Preconception health disparities among reproductive-aged women with and without disabilities in Canada.

OBJECTIVES: Preconception health (PCH), which describes the health status of reproductive-aged individuals, can influence reproductive, maternal, and fetal/neonatal outcomes. PCH disparities have been observed in certain populations, prompting the development of tailored resources. Our objective was to compare the PCH characteristics of women with and without disabilities. METHODS: We undertook a secondary analysis of the 2003-2014 cycles of the Canadian Community Health Survey (CCHS), which included n = 115,295 women aged 15-49 years. Among these, we also examined a sub-sample of n = 12,495 women with a subsequent obstetrical delivery identified in a linkage of the CCHS with the Discharge Abstract Database (DAD, 2003-2017). The outcomes were 8 PCH indicators. We used modified Poisson regression to estimate adjusted prevalence ratios (aPRs) for each PCH indicator, comparing women with and without disabilities, and multinomial logistic regression to calculate adjusted odds ratios for 1, 2, and ≥ 3 PCH indicators (vs. 0). Analyses were adjusted for baseline demographics. RESULTS: Reproductive-aged women with disabilities had significantly increased aPRs of smoking (1.42 [95% CI:1.37-1.48]), obesity (1.57 [1.48-1.65]), and self-reported fair/poor physical (5.56 [5.09-6.07]) and mental health (4.07 [3.71-4.47]), compared to those without disabilities. They were also more likely to have ≥ 3, 2, and 1 PCH indicators (vs. 0). Findings were similar in the sub-sample with a subsequent obstetrical delivery. CONCLUSION: Canadian reproductive-aged women with disabilities experience important PCH disparities. Further research is needed to inform tailored education and resources to support PCH in individuals with disabilities, in combination with policies to address structural barriers to PCH.

RéSUMé: OBJECTIFS: La santé préconceptionnelle (SPC), qui décrit l'état de santé des personnes en âge de procréer, peut influencer les résultats reproductifs, maternels et fœtaux/néonataux. Des disparités en matière de SPC ont été observées dans certaines populations, ce qui a conduit à la mise en place de ressources adaptées. Notre objectif était de comparer les caractéristiques de la SPC des femmes handicapées et non handicapées. MéTHODES: Nous avons entrepris une analyse secondaire des cycles 2003­2014 de l'Enquête sur la santé dans les collectivités canadiennes (ESCC), qui comprenait n = 115 295 femmes âgées de 15 à 49 ans. Parmi celles-ci, nous avons également examiné un sous-échantillon de n = 12 495 femmes ayant subi un accouchement obstétrique subséquent, identifiées dans le cadre d'un couplage de l'ESCC avec la Base de données sur les congés des patients (BDCP, 2003‒2017). Les résultats étaient 8 indicateurs de la SPC. Nous avons utilisé la régression de Poisson modifiée pour estimer les ratios de prévalence ajustés (aPR) pour chaque indicateur SPC, en comparant les femmes avec et sans handicap, et la régression logistique multinomiale pour calculer les rapports de cotes ajustés pour 1, 2 et ≥ 3 indicateurs SPC (par rapport à 0). Les analyses ont été ajustées en fonction des données démographiques de base. RéSULTATS: Les femmes handicapées en âge de procréer présentaient des aPR significativement plus élevés de tabagisme (1,42 [IC 95%: 1,37 à 1,48]), d'obésité (1,57 [1,48 à 1,65]) et de santé physique (5,56 [5,09 à 6,07]) et mentale (4,07 [3,71 à 4,47]) auto déclarée passable/mauvaise, par rapport à celles qui n'avaient pas de handicap. Elles étaient également plus susceptibles d'avoir ≥ 3, 2 et 1 indicateurs SPC (par rapport à 0). Les résultats étaient similaires dans le sous-échantillon avec un accouchement obstétrical ultérieur. CONCLUSION: Les femmes handicapées en âge de procréer au Canada connaissent d'importantes disparités en matière de SPC. D'autres recherches sont nécessaires pour fournir une éducation et des ressources adaptées afin de soutenir la SPC chez les personnes handicapées, en combinaison avec des politiques visant à éliminer les obstacles structurels à la SPC.

Pregnancy Outcomes in Canadian Women With Disabilities: Results From Linked Survey and Health Administrative Data.

