Prioritizing Mental Health within HIV and Tuberculosis Services in PEPFAR.

Underprioritization of mental health is a global problem and threatens the decades-long progress of the US President's Emergency Plan for AIDS Relief (PEPFAR) program. In recent years, mental health has become globally recognized as a part of universal healthcare, making this an opportune moment for the global community to integrate mental health services into routine programming. PEPFAR is well positioned to lead by example. We conceptualized 5 key strategies that might help serve as a framework to support mental health programming as part of PEPFAR's current 5-year strategic plan. PEPFAR and the global community have an opportunity to identify mental health service gaps and interweave global mental health priorities with actions to end the HIV and TB epidemics by 2030.

Trust and trustworthy artificial intelligence: A research agenda for AI in the environmental sciences.

Demands to manage the risks of artificial intelligence (AI) are growing. These demands and the government standards arising from them both call for trustworthy AI. In response, we adopt a convergent approach to review, evaluate, and synthesize research on the trust and trustworthiness of AI in the environmental sciences and propose a research agenda. Evidential and conceptual histories of research on trust and trustworthiness reveal persisting ambiguities and measurement shortcomings related to inconsistent attention to the contextual and social dependencies and dynamics of trust. Potentially underappreciated in the development of trustworthy AI for environmental sciences is the importance of engaging AI users and other stakeholders, which human-AI teaming perspectives on AI development similarly underscore. Co-development strategies may also help reconcile efforts to develop performance-based trustworthiness standards with dynamic and contextual notions of trust. We illustrate the importance of these themes with applied examples and show how insights from research on trust and the communication of risk and uncertainty can help advance the understanding of trust and trustworthiness of AI in the environmental sciences.

How effective is community-based management of freshwater resources? A review.

Despite the existence of numerous research studies on community-based conservation, relatively few focus on the particularities of freshwater ecosystems. Freshwater ecosystems are distinct from terrestrial and marine ecosystems, exhibiting both greater concentrations of biodiversity and elevated threats. In addition, freshwater resources have distinct social, legal, political, and economic characteristics which limit the generalizability of community-based conservation research from other ecological domains. We examine peer-reviewed literature on community-based management of freshwater resources to understand and assess project contexts and outcomes. Our review indicates that studies of freshwater community-based management are limited in number and representativeness. While positive outcomes for both biodiversity and human well-being are commonly reported, limitations due to study design constrain the ability to infer the significance or causality of these effects. Overall, our analysis indicates that there are several gaps in the available research: across geographic regions, freshwater ecosystem types, intervention types, and environmental and human well-being outcome types. Given the importance of freshwater resources to Indigenous Peoples and local communities, our review highlights the critical need to generate evidence across more diverse contexts to achieve greater clarity on whether and how community-based projects can be most effective.

Adapting the Community-based Health Planning and Services (CHPS) to engage poor urban communities in Ghana: protocol for a participatory action research study.

INTRODUCTION: With rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities. METHODS AND ANALYSIS: A Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 ('reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement. ETHICS AND DISSEMINATION: This study has been approved by the University of York's Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK.

Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana.

INTRODUCTION: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and identified potential mediating factors among healthcare workers in Ghana. METHODS: Healthcare workers in Ghana completed a cross-sectional self-administered online survey from April to May 2020; 414 and 409 completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial scales. We assessed associations using linear regressions with robust standard errors. RESULTS: The average score for preparedness was 24 (SD = 8.8), 16.3 (SD = 5.9) for stress, and 37.4 (SD = 15.5) for burnout. In multivariate analysis, healthcare workers who felt somewhat prepared and prepared had lower stress (ß = -1.89, 95% CI: -3.49 to -0.30 and ß = -2.66, 95% CI: -4.48 to -0.84) and burnout (ß = -7.74, 95% CI: -11.8 to -3.64 and ß = -9.25, 95% CI: -14.1 to -4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to 17% of the effect. CONCLUSIONS: Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions, incentives, and health systemic changes to increase healthcare workers' morale and capacity to respond to the pandemic are needed.

Optimizing task-sharing in abortion care in Ghana: Stakeholder perspectives.

