Transactional sex in humanitarian settings: A comparative analysis of livelihood and demographic predictors.

Millions of people have been displaced within or outside their countries. Disruptions associated with displacement often lead to transactional sex with dire social, sexual and reproductive health implications. A common driver of transactional sex is food insecurity among refugees and internally displaced persons (IDPs), yet IDP/refugee settings offer an opportunity for females to challenge and renegotiate gender norms and exercise greater control over their lives and sexuality. We compared predictors of transactional sex across humanitarian settings and found them to be significantly different. Among IDPs, the likelihood of transactional sex reduces with having access to food ration and education, but increases with having 'other sources' of income. Among refugees, transactional sex likelihood reduces with having either/both parent(s) alive but increases with working for money. Hence, multiple factors drive transactional sex in different contexts. Protecting women in humanitarian situations from the risks of transactional sex requires an understanding of these differences.

Des millions de personnes ont été déplacées à l'intérieur ou à l'extérieur de leur pays. Les perturbations associées au déplacement conduisent souvent à des relations sexuelles transactionnelles avec des conséquences désastreuses sur la santé sociale, sexuelle et reproductive. L'insécurité alimentaire parmi les réfugiés et les personnes déplacées à l'intérieur de leur propre pays (PDI) est un facteur courant du sexe transactionnel. Pourtant, les contextes de PDI/réfugiés offrent aux femmes la possibilité de remettre en question et de renégocier les normes de genre et d'exercer un plus grand contrôle sur leur vie et leur sexualité. Nous avons comparé les prédicteurs du sexe transactionnel dans différents contextes humanitaires et nous avons constaté qu'ils étaient significativement différents. Parmi les personnes déplacées, la probabilité de relations sexuelles transactionnelles diminue avec l'accès à la ration alimentaire et à l'éducation, mais augmente avec « d'autres sources ¼ de revenus. Parmi les réfugiés, la probabilité de relations sexuelles transactionnelles diminue lorsque l'un ou les deux parents sont en vie, mais augmente lorsque l'on travaille pour de l'argent. Par conséquent, de multiples facteurs déterminent le sexe transactionnel dans différents contextes. Protéger les femmes dans les situations humanitaires contre les risques liés aux relations sexuelles transactionnelles nécessite une compréhension de ces différences..

Contraceptive use, menstrual resumption, and experience of pregnancy and birth among girls and young women in an internally displaced persons camp in Northeastern Nigeria.

In Northeastern Nigeria 600,000 internally displaced girls and women need sexual and reproductive health and rights (SRHR) services. We examined the relationships between contraceptive use, menstrual resumption, and pregnancy and birth experiences among girls (ages 15-19) and young women (ages 20-24) in an IDP camp. Data are from a cross-sectional survey collected using three-stage cluster sampling; the analytic sample is 480. Data were analyzed in Stata 14 using logistic regression models. Sixty-three percent of respondents had ever had sex and over half were currently sexually active. Current contraceptive use was 8% and 47% had ever been pregnant. Older respondents and those who had ever had sex were more likely to have heard of a contraceptive method and current use was higher for women with 5 or more births. These findings indicate a need for better contraceptive education for girls before sexual activity and promotion of contraception that accounts for fertility preferences in this setting.

Prevalence and Correlates of Sexual abuse among Female Out-of- School Adolescents in Iwaya Community, Lagos State, Nigeria.

This study set out to document the prevalence and predictors of sexual intercourse with persons below the age of consent (statutory rape) and outright sex without consent (rape) among out-of-school adolescents in an urban slum in Lagos, Nigeria. Data gathered from a survey of 480 participants were employed. About 14% and 35% of the participants had been victims of rape and statutory rape respectively. Experience of rape was found to be a function of age and basic deprivation (Cox and Snell's R2 of 0.060 and a Nagelkerke's R2 of 0.108). Another model (with a Cox and Snell's R2 of 0.286 and a Nagelkerke's R2 of 0.394) shows that predictors of the experience of statutory rape include age, basic deprivation, living arrangement and previous attendance of school. In view of the overarching influence of basic deprivation on the experience of sexual abuse, an intervention programme that addresses the material conditions of adolescent girls in Nigeria is recommended.

