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Peterman A, Palermo TM, Ferrari G. Still a leap of faith: microfinance initiatives for reduction of violence against women and children in low-income and middle-income countries. BMJ Glob Health 2018; 3:e001143. [PMID: 30588347 PMCID: PMC6278915 DOI: 10.1136/bmjgh-2018-001143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amber Peterman
- Social and Economic Policy Unit, UNICEF Office of Research--Innocenti, Florence, Italy
- Department of Public Policy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tia M Palermo
- Social and Economic Policy Unit, UNICEF Office of Research--Innocenti, Florence, Italy
| | - Giulia Ferrari
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Tankard ME, Iyengar R. Economic Policies and Intimate Partner Violence Prevention: Emerging Complexities in the Literature. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:3367-3387. [PMID: 30253719 DOI: 10.1177/0886260518798354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although the question of whether economic policies serve to reduce rates of intimate partner violence (IPV) has long been raised, rigorous tests of this question have only begun to take place recently. Given the mixed evidence to date, much remains unknown about the circumstances in which a positive or negative relationship holds between changes in financial well-being and IPV. We describe an empirically based theoretical model that may link economic empowerment to IPV and that highlights research questions for further testing. This model reflects two theoretical pathways through which economic policies may reduce IPV: A program may activate social and psychological empowerment as protective factors and a program may deactivate cognitive and behavioral risk factors such as stress and substance abuse. We then consider the relevance of each of a range of economic policies and review existing experimental evidence regarding the effect of such programs on IPV. We discuss unconditional and conditional cash transfers, savings programs, microfinance and income generation programs, and economic programs combined with relationship-related training. Gaps in research on this topic and emerging complexities in the literature suggest the following three key areas that would benefit from greater research and evaluation: comparison across programs based on size and design, assessment of the returns to economic empowerment of young adults, and more evaluations in high-income countries.
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Moynihan M, Pitcher C, Saewyc E. Interventions that Foster Healing Among Sexually Exploited Children and Adolescents: A Systematic Review. JOURNAL OF CHILD SEXUAL ABUSE 2018; 27:403-423. [PMID: 29893634 DOI: 10.1080/10538712.2018.1477220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Sexual exploitation of children and adolescents is a pressing, yet largely under-recognized form of child abuse. The goals of this review were to identify interventions that have been implemented with sexually exploited children and adolescents and to better understand their effectiveness for fostering healing with this population. Our systematic search generated 4,358 publications of which 21 met our inclusion criteria. Based on their objectives and delivery, we organized the interventions into five categories: (a) focused health and/or social services, (b) intensive case management models, (c) psychoeducational therapy groups, (d) residential programs, and (e) other. Most programs were gender-specific, targeting girls and young women with just one being for boys and young men only. Studies reported on a range of outcomes including psychosocial outcomes, risky behaviors, trauma responses, mental health, protective factors, and public health outcomes. Despite differences in delivery, most of the interventions did, to some degree, appear to foster healing among sexually exploited children and adolescents. Findings from this review have implications for researchers, policy and program developers, and frontline practitioners who, through partnerships with one another, can advocate for the creation of evidence-informed, purpose-built, and thoughtfully delivered interventions.
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Affiliation(s)
- Melissa Moynihan
- a Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing , University of British Columbia , Vancouver , Canada
| | - Claire Pitcher
- a Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing , University of British Columbia , Vancouver , Canada
| | - Elizabeth Saewyc
- a Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing , University of British Columbia , Vancouver , Canada
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Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods. AIDS Behav 2018; 22:1253-1264. [PMID: 29273945 DOI: 10.1007/s10461-017-1997-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.
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Beauclair R, Dushoff J, Delva W. Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi. BMC Public Health 2018; 18:403. [PMID: 29587710 PMCID: PMC5872581 DOI: 10.1186/s12889-018-5327-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background Age disparities in sexual relationships have been proposed as a key risk factor for HIV transmission in Sub-Saharan Africa, but evidence remains inconclusive. The SIHR study, a cluster randomised trial of a cash transfer programme in Malawi, found that young women in the intervention groups were less likely to have had a sexual partner aged 25 or older, and less likely to test positive for HIV and HSV-2 at follow-up compared to control groups. We examined the hypotheses that girls in the intervention groups had smaller age differences than control groups and that large age differences were associated with relationship-level HIV transmission risk factors: inconsistent condom use, sex frequency, and relationship duration. Methods We conducted an analysis of schoolgirls in the Schooling, Income, and Health Risk (SIHR) study aged 13-22 at baseline (n = 2907). We investigated the effects of study arm, trial stage and participant age on age differences in sexual relationships using a linear mixed-effects model. Cumulative-link mixed-effects models were used to estimate the effect of relationship age difference on condom use and sex frequency, and a Cox proportional hazard model was used to estimate the effect of relationship age difference on relationship duration. We controlled for the girl’s age, number of partners, study group and study round. Results Girls receiving cash transfers, on average, had smaller age differences in relationships compared to controls, though the estimated difference was not statistically significant (− 0.43 years; 95% CI: -1.03, 0.17). The older the participant was, the smaller her age differences (− 0.67 per 4-year increase in age; 95% CI: -0.99, − 0.35). Among controls, after the cash transfers had ended the average age difference was 0.82 years larger than during the intervention (95% CI: 0.43, 1.21), suggesting a possible indirect effect of the study on behaviour in the community as a whole. Across treatment groups, larger age differences in relationships were associated with lower levels of condom use, more frequent sex, and longer relationship durations. Conclusions Cash-transfer programmes may prevent HIV transmission in part by encouraging young women to form age-similar relationships, which are characterised by increased condom use and reduced sex frequency. The benefits of these programmes may extend to those who are not directly receiving the cash. Electronic supplementary material The online version of this article (10.1186/s12889-018-5327-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roxanne Beauclair
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,The South African Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch, 7600, South Africa.
| | - Jonathan Dushoff
- Department of Biology, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.,The South African Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch, 7600, South Africa.,Center for Statistics, Hasselt University, Campus Diepenbeek, Agoralaan Building D, 3590, Diepenbeek, Belgium.,Rega Institute for Medical Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Palma DM, Orcasita LT. Considerations for the design of Human Immunodeficiency Virus (HIV) prevention programs for lesbian and bisexual women. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1807-57622016.0790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Several strategies and guidelines for HIV prevention in different population groups have been established throughout the epidemic. However, there is an urgent need to include lesbian and bisexual women (LB women) in prevention programs and address their particular health care needs. This paper discusses key aspects that must be considered in the design of HIV prevention programs oriented toward this specific population. Due to the lack of research assessing prevention strategies for LB women, these reflections emerged by reviewing literature in similar groups and by the direct work of the authors within this group. Their inclusion in the HIV prevention agenda is essential to safeguard their right to health care in terms of receiving accurate information about sexuality and health, participating in health care programs and being treated equally and without any discrimination.
