A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa

BACKGROUND: Intimate partner violence (IPV) affects more than one in three women in sub-Saharan Africa (SSA). It is associated with both pregnancy and HIV, adversely affecting women in this region. This is the first systematic examination of the effects of IPV on HIV-positive (HIV+) pregnant women in SSA. METHODS: A systematic review of the literature on HIV+ pregnant women experiencing IPV in SSA was carried out. Searches were carried out in PubMed, Web of Science and African Journals Online databases. Articles published between January 2010 and June 2020, in English, were included. Data extraction included details on study locations, study design, study participants and the study outcome variables (depression, IPV, medication adherence, postpartum unsafe sex, and HIV disclosure). RESULTS: Fourteen studies (ten cross-sectional studies, four cohort studies) were included. Results indicate a high prevalence of IPV amongst pregnant women with HIV in SSA (18.0 to 63.1%). The results suggest an association between HIV-positive status and consequences of IPV during pregnancy, particularly mental health effects, such as depression symptoms and suicidal ideation. HIV-related stigma has a key role within the relationship between HIV and IPV during pregnancy. One study described that the presence of IPV reduces adherence to Prevention of Mother-To-Child Transmission (PMTCT) medication. Three studies reported no association between HIV positive status or HIV status disclosure and IPV during pregnancy. DISCUSSION/CONCLUSIONS: The systematic review confirms interconnections between IPV and HIV seropositivity amongst pregnant women in SSA. Importantly, stigma, social isolation and poor mental health hinder help-seeking, disclosure, and treatment adherence among HIV+ pregnant women exposed to IPV in SSA. As a result, the potential of community interventions to tackle issues associated with IPV in HIV-positive pregnant women in this area should be explored in research, policy, and practice

Agent-based modeling for migration and modern slavery research: a systematic review

AbstractThis systematic review aims to synthesize how agent-based modeling (ABM) has been used in migration and modern slavery research and provide the basis to model development for social science researchers exploring the use of ABM. We searched five bibliographic databases using two terminology categories: (1) migration or modern slavery terminology; (2) complex system methods terminology. Two reviewers conducted independent article screening. Peer-reviewed articles presenting original migration or modern slavery ABMs were included. Data extraction included model development steps and model characteristics. The dataset was synthesized and compared across studies. We identified 28 articles for inclusion. Many of the ABMs tested theories and about half were based on empirical data. Model development varied considerably and reported methods were extremely opaque. Only five studies used a structured development framework. The most common model involved agents deciding whether and where to migrate and attempting migration. Climate change was a common exogenous scenario modeled. Most of the ABMs did not undergo any sensitivity analysis or validation.ABM has a greater capacity to account for heterogeneous and dynamic decision-making than more frequently applied methods in research on migration and modern slavery. However, there is still a paucity of studies adopting ABM methods. These reviewed ABMs highlight gaps in the reporting and implementing of model development. ABM is a promising technique to address many urgent and complex questions in research on migration and modern slavery to better support decision-makers, but addressing current methodological gaps is a critical first step.</jats:p

Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses.

In an Editorial, Ligia Kiss and Cathy Zimmerman discuss the need for research on the prevention of human trafficking and mitigation of its effects

Men's and women's experiences of violence and traumatic events in rural Cote d'Ivoire before, during and after a period of armed conflict.

OBJECTIVE: We assessed men's and women's experiences of gender based violence and other traumatic events in Côte d'Ivoire, a West African conflict-affected setting, before, during and after a period of active armed conflict (2000-2007). DESIGN: Cross-sectional, household survey. SETTING: 12 rural communities directly impacted by the Crisis in Côte d'Ivoire, spanning regions controlled by government forces, rebels and UN peacekeepers in 2008. PARTICIPANTS: 2678 men and women aged 15-49 years. PRIMARY OUTCOME MEASURES: Violence exposures measured since age 15. Questions included intimate partner physical and sexual violence; physical and sexual violence by others (including combatants) and exposure to traumatic events before, during and after the Crisis period (2000-2007). RESULTS: Physical and/or sexual violence since age 15 was reported by 57.1% women and 40.2% men (p=0.01); 29.9% women and 12.3% men reported exposure to any violence in the past year. Nearly 1 in 10 women (9.9%) and 5.9% men (p=0.03) were forced to have sex by a non-partner since age 15, and 14.8% women and 3.3% men (p=0.00) reported their first sexual experience was forced. Combatants were rarely reported as sexual violence perpetrators (0.3% women). After the Crisis, intimate partner physical violence was the most frequently reported form of violence and highest among women (20.9% women, 9.9% men, p=0.00). Fearing for their life was reported by men and women before, during and after the Crisis. CONCLUSIONS: Sexual violence in conflict remains a critical international policy concern. However, men and women experience different types of violence before, during and after conflict. In many conflict settings, other forms of violence, including intimate partner violence, may be more widespread than conflict-related sexual violence. Alongside service provision for rape survivors, our findings underscore the need for postconflict reconstruction efforts to invest in programmes to prevent and respond to intimate partner violence and trauma

