Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.564
Filtrar
1.
JAMA Netw Open ; 4(6): e2113787, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1274644

RESUMO

Importance: COVID-19 lockdowns may affect economic and health outcomes, but evidence from low- and middle-income countries remains limited. Objective: To assess the economic security, food security, health, and sexual behavior of women at high risk of HIV infection in rural Kenya during the COVID-19 pandemic. Design, Setting, and Participants: This survey study of women enrolled in a randomized trial in a rural county in Kenya combined results from phone interviews, conducted while social distancing measures were in effect between May 13 and June 29, 2020, with longitudinal, in-person surveys administered between September 1, 2019, and March 25, 2020. Enrolled participants were HIV-negative and had 2 or more sexual partners within the past month. Surveys collected information on economic conditions, food security, health status, and sexual behavior. Subgroup analyses compared outcomes by reliance on transactional sex for income and by educational attainment. Data were analyzed between May 2020 and April 2021. Main Outcomes and Measures: Self-reported income, employment hours, numbers of sexual partners and transactional sex partners, food security, and COVID-19 prevention behaviors. Results: A total of 1725 women participated, with a mean (SD) age of 29.3 (6.8) years and 1170 (68.0%) reporting sex work as an income source before the COVID-19 pandemic. During the pandemic, participants reported experiencing a 52% decline in mean (SD) weekly income, from $11.25 (13.46) to $5.38 (12.51) (difference, -$5.86; 95% CI, -$6.91 to -$4.82; P < .001). In all, 1385 participants (80.3%) reported difficulty obtaining food in the past month, and 1500 (87.0%) worried about having enough to eat at least once. Reported numbers of sexual partners declined from a mean (SD) total of 1.8 (1.2) partners before COVID-19 to 1.1 (1.0) during (difference, -0.75 partners; 95% CI, -0.84 to -0.67 partners; P < .001), and transactional sex partners declined from 1.0 (1.1) to 0.5 (0.8) (difference, -0.57 partners; 95% CI, -0.64 to -0.50 partners; P < .001). In subgroup analyses, women reliant on transactional sex for income were 18.3% (95% CI, 11.4% to 25.2%) more likely to report being sometimes or often worried that their household would have enough food than women not reliant on transactional sex (P < .001), and their reported decline in employment was 4.6 hours (95% CI, -7.9 to -1.2 hours) greater than women not reliant on transactional sex (P = .008). Conclusions and Relevance: In this survey study, COVID-19 was associated with large reductions in economic security among women at high risk of HIV infection in Kenya. However, shifts in sexual behavior may have temporarily decreased their risk of HIV infection.


Assuntos
COVID-19 , Infecções por HIV/etiologia , Renda/estatística & dados numéricos , Distanciamento Físico , Comportamento Sexual/estatística & dados numéricos , Adulto , Feminino , Humanos , Quênia , Estudos Longitudinais , Pobreza/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Assunção de Riscos , População Rural/estatística & dados numéricos , SARS-CoV-2 , Trabalho Sexual/estatística & dados numéricos , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
2.
JAMA Netw Open ; 4(6): e2113787, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34137826

