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Ndlazi GJ, Hanley S, Maddocks ST, Chetty V. Perceptions of women enrolled in a cardiovascular disease screening and prevention in HIV study. S Afr Fam Pract (2004) 2022. [DOI: 10.4102/safp.v64i1.5554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Men's Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav 2021; 25:1890-1900. [PMID: 33389318 DOI: 10.1007/s10461-020-03119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/20/2023]
Abstract
The dapivirine vaginal ring has been well-tolerated and shown to prevent HIV in clinical trials. The ring is female initiated, yet endorsement for use is sought from male partners in many relationships. In clinical studies, participants have expressed worries about men detecting rings during vaginal sex, which introduces concerns about product use disclosure, sexual pleasure, penile harm, inter-partner dynamics, and ring removals. This study reports African men's firsthand sexual experiences with the ring. Qualitative data were captured through 11 focus group discussions and one in-depth interview with 54 male partners of ring-users at six research sites in Malawi, South Africa, Uganda and Zimbabwe. Following a semi-structured guide, and using demonstration rings, vulva and penis models, men were asked to discuss the ring's impact on sex and views on male engagement and ring use. Interviews were facilitated by local male social scientists, audio-recorded, translated into English, and analyzed thematically. 22 (41%) of the male partners reported feeling the ring during sex, often attributed to perceived incorrect insertion. Many men described the ring as "scratching" the tip of their penises, and sensations of "prodding" something that "blocked" the vagina and prohibited "full entry". In most cases, feelings dissipated with time or when sexual fluids increased. Less common descriptions included perceiving the vaginal texture, wetness and size as different, which increased pleasure for some, and decreased for others. Over half (59%) never noticed the ring; some attempting and failing to feel it during intercourse. A majority of men reported that the ring did not lead to changes in sexual positions, feelings, frequency or experience of sex, although some were initially afraid that the ring was a "magic snake" or "potion". Male partners expressed strong opinions that ring use was a shared prevention responsibility that men should be engaged in, especially for maintaining trust and open communication in relationships. The ring was noticed by many male partners, particularly during women's initial stages of ring use, although this led to few sexual problems or changes. Nevertheless, results suggest that risk of ring discovery should be discussed with women to mitigate any potential negative reactions or social harm. Strategies to increase male partner engagement will enhance support of this prevention method for women.
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Namatovu HK, Oyana TJ, Sol HG. Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda - A qualitative study using the unified theory of acceptance and use of technology model. Digit Health 2021; 7:20552076211064406. [PMID: 34900326 PMCID: PMC8664308 DOI: 10.1177/20552076211064406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Current empirical evidence suggests that successful adoption of eHealth systems improves maternal health outcomes, yet there are still existing gaps in adopting such systems in Uganda. Service delivery in maternal health is operating in a spectrum of inadequacy, hence eHealth adoption cannot ensue. This study set out to explore the challenges that impede eHealth adoption in women's routine antenatal care practices in Uganda. A qualitative approach using semi-structured interviews was employed to document challenges. These challenges were classified based on a unified theory of acceptance and use of technology constructs. One hundred and fifteen expectant mothers, aged between 18 and 49 years, who spoke either English or Luganda were included in the study that took place between January to May 2019. Thematic analysis using template analysis was adopted to analyse qualitative responses. Challenges were categorised based on five principal unified theories of acceptance and use of technology constructs namely: performance expectancy, effort expectancy, social influence, facilitating conditions and behavioural intention. Facilitating conditions had more influence on technology acceptance and adoption than the other four constructs. Specifically, the lack of training prior to using the system, technical support, computers and smart phones had a downhill effect on adoption. Subsequently, the cost of data services, internet intermittency, and the lack of systems that bridge the gap between mothers and health providers further hindered technology uptake. In conclusion, strategies such as co-development, training end-users, garnering support at the national and hospital levels should be advocated to improve user acceptance of technology.
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Affiliation(s)
- Hasifah Kasujja Namatovu
- Department of Information Systems, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Tonny Justus Oyana
- Geospatial Data and Computational Intelligence Lab, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Henk Gerard Sol
- Faculty of Economics and Business, University of Groningen, the Netherlands
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Milford C, Beksinska M, Smit J, Deperthes B. Lubrication and Vaginal Sex: Lubricant Use and Preferences in General Population Women and Women at Risk of HIV. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2103-2116. [PMID: 32222851 DOI: 10.1007/s10508-020-01673-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Personal or additional lubricants are used by individuals to enhance sexual experience. Lubrication norms during sex are linked to factors including sociocultural norms, gender dynamics, age, and education. This article provides an overview of literature, exploring thematic areas of interest and relevance to the topic. In some regions/countries, lubricated sex is preferable, and in others, a dry/tight vagina is preferred. Women may use a variety of products to achieve these states. There is little research on lubrication preferences during sex; however, microbicide gel acceptability and adherence studies have provided some insight into these preferences. There is a need for more information on lubrication preferences, including volumes, frequency of use, and site of application. In addition, condom use with lubricants needs further exploration. Context, gender, and individual preferences have implications for acceptability and use of personal additional lubricants and should be taken into account during marketing and dissemination of these products.
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Affiliation(s)
- Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa.
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa
| | - Jennifer Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa
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Gitome SW, Kwena ZA, Harper CC, Cohen CR, Bukusi EA. Educating men about vaginal microbicides: considerations from Kenya. CULTURE, HEALTH & SEXUALITY 2020; 22:660-674. [PMID: 31241426 DOI: 10.1080/13691058.2019.1627583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
Men desire to be involved in their partner's decision-making about vaginal microbicide use. This coincides with women's desire to inform male partners about their microbicide use. Educating men about microbicides may enhance acceptability and generate critical support for the female participants of microbicide trials. In this multiphase mixed-methods study, we adapted an educational intervention on vaginal microbicides and tested it among men (n = 45) to determine its effect on men's knowledge regarding HIV/STI, vaginal microbicides and microbicide trials. We also conducted focus group discussions (FGDs) with the female partners (K = 3, n = 43) of the study participants and community representatives (K = 2, n = 24) to obtain their views on male partner microbicide education. We analysed FGD data for key themes using content analysis. HIV and vaginal microbicide knowledge scores increased significantly among men after the educational intervention. Both women and men highly supported male partner microbicide education, in the context of existing gender relations, to increase men's understanding about microbicides, promote adherence and help women gain their partners' trust. Complex gender dynamics should be considered when designing male partner educational interventions to improve acceptability and the use of microbicides and other female-initiated HIV prevention methods.
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Affiliation(s)
- Serah W Gitome
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zachary A Kwena
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cynthia C Harper
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, San Francisco, CA, USA
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
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Gibore NS, Bali TAL. Community perspectives: An exploration of potential barriers to men's involvement in maternity care in a central Tanzanian community. PLoS One 2020; 15:e0232939. [PMID: 32437360 PMCID: PMC7241761 DOI: 10.1371/journal.pone.0232939] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Male involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men’s involvement in maternity care in central Tanzania. Methods Qualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men’s maternity care involvement indicators, benefits of men’s involvement in maternity health care services and barriers to men’s involvement in maternity health care services. Results Both men and women participants acknowledged the importance of men’s involvement in maternity health care services, even though few men actually got involved. Identified benefits of men’s involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men’s involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services. Conclusions Men’s involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners’ presence in the delivery room. Intervention to increase men’s involvement in maternity care should address individual and systemic barriers to men’s involvement.
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Affiliation(s)
- Nyasiro S. Gibore
- Department of Public Health, School of Medicine, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
- * E-mail: , ,
| | - Theodora A. L. Bali
- Department of Education, Faculty of Humanities and Education, Saint John’s University of Tanzania, Dodoma, Tanzania
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Gibore NS, Bali TAL, Kibusi SM. Factors influencing men's involvement in antenatal care services: a cross-sectional study in a low resource setting, Central Tanzania. Reprod Health 2019; 16:52. [PMID: 31072322 PMCID: PMC6509760 DOI: 10.1186/s12978-019-0721-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Men’s involvement can impact the delays in the decision to seek health care and in reaching a health facility, which are contributing causes for increased maternal mortality. Despite of the call to involve men in antenatal care, their participation is not well understood. This study aimed to determine the level of men’s involvement in antenatal care and the factors influencing their involvement in these services. Methods A cross sectional study of 966 randomly selected men aged 18 years or older was conducted in Dodoma Region, from June 2014 to November 2015. Face to face interviews were conducted using a pretested structured questionnaire. The outcome variable was men’s involvement and was constructed from four dichotomized items which were scored zero to two for low involvement and three to four for high involvement. A multiple logistic model was used to measure the factors influencing men’s involvement in antenatal care services. Results The level of men’s involvement in antenatal care was high (53.9%). Majority 89% of respondents made joint decisions on seeking antenatal care. More than half (63.4%) of respondents accompanied their partners to the antenatal clinic at least once. Less than a quarter (23.5%) of men was able to discuss issues related to pregnancy with their partner’s health care providers. About 77.3% of respondents provided physical support to their partners during the antenatal period. Factors influencing men’s involvement in antenatal care were occupation (AOR = 0.692, 95% CI = 0.511–0.936), ethnicity (AOR = 1.495, 95% CI = 1.066–2.097), religion (AOR = 1.826, 95% CI = 1.245–2.677), waiting time (AOR = 1.444, 95% CI = 1.094–1.906), information regarding men’s involvement in antenatal care (AOR = 3.077, 95% CI = 2.076–4.562) and men’s perception about theattitude of health care providers (AOR = 1.548, 95%CI = 1.090–2.199). Conclusion Overall, more than half of respondents reported high involvement in antenatal care services. Access to information on men’s involvement, religion, occupation, ethnicity, waiting time and men’s perception about the attitude of care providers were significant factors influencing men’s involvement in antenatal care services in this study. Health promotion is needed to empower men with essential information for meaningful involvement in antenatal care services.
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Affiliation(s)
- Nyasiro S Gibore
- Department of Public Health, School of Nursing and Public Health, College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania.
| | - Theodora A L Bali
- Department of Education, Faculty of Humanities and Education, Saint John's University of Tanzania, P.O. Box, 47, Dodoma, Tanzania
| | - Stephen M Kibusi
- Department of Public Health, School of Nursing and Public Health, College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania
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Hartmann M, Palanee-Phillips T, O'Rourke S, Adewumi K, Tenza S, Mathebula F, Wagner D, Ayub A, Montgomery ET. The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa. AIDS Care 2018; 31:660-666. [PMID: 30309246 DOI: 10.1080/09540121.2018.1533227] [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: 12/22/2022]
Abstract
Despite being designed for autonomous use, research suggests partner approval is often in women's microbicide use. Microbicide study participants have described many ways product use affects relationships, from improving sexual pleasure to increasing harm, including exacerbating intimate partner violence (IPV). As the dapivirine ring proceeds closer to licensure, supporting women's agency to use microbicides safely is a priority. We conducted 42 in-depth interviews with former participants of the Microbicide Trials Network (MTN)-020 trial of the dapivirine vaginal ring and their male partners in Johannesburg, South Africa, to explore how ring use and partnership dynamics interacted. We sampled women who reported harms or partner non-support and women with supportive partners. Male and female narratives revealed high background levels of IPV. Women described how study participation/ring use exacerbated violence, and for a few couples served as a rationale for additional abuse. In response, women described feeling powerless and fearful of conflict, resulting in product nonuse. For one participant violence was reduced, and for several others, empowerment was sparked. These findings suggest future providers have the opportunity to shift more women from a place of fear/violence to one of safety/empowerment through the integration of IPV screening and relationship counselling.
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Affiliation(s)
- Miriam Hartmann
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | | | - Shannon O'Rourke
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Konyin Adewumi
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Siyanda Tenza
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Florence Mathebula
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Danielle Wagner
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Asha Ayub
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
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Davis LM, Kostick KM. Balancing risk, interpersonal intimacy and agency: perspectives from marginalised women in Zambia. CULTURE, HEALTH & SEXUALITY 2018; 20:1102-1116. [PMID: 29764308 DOI: 10.1080/13691058.2018.1462889] [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: 06/08/2023]
Abstract
Women are most exposed to sexual health risks within their marital relationships, primarily due to the sexually risky behaviours of their spouses. Studies show that expanding agency is critical for women to mitigate both physical and sexual health risks and is linked to increased psycho-social well-being and economic independence. Drawing on qualitative and quantitative primary data collected from a peri-urban community in Zambia, this paper explores how women exert agency in a community where few educational and economic opportunities and substantial food insecurity exacerbate women's risk for HIV within their marital relationships. It also examines how expressions of agency within marital unions can reduce HIV risk exposure and lead to socio-economic benefits. However, expressions of agency can also create physical, psycho-social and sexual health risks, particularly when spouses do not support independent decision-making and actions that women consider necessary to support the household and maintain intimacy. Findings highlight the importance of community involvement and addressing harmful socio-cultural norms to foster the realisation of women's agency.
