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Despite the growing body of evidence demonstrating the high prevalence of intimate partner violence (IPV) among male couples and the unique antecedents to IPV that male couples may experience, research efforts have focused almost exclusively on North American populations. Missing from the literature is an understanding of the experience of IPV among male couples in African nations where social norms and legal restrictions around same-sex behavior may be more conservative. This paper presents data from an innovative study of male couples (Together Tomorrow) from two Southern African countries characterized by high prevalence of HIV: Namibia and South Africa. A one-time cross-sectional survey was conducted with 140 partnered MSM (70 couples) in Namibia and 300 partnered MSM (150 couples) in KZN, South Africa, for a total sample size of 440 partnered MSM (220 couples). Surveys measured the recent (12 month) experience of physical, sexual and emotional IPV and the experience of sexuality-related stressors. Reporting of IPV was relatively low: 7.3% reported being the victim of IPV from their male partner in the 12 months prior to the survey, and 10.2% reported participating in bi-directional IPV in their relationship in the previous 12 months. Men who reported different experiences of internalized homophobia and external acts of discrimination were more likely to report IPV and bi-directional IPV. The results offer several potential intervention points to disrupt pathways between stigma and IPV for partnered MSM in South Africa and Namibia, and point to the need for services for this critically overlooked population., Author(s): Rob Stephenson [sup.1] [sup.2] , Lynae A. Darbes [sup.2] [sup.3] , Tanaka Chavanduka [sup.2] , Zaynab Essack [sup.4] [sup.5] , Heidi van Rooyen [sup.4] [sup.6] Author Affiliations: (1) grid.214458.e, [...]

Background: Daily oral pre-exposure prophylaxis (PrEP) is available and recommended for men who have sex with men (MSM) at risk for HIV infection. Other HIV prevention products are being developed, including long-acting injectable (LAI) and event-based oral and topical formulations. Understanding preferences for potential products by MSM can help direct further development of prevention messaging. Methods: We present baseline data from HIV-negative participants enrolled in the US Mobile Messaging for Men (M-cubed) Study. Participants were asked their likelihood of and rank order preference for using daily oral PrEP and various potentia prevention products (one- to -three-month injections, 2-1-1 sexual event oral dosing, anal or penile gel, or anal suppository), and their sociodemographic characteristics. Bivariate and multivariable logistics regression assessed demographic associations with likelihood of use and rank order preference. Results: Overall, most MSM reported a likelihood of using LAI (74%), sexual event-based pills (67%) and penile gel (64%). Men who reported recent unprotected (condomless and PrEPless) anal sex most preferred a penile gel formulation (74%), followed closely by LAI and event-based pills (73% each). Current PrEP users (vs. non-users) had greater odds of reporting likelihood to use LAI (AOR = 3.29, 95% CI = 2.12 to 5.11), whereas men reporting recent unprotected anal sex had a greater odds of likelihood to use a penile gel (AOR = 1.79, 95% CI = 1.27 to 2.52) and an anal suppository (AOR = 1.48, 95% CI = 1.08 to 2.02). Hispanic/Latino (vs. White) MSM (AOR = 2.29, 95% CI = 1.40 to 3.73) and, marginally, Black MSM (AOR = 1.54, 95% CI = 1.00 to 2.38) had greater odds of reporting likelihood to use penile gel. Similar patterns were found for rank ordering preference of products, including condoms. Conclusions: Most MSM were interested in using various potential future HIV prevention products, especially LAI. However, two typologies of potential users emerged: men who prefer sexual event-based methods (condoms, event-based pill, sexua gels and suppositories) and men who prefer non-sexual event-based methods (daily pill, LAI). Men who reported recent unprotected anal sex preferred a penile gel product most, followed closely by sexual event-based pills and LAI. Racial/ethnic differences were noted as well. These findings on product preferences can help in formulation development and messaging. Keywords: PrEP; prophylaxis; HIV; MSM; men who have sex with men; prevention products; prevention methods, 1 | INTRODUCTION Currently available for use in the United States, daily administered PrEP in pill form is efficacious and recommended to prevent HIV infection in individuals at high risk [...]

The World Health Organization (WHO) estimated that in 2016 the global annual incidence of chlamydia, gonorrhoea, trichomoniasis and syphilis among people 15 to 49 years of age was 376.4 million [...]

Women in India experience high rates of intimate partner violence (IPV) and low rates of adherence to World Health Organization (WHO) breastfeeding guidelines, contributing to poor maternal and child health outcomes. However, there is little evidence for how IPV might influence ability to adhere to these guidelines in India. This study examines how different forms and severity levels of IPV are associated with current infant feeding behavior throughout the first year of life in an effort to begin to fill this gap in the literature and provide information to improve infant feeding programs. Data are analyzed from the 2015 Indian National Family Health Survey. The sample comprised women who reported initiating breastfeeding in the past 12 months and who were selected for the Domestic Violence Module (n = 6812). Two outcome variables were created to measure current adherence to the WHO breastfeeding guidelines for mothers of 1) infants 6 months and younger and 2) infants 7 to 12 months. Two logistic regression models were fit to measure associations between the outcome variables and non-severe physical violence, severe physical violence, and sexual violence. Less than one-third of women reported adhering to WHO breastfeeding guidelines. Only severe physical violence was significantly associated with lower odds of current exclusive breastfeeding among mothers of infants 0 to 6 months. This analysis advances the understanding of how IPV is associated with suboptimal breastfeeding behavior by categorizing the severity of violence and including infants through the first year of life. The results suggest it may be crucial to focus intervention efforts on mothers with younger infants if the negative health effects of early weaning are to be avoided. Additional study of IPV in mothers of older infants should focus on the temporality of violence, which may elucidate additional findings regarding IPV and breastfeeding in this population., Author(s): Nicholas Metheny [sup.1] [sup.2] , Rob Stephenson [sup.1] [sup.2] Author Affiliations: (1) grid.214458.e, 0000000086837370, University of Michigan School of Nursing, , 400 North Ingalls St, 48109, Ann Arbor, MI, [...]

Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies., Author(s): Rob Stephenson [sup.1] [sup.2] , A. Sharma [sup.2] , M. J. Mimiaga [sup.3] [sup.4] [sup.5] [sup.6] , R. Garofalo [sup.7] [sup.8] , E. Brown [sup.6] , A. Bratcher [sup.9] [...]

CONTEXT: Variability in the conceptualization and measurement of women's empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy--a specific measure of empowerment--and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. METHODS: Survey data were collected from a sample of 325 urban Ghanaian women aged 15-24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales--decision making and communication--and women's use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. RESULTS: In multivariable analyses, reproductive autonomy decision making--but not reproductive autonomy communication--was positively associated with women's modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1-9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. CONCLUSIONS: The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context. Contexto: La variabilidad en la conceptualizaciony medicion del empoderamiento de las mujeres ha resultado en hallazgos inconsistentes con respecto a las relaciones entre el empoderamiento y los resultados de salud sexual y reproductiva. La autonomia reproductiva--una medida especifica del empoderamiento--y su papel en el uso de anticonceptivos modernos, rara vez han sido evaluados en contextos subsaharianos. Metodos: Los datos de la encuesta se obtuvieron a partir de una muestra de 325 mujeres urbanas ghanesas de 15 a 24 anos de edad, reclutadas en centros de salud y escuelas en Kumasi y Accra en marzo de 2015. Se utilizaron analisis de regresion logistica bivariada y multivariada para examinar las asociaciones entre dos subescalas adaptadas de autonomia reproductiva: toma de decisiones y comunicacion, asi como el uso de anticonceptivos modernos en la ultima relacion sexual por parte de las mujeres, despues de controlar covariables demograficas, reproductivas y el contexto social (i.e. aprobacion y el estigma relacionado con la salud sexual y reproductiva de las adolescentes). Resultados: En los analisis multivariados, la toma de decisiones sobre la autonomia reproductiva--pero no la comunicacion sobre la autonomia reproductiva--se asocio positivamente con el uso de anticonceptivos modernos por parte de las mujeres en la ultima relacion sexual (razon de probabilidades, 1.1); La edad, haber estado empleada en los ultimos siete dias y vivir en Kumasi tambien se asocio positivamente con el uso de anticonceptivos modernos (1.1-9.8), mientras que el hecho de haber tenido un embarazo previo se asocio negativamente con el resultado (0.3). La toma de decisiones sobre autonomia reproductiva se asocio positivamente con el uso de anticonceptivos en un modelo posterior que incluyo la aprobacion social de la salud sexual y reproductiva de las adolescentes (1.1), pero no en los modelos que incluyeron el estigma hacia la salud sexual y reproductiva de las adolescentes. Conclusiones: La construccion teorica de la autonomia reproductiva y la subescala de toma de decisiones en particular, demostraron tener relevancia para los resultados de planificacion familiar entre las mujeres jovenes en Ghana y pueden tener utilidad en entornos globales. Las investigaciones futuras deben explorar la comunicacion sobre autonomia reproductiva y los posibles efectos de confusion del contexto social. Contexte: La variabilite de la conceptualisation et de la mesure de l'autonomisation des femmes a produit des conclusions divergentes sur les relations entre l'autonomisation et les resultats de sante sexuelle et reproductive. L'autonomie reproductive--une mesure specifique de l'autonomisation--et son role dans la pratique contraceptive moderne n'ont guere ete evalues dans les contextes subsahariens. Methodes: Les donnees de l'etude proviennent d'un echantillon de 325 Ghaneennes urbaines agees de 15 a 24 ans, recrutees dans des structures sanitaires et ecoles de Kumasi et d'Accra en mars 2015. Des analyses de regression logistique bi- et multivariees ont servi a l'examen des associations entre deux sous-echelles adaptees d'autonomie reproductive--la prise de decision et la communication--et la pratique de la contraception moderne des femmes au dernier rapport sexuel, sous controle des covariables de contexte demographique, reproductif et social (approbation et stigmatisation a l'egard de la sante sexuelle et reproductive des adolescentes). Resultats: Dans les analyses multivariees, la prise de decision liee a l'autonomie reproductive--mais pas la communication--s'est revelee associee positivement a la pratique contraceptive moderne des femmes au dernier rapport sexuel (RC, 1,1). L'age, l'emploi durant les sept jours precedents et la residence a Kumasi presentent aussi une association positive avec la pratique contraceptive moderne (1,1-9,8), tandis que l'existence d'une grossesse anterieure est en association negative avec ce resultat (0,3). L'association positive de la prise de decision en matiere d'autonomie reproductive avec la pratique contraceptive se maintient dans un modele ulterieur tenant compte de l'approbation sociale de la sante sexuelle et reproductive des adolescentes (1,1), mais pas dans ceux tenant compte de la stigmatisation a son egard. Conclusions: Le concept d'autonomie reproductive, et la sous-echelle de prise de decision en particulier, se sont averes pertinents en termes de resultats de la planification familiale parmi les jeunes femmes du Ghana et pourraient se reveler utiles dans les contextes mondiaux. La recherche future devra etudier plus avant la communication, eu egard a l'autonomie reproductive, et les effets de confusion potentiels du contexte social., Unintended pregnancy, commonly defined as a pregnancy that is mistimed or unwanted, occurs disproportionately among socially disadvantaged women and is often related to a woman's lack of autonomy or power [...]

