Care-seeking patterns and timely access to care among survivors of sexual violence in North Kivu, the Democratic Republic of the Congo: a retrospective file-based study.

BACKGROUND: Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence. OBJECTIVE: The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence. METHODS: Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014-2018. RESULTS: Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred. CONCLUSION: Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.

Main findings: Timely access to care for survivors of sexual violence is crucial yet challenging in many places, including in North Kivu, the Democratic Republic of the Congo. This study shows that a majority of survivors access care through specialised clinics, that access is limited for male and child survivors, and highlights factors influencing timely access to care for survivors of sexual violence.Added knowledge: This study shows that age, sex, and different referral pathways impact timely care seeking among survivors of sexual violence accessing care.Global health impact for policy and action: A better understanding of care-seeking patterns and which factors influence timely care seeking is useful when designing and implementing programmes responding to survivors of sexual violence.

No evidence, no problem? A critical interpretive synthesis of the vulnerabilities to and experiences of sexual violence among young migrants in Europe.

BACKGROUND: Growing evidence indicates that young migrants are particularly vulnerable to sexual violence, however most research has focused on instances of sexual violence occurring in conflict zones and during transit. Much less attention has been given to the vulnerabilities to and experiences of sexual violence among young migrants in Europe. OBJECTIVES: To understand the scientific evidence regarding the experiences of and vulnerabilities to sexual violence among young migrants (aged 11-30 years) in Europe. METHODS: A search of three databases resulted in 1279 peer reviewed articles published between 2002 and 2022. Of these, 11 were included in this review. A critical interpretive synthesis methodology was applied. RESULTS: Few studies investigate sexual violence among young migrants in Europe. The existing studies focus on very specific sub-groups of migrants, and as such, experiences of persons outside these groups are largely absent from the academic discourse. How sexual violence is understood varies across studies, often conflated with other forms of violence, hampering comparisons. However, the results of this review indicate that young migrants in Europe, both male and female, experience sexual violence and there are multiple sources of vulnerabilities at all levels of the socioecological model. CONCLUSION: The scarcity of research regarding sexual violence among young migrants in Europe could give rise to the perception that no evidence means no problem, resulting in a continued lack of attention to this issue. There is a critical need to address this gap to inform prevention interventions, to identify victims, and to facilitate access to care.

● Main findings: There is a dearth of European studies investigating sexual violence young migrants' though what little there is indicates that they are particularly vulnerable.● Added knowledge: This study employed a critical interpretive synthesis compiling all available academic research between 2002­2022 identifying only 11 relevant studies.● Global health impact of policy and action: More research is required to understand young migrants' vulnerabilities to and experiences of sexual violence in order facilitate the development of appropriate prevention and response strategies that meet their needs.

Immigrant men 's perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study.

BACKGROUND: Male involvement in maternal health care has proven to be beneficial for improving maternal and child health and is often crucial in areas of family planning and contraceptive use. However, compared to male involvement in maternal health care, male involvement in contraceptive counselling is complex and controversial and thus faces certain challenges. Immigrant men in Sweden are often accompanying their partner for contraceptive counselling. Little is known about their presence and role. AIM: To explore how immigrant men from the Middle East and Afghanistan perceive and experience accompanying their partner for contraceptive counselling provided by midwives in Sweden. METHODS: Inductive qualitative content analysis guided the interpretation of data based on 21 individual in-depth interviews. FINDINGS: Balancing conflicting values and norms about sexual and reproductive health and rights including family planning was challenging and confusing when living in Sweden. Contraceptive counselling was perceived as a joint visit, and men were often acting as decision makers. The midwife's role as a contraceptive counsellor was perceived as trusted, but knowledge was lacking about the Swedish midwifery model and the Swedish healthcare system. Providers' ways of communicating sensitive information were crucial. Without marriage contraceptive counselling was unthinkable. CONCLUSION: Highlighting male engagement and including men's sexual and reproductive health at policy levels are necessary for improving women's sexual and reproductive health and rights. Additional and new ways of contraceptive counselling and midwifery services, such as outreach work and joint visits, are needed in order to reach both men and women.

Psychosocial study environment characteristics associated with exposure to sexual harassment at a large public university in southern Sweden: a cross-sectional study.

