Youth perspectives on mental health during COVID-19 lockdown in a Small Island Developing State: implications for emergency response.

Introduction: Evidence exploring the relationship between COVID-19 mitigation measures and mental health has primarily been from quantitative studies in large, developed countries. A qualitative study to explore the knowledge, attitudes and behaviors of young people living in Trinidad and Tobago was conducted to engage and collaborate with youth on matters affecting them during the pandemic. Methods: Ten virtual focus groups were conducted with 64 participants aged 18 to 24 in 2021 when partial lockdown measures were in effect for COVID-19 prevention. Groups were stratified by geographic location and socioeconomic status. The recordings were transcribed and analyzed to explore themes of importance to youth. Results: Negative impacts on mental health emerged as a strong theme. Lack of timelines for restrictions led to wide ranging mental health impacts, conflict and tension existed in home environments, longer restrictions led to erosion of the social culture, and young people experienced stress about the changing face of education and job security due to the pandemic. Discussion: Measures taken to address one serious public health concern, COVID-19, led to the aggravation of another serious public health concern, mental ill-health. Mental health initiatives to help young people navigate issues specific to their generation must be developed. In low resourced Small Island Developing States settings. The increased need for mental health services during and because of the COVID-19 pandemic highlights the need for strengthening the capacity and resilience of these to respond to environmental and health emergencies. Building the resilience of educational and employment services is also needed.

Intravaginal and menstrual practices among women working in food and recreational facilities in Mwanza, Tanzania: implications for microbicide trials.

Intravaginal and menstrual practices may potentially influence results of trials of microbicides for HIV prevention through effects on the vaginal environment and on adherence to microbicide and placebo products. As part of the feasibility study for the Microbicides Development Programme Phase 3 trial of a vaginal microbicide in Mwanza, a variety of quantitative and qualitative methods were used to describe these practices, associations with behaviour and underlying social norms among women working in food and recreational facilities. Intravaginal cleansing by inserting fingers and either water alone or soap and water was thought necessary to remove "uchafu" (dirt), referring to vaginal secretions, including menstrual blood and post-coital discharge. Vaginal cleansing was carried out within 2 hours after 45% of sex acts. Sexual enhancement practices were less common. Intravaginal and menstrual practices and associated behaviours and demographic factors should be measured and monitored throughout microbicide trials to enable analyses of their impacts on microbicide effectiveness.

Validity of coital diaries in a feasibility study for the Microbicides Development Programme trial among women at high risk of HIV/AIDS in Mwanza, Tanzania.

OBJECTIVES: To compare coital diaries and face-to-face interviews (FFIs) in measuring sexual behaviour among women at high risk of HIV. To assess the effect of differing levels of support from researchers on reporting in coital diaries and FFIs. METHODS: Three groups of 50 women were randomly selected from a cohort of food and recreational facility workers participating in a microbicide trial feasibility study and received differing levels of researcher support. Minimum support involved delivering and collecting coital diaries weekly; medium support included a weekly FFI and discussion of concerns; intensive support also included an unscheduled mid-week visit when diaries were checked and concerns addressed. All respondents participated in an exit FFI, including questions on sexual behaviour over the four-week study period and study acceptability. RESULTS: Sexual behaviours were generally reported more frequently in coital diaries than weekly or exit interviews. Vaginal and anal sex, male and female condom use, vaginal cleaning and lubrication, sex during menstruation and sex with irregular and regular partners were reported more frequently in coital diaries than exit interviews. In coital diaries, level of support was associated with reporting of vaginal sex and cleaning. In exit interviews, support level was associated with reporting of vaginal sex, vaginal cleaning and sex with regular, irregular and commercial partners. Women with minimum support reported least satisfaction with the research process. Women with intensive support were most likely to report that they informed someone about their study participation and that they completed diaries daily. CONCLUSION: Compared with FFIs, coital diaries resulted in higher reporting of socially stigmatised activities, and sexual behaviour reporting varied less by level of support. More researcher support enhanced study acceptability.

Sexually transmitted infection service use and risk factors for HIV infection among female sex workers in Georgetown, Guyana.

OBJECTIVES: To identify risk factors for HIV and sexually transmitted infection (STI) service use patterns among female sex workers in Georgetown, Guyana. DESIGN: A cross-sectional study was conducted among 299 female commercial sex workers. METHODS: HIV prevalence was assessed using an oral fluid test, and sociodemographic and behavioral data by interview administered by sex workers and women's group members. RESULTS: HIV prevalence was 30.6% [95% confidence interval (CI) 24.9-36.3]. Multivariate logistic regression found a significant association between HIV infection and having a vaginal ulcer in the last 12 months [odds ratio (OR) 4.0, CI 1.4-12.0]. Having had a vaginal ulcer was associated with use of cocaine. Multivariate logistic regression on STI service use variables found significant associations between HIV infection and getting condoms from public sector STI services (OR 3.1, CI 1.6-5.8), not going back for HIV test results (OR 3.4, CI 1.1-10.1), and last getting tested for HIV more than 6 months ago (OR 2.8, CI 1.3-6.2). CONCLUSIONS: An active program of screening and treatment of ulcerative STIs should be combined with substance abuse services for sex workers (SW). Condom promotion services are reaching SW at high risk, but HIV stigma may prevent SW at high risk from accessing HIV test results.

A typology of groups at risk of HIV/STI in a gold mining town in north-western Tanzania.

Mining communities with migrant populations are high-risk locations for human immunodeficiency virus (HIV)/sexually transmitted infection transmission in Sub-Saharan Africa. Interventions presupposing certain groups to be at high risk, such as those working exclusively as commercial sex workers, may divert attention from other high-risk groups. Qualitative research was conducted in a small town adjacent to a large-scale commercial gold mine in north-western Tanzania. Objectives were to identify populations at high risk of HIV and suggest suitable behavioural interventions by gaining an understanding of sexual behaviour patterns in the town. Rapid assessment procedures were employed comprising participant observation, informal questioning and in-depth interviews. Epidemiological categories of "core", "bridging" and "general" populations may not be adequate to the understanding of risk. Many types of women were found to receive payment for sex, distinguished by permanency of residence, age, relationship status, accommodation and income-earning activity. Paying for sex and having multiple partners was common among most men. The town was a high-risk environment as a result of the economic opportunities available there (in contrast to the poverty of surrounding areas), which were often accessed by offering sex in exchange for money or gifts. In this environment, the potential for spread of HIV infection between sub-populations was high and identification of distinct high- and low-risk groups not possible. However, the methodology enabled the identification of different social circumstances of risk, such as residential arrangements, employment status and venues for recreation, associated with different types of people. Targeted interventions may be oriented to specific circumstances in order to address risk practices in a culturally appropriate manner. It is useful to think of risk environments rather than attributing risk to types of people, and to target interventions to these environments. The methodology also enabled an approach to interventions sensitive to different circumstances associated with risk within the town while identifying structural factors affecting risk at the level of the town as a whole.