Ongoing internal conflict, high gender inequality, and a patriarchal society contribute to a high prevalence of intimate partner violence towards women (IPV) in Afghanistan. Seeking help from formal and informal sources can provide social support to IPV survivors, buffering negative health consequences. The purpose of this study is to examine the individual, interpersonal, and community-level factors associated with help-seeking for physical, sexual, and emotional IPV in Afghanistan using a nationally-representative sample of women aged 15-49. Data for this analysis comes from the 2015 Afghanistan Demographic and Health Survey. The outcome variable is a binary measure of informal or formal help-seeking behavior among women who reported physical, sexual, or emotional IPV in the last 12 months. Drawing on existing theory of help-seeking for IPV, key covariates included summative indices of health care use, decision-making power, and barriers to accessing health care measured at both the individual and community levels using multilevel modeling. Nearly half (46%) of women in the dataset reported experiencing some type of IPV in the past 12 months. Among the 20% of women who reported seeking help for IPV, informal sources of support were used almost universally. Engagement with the health care system, barriers to accessing health care, and decision-making power were all significantly associated with seeking help for IPV. IPV is widespread in Afghanistan and help-seeking is uncommon. A better understanding of what shapes help-seeking in this context may allow more women to disclose violence, increasing social support and reducing the negative health effects of IPV., Author(s): Nicholas Metheny [sup.1] [sup.2] , Rob Stephenson [sup.1] [sup.2] Author Affiliations: (Aff1) 0000000086837370, grid.214458.e, University of Michigan School of Nursing, , 400 North Ingalls St., 48109, Ann Arbor, MI, [...]

