMCID: PMC8478349 DOI: 10.1111/fare.12462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 05/09/2020] [Indexed: 05/25/2023]
Abstract
As a fundamental aspect of the human experience, sexuality is experienced at every stage in the lifespan. Sexual values, behaviors, and health are important components of individual and family well-being. Educating about such a fundamental aspect of life is both obvious and crucial. In this article, we consider the potential of sexuality education in the field and profession of family life education (FLE). We critique sexuality education in the United States, and we critique the marginal place of human sexuality in the FLE field. We then offer recommendations for incorporating lifespan, socio-ecological, family systems and intersectionality into sexuality education, and recommendations for FLE and sexuality education research and practice. We argue that educating about sexuality in the context of FLE-and activating the profession of FLE for sexuality education-will strategically advance sexuality education, sexual health, and the field of FLE.
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89
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Edwards T, Mkwanazi N, Mitchell J, Bland RM, Rochat TJ. Empowering parents for human immunodeficiency virus prevention: Health and sex education at home. South Afr J HIV Med 2020; 21:970. [PMID: 32670624 PMCID: PMC7343931 DOI: 10.4102/sajhivmed.v21i1.970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improving health literacy amongst human immunodeficiency virus (HIV)-positive mothers could strengthen child and adolescent HIV prevention. The Amagugu intervention included health literacy materials to strengthen maternal communication and has demonstrated success in low-resource HIV-endemic settings. OBJECTIVES Our aims were to (1) evaluate whether Amagugu materials improved health literacy leading to changes in parental behaviour towards communicating on topics such as HIV, health behaviours and sex education, and (2) explore what additional information and materials mothers would find helpful. METHOD The Amagugu evaluation included 281 HIV-positive mothers and their HIV-uninfected children (6-10 years). Process evaluation data from exit interviews were analysed using content analysis and logistic regression techniques. RESULTS Of 281 mothers, 276 (98.0%) requested more educational storybooks: 99 (35.2%) on moral development/future aspirations, 92 (32.7%) on general health, safety and health promotion, and 67 (23.8%) on HIV and disease management. Compared to baseline, mothers reported that the materials increased discussion on the risks of bullying from friends (150; 53.4%), teacher problems (142; 50.5%), physical abuse (147; 52.3%) and sexual abuse (126; 44.8%). Most mothers used the 'HIV Body Map' for health (274; 97.5%) and sex education (267; 95.0%). The use of a low-cost doll was reported to enhance mother-child communication by increasing mother-child play (264; 94.3%) and maternal attentiveness to the child's feelings (262; 93.6%). CONCLUSION Parent-led health education in the home seems feasible, acceptable and effective and should be capitalised on in HIV prevention strategies. Further testing in controlled studies is recommended.
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Affiliation(s)
- Taygen Edwards
- Africa Health Research Institute, Somkhele, South Africa
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ntombizodumo Mkwanazi
- Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanie Mitchell
- Lentegeur Psychiatric Hospital, Department of Health, Government of the Western Cape, Cape Town, South Africa
| | - Ruth M Bland
- Royal Hospital for Sick Children, Glasgow, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamsen J Rochat
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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90
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Iwelunmor J, Nwaozuru U, Obiezu-Umeh C, Uzoaru F, Ehiri J, Curley J, Ezechi O, Airhihenbuwa C, Ssewamala F. Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework. Implement Sci Commun 2020; 1:53. [PMID: 32885209 PMCID: PMC7427963 DOI: 10.1186/s43058-020-00042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. METHODS We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. RESULTS A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). CONCLUSIONS Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Florida Uzoaru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
| | - Jami Curley
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos State Nigeria
| | - Collins Airhihenbuwa
- School of Public Health, Global Research Against Noncommunicable Diseases, Georgia State University, 140 Decatur Street SE, Atlanta, GA 30303 USA
| | - Fred Ssewamala
- Brown School, Washington University in Saint Louis, 1 Brookings Drive, Saint Louis, MO 63130 USA
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91
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Vallejo-Medina P, Correa JC, Gómez-Lugo M, Saavedra-Roa DA, García-Montaño E, Pérez-Pedraza D, Niebles-Charris J, García-Roncallo P, Abello-Luque D, Espada JP, Morales A. A text mining approach for adapting a school-based sexual health promotion program in Colombia. Prev Med Rep 2020; 18:101090. [PMID: 32322460 PMCID: PMC7160447 DOI: 10.1016/j.pmedr.2020.101090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/08/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
A common practice among clinical psychologists and other health professionals is the use of school-based sexual health promotion programs as a means for preventing sexually transmitted infections. A fundamental criterion for the designing and adaptation of these programs is the age of their target populations because limited education and language are the most relevant factors that limit the efficacy of these programs. The contribution of this paper consists of assessing both the readability of the written materials that accompany the contents of a Spanish-written school-based sexual health promotion program used in Colombia, as well as the words co-occurrence network structure of its contents. The readability of the evaluated program corresponded to its intended target population aged between 14 and 19, with the schooling of 9-13 years of education. The resulting words co-occurrence network structure of the COMPAS program also mirrored its theoretical content. These results all together are deemed as empirical evidence of the adequacy of the program.
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Affiliation(s)
| | - Juan C. Correa
- Fundación Universitaria Konrad Lorenz, School of Psychology, Bogotá, Colombia
| | - Mayra Gómez-Lugo
- Fundación Universitaria Konrad Lorenz, School of Psychology, Bogotá, Colombia
| | | | | | | | | | | | | | - José Pedro Espada
- Universidad Miguel Hernandez de Elche, Health Psychology Department, Elche, Spain
| | - Alexandra Morales
- Universidad Miguel Hernandez de Elche, Health Psychology Department, Elche, Spain
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92
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Garzón-Orjuela N, Samacá-Samacá D, Moreno-Chaparro J, Ballesteros-Cabrera MDP, Eslava-Schmalbach J. Effectiveness of Sex Education Interventions in Adolescents: An Overview. Compr Child Adolesc Nurs 2020; 44:15-48. [PMID: 32048888 DOI: 10.1080/24694193.2020.1713251] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations.
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Affiliation(s)
- Nathaly Garzón-Orjuela
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Daniel Samacá-Samacá
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jaime Moreno-Chaparro
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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93
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Smith MK, Wei C, Liu C, Pan SW, Ong JJ, Tucker JD. Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:721-731. [PMID: 31571020 PMCID: PMC7035172 DOI: 10.1007/s10508-019-01481-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 06/10/2023]
Abstract
Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a "bridge population" of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. In total, 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. Model fit indicated a population structure made up of four classes that we characterized as "Gender nonconforming" (4.3%), "Closeted-unmarried" (29.9%), "Closeted-married" (24.6%), and "Out" (41.2%). Members of the "gender nonconforming" class were more likely to report HIV-related risk behaviors, and "Closeted-unmarried" class members were less likely to report health-seeking behaviors, both relative to "Out" members. The largest latent class was made up of members of the "Out" class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of "closeted" classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.
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Affiliation(s)
- M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, 1300 South 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
- University of North Carolina Project-China, Guangzhou, China.
| | - Chongyi Wei
- University of North Carolina Project-China, Guangzhou, China
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, New Brunswick, NJ, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Department of Sociology, University of California San Diego, San Diego, CA, USA
| | - Stephen W Pan
- University of North Carolina Project-China, Guangzhou, China
- Xi'an Jiatong-Liverpool University, Suzhou, China
| | - Jason J Ong
- University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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94
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Barrense-Dias Y, Akre C, Surís JC, Berchtold A, Morselli D, Jacot-Descombes C, Leeners B. Does the Primary Resource of Sex Education Matter? A Swiss National Study. JOURNAL OF SEX RESEARCH 2020; 57:166-176. [PMID: 31215800 DOI: 10.1080/00224499.2019.1626331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sex education (SE) remains a subject of debate, including controversies on resources. The purpose of this paper was to determine the main SE resource during adolescence and its associations with personal characteristics and sexual behaviors of youths. Data were obtained from a self-administrated Swiss national survey on sexuality among young adults (mean age 26.3). Participants (N = 4978) were divided into six groups according to their main SE resource during their adolescence: Friends (1939; 38.9%), Parents (1361; 27.3%), School (n = 949; 19.1%), The Internet (399; 8.0%), Nobody (172; 3.5%) and Other (157; 3.2%). Groups were compared on sociodemographic, first sexual experiences, pregnancy, risky sexual behaviors, and undesired sexual experiences data. Males and non-heterosexual participants were overrepresented in the Internet group while, females more often reported their parents as their main SE resource. Participants in the School group reported the lowest rates of sexually transmitted infections and Friends the highest. Compared to the School group, those in the Friends, Internet, Nobody, and Other groups were more likely to report undesired sexual experiences. Few differences appeared between parents and school. Even though some resources such as friends or the Internet presented negative outcomes when they were assessed individually, we cannot deny the important place that they occupy in the lives of some youths.