We compared maternal, labour/delivery, and birth outcomes in women with versus without disabilities using a linkage of 2003-2014 Canadian Community Health Survey (CCHS) and 2003-2017 Discharge Abstract Database data. Modified Poisson regression was used to compare 15-49-year-old women with (n = 2430) and without (n = 10 375) disabilities with a singleton birth ≤5 years after their CCHS interview. Women with disabilities were at elevated risk of prenatal hospitalization (10.3% vs. 6.6%; adjusted prevalence ratio 1.33, 95% CI 1.03-1.72). They were also at elevated risk of preterm birth (8.7% vs. 6.2%), but this was attenuated after adjustment. Women with disabilities could benefit from tailored prenatal care.

The pursuit of clinical recognition: Aesthetics, care, and music therapy in North American hospitals.

This article examines the making of clinical care by tracing how music therapists integrate their work within North American hospitals. Situated on the margins of the clinic, music therapists are in pursuit of clinical recognition-to be perceived and understood as valuable to biomedicine. The pursuit of clinical recognition illustrates how the configuration of care is an aesthetic concern, negotiated not only through processes of reasoning and rationalization but also through sensory-affective experiences. Music therapists cultivate a clinical aesthetic to their care by demonstrating clinical efficacy to their medical colleagues and self-fashioning clinical subjectivities through participation in medical rounds and charting. While clinical recognition creates conditions of possibility for music therapists to provide care in biomedical institutions, recognition is perpetually elusive for hospital music therapists. By cultivating sonic atmospheres and connections, music therapists disrupt and exceed a normative clinical aesthetic, illustrating ways of caring in the clinic beyond biomedical scripts.

Contraception use among female youth with disabilities: Secondary analysis of a Canadian cross-sectional survey.

BACKGROUND: Non-use of contraception among sexually active youth is an important contributor to unintended pregnancy, but contraception use among disabled youth is poorly understood. OBJECTIVE: To compare contraception use in female youth with and without disabilities. METHODS: We used data from the 2013-2014 Canadian Community Health Survey on sexually active 15 to 24-year-old females with (n = 831) and without (n = 2,700) a self-reported functional or activity limitation, who reported that it was important to them to avoid getting pregnant. We used log binomial regression to derive adjusted prevalence ratios (aPR) for use of any vs. no contraception, and for oral contraception, injectable contraception, condoms, other contraception methods, and dual methods separately, comparing youth with and without disabilities. Adjusted analyses controlled for age, school enrollment, household income, marital status, race/ethnicity, immigrant status, and health region. RESULTS: There were no differences in the use of any contraception (85.4% vs. 84.2%; aPR 1.03, 95% CI 0.998-1.06), oral contraception (aPR 0.98, 95% CI 0.92-1.05), condoms (aPR 1.00, 95% CI 0.92-1.09), or dual methods (aPR 1.02, 95% CI 0.91-1.15), comparing youth with and without disabilities. Those with disabilities were more likely to use injectable contraception (aPR 2.31, 95% CI 1.59-3.38) and other contraception methods (aPR 1.54, 95% CI 1.25-1.90). CONCLUSION: Youth at risk of unintended pregnancy had similar overall use of contraception, regardless of disability status. Future studies should examine the reasons for higher uptake of injectable contraception in youth with disabilities, with possible implications for health care provider education on access to youth-controlled methods for this group.

The contribution of veterinary public health to the management of the COVID-19 pandemic from a One Health perspective.

The human coronavirus disease 2019 (COVID-19) pandemic represents one of the greatest public health crises in recent history, which has caused unprecedented and massive disruptions of social and economic life globally, and the biggest communication challenges for public information-sharing. While there is strong evidence that bats are the animal source of SARS-CoV-2, the causative agent of COVID-19, there are many uncertainties around the epidemiology, the intermediate animal species, and potential animal routes of SARS-Cov-2 transmission to humans. While it has also long been known that coronaviruses circulate among different animal species, including SARS-CoV and MERS-CoV, responsible for the pandemics of severe acute respiratory syndrome and Middle East respiratory syndrome endemic in Middle Eastern countries in 2002-2003 and 2012 respectively, the way this pandemic is being managed tends to downplay or neglect the veterinary contribution, which is not in line with the One Health approach, if we consider that the genesis of the COVID-19 pandemic, likewise SARS and MERS lies on a close and interdependent links of humans, animals and the environment. To overcome this flaw, and to better operationalize the One Health approach, there are several lines of contributions the veterinary profession might provide to manage the COVID-19 pandemic in the framework of interventions jointly concerted in the veterinary and medical domains, notably: the experience in dealing with past animal epidemics, the skills in conducting wildlife surveillance targeting emerging pathogens at risky hot spots, and with the aim to predict and prevent future pandemics, the laboratory support for the diagnosis and molecular characterization of SARS-CoV-2 and human samples testing, and animal import risk assessment to define COVID-19 risk strategy for international air travel. The veterinary profession presents itself ontologically with a strong One Health accent and all the related valuable knowledge can be properly integrated within centralised multidisciplinary task-forces set up at the national and international level, with a renewed role in the management and monitoring structures required for managing the COVID-19 pandemic.

Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa.

OBJECTIVE: This study examines the role of age-disparate partnerships on young women's HIV risk by investigating coital frequency and condom use within age-disparate partnerships involving women aged 15 to 24. DESIGN: A community-based, cross-sectional study was conducted. SETTING: Participants were randomly selected using a two-stage random sampling method in uMgungundlovu district, KwaZulu-Natal, South Africa, between June 2014 and June 2015. PARTICIPANTS: A total of 1306 15-24-year-old women in an ongoing heterosexual partnership were included in the analysis. Participants had to be a resident in the area for 12 months, and able to provide informed consent and speak one of the local languages (Zulu or English). PRIMARY AND SECONDARY OUTCOME MEASURES: Sexual frequency was assessed by asking participants how many times they had sex with each partner in the past 12 months. The degree of condomless sex within partnerships was assessed in the survey by asking participants how often they used a condom with their partners. RESULTS: Age-disparate partnerships were associated with a higher order category (once, 2-5, 6-10, 11-20, >20) of coital frequency (adjusted OR (aOR) 1.32, p<0.05, 95% CI 1.02 to 1.71) and with sex on more than 10 occasions (aOR 1.48, p<0.01, 95% CI 1.12 to 1.96) compared with age-similar partnerships. Age-disparate partnerships were also more likely to involve sex on more than 10 occasions with inconsistent condom use (aOR 1.43, p<0.05, 95% CI 1.04 to 1.96) in the previous 12 months. CONCLUSION: The finding that increased sexual activity is positively associated with age-disparate partnerships adds to the evidence that age-disparate partnerships pose greater HIV risk for young women. Our study results indicate that interventions to reduce risky sexual behaviour within age-disparate partnerships remain relevant to reducing the high HIV incidence rates among adolescent girls and young women.

Age-disparate partnerships and HSV-2 among adolescent girls and young women in South Africa: implications for HIV infection risk.

OBJECTIVE: There is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk. METHODS: Cross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15-24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women. RESULTS: HSV-2 prevalence was 55% among 15-24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)). CONCLUSIONS: Results indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.

Machine Learning-Augmented Propensity Score-Adjusted Multilevel Mixed Effects Panel Analysis of Hands-On Cooking and Nutrition Education versus Traditional Curriculum for Medical Students as Preventive Cardiology: Multisite Cohort Study of 3,248 Trainees over 5 Years.

BACKGROUND: Cardiovascular disease (CVD) annually claims more lives and costs more dollars than any other disease globally amid widening health disparities, despite the known significant reductions in this burden by low cost dietary changes. The world's first medical school-based teaching kitchen therefore launched CHOP-Medical Students as the largest known multisite cohort study of hands-on cooking and nutrition education versus traditional curriculum for medical students. METHODS: This analysis provides a novel integration of artificial intelligence-based machine learning (ML) with causal inference statistics. 43 ML automated algorithms were tested, with the top performer compared to triply robust propensity score-adjusted multilevel mixed effects regression panel analysis of longitudinal data. Inverse-variance weighted fixed effects meta-analysis pooled the individual estimates for competencies. RESULTS: 3,248 unique medical trainees met study criteria from 20 medical schools nationally from August 1, 2012, to June 26, 2017, generating 4,026 completed validated surveys. ML analysis produced similar results to the causal inference statistics based on root mean squared error and accuracy. Hands-on cooking and nutrition education compared to traditional medical school curriculum significantly improved student competencies (OR 2.14, 95% CI 2.00-2.28, p < 0.001) and MedDiet adherence (OR 1.40, 95% CI 1.07-1.84, p = 0.015), while reducing trainees' soft drink consumption (OR 0.56, 95% CI 0.37-0.85, p = 0.007). Overall improved competencies were demonstrated from the initial study site through the scale-up of the intervention to 10 sites nationally (p < 0.001). DISCUSSION: This study provides the first machine learning-augmented causal inference analysis of a multisite cohort showing hands-on cooking and nutrition education for medical trainees improves their competencies counseling patients on nutrition, while improving students' own diets. This study suggests that the public health and medical sectors can unite population health management and precision medicine for a sustainable model of next-generation health systems providing effective, equitable, accessible care beginning with reversing the CVD epidemic.

