Venezuelan migrants and access to contraception in Colombia: A mixed research approach towards understanding patterns of inequality.

BACKGROUND: Migration should not put at risk the achievements of SDG 3: Universal Access to Sexual and Reproductive Healthcare, particularly access to contraceptive methods for Venezuelan migrants in receiving countries such as Colombia. Each year, more than 2 million men and women have access to modern contraceptive methods in Colombia. However, amid the pandemic, disruptions in supply chains, the interruption of essential services for sexual and reproductive health, and social inequalities may jeopardize these gains in contraception among Venezuelan migrants and refugees. The measurement of inequalities focuses on identifying the epicenter of inequity that is particularly relevant within the humanitarian response under strain. The objective of this article is to identify inequalities in access to contraception services among the migrant and refugee populations in six cities that concentrate 70% of the Venezuelan migration into Colombia and to discuss the challenges they represent for future emergencies. METHODS AND FINDINGS: We used a cross-sectional, descriptive study that included a mixed research approach (quantitative and qualitative analyses) based on three activities: i) analysis of contraceptive care records for the period 2018-2019; ii) measurement of inequalities in access to contraceptive services, and iii) design and implementation of twelve focus groups among Venezuelan migrants and refugees for discussion. RESULTS: Despite the evidence of a 70% increase in the use of contraceptive services among Venezuelan migrants between 2018 and 2019, there are absolute and relative inequalities in access to contraceptive methods both in the migrant and refugee populations versus the host population. The inequalities are mainly explained by the demographic dependency rate and the lack of job opportunities. CONCLUSIONS: The provision of essential sexual and reproductive health services to migrant and host populations must be regular, continuous, and shielded so that under no circumstances is it interrupted neither for infectious disease outbreaks to climate change emergencies in the future.

Percepciones de niñas, niños y adolescentes sobre violencias en los entornos familiar y escolar en ocho municipios de Colombia / Children and adolescents' perception of violence in family and school settings from eight municipalities in Colombia / Percepções de crianças e adolescentes sobre violência nos ambientes familiar e escolar em oito municípios na Colômbia

Resumen Objetivo: Esta investigación explora las percepciones, actitudes y prácticas de niñas, niños y adolescentes sobre violencias en los entornos familiar y escolar. Metodología: Durante 2018, se aplicó una encuesta sobre sexualidad, convivencia familiar y entorno escolar a 16 558 niñas, niños y adolescentes escolarizados de entre 9 y 19 años de edad, habitantes de ocho municipios de Colombia, de las zonas Caribe y Pacífico. Resultados: Se encontraron porcentajes altos de violencia en el hogar y de actitudes violentas en el entorno escolar, además de bajos índices de educación sobre temas relacionados con la violencia de género. La violencia física fue ejercida en mayor frecuencia en los niños y adolescentes varones, entre los 15 y 19 años, y en los municipios de Bahía Solano y El Carmen de Atrato. En contraste, la violencia sexual fue principalmente ejercida a las niñas, entre los 9 y 11 años, y en los municipios de Uribía y Pivijay. Conclusiones: las normas de género y las expectativas sociales atribuidas a las personas en función de su sexo exponen a niñas, niños y adolescentes a violencias diferenciadas; a ello se suman la edad y el lugar en el que se habita.

Abstract Objective: The study explores children and adolescents'perceptions, attitudes and behaviors regarding violence in family and school settings. Methodology: A survey about sexuality, family life and the school setting was conducted in 2018 to 16,558 children and adolescents aged between 9 and 19 years, who were attending school and were residents of eight municipalities of the Caribbean and Pacific regions of Colombia. Results: High percentages of family violence and violent behavior in the school setting were found along with a low degree of knowledge about subjects related to gender-based violence. Young boys and male adolescents aged between 15 and 19 years from Bahía Solano and El Carmen de Atrato municipalities were exposed most frequently to physical violence while girls aged between 9 and 11 years from Uribía and Pivijay were exposed mostly to sexual violence. Conclusions: Gender norms and social expectations expose children and adolescents to different types of violence. Other contributing factors are age and place of residence.

Resumo Objetivo: Explorar percepções, atitudes e práticas de algumas crianças e adolescentes sobre a violência nos ambientes familiar e escolar. Metodologia: Em 2018, foi aplicada uma pesquisa sobre sexualidade, vida familiar e ambiente escolar em 16.558 meninas, meninos e adolescentes entre 9 e 19 anos, habitantes de oito municípios da Colômbia. Resultados: Foram encontrados altos percentuais de violência doméstica e atitudes violentas no ambiente escolar, além de baixos níveis de educação em questões relacionadas à violência de gênero. A violência física foi maior em meninos e adolescentes, entre 15 e 19 anos, e nos municípios de Bahía Solano e El Carmen de Atrato. Por outro lado, a violência sexual foi maior em meninas, entre 9 e 11 anos, e nos municípios de Uribía e Pivijay. Conclusões: as normas de gênero e as expectativas sociais atribuídas às pessoas com base no sexo, expõem meninas e meninos e adolescentes à violência diferenciada, agregando idade e local onde moram.

Conocimientos, actitudes y prácticas de niñas y niños sobre educación sexual integral en ocho municipios de Colombia / Knowledge, attitudes and practices of girls and boys on comprehensive sexual education in eight municipalities of Colombia

Resumen Introducción: La educación integral para la sexualidad permite dotar a niñas/os y adolescentes de conocimientos basados en datos empíricos, habilidades, actitudes y valores que fortalecen sus procesos de empoderamiento para disfrutar del derecho a la salud, el bienestar y la dignidad humana; además, les permite comprender cómo proteger y velar por la garantía de sus derechos a lo largo de su vida. Objetivo: Describir los conocimientos, actitudes y prácticas en educación sexual integral de 6 645 niñas y niños escolarizados en ocho municipios priorizados de Colombia. Metodología: Ocho municipios fueron seleccionados según indicadores socio-demográficos, embarazo adolescente y violencia de género. Los criterios de inclusión fueron definidos: niñas/os escolarizados de entre nueve y 11 años de edad y con residencia habitual en el municipio. Una encuesta de Conocimientos, Actitudes y Prácticas fue diseñada, validada y aplicada para recolectar datos de 5 600 hogares, 50 instituciones educativas y 6 645 niñas/ os. Se realizó un análisis descriptivo de la muestra, profundizando en los datos obtenidos del cuestionario aplicado a niñas/os. Resultados: Se encontraron altos porcentajes de desacuerdo de violencia directa contra la mujer y validación de formas sutiles de violencia en las niñas/os. Los niños reciben más castigos físicos que las niñas. El término sexualidad es desconocido por la mayoría de niñas y niños, quienes creen conocerlo lo dialogan principalmente con su mamá y más del 20 % no lo hablan con nadie. Las niñas y niños participantes están iniciando relaciones sexuales a edades tempranas sin previa educación en sexualidad. Conclusiones: Las niñas y niños interiorizan y reafirman roles tradicionales de género y tienen percepciones erradas sobre la sexualidad, por lo cual, es necesario profundizar en el significado de sexualidad y sobre la violencia basada en género. Esto con el fin de desarrollar capacidades en la toma de decisiones, que influyan positivamente en sus proyectos de vida.

