RESUMO
Globally, reproductive health research among female sex workers (FSWs) often focuses on pregnancy prevention, but many women who sell sex aspire to have children in the future. In Bangladesh, where early marriage and parenthood is the norm, we examine reproductive histories and childbearing desires of young women who sell sex in brothels. We interviewed 1061 FSWs aged 18 to 24 in eight brothels in three Bangladesh divisions. Interviewers elicited information on sociodemographic characteristics, contraceptive use, pregnancy history, and childbearing desire. Bivariate and multivariate analyses were conducted to examine correlates of wanting to have a child within 24 months.
Assuntos
Saúde Reprodutiva/normas , Profissionais do Sexo/psicologia , Adolescente , Bangladesh/epidemiologia , Serviços de Planejamento Familiar/normas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
Research and programs for female sex workers (FSWs) tend to focus exclusively on HIV prevention, with little attention paid to how pregnancy affects their lives. We examine the circumstances surrounding pregnancy and childbirth among women selling sex in Ethiopia. In Adama City, researchers asked 30 FSWs aged 18 and older who had ever been pregnant to participate in in-depth interviews. The women reported on pregnancies experienced both before and after they had begun selling sex. They identified some of the fathers as clients, former partners, and current partners, but they did not know the identities of the other fathers. Missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy. Abortion was common, typically with a medication regimen at a facility. Comprehensive sexual and reproductive health services should be provided to women who sell sex, in recognition and support of their need for family planning and their desire to plan whether and when to have children.
Assuntos
Serviços de Planejamento Familiar , Gravidez não Planejada , Profissionais do Sexo/psicologia , Aborto Induzido/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Etiópia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Intenção , Entrevistas como Assunto , Gravidez , Adulto JovemRESUMO
OBJECTIVES: Female sex workers (FSW) often have unprotected sex. Emergency contraceptive pills (ECP) are an important back-up method to prevent unwanted pregnancy among FSW. We examine ECP use among FSW in Swaziland. METHODS: Using data from a 2011 respondent-driven sampling survey of 325 Swazi FSW, we explored the association between individual characteristics and ever having used ECP. RESULTS: In weighted analyses, 27.5% of FSW had ever used ECP. Most (77.8%) had ever been pregnant, among whom 48.7% had had an unwanted pregnancy and 11.7% had had an abortion. Nearly half (47.5%) had experienced condom failure in the past month. Significant independent correlates of ECP use were younger age, higher education, higher income, having two or more children, and never having been married. CONCLUSIONS: FSW who are older or of lower socioeconomic status may not have adequate access to ECP. By better addressing these women's family planning needs, the dual goals of preventing unwanted pregnancy and preventing vertical transmission of HIV can be achieved.
Assuntos
Anticoncepcionais Pós-Coito/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Essuatíni , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Saúde da Mulher , Adulto JovemRESUMO
OBJECTIVES: Nonbarrier modern contraceptive users often are less likely to use condoms, particularly with more intimate sex partners. We examine whether female sex workers (FSWs) in Swaziland who use nonbarrier contraception use condoms less consistently and whether this inverse association varies by relationship type. METHODS: In 2011, we conducted a survey among 325 Swazi FSWs using respondent-driven sampling. Each woman reported on condom use during sexual activity in the past month with up to 3 partner types (new clients, regular clients, noncommercial partners). We used a generalized estimating equation model to conduct a relationship-level multivariate logistic regression analysis of correlates of consistent condom use in the past month. We tested whether relationship type modified the effect of nonbarrier modern contraception on condom use. RESULTS: Each participant reported up to 3 observations, for a total of 892 measures of condom use in the past month. Compared with sexual activity with new clients, sex with regular clients and noncommercial partners was less likely to be protected by consistent condom use (adjusted odds ratio, 0.30 [95% confidence interval, 0.19-0.47] for regular clients; adjusted odds ratio, 0.15 [95% confidence interval, 0.09-0.24] for noncommercial partners). There was no significant association between condom use and nonbarrier modern contraceptive use. CONCLUSIONS: These data highlight the need to provide condoms and condom-compatible lubricants and targeted education programs for FSWs and their male sex partners to encourage the consistent use of these commodities with all sex partners, irrespective of the use of other contraceptive methods.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Adulto , Anticoncepção , Comportamento Contraceptivo/psicologia , Escolaridade , Essuatíni/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Análise Multivariada , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Sexo sem ProteçãoRESUMO
