Women's attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role?

Empowering women as enablers in public health: A quantitative-qualitative systematic review of the gender-transformative approach

Women are expected to take on multiple roles as caregivers and health care providers, but they are still often perceived as victims or beneficiaries rather than enablers. We aimed to explore women's empowerment and gender equality in public health systems and identify proactive enablers that can be incorporated into projects. A systematic review of peer-reviewed literature as well as text analysis were conducted to examine changes in perceptions of women's roles in public health projects. The authors conducted a quantitative analysis of the collected article titles, which revealed a shift in research from identifying risk factors to exploring women's autonomy in health promotion. However, our qualitative review of the articles showed that previous gender-related projects used a gender-sensitive approach that perpetuated the view of women as victims or beneficiaries rather than enablers. The concept of proactive enablers in all aspects of project planning and implementation ensures that women's roles are fully recognized and valued.

Sub-Saharan Irregular Migrant Women's Sexuality: A Qualitative Study in Humanitarian Reception Centers

Irregular female migration to Europe is a growing phenomenon, as more and more women are fleeing their countries of origin due to gender inequality and violence. During the migration process, women experience physical, psychological and social problems that affect their sex lives. The aim of our study is to describe and understand how irregular migrant women living in humanitarian reception centers experience their sexuality at different stages of the migration process. This qualitative phenomenological study collected data through sixteen in-depth interviews with irregular migrant women between January and February 2023. Data analysis was carried out using ATLAS-ti 23.0 software, from which three themes were extracted: (1) The reality of sub-Saharan women's sexuality, (2) In search of a better life: the choice between taking the risk or surrendering, and (3) The sexual revolution among migrants. Sub-Saharan women's sexuality is subject to a complex normative order. The migratory process has severe consequences on migrant women's sex life. The sexual needs of irregular migrant women admitted to humanitarian reception centers undergo a process of change that must be understood by healthcare providers in order to make improvements to care provision.

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016-2018

OBJECTIVE

The aim of this study was to assess the prevalence of not testing for HIV and its determinants among young adult women aged 15-29 years in Papua New Guinea (PNG).

DESIGN AND SETTING

The study used secondary data from the 2016 to 2018 PNG Demographic and Health Survey (PNGDHS), a nationally representative cross-sectional survey that used a two-stage stratified sampling.

PARTICIPANTS

A total weighed sample of 5164 young adult women aged 15-29 years were included in the analysis.

PRIMARY OUTCOME MEASURE

Ever been tested for HIV was the primary outcome of the study. All analyses were adjusted using survey weights to account for unequal sampling probabilities.

RESULTS

The prevalence of not testing for HIV was 58.8% (95% CI: 57.4% to 60.1%). The mean age was 21.65 years (SD = 4.23). Of the women who were not tested for HIV, the majority were never married (79.4%), without formal education (63%), not working (60.2%), and from rural areas (62.9%). In the multivariable analysis, those who were never married (adjusted OR (AOR) 4.9, 95% CI 3.6 to 6.6), had poor wealth index (AOR 1.8, 95% CI 1.3 to 2.5), were from rural areas (AOR 2.0, 95% CI 1.5 to 2.6), were from the Momase region (AOR 1.3, 95% CI 1.0 to 1.7), did not read newspapers or magazines (AOR 1.7, 95% CI 1.3 to 2.1), did not listen to the radio (AOR 1.5, 95% CI 1.1 to 2.0), experienced early sexual debut (AOR 1.5, 95% CI 1.1 to 1.9), had one sexual partner (AOR 1.5, 95% CI 1.2 to 2.0) and reported no sexually transmitted infection (STI) in the past 12 months (AOR 1.8, 95% CI 1.1 to 3.1) had higher odds of not testing for HIV.

CONCLUSIONS

Our study found a very high unmet need for HIV testing among young adult women in PNG. Health promotion programmes should be designed to increase HIV knowledge and access to testing services, particularly targeting young women who are disadvantaged and from rural areas.

Polygamy and safe sex negotiation among married women: evidence from Cameroon

BACKGROUND

Research indicates that women in polygamous relationships may be exposed to unique sexual and reproductive health challenges. However, there are very few studies that examine whether polygamy is associated with safe sex negotiation among married women in sub-Saharan Africa, including Cameroon.

METHODS

Using the 2018 Cameroon Demographic and Health Survey, we apply logistic regression analysis to compare two indicators of safe sex negotiation (i.e., the ability to ask for condom use and refuse sex against their partner) between polygamous (n = 1,628) and monogamous (n = 5,686) women aged 15-49 years old.

RESULTS

We find that 67% and 50% of married women can ask for condom use and refuse sex against their partner, respectively. Multivariate analysis further reveals that women in polygamous relationships are less likely to report they can ask for condom use (OR = 0.71, p < 0.001) and refuse sex (OR = 0.64, p < 0.001) in comparison to their monogamous counterparts.

CONCLUSIONS

Our analysis found that in Cameroon, women in polygamous relationships, Muslim women, married women with inadequate HIV knowledge, those who had never been tested for HIV and women with lower socioeconomic status are less likely to negotiate for safe sex. Based on these findings, we discuss several implications for policymakers, including the establishment of a comprehensive family planning educational program and the deployment of community health workers to disseminate educational initiatives pertaining to safe sex negotiation to community members.

Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries

Different sexes and genders experience differentiated risks of acquiring infections, including drug-resistant infections, and of becoming ill. Different genders also have different health-seeking behaviours that shape their likelihood of having access to and appropriately using and administering antimicrobials. Consequently, they are distinctly affected by antimicrobial resistance (AMR). As such, it is crucial to incorporate perspectives on sex and gender in the study of both AMR and antimicrobial use in order to present a full picture of AMR's drivers and impact. An intersectional approach to understanding gender and AMR can display how gender and other components 'intersect' to shape the experiences of individuals and groups affected by AMR. However, there are insufficient data on the burden of AMR disaggregated by gender and other socio-economic characteristics, and where available, it is fragmented. For example, to date, the best estimate of the global burden of bacterial AMR published in The Lancet does not consider gender or other social stratifiers in its analysis. To address this evidence gap, we undertook a scoping review to examine how sex and gender compounded by other axes of marginalization influence one's vulnerability and exposure to AMR as well as one's access to and use of antimicrobials. We undertook a gendered analysis of AMR, using intersectionality as a concept to help us understand the multiple and overlapping ways in which different people experience exposure vulnerability to AMR. This approach is crucial in informing a more nuanced view of the burden and drivers of AMR. The intersectional gender lens should be taken into account in AMR surveillance, antimicrobial stewardship, infection prevention and control and public and professional awareness efforts, both donor and government funded, as well as national and international policies and programmes tackling AMR such as through national action plans.

Factors affecting the safe sexual behaviors of Korean young adults by gender: a structural equation model

PURPOSE

The aim of this study was to determine the factors that influence safe sexual behaviors of Korean young adults and identify differences by gender.

METHODS

This study aimed to determine which factors affected safe sexual behaviors based on the Theory of Planned Behavior. Data from 437 Korean young adults (in their 20s and 30s) were collected via online survey between January 3 and January 28, 2022. The questionnaire included items on sexual body image, sexual role perception, sexual attitudes, sexual socialization, sexual communication, and safe sexual behaviors. Structural equation modeling was performed.

RESULTS

According to the overall model fit of the hypothetical model, the final model was acceptable and explained 49% of safe sexual behaviors. Sexual attitudes (β=-.70, p<.001) and sexual communication (β=.53, p<.001) directly affected safe sexual behaviors, and sexual role perception (β=.42, p<.001) indirectly affected safe sexual behaviors in a combined model. There were gender differences in the path from sexual attitudes (β=-.94, p<.001) and sexual communication (β=.66, p<.001) to safe sexual behaviors and from sexual body image (β=.27, p<.001) to sexual communication.

CONCLUSION

Sexual attitudes and sexual communication were predictors of safe sexual behaviors, which differed by gender. Strategies that consider sexual attitudes, sexual communication, sexual role perception, and differences between men and women should be developed to improve the safe sexual behaviors of young adults.

Prevalence and factors associated with condom use among sexually active young women in Haiti: evidence from the 2016/17 Haiti demographic and health survey

BACKGROUND

Young women in Haiti remain vulnerable to sexually transmitted infections and unintended pregnancy. However, little is known about condom use among this population. This study examined the prevalence and the factors associated with condom use among sexually active young women in Haiti.

METHODS

Data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the factors associated with condom use among sexually active young women in Haiti were assessed using descriptive statistics and binary logistic regression model.

RESULTS

The prevalence of condom use was 15.4% (95% CI 14.0-16.8). Being teenage (AOR = 1.34; 95% CI: 1.04-1.74), living in urban areas (AOR = 1.41; 95% CI = 1.04-1.90), having higher education level (AOR = 2.39; 95% CI: 1.44-4.00), being in the middle or rich category of household wealth index (AOR = 2.32; 95% CI: 1.53-3.53 and AOR = 2.93; 95% CI: 1.90-4.52), having correct knowledge of ovulatory cycle (AOR = 1.65; 95% CI: 1.30-2.10), having 2-3 lifetime sexual partners and one lifetime sexual partner (AOR = 2.04; 95% CI: 1.36-3.06 and AOR = 2.07; 95% CI: 1.35-3.17) had significantly higher odds of using condom. In addition, sexually active young women whose last partner was their boyfriend (AOR = 4.38; 95% CI: 2.82-6.81), and those whose last partner was a friend/casual acquaintance/commercial sex worker (AOR = 5.29; 95% CI: 2.18-12.85) were associated with increased likelihood of using condom compared with their counterparts whose partner was their spouse.

CONCLUSION

The Haitian government as well as institutions involved in sexual health should consider these factors when designing sexual and reproductive health interventions targeting young women. More specifically, to increase condom use and reduce risky sexual behaviors, they should combine efforts to raise awareness and induce sexual behavioral changes at two levels. In the education system, they should reinforce sexual education in primary and secondary schools while paying special attention to rural areas. In the whole society, it is important to deepen efforts toward increased awareness on family planning and condom use, through mass media and local organizations including religious ones. Priority should be given to the poorer households, young people and women, and rural areas, in order to maximize reduction in early and unintended pregnancy, and sexually transmitted infections. Interventions should include a condom price subsidy and a campaign to destigmatize condom use which is actually a "male affair".

Women's ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria

BACKGROUND

Existing studies established that safer sex negotiation influences contraceptive use, and women who are able to negotiate safer sex were expected to be contraceptive users. However, it is not certain that all contraceptive users have the ability to negotiate safer sex. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners. The study assesses the prevalence of women's ability to negotiate safer sex and examines the determinants of women's ability to negotiate safer sex among contraceptive users and non-users.

METHODS

The comparative cross-sectional research design was adopted. Data were extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a sample of 2,765 contraceptive users and 20,304 non-users. The outcome variable was women's ability to negotiate safer sex with partners. The explanatory variables examined are eight socio-demographic characteristics (age, child marriage, education, parity, media exposure, religion, work status, and experience of female genital mutilation), six relational characteristics (healthcare autonomy, financial autonomy, household wealth quintile, partners' education, ownership of assets, and type of marriage). Attitude to wife-beating, male controlling behavior, place of residence, and geo-political zone of residence were included as control variables. Multivariable regression models were estimated.

RESULTS

Findings showed that 6.2% of women who were not able to negotiate safer sex were contraceptive users, while 15.9% of women who were able to negotiate safer sex were contraceptive users. Among non-users, the significant determinants were child marriage, education, parity, mass media exposure, religion, work status, healthcare autonomy, financial autonomy, household wealth, partner education, type of marriage, geo-political zone, attitude to wife-beating, and male controlling behavior. Regarding contraceptive users, the significant determinants were parity, religion, the experience of female genital mutilation, financial autonomy, partner education, type of marriage, and the geo-political zone of residence.

CONCLUSION

The ability to negotiate safer sex differs among contraceptive users and non-users. Also, the determinants of the ability to negotiate safer sex differ among contraceptive users and non-users. While existing strategies may continue to focus on women not using contraceptives, new strategies promoting reproductive autonomy are required among contraceptive users.

Exploring the perception and socio-cultural barriers to safer sex negotiation among married women in Northwest Nigeria

Background

Safer sex negotiation refers to the means through which partners in sexual relationships agree to have intercourse that protects both partners from adverse sexual health outcomes. Evidence is sparse on the socio-cultural barriers to safer sex negotiation, especially in Northwest Nigeria where almost every aspect of women’s lives is influenced by religious and cultural norms. Understanding the socio-cultural barriers requires having knowledge of the perspectives of community stakeholders such as religious leaders, and community leaders. Thus, from the perspectives of community stakeholders, this study explored the perception and socio-cultural barriers to safer sex negotiation of married women in Northwest Nigeria.

Method

A qualitative research design was adopted. Participants were purposively selected across six states, namely, Kano, Katsina, Jigawa, Kebbi, Kaduna, and Zamfara. Data were collected through Key Informant Interview (KII). A total of 24 KIIs were conducted using the in-depth interview guide developed for the study. The selection of the participants was stratified between rural and urban areas. The interviews were tape-recorded, transcribed, and translated from the Hausa language into the English language. Verbal and written informed consent were obtained from participants prior to the interviews. Data were analyzed using inductive thematic content analysis.

Results

Safer sex negotiation was well-understood by community stakeholders. Men dominate women in sexual relationships through the suppression of women’s agency to negotiate safer sex. Married women endured domination by males in sexual relationships to sustain conjugal harmony. The practice of complying with traditional, cultural, and religious norms in marital relationships deters women from negotiating safer sex. Other socio-cultural causes of the inability to negotiate safer sex are child marriage, poverty, poor education, and polygyny.

Conclusion

Community stakeholders have a clear understanding of safer sex negotiation in Northwest Nigeria but this has not translated into a widespread practice of safer sex negotiation by married women due to diverse socio-cultural barriers. Strategies that will empower women not only to gain more access to relevant sexual and reproductive health information and services but also to encourage women’s assertiveness in family reproductive health decisions are imperative in Northwest Nigeria.