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Inroads for HIV prevention among men: Findings from mixed methods research in the context of the DREAMS partnership in Southern Africa
No full textObjective: To assess trends in men\u27s HIV risk factors and service use, and their experiences with prevention programming, during an intensive HIV response for adolescent girls and young women and their male partners. Design: Independent cross-sectional surveys in 2016–2017 and 2018 with men in Eswatini (20–34 years-old, n = 1391) and Durban, South Africa (20–40 years-old; n = 1665), complemented by 74 in-depth interviews (IDIs) with men exposed to HIV services/prevention programming. Methods: Survey recruitment was primarily at hot-spot venues. We assessed Round 1–2 trends in HIV risk factors and service use, overall and by HIV risk profiles. IDI respondents were identified via survey responses or program partners. Results: HIV risk factors were prevalent in both countries at each survey round, although there were reductions over time among the highest risk profiles in South Africa. Most men were engaged in HIV services (e.g. nearly two-thirds tested for HIV in the last year at round 2, with large increases in Eswatini). Qualitative data suggest HIV service uptake was facilitated by increased convenience and supportive information/messaging about HIV treatment efficacy. Men described eagerly receiving the information and support offered in HIV prevention programming, and effects on HIV risk reduction and newly engaging in HIV services. However, less than 15% of survey respondents reported being reached by such programming. Conclusion: Important inroads have been made to engage men in HIV services and prevention programming in the two countries, including among the high-risk profiles. Still, improving coverage of comprehensive HIV prevention programming is critical, particularly for men most at risk
Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis
No full textObjective: Access to high-quality, respectful care is a basic human right. A lack of respectful care during childbirth is associated with poor outcomes and can negatively influence care-seeking and maternal mental health. We aimed to describe how women perceive their experience of maternity care in Malawi. Methods: We implemented a cross-sectional survey of women (n = 660) who delivered in 25 birth facilities in four districts in Malawi in March 2020 using a validated 30-item, 90-point person-centered maternity care (PCMC) scale. We used descriptive statistics to examine women\u27s experience of care and analyzed bivariable and multivariable mixed-effects models to evaluate predictors of PCMC. Statistical models accounted for clustering of women at the facility level and included maternal age, marital status, education, parity, mother or infant complications, timing of antenatal care (ANC), provider cadre and gender, facility type and sector, and district. Results: Mean PCMC score was 57.5 (range 21–84), with the lowest score (12.4 of 27 points) in communication and autonomy. Women reported: being prohibited from having a birth companion during labor (49.4%) or delivery (60.3%); providers did not introduce themselves (81.1%); providers did not ask consent before procedures/examinations (42.4%); women felt they could not ask questions (40.9%); and were not involved in care decisions (61.5%). Few women reported being frequently abused physically (2%) or verbally (3.5%); almost all had water/electricity available ( \u3e 95%). In bivariate analyses, statistically significant positive associations were found between PCMC score and early ANC, male accompaniment to the facility, male provider, and a lack of complications; all associations remained at least potentially statistically significant in multivariable modeling. Conclusions: Physical and verbal abuse and a lack of basic amenities were rare, while a lack of communication with patients and social support were common. Maternal characteristics (like timing of ANC and maternal or newborn complications) were predictors of RMC, while facility/system factors, like facility type and sector, were not. Continued efforts to improve respectful care will require strengthening provider communication skills and encouraging patient and companion involvement in care
Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: Evidence from Kenya, Malawi and Zambia
No full textObjectives: To assess temporal shifts in HIV risk factors among adolescent girls (AG, aged 15–19 years) and young women (YW, aged 20–24 years) in Kenya, Malawi and Zambia. Design: Prospective cohorts with two time points (Kenya: 2016/2017, 2018; Malawi: 2017, 2018; Zambia: 2016/2017, 2018). Setting: Community-based programming. Participants: 1247 AG (Kenya: 389, Malawi: 371, Zambia: 487) and 1628 YW (Kenya: 347, Malawi: 883, Zambia: 398). Intervention: Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral approach to reduce AGYW’s HIV vulnerability by delivering a package of tailored, multilayered activities and services. | Primary and secondary outcome measures: HIV testing, sexually transmitted infection (STI) symptom experience, number of sexual partners, condom use (consistently, at last sex), transactional sex, experience of physical violence (from intimate partners) and sexual violence (from intimate partners and strangers/non-partners). Results: Changes in HIV-related risk behaviours among DREAMS participants varied by age group and country. Among AG, HIV testing increased (Kenya and Zambia) and sexual violence from partners (in Kenya and Malawi) and non-partners (in Malawi) decreased. Among YW, HIV testing increased and STI experience decreased in Malawi; consistent condom use decreased in Kenya; transactional sex increased in Kenya and Zambia; and physical violence (in Malawi) and sexual violence from partners (in Kenya and Malawi) and non-partners (all three countries) decreased over time. Conclusions: Improvements in HIV testing and reductions in experiences of sexual violence were coupled with variable shifts in HIV-related risk behaviours among DREAMS participants in Kenya, Malawi and Zambia. Additional consideration of AGYW’s risk circumstances during key life transitions may be needed to address the risk heterogeneity among AG and YW across different contexts
Webinar—From Data to Action: Informing Menstrual Health Management Programs
Get PDFThe Population Council’s Girl Innovation, Research, and Learning (GIRL) Center and Evidence for Gender and Education Resource (EGER) program hosted the second virtual webinar of its From Data to Action Series, “Informing Menstrual Health Management Programs” in February 2022. The webinar featured a global systematic review and results from a randomized trial in Kenya on menstrual health management (MHM) programs. ZanaAfrica shared perspectives on program implementation and how the evidence is shaping their approach