We examined data from a clinic-based survey of 1,222 Bolivian female sex workers (FSWs) to assess whether use of nonbarrier modern contraception is associated with less consistent condom use with clients and noncommercial partners. Women who were using nonbarrier modern contraception were less likely than nonusers to consistently use condoms with noncommercial partners (AOR 0.393, 95% CI 0.203-0.759, p = .005). With clients, this inverse association did not hold. Public health professionals must consider both disease prevention and pregnancy prevention needs in this vulnerable population, and messages should be tailored to encourage dual method use with all partners.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo , Anticoncepcionais Femininos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Profissionais do Sexo/psicologia , Adolescente , Adulto , Bolívia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Gravidez , Gravidez não Desejada , Comportamento de Redução do Risco , Sexo Seguro/estatística & dados numéricos , Trabalho Sexual/psicologia , Parceiros Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana , Adulto JovemRESUMO
BACKGROUND: The mere availability of family planning (FP) services is not sufficient to improve reproductive health; services must also be of adequate quality. The introduction of new contraceptive methods is a means of improving quality of care. The Standard Days Method (SDM) is a new fertility-awareness-based contraceptive method that has been successfully added to reproductive health care services around the world. CONTENT: Framed by the Bruce-Jain quality-of-care paradigm, this paper describes how the introduction of SDM in developing country settings can improve the six elements of quality while contributing to the intrinsic variety of available methods. SDM meets the needs of women and couples who opt not to use other modern methods. SDM providers are sensitised to the potential of fertility-awareness-based contraception as an appropriate choice for these clients. SDM requires the involvement of both partners and thus offers a natural entry point for providers to further explore partner communication, intimate partner violence, condoms, and HIV/STIs. CONCLUSION: SDM introduction broadens the range of FP methods available to couples in developing countries. SDM counselling presents an opportunity for FP providers to discuss important interpersonal and reproductive health issues with potential users.
Assuntos
Países em Desenvolvimento , Métodos Naturais de Planejamento Familiar , Garantia da Qualidade dos Cuidados de Saúde/normas , Comportamento de Escolha , Feminino , Fertilidade/fisiologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Métodos Naturais de Planejamento Familiar/psicologia , Métodos Naturais de Planejamento Familiar/estatística & dados numéricos , Serviços de Saúde ReprodutivaRESUMO
BACKGROUND: To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia. CHATBOT DEVELOPMENT: We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform. CHATBOT USER TEST: Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP. CONCLUSIONS: Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.
Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Gravidez , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Serviços de Planejamento Familiar , Zâmbia , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Instituições de Assistência AmbulatorialRESUMO
BACKGROUND: With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women-including female sex workers-often plan to have children someday. Various "safer conception" strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. METHODS: At integrated community-based HIV/FP service delivery sites operated by Jhpiego's Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. RESULTS: Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was "too little." Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13-4.20) and having fewer children (AOR 0.65, 95% CI 0.48-0.87). Viral suppression was not associated with fertility desire. CONCLUSIONS: Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Fertilização , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Avaliação das Necessidades/estatística & dados numéricos , Complicações Infecciosas na Gravidez/psicologia , Profissionais do Sexo/psicologia , Adulto , Criança , Aconselhamento , Estudos Transversais , Feminino , Fertilidade , HIV/isolamento & purificação , Infecções por HIV/psicologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais/psicologiaRESUMO
OBJECTIVE(S): To describe stigma among seropositive MSM, female sex workers (FSWs), and Haitian-descent individuals in the Dominican Republic, and to assess whether stigma is associated with HIV treatment outcomes. DESIGN: Cross-sectional survey using Stigma Index 2.0. METHODS: People living with HIV (PLHIV) interviewed seropositive adult MSM, FSWs, Haitian-descent persons, and other PLHIV who did not identify with these communities about experiences of social exclusion, harassment, stigma in healthcare settings, and internalized stigma. Bivariate analyses were conducted to compare experiences between FSWs and other women; MSM and other men; and Haitian-descent participants and non-Haitian PLHIV. Within each community, separate multivariate logistic regression analyses were conducted to examine the association between stigma experiences with viral suppression and with missed antiretroviral doses. RESULTS: The 891 participants consisted of 154 MSM, 216 FSWs, 90 Haitian-descent persons, and 447 who did not identify with any of these three communities. Compared with other women, FSWs reported significantly higher levels of harassment due to their HIV status, and those of Haitian descent reported significantly lower levels of social exclusion compared with non-Haitian PLHIV. In adjusted analyses, MSM who experienced more stigma in HIV-specific services had a significantly lower odds of knowing they had undetectable viral load (adjusted odds ratio 0.37, Pâ<â0.05). Higher internalized stigma scores were significantly associated with missing an antiretroviral treatment dose among FSWs (adjusted odds ratio 1.26, Pâ<â0.05). CONCLUSION: For FSWs and MSM, efforts to mitigate HIV-related stigma are necessary to improve treatment adherence and viral suppression. For Haitian-descent PLHIV, interventions must address not only their HIV-specific needs, but also the broader social and legal barriers to care.
