Gender Inequality and Traditional Social Norms as Predictors of Risky Sex among Men in the North Indian States of Uttar Pradesh and Uttarakhand: Quantitative and Qualitative Analyses

Quantitative data from the National Family Health Survey (NFHS-3) and qualitative data from an NIH-funded study in the north Indian states of Uttar Pradesh and Uttarakhand were used to examine the relationship between men's risky sex (non-marital and unprotected sex) and their gender equality attitudes and expressed social norms. Gender equality dimensions in the quantitative analysis were developed based on men's attitudes towards wife-beating, feelings regarding wives ability to refuse sex, history of family violence, and views on whether women had the right to make household decisions and have financial autonomy. Logistic regression models were fit to explore the influence of gender equality dimensions on reported non-marital sex and condom use. Qualitative analysis explored how men's gender attitudes and expressed social norms were related to their risky sex. Quantitative analysis indicated that men who were more likely to report non-marital sex were those who had a history of family violence [OR=1.83; 95% CI=(1.05-3.17) for married men; OR=1.93; 95% CI=(1.44-2.59) for unmarried men], felt that wifebeating was acceptable [OR=1.93; 95% CI=(1.10-3.38) for married men], and felt that women should not have the right to refuse sex [OR=2.17; 95% CI=(1.05-4.48) for married men]. Men who were more likely to report using condoms during non-marital sex were those who felt that wife-beating was never acceptable, compared to men who felt that wife-beating was acceptable [OR=2.13; 95% CI=(1.35-3.36)]. Qualitative analysis revealed that men felt that women are sexually insatiable, should have no say over their own sexual needs, and be dependent on men to be sexually gratified. Men also indicated that certain restrictive social norms drove them to more, rather than less, non-marital sex. Men who reported no or inconsistent condom use felt that condoms prevented them from having "real" sex, that women did not have the right to request men to use condoms or to purchase condoms, and that men had the right to force women to have unprotected sex. Interventions that seek to curb the spread of STIs and HIV in India through reducing men's risky sex should promote a redefinition of men's traditional masculinity norms to incorporate acceptance of gender equality and prevention of violence against women

Pregnant women and infants as sentinel populations to monitor prevalence of malaria: results of pilot study in Lake Zone of Tanzania

As malaria control interventions are scaled-up, rational approaches are needed for monitoring impact over time. One proposed approach includes monitoring the prevalence of malaria infection among pregnant women and children at the time of routine preventive health facility (HF) visits. This pilot explored the feasibility and utility of tracking the prevalence of malaria infection in pregnant women attending their first antenatal care (ANC) visit and infants presenting at 9-12 months of age for measles vaccination.; Pregnant women attending first ANC and infants nine to 12 months old presenting for measles vaccination at a non-probability sample of 54 HFs in Tanzania's Lake Zone (Mara, Mwanza and Kagera Regions) were screened for malaria infection using a malaria rapid diagnostic test (RDT) from December 2012 to November 2013, regardless of symptoms. Participants who tested positive were treated for malaria per national guidelines. Data were collected monthly.; Overall 89.9 and 78.1 % of expected monthly reports on malaria infection prevalence were received for pregnant women and infants, respectively. Among 51,467 pregnant women and 35,155 infants attending routine preventive HF visits, 41.2 and 37.3 % were tested with RDT, respectively. Malaria infection prevalence was 12.8 % [95 % confidence interval (CI) 11.3-14.3] among pregnant women and 11.0 % (95 % CI 9.5-12.5) among infants, and varied by month. There was good correlation of the prevalence of malaria among pregnant women and infants at the HF level (Spearman rho = 0.6; p < 0.001). This approach is estimated to cost $1.28 for every person tested, with the RDT accounting for 72 % of the cost.; Malaria infection was common and well correlated among pregnant women and infants attending routine health services. Routine screening of these readily accessible populations may offer a practical strategy for continuously tracking malaria trends, particularly seasonal variation. Positivity rates among afebrile individuals presenting for routine care offer an advantage as they are unaffected by the prevalence of other causes of febrile illness, which could influence positivity rates among febrile patients presenting to outpatient clinics. The data presented here suggest that in addition to contributing to clinical management, ongoing screening of pregnant women could be used for routine surveillance and detection of hotspots

Report from a symposium on catalyzing primary and secondary prevention of cancer in India

PurposeOral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. MethodsIndian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages.ResultsInnovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences.ConclusionsSymposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival