Evaluating the Relationship Between Physician Characteristics and Opioid Knowledge and Use of Opioid And Non-opioid Chronic Pain Management Strategies

Opioid use disorder (OUD) is a mental health condition that has high personal, societal, and emotional costs. Opioid use disorder, misuse, and abuse is a national epidemic. Many factors have contributed to the increased use of opioids and OUD. One such factor is the heightened emphasis on pain management in the medical community, one that that began nearly two decades ago. This has led to increased prescribing of opioid-based medication for chronic pain patients. This contributed in part to the development of OUD in many individuals who became addicted to opioids. For this reason, current guidelines discourage the use of opioid-based pain medication for chronic pain under most conditions. The purpose of this study is to evaluate the relationship between physician characteristics (i.e. length of time since graduation, physician specialty), and opioid knowledge and opioid/non-opioid treatment recommendations for the treatment of chronic pain. It was hypothesized that, in light of the heightened emphasis on opioid use and pain management using non-opioid alternatives, physicians who graduated more recently would have greater opioid knowledge and will recommend more alternative chronic pain treatment strategies. The present study included 49 physicians who were contacted through social media and email. Responding physicians were asked to complete multiple measures, following a brief screening for inclusion. They were then asked to read a brief vignette involving a patient experiencing chronic pain and to select from a list of all treatment recommendations that they would endorse. Finally, they were asked to complete a brief opioid knowledge survey developed for this study and a demographic questionnaire. Results revealed no significant association between year of graduation, physician specialty, age, race, or biological sex on opioid knowledge or use of non-opioid alternative treatments. Future research using a larger sample size, with different specialties, or looking at differences between medical degree (allopathic vs. osteopathic) may yield more significant findings

‘One Hand Can’t Clap by Itself’: Engagement of Boys and Men in Kembatti Mentti Gezzimma’s Intervention to Eliminate Female Genital Mutilation and Circumcision in Kembatta Zone, Ethiopia

The successful involvement of men and women as part of a community-wide approach to shifting deep-rooted norms is critical for the abandonment of female genital mutilation and cutting (FGM-C). However, there is limited research exploring how and why men engage in processes of abandonment and how this relates to shifts in gender relations within private and public spaces. This study assessed the process of change among men and boys targeted by Kembatti Mentti Gezzimma (KMG) Ethiopia’s intervention in the Kembatta zone of Ethiopia, which has challenged social acceptance of, and reduced the prevalence of, FGM-C at phenomenal rates (UNICEF 2008). Across four villages, in two districts in the Kembatta Zone, 21 interviews were conducted with KMG staff, male and female beneficiaries, and stakeholders including women’s group association members, youth group members, idir (mutual assistance groups or agricultural assistance groups), and religious and sub-district leaders. Additional interviews were conducted with a staff member in Sidama zone and two KMG management staff in Addis Ababa. Interviews assessed achievements of KMG’s intervention and how men and boys were successfully engaged. Most significant stories of change, which elicited narratives around how and why KMG has impacted participants’ lives, were collected from all interviewees. Data was analyzed using thematic analysis. The data indicates how KMG considers boys and men as agents of change including as members of community FGM-C prevention assemblies, supporting boys and men to disseminate prevention information, and developing and implementing sanctions for those who continue the practice. KMG’s community conversations educated men and women collectively about the harmful health, economic and interpersonal effects of FGM-C, and the related benefits of abandoning the practice. Providing alternative income generating opportunities for traditional circumcisers, celebrating whole body, ‘healthy life’1 events to replace former celebrations of FGM-C, and integrating economic and environmental development were particularly effective for harnessing community support. The data indicated that the intervention diminished other harmful practices including bride abduction and widow inheritance and generated shifts in men’s and women’s support for women’s access to property inheritance, political participation, positive sexuality, household decision-making and reducing women’s domestic burden. Although men were effectively engaged in both public and private spaces, men’s participation appeared to be more gender transformative in interpersonal domains. Given the significant achievements, many valuable lessons can be learned from KMG’s approach to shift underlying social norms, and meaningfully engage men in FGM-C abandonment and gender equality

Sexual and reproductive health perceptions and practices as revealed in the sexual history narratives of South African men living in a time of HIV/AIDS.

Abstract The frequent positioning of men's sexual risk-taking as driving the HIV/AIDS epidemic in South Africa has triggered interest in men's sexual and reproductive health (SRH) perceptions, attitudes, and practices. Much research, however, presents men as a homogenous group, and focuses on the quantifiable aspects of male sexual behaviors, providing an inadequate basis for understanding men's SRH needs and addressing the gendered aspects of HIV prevention. This study used sexual history narratives to yield more nuanced and contextualized understandings of male sexuality as it relates to SRH. Fifty sexual life history individual interviews and 10 focus-group discussions (FGDs) with men, as well as 25 sexual life history interviews with women, were conducted with participants purposively sampled from three age categories: (18-24, 25-55, and 55+ years), a wide range of cultural and racial backgrounds, and in urban and rural sites across 5 provinces in South Africa. Interviews and FGDs elicited stories of participant's early knowledge of sex and sexual experimentation and then explored sexual relationships and experiences in adulthood-including engagement with HIV risks and SRH management. The data were analyzed using a thematic approach. Many male participants conformed to dominant norms of masculinity associated with a high risk of sexually transmitted infections including HIV, such as having regular unprotected sex, reluctance to test for HIV, and poor SRH-seeking behaviors. Yet, the narrative accounts reveal instances of men taking steps to protect their own SRH and that of their partners, and the complex ways in which hegemonic gender norms influence men and women's SRH. Ultimately, the study points to the value of sexual biographies for gaining a deeper understanding of male sexuality, and the social structures, meanings, and experiences that underlie it. Such insights are critical to more effectively engaging men in HIV prevention efforts

The ‘One Man Can’ Model: Community Mobilisation as an Approach to Promote Gender Equality and Reduce HIV Vulnerability in South Africa

One of the main contextual factors driving the HIV epidemic in Sub-Saharan Africa is shared social norms reinforcing restrictive masculine and feminine roles and inequitable gender relationships, which limit women’s ability to protect themselves from HIV while simultaneously putting social pressure on men to take on a range of sexual and health risks. A growing body of scholarship and programme development focuses on the impacts of engaging men and boys in reducing women’s and girls’ HIV vulnerability as well as improving men’s health and well being. To further understand the benefits of engaging men and boys for gender equality and HIV prevention, this study explores the impacts of the South African non government organisation, Sonke Gender Justice’s ‘One Man Can’ (OMC) community mobilisation approach in a multi level HIV prevention intervention to address the community level factors that contribute to women and girls’ increased HIV vulnerability and men’s HIV risk taking behaviour. This case study examines qualitative data collected as part of a gender equality and HIV prevention intervention implemented in rural South Africa that engaged men 18 to 35 years old to increase their support for girls’ and women’s rights and to decrease men’s unsafe sexual practices, especially those that increase girls’ and young women’s vulnerability to HIV infection. Our findings indicate significant attitudinal and some behavioural changes around gender and HIV risk amongst OMC community mobilisers, community action team (CAT) members, and community members exposed to the intervention. At the interpersonal level, adoption of gender equitable beliefs and values had positive effects of improved interpersonal communication and a more balanced division of labour in the home. At the community level, participation in collective activities and increased social awareness of men’s and women’s unique HIV vulnerabilities produced changes in community members’ lives and relationships and created new pathways for collective action for social change. Key lessons learned and potential policy implications are offered

Lessons learned from engaging men in sexual and reproductive health as clients, partners and advocates of change in the Hoima district of Uganda.

This study examined the impact of a three-year intervention project conducted in the Hoima district of Uganda, which sought to engage men in sexual and reproductive health as clients, equal partners and advocates of change. Structured surveys with 164 self-reported heterosexual men aged 18-54 years were used to assess knowledge and attitudes towards sexual and reproductive health. Data from these were analysed using Stata and SPSS. Additionally, five focus groups were conducted with the female partners and male beneficiaries of the project and with project peer educators. Four interviews were conducted with project staff and male beneficiaries. Data from these and the focus groups were analysed using a thematic approach. Following the intervention, a significantly greater number of men accessed, and supported their partners in accessing sexual health services services, had gained sexual and reproductive health awareness, reported sharing domestic duties and contraceptive decision-making, and displayed a decreased tolerance for domestic violence. It was more difficult to assess men's involvement and behaviours as advocates of change, which sheds light on the complexities of a gender transformative project and the importance of evaluating such projects from both men's and their partners' perspectives and at different levels of the male involvement model in sexual and reproductive health

Engendering Men: A Collaborative Review of Evidence on Men and Boys in Social Change and Gender Equality

This evidence review is part of a two-year learning and evidence project, EMERGE – or ‘Engendering Men: Evidence on Routes to Gender Equality’ – being undertaken by the Institute of Development Studies, Promundo-US and Sonke Gender Justice between January 2014 and January 2016, with funding from the UK Department for International Development (DFID). The evidence review, combined with other project elements, aims to cultivate stronger leadership for working with boys and men to promote gender equality, by gathering, interrelating, analysing and strategically disseminating evidence and lessons in targeted and accessible formats for improved learning, policy and practice

Reappraising men's sexual behaviors and gendered attitudes from the sexual-history narratives of South African men and women in a time of HIV/AIDS.

