Review of global evidence on effective health services and comprehensive sexuality education for adolescents

Swiss TPHThe world has more young people than ever before and a large number of them are adolescents between the ages of 10-19 in least developed countries. Today’s young women and men have growing aspirations and many strive for better education, good health care and jobs to support themselves and their families. Adolescents and youth face many health issues such as early pregnancy and childbirth, sexually transmitted infections, substance abuse, malnutrition and obesity, and unintentional injuries. Young peoples’ rights have advanced, but building on the achievements and safeguarding these rights - particularly reproductive health rights and the rights of adolescent girls and young women - remains a major challenge. The evidence on what works and does not work globally to foster the health and rights of young people is evolving. Thanks to an increased emphasis on high-quality monitoring and evaluation practices in recent years, we now know that a number of approaches in adolescent sexual and reproductive health (ASRH), some of which were promoted and implemented by global leaders in this field, do not fully meet their objectives. Other interventions are emerging, especially in the field of youth-friendly health services and comprehensive sexuality education, and show promising results, calling for a more global commitment and resources. We will present the latest evidence on which approaches have had an impact on young people’s health and reflect on the necessary conditions for their implementation

Pharmacists as youth-friendly service providers: documenting condom and emergency contraception dispensing in Kenya

This Kenya-based study ascertained whether pharmacies were an untapped source of 'youth-friendly' health services by determining (1) whether young people (aged 18-24) could successfully obtain condoms and emergency contraception (ECP); (2) whether contraceptives were dispensed according to national guidelines; and (3) how young people felt about obtaining ECP and condoms from pharmacy personnel.; This study used several methods to capture and cross-check purchasing experiences as reported by young people with those of dispensing pharmacy personnel. These included: focus group discussions; in-depth interviews; key informant interviews; and mystery shoppers.; When in stock, young people were successfully able to obtain ECP and condoms from pharmacies. Counselling was sporadic: when it happened, it was not always accurate. Despite a lack of counselling, young people reported being satisfied with the quick, transactional interaction with pharmacy personnel.; The brief, transactional interactions between pharmacy personnel and young clients appear to be 'youth-friendly enough'. While there is room to strengthen the services provided (improving both accuracy and scope), this should be done in a manner that does not fundamentally alter the current interaction

Intravaginal Practices, Vaginal Infections and HIV Acquisition: Systematic Review and Meta-Analysis

BACKGROUND: Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity. The objectives of this study were to examine evidence for associations between: intravaginal practices and acquisition of HIV infection; intravaginal practices and vaginal infections; and vaginal infections and HIV acquisition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review of prospective longitudinal studies, searching 15 electronic databases of journals and abstracts from two international conferences to 31(st) January 2008. Relevant articles were selected and data extracted in duplicate. Results were examined visually in forest plots and combined using random effects meta-analysis where appropriate. Of 2120 unique references we included 22 publications from 15 different studies in sub-Saharan Africa and the USA. Seven publications from five studies examined a range of intravaginal practices and HIV infection. No specific vaginal practices showed a protective effect against HIV or vaginal infections. Insertion of products for sex was associated with HIV in unadjusted analyses; only one study gave an adjusted estimate, which showed no association (hazard ratio 1.09, 95% confidence interval, CI 0.71, 1.67). HIV incidence was higher in women reporting intravaginal cleansing but confidence intervals were wide and heterogeneity high (adjusted hazard ratio 1.88, 95%CI 0.53, 6.69, I(2) 83.2%). HIV incidence was higher in women with bacterial vaginosis (adjusted effect 1.57, 95%CI 1.26, 1.94, I(2) 19.0%) and Trichomonas vaginalis (adjusted effect 1.64, 95%CI 1.28, 2.09, I(2) 0.0%). CONCLUSIONS/SIGNIFICANCE: A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking. Intravaginal practices do not appear to protect women from vaginal infections or HIV and some might be harmful

Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

AbstractAccountability mechanisms help governments and development partners fulfill the promises and commitments they make to global initiatives such as the Millennium Development Goals and the Global Strategy on Women’s and Children’s health, and regional or national strategies such as the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA). But without directed pressure, comparative data and tools to provide insight into successes, failures, and overall results, accountability fails. The analysis of accountability mechanisms in five countries supported by the Evidence for Action program shows that accountability is most effective when it is connected across global and national levels; civil society has a central and independent role; proactive, immediate and targeted implementation mechanisms are funded from the start; advocacy for accountability is combined with local outreach activities such as blood drives; local and national champions (Presidents, First Ladies, Ministers) help draw public attention to government performance; scorecards are developed to provide insight into performance and highlight necessary improvements; and politicians at subnational level are supported by national leaders to effect change. Under the Sustainable Development Goals, accountability and advocacy supported by global and regional intergovernmental organizations, constantly monitored and with commensurate retribution for nonperformance will remain essential

Chlamydia control activities in Europe: cross-sectional survey

Background: Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. Methods: The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. Results: Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). Conclusion: A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programme

Women’s health, hygiene and HIV in Sub-Saharan Africa : the role of vaginal practices

In 2010, half of the 22.5 million people living with HIV in Sub-Saharan Africa were women and girls.203 Increased biological susceptibility to HIV infection, legal and social inequalities and sexual-social behaviours contribute to tipping the burden of ill health and infection toward women.3-4 Researchers studying HIV vaccines and vaginal microbicides have long suspected that relative variations in vaginal health play an important role in HIV rates. These differences might be linked to reproductive tract infections or behaviours that increase inflammation, lesions or change the vaginal microbiota.5-7 It is difficult to determine how important vaginal factors are in increasing a woman’s risk for HIV acquisition, because of the many other factors also influence HIV transmissibility. In this thesis we use qualitative and quantitative research methods to investigate vaginal practices used by women in Sub-Saharan Africa, and to determine whether their use increases women’s risk of acquiring HIV infection. The results of country studies in Mozambique and South Africa have shown that vaginal practices are more varied and diverse than previously thought and some practices such as intravaginal cleansing are extremely common. An aggregate systematic review and an individual patient data meta-analysis showed that some practices are clearly not benign; indeed women’s use of some practices to address sexual or reproductive health concerns through self-treatment or increased hygiene practices may in fact be placing them at greater risk. Results however between studies are inconsistent leaving the critical question about harm of some practices unanswered.93 A meta-ethnography gave insight that practices are an important source of power for women to control their relationships and health indicating that changing practices will require an appreciation of the role they play in women’s lives. As new HIV prevention technologies become available, it will be critical for programmes to develop introduction strategies that take into account women’s vaginal practice preferences whether they are for health, sexual or hygiene purposes

Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

Current attempts to address the high burden of sexual health morbidity and mortality in developing countries remain limited in scale due to a range of health system constraints. We conducted a literature review of the policy and programmatic issues that influence the integration of sexual health into primary care services in developing countries. Forty-seven reports were identified from a search of both peer-reviewed and gray literature. Key issues identified were intersectoral and intergovernmental coordination; management and organizational issues including decentralization, health sector reform, logistics, and referral systems; human resources, including training and support required to increase service scope; relationships between the public and private sectors; and scaling-up and financing issues

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa.

BACKGROUND: Despite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking. METHODS: Using Noblit and Hare's meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass' notion of first-, second-, and third-order constructs. RESULTS: The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as 'opt-out' provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers' inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women's decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. CONCLUSIONS: Improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA