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Examining concordance of sexual-related factors and PrEP eligibility with HIV risk perception among adolescent girls and young women: Cross-sectional insights from DREAMS sites in Kenya, Malawi, and Zambia
No full textBackground: HIV risk perception is an important cognition for prevention, theoretically engendering service-seeking and risk-reduction behaviors, but its composition remains poorly understood. We examined country-specific correlates of self-appraised HIV exposure risk among sexually active adolescent girls and young women (AGYW, aged 15–24 years) without HIV in Kenya, Malawi, and Zambia. We also explored overlaps between self-appraised HIV exposure risk and pre-exposure prophylaxis (PrEP) eligibility to identify engagement opportunities. Methods: We analyzed cross-sectional data (2016/2017) to estimate sexual-related correlates of self-appraised HIV exposure risk (likely vs. not, temporally framed as “ever”) using log-Poisson models with robust standard errors. For sexual-related factors with an unadjusted p ≤ 0.10, individual adjusted models were fitted, controlling for sociodemographic and cognitive factors with an unadjusted p ≤ 0.10. PrEP eligibility was defined using national guidelines; since conditional criteria are in Malawi’s (age-disparate sex + ever-pregnant) and Zambia’s (multiple partners + condomless sex) guidelines, we also assessed PrEP eligibility after decoupling these factors. Results: Few AGYW reported likely HIV exposures (Kenya [N = 746]: 15.7%, Malawi [N = 1348]: 46.2%, Zambia [N = 349]: 9.5%) despite ubiquitous HIV risk (98.7%, 99.8%, and 98.9% of Kenyan, Malawian, and Zambian AGYW reported ≥ 1 sexual-related factor). However, the adjusted models found some actual-perceived risk concordance. Positive correlates of self-appraised likely HIV exposures included partner(s)’ likely HIV exposure (all countries); partner(s)’ unknown HIV status and other partners (Kenya, Malawi); STI symptoms and partner(s) living outside the community (Kenya); non-partner sexual violence (Zambia); and transactional sex, multiple partners, pre-coital alcohol use, and physical/sexual intimate partner violence (Malawi). Per national guidelines, PrEP eligibility criteria differentially identified HIV risk (Kenya: 93.6%, Malawi: 53.3%, Zambia: 44.6%), and self-appraised likely HIV exposures were low among PrEP-eligible AGYW (Kenya: 16.5%, Malawi: 48.5%, Zambia: 18.8%). Decoupling Malawi’s and Zambia’s conditional PrEP criteria could increase risk identification to \u3e 85% and potential engagement by ~ 70% and ~ 30%, respectively. Conclusions: AGYW\u27s HIV risk perceptions were mostly influenced by factors beyond their locus of control. Conditional PrEP eligibility criteria may inhibit AGYW’s access and uptake in some settings: countries should consider decoupling these factors to minimize barriers. Intersections between autonomy, behaviors, and perceptions among AGYW in gender-inequitable settings warrants further investigation
Support for healthcare provider education—Overview
Get PDFThis document provides an overview of the Population Council’s Healthcare Provider (HCP) education resources to support healthcare providers and other key stakeholders to raise awareness for, prescribe and support women to use of the dapivirine vaginal ring (DVR, also known as the PrEP ring)
SAHELI: Study and action on hysterectomy: Evidence on women’s health through the life course in India—Protocol for a mixed-methods study
No full textHysterectomy, the surgical removal of the uterus, is one of the most common surgeries performed on women. While it can be life-saving for specific conditions, hysterectomy conducted much before natural menopause (early hysterectomy) can also have negative consequences on women’s health, such as increased risk of cardiovascular disease or osteoporosis. Most research on hysterectomy is from high-income countries. However, recent national studies in India indicate high rates of hysterectomy in some regions, amongst women in their mid-thirties - at least a decade before natural menopause. It is also more common amongst disadvantaged women in rural areas and with less education.
We have initiated a new study, SAHELI, to investigate the individual, health system and social drivers of early hysterectomy in India and to explore the effects on women through the life course. We will conduct large-scale surveys of women ages 25–49 years in three Indian states with high prevalence of hysterectomy. Subsequently, we will conduct in-depth qualitative interviews with women who have undergone hysterectomy or sought gynaecological treatment, along with health care providers and other influences in women’s lives. We will combine these findings with evidence syntheses and consultations with women’s groups, health care providers and policymakers.
