Male perspectives on intimate partner violence: A qualitative analysis from South Africa

Background Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV. Methods We explored adult men’s perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework. Results Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence. Conclusion Interventions aimed at reducing IPV should consider the cultural and social impact on men’s use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women

Exploring Mental Health and Academic Outcomes of Children Receiving Non-manualized, Transdiagnostic, Task-Shifted Mental Health Care From Their Teachers in a Low-and-Middle Income Country

A majority of children worldwide who face mental health difficulties, especially in low-and-middle income countries, remain undiagnosed and untreated. This deficit roots in part from a lack of trained professionals qualified to provide care. Task-shifting the provision of treatment to teachers, individuals with consistent access to children, can reduce the care gap. The current study investigated whether the implementation of a pilot trial of Tealeaf-Mansik Swastha (Teachers Leading the Frontlines—Mental Health; “Tealeaf”) was associated with improvements in child mental health and academic outcomes. Tealeaf is a transdiagnostic, non-manualized, task-shifting intervention in which teachers identify students in need of mental health care and then provide task-shifted care for them using an emerging, novel therapy modality, “education as mental health therapy” (Ed-MH). Pre-post standardized quantitative measures focused on child mental health status and academics. The measures were completed by multiple raters and compared to determine whether changes occurred. Results indicated that primary teacher raters observed significant improvements in child mental health symptoms overall, while secondary teacher raters and caregivers noted improvement for certain diagnostic categories. Caregivers observed on average a decreased impact of their children's mental health symptoms on their children's lives. Academically, math scores significantly improved while reading trended toward significance. Preliminary evidence overall supports the viability of Tealeaf and Ed-MH for positively impacting child mental health and academics. Future directions include the implementation of a formalized, randomized-controlled trial to strengthen preliminary outcomes

Gender, power, and vertical HIV prevention in urban Zambia

Biomedical and behavioral interventions can virtually eliminate the risk of vertical (i.e., mother-to-child) HIV transmission. Pregnant and breastfeeding women’s adherence to prevention of mother-to-child transmission (PMTCT) interventions, however, remains a challenge across sub-Saharan Africa. Using a concurrent mixed methods approach, including a survey and semi-structured interviews, I test whether a relationship exists between women’s low power within married couples (based on domains from the Theory of Gender and Power) and adherence across the PMTCT cascade of care, including drug adherence during and after pregnancy, safe infant feeding practices, and pediatric HIV testing. The results of this study indicate that intimate partner violence is particularly detrimental to PMTCT adherence. Certain PMTCT protocols are also affected by partner controlling behaviors, participation in household decisions, and economic dependence, but not to the same extent as violence. Women with low power cite a lack of partner support and an unwillingness to disclose their HIV status to the husband due to fear of violence or abandonment as reasons for low PMTCT adherence. Conversely, women with high power cite partner support and the ability to prioritize PMTCT, sometimes even over the marriage, as enabling adherence. Based on these results, augmented efforts to address gender power dynamics both in society and within the home are recommended to promote the health of HIV-positive women and their families

The social dynamics of selling sex in Mombasa, Kenya: a qualitative study contextualizing high risk sexual behaviour

Female sex workers (FSWs) in sub-Saharan Africa have one of the highest HIV seroprevelance rates of any population. Effective safe sex interventions are urgently needed to stop the transmission of HIV during commercial sex. Despite widespread education, counselling, and condom distribution interventions among FSWs, unprotected sexual intercourse remains a large behavioural challenge. Research on this topic has been limited primarily to establishing the frequency of high risk sexual behaviour without a comprehensive analysis of the social environment creating these factors, especially gender inequality. Through qualitative in-depth interviews and focus group discussions with FSWs, this article contextualizes the selling of sex in one large urban city of Kenya. The results of this study indicate that FSWs will never be able to enforce safe sex among male clients in such settings without structural interventions that address gendered socioeconomic power imbalances. Policy implications based on these findings include re-evaluating laws against the selling of sex and prioritizing female education and economic opportunities. (Afr J Reprod Health 2013; 17[2]: 141-149).Les femmes prostituées(FP) en Afrique sub-saharienne ont l'un des taux les plus élevés de la séroprévalence du VIH de toute population. Il faut des interventions sexuelles efficaces sûres de toute urgence pour arrêter la transmission du VIH lors des rapports sexuels commerciaux. En dépit de vastes interventions d'éducation, de conseils et de préservatifs parmi les femmes prostituées, les rapports sexuels à haut risque reste un grand défi comportemental. La recherche sur ce sujet a été limitée principalement à établissement de la fréquence des comportements sexuels à risque, sans une analyse complète de l'environnement social qui crée ces facteurs, en particulier les inégalités entre les sexes. A travers des entretiens approfondis et des discussions de groupe avec les femmes prostituées, cet article met en contexte le commerce du sexe dans une grande ville urbaine au Kenya. Les résultats de cette étude indiquent que les femmes prostituées ne seront jamais en mesure d'appliquer le sexe sans risque chez les clients masculins dans de tels contextes, sans des interventions structurelles qui s’occupent des déséquilibres du pouvoir socio-économiques basés sur l’inégalité des sexes. Les implications politiques fondées sur ces résultats comprennent la révaluation des lois contre la commercialisation du sexe et la hiérarchisation de l’éducation des femmes et des opportunités économiques. (Afr J Reprod Health 2013); 17[2]: 141-149)