BACKGROUND: Universities can be understood as work-like environments for students, with similar risks and expectations regarding psychosocial environment. Limited research has examined this study environment from a Demand-Control-Support perspective with regard to sexual harassment. Understanding this environment is key to designing protective measures. This study aimed to examine the association between individual and psychosocial study environment characteristics and exposure to sexual harassment among students at Lund University, Sweden. METHODS: This cross-sectional study utilised data from an online survey conducted among students. Questions on background characteristics, exposure to sexual harassment while at university and psychosocial study environment as measured by a Demand-Control-Support-instrument were used. Bivariate, and multivariable logistic regressions were used, together with Population Attributable Fractions (PAF), and synergy indexes (SI). RESULTS: High demands and low control were independently associated with higher odds of being exposed to sexual harassment among both females and males (OR 1.41, OR 1.26 and OR 1.55, OR1.34, respectively). When adjusting for background characteristics, high study strain (combination of high demands and low control) was associated with exposure to sexual harassment among both female and male respondents (aOR 1.67 and 1.98 respectively) and could account for PAF of 14% and 15% of study environment sexual harassment for females and males, respectively. Low lecturer support was associated with higher odds for sexual harassment among females (aOR 1.19) but not males. Little evidence was found for a buffering effect of student support on high strain and sexual harassment (SI 0.7). CONCLUSION: Working to reduce situations of high strain study environments could be an effective strategy for reducing sexual harassment in university settings. Improving support from lecturers could also modify this relationship, but more research is required to identify causal pathways underlying this result.

Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus: a cross-sectional study using demographic and health survey data.

BACKGROUND: Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia. METHOD: Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15-49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables. RESULTS: Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25-49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged [Formula: see text]years. CONCLUSION: Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.

Coming across a hidden problem in an excluded population in Sweden: professionals' experiences of young migrants' disclosures of sexual violence.

Growing evidence suggests that young migrants are particularly vulnerable to sexual violence. As young migrants often lack family and social networks, professionals are often the recipients of disclosures of sexual violence. This study aimed to explore how professionals experience young migrants' disclosures of sexual violence. A qualitative design was used, based on 14 semi-structured interviews with a range of professionals from the public sector and civil society in southern Sweden. The data were analysed using qualitative content analysis. The overarching theme developed was 'coming across the hidden problem of sexual violence in an excluded population' supported by three sub-themes: 'linking structural marginalisation and vulnerability to sexual violence'; 'realising that sexual violence is one among many other concerns'; and 'taking pride in backing up young people betrayed by society'. Professionals expressed a strong sense of responsibility due to the complex vulnerabilities of young migrants and their lack of access to services. This, coupled with the lack of clarity about how to respond to disclosures of sexual violence, can lead to moral distress. There is a need to strengthen support for professionals, including recognition of ethical dilemmas and the establishment of formal connections between organisations making access more straightforward and predictable.

Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners' attitudes and practices in low-income countries.

INTRODUCTION: In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners' knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners' knowledge, attitudes and practices concerning SRHR in low-income countries. OBJECTIVES: 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners' SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees' characteristics, their SRHR work environment and transfer of training. METHODS: A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees' pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees' baseline characteristics and post-training attitudes and practices. RESULTS: Trainees' self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. CONCLUSION: The findings indicate that the ITP was effective in improving trainees' self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.

What is the role of global health and sustainable development in Swedish medical education? A qualitative study of key stakeholders' perspectives.

