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1.
Health Aff (Millwood) ; 41(2): 195-202, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130060

RESUMEN

Few studies have illustrated how racism influences Black women's use of reproductive health care services. This article presents findings of a collaborative study conducted by a research team and a reproductive justice organization to understand Black women's concerns with sexual and reproductive health services. The qualitative research was conducted with Black women living in Georgia and North Carolina, using a community-based participatory research approach. Themes were developed from participant accounts that highlight how racism, both structural and individual, influenced their reproductive health care access, utilization, and experience. Structural racism affected participants' finances and led some to forgo care or face barriers to obtaining care. Individual racism resulted in some women electing to receive care only from same-race medical providers. These findings suggest a need for policies and practices that address structural barriers to reproductive health care access and improve the reproductive health experience of Black women.


Asunto(s)
Racismo , Servicios de Salud Reproductiva , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Salud Reproductiva , Conducta Sexual
2.
J Sex Med ; 19(7): 1090-1097, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35654717

RESUMEN

BACKGROUND: Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower. AIM: To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men. METHODS: Sexual identity was measured with the standard question: "Do you consider yourself to be heterosexual, gay, or bisexual?" Men who provided a complete set of answers to the study tools and replied "yes" to the question: "Have you ever had a problem with sexual functioning that lasted at least several months?" were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: "Did you seek professional assistance then?" Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking. OUTCOMES: Contacting a specialist when experiencing a sexual problem. RESULTS: A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor's visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017). CLINICAL TRANSLATION: Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpathologizing approach to sexual diversity. STRENGTHS AND LIMITATIONS: The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress. CONCLUSION: Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment. Grabski B., Kasparek K., Koziara K., et al. Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress. J Sex Med 2022;19:1090-1097.


Asunto(s)
Bisexualidad , Minorías Sexuales y de Género , Bisexualidad/psicología , Estudios Transversales , Identidad de Género , Homofobia/psicología , Homosexualidad Masculina/psicología , Humanos , Masculino , Conducta Sexual
3.
4.
Br J Sociol ; 73(3): 571-586, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35690996

RESUMEN

Masculinities scholarship tends toward describing autonomy as bound up with hegemonic masculine ideals such as independence, atomization, and self-sufficiency, without fully delving into the concept of autonomy. This article offers a more in-depth conceptual treatment of autonomy, compared to its more simplified rendering in the literature on the dominant relational conceptualizations of masculinities. In doing so, we follow recent calls to avoid categorizing men according to typologies of masculinity, drawing instead on feminist theorizations of masculine autonomy and relationality to explore how both manifest in men's lives. We draw on a study of men's drinking practices, with our data coming from focus groups with 101 men in metropolitan and regional/rural Victoria, Australia; but the issues we attend to have relevance, and can be an impetus, for further scholarly thinking about autonomy in men's lives well beyond drinking practices, and in other similar industrialized nations. We explore how masculine autonomy remains an influential and harmful discourse, often impeding possibilities for men's greater intimacy, connection and care and reproducing gendered hierarchies. However, we simultaneously highlight how men are inescapably relationally situated, exposing masculine autonomy as a discursive ideal of valorized forms of masculinity rather than an achievable state in practice. We argue that acknowledging how men are relationally embedded and interdependent in practice offers potential avenues for further fostering men's care, intimacy and relationality, and might work toward ameliorating gendered inequalities that see care work and the work of sustaining relational networks disproportionately falling to women and marginalized men.


Asunto(s)
Masculinidad , Salud del Hombre , Femenino , Grupos Focales , Humanos , Masculino , Conducta Sexual , Victoria
6.
Science ; 376(6600): 1364-1365, 2022 06 24.
Artículo en Inglés | MEDLINE | ID: mdl-35737802

RESUMEN

The once slow spreading virus may have found a new niche in tightly connected sexual networks.


Asunto(s)
Viruela de los Simios , Minorías Sexuales y de Género , Animales , Homosexualidad Masculina , Humanos , Masculino , Virus de la Viruela del Simio , Conducta Sexual
7.
Medicine (Baltimore) ; 101(25): e29509, 2022 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-35758393