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Affiliation(s)
- Yara Barrense-Dias
- Research Group on Adolescent Health (GRSA), Center for Primary Care and Public Health (Unisanté), - University of Lausanne, Lausanne, Switzerland
| | - Christina Akre
- Research Group on Adolescent Health (GRSA), Center for Primary Care and Public Health (Unisanté), - University of Lausanne, Lausanne, Switzerland
| | - Joan-Carles Surís
- Research Group on Adolescent Health (GRSA), Center for Primary Care and Public Health (Unisanté), - University of Lausanne, Lausanne, Switzerland
| | - André Berchtold
- Institute of Social Sciences & Swiss Center of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
| | - Davide Morselli
- Institute of Social Sciences & Swiss Center of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
| | | | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
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95
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Irfan M, Hussain NHN, Noor NM, Mohamed M, Ismail SB. Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review. J Sex Med 2020; 17:412-430. [PMID: 31955912 DOI: 10.1016/j.jsxm.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/30/2019] [Accepted: 12/04/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Sexual activity is an essential human need and an important predictor of other aspects of human life. A literature review was conducted to investigate whether sexual abstinence in young and middle-aged men is generally considered a deliberate, healthy behavior and whether it has other causes and consequences. AIM To review the prevalence and factors associated with sexual abstinence in young (10-24 years) and middle-aged (25-59 years) men. METHODS Studies were retrieved from Science Direct, PubMed, and EBSCOhost published from 2008 to 2019. The selection criteria were original population- or community-based articles, published in the English language, on sexual abstinence, and in young and middle-aged men. MAIN OUTCOME MEASURE This article reviewed the literature on the proportions of and factors associated with sexual abstinence in young and middle-aged men. RESULTS A total of 13,154 studies were retrieved, from which data were extracted for 37 population- or community-based studies. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The prevalence of primary sexual abstinence was 3.4%-83.3% for young men and 12.5%-15.5% for middle-aged men. The prevalence of secondary abstinence for young men ranged from 1.3% to 83.6%, while for middle-aged men, it was from 1.2% to 67.7%. The prevalence of sexual abstinence decreased with increasing age in young men but increased with increasing age in middle-aged men. The significant factors reported were age, single status, poor relationships, low socioeconomic status, sex education, religious practices, caring and monitoring parents, and not using alcohol, cigarettes, or drugs. Although the variations in findings from different studies can be explained by different regions and cultures, the information cannot be generalized worldwide because of a lack of studies in Asian and Australian populations. CLINICAL IMPLICATIONS The studies on sexual abstinence in the future should use a consistent and standard definition, cover all sexual behaviors, and investigate all related factors. STRENGTH & LIMITATIONS The restricted timeframe (2008-2019), English language, availability of full text, and variability in definition and time duration may be the sources of bias. CONCLUSION Young men had higher proportions of sexual abstinence than middle-aged men, and age, unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about sexually transmitted infections were common predictors of sexual abstinence in most of the men. Although determinants of sexual abstinence were identified, further investigation of biological factors in men younger than 60 years is needed. Irfan M, Hussain NHN, Noor NM, et al. Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review. J Sex Med 2020;17:412-430.
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Affiliation(s)
- Muhammad Irfan
- Women's Health Development Unit, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Department of Zoology, Pir Mehr Ali Shah, Arid Agriculture University, Rawalpindi, Pakistan
| | - Nik Hazlina Nik Hussain
- Women's Health Development Unit, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
| | - Norhayati Mohd Noor
- Department of Family Medicine, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mahaneem Mohamed
- Department of Physiology School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Shaiful Bahari Ismail
- Department of Family Medicine, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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96
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Finlay JE, Assefa N, Mwanyika-Sando M, Dessie Y, Harling G, Njau T, Chukwu A, Oduola A, Shah I, Adanu R, Bukenya J. Sexual and reproductive health knowledge among adolescents in eight sites across sub-Saharan Africa. Trop Med Int Health 2019; 25:44-53. [PMID: 31691455 DOI: 10.1111/tmi.13332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine knowledge of menstruation, HIV and STIs other than HIV across eight sites in SSA to develop effective programmatic interventions enabling adolescents to achieve positive SRH as their transition to adulthood. METHODS We combine data from eight Health and Demographic Surveillance Sites across sub-Saharan Africa, from an adolescent-specific survey that included 7116 males and females age 10-19 years old. We provide pooled and site-specific estimates from multiple analytic models examining the how year-specific age, school attendance and work correlate with knowledge of menstruation, HIV knowledge and knowledge of sexually transmitted infections (STIs) other than HIV. RESULTS Many adolescents lack knowledge of menstruation (37.3%, 95% CI 31.8, 43.1 do not know of menstruation) and STIs other than HIV (55.9%, 95% CI 50.4, 61.3 do not know of other STIs). In multivariate analysis, older age, being in school and wealth are significant positive correlates of STI knowledge. Older adolescent age, female sex and being in school are significant positive correlates of knowledge of menstruation. Knowledge of HIV is high (89.7%, 95% CI 8.3, 12.7 know of HIV) and relatively similar across adolescent age, sex, wealth and school and work attendance. CONCLUSION Knowledge of HIV is widespread across adolescents in these communities in sub-Saharan Africa, but knowledge of other dimensions of sexual and reproductive health - menstruation and other STIs in this study - is lacking especially for early adolescents (10- to 14-year olds). The dissemination of more comprehensive sexual and reproductive health information is needed within these and similar communities in SSA to help adolescents gain insight on how to make their own decisions towards positive adolescent sexual and reproductive health and protect them from risks.
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Affiliation(s)
- Jocelyn E Finlay
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | | | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Guy Harling
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tasiana Njau
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Ayoade Oduola
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana
| | - Justine Bukenya
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
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97
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Joe-Ikechebelu NN, Azuike EC, Nwankwo BE, Ezebialu IU, Ngene WO, Eleje GU. HIV prevention cascade theory and its relation to social dimensions of health: a case for Nigeria. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:193-200. [PMID: 31686918 PMCID: PMC6709786 DOI: 10.2147/hiv.s210190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/18/2019] [Indexed: 11/23/2022]
Abstract
Background Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa. Within the last three decades, majority of HIV programs in Nigeria were treatment strategies with few prevention approaches. The persistence of HIV prevalence despite the treatment blueprint has led to a concerted call to HIV Prevention Cascade (HPC) theory which ensures continuous sophisticated interrelationship that stretches beyond the biomedical interventions of treatment. To our knowledge, there is no previous review on HPC theory in Nigerian context. Objectives The aim of this review was to explore and outline the HIV/AIDS prevention cascade theory in relation to the achievement of the global 90-90-90 target set by the United Nations Programme on HIV and AIDS and suggest possible avenues to maximize on strengths and weaknesses of HPC in Nigeria. Methods In this mini-review, the authors utilized standardized search measures in the review of published articles in credible domains across the HPC in PubMed, Research gate, Google Scholar, Mendeley Reference Manager and Cochrane Library from January 1980 to December 2018. Referenced sections of the articles identified were used to hand-search additional references not retrieved by the initial search engines. The authors performed an evaluation of selected studies on three cascade theories: epidemiological, behavioral and social science with an integration of the supply, demand and adherence sides. Results We included nine review articles reporting three different cascade theories. Only one included study applied the cascade theories exclusively in Nigerian context. We could only conduct narrative synthesis. Conclusion There is scarceness of currently published evidence on HPC in Nigerian context. HPC allows for a paradigm shift and sequential process of events to eliminate the epidemic of HIV using HIV prevention perspectives in Nigerian settings. Since data are sparse, more research is needed on HPC theory.