BACKGROUND: Global health and sustainable development have increasingly been recognised as important parts of medical education, yet education on these issues remains fragmented and scarce. In 2020, a bill to reform the national medical curricula across all Swedish medical schools was introduced, including a greater emphasis on global health and sustainable development. This study aimed to explore the perspectives of key stakeholders in medical education on the role of global health and sustainable development in Swedish medical education. METHODS: This was a qualitative study based on semi-structured interviews with 11 key stakeholders in medical education, broadly defined as faculty board members (dean and/or vice-deans for medical education) and/or programme chairs representing six universities. Data were analysed using qualitative content analyis (QCA). The study was conducted according to the Consolidated Criteria for Reporting Qualitative research (COREQ) guidelines. RESULTS: Stakeholders discussed the challenges and opportunities associated with the modification of medical education, which was seen as necessary modernisation to fit the changing societal perception of the role of medical doctors. The anchoring process of redesigning the curriculum and integrating global health and sustainable development was discussed, with emphasis on ownership and mandate and the role of teachers and students in the process. Finding a shared understanding of global health and sustainable development was perceived as a challenge, associated with resistance due to fear of curriculum overload. To overcome this, integrating global health and sustainable development with other topics and developing existing components of the curricula were seen as important. Additionally, it was stressed that fostering capacity building and developing infrastructure, including utilization of digital tools and collaborations, were essential to ensure successful implementation. CONCLUSIONS: Medical institutions should prepare future doctors to respond to the needs of a globalised world, which include knowledge of global health and sustainable development. However, conceptual uncertainties and questions about ownership remain among key stakeholders in medical education. Yet, key stakeholders also highlight that the inclusion of global health and sustainable development in the new curricula represents multiple overarching educational opportunities that can bring about necessary improvement.

Validating a modified instrument for measuring Demand-Control-Support among students at a large university in southern Sweden.

BACKGROUND: University students experience a distinct working environment in the context of completing their studies. In line with existing research into the connection between workplace environment and stress, it is rational to believe that such study environments can affect the level of stress that students experience. However, few instruments have been developed for measuring this. OBJECTIVE: The aim of this study was to validate a modified instrument based on the Demand-Control-Support (DCS) model among students at a large university in southern Sweden to determine its utility for assessing the psychosocial properties of the study environment. METHODS: Data from a survey performed at a Swedish university in 2019, which generated 8960 valid cases, was used. Of these cases, 5410 studied a course or programme at bachelor level, 3170 a course or programme at master level, and 366 a combination of courses and programmes on the two levels (14 missing). A 22-item DCS-instrument for students was used comprising four scales: Psychological workload (demand) with nine items, Decision latitude (control) with eight items, supervisor/lecturer support with four items, and colleague/student support with three items. Construct validity was examined using exploratory factor analysis (EFA) and internal consistency using Cronbach's alpha. RESULTS: The results of the exploratory factor analysis of the Demand-Control components support a 3-dimension solution with dimensions corresponding to psychological demands, skill discretion, and decision authority in the original DCS model. Cronbach's alpha coefficients were acceptable for Control (0.60) and Student Support (0.72) and very good for the Demand and Supervisor Support scales (0.81 and 0.84, respectively). CONCLUSIONS: The results suggest that the validated 22-item DCS-instrument is a reliable and valid tool for assessing Demand, Control, and Support elements of the psychosocial study environment among student populations. Further research is necessary to examine the predictive validity of this modified instrument.

Finding a safe space for learning and exploration: A qualitative study of recently diagnosed men's experiences of peer support for HIV in Sweden.

In Sweden men account for most new HIV cases, and little is known about the peer support needs of people living with HIV in Sweden. This qualitative study explored how recently diagnosed men perceive and experience peer support in Sweden. Purposively sampled from HIV patient organizations and infectious disease clinics throughout Sweden, data was collected through in-depth individual interviews with 10 men living with HIV, who have experience participating in peer support. Latent and manifest qualitative content analysis produced the overarching theme of Finding a safe space for learning and exploration. Participants used peer support to access key information and skills and as a space to safely explore life with HIV. Participants perceived successful peer support as having the right peer while also receiving support at the right location. Study recommendations include further research on how a peer is defined within the U = U era, further research on the peer support needs of young adults, and further research on the accessibility of peer support.

Cultivating resilience and hope: A qualitative study of a pilot program using patient navigators to assist men who have sex with men with retention in the HIV care continuum in Uganda.