Ghana has made progress in expanding providers in abortion care but access to the service is still a challenge. We explored stakeholder perspectives on task-sharing in abortion care and the opportunities that exist to optimize this strategy in Ghana. We purposively sampled 12 representatives of agencies that played a key role in expanding abortion care to include midwives for key informant interviews. All interviews were audio recorded, transcribed verbatim, and then coded for thematic analysis. Stakeholders indicated that Ghana was motivated to practice task-sharing in abortion care because unsafe abortion was contributing significantly to maternal mortality. They noted that the Ghana Health Service utilized the high maternal mortality in the country at the time, advancements in medicine, and the lack of clarity in the definition of the term "health practitioner" to work with partner nongovernmental organizations to successfully task-share abortion care to include midwives. Access, however, is still poor and provider stigma continues to contribute significantly to conscientious objection. This calls for further task-sharing in abortion care to include medical or physician assistants, community health officers, and pharmacists to ensure that more women have access to abortion care.

Trends and risk factors associated with stillbirths: A case study of the Navrongo War Memorial Hospital in Northern Ghana.

BACKGROUND: Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. METHODS: Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. RESULTS: A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). CONCLUSION: Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM.

Prevalence and adverse obstetric outcomes of female genital mutilation among women in rural Northern Ghana.

BACKGROUND: Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. METHODS: We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. RESULTS: A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. CONCLUSIONS: Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM.

Using Social Media To Increase HIV Testing Among Men Who Have Sex with Men - Beijing, China, 2013-2017.

The prevalence of human immunodeficiency virus (HIV) infection in China is low overall (0.06%) (1); however, it is substantially higher (8.0%) among men who have sex with men (MSM) (2), and the stigmatization of same-sex behaviors in China presents challenges for HIV prevention and treatment efforts. In 2015, Blued, a Beijing-based media company that operates an online dating application popular among Chinese MSM, launched an ongoing HIV testing campaign that combined its push-notification† platform and geolocation capabilities to encourage HIV testing among MSM in Beijing. To assess trends in use of HIV testing services, Blued and CDC's China HIV program examined testing at six Blued-operated Beijing HIV testing centers from 2 years before the campaign launch in 2015 through December 31, 2017. A sharp increase in HIV testing followed the launch of Blued's online campaign, indicating that leveraging social media platforms and their geolocation-based text messaging functionality might be useful in increasing HIV testing among MSM, particularly those aged ≤35 years.

Efficacy of a Small-Group Intervention for Post-Incarcerated Black Men Who Have Sex with Men and Women (MSMW).

We conducted a randomized controlled trial of a six-session behavioral intervention designed to reduce frequency of condomless sex and numbers of sex partners among recently incarcerated, bisexual Black men. One hundred participants were assigned to the small-group intervention, Men in Life Environments (MILE), and 112 were assigned to the control condition. Among those assigned to MILE, 69% attended at least one session, 88% of whom attended all sessions. At 3-months' follow-up, large reductions in risk behaviors were reported by both groups. Means for episodes of condomless sex in the previous 3 months declined from 27.7 to 8.0 for the intervention and 25.6 to 6.7 for the control group. Reductions were not greater for the intervention than those of the control group. Regression to the mean, respondent burden, and implementation issues, such as moving from office-based to field-based survey administration at follow-up, may have contributed to the large declines reported by both groups.

Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana.

OBJECTIVE: To assess the prevalence of conscientious objection (CO), motivations, knowledge of Ghana's abortion law, attitudes, and behaviors toward abortion provision among medical providers in northern Ghana, and measures to regulate CO. METHODS: Between June and November 2015, the present cross-sectional survey-based descriptive study measured prevalence, knowledge, and attitudes about CO among 213 eligible health practitioners who were trained in abortion provision and working in hospital facilities in northern Ghana. Results were stratified by facility ownership and provider type. RESULTS: Approximately half (94/213, 44.1%) of trained providers reported that they were currently providing abortions. The overall prevalence of self-identified and hypothetical objection was 37.9% and 33.8%, respectively. Among 87 physicians, 37 (42.5%) and 39 (44.8%) were categorized as self-identified and hypothetical objectors, respectively. Among 126 midwives, nurses, and physician assistants, 43 (34.7%) and 33 (26.2%) were coded as self-identified and hypothetical objectors, respectively. A high proportion of providers reported familiarity with Ghana's abortion law and supported regulation of CO. CONCLUSION: CO based on moral and religious grounds is prevalent in northern Ghana. Providers indicated an acceptance of policies and guidelines that would regulate its application to reduce the burden that CO poses for women seeking abortion services.