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Iwelunmor J, Blackstone S, Nwaozuru U, Conserve D, Iwelunmor P, Ehiri JE. Sexual and reproductive health priorities of adolescent girls in Lagos, Nigeria: findings from free-listing interviews. Int J Adolesc Med Health 2017; 30:/j/ijamh.ahead-of-print/ijamh-2016-0105/ijamh-2016-0105.xml. [PMID: 28525320 DOI: 10.1515/ijamh-2016-0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/26/2016] [Indexed: 11/15/2022]
Abstract
Background Adolescent girls in Nigeria experience a disproportionately high burden of sexual and reproductive health disparities that affect their well-being. Yet, little is known about adolescent girls' own unique perspectives of the sexual and reproductive health challenges they face, and possible solutions to these challenges. Aims To explore top sexual and reproductive health concerns of female adolescents in Nigeria and their perceptions regarding potential solutions to these issues. Methods Eighty adolescent girls attending two public secondary schools in Lagos, Nigeria completed individual free-listing interviews. Items assessed their perceptions of the most important sexual and reproductive health issues and potential solutions to these issues at the individual and societal level. Data were analyzed using Anthropac 4.98 to sort the lists by item frequency as well as to determine Smith's salience index (S). Results The top five sexual and reproductive health concerns identified by participants were human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), followed by menstrual pain, vaginal infections, sexual abuse and teenage pregnancy. Adolescent girls stated that youth empowerment programs that provide access to skills-building opportunities and mentors was one potential strategy for addressing their sexual and reproductive health priorities. Other solutions identified were access to medical checkups, general health talks focused on their sexual and reproductive health concerns as well as access to health facilities and opportunities to build self-efficacy skills. Conclusion Adolescent girls in Nigeria need to be engaged in becoming powerful agents in improving their own sexual and reproductive health, and in crafting solutions that may be effective in enabling them to achieve their full potential and rights to health and well-being. The findings will be used to develop an intervention targeting the sexual and reproductive health priorities of adolescent girls in Lagos, Nigeria.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S.4th, Champaign, IL, 61822, USA
| | - Sarah Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ucheoma Nwaozuru
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Donaldson Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Patricia Iwelunmor
- Morning Star Health and Human Development Foundation, Festac Town, Lagos, Nigeria
| | - John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Zakaras JM, Weiser SD, Hatcher AM, Weke E, Burger RL, Cohen CR, Bukusi EA, Dworkin SL. A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1121-1133. [PMID: 27507020 PMCID: PMC5299074 DOI: 10.1007/s10508-016-0828-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 06/02/2023]
Abstract
Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and nine control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.
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Affiliation(s)
- Jennifer M Zakaras
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Abigail M Hatcher
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shari L Dworkin
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
- UCSF School of Nursing, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA.
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Gibbs A, Washington L, Willan S, Ntini N, Khumalo T, Mbatha N, Sikweyiya Y, Shai N, Chirwa E, Strauss M, Ferrari G, Jewkes R. The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics. BMC Public Health 2017; 17:336. [PMID: 28427380 PMCID: PMC5397780 DOI: 10.1186/s12889-017-4223-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/01/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Preventing intimate partner violence (IPV) remains a global public health challenge. Studies suggest urban informal settlements have particularly high levels of IPV and HIV-prevalence and these settlements are rapidly growing. The current evidence base of effective approaches to preventing IPV recognizes the potential of combining economic strengthening and gender transformative interventions. However, few of these interventions have been done in urban informal settlements, and almost none have included men as direct recipients of these interventions. METHODS Stepping Stones and Creating Futures intervention is a participatory gender transformative and livelihoods strengthening intervention. It is being evaluated through a cluster randomized control trial amongst young women and men (18-30) living in urban informal settlements in eThekwini Municipality, South Africa. The evaluation includes a qualitative process evaluation and cost-effectiveness analysis. A comparison of baseline characteristics of participants is also included. DISCUSSION This is one of the first large trials to prevent IPV and HIV-vulnerability amongst young women and men in urban informal settlements. Given the mixed methods evaluation, the results of this trial have the ability to develop a stronger understanding of what works to prevent violence against women and the processes of change in interventions. TRIAL REGISTRATION NCT03022370 . Registered 13 January 2017, retrospectively registered.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | | | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nolwazi Ntini
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Thobani Khumalo
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | | | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Giulia Ferrari
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Masa R, Chowa G. A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:324-338. [PMID: 28368779 PMCID: PMC5963720 DOI: 10.1080/19371918.2017.1289874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intrapersonal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity.
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62
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Gibbs A, Jacobson J, Kerr Wilson A. A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours. Glob Health Action 2017; 10:1290427. [PMID: 28467193 PMCID: PMC5645712 DOI: 10.1080/16549716.2017.1290427] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/31/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV. OBJECTIVE/METHODS We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours. RESULTS Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes. CONCLUSIONS The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med 2016; 168:186-197. [DOI: 10.1016/j.socscimed.2016.09.023] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023]
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Toska E, Gittings L, Hodes R, Cluver LD, Govender K, Chademana KE, Gutiérrez VE. Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2016; 15:123-40. [PMID: 27399042 PMCID: PMC5558245 DOI: 10.2989/16085906.2016.1194299] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that promote HIV prevention, and (iii) identify critical research gaps in social protection and HIV prevention, in Eastern and Southern Africa. Causal pathways of inequality, poverty, gender and HIV risk require flexible and responsive social protection mechanisms. Results confirmed that HIV-inclusive child-and adolescent-sensitive social protection has the potential to interrupt risk pathways to HIV infection and foster resilience. In particular, empirical evidence (literature and expert feedback) detailed the effectiveness of combination social protection particularly cash/in-kind components combined with "care" and "capability" among children and adolescents. Social protection programmes should be dynamic and flexible, and consider age, gender, HIV-related stigma, and context, including cultural norms, which offer opportunities to improve programmatic coverage, reach and uptake. Effective HIV prevention also requires integrated social protection policies, developed through strong national government ownership and leadership. Future research should explore which combinations of social protection work for sub-groups of children and adolescents, particularly those living with HIV.
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Affiliation(s)
- Elona Toska
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Social Sciences Building,12 University Avenue, Rondebosch, Cape Town, 7701, Western Cape, South Africa
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
| | - Lesley Gittings
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Social Sciences Building,12 University Avenue, Rondebosch, Cape Town, 7701, Western Cape, South Africa
- School of Public Health and Family Medicine, Division of Social and Behavioural Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Rebecca Hodes
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, 4.26 Leslie Social Sciences Building,12 University Avenue, Rondebosch, Cape Town, 7701, Western Cape, South Africa
| | - Lucie D. Cluver
- School of Public Health and Family Medicine, Division of Social and Behavioural Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - KE Chademana
- School of Public Health, University of the Western Cape, Private Bag X17 Bellville, Cape Town, South Africa
| | - Vincent Evans Gutiérrez
- School of Public Health and Family Medicine, Division of Social and Behavioural Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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O'Malley TL, Burke JG. A systematic review of microfinance and women's health literature: Directions for future research. Glob Public Health 2016; 12:1433-1460. [PMID: 27080539 DOI: 10.1080/17441692.2016.1170181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While growing evidence suggests that microfinance is an effective approach for improved women's health, a significant gap remains in our understanding. The objective of this review is to synthesise the findings from published literature focused on microfinance and health issues particularly affecting women, including HIV/AIDS, reproductive health, mental health, and violence. Forty-one articles that examine the impact of microfinance participation on women's health were identified through a systematic search of electronic databases, coded using a structured abstraction form, and synthesised. Review results indicate that the impact of microfinance on women's health is an area in great need of research and publication attention. Varied quality and reporting in the identified articles restricted the ability to draw concrete conclusions regarding the relationship between microfinance participation and women's health, but led to the identification of current gaps in existing published research. Future research should work to address the recommendations provided in order to offer additional evidence to better understand the use of microfinance programming as a structural intervention to improve women's health.
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Affiliation(s)
- T L O'Malley
- a Department of Behavioral and Community Health Sciences, Graduate School of Public Heath , University of Pittsburgh , Pittsburgh , PA , USA
| | - J G Burke
- a Department of Behavioral and Community Health Sciences, Graduate School of Public Heath , University of Pittsburgh , Pittsburgh , PA , USA
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66
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Fielding-Miller R, Dunkle KL, Jama-Shai N, Windle M, Hadley C, Cooper HLF. The feminine ideal and transactional sex: Navigating respectability and risk in Swaziland. Soc Sci Med 2016; 158:24-33. [PMID: 27107148 DOI: 10.1016/j.socscimed.2016.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/17/2016] [Accepted: 04/06/2016] [Indexed: 11/15/2022]
Abstract
Women who engage in transactional sex are not only at increased risk of HIV and intimate partner violence, but also face social risks including gossip and ostracism. These social and physical risks may be dependent on both what a woman expects and needs from her partner and how her community perceives the relationship. Gender theory suggests that some of these social risks may hinge on whether or not a woman's relationship threatens dominant masculinity. We conducted a qualitative study in Swaziland from September 2013 to October 2014 to explore transactional sex and respectable femininity through the lens of hegemonic gender theory. Using cultural consensus modeling, we identified cultural models of transactional sex and conducted 16 in-depth interviews with model key informants and 3 focus group discussions, for a total of 41 participants. We identified 4 main models of transactional relationships: One typified by marriage and high social respectability, a second in which women aspire towards marriage, a third particular to University students, and a fourth "sugar daddy" model. Women in all models expected and received significant financial support from their male partners. However, women in less respectable relationships risked social censure and stigma if they were discovered, in part because aspects of their relationship threatened hegemonic masculinity. Conversely, women who received male support in respectable relationships had to carefully select HIV risk reduction strategies that did not threaten their relationship and associated social status. Research and programming efforts typically focus only on the less socially respectable forms of transactional sex. This risks reinforcing stigma for women in relationships that are already considered socially unacceptable while ignoring the unique HIV risks faced by women in more respectable relationships.
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Affiliation(s)
- Rebecca Fielding-Miller
- University of California, San Diego, 9500 Gillman Drive #0507, San Diego, CA 92093, United States.
| | - Kristin L Dunkle
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Nwabisa Jama-Shai
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Michael Windle
- Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Craig Hadley
- Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Hannah L F Cooper
- Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
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Thurman TR, Kidman R, Carton TW, Chiroro P. Psychological and behavioral interventions to reduce HIV risk: evidence from a randomized control trial among orphaned and vulnerable adolescents in South Africa. AIDS Care 2016; 28 Suppl 1:8-15. [PMID: 26886261 PMCID: PMC4828594 DOI: 10.1080/09540121.2016.1146213] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/20/2016] [Indexed: 11/08/2022]
Abstract
Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions. With 95% retention, 1014 adolescents were interviewed three times over a 22-month period. Intent-to-treat analyses, applying multivariate difference-in-difference probit regressions, were performed separately for boys and girls to assess intervention impacts on sexual risk behaviors. Exposure to a single intervention did not impact behaviors. Exposure to both interventions was associated with risk-reduction behaviors, but the outcomes varied by gender: boys reported fewer risky sexual partnerships (β = -.48, p = .05) and girls reported more consistent condom (β = 1.37, p = .02). There was no difference in the likelihood of sexual debut for either gender. Providing both psychological and behavioral interventions resulted in long-term changes in sexual behavior that were not present when either intervention was provided in isolation. Multifaceted approaches for reducing sexual risk behaviors among vulnerable adolescents hold significant promise for mitigating the HIV epidemic among this priority population.
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Affiliation(s)
- T. R. Thurman
- Tulane University School of Social Work, Highly Vulnerable Children Research Center, New Orleans, LA, USA
- Tulane International LLC South Africa, Cape Town, South Africa
| | - R. Kidman
- Department of Preventive Medicine, Stony Brook Medicine, Health Sciences Center, Stony Brook, NY, USA
| | - T. W. Carton
- Health Services Research, Louisiana Public Health Institute, New Orleans, LA, USA
| | - P. Chiroro
- Impact Research International, Pretoria, South Africa
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Bhardwaj S, Carter B, Aarons GA, Chi BH. Implementation Research for the Prevention of Mother-to-Child HIV Transmission in Sub-Saharan Africa: Existing Evidence, Current Gaps, and New Opportunities. Curr HIV/AIDS Rep 2016; 12:246-55. [PMID: 25877252 DOI: 10.1007/s11904-015-0260-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tremendous gains have been made in the prevention of mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Ambitious goals for the "virtual elimination" of pediatric HIV appear increasingly feasible, driven by new scientific advances, forward-thinking health policy, and substantial donor investment. To fulfill this promise, however, rapid and effective implementation of evidence-based practices must be brought to scale across a diversity of settings. The discipline of implementation research can facilitate this translation from policy into practice; however, to date, its core principles and frameworks have been inconsistently applied in the field. We reviewed the recent developments in implementation research across each of the four "prongs" of a comprehensive PMTCT approach. While significant progress continues to be made, a greater emphasis on context, fidelity, and scalability-in the design and dissemination of study results-would greatly enhance current efforts and provide the necessary foundation for future evidence-based programs.
