How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries.

BACKGROUND: Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched. OBJECTIVE: We examined how six francophone West African countries (Burkina Faso, Côte d'Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF). METHODS: We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories. RESULTS: In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs' deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking. CONCLUSIONS: There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.

Main findings: Although community health is a key component of the Investment Cases and the Project Appraisal Documents of most of the six francophone West African countries studied, the level of investment varies considerably between countries, and mostly skewed to community health workers, with very little left over for broader community engagement and oversight processes.Added knowledge: The study describes community health actors, community health interventions and monitoring within a global health initiative, how they fit into the wider health system, the challenges and weaknesses they face and the measures taken to mitigate them, and how they are budgeted.Global health impact for policy and action: There is a need to adopt a holistic community health systems approach, rather than one focused mainly on CHWs, to fully harness community health's potential to improve reproductive, maternal, newborn, child, and adolescent health and nutrition.

Searching for effective strategies to reach boys and young men; a mixed-methods study protocol for youth clinics in Sweden.

BACKGROUND: Efforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys' and young men's access to youth clinics in Sweden. METHODS: Employing a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden - chosen for their demographic and geographic diversity - will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness. DISCUSSION: The added value of this project is generating robust evidence regarding boys and young men's involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men's SRH; (2) informing future young men's health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men's participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.

Sexual and reproductive health service utilization and associated factors among youth workers at Kombolcha Industry Park, Kombolcha town, Northeast Ethiopia, 2023.

Background: Youth is a decisive age that shapes the direction of their life and that of their family. However, due to the host of biological, social, and economic factors, youth Industry Park workers can be at high risk of adverse sexual and reproductive health outcomes. Therefore, assessing youth sexual and reproductive health service utilization and associated factors among youth workers is very crucial for timely intervention to their gaps. Objective: This study aimed to assess sexual and reproductive health service utilization and associated factors among youth workers working at Kombolcha Industry Park Kombolcha, Northeast Ethiopia, 2023. Methods: An institutional-based cross-sectional study was conducted at Kombolcha Industry Park, Kombolcha, among a total of 422 youth workers from 1 January to 30 January 2023. A simple random sampling technique was used to access a total of 422 youth workers in Kombolcha Industry Park. The data were collected using pre-test, structured, and interviewer-administered questionnaires. Data were entered into Epi Data version 3.1 and were exported to SPSS version 26 for analysis. Bi-variable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio with 95% confidence interval was estimated to measure the strength of the association. The level of statistical significance was declared at a p value of less than 0.05. Results: Overall utilization of reproductive health services was 45.50%. Being married [adjusted odds ratio (AOR) = 5.76, 95% CI (2.94, 11.25)], near distance of sexual and reproductive health (SRH) facility to home [AOR = 2.57, 95% CI (1.60, 4.14)], having good knowledge [AOR = 9.23 95%CI (4.88, 17.44)], and good attitude about SRH [AOR = 2.06 95% CI (1.29, 3.28)] were significantly associated with youth SRHs utilization. Conclusion: Youth sexual and reproductive health service utilization among youth workers of Kombolcha Industry Park was low. Ensuring SRHs availability and accessibility, empowering youth with knowledge of SRHs, and advocating sexual and reproductive health services to develop a good attitude might be important in improving reproductive health service utilization. Future researchers should address segments of the population other than Kombolcha Industry Park.

Changing direction for health in Africa.

Current developments augurs well for sexual and reproductive health in Africa. With the African Union joining the G20 group, it is expected that its regional health priorities will be given special consideration. Social protection and empowerment of youth and women were prominent at the recent Summit of the Future. The impending change in leadership at the African regional office of the World Health Organization brings great expectations for sound policy formulation and surveillance for detecting outbreaks of epidemics. At the United Nations, Africa will benefit from reform of the Security Council besides intensified activities pertaining to the Sustainable Development Goals.

