Barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake and adherence among men who have sex with men (MSM) in Thailand: a qualitative study.

Young MSM (YMSM), aged 15-24, account for nearly half of new HIV infections in Thailand. Pre-exposure prophylaxis (PrEP) is an effective prevention medicine for populations at substantial HIV risk, yet YMSM frequently have suboptimal uptake of and adherence to PrEP. We conducted 35 in-depth interviews with YMSM to explore barriers and facilitators of both PrEP initiation and adherence. Interviews also elicited the perceptions and experiences of healthcare providers (HCPs) working with YMSM at three clinics in Bangkok. Primary barriers to PrEP initiation were limited accessibility, insufficient knowledge, and efficacy concerns; HCPs identified no-to-low self-perception of HIV risk, pre-existing health problems, fears of side effects, and living in distant provinces as barriers to PrEP initiation. YMSM primarily reported PrEP information and self-perceptions of elevated HIV risk as facilitators to PrEP initiation. Additionally, forgetfulness and low HIV risk awareness were common barriers to PrEP adherence. Reminders were a prominent facilitator of PrEP adherence alongside disclosure to close relationships, the routinization of regimens, and convenient facilities. HCPs regarded counseling as the leading facilitator of PrEP adherence. By understanding the barriers/facilitators of PrEP use, the current study seeks to help develop evidence-informed PrEP intervention programs among YMSM while considering cultural sensitivity.

Hitting the target and missing the point? A BEME systematic review of evidence regarding the efficacy of statutory and mandatory training in health and care: BEME Guide No. 87.

BACKGROUND: Mandatory training is considered fundamental to establishing and maintaining high standards of professional practice. There is little evidence however, of the training either achieving its required learning outcomes, or delivering improvement in outcomes for patients. Whist organisations may be hitting their compliance target for mandatory training, is the purpose missing the point? This systematic review aims to synthesize and evaluate the efficacy of statutory and mandatory training. METHODS: PubMed, EMBASE, CNAHL, ERIC and Cochrane Central registers were searched on 23rd May 2023. All research designs were included and reported training had to specify an organisational mandate within a healthcare setting. Data was coded using a modified Kirkpatrick (KP) rating system. Critical appraisal was undertaken using the Modified Medical Education Research Study Quality Instrument, Critical Appraisal Skills Programme Qualitative Studies checklist and Mixed Methods Assessment Tool. RESULTS: Twenty-five studies were included, featuring 9132 participants and 1348 patient cases audited. Studies described evaluation of mandatory training according to Kirkpatrick's outcomes levels 1-4b, with the majority (68%) undertaken in the UK and within acute settings. Training duration varied from 5 min to 3 days. There is a lack of consensus regarding mandatory training rationale, core topics, duration, and optimum refresher training period. Currently, mandatory training does not consistently translate to widescale improvements in safe practice or improved patient outcomes. CONCLUSIONS: Due to the lack of international consensus regarding the need for mandated training, most papers originated from countries with centrally administered national health care systems. The rationale for mandating training programmes remains undefined. The assumption that mandatory training is delivering safe practice outcomes is not supported by studies included in this review. The findings of this review offer a basis for further research to be undertaken to assist with the design, facilitation, and impact of mandatory training.

Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States.

This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.

Exploring the role of psychological assistance hotlines in improving mental health problems among Chinese adult women: A perspective based on social expectations and gender roles.

This paper looks at how social expectations and gender roles affect the mental health of Chinese women. Traditional Chinese culture, influenced by Confucianism and patriarchy, still has a negative impact on women's mental well-being, despite efforts for gender equality. Women's mental health is vital for both individuals and society, and this study aims to understand these issues better to help shape policies and interventions.

Dis/re-orienting design through norm-critical gender lenses: an educational case in Turkey.

Design, as a practice of developing solutions beyond products, and increasingly services and policies, inevitably poses an impact on gender (in)equality which remains largely unrecognized by design practitioners. This paper advocates the urgent need for adopting gender lenses in design education for sustainable cultural transformation through proper recognition of the complexity of any societal and cultural issue, power relations and inequalities, and introduces an initial attempt through a graduate-level educational design project. Throughout the project, students critically reflected on existing orientations in designing to develop norm-critical gender lenses, contained the resultant disorientation emerging from the contrast between their critical approaches and local contexts, and explored novel directions as reorientation to address four different societal and cultural issues and develop 11 design outcomes aiming at gender equality, social justice-oriented empowerment, and cultural transformation. The authors analyzed the design processes and outcomes to reveal opportunities and challenges for developing and deploying norm-critical gender lenses in tackling complex, intersecting socio-cultural and political issues, under three themes: gender stereotypes, norms, expectations, and roles; intersectional power relations and inequalities embedded in the social structure; and social justice-oriented empowerment beyond the market-oriented individualistic neoliberal order. A shift in the perceptions of the role of designers, from creator/problem-solver to facilitator/participant, and design outcomes, from absolute solutions to intermediaries of sociological and political imaginations, is found crucial in this endeavor, which requires safe spaces for future designers to reflect on existing orientations, contain disorientation with negative capability, and explore novel ways through reorientation.

Role of Gender perceptions in shaping gender-based discrimination and gender equality among school-going adolescents, Telangana: A cross-sectional community-based study.

Background: Adolescence is a unique phase of life, facilitates the transition of a child to an adult, and thus is characterized with distinctive challenges as well as potentialities. Gender socialization during adolescence is shaped by the family, culture, and social construct results to development of attitudes, with more consistent and organized vision toward self and the society. Aim: The present study aims to identify the gender attitudes, perceived gender role, and gender discrimination among adolescents. Materials and Methods: Cross-sectional descriptive design adopted to study the gender perceptions among adolescents (N = 200) between 8th and 12th standards and meeting the inclusive criteria. Data were collected on gender attributes, attitudes, and perceived discrimination based on gender. Gender equality scores measured among students were categorized between high and low. Results: Findings reveal the persistence of gendered attitudes, roles, and relationships based on gender; 54% girls and 58% boys reported that boys/men are expected to be tough and less emotional and (37.5% girls; 46% boys) agreed that men were decision makers in the financial and family matters and women were felt as lesser role players. Overall, 46% were with gender-biased perceptions. Girls (18%) and boys (5%) reported sexual abuse; however, for any gender abuse, only 16% preferred to seek help from the family members. Conclusion: Findings of the present study highlight the need for gender sensitization in education and schools to transform gender-balanced attitudes and behaviors from young age which greatly affect the inter-personal relationships, affecting behaviors and relationships in families and societies in adulthood.

Against age limits for men in reproductive care.

Almost all countries and fertility clinics impose age limits on women who want to become pregnant through Assisted Reproductive Technologies (ART). Age limits for aspiring fathers, however, are much less common and remain a topic of debate. This article departs from the principle of reproductive autonomy and a conditional positive right to receive ART, and asks whether there are convincing arguments to also impose age limits on aspiring fathers. After considering three consequentialist approaches to justifying age limits for aspiring fathers, we take in a concrete normative stance by concluding that those are not strong enough to justify such cut-offs. We reinforce our position by drawing a comparison between the case of a 39-year-old woman who wants to become a single mother via a sperm donor on the one hand, and on the other hand the same woman who wants to have a child with a 64-year-old man who she loves and who is willing to care for the child as long as he is able to. We conclude that, as long as appropriate precautions are taken to protect the welfare of the future child, couples who want to receive fertility treatment should never be limited on the basis of the age of the (male) partner. An absence of age limits for men would respect the reproductive autonomy of both the man and the woman.

Authorship of Italian medical literature on neuroendocrine neoplasms: any gender gap?

PURPOSE: While males have dominated the physician lines over the last decades the recent female doctors' number increasing might progressively reduce this gender gap. This might be not fully true in the academic/research area. We aimed to analyze the gender distribution of first/senior Italian authors on neuroendocrine neoplasm papers published on peer reviewed journals. METHODS: Publications from January 2019 to September 2023 were reviewed; only papers with first and/or senior Italian authors were included. First/senior author gender, type of article, co-authorship with foreign authors were the variable analyzed. RESULTS: 742 papers with Italian first and/or senior authors were retrieved, 449 (60.5%) multicentric, 285 (38.4%) original articles. A female author was first and senior author in 386/742 (52%) and in 228/742 (31%) papers, respectively. 150 (20.2%) papers included foreign coauthors, being an Italian female researcher first author in 50 papers (33%), senior author in 28 (18.6%). The number of Italian female first/senior authors has been increasing over the years (22 in 2019, 113 in 2022; 16 in 2019, 62 in 2022, respectively). The first/senior female authors were mainly Oncologists/Endocrinologists/Pathologists rather than Gastroenterologists/Nuclear Medicine doctors/Surgeons/Radiologists. CONCLUSION: There has been an increase in the prevalence of female authorship of published research in the neuroendocrine setting over the last 5 years, which partially reflects the current distributions in this field, taking into account that several specialties with different gender distribution are involved. However, senior authorship continues to be primarily men. Efforts should be made to improve proportionate gender representation in both clinical and academic/research setting.

Advancing Gender Equality in Healthcare Leadership: Protocol to Co-Design and Evaluate a Leadership and Mentoring Intervention in Tanzania.

