Disagreement about perceptions of patient disability between the stroke patient and caregiver: a cross sectional study exploring the association to patient and caregiver quality of life.

OBJECTIVES: This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. METHODS: A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. RESULTS: Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. CONCLUSION: Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver.

Factors promoting and inhibiting exercise for older women in Kyoto, Japan.

The main objective of this research was to explore promoting and inhibiting factors of exercise among older women in Kyoto, Japan to seek effective strategies for exercise promotion. More specifically, this research aimed to explore the role of possible selves, which can influence the current view of self and act as an incentive for future behavior, as a facilitator and/or barrier to exercise. Data were collected using semi-structured questionnaires and in-depth interviews among women aged 65 and above in Kyoto city through snowball sampling from August to September 2018. Transcripts were analyzed using thematic analysis, then were summarized into a conceptual model. This research revealed a wide range of factors that promote or inhibit exercise. Beside well-known factors such as social factors, physical factors and beliefs about exercise, unexpected factors that seem strongly related to culture and aging in Japan were identified. The unique factors encapsulated in the category of {altruism} emerged as the significant barrier to exercise. In contrast, {egoism} emerged as an important facilitator of exercise. In conclusion, it may be possible to suggest that integrating the role of mother, wife, daughter or grandmother into exercise and its promotion may be beneficial for women aged 65 and above in Kyoto city. To generalize recommendations made, further research is required with a larger sample size and geographical area. Furthermore, findings may differ depending on the cultural background, generations and gender studied.

What are the motivators and barriers for older women in Japan to stay physically active? The main objective of this research was to explore promoting and inhibiting factors of exercise among older women in Kyoto, Japan to seek effective strategies for exercise promotion. A questionnaire prior to interview identified current physical activity, exercise and 'possible selves', which was expected to provide insight into the conceptual link between individuals' cognition and motivation related to exercise behavior. Beside well-known factors that promote or inhibit exercise such as social factors, physical factors and belief toward exercise, unexpected factors that seem strongly related to aging and the nature of the collective culture were identified. The unique factors encapsulated in the category of {altruism} emerged as the dominant barrier to exercise. In contrast, {egoism} emerged as an important facilitator of exercise. In conclusion, it may be possible to suggest that interlinking of the role of mother, wife, daughter or grandmother into exercise and its promotion may be beneficial for women aged 65 and above in Kyoto city. To generalize recommendations made, further research is required with a larger sample size and geographical spread. Furthermore, outcomes may differ depending on the cultural background, generations and gender studied.

Prevalence of gambling disorder and its correlates among homeless men in Osaka city, Japan.

Internationally, the prevalence of gambling disorder has been reported to be higher among homeless people than the general population; however, little is known about the factors associated with gambling disorder in this population. The present study aimed to investigate the prevalence of gambling disorder and its associated factors among homeless men using shelters in Osaka City. A cross-sectional survey was conducted from 30 to 2018 to 4 January 2019, using the 2017 Japanese National Survey of Gambling (JNSG) questionnaire, supplemented with questions about homeless experiences, drinking, and smoking. Using the South Oaks Gambling Screen, the presence of gambling disorder was determined by a score ≥ 5 out of 20. Multivariate logistic regression was conducted to explore factors associated with lifetime gambling disorder. Lifetime and past-year prevalence of gambling disorder among 103 participants was 43.7% (95% confidence interval [CI]: 34.5-53.3) and 3.9% (95% CI: 1.5-9.6), respectively, which are higher than the 6.7% and 1.5% found among men in the 2017 JNSG. Reasons reported for currently gambling less were primarily financial. Factors associated with lifetime GD included "more than 20 years since the first incidence of homelessness" (adjusted odds ratio [AOR]: 4.97, 95% CI: 1.50-16.45) and "more than five incidences of homelessness" (AOR: 4.51, 95% CI: 1.06-19.26). When homeless individuals with gambling disorder try to rebuild and stabilize their lives, the presence or resurgence of gambling disorder may hinder the process and pose a risk of recurring homelessness. Comprehensive support services for homeless individuals with gambling disorder are required. (250 words).

Intimate partner violence and unmet need for family planning in Afghan women: the implication for policy and practice.