RESUMEN

ABSTRACT: Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). AIDS is characterized by an impaired immune system and low cellular immunity. The main manifestation of AIDS is a reduction in the number of CD4+ T cells and alteration in cytokine concentration. The present work aimed to explore the expression of IL-31 in HIV infection and disease progression.Serum samples were collected from HIV-infected patients with different routes of disease transmission. The subjects included 24 patients who were infected with HIV upon blood transmission and 36 patients who had acquired the disease through sexual transmission (21 cases of homosexual transmission and 15 cases of heterosexual transmission). In addition, 20 normal healthy individuals were included to serve as the control group. The levels of IL-31 in the collected serum samples were estimated using the human IL-31 Platinum ELISA kit.The serum analysis results revealed that the concentration of IL-31 in the serum samples for the blood transmission, sexually transmission, and normal group patients was 4.07 ±â€Š1.63 pg/L, 7.43 ±â€Š1.15 pg/L, and 2.87 ±â€Š1.04 pg/L, respectively. The statistical analysis revealed that the concentration of IL-31 in HIV-1 infection was higher than that in the normal control. In addition, the expression of IL-31 was significantly higher in the sexual transmission group compared to the blood transmission group (P < .05).IL-31 could have an important role in HIV infection, although the role of IL-31 in disease progression in HIV-infected individuals requires further research.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Progresión de la Enfermedad , Infecciones por VIH/complicaciones , Heterosexualidad , Humanos , Conducta Sexual
8.
Swiss Med Wkly ; 152: w30192, 2022 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-35758418

RESUMEN

BACKGROUND: Changes in mental and sexual health among men having sex with men (MSM) due to the SARS-CoV-2 pandemic remain unclear. METHODS: Design: Longitudinal analysis of an ongoing, multicentre, pre-exposure prophylaxis (PrEP) cohort (NCT03893188) in Switzerland. Participants: HIV-negative MSM aged ≥18 who completed at least one questionnaire before and one after the start of the SARS-CoV-2 pandemic. Outcomes: Primary: mental health, defined as anxiety and depression scores assessed by the Patient Health Questionnaire-4. Secondary: sexual behaviour, well-being, PrEP use and disruption of care. Outcomes were assessed over seven periods corresponding to different SARS-CoV-2 prevention measures in Switzerland. We performed pairwise comparisons between periods (Wilcoxon signed rank test). RESULTS: Data from 1,043 participants were included. Whilst anxiety scores remained stable over time, depression scores worsened in the second wave and the second lockdown period compared to pre-pandemic scores. This was confirmed by pairwise comparisons (pre-SARS-CoV-2/second wave and pre-SARS-CoV-2/second lockdown: p <0.001). Downward trends in sexual activity,sexualized substance use, and a switch from daily to "event-driven" PrEP were found. Disruption of care affected 42.6% (790/1856) of daily PrEP users' follow-up visits. CONCLUSION: In this longitudinal analysis of a PrEP cohort enrolling MSM, depression scores worsened in the second wave and the second lockdown compared to the pre-pandemic period.


Asunto(s)
COVID-19 , Infecciones por VIH , Profilaxis Pre-Exposición , Salud Sexual , Minorías Sexuales y de Género , COVID-19/prevención & control , Estudios de Cohortes , Control de Enfermedades Transmisibles , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , Pandemias/prevención & control , SARS-CoV-2 , Conducta Sexual
10.
Artículo en Inglés | MEDLINE | ID: mdl-35682446

RESUMEN

Background: The aim of this study was to evaluate the trends of prevalence of health risk behaviors (HRBs) and health conditions over a 10 year period (2008-2018) in a representative sample of adolescents of Tuscany Region, Italy. Methods: This was a repeated cross-sectional (four survey waves) study. The prevalence of 17 HRBs and health conditions were analyzed by age, sex, and socioeconomic status (SES). Results: A total of 21,943 students were surveyed. During the study period, decreases in smoking participation, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased. Males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking, and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetable consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low-SES students than in high-SES students. Conclusions: The findings showed different tendencies in adolescent participation in HRBs over the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females' risk-taking behavior on the rise require careful monitoring.


Asunto(s)
Conducta del Adolescente , Alcoholismo , Trastornos Relacionados con Sustancias , Adolescente , Estudios Transversales , Femenino , Conductas de Riesgo para la Salud , Humanos , Masculino , Asunción de Riesgos , Conducta Sexual , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
11.
J Int Assoc Provid AIDS Care ; 21: 23259582221107327, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35699978

RESUMEN

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in Alabama to explore opportunities for and barriers to sexual health care including PrEP prescription. Twelve AGYW participated in IDIs with median age 20 (range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3 months, and 6 reported prior STI. Themes included: 1) Stigma related to sex contributes to inadequate discussions with educators, healthcare providers, and parents about sexual health; 2) Intersecting stigmas around race and gender impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but don't perceive it as an option for them. Multifaceted interventions utilizing the perspectives, voices, and experiences of Black cisgender AGYW are needed to curb the HIV epidemic in Alabama and the U.S. South.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Salud Sexual , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Conducta Sexual , Parejas Sexuales , Adulto Joven
12.
Enferm Clin (Engl Ed) ; 32 Suppl 1: S38-S45, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35688566

RESUMEN

AIM: To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation. METHOD: Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected. RESULTS: On average the participants were 20.70 years old (±2.1), had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p<.001) and the age at first sexual intercourse (H=26.749, p<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (rs=-.168, p<.001) and positively correlated with the number of sexual partners (rs=.243, p<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; p<.01). CONCLUSIONS: There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.