Background: Women constitute almost two thirds of the health and social workforce. Yet, the proportion of women in decision-making positions remains significantly low leading to gender inequities in access to and appropriateness of healthcare. Several barriers which limit women's advancement to leadership positions have been documented and they generally constitute of gender stereotypes, discrimination and inhibiting systems; these hinderances are compounded by intersection with other social identities. Amelioration of the barriers has the potential to enhance women's participation in leadership and strengthen the existing health systems. Objective: This protocol describes a proposed study aimed at addressing the organisational and individual barriers to the advancement of women to leadership positions in the Tanzanian health sector, and to evaluate the influence on leadership competencies and career advancement actions of the female health workforce. Method: The study utilises a gender transformative approach, co-design and implementation science in the development and integration of a leadership and mentorship intervention for women in the Tanzanian health context. The key steps in this research include quantifying the gender ratio in healthcare leadership; identifying the individual and organisational barriers to women's leadership; reviewing existing leadership, mentorship and career advancement interventions for women; recruiting programme participants for a leadership and mentorship programme; running a co-design workshop with programme participants and stakeholders; implementing a leadership and mentorship programme; and conducting a collaborative evaluation and lessons learnt. Conclusions: This research underscores the notion that progression towards gender equality in healthcare leadership is attained by fashioning a system that supports the advancement of women. We also argue that one of the pivotal indicators of progress towards the gender equality sustainable development goal is the number of women in senior and middle management positions, which we hope to further through this research.

Demographics and Career Trends of Urology Fellowship Directors in the United States.

INTRODUCTION: Fellowship directors (FDs) hold significant leadership roles within the academic urology community. We sought to characterize common trends in training and academic productivity among urology FDs. Moreover, we aimed to characterize gender differences across subspecialties to better inform gender-based inclusion efforts and contemporary leadership pathways. METHODS: FDs were studied across 6 urologic subspecialties. Society and institutional websites were queried for demographics, education/training institutions, timelines of career milestones, and academic productivity. χ2, Mann-Whitney U, and Kruskal-Wallis tests and Kendall tau rank correlation were employed with an alpha cutoff of .05. RESULTS: There were 219 FDs included, representing 208 fellowship programs at 93 institutions. FDs were 176 (80%) males and 43 (20%) females. There was a significant association between gender and subspecialty. The median age for all FDs was 52 years old. Significant differences in age were demonstrated across subspecialties. For all FDs, females were younger than males, at 49 and 53 years, respectively (P = .001). The median H-index for all FDs was 23.5. H-index was significantly different between genders and subspecialities. There was a strong, positive correlation between age vs H-index for all FDs. Half of FDs had completed fellowship training at one of 14 institutions. CONCLUSIONS: We describe the landscape of leadership in urology subspecialty training. There are an increasing number of female FDs. Composition of leadership varies by subspecialty; however, the careers of all current urology FDs are marked by lifelong achievements in academic productivity. Moreover, a small group of institutions produce a substantial number of FDs.

A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis.

HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.

Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia.

This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (ß = 0.329, p < .01, ß = 0.917, p < 0.01), and negatively with physician-patient interaction quality (ß = -0.167, p = 0.051; ß = -0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = -1.966, p < 0.05) and increased HIV infection concern (z = -1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.

Gender equality and smoking among 15 to 25 year olds-a time-based ecological analysis of developments in Germany from 1960 to 2005.

Introduction: Smoking is a major risk factor for premature death and health problems in which there are significant gender differences in the prevalence of smoking. This ecological study examines the correlation between changes in gender equality and prevalence of smoking among young adults (15-25 years old) in Germany over a period of 45 years (1960-2005). Methods: Gender inequality was measured using the United Nations Gender Inequality Index (GII), which is composed of three dimensions; health, empowerment and labour market. It was calculated for the entire registered German population in five-year intervals with values between 0 and 1 (1 = highest inequality). The smoking prevalence of young women and men in Germany was established using a reconstruction method. A gender smoking ratio (GSR) with values between 0 and 1 was determined (1 = identical smoking prevalence among men and women). The smoking behaviour was illustrated and stratified by education. The correlation between the GII and the GSR was analysed. Results: The GII decreased from 0.98 to 0.56 between 1960 and 2005. The GSR increased from 0.34 to 0.93. There was a strong negative correlation between the GII and the GSR (r = -0.71). The strength of the correlation fell slightly as the level of education decreased. An increase in gender equality as measured by the GII came along with similarities of smoking prevalence between young women and young men. Conclusion: Successful tobacco prevention among young women and men may benefit from involving experts in gender-specific public health research to develop counter-advertising and gender-specific information as needed.

