Shunt freedom in slit ventricle syndrome: using paradoxical ventriculomegaly following lumbar shunting to our advantage. Illustrative cases.

BACKGROUND: The authors present two cases of paradoxical ventriculomegaly after lumboperitoneal (LP) shunting in patients with slit ventricle syndrome (SVS). OBSERVATIONS: After placement of an LP shunt, both patients rapidly developed radiographic and clinically symptomatic ventricular enlargement. The then generous ventricular corridors allowed both patients to be treated by endoscopic third ventriculostomy (ETV) with concurrent removal of their LP shunt. The patients then underwent staged increases in their shunt resistance to the maximum setting and remain asymptomatic. LESSONS: The authors suggest that this paradoxical ventriculomegaly may have resulted from a pressure gradient between the shunt systems in the intra- and extraventricular spaces due to a noncommunicating etiology of their hydrocephalus. ETV may successfully exploit this newfound obstructive hydrocephalus and provide resolution of the radiographic and clinical hydrocephalus through allowing for improved communication between the cranial and lumbar cerebrospinal fluid spaces in SVS.

Exploring the Relationship Between Stigma, Stigma Challenges, and Disclosure Among Slum-Dwelling Survivors of Intimate Partner Violence in Kenya.

This article uses survey data from 131 women living in urban slums in Kenya to explore associations between stigma, stigma challenges, empowerment, and disclosure of intimate partner violence (IPV). A total of 81.7% of women reported informal or formal disclosure of IPV. A bystander offering help and experiencing stigma were associated with significant increases in the odds of informal and formal disclosure. There were also significant positive associations between participating in financial decision-making, membership in survivor support groups, and formal disclosure. Results suggest that interpersonal, community, and structural challenges to stigma interfere with stigma as a barrier to disclosure.

Intersectional harassment and deviant embodiment among Autistic adults: (dis)ability, gender and sexuality.

Harassment scholarship increasingly attends to the intersectional nature of harassment and its function within systems of domination. However, little of this work includes disability. In-depth interviews with 24 adults on the autism spectrum in the USA demonstrate the intersections of gender, sexuality and (dis)ability in the construction of deviant embodiments as targets for harassment. These intersections also shape how participants made sense of these experiences of violence. Participants' disability characteristics were often read as gender or sexual variance, with harassers relying on sexist and heterosexist constructs to frighten, demean or humiliate them for disability characteristics. Participant experiences demonstrate the cisgender basis of 'able-bodied' identity as well as the 'able-bodied' basis of cisgender and heterosexual identities and experiences. The interdependency of gender, sexuality and (dis)ability embodiment point to how it is critical for scholars and activists to account for the role of gender and heterosexist harassment in ableist oppression and disability harassment in (hetero)sexist oppression, as well as the limits of current US law enforcement structures in providing redress for harassment.

Qualitative Exploration of Sexual Experiences Among Adults on the Autism Spectrum: Implications for Sex Education.

CONTEXT: The increasing prevalence of autism since the 1990s has led to growing demand for sex education that meets the needs of persons on the autism spectrum. Yet there is a dearth of research documenting the firsthand experiences and perspectives of autistic individuals. METHODS: A thematic analysis was conducted of in-depth, Internet-facilitated interviews with 24 adults on the autism spectrum who were recruited from Internet community spaces between November 2012 and May 2013. Inclusion criteria were self-identification as a person on the autism spectrum, being a U.S. resident, being aged 18 or older, and having the ability to communicate orally or through writing. RESULTS: Participants were aged 18-61 and were living in the community at the time of interview, most with limited extrafamilial support. They were less likely than the general population to be heterosexual or gender-conforming and were more likely to have experienced romantic or sexual debut after age 18. Participants' most common concerns were courtship difficulties and sensory dysregulation in the context of partnered sexuality. These concerns were exacerbated by inadequate and inappropriate sex education experiences. Participants addressed challenges by using sensory barriers (e.g., latex gloves); planning when and how to have sex; negotiating alternatives to sexual scripts predicated on nondisabled experience; and practicing explicit and intentional communication. CONCLUSIONS: Individuals on the autism spectrum would benefit from sex education that normalizes differences (e.g., in identities and experiences of sexuality), is offered throughout young adulthood, addresses disability-relevant sensory and communication needs, and includes practicing neurotypical sociosexual norms.

The gift of agency: sexual exchange scripts among Nigerian youth.

This article examines the practice of directly exchanging goods for sexual intercourse using data from 36 focus-group discussions with youth living in rural southern Nigeria. Conceptualizing this practice as a sexual script, the authors conduct a deductive thematic analysis framed by the broader context in which sexual exchange occurs. Combining scripting theory with an analysis of the form of the payment, it was found that the cultural script of exchange supports girls' agency. However, at the interpersonal level of practice, this script often loses out in conflict with the cultural scripting of male control. The shape of this practice is influenced by intrapsychic scripts (e.g., sexual violence is an option), interpersonal resources (e.g., family money), and cultural scripts (e.g., stuff and status bring friends). In the final analysis, sexual exchange is found to be a script that both enables and restricts agency. It is a power niche for those with limited social and economic power, enabling them to seek and access material goods, social status, and sexual experience. It is also a means of coercing unwanted sex via peer and parental pressure, poverty, and a context of gender inequality. Implications for HIV prevention are discussed.

Peer-led interventions to reduce HIV risk of youth: a review.

One approach in HIV prevention programming targeting youth is to use peer leaders in what is referred to as peer education programming. This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and are delivered in low- and middle-income countries. Interventions were identified through a comprehensive search of the peer reviewed AIDS-related literature as well as publication lists of major organizations in the UN family that address HIV and AIDS. Our synthesis of study results finds that these programs have demonstrated success in effecting positive change in knowledge and condom use and have demonstrated some success in changing community attitudes and norms. Effects on other sexual behaviors and STI rates were equivocal. We include an overview of characteristics of successful programs, a review of program limitations, and recommendations for the development and implementation of successful community-based peer-led programs in low-income countries.