Hurricane impact associated with transactional sex and moderated, but not mediated, by economic factors in Okay, Haiti

Extreme weather events and disruptions to HIV services: a systematic review

BACKGROUND

Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.

METHODS

For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.

FINDINGS

Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.

INTERPRETATION

Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.

FUNDING

None.

Associations between climate change-related factors and sexual health: A scoping review

There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.

Risk and Protective Factors for Violence Against Women and Girls Living in Conflict and Natural Disaster-Affected Settings: A Systematic Review

This systematic review provides an overview of existing research on risk and protective factors associated with violence against women and girls (VAWG) in conflict and natural disaster settings. PubMed (Medline); PsycINFO; Scopus; and Cochrane Center trials registrar were searched as well as relevant internet repositories for VAWG research. The inclusion criteria covered studies that were published between January 1995 and December 2020, documented risk and/or protective factors for VAWG in conflict or natural disaster-affected settings and included primary or secondary data analysis. A total of 1,413 records were initially identified and 86 articles (covering 77 studies) were included in the final analysis. The findings show that many preexisting risk factors for VAWG are exacerbated in armed conflict and natural disaster-affected settings. Poverty and economic stress, men's substance abuse, exposure to violence, changing gender roles in contexts of inequitable gender norms, and a lack of social support are some of the risk factors associated with male perpetration or female experience of violence. In addition, risk factors specific to experiences during armed conflict or in a natural disaster (e.g., displacement, insecurity or congestion in and around displacement camps, militarization of society, killing of family, destruction of property, etc.) are associated with higher prevalence of VAWG in these contexts.

Unwanted sexual activity among United States women early in the COVID-19 pandemic

BACKGROUND

Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security.

OBJECTIVE

This study aimed to describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among US women early in the COVID-19 pandemic.

STUDY DESIGN

The National US Women's Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3200 English-speaking women (88% cooperation rate) aged 18 to 90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely, racial and ethnic subgroups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying "how the coronavirus pandemic is affecting your sex life" were assessed using conventional content analysis. Logistic regression analyses-adjusting for sociodemographic characteristics, self-reported health, and prepandemic health-related socioeconomic risk factors, including food insecurity, housing instability, utilities and transportation difficulties, and interpersonal violence-were used to model the odds of unwanted sex by a pandemic-related change in health-related socioeconomic risk factors.

RESULTS

The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about the transmission of the virus because of sex, and having sex to meet the partner's needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4-10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7-4.3).

CONCLUSION

More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.

Disasters, Gender, and HIV Infection: The Impact of the 2010 Haiti Earthquake

Although disasters threaten all people who experience them, they do not affect all members of society in the same way. Its effects are not solely restricted to the economic sphere; they also affect the physical and mental health of those who suffer from them, having a particular impact on women and limiting their life chances. The aim of this study was to examine the impact the 2010 Haiti earthquake had on the seropositivity of female survivors.

METHOD

Using data from the Demographic and Health Survey, this study examines the impact of the 2010 Haiti earthquake on gender relations associated with the probability of being HIV positive through the differences-in-differences strategy.

RESULTS

A differential of four percentage points is observed in the probability of HIV seropositivity between men and women, favoring men. Additionally, it is observed that the probability of seropositivity intensifies when the cohabitation household is headed by a woman.

CONCLUSION

Disasters are not indifferent to the gender of the people affected. In the second decade of the 21st century, the conclusions obtained show, once again, the need for incorporating the gender perspective into the management of natural hazards in the field of health. This is the case of the differential exposure to HIV after the earthquake in Haiti.