Gender norms in a context of legal pluralism: Impacts on the health of women and girls in Ethiopia.

To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all.

Boundary violations and university teachers' well-being during mandatory telework: Recovery's role and gender differences.

BACKGROUND: This study aimed to explore the role of psychological detachment from work in the relationship of boundary violations and flourishing, as well as gender differences among university teachers during mandatory telework. We developed and tested a moderate mediation model where psychological detachment was the explanatory mechanism of the relationship between boundary violations with flourishing and using gender as the moderating variable. METHODS: A cross-sectional study was conducted with a sample of 921 Brazilian university teachers (mean age 44 years, 681 women and 240 men) during mandatory telework. Multigroup analysis and moderate mediation were performed using Mplus 7.2. RESULTS: Psychological detachment mediated the relationship between boundary violations (in both directions) and flourishing and work-to-family violations were more harmful to women' recovery instead family-to-work violations were more harmful to men' recovery, among university teachers during mandatory telework. CONCLUSION: By focusing on boundary violations in the context of mandatory telework, the study sheds light on the impact of blurred boundaries between work and personal life. This contributes both literature on work-life balance and literature recovery. Moreover, it helps to understand a crisis setting of remote work. Further, the study's findings regarding gender differences highlight how men and women may experience and cope with boundary violations differently during mandatory telework, supporting future specific interventions across genders.

Everything changes but nothing changes: gender stereotypes in the Italian population.

PURPOSE: Gender stereotypes refer to consensual or cultural shared beliefs about the attributes of men and women, influencing society behaviors, interpersonal relationships, education, and workplace. The literature has shown the existence of gender stereotypes on career choices, internalization of roles, and school and social experiences and demonstrates the impact of demographic factors on stereotypes. However, all the studies conducted in Italy available in scientific literature analyzed small sample sizes within specific schools of university settings, with a limited age range. METHODS: To assess the current state of gender stereotypes in Italy, we conducted an online survey from October 2022 to January 2023 on the general population residing in Italy. The questionnaire comprised sociodemographic factors and questions about gender stereotypes, investigating six fields: games, jobs, personality traits, home and family activities, sports, and moral judgments. RESULTS: The study involved 1854 participants, mostly women (70.1%) with an undergraduate or postgraduate degree (57.5%). The statistical and descriptive analyses revealed that gender stereotypes influenced respondents' beliefs, with statistically significant effects observed in most questions when stratifying by age, gender, and degree. Principal component analysis was performed to assess latent variables in different fields, revealing significant main stereotypes in each category. No statistically significant differences between men and women were found for the fields home and family activities, games, and moral judgments, confirming that stereotypes affect both men and women in the same way. CONCLUSIONS: Our results show the persistence of gender stereotypes in any fields investigated, although our cohort is predominantly composed of high educational level women living in the North of Italy. This demonstrates that the long-standing gender stereotypes are prevalent, pernicious, and, unfortunately, internalized at times even by successful women pushbacking and sabotaging them unconsciously.

AIDSImpact special issue: pathways to transactional sex among peri-urban South African women: the role of relationship control, food insecurity and alcohol misuse.

Transactional sex increases sub-Saharan African women's risk of HIV acquisition. We quantitatively explored the pathways contributing towards women's future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months' later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18-35 years were enrolled and 80.5% (n = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02-0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating.

"AIDSImpact Special Issue" - High PrEP acceptability and need for tailored implementation in Cambodian key populations: results from a qualitative assessment.

The HIV epidemics in Cambodia is concentrated in key populations (KPs). Pre-exposure prophylaxis (PrEP) has been officially approved in the country since 2019. However, its use may still be controversial after a PrEP clinical trial was interrupted in Cambodia after being deemed unethical in 2004. In this context, it was necessary to evaluate PrEP acceptability and administration preferences of KPs in Cambodia, with a view to increasing roll-out and uptake. We conducted a qualitative study in 2022 comprising six focus groups and four semi-structured individual interviews with transgender women, men who have sex with men, male entertainment workers, venue-based female entertainment workers (FEW), street-based FEW, and PrEP users who participated in a PrEP pilot study that started in 2019. Overall, KPs positively perceived PrEP, with some reservations. They preferred daily, community-based PrEP to event-driven, hospital-based PrEP, and highlighted that injectable PrEP would be a potential option if it became available in Cambodia. We recommend (i) proposing different PrEP regimens and PrEP delivery-models to broaden PrEP acceptability and adherence in Cambodia (ii) increasing the number of community-based organisations and improving the services they offer, (iii) rolling out injectable PrEP when it becomes officially available, and (iv) improving PrEP side effects information.

COVID-19, pandemic lockdowns and intimate partner violence among HIV-positive women in Ghana.

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.