BACKGROUND: Intimate Partner Violence (IPV) is a serious public health issue and has been linked to a range of adverse health outcomes. This study explored the prevalence of IPV and its relationship with the unmet need for family planning among a sample of married Afghan women aged 18-49 years. METHODS: This study used the data from Afghanistan Demographic and Health Survey (DHS) conducted in 2015. The data relating to IPV, unmet need for family planning, and sociodemographic characteristics of Afghan women aged 18-49 (n = 20,593) were extracted and analyzed accounting for the sampling weights and survey design in bivariate and multivariate analyses using the STATA software version 14. RESULTS: An estimated 55.89% experienced some type of IPV during the last 12 months. Unmet need for family planning was documented in less than a third of the population. Illiterate employed women from poorer families who were living in the rural areas were more likely to suffer from any type of IPV. Moreover, those from Pashtun, Tajik, and Pashai ethnic groups had a higher odds of any type of violence compared to the reference group (Turkmen). Illiterate women (OR = 1.37, 95% CI 1.02-1.83) with more than 5 pregnancy experiences (OR = 1.44, 95% CI 1.19-1.74) had more unmet needs for family planning compared to the reference group. The unmet needs were almost 40% and 30% less likely to be observed among women from Pashtun and Tajik ethnic backgrounds compared to the reference group (Turkmen), respectively. The likelihood of having unmet needs was 30% less in those women who suffered from any type of violence. CONCLUSION: IPV is an important predictor of several adverse health outcomes. The findings portray the disastrous situation of Afghan women's rights violation and violence against them and communicate an important message to the international communities and human rights advocate to take immediate actions in order to mitigate the current situation and prevent the violence against Afghan women to improve the integrity of their reproductive health.

Intimate partner violence (IPV) involves not only physical, emotional, and sexual violence but also controlling behavior and could be associated with several adverse health outcomes. In this study, the authors used the data from Afghanistan Demographic and Health Survey (DHS) conducted in 2015 and explored the relationship between IPV and unmet need for family planning among Afghan women aged 18­49 years. IPV was observed in more than half of the Afghan women aged 18­49 years and almost 30% reported unmet needs for family planning. Interestingly, IPV was associated with a lower unmet need for family planning. This has been attributed to the reluctance of the victim woman to bring a child to the hostile environment and protect herself from acquiring the STDs that could be transmitted from a risky partner. Illiterate poor Afghan women were more likely to suffer from IPV and experience the unmet need for family planning. In addition, the rate of IPV was higher among Pashtun and Tajik ethnic groups; conversely, the rate of unmet need for family planning was low among them. The findings reflect on the most current situation of domestic violence among Afghan women and its impact on reproductive outcomes and the results could inform the international communities and human rights advocate to prevent the violence against Afghan women and improve their reproductive health.

Predictors of health-related quality of life among older adults living with HIV in Thailand: results from the baseline and follow-up surveys.

The current longitudinal study consisted of baseline and follow-up surveys among older adults living with HIV (OALHIV) in Thailand. The health-related quality of life (HRQoL) was assessed using the Medical Outcomes Study HIV (MOS-HIV) questionnaire. We performed multiple linear regression analysis to document correlates of HRQoL at baseline and the predictors of the changes in HRQoL at follow-up. Of the 364 participants recruited at baseline; 327 (89.9%) completed the follow-up survey. The mean (SD) Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were respectively 49.8 (7.3) and 53.2 (6.4). There was a significant increase in the mean score of most of the MOS-HIV domains, ranging between 1.3 for the PHS and 26.9 for the energy/fatigue dimension. In contrast, the mean score significantly decreased by 4.1 and 10.3 points, respectively for the cognitive and social functioning. Female gender was a predictor of the decline in social (ß = -11.37; P = 0.031) and cognitive (ß = -8.05; P = 0.002) functioning at follow-up, while being married was related to an increase of in the score of energy/fatigue (vitality) (ß = 5.98; P = 0.011) at follow-up. Physical exercise was associated with an increase in social functioning (ß = 9.38; p = 0.042). Overall the HRQoL of OALHIV improved or was maintained over time.

Barriers and associated factors for adequate antenatal care among Afghan women in Iran; findings from a community-based survey.