Asunto(s)
Coito , Parejas Sexuales , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Humanos , México , Conducta Sexual , Adulto Joven
14.
Cien Saude Colet ; 27(7): 2763-2776, 2022 Jul.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-35730845

RESUMEN

This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.


O objetivo do estudo foi estimar a prevalência de iniciação sexual entre 10 e 14 anos, em estudantes do segundo ano do ensino médio da rede pública e privada da IX RA do município de Rio de Janeiro-RJ, e identificar subgrupos mais vulneráveis à situação. A amostra foi composta por 694 estudantes, selecionados através de uma amostragem por conglomerados e estratificada por turno de aula e características administrativa da escola. As informações foram coletadas através de questionário estruturado de autopreenchimento. Intervalos de confiança a 95% e o teste Qui-Quadrado (χ2) foram usados para avaliar a heterogeneidade das proporções entre subgrupos. A prevalência do evento foi 18,4%, sendo maior: em meninos; em subgrupos de maior vulnerabilidade social; entre os que ficaram/namoraram até 14 anos; os que foram vítimas de violência sexual em relacionamentos afetivo-sexuais; e os que apresentaram comportamentos de riscos à saúde. A alta frequência de iniciação sexual na adolescência precoce, especialmente em grupos mais vulneráveis, evidencia que a situação deve ser compreendida e enfrentada com políticas públicas intersetoriais que leve em consideração um contexto social de múltiplas carências e não apenas à saúde reprodutiva.


Asunto(s)
Conducta Sexual , Vulnerabilidad Social , Adolescente , Brasil/epidemiología , Niño , Humanos , Masculino , Salud Reproductiva , Instituciones Académicas
15.
Cien Saude Colet ; 27(7): 2867-2877, 2022 Jul.
Artículo en Portugués | MEDLINE | ID: mdl-35730853

RESUMEN

The scope of this article is to build and validate an instrument to measure the intention to use condoms among women in a context of social vulnerability. It involved methodological research, the elaboration stage of which involved 111 women from a previous study, and the content validation stage had 166 participants, including female frequenters of a healthcare service, specialized referees and teachers. In the validation process, the Content Validity Index per Item, General Content Validity Index and Cronbach's Alpha were used. The instrument included 29 items and had a General Content Validity Index of 0.99. The semantic validation resulted in the insertion of pictorial signs in the response scales. The pilot study generated Cronbach's alpha of 0.61 (CI: 0.48-0.72). The validated instrument is a tool that can assist health workers and researchers in predicting condom use, providing input for preventive interventions towards safe sexual practices among women in situations of social vulnerability.


O objetivo deste artigo é construir e validar um instrumento de medida da intenção de uso de preservativos entre mulheres em contexto de vulnerabilidade social. Pesquisa metodológica cuja etapa de construção envolveu 111 mulheres em estudo prévio e a validação do conteúdo e face contou com 166 participantes, entre usuárias de um serviço de saúde, juízes especialistas e docentes. No processo de validação foram utilizados o Índice de Validade de Conteúdo por Item, Índice de Validade de Conteúdo Geral e Alfa de Cronbach. O instrumento constou de 29 itens, com Índice de Validade de Conteúdo Geral 0,99. A validação semântica resultou na inserção de sinais pictóricos nas escalas de resposta. O estudo piloto gerou Alfa de Cronbach 0,61 (IC: 0,48-0,72). O instrumento validado constitui-se ferramenta que pode auxiliar trabalhadores da saúde e pesquisadores na predição do uso de preservativos, guiando intervenções preventivas na direção de práticas sexuais seguras entre mulheres em situação de vulnerabilidade social.