What is the prevalence of and associations with forced labour experiences among male migrants from Dolakha, Nepal? Findings from a cross-sectional study of returnee migrants.

OBJECTIVES: Growing numbers of people are migrating outside their country for work, and many experience precarious conditions, which have been linked to poor physical and mental health. While international dialogue on human trafficking, forced labour and slavery increases, prevalence data of such experiences remain limited. METHODS: Men from Dolakha, Nepal, who had ever migrated outside of Nepal for work were interviewed on their experiences, from predeparture to return (n=194). Forced labour was assessed among those who returned within the past 10 years (n=140) using the International Labour Organization's forced labour dimensions: (1) unfree recruitment; (2) work and life under duress; and (3) impossibility to leave employer. Forced labour is positive if any one of the dimensions is positive. RESULTS: Participants had worked in India (34%), Malaysia (34%) and the Gulf Cooperation Council countries (29%), working in factories (29%), as labourers/porters (15%) or in skilled employment (12%). Among more recent returnees (n=140), 44% experienced unfree recruitment, 71% work and life under duress and 14% impossibility to leave employer. Overall, 73% experienced forced labour during their most recent labour migration.Forced labour was more prevalent among those who had taken loans for their migration (PR 1.23) and slightly less prevalent among those who had migrated more than once (PR 0.87); however the proportion of those who experienced forced labour was still high (67%). Age, destination and duration of stay were associated with only certain dimensions of forced labour. CONCLUSION: Forced labour experiences were common during recruitment and at destination. Migrant workers need better advice on assessing agencies and brokers, and on accessing services at destinations. As labour migration from Nepal is not likely to reduce in the near future, interventions and policies at both source and destinations need to better address the challenges migrants face so they can achieve safer outcomes

Migration Planning Among Female Prospective Labour Migrants from Nepal: A Comparison of First-Time and Repeat-Migrants

As international female labour migration has increased, so too have efforts to prevent the exploitation of labour migrants. However, evidence to underpin prevention efforts remains limited, with little known about labour migrants’ migration planning processes. Using data from a survey of female prospective labour migrants from Nepal, this article compares socio-demographics and migration-planning processes between first-time and repeat-migrants. We identified several factors which might increase repeat-migrants’ vulnerability to exploitation during the migration process, or obstruct their engagement in pre-migration interventions: more rapid migration planning than first-time migrants; lower involvement in community groups; and a perception that they already have the knowledge they need. Only one-third of repeat-migrants planned to go to the same destination and 42 per cent to work in the same sector as previously. With repeat-migration a common livelihoods strategy, it is crucial that interventions are guided by evidence on the needs of both first-time- and repeat-migrants

The use of Bayesian networks for realist evaluation of complex interventions: evidence for prevention of human trafficking

Complex systems and realist evaluation offer promising approaches for evaluat-ing social interventions. These approaches take into account the complex interplay among factors to produce outcomes, instead of attempting to isolate single causes of observed effects. This paper explores the use of Bayesian networks (BNs) in real-ist evaluation of interventions to prevent complex social problems. It draws on the example of the theory-based evaluation of the Work in Freedom Programme (WIF), a large UK-funded anti-trafficking intervention by the International Labour Organi-sation in South Asia. We used BN to explore causal pathways to human traffick-ing using data from 519 Nepalese returnee migrants. The findings suggest that risks of trafficking are mostly determined by migrants’ destination country, how they are recruited and in which sector they work. These findings challenge widely held assumptions about individual-level vulnerability and emphasize that future invest-ments will benefit from approaches that recognise the complexity of an interven-tion’s causal mechanisms in social contexts. BNs are a useful approach for the con-ceptualisation, design and evaluation of complex social intervention

The mental health and well-being of internally displaced female Yazidis in the Kurdistan Region of Iraq: a realist review of psychosocial interventions and the impact of COVID-19

