Inequities in COVID-19-Related Patient Outcomes by Socio-Demographic Characteristics: A Scoping Review.

Socio-demographic inequities in health treatment and outcomes are not new. However, the COVID-19 pandemic presented new opportunities to examine and address biases. This article describes a scoping review of 170 papers published prior to the onset of global vaccinations and treatment (December 2021). We report differentiated COVID-19-related patient outcomes for people with various socio-demographic characteristics, including the need for intubation and ventilation, intensive care unit admission, discharge to hospice care, and mortality. Using the PROGRESS-Plus framework, we determined that the most researched socio-demographic factor was race/ethnicity/culture/language. Members of minoritized racial and ethnic groups tended to have worse COVID-19-related patient outcomes; more research is needed about other categories of social disadvantage, given the scarcity of literature on these factors at the time of the review. It is only by researching and addressing the causes of social disadvantage that we can avoid such injustice in future public health crises.

Differentiating sex and gender in health research to achieve gender equity.

Effectively tracking progress on initiatives focused on gender equity requires clear differentiation between the terms sex and gender. Sex usually refers to a person's biological characteristics, whereas gender refers to socially constructed roles and norms. Although both terms are often treated as binaries, gender is a spectrum and sex may include intersex individuals. While the terms are interrelated, they are sometimes conflated or used interchangeably in health data. Their fundamental distinctions, however, have implications for the conduct of research and the design of interventions targeting sex- and gender-based health disparities. We use the example of coronavirus disease 2019 to show how conflating these terms in data collection makes it difficult to ascertain whether disparities in infection rates, morbidity and mortality are determined by sex or gender. Although the exact process of collecting data on sex and gender may need to be adapted for specific contexts, there are steps that can be taken so that health data better reflect the differences between these concepts. Possible actions include using a two-step data collection process to determine both sex and gender of individuals, and encouraging recognition of intersex, third gender, transgender and gender nonbinary people. There also needs to be acceptance and commitment by data collectors and research editors; for example, by using tools such as the Sex and Gender Equity in Research checklist. With clearer distinctions between these foundational terms and how they are used in health data, we can achieve more accurate research findings, better-tailored interventions and better progress towards gender equity.

Pour suivre efficacement les progrès des initiatives centrées sur l'égalité des genres, il est impératif de distinguer clairement les termes «sexe¼ et «genre¼. Le sexe fait généralement référence aux caractéristiques biologiques d'une personne, tandis que le genre se rapporte aux normes et rôles socialement construits. Bien que ces termes soient souvent considérés comme binaires, le genre est un spectre et le sexe est susceptible d'inclure les individus intersexués. Tous deux sont étroitement liés; en revanche, ils sont parfois confondus ou employés comme synonymes dans les données relatives à la santé. Pourtant, leurs différences fondamentales ont des conséquences sur la conduite des recherches et l'élaboration d'interventions ciblant les disparités sanitaires fondées sur le sexe et le genre. Dans le présent document, nous citons l'exemple de la maladie à coronavirus 2019 pour montrer que, lorsque ces termes sont assimilés l'un à l'autre dans la collecte de données, il devient difficile d'établir si le sexe ou le genre entraîne des variations au niveau des taux d'infection, de morbidité et de mortalité. Il pourrait s'avérer nécessaire d'adapter la méthode utilisée pour recueillir les données sur le sexe et le genre dans certains contextes spécifiques; néanmoins, il est possible d'entreprendre des démarches pour que les données relatives à la santé reflètent davantage les différences entre ces concepts. Parmi les actions envisagées figure l'usage d'un processus de collecte des données en deux étapes, servant à déterminer tant le sexe que le genre des individus et favorisant la reconnaissance des personnes intersexuées, du troisième genre, transgenres et non binaires. Celles et ceux chargés de récolter les données et de rédiger les recherches doivent également faire preuve d'acceptation et d'engagement, notamment en recourant à des outils tels que la liste de contrôle issue des recommandations sur l'égalité des sexes et des genres dans la recherche (Sex and Gender Equity in Research, SAGER). Mieux comprendre les différences entre ces deux termes essentiels et leur emploi dans les données sanitaires aboutira à des résultats plus précis, des interventions plus pertinentes et davantage de progrès vers l'égalité des genres.

