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Mphande M, Paneno R, Robson I, Phiri K, Cornell M, van Oosterhout JJ, Njala J, Phiri S, Dovel K. Providing HIV Treatment during community-wide flooding: experiences of clients and Health Care Workers in Malawi. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.28.24306432. [PMID: 38746218 PMCID: PMC11092694 DOI: 10.1101/2024.04.28.24306432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background In Malawi, community wide flooding, especially in high HIV burdened districts, continues to affect continuity of care and access to facilities. We explored the lived experiences of clients and healthcare workers (HCWs) to gain understanding of challenges and to propose interventions for improved ART care delivery. Methods Participants came six health facilities and surrounding communities impacted by flooding between Dec 2021-Apr 2022 in Chikwawa, Nsanje and Mulanje districts in Malawi. Facilities are supported by Partners in Hope, a local NGO and PEPFAR/USAID partner.We conducted In-depth interviews with (IDIs) ART clients identified through medical chart reviews and focus group discussions (FGDs) with HCWs. IDIs and FGDs were coded using inductive and deductive methods in Atlas.ti. Results We conducted IDIs with 23 respondents, of which, ten were women, ten experienced treatment interruption (>28 days without medication) and 17 relocated from their homes. The Six FGDs involved 37 HCWs. (21 ART providers; 16 lay cadre).In IDIs, most clients who relocated and lost livestock, possessions and ART medications. They travelling for income generation. Barriers to care included dangerous travel conditions, competing needs for time and fear of ill treatment at facilities. Some outreach clinics did not provide ART. Respondents were motivated to remain on care and motivators included fear of developing illnesses and HIV-status acceptance.All providers said that lack of standardized guidelines affected preparedness and response and they advocated for guidelines, stakeholder coordination and adequate resources. Most also reported personal physical exhaustion, damage to their own houses and property, and drug stock-outs. Documentation due to loss of registers was also mostly mentioned. Discussion Clients motivated to remain in care but face barriers and challenges. National flooding protocols, adequate resource planning and seasonal 6-month ART dispensing may improve ART outcomes.
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Williams KM, Olisa AL, Wilcher R. Exploring linkages: addressing the relationship between the climate crisis and HIV prevention with recommendations for emerging pre-exposure prophylaxis programs. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1369762. [PMID: 38596665 PMCID: PMC11002151 DOI: 10.3389/frph.2024.1369762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
Short- and long-term impacts of the climate crisis continue to be felt across the public health landscape. Many individuals marginalized by the climate crisis also navigate a higher likelihood of exposure to HIV. By understanding this relationship, we can better position HIV prevention, and pre-exposure prophylaxis (PrEP) programs specifically, to meet user needs in communities experiencing the effects of the climate crisis. In support, we propose four recommendations for mitigating the impact of the climate crisis on those who may benefit from PrEP: (1) leverage existing and emerging research and lived experience to intentionally target and appropriately reach individuals affected by the climate crisis who may need or want PrEP; (2) emphasize the need for more climate-resilient PrEP products within the research and development pipeline; (3) build a continued understanding of the role of the climate crisis-HIV relationship in product introduction through national collaboration; and (4) strengthen the integration of PrEP service delivery and response to intimate partner violence. The PrEP market is set for rapid expansion with the introduction of new prevention methods to enable choice. To be comprehensively responsive to potential PrEP users, we must consider and address how the climate crisis changes not only the environmental landscape, but the prevention ecosystem.
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Affiliation(s)
| | | | - Rose Wilcher
- Science Facilitation, FHI 360, Durham, NC, United States
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Logie CH, Okumu M, Admassu Z, Perez-Brumer A, Ahmed R, Luna ML, MacKenzie F, Kortenaar JL, Berry I, Hakiza R, Katisi B, Musoke DK, Nakitende A, Batte S, Kyambadde P, Taing L, Giordana G, Mbuagbaw L. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 2024; 28:507-523. [PMID: 38048017 DOI: 10.1007/s10461-023-04240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada.
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Marianne Lahai Luna
- Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | | | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Lina Taing
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
| | - Gio Giordana
- World Food Programme East Africa, Nairobi, Kenya
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Logie CH, Toccalino D, MacKenzie F, Hasham A, Narasimhan M, Donkers H, Lorimer N, Malama K. Associations between climate change-related factors and sexual health: A scoping review. Glob Public Health 2024; 19:2299718. [PMID: 38190290 DOI: 10.1080/17441692.2023.2299718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
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.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Holly Donkers
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Rousseau C. Climate change and sexual and reproductive health: what implications for future research? Sex Reprod Health Matters 2023; 31:2232196. [PMID: 37594319 PMCID: PMC10444000 DOI: 10.1080/26410397.2023.2232196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Catherine Rousseau
- PhD candidate, Interdisciplinary School of Health Sciences, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
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Williams KM, Miller N, Tutegyereize L, Olisa AL, Chakare T, Jeckonia P, Mullick S, Atieno MA, Nhamo D, Rademacher KH. Defining principles for a choice-based approach to HIV prevention. THE LANCET HIV 2023; 10:e269-e272. [PMID: 37001965 DOI: 10.1016/s2352-3018(23)00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 03/30/2023]
Abstract
The HIV prevention landscape is on the cusp of an unprecedented era of multiple biomedical prevention products available for distribution. Several HIV prevention options, such as oral pre-exposure prophylaxis (PrEP), dapivirine vaginal rings, and injectable cabotegravir for PrEP, are becoming more widely available. Although the future HIV prevention market promises to be rich in options, it would benefit from a core set of principles that uphold choice in all phases of product development, assessment, and introduction. These principles, as presented in this Viewpoint, show the applicability, opportunities, and challenges of choice in different contexts of HIV prevention and provide checkpoints of accountability. By committing to these principles, stakeholders at national and global levels can advance choice across all phases of the HIV prevention market, thereby ensuring that individuals can realise their right to choose when and how to prevent HIV in their own lives.
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Affiliation(s)
| | | | | | | | | | | | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Mahapatra B, Chaudhuri T, Saggurti N. Climate change vulnerability, and health of women and children: Evidence from India using district level data. Int J Gynaecol Obstet 2023; 160:437-446. [PMID: 36254784 DOI: 10.1002/ijgo.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To understand how climate change vulnerability is associated with women and children's health (WCH) at the district level in India. METHODS The district-specific climate change vulnerability index was mapped to the district level NFHS-5 data (N = 674). Fractional regression and spatial analyses were performed to examine the strength of association and the presence of geographic clustering. RESULTS Bivariate analysis revealed that the levels of WCH indicators were lower in districts with a high vulnerability index than in those with a low vulnerability index. Multivariable analyses suggested that with a 1% increase in the vulnerability index, the proportion of modern contraceptive use was reduced by 0.22, four or more prenatal care visits by 0.14, postnatal care by 0.11, and full immunization by 0.12; whereas wasting and underweight proportions increased by 0.07 and 0.10, respectively. The spatial analysis found that in about 70-118 districts, mostly in eastern India, where climate vulnerability was high the WCH outcomes were also poor. CONCLUSION There is a macro-level association between climate change vulnerability and WCH, as districts that had high levels of climate change vulnerability also performed poorly in WCH. There is a need for an integrated approach that considers geography-specific climate change threats to develop health programs.
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