Les développements actuels sont de bon augure pour la santé sexuelle et reproductive en Afrique. Avec l'adhésion de l'Union africaine au groupe du G20, on s'attend à ce que ses priorités régionales en matière de santé fassent l'objet d'une attention particulière. La protection sociale et l'autonomisation des jeunes et des femmes étaient au centre du récent Sommet du futur. Le changement imminent à la tête du bureau régional africain de l'Organisation mondiale de la santé suscite de grands espoirs en matière de formulation de politiques et de surveillance judicieuses pour détecter les flambées d'épidémies. Aux Nations Unies, l'Afrique bénéficiera de la réforme du Conseil de sécurité ainsi que de l'intensification des activités liées aux objectifs de développement durable.

Assessing the impact of climate change on reproductive health: A content analysis of climate journalism coverage.

complications, infectious diseases, maternal and infant health in disasters, gender-based violence, healthcare access inequities, mental health impacts, and food security issues. Findings reveal an uneven distribution of coverage across continents, with potential language bias in English-dominated sources. Acknowledging limitations, future research directions emphasize a more inclusive approach, incorporating diverse linguistic perspectives and qualitative exploration of community experiences. The study underscores the imperative for global representation in media discourse This research explores the intricate relationship between climate change and reproductive health through an analysis of 1000 global news articles from 2018 onwards. Utilizing Latent Dirichlet Allocation (LDA), key topics in media coverage are identified, encompassing fertility challenges, pregnancy and advocates for comprehensive, evidence-based strategies to address the complex interplay between climate change and reproductive health.

Cette recherche explore la relation complexe entre le changement climatique et la santé reproductive à travers une analyse de 1 000 articles de presse mondiaux à partir de 2018. Grâce à l'allocation de Dirichlet latente (LDA), des sujets clés de la couverture médiatique sont identifiés, englobant les problèmes de fertilité, les complications de la grossesse, les maladies infectieuses, la santé maternelle et infantile en cas de catastrophe, la violence sexiste, les inégalités d'accès aux soins de santé, les impacts sur la santé mentale et les problèmes de sécurité alimentaire. . Les résultats révèlent une répartition inégale de la couverture à travers les continents, avec un biais linguistique potentiel dans les sources à dominante anglaise. Reconnaissant les limites, les futures orientations de recherche mettent l'accent sur une approche plus inclusive, intégrant diverses perspectives linguistiques et une exploration qualitative des expériences communautaires. L'étude souligne l'impératif d'une représentation mondiale dans le discours médiatique et préconise des stratégies globales et fondées sur des preuves pour aborder l'interaction complexe entre le changement climatique et la santé reproductive.

Nurses' Provision of Sexual and Reproductive Health to Community-Dwelling Older Adults: An Integrative Review.

PURPOSE: To explore barriers and facilitators to nurses' provision of sexual and reproductive health (SRH) care to community-dwelling older adults. METHOD: An integrative literature review was performed using Whittemore and Knafl's method. Three databases were searched for research conducted between 2012 and 2023, and the Mixed Methods Appraisal Tool was used to determine the quality of included studies. RESULTS: Nine studies were ultimately included for analysis, and themes were Barriers to SRH Care and Facilitators of SRH Care. Barriers to SRH Care included: nurses' lack of knowledge about older adults' sexual health, discomfort discussing sexual topics, age-related stereotypes regarding older adults' sexuality, and older adults' lack of knowledge of and reluctance to discuss sexuality and sexual health issues. Facilitators of SRH Care included: gender of health care provider, nursing education on effective communication strategies, encouraging open dialogue to challenge ageist perceptions, and sexual education for older adults. CONCLUSION: Findings underscore the impact of stigma and negative ageist assumptions on whether discussions about SRH occur between nurses and older adults. There is a need for comprehensive education for nurses and older adults about SRH to recognize sexual health needs and promote open and constructive conversations. Moreover, research about how to best facilitate older adults' SRH is needed. [Journal of Gerontological Nursing, 50(10), 17-23.].

Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers.

BACKGROUND: Immigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services. METHODS: An exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach. RESULTS: Language barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles. CONCLUSION: This study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

From genes to reproductive health: Immune cell influences on abortion.

BACKGROUND: The relationship between dysregulation of the immune system and reproductive health, particularly in the context of abortion, is an area of critical research. Identifying the immunological factors that contribute to abortion could provide valuable insights into its prevention and management. METHODS: This study used bidirectional two-sample Mendelian Randomization (MR) approach to evaluate the causal link between 731 immune cell features and the risk of abortion. The study analyzed GWAS data from 257,561 Europeans, including 7,069 cases and 250,492 controls, by utilizing genetic variation as instrumental variables. The immune phenotypes included several cell types, including B cells, T cells, TBNK cells, Treg cells, and monocytes. These were analyzed using the 'TwoSampleMR' package in R software. RESULTS: The study identified 34 immune phenotypes that have a significant causal relationship with abortion risk. Notably, Results from the B cell group showed a positive correlation between abortion and certain phenotypes, including Unsw mem %B cell, PB/PC %B cell, IgD+ CD24+ %B cell and Naive-mature B cell %lymphocyte. In the T cell group, certain maturation stages such as Naive CD8br %T cell and CD4 on CD45RA+ CD4+ exhibited negative causal links, whereas CCR7 on naive CD8br showed a positive association. The group of Treg cells showed both positive and negative causal relationships with abortion, highlighting the complexity of immune regulation in reproductive health. CONCLUSIONS: This study reflects the causal relationship between different subtypes of different immune cells and abortion. The results underscore the importance of the immune system in reproductive health and suggest potential therapeutic interventions targeting these immunological pathways.

Barriers and facilitators to women's access to sexual and reproductive health services in rural Australia: a systematic review.

BACKGROUND: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions. METHODS: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model. RESULTS: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. CONCLUSION: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs.

Health aspects of the presidential election in the United States.

The prospect of a Biden-Trump rematch had raised concerns. The argument of Trump on the older age of Biden led to a boomerang effect when the latter was replaced by the much younger Kamala Harris whose mixed African and Asian ancestry should lead to her support on international issues. Swing voters might be attracted by her potential as the first female president. Assertive on the politically controversial issue of abortion, Kamala Harris already spent a substantial part of her vice-presidency on women issues. Her promotion of sexual and reproductive rights during the presidential campaign augurs well for restoring those priorities on the American political agenda.

La perspective d'une revanche Biden-Trump avait suscité des inquiétudes. L'argument de Trump sur l'âge avancé de Biden a provoqué un effet boomerang lorsque ce dernier a été remplacé par la bien plus jeune Kamala Harris dont l'ascendance mixte africaine et asiatique devrait lui valoir son soutien sur les questions internationales. Les électeurs swing pourraient être attirés par son potentiel en tant que première femme présidente. Affirmée sur la question politiquement controversée de l'avortement, Kamala Harris a déjà consacré une partie substantielle de sa vice-présidence aux questions féminines. Sa promotion des droits sexuels et reproductifs pendant la campagne présidentielle augure bien du rétablissement de ces priorités sur l'agenda politique américain.

Access to and provision of sexual and reproductive health services in Ekurhuleni, South Africa: Experiences and coping strategies of migrant women and healthcare workers.

The importance of universal access to health services including sexual and reproductive health and rights (SRHR) services by migrant populations and the fundamental role of healthcare workers in providing SRHR services, requires a balanced understanding of the experiences of both migrants and healthcare workers. This study explored the experiences of migrant women in accessing and utilising SRHR services and the experiences of healthcare workers in providing SRHR and HIV services in Ekurhuleni, South Africa. In-depth interviews were conducted with five internal migrants, eight international migrant women aged 18-49 years, and four healthcare workers. Migrant women were selected using snowball sampling while healthcare workers were purposively sampled. Migrant women face multifaceted challenges including but not limited to language barriers, discrimination based on migration status, cultural and religious hurdles when accessing and utilising SRHR and HIV services. Similarly, healthcare workers encounter challenges in providing SRHR and HIV services to migrant women which include language barriers and having migrants who seek services without referral documentation and legal migration documents. Training healthcare workers on cultural sensitivity and integration of migrant friendly services in the health policy may improve migrant women's experiences in accessing and utilising as well as healthcare workers' experiences in providing SRHR services.

