Psychosocial health in adolescent unmarried motherhood in rural Uganda: implications for community based collaborative mental health education, and empowerment strategies in the prevention of depression and suicide

Teenage pregnancy rates in Uganda are among the highest in Sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and recognised by Uganda’s government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally-living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress and social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon amongst this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers’ feelings of depression, while mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked the knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage, and, in a context of poor mental health service access, there is a substantial role for community mobilisation and promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach

Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

Background: Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously

Future international workforce programme – Uganda & Somaliland (FIWPUS) Grant Completion Report

We have completed a review of current guidelines and evidence regarding international nursing standards for education and practice, and updated this review to ensure it is relevant to 2022. This is evidenced by a written report

Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries.

BACKGROUND: Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. METHODS: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. RESULTS: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. CONCLUSION: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously

Home-based HIV counseling and testing : client experiences and perceptions in Eastern Uganda

BACKGROUND: Though prevention and treatment depend on individuals knowing their HIV status, the uptake of testing remains low in Sub-Saharan Africa. One initiative to encourage HIV testing involves delivering services at home. However, doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. METHODS: We conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6-12 months prior to the interviews. Semi-structured questionnaires elicited information on clients' experiences, from initial community mobilization up to receipt of results and access to HIV services post-test. RESULTS: We found that 95% of our respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. The majority of respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. Most respondents considered their own homes as more private than health facilities. Twelve respondents reported that they tested positive, 11 were referred for follow-up care, seven actually went for care, and only 5 knew their CD4 counts. All HIV infected individuals who were married or cohabiting had disclosed their status to their partners. CONCLUSION: These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention

Exploring 'spaces for community dialogue' among adults and children in collective identification, sharing and mitigation of HIV/AIDS concerns in Uganda

# Background Through experience and research, the Uganda government perceived the HIV/AIDS pandemic as a multi-dimensional problem and practically demonstrated that multi-sectoral and multidisciplinary interventions are the best approaches to address this. This calls for collaborative efforts among all stakeholders with respect to their mandates, areas of comparative advantage and expertise. In this study, we explored the role of 'spaces for community dialogues' among adults and children in the collective identification, sharing and mitigation of HIV/AIDS concerns in Uganda. # Methods This was an ethnographic study conducted between 2009 and 2015 in two purposively selected districts most hit by HIV/AIDS. We employed multiple data collection methods, including participant observation, in-depth interviews, focus group discussions, participatory rural appraisal and key informant interviews. Ethics clearance was obtained from Makerere University, College of Humanities and Social Sciences, and from the two social support agencies. Data were synthesised and analysed using thematic analysis. # Results Findings show that bazaars, mother or father talks, testing sites and regular spaces, banana beer parties, village meetings, school settings, and community events provided safe environments for interaction about HIV/AIDS concerns among children and adults. Children expressed their views through visual techniques with the support of adults. The use of catalysts facilitated effective interactions by harmonizing experiences of those directly impacted by HIV/AIDS and those providing the needed helping skills. # Conclusion Dialogue is an act of creations that cannot be consumed by participants. Spaces for dialogue are real sites that societies use in their daily interactions. Children are active participants in the struggle to mitigate the adverse effects of HIV/AIDS. Despite differences in ways of sharing messages, spaces in a community settings were deemed appropriate for dialogue on HIV/AIDS issues

Making Improvisations, Reconfiguring Livelihoods: Surviving the COVID-19 Lockdown by Urban Residents in Uganda

The declaration of the coronavirus disease 2019 (COVID-19) pandemic led to the enforcement of national lockdowns in several countries. While lockdowns are generally effective in containing the spread of infectious diseases, they are associated with negative impacts on livelihoods. Although evidence suggests that urban informal sector populations in low-resource settings bore the brunt of the adverse economic effects of COVID-19 lockdowns, there is little on how they survived. The article provides insights into the survival mechanisms of urban informal sector populations during a COVID-19 lockdown. Data are from narrative interviews with 30 residents of Kampala City and surrounding areas. We found that the COVID-19 lockdown chiefly jeopardized the livelihoods of urban residents through job loss and reduced incomes. Affected individuals and households primarily survived by making improvisations such as adjusting expenditures and reconfiguring their livelihoods. The cardinal elements of the informal sector, such as limited regulation, served as both a facilitator and constraint to survival. Therefore, the informal sector is an important buffer against livelihood shocks in situations of crisis. However, its inherent limitations imply that promoting livelihood resilience among urban residents during lockdowns and similar shocks may necessitate harnessing both formal and informal safety nets