The role of education and income as protective factors against intimate partner violence and HIV exposure among Kenyan women.

Introduction: Intimate partner violence (IPV) is a public health problem that impacts approximately one in three women worldwide in their life-time. The purpose of the study was to explore the lived experiences of women teachers and violence in Kenya. It also explores the intersection between intimate partner violence, HIV risk, and gender inequality. Method: Data were collected through two focus groups of a total of 15 women teachers. We recruited women ages 21-44 from two geographically diverse urban and rural schools. The data were analyzed using a thematic analysis method to identify text themes and meaning patterns. Results: Three contextual experiences emerged: socio-cultural influences of gender norms, masculinity and patriarchy; uneven power dynamics; and institutionalized gender inequality. Discussion: Findings suggest that education alone is not sufficient to end GBV. Comprehensive and gender transformative governmental policy approaches are needed to mitigate GBV in Kenya.

Ecological Factors of Telemental Healthcare Utilization Among Adolescents with Increased Substance Use During the COVID-19 Pandemic: The Moderating Effect of Gender.

Background: Adolescent substance use is often associated with concurrent mental health problems (e.g., depression, suicide attempts, parental emotional and physical abuse, not feeling close to people at school, and lower virtual connectedness) at multiple ecological levels. Objective: This study examined whether such risk factors among adolescents were associated with the use of telemental healthcare (TMHC) and whether gender moderated these associations. Methods: Data were drawn from the Adolescent Behaviors and Experiences Survey, collected by the U.S. Centers for Disease Control and Prevention from January to June 2021. A hierarchical multiple logistic regression analysis was conducted using a national sample of 1,460 students in Grades 9-12 in the United States who reported having used more alcohol and/or drugs during the pandemic than before it started. Results: The results showed that only 15.3% of students sought TMHC. Students reporting increased substance use during the pandemic were more likely to use TMHC if they experienced more severe mental health problems (e.g., suicide attempts) compared to other ecological factors, such as issues with their family, school, or community. Analysis of the moderating effect showed that the closer male students felt to people at school, the more likely they were to seek TMHC, whereas the opposite was true for female students. Conclusions: The findings highlighted that feeling close to people at school is an important aspect of understanding the help-seeking behavior of female and male adolescent substance users.

Exploring Help-Seeking Predictors Among Colombian Victims of Intimate Partner Violence in Different Age Groups.

This study examined the extent, source, and individual, microsystem, exosystem, and macrosystem-level (Heise's Ecological Model) predictors of help-seeking behaviors among women of different age groups in Colombia. Data on 12,915 married or cohabitating women who had experienced diverse forms of intimate partner violence (IPV) were obtained from the Colombia Demographic Health Survey 2015. More than half of the Colombian women who reported some form of IPV experience did not seek any help. Women aged 25-39 were less likely to seek help. Type of violence and experience of IPV and education were the strongest predictors of help-seeking among women in all age groups. Implications for research and programming are discussed.

Addressing the Syndemics of HIV, Mental Health, and COVID-19 Using the Health and Human Rights Framework among Youth Living with HIV, in Uganda: an Interpretive Phenomenological Study.

Stigma and discrimination negatively impact the prevention, treatment, and care of HIV. The COVID-19 pandemic increased this complexity and created a cluster of synergistic health contexts, wherein the physiological aspects of HIV and the social and environmental conditions increased the vulnerability in health outcomes for youth living with HIV (YPLHIV) in Kampala, Uganda. We used interpretive phenomenological analysis (IPA) and the syndemics framework to understand the lived experiences of YPLHIV. From December 2020 to May 2021, six qualitative focus groups were held with 31 youth living with HIV to understand the lived experiences of YPLHIV. The guided questions used were audio-recorded, transcribed verbatim, and coded for thematic analysis. Findings highlight the complexity of intersecting stigma of HIV and COVID-19 that have worsened antiretroviral treatment adherence and mental health issues due to lack of access to critical needs such as fears of food insecurity, health-related worries, the fear of perishing due to COVID-19, and human rights concerns related to gender and sexual identity. The study recommends addressing human rights-related concerns in addition to health-related concerns to comprehensively mitigate the syndemics of HIV and COVID-19 for YPLHIV in Uganda.

Barriers to Help-Seeking for Domestic Violence in Kyrgyzstan: Perspectives of Criminal Justice, Social, Health, and Educational Professionals.