BACKGROUND: Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. Almost 97% of Iranian expectant women are receiving adequate ANC (4 or more visits). However, the situation for pregnant Afghan women is unclear. Some studies indicated low access to ANC among Afghan women. In the present study, we aimed to explore the sociodemographic factors and potential barriers associated with adequate ANC among Afghan women in Iran. METHODS: A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18-45 years old at three health centers in south region of Tehran. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC using a questionnaire and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis. RESULTS: Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The women in older age group, those with higher education and family income, women with longer length of stay, those of legal status were more likely to have adequate ANC. In multivariate analysis, the poor knowledge and attitude toward ANC (AOR = 0.06; 95% CI [0.03-0.15]), the poor quality of services (AOR = 0.17 95% CI [0.07-0.41]); and to some extent, the difficulties in access (AOR = 0.33; 95% CI [0.11-1.00]) were the main obstacles toward adequate ANC among the study population. CONCLUSION: Our study emphasized the important role of the personal knowledge and attitude toward ANC with adequate antenatal care among Afghan women in Iran. This could be addressed by well-oriented interventions and health education for Afghan women. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services to improve the access and quality care among Afghan women in Iran.

"It is good, but I can't afford it " potential barriers to adequate prenatal care among Afghan women in Iran: a qualitative study in South Tehran.

BACKGROUND: An estimated 96% of registered refugees in Iran are Afghan. Almost half of them are young women at the reproductive age. The adequate maternity care is crucial for healthy pregnancy. There is limited knowledge regarding the access and adequacy of maternity care among Afghan women in Iran. The reports from ministry of health (MOH) implicate higher prevalence of perinatal complications in Afghan population. This mainly attributed to the inadequate prenatal care during pregnancy. Therefore, this paper explores the potential barriers to prenatal care among Afghan women in Iran. METHODS: Using convenience sampling, thirty pregnant Afghan women were recruited at three community health centers with the highest number of Afghan visitors in Tehran, the capital city of Iran. Data were collected through face-to-face interviews in Persian language using an interview guide. The interviewers were two bilingual Afghan graduate midwifery students. Each interview lasted for an hour. The questions regarding the concerns and experienced obstacles in seeking prenatal care were asked. The interviews were transcribed into original language (Persian) and analyzed using content analysis and further translated back into English. The main themes were extracted grouping the similar codes and categories after careful consideration and consensus between the researchers. RESULTS: The financial constraints and lack of affordable health insurance with adequate coverage of prenatal care services, particularly the diagnostic and screening tests, were the most frequent reported obstacles by Afghan women. In addition, personnel behavior, transportation issues, stigma and discrimination, cultural concerns, legal and immigration issues were also mentioned as the source of disappointment and inadequate utilization of such services. CONCLUSIONS: The findings of present study emphasize the necessity of available and most importantly, affordable prenatal care for Afghan women in Iran. Providing an affordable health insurance with adequate coverage of prenatal and delivery services, could reduce the financial burden, facilitate the access, and ensure the maternal and child health in this vulnerable population. The issues of fear and concern of deportation must be removed for at least illegal Afghan mothers to ensure their access to maternity care and improve the health of both mother and offspring.

A comparison of socio-behavioral risk factors between HIV-infected and non-infected older adults in Northern Thailand.

There is a shift in the demographic profile of people living with HIV toward older age groups. The current study compares alcohol use, smoking, and physical exercise between HIV-infected and non-infected older adults recruited in 12 community hospitals in Chiang Mai Province, Northern Thailand. Participants in the two groups were 50 years and above, matched by age and gender. The sample included 364 participants in each of the groups. Older adults living with HIV were less likely to report drinking alcohol in the past year (AOR, 0.55; CI, 0.34-0.89, P = 0.015) and more likely to report being currently engaged in physical activities (AOR, 2.58; CI, 1.77-3.76, P < 0.001). There was no difference between the two groups in terms of "current smoking status". Older adults living with HIV were healthier than their non-infected counterparts in terms of the socio-behavioral risks.

"I felt angry, but I couldn't do anything about it": a qualitative study of cyberbullying among Taiwanese high school students.

BACKGROUND: Cyberbullying is a growing public health concern threatening the well-being of adolescents in both developed and developing countries. In Taiwan, qualitative research exploring the experiences and perceptions of cyberbullying among Taiwanese young people is lacking. METHODS: We conducted in-depth interviews with a convenience sample of high school students (aged 16 to 18) from five schools in Taipei, Taiwan, without prior knowledge of their cyberbullying experiences. In total, 48 participants were interviewed. RESULTS: We found that the experience of cyberbullying is common, frequently occurs anonymously and publicly on unofficial school Facebook pages created by students themselves, and manifests in multiple ways, such as name-calling, uploading photos, and/or excluding victims from online groups of friends. Exclusion, which may be a type of cyberbullying unique to the Asian context, causes a sense of isolation, helplessness, or hopelessness, even producing mental health effects in the victims because people place the utmost importance on interpersonal harmony due to the Confucian values in collectivistic Asian societies. In addition, our study revealed reasons for cyberbullying that also potentially reflect the collectivistic values of Asian societies. These reasons included fun, discrimination, jealousy, revenge, and punishment of peers who broke school or social rules/norms, for example, by cheating others or being promiscuous. CONCLUSIONS: Our findings reveal the pressing need for the Taiwanese school system to develop cyberbullying prevention programmes considering the nature and sociocultural characteristics of cyberbullying.

Overlap of traditional bullying and cyberbullying and correlates of bullying among Taiwanese adolescents: a cross-sectional study.

BACKGROUND: Due to the rapid development of information and communication technologies, cyberbullying has emerged as a threat to adolescents. This study aimed to investigate the prevalence and correlates among profiles of traditional bullying, cyberbullying, and combined bullying among Taiwanese high school students. METHODS: This cross-sectional study employed two-stage cluster sampling in Taipei City, Taiwan. In total, 2028 high school students completed an anonymous questionnaire between March and May 2018. Nominal logistic regression analysis was performed, adjusting for clustering, to examine the correlates of each type-role category of bullying. RESULTS: The prevalence rates of cyberbullying, traditional bullying, and combined bullying were 9.9, 13.3, and 9.4%, respectively, indicating that one-third of students were involved in one of these types of bullying; 48.7% of those involved in cyberbullying also experienced traditional bullying, and 41.5% of those involved in traditional bullying also experienced cyberbullying. In any type of bullying, not only being a victim but also being a bully/bully-victim was significantly associated with at least one mental health problem (serious psychological distress, self-harm, or suicidal ideation), except in the case of cyberbullying bullies/bully-victims. Internet abuse and alcohol use were more concentrated among bullies/bully-victims than victims for all types of bullying, and a similar trend was observed among types of schools and school climates, suggesting that specific behavioural circumstances or school backgrounds are associated with bullying perpetration. CONCLUSIONS: Bullying is a prevalent and complex phenomenon among adolescents in Taiwan, where traditional bullying and cyberbullying frequently overlap and are likely to occur against specific backgrounds. These facts should be taken into account in future bullying prevention and support programmes in Taiwan.

Recreational Drug Use, Polydrug Use and Sexual Behaviors Among Men Who Have Sex With Men in Southwestern China: A Cross-Sectional Study.

Although recreational drug use is associated with risky sexual behaviors and HIV infection among men who have sex with men (MSM), it is unclear to what extent these behaviors and outcomes differ between single-drug users and polydrug users in China. This is a cross-sectional study conducted from July to September 2016 among MSM in three cities of Sichuan Province, China. Multinomial logistic regression was performed to examine factors correlated with single-drug and polydrug use. A total of 1,122 participants were included in the study. Overall, 28% of MSM have ever used recreational drugs, of whom 64.0% were single-drug users, and 36.0% were polydrug users. Factors associated with both single-drug and polydrug use included: receptive sexual role (single-drug use: AOR = 1.79, 95% CI: 1.05-3.07; polydrug use: AOR = 6.00, 95% CI: 2.54-14.17), engaging in group sex (AOR = 2.23, 95% CI: 1.28-3.87; AOR = 4.68, 95% CI: 2.41-9.08), frequent alcohol use (AOR = 3.11, 95% CI: 1.75-5.52; AOR = 6.41, 95% CI: 2.50-16.47), seeking partners mainly by Internet (AOR = 4.87, 95% CI: 3.31-7.17; AOR = 4.58, 95% CI: 2.58-8.14), history of STIs (AOR = 1.86, 95% CI: 1.08-3.21; AOR = 3.32, 95% CI: 1.77-6.26) and HIV infection (AOR = 1.76, 95% CI: 1.02-3.02; AOR = 3.19, 95% CI: 1.62-6.26). Our findings suggest the urgent need for HIV and STIs prevention programs among MSM in China to integrate strategies that mitigate recreational drug use.

RISKY SEXUAL BEHAVIOR AMONG OUT-OF-SCHOOL THAI AND NON-THAI YOUTH IN URBAN CHIANG MAI, THAILAND.

