Age Matters: determinants of sexual and reproductive health vulnerabilities amongst young women who sell sex (16–24 years) in Zimbabwe.

HEARD, 2021.Introduction: Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. Objective: This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16–24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16–24 year age band. Methods: In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. Results: Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16–19 years) and older YWSS (20–24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a “sex worker” identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. Conclusions: We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes

Why doesn't the decriminalization of same sex sexuality and sex work ensure rights? : the legality and social acceptance of transgressive sexualities in urban Mozambique.

HEARD, 2021.Background: The dependence on the law to direct people’s behaviour is known for its imperfections, yet it has become a mainstream response to social problems in modern day society. It is also the pathway through which internationally-recognised rights obligations, including sexual rights, are anticipated to diffuse across distinctly different societies. We studied the introduction of new legal standards in Mozambique, with an interest in their ability to promote the rights of lesbian, gay, bisexual, transgender, intersex (LGBTI) people and sex workers. Methods: Between 2019 and 2020, we conducted sixteen key informant interviews with jurists, policymakers, and civil society advocates at national level and seventy-eight interviews with opinion leaders from local communities in three urban sites situated across Northern, Central, and Southern Mozambique. Results: The new legal standards, in which same-sex sexuality and sex work are no longer criminalised, found little resonance with intersecting religious, sexual, gender, and socio-cultural norms. Whilst there was a consensus not to discriminate, sensitisation and rehabilitation of LGBTI people and sex workers were considered imperative. This stance, coupled with a continued presence of ambiguous language in and incongruences between legislative pieces, attenuates the country’s commitment to internationally recognised rights obligations. Conclusions: In a context of weak civilian awareness and support, the legal reforms are not likely to make a profound positive impact on the lives of LGBTI people and sex workers. Policy action should extend beyond health and law enforcement institutions and draw in community leaders to mediate the social processes that undercut the universality of rights

Serological and PCR-based markers of ocular Chlamydia trachomatis transmission in northern Ghana after elimination of trachoma as a public health problem.

BACKGROUND: Validation of elimination of trachoma as a public health problem is based on clinical indicators, using the WHO simplified grading system. Chlamydia trachomatis (Ct) infection and anti-Ct antibody responses (anti-Pgp3) have both been evaluated as alternative indicators in settings with varying levels of trachoma. There is a need to evaluate the feasibility of using tests for Ct infection and anti-Pgp3 antibodies at scale in a trachoma-endemic country and to establish the added value of the data generated for understanding transmission dynamics in the peri-elimination setting. METHODOLOGY/PRINCIPAL FINDINGS: Dried blood spots for serological testing and ocular swabs for Ct infection testing (taken from children aged 1-9 years) were integrated into the pre-validation trachoma surveys conducted in the Northern and Upper West regions of Ghana in 2015 and 2016. Ct infection was detected using the GeneXpert PCR platform and the presence of anti-Pgp3 antibodies was detected using both the ELISA assay and multiplex bead array (MBA). The overall mean cluster-summarised TF prevalence (the clinical indicator) was 0.8% (95% CI: 0.6-1.0) and Ct infection prevalence was 0.04% (95%CI: 0.00-0.12). Anti-Pgp3 seroprevalence using the ELISA was 5.5% (95% CI: 4.8-6.3) compared to 4.3% (95%CI: 3.7-4.9) using the MBA. There was strong evidence from both assays that seropositivity increased with age (p<0.001), although the seroconversion rate was estimated to be very low (between 1.2 to 1.3 yearly events per 100 children). CONCLUSIONS/SIGNIFICANCE: Infection and serological data provide useful information to aid in understanding Ct transmission dynamics. Elimination of trachoma as a public health problem does not equate to the absence of ocular Ct infection nor cessation in acquisition of anti-Ct antibodies

HIV/AIDS financing: a case for improving the quality and quantity of aid.

NoThere is no doubt that increasing amounts of funding are needed to provide a full package of HIV/AIDS prevention, treatment and mitigation interventions to Africa. However, even the existing funding flows are posing considerable challenges at a national level. In the quest for rapid results, donors have too often chosen to alleviate the lack of local capacity by bringing in foreign technical assistance or building parallel systems for delivering commodities such as drugs that may not be sustainable over the long term once external assistance stops. Even when such interventions may be relevant, they do not address the biggest challenge, namely how to build up the capacity and the systems needed for large-scale implementation of the AIDS response. This article argues that to attain the needed efficacy in HIV/AIDS mitigation programmes, further sustainable increase in external financing is certainly required (particularly for treatment programmes), but even more important is the need to implement them

AIDS in Africa: how the poor are dying

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The global AIDS fund: context and opportunity

The Global Fund to Fight AIDS offers great promise as an instrument of global action to address the devastating effects of the disease. Yet the enormity of its promise also speaks to the scope of its mission: to facilitate the financing by governments, corporations, philanthropical bodies and individuals of a massive effort to address the epidemic that has to date outpaced previous efforts at effective control. A key challenge is to devise a governance structure that makes effective action likely, satisfies donors, responds efficiently, and produces observable results. By examining recent developments, this paper seeks to outline facets of the governance challenge facing the Global AIDS Fund

Regionalisation and Security in Southern Africa.

NoOnce torn by ideological conflicts and the dominance of command economies, Southern Africa is now moving towards economic liberalism and openness. In general, the ascendancy of 'market economics' is acknowledged by its governments, albeit with different degrees of enthusiasm. Theoretically rich and empirically engaging this timely book offers a critical insight into the ensuing debate on regionalism and the process of regionalization in southern Africa

Africa's AIDS crisis in context: 'how the poor are dying'

The 13th International Conference on AIDS held in Durban, South Africa, highlighted the social catastrophe unfolding on the African continent. The meeting took place in the country with the largest number of people infected by HIV - the virus that causes AIDS - on the continent that is home to 70% of the world's HIV-infected population. The cruel irony of the unfolding human tragedy is that Africa is also the least equipped region in the world to deal with the multiplicity of challenges posed by the HIV virus. Drawn from ongoing research in southern Africa, this article charts the relationship between poverty, HIV prevalence and the politics of global response