How do changes in motivation to prevent pregnancy influence contraceptive continuation? Results from a longitudinal study with women who receive family planning services from community pharmacists and patent and proprietary medicine vendors in Nigeria
No full textBackground: Studies have shown that motivation to avoid pregnancy is associated with contraceptive use and continuation. These motivations can change, however, even within a short period of time. This paper uses longitudinal data to look at women’s motivation to avoid pregnancy at two time points, and how changes in motivation influence contraceptive continuation. Methods: Data for this analysis came from an evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service from these sources and again approximately 9 months later. The dependent variable was contraceptive continuation at the follow-up interview. A categorical independent variable was used to represent changes in motivation to avoid pregnancy from enrollment to the follow-up interview. Univariate and multivariate logistic regression models were used to assess the association between changes in motivation and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated to avoid pregnancy were significantly more likely to continue using contraception compared to women who became more motivated (AOR 2.5; 95% CI 1.0–6.0). Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated (AOR 0.36 95% CI 0.1–0.9). Conclusion: FP providers, including private sector pharmacists and drug shop owners, should continuously check-in with women about their motivations around pregnancy to support continuation among those who wish to avoid pregnancy
Informing social media campaigns through social listening and monitoring summary
No full textThe Breakthrough RESEARCH project is included as a case study in the Digital Health Compendium hosted by The Medical Concierge Group (TMCG) in partnership with Population Reference Bureau under the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) project. The Compendium features case studies of digital health technologies related to family planning used in different regions of the world. It gives policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs
Changing the script: Intergenerational communication about sexual and reproductive health in Niamey, Niger
No full textMost strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents’ lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15–24) and adults ( ≥ 25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults’ communication skills, and changing the “script” to a more life-affirming view of SRH
Behavioral tactics to support providers in offering quality care: Insights from provider behavior change research and practice
Get PDFThis document offers a synthesis of insights from recent research and design activities conducted by ideas42 through Breakthrough RESEARCH, Breakthrough ACTION, and other projects across nine different low- and middle-income settings about the behavioral roots of challenges health care providers face in providing high quality services. We discuss how the physical and social environment in which they work and live sends signals to providers about what is important, how they can navigate difficulties, and how well they are performing. We discuss how experiences outside the health facility impact how providers approach their professional duties. We also discuss how pervasive time and resource constraints create a cognitive and emotional burden that gets in the way of what they can do, even within these constraints. For each challenge, we also share lessons emerging from this research about about how global health practitioners can address these challenges through program design and implementation
Lack of opportunities for indigenous young women in Guatemala: Forced mobility and absence of social protection systems
No full textGuatemala offers limited opportunities for young people to reach their full potential, with critical gaps in public programs offered to indigenous youth. Lack of opportunities is particularly challenging for young indigenous women, who struggle to continue their education from a young age and find employment in unsafe domestic and commercial jobs later in life. Municipalities are constrained to offer opportunities for youth due to the lack of public investments that allocate scarce resources for local governments to invest in youth. In this context, the journey in search of opportunities can be characterized as forced mobility due a weak social protection system that is not able to guarantee basic entitlements for indigenous youth. This study builds on qualitative interview data with local government officers in mainly-indigenous municipalities to characterize the opportunities offered to young people overall and young women in particular. We find that lack of access to education leads to migration and low paid jobs that disproportionally expose females to domestic work and commercial exploitation. Due to conservative views that limit sexuality education in rural settings, young women who cannot afford to migrate, thus stay at home and have no other options that marrying young. Increased and consistent public investment with a gender-approach is urgent to strengthen a social protection system that works for indigenous youth, offering alternative opportunities to forced mobility and unsafe migration
Age-of-consent requirements and adolescent HIV testing in low-and middle-income countries: Multinational insights from 51 population-based surveys
No full textBackground: Pervasive social and structural barriers—including national policies—inhibit HIV testing uptake among priority populations, including adolescents. We assessed the relationship between age-of-consent policies for HIV testing and adolescent HIV testing coverage in 51 low- and middle-income countries. Methods: We pooled data from household surveys (2010–2020) and calculated the weighted country-level prevalence of lifetime HIV testing separately for adolescent girls and boys (ages 15–19). We then abstracted age-of-consent requirements for HIV testing across countries. Using multivariable linear regression, we estimated the average difference in national HIV testing coverage estimates for adolescent girls and boys by age-of-consent restrictions for HIV testing. Results: National HIV testing coverage estimates ranged from 0.7% to 72.5% among girls (median: 18.0%) and 0% to 73.2% among boys (median: 7.5%) in Pakistan and Lesotho, respectively. In adjusted models, HIV testing coverage in countries requiring parental consent for individualsConclusions: Age-of-consent policies are persistent obstacles to adolescent HIV testing. Repealing parental consent requirements for HIV testing is needed to expand coverage and accelerate progress towards global HIV treatment and prevention targets