Out-of-school youth in Thailand engage in risky sexual behavior that puts them at risk for contracting HIV infection and can have other negative sexual reproductive health outcomes. No study has examined risky sexual behaviors and compared them between Thai and non-Thai out-of-school youth. The current study compares sexual risk behavior and HIV testing behavior between out-of-school Thai and non-Thai youth. We conducted face-to-face interviews in this study population in urban Chiang Mai during 2014. Participants were recruited through convenience sampling from two main sources: non-formal education centers (NFECs) and social meeting places. We recruited 924 youth, aged 15-24 years, of whom 424 (45.9%) were Thai and 500 (54.1%) were non-Thai. The majority were attending NFECs (82.3%). Of the sexually experienced participants (57.7%), 75.4% did not use condoms consistently, and 50.3% had at least 2 lifetime sexual partners. Among the study participants, the Thai studied youth had significantly higher odds of ever having had sex (AOR=2.33; 95% CI: 1.56-3.49; p<0.001), having an earlier sexual debut (AOR=5.52; 95% CI: 2.71-11.25; p<0.001) and having a larger number of lifetime sexual partners (AOR=2.31; 95% CI: 1.37-3.88; p=0.002) than non-Thai participants. There was no significant difference between the Thai and non-Thai participants in terms of having HIV testing. The Thai studied youth were more likely to engage in risky sexual behavior than the non-Thai youth. However, both groups displayed risky sexual behaviors. Future research should explore indepth the drivers of risky sexual behaviors among both Thai and non-Thai youth.

Changes in Sexual Behavior and Attitudes Across Generations and Gender Among a Population-Based Probability Sample From an Urbanizing Province in Thailand.

Thailand has undergone rapid modernization with implications for changes in sexual norms. We investigated sexual behavior and attitudes across generations and gender among a probability sample of the general population of Nonthaburi province located near Bangkok in 2012. A tablet-based survey was performed among 2,138 men and women aged 15-59 years identified through a three-stage, stratified, probability proportional to size, clustered sampling. Descriptive statistical analysis was carried out accounting for the effects of multistage sampling. Relationship of age and gender to sexual behavior and attitudes was analyzed by bivariate analysis followed by multivariate logistic regression analysis to adjust for possible confounding. Patterns of sexual behavior and attitudes varied substantially across generations and gender. We found strong evidence for a decline in the age of sexual initiation, a shift in the type of the first sexual partner, and a greater rate of acceptance of adolescent premarital sex among younger generations. The study highlighted profound changes among young women as evidenced by a higher number of lifetime sexual partners as compared to older women. In contrast to the significant gender gap in older generations, sexual profiles of Thai young women have evolved to resemble those of young men with attitudes gradually converging to similar sexual standards. Our data suggest that higher education, being never-married, and an urban lifestyle may have been associated with these changes. Our study found that Thai sexual norms are changing dramatically. It is vital to continue monitoring such changes, considering the potential impact on the HIV/STIs epidemic and unintended pregnancies.

Multiple sexual partnerships and their correlates among Facebook users in Swaziland: an online cross-sectional study.

Social networking sites (SNSs) have been suggested to facilitate risky sexual activities. However, it is unknown and of concern how SNSs such as Facebook shape risky sexual activities in developing settings such as Swaziland, the country hardest hit by HIV and AIDS. We conducted an online cross-sectional study in 2012 to explore the prevalence of multiple sexual partnerships (MSPs) and their correlates among Facebook users in Swaziland. The response rate was 44.1% (N = 882); relatively, an equal proportion of men 82.7% (341/414) and 82.9% (388/468) women had ever had sex. Of those sexually active, 44.9% of men and 30.7% of women reported having sex with someone they met on Facebook. Approximately half of the participants (61.6% men, 41.0% women and 50.6% total) reported MSPs over the past 12 months. Multiple logistic regression analysis revealed that time spent on Facebook, "finding it easier to initiate a romantic conversation on Facebook" and having had sex with someone met on Facebook were significantly associated with having MSPs (adjusted odds ratio = 1.6-3.8). The potential impact of risky sexual behaviour among Facebook users should be appropriately addressed particularly in high HIV-prevalent settings like Swaziland.

Changing patterns of HIV epidemic in 30 years in East Asia.

The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.