Migration status, reproductive health knowledge and sexual behaviour among female out-of-school adolescents in Iwaya community, Lagos, Nigeria.

Reproductive health is an essential aspect of the wellbeing of adolescents. Therefore reproductive health knowledge and sexual behaviour deservedly attract the attention of researchers, programme planners and policy implementers working with young people. Yet in Nigeria, little is known about the effect of migration status on reproductive health knowledge and sexual activities of young people in general and out-of-school adolescent girls in particular. This study used data from a survey of 480 out-of-school adolescent girls to provide empirical answers to these puzzles. The results indicated that migrants were less knowledgeable about HIV and AIDS but were as poorly aware of methods of contraceptives as non-migrants. The observed differentials had no significant effect on sexual practices such as involvement in penetrative sexual intercourse and multiple sexual partnerships. The study concluded that migration status is a major basis for social exclusion in the study population and recommends more inclusive approaches in the implementation of reproductive health programmes.

Empowering teachers to change youth practices: evaluating teacher delivery and responses to the FLHE programme in Edo State, Nigeria.

School-based programming is one of the most common approaches to HIV/AIDS prevention among youth. This paper presents the history and development of the Family Life and HIV Education (FLHE) programme in Edo State, Nigeria and results of evaluation of teacher actions and responses to training in its delivery. Results indicate that teachers benefited from the training, were aware of new and/or existing teaching resources and began to teach about HIV/AIDS. Teachers expressed that the programme facilitated open dialogue about HIV/AIDS. However, given limited human resources, FLHE was viewed as additional work to already overloaded teaching schedules. It is recommended that the Ministry of Education channel resources to enhance teachers' efforts towards combating HIV/AIDS. To facilitate learning about sexual health and family life, it is recommended that FLHE-based training be viewed as the first rather than the only step towards teacher professional development in this area.

The Sexual and Reproductive Health Context of an Internally Displaced Persons' Camp in Northeastern Nigeria: Narratives of Girls and Young Women.

In humanitarian settings, ~35 million girls and young women of reproductive age (15-24) are in urgent need of sexual and reproductive health (SRH) information and services. Young women and girls in humanitarian contexts are particularly vulnerable to unwanted pregnancies, unsafe abortion, gender-based violence, and early and forced marriage. We sought to understand girls' and young women's experiences with unwanted pregnancy, abortion, contraception, sexually transmitted infections (STIs), gender-based violence (GBV), and forced marriage in an IDP camp in Northeastern Nigeria. We conducted 25 in-depth interviews with girls aged 15-19 (N = 13; 8 single and 5 married) and young women aged 20-24 (N = 12; 3 single and 9 married). All interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. The participants in our study fled from and witnessed violence to arrive in the IDP camp with little material support. Lack of necessities, especially food, has driven many to sex in exchange for goods or into forced marriages. This, in turn, leads to increased unwanted pregnancies and unsafe abortions. Participants had limited knowledge about contraception, and some information about SRH services available in the camp, but overall, knowledge and utilization of SRH services was low.

Changes in knowledge and attitudes among junior secondary students exposed to the family life and HIV education curriculum in Lagos State, Nigeria.

To address the needs of young people in Lagos State, Nigeria, for information about family life and HIV, the Lagos State Ministry of Education, in collaboration with Action Health Incorporated, began to offer the Family Life and HIV Education Curriculum in government junior secondary schools in 2003. Knowledge and attitudes were measured in a sample of 1,366 students in Lagos State, Nigeria, in November 2004, at the beginning of the school year, and again in July 2005 after receiving a year of the Family Life and HIV Education Curriculum. Students exposed to the curriculum significantly increased knowledge of sexuality and HIV, support for abstinence, and gender role equality.