Service-seeking behaviors among male victims of violence in five African countries: The effects of positive and adverse childhood experiences.

BACKGROUND: Violence against boys and men is widely under-reported. Boys and men face unique and gendered barriers to accessing services following experiences of violence. PARTICIPANTS AND SETTING: The study is a secondary data analysis of five nationally representative population-based Violence Against Children and Youth Surveys (VACS) conducted in Kenya (2019), Côte d'Ivoire (2018), Lesotho (2018), Mozambique (2019), and Namibia (2019). Analysis was limited to males between 18 and 24 years who experienced lifetime physical or sexual violence. OBJECTIVE AND METHODS: We analyzed the association between positive and adverse childhood experiences (PCEs and ACEs), and seeking post-violence services among males using bivariate chi-squared tests and multivariable logistic regression. RESULTS: 8.02 % (5.55-10.50 %) of male victims between the ages of 18 and 24 sought services for any lifetime physical or sexual violence. Witnessing interparental violence and experiencing death of one or both parents were each associated with increased odds of having sought post-violence services (aOR 2.43; 95 % CI: 1.25-4.79; aOR 2.27; 95 % CI: 1.14-4.50), controlling for education, violence frequency, and violence type. High parental monitoring was associated with increased odds of service seeking (aOR 1.79; 95 % CI: 1.02-3.16), while strong father-child relationship was associated with lower odds (aOR 0.45; 95 % CI: 0.23-0.89). CONCLUSION: These findings contribute to limited research on service-seeking behaviors among men and boys. While some parent-youth relationship factors were associated with higher odds of service-seeking, the outcome remained rare. Age and gender-related barriers should be addressed where post-violence care services are offered.

Understanding Gender-Based Violence Service Delivery in CDC-Supported Health Facilities: 15 Sub-Saharan African Countries, 2017-2021.

Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.

The evolution of DREAMS: using data for continuous program improvement.

The DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership, a public-private partnership launched by the United States President's Emergency Plan for AIDS Relief (PEPFAR), represents the largest investment in comprehensive HIV prevention for adolescent girls and young women (AGYW) ever made in a single global initiative. This paper describes the evolution of programming over time using the triangulation of multiple data sources to develop and refine an impactful program, as well as to improve efficacy and resource investment. Methods of analysis used to evolve this programming include reviews of literature on behavioral, biomedical and structural interventions, and HIV vulnerability; PEPFAR program data; external implementation science and impact studies;observations from site visits; in-depth reviews of program materials; and inputs from AGYW and other stakeholders. Key program improvements made in response to this real-time data use are described, including the rationale for programmatic changes and the evidence base for continual program refinements. This review emphasizes the importance and process of implementing the most effective combination of structural and biomedical HIV prevention programming, based on the best available science, while also adapting to local context in a way that does not compromise effectiveness or violate core implementation principles. Data from research and evaluation are critical to move the HIV prevention field toward more impactful and efficient programming responsive to the lived realities of AGYW. A central tenant to using these data sources effectively is the inclusion of AGYW in decision-making throughout the planning and implementation of programming.

Lactation in large litters influences anxiety, memory, and spreading depression in adult male rats that were chronically subjected to a non-convulsive pilocarpine dose.

Objectives: Unfavorable lactation influences brain excitability and behavioral reactions in adults. Administration early in life of the cholinergic agonist, pilocarpine, even at non-convulsive doses, alters the brain excitability-related phenomenon known as cortical spreading depression (CSD), and produce anxiogenic-like behavior. However, the influence of unfavorable lactation on the CSD- and memory-effects of pilocarpine administration late in life has not been investigated. Herein, we analyzed the ponderal, electrophysiological (CSD), and behavioral effects of chronic treatment with a non-convulsive dose of pilocarpine, in adult rats suckled under favorable and unfavorable conditions.Methods: Wistar rats were suckled in litters with 9 or 15 pups (groups L9 and L15, respectively). A very low dose of pilocarpine (45/mg/kg/day) was chronically administered in mature rats from postnatal day (PND) 69-90. Behavioral tests occurred at PND91 [elevated plus maze (EPM)], PND93 [open field (OF)], and PND94-95 [object recognition memory (ORM)]. CSD was recorded between PND96-120.Results: Pilocarpine-treated rats performed worse in the anxiety and memory tests, and displayed lower CSD propagation velocity when compared with saline-treated controls. In addition, L15 rats showed an increase in the distance traveled and a decrease in the immobility time in the EPM, impaired ORM, and accelerated CSD propagation when compared with L9 rats (p ≤ 0.05).Discussion: These data suggest that sub-convulsive pilocarpine treatment in adult rats can affect behavioral and excitability-related reactions. In addition, unfavorable lactation increases the ambulatory effects of pilocarpine. Further studies should investigate the possible cholinergic molecular mechanisms involved in these effects.

