Sexual risk behaviors among young migrants and key populations in Sweden

Background: The approximate number of young migrants (aged 15 to 24 years) is almost 32 million globally. In Sweden, in 2022, nearly 2.5% of all citizens were foreign-born aged 15-24. Previous research has shown that young migrants are at increased risk of engaging in sexual risk behaviors, including sexual minorities, such as men who have sex with men (MSM). In addition, migrants can suffer from poor health due to their migration journey and postmigration living circumstances. The aim of this thesis is to assess the prevalence of sexual risk behaviors and the sociodemographic factors that can influence the sexual risk behaviors among young foreign-born key populations who are at risk for HIV in Sweden. Additionally, to assess the prevalence of sexual risk behavior transactional sex among MSM and foreign-born MSM living in Sweden. Methods: Four papers were completed using data from two cross-sectional surveys: one from a migrant SRHR study conducted in Sweden during 2017-2018 (Papers I and II) and another from the European Men who have sex with men Internet Survey (EMIS) conducted in 2017 (Papers III and IV). In Paper I, 1563 participants aged between 15 and 25 years (56% male, 44% female) were eligible to participate in the assessment of sexual risk behavior prevalence, and in paper II, 976 (54% male, 46% female) participants to assess the prevalence of poor mental health. Descriptive, bivariate and multivariable logistic regression analyses were performed to estimate the relationship between sexual risk behavior and demographic and migrationrelated variables (Paper I). In paper II, we assess the association between mental health, sexual risk behavior, willingness to take risks, and demographic and migration-related variables. In the EMIS–2017 papers, 4443 MSM participants reporting to live in Sweden are included to assess the prevalence of engaging in transactional sex. Descriptive, bivariate and multivariable logistic regression analyses were performed to estimate the prevalence of transactional sex and the relationship between transactional sex and demographic and migration-related variables (paper III) and HIV status (paper IV). Results: In paper I, the overall prevalence of sexual risk behaviors in the past year was 33% (n=536). Condomless sex was the most prevalent sexual risk behavior, with increased odds among those coming from the Americas and Europe (compared to Syria) and coming to Sweden to live with a family (compared to those arriving as asylum seekers/refugees), including younger age and living longer in Sweden. Belonging to Islam decreased the odds. Increased odds for engaging in sex under drug influence were among young migrants born in Europe or a MENA country and those who came to Sweden to work or study, while age decreased the odds. Young migrants who came to work or study and lived longer in Sweden had increased odds of engaging in exchanging sex for money or goods. In paper II, 59% of participants reported poor mental health. Participants who reported living 4 and 5 years in Sweden had increased odds of poor mental health outcomes compared to those who lived in Sweden for less than one year. Living alone or with friends they had known earlier (compared to those living with family), being female, coming from Syria, engaging in sexual risk behaviors, and the willingness to take risks increased the odds of reporting poor mental health. Being highly educated, born in Asia, Europe, or Africa, and coming to live with family (compared to coming as an asylum seeker/refugee) decreased the odds of poor mental health. In paper III, we observe that the overall prevalence of engaging in selling sex ever was 13.2% (16% in foreign-born and 12.7% in Swedish-born) and 5.9% in the previous five years (8.4% foreign-born and 5.4% Swedish-born) among participants. Increased odds of selling sex were observed among those who were younger, reporting to struggle on their current income, being foreign-born, not defining their sexual orientation, and reporting to had sex with a woman in the previous 12 months. Low levels of outness decreased the odds of selling sex among Swedishborn MSM, contrary to foreign-born MSM, where higher levels of outness increased the odds of selling sex. Prevalence of buying sex ever was 10.8% (11.6% in foreignborn and 10.7% in Swedish-born) and 6.7% in the previous five years (6.9% foreignborn and 6.6% in Swedish-born). Factors increasing the odds of buying sex were higher education and not having a current partner, while younger age, low level of outness and defining as bisexual (compared to gay/homosexual) decreased the odds, including years of living in Sweden among foreign-born MSM. In paper IV, 5.4% of participants reported living with HIV (8.8% foreign-born and 4.8% Swedish-born). In the overall sample, the factors for increasing odds of reporting living with HIV were buying and selling sex in the past five years, being foreign-born, and really struggling with current income. Factors decreasing the odds for reporting living with HIV were younger age (up to 34 years compared to 65 and above), low levels of outness, always using a condom, including with a non-steady partner , and one to five sexual partners in the previous 12 months. Factor decreasing the odds among foreign-born MSM were 20-39 years old, higher education, living comfortably, always using a condom in the past 12 months and years lived in Sweden. Among Swedish-born MSM, low levels of outness, having one partner, and using a condom always and with a non-steady partner in the past 12 months (compared to never using a condom) were decreasing the odds. Conclusions: One in three young migrants aged 15-25 years living in Sweden reported engaging in sexual risk behavior, predominantly in condomless sex. Those who engage in sexual risk behavior also have increased odds of poor mental health. We observe that foreign-born MSM participants living in Sweden had a higher prevalence of transactional sex engagement than their Swedish-born MSM peers. Transactional sex remains a risk factor for living with HIV among MSM, particularly among foreign-born. Socio-demographic characteristics and migration influence young migrants’ sexual risk behavior. These findings can inform the design of social, economic, and political programs that aim promote safer sexual behaviors among young migrants. These findings can also benefit future targeting and tailoring of HIV prevention and testing programs reaching MSM and meeting the various needs of different MSM subpopulations

Global strategies and local implementation of health and health-related SDGs: Lessons from consultation in countries across five regions

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018-2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated growing political commitment to HHSDGs, with augmentation of multisectoral institutional arrangements, strengthening of monitoring systems and engagement of development partners. On the other hand, there has been limited involvement of civic society representatives and academia, relatively few capacity development initiatives were in place, a well-crafted communication strategy was missing, and there is limited evidence of additional domestic financing for implementing HHSDGs. While the momentum towards universal health coverage is notable, explicit linkages with non-health SDGs and integrated multisectoral implementation strategies are lacking. The study offers messages to LMICs that would allow for a full decade of accelerated implementation of HHSDGs, and points to the need for more implementation research in each domain and for testing interventions that are likely to work before scale-up

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

__Background:__ Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. __Methods:__ We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations

A call for an immediate ceasefire and peaceful end to the Russian aggression against Ukraine

The Lancet–SIGHT Commission condemns the Russian Government's aggression against Ukraine and its attacks on civilians and civilian infrastructure, including health workers and hospitals. We support the March 2, 2022 UN General Assembly (UNGA) resolution ES-11/1 that “deplores in the strongest terms the aggression by the Russian Federation”. The indiscriminate use of weaponry violates international humanitarian law and has caused catastrophic health impacts, especially on children, older people, and disabled persons, and social and economic disruptions that will be long lasting. There are nuclear risks, both from Russian attacks on Ukrainian nuclear facilities and the potential for nuclear weapons use. There is a further risk that Russia might use chemical or biological weapons. We call for an immediate ceasefire and the appointment of a mediator to facilitate negotiations for a sustainable and peaceful settlement on the basis of international law to end the conflict. We urge the global health community to deliver humanitarian assistance impartially to all those affected by and fleeing the war; document atrocities committed against civilians and the devastating impacts of the war; counter disinformation about the conflict; and advocate for a peaceful settlement. We also call for an end to the repression of those in Russia protesting the war.http://www.thelancet.comhj2023Economic

Prevalence and risk factors for transactional sex among Swedish-born and foreign-born MSM in Sweden

Background: Little is known about transactional sex (TS) (selling and buying sex) among men who have sex with men (MSM) in Sweden, especially among foreign-born MSM. This study aims to assess the prevalence and risk factors of TS (ever and in the previous five years) among MSM living in Sweden and to determine if there is a difference between Swedish-born MSM and foreign-born MSM. Methods: Swedish data from a multicountry online banner survey (EMIS-2017) was used (n = 4443). Multivariable regression analysis was applied to analyse the data. Results: The prevalence of ever-selling sex among all MSM participants was 13.2% and 5.9% in the previous five years. Selling sex ever and in the previous five years was higher among foreign-born MSM (16% and 8.4%, respectively) than Swedish-born MSM (12.7% and 5.4%, respectively). Among all participants, younger age (aOR:3.19, 95% CI:1.57-6.45) and really struggling to live on current income (aOR:3.37, 95% CI:2.29-4.96) increased the odds of selling sex. Being foreign-born MSM (aOR:1.33, 95% CI:1.02-1.73) and having had sex with a woman in the previous 12 months increased the odds of selling sex (aOR:1.44, 95% CI:1.00-2.07). The prevalence of ever buying sex among MSM participants in Sweden was 10.8% and 6.7% in the previous five years, with the same trend among foreign-born MSM (11.6% and 6.9%, respectively) and Swedish-born MSM (10.7% and 6.6%, respectively). Higher education and not having a current partner increased the odds of buying sex. Younger age was protective for buying sex (aOR:0.05, 95% CI:0.02-0.14). Among the foreign-born MSM, the length of stay in Sweden decreased the odds of buying sex (aOR: 0.98, 95% CI: 0.96-0.99). Conclusions: The comparatively high prevalence of TS among MSM participants in Sweden, where buying sex is illegal, with a higher prevalence among foreign-born MSM participants, calls for sexual and reproductive health and rights interventions in this population. Increased attention, including HIV prevention programming and education, should be aimed at younger MSM, MSM struggling with their current income, and foreign-born MSM, as they are more likely to report selling sex

Solidarity and universal preparedness for health after covid-19

Göran Tomson and colleagues argue that our ability to control pandemics requires global action to counter inequalities from demographic, environmental, technological, and other megatrend

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

Abstract Background Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. Methods We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. Results Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. Conclusions Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs

From microbiome composition to functional engineering, one step at a time.

SUMMARYCommunities of microorganisms (microbiota) are present in all habitats on Earth and are relevant for agriculture, health, and climate. Deciphering the mechanisms that determine microbiota dynamics and functioning within the context of their respective environments or hosts (the microbiomes) is crucially important. However, the sheer taxonomic, metabolic, functional, and spatial complexity of most microbiomes poses substantial challenges to advancing our knowledge of these mechanisms. While nucleic acid sequencing technologies can chart microbiota composition with high precision, we mostly lack information about the functional roles and interactions of each strain present in a given microbiome. This limits our ability to predict microbiome function in natural habitats and, in the case of dysfunction or dysbiosis, to redirect microbiomes onto stable paths. Here, we will discuss a systematic approach (dubbed the N+1/N-1 concept) to enable step-by-step dissection of microbiome assembly and functioning, as well as intervention procedures to introduce or eliminate one particular microbial strain at a time. The N+1/N-1 concept is informed by natural invasion events and selects culturable, genetically accessible microbes with well-annotated genomes to chart their proliferation or decline within defined synthetic and/or complex natural microbiota. This approach enables harnessing classical microbiological and diversity approaches, as well as omics tools and mathematical modeling to decipher the mechanisms underlying N+1/N-1 microbiota outcomes. Application of this concept further provides stepping stones and benchmarks for microbiome structure and function analyses and more complex microbiome intervention strategies