Search

Decades of collective and cumulative work by practitioners, activists and researchers have made violence prevention an important part of international development agendas. However, violence prevention and response work addressing women and children has historically been siloed. Those working at the intersection of violence against women (VaW) and violence against children (VaC) have wrestled with the age–gender divide. Addressing the historical and political influences that underpin this divide will likely enhance progress towards more integrated strategies. This paper examines the origins and development of this polarisation and potential strategies for a more coordinated and collaborative agenda. This paper draws on the insights gained from eleven (11) semi-structured interviews conducted with key violence prevention actors in VaW and VaC from across the globe, alongside relevant published literature. Informants were purposively sampled on the basis of their expertise in the field. Findings reveal key differences and tensions between the two fields, including in collection and use of research and evidence, core conceptual frameworks, and the development, funding and implementation of policy and practice. Potential opportunities for future synergies between the two fields are highlighted, particularly through a focus on the adolescent girl. [ABSTRACT FROM AUTHOR]

Several health research organisations whose work focuses on international collaboration outline guidelines that support ethical practice in health research partnerships including building consensus around good collaborative research practice. This paper explores researcher's perspectives, experiences, and reflections on the elements of successful health research partnerships between Northern and Southern countries/institutions. The study adopted a qualitative research approach using in-depth interviews to explore what an authentic partnership is as experienced and aspired by stakeholders in health research partnerships in Zambia. Interviews were conducted with stakeholders implementing various health research activities in the country. Our findings revealed that Southern partners aspired for equal status and participation, transparency, and accountability, interdependency, and reciprocity, commitment to shared goals, open dialogue and sustainability in partnerships. While to some extent these aspirations overlap with the categories covered throughout the different partnership guidelines, some key aspects go beyond what is included in existing recommendations such as status and recognition which are salient in the broader guidelines. An important aspect in dismantling power structures that causes inequality in partnerships is through generating knowledge and innovation using local resources in the South to address local needs which can be subsequently re-used to address challenges at the global level. [ABSTRACT FROM AUTHOR]

Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9–13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector. [ABSTRACT FROM AUTHOR]

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative. [ABSTRACT FROM AUTHOR]

In this paper, we present findings from a qualitative study that gathered Nicaraguans’ perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, ‘beneficiary’ community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants’ positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs. [ABSTRACT FROM PUBLISHER]

Campus sexual violence risk reduction and resistance interventions have been developed and tested among female students in the global North and proven effective. Evidence-based interventions to prevent sexual violence tested amongst female students in the global South and in South African campuses are lacking. We present preliminary evidence of promise of Ntombi Vimbela! (NV!), a sexual violence prevention intervention piloted amongst first year female students in eight purposively selected campuses in South Africa. Focus group discussions were conducted with 118 female students who participated in NV! workshops. Most students found the content of NV! relevant and reported having experienced its positive effects. They perceived that NV! empowered them with skills to assess and deal with sexual assault risky situations. NV! changed their attitudes and beliefs about gender, shifted their acceptance of rape myths and beliefs, improved communication skills, enhanced self-esteem, and confidence to defend oneself in risky sexual assault situations. Few participants were unsure whether they will be able to use the skill in real life. These findings indicate a range of short-term positive outcomes which we anticipate would reduce the risk of sexual assault among first year female students. This suggests that NV! should be subject to further evaluation. [ABSTRACT FROM AUTHOR]

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or receiving HIV care in the context of antenatal care. Data were coded inductively and analysed thematically. Participants reported benefits of couple testing during antenatal care, including facilitated HIV status disclosure and mutual support for HIV care-seeking. However, unintended consequences included women attending without partners, being refused or delayed access to antenatal services. Some women were required to obtain letters from village leaders to justify the absence of their partners, again to delaying or disrupting care-seeking. When partners attended antenatal care, consultations were reportedly more likely to focus on HIV testing, and less on antenatal or neonatal care. Strategies to increase men's attendance at HIV clinics with their partners can promote mutual support within couples for HIV care engagement, but may risk undermining engagement in pregnancy and HIV care for some women if over-stringently applied. Efforts are needed to address the underlying pervasive stigma associated with HIV care, both alone and as a couple. [ABSTRACT FROM AUTHOR]

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services. [ABSTRACT FROM AUTHOR]

The burden of non-communicable diseases (NCDs) continues to grow in Vietnam, and reducing the burden of NCDs is a national priority. This study explored perspective of community health workers (CHWs), known as Village Health Workers (VHWs) in Vietnam, and public health leaders towards potential of expanding VHWs' role to deliver NCDs prevention and control services, and determined barriers and facilitators. We conducted focus group discussions (FGDs) with VHWs (n = 24) and in-depth interviews (IDIs) with public health administrators (n = 13). The findings show that VHWs in Vietnam deliver multiple public health services, including several NCDs related services. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Facilitators include government commitment to NCDs prevention and control, priority on capacity building, professional recognition and provision of incentives with availability of appropriate resources. While additional quantitative studies are needed to supplement the current qualitative findings, the current results inform the policy and intervention development in engaging VHWs in the delivery of community-based NCDs prevention and control initiatives in Vietnam. [ABSTRACT FROM AUTHOR]

Understanding the experiences of community health workers (CHWs) through the use of participatory visual methods (PVMs) has been relatively underexplored. One such PVM is photovoice, which involves the capture of photographic images related to issues of social importance. In this study, we explore challenges faced by eight CHWs in Mukono District, Uganda through the use of photovoice. Over a six-week period, CHWs captured 62 relevant photographs. Subsequent individual interviews and group discussions were held with the CHWs regarding the content of the photographs. Using traditional content analysis, a range of themes related to perceived challenges faced by the CHWs were highlighted, including poor infrastructure, insufficient on-going training and supervision, relationships with other health professionals and equipment supplies. Suggestions were raised as to why such challenges existed and how they could be addressed; mainly through increased roles of the government and supporting NGOs. Overall, photovoice was generally a feasible method to highlight the challenges faced by CHWs, however community acceptability regarding image capture and consent taking may prove challenging, given past historical experiences. The use of photovoice in this study highlighted the need to address the multiple and complex challenges faced by CHWs in order to help them fulfil their roles. [ABSTRACT FROM AUTHOR]

Adult HIV prevalence in Kenya was 5.9% in 2017. However, in the counties of Kisumu, Siaya, and Homa Bay, HIV prevalence was over 15%. Biomedical interventions, including home-based testing and counselling (HBTC), HIV treatment and pre-exposure prophylaxis (PrEP) provide opportunities to reduce HIV transmission, particularly in rural communities with limited access to health services. Faith-based institutions play an important role in the Kenyan social fabric, providing over 40% of all health care services in Kenya, but have played limited roles in promoting HIV prevention interventions. We conducted qualitative interviews with 45 medical professionals and focus groups with 93 faith leaders in Kisumu and Busia Counties, Kenya. We explored their knowledge, opinions, and experiences in promoting biomedical HIV prevention modalities, including HBTC and PrEP. Knowledge about and engagement in efforts to promote HIV prevention modalities varied; few health providers had partnered with faith leaders on HIV prevention programmes. Faith leaders and health providers agreed about the importance of increasing faith leaders' participation in HIV prevention and were positive about increasing their HIV prevention partnerships. Most faith leaders requested capacity building to better understand biomedical HIV prevention modalities and expressed interest in collaborating with clinical partners to spread awareness about HIV prevention modalities. [ABSTRACT FROM AUTHOR]

Increasing numbers of people living with HIV (PLHIV) in sub-Saharan Africa are experiencing failure of first-line antiretroviral therapy and transitioning onto second-line regimens. However, there is a dearth of research on their treatment experiences. We conducted in-depth interviews with 43 PLHIV on second- or third-line antiretroviral therapy and 15 HIV health workers in Kenya, Malawi and Mozambique to explore patients' and health workers' perspectives on these transitions. Interviews were audio-recorded, transcribed and translated into English. Data were coded inductively and analysed thematically. In all settings, experiences of treatment failure and associated episodes of ill-health disrupted daily social and economic activities, and recalled earlier fears of dying from HIV. Transitioning onto more effective regimens often represented a second (or third) chance to (re-)engage with HIV care, with patients prioritising their health over other aspects of their lives. However, many patients struggled to maintain these transformations, particularly when faced with persistent social challenges to pill-taking, alongside the burden of more complex regimens and an inability to mobilise sufficient resources to accommodate change. Efforts to identify treatment failure and support regimen change must account for these patients' unique illness and treatment histories, and interventions should incorporate tailored counselling and social and economic support. [ABSTRACT FROM AUTHOR]

Two common public models of community health centres (CHCs) exist in China, i.e. the ‘government-owned and government-managed’ CHCs (G-CHCs) and the ‘government-owned and hospital-managed’ CHCs (H-CHCs). Shanghai and Shenzhen are two Chinese megacities that lead the primary care development on the G-CHC and H-CHC models, respectively. Using a qualitative case study design, this study compares the management of the G-CHC model in Shanghai and H-CHC model in Shenzhen, through perspectives of a range of health providers. In each city, we randomly selected four CHCs and in total conducted 31 interviews with officers from the municipal health authorities, directors, GPs, nurses and public health doctors of the CHCs. When comparing with the H-CHC model in Shenzhen, the G-CHC model in Shanghai, a model with more simplified but accountable structure tended to present better management conditions, in terms of financial transparency, recruitment autonomy, community health workforce development (CHC staffing and family medicine training), funding and priority for public health. However, regardless of the models, staff retention remained a challenge. While our study tends to suggest that the G-CHC model in Shanghai presents better management conditions, future study can test whether and to what extent the model itself can lead to such differences. [ABSTRACT FROM AUTHOR]

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries - the United States, Nigeria, Pakistan, Peru and Mexico - to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations. [ABSTRACT FROM AUTHOR]