HIV Risk Among Adolescent Girls and Young Women in Age-Disparate Partnerships: Evidence From KwaZulu-Natal, South Africa.

BACKGROUND: Evidence on the role of age-disparate partnerships in high HIV-infection rates among young women in sub-Saharan Africa remains inconclusive. This study examined the HIV-infection risk associated with age-disparate partnerships among 15- to 24-year-old women in a hyperendemic setting in South Africa. METHODS: Face-to-face questionnaire, and laboratory HIV and viral load data were collected during 2014-2015 among a representative sample (15-49 years old) in KwaZulu-Natal. The association between age-disparate partnerships (age difference ≥5 years) and HIV status among 15- to 24-year-old women (N = 1459) was assessed using multiple logistic regression analyses. Data from the male sample on all on-going partnerships (N = 1229) involving 15- to 24-year-old women were used to assess whether young women's age-disparate male partners were more likely to have a viral load ≥1000 copies per milliliter, a marker of HIV-infection risk. RESULTS: Women reporting an age disparity in any of their 3 most recent partnerships were more likely to test HIV positive compared to women with only age-similar partners [adjusted odds ratio (aOR): 1.58, 95% confidence interval (CI): 1.20 to 2.09, P < 0.01]. Among partnerships men reported with 15- to 24-year-old women, the age-disparate male partners were more likely to be HIV positive and have a viral load ≥1000 copies per milliliter (aOR: 2.05, 95% CI: 1.30 to 3.24, P < 0.01) compared with age-similar partners. Results were similar for each category of age disparity: partners 5-9 years older (aOR: 2.01, 95% CI: 1.18 to 3.43, P = 0.010) and those ≥10 years older (aOR: 2.17, 95% CI: 1.01-4.66, P = 0.048). CONCLUSIONS: Results indicate that age-disparate partnerships increase young women's HIV risk, although conclusive evidence was not ascertained. Interventions addressing risk from age-disparate sexual partnering, including expanding antiretroviral treatment among older partners, may help to reduce HIV incidence among young women.

The association between psychological distress, alcohol use and physical non-communicable diseases in a nationally representative sample of South Africans.

This study examines the associations between symptoms of mental disorders and diabetes and hypertension in a nationally representative sample of South Africans. We examined unadjusted and adjusted associations of socio-demographic characteristics, alcohol use and psychological distress with diabetes and hypertension. Multivariate logistic regression revealed that hypertension is significantly associated with age, while diabetes is significantly associated with age, population group and psychological distress. The association between psychological distress and diabetes found here suggests the usefulness of additional research using more detailed measures of psychiatric disorders in local studies and reinforces clinical calls for attention to psychiatric screening in patients with diabetes.

HIV Prevalence and ART Use Among Men in Partnerships with 15-29 Year Old Women in South Africa: HIV Risk Implications for Young Women in Age-Disparate Partnerships.

This study assesses whether men's ART use mitigates HIV-risk within age-disparate partnerships. Using data from the 2012 South African National HIV survey, we analyzed differences in HIV prevalence and ART use between men in age-disparate and age-similar partnerships with young women aged 15-29 using multiple logistic regression analyses. Within partnerships involving women 15-24 years old, men in age-disparate partnerships were more likely to be HIV-positive (5-9 year age-gap: aOR 2.8, 95%CI 1.4-5.2; p < 0.01; 10+ year age-gap: aOR 2.2, 95%CI 1.0-4.6; p < 0.05). Men in age-disparate partnerships who were 5-9 years older were significantly more likely to be HIV-positive and ART-naïve (aOR 2.4, 95%CI 1.2-4.8; p < 0.05), while this was not the case for men 10+ years older (aOR 1.5, 95%CI 0.7-3.6; p = 0.32). No evidence was found that 25-29 year old women were at greater HIV-risk in age-disparate partnerships. Our results indicate that young women aged 15-24 have a greater likelihood of exposure to HIV through age-disparate partnerships, but ART use among men 10+ years older could mitigate risk.