Forced Sexual Initiation and Early Sexual Debut and Associated Risk Factors and Health Problems Among Adolescent Girls and Young Women - Violence Against Children and Youth Surveys, Nine PEPFAR Countries, 2007-2018.

Adolescent girls and young women aged 13-24 years are disproportionately affected by HIV in sub-Saharan Africa (1), resulting from biologic, behavioral, and structural* factors, including violence. Girls in sub-Saharan Africa also experience sexual violence at higher rates than do boys (2), and women who experience intimate partner violence have 1.3-2.0 times the odds of acquiring HIV infection, compared with those who do not (3). Violence Against Children and Youth Survey (VACS) data during 2007-2018 from nine countries funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) were analyzed to estimate prevalence and assess factors associated with early sexual debut and forced sexual initiation.† Among adolescent girls and young women aged 13-24 years who ever had sex, the prevalence of lifetime sexual violence ranged from 12.5% to 49.3%, and forced sexual initiation ranged from 14.7% to 38.9%; early sexual debut among adolescent girls and young women aged 16-24 years ranged from 14.4% to 40.1%. In multiple logistic regression models, forced sexual initiation was associated with being unmarried, violence victimization, risky sexual behaviors, sexually transmitted infections (STIs), and poor mental health. Early sexual debut was associated with lower education, marriage, ever witnessing parental intimate partner violence during childhood, risky sexual behaviors, poor mental health, and less HIV testing. Comprehensive violence and HIV prevention programming is needed to delay sexual debut and protect adolescent girls and young women from forced sex.

Engaging Students to Improve Sexual and Reproductive Health: A Report of the University Leadership for Change Initiative in Niger.

Few development projects have addressed the sexual and reproductive health (SRH) needs of university students in West Africa or sought to promote student leadership to extend SRH benefits to others. This report presents results from the Evidence-to- Action Project's University Leadership for Change Initiative in Niger which had the goal to begin filling this gap. The Initiative used an innovative behavior change methodology with students at Abdou Moumouni University in Niamey, Niger and subsequently expanded it to three additional universities by applying ExpandNet scale-up approaches. 200 students trained as peer leaders reached almost 8,000 youths with SRH information and counseling, student leaders and university clinic staff distributed nearly 80,000 condoms and the project achieved national policy change through its collaboration with the Ministry of Public Health and the Ministry of Higher Education, Research and Innovations. The report concludes with key lessons about the benefits of student engagement and creativity in this effort.

Monosodium glutamate and treadmill exercise: Anxiety-like behavior and spreading depression features in young adult rats.

OBJECTIVES: The route of administration is an important factor in determining the action of some drugs. We previously demonstrated that subcutaneous monosodium glutamate (MSG) accelerated cortical spreading depression (CSD) in the rat and that treadmill exercise attenuated this effect. This study evaluated whether other routes of administration exert the same action by testing orogastric (gavage) and topical cortical MSG administration in treadmill-exercised and sedentary rats. Additionally, in the orogastric treatment we tested anxiety-like behavior. METHODS: Exercised and sedentary rats received per gavage water or MSG (1 or 2 g/kg) daily from postnatal (P) day 7 to 27. Behavioral tests (open field and elevated plus-maze) occurred at P53 ± 3. At P56 ± 3, we analyzed CSD parameters (velocity, amplitude, and duration of the negative potential change). Other three groups of rats received an MSG solution (25, 50 or 75 mg/ml) topically to the intact dura mater during CSD recording. RESULTS: MSG-gavage increased anxiety-like behavior and the CSD velocities compared with water-treated controls (P < 0.05). Exercise decelerated CSD. In contrast to gavage, which accelerated CSD, topical MSG dose-dependently and reversibly impaired CSD propagation, reduced CSD amplitude and increased CSD duration (P < 0.05). CONCLUSIONS: The exercise-dependent attenuation of the effects of MSG confirms our previous results in rats treated subcutaneously with MSG. CSD results suggest two distinct mechanisms for gavage and topical MSG administration. Additionally, data suggest that exercise can help protect the developing and adult brain against the deleterious actions of MSG.

Neonatal administration of goat whey modulates memory and cortical spreading depression in rats previously suckled under different litter sizes: Possible role of sialic acid.