HIV-Positive Women Taking Lifelong Antiretroviral Therapy Report Better Adherence Than Women Taking Short-Course Prophylaxis During and After Pregnancy Under PMTCT Program Option A in Lusaka, Zambia

Background and Objectives: HIV-positive women’s adherence to antiretrovirals is critical for prevention of mother-to-child transmission. We aimed to establish if mothers taking triple lifelong antiretroviral therapy report higher adherence compared to mothers taking short-course prophylaxis under Option A in Lusaka, Zambia. Methods: In this clinic-based cross-sectional study, we interviewed 320 HIV-positive mothers at a large public health facility in Lusaka in 2014. Participants reported adherence using a visual analog scale. Multiple logistic regression models were used to determine the adjusted odds of adherence by mother’s prescribed regimen. Results: Women taking lifelong triple antiretroviral therapy report higher adjusted odds of adherence during pregnancy, postpartum, and to giving the infant prophylaxis compared to women to women taking short-course prophylaxis. Discussion: Women on lifelong therapy may have better adherence compared to women on short course prophylaxis because they knew their positive status for longer or were symptomatic with HIV-related disease. The lifelong therapy regimen may be easier for women to follow, particularly because they are required to give the infant prophylaxis for a shorter duration of time. Conclusions and Global Health Implications: Our results indicate that lifelong triple antiretroviral therapy has the potential to promote better drug adherence during and after pregnancy among women living with HIV in sub-Saharan Africa, compared to short-course antiretroviral regimens. Key words: HIV-positive Women • Prevention of Mother-to-Child Transmission • Antiretroviral Therapy • Adherence • Zambia • Option A • PMTCT • ART Copyright © 2017 Hampanda et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

An mHealth pilot designed to increase the reach of prevention of mother-to-child transmission of HIV (PMTCT) across the treatment cascade in a resource-constrained setting in Tanzania.

BackgroundData collection and integrated reporting between the multiple health facilities for supporting more efficient care linkages is an indispensable element for prevention of mother-to-child transmission of HIV (PMTCT) by fostering continuity of patient care and improving the treatment cascade for HIV-infected pregnant women. mHealth potentially presents timely solutions to the data challenges related to efficient and effective care delivery in resource-constrained settings, particularly in low- and middle-income countries.MethodsThis randomized controlled pilot study used stratified random sampling for the selection of seven intervention and seven control sites in Misungwi, Tanzania, a rural district in the northwestern region. Twenty-eight health workers at seven intervention health facilities used the Tanzania Health Information Technology (T-HIT) system during a 3-month period from February 23, 2015, through May 23, 2015, to capture antenatal, delivery, and postnatal patient visits.ResultsT-HIT was designed for use on tablets with the goal to improve reporting, surveillance and monitoring of HIV rates and care delivery in the remote and rural settings. Health workers successfully recorded 2,453 visits. Of these, 1,594 were antenatal visits, 484 deliveries were recorded, and 375 were postnatal visits. Within the antenatal visits, 96% of women had a single visit (1474). Healthcare workers were unable to test 6.7% of women antenatally for HIV.ConclusionThe T-HIT pilot demonstrated the feasibility for implementing an mHealth integrated solution in a rural, low-resource setting that links tablet-based surveillance, health worker capacity-building and patient reminders into a single robust and responsive system. Although the implementation phase was only three months, the pilot generated evidence that T-HIT has potential for improving patient outcomes by providing more comprehensive, linked, and timely PMTCT care data at the individual and clinic levels