Spousal concordance in attitudes toward intimate partner violence (IPV) and its association with physical IPV against women: A cross-sectional study among young married couples in rural India

This study aimed to assess couple concordance in attitudes toward intimate partner violence (IPV) and its association with physical IPV against women. A cross-sectional survey was conducted with 1,201 nonsterilized women aged 18–29 years and their husbands. It was found that husbands were significantly more likely (69.9%, 95% Confidence Interval (CI): 67.3%, 72.5%) to justify IPV than wives (56.5%, 95% CI: 53.7%, 59.3%). Couples who both hold attitudes justifying IPV against women (Adjusted Odds Ratio (AOR): 3.5; 95% CI: 1.57%–8.00%) and couples where women hold these attitudes, but men do not (AOR: 2.93; 95% CI: 1.18–7.28), were more likely to report male-perpetrated IPV against women in the prior 12 months

\u3ci\u3eEx vivo\u3c/i\u3e colonic tissue susceptibility to HIV-1 in cisgender men and women

The biology of HIV-1 acquisition through unprotected receptive anal intercourse is understudied. Considering that sex hormones are implicated in intestinal physiology, pathology, and HIV acquisition and pathogenesis, we explored links between sex hormones, ex vivo HIV-1BaL infection of colonic mucosa, and candidate biomarkers of susceptibility to HIV-1 (CD4+ T cell frequencies and immune mediators) in cisgender women and men. No consistent significant associations between sex hormone concentrations and ex vivo tissue infection with HIV- 1BaL were detected. In men, serum estradiol (E2) concentrations were positively associated with tissue proinflammatory mediators (IL17A, GM-CSF, IFNγ, TNFα, and MIG/CXCL9) and serum testosterone concentrations were negatively associated with frequencies of activated CD4+ T cells (CD4+CCR5+, CD4+HLADR+, and CD4+CD38+HLA-DR+). In women, the only significant interactions were positive associations between progesterone (P4)/E2 ratios and tissue ILRA concentrations and between P4/E2 ratios and frequencies of tissue CD4+α4β7high+ T cells. The study did not reveal relationships between biological sex or phase of the menstrual cycle and ex vivo tissue HIV-1BaL infection and tissue immune mediators. A comparison of CD4+ T cell frequencies between study groups revealed a higher frequency of tissue CD4+α4β7high+ T cells in women versus men. In contrast, higher frequencies of tissue CD4+CD103+ T cells were detected in men versus women in the follicular phase of the menstrual cycle. Overall, the study identified associations between systemic sex hormone concentrations, biological sex, and tissue candidate biomarkers of susceptibility to HIV-1. The significance of these results for tissue susceptibility to HIV-1 and early HIV-1 pathogenesis warrants further investigation

“I have to do it in secrecy”: Provider perspectives on HIV service delivery and quality of care for key populations in Zambia

Key populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers

Reclaiming African leadership to end FGM/C

By exploring the history of the fight against FGM/C, this SRHM blog aims to inspire African changemakers to reclaim the legacy of past generations. Celebrating past initiatives led by Africans will strengthen their rightful role as leaders in the forefront of continuous endeavors to enable change in their communities and beyond

Classifying climate vulnerability and inequalities in India, Mexico, and Nigeria: A latent class analysis approach

Background: The climate crisis exacerbates social, economic, and health disparities. This study employs innovative methods to identify distinct groups affected by recent climate events. Methods: A mobile phone-based survey was conducted in April 2022 with individuals residing in multiple climate-affected states across three countries: India (n=1,020), Mexico (n=1,020), and Nigeria (n=1,021). Latent class analysis and classification and regression tree (CART) analysis were used to identify the groups most exposed to climate events, the effects and responses taken, and then to identify the characteristics associated with group membership. Effects included housing damage or lost work, while responses included actions such as borrowing money or dropping out of school. Results: Findings revealed four distinct groups: Group 1 reported low exposure, no effects, or responses (49% of respondents in India, 43% in Mexico, and 27% in Nigeria); Group 2 experienced multiple hazards with moderate effects and some responses; Group 3 was characterized by drought exposure with more effects and responses taken; Group 4 was affected by heavy flooding and rainfall with varied effects. Notably, India had the largest proportion of respondents in Group 3 (17%), in Mexico over a quarte (29%) were in group 4, while over half of Nigerian respondents were in Group 2 (52%). Characteristics associated with membership in each group varied by country. Overall, men from rural areas with lower incomes and reliant on agriculture experienced the highest levels of exposure and vulnerability, while urban women from higher-income households were the least affected. Discussion: This study underscores the importance of considering the intersectionality of risk and vulnerability when formulating policies and programs to address the impacts of climate change. Results emphasize the need for multi-sectoral policies that target the needs of different groups, to reduce inequalities and tailor to the context-specific needs of the most vulnerable people and households

Risk factors for and outcomes of ring expulsions with a one year contraceptive vaginal system

