The role of self-care interventions on men’s health-seeking behaviours to advance their sexual and reproductive health and rights

Background: Self-care interventions are influencing people’s access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men’s health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. Main text: A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men’s lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men’s health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. Conclusion: Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men’s engagement with health services and with their own self care practices

Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women’s Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV

Neighborhood Racial Diversity, Socioeconomic Status, and Perceptions of HIV-Related Discrimination and Internalized HIV Stigma among Women Living with HIV in the United States

Relationships that traverse sociodemographic categories may improve community attitudes toward marginalized groups and potentially protect members of those groups from stigma and discrimination. The present study evaluated whether internalized HIV stigma and perceived HIV-related discrimination in health care settings differ based on individual-and neighborhood-level characteristics of women living with HIV (WLHIV). We also sought to extend previous conceptual and empirical work to explore whether perceived HIV-related discrimination mediated the association between neighborhood racial diversity and internalized HIV stigma. A total of 1256 WLHIV in the Women's Interagency HIV Study (WIHS) attending 10 sites in metropolitan areas across the United States completed measures of internalized HIV stigma and perceived HIV-related discrimination in health care settings. Participants also provided residential information that was geocoded into Federal Information Processing Standard (FIPS) codes and linked with census-tract level indicators. In cross-sectional analyses, greater neighborhood racial diversity was associated with less internalized HIV stigma and less perceived HIV-related discrimination regardless of individual race. Neighborhood median income was positively associated with internalized HIV stigma and perceived discrimination, while individual income was negatively associated with perceptions of stigma and discrimination. In an exploratory mediation analysis, neighborhood racial diversity had a significant indirect effect on internalized HIV stigma through perceived HIV-related discrimination. An indirect effect between neighborhood income and internalized stigma was not supported. These findings suggest that greater neighborhood racial diversity may lessen HIV stigma processes at the individual level and that HIV stigma-reduction interventions may be most needed in communities that lack racial diversity

HPV vaccine acceptability among men: A systematic review and meta-Analysis

Objective To understand rates of human papillomavirus (HPV) vaccine acceptability and factors correlated with HPV vaccine acceptability. Design Meta-Analyses of cross-sectional studies. Data sources We used a comprehensive search strategy across multiple electronic databases with no date or language restrictions to locate studies that examined rates and/or correlates of HPV vaccine acceptability. Search keywords included vaccine, acceptability and all terms for HPV. Review methods We calculated mean HPV vaccine acceptability across studies. We conducted meta-Analysis using a random effects model on studies reporting correlates of HPV vaccine acceptability. All studies were assessed for risk of bias. Results Of 301 identified studies, 29 were included. Across 22 studies (n=8360), weighted mean HPV vaccine acceptability=50.4 (SD 21.5) (100-point scale). Among 16 studies (n=5048) included in meta-Analyses, perceived HPV vaccine benefits, anticipatory regret, partner thinks one should get vaccine and healthcare provider recommendation had medium effect sizes, and the following factors had small effect sizes on HPV vaccine acceptability: perceived HPV vaccine effectiveness, need for multiple shots, fear of needles, fear of side effects, supportive/accepting social environment, perceived risk/susceptibility to HPV, perceived HPV severity, number of lifetime sexual partners, having a current sex partner, non-receipt of hepatitis B vaccine, smoking cigarettes, history of sexually transmitted infection, HPV awareness, HPV knowledge, cost, logistical barriers, being employed and non-white ethnicity. Conclusions Public health campaigns that promote positive HPV vaccine attitudes and awareness about HPV risk in men, and interventions to promote healthcare provider recommendation of HPV vaccination for boys and mitigate obstacles due to cost and logistical barriers may support HPV vaccine acceptability for men. Future investigations employing rigorous designs, including intervention studies, are needed to support effective HPV vaccine promotion among men

Self care interventions could advance sexual and reproductive health in humanitarian settings

PubMedID: 30936067Forcibly displaced people often lack access to adequate sexual and reproductive health services. Carmen Logie and colleagues examine the role of self care interventions in filling the gap © Published by the BMJ Publishing Group Limited