OBJECTIVES: Goat whey, a usually discarded byproduct from goat cheese manufacturing, is a good source of sialic acid (SA), an oligosaccharide that is involved in processes such as memory and brain excitability. Here, we investigated in rats the effect of dried goat whey (DGW) on memory and the brain excitability-dependent phenomenon known as cortical spreading depression (CSD). We also provide evidence for the involvement of SA in this effect. In addition, we tested animals under unfavorable suckling conditions to evaluate whether nutritional deficiency would modulate DGW action. METHODS: Wistar rats were suckled in litters with 9 and 15 pups (groups L9 and L15, respectively). From postnatal (P) days 7-14, the animals received per gavage 17.45 g of DGW/kg/day, or SA (20 mg/kg/day or 100 mg/kg/day). At P28-30, we tested the animals' memory in the object recognition paradigm. At P35-45 we recorded CSD and analyze its velocity of propagation, amplitude, and duration. RESULTS: In the object recognition test, the L15 DGW-treated rats performed better than the L15-controls. The L15 rats displayed higher CSD velocities compared with L9 groups. The DGW and SA groups exhibited higher CSD velocity than the naïve- and saline-treated controls, regardless the lactation status (P < 0.05). DISCUSSION: Our results documented a novel effect of DGW on memory and CSD. SA dose-dependently facilitated CSD, suggesting its involvement on the DGW action. DGW is considered a potential supplement to improve brain development and function in malnourished children, and this shall be further translationally investigated.

Invest in adolescents and young people: it pays.

This year's Women Deliver conference made a strong call for investing in the health and development of adolescents and young people. It highlighted the unique problems faced by adolescent girls and young women-some of the most vulnerable and neglected individuals in the world-and stressed the importance of addressing their needs and rights, not only for their individual benefit, but also to achieve global goals such as reducing maternal mortality and HIV infection.In response to an invitation from the editors of Reproductive Health, we-the sixteen coauthors of this commentary-put together key themes that reverberated throughout the conference, on the health and development needs of adolescents and young people, and promising solutions to meet them.1. Investing in adolescents and young people is crucial for ensuring health, creating prosperity and fulfilling human rights.2. Gender inequality contributes to many health and social problems. Adolescent girls and boys, and their families and communities, should be challenged and supported to change inequitable gender norms.- Child marriage utterly disempowers girls. It is one of the most devastating manifestations of gender discrimination.- Negative social and cultural attitudes towards menstruation constrain the lives of millions of girls. This may well establish the foundation for lifelong discomfort felt by girls about their bodies and reticence in seeking help when problems arise.3. Adolescents need comprehensive, accurate and developmentally appropriate sexuality education. This will provide the bedrock for attitude formation and decision making.4. Adolescent-centered health services can prevent sexual and reproductive health problems and detect and treat them if and when they occur.5. National governments have the authority and the responsibility to address social and cultural barriers to the provision of sexual and reproductive health education and services for adolescents and young people.6. Adolescents should be involved more meaningfully in national and local actions intended to meet their needs and respond to their problems.7. The time to act is now. We know more now than ever before about the health and development needs of adolescents and young people, as well as the solutions to meeting those needs.

Ovariectomy in the developing rat decelerates cortical spreading depression in adult brain.

The brain of mammals is one important target organ for the action of gonadal steroids and, when occurring during development, this hormonal influence may result in important repercussion on the brain electrophysiological properties at adulthood, some of which depending on the brain excitability. Here we have characterized in early-ovariectomized adult rats the brain ability to propagate the excitability-related phenomenon known as cortical spreading depression (CSD), as an index of the cerebral electrophysiological effects of the early-induced absence of the ovarian hormones. Wistar female rat pups (7-day old) underwent bilateral ovariectomy (Ovx group; n=21) or Sham surgery (Sham group; n=22), or no surgery (Naive group; n=22). When the pups became adult (90-130 days), they were submitted to the recording of CSD (electrocorticogram and slow DC-voltage variation) in two points of the cortical surface during 4h. Compared with both Naïve and Sham controls, bilateral ovariectomy early in life resulted in significantly higher body weights (from days 50-65 onwards) and severely reduced uterus weights at adulthood. Furthermore, in the Ovx animals the amplitudes and durations of the DC-potential changes of CSD were higher, and the CSD propagation velocities were reduced. Another group of rats ovariectomized in adulthood did not present such CSD alterations. It is concluded that ovariectomy during brain development is causally associated with the CSD changes in the adult brain, indicating a long-lasting effect, which we suggest as being related to the long-term suppression of the action of the ovarian hormones on brain excitability.