Racial Pride and Condom Use in Post-Incarcerated African-American Men Who Have Sex With Men and Women: Test of a Conceptual Model for the Men in Life Environments Intervention.

African-American men who have sex with men and women (MSMW) are among those most heavily impacted by HIV in the United States, and those who have histories of incarceration are at further risk of infection. The Men in Life Environments (MILE) HIV prevention intervention was developed to provide culturally appropriate skills-based education and support for African-American MSMW with recent histories of incarceration. The MILE's conceptual framework was informed by three theories: Theory of Reasoned Action and Planned Behavior, Critical Thinking and Cultural Affirmation Model, and Empowerment Theory. The theory-based framework posits that improving racial pride is crucial in building self-efficacy and intentions that in turn promote health-protective behaviors. Therefore, our study aimed to assess whether baseline associations between racial pride and condom use self-efficacy, intentions, and behaviors among African-American MSMW with histories of incarceration align with our conceptual model. We report data on 212 participants recruited from Los Angeles County Sheriff's Department Men's Central Jail and the local community. Using structural equation modeling, we tested two separate models: one with female sexual partners and one with male sexual partners, while stratifying by participant's HIV status. Only among HIV-negative participants was greater racial pride associated with less condomless intercourse with men. In this group, greater self-efficacy and intentions-but not racial pride-predicted less condomless intercourse with women. Our findings suggest that racial pride is an important factor to address in HIV prevention interventions for post-incarcerated African-American MSMW.

Changing hearts and minds: Results from a multi-country gender and sexual diversity training.

Engaging key populations, including gender and sexual minorities, is essential to meeting global targets for reducing new HIV infections and improving the HIV continuum of care. Negative attitudes toward gender and sexual minorities serve as a barrier to political will and effective programming for HIV health services. The President's Emergency Plan for AIDS Relief (PEPFAR), established in 2003, provided Gender and Sexual Diversity Trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. The outcomes of these one-day trainings were evaluated among a subset of participants using a mixed methods pre- and post-training study design. Findings suggest that sustainable decreases in negative attitudes toward gender and sexual minorities are achievable with a one-day training.

Assault injury presentation and lifetime psychological trauma in emergency centre patients in South Africa: A cross-sectional study.

There is a paucity of data from emergency centers regarding (a) the prevalence of recurrent assault injury and prior psychological trauma, and (b) psychosocial predictors of assault-injury presentation. OBJECTIVE: To address the above gaps to identify psychosocial needs and injury-prevention opportunities. METHOD: Patients presenting with assault or unintentional injuries were recruited from 2 emergency centers (ECs; n = 200) and assessed for injury history, traumatic events, and mental disorders. Descriptive statistics were computed and predictors for assault-injury presentation and recurrent assault injury were identified using logistic regression. Univariate regression models were employed to identify significant variables before entering these into multivariate models. RESULTS: The majority of the participants were male (67%), of whom 43% were between the ages of 25 and 40 years. The median number of lifetime traumatic events was 7. Recurrent assault injury was found in 31%. These injuries were predicted by lifetime traumatic events other than injury (OR = 1.035, 95% CI [1, 1.07]). Assault-injury presentation was significantly less likely in female participants (OR = 0.221, 95% CI [0.1, 0.5]) and was associated with high levels of witnessing community violence (OR = 1.157, 95% CI [1.01, 1.32]). CONCLUSION: Patients presenting with assault injuries are at risk for injury recurrence, have high levels of past psychological trauma, and should be screened for psychosocial risk. Further research is needed to assess the role of past psychological trauma in risk for assault injury, and clarify treatment needs. The role of EC-based interventions in injury prevention and mental health requires increased recognition in South African policy and practice. (PsycINFO Database Record

Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren.