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Affiliation(s)
- Lwendo Moonzwe Davis
- a ICF, International Health Division , University of Connecticut , Rockville , MD , USA
| | - Kristin Marie Kostick
- b Center for Medical Ethics and Health Policy , Baylor College of Medicine , Houston , TX , USA
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Reuben Mahiti G, Mbekenga CK, Dennis Kiwara A, Hurtig AK, Goicolea I. Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study. Glob Health Action 2018; 10:1361184. [PMID: 28882101 PMCID: PMC5645690 DOI: 10.1080/16549716.2017.1361184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19–65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The cross-category theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
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Affiliation(s)
- Gladys Reuben Mahiti
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Columba K Mbekenga
- b School of Nursing and Midwifery , Agakhan University , Dar es Salaam , Tanzania
| | - Angwara Dennis Kiwara
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Anna-Karin Hurtig
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
| | - Isabel Goicolea
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
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Gollub EL, Stein ZA. Beyond LARC: Advancing Reproductive Health to Include Men. Am J Public Health 2018; 106:1169-70. [PMID: 27285254 DOI: 10.2105/ajph.2016.303245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Erica L Gollub
- Erica L. Gollub is with the Department of Epidemiology at the Robert Stempel College of Public Health and Social Work at Florida International University, Miami. Zena A. Stein is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY and the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York
| | - Zena A Stein
- Erica L. Gollub is with the Department of Epidemiology at the Robert Stempel College of Public Health and Social Work at Florida International University, Miami. Zena A. Stein is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY and the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York
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Chimoyi L, Kamndaya M, Venables E, von Knorring N, Stadler J, MacPhail C, Chersich MF, Rees H, Delany-Moretlwe S. Using surrogate vaccines to assess feasibility and acceptability of future HIV vaccine trials in men: a randomised trial in inner-city Johannesburg, South Africa. BMC Public Health 2017; 17:524. [PMID: 28832280 PMCID: PMC5498868 DOI: 10.1186/s12889-017-4355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Developing an effective HIV vaccine is the overriding priority for HIV prevention research. Enrolling and maintaining cohorts of men into HIV vaccine efficacy trials is a necessary prerequisite for the development and licensure of a safe and efficacious vaccine. METHODS One hundred-fifty consenting HIV-negative men were enrolled into a pilot 1:1 randomised controlled trial of immediate vaccination with a three-dose hepatitis B vaccine compared to deferred vaccination (at 12 months) to investigate feasibility and acceptability of a future HIV vaccine trial in this population. Adverse events, changes in risk behaviour, acceptability of trial procedures and motivations for participation in future trials were assessed. RESULTS Men were a median 25 years old (inter-quartile range = 23-29), 53% were employed, 90% secondary school educated and 67% uncircumcised. Of the 900 scheduled study visits, 90% were completed in the immediate vaccination arm (405/450) and 88% (396/450) in the delayed arm (P = 0.338). Acceptability of trial procedures and services was very high overall. However, only 65% of the deferred group strongly liked being randomised compared to 90% in the immediate group (P = 0.001). Informed consent processes were viewed favourably by 92% of the delayed and 82% of the immediate group (P = 0.080). Good quality health services, especially if provided by a male nurse, were rated highly. Even though almost all participants had some concern about the safety of a future HIV vaccine (98%), the majority were willing to participate in a future trial. Future trial participation would be motivated mainly by the potential for accessing an effective vaccine (81%) and altruism (75%), rather than by reimbursement incentives (2%). CONCLUSIONS Recruitment and retention of men into vaccine trials is feasible and acceptable in our setting. Findings from this surrogate vaccine trial show a high willingness to participate in future HIV vaccine trials. While access to potentially effective vaccines is important, quality health services are an equally compelling incentive for enrolment.
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Affiliation(s)
- Lucy Chimoyi
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mphatso Kamndaya
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emilie Venables
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nina von Knorring
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Stadler
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Matthew F Chersich
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Mweemba O, Dixey R, Bond V, White A. The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia. Glob Public Health 2017; 13:931-943. [PMID: 28604240 DOI: 10.1080/17441692.2017.1337800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vaginal microbicides are heralded as a woman's HIV prevention method. This study, conducted in a microbicide clinical trial setting in Zambia, explored how the social construction of masculinity and sexual behaviour influenced the acceptability of vaginal microbicides. The data were generated from 18 In-depth Interviews and 8 Focus Group Discussions. The data were analysed thematically. The study found that hegemonic masculinity influenced the use of vaginal microbicides positively and negatively, in multiple ways including: decision to initiate gel use, autonomous use of the gel, and consistent use of the gel. Men were seen as heads of households and decision-makers who approved their partners' intentions to initiate gel use. Autonomous gel use by women was not supported because it challenged men's dominant position in sexual matters and at a family level. The socially accepted notion that men engaged in multiple sexual relationships also influenced women's decision to use the gel. Sustained gel use depended on the perceived effect of the gel on men's sexual desires, sexual performance, fertility, and sexual behaviour. This study suggests that acceptability of microbicides partially lies within the realm of men, with use constrained and dictated by cultural constructs and practice of masculinity and gender.