Assuntos
Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Profissionais do Sexo/psicologia , Estigma Social , Adulto , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Haiti/etnologia , Humanos , Masculino , PrevalênciaRESUMO
CONTEXT: Little is known about health care providers' knowledge of, attitudes toward and provision of emergency contraceptive pills in the English-speaking Caribbean, where sexual violence and unplanned pregnancies are persistent public health problems. METHODS: We conducted interviewer-administered surveys of 200 Barbadian and 228 Jamaican pharmacists, general practitioners, obstetrician-gynecologists and nurses in 2005-2006. For each country, Pearson's chi-square tests were used to assess differences in responses among the four provider groups. RESULTS: Nearly all respondents had heard of emergency contraceptive pills, and large majorities of Barbadian and Jamaican providers had dispensed the method. However, about half had ever refused to dispense it; frequently cited reasons were medical contraindications to use, recent use, method unavailability, safety concerns and being uncomfortable prescribing it. Only one in five providers knew that the method could be safely used as often as needed, and few knew that it was effective if taken within 120 hours of unprotected sexual intercourse. About a quarter of Barbadian and half of Jamaican providers thought the method should be available without a prescription, and half of all providers believed that its use encourages sexual risk-taking and leads to increased STI transmission. Nonetheless, most respondents believed the method was necessary to reduce rates of unintended pregnancy and were willing to dispense it to rape victims, women who had experienced condom failure and women who had not used a contraceptive. CONCLUSIONS: Future educational efforts among Jamaican and Barbadian health care providers should emphasize the safety and proper use of emergency contraceptive pills, as well as the need to increase the availability of the method.
Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Anticoncepção Pós-Coito/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adulto , Atitude do Pessoal de Saúde/etnologia , Barbados , Anticoncepção Pós-Coito/psicologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Dhaka City is home to thousands of migrants from Bangladesh's rural areas who often live in the streets. Prior studies examine street youth's practice of selling sex as a survival mechanism. We assess their less-studied practice of paying for sex and its association with sexual risk behaviors and outcomes. METHODS: As part of the global Link Up project, trained interviewers recruited 447 young men who live on the streets, ages 15-24, from seven Dhaka City "hotspots" to participate in a survey about sexual health. Among those who ever had sex, we examined frequencies and conducted bivariate analyses of sociodemographic characteristics by paying for sex status. We then conducted bivariate and multivariate logistic regression analyses of paying for sex in the last 12 months and sexual health behaviors and outcomes. RESULTS: Median participant age was 18 years. Among those who ever had sex (N = 321), 80% reported paying for sex in the last 12 months and 15% reported selling sex in the last 12 months. In multivariate analyses, those who paid for sex had significantly increased odds of reporting sexually transmitted infection-related symptoms in the last six months (adjusted odds ratio = 1.76, 95% confidence interval [CI] = 1.17-2.64) and engaging in unprotected last sex with a nonprimary partner (adjusted odds ratio = 2.19, CI = 1.58-3.03). CONCLUSIONS: The adverse factors associated with paying for sex among young men who live on the streets in Dhaka City highlight the need for programs to educate on HIV/sexually transmitted infection prevention and promote condom use, STI screening/treatment, and HIV testing in this population.
Assuntos
Jovens em Situação de Rua/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Populações Vulneráveis , Adolescente , Adulto , Bangladesh , Estudos Transversais , Infecções por HIV/prevenção & controle , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Migrantes/estatística & dados numéricos , Adulto JovemRESUMO
Sex workers and their clients are particularly vulnerable to HIV/STI transmission. Most research on condom use has focused on barriers preventing use; less is known about attitudes, motivations and strategies employed by those who feel positively about condoms and who use them successfully. For this qualitative study, we conducted focus group discussions with sex workers (14), both female and transvestite, in Ciudad Juarez, Mexico, and female sex workers (17) and male clients (11) in Santo Domingo, Dominican Republic, who identified themselves as successful condom users in a condom use questionnaire. Discussions explored definitions of successful condom use, motivations and strategies for condom use and messages for future condom promotion. Sex workers defined successful condom use as being in agreement with their clients and partners about using condoms, protecting themselves from disease and unwanted pregnancy, and feeling good about using condoms. Condoms were seen to be hygienic, offer protection and provide a sense of security and peace of mind. Specific strategies included always having condoms on hand, stressing the positive aspects of condoms and eroticising condom use. Future educational messages should emphasise condom use to protect loved ones, increase security and pleasure during sex, and demonstrate respect for both sex workers, clients and partners.
Assuntos
Preservativos/estatística & dados numéricos , Trabalho Sexual , Adolescente , Adulto , República Dominicana , Feminino , Grupos Focais , Promoção da Saúde , Humanos , Masculino , México , Sexo Seguro , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Although highly legally restricted, abortion is legal in cases of rape throughout Mexico. This study describes women's and physicians' experiences obtaining/providing legal abortion services in cases of rape in Mexico City. MATERIAL AND METHODS: We interviewed five women who experienced a pregnancy as a result of rape. Physicians and organizations that provide services to rape survivors recruited the women. We also interviewed seven physicians who provide legal abortion services. We used the qualitative analysis software Ethnograph to analyze interview transcripts. RESULTS: Women and physicians agreed that the process to obtain legal authorization for an abortion is time-consuming and bureaucratic. There is a lack of information about places and procedures to report the rape and to obtain a legal abortion. A majority of the women experienced a denial process of the rape that contributed to their delayed access to abortion services, exacerbated by the cumbersome legal process. CONCLUSION: In Mexico City, physicians and rape survivors face structural barriers and personal barriers to providing or obtaining legal abortion.
Assuntos
Aborto Legal/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Estupro , Adolescente , Adulto , Feminino , Humanos , México , Gravidez , Adulto JovemRESUMO
BACKGROUND: In Mexico, abortion is legal only in limited, specific circumstances and unsafe abortion complications are estimated to be the fourth leading cause of maternal mortality. Our study sought to understand the opinions Mexicans hold about abortion and sexuality and to learn about their fears and hopes about more liberalized abortion laws in Mexico. METHODS: We carried out 12 focus groups with a total of 87 women and men, aged 18-24. Six focus groups took place in Mexico City and six in Merida, Yucatan. One reader thematically analyzed and coded discussion transcripts. RESULTS: Participants favoring highly restrictive abortion laws generally felt that pregnant women should "face the consequences" of having a baby, whereas those who favored less restrictive laws focused less on culpability and more on the woman's right to control her future. Mexico City participants generally had more liberal abortion opinions. Most Merida participants thought abortion was never legal, despite the fact that their state has the country's most liberal abortion laws. Many felt that, if abortion were legal, there would be more abortions but that it would likely be a safer procedure. CONCLUSIONS: Merida participants' more conservative attitudes may be a reflection of their lower educational levels and largerproportion of Catholic participants compared to the Mexico City groups. It is critical to introduce more balanced information that emphasizes the safety of abortions performed under legal conditions and address fears of greatly elevated abortion rates if abortion laws were liberalized. Mexican young adults need more scientific, balanced sources of information on abortion and abortion law.
Assuntos
Aborto Legal , Aborto Legal/psicologia , Adolescente , Informação de Saúde ao Consumidor , Medo , Feminino , Humanos , Masculino , México , População Urbana , Adulto JovemRESUMO
Although condoms can prevent sexually transmitted infections and unwanted pregnancies, use remains low worldwide. Rather than continue to investigate the barriers to use, this study sought to obtain information from students and factory workers who identify themselves as successful condom users. After developing a novel successful condom use scale, we conducted 793 interviews among students and factory workers in Ciudad Juárez, Mexico and Santo Domingo, Dominican Republic. We compared successful users to unsuccessful users and invited successful users to participate in focus group discussions. Among students, successful condom users were more likely to be from Mexico. Factory workers identified as successful condom users were more likely to have had fewer casual sexual partners. Focus group participants cited condoms' accessibility, security, and cleanliness as reasons for use. Use differed by partner type, stable versus casual. These findings should be considered when developing condom promotion campaigns.
Assuntos
Preservativos/estatística & dados numéricos , Adolescente , Adulto , República Dominicana , Feminino , Humanos , Indústrias , Masculino , México , Estudantes , Adulto JovemRESUMO
OBJECTIVES: To examine whether nonbarrier modern contraceptive use is associated with less consistent condom use among Kenyan female sex workers (FSWs). STUDY DESIGN: Researchers recruited 579 FSWs using respondent-driven sampling. We conducted multivariate logistic regression to examine the association between consistent condom use and female-controlled nonbarrier modern contraceptive use. RESULTS: A total of 98.8% reported using male condoms in the past month, and 64.6% reported using female-controlled nonbarrier modern contraception. In multivariate analysis, female-controlled nonbarrier modern contraceptive use was not associated with decreased condom use with clients or nonpaying partners. CONCLUSION: Consistency of condom use is not compromised when FSWs use available female-controlled nonbarrier modern contraception. IMPLICATIONS: FSWs should be encouraged to use condoms consistently, whether or not other methods are used simultaneously.