Es necesaria una clara diferenciación entre los términos sexo y género para realizar un seguimiento eficaz del progreso de las iniciativas centradas en la igualdad de género. Por lo general, el término sexo hace referencia a las características biológicas de una persona, mientras que el término género hace referencia a las funciones y normas que dicta la sociedad. Aunque con frecuencia ambos términos se tratan como binarios, género es un espectro y sexo puede albergar personas intersexuales. Aunque estos términos están relacionados entre sí, en ocasiones se confunden o se utilizan indistintamente en los datos sanitarios. Sin embargo, las diferencias fundamentales que existen entre ellos, tienen implicaciones a la hora de llevar a cabo la investigación y el diseño de intervenciones centradas en las disparidades de los datos sanitarios a causa del uso de los términos sexo y género. Utilizamos el ejemplo de la enfermedad de coronavirus de 2019 para mostrar cómo el hecho de confundir estos términos a la hora de recopilar datos, hace que sea más difícil constatar si las disparidades existentes en las tasas de infección, morbilidad y mortalidad están determinadas por sexo o por género. Aunque es posible que sea necesario adaptar el proceso exacto de recopilación de datos sobre sexo y género a contextos específicos, se pueden adoptar medidas para que los datos sanitarios reflejen mejor las diferencias entre estos conceptos. Las posibles medidas incluyen el uso de un proceso de recopilación de datos compuesto de dos pasos para determinar tanto el sexo como el género de las personas, y fomentar el reconocimiento de las personas intersexuales, de tercer género, transgénero y de género no binario. Del mismo modo, es necesario que exista aceptación y compromiso por parte de los recopiladores de datos y de los editores de investigaciones; por ejemplo, mediante el uso de herramientas como la lista de verificación de Sexo e Igualdad de Género en la Investigación. Con distinciones más claras entre estos términos fundamentales, así como en la manera de utilizarlos en los datos sanitarios, podemos lograr resultados de investigación más precisos, intervenciones mejor adaptadas y mejores avances en la igualdad de género.

Associations Between Implicit and Explicit Condom Use Measures With Condom Use Barriers: Relationships Make A Difference.

OBJECTIVE: The association between explicit and implicit psychological measures might be affected by the similarity of the assessment method and by the overlap of the components of the constructs being assessed. This study examined the association between condom use barriers and explicit and implicit measurements of condom use and the moderating role of sexual intercourse in these associations. DESIGN: This was a cross sectional correlational study. An analysis of baseline data from a randomized controlled trial including 149 university students was included. MAIN MEASURES: These included a questionnaire assessing condom use barriers, an implicit condom use test (a structured semi-projective test), and an explicit condom use question. Hierarchical regressions and correlations were examined in the full sample and by groups of participants with and without sexual intercourse. RESULTS: In those without sexual intercourse, all barriers sub-scales were significantly and negatively correlated with implicit condom use and unrelated to explicit condom use. In contrast, among those engaged in sexual intercourse, barriers were significantly and negatively correlated with the explicit condom use measure, and only barriers concerning partner and motivation correlated with implicit condom use tendencies. CONCLUSION: Having a sexual partner plays a major role in the relations between barriers and implicit and explicit condom use measures. The pattern of the results is discussed in relation to cognitive and social factors.

Abortion Services in Humanitarian Contexts.

Conditions prevailing in humanitarian crises often create a coercive environment for women. Material and security needs and pre-exisiting inequalities render women particularly vulnerable to social and contextual coercion in such situations, which can often result in unwanted pregnancies. Some women may resort to unsafe abortions, sometimes resulting in death. Currently, abortion services provided by humanitarian agencies are either unavailable or fail to meet the real need in humanitarian settings. Accessible family planning, contraceptives, and early remedies should all be available, along with counselling. In addition, a pro-choice approach and accompanying abortion services should be a fundamental pillar of health services available to women in emergencies.