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Affiliation(s)
- Oliver Mweemba
- a Department of Public Health , University of Zambia , Lusaka , Zambia
| | - Rachael Dixey
- b Centre for Health Promotion Research, Leeds Beckett University , Leeds , UK
| | - Virginia Bond
- c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK.,d ZAMBART Project , University of Zambia , Lusaka , Zambia
| | - Alan White
- e Centre for Men's Health, Leeds Beckett University , Leeds , UK
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Gollub EL, Dévieux J, Michele JG, Pierre Ste-Rose S, Neptune S, Pelletier V. “This Method, I Think, Can Shed New Light”. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 36:253-263. [DOI: 10.1177/0272684x16666432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improving the reproductive health of immigrant populations requires understanding the specific context of risk and need. As part of a field trial of the FemCap™, a woman-initiated cervical barrier contraceptive, we conducted postintervention focus group discussions (FGDs) with 20 women (five FGDs) of Haitian background, the majority of whom were born in Haiti and spoke Haitian Créole at home, at a community health center in south Florida. Participants discussed the role of religion and inequitable gender norms in Haitian traditions about family planning decisions and provided important insights into the gender-power nuances of their partnership dynamics vis à vis the use of female barrier methods. Encouraged by more equitable gender norms in the United States, participants were eager to serve as health education agents, with strong altruistic sentiments toward other Haitian girls and women who they felt could be encouraged to negotiate for greater reproductive decision-making power.
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Affiliation(s)
- Erica L. Gollub
- Department of Health Studies, College of Health Professions, Pace University, Pleasantville, NY, USA
| | - Jessy Dévieux
- AIDS Prevention Program and Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Biscayne Bay Campus, Miami, FL, USA
| | - Jean-Gilles Michele
- AIDS Prevention Program and Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Biscayne Bay Campus, Miami, FL, USA
| | - Suzette Pierre Ste-Rose
- Department of Health Promotion and Disease Prevention Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sandra Neptune
- AIDS Prevention Program and Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Biscayne Bay Campus, Miami, FL, USA
| | - Valerie Pelletier
- Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Optimizing HIV prevention for women: a review of evidence from microbicide studies and considerations for gender-sensitive microbicide introduction. J Int AIDS Soc 2015; 18:20536. [PMID: 26700845 PMCID: PMC4689151 DOI: 10.7448/ias.18.1.20536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/23/2015] [Accepted: 11/13/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction Microbicides were conceptualized as a product that could give women increased agency over HIV prevention. However, gender-related norms and inequalities that place women and girls at risk of acquiring HIV are also likely to affect their ability to use microbicides. Understanding how gendered norms and inequalities may pose obstacles to women's microbicide use is important to inform product design, microbicide trial implementation and eventually microbicide and other antiretroviral-based prevention programmes. We reviewed published vaginal microbicide studies to identify gender-related factors that are likely to affect microbicide acceptability, access and adherence. We make recommendations on product design, trial implementation, positioning, marketing and delivery of microbicides in a way that takes into account the gender-related norms and inequalities identified in the review. Methods We conducted PubMed searches for microbicide studies published in journals between 2000 and 2013. Search terms included trial names (e.g. “MDP301”), microbicide product names (e.g. “BufferGel”), researchers’ names (e.g. “van der Straten”) and other relevant terms (e.g. “microbicide”). We included microbicide clinical trials; surrogate studies in which a vaginal gel, ring or diaphragm was used without an active ingredient; and hypothetical studies in which no product was used. Social and behavioural studies implemented in conjunction with clinical trials and surrogate studies were also included. Although we recognize the importance of rectal microbicides to women, we did not include studies of rectal microbicides, as most of them focused on men who have sex with men. Using a standardized review template, three reviewers read the articles and looked for gender-related findings in key domains (e.g. product acceptability, sexual pleasure, partner communication, microbicide access and adherence). Results and discussion The gendered norms, roles and relations that will likely affect women's ability to access and use microbicides are related to two broad categories: norms regulating women's and men's sexuality and power dynamics within intimate relationships. Though norms about women's and men's sexuality vary among cultural contexts, women's sexual behaviour and pleasure are typically less socially acceptable and more restricted than men's. These norms drive the need for woman-initiated HIV prevention, but also have implications for microbicide acceptability and how they are likely to be used by women of different ages and relationship types. Women's limited power to negotiate the circumstances of their intimate relationships and sex lives will impact their ability to access and use microbicides. Men's role in women's effective microbicide use can range from opposition to non-interference to active support. Conclusions Identifying an effective microbicide that women can use consistently is vital to the future of HIV prevention for women. Once such a microbicide is identified and licensed, positioning, marketing and delivering microbicides in a way that takes into account the gendered norms and inequalities we have identified would help maximize access and adherence. It also has the potential to improve communication about sexuality, strengthen relationships between women and men and increase women's agency over their bodies and their health.