In Uganda, due to the criminalization of same-sex sexual practices, men who have sex with men (MSM) experience barriers to accessing HIV care. To retain patients within the HIV Care Continuum, some health interventions have used patient navigators as an ancillary support service. To understand the potential care benefits of using patient navigators for marginalized populations experiencing challenges to HIV care and treatment access in a Ugandan context, this qualitative study explored the experiences of newly diagnosed MSM using patient navigators for ARV retention in care in Kampala. Additionally, to gain insight into the feasibility of patient navigator interventions, this study also aimed to understand the perspectives and experiences of patient navigators working with HIV positive MSM. Individual in-depth, semi structured interviews were conducted with 24 HIV positive MSM and four patient navigators that were part of a patient navigator pilot program from January 2019 -December 2020. Analysis was done using manifest and latent qualitative content analysis. Results showed that HIV positive MSM in Uganda experienced a variety of social, emotional, and financial challenges that placed them at risk for dropping off the HIV Care Continuum. Patient navigators provided HIV positive MSM with the skills, support, and resources necessary to overcome these challenges. Based on study results, we conclude that within the patient navigator pilot program, patient navigators improved MSM participants' quality of life by helping them to achieve the HIV Care Continuum stages: diagnosis, linked to care, receiving HIV treatment, and retention in care. Study results suggest future research is needed on the psychosocial support needs of patient navigators, how the support needs of MSM change throughout their lifetime on the HIV Care Continuum, and how potential benefits of patient navigators may differ in rural Ugandan contexts.

Risky sexual behavior and self-rated mental health among young adults in Skåne, Sweden - a cross-sectional study.

BACKGROUND: Risky sexual behavior is a public health challenge that significantly affects young people's health and well-being in Sweden and throughout the world. Moreover, poor mental health, anxiety and depression among adolescents and young adults have increased in recent years. However, although hypothesized, the associations between general mental health and risky sexual behavior among young adults are less established. Thus, this study aimed to examine the association between self-rated mental health and risky sexual behavior among young adults in southern Sweden. METHODS: Population-based, cross-sectional survey data from 2968 participants aged 18-30 years old residing in southern Sweden was used (response rate 42%). The survey included questions on sexual behavior, alcohol habits, sociodemographic background, and mental health. Logistic regression was used to examine the associations between mental health, depression, anxiety, and risky sexual behavior, stratified by sex (gender). Indicators for risky sexual behavior included not using a condom, non-condom use with casual partner, and multiple (≥2) sexual partners during the last year. RESULTS: Generally, male participants rated their depression and anxiety levels considerably lower than their female counterparts. Poor mental health, high depression, and high anxiety scores (levels) were significantly associated with having multiple sexual partners among among female participants; adjusted odds ratios (aOR) was 1.3 (95% CI 1.01 to 1.71). However, findings among males were not statistically significant. Furthermore, overall results indicated that higher depression and anxiety scores were associated with 1.4 and 1.6 higher odds, respectively, of not using condom with a casual partner in the most recent sexual encounter. Similarly, higher anxiety scores were associated with non-condom use in the latest sexual encounter, aOR 1.4 (1.1-1.7), but no significant gender-specific associations were found. CONCLUSION: The associations found between poor mental health factors and multiple sex partners among females warrant consideration in future public health interventions. Further research to increase the understanding of the causal mechanisms that link mental health factors and risky sexual behavior, especially multiple sex partners, among young adult females is needed to support evidence-based interventions.

Validation of Lund University Sexual Harassment Inventory (LUSHI)-A Proposed Instrument for Assessing Sexual Harassment among University Employees and Students.

The objective was to investigate the validity and reliability of a new instrument assessing sexual harassment at a public university in Sweden. In-depth interviews and focus group discussions resulted in a 10-item instrument, the 'Lund University Sexual Harassment Inventory' (LUSHI). A survey was sent to all staff, including PhD students, and students, with a response rate of 33% (n = 2736) and 32% (n = 9667), respectively. Exploratory factor analysis and Cronbach's alpha statistics were applied. Having experienced one or more of 10 specific behaviors was defined as sexual harassment exposure and was reported by 17.1% of staff/PhD students and 21.1% of students. Exploratory factor analysis yielded two factors with Eigenvalues above 1, labeled 'unwanted sexual attention of soliciting type' and 'unwanted sexual attention of non-soliciting type'. Rape/attempted rape fell outside of the two factors. The Cronbach's alpha values of the original 10-item scale and of the two newly formed scales were 0.80, 0.80, and 0.66, respectively. The mentioned statistics were markedly similar among men, women, and non-binary individuals and between staff/PhD students and students. We conclude that the 10-item instrument could be used for assessing sexual harassment in university settings or any type of workplace.

Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing.

BACKGROUND: Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services. AIM: To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing. METHOD: Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect. RESULT: The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills. CONCLUSION: Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.

Immigrant women's perspectives on contraceptive counselling provided by midwives in Sweden - a qualitative study.

Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women's health at both individual and societal levels. This study explored immigrant women's perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife's professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.

Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia.

BACKGROUND: The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence. OBJECTIVE: The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries. METHODS: The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders. RESULTS: Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services. CONCLUSIONS: Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016.

BACKGROUND: Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear. OBJECTIVES: To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania. METHODS: Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014-2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15-19 years, compared to mothers aged 20-29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival. RESULTS: About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20-29 years-old-mothers, HR 1.80 (95% CI 1.22-2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62-10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers. CONCLUSION: Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents' obstetric care conducted by only skilled personnel should be introduced and implemented.

'Relationships on campus are situationships': A grounded theory study of sexual relationships at a Ugandan university.

Understanding the complexities of sexual relationships is essential to understand the risky sexual behaviours among young people in Ugandan universities. Nine focus group discussions conducted with 31 males and 33 female students in 2014 utilising the grounded theory approach explored the role of sexual relationships in their lives. 'Relationships in campus are situationships' emerged as the core category and referred to the variety of sexual interactions within relationships among young people in a Ugandan university. The study findings indicated that sexual interactions often follow a sexual script that undergoes transitions to negotiate various situations. The sexual scripts in these situationships were strongly influenced by local socio-cultural norms and global aspirations among young people. Students often discussed these sexual scripts within a wider discourse on transactional sexual relationships. The motivations for transactional sexual relationships ranged from 'fulfilling aspirations' of various kinds on the one hand to 'being forced into trading sex' to overcome socio-economic vulnerabilities. Sexual relationships were facilitated by the perception of a university as a sexualized space in which one may enjoy a period of emerging adulthood characterized by exploration in relationships, access to alcohol and prolonged delay in assuming the traditional adult roles of marriage and family. The sexual scripts at the cultural level were grounded in traditional gender roles although at the same time, were under transition during university life with the growing influence of globalization and consumerism in the Ugandan society. Young men and young women must be engaged to critically challenge the implicit assumptions about sexual interactions within various situations that may put them at risk for poor sexual health outcomes.

Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia: a qualitative study.

BACKGROUND: Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake. METHOD: A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes. RESULT: Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence. CONCLUSION: The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake.

HIV self-testing for men who have sex with men in Sweden. A cross-sectional study concerning interest to use HIV self-tests.

BACKGROUND: HIV self-testing (HIVST) has been found to have high acceptability among men who have sex with men (MSM) internationally and might contribute to increase testing frequencies, but many countries, including Sweden, lack policies for using HIVST. OBJECTIVE: To examine interest to use and willingness to pay for HIVST, and associated factors, among MSM attending HIV testing venues in Sweden. METHOD: This cross-sectional study analyzed data from a self-administered survey, consisting of 33 questions, collected at six HIV testing venues in Sweden in 2018. The sample consisted of sexually active men who have sex with men, aged ≥ 18 years, and not diagnosed with HIV. Data were analyzed descriptively and by univariable and multivariable logistic regression. RESULT: Among 663 participants (median age 33 years), 436 respondents (65.8%) expressed interest to use HIVST. Among those interested, less than half, 205 (47.0%), were willing to pay for HIVST. Being interested in HIVST was found to be negatively associated with being in the 55 years or older age group (AOR 0.31, CI 0.14-0.71), and having had syphilis, rectal chlamydia, or rectal gonorrhea in the preceding 12 months (AOR 0.56, CI 0.32-0.99). In the sample of MSM interested in HIVST, willingness to pay was positively associated with being in the age groups 35-44 years (AOR 2.94, CI 1.40-6.21), 45-54 years (AOR 2.82, CI 1.16-6.90), and 55 years or above (AOR 3.90, CI 1.19-12.81), and negatively associated with being single (AOR 0.56, CI 0.36-0.88). CONCLUSION: This study found high interest for HIVST in a sample of MSM in Sweden. However, HIVST offered at a cost is likely to negatively affect uptake among MSM broadly, compared with free availability.