Female sex workers living with HIV are at increased risk for negative health outcomes and multiple levels of stigma. However, there is limited research on female sex workers living with HIV and even less focused on reproductive health. We analyzed data using logistic regression from a cohort of 247 female sex workers of reproductive age living with HIV in Santo Domingo, Dominican Republic to assess factors associated with fertility desire. Most participants had children (93.1%; mean: 2.8; range: 1,8) and 28.3% reported fertility desire. Bivariate regression analysis uncovered that participants who desired children were less likely to report being on antiretroviral treatment and more likely to have a detectable viral load. Multivariate regression results showed participants who desired more children were: less likely to be older, have higher levels of HIV-related internalized stigma, have a history of pregnancy loss, have fewer children and have a perception that their partner has negative feelings about pregnancy. Individual and interpersonal characteristics were found to be associated with fertility desire in this study. Additional in-depth research is needed to understand how the role of stigma, partner dynamics and reproductive history as it relates to fertility desire, in order to ensure the reproductive health and wellbeing of this population.
Health facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana. Data on mothers (n = 783) aged 15–49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women's social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women's network structure and functions, as well as the interaction between network characteristics and facility delivery. Higher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10–2.34]) and informational support (OR: 1.66, CI: 1.08–2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21–4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care. Social support from network members was critical to facilitating health facility delivery, and support was further enhanced by women's network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women's social networks.
We applaud Merike Blofield and colleagues (January, 2022)1Blofield M Knaul F Calderon-Anyosa R et al.A diagonal and social protection plus approach to meet the challenges of the covid-19 syndemic: cash transfers and intimate partner violence interventions in Latin America.Lancet Glob Health. 2022; 10: e148-e153Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar for highlighting the potential of cash transfer programmes to reduce intimate partner violence (IPV) in Latin America during the COVID-19 pandemic. On the basis of our research in Latin America and other regions, we argue that the potential of cash transfers to reduce IPV is relevant globally. We also note important nuances to the points made by Blofield and colleagues, some of which are particularly relevant for other regions where the prevalence of IPV is highest. The authors limit their focus to this region, partly because Latin America's cash transfer programmes are among the most established. However, nascent cash transfer programmes in sub-Saharan Africa and south Asia also provide a unique opportunity to build integrated efforts for IPV prevention from inception. A key pathway through which cash transfers reduce IPV is by reducing poverty, and the impact is particularly strong in low-income countries. Indeed, gender-responsive social protection (including cash transfers) is key to sustainably reducing poverty. The authors focus on conditional cash transfers, noting that these programmes improve economic autonomy despite burdening women with having to fulfil conditions. We clarify that the evidence does not suggest that improvements in women's outcomes require these conditions. Unconditional cash transfer programmes have led to increased women's economic autonomy without increasing their time burden.2Bonilla J Zarzur RC Handa S et al.Cash for women's empowerment? A mixed-methods evaluation of the government of Zambia's child grant program.World Dev. 2017; 95: 55-72Crossref PubMed Scopus (39) Google Scholar Given that conditions can penalise the most marginalised households, we recommend that cash transfer programmes avoid hard conditions from the outset. The authors' Viewpoint centres on programmes targeted to women. However, cash transfers targeted to households can also reduce IPV, because cash transfers can alleviate risk factors for IPV (including poverty and associated household conflict) regardless of the transfer recipient.3Buller A Peterman A Ranganathan M Bleile A Hidrobo M Heise L A mixed-method review of cash transfers and intimate partner violence in low- and middle-income countries.World Bank Res Obser. 2018; 33: 218-258Crossref Scopus (82) Google Scholar Although targeting cash transfers to women might have additional benefits, it is not needed for cash transfers to reduce IPV. Moreover, effective case management that links households receiving cash transfers to other services can additionally reduce and respond to violence,4Botea I Coudouel A Heinemann A Kuttner S Safety first: how to leverage social safety nets to prevent gender based violence. World Bank, Washington, DC2021Google Scholar regardless of which household member is targeted for cash transfer. Blofield and colleagues1Blofield M Knaul F Calderon-Anyosa R et al.A diagonal and social protection plus approach to meet the challenges of the covid-19 syndemic: cash transfers and intimate partner violence interventions in Latin America.Lancet Glob Health. 2022; 10: e148-e153Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar call for more evidence from Latin America on cash transfers with complementary components aimed at violence reduction. We agree that more evidence is needed from Latin America, but we advocate for a broader research agenda. Through the Cash Transfer and Intimate Partner Violence Research Collaborative, we are generating mixed-methods evidence from Latin America, sub-Saharan Africa, and south Asia on how the impacts of cash transfer programmes are shaped by design features, complementary programming, and contextual factors, as well as whether impacts are sustained after the programme.5International Food Policy Research InstituteCash Transfer and Intimate Partner Violence Research Collaborative.https://www.ifpri.org/project/cash-transfer-and-intimate-partner-violence-research-collaborativeDate: 2021Date accessed: December 8, 2021Google Scholar We also call for evidence on cash transfers in crisis settings, which is increasingly crucial to inform programming for IPV prevention among vulnerable women globally. We declare no competing interests. A diagonal and social protection plus approach to meet the challenges of the COVID-19 syndemic: cash transfers and intimate partner violence interventions in Latin AmericaLatin America has been particularly hard hit by the COVID-19 syndemic, including the associated economic fallout that has threatened the livelihoods of most families. Social protection platforms and policies should have a crucial role in safeguarding individual and family wellbeing; however, the response has been insufficient to address the scale of the crisis. In this Viewpoint, we focus on two policy challenges of the COVID-19 syndemic: rapidly and effectively providing financial support to the many families that lost livelihoods, and responding to and mitigating the increased risk of intimate partner violence (IPV). Full-Text PDF Open Access
Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants’ interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW’s perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach.
The rise in opioid overdoses has disproportionately affected the Central Appalachian region of the United States. Stigma towards people who use drugs (PWUD) has limited access to life-saving harm reduction services in the region. Previous research has emphasized the need to engage communities to reduce stigma, yet these efforts can lead to backlash. The purpose of this study was to explore how stigma affects harm reduction practitioners' approaches to community engagement. We analyzed qualitative interviews with harm reduction practitioners (n = 35) in Central Appalachia. We used deductive and inductive coding, as well as narrative summaries, to identify harm reduction practitioners' descriptions of stigma and their resulting approaches to community engagement. We identified three in vivo codes that encapsulated the main community engagement strategies, "flying under the radar," "spreading the word," and "damage control," and assessed how each strategy influenced program operations. Most participants (n = 18) "spread the word," or conducted community engagement activities to combat social stigma about harm reduction services. While many were able to gain approval in the community, some experienced pushback from certain stakeholders. Eleven participants "flew under the radar," or decided not to engage stakeholders about their program, after perceiving that social and enacted stigma were too great to overcome. While they did not experience backlash, they could not access some funding sources or partner with state-sanctioned organizations. Finally, a few participants (n = 6) did not proactively choose an engagement approach and instead had to conduct "damage control" to assuage community concerns about their services. To determine the most appropriate engagement strategy, harm reduction practitioners may benefit from evaluating the levels of stigma within their community. Federal, state, and local funding and policy interventions are needed to augment stigma reduction efforts within Central Appalachia.
Background Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens. Methods Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis. Results Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be "likely" or "very likely" to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90–11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05–12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41–6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27–4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00–1.34/DR: AOR 1.07 per year; 95% CI 1.00–1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use. Conclusions We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.
Type 2 diabetes (T2D) is changing the burden of disease across Latin America. In this formative, qualitative study, we explored experiences of T2D diagnosis and management among adults in rural Dominican Republic. We conducted 28 in-depth interviews (12 men, 16 women) and used inductive analysis to explore the emotional burden of T2D and identify coping strategies. We found that stress relating to T2D began at diagnosis and persisted throughout management. Stress was produced by concerns about healthy food and medication access, fears about illness-induced injury, and the cyclical process of experiencing stress. Participants identified diabetes care and free medication services as external stress-reducers. Internally, participants’ mitigated stress by not thinking about diabetes (“ no dar mente”). Our study highlights the importance of a contextualized understanding of diabetes-related stress and the need for individual, clinic, and community-level interventions to reduce stressors and improve health outcomes among adults with T2D.
'%3e%3cpath fill='%23001489' d='M0 0v6h9V0z'/%3e%3cpath fill='%23e03c31' d='M0 0v3h9V0z'/%3e%3cg stroke='%23fff' stroke-width='2'%3e%3cpath id='d' d='m0 0 4.5 3L0 6m4.5-3H9'/%3e%3cuse xlink:href='%23b' stroke='%23ffb81c' clip-path='url(%23c)'/%3e%3c/g%3e%3cuse xlink:href='%23d' fill='none' stroke='%23007749' stroke-width='1.2'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)