BACKGROUND: The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren. OBJECTIVE: To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren. DESIGN: This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue(®) photometer was used to measure haemoglobin (Hb), while the code transmission test (CTT), adapted from the Test of Everyday Attention for Children (TEA-Ch), was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012. RESULTS: We observed significant malaria parasite prevalence reductions of 62.8 and 59.2% in Study Arm 1 from 24.2 to 9.0%, p<0.01, and 59.2% in Study Arm 2 from 26.7 to 10.9%, p<0.01), respectively, compared to 8.93% in Control Arm 3 (from 34.7 to 31.6%, p>0.05). Meanwhile, anaemia prevalence reduced significantly (p<0.01) in all three study arms after interventions by 38.4% (from 19.8 to 12.2%), 20.7% (from 26.6 to 21.1%), and 36.0% (from 28.3 to 18.1%) in Study Arms 1, 2, and 3, respectively. Although the interventions had no significant effects on Hb levels, anaemia prevalence reduced insignificantly by 38.4 and 20.7% in Study Arms 1 and 2, respectively, compared to 36.0% in Control Arm 3. Among schoolchildren in Study Arms 1 and 2, mean CTT score improved significantly after interventions by 10.4% (from 3.18 to 3.55, p=0.01) and 20.5% (from 2.83 to 3.56, p=0.01) respectively, compared to 5.75% in Control Arm 3 (from 2.95 to 3.13, p=0.09). Likewise, mean recall test score improvements after interventions were 16.9% (from 2.07 to 2.49, p=0.01) and 27.9% (from 1.91 to 2.65, p=0.01) in Study Arms 1 and 2, respectively, compared to 18.3% (from 1.92 to 2.35, p=0.01) in Control Arm 3. CONCLUSION: Combined intermittent preventive treatment of malaria and deworming reduced prevalence of anaemia and improved sustained attention and recall in schoolchildren. Best results for sustained attention and recall were seen in Study Arm 2.

Validation of the Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study.

INTRODUCTION AND AIM: Given the high prevalence and detrimental consequences of alcohol or other drug (AOD) use in low- and middle-income countries, a screening tool for early detection in health care, including emergency care, is critical. We set out to validate the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for the South African context. DESIGN AND METHODS: We interviewed emergency centre patients (n = 200) in Cape Town for this cross-sectional study conducted from January to March 2013 utilising a questionnaire battery, including the ASSIST and Mini International Neuropsychiatric Interview. Internal consistency (Cronbach's alpha) and screening properties of the ASSIST (receiver operating characteristic analysis) were examined utilising the Mini International Neuropsychiatric Interview AOD use modules as the gold standard. RESULTS: Cronbach's alpha for alcohol and illicit drugs ranged from 0.81 to 0.95 indicating good internal consistency. ASSIST cut-off scores show a good sensitivity and specificity for discrimination particularly when distinguishing between substance use and abuse, rather than dependence. For alcohol, the area under the curve was 0.94 for distinguishing between use and abuse, and this dropped to 0.68 for distinguishing between abuse and dependence, while the statistic remained high for both use/abuse and abuse/dependence for illicit drugs: 0.95 and 0.96. DISCUSSION AND CONCLUSION: AOD abuse was associated with cut-off scores below the World Health Organization recommended levels, in keeping with various international studies suggesting that individuals with lower scores be offered interventions. The ASSIST was found to be useful for South African health care and holds promise for cost-effective task-shifting approaches in lower resourced settings. [van der Westhuizen C, Wyatt G, Williams JK, Stein DJ, Sorsdahl K. Validation of the Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study. Drug Alcohol Rev 2016;35:702-709].

Ebola virus disease surveillance and response preparedness in northern Ghana.