Abstract Introduction: Comprehensive sexuality education enables children and adolescents to be provided with knowledge based on empirical data, skills, attitudes, and values that strengthen their empowerment processes to enjoy their right to health, well-being, and human dignity. Additionally, it allows them to understand how to protect and guarantee their rights throughout their lives. Objective: To describe the knowledge, attitudes, and practices in comprehensive sexuality education of 6,645 school age children enrolled in eight prioritized municipalities in Colombia. Methods: Eight municipalities were selected according to its sociodemographic characteristics, and indicators of teenage pregnancy and gender-based violence. The inclusion criteria were: children going to school between nine and eleven years old and habitually residing in the municipality. A Knowledge, Attitudes and Practices survey was designed, validated and applied to 5,600 families, 50 schools and 6,645 children. A descriptive analysis of the sample obtained was carried out, delving into the data obtained from the children's survey. Results: High percentages of disagreement regarding direct violence against women were found in children's responses, as well as validation of subtle forms of violence. Boys received more physical punishment than girls. The term sexuality is unknown by the majority of surveyed boys and girls, those who believe to understand it have discussed it mainly with their mothers and more than 20% have not spoken about it with anyone. The participating boys and girls are initiating sexual relations at an early age without prior sexuality education. Conclusions: Girls and boys internalize and reaffirm traditional gender roles and have wrong perceptions about sexuality. That is why, to develop with them decision-making skills that will have positively influence in their life projects it is necessary to deepen the meaning of sexuality and gender-based violence.

Respuesta social a las medidas no farmacológicas para controlar la propagación del COVID-19 en Colombia / Social response to non-pharmacological measures to control the spread of COVID-19 in Colombia

Resumen Introducción: Los gobiernos al inicio de la pandemia, con el fin de mitigar y suprimir la propagación del virus implementaron medidas no farmacológicas ante la falta de vacunas y tratamientos farmacológicos efectivos. El gobierno colombiano emprendió acciones para controlar el contagio del COVID-19. Estas afectaron a la población y por ello el país requiere una evaluación profunda de la respuesta social ante la pandemia. Objetivo: Analizar la respuesta social a las medidas no farmacológicas para controlar la propagación del COVID-19 en Colombia. Metodología: Estudio exploratorio descriptivo transversal. El total de personas que respondieron la encuesta fue de 3549 adultos, entre el 8 y el 20 de abril de 2020. Resultados: En el país existen tres grupos de personas que han respondido a la pandemia de formas diferentes: quienes se resisten (34 %), quienes sufren (26 %) y quienes la aceptan (40 °%). En general, 90 % de las personas adoptó al menos una medida para protegerse, el 68 % adoptó más de tres medidas de higiene y autocuidado y un 60 °% implementó más de tres medidas de distanciamiento físico. Conclusiones: Al inicio de la pandemia, la ausencia de una vacuna hizo que las acciones individuales fueran tan importantes como las medidas implementadas por el gobierno. Sin embargo, pedagogía a nivel comunitario y el acceso a la información correcta, clara y concisa contribuyó con cambios de comportamientos positivos en la higiene, autocuidado y adherencia a medidas de distanciamiento, todo esto ha sido crucial para detener la propagación de COVID-19.

Abstract Introduction: At the beginning of the pandemic, governments implemented non-pharmacological measures to mitigate and suppress the spread of the virus in the absence of vaccines and effective pharmacological treatments. The Colombian government undertook actions to control the spread of COVID-19. These affected the population; therefore, the country requires a thorough evaluation of the social response to the pandemic. Objective: To analyze the social response to non-pharmacological measures to control the spread of COVID-19 in Colombia. Methodology: Cross-sectional descriptive exploratory study. The total number of people who responded to the survey was 3549 adults, between April 8 and 20, 2020. Results: There are three groups of people in the country who are responding to the pandemic in different ways: those who resist (34%), those who suffer (26%) and those who accept it (40%). Overall, 90% of people took at least one measure to protect themselves and others, 68% took more than three hygiene and self-care measures, 60% implemented more than three physical distancing measures. Conclusions: At the beginning of the pandemic, in the absence of a vaccine, individual actions are as important as measures implemented by the government. However, community-level education and access to correct, clear and concise information contributed to positive behavioral changes in hygiene, self-care and adherence to distancing measures, all of which are crucial to stop the spread of COVID-19.

[Social inequalities related to antimicrobial resistance in N. gonorrhoeae in ColombiaDesigualdades sociais relacionadas à resistência antimicrobiana de N. gonorrhoeae na Colômbia]. / Desigualdades sociales relacionadas con la resistencia a antimicrobianos de N. gonorrhoeae en Colombia.