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Affiliation(s)
- Ngozi N Joe-Ikechebelu
- Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.,Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Emmanuel C Azuike
- Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.,Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Basil E Nwankwo
- Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.,Office of the Chief Medical Director, Chukwuemeka Odumegwu Ojukwu University, Teaching Hospital, Awka, Nigeria
| | - Ifeanyichukwu U Ezebialu
- Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.,Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Williams O Ngene
- Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.,Department of Physiotherapy, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - George U Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
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98
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Kemigisha E, Bruce K, Ivanova O, Leye E, Coene G, Ruzaaza GN, Ninsiima AB, Mlahagwa W, Nyakato VN, Michielsen K. Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda. BMC Public Health 2019; 19:1393. [PMID: 31660918 PMCID: PMC6819440 DOI: 10.1186/s12889-019-7805-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Limited research has been conducted on the effectiveness of sexuality education for very young adolescents (VYAs) ages 10–14 years in Sub-Saharan Africa. Furthermore, evaluations of sexuality education programs often report outcomes of risky sexual practices, yet positive aspects of sexuality are hardly studied and rarely reported. This study evaluates the effectiveness of a Comprehensive Sexuality Education (CSE) intervention for VYAs in Uganda, analyzing both positive and negative outcome indicators. Methods We conducted a mixed methods study, incorporating a cluster randomized trial (NCT03669913) among pupils in 33 randomly selected primary schools in Mbarara district. This was followed by a qualitative evaluation of the intervention in 4 schools that included 14 in-depth interviews and 3 focus group discussions distributed among pupils, teachers and parents. Quantitative data were analyzed using ordered logistic regression to compare differences in the change from baseline to endline between the intervention and control arms. We conducted bivariate analysis and multiple regression analysis controlling for key covariates, including age, gender, school location (rural vs urban), truancy, and orphanhood. Qualitative data were analyzed by thematic approach using ATLAS TI. Results Between July 2016 and August 2017, 1096 pupils were recruited. Outcomes were studied among 380 pupils in the intervention arm and 484 pupils in the control arm. The proportion of pupils who ever had sex increased from 9 to 12.1% in intervention compared to 5.2 to 7.4% in the control group between baseline and endline, however the differences between groups were not statistically significant. We found greater improvements in sexual and reproductive health (SRH) knowledge among intervention schools (AOR: 2.18, 95% CI: 1.66–2.86) and no significant differences in self-esteem, body image or gender equitable norms. Qualitative evidence echoes perceived SRH knowledge acquisition, increased their perception of SRH related risks, and intentions to delay sexual intercourse to prevent unwanted pregnancy, HIV and other STIs. Conclusion This study demonstrates that CSE can improve SRH knowledge and behavioral intentions among VYAs in Uganda. These results further emphasize the importance of initiating sexuality education before most adolescents have started engaging in sexual activity, enabling them to make informed decisions in the future. Trial registration NCT03669913, registered retrospectively on September 13th, 2018.
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Affiliation(s)
- Elizabeth Kemigisha
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda. .,International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katharine Bruce
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802, Munich, Germany
| | - Els Leye
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Gad N Ruzaaza
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Anna B Ninsiima
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Wendo Mlahagwa
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Viola N Nyakato
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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99
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Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya. J Acquir Immune Defic Syndr 2019; 79:296-304. [PMID: 30113403 PMCID: PMC6203425 DOI: 10.1097/qai.0000000000001826] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV. METHODS We conducted a cross-sectional biobehavioral survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N = 408), transactional sex (N = 177), or casual sex (N = 714) and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV). RESULTS The median age at first sex was 16 years (interquartile range 14-18). A total of 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex, respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 [GBV adjusted odds ratio (AOR) 1.4, 95% confidence interval (CI): 1.0 to 1.9; HIV AOR 1.9, 95% CI: 1.1 to 1.3]; before or within 1 year of menarche (GBV AOR 1.3, 95% CI: 1.0 to 1.7; HIV AOR 2.1, 95% CI: 1.3 to 3.6); and receipt of money (GBV AOR 1.9, 95% CI: 1.4 to 2.5; HIV AOR 2.0, 95% CI: 1.2 to 3.4). CONCLUSIONS HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW's trajectory of risk. HIV prevention programs should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.
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100
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Sharma MK, Anand N, Thamilselvan P, Suma N, John N, Sahu M, Chakraborty Thakur P, Baglari H, Singh P. Is porn use becoming a modality of sex education among teenagers? A case study. Asian J Psychiatr 2019; 45:18-19. [PMID: 31445305 DOI: 10.1016/j.ajp.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Manoj Kumar Sharma
- Professor of Clinical Psychology, Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, NIMHANS, Bangalore.
| | - Nitin Anand
- Associate Professor of Clinical Psychology, Department of Clinical Psychology, NIMHANS, Bangalore
| | - P Thamilselvan
- Research Scholar, Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, NIMHANS, Bangalore
| | - N Suma
- Clinical Psychologist, Department of Clinical Psychology, NIMHANS, Bangalore
| | - Nisha John
- Clinical Psychologist, Department of Clinical Psychology, NIMHANS, Bangalore
| | - Maya Sahu
- Research Scholar, Department of Nursing, NIMHANS, Bangalore
| | - Pranjali Chakraborty Thakur
- Research Scholar, Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, NIMHANS, Bangalore
| | - Happy Baglari
- Research Scholar, Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, NIMHANS, Bangalore
| | - Priya Singh
- Research Scholar, Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, NIMHANS, Bangalore
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