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Fielding-Miller R, Dunkle KL, Cooper HLF, Windle M, Hadley C. Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation. Soc Sci Med 2016; 148:25-33. [PMID: 26647365 PMCID: PMC4698209 DOI: 10.1016/j.socscimed.2015.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
Transactional sex is associated with increased risk of HIV and gender based violence in southern Africa and around the world. However the typical quantitative operationalization, "the exchange of gifts or money for sex," can be at odds with a wide array of relationship types and motivations described in qualitative explorations. To build on the strengths of both qualitative and quantitative research streams, we used cultural consensus models to identify distinct models of transactional sex in Swaziland. The process allowed us to build and validate emic scales of transactional sex, while identifying key informants for qualitative interviews within each model to contextualize women's experiences and risk perceptions. We used logistic and multinomial logistic regression models to measure associations with condom use and social status outcomes. Fieldwork was conducted between November 2013 and December 2014 in the Hhohho and Manzini regions. We identified three distinct models of transactional sex in Swaziland based on 124 Swazi women's emic valuation of what they hoped to receive in exchange for sex with their partners. In a clinic-based survey (n = 406), consensus model scales were more sensitive to condom use than the etic definition. Model consonance had distinct effects on social status for the three different models. Transactional sex is better measured as an emic spectrum of expectations within a relationship, rather than an etic binary relationship type. Cultural consensus models allowed us to blend qualitative and quantitative approaches to create an emicly valid quantitative scale grounded in qualitative context.
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Affiliation(s)
- Rebecca Fielding-Miller
- University of California, San Diego, 9500 Gillman Drive #0507, San Diego, CA, 92093, United States.
| | - Kristin L Dunkle
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Hannah L F Cooper
- Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
| | - Michael Windle
- Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
| | - Craig Hadley
- Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
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Minigrants for Community Health: A Randomized Controlled Trial of Their Impact on Family Food Gardening. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 22:379-86. [PMID: 26618848 DOI: 10.1097/phh.0000000000000359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of minigrants on home food gardening and review 28 health-related minigrant programs reported in the literature for lessons relevant for using minigrant programs to promote community health. DESIGN Randomized controlled trial of the impact of minigrants on square footage of food garden area and on garden initiation in 2010 versus 2011. Interviews with participants were also conducted and coded and the literature was reviewed for findings from other community health minigrant programs. SETTING Laramie, Wyoming. PARTICIPANTS Sixty adults living in 53 households who attended a gardening training workshop in April 2011. INTERVENTION A $40 minigrant in the form of a voucher, valid at a local gardening store. RESULTS Minigrant recipients were more likely to increase their gardening space than the control group. The average increase for the intervention group was 39.2 ft (3.62 m) while the control group average garden plot size decreased slightly, on average, by 1.4 ft (-0.13 m). However, the data were not normally distributed and, therefore, nonparametric statistical tests were used. For the subset of 20 households that did not garden at all in 2010, minigrants also provided motivation to start gardening (8 of 10 minigrant households started a garden vs 2 of 10 control households). Results reported from other health minigrant programs are also positive, though few had quantitative outcomes or control groups for comparison. CONCLUSIONS Even with very small amounts of money, minigrants show promise as an ethical, inexpensive, empowering, and effective health promotion strategy to enable families and communities to improve their health.
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