Background: The FDA-approved, segesterone acetate/ethinyl estradiol, ring-shaped contraceptive vaginal system, known was Annovera (Sever Pharma Solutions/QPharma, Malmö, Sweden inserted and removed under a woman’s control for a 21 day in/7 day out regimen for up to 13 cycles of use. Objectives: We aimed to describe patterns of ring expulsion over time, identify potential predictors of expulsion and evaluate the impact of expulsions on method discontinuation and pregnancy risk. Study Design: Using data from 2064 participants in two multinational Phase 3 clinical trials of this contraceptive vaginal system we examined data from participants’ daily diaries for documentation of complete ring expulsion. We modeled the odds of reported expulsions over time, adjusting for background and demographic characteristics, using mixed-effects logistic regression models with random intercepts. We compared probability of continuation between those who did and did not report expulsions in the first cycle of use using survival analysis and hazards modeling. To determine if expulsions during the first cycle of use affected risk of pregnancy, we calculated Pearl Indices. Results: Most participants (75%) never experienced any expulsions during any cycle of use, with 91-97% not experiencing an expulsion during any one cycle. The incidence of expulsion was highest in Cycle 1 (9%). The odds of experiencing expulsions decreased by half in cycles 2-8 3 vs cycle 1 (0.48 95% CI 0.40-0.58) and in in cycles 9-13 expulsions were about a third that in cycle 1 (0.32 95% CI 0.26-0.41). Of those who did experience expulsions, most (62-84%) experienced ≤2 expulsions per cycle. Participants from study sites in Latin America vs U.S. had higher odds of not experiencing an expulsion (OR 1.95, 95% CI 1.45-2.63). Women with more education had higher odds of experiencing an expulsion. Notably, parity, age and BMI were not associated with expulsion. Participants who did experience any expulsions in Cycle 1 were more likely to discontinue early hazards ratio 1.28, 95% CI (1.14, 1.43) compared to participants who had an expulsion. The Pearl Index for participants who had expulsions during Cycle 1 was 3.99 (95% CI: 1.29-9.31), higher than among participants who reported no expulsions (PI 2.39, 95% CI: 1.61-3.41) but the overlapping confidence intervals indicate there is not sufficient evidence to demonstrate an association between expulsions and pregnancy risk. Conclusions: Expulsions were infrequent overall, decreased with subsequent cycles of use and were not associated with BMI or parity. Early discontinuation of product use was higher among participants who experienced an expulsion during Cycle 1. While it is unclear whether pregnancy risk is associated with expulsions, early recognition of expulsions among users may identify those at higher risk for discontinuation and may highlight, where enhanced anticipatory counselling and guidance may be advantageous

Young female migrants and job placement brokers in Addis Ababa, Ethiopia

Introduction: Rates of urbanization in Ethiopia are high and adolescent girls and young women are predominant among those who move from rural to urban areas. Young women frequently undertake rural-urban migration on their own or with a friend, and with little planning for their initial settlement in the city. They frequently rely on job placement brokers to place them into jobs upon arrival, with positions such as domestic work normally including accommodation. Methods: This is a qualitative study undertaken at the two largest bus stages in Addis Ababa, which are points of arrival for a large number of migrants from rural areas. Three categories of respondents were interviewed in-depth: migrant young women who had arrived within the last few days, job placement brokers who are located in and around the bus station, and market women/vendors at the bus stations who interact with both migrants and brokers. Results: Migrant girls\u27 point of arrival was an inflection point of risk, especially among girls who were on their own, not accompanied or met at the bus terminal and lacking in plans or preparation of accommodation. Such girls were targeted by thieves at the bus station and by unscrupulous brokers, some of whom forced girls into sexual relations before placing them into paid work. In contrast, market women and some well-meaning brokers took steps to protect girls such as providing temporary accommodation. Conclusion: This research underscores the need for intensified support to rural-urban migrants to ensure safety and security at the time of arrival at their destination. This includes promotion of pre-migration education and planning; safety assets including sufficient money, cell phones and alternative contacts in the city; and arrangement for immediate, safe and secure accommodation. As a result of the study, a pilot program has been developed, using local resources to extend support for newly arriving migrant girls and young women

Pattern and determinants of contraceptive use among the muslim women in Wajir and Lamu counties in Kenya: A cross-sectional study

Background: Improving access to family planning (FP) is associated with positive health benefits that includes averting nearly a third of all maternal deaths and 10% of childhood deaths. Kenya has made great strides in improving access to family planning services. However, amid this considerable progress, regional variation has been noted which begs the need for a clearer understanding of the the patterns and determinants that drive these inconsistencies. Methods: We conducted a cross-sectional study that involved 663 Muslim women of reproductive age (15–49 years) from Wajir and Lamu counties in Kenya between March and October 2018.The objective of this study was to understand patterns and determinants of contraceptive use in two predominantly Muslim settings of Lamu and Wajir counties that have varying contraceptive uptake. Eligible women were interviewed using a semi-structured questionnaire containing socio-demographic information and history of family planning use. Simple and multiple logistic regression were used to identify determinants of family planning use. The results were presented as Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) ratios at 95% confidence interval. A p-value of 0.05 was considered statistically significant. Results: Of the 663 Muslim women of reproductive age consenting to participate in the study, 51.5%, n = 342 and 48.5%, n = 321 were from Lamu and Wajir County, respectively. The prevalence of women currently using contraceptive was 18.6% (n = 123). In Lamu, the prevalence was 32.8%, while in Wajir, it was 3.4%. The determinants of current contraceptive use in Lamu include; marital status, age at marriage, employment status, discussion with a partner on FP, acceptability of FP in culture, and willingness to obtain information on FP. While in Wajir, determinants of current contraceptive use were education, and the belief that family planning is allowed in Islam. Conclusions: Our study found moderately high use of contraceptives among Muslim women of reproductive age in Lamu county and very low contraceptive use among women in Wajir. Given the role of men in decision making, it is critical to design male involvement strategy particularly in Wajir where the male influence is very prominent. It is critical for the government to invest in women and girls’ education to enhance their ability to make informed decisions; particularly in Wajir where FP uptake is low with low education attainment. Further, our findings highlight the need for culturally appropriate messages and involvement of religious leaders to demystify the myths and misconception around family planning and Islam particularly in Wajir