RESUMO

Importance: COVID-19 lockdowns may affect economic and health outcomes, but evidence from low- and middle-income countries remains limited. Objective: To assess the economic security, food security, health, and sexual behavior of women at high risk of HIV infection in rural Kenya during the COVID-19 pandemic. Design, Setting, and Participants: This survey study of women enrolled in a randomized trial in a rural county in Kenya combined results from phone interviews, conducted while social distancing measures were in effect between May 13 and June 29, 2020, with longitudinal, in-person surveys administered between September 1, 2019, and March 25, 2020. Enrolled participants were HIV-negative and had 2 or more sexual partners within the past month. Surveys collected information on economic conditions, food security, health status, and sexual behavior. Subgroup analyses compared outcomes by reliance on transactional sex for income and by educational attainment. Data were analyzed between May 2020 and April 2021. Main Outcomes and Measures: Self-reported income, employment hours, numbers of sexual partners and transactional sex partners, food security, and COVID-19 prevention behaviors. Results: A total of 1725 women participated, with a mean (SD) age of 29.3 (6.8) years and 1170 (68.0%) reporting sex work as an income source before the COVID-19 pandemic. During the pandemic, participants reported experiencing a 52% decline in mean (SD) weekly income, from $11.25 (13.46) to $5.38 (12.51) (difference, -$5.86; 95% CI, -$6.91 to -$4.82; P < .001). In all, 1385 participants (80.3%) reported difficulty obtaining food in the past month, and 1500 (87.0%) worried about having enough to eat at least once. Reported numbers of sexual partners declined from a mean (SD) total of 1.8 (1.2) partners before COVID-19 to 1.1 (1.0) during (difference, -0.75 partners; 95% CI, -0.84 to -0.67 partners; P < .001), and transactional sex partners declined from 1.0 (1.1) to 0.5 (0.8) (difference, -0.57 partners; 95% CI, -0.64 to -0.50 partners; P < .001). In subgroup analyses, women reliant on transactional sex for income were 18.3% (95% CI, 11.4% to 25.2%) more likely to report being sometimes or often worried that their household would have enough food than women not reliant on transactional sex (P < .001), and their reported decline in employment was 4.6 hours (95% CI, -7.9 to -1.2 hours) greater than women not reliant on transactional sex (P = .008). Conclusions and Relevance: In this survey study, COVID-19 was associated with large reductions in economic security among women at high risk of HIV infection in Kenya. However, shifts in sexual behavior may have temporarily decreased their risk of HIV infection.


Assuntos
COVID-19 , Infecções por HIV/etiologia , Renda/estatística & dados numéricos , Distanciamento Físico , Comportamento Sexual/estatística & dados numéricos , Adulto , Feminino , Humanos , Quênia , Estudos Longitudinais , Pobreza/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Assunção de Riscos , População Rural/estatística & dados numéricos , SARS-CoV-2 , Trabalho Sexual/estatística & dados numéricos , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
3.
Reprod Health ; 18(Suppl 1): 119, 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34134704

RESUMO

BACKGROUND: Intimate partner violence (IPV) is a global public health and human rights issue that affects millions of women and girls. While disaggregated national statistics are crucial to assess inequalities, little evidence exists on inequalities in exposure to violence against adolescents and young women (AYW). The aim of this study was to determine inequalities in physical or sexual IPV against AYW and beliefs about gender based violence (GBV) in sub-Saharan Africa (SSA). METHODS: We used data from the most recent Demographic and Health Surveys (DHS) conducted in 27 countries in SSA. Only data from surveys conducted after 2010 were included. Our analysis focused on married or cohabiting AYW aged 15-24 years and compared inequalities in physical or sexual IPV by place of residence, education and wealth. We also examined IPV variations by AYW's beliefs about GBV and the association of country characteristics such as gender inequality with IPV prevalence. RESULTS: The proportion of AYW reporting IPV in the year before the survey ranged from 6.5% in Comoros to 43.3% in Gabon, with a median of 25.2%. Overall, reported IPV levels were higher in countries in the Central Africa region than other sub-regions. Although the prevalence of IPV varied by place of residence, education and wealth, there was no clear pattern of inequalities. In many countries with high prevalence of IPV, a higher proportion of AYW from rural areas, with lower education and from the poorest wealth quintile reported IPV. In almost all countries, a greater proportion of AYW who approved wife beating for any reason reported IPV compared to their counterparts who disapproved wife beating. Reporting of IPV was weakly correlated with the Gender Inequality Index and other societal level variables but was moderately positively correlated with adult alcohol consumption (r = 0.48) and negative attitudes towards GBV (r = 0.38). CONCLUSION: IPV is pervasive among AYW, with substantial variation across and within countries reflecting the role of contextual and structural factors in shaping the vulnerability to IPV. The lack of consistent patterns of inequalities by the stratifiers within countries shows that IPV against women and girls cuts across socio-economic boundaries suggesting the need for comprehensive and multi-sectoral approaches to preventing and responding to IPV.


Assuntos
Violência de Gênero/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Feminino , Violência de Gênero/etnologia , Inquéritos Epidemiológicos , Humanos , Relações Interpessoais , Violência por Parceiro Íntimo/etnologia , Prevalência , Fatores de Risco , Parceiros Sexuais , Adulto Jovem
4.
Pan Afr Med J ; 38: 176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995783

RESUMO

Introduction: Antiretroviral therapy (ART) significantly increases the life expectancy of HIV positive people by improving quality of life as well as enabling them to resume sexual activity. A growing number of people living with HIV became a source of exposure to sexually transmitted infections, including other strains of HIV that place others at risk unless they consistently use condoms. This study assessed the magnitude of unprotected sexual practices and associated factors among adult people living with HIV on ART in public hospitals of the Kembata Tembaro Zone, Southern Ethiopia. Methods: a facility-based cross-sectional study was conducted among adult people living with HIV on ART in public hospitals of the zone from March 1-30, 2016. Data were collected by a pretested and structured questionnaire. Binary logistic regression was used to investigate variables, independently associated with the outcome variable. The adjusted odds ratio with 95% CI used to show the strength of the association and a P-value < 0.05 was used to declare the cut-off point in determining the level of significance. Results: the study revealed that 40.9% of respondents practiced unprotected sexual intercourse. On multivariate logistic regression analyses, being females, having more than one sexual partner, mean monthly income of <530 Ethiopian birrs/ month, those who had a seropositive partner, a partner of unknown serostatus, and respondents who had insufficient knowledge of HIV transmission and prevention were statically significant with the outcome variable. Conclusion: the scarcity of knowledge on HIV transmission, negative attitude towards condom use, non-disclosure status and having more than one sexual partnership increased likelihood of have unprotected sex among the respondents.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Etiópia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
5.
J Pediatr Adolesc Gynecol ; 34(4): 477-483, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33838331

RESUMO

STUDY OBJECTIVE: Our objective was to describe sexual behavior and contraceptive use among assigned female cisgender and gender minority college students (ie, those whose gender identity does not match their sex assigned at birth). DESIGN: Cross-sectional surveys administered as part of the fall 2015 through spring 2018 administrations of the National College Health Assessment. SETTING: Colleges across the United States. PARTICIPANTS: A total of 185,289 cisgender and gender minority assigned females aged 18-25 years. MAIN OUTCOME MEASURES: Recent vaginal intercourse; number and gender of sexual partners; use of contraception; use of protective barriers during vaginal intercourse. RESULTS: Both gender minority and cisgender students often reported having male sexual partners, but gender minority students were more likely to report having partners of another gender identity (eg, women, trans women). Gender minorities were less likely than cisgender students to report having vaginal intercourse (adjusted odds ratio [AOR]: 0.86; 95% confidence interval [95% CI]: 0.80, 0.93). Gender minorities were less likely than cisgender students to report using any contraceptive methods (AOR: 0.86; 95% CI: 0.73, 1.03), and were less likely to consistently use barrier methods (AOR: 0.72; 95% CI: 0.64, 0.81) or emergency contraception (AOR: 0.56; 95% CI: 0.48, 0.65). However, gender minorities were more likely to use Tier 1 and Tier 3 contraceptive methods than cisgender women. CONCLUSIONS: Providers must be trained to meet the contraceptive counseling needs of cisgender and gender minority patients. Providers should explicitly ask all patients about the sex/gender of the patients' sexual partners and the sexual behaviors in which they engage, to assess sexual risk and healthcare needs.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Identidade de Gênero , Humanos , Masculino , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
6.
Reprod Health ; 18(1): 85, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892759

RESUMO

BACKGROUND: Despite Ethiopia's enormous effort in youth-friendly service provision, little was investigated about the challenges of accessing sexual and reproductive health services in Western Ethiopia. Thus, this study aimed to assess factors associated with the utilization of adolescent and youth sexual and reproductive health services in this area. METHODS: A community-based cross-sectional quantitative method mixed with the qualitative inquiry was conducted among 771 adolescents and youth aged 15 to 24 years from February 1 to 28, 2020. Data were collected through face-to-face interviews using pretested structured questionaries. Data were entered using EPI-INFO version 7.0 and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. The qualitative inquiry was collected through in-depth interviews with service providers, focus group discussions, and observation checklists of service units in the study facilities. Data were analyzed thematically. RESULTS: The mean age of participants was 18.99 years (SD ± 2.49). Two hundred seventeen (28.1%) of participants reported that they have ever heard about adolescents' and youth's reproductive health services. Only 66 (8.6%) have ever visited health facilities for sexual and reproductive health (SRH) services. Factors associated with the utilization of sexual and reproductive health service were age from 15 to 19 years (AOR = 0.36; 95%CI: 0.17, 0.76), history of having sexual intercourse(AOR = 5.34;95%CI: 2.53, 11.23), ever heard about sexual reproductive health service (AOR = 11.33; 95%CI: 5.59, 22.96), and visited a health facility for other health services (AOR = 5.12; 95%CI:1.72,15.24). CONCLUSION: Sexual and reproductive health service utilization among adolescents and youth was found to be low. The factors associated with adolescents and youth sexual and reproductive health services utilization were age, history of ever having sexual intercourse, ever heard about SRH services, and visit the health facility for other services. Therefore, it is better if the concerned bodies work on improving awareness of adolescents and youth towards SRH services and integrating these services into other routine services.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva , Adolescente , Estudos Transversais , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
7.
Cancer Causes Control ; 32(6): 645-651, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33846853

RESUMO

PURPOSE: Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality. METHOD: Data come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals. RESULTS: We found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same-sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners. CONCLUSION: Sexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations.


Assuntos
Dieta/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto , Bissexualidade/psicologia , Bissexualidade/estatística & dados numéricos , Estudos de Coortes , Dieta/psicologia , Dieta/normas , Feminino , Heterossexualidade/psicologia , Heterossexualidade/estatística & dados numéricos , Homossexualidade Feminina/psicologia , Homossexualidade Feminina/estatística & dados numéricos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Fatores de Risco , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
8.
Public Health ; 194: 116-120, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33887599

RESUMO

OBJECTIVES: Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran. STUDY DESIGN: In this cross-sectional study, we recruited 202 homeless youth (age: 15-29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017. METHODS: Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis. RESULTS: The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1-192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3-15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1-4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1-8.8). CONCLUSION: Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.


Assuntos
Preservativos/estatística & dados numéricos , Jovens em Situação de Rua/psicologia , Casamento/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Jovens em Situação de Rua/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 21(1): 253, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771106

RESUMO

BACKGROUND: Adolescent pregnancy is a major public health problem both in developed and developing countries with huge consequences to maternal health and pregnancy outcomes. However, there is limited evidence on the prevalence and associated factors of adolescent pregnancy in East Africa. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent pregnancy in Eastern Africa. METHOD: The most recent Demographic and Health Survey (DHS) datasets of the 12 East African countries were used. A total weighted sample of 17, 234 adolescent girls who ever had sex was included. A multilevel binary logistic regression analysis was fitted to identify the significantly associated factors of adolescent pregnancy. Finally, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the factors that are significantly associated with adolescent pregnancy. RESULTS: The overall prevalence of adolescent pregnancy in East Africa was 54.6% (95%CI: 53.85, 55.34%). In the multivariable multilevel analysis; being age 18-19 years [AOR = 3.06; 95%CI: 2.83, 3.31], using contraceptive [AOR = 1.41; 95%CI: 1.28, 1.55], being employed girls [AOR = 1.11; 95%CI: 1.03, 1.19], being spouse/head within the family [AOR = 1.62; 95% CI: 1.45, 1.82], and being from higher community level contraceptive utilization [AOR = 1.10; 95%CI:1.02, 1.19] were associated with higher odds of adolescent pregnancy. While adolescent girls attained secondary education and higher [AOR = 0.78; 95%CI: 0.68, 0.91], initiation of sex at age of 15 to 14 years [AOR = 0.69; 95%CI: 0.63, 0.75] and 18 to 19 years [AOR = 0.31; 95%CI: 0.27, 0.35], being unmarried [AOR = 0.25; 95%CI: 0.23, 0.28], having media exposure [AOR = 0.85; 95%CI: 0.78, 0.92], and being girls from rich household [AOR = 0.64; 95%CI: 0.58, 0.71] were associated with lower odds of adolescent pregnancy. CONCLUSION: This study found that adolescent pregnancy remains a common health care problem in East Africa. Age, contraceptive utilization, marital status, working status, household wealth status, community-level contraceptive utilization, age at initiation of sex, media exposure, educational level and relation to the household head were associated with adolescent pregnancy. Therefore, designing public health interventions targeting higher risk adolescent girls such as those from the poorest household through enhancing maternal education and empowerment is vital to reduce adolescent pregnancy and its complications.