L'importance de l'accès universel aux services de santé, y compris les services de santé et de droits sexuels et reproductifs (SDSR) pour les populations migrantes et le rôle fondamental des agents de santé dans la fourniture de services SDSR, nécessitent une compréhension équilibrée des expériences des migrants et des agents de santé. Cette étude a exploré les expériences des femmes migrantes en matière d'accès et d'utilisation des services SDSR et les expériences des agents de santé dans la fourniture de services SDSR et VIH à Ekurhuleni, Afrique du Sud. Des entretiens approfondis ont été menés avec cinq migrants internes, huit femmes migrantes internationales âgées de 18 à 49 ans et quatre agents de santé. Les femmes migrantes ont été sélectionnées à l'aide d'un échantillonnage boule de neige tandis que les travailleurs de la santé ont été échantillonnés à dessein. Les femmes migrantes sont confrontées à des défis multiformes, notamment les barrières linguistiques, la discrimination basée sur le statut migratoire, les obstacles culturels et religieux lors de l'accès et de l'utilisation des services SDSR et VIH. De même, les agents de santé rencontrent des difficultés pour fournir des services SDSR et VIH aux femmes migrantes, notamment des barrières linguistiques et le fait que les migrantes recherchent des services sans documents de référence ni documents de migration légaux. La formation des agents de santé à la sensibilité culturelle et à l'intégration de services adaptés aux migrants dans la politique de santé peut améliorer les expériences des femmes migrantes en matière d'accès et d'utilisation, ainsi que les expériences des agents de santé dans la fourniture de services SDSR.

Primary healthcare providers' knowledge, practices and beliefs relating to preventive sexual and reproductive health care for women from refugee and asylum-seeking backgrounds in Australia: a national cross-sectional survey.

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

Reproductive health needs of HIV serodiscordant couples: a systematic review.

Objectives: HIV is closely linked to reproductive and sexual health. HIV Serodiscordant couples face significant social, reproductive, and sexual challenges. This systematic review aimed to identify their reproductive health needs. Methods: A comprehensive literature search was conducted across six databases: Scopus, PubMed, Web of Science, Google Scholar, Magiran, and Iranmedex. No date restrictions were applied, and only English-language articles published before February 21, 2023, were included. We also searched the grey literature and conducted forward/backward citation searches. Results: From an initial 758 articles, 18 met the inclusion criteria. Studies were qualitative (n = 10) and quantitative (n = 8). Key reproductive health needs included (1) childbearing intention, (2) HIV serodiscordance and sexuality, (3) psychological and social support, (4) training and consultation services, (5) access to reliable information, and (6) focused training for healthcare providers. Conclusion: HIV-discordant couples face various reproductive health challenges. Implementing comprehensive guidelines for reproductive and sexual health, rehabilitation, and fertility planning is crucial to improving their quality of life and health. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023393567.

New evidence on adolescent sexual and reproductive health and rights from the West and Central African region.

The African Journal of Reproductive Health is pleased to publish these compendiums of original research in this special edition that document new findings in adolescent sexual and reproductive health and rights from the West and Central African region (WCA). While sub-Saharan Africa has some of the worst indicators of sexual and reproductive health and rights (SRHR) in the world, the indicators are more daunting in the WCA region. To date, the WCA is recognized to have the highest rates of unwanted pregnancy, unsafe abortion, and human immunodeficiency virus (HIV) and other sexually transmissible infections, as well as the lowest contraceptive prevalence rates among adolescents worldwide.1 Despite the high rate of adverse adolescent reproductive health outcomes in WCA, there has been limited documentations of the socio-cultural and economic circumstances that perpetuate these adverse consequences. There have also been no purposefully designed interventions that provide strong scientific evidence for developing strategies to reverse the trend.