"If I have nothing to eat, I get angry and push the pills bottle away from me": A qualitative study of patient determinants of adherence to antiretroviral therapy in the Democratic Republic of Congo.

The global response to the HIV/AIDS epidemic has improved access to antiretroviral therapy (ART) and has contributed to decreased HIV/AIDS morbidity and mortality in sub-Saharan Africa. Patient adherence to ART is crucial to the success of HIV/AIDS treatment. However, little is known about the determinants of adherence to ART among people living with HIV/AIDS (PLWHA) in the Democratic Republic of Congo (DRC). This qualitative study used in-depth semi-structured patient interviews, a purposive sampling strategy and thematic analysis scheme to identify barriers and facilitators of adherence to ART in the DRC. We recruited three categories of participants from the Centre Hospitalier Monkole and the NGO ACS/Amo-Congo including participants on antiretroviral (ARV) treatment (n = 19), on ARV re-treatment (n = 13) and lost to follow-up (n = 6). Among 38 participants interviewed, 24 were female and the median age was 41 years. Food insecurity as a barrier to adherence emerged as a dominant theme across the three categories of participants. Other barriers included financial constraints, forgetfulness and fear of disclosure/stigma. Religious beliefs were both a barrier and a facilitator to ART adherence. We found that food insecurity was a common and an important barrier to ART adherence among patients in the DRC. Our findings suggest that food insecurity should be appropriately addressed and incorporated into ARV treatment programs to ensure patient adherence and ultimately the long-term success of HIV treatment in the region.

Vulnerability to HIV infection among female drug users in Kathmandu Valley, Nepal: a cross-sectional study.

BACKGROUND: Women who use drugs are extremely vulnerable to HIV and sexually transmitted infections (STIs), but studies on risk behaviours and HIV infection among female drug users are limited in Nepal. METHODS: In this cross-sectional study conducted between September 2010 and May 2011, HIV prevalence and risk factors for HIV infection were investigated among female drug users recruited in drop-in centres, parks and streets in the Kathmandu Valley. The participants completed face-to-face interviews for a structured questionnaire, HIV pre-test counselling, specimen collection for HIV test and they were provided with their results at post-test counselling. RESULTS: A total of 269 female drug users were recruited, of whom 28% (n=77) were found HIV positive; the majority (78%, n=211) being injecting drug users and aged below 25 years (57%, n = 155). Nearly half (n = 137) of the total participants had shared needles or syringes in the past month, and 131 and 102 participants were involved in commercial or casual sex respectively with only half or less of them having had used condoms in the last 12 months. In multivariate analysis the variables associated with HIV infection included: (a) older age; (b) history of school attendance; (c) frequency of sharing of injection instruments; and (d) unsafe sex with commercial or casual partners. CONCLUSIONS: HIV was highly prevalent among female drug users in the Kathmandu Valley, with its risk being strongly associated not only with unsafe injection practice but also with unsafe sexual behaviours. Awareness raising programmes and preventive measures such as condom distribution, needle or syringe exchange or methadone maintenance therapy should be urgently introduced in this neglected subpopulation.

HIV antibody testing and its correlates among heterosexual attendees of sexually transmitted disease clinics in China.

BACKGROUND: This study was conducted to determine the prevalence of HIV antibody testing and associated factors among heterosexual sexually transmitted disease (STD) clinic attendees in China. METHODS: A self-administered questionnaire was administered among 823 attendees of 4 STD clinics of Zhejiang Province, China in October to December 2007. Psychosocial and behavioural factors associated with HIV antibody testing were identified in both genders using univariate and multivariate analyses. RESULTS: Of all 823 STD clinic attendees, 9.3% of male and 18.0% of female attendees underwent HIV antibody testing in the most recent 6 months, and 60% of the participants had gotten no educational/behavioral intervention related to HIV prevention. The correlates for HIV antibody testing in the most recent 6 months as identified by multivariate analysis were ever condom use [odds ratio (OR), 10.37; 95% confidence interval (CI), 1.32-81.22]; ever anal/oral sex (OR, 3.13; 95% CI, 1.03-9.50) during their lifetime; having ever received three to seven types of behavioural interventions in the most recent 6 months (OR, 3.70; 95% CI, 1.32-10.36) among male subjects; and ever condom use (OR, 12.50; 95% CI, 2.20-71.01), STD history (OR, 3.86; 95% CI, 1.26-11.86) over their lifetime, or having ever received three to seven types of behavioural interventions in the most recent 6 months (OR, 8.68; 95% CI, 2.39-31.46) in female subjects. A lifetime experience of casual/commercial sex partners was strongly negatively associated with HIV testing in female subjects (OR, 0.08; 95% CI, 0.01-0.83). CONCLUSION: The low prevalence of HIV antibody testing and behavioural intervention among STD clinic attendees indicates a need for more targeted, intensive behavioural interventions to promote HIV antibody testing in this population.