Assuntos
Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Profissionais do Sexo/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Soropositividade para HIV/epidemiologia , Humanos , Quênia , Masculino , Sexo Seguro , Parceiros SexuaisRESUMO
BACKGROUND: Abortion laws are extremely restrictive in Brazil. The knowledge, opinions of abortion laws, and abortion practices of obstetrician-gynecologists can have a significant impact on women's access to safe abortion. METHODS: We conducted a mail-in survey with a 10% random sample of obstetrician-gynecologists affiliated with the Brazilian Federation of Obstetricians and Gynecologists. We documented participants' experiences performing abortion under a range of legal and illegal circumstances, and asked about which abortion techniques they had experience with. We used chi-square tests and crude logistic regression models to determine which sociodemographic, knowledge-related, or practice-related variables were associated with physician opinion. RESULTS: Of the 1,500 questionnaires that we mailed out, we received responses from 572 (38%). Less than half (48%) of the respondents reported accurate knowledge about abortion law and 77% thought that the law should be more liberal. One-third of respondents reported having previous experience performing an abortion, and very few of these physicians reported having experience with manual vacuum aspiration (MVA) or with misoprostol with either mifepristone or methotrexate. Physicians that favored liberalization of the law were more likely to have correct knowledge about abortion law, and to be in favor of public funding for abortion services. CONCLUSION: Brazilian obstetrician-gynecologists need more information on abortion laws and on safe, effective abortion procedures.
RESUMO
CONTEXT: Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better understanding of sex workers' use of condoms and nonbarrier methods is needed to help them meet their contraceptive and STI protection needs. METHODS: A 2011 respondent-driven sampling survey collected reproductive health and contraceptive use data from 325 female sex workers in Swaziland. Multinomial logistic regression analysis was used to identify associations between selected characteristics and four outcomes of contraceptive use over the past month: consistent condom use alone; nonbarrier modern contraceptive use (either alone or with inconsistent condom use); dual method use; and inconsistent condom use, other method use or nonuse. Adjusted predicted probabilities were also calculated to determine patterns of association. RESULTS: After adjustments were made for background and behavioral factors, 16% of female sex workers were found to be consistent users of condoms alone; 39% used nonbarrier modern methods (without consistent condom use); 8% were dual method users; and 38% were inconsistent condom users or used other methods or none. Women who reported recent condom failure were less likely than others to be consistent condom users (6% vs. 22%). Consistent use of condoms alone was more common among women who had had no noncommercial partners in the past month than among those who reported two or more such partners (39% vs. 3%). In addition, respondents who had children were more likely than their nulliparous counterparts to report use of nonbarrier methods alone (65% vs. 14%). CONCLUSIONS: Inconsistent or no condom use among nonbarrier contraceptive users underscores the need to incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and noncommercial partners.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Assunção de Riscos , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto , Comportamento Contraceptivo/psicologia , Essuatíni/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Condições Sociais , Inquéritos e Questionários , Sexo sem Proteção , Saúde da Mulher , Adulto JovemRESUMO
OBJECTIVE: To describe abortion history and current contraceptive use among female sex workers (FSWs) in Moscow, Russia. METHODS: A clinic-based survey was conducted among 147 FSWs in Moscow during an 8-month period in 2005. RESULTS: In total, 83 of 143 (58.0%) FSWs reported a history of abortion, with 45 of 143 (31.5%) indicating multiple abortions. Condoms were the primary form of contraception (145/146 [99.3%]); just 17 of 142 (12.0%) FSWs reported using non-barrier modern contraception. All women who reported using a non-barrier modern method also indicated condom use (i.e. dual protection). Non-barrier contraceptive use was associated with inconsistent condom use (odds ratio [OR] 3.10; 95% confidence interval [CI], 1.07-9.02) and multiple abortions (OR 4.71; 95% CI, 1.19-18.62). CONCLUSION: The results illustrate substantial risk for unintended pregnancy among FSWs. Further research is needed regarding the dynamics of non-barrier contraception and condom use. Efforts to improve the health and wellbeing of FSWs should include access to safe and effective contraception, in addition to HIV prevention.