Objective To assess the prevalence of physical and sexual violence motivated by perception of sexual orientation and gender identity in sexual and gender minorities. Methods We searched nine databases without language restrictions for peer- reviewed and grey literature published from 2000 to April 2016. We included studies with more than 50 participants that measured the prevalence of physical and sexual violence perceived as being motivated by sexual orientation and gender identity or gender expression. We excluded intimate partner violence and self-harm. Due to heterogeneity and the absence of confidence intervals in most studies, we made no meta-analysis. Findings We included 76 articles from 50 countries. These covered 74 studies conducted between 1995 and 2014, including a total of 202607 sexual and gender minority participants. The quality of data was relatively poor due to a lack of standardized measures and sometimes small and non-randomized samples. In studies where all sexual and gender minorities were analysed as one population, the prevalence of physical and sexual violence ranged from 6% (In a study including 240 people) to 25% (49/196 people) and 5.6% (28/504) to 11.4% (55/484), respectively. For transgender people the prevalence ranged from 11.8% (of a subsample of 34 people) to 68.2% (75/110) and 7.0% (in a study including 255 people) to 49.1% (54/110). Conclusion More data are needed on the prevalence, risk factors and consequences of physical and sexual violence motivated by sexual orientation and gender identity in different geographical and cultural settings. National violence prevention policies and interventions should include sexual and gender minorities. Objectif Estimer la prevalence des violences physiques et sexuelles motivees par la perception de l'orientation sexuelle et de l'identite de genre dans les minorltes sexuelles. Methodes Nous avons recherche dans neuf bases de donnees, sans restriction de langue, des documents soumis a comite de lecture ou non et publies entre 2000 et avril 2016. Nous avons Indus les etudes de plus de 50 participants qul ont mesure la prevalence des violences physiques et sexuelles pergues comme etant motivees par l'orientation sexuelle et l'identite ou l'expression de genre. Nous avons exclu les violences conjugales et les actes auto-agresslfs. En raison de l'heterogenelte des etudes et de l'absence d'Intervalle de confiance dans la plupart d'entre elles, nous n'avons pas realise de meta-analyse. Resultats Nous avons pris en compte 76 articles provenant de 50 pays. Ceux-cl s'interessaient a 74 etudes, menees entre 1995 et 2014, qul portaient sur un total de 202 607 participants issus de minorites sexuelles. La qualite des donnees etait relativement mauvalse a cause de l'absence de mesures standardlsees et, parfols, d'echantillons reduits et non randomises. Dans les etudes qui ont analyse l'ensemble des minorites sexuelles comme une seule population, la prevalence des violences physiques et sexuelles allait respectivement de 6% (dans une etude sur 240 personnes) a 25% (49/196 personnes) et de 5,6% (28/504) a 11,4% (55/484). Pour les personnes transgenre, la prevalence allait de 11,8% (dans un sousgroupe de 34 personnes) a 68,2% (75/110) et de 7,0% (dans une etude sur 255 personnes) a 49,1 % (54/110). Conclusion Il est necessalre d'avoir davantage de donnees sur la prevalence, les facteurs de risque et les consequences des violences physiques et sexuelles motivees par l'orientation sexuelle et l'identite de genre dans dlfferentes regions et dlfferents contextes cultureis. Les politiques et les actions nationales de prevention de la violence devralent prendre en compte les minorltes sexuelles. Objetivo Evaluar la prevalence de la violencia fisica y sexual motivada por la percepcion de la orientacion sexual y la Identidad de genero en las minorias sexuales y de genero. Metodos Se realizaron busquedas en nueve bases de datos sin restricciones de idioma en busca de literatura gris y examinada por expertos publicada desde 2000 hasta abril de 2016. Incluimos estudios con mas de 50 participantes que midieron la prevalencia de la violencia fisica y sexual percibida como motivada por la orientacion sexual y la identidad o la expresion de genero. Excluimos la violencia en la pareja intima y la autolesion. Debido a la heterogeneidad y la ausencia de intervalos de confianza en la mayoria de los estudios, no realizamos ningun metanalisis. Resultados Se incluyeron 76 articulos de 50 paises. Estos cubrieron 74 estudios realizados entre 1995 y 2014, incluyendo un total de 202.607 participantes de minorias sexuales y de genero. La calidad de los datos fue relativamente baja debido a la falta de medidas estandarizadas y, en ocasiones, muestras pequenas y no aleatorizadas. En los estudios en los que todas las minorias sexuales y de genero se analizaron como una unica poblacion, la prevalencia de la violencia fisica y sexual vario del 6% (en un estudio que incluia a 240 personas) al 25% (49/196 personas) y del 5,6% (28/504) al 11,4% (55/484), respectivamente. Para las personas transexuales, la prevalencia vario del 11,8% (de una submuestra de 34 personas) al 68,2% (75/110) y del 7,0% (en un estudio que incluyo a 255 personas) al 49,1% (54/110). Conclusion Se necesitan mas datos sobre la prevalencia, los factores de riesgo y las consecuencias de la violencia fisica y sexual motivada por la orientacion sexual y la identidad de genero en diferentes entornos geograficos y culturales. Las politicas e intervenciones nacionales de prevencion de la violencia deberian incluir las minorias sexualesy de genero., Introduction On 17 June 2011, the United Nations (UN) Human Rights Council passed a resolution that expressed grave concern at violence and discrimination against individuals based on their sexual orientation [...]

CONTEXT: Intimate partner violence (IPV) is associated with negative physical and mental health outcomes. Antenatal care can act as a link to IPV services, but experiencing IPV may be associated with reduced uptake of antenatal care, an issue that has received little attention from researchers. METHODS: A scoping review was conducted to synthesize quantitative research on IPV and uptake of antenatal care in low-resource settings. Keyword searches of PubMed and other databases and snowball searches of reference lists were conducted to identify articles published in 2005-2015 that measured one or more types of IPV (physical, sexual or emotional) or controlling behavior and assessed the relationship of such abuse with use of antenatal care. For each identified article, key characteristics and findings were abstracted, and study quality was assessed. RESULTS: Sixteen articles, representing 10 low- and middle-income countries, met the inclusion criteria. Most studies were of medium-to-high quality but low rigor, reflecting the abundance of cross-sectional studies in the literature. In all 16 studies, IPV was negatively associated with initiation of antenatal care, number of visits or use of a skilled provider. Analyses revealed reduced odds of antenatal care use among women who had experienced IPV (odds ratios, 0.5-0.8) and elevated odds of antenatal care use among women who had not experienced IPV or of nonuse among women who had experienced IPV (1.2-4.1). CONCLUSION: Women in low-resource settings who experience IPV have a reduced likelihood of obtaining optimal antenatal care and may benefit from interventions to mitigate barriers to care., Global estimates suggest that approximately 30% of everpartnered women of reproductive age (15-49) report having experienced physical or sexual violence perpetrated by an intimate male partner. (1) The prevalence of [...]

CONTEXT: Use of maternal health care can reduce maternal morbidity and mortality in countries like Bangladesh, where rates of these outcomes are high. Community characteristics are associated with use of maternal care services, but it is unclear whether deviation from community norms is associated with service use. METHODS: Data from the 2014 Bangladesh Demographic and Health Survey on 4,106 ever-married women aged 15-49 were used to examine relationships between women's deviation from their communities on socioeconomic, fertility and other characteristics and use of maternal health care (antenatal care, delivery care, postpartum care and a composite measure). Characteristics were examined at the individual and community levels and as deviance variables that indicated whether respondents differed from local norms in a positive way (e.g., being employed when others were not) or a negative way (being unemployed when others had jobs). Associations were identified using logistic regression. RESULTS: Sixty-three percent of women had had postpartum care; smaller proportions had had delivery care (40%), antenatal care (27%) or all three types (17%). Several deviance variables were associated with service use. Negative deviance on women's employment was associated with antenatal care (odds ratio, 1.3); positive deviance on violence justification, exposure to family planning messages and husband's employment was associated with delivery care (1.3-4.8); positive deviance on husband's employment was associated with not receiving postpartum care (0.7); and negative deviance on women's employment and positive deviance on age at marriage were associated with receipt of all three services (1.4-1.7). CONCLUSION: Understanding associations between deviation from community norms and receipt of maternal health care may provide deeper understanding of variation within communities regarding whether women use services., Although the global maternal mortality ratio dropped by 44% between 1990 and 2015,1 maternal mortality remains high. Approximately 303,000 women died from complications of pregnancy and childbirth in 2015, (1) [...]

: Background: Daily oral pre‐exposure prophylaxis (PrEP) is available and recommended for men who have sex with men (MSM) at risk for HIV infection. Other HIV prevention products are being developed, including long‐acting injectable (LAI) and event‐based oral and topical formulations. Understanding preferences for potential products by MSM can help direct further development of prevention messaging. Methods: We present baseline data from HIV‐negative participants enrolled in the US Mobile Messaging for Men (M‐cubed) Study. Participants were asked their likelihood of and rank order preference for using daily oral PrEP and various potential prevention products (one‐ to ‐three‐month injections, 2‐1‐1 sexual event oral dosing, anal or penile gel, or anal suppository), and their sociodemographic characteristics. Bivariate and multivariable logistics regression assessed demographic associations with likelihood of use and rank order preference. Results: Overall, most MSM reported a likelihood of using LAI (74%), sexual event‐based pills (67%) and penile gel (64%). Men who reported recent unprotected (condomless and PrEPless) anal sex most preferred a penile gel formulation (74%), followed closely by LAI and event‐based pills (73% each). Current PrEP users (vs. non‐users) had greater odds of reporting likelihood to use LAI (AOR = 3.29, 95% CI = 2.12 to 5.11), whereas men reporting recent unprotected anal sex had a greater odds of likelihood to use a penile gel (AOR = 1.79, 95% CI = 1.27 to 2.52) and an anal suppository (AOR = 1.48, 95% CI = 1.08 to 2.02). Hispanic/Latino (vs. White) MSM (AOR = 2.29, 95% CI = 1.40 to 3.73) and, marginally, Black MSM (AOR = 1.54, 95% CI = 1.00 to 2.38) had greater odds of reporting likelihood to use penile gel. Similar patterns were found for rank ordering preference of products, including condoms. Conclusions: Most MSM were interested in using various potential future HIV prevention products, especially LAI. However, two typologies of potential users emerged: men who prefer sexual event‐based methods (condoms, event‐based pill, sexual gels and suppositories) and men who prefer non‐sexual event‐based methods (daily pill, LAI). Men who reported recent unprotected anal sex preferred a penile gel product most, followed closely by sexual event‐based pills and LAI. Racial/ethnic differences were noted as well. These findings on product preferences can help in formulation development and messaging., INTRODUCTION Currently available for use in the United States, daily administered PrEP in pill form is efficacious and recommended to prevent HIV infection in individuals at high risk for HIV [...]

Introduction: The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. Methods: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Results: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p = 0.002). Conclusions: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting. Keywords: adolescent; transition; HIV; care engagement; continuum; engagement; youth, Introduction Adolescents and young adults represent a growing number of people living with HIV in the United States, reflecting both improvements in survival among perinatally infected youth and the rising [...]

CONTEXT: The literature on intimate partner violence in resource-poor contexts relies primarily on cross-sectional studies. Because changes in women's status and empowerment are hypothesized to influence violence vulnerability, longitudinal studies [...]

CONTEXT: Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions. To increase uptake of preventive services and behaviors, it is important to [...]

CONTEXT: In many parts of Africa, women are most likely to become infected with HIV by having unprotected sex with their husbands, who may have acquired the virus through extramarital [...]

Objectives. I examined the role of community-level factors in the reporting of risky sexual behaviors among young people aged 15 to 24 years in 3 African countries with varying HIV prevalence rates. Methods. I analyzed demographic and health survey data from Burkina Faso, Ghana, and Zambia during the period 2001 through 2003 to identify individual, household, and community factors associated with reports of risky sexual behaviors. Results. The mechanisms through which the community environment shaped sexual behaviors varied among young men and young women. Community demographic profiles were not associated with reports of risky sexual behavior among young women but were influential in shaping the behavior of young men. Prevailing economic conditions and the behaviors and attitudes of adults in the community were strong influences on young people's sexual behaviors. Conclusions. These results provide strong support for a focus on community-level influences as an intervention point for behavioral change. Such interventions, however, should recognize specific cultural settings and the different pathways through which the community can shape the sexual behaviors of young men and women. doi:10.2105/AJPH.2007. 126904)

CONTEXT: Although a growing number of studies have examined how community factors influence contraceptive use, few have explored how such factors affect method choice. METHODS: Data from the 1998 South [...]

Introduction: The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. Methods: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Results: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p = 0.002). Conclusions: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting. Keywords: adolescent; transition; HIV; care engagement; continuum; engagement; youth, Introduction Adolescents and young adults represent a growing number of people living with HIV in the United States, reflecting both improvements in survival among perinatally infected youth and the rising [...]

Objectives. We examined the role of community-level factors in explaining geographic variations in modern contraceptive use in 6 African countries. Methods. We analyzed Demographic and Health Survey and contextual data sources with multilevel modeling techniques to identify factors contributing to geographic variations in women's use of modern contraceptives. Results. We found significant associations between several community-level factors and reported use of modern contraceptive methods. We also identified several pathways of influence between the community and the individual. Conclusions. Aspects of a community's sociocultural and economic environment appear to influence a woman's use of modern contraceptive methods.

CONTEXT: Although there is increasing recognition of the global scope of domestic violence and the potential reproductive health consequences of violence, little is known about the relationship between physical and [...]

Objective. We examined the effect of physical violence during pregnancy on perinatal and early-childhood mortality. Methods. We estimated the prevalence of domestic violence during pregnancy among a population-based sample of 2199 women in Uttar Pradesh, India. We used a survival regression model to examine the risks for perinatal, neonatal, postneonatal, and early-childhood (aged 1-3 years) mortality by mother's exposure to domestic violence, after we controlled for other sociodemographic and maternal health behavior risk factors. Results. Eighteen percent of the women in our study experienced domestic violence during their last pregnancy. After we adjusted for other risk factors, births among mothers who had experienced domestic violence had risks for perinatal and neonatal mortality that were 2.59 (95% confidence interval [CI] = 1.35, 4.95) and 2.37 (95% CI = 1.21, 4.62) times higher, respectively, than births among mothers who had not experienced violence. We found no significant associations between domestic violence and either postneonatal or early-childhood mortality. Conclusions. Domestic violence is a significant risk factor for perinatal and neonatal mortality.

CONTEXT: Although the vast majority of Pakistani women are familiar with family planning methods, use of contraceptives remains low. Identifying the characteristics of family planning providers and health facilities that [...]

This study examines the association between domestic violence and the subsequent adoption of modern contraception in North India. Matched data on married couples who were not practicing contraception are analyzed from companion surveys of married husbands and wives in five districts of Uttar Pradesh. By means of hazard modeling, a significant negative association was found between a husband's reporting of using physical domestic violence against his wife and the couple's adoption of a modern method of contraception. Community norms that were more tolerant of domestic violence were, in contrast, not a significant predictor of subsequent method adoption. The results highlight the need to address the issue of support for women experiencing domestic violence within existing family planning services and to sensitize service providers to the specific needs of women experiencing such violence., During the past decade, a discernible increase has occurred in awareness of the global scope and significance of domestic violence (Heise et al. 1994a, 1994b, and 1999). In addition to [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.chiabu.2005.10.009 Byline: Rob Stephenson (a), Payam Sheikhattari (b), Nazilla Assasi (c), Hassan Eftekhar (d), Qasem Zamani (c), Bahram Maleki (e), Hamid Kiabayan (f) Keywords: Child maltreatment; School; Iran Abstract: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes, and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. Author Affiliation: (a) HUBERT Department of Global Health, The Rollins School of Public Health, Emory University, 1518 Clifton Road NE #722, Atlanta, GA 30322, USA (b) Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (c) Departments of Epidemiology and Biostatistics, School of Public Health, Tehran Medical University, Tehran, Iran (d) Department of Health Services, School of Public Health, Tehran Medical University, Tehran, Iran (e) Kurdistan Modares Teacher Training Center, Taleghani Street, Sohrevardi Square, Sanandaj, Iran (f) American Professional Society on the Abuse of Children (APSAC), Chicago, IL, USA Article History: Received 3 March 2004; Revised 28 September 2005; Accepted 13 October 2005

Objective: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes, and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. Methods: Data were collected from 1,370 school students, age 11-18. Separate logistic models are fitted for six binary outcomes examining self-reported experiences of physical maltreatment in the home or school, mental maltreatment in the home or school, and child neglect in the home or school. Results: Male children were more likely to report experiencing any kind of child maltreatment than girls. Residency in a rural area, poor parental relationships and the use of addictive substances by household members were associated with increased odds of reporting child maltreatment. Poor school performance was associated with the reporting of experiencing maltreatment at school. Conclusion: Each of the forms of child maltreatment is highly correlated with socioeconomic, demographic, and living condition factors. The results point to the strong influence that familial factors have in shaping a child's likelihood of reporting maltreatment. Characteristics of the mother were associated with maltreatment, but not characteristics of the father. The results highlight a number of mechanisms through which public health interventions may seek to reduce the prevalence of child maltreatment in Kurdistan; different approaches are needed to reduce child maltreatment in the home and school environments. Keywords: Child maltreatment; School; Iran

Objectives. We examined individual- and community-level influences on domestic violence in Uttar Pradesh, North India. Methods. Multilevel modeling was used to explore domestic violence outcomes among a sample of 4520 married men. Results. Recent physical and sexual domestic violence was associated with the individual-level variables of childlessness, economic pressure, and intergenerational transmission of violence. A community environment of violent crime was associated with elevated risks of both physical and sexual violence. Community-level norms concerning wife beating were significantly related only to physical violence. Conclusions. Important similarities as well as differences were evident in risk factors for physical and sexual domestic violence. Higher socioeconomic status was found to be protective against physical but not sexual violence. Our results provide additional support for the importance of contextual factors in shaping women's risks of physical and sexual violence.

Objectives. Previous studies of maternal health-seeking behavior focused on individual- and household-level factors. We examined community-level influences on the decision to deliver a child in a health facility across 6 African countries. Methods. Demographic and Health Survey data were linked with contextual data, and multilevel models were fitted to identify the determinants of childbirth in a health facility in the 6 countries. Results. We found strong community-level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified. Conclusions. Community economic development, the climate of female autonomy, service provision, and fertility preferences all exert an influence on a woman's decision to seek care during labor, but significant community variation remains unexplained.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2004.08.057 Byline: Alaka Malwade Basu (a), Rob Stephenson (b) Keywords: Maternal schooling; Education; Child mortality; India Abstract: This paper examines the impact of 'low' levels of maternal education on the proximate determinants of child mortality using data from the 1992/93 Indian National Family Health Survey. Twenty-two outcomes are investigated, representing child mortality and morbidity, illness management, service utilization and health behaviours. Maternal education is a significant correlate of each of the outcomes, and even low levels of education increase child survival prospects and health-related behaviours, except for neonatal mortality and the effective management of diarrhoea. We speculate on some of the possible mechanisms behind such impressive findings and suggest that rather than female autonomy, it may be the 'hidden curriculum' values of discipline and obedience of authority that account for them. Author Affiliation: (a) Department of Sociology, Cornell University, 352 Uris Hall, Ithaca, NY 14853, USA (b) Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA

This paper examines the impact of 'low' levels of maternal education on the proximate determinants of child mortality using data from the 1992/93 Indian National Family Health Survey. Twenty-two outcomes are investigated, representing child mortality and morbidity, illness management, service utilization and health behaviours. Maternal education is a significant correlate of each of the outcomes, and even low levels of education increase child survival prospects and health-related behaviours, except for neonatal mortality and the effective management of diarrhoea. We speculate on some of the possible mechanisms behind such impressive findings and suggest that rather than female autonomy, it may be the 'hidden curriculum' values of discipline and obedience of authority that account for them. Keywords: Maternal schooling; Education; Child mortality; India

Objectives. There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. Methods. Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. Results. The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. Conclusions. Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.

The detrimental impact of short preceding birth intervals on infant and early childhood mortality is well documented in demographic literature, although the pathways of influence within the relationship remain an area of debate. This paper examines the impact of the length of the preceding birth interval on under-two mortality in India, and examines the pathways through which short preceding birth intervals may lead to an increased risk of mortality. Three mortality periods are examined: neonatal, early post neonatal and late post-neonatal and toddler, using the 1992 Indian National Family Health Survey. A multilevel modelling approach is used to account for the hierarchical nature of the data. The determinants of infants following a short or long birth interval are also examined. The results show that short preceding birth, intervals (< 18 months) are associated with an increased risk of mortality in all three age groups, and the effect is particularly marked in the early post-neonatal period. Significant interactions were found between the length of the preceding birth interval and maternal education, gender and the survival status of the previous child. The significance of these interactions varied with the age of the child. The results highlight the diluting effect that a higher level of maternal education has on the relationship between short preceding birth intervals and mortality risk. There is evidence to suggest that sibling rivalry is a pathway through which short birth intervals influence mortality, with the death of the previous sibling removing the competition for scarce resources, and resulting in lower risks of mortality than if the previous sibling was still alive. The greatest risks of an infant following a short birth interval are among those whose previous sibling died, high parities, those with young mothers, and those whose previous sibling was breastfed for a short duration. Keywords: Birth spacing; Mortality; Sibling rivalry; Multilevel modelling; India

This study examines the determinants of tire use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which tire individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular 'community' effect on service use. (STUDIES IN FAMILY PLANNING 2002; 33[4]: 309-320), Studies of the use of reproductive health-care services have focused on the influence of individual and household characteristics and have largely ignored the influence of community attributes and the characteristics [...]

We set out to explore the influence of environment on ethnic inequalities in health. Studies exploring the relationship between environment and health have tended to ignore the role of ethnicity, and the health impact of the residential concentration of ethnic minority groups in disadvantaged areas. Those that have explored the role of ethnicity tend to focus on the way in which residential concentration may promote a sense of community among ethnic minority groups, and, consequently, may be protective of health (the `ethnic density effect'). Again, they have tended to ignore the health impact of the concentration of ethnic minority groups in areas of social and economic disadvantage. We undertook a factor analysis to determine aspects of perception of `quality' of the local environment, followed by multi-level analyses to explore the relationship between self-reported fair or poor health and individual- and ward-level characteristics among four ethnic groups (Caribbean, Indian, Pakistani and Bangladeshi, and white) in the UK. Results of the factor analysis suggested three underlying dimensions of perception of quality of the local area, related to the quality of the local environment, the provision of local amenities and local problems of crime and nuisance. These factors were entered into the multi-level models at level 2, along with indicators of ward-level ethnic density and Townsend's deprivation score, with age, gender and household social class entered at level 1. In general, there was a residual random ward-level effect suggesting an area influence on self-assessed health. However, on the whole, none of the ward-level indicators showed any statistically significant association with self-assessed health, making it difficult to precisely determine the mechanisms operating. These findings suggest, though, that there is no ethnic density effect on self-assessed health for ethnic minority groups. Keywords: Ethnicity; Environment; Ethnic density; Health; Multi-level modelling; Social class, UK

This article promotes a more complete understanding of social change by analyzing spatial patterns of contraceptive use in Bangladesh and the contiguous state of West Bengal in India. Multi-level analyses that control for variations in individual- and household-level correlates show an important role for cross-border influences only in those districts that share a common language across the border. The districts that are positive outliers in contraception hug the Bangladesh--West Bengal border. A map of outliers shows that the positive outliers form a contiguous band in a manner suggestive of a role for contagion.

A study was conducted to investigate the effect of informed consent content on baseline contraceptive knowledge. It is concluded that the design of informed consent materials need to maintain a balance between making sure that participants provide truly informed consent and educating participants in ways that do not compromise the evaluation of the effect of behavioral interventions.

A study was conducted to investigate how domestic violence affects the use of contraceptives by women in a rural village in India. Findings explores covert strategies used to avoid pregnancy, which also tend to increase women's risk of experiencing domestic violence.

The relationship between male-to-female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India are examined. It was found that women who experienced physical violence from their husbands were less likely to adopt contraception and more likely to experience an unwanted pregnancy.

Byline: Rob. Stephenson Over the past two decades, two significant public health concerns have begun to draw increasing attention in India: the increasing prevalence of human immunodeficiency virus (HIV) and [...]