Asunto(s)
Condones , Sexo Seguro , Femenino , Humanos , Proyectos Piloto , Psicometría/métodos , Reproducibilidad de los Resultados , Conducta Sexual , Encuestas y Cuestionarios
16.
Minerva Obstet Gynecol ; 74(3): 302-307, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35642714

RESUMEN

This paper tests the hypothesis that medications combined with behavioral sex therapy might lessen pain and restore sexuality in women with provoked vulvodynia. Three women affected by vulvodynia, otherwise healthy, in heterosexual relationship were treated at the Department of Obstetrics and Gynecology in a university hospital. In consecutive sessions of behavioral sex therapy, oral tricyclic antidepressants and vulvar applications of estrogen and hydrocortisone creams were prescribed in association with vaginal dilators and sensate focus exercises. The outcome supports the hypothesis that combined medications and sexual behavior interventions may be effective in lessening pain and restoring sexuality in women with provoked vulvodynia. The different dyadic balances observed in this small case series suggest how to best use this protocol. The positive results appear to be mostly due to behavioral sex therapy that was the new element added to the combination of pharmacological agents commonly used to treat provoked vulvodynia.


Asunto(s)
Vulvodinia , Terapia Conductista , Femenino , Humanos , Dolor , Conducta Sexual , Sexualidad , Vulvodinia/tratamiento farmacológico
17.
Acta Biomed ; 93(S3): e2022145, 2022 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-35666121

RESUMEN

BACKGROUND AND AIM: Disorders of sexual differentiation (DSD) with karyotype 46,XY include gonadal developmental differences such as complete gonadal dysgenesis, partial gonadal dysgenesis, testicular regression and ovotesticular sexual differentiation disorder, differences in androgen synthesis or action, such as androgen synthesis deficiency, androgen action deficits, LH receptor deficiency, AMH synthesis or action deficits, and other conditions such as severe hypospadias, cloaca estrophy, etc. Methods: A 17 years-old girl came to our attention for hirsutism, clitoral hypertrophy, primary amenorrhea, and bilateral mammary hypoplasia. According to clinical features and anamnesis, the diagnosis of 46, XY DSD was made. For diagnostic purposes, she underwent an extensive genetic analysis, hormone dosage and instrumental examinations. After a clitoridoplasty and hormone replacement treatment, the patient performs appropriate multidisciplinary follow-up and regular psychotherapy. RESULTS: The clinical case reported falls, according to the recent classification developed by the Chicago Consensus, within the scope of DSD with karyotype 46, XY. About 160 cases of patients with 17ß-HSD3 deficiency, diagnosed at a mean age of 12 years, are described in the literature, most of them coming from Western Asia and Europe and only three cases from Eastern Asia. Clinically, about 30% of patients showed virilization, 20% clitoromegaly, ambiguous genitalia, inguinal/labial mass, 16% primary amenorrhea, and 5% absence of mammary development, features that are partly traced in the case described here. CONCLUSIONS: This case underscores the complexity of managing individuals with DSD. Having acquired the concept that irreversible surgery should be avoided, except in cases where failure to do so would determine health risks, the primary objective of the medical decision lies in meeting conditions aimed at harmonious sexual identification, especially regarding sexual activity and fertility, involving a team of experienced professionals (psychologists, pediatricians, surgeons, endocrinologists, radiologists), capable of promptly identifying suggestive clinical signs.


Asunto(s)
Trastornos del Desarrollo Sexual , Disgenesia Gonadal 46 XY , Disgenesia Gonadal , Adolescente , Amenorrea/complicaciones , Andrógenos , Niño , Trastornos del Desarrollo Sexual/diagnóstico , Trastornos del Desarrollo Sexual/genética , Femenino , Disgenesia Gonadal/complicaciones , Disgenesia Gonadal 46 XY/complicaciones , Disgenesia Gonadal 46 XY/diagnóstico , Humanos , Masculino , Conducta Sexual
18.
Dermatol Online J ; 28(2)2022 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-35670680

RESUMEN

Dermatologists serve a vast array of patients with unique backgrounds. The National Institutes of Health (NIH) designated members of sexual and gender minorities as underrepresented in scholarly literature. Our study examines the past 10 years of studies published in highly-cited dermatologic journals, surveying each study for common data collection of sexual orientation and gender identity (SOGI) in dermatological studies. We found representation of sexual and gender minorities to be increasing in dermatological studies but recommend that SOGI data be collected regularly just as any other common variable in dermatological patient studies.