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Montgomery ET, van der Straten A, Stadler J, Hartmann M, Magazi B, Mathebula F, Laborde N, Soto-Torres L. Male Partner Influence on Women's HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: the Importance of "Understanding". AIDS Behav 2015; 19:784-93. [PMID: 25416076 DOI: 10.1007/s10461-014-0950-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is widespread evidence that male partners influence women's ability and willingness to join HIV prevention trials and to use female-controlled prevention strategies such as microbicide gels. VOICE-C was an ancillary study to the Microbicide Trials Network's VOICE trial at the Johannesburg site that explored social and structural factors influencing women's use of study tablets and vaginal gel. Qualitative data were analyzed from 102 randomly-selected VOICE participants interviewed through in-depth interviews (IDI, n = 41); ethnographic interviews (n = 21) or focus group discussions (FGD, n = 40) and 22 male partners interviewed in 14 IDI and 2 FGD. Male partners' "understanding" pervaded as a central explanation for how male partners directly and indirectly influenced their female partners' trial participation and product use, irrespective of assignment to the gel or tablet study groups. The meaning behind "understanding" in this context was described by both men and women in two important and complementary ways: (1) "comprehension" of the study purpose including biological properties or effects of the products, and (2) "support/agreeability" for female partners being study participants or using products. During analysis a third dimension of "understanding" emerged as men's acceptance of larger shifts in gender roles and relationship power, and the potential implications of women's increased access to biomedical knowledge, services and prevention methods. Despite displays of some female agency to negotiate and use HIV prevention methods, male partners still have a critical influence on women's ability and willingness to do so. Efforts to increase their understanding of research goals, study design and products' mechanisms of action could ameliorate distrust, empower men to serve as product advocates, adherence buddies, and foster greater adherence support for women in situations where it is needed. Strategies to address gender norms and the broader implications these have for female-initiated HIV prevention should likewise be integrated into future research and program activities.
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Kelly CA, Friedland BA, Morar NS, Katzen LL, Ramjee G, Mokgatle MM, Ahmed K. To tell or not to tell: male partner engagement in a Phase 3 microbicide efficacy trial in South Africa. CULTURE, HEALTH & SEXUALITY 2015; 17:1004-1020. [PMID: 25913101 DOI: 10.1080/13691058.2015.1030451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gender norms that privilege men's sexual power and pleasure, and distrust of condom use in intimate relationships, leave women vulnerable to HIV and other sexually transmitted infections. Vaginal microbicides allow women to exert a degree of control over their sexual health, through responsibility for product insertion as well as the possibility of covert use. In practice, however, the uptake of new HIV-prevention products is heavily influenced by partnership dynamics. This paper presents a secondary analysis of data from two qualitative sub-studies conducted during a Phase 3 microbicide efficacy trial in South Africa. Using transcripts from in-depth interviews and focus group discussions with 278 female trial participants and 27 male partners, we investigated the extent to which women disclosed microbicide use to their partners, and the level and types of male engagement with microbicide use. Most women chose to communicate with their partners about the trial, but the timing and content of associated discussions differed according to their motivation for disclosure. Men provided their partners with both moral and practical support, but reported a desire for greater involvement in decision-making surrounding microbicide uptake and use. The findings inform recommendations for constructive male participation in future trials and, ultimately, introduction of a marketed product.