Purpose: Research with survivors of domestic violence (DV) suggests that most do not seek supportive services from formal organizations. The purpose of this study is to understand the structural and legal barriers that prevent survivors of DV from seeking help in Kyrgyzstan from the perspectives of professionals within the areas of law enforcement, judicial system, social, health, and educational sectors working directly with survivors. Methods: We conducted 20 semi-structured interviews and 8 focus groups with 83 professionals who are employed as domestic violence or legal advocates, psychologists, healthcare providers, educators, and law enforcement officials who had worked with the survivors of DV in their current positions. We analyzed the data using a multistep strategy derived from grounded theory methods. Results: The findings of the study highlighted six structural barriers: (1) financial dependence on the abuser, (2) stigma and shame of seeking help, (3) few crisis centers and rigid acceptance criteria for temporary protection, (4) the normalization and societal acceptance of abuse, (5) a lack of property rights for women, and (6) distrust of formal services. The participants indicated five legal barriers, including the following: (1) insufficient sanctions for abusers, (2) unclear provisions and inadequate enforcement of law, (3) a low likelihood of prosecution, (4) poor procedures, stereotypes of survivors, and revictimization during investigations, and (5) protection for abusers who work in positions of power. Conclusions: The structural and legal barriers that survivors face when seeking help are formidable challenges that will require extensive support from professionals working in the fields of criminal justice, social work, and public health. Findings suggest that both short-term and longer-term interventions that require sustainability of prevention efforts are necessary to address barriers to help-seeking identified in the study.

Exploring factors associated with HIV secondary stigma among adolescents and young adults in Uganda: A cross-sectional study.

HIV stigma is a public health problem. It refers to irrational judgments and attitudes towards people living with or at risk of HIV. Among adolescents and young adults living with HIV, stigma can negatively influence help-seeking decisions and impede HIV prevention efforts. The present study aimed to explore social-ecological factors associated with HIV-related stigma using a cross-sectional study design. Data used were from the 2016 Uganda Demographic and Health Survey [UDHS] of young men (n = 2214) and young women (n = 8058) aged 15-24 years. We conducted a gender disaggregated multivariable logistic regression to understand social-ecological factors associated with HIV secondary stigma. An overwhelming majority of participants (85%) indicated that secondary HIV stigma was associated with factors such as gender, ethnicity, education, wealth, cultural attitudes, and testing experiences. The study concludes that many young people living with HIV experience stigma in Uganda. Therefore, the government of Uganda, health professionals, and researchers should consider developing interventions that address HIV stigma and discrimination. Supportive programmes, such as peer support services and community-based interventions, are needed to help young people living with HIV learn to cope with the illness.

Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda.

With over 1.4 million refugees, Uganda is Sub-Saharan Africa's largest refugee-hosting nation. Bidi Bidi, Uganda's largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16-24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention's efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts.

COVID-19 and disconnected youth: Lessons and opportunities from OECD countries.

AIMS: This paper highlights how the novel coronavirus pandemic (COVID-19) has amplified economic instability and health risks for disconnected youth and young adults (YYA). We offer a brief review of governmental policy responses in four OECD countries and how they may impact the disconnect YYA within those countries. METHODS: Literature was reviewed utilizing Cochrane Library, ERIC, PsychINFO, PubMed/MEDLINE and Web of Science to outline existing inequities among disconnected YYA and COVID-19 economic and health impacts. Government responses to COVID-19 from four OECD countries were reviewed. Using the social protection model, we highlighted significant policy changes and developments that influence the protection of vulnerable populations and evaluated the potential effect of long-term economic dislocations prompted by the COVID-19 pandemic. RESULTS: Disconnected YYA suffered significant financial and health burdens with no social protection floor in place. Lessons learned prior to and during the pandemic indicate that initiatives aimed at improving health and well-being among vulnerable YYA and their communities must be adequately funded, flexible, and comprehensive. Attempts to connect or reconnect YYA who were disconnected prior to the COVID-19 pandemic will require a re-envisioning of policy. CONCLUSIONS: Globally, governments must invest in social safety net programs that focus on supporting those most at-risk. A concentrated focus on job creation, education and training, and paid work experience, investments in early childhood care and education, housing, health and mental health care is necessary to not only offset the pandemic's effects but also support thriving in the future for YYA.

The Relationship between Dark Triad Personality Traits and Sexting Behaviors among Adolescents and Young Adults across 11 Countries.

BACKGROUND: Sexting is an increasingly common phenomenon among adolescents and young adults. Some studies have investigated the role of personality traits in different sexting behaviors within mainstream personality taxonomies like Big Five and HEXACO. However, very few studies have investigated the role of maladaptive personality factors in sexting. Therefore, the present study investigated the relationship between Dark Triad Personality Traits and experimental (i.e., sharing own sexts), risky (i.e., sexting under substance use and with strangers), and aggravated sexting (i.e., non-consensual sexting and sexting under pressure) across 11 countries. METHODS: An online survey was completed by 6093 participants (Mage = 20.35; SDage = 3.63) from 11 different countries which covered four continents (Europe, Asia, Africa, and America). Participants completed the Sexting Behaviors Questionnaire and the 12-item Dark Triad Dirty Dozen scale. RESULTS: Hierarchical regression analyses showed that sharing own sexts was positively predicted by Machiavellianism and Narcissism. Both risky and aggravated sexting were positively predicted by Machiavellianism and Psychopathy. CONCLUSIONS: The present study provided empirical evidence that different sexting behaviors were predicted by Dark Triad Personality Traits, showing a relevant role of Machiavellianism in all kinds of investigated sexting behaviors. Research, clinical, and education implications for prevention programs are discussed.

Sexually Transmitted Diseases Among College Students in Sierra Leone: A Life Course Ecological Analysis.

Applying life course theory, this study examined the direct and indirect effects of adverse childhood experiences (ACEs) on the risk of contracting sexually transmitted diseases (STDs), mediated by early sexual activity (first sexual experience before age 15), number of lifetime sex partners, and mental health problems. The link between ACEs and mental health on college students' sexual risk is still understudied. Using cross-sectional data from a sample of 327 college students in Sierra Leone, this study tested the hypothesized mediation model using structural equation modeling analysis. The results showed that ACEs significantly increased sexual risks. Specifically, ACEs increased the risk of early initiation of sexual activity and the number of lifetime sex partners, which in turn increased the risk of STDs. Furthermore, ACEs significantly predicted negative mental health and were significantly associated with an increased risk of STDs. Effective future intervention strategies should include health education programs to address the lifelong effects of ACEs and mental health treatment.

Intimate Partner Violence and Women's Mental Health: The Mediating Role of Coping Strategies Among Women Seeking Help From the Police.

Many variables explain the link between intimate partner violence (IPV) and its impact on women's mental health. This proposition is mostly from samples drawn from battered women's shelters, batterer intervention programs (BIPs), emergency rooms, and medical clinics. We know little about the psychological well-being of women who report abuse to police departments. This study used data from case records of women who experience IPV and sought help from a city police station located in the southwest United States. These case records were examined to identify how sociodemographic characteristics of age, ethnicity, marital status, financial dependence, resources of social support, and coping strategies related with type and number of IPV incidents as well as mental health symptoms. The sample consisted of 154 women, majority of whom experienced physical violence (70.1%), sexual violence (9.1%), emotional violence/stalking (14.9%), and combined, that is, reporting more than one (5.8%). Approximately 67.5% of the women reported some mental health symptoms. Social support and coping strategies significantly distinguished women's experience of mental health symptoms. Unexpectedly, the current data indicate that women who scored higher in perceived social support significantly reported more mental health symptoms. Coping strategies mediated the relationship between IPV and mental health symptoms. The findings suggest that availability of coping resources may mitigate repeated IPV and modify the impact of mental health. In discussing prevention and intervention efforts with women who have experienced or are at risk of experiencing IPV, practitioners can help women employ empowering coping strategies that are built on their resilience. In addition, mental health professionals working with the police, especially in community policing setting, can achieve promising outcomes for women experiencing violence.

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey.

Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents.

The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis.

This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.

Hegemonic Masculinity Attitudes Toward Female Genital Mutilation/Cutting Among a Sample of College Students in Northern and Southern Sierra Leone.

Introduction: Female genital mutilation or cutting (FGM/C) is a public health problem. Approximately three million women and girls undergo FGM/C every year, worldwide. The purpose of the study was to assess the influence of education on hegemonic masculinity attitudes between male and female students and whether parental education differentiated the groups. Method: A cross-section design was used. Data were collected through a survey response from 338 students in May 2017. The data were analyzed using chi-square and correlational tests. Results: Education did not change the attitudes of students toward FGM/C (χ2 = 3.64, p = .16); however, parental education had an influence on both male and female students' attitudes toward FGM/C. Discussion: The study suggests that education alone may not be sufficient to end FGM/C practice. A comprehensive community-led strategy incorporating culturally congruent health care to involve multiple parties of health professionals, religious leaders, government, and policy makers may be needed to address the problem.

The Gendered Self of Chinese Lesbians: Self-Esteem as a Mediator Between Gender Roles and Depression.