This study will contribute first-time evidence on hysterectomy and women\u27s health in India, with a focus on understanding influences on women\u27s health through the life course. We will gain insights into women\u27s treatment choices and health care options when faced with gynaecological morbidity, as well as the consequences of undergoing early hysterectomy on physical and social well-being. Bringing together a wide range of evidence, we aim to provide policy-relevant insights on potential interventions to improve women’s health in India and similar settings
Women’s access to safe abortion and postabortion care services in Pakistan: The role of gender and related factors
No full textThis chapter describes how gender and other intersectional factors play a role in unintended pregnancy, access to safe abortion, and postabortion care in Pakistan. The chapter draws on qualitative data from a national study on postabortion care carried out in 2011–2012 among women who had undergone an abortion in the previous 6 months, service providers, and men and women from urban and rural communities in five districts of Punjab and Sindh provinces. The data are reanalyzed to throw light on the broader context that shapes women’s access to abortion in Pakistan where unmet needs have remained persistently and high and wide disparities exist in access to healthcare
Assessing per-sex-act HIV-1 risk reduction among women using the Dapivirine Vaginal Ring
No full textBackground: Confounding introduced by individuals’ sexual risk behavior is potentially a significant source of bias in HIV-1 prevention intervention studies. To more completely account for sexual behaviors when assessing the efficacy of the monthly dapivirine ring, a new longer-acting HIV-1 prevention option for women, we estimated per-sex-act risk reduction associated with product use. Methods: We conducted a secondary analysis of data from MTN-020/ASPIRE, a phase 3, randomized, placebo-controlled efficacy trial of the dapivirine ring that recruited HIV-uninfected, African women aged 18–45 years. With cumulative sex acts as the time scale, we used multivariable Cox regression with inverse probability of censoring weights to estimate HIV-1 risk reduction associated with a rate of dapivirine release indicative of consistent product use. Results: Women in the dapivirine ring group (n = 1187) had an estimated incidence rate of 2.3 (95% confidence interval [CI], 1.8–3.1) HIV-1 acquisition events per 10 000 sex acts versus 3.6 (95% CI, 2.9–4.4) per 10 000 acts in the placebo group (n = 1187). Dapivirine release indicative of consistent ring use was associated with a 63% (95% CI, 33%–80%) per-sex-act HIV-1 risk reduction. Conclusions: These results support the efficacy of the dapivirine vaginal ring for HIV-1 prevention and help to inform decision-making for women, providers, and policymakers regarding product use.
The dapivirine vaginal rings used in this study were developed and supplied by the International Partnership for Microbicides (IPM)
Evidence-based approaches to addressing sexual violence: Innovations in HIV prevention and support—Summary
Get PDFNavigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia
No full textIntroduction: Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW). Objective: To explore the barriers and facilitators to ANC services among AGYW and how these factors might differ by age and HIV status. Design: This qualitative study employs a combination of in-depth interviews (IDIs) and focus group discussions (FGDs) to gather comprehensive insights into the experiences of AGYW regarding ANC services. The study design follows a socio-ecological framework (SEF) to identify multiple levels of influence on ANC utilization. Methods: We conducted 40 IDIs with AGYW aged 15-24; and 2 FGDs with caregivers of AGYW (n = 16). IDIs explored AGYWs barriers and facilitators to accessing and utilizing healthcare services during pregnancy, as well as social support and HIV treatment and prevention. FGD topics included social support, barriers and facilitators to ANC, and HIV services. We developed a codebook based on the SEF and coded transcripts using Dedoose software. Results: Results showed that early pregnancy knowledge did not always translate to AGYW seeking ANC services right away or within the first trimester. More than half of the AGYW did not initiate ANC until well into the second trimester. Factors including lack of motivation, denial of pregnancy, desires to terminate pregnancies, social norms, policies, clinic environment, and financial constraints contributed to delays in ANC initiation. Social support from family, partners, peers, and the community were crucial motivators for early ANC. Lastly, challenges to ANC continuation included lack of transportation, long clinic waiting times, perceived provider indifference, and stigma at both community and clinic levels. Conclusion: In conclusion, gaining insights from qualitative data is essential for comprehensively understanding the barriers and challenges to accessing ANC among this specific age group. By identifying and addressing these barriers while enhancing facilitators, effective programs can be developed and implemented to improve the health and well-being of young mothers and their children
Overview and impact of young feminist organizing in Mexico: Rapid evidence assessment
Get PDFIn Mexico, young feminists and youth-led feminist movements are already leading the way and pursuing radical approaches to addressing social injustice, such as gender-based violence (GBV), lack of sexual and reproductive health care, and gender discrimination. Although young feminist organizations (YFOs) in Mexico are showing an increasing ability to advocate for and effect change, there is limited systematized evidence on YFO strategies and impact. This Rapid Evidence Assessment (REA) provides an overview of the YFO landscape strategies, and impact on policy and social change in Mexico from 2010 to 2023. Young feminists were defined as those aged 15 to 30. This REA is part of a feminist participatory action research project to assess the impact of YFOs in Mexico and Kenya. It sought to clarify the landscape and impact of YFOs in Mexico and provide a summary of key emerging issues
PrEP Ring for HIV Prevention—Video series
No full textThe PrEP Ring is a long-acting vaginal ring that a woman can use to reduce the risk of HIV transmission during vaginal sex. Women urgently need options for HIV prevention, so that they can choose that best method that meets their needs and circumstances. These videos, available in eight languages, illustrate how to use the dapivirine vaginal ring (PrEP Ring).
Available in: Afrikaans, Bahasa, Bemba, English, French, Kenyan Swahili, Kinyarwanda, Luganda, Portuguese, Setswana, Shona, Sotho, Swati, Xhosa, and Zul
Construire la résilience des adolescentes au Sahel : Rapport de synthèse régional d’une recherche participative à méthodes mixtes
No full textRecent evidence shows that major efforts are needed to improve the lives and protect the rights of adolescent girls in the Sahel. UNICEF’s Building Resilience in the Sahel (BRS) programme implemented in Mali, Mauritania and Niger, funded by the German Federal Ministry for Economic Cooperation and Development and designed with the World Food Programme and the German Agency for International Cooperation, supports innovative approaches and strategies to increase access to basic social services, through catalysing change in national and decentralized government systems, in communities and in individuals, to improve the lives of children and adolescents.
This study on adolescent girls’ resilience conducted by UNICEF in Mali, Mauritania and Niger in 2023-2024 aimed to make important discoveries about the contexts and capabilities of adolescent girls in the Sahel and the change strategies required. The study findings presented in this report contribute to developing a new model for the resilience of adolescent girls in the Sahel.
This report also provides recommendations for technical and financial partners, decision-makers, practitioners and researchers