Asunto(s)
Identidad de Género , Minorías Sexuales y de Género , Femenino , Humanos , Masculino , Conducta Sexual , Encuestas y Cuestionarios
19.
Reprod Health ; 19(1): 135, 2022 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-35668397

RESUMEN

BACKGROUND: There is often collateral damage to health systems during epidemics, affecting women and girls the most, with reduced access to non-outbreak related services, particularly in humanitarian settings. This rapid case study examines sexual and reproductive health (SRH) services in the Democratic Republic of the Congo when the COVID-19 hit, towards the end of an Ebola Virus Disease (EVD) outbreak, and in a context of protracted insecurity. METHODS: This study draws on quantitative analysis of routine data from four health zones, a document review of policies and protocols, and 13 key-informant interviews with staff from the Ministry of Public Health, United Nations agencies, international and national non-governmental organizations, and civil society organizations. RESULTS: Utilization of SRH services decreased initially but recovered by August 2020. Significant fluctuations remained across areas, due to the end of free care once Ebola funding ceased, insecurity, number of COVID-19 cases, and funding levels. The response to COVID-19 was top-down, focused on infection and prevention control measures, with a lack of funding, technical expertise and overall momentum that characterized the EVD response. Communities and civil society did not play an active role for the planning of the COVID-19 response. While health zone and facility staff showed resilience, developing adaptations to maintain SRH provision, these adaptations were short-lived and inconsistent without external support and funding. CONCLUSION: The EVD outbreak was an opportunity for health system strengthening that was not sustained during COVID-19. This had consequences for access to SRH services, with limited-resources available and deprioritization of SRH.


Women and girls often face increased challenges to accessing healthcare during epidemics on top of pre-existing health disparities. There is emerging evidence that COVID-19 has had negative impacts on the health of women and girls in sub-Saharan Africa due to diverted funding, reduced services, negative socioeconomic impacts, and increased or new barriers to access. In the DRC, COVID-19 hit shortly after the end of an Ebola epidemic within a context of protracted insecurity. This study used mixed methods and drew upon 13 interviews to examine the effects of COVID-19 on SRH services in North Kivu and how the health system did or did not adapt to ensure continued access and utilization of SRH services. There was limited prioritization of SRH during COVID-19. Although the government issued policies on how to adapt SRH services, these were developed centrally, without much guidance on how to operationalize these policies in different contexts. Consequently, healthcare providers and civil society actors developed their own ways to continue activities at local levels, not necessarily in a systematic way. There was limited longer-term strengthening of the health system that could adapt to the subsequent COVID-19 pandemic aside from increased capacity of healthcare providers to manage infection prevention and control measures. However, this was hampered by the lack of personal protective equipment that received no external support. Therefore, donors need to consider how resources can be leveraged to support sustained strengthening of the health system to be able to adapt to shocks even when resources are limited.


Asunto(s)
COVID-19 , Fiebre Hemorrágica Ebola , Servicios de Salud Reproductiva , COVID-19/epidemiología , Brotes de Enfermedades , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Salud Reproductiva , Conducta Sexual
20.
BMC Health Serv Res ; 22(1): 750, 2022 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-35668408

RESUMEN

BACKGROUND: 'Syndemic' refers to socially produced, intertwined, and co-occurring epidemics. Syndemic theory is increasingly used to understand the population-level relationships between sexual health (including HIV) and mental health (including problematic substance use) epidemics. Syndemic-informed clinical interventions are rare. METHODS: We therefore asked 22 sexual health practitioners from six sexual health clinics in British Columbia, Canada to define the word 'syndemic' and then asked how the theory related to their clinical practice. RESULTS: Responses to syndemic theory ranged widely, with some practitioners providing nuanced and clinically informed definitions, others expressing a vague familiarity with the term, and others still having no prior knowledge of it. Where practitioners acknowledged the relevance of syndemic theory to their practice, they articulated specific ways in which syndemics create moral distress, that is, feeling that the most ethical course of action is different from what they are mandated to do. While some practitioners routinely used open-ended questions to understand the social and economic contexts of patients' sexual health needs, they described an uneasiness at potentially having surfaced concerns that could not be addressed in the sexual health clinic. Many observed persistent social, mental health, and substance use-related needs among their patients, but were unable to find feasible solutions to these issues. CONCLUSIONS: We therefore propose that interventions are needed to support sexual health practitioners in addressing psychosocial health needs that extend beyond their scope of practice, thereby reducing 'syndemic moral distress'.


Asunto(s)
Epidemias , Infecciones por VIH , Salud Sexual , Trastornos Relacionados con Sustancias , Colombia Británica/epidemiología , Infecciones por VIH/epidemiología , Humanos , Salud Mental , Principios Morales , Conducta Sexual/psicología , Trastornos Relacionados con Sustancias/epidemiología , Sindémico
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