NO ESTAS SOLA: SOCIAL COHESION, HIV STIGMA, AND HIV/STI PREVENTION AMONG FEMALE SEX WORKERS LIVING WITH HIV IN SANTO DOMINGO

Background: Research on HIV/STI prevention interventions for female sex workers (FSW) living with HIV is limited, with almost no studies that have analyzed the role of social cohesion as a potential strategy to prevent HIV re-infection, STI infection, and onward HIV transmission in this specific population. Methods: This study examined whether social cohesion influences HIV/STI prevention behaviors among FSW living with HIV in the Dominican Republic and, if so, what may explain this relationship. We used an explanatory sequential mixed methods design with quantitative data from the cross-sectional endline survey of Abriendo Puertas (opening doors) and qualitative data from a group of 34 FSW. Abriendo Puertas was a multi-level intervention for FSW living with HIV in Santo Domingo, Dominican Republic (DR). Results: Manuscript one found that social cohesion was associated with CCU with clients and STI prevalence among the study participants. Manuscript two found that social cohesion may reduce the negative impact of stigma on CCU with clients. Additionally, results indicate the limitations of current measurement tools in assessing layered stigma related to HIV outcomes among sex workers. Finally, manuscript 3 indicated that social cohesion provided a safe psychosocial space for de-stigmatized narratives to emerge and be practiced, leading to the reconstruction of identity in positive terms and the uptake of positive health behaviors. Conclusions: Promoting social cohesion may be an important HIV/STI prevention strategy among FSW living with HIV that should be included in multi-level HIV/STI prevention, treatment, and care interventions. Findings also indicate the importance of analyzing social cohesion and various HIV/STI prevention behaviors and outcomes from multiple perspectives to develop a more holistic understanding of the social dynamics underlying health behaviors

Shedding light on a HIV blind spot: Factors associated with men’s HIV testing in five African countries

Men’s relatively low rates of HIV testing has been termed the ‘HIV blind spot’ and recently declared by UNAIDS as a top priority. This study uses data from five nationally representative Demographic and Health Surveys in Kenya, Malawi, Mozambique, Zambia, and Zimbabwe to explore factors associated with men’s lifetime HIV testing. Between 29.3% and 34.9% of men ages 15–49 in these countries had never tested for HIV and men who held accepting attitudes towards gender-based violence, who lacked HIV knowledge, and who held stigmatising views of HIV were more likely to report never testing for HIV. Findings are interpreted, including a discussion of the possible unintended consequences of current 90-90-90 targets on men’s relatively low testing rates. The results point to possible intervention opportunities to increase HIV testing among men in high-HIV prevalence settings in Eastern and Southern Africa and emphasise the importance of changing men’s perceptions related to stigma and gender norms

Young people and COVID-19 : Behavioural considerations for promoting safe behaviours. Policy brief

In the context of the coronavirus disease (COVID-19) pandemic response, WHO identifies young people as a priority target audience with specific concerns, experiences and behaviours. This policy brief provides relevant insights from behavioural evidence and a set of behavioural considerations for those promoting COVID-19 preventive behaviours among young people. Designers of programmes and initiatives targeting youth may find it helpful to refer to the youth-specific barriers and drivers identified in this policy brief and to prioritize these for testing when planning initiatives targeted at young people

Postpartum family planning uptake in Uganda: findings from the lot quality assurance sampling survey

Abstract Background The initiation and use of family planning (FP) services within the first 12 months following childbirth, postpartum family planning (PPFP), promotes safe motherhood by reducing unintended pregnancies and ensuring appropriate pregnancy spacing. However, there is a paucity of information on PPFP uptake from community surveys. This study aimed to quantify the reported use of PPFP and identify predictors and barriers to PPFP uptake from a large community survey. Methods We analysed data collected from the 2021 Lot Quality Assurance Sampling (LQAS) survey, a cross-sectional community and household survey that covered 68 districts in Uganda. The survey uses small sample sizes to designate health or administrative geographical areas which are assessed to determine whether they achieved the pre-determined target for defined indicators of interest. We abstracted and analysed data collected from mothers of children aged 12 months or younger on reproductive health and FP. PPFP use was defined as the reported use of modern FP by the mother or their partner. Associations were measured using Pearson’s chi-square test at 5% significance. Multivariate logistic regression was performed for variables that were significantly associated with PPFP use to identify the predictors of PPFP. Results Overall, 8103 mothers of children aged less than 12 years were included in the analysis; the majority of mothers, 55.8% (4521/8103) were above 24 years while 11.7% (950/8103) were 19 years and under. 98% (7942/8103) of the mothers attended at least one antenatal care (ANC) visit and 86.3% (6997/8103) delivered at a health facility. Only 10% (814/8103) of mothers who participated in the survey reported PPFP use at the time of the survey. Reporting of PPFP use was 5 times higher among mothers of children aged 7–12 months (AOR 4.9; 95%CI 4.1–5.8), 50% higher among mothers with secondary education (AOR 1.5; 95%CI 1.0-2.3), 80% higher among breastfeeding mothers (AOR 1.8; 95%CI 1.3–2.4) and 30% lower among those that didn’t receive a health worker visit within 3 months preceding the survey (AOR 0.7; 95% CI 0.5–0.8). Among 4.6% (372/8103) who stated a reason for non-use of PPFP, the most cited reasons for not using were breastfeeding 43% (161/372), fear of side effects 26.9% (100/372), respondent/partner opposition 17.6% (48/372) and infrequent sex 12.1% (48/372). Conclusion The analysis showed a low proportion of PPFP uptake among mothers of children under 12 years. Possible barriers included child age, education, a health worker visit, and side effects and perceived benefits of possibly improperly implementing lactation amenorrhea method. Integration of social, community and health services could provide a more holistic approach to improving PPFP uptake

Behavioural and social sciences are critical for pandemic prevention, preparedness, and response. WHO Technical Advisory Group on Behavioural Insights and Sciences for Health [Open Letter]

Open letter to the Bureau of the Intergovernmental Negotiating Body to strengthen pandemic prevention, preparedness and respons