Sexual minority women are at an elevated risk for depression compared to heterosexual women, yet less is known about how gender roles affect the mental health of sexual minority women. Existing studies examining the role of self-esteem in the relationship between gender roles and depression are scarce and have predominantly focused on heterosexual populations. Using a cross-sectional survey of Chinese lesbians in Hong Kong (N = 438), the study tested the direct and indirect effects of different types of gender roles (masculine, feminine, and androgynous) on depression through the mediating factor of self-esteem. We found that masculinity and androgyny were positively associated with self-esteem, while femininity was negatively associated with self-esteem. More importantly, self-esteem fully mediated the inverse relationship between masculinity and depression and that between androgyny and depression. The positive relationship between femininity and depression was also fully mediated by self-esteem. By examining different types of gender roles and incorporating gender roles, self-esteem, and depression into a unified framework, the research highlighted the particularly protective effect of androgyny, which had the strongest positive direct effect on self-esteem and indirect effect on depression through the mediation of self-esteem compared to the effects of other types of gender roles. Our results illuminate the importance of understanding how individual differences in gender roles relate to the mental health of sexual minority women in future research and interventions. Implications for interventions that help Chinese lesbians cope with gender expectations and improve their mental health are discussed.

Psychosocial Syndemics and Sexual Risk Practices Among U.S. Adolescents: Findings from the 2017 U.S. Youth Behavioral Survey.

BACKGROUND: The present study aims to (1) identify classes of psychosocial syndemics among adolescents in the U.S. based on psychological factors, such as depression and suicidal ideation, and social factors, such as binge drinking, alcohol use, and drug use; (2) identify correlates of psychosocial syndemics; and (3) examine the independent associations between psychosocial syndemic factors and sexual risk practices. METHOD: We used latent class analysis and a sample of 14,762 U.S. high school students who participated in the 2017 Youth Risk Behavior Surveillance System to examine youth population profiles based on shared characteristics of syndemics. Adjusting for sociodemographic factors, we conducted logistic regression to explore the connections between psychosocial syndemic factors and three sexual risk practices, namely, early initiation of sexual intercourse, condom use, and sex with multiple partners. RESULTS: The study results indicate that three classes of risk exist among the sample: substance misuse (class 1, n = 3872, 26.2%), normative (class 2, n = 8791, 59.6%), and mental health problems (class 3, n = 2099, 14.2%). Class membership of psychosocial syndemics was significantly different by gender, age group, and race. The odds of initiating sexual intercourse before age 13 were positively associated with participants belonging in the substance misuse class and the mental health problem class. The odds of using condoms during the last sexual intercourse for currently sexually active adolescents were lower for participants classified in the substance misuse class. The likelihood of reporting having sex with four or more partners in a lifetime was higher among participants belonging to the substance misuse class. CONCLUSION: The study advances our understanding of the heterogeneity of class membership associated with psychosocial syndemic risk factors among adolescents and extends our understanding of syndemics in the area of adolescent health. Thus, practitioners and policymakers can design multicomponent and multilevel school-based HIV/STI prevention programs that meet the needs of adolescents.

Marital Rape and HIV Risk in Uganda: The Impact of Women's Empowerment Factors.

This study used Uganda Demographic Health Survey data (2011) to examine the role of women's empowerment in reducing HIV risk among married women who experienced sexual violence in Uganda. The sample size was 8,674 ever-married women aged 15-49 years. Significant differences were revealed for marital rape, women's empowerment variables, and reducing HIV risk according to sociodemographic characteristics. Women's labor force participation partially mediated the relationship between sexual violence and reducing HIV risk, but decision making did not. Findings highlight the need for the development and implementation of policies and programs to address marital rape and reduce HIV risk within institutions of marriage.

School-based HIV/AIDS education, risky sexual behaviors, and HIV testing among high school students in the United States.

This study assessed the practical value of HIV/AIDS education among at-risk adolescents in the United States. Data were drawn from the 2013 Youth Risk Behavior Surveillance System spanning students in grades 9-12 who have engaged in sexual intercourse. A multivariate hierarchical logistic regression analysis was employed to test: (1) the individual effects of school-based HIV/AIDS education and risky sexual behaviors on the probability of HIV testing and (2) the interaction effects to estimate the degree to which the education effect varied by specific risky sexual behavior. The results indicated that students who engaged in risky sexual activities and received HIV/AIDS education were more likely to test for HIV compared to those who did not receive HIV/AIDS education. The relationship between education and HIV testing also varied according to the number of recent sexual partners. The findings have policy and practice implications. Specifically, HIV/AIDS education that promotes HIV testing should be encouraged particularly with the high-risk student population.

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system.

BACKGROUND: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. METHODS: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14-18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. RESULTS: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. LIMITATIONS: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. CONCLUSIONS: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.