Vulnerability Amplified: The Impact of the COVID-19 Pandemic on LGBTIQ People

In this pioneering report, "Vulnerability Amplified: The Impact of the COVID-19 Pandemic on LGBTIQ people", OutRight Action International documents the effects of the pandemic on LGBTIQ people.While the COVID-19 pandemic leaves no country and no individual unaffected, drawing on almost 60 rapid research interviews conducted with LGBTIQ people in 38 countries from all regions of the world, the report overwhelmingly shows that the challenges faced by LGBTIQ people as a result of the virus and surrounding containment measures are specific and amplified compared to the broader population.The specific challenges faced by LGBTIQ people identified in OutRight's new report are:Devastation of livelihoods – rising food and shelter insecurity resulting from job loss, and economic fall out as a result of over-representation of LGBTIQ people in the informal sector and broad employment discrimination;Disruptions in accessing health care, including crucial HIV medication and gender affirming treatments, and reluctance to seek health care due to discrimination, stigma and refusal of services experienced by LGBTIQ people even outside a pandemic;Elevated risk of domestic and family violence – the most prevalent form of violence faced by LGBTIQ people on a day-to-day basis is heightened in circumstances of lockdowns, curfews and lack of access to support services and community resources;Social isolation and increased anxiety which are further heightened by being cut off from chosen families and the LGBTIQ community;Scapegoating, societal discrimination and stigma – there is an unfortunate history of LGBTIQ people being blamed for emergency situations, leading to further stigmatization, marginalization, violence and danger;Abuse of state power – repression, exclusion, and criminalization are all on the rise in countries prone to authoritarianism and regressive gender ideologies, with some states using the emergency situation to clamp down specifically on LGBTIQ people;Concerns about organizational survival – amplifying the effects even further are the impacts on LGBTIQ community organizations and spaces, which are a lifeline to countless LGBTIQ people. Organizations now face an uncertain future with funding cuts, lockdowns, and having to shift activities on line while calls for direct, practical support are on the rise

Harmful Treatment: The Global Reach of So-Called Conversion Therapy

This pioneering report by OutRight Action International provides a global snapshot of what is known about "conversion therapy" around the world, including who is most vulnerable, what factors lead LGBTIQ people to choose or to be subjected to these harmful practices, what are the main forms of "conversion therapy," and who are the main perpetrators.This report draws on data from an extensive literature review, the first-ever global survey on the topic, and in-depth interviews with experts and survivors from various countries

Breast Ultrasound Following a Positive Clinical Breast Examination: Does It Have a Role in Low- and Middle-Income Countries?

Purpose: Breast cancer is the most common cancer among women worldwide, with an estimated 1.7 million new cases occurring in 2012. The majority of cases and deaths occur in low- and middle-income countries (LMICs), where population-based mammography screening is not available and countries must rely on clinical breast examination (CBE). Since ultrasound has the potential to reduce unnecessary biopsies by triaging women with palpable or focal breast findings at CBE, we searched for evidence in the literature on the effectiveness of ultrasound in detecting potential breast cancer following positive CBE findings. Methods: We reviewed the literature from 2000 to 2014 for evidence on the performance of breast ultrasound, in the absence of mammography, used to evaluate women after a positive CBE. From the studies meeting our inclusion/exclusion criteria for our analysis, we extracted data on the study design, location, ultrasound transducer parameters, patient age, method for determining positive and negative cases, and number of malignancies detected/total number of women studied. Results: We found 15 studies matching our inclusion/exclusion criteria, 9 from high-income countries and 6 from LMICs. Despite considerable variability in study design and patient populations, breast ultrasound consistently showed high sensitivity (median = 94 percent) and specificity (median = 80 percent) for detecting breast cancer and identifying normal and benign findings not requiring a biopsy. Clear patterns related to transducer frequency or income level were not discernible given the variations in patient populations and final diagnostic determinations. Conclusion: Our systematic review suggests that breast ultrasound following a positive CBE may be a powerful diagnostic test to determine those who do or do not need biopsy. We encourage further research in breast ultrasound use after a positive CBE in LMICs to assess the accuracy of ultrasound in these settings and the feasibility of widespread implementation

Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery – The AIMS (Antibiotics in Miscarriage Surgery) trial: study protocol for a randomized controlled trial