Includes abstract.Includes bibliographical references.While the frequent positioning of men's sexual behaviours as driving the HIV epidemic in South Africa has generated much interest in men's sexuality, much research to date has presented men as a homogenous group, or treats male sexuality as a set of isolated, individually driven behaviours. As a result, the current body of knowledge provides only a partial basis for meeting men's sexual and reproductive health (SRH) needs and addressing HIV-prevention among men. A narrative approach, which foregrounds the diversity and meaning in participant's lived experiences, was used in this study to examine the subjective and social impact of dominant norms of masculinity on South African men's sexual behaviours and gendered attitudes. This was expected to yield more nuanced, and contextualised understandings of men's SRH, with practical consideration for what means of men's sexual health can be enhanced. Fifty sexual-history interviews and ten focus group discussions with men, and twenty-five sexual-history interviews with women, were conducted with participants purposely sampled from three age categories (aged 18–24, 25–54, and 55+ years), a range of language and racial backgrounds, and urban and rural sites across five provinces in South Africa. The interviews were structured to elicit accounts of early knowledge of sex and sexual experimentation and to explore the range of sexual relationships and experiences among men and women throughout their adulthood. Participants' engagement with the risk of sexually transmitted infections, including HIV, and their reproductive health management were also explored. The data were analysed using the principles of thematic and narrative analysis, with NVivo software used for data management. The data appreciates the diversity and fluidity in men and women's lived experiences while recognising the social and cultural norms that structure sexuality. The narratives reveal a number of footholds for understanding how individual men both conform to and resist gender norms that can be damaging to their SRH. Such findings provide insights to inform how programmes and services could better engage men in HIV prevention and care. Especially, the study points to the value of a narrative approach to more deeply understand men's sexual risk and agency and the social structures, meanings and experiences that underlie it

Love matters: exploring conceptions of love in Rwanda and Swaziland and relationship to HIV and intimate partner violence.

Health risks such as intimate partner violence (IPV) and HIV infection often occur within intimate sexual relationships, yet the study of love and intimacy is largely absent from health research on African populations. This study explores how women and men in Rwanda and Swaziland understand and represent love in their intimate sexual partnerships. In Rwanda, 58 in-depth interviews with 15 couples, 12 interviews with activists, and 24 focus group discussions were carried out during formative and evaluative research of the Indashyikirwa programme, which aims to reduce IPV and support healthy couple relationships. In Swaziland, 117 in-depth, life-course interviews with 14 women and 14 men focused on understanding intimate sexual partnerships. We analysed these qualitative data thematically using a Grounded Theory approach. Participants described love as being foundational to their intimate sexual partnerships. Women and men emphasised that love is seen and expressed through actions and tangible evidence such as gifts and material support, acts of service, showing intentions for marriage, sexual faithfulness, and spending time together. Some participants expressed ambivalent narratives regarding love, gifts, and money, acknowledging that they desired partners who demonstrated love through material support while implying that true love should be untainted by desires for wealth. IPV characterised many relationships and was perceived as a threat to love, even as love was seen as a potential antidote to IPV. Careful scholarship of love is critical to better understand protective and risk factors for HIV and IPV and for interventions that seek to ameliorate these risks

Sexual coercion, consent and negotiation: processes of change amongst couples participating in the Indashyikirwa programme in Rwanda.

Sexual coercion among married or cohabitating couples is a complex phenomenon with few effective strategies for prevention. This paper explores sexual coercion among couples from rural Rwanda who participated in Indashyikirwa, a 4-year intimate partner violence prevention programme that included a 5-month couples curriculum to promote equalitarian, non-violent relationships. Drawing on three rounds of longitudinal qualitative interviews with partners from 14 couples (28 individuals), this paper explores processes of change in experiences and conceptualisations of coerced sex over the course of the intervention and 1 year after. The data were analysed using thematic and dyadic analysis. Both partners of couples reported significant changes in their sexual relationship, including reduced experiences of coerced sex, greater communication about sex and increased acceptability for women to initiate sex. Men and women became more willing to disclose sexual coercion over the course of the interviews, both current and past experiences, and couples' accounts generally became more concordant. Findings yield insights to inform programming to prevent coerced sex among spouses. These include grounding discussion of sexual coercion in an analysis of gendered power and norms, reflecting on the consequences of broader forms of sexual coercion and employing a benefits-driven, skills-based approach