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According to the World Health Organization, intimate partner violence (IPV) affects 35% of women worldwide and 40% of pregnant women, often resulting in maternal and infant death and harm. Displaced persons are at higher risk of abuse compared to the general population. While few studies have explored IPV in Iraq, research from Erbil, Iraq showed nearly 60% of women reported experiencing IPV in their lifetime. No publications examining IPV among displaced women in Iraq exist. Considering the severe impacts of IPV in pregnancy and the associated risks for IPV among women in refugee camps, this paper presents the first analysis of prevalence and factors associated with lifetime IPV among displaced pregnant women in two Iraqi refugee camps. Thirteen percent of women reported experiencing any abuse and experiencing IPV was associated with receiving fewer years of schooling (p = 0.04), not having a private doctor (p = 0.002), attending the first prenatal visit during the third trimester (p = 0.03), feeling pressure to have a child (p = 0.003), knowing someone who was physically injured by their husband (p = 0.05), experiencing suicidal ideation (p = 0.02), and being worried about harming one's baby (p = 0.02). Policy and programme recommendations for screening and prevention of IPV in resource-limited settings are provided. [ABSTRACT FROM AUTHOR]

This paper offers a new interpretation of the ‘resistance’ carried out by local civil society organisations in Cambodia against intimate partner violence (IPV). In this, the paper explores the nexus between ‘rupture’, ‘resistance’ and ‘repetition’ and concludes that different ‘repetitions’ can contribute to acts of violence while simultaneously creating possibilities for resisting IPV. In regard to the latter, the concept of ‘rupture’ is investigated as a performative politics through which organisations try to disrupt the ‘repetitions’ of violent masculinities. Furthermore, it is argued that the importance of ‘repetitions’ and the concept of time should be acknowledged. The French criminal defence lawyer Jacques Vergès’ understanding of ‘rupture’ and the French philosopher Gilles Deleuze's notions of ‘repetition’ inform the analysis. To exemplify our discussion and findings, the paper embraces stories of a number of civil society workers who facilitate various men's groups in Cambodia in order to negotiate the practice of IPV. [ABSTRACT FROM AUTHOR]

Vietnam's health system continues to make great progress in improving its capacities and performance. However, despite the many significant achievements that have been made, this paper summaries 11 health system research papers from different perspectives with the aim of providing scientific evidence for policy actions in Vietnam. Health system research is ultimately concerned with improving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development, with full involvement of all actors. We hope the findings from this cluster of papers provide some insights into issues of importance for the continued advancement and strengthening of the health system in Vietnam and can be considered a valid and reliable resource to inform planning, management and policy-making decisions. [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]

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation. [ABSTRACT FROM AUTHOR]

This article approaches the emergence of social subjects – associativism – and the formation of horizontal circuits of solidarity, both of which were decisive processes for saving lives in favelas and suburbs in Rio de Janeiro during the Covid-19 pandemic. The impact of the pandemic has been enormous collective trauma that accentuated the collapse of health surveillance systems and generated a catastrophe and humanitarian crisis in the city. Solidarity and local collective cooperation processes had decisive effects as a new protagonism, generating synergy with health actions and social programmes. They contributed decisively to actions that made forms of immunological protection, food security, and access to basic care possible in adverse contexts with weak policies and severe limitations for social isolation. Highlighting the importance of collective health surveillance and assistance actions from local associations, this paper discusses public health actions in the favela territories that demonstrate how communities, universities, public officials, and public health networks can develop policies and projects to confront Covid-19 in the favelas. [ABSTRACT FROM AUTHOR]

The United Nation ('UN') Convention on the Rights of Persons with Disabilities ('CRPD' or 'Convention'), while addressing some intersectionalities, does not explicitly mention sexual orientation, gender identity and expression, and sex characteristics (SOGIESC). However, the practice of the Committee on the Rights of Persons with Disabilities ('CteeRPD' or 'Committee') has developed significantly over the past years to include the intersections of disability and SOGIESC into the discourse. This paper examines these developments from a queer intersectional perspective based on the document analysis. We analysed a range of documents adopted by the Committee itself, as well as shadow reports submitted to the CteeRPD by civil society, to map the challenges existing at the intersections of disability and SOGIESC. The results of the analysis demonstrate a quantitative shift in the CRPD intersectional discourse, but also qualitative changes in the positioning of the subject – the one living on the intersections of disability and SOGIESC, related structural powers and hierarchies. Based on the analysis, we use a quadruple framework to show how this subject is defined, described, protected and embraced by the CteeRPD, what concrete features of this positioning has been developed already, what gaps still exist and how they can be addressed. [ABSTRACT FROM AUTHOR]

Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic inaugurated a new global order of public life and health marked by death, despair and alienation. As a crisis of a global scale, it made the task of (re)imagination simultaneously necessary and extremely difficult. It is this double bind of the difficulty and imminence of imagination that motivates the curation of this special issue. In this introduction, we map the connections between the theme of this volume and the key ideas that constitute its varied contributions, which we organised under three broad mobilising ideas: Rights and Resilience; Sexuality, Health and Justice; and Politics of Knowledge Production and Collaborations. Contributions cover myriad issues, engage in methodological innovations and play with diverse genres. Alongside more traditional academic writings, there are community-based research papers, activist conversations, visual essays, reflective pieces and interviews. The geographical span of the contributions brings insights from around the world and the number of topics covered in this issue are equally vast including, among others, mental health, disability, environment, sex work, violence, queerness, LGBTQ+ experiences, love and anger. The aim of this special issue, then, is to challenge the Manichean distinctions that are often drawn between research and activism, and by extension, between theory and practice. [ABSTRACT FROM AUTHOR]

Colonial medical education and public health policies emerged from an intriguing discourse of negotiation between the government and the people. These 'structured conflicts', rooted in the politics and the debates of the colonial institutions not only provided opportunities for creative thinking about public health but also for imposing constraints. The colonial and post-colonial India medical legislative debates revealing a new language of protest, assumed greater significance with the growing nationalist movement and the general (though variegated) intellectual polarisation – western and indigenous systems of medicine. Problematising the historiographic assertion of medical modernisation in colonial India to be a part of 'civilising mission', this paper argues that legislature emerged as a platform of activism and protest against the colonial and post-colonial State's appropriation of modernity. While some members appealed for extending the benefit of 'modern' western medicine to the general Indian population, some debated in favour of introducing the indigenous medical systems to the terms of modern professionalisation. The post-colonial policies reveal the true significance of the legislative debates in reviving the position of indigenous systems of medicine in the context of professional modernity. [ABSTRACT FROM AUTHOR]

Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming. [ABSTRACT FROM AUTHOR]

The Creative Change Laboratory (CCoLAB) was conceived as an immersive learning space in which young people from the Western Cape province of South Africa could develop unconventional solutions to problems in their communities. Unlike most art-activism projects, CCoLAB harnessed a wide range of expressive forms (visual art, interactive drama, narrative writing and photography/videography) to identify, analyse and respond to social justice challenges. In many ways, CCoLAB was an experiment, asking what could be achieved if an art-activism project was held over a long period and was not constrained by a focus on just one theme/topic. Over eight months, CCoLAB's twenty collaborators were exposed to different ways of thinking and doing activism, culminating in the development of original creative prototypes. Many of the final artworks spoke to the nuances of sexuality, gender and health, exploring topics such as sexual- and gender-based violence, the everyday challenges facing queer and trans youth, and physical, mental and emotional wellbeing. Drawing on artworks produced during the project, facilitator/collaborator reflections, and audio and visual recordings made during the process, this paper investigates the benefits and challenges of long-term, well-resourced art-activism interventions. [ABSTRACT FROM AUTHOR]

The roles that rapid, point-of-care tests will play in healthcare in low-income settings are likely to expand over the coming years. Yet, very little is known about how they are incorporated into practice, and what it means to use and rely upon them. This paper focuses on the rapid diagnostic test for malaria (mRDT), examining its introduction into low-level public health facilities in Tanzania within an intervention to improve the targeting of costly malaria medication. We interviewed 26 health workers to explore how a participatory training programme, mobile phone messages, posters and leaflets shaped the use and interpretation of the test. Drawing on notions of biopolitics, this paper examines how technologies of the self and mechanisms of surveillance bolstered the role mRDT in clinical decision-making. It shows how the significance of the test interacted with local knowledge, the availability of other medication, and local understandings of good clinical practice. Our findings suggest that in a context in which care is reduced to the provision of medicines, strict adherence to mRDT results may be underpinned by increasing the use of other pharmaceuticals or may leave health workers with patients for whom they are unable to provide care. [ABSTRACT FROM PUBLISHER]

How does the private sector structure the trajectory of a country's universal healthcare programme? Social scientists have long pointed to the importance of path dependence in shaping health reform. Yet, rarely have middle-income countries' experience with the private sector under Universal Health Coverage (UHC) been examined from comparative perspective. In this paper, we explore the changing landscape of the health sector in Brazil and Thailand before UHC reform and after. We find path-dependent processes at work that have pushed two countries that both adopted UHC reforms in divergent directions. In Brazil, a comparatively large and entrenched private sector that existed before reform has grown over time, and a sizable private health insurance industry has exerted powerful influence on health policy, weakening the public sector. In Thailand, constraints on private health insurance growth and sustained investment in public health infrastructure and governance have helped check the growth of private sector influence, although battles over health policy still remain contentious. The experiences of these countries offer lessons for policymakers seeking to achieve and maintain robust UHC programmes in other contexts. [ABSTRACT FROM AUTHOR]

In 2018, the sugar-sweetened beverage (SSB) industry introduced a ballot measure (I-1634) in Washington State of the United States to prevent further local taxes on groceries. The measure, which passed, is emblematic of new pre-emptive legislative strategies by the SSB industry to block soda taxes and conceal those strategies under the guise of preventing burdensome 'grocery taxes'. This paper uses qualitative framing analysis to examine a public archive of 1218 Facebook advertisements to understand how I-1634 proponents shaped public discourse and engaged in misinformation efforts online during the lead up to the passage of I-1634. Coding strategies identified 7 compelling and inter-related framing strategies used by the campaign. These included strategies that misinformed the public about the threat of grocery taxation and the economic impacts it would have on the region. Strategies to conceal the true intent of the ballot measure and the sponsors of the campaign were aided by Facebook's advertising platform, which does not moderate misinformation in advertising and allows advertisers to conceal their sponsors. We urge public health researchers and advocates to pay more attention to how Facebook and other social media platforms can be used by industries to target voters, misinform publics, and misconstrue industry support. [ABSTRACT FROM AUTHOR]

Syndemic theory hypothesises that observed clusters of diseases are the result of harmful social conditions. Critiques of syndemics present the theory as ambiguous and lacking empirical evidence. Syndemics are evidenced through qualitative assessments drawing on observations, epidemiology, and biomedical evidence to explain bio-bio and bio-social interactions. Quantitative syndemic studies commonly apply a summative approach, whereby the outcome is a result of the cumulative effect of the individual elements. More recently, quantitative studies apply analyses to assess mechanical interactions among conditions. This paper applies a synergy factor analysis to measure synergy – the enhancement of the effect of one element on the effect of the others. Data from the canonical quantitative syndemic analysis study was reanalysed to assess synergy among the elements of the SAVA syndemic (substance ab/use, violence, HIV/AIDS). Contrary to original study findings, which applied a summative approach, no synergy was measured. Synergistic interactions were confirmed among a subset of the study population; the effects of substance ab/use and violence on HIV were more than two times greater in White MSM than the predicted joint effect (SF = 2·32, 95%CI 1·02–5·11, p = 0·044), indicating synergy. Synergy factor analysis presents an accessible tool to measure syndemic interactions and facilitate timely global health responses. [ABSTRACT FROM AUTHOR]

Up to two-thirds of South African adolescent mothers drop out of school, which increases their HIV risk and other poor health outcomes. Despite variability in adolescent mothers' schooling trajectories, we have a limited understanding of their re-enrollment in school following the life-changing circumstance of childbirth. In this paper, we draw on qualitative interviews (n = 16) and quantitative surveys (n = 109) with adolescent mothers (aged 14–19) who had recently given birth to describe how access to individual and social resources contributes to their resilience following childbirth and thus affects their ability to re-enroll in school. Nearly all the adolescent mothers in our study expressed a desire to return to school, and most of their families also emotionally supported adolescent mothers in these goals. Despite mothers' high hopes and familial emotional support, only half of the adolescent mothers re-enrolled in the first six months following childbirth. Adolescent mothers' re-entry trajectories were strongly affected by institutional support and by family members' provision of instrumental support. To a lesser extent, support from partners and peers also played a role in re-enrollment. Multilevel interventions to maximise resilience following the onset of early motherhood may facilitate return to school and positively influence adolescent mothers' health and well-being. [ABSTRACT FROM AUTHOR]

