Gender-Based Violence and HIV Risk among Female Sex Workers in Iringa, Tanzania: Implications for a Community Empowerment Response

Globally, female sex workers (FSWs) bear a disproportionate burden of GBV and HIV. Prior work has demonstrated how substance use overlaps with GBV and HIV to further increase FSWs’ risk for negative health outcomes. This dissertation explored how aspects of the sex work environment, including physical, social, economic, and political factors, facilitate alcohol consumption and influence FSWs’ risk for GBV and HIV in Iringa, Tanzania. The ways in which sex workers collectively mobilize to address these factors and access their health and human rights was also explored. Additionally, this dissertation examined FSWs’ experiences accessing justice for violence perpetrated against them. This study was nested within a community-randomized controlled trial of a combination HIV prevention intervention among FSWs in Iringa, Tanzania. Utilizing baseline data from the parent study, this dissertation first conducted logistic regressions to assess the relationship between substance use, GBV, and consistent condom use with clients among a cohort of 496 FSWs. Additionally, 24 FSWs were purposively sampled to participate in in-depth interviews (IDIs) which aimed to gain a nuanced understanding of the role alcohol plays in both HIV and GBV related risk in the context of venue-based female sex work, as well as women’s experiences accessing justice for violence perpetrated against them. Qualitative data analysis was facilitated through the framework approach, in which the researcher begins analysis with a list of a priori codes, informed by the literature, while allowing for other domains to emerge from the data. Quantitative results suggest that intoxication during sex work is associated with significantly increased odds of GBV (aOR: 1.67, 95% CI: 1.08, 2.59) and reduced odds of consistent condom use with clients (aOR: 0.59, 95% CI: 0.37, 0.95). Qualitative analysis suggests that routine interactions between FSWs and their clients at specific moments in time and space during the sex exchange process facilitate alcohol consumption and increase FSWs’ risk for GBV and HIV. Furthermore, participants revealed how they mobilize their collective agency to address these environmental factors to limit alcohol consumption, prevent GBV, and promote condom use among their colleagues. Finally, qualitative results suggest that FSWs are routinely denied access to justice for violence perpetrated against them due to their occupation, and face human rights abuses at the hands of the police when they report violence to the authorities. Findings from this dissertation highlight the need for community empowerment approaches for HIV prevention among FSWs to address the intersection between alcohol consumption, GBV, and unprotected sex. Such models should provide FSWs with the opportunity to mobilize their collective agency to disrupt aspects of the sex work environment that facilitate alcohol use and increase FSWs’ risk for GBV and HIV. Finally, this study suggests that future community empowerment interventions should also provide FSWs with the skills and knowledge to join together in solidarity, in tandem with key stakeholders, to demand access to justice for violence perpetrated against them. It is possible that such an approach could reduce violence and HIV among FSWs in Tanzania and in similar settings

Breastfeeding-Family-Friendly City Assessment

Idaho is the only state in the U.S. without laws protecting breastfeeding mothers, even though Idaho has one of the highest rates of breastfeeding in the country (“Idaho breastfeeding laws”, 2017). Businesses and organizations can support breastfeeding by providing a place for mothers to express breast milk and creating a culture of support for employees and customers. A community health assessment of selected Boise businesses and organizations using the Breastfeeding Family Friendly City Designation (BFF-CD) framework (Labbok, n.d.) was done with the purpose of determining support for breastfeeding families in the Boise area. This project was reviewed by the Boise State University ORC and was deemed exempt. Structured interviews were conducted with representatives of 20 businesses and organizations. These interviews included questions about breastfeeding policies for employees and customers to help determine breastfeeding friendliness, such as providing places for pumping breast milk, and privacy for breastfeeding. The coalitions have little information about breastfeeding support and practices in the Boise city area. The information obtained will help Central District Health Department Breastfeeding Coalition and the Idaho Breastfeeding Coalition promote a breastfeeding friendly community. Results of the assessment and interviews will be shared in this poster presentation

Community perceptions of childbearing and use of safer conception strategies among HIV‐discordant couples in Kisumu, Kenya

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138196/1/jia29972.pd

The power and process of shifting gender norms: Insights from a randomized controlled trial in South Africa

This Project SOAR report summarizes findings from a randomized controlled trial of Tsima ra rihanyu (“working together for health”), a three-year community mobilization program for treatment as prevention that aimed to address the social barriers to HIV testing and treatment in Mpumalanga Province, South Africa. In this report, the authors explore the types of gender norms that are salient for women and men, how these relate to HIV testing and treatment, and the pathways through which gender norms operate to affect women’s and men’s HIV service use and experience and perpetration of intimate partner violence

Adverse Fetal and Neonatal Outcomes Associated with a Life-Long High Fat Diet: Role of Altered Development of the Placental Vasculature

Maternal obesity results in a number of obstetrical and fetal complications with both immediate and long-term consequences. The increased prevalence of obesity has resulted in increasing numbers of women of reproductive age in this high-risk group. Since many of these obese women have been subjected to hypercaloric diets from early childhood we have developed a rodent model of life-long maternal obesity to more clearly understand the mechanisms that contribute to adverse pregnancy outcomes in obese women. Female Sprague Dawley rats were fed a control diet (CON - 16% of calories from fat) or high fat diet (HF - 45% of calories from fat) from 3 to 19 weeks of age. Prior to pregnancy HF-fed dams exhibited significant increases in body fat, serum leptin and triglycerides. A subset of dams was sacrificed at gestational day 15 to evaluate fetal and placental development. The remaining animals were allowed to deliver normally. HF-fed dams exhibited a more than 3-fold increase in fetal death and decreased neonatal survival. These outcomes were associated with altered vascular development in the placenta, as well as increased hypoxia in the labyrinth. We propose that the altered placental vasculature may result in reduced oxygenation of the fetal tissues contributing to premature demise and poor neonatal survival

Proceedings from the Ice Hockey Summit III: Action on Concussion

Objectives The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: (1) describe sport related concussion (SRC) epidemiology, (2) classify prevention strategies, (3) define objective, diagnostic tests, (4) identify treatment and (5) integrate science and clinical care into prioritized action plans and policy. Methods Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches and officials) voted to prioritize these action items in the final Summit session. Results (1) establish a national and international hockey data base for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care (POC); and (6) mandate baseline testing to improve concussion diagnosis for all age groups. Conclusions Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity and consequences of concussion in the sport of ice hockey