Using Peer Education to Promote Psychosocial and Occupational Health and Empowerment Among Female Sex Workers in Nepal.

Female sex workers (FSWs) in Nepal are vulnerable to an array of occupational risks, which may compromise their psychosocial health and ability to engage in protective behaviors. A peer education (PE) intervention designed to empower and promote the psychosocial health of FSWs was pilot tested in Kathmandu, Nepal. FSWs who were exposed to the PE intervention (n = 96) had significantly higher scores on psychosocial health knowledge, perceived self-efficacy and ability to access resources, happiness, and job control compared with those who were not (n = 64). PE may be a promising way to promote psychosocial health and empowerment among FSWs.

Predictors of Recent HIV Testing Among Chinese Men Who Have Sex with Men: A Barrier Perspective.

In China, men who have sex with men (MSM) account for an increasing proportion of new HIV infections. We aim to assess recent HIV testing (in the past 6 months) among Chinese MSM and to identify barriers to testing. A nationwide sample of MSM (n = 1100) from mainland China was recruited. Data on sociodemographics, HIV-related risks, perceived barriers to testing, and testing behaviors were collected. Approximately 30% of MSM had recently undergone HIV testing. With regard to testing, almost half endorsed each of three barriers: did not believe themselves to be at HIV risk, had a fear of being diagnosed HIV positive, and feared their privacy would be violated during testing. Five distinct classes of barriers were identified from the responses. The adjusted multivariable logistic regression model demonstrated that the participants in both the "uncertainty concerning testing sites" and "low risk and privacy violation" classes were less likely to undergo testing than those in the "minimal barrier" class. Men who were unsure of their HIV status were less likely to undergo testing. Furthermore, participants who had multiple male sexual partners and who engaged in substance use over the preceding 6 months were more likely to undergo testing. Distinct subgroups of testing and HIV status varied within the different barrier classifications. Recent HIV testing rates remain low among MSM in China. Barrier factors associated with testing point to the necessity for preventing and controlling HIV, including increasing the privacy of sites or educating MSM on the importance of testing regularly.

Providers' Perceptions and Training Needs for Counseling Adolescents Undergoing Voluntary Medical Male Circumcision.

Background: The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10-19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMMC facility managers and providers about current training content and their perspectives on age-appropriate adolescent counseling. Methods: Semistructured in-depth interviews were conducted with 33 VMMC providers in Tanzania (n = 12), South Africa (n = 9), and Zimbabwe (n = 12) and with 4 key informant facility managers in each country (total 12). Two coders independently coded the data thematically using a 2-step process and Atlas.ti qualitative coding software. Results: Providers and facility managers discussed limitations with current VMMC training, noting the need for adolescent-specific guidelines and counseling skills. Providers expressed hesitation in communicating complete sexual health information-including HIV testing, HIV prevention, proper condom usage, the importance of knowing a partner's HIV status, and abstinence from sex or masturbation during wound healing-with younger males (aged <15 years) and/or those assumed to be sexually inexperienced. Many providers revealed that they did not assess adolescent clients' sexual experience and deemed sexual topics to be irrelevant or inappropriate. Providers preferred counseling younger adolescents with their parents or guardians present, typically focusing primarily on wound care and procedural information. Conclusions: Lack of training for working with adolescents influences the type of information communicated. Preconceptions hinder counseling that supports comprehensive HIV preventive behaviors and complete wound care information, particularly for younger adolescents.

Adolescent Wound-Care Self-Efficacy and Practices After Voluntary Medical Male Circumcision-A Multicountry Assessment.