HIV Serostatus Disclosure to Sexual Partners Among Sexually Active People Living with HIV in South Africa: Results from the 2012 National Population-Based Household Survey.

This paper explores the prevalence and correlates of HIV seropositive status disclosure to sexual partners by people living with HIV (PLHIV) in South Africa. Secondary analysis of the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey was conducted on data obtained from 934 sexually active PLHIV aged 15 years and older who responded to the question about HIV seropositive status disclosure. Overall, a large majority of respondents (77.1 %) reported disclosing their HIV-positive status to all their current sex partners. Multiple regression analysis, after adjustments for sex, marital status and locality type, revealed that those who were living together, going steady, and those who were single were all 60 % [adjusted odds ratio (AOR) = 0.4, 95 % CIs 0.20-0.78; AOR = 0.4, 95 % CIs 0.24-0.77; and AOR = 0.4, 95 % CIs 0.19-1.00, all ps < 0.05] less likely to disclose their HIV positive status to their partners compared to those who were married. Those who lived in rural formal areas were 70 % less likely to disclose their HIV status to their partners compared to those who stayed in urban formal areas (AOR = 0.3, 95 % CI 0.17-0.69, p < 0.001). Those who had correct HIV knowledge and rejection of myths were 2.0 times more likely to disclose their HIV status to their partners compared to those who did not have correct HIV knowledge and rejection of myths (AOR = 2.0, 95 % CI 1.04-3.68, p < 0.05). In conclusion, intervention programmes which help improve HIV seropositive status disclosure are needed by PLHIV who are not married, live in rural formal areas, and have incorrect HIV knowledge and rejection of myths.

Petroleum hydrocarbon persistence following the Deepwater Horizon oil spill as a function of shoreline energy.

An important aspect of oil spill science is understanding how the compounds within spilled oil, especially toxic components, change with weathering. In this study we follow the evolution of petroleum hydrocarbons, including n-alkanes, polycyclic aromatic hydrocarbons (PAHs) and alkylated PAHs, on a Louisiana beach and salt marsh for three years following the Deepwater Horizon spill. Relative to source oil, we report overall depletion of low molecular weight n-alkanes and PAHs in all locations with time. The magnitude of depletion, however, depends on the sampling location, whereby sites with highest wave energy have highest compound depletion. Oiled sediment from an enclosed bay shows high enrichment of high molecular weight PAHs relative to 17α(H),21ß(H)-hopane, suggesting the contribution from sources other than the Deepwater Horizon spill, such as fossil fuel burning. This insight into hydrocarbon persistence as a function of hydrography and hydrocarbon source can inform policy and response for future spills.

An in-depth survey of the oil spill literature since 1968: Long term trends and changes since Deepwater Horizon.

In order to characterize the state of oil spill research and describe how the field has changed since its inception in the 1960s and since the Deepwater Horizon spill in 2010, we examined approximately 10% of oil spill literature (1255 of over 11,000 publications) published from 1968 to 2015. We find that, despite its episodic nature, oil spill research is a rapidly expanding field with a growth rate faster than that of science as a whole. There is a massive post-Deepwater Horizon shift of research attention to the Gulf of Mexico, from 2% of studies in 2004-2008 to 61% in 2014-2015, thus ranking Deepwater Horizon as the most studied oil spill. There is, however, a longstanding gap in research in that only 1% of studies deal with the effects of oil spills on human health. These results provide a better understanding of the current trends and gaps within the field.

Sexual Behaviour of Men and Women within Age-Disparate Partnerships in South Africa: Implications for Young Women's HIV Risk.

BACKGROUND: Age-disparate partnerships are hypothesized to increase HIV-risk for young women. However, the evidence base remains mixed. Most studies have focused only on unprotected sex among women in the partnership. Consequently, little is known about other risky behaviours, such as transactional sex, alcohol use, and concurrency, as well as the behaviours of the men who partner with young women. We therefore examined differences in various sexual behaviours of both young women and their male partners by partnership age difference. METHODS: We used nationally representative data from South Africa (2012) on partnerships reported by 16-24 year old black African women (n = 818) and by black African men in partnerships with 16-24 year old women (n = 985). We compared sexual behaviours in age-disparate partnerships and age-similar partnerships, using multiple logistic regression to control for potential confounders and to assess rural/urban differences. RESULTS: Young women in age-disparate partnerships were more likely to report unprotected sex than young women in similar-aged partnerships (aOR:1.51; p = 0.014; 95%CI:1.09-2.11). Men in partnerships with young women were more likely to report unprotected sex (aOR:1.92; p<0.01; 95%CI:1.31-2.81), transactional sex (aOR:2.73; p<0.01; 95%CI:1.64-4.56), drinking alcohol before sex (aOR:1.60; p = 0.062; 95%CI:0.98-2.61), and concurrency (aOR:1.39; p = 0.097; 95%CI:0.94-2.07) when their partners were five or more years younger. The association between age-disparate partnerships and transactional sex (aOR:4.14; p<0.01; 95%CI: 2.03-8.46) and alcohol use (aOR:2.24; p<0.013; 95%CI:1.20-4.19) was only found in urban areas. CONCLUSIONS: Results provide evidence that young women's age-disparate partnerships involve greater sexual risk, particularly through the risky behaviours of their male partners, with the risk amplified for young women in urban areas.

HIV Risk Among Men Who Have Sex With Men, Women Who Have Sex With Women, Lesbian, Gay, Bisexual and Transgender Populations in South Africa: A Mini-Review.

BACKGROUND: The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. OBJECTIVES: This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. METHOD: Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. RESULTS: In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. CONCLUSION: Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.

New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012.

This article presents key findings from the 2012 HIV prevalence, incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002, 2005, 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4-13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25-49 years were most affected, 25.2% [95% CI: 23.2-27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8-11.6] in 2008 to 12.2% [95% CI: 11.4-13.1] in 2012 (p < 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p < 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87-1.27], with the highest incidence among Black African females aged 20-34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15-24 years, and was significantly higher among male youth than female (16.7% vs. 5.0% respectively, p < 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p < 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p < 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However, there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical, behavioural, social and structural prevention interventions to reverse the tide in the fight against HIV.

Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey.

South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N = 17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV-positive compared to all other marital spouses groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV-positive were found to be lower among married individuals who lived with their spouses compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socio-economic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships.

New insights into HIV epidemic in South Africa: key findings from the national HIV prevalence: incidence and behaviour burvey; 2012

This article presents key findings from the 2012 HIV prevalence; incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002; 2005; 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4-13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25-49 years were most affected; 25.2% [95% CI: 23.2-27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8-11.6] in 2008 to 12.2% [95% CI: 11.4-13.1] in 2012 (p 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87-1.27]; with the highest incidence among Black African females aged 20-34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15-24 years; and was significantly higher among male youth than female (16.7% vs. 5.0% respectively; p 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However; there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical; behavioural; social and structural prevention interventions to reverse the tide in the fight against HIV

Gender differences in public perceptions on National Health Insurance.

BACKGROUND: Implementation of National Health Insurance (NHI) commenced recently. With the promise of addressing drastic inequalities in the health sector, NHI has the potential to positively transform the health system . In particular, NHI could have a significant positive impact on females, who are disadvantaged under the current system, with higher rates of poor health and lower rates of medical scheme membership compared with males. Despite NHI's transformative potential, however, the public discourse on NHI as portrayed in the media suggests that it is an unpopular policy. The evidence presented in this paper is to the contrary. OBJECTIVES: To assess the general public's opinion on NHI and to explore gender differences in perceptions. METHODS: This paper reports on findings from a 2010 cross-sectional nationally representative survey of the South African population that assessed social attitudes, including perceptions on NHI. Sex-disaggregated data were analysed in SPSS version 20. RESULTS AND CONCLUSIONS: There is broad public acceptance of NHI, indicating that an overwhelming majority of South Africans would prefer an NHI system to the current two-tiered system. Support for NHI has increased since similar studies in 2005 and 2008, with the simultaneous growth of public discourse on the policy. More females than males support NHI, reflecting the potential of the NHI system to have a positive impact on gender equality and the health of women and girls.