Do case-only designs yield consistent results between them and across different databases (DB)? Hip fractures associated with Benzodiazepines (BZD) as a case study

Background: The case crossover (CXO) and selfcontrolled case series designs (SCCS) are increasingly used in pharmacoepidemiology. In both designs relative risk estimates are obtained within persons rather than between persons thus implicitly controlling for fixed confounding variables. Objectives: To examine the consistency of relative risk estimates of hip/femur fractures (HF) associated with the use of BZD across case-only designs and across two different DB, when same protocol and analytical methods are applied. Methods: CXO and SCCS studies were carried out in BIFAP (Spain) and CPRD (UK). For the CXO, exposure to BZD was divided into non-use, current (up to 30 days after the end of last supply), and recent (1-60 days after). A case moment with four control moments (each 90 days apart) were defined from index date (HF); odds ratios (OR; 95%CI) of current use vs. non-use were estimated using conditional logistic regression with adjustment for co-medications (AOR). For the SCCS, exposure to BZD was divided similarly, but current use was subdivided into:1-30; 31-60; 61-182; 183-365; and >365 days. A conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use as compared to non-use, adjusted for age. To investigate possible event-exposure dependence we also evaluated the relative risk excluding a pre-exposure time of 30 days. Results: In the CXO current use of BZD was associated with an increased risk of HF in both DB, BIFAP [crude OR= 1.70 (1.50-1.92); AOR= 1.47 (1.29-1.67)] and CPRD [crude OR= 1.75 (1.60-1.92); AOR= 1.55 (1.41-1.67)]. In the SCCS IRRs for the first current period was 0.79 (0.68-0.92) in BIFAP and 1.42 (1.27-1.59) in CPRD. However, when we removed the 30 day pre-exposure period from non-use, the IRR for first current period was 1.40 (1.21-1.62) in BIFAP and 1.59 (1.42-1.78) in CPRD. Conclusions: CXO designs yielded consistent results across DB, while SCCS did not. However, once we accounted for the event-exposure dependence, estimates derived from SCCS were more consistent across DBs and with CXO results

Risk of hip fractures associated with benzodiazepines: Applying common protocol to a multi-database nested case-control study. The protect project

Background: The association between benzodiazepines (BZD) and hip fractures has been estimated in several observational studies although diverse methodologies and definitions have hampered comparability. Objectives: To evaluate the discrepancies in the risk estimates of hip/femur fractures associated with BDZs across different databases and to assess the impact of different matching strategies. Methods: A case control study nested in a cohort of BZD users, examining their association with the risk of hip/ femur fracture between 2001 and 2009, was performed within 3 databases, the BIFAP (Spain), the CPRD (UK) and the Mondriaan (Netherlands) database. A risk set sampling matching was performed using two strategies: 1) controls matched by age (up to ± 2 years), sex and time in the cohort (up to ± 6 months) and 2) controls selected with the smallest Manhattan distance according same matching factors. Co-morbidity and co-medication adjusted OR and (95% confidence intervals) were estimated for current use (up to 30 days after last supply) vs. past (>60 days after current use) using conditional logistic regression models. Sensitivity analysis was performed in CPRD including matching by general practice (GP). Results: Adjusted ORs (matching 1) for current use were 1.14 (1.03-1.27) in BIFAP; 1.32 (1.22-1.42) in CPRD, and 1.34 (0.63-2.82) in Mondriaan. Matching 2 resulted in ORs of 1.09 (1.03-1.27), 1.29 (1.17-1.42) and 1.28 (0.60-2.71) in BIFAP, CPRD and Mondriaan respectively. In CPRD, adding GP-practice as a matching factor to matching strategy 1 increased the OR to 1.46 (1.35-1.59). Conclusions: By applying a common protocol, the estimated risk of hip/femur fractures associated to BZD was consistent between studies. The different matching strategies did not influence the risk estimates substantially, however the inclusion of GP-practice as matching factor should be carefully considered in further studies