Sexual and Reproductive Health and Rights of Refugee Women in Europe: rights, policies, status and needs. Literature review

B

Reducing HIV/AIDS in young people in Sub-Sahara Africa: gaps in research and the role of theory

This paper discusses the role of education in preventing HIV in children and young people in sub-Sahara Africa and presents the results of policy advisory research conducted on behalf of the Belgian Development Cooperation. The research consisted of a literature review and a field study in Rwanda. Relative to the high number of HIV prevention activities in sub-Sahara Africa, there is a limited number of scientific data on HIV risk reduction interventions for young people in this region. Longitudinal studies are especially scarce. Preliminary results show that many interventions have only a marginal impact on reducing sexual risk behaviour. Factors influencing programme effectiveness include the consistency and accuracy of messages and information, the provision of life-skills, social support and access to contraceptives, the intensity and duration of the programme, the training of the facilitators and the age of the target population. The HIV/ AIDS pandemic has a potentially devastating impact on the education sector. Because few countries have monitoring systems in place that quantify the absenteeism, morbidity and mortality of teachers and students infected with or affected by HIV/AIDS, there is only anecdotal evidence available for illustrating this impact. The final section discusses the current gaps in research and the important role of theory in increasing the impact and improving the evaluations of HIV/AIDS education interventions

Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial

<p>Abstract</p> <p>Background</p> <p>Minor and mild-major depression are highly prevalent in primary care. There is insufficient evidence for the effectiveness of antidepressants in the treatment of minor and mild-major depression. We compared the effectiveness of usual primary care treatment, with or without antidepressants, in minor and mild-major depression.</p> <p>Methods</p> <p>A pragmatic patient-randomized equivalence trial with 52 weeks follow-up was conducted in The Netherlands. In total, 59 primary care physicians (PCPs) recruited and treated 181 adult patients with minor or mild-major depression. Patients were randomized to four consultations within 3 months of usual care plus antidepressants (UCandAD) or usual care alone (UCnoAD). The Montgomery Åsberg Depression Rating Scale (MADRS) was used to assess changes in severity of depressive symptoms. The predefined equivalence margin was set at five points. Multilevel analysis was used to analyze the data. Secondary outcome measures were the Short-Form 36 (SF-36), and the Client Satisfaction Questionnaire (CSQ-8).</p> <p>Results</p> <p>Patients received on average 3.0 (SD 1.4) 15-min consultations within 3 months with (n = 85) or without paroxetine (n = 96). Equivalence of UCandAD and UCnoAD was demonstrated in the intention-to-treat analyses as well as the per-protocol analysis after 6 weeks, but not at 13, 26 and 52 weeks follow-up. No statistical differences in effectiveness between treatment groups were found in the intention-to-treat analysis. No differences in the physical and mental functioning (SF-36) were found between the treatment groups. Patients allocated to UCandAD were slightly more satisfied with their treatment at 13 weeks follow-up (but not at 52 weeks follow-up) than patients allocated to UCnoAD. Preliminary analyses suggested that subgroups such as patients with mild-major (instead of a minor) depression might benefit from antidepressant treatment. Patients who were assigned to their preferred treatment (in particular to UCnoAD) were more often compliant and had better clinical outcomes.</p> <p>Conclusion</p> <p>UCandAD was as effective as UCnoAD over the first 6 weeks, but not at 13, 26, and 52 weeks. However, superiority of either treatment could not be demonstrated either. The question whether antidepressants add any clinical effect to usual care remains unresolved. We recommend future studies to look for subgroups of patients who may benefit from antidepressants.</p> <p>Trial registration</p> <p>Dutch Trial Registry ISRCN03007807.</p

A rights-based approach to prevention and response to gender-based violence in conflict settings

C

Combating HIV/AIDS in children and youth: obstacles to behaviour change and the role of theory

Objectives To study the impact of education on HIV/AIDS in sub-Sahara Africa and to assess the implementation of HIV education policies in Rwanda. Methods - A literature review on the relation between HIV/AIDS and education in sub-Sahara Africa; - A field study in Rwanda to assess the implementation of HIV/AIDS education policies in this country: o 28 in-depth interviews with stakeholders in policy development and implementation; o in-depth interviews with the school authorities and 8 teachers of 5 secondary schools; o focus group discussions with 84 students of the same schools. Results The literature review shows that despite two decades of experience the impact of HIV/AIDS education on sexual behaviour of children and youth is small. Programmes that are successful usually share several characteristics: they embed HIV/AIDS in broader SRH education, teach specific skills, focus on a specific behaviour, are long and intense and use trained facilitators. On the other hand, social norms, lack of materials and insufficient teacher training hinder the good implementation of HIV/AIDS education. The literature review also shows a lack of qualitative evaluations of HIV/AIDS education due to the methodological difficulty of measuring sexual behaviour and the lack of good universal indicators. Behavioural theories can fill this gap, and provide a good basis for development, implementation, monitoring and evaluation of HIV/AIDS education interventions. However, the literature review revealed difficulties in correctly using behavioural theories and showed that several aspects of these theories have not yet been tested. Theory and practice are still very distant. The interviews held as part of the field study revealed that the number of partners involved in the development and implementation of HIV/AIDS education policies has recently exploded, putting a great burden upon government structures to harmonize programmes and coordinate activities. On the field this results in duplication, contradictory messages and lack of quality control of HIV/AIDS education. Students, even in schools with anti-AIDS clubs, HIV/AIDS curriculum and peer educators, unanimously express a need for more HIV/AIDS and sexuality education, educational material and access to services. Conclusions HIV/AIDS education should be comprehensive in order to have effect. Researchers should be supported in developing implementation methods for behavioural theories and indicators that can be used universally, and coordination efforts should be strengthened