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Access to transition-related health care among transmasculine people in India: A mixed-methods investigation
No full textLittle research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from ‘Our Health Matters’, a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons’ care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care
Phase 1 randomized trials to assess safety, pharmacokinetics, and vaginal bleeding associated with use of extended duration dapivirine and levonorgestrel vaginal rings
No full textBackground: Vaginal rings formulated to deliver two drugs simultaneously have potential as user-controlled, long-acting methods for dual prevention of HIV and pregnancy. Methods: Two phase 1 randomized trials (MTN-030/IPM 041 and MTN-044/IPM 053/CCN019) respectively enrolled 24 and 25 healthy, HIV-negative participants to evaluate safety, pharmacokinetics, and vaginal bleeding associated with use of a vaginal ring containing 200mg dapivirine (DPV) and 320mg levonorgestrel (LNG) designed for 90-day use. MTN-030/IPM 041 compared the DPV/LNG ring to a DPV-only ring (200mg) over 14 days of use. MTN-044/IPM 053/CCN019 compared continuous or cyclic use of the DPV/LNG ring over 90 days of use. Safety was assessed by recording adverse events (AEs). DPV and LNG concentrations were quantified in plasma, cervicovaginal fluid, and cervical tissue. Vaginal bleeding was self-reported. Results: There were no differences in the proportion of participants with grade 2 genitourinary AEs or grade 3 AEs with DPV/LNG ring vs. DPV ring use (p = .22), or with DPV/LNG ring continuous vs. cyclic use (p = .67). Higher plasma DPV concentrations were observed in users of DPV/LNG compared to DPV-only rings (Cmax p = 0.049; AUC p = 0.091). Plasma DPV and LNG concentrations were comparable with continuous and cyclic use (Cmax p = 0.74; AUC p = 0.25). With cyclic use, median nadir plasma DPV concentration was approximately 300 pg/mL two days after removal and median t1/2 for cervicovaginal fluid DPV concentration was 5.76 hours (n = 3). Overall bleeding experiences did not differ between continuous and cyclic users (p = 0.12). Conclusions: The extended duration DPV/ LNG rings were well tolerated and the observed DPV concentrations in plasma and cervicovaginal fluid when used continuously exceeded concentrations observed in previous DPV ring efficacy studies. LNG concentrations in plasma were comparable with other efficacious LNG-based contraceptives. Genital DPV concentrations had a short half-life and were thus not well sustained following ring removal
L\u27utilisation de la méthode des confidentes pour mesurer les cas nouveaux ou récents de mutilations génitales féminines : aperçu du comté de Narok, Kenya
No full textViolence against children and youth in refugee settings in Uganda: Factsheet
Get PDFThis factsheet presents key findings from the first-ever Humanitarian Violence Against Children and Youth Survey conducted in refugee settlements across Uganda
Acceptability of the dapivirine vaginal ring and daily oral pre-exposure prophylaxis (PrEP) during pregnancy in Malawi, South Africa, Uganda, and Zimbabwe
No full textPregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring’s recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants’ preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy.
The dapivirine vaginal rings used in this study were developed and supplied by the International Partnership for Microbicides (IPM)
Revisiting women\u27s empowerment and contraception
No full textThis essay explores and reviews the literature from low- and middle-income countries on the pathways of influence between women\u27s empowerment and reproductive outcomes, specially focusing on contraception, and points to some outstanding gaps. We adopt a framework that assesses the influence of contextual factors, notably kinship structures, and marriage systems, on women\u27s empowerment and agency and other transformational factors affecting women\u27s agency and gender roles and wielding direct and indirect influences on empowerment and contraceptive outcomes. The review of around 80 studies highlights that even after other factors are adjusted, women\u27s agency has a strong influence on contraceptive outcomes. Contraceptive use levels are likely influenced by community-level factors above and beyond individual-level factors. Transformational factors, especially exogenous factors such as education and family planning programs, have independent and direct effects on contraceptive outcomes, at times even weakening or canceling out the effects of women\u27s agency. Comprehensive contraceptive transition theory must reserve a central place for women\u27s empowerment through agency and gender roles, particularly the ability of women and girls to make independent and free contraceptive choices. Relatedly, progress in contraceptive transition should be assessed according to not only contraceptive prevalence but also women\u27s ability to use their preferred choice of methods for achieving reproductive rights
Gendered socio-economic and mental health effects of the COVID-19 pandemic among adults living in selected informal settlements in Kenya: An intersectional analysis
No full textBackground: COVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic. Methods: We analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants’ mental health was examined using modified Poisson regression. Results: A total of 4,050 participants were interviewed, 66% female and median age 38 [interquartile range (IQR): 29–46]. Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥50 years) (PR = 1.33, 95% CI = 1.17–1.51, p \u3c 0.001) than older males (PR = 1.22, 95% CI = 1.17–1.27, p \u3c 0.001). Partial loss of income was protective against negative mental health outcomes among young males (18–29 years) (PR = 0.81, 95% CI = 0.76–0.87, p \u3c 0.001) but linked to negative outcomes among middle-aged males (30–49 years old) (PR = 1.14, 95% CI = 1.12–1.16, p \u3c 0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR = 1.49, 95% CI = 1.22–1.83, p \u3c 0.001; married female: PR = 1.42, 95% CI = 1.26–1.60, p \u3c 0.001). Conclusion: We observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socio-economic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises
Adolescent school retention post COVID-19 school closures in Kenya: A mixed-methods study
No full textThis mixed methods study investigated factors associated with school retention among marginalized adolescents in four different settings in Kenya, following COVID-19 school closures. Logistic regressions were used to examine factors associated with school retention in 2022 among 1798 adolescent students aged 10–19 in 2020. Qualitative data from 89 in-depth interviews (64 adolescents aged 11–19 and 25 parents), and 21 key informants were thematically analysed. Among female adolescents, age (aOR = 0.76, 95% CI: 0.67, 0.87) and internet access (aOR = 0.55, 95% CI: 0.35, 0.87) were negatively associated with school retention. Engaging in income-generating activities was similarly linked to reduced school retention (aOR = 0.27, 95% CI: 0.16, 0.46). For male adolescents, household loss of income (aOR = 0.40, 95% CI: 0.21, 0.76) and engaging in income-generating activities (aOR = 0.07, 95% CI: 0.02, 0.19) were associated with lower school retention. The qualitative findings highlighted the gendered nature of barriers to school retention. Specifically, pregnancy, child marriage, and related childcare responsibilities emerged as important constraints for girls, whereas engaging in income-generating activities and drug and alcohol use were more dominant factors for boys. Across both genders, financial constraints were a key barrier to school retention. This study underscores the multifaceted nature of factors influencing school retention among marginalized adolescents in times of crisis such as the COVID-19 pandemic. The findings provide useful information for designing targeted policies and programmes for adolescent school retention in times of crisis