Internal migration and utilization of reproductive and maternity care among women in Pakistan: evidence from a recent National Survey.

Background: During the last decades, migratory behavior has had a key role in population growth and redistribution in Pakistan. Migration has far-reaching socioeconomic implications for individuals and society at large that could influence the health integrity of Pakistani women. This study aimed to describe the migration patterns and drivers as well as their association with adequate access to reproductive and maternal care among married Pakistani women aged 15-49. Methods: The data from the 2017-18 Pakistan Demographic Health Survey (PDHS) was used to extract the information on the explanatory (sociodemographic and migration backgrounds) and outcome variables (unmet needs for family planning, adequate antenatal care, and delivery at health facilities). Bivariate and multivariate logistic regression analyses were employed to examine the relationship between these explanatory and outcome variables before and after adjustment for sociodemographic inequalities. Results: In unadjusted models, the odds of having adequate ANC and delivery at health facilities were approximately 2 to 4 times higher in those living (urban non-migrant), moving to (urban to urban, rural to urban), or leaving the urban areas (rural to urban) as compared to rural non-migrants; likewise, the odds of the unmet needs for family planning was about 20-50% lower in the same migration streams compared to rural non-migrant. However, after adjustment for sociodemographic inequalities, most of these associations attenuated and only the association of urban to urban migration with unmet needs for family planning and the association of urban non-migrant with delivery at health facilities remained significant. Conclusion: Although the findings suggest that Internal migration flows, particularly those to urban areas (urban to urban and rural to urban), could be associated with better access to reproductive and maternity care among married Pakistani women aged 15-49 years; adjustment for sociodemographic inequalities, particularly education and wealth, nullified this association to a great extent. This has important implications for current policies and interventions in Pakistan and calls for policy reform and women's rights advocacy to enhance the literacy level of young Pakistani girls through well-tailored interventions, maintaining them at school.

Unmet needs in long-term outpatient rehabilitative care: a qualitative and multi-perspective study in Japan.

PURPOSE: This study explores the experiences and unmet needs related to post-discharge long-term rehabilitation from triadic perspective of male patients with stroke, caregivers, and rehabilitation professionals. METHODS: This is an exploratory qualitative study using in-depth interviews conducted in two outpatient rehabilitation facilities in Japan. Nine male patients with stroke, ten caregivers, and five rehabilitation professionals participated in this study. The data were coded, followed by thematic analysis. RESULTS: Patients who did not achieve further physical recovery regardless of their efforts experienced a loss of motivation and lost sight of their goals. Moreover, caregivers regarded such patients as lazy and reported feeling frustrated with them. Furthermore, patients and caregivers had unmet needs regarding communication with professionals and psychological and emotional care. In contrast, professionals perceived time constraints on outpatient rehabilitation service provision and sometimes narrowed the scope of the care approach to physical function aspects for providing services efficiently. They also expressed difficulties in identifying patients' needs, values, and meaningful goals. CONCLUSIONS: These findings suggest that in Japanese post-stroke outpatient rehabilitation, there is a need to adopt a comprehensive care approach, enhance the quality of communication, and involve caregivers in the rehabilitation process in limited-resource situations.IMPLICATIONS FOR REHABILITATIONIn long-term outpatient rehabilitation services in the community, stroke patients and their caregivers often face a physical recovery plateau.A comprehensive approach such as enhancing the quality of communication and providing psychological and emotional care -other than physical rehabilitation- is needed, particularly once the patient physical recovery stagnates.Involving caregivers in the rehabilitation process may be helpful for rehabilitation professionals to understand a potential problem that the patient cannot express but the caregiver can.It can be crucial to develop strategies that enable the rehabilitation professionals to provide a comprehensive care approach and prevent too much reliance on physical rehabilitation under the time-constraint situation in outpatient rehabilitation services.