Exploring Couples' Processes of Change in the Context of SASA!, a Violence Against Women and HIV Prevention Intervention in Uganda.

There is now a growing body of research indicating that prevention interventions can reduce intimate partner violence (IPV); much less is known, however, about how couples exposed to these interventions experience the change process, particularly in low-income countries. Understanding the dynamic process that brings about the cessation of IPV is essential for understanding how interventions work (or don't) to reduce IPV. This study aimed to provide a better understanding of how couples' involvement with SASA!-a violence against women and HIV-related community mobilisation intervention developed by Raising Voices in Uganda-influenced processes of change in relationships. Qualitative data were collected from each partner in separate in-depth interviews following the intervention. Dyadic analysis was conducted using framework analysis methods. Study findings suggest that engagement with SASA! contributed to varied experiences and degrees of change at the individual and relationship levels. Reflection around healthy relationships and communication skills learned through SASA! activities or community activists led to more positive interaction among many couples, which reduced conflict and IPV. This nurtured a growing trust and respect between many partners, facilitating change in longstanding conflicts and generating greater intimacy and love as well as increased partnership among couples to manage economic challenges. This study draws attention to the value of researching and working with both women, men and couples to prevent IPV and suggests IPV prevention interventions may benefit from the inclusion of relationship skills building and support within the context of community mobilisation interventions

Femmes et hommes face aux grossesses non prévues au Maroc et au Sénégal

Cet article étudie la manière dont les femmes ou les couples gèrent les grossesses non prévues dans les capitales du Maroc et du Sénégal (Rabat et Dakar), deux pays soumis à des règles strictes en matière de sexualité des célibataires. Nous analysons les logiques sociales et individuelles qui prévalent à l'annonce d'une grossesse inattendue et la manière dont se prennent les décisions qui vont aboutir à la poursuite de cette grossesse ou à son interruption. Nous nous basons sur des données qualitatives tirées d'un programme financé par l'Union Européenne entre 2005 et 2009, sur l'usage de la contraception d'urgence dans les villes africaines. Nos résultats montrent qu'en dépit de programmes de planification familiale plus performants dans leur pays, les femmes de Rabat vivent leur entrée en sexualité dans des conditions difficiles. Si à Dakar la chasteté avant le mariage est prônée, le non-respect de cette règle entraîne des sanctions beaucoup moins sévères qu'au Maroc. Le choix de l'avortement en cas de grossesse non prévue évolue avec le cycle de vie des individus et selon le stade de la relation. Une pratique envisageable à un moment donné, ne l'est plus forcément à d'autres moments de la relation. Enfin, dans les deux villes, nos données révèlent une forte implication des familles dans la gestion de la formation des couples et de leur fécondité. Cette tendance apparaît cependant plus exacerbée au Maroc où les familles se mobilisent parfois âprement pour obliger ou interdire un avortement

Measuring Under-Five Mortality: Validation of New Low-Cost Methods

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Diversity among clients of female sex workers in India: comparing risk profiles and intervention impact by site of solicitation. implications for the vulnerability of less visible female sex workers.

BACKGROUND: It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners. METHODS: The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients' consistent condom use with FSW. RESULTS: Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated. CONCLUSION: Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks

Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden

[Accepted Manuscript] 'Enhance her pleasure - and your grip strength': Men's Health magazine and pseudo-reciprocal pleasure.

This paper provides a snapshot of the Top Ten free, digital Men's Health magazine articles, accessed on a randomly selected day, that can be viewed as a collection; both a product for readership consumption and a construct of readership priorities. Through close textual analysis, we examine how discourses about masculinity, heterosex and consumerism have intersected to create a model of masculinity based on the discipline of male pleasure, which impacts on men's approach to female pleasure and gender dynamics. The analysis contributes to the developing research about the sexual and bodily discourses the magazine promotes and identifies a model of masculinity where men can 'have their cake and eat it'; seeming to adhere to ideals of gender equality and reciprocity while retaining their traditional patriarchal position of producer/provider. They are encouraged to do so by approaching female orgasm as a product, which they can 'purchase' through adhering to Men's Health magazine's sexual advice and bodily labour at control, delay and discipline of their own pleasure and orgasm. We argue that this approach to sex disenfranchises men, and in turn their partners, of opportunities to access alternative models of embodied pleasure