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Engaging male partners in women's microbicide use: evidence from clinical trials and implications for future research and microbicide introduction. J Int AIDS Soc 2014; 17:19159. [PMID: 25224618 PMCID: PMC4163996 DOI: 10.7448/ias.17.3.19159] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/25/2014] [Accepted: 07/22/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Constructively engaging male partners in women-centred health programs such as family planning and prevention of mother-to-child HIV transmission has resulted in both improved health outcomes and stronger relationships. Concerted efforts to engage men in microbicide use could make it easier for women to access and use microbicides in the future. This paper synthesizes findings from studies that investigated men's role in their partners' microbicide use during clinical trials to inform recommendations for male engagement in women's microbicide use. METHODS We conducted primary and secondary analyses of data from six qualitative studies implemented in conjunction with microbicide clinical trials in South Africa, Kenya, and Tanzania. The analyses included data from 535 interviews and 107 focus groups with trial participants, male partners, and community members to answer research questions on partner communication about microbicides, men's role in women's microbicide use, and potential strategies for engaging men in future microbicide introduction. We synthesized the findings across the studies and developed recommendations. RESULTS The majority of women in steady partnerships wanted agreement from their partners to use microbicides. Women used various strategies to obtain their agreement, including using the product for a while before telling their partners, giving men information gradually, and continuing to bring up microbicides until resistant partners acquiesced. Among men who were aware their partners were participating in a trial and using microbicides, involvement ranged from opposition to agreement/non-interference to active support. Both men and women expressed a desire for men to have access to information about microbicides and to be able to talk with a healthcare provider about microbicides. CONCLUSIONS We recommend counselling women on whether and how to involve their partners including strategies for gaining partner approval; providing couples' counselling on microbicides so men have the opportunity to talk with providers; and targeting men with community education and mass media to increase their awareness and acceptance of microbicides. These strategies should be tested in microbicide trials, open-label studies, and demonstration projects to identify effective male engagement approaches to include in eventual microbicide introduction. Efforts to engage men must take care not to diminish women's agency to decide whether to use the product and inform their partners.
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Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis. BMC Pregnancy Childbirth 2014; 14:269. [PMID: 25112497 PMCID: PMC4137075 DOI: 10.1186/1471-2393-14-269] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background Male involvement in various health practices is recognized as an important factor in improving maternal and child health outcomes. Male involvement interventions involve men in a variety of ways, at varying levels of inclusion and use a range of outcome measures. There is little agreement on how male involvement should be measured and some authors contend that male involvement may actually be detrimental to women’s empowerment and autonomy. Few studies explore the realities, perceptions, determinants and efficacy of male involvement in newborn care, especially in African contexts. Methods Birth narratives of recent mothers (n = 25), in-depth interviews with recent fathers (n = 12) and two focus group discussions with fathers (n = 22) were conducted during the formative research phase of a community-based newborn care trial. Secondary analysis of this qualitative data identified emergent themes and established overall associations related to male involvement, newborn care and household roles in a rural African setting. Results Data revealed that gender dictates many of the perceptions and politics surrounding newborn care in this context. The influence of mother-in-laws and generational power dynamics were also identified as significant. Women alone perform almost all tasks related to newborn care whereas men take on the traditional responsibilities of economic providers and decision makers, especially concerning their wives’ and children’s health. Most men were interested in being more involved in newborn care but identified barriers to increased involvement, many of which related to gendered and generational divisions of labour and space. Conclusions Men defined involvement in a variety of ways, even if they were not physically involved in carrying out newborn care tasks. Some participant comments revealed potential risks of increasing male involvement suggesting that male involvement alone should not be an outcome in future interventions. Rather, the effect of male involvement on women’s autonomy, the dynamics of senior women’s influence and power and the real impact on health outcomes should be considered in intervention design and implementation. Any male involvement intervention should integrate a detailed understanding of context and strategies to include men in maternal and child health should be mutually empowering for both women and men.