Assuntos
Anticoncepção/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , África Oriental , Fatores Etários , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Estado Civil , Gravidez , Gravidez na Adolescência/prevenção & controle , Prevalência , Adulto Jovem
11.
Lancet HIV ; 8(3): e175-e180, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33662266

RESUMO

There is widespread unawareness and disbelief regarding the evidence-based conclusion that people who have a sustained undetectable HIV viral load cannot sexually transmit HIV-ie, undetectable=untransmittable (U=U). Long-standing, misguided fear about HIV transmission persists; consequently, so does the policing of sexual expression and the penalisation of pleasure faced by people with HIV. Many people with HIV with an undetectable viral load have unnecessarily abstained from condomless sex, avoided serodifferent partnering, and had anxiety about onward sexual transmission due to perceived HIV risk that is now known to be non-existent. Some health professionals have refrained from correcting this misinformation because of concerns that people with HIV will engage in more condomless sex or have more sexual partners upon learning of U=U. Withholding information about U=U is thus rooted in behavioural assumptions and is scientifically unfounded. Moreover, withholding such information violates medical ethics, perpetuates health inequities, and infringes on the sexual health and human rights of people with HIV. Health professionals and the broader public health community have an ethical responsibility to actively address misinformation about HIV transmission and disseminate the U=U message to all people.


Assuntos
Comunicação , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Comportamento Sexual/estatística & dados numéricos , Carga Viral/estatística & dados numéricos , Preservativos , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Risco , Assunção de Riscos , Parceiros Sexuais , Sexo sem Proteção/psicologia
12.
Reprod Health ; 18(1): 48, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622358

RESUMO

BACKGROUND: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults'/parents' and adolescent girls' narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. METHODS: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15-19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. RESULTS: Findings highlighted adults' perceptions on adolescents' sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents' sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. CONCLUSIONS: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.


Assuntos
Comportamento Contraceptivo , Casamento , Relações Pais-Filho , Percepção , Psicologia do Adolescente , Adolescente , Comportamento do Adolescente/fisiologia , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Quênia/epidemiologia , Casamento/psicologia , Casamento/estatística & dados numéricos , Relações Pais-Filho/etnologia , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Gravidez na Adolescência/estatística & dados numéricos , Pesquisa Qualitativa , Educação Sexual/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
13.
Pan Afr Med J ; 38: 7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33520076

RESUMO

Introduction: globally young people constitute one quarter of the population. They are the most vibrant and productive sector, but they are also prone to more risky sexual behaviour (RSB) with attendant negative consequences. In the Niger Delta Region of Nigeria, persistent conflicts and socioeconomic difficulty predisposes young people to risky conducts including RSB. The aim of this study is to explore the psychosocial correlates of risky sexual behaviour amongst students in the Niger Delta University, Bayelsa. Methods: we undertook a descriptive cross-sectional survey of students in the university. A multistage random sampling technique was used to recruit 400 students who completed a self-administered questionnaire. The data collected was analyzed using SPSS version 20.0. Results: out of the 400 students, 64.3% (257) engaged in RSB and 46.8% (187) were currently engaging in RSB. Rates of self-reported depression, suicidal ideation and attempt were 62.3% (249), 18.0% (72) and 14.3% (54) respectively. Independent correlates of RSB include being older than 19 years (aOR. 2.82; 95% C.I. 1.44 -5.51), male gender (aOR. 1.70; 95% C.I. 1.08-2.66), having depression (aOR. 1.83; 95% C.I. 1.15-2.92), being diagnosed with a sexually transmitted disease (STD)/HIV (aOR. 2.08; 95% C.I. 1.12-3.86), and having been taught about condoms (aOR. 1.80; 95% C.I. 1.13-2.86). Conclusion: risky sexual behaviours have negative psychosocial and health implications. Regular and continuous health education targeted at young people is essential to reduce the social and health effects associated with RSB.


Assuntos
Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria , Fatores de Risco , Fatores Sexuais , Estudantes/psicologia , Inquéritos e Questionários , Universidades , Adulto Jovem
14.
Int J Equity Health ; 20(1): 11, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407497

RESUMO

BACKGROUND: Equity is a guiding principle of the Global Strategy for Women, Children and Adolescents' Health (2016-2030) aimed at improving adolescent health and responding more effectively to adolescents' needs. We investigated the socioeconomic differentials in having multiple sexual partners and condom use among unmarried adolescents who reported ever having had sex aged 15-19 years in 14 sub-Saharan countries. METHODS: Using the most recent publicly available Demographic and Health Surveys conducted between 2011 and 2018, we calculated survey- and sex-specific proportions of two or more partners and condomless sex, both overall and by selected socioeconomic characteristics and we fitted logistic regression models to estimate the survey- and sex-specific adjusted odds ratios. The pooled adjusted odds ratios were estimated using multilevel logistic regression. RESULTS: In most countries, higher percentages of male adolescents than female adolescents reported having more than one partner in the last 12 months. Conversely, a lower percentage of young male reported having condomless sex when compared to young female: from 19.8% in Gabon to 84.5% in Sierra Leone among male adolescents and from 32.6% in Gabon to 93.2% in Sierra Leone among female adolescents. In the multilevel analyses, condomless sex was associated with place of residence, wealth and schooling for both female and male adolescents, while among male adolescents multiple partnerships was significantly associated with place of residence. CONCLUSION: Our findings on disparities in condomless sex associated with socioeconomic characteristics might reflect constraint choice and decision making. Results also suggest the need for educational programming and services and better access to barrier methods.


Assuntos
Comportamento do Adolescente/psicologia , Preservativos , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais/psicologia , Adolescente , Adulto , África ao Sul do Saara , Feminino , Humanos , Masculino , Análise Multinível , Razão de Chances , Gravidez , Assunção de Riscos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
15.
J Acquir Immune Defic Syndr ; 87(1): 652-662, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33507013

RESUMO

INTRODUCTION: Young women who sell sex (YWSS) are at disproportionate risk of HIV. Reducing YWSS' vulnerability requires engaging their male sexual partners. To achieve this, we need to understand the characteristics and dynamics of their sexual partnerships to inform effective interventions. METHODS: We conducted a mixed-methods study to compare YWSS' qualitative descriptions of male partners with categories reported in a behavioral survey. Data were drawn from enrollment into an evaluation of the DREAMS initiative in Zimbabwe in 2017. As part of a respondent-driven sampling survey, we recruited 40 seed participants from 2 intervention and 4 comparison sites. We conducted semistructured interviews with 19 "seeds," followed by a behavioral survey with 2387 YWSS. We interpreted quantitative and qualitative data together to understand how YWSS perceived male sexual partners, assess how well survey variables related to narrative descriptions, and describe patterns of risk behavior within partnerships. RESULTS: Qualitative data suggest survey categories "husband" and "client" reflect YWSS' perceptions but "regular partner/boyfriend" and "casual partner" do not. In interviews, use of the term "boyfriend" was common, describing diverse relationships with mixed emotional and financial benefits. More than 85% of male partners provided money to YWSS, but women were less likely to report condomless sex with clients than regular partners (11% vs 37%) and more likely to report condomless sex with partners who ever forced them to have sex (37% vs 21%). CONCLUSIONS: Reducing HIV risk among YWSS requires prevention messages and tools that recognize diverse and changing vulnerability within and between sexual relationships with different male partners.


Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Assunção de Riscos , Profissionais do Sexo/educação , Parceiros Sexuais/psicologia , Sexo sem Proteção , Adulto Jovem , Zimbábue
16.
J Infect Dis ; 223(6): 1019-1028, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: covidwho-1155785

RESUMO

BACKGROUND: The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. METHODS: We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19-related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment). RESULTS: A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, -227 cases), but have net protective effect for STIs (-23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases. CONCLUSIONS: Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.


Assuntos
COVID-19/epidemiologia , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Georgia/epidemiologia , Homossexualidade Masculina , Humanos , Incidência , Masculino , Modelos Estatísticos , Pandemias , Parceiros Sexuais , Minorias Sexuais e de Gênero
17.
J Acquir Immune Defic Syndr ; 87(1): 639-643, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1169725

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had unforeseen consequences on the delivery of HIV and sexually transmitted disease (STD) prevention services. However, little is known about how the pandemic has impacted pre-exposure prophylaxis (PrEP)-using men who have sex with men (MSM). METHODS: Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered 10 surveys in total, including 1 ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n = 56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effect regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months. RESULTS: A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally-number of male sexual partners, anal sex acts, condomless anal sex, and oral sex (all measured in the past 2 weeks)-there was a decrease from February to April followed by an increase from April to June. DISCUSSION: Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.