Background: The estimated annual global burden of miscarriage is 33 million out of 210 million pregnancies. Many women undergoing miscarriage have surgery to remove pregnancy tissues, resulting in miscarriage surgery being one of the most common operations performed in hospitals in low-income countries. Infection is a serious consequence and can result in serious illness and death. In low-income settings, the infection rate following miscarriage surgery has been reported to be high. Good quality evidence on the use of prophylactic antibiotics for surgical miscarriage management is not available. Given that miscarriage surgery is common, and infective complications are frequent and serious, prophylactic antibiotics may offer a simple and affordable intervention to improve outcomes.Methods: Eligible patients will be approached once the diagnosis of miscarriage has been made according to local practice. Once informed consent has been given, participants will be randomly allocated using a secure internet facility (1:1 ratio) to a single dose of oral doxycycline (400 mg) and metronidazole (400 mg) or placebo. Allocation will be concealed to both the patient and the healthcare providers. A total of 3400 women will be randomised, 1700 in each arm. The medication will be given approximately 2 hours before surgery, which will be provided according to local practice. The primary outcome is pelvic infection 2 weeks after surgery. Women will be invited to the hospital for a clinical assessment at 2 weeks. Secondary outcomes include overall antibiotic use, individual components of the primary outcome, death, hospital admission, unplanned consultations, blood transfusion, vomiting, diarrhoea, adverse events, anaphylaxis and allergy, duration of clinical symptoms, and days before return to usual activities. An economic evaluation will be performed to determine if prophylactic antibioticsare cost-effective.Discussion: This trial will assess whether a single dose of doxycycline (400 mg) and metronidazole (400 mg) taken orally 2 hours before miscarriage surgery can reduce the incidence of pelvic infection in women up to 2 weeks after miscarriage surgery

A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery.

BACKGROUND: Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries. METHODS: We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one of these features and the clinically identified need to administer antibiotics. The definition of pelvic infection was changed before the unblinding of the data; the original strict definition was two or more of the clinical features, without reference to the administration of antibiotics. RESULTS: We enrolled 3412 patients in Malawi, Pakistan, Tanzania, and Uganda. A total of 1705 patients were assigned to receive antibiotics and 1707 to receive placebo. The risk of pelvic infection was 4.1% (68 of 1676 pregnancies) in the antibiotics group and 5.3% (90 of 1684 pregnancies) in the placebo group (risk ratio, 0.77; 95% confidence interval [CI], 0.56 to 1.04; P = 0.09). Pelvic infection according to original strict criteria was diagnosed in 1.5% (26 of 1700 pregnancies) and 2.6% (44 of 1704 pregnancies), respectively (risk ratio, 0.60; 95% CI, 0.37 to 0.96). There were no significant between-group differences in adverse events. CONCLUSIONS: Antibiotic prophylaxis before miscarriage surgery did not result in a significantly lower risk of pelvic infection, as defined by pragmatic broad criteria, than placebo. (Funded by the Medical Research Council and others; AIMS Current Controlled Trials number, ISRCTN97143849.)

Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery - The AIMS (Antibiotics in Miscarriage Surgery) trial: study protocol for a randomized controlled trial

Follow-up card. (DOCX 605 kb

Global LGBTQI Movements, Human Rights, and Health: Notes from the Frontlines

The speakers will provide a brief overview of the status of human rights for LGBTQI people around the world, including both recent global and national milestones, as well as examples of backlash and how local communities are responding. They will also describe how global institutions such as the United Nations are working towards advancement of equality for LGBTQI people regardless of where they live, and the challenges they are facing. Finally, they will discuss the manifestations and impact of stigma and discrimination on peoples’ lives and describe, based on first-hand experience, how LGBTQI activists in every corner of the world are fighting for their rights, often in the face pervasive hostility, to bring justice to their communities. About the Lecturers: Amie Bishop has decades of experience in global health and human rights and currently works in Seattle as an independent consultant on these issues. Since 2008, she has served on the Board of Directors and is now Board Co-Chair for Outright Action International, which has advocated for equality and justice for LGBTQI people for more than 25 years. Anthony Adero is a Kenyan human rights, LGBTQ and HIV activist who has been living in Seattle for four years. In Kenya, he lobbied for improved human rights and access to sexual health information for homosexual men, especially related to the prevention of sexually transmitted infections (STIs). He currently works as a Client Navigator at the Lifelong AIDS Alliance

Factors affecting utilization of cervical cancer prevention services in low-resource settings

Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided