'Virus Carriers' and HIV testing: navigating Ukraine's HIV policies and programming for female sex workers

Background: There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice. Methods: To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation. Results: HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing. Conclusion: Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine

Different perceptions of the burden of upper GI endoscopy: an empirical study in three patient groups

Background: Few studies have evaluated patients' perceived burden of cancer surveillance tests. Cancer screening and surveillance, however, require a large number of patients to undergo potentially burdensome tests with only some experiencing health gains from it. We investigated the determinants of patients' reported burden of upper gastrointestinal (GI) endoscopy by comparing data from three patient groups. Patients and methods: A total of 476 patients were included: 180 patients under regular surveillance for Barrett esophagus (BE), a premalignant disorder; 214 patients with non-specific upper GI symptoms (NS), and 82 patients recently diagnosed with upper GI cancer (CA). We assessed pain, discomfort and overall burden experienced during endoscopy, symptoms in the week afterwards and psychological distress over time (Hospital Anxiety and Depression scale and Impact of Event Scale). Results: Two-thirds (66%) of patients reported discomfort and overall burden of upper GI endoscopy. Only 23% reported any pain. BE patients reported significantly less discomfort, pain and overall burden than the other patients: those with NS reported more discomfort, CA patients more pain, and both more overall burden. These differences could be statistically explained by the number of previous endoscopies and whether sedation was provided or not, but not by patient characteristics. Conclusion: The perception of upper GI endoscopy varies by patient group, due to potential adaptation after multiple endoscopies and aspects of th

Integrating community service learning into a master’s program

Purpose: In order to address the complex problems of society, the innovation research process should incorporate technical, social, economic and ethical factors, but also actively involve a diverse group of non-scientific actors. One way to prepare students for this type of research is to create “Citizen Scholars,” students who want to work for the betterment of society. Arvanitakis and Hornsby (2016) argue that we need to change how we teach and train students in specific proficiencies. The purpose of this paper is to assess how the pedagogical approach applied within the program contributes to building the proficiencies and attributes as described by Arvanitakis and Hornsby (2016). Design/methodology/approach: The authors conducted a total of 12 interviews with alumni who started their program in 2014, one focus group discussion with lecturers and 132 questionnaires with alumni to discuss to what extend the proficiencies are trained in the program and whether these are used in their current jobs. The authors also included data of an earlier study conducted in 2014. These data contain 26 interviews with students during the first year of the program. These students graduated in 2017 and are thus from the same cohort as the alumni. Findings: The results show that the pedagogical approach in the management policy analysis program trains all the attributes. Important elements in the program are: the inquiry-based approach intertwined with community service learning (CSL) throughout the program; gradually increased complexity of the real-world problems addressed; students working in teams; and gradually reducing support of the lecturer. Research limitations/implications: The authors conclude that our pedagogical approach applied in the program contributes to learning the proficiencies. The authors argue that for the training of inter- and transdisciplinary, the proficiency knowledge integration should be added. Practical implications: The result show that more inquiry-based approaches and CSL programs can stimulate the four clusters of proficiencies, which should hold a central place in universities if we want to create citizen scholars. Social implications: With the approach, students contribute to research issues of local communities. Originality/value: Despite the increasing interest of higher education to involve civic activities in the curricula, few pedagogical approaches are described. The research shows that theoretical insights in the adaption of a model to realize a citizen scholar

Married couples' dynamics, gender attitudes and contraception use in Savannakhet Province, Lao PDR

BACKGROUND: The use of contraception in Lao PDR remains inadequate. In 2017, unmet contraception needs among married women aged 15-49 were 14.3% in Lao PDR overall and 18.6% in the province of Savannakhet. Although the government has a goal to reduce gender inequalities, they still persist in many areas. OBJECTIVE: The aim of this research was to understand the extent to which couples' dynamics and gender attitudes affect contraception use in Savannakhet, Lao PDR. METHODS: To conduct this research, mixed methods were used. Quantitative methods took the form of a survey filled out by 200 married couples in the province of Savannakhet. Afterwards, focus group discussions were carried out to give meaning to the quantitative data and to obtain a deeper understanding of gender roles and contraceptive use. RESULTS: Findings showed that most couples rely on female-dependent contraceptives and that while women hold most of the family planning responsibility, men's opinions have more weight on the final decision. Additionally, women's financial autonomy and spousal communication regarding birth control were associated with contraceptive use within the couple. However, this communication usually began after the birth of the third child. Lastly, the hypothesis that egalitarian gender attitudes were associated with contraceptive use could not be confirmed. CONCLUSION: This study clearly demonstrates that contraception use is influenced by couples' dynamics, more specifically spousal communication, in Lao PDR. The findings have highlighted the need to involve men in all stages of family planning, and to foster both spousal communication and financial autonomy for women. If the findings are implemented, this may foster shared decision making within couples

Utilization of Kenya's free maternal health services among women living in Kibera slums: a cross-sectional study

Introduction: This study was aimed at determining factors affecting utilization of public health facilities by pregnant Kenyan women living in Kibera slums, Nairobi since the implementation of the Free Maternal Service (FMS) Program in 2013. Methods: This was a cross-sectional study done on 396 women who delivered between 2014 and 2015. Interview questions addressed socio-demographic characteristics, perception of quality of care in public health facilities, awareness of the FMS Program, antenatal care (ANC) and delivery service utilization. Results: 43.9% delivered in a public health facility, 30.3% in a private non-profit health facility (NGO), 22.7% in a private health facility and 3.0% at home. Of the 97% of the women who delivered in a health facility, only 43.9% delivered in a public health facility despite these facilities having free maternal services. Factors that favoured the Free Maternal Service uptake included a positive perception of the public health facility, living within close proximity, learning about the Program from a support group and a short waiting time before being examined by the doctor. On the other hand, safe delivery, quality of service, accessing a health facility on foot, ANC attendance at a private and a non-profit health facility were associated with low uptake of the free maternal services. Conclusion: The uptake of the Free Maternal Service program can improve if the Kenyan government directs its efforts towards changing women's perception on quality of care in public health facilities and to improve access to health facilities in slum areas of Nairobi

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio‐economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in‐and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross‐cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health‐ and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda‐setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non‐expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non‐experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health‐ and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein

Prevalence of Hypertension in Vietnam:A Systematic Review and Meta-Analysis

Studies on the prevalence of hypertension in Vietnam have reported various estimates. There is no up-to-date assessment of the evidence on the magnitude of hypertension in Vietnam. Search engines for scientific and gray literature were used to identify relevant records for eligibility screening and quality assessment. Data from selected articles were extracted using standardized spreadsheets. Statistical analysis included estimating pooled prevalence and odds ratio, heterogeneity evaluation, meta-regression, and subgroup analysis, in addition to sensitivity analysis and publication bias evaluation. The pooled prevalence of measured hypertension in Vietnam was 21.1% (95% confidence interval = 18.5-23.7) based on 10 studies, and 18.4% (95% confidence interval = 15.2-21.8) based on 3 national surveys. Lower pooled prevalence was estimated for hypertension awareness (9.3%) and hypertension treatment (4.7%). The pooled prevalence of measured hypertension is significantly higher among men. The pooled prevalence of measured hypertension and hypertension awareness and treatment were significantly lower in rural settings. There is a need to strengthen efforts for primary and secondary prevention and disease management to reduce morbidity and mortality, especially in rural residence settings