HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia.

OBJECTIVE: To measure prevalence of HIV and syphilis and describe characteristics of sex work among female sex workers (FSWs) in Hargeisa, Somaliland, Somalia. METHODS: A cross-sectional survey recruited 237 FSWs using respondent-driven sampling (RDS). A face-to-face, structured interview using handheld-assisted personal interviewing (HAPI) on personal digital assistants (PDAs) was completed and blood collected for serological testing. RESULTS: FSWs 15-19 years old accounted for 6.9% of the population; 20-24 year-old constituted an additional 18.0%. The majority (86.6%) never attended school. International (59.0%) and interzonal (10.7%) migration was common. Most (95.7%) reported no other source of income; 13.8% had five or more clients in the last 7 days. A minority (38.4%) had heard of STIs, even fewer (6.9%) held no misconceptions about HIV. Only 24% of FSW reported using a condom at last transactional sex, and 4% reported ever been tested for HIV. HIV prevalence was 5.2% and syphilis prevalence was 3.1%. CONCLUSION: Sex work in Hargeisa, Somaliland, Somalia, is characterized by high numbers of sexual acts and extremely low knowledge of HIV. This study illustrates the need for targeted HIV prevention interventions focusing on HIV testing, risk-reduction awareness raising, and review of condom availability and distribution mechanisms among FSWs and males engaging with FSWs

Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: evidence from cross-sectional baseline and endline cluster surveys

Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27–4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99–22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings

A method for small-area estimation of population mortality in settings affected by crises.

BACKGROUND: Populations affected by crises (armed conflict, food insecurity, natural disasters) are poorly covered by demographic surveillance. As such, crisis-wide estimation of population mortality is extremely challenging, resulting in a lack of evidence to inform humanitarian response and conflict resolution. METHODS: We describe here a 'small-area estimation' method to circumvent these data gaps and quantify both total and excess (i.e. crisis-attributable) death rates and tolls, both overall and for granular geographic (e.g. district) and time (e.g. month) strata. The method is based on analysis of data previously collected by national and humanitarian actors, including ground survey observations of mortality, displacement-adjusted population denominators and datasets of variables that may predict the death rate. We describe the six sequential steps required for the method's implementation and illustrate its recent application in Somalia, South Sudan and northeast Nigeria, based on a generic set of analysis scripts. RESULTS: Descriptive analysis of ground survey data reveals informative patterns, e.g. concerning the contribution of injuries to overall mortality, or household net migration. Despite some data sparsity, for each crisis that we have applied the method to thus far, available predictor data allow the specification of reasonably predictive mixed effects models of crude and under 5 years death rate, validated using cross-validation. Assumptions about values of the predictors in the absence of a crisis provide counterfactual and excess mortality estimates. CONCLUSIONS: The method enables retrospective estimation of crisis-attributable mortality with considerable geographic and period stratification, and can therefore contribute to better understanding and historical memorialisation of the public health effects of crises. We discuss key limitations and areas for further development

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Experience of sexual intercourse and reported risk behaviour among an ethnically diverse sample of young people.

BACKGROUND: Certain Black and Minority Ethnic (BME) groups have been identified as bearing a disproportionate burden of sexual ill health in the UK. There still exists a significant gap in the evidence-base concerning the sexual behaviours of BME youth. METHODS: We conducted a cross-sectional survey of 16 secondary schools in London, where the proportion of BME students exceeded two-thirds of the intake. The aim was to identify the factors associated with sexual intercourse and sexual risk behaviours. RESULTS: 2801 students aged 15 to 18 completed questionnaires. Compared with White British males, Black males were significantly more likely to report sexual intercourse (OR 3.04, 95% CI 1.92-4.81). Compared with White British females, Asian females were significantly less likely to report sexual intercourse (OR 0.43, 95% CI 0.27-0.69). Both sexes reporting school as their main source of information, as opposed to their family, had a lower likelihood of intercourse (males OR 0.33, 95% CI 0.21-0.53, females OR 0.39, 95% CI 0.25-0.62). Compared with White British males, contraceptive use at first ever intercourse was significantly less likely among Black males (OR 0.35, 95% CI 0.16-0.98) and males of Mixed ethnicity (OR 0.24, 95% CI 0.06-0.92). Among females, higher sexual health knowledge was associated with contraceptive use (OR 4.69, 95% CI 1.76-12.49). Males reporting higher sexual health knowledge were more likely to be 'sexually competent' at first ever intercourse (OR 2.28, 95% CI 1.10-4.69). CONCLUSIONS: Given the importance of sexual health knowledge, ensuring this is improved among all ethnic groups, especially the Black and Mixed male groups, is a key message to arise from this study. Delivering this information in a 'culturally competent' manner is an important goal

Sexual health knowledge, attitudes and behaviours among an ethnically diverse sample of young people in the UK

Objective To provide evidence about the sexual health knowledge, attitudes and behaviours of an ethnically diverse sample of young people from Secondary/High schools in London. Design Cross-sectional questionnaire-based survey. The sample consisted of students in school Years 11 to 13 (aged 15–18 years), present in school on the day of questionnaire administration. Setting Sixteen Secondary/High schools in London where the Black and Minority Ethnic (BME) population exceeded two-thirds of the intake. Questionnaires were completed by 2602 students aged 15 to 18, who self-defined their ethnicity as follows: White British ( n= 559), White Other ( n = 256), Black ( n = 710) and Asian ( n = 1077). Method Self-administered 30-minute questionnaire completed under ‘exam’ conditions, distributed and collected by a team of ethnically diverse fieldworkers. This questionnaire recorded socio-demographic information, sexual health knowledge, sexual health attitudes, experience of sexual intercourse, and sexual risk behaviour and outcomes. Results BME groups, relative to White British, generally reported poorer sexual health knowledge. Low level knowledge regarding STIs was particularly evident. The White British students were generally the most liberal in their attitudes to sex. With 65 per cent of Black Caribbean males reporting experience of sexual intercourse, and 48 per cent reporting first intercourse under the age of 16, this group is possibly the most at risk of poor sexual health. Although less likely to report sexual inter-course than Black Caribbeans, Black African females and Asian males and females also reported risk behaviour. Conclusion The findings demonstrate diverse sexual health knowledge, sexual attitudes and sexual behaviours among ethnic groups. This diversity demonstrates the importance of tailoring health education and promotion to meet the specific needs of ethnic groups. </jats:p