OBJECTIVE: Measure social inequalities in antimicrobial resistance in Neisseria gonorrhoeae in Colombia. METHODS: Ecological study using a multi-panel of data, disaggregated at the subnational level, and using isolations of N. gonorrhoeae as a proxy for antimicrobial resistance (AMR) between 2009 and 2018. A sociodemographic characterization, an analysis of the antimicrobial sensitivity of isolations of N. gonorrhoeae, and a measurement of inequalities in AMR in N. gonorrhoeae were conducted using the slope index of inequality, the relative inequality index, and the concentration index. RESULTS: The findings indicate antimicrobial resistance to penicillin (50.7%) and tetracycline (67.3%) in isolations of N. gonorrhoeae, and the existence of absolute and relative inequalities during the study period. Access barriers to health services, not having received information on the prevention of sexually transmitted infections, basic unmet needs, and illiteracy explained the inequalities in AMR in N. gonorrhoeae. CONCLUSIONS: Six recommendations emerged with a view to largely containing AMR in N. gonorrhoeae: i) increase awareness of safe sexual and reproductive health; ii) rethink how to deliver key messages with an equity approach; iii) improve information, prescription, and drug chain systems; iv) form coalitions to improve response and share objectives with the private sector; v) improve the availability and disaggregation of data; and vi) support research on inequalities in AMR.

OBJETIVO: Medir as desigualdades sociais na resistência antimicrobiana de Neisseria gonorrhoeae na Colômbia. MÉTODOS: Estudo ecológico que utilizou um painel múltiplo de dados desagregados ao nível subnacional de isolados de N. gonorrhoeae como substituto para a resistência antimicrobiana (RAM) entre 2009 e 2018. Realizamos uma caracterização sociodemográfica, uma análise da sensibilidade antimicrobiana dos isolados de N. gonorrhoeae e uma medição das desigualdades na RAM para N. gonorrhoeae utilizando o índice absoluto de desigualdade, o índice relativo de desigualdade e o índice de concentração. RESULTADOS: Os resultados indicam a existência de resistência antimicrobiana nos isolados de N. gonorrhoeae à penicilina (50,7%) e à tetraciclina (67,3%), bem como desigualdades absolutas e relativas durante o período analisado. Os obstáculos no acesso aos serviços de saúde, a falta de informações sobre a prevenção de infecções sexualmente transmissíveis, a existência de necessidades básicas não satisfeitas e o analfabetismo explicam as desigualdades na RAM de N. gonorrhoeae. CONCLUSÕES: Podem ser feitas seis recomendações para conter em grande medida a RAM de N. gonorrhoeae: i) aumentar a conscientização sobre a saúde sexual e reprodutiva segura, ii) repensar a forma de transmitir as mensagens principais, com foco na equidade, iii) melhorar os sistemas de informação, prescrição e a cadeia de medicamentos, iv) criar coalisões para melhorar a capacidade de resposta e compartilhar objetivos com o setor privado, v) melhorar a disponibilidade e a desagregação de dados e vi) apoiar a pesquisa sobre as desigualdades na RAM.

Desigualdades sociales relacionadas con la resistencia a antimicrobianos de N. gonorrhoeae en Colombia

[RESUMEN]. Objetivo. Medir desigualdades sociales en la resistencia antimicrobiana de la Neisseria gonorrhoeae en Colombia. Métodos. Estudio ecológico utilizando un multipanel de datos desagregado a nivel subnacional de los aislamientos en la N. gonorrhoeae como proxy de resistencia antimicrobiana (RAM) entre 2009 y 2018. Se llevó a cabo una caracterización sociodemográfica, un análisis de la sensibilidad antimicrobiana de aislamientos de N. gonorrhoeae, y una medición de desigualdades en la RAM para la N. gonorrhoeae mediante el índice de desigualdad de la pendiente, el índice de desigualdad relativo y el índice de concentración. Resultados. Los hallazgos indican resistencia antimicrobiana de aislamientos de N. gonorrhoeae a penicilina (50,7%) y tetraciclina (67,3%); y la existencia de desigualdades absolutas y relativas durante el período analizado. Las barreras de acceso a servicios de salud, no haber recibido información de prevención de las infecciones de transmisión sexual, necesidades básicas insatisfechas y analfabetismo explicaron las desigualdades en la RAM de la N. gonorrhoeae. Conclusiones. Seis recomendaciones emergen para contener en gran medida la RAM en la N. gonorrhoeae: i) aumentar conciencia sobre la salud sexual y reproductiva segura; ii) repensar cómo entregar mensajes claves con enfoque de equidad; iii) mejorar los sistemas de información, prescripción y cadena de medicamentos; iv) crear coaliciones para mejorar la respuesta y compartir objetivos con el sector privado; v) mejorar la disponibilidad y desagregación de los datos; y vi) apoyar investigaciones en desigualdades en RAM.

[ABSTRACT]. Objective. Measure social inequalities in antimicrobial resistance in Neisseria gonorrhoeae in Colombia. Methods. Ecological study using a multi-panel of data, disaggregated at the subnational level, and using isolations of N. gonorrhoeae as a proxy for antimicrobial resistance (AMR) between 2009 and 2018. A sociodemographic characterization, an analysis of the antimicrobial sensitivity of isolations of N. gonorrhoeae, and a measurement of inequalities in AMR in N. gonorrhoeae were conducted using the slope index of inequality, the relative inequality index, and the concentration index. Results. The findings indicate antimicrobial resistance to penicillin (50.7%) and tetracycline (67.3%) in isolations of N. gonorrhoeae, and the existence of absolute and relative inequalities during the study period. Access barriers to health services, not having received information on the prevention of sexually transmitted infections, basic unmet needs, and illiteracy explained the inequalities in AMR in N. gonorrhoeae. Conclusions. Six recommendations emerged with a view to largely containing AMR in N. gonorrhoeae: i) increase awareness of safe sexual and reproductive health; ii) rethink how to deliver key messages with an equity approach; iii) improve information, prescription, and drug chain systems; iv) form coalitions to improve response and share objectives with the private sector; v) improve the availability and disaggregation of data; and vi) support research on inequalities in AMR.

[RESUMO]. Objetivo. Medir as desigualdades sociais na resistência antimicrobiana de Neisseria gonorrhoeae na Colômbia. Métodos. Estudo ecológico que utilizou um painel múltiplo de dados desagregados ao nível subnacional de isolados de N. gonorrhoeae como substituto para a resistência antimicrobiana (RAM) entre 2009 e 2018. Realizamos uma caracterização sociodemográfica, uma análise da sensibilidade antimicrobiana dos isolados de N. gonorrhoeae e uma medição das desigualdades na RAM para N. gonorrhoeae utilizando o índice absoluto de desigualdade, o índice relativo de desigualdade e o índice de concentração. Resultados. Os resultados indicam a existência de resistência antimicrobiana nos isolados de N. gonorrhoeae à penicilina (50,7%) e à tetraciclina (67,3%), bem como desigualdades absolutas e relativas durante o período analisado. Os obstáculos no acesso aos serviços de saúde, a falta de informações sobre a prevenção de infecções sexualmente transmissíveis, a existência de necessidades básicas não satisfeitas e o analfabetismo explicam as desigualdades na RAM de N. gonorrhoeae. Conclusões. Podem ser feitas seis recomendações para conter em grande medida a RAM de N. gonorrhoeae: i) aumentar a conscientização sobre a saúde sexual e reprodutiva segura, ii) repensar a forma de transmitir as mensagens principais, com foco na equidade, iii) melhorar os sistemas de informação, prescrição e a cadeia de medicamentos, iv) criar coalisões para melhorar a capacidade de resposta e compartilhar objetivos com o setor privado, v) melhorar a disponibilidade e a desagregação de dados e vi) apoiar a pesquisa sobre as desigualdades na RAM.