Background: Adolescent boys (aged 10-19 years) constitute the majority of voluntary medical male circumcision (VMMC) clients in sub-Saharan Africa. They are at higher risk of postoperative infections compared to adults. We explored adolescents' wound-care knowledge, self-efficacy, and practices after VMMC to inform strategies for reducing the risks of infectious complications postoperatively. Methods: Quantitative and qualitative data were collected in South Africa, Tanzania, and Zimbabwe between June 2015 to September 2016. A postprocedure survey was conducted approximately 7-10 days after VMMC among male adolescents (n = 1293) who had completed a preprocedure survey; the postprocedure survey assessed knowledge of proper wound care and wound-care self-efficacy. We also conducted in-depth interviews (n = 92) with male adolescents 6-10 weeks after the VMMC procedure to further explore comprehension of providers' wound-care instructions as well as wound-care practices, and we held 24 focus group discussions with randomly selected parents/guardians of the adolescents. Results: Adolescent VMMC clients face multiple challenges with postcircumcision wound care owing to factors such as forgetting, misinterpreting, and disregarding provider instructions. Although younger adolescents stated that parental intervention helped them overcome potential hindrances to wound care, parents and guardians lacked crucial information on wound care because most had not attended counseling sessions. Some older adolescents reported ignoring symptoms of infection and not returning to the clinic for review when an adverse event had occurred. Conclusions: Increased involvement of parents/guardians in wound-care counseling for younger adolescents and in wound-care supervision, alongside the development of age-appropriate materials on wound care, are needed to minimize postoperative complications after VMMC.

"Love me, parents!": impact evaluation of a national social and behavioral change communication campaign on maternal health outcomes in Tanzania.

BACKGROUND: Despite marked improvements over the last few decades, maternal mortality in Tanzania remains among the world's highest at 454 maternal deaths per 100,000 live births. Many factors contribute to this disparity, such as a lack of attendance at antenatal care (ANC) services and low rates of delivery at a health facility with a skilled provider. The Wazazi Nipendeni (Love me, parents) social and behavioral change communication campaign was launched in Tanzania in 2012 to improve a range of maternal health outcomes, including individual birth planning, timely ANC attendance, and giving birth in a healthcare facility. METHODS: An evaluation to determine the impact of the national Wazazi Nipendeni campaign was conducted in five purposively selected regions of Tanzania using exit interviews with pregnant and post-natal women attending ANC clinics. A total of 1708 women were interviewed regarding campaign exposure, ANC attendance, and individual birth planning. RESULTS: Over one third of interviewed women (35.1%) reported exposure to the campaign in the last month. The more sources from which women reported hearing the Wazazi Nipendeni message, the more they planned for the birth of their child (ß = 0.08, p = .001). Greater numbers of types of exposure to the Wazazi Nipendeni message was associated with an increase in ANC visits (ß = 0.05, p = .004). Intervention exposure did not significantly predict the timing of the first ANC visit or HIV testing in the adjusted model, however, findings showed that exposure did predict whether women delivered at a health care facility (or not) and whether they tested for HIV with a partner in the unadjusted models. CONCLUSIONS: The Wazazi Nipendeni campaign shows promise that such a behavior change communication intervention could lead to better pregnancy and childbirth outcomes for women in low resource settings. For outcomes such as HIV testing, message exposure showed some promising effects, but demographic variables such as age and socioeconomic status appear to be important as well.

Correlates of Condom Use and Procedure Knowledge Among Men Accessing Voluntary Medical Male Circumcision in Malawi.

PURPOSE: This study examined correlates of condom use (CU) and voluntary medical male circumcision (VMMC) knowledge among men accessing VMMC services in Malawi. METHODS: Two hundred sixty-nine men ages 16 or older accessing VMMC were recruited at service sites. Bivariate and multivariate logistic regressions were used to determine associations, and the relative odds of CU at last sex with VMMC knowledge. Correlates included the following: education, age, location, religion, marital status, ever tested for HIV, having casual/concurrent sexual partners, and alcohol use before sex. RESULTS: The multivariate analysis revealed CU was associated with having a casual/concurrent partner in the previous 3 months and negatively associated with being age 27 or older and single, with participants who had casual/concurrent partners being more likely to use condoms than counterparts who did not have casual/concurrent partners, and those who were over age 27 and single being less likely to do so. VMMC knowledge was associated with education and location, with men with higher education and living in urban areas more likely to know that VMMC partially protects against HIV. CONCLUSION: Results highlight the need to ensure information about VMMC is appropriate for rural men with lower education. Further research is needed to understand the risk profile of men accessing VMMC and the reasons why men who do not know VMMC partially protects against HIV are seeking the service.

Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review.

BACKGROUND: Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. METHODS AND FINDINGS: A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. CONCLUSIONS: VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.

Understanding the experiences and needs of female commercial sex workers in Kathmandu, Nepal.

Through this exploratory study, we sought to better understand Nepali female commercial sex workers' (FCSWs') experiences in order to inform HIV prevention and health promotion interventions for this vulnerable and hard-to-reach population. Data were collected through phenomenological interviews with eight FCSWs. Through analysis we reveal promising intervention points to enhance FCSW health, empowerment, and overall well-being. Researchers suggest a combination of structural and individual programs is essential to improving the circumstances of Nepali FCSWs and preventing the spread of HIV. Given Nepal's limited resources and complex environment, it is imperative future prevention programs are focused and guided by FCSWs' lived experiences.

An assessment of HIV testing in Tanzania to inform future strategies and interventions.

This study identified characteristics of Tanzanians who have never tested for HIV in order to inform localized interventions to increase HIV testing coverage and uptake. A total of 3257 randomly selected participants aged 18-49 years were surveyed in 16 Mainland regions. Those surveyed were asked about demographics, HIV risk perception, HIV testing behavior, knowledge of both their own and partner's HIV status, and if they were tested with their partner. Approximately 22% of women and 46% of men reported never testing for HIV, with those who are younger (18-24 years), single/never married, living in rural areas, less educated, and having multiple sexual partners in the past year less likely to have tested. The gender differences in HIV testing behavior identified are supported by existing research. No association was found in either gender between HIV risk perception and testing, however, those least likely to test were those with multiple sex partners. These findings can help better target localized interventions focused on younger, single people, and those with multiple sex partners.

Smoke-free or not: a pilot evaluation in selected Beijing Hospitals.

BACKGROUND: China enacted a policy to ban smoking in hospitals. The Chinese Association for Tobacco Control (CATC) developed a program to help hospitals implement this policy. They conducted a program and an assessment in 3 Chinese cities (Beijing, Shanghai and Guangdong). A more in-depth evaluation was implemented with a sub-sample of hospitals in Beijing (N = 7) to provide an independent assessment. This independent assessment focused on evaluating policy development and an assessment of secondhand smoke (SHS) to determine compliance with the smoke-free policy initiative. METHODS: Pre- and post-survey data were collected at each of the selected hospitals with a total sample of 2835 physicians at pre-intervention and 2812 at post-intervention. Smoking rates pre- and post-policy implementation, change in knowledge, attitudes and practices among physicians, and compliance with policy were assessed. Measurements of airborne nicotine concentrations in selected locations in each hospital were taken: main hospital lobby; main outpatient center; emergency waiting room; and stairwell adjacent to a large inpatient ward. Hospital policies were collected, translated and rated for incorporated components necessary to implement a smoke-free policy. RESULTS: Physicians' smoking rates decreased and attitudes towards tobacco control improved significantly from pre-to post-intervention. Smoking was still reported in certain areas of the hospital with 96% of passive nicotine monitors as well as self-report indicating continued smoking. Nicotine levels ranged from <0.0056 to 3.94 µg/m3), with an overall mean of .667 µg/m3. Hospitals that established stronger policies seemed to have lower levels of nicotine, suggesting a relationship between policy development and compliance. This finding is interesting but just suggestive and requires further investigation to truly demonstrate if stronger policies improve compliance and produce better outcomes. CONCLUSION: As implementation strategies for smoke-free environments are improved and more resources are focused on hospitals, China is making progress toward achieving smoke-free hospitals. Using a model program could increase the prevalence of SHS policies across China. However, relying only on survey data may not provide an accurate assessment of this progress, and more extensive evaluation efforts are useful to understand how change can and does occur.