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Reid-Hresko J. Our bodies are our own: resistance to ABC-based HIV-prevention programmes in northern Tanzanian conservation organisations. CULTURE, HEALTH & SEXUALITY 2014; 16:765-779. [PMID: 24816078 DOI: 10.1080/13691058.2014.911959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
ABC-based HIV-prevention programmes have been widely employed in northern Tanzanian wildlife conservation settings in an attempt to (re)shape the sexual behaviours of conservation actors. Utilising findings from 66 semi-structured interviews conducted in 2009-2010, this paper examines ABC prevention as a form of Foucauldian governmentality--circulating technologies of power that mobilise disciplinary technologies and attempt to transform such efforts into technologies of the self--and explores how individuals understand and respond to attempts to govern their behaviour. ABC regimes attempt to rework subjectivity, positioning HIV-related behaviours within a risk-based neoliberal rationality. However, efforts to use ABC as a technology to govern populations and individual bodies are largely incommensurate with existing Tanzanian sociocultural formations, including economic and gendered inequalities, and local understandings of sexuality. The language research participants used to talk about ABC and the justifications they offered for non-compliance illuminate this discrepancy. Data reveal that the recipients of ABC campaigns are active producers of understandings that work for them in their lives, but may not produce the behavioural shifts envisioned by programme goals. These findings corroborate previous research, which questions the continued plausibility of ABC as a stand-alone HIV- prevention framework.
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Affiliation(s)
- John Reid-Hresko
- a Division of Social Science, Quest University Canada , British Columbia , Canada
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Hidden harms: women's narratives of intimate partner violence in a microbicide trial, South Africa. Soc Sci Med 2014; 110:49-55. [PMID: 24721447 DOI: 10.1016/j.socscimed.2014.03.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/12/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
In a context of high rates of intimate partner violence (IPV), trials of female-controlled technologies for HIV prevention such as microbicides may increase the possibility of social harms. Seeking to explore the relationship between IPV and microbicide use further, this paper documents women's narratives of participating in the Microbicide Development Program (MDP) trial in Johannesburg, South Africa, and experiences of partner violence and conflict. A social science sub-study, nested within the trial, was conducted between September 2005 and August 2009, and 401 serial in-depth-interviews were undertaken with 150 women. Using coded interview transcripts, we describe the distribution of IPV and the possible association thereof with microbicide gel use and trial participation. More than a third of these 150 women reported IPV, of which half the cases were related to involvement in the trial. In their narratives, those women reporting IPV cast their partners as authoritarian, controlling and suspicious and reported verbal abuse, abandonment, and in some cases, beatings. Shared experiences of everyday violence shaped women's feelings of unease about revealing their participation in the trial to intimate partners and attempted concealment further contributed to strains and conflict within relationships. Our findings point to the role of social scientific enquiry in identifying the less obvious, hidden negative impacts of participation in a clinical trial therefore exposing limitations in the biomedical construction of 'social harms', as well as the implications thereof for potential future use outside the clinical trial setting.
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Callands TA, Sipsma HL, Betancourt TS, Hansen NB. Experiences and acceptance of intimate partner violence: associations with sexually transmitted infection symptoms and ability to negotiate sexual safety among young Liberian women. CULTURE, HEALTH & SEXUALITY 2013; 15:680-94. [PMID: 23586393 PMCID: PMC3686894 DOI: 10.1080/13691058.2013.779030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Women who experience intimate partner violence (IPV) may be at elevated risk for poor sexual health outcomes, including sexually transmitted infections (STIs). This association, however, has not been consistently demonstrated in low-income or post-conflict countries. Furthermore, the role that attitudes towards IPV play in sexual-health outcomes and behaviour has rarely been examined. We examined associations between IPV experiences, accepting attitudes towards physical IPV, and sexual-health and behavioural outcomes among 592 young women in post-conflict Liberia. Participants' experiences with either moderate or severe physical violence or sexual violence were common. Additionally, accepting attitudes towards physical IPV were positively associated with reporting STI symptoms, IPV experiences and the ability to negotiate safe sex. Findings suggest that for sexual-health-promotion and risk-reduction-intervention efforts to achieve full impact, interventions must address the contextual influence of violence, including individual attitudes toward IPV.
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Affiliation(s)
- Tamora A Callands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Abstract
HIV prevention that uses gender as an analytical framework tends to focus on the ways in which gender inequalities differentially affect women's susceptibility to HIV infection. Men, in this context, are often conceptualized as aggressors, as opposed to women, who are seen as passive victims of HIV infection. In recent years, a growing number of researchers and public health officials have called attention to the pitfalls of this paradigm, pointing out that gender inequities harm both women and men. The first step towards transforming gender norms is to understand what norms currently exist. With this in mind, the aim of this paper is to consolidate and analyse literature that examines structural factors that contribute to the continued HIV infection of men in Swaziland, the country with the highest prevalence of HIV. Gaps in current literature related to this topic are also elucidated. Findings highlight the need for research to be conducted in Swaziland and elsewhere that investigates the effects of gender norms on the wellbeing of both women and men.
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Affiliation(s)
- Shari Feirman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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