Le Journal africain de la santé reproductive est heureux de publier ces recueils de recherches originales dans cette édition spéciale qui documentent les nouvelles découvertes sur la santé et les droits sexuels et reproductifs des adolescents de la région de l'Afrique de l'Ouest et du Centre (WCA). Alors que l'Afrique subsaharienne possède certains des pires indicateurs au monde en matière de santé et de droits sexuels et reproductifs (SDSR), les indicateurs sont plus intimidants dans la région AOC. À ce jour, l'AOC est reconnue pour avoir les taux les plus élevés de grossesses non désirées, d'avortements à risque, de virus de l'immunodéficience humaine (VIH) et d'autres infections sexuellement transmissibles, ainsi que les taux de prévalence contraceptive les plus faibles parmi les adolescents dans le monde.1 Malgré le taux élevé de En dépit des résultats négatifs en matière de santé reproductive des adolescents en AOC, il existe peu de documentation sur les circonstances socioculturelles et économiques qui perpétuent ces conséquences néfastes. Il n'y a pas non plus d'interventions spécialement conçues qui fournissent des preuves scientifiques solides pour élaborer des stratégies visant à inverser la tendance.

Gender and adolescent sexual and reproductive health and rights in West and Central Africa: New evidence and emerging gaps.

The West and Central Africa (WCA) region is a natural resource-rich, 24-country, contiguous area with a population of nearly 500 million people. The median age for the region is currently 18 years and approximately one-third of its population is aged between 10 and 24 years. If current demographic trends in the region persist, its population will reach 1.5 billion by 2050. At that time, WCA will not only have the largest number of young people globally, but it will also be the only part of the world whose population of young people will continue to increase1. Many countries in the region are also or have recently been involved in armed conflicts, which have devastated infrastructure, displaced people, stifled development, and more importantly, resulted in myriad deaths and morbidities.

La région de l'Afrique de l'Ouest et du Centre (AOC) est une zone contiguë de 24 pays riches en ressources naturelles et comptant près de 500 millions d'habitants. L'âge médian de la région est actuellement de 18 ans et environ un tiers de sa population est âgée de 10 à 24 ans. Si les tendances démographiques actuelles de la région persistent, la population de la région atteindra 1,5 milliard d'habitants d'ici 2050. À cette époque, l'AOC comptera non seulement le plus grand nombre de jeunes au monde, mais elle sera également la seule partie du monde dont la population de le nombre de jeunes va continuer à augmenter1. De nombreux pays de la région sont également ou ont été récemment impliqués dans des conflits armés, qui ont dévasté les infrastructures, déplacé les populations, étouffé le développement et, plus important encore, entraîné une myriade de morts et de morbidités.

Positive masculinity programmes and attitudes towards nonconforming gender identities among young males in urban Democratic Republic of Congo, Nigeria, and Rwanda.

Implementing programmes on sexual and reproductive health and rights (SRHR) in sub-Saharan Africa often involves promoting inclusive sexual identity/orientation. However, whether and how the programmes are changing gender norms in the target populations have not been established. This study was designed to determine whether participation in Positive Masculinity (PM) programmes can change attitudes associated with prevailing gender norms. We explored attitudes towards nonconforming sexual identity/orientation among young males in selected informal settlements in Democratic Republic of the Congo (DRC), Nigeria and Rwanda. The key variables we tested included "country of participation" and other socio-demographics such as "education", "marital status" and "prior residential location" (rural or urban). We found no significant association between participation in PM programmes with attitudes towards nonconforming sexual identities/orientations across our target populations irrespective of educational qualification, marital status, and previous location of residence. By contrast, religious teachings showed up in the qualitative responses as a significant factor influencing young people's resistance to PM programmes' advocating for inclusive sexuality. Additionally, negative masculinity attributes had significant negative association with attitudes towards nonconforming sexual identity, while respondents with violent tendencies showed significant positive attitudes. We conclude that current PM interventions do not significantly contribute to positive attitudes towards inclusive sexuality in DRC, Nigeria, and Rwanda.