A humanizacão como dimensão pública das políticas de saúde / Humanization as a public dimension of the policies in the health system

No momento em que se assume a humanizacão como aspecto fundamental nas políticas de saúde urge que o conceito de humanizacão seja reavaliado e criticado para que possa efetuar-se como mudanca nos modelos de atencão e de gestão. Tal urgência se configura pela banalizacão com que o tema vem sendo tratado, assim como pela fragmentacão das práticas ligadas a programas de humanizacão. Trata-se de um mesmo problema em uma dupla inscricão teórico-prática, daí a necessidade de redefinicão do conceito de humanizacão, bem como dos modos de construcão de uma política pública e transversal de humanizacão da/na saúde. Este segundo aspecto apontou para o debate sobre a dimensão pública das políticas de saúde em sua relacão com o Estado. O texto se dedica, orientado pela análise foucaultiana do poder, a examinar o conceito de humanizacão na relacão do Estado com as políticas públicas como experiência concreta, afirmando que não há como garantir uma política nacional de humanizacão da saúde sem que se confronte com o tema do humanismo no contemporâneo. Esta tarefa não é simples, já que o pensamento no século 20 foi fortemente marcado por uma crítica anti-humanista que deve agora ser retomada para que possamos nos reposicionar.

A psicologia e o sistema único de saúde: quais interfaces? / Psychology and public health system: what are the interfaces?

Discute-se a relação da Psicologia com o Sistema Unico de Saúde (SUS) no Brasil tomando-se como ponto de partida uma crítica à separação entre clínica e política fortemente presente na formação e na prática profissional dos Psicólogos. Indicam-se três princípios para a construção de políticas públicas em saúde: o da inseparabilidade, o da autonomia e co-responsabilidade e o da transversalidade, estando a contribuição da Psicologia no entrecruzamento do exercício destes três princípios. O artigo destaca, ainda, a importância dos modos de fazer acontecer as políticas públicas, indicando a urgência na criação de dispositivos que dêem suporte à experimentação das políticas no jogo de conflitos de interesses, desejos e necessidades dos diferentes atores que compõem a rede de saúde.

Política do Ministério da Saúde para atenção integral a usuários de álcool e outras drogas / Politics of the Ministry of Health for integral attention to users of alcohol and other drugs

Os desafios colocados pela realidade contemporânea exigem esforços para construção de políticas públicas de atenção à saúde. Historicamente, a questão sobre a temática droga foi vista exclusivamente pela ótica predominantemente psiquiátrica ou médica. O uso e/ou abuso e/ou dependência de álcool e outras drogas representam um problema que é do âmbito da saúde pública, que pressupõe necessária interface com outros programas do Ministério da Saúde, de outros ministérios (Justiça, Educação, Secretaria de Direitos Humanos), organizações governamentais e nãoðgovernamentais e demais representantes da sociedade civil organizada, garantindo, assim, a intersetorialidade na construção de uma política de prevenção, tratamento e educação para o uso/consumo de álcool e outras drogas. Entendemos que sobre este tema há predomínio da heterogeneidade, já que afeta diferentes pessoas de diferentes maneiras, por diferentes razões, em diferentes contextos e circunstâncias. As ações de saúde devem atender às diferentes especificidades (isto é: eqüidade, universalidade e integralidade do Sistema Único de Saúde/SUS) apresentadas pelo consumidor. Portanto, para que esta política de saúde seja coerente, eficaz e efetiva, devemos ter em conta que as distintas estratégias (retardo no consumo de drogas, redução de danos associada ao consumo e superação do consumo) são complementares e fundamentais para a sua construção

Entrevista com Gilles Monceau / Interview with Gilles Monceau

Esta entrevista foi realizada por ocasião do 1° Seminário Internacional de Análise Institucional, organizado pelo Mestrado de Psicologia, do Departamento de Psicologia da UFF, em setembro de 2002.

Clínica e biopolítica na experiência do contemporâneo / Clinic and biopolitics in the contemporary experience

O artigo discute algumas contribuições da última fase da obra de M. Foucault para o campo da clínica. Destacamos as noções de “biopolítica” e de “sociedade da regulamentação”, formuladas pelo autor em meados da década de 1970, assim como sua reavaliação do projeto da modernidade proposto no Esclarecimento do século XVIII. A atualidade do pensamento de Foucault como crítico da contemporaneidade é considerada com base não só em seus textos como também em autores que comentam a sua obra e dão continuidade às questões formuladas por ele. Por fim, a idéia de liberdade em Foucault nos serve como importante orientação em nossa definição do trabalho da clínica.