BACKGROUND: The recent Ebola virus disease (EVD) outbreak has been described as unprecedented in terms of morbidity, mortality, and geographical extension. It also revealed many weaknesses and inadequacies for disease surveillance and response systems in Africa due to underqualified staff, cultural beliefs, and lack of trust for the formal health care sector. In 2014, Ghana had high risk of importation of EVD cases. OBJECTIVE: The objective of this study was to assess the EVD surveillance and response system in northern Ghana. DESIGN: This was an observational study conducted among 47 health workers (district directors, medical, disease control, and laboratory officers) in all 13 districts of the Upper East Region representing public, mission, and private health services. A semi-structured questionnaire with focus on core and support functions (e.g. detection, confirmation) was administered to the informants. Their responses were recorded according to specific themes. In addition, 34 weekly Integrated Disease Surveillance and Response reports (August 2014 to March 2015) were collated from each district. RESULTS: In 2014 and 2015, a total of 10 suspected Ebola cases were clinically diagnosed from four districts. Out of the suspected cases, eight died and the cause of death was unexplained. All the 10 suspected cases were reported, none was confirmed. The informants had knowledge on EVD surveillance and data reporting. However, there were gaps such as delayed reporting, low quality protective equipment (e.g. gloves, aprons), inadequate staff, and lack of laboratory capacity. The majority (38/47) of the respondents were not satisfied with EVD surveillance system and response preparedness due to lack of infrared thermometers, ineffective screening, and lack of isolation centres. CONCLUSION: EVD surveillance and response preparedness is insufficient and the epidemic is a wake-up call for early detection and response preparedness. Ebola surveillance remains a neglected public health issue. Thus, disease surveillance strengthening is urgently needed in Ghana.

Sexual Risk Behaviors and Substance Use Among Men Sexually Victimized by Women.

OBJECTIVES: To investigate whether forced sex of men by women was associated with sexual risk behaviors, and whether this association was mediated by substance use. METHODS: Data from US men aged 18 years or older at interview in the National Survey of Family Growth 2006-2010 (n = 8108) who reported sexual behavior history. Outcome variables were condom use at most recent sex and number of lifetime sexual partners. Sexual activity covariates included age at first consensual sex and treatment of sexually transmitted infections. Alcohol and drug use were the mediating factors. RESULTS: Six percent of men reported forced sex by a woman at a mean age of 18 years. On average, victimized men had 3 more lifetime sexual partners than nonvictimized men (P < .01). Furthermore, victimized men who reported drug use had, on average, 4 more female sexual partners (P < .01) than nonvictimized men. Marijuana (P < .05) and crack cocaine use (P < .05) partially mediated the association between forced sex and number of female partners. Neither condom use nor number of male partners differed between victimized and nonvictimized men. CONCLUSIONS: A nontrivial fraction of men experience forced sex by women; some of them have elevated sexual risk behaviors.

Validation of the Self Reporting Questionnaire 20-Item (SRQ-20) for Use in a Low- and Middle-Income Country Emergency Centre Setting.

Common mental disorders are highly prevalent in emergency centre (EC) patients, yet few brief screening tools have been validated for low- and middle-income country (LMIC) ECs. This study explored the psychometric properties of the SRQ-20 screening tool in South African ECs using the Mini Neuropsychiatric Interview (MINI) as the gold standard comparison tool. Patients (n=200) from two ECs in Cape Town, South Africa were interviewed using the SRQ-20 and the MINI. Internal consistency, screening properties and factorial validity were examined. The SRQ-20 was effective in identifying participants with major depression, anxiety disorders or suicidality and displayed good internal consistency. The optimal cutoff scores were 4/5 and 6/7 for men and women respectively. The factor structure differed by gender. The SRQ-20 is a useful tool for EC settings in South Africa and holds promise for task-shifted approaches to decreasing the LMIC burden of mental disorders.

Food insecurity and intimate partner violence against women: results from the California Women's Health Survey.

OBJECTIVE: To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women. DESIGN: Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence. SETTING: Data from 6 years of the California Women's Health Survey. SUBJECTS: Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA. RESULTS: We found: (i) that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; (ii) a strong positive association between food insecurity and intimate partner violence; (iii) evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and (iv) higher odds of intimate partner violence among those reporting more severe food insecurity. CONCLUSIONS: Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.