Assuntos
COVID-19/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação , Pandemias , SARS-CoV-2/isolamento & purificação , Sexo Seguro , Minorias Sexuais e de Gênero/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
18.
J Acquir Immune Defic Syndr ; 86(2): 153-156, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1050219

RESUMO

BACKGROUND: A second wave of COVID-19 began in late June in Victoria, Australia. Stage 3 then Stage 4 restrictions were introduced in July-August. This study aimed to compare the use of pre-exposure prophylaxis (PrEP) and sexual practices among men who have sex with men taking PrEP between May-June (post-first lockdown) and July-August (second lockdown). METHODS: This was an online survey conducted among men who have sex with men who had their PrEP managed at the Melbourne Sexual Health Centre, Australia. A short message service with a link to the survey was sent to 503 PrEP clients who provided consent to receive a short message service from Melbourne Sexual Health Centre in August 2020. RESULTS: Of the 192 participants completed the survey, 153 (80%) did not change how they took PrEP. Of the 136 daily PrEP users, 111 (82%) continued to take daily PrEP, 3 (2%) switched to on-demand PrEP, and 22 (16%) stopped PrEP in July-August. Men generally reported that they had no partners or decreased sexual activities during second lockdown compared with post-first lockdown; the number of casual sex partners (43% decreased vs. 3% increased) and the number of kissing partners (36% decreased vs. 3% increased). Most men reported no chemsex (79%) or group sex (77%) in May-August. 10% (13/127) of men had ever worn face masks during sex in May-August. CONCLUSION: During the second wave of COVID-19 in Victoria, most men did not change the way they used PrEP but the majority had no risks or reduced sexual practices while one in 10 men wore a face mask during sex.


Assuntos
COVID-19 , Homossexualidade Masculina/estatística & dados numéricos , Máscaras , Sexo Seguro , Comportamento Sexual/estatística & dados numéricos , Adulto , Austrália , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/estatística & dados numéricos , SARS-CoV-2 , Inquéritos e Questionários
19.
J Infect Dis ; 223(6): 1019-1028, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33507308

RESUMO

BACKGROUND: The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. METHODS: We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19-related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment). RESULTS: A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, -227 cases), but have net protective effect for STIs (-23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases. CONCLUSIONS: Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.


Assuntos
COVID-19/epidemiologia , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Georgia/epidemiologia , Homossexualidade Masculina , Humanos , Incidência , Masculino , Modelos Estatísticos , Pandemias , Parceiros Sexuais , Minorias Sexuais e de Gênero
20.
PLoS One ; 16(1): e0245883, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33493186

RESUMO

INTRODUCTION: Inadequate efforts towards meeting the sexual and reproductive health needs of adolescents and young people, who disproportionately share the burden of unwanted pregnancies, poor maternal and child health outcomes, risks of RTI/STI and HIV/AIDS, increase the risk of losing much of the progress made towards the Millennium Development Goals over the last decade, particularly in the context of low-and-middle-income countries like India. DATA AND METHODS: Using the nationally representative data on 160551 unmarried young women aged 15-24 years from the District Level Reproductive and Child Health Survey (DLHS: 2007-2008) in India, this research evaluated the demographic and socioeconomic differentials in the access to family life/sex education (FLE) among youth in India. Using the adjusted multiple logistic regression models, the association between access to family life/sex education and attitudes towards a range of sexual and reproductive health matters among young unmarried Indian women were investigated. RESULTS: Less than half of the unmarried young women had received some form of FLE (48 percent) in India. However, there were substantial demographic and socioeconomic variations in their access to FLE, as relatively less educated women from the poorest wealth quintiles, religious and social minorities (Muslims, Scheduled Castes/Scheduled Tribes) were significantly less likely to receive FLE as compared to other women. Importantly, the likelihood of holding favourable/positive attitudes towards reproductive processes, knowledge and discussion of contraceptive methods, precise awareness about the transmission pathways of RTIs/STIs and HIV/AIDS was significantly higher among those women in India who had access to FLE. CONCLUSION: The present research underscores the protective role of family life education towards improving the sexual and reproductive life experiences of young people. It further underscores the vital need to implement a comprehensive and culturally appropriate programme of family life education in order to meet the sexual and reproductive health demands of the adolescents and young people in India.


Assuntos
Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , Pessoa Solteira/psicologia , Adolescente , Feminino , Humanos , Índia , Análise Multivariada , População Rural/estatística & dados numéricos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Classe Social , Inquéritos e Questionários , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...