Motivations and barriers to uptake and use of female-initiated, biomedical HIV prevention products in sub-Saharan Africa: an adapted meta-ethnography

Abstract: Background: Women bear a disproportionate burden of HIV throughout the world prompting extensive research into HIV prevention products for women which has met with varied success. With an aim of informing future policy and programming, this review examines the barriers and motivations to the uptake and use of female initiated products in sub-Saharan countries. Methods: We conducted a systematic review as an adapted meta-ethnography of qualitative data focused on actual use of products. After deduplication, 10,581 and 3861 papers in the first and second round respectively were screened. Following the PRISMA guidance, 22 papers were selected and synthesized using Malpass’s definitions of first, second, and third order constructs. First order constructs, consisting of participant data published in the selected papers, were extracted and categorised by second and third order constructs for analysis. A weight of evidence review was conducted to compare and assess quality across the papers. Results: The 22 papers selected span 11 studies in 13 countries. We derived 23 s order constructs that were translated into seven overarching third order constructs: Sexual Satisfaction, Trust, Empowerment and Control, Personal Well-being, Product use in the social-cultural environment, Practical Considerations, Risk Reduction, and Perceptions of Efficacy. Relationships and trust were seen to be as or more important for product use as efficacy. These constructs reveal an inherent inter-relationality where decision making around HIV prevention uptake and use cannot be binary or mono-faceted, but rather conducted on multiple levels. We developed a framework illustrating the central and proximal natures of constructs as they relate to the decision-making process surrounding the use of prevention products. Conclusions: Health systems, structural, and individual level HIV prevention interventions for women should adopt a holistic approach. Interventions should attend to the ways in which HIV prevention products can serve to reduce the likelihood of HIV transmission, as well as help to protect partnerships, enhance sexual pleasure, and take into account woman’s roles in the social environment. Stigma, as well as sexuality, is likely to continue to influence product uptake and use and should be prominently taken into account in large-scale interventions. Trial registration: Not applicable

Health, wealth or family ties? Why Turkish work migrants return from Germany

Razum O, Sahin-Hodoglugil NN, Polit K. Health, wealth or family ties? Why Turkish work migrants return from Germany. JOURNAL OF ETHNIC AND MIGRATION STUDIES. 2005;31(4):719-739.In the 1960s and 1970s, hundreds of thousands of Turkish workers migrated to Germany. Some settled there, others returned to Turkey after a few years. To explore how the experience of life between two cultures and in transnational families affected the decision to return, we conducted focus-group sessions with male returnees in Turkey who had spent varying lengths of time in Germany. Return was rarely based on purely economic or health-related motives; value-oriented and emotional themes almost always played a role. There were complex interactions between particular themes, e.g. perceived health status and economic success. We organised our findings into three 'ideal types': first, the I nostalgic' returned migrant who is facing socio-economic problems in Turkey and has a transfigured notion of life in Germany which he would like to but cannot resume; second, the 'cultural traditionalist' who considers Turkish culture superior and left Germany without remorse after having made some money; and third, the 'player of two systems' who thrives in both Turkey and Germany. This typology helps to structure and understand the complex themes underlying the decision to return-migrate