Abstract Background Yazidis in the Kurdistan Region of Iraq have been exposed to recurrent traumatic experiences associated with genocide and gender-based violence (GBV). In 2014, ISIS perpetrated another genocide against the Yazidi community of Sinjar. Women and girls were held captive, raped and beaten. Many have been forced into displacement. Rates of post-traumatic stress disorder (PTSD) and suicide are high. Limited research has evaluated interventions delivered to this population. Methods This review explores how the global evidence on psychosocial interventions for female survivors of conflict-related sexual violence applies to the context of the female Yazidi population. We used a realist review to explore mechanisms underpinning complex psychosocial interventions delivered to internally displaced, conflict-affected females. Findings were cross-referenced with eight realist, semi-structured interviews with stakeholders who deliver interventions to female Yazidis in the Kurdistan Region of Iraq. Interviews also allowed us to explore the impact of COVID-19 on effectiveness of interventions. Results Seven mechanisms underpinned positive mental health outcomes (reduced PTSD, depression, anxiety, suicidal ideation): safe spaces, a strong therapeutic relationship, social connection, mental health literacy, cultural-competency, gender-matching and empowerment. Interviews confirmed relevance and applicability of mechanisms to the displaced female Yazidi population. Interviews also reported increased PTSD, depression, suicide and flashbacks since the start of the COVID-19 pandemic, with significant disruptions to interventions. Conclusion COVID-19 is just one of many challenges in the implementation and delivery of interventions. Responding to the mental health needs of female Yazidis exposed to chronic collective violence requires recognition of their sociocultural context and everyday experiences

Results from a before-and-after learning assessment of pre-migration departure training for prospective female migrants in Odisha, India

Work in Freedom (WiF) was a large multi-component intervention managed by the International Labour Organization (ILO) and funded by the Department for International Development (DFID), to prevent labour trafficking. WiF was implemented in India, Nepal and Bangladesh as source countries, and Lebanon and Jordan as destination countries, from 2013 to 2018. WiF’s community-based activities aimed to prevent labour trafficking by enhancing women’s autonomy, fostering adoption of ‘safe migration’ practices and assertion of migrant workers’ rights. The India component of WiF focussed on prospective in-country migrants only. A two-day pre-migration training event was organised for women who expressed an interest in migrating for work during WIF direct outreach sessions. The purpose of the sessions was to help women to make informed decisions about whether, and how, to migrate for work. They included modules on self-care, financial literacy, use of technology to ensure wellbeing, and safety in transit and at destination. Sessions were organised at the Gram Panchayat (village assembly) level and held once approximately 30 women had signed up per session (multiple sessions were held with different groups of approximately 30 women). The training was implemented by the Self Employed Women’s Association (SEWA) and AAINA, local NGOs with experience in gender, and labour mobilisation and organisation among women. This dataset contains data provided by 347 women who participated in pre-migration training and completed pre-training and post-training interviews. Dataset variables are listed in the accompanying questionnaire

Trafficking of Vietnamese women and girls for marriage in China.

BACKGROUND: Bride-trafficking has been a growing phenomenon in Southeast Asia, particularly in China, where one-child policies have resulted in demographic imbalances favoring males. Yet, empirical evidence about women and girls sold into marriage in China remains sparse. METHODS: This study describes the experiences of 51 Vietnamese women and girls as young as 14 in post-trafficking services who were sold into marriage in China. A consecutive sample of individuals from five services in Vietnam were invited to be interviewed within the first 2 weeks of admission. It is part of a wider dataset for research on the health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam, the largest study to date on human trafficking and health. We calculated proportions for all variables and conducted bivariate analyses using Fisher Exact Tests for their associations with mental health disorders symptoms. RESULTS: Before leaving home, 31% (n = 15) participants were married. Participants reported high levels of sexual violence (n = 43; 86%) while trafficked and59% (n = 30) spent time in detention before returning to Vietnam. Once in post-trafficking care 52.9% (n = 27) reported probable depression, anxiety or post-traumatic stress disorders (PTSD), two women (4%) attempted suicide in the past month and 38 (75%) remained afraid of their trafficker. Ten (22%) became pregnant while trafficked, and seven (16%) were pregnant at the interview. CONCLUSIONS: The cross-border bride trade between Vietnam and China raises complex policy issues, including questions about detention and immigration rights and strategies for supported return processes, including maternal and child health services. As the repercussions of China's absent female population will persist, Vietnam and China must grapple with the political and social conditions to implement prevention strategies, and resources for women who fall prey to this cross-border bride trade