La mise en œuvre de programmes sur la santé et les droits sexuels et reproductifs (SDSR) en Afrique subsaharienne implique souvent la promotion d'une identité/orientation sexuelle inclusive. Cependant, il n'a pas été établi si et comment les programmes modifient les normes de genre dans les populations cibles. Cette étude a été conçue pour déterminer si la participation à des programmes de masculinité positive (PM) peut changer les attitudes associées aux normes de genre dominantes. Nous avons exploré les attitudes à l'égard de l'identité/orientation sexuelle non conforme chez les jeunes hommes dans des quartiers informels sélectionnés en République démocratique du Congo (RDC), au Nigeria et au Rwanda. Les variables clés que nous avons testées comprenaient le « pays de participation ¼ et d'autres données sociodémographiques telles que « l'éducation ¼, « l'état civil ¼ et « le lieu de résidence antérieur ¼ (rural ou urbain). Nous n'avons trouvé aucune association significative entre la participation à des programmes de PM et les attitudes à l'égard des identités/orientations sexuelles non conformes au sein de nos populations cibles, indépendamment du diplôme, de l'état civil et du lieu de résidence précédent. En revanche, les enseignements religieux sont apparus dans les réponses qualitatives comme un facteur important influençant la résistance des jeunes aux programmes PM prônant une sexualité inclusive. De plus, les attributs négatifs de la masculinité présentaient une association négative significative avec les attitudes à l'égard d'une identité sexuelle non conforme, tandis que les répondants ayant des tendances violentes montraient des attitudes positives significatives. Nous concluons que les interventions actuelles de PM ne contribuent pas de manière significative à des attitudes positives envers une sexualité inclusive en RDC, au Nigeria et au Rwanda.

Positive masculinity programmes and sexual and reproductive health behaviours among boys and men in poor urban settlements in Democratic Republic of Congo, Nigeria, and Rwanda.

As Positive Masculinity (PM) Programmes continue to develop globally, it is important to examine their role in Sexual and Reproductive Health and Rights (SRHR) outcomes. This multi-country qualitative study was conducted using in-depth interviews (IDI) and focus group discussions (FGDs) with community members, beneficiaries and implementers of PM programmes. The findings show that PM programmes are designed using a gender lens to make boys and men more aware and conscious of harmful masculinity traits and their effect on SRHR. The beneficiaries of the interventions report imbibing positive SRHR behaviours by being sexually responsible - upholding sexual rights, taking precautions against sexually transmitted Infections (STIs) and learning proper communication with their partners. They also report acting as vanguards of positive gender norms to their families and peers. Although there are challenges in implementing PM programmes, the results of the study suggest that interventions targeting boys and men hold promise for improving boys' and men's health behaviours and promoting gender equality in poor urban settings.

Alors que les programmes de masculinité positive (PM) continuent de se développer à l'échelle mondiale, il est important d'examiner leur rôle dans les résultats en matière de santé et de droits sexuels et reproductifs (SDSR). Cette étude qualitative multi pays a été menée à l'aide d'entretiens approfondis (IDI) et de discussions de groupe (FGD) avec des membres de la communauté, des bénéficiaires et des responsables de la mise en œuvre des programmes PM. Les résultats montrent que les programmes PM sont conçus en utilisant une optique de genre pour rendre les garçons et les hommes plus conscients des traits de masculinité néfastes et de leurs effets sur la SDSR. Les bénéficiaires des interventions déclarent avoir adopté des comportements positifs en matière de SDSR en étant sexuellement responsables ­ en respectant leurs droits sexuels, en prenant des précautions contre les infections sexuellement transmissibles (IST) et en apprenant une bonne communication avec leurs partenaires. Ils déclarent également agir en tant qu'avant-gardes des normes de genre positives auprès de leurs familles et de leurs pairs. Bien que la mise en œuvre des programmes PM présente des difficultés, les résultats de l'étude suggèrent que les interventions ciblant les garçons et les hommes sont prometteuses pour améliorer les comportements de santé des garçons et des hommes et promouvoir l'égalité des sexes dans les milieux urbains pauvres.