This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation. [ABSTRACT FROM AUTHOR]

Objectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15–24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) in Kenya bear a heavy burden of HIV/STIs and are a priority population in the national HIV/AIDS response, yet remain criminalised and stigmatised within society. HIV pre-exposure prophylaxis (PrEP) offers an opportunity to significantly impact the HIV epidemic, as does the concept of U = U, whereby those who are living with HIV and on treatment are uninfectious when their viral load has been suppressed so as to be undetectable. However, the value of such innovations will not be realised without sufficient understanding of, and respect for, the sexual health service provision needs of MSM. This paper describes findings from 30 in-depth interviews with MSM living in Nairobi that explored engagement with sexual health service providers, barriers to access and perceived opportunities to improve service design and delivery. Findings indicate concern relating to the professionalism of some staff working within public hospitals as well as feelings that many sexual health services were not considered safe spaces for the discussion of MSM-specific sexual behaviour. Diverse views were expressed relating to comfort in public, community and private sexual health services as well as how these are and should be organised. [ABSTRACT FROM AUTHOR]

The movement to decolonise global health is gathering pace. In its concern with the fundamental, distal causes of inequality and its call for social justice, the decolonisation movement forces us to question how global health works, for whom, where it is located, its funding practices, power asymmetries, cultures of collaboration and publication. This paper uses a new book by Harvard-based physician-anthropologist Eugene T. Richardson, Epidemic Illusions, as a point of departure for a broader analysis of the nature of global health knowledge, science, authorship, research and practice. Written in a 'carnivalesque' style, the book proceeds through a series of 'ironic (re)descriptions' to argue that global public health is an 'apparatus of coloniality'. In so doing, the book is generative of four ironic turns that we explore through the themes of guilt, humility, privilege and ambiguity. In locating these ironic turns within the broader landscape of global health, we reflect on whether the means of such a book achieve the ends of decolonisation. [ABSTRACT FROM AUTHOR]

The recommendation to start antiretroviral treatment independently of CD4 or viral load count is adopted as a strategy for reducing HIV/AIDS incidence rates in countries with a high prevalence rate, such as Lesotho. For example, the number of new HIV infections has lowered from 20,000 in 2010 to 11,000 in 2018 [UNAIDS Country Factsheets. (2019). ]. Lesotho introduced the 'test and treat' strategy in 2013 to address the HIV/AIDS pandemic, representing a shift from the provider-initiated HIV testing and counselling guidelines. The purpose of this paper was to understand pregnant women's concerns about starting antiretroviral treatment to limit risks of mother-to-child HIV-transmission during the implementation of 'test and treat' protocol in Lesotho. The study used a qualitative research approach and collected information from Lesotho public antenatal clinics. In-depth interviews were conducted with eighteen pregnant women living with HIV/AIDS and data were analysed manually following the constructivist grounded theory. Findings reveal the sadness experienced at the diagnosis stage, concerns about accessing treatment and maintaining adherence, and concerns about disclosure. It was concluded that these factors stemmed from fears about triggering enacted stigma in the illness experience of pregnant women, which could hamper the implementation of the 'test and treat' protocol in Lesotho. [ABSTRACT FROM AUTHOR]

High levels of adolescent pregnancy and child marriage rates in low- and middle-income countries is an issue of concern to many stakeholders, including in Zambia where almost one-third of women give birth before age 18. The aim of this paper is to explore and analyse social norms concerning adolescents' sexual behaviour within the context of an intervention trial in rural communities in southern Zambia. It is based on a qualitative study applying individual interviews, focus group discussions and participatory research methods. We apply the distinction between injunctive and descriptive norms to demonstrate that adolescent girls are caught between conflicting norms. Injunctive norms express that premarital sex, contraceptive use, and discussions about sex between adults and youths are socially condemned. At the same time poor girls are reported to feel pressure towards having sexual relations for the economic benefits such relations can bring, and this practice is considered so common that it amounts to a descriptive norm. Norms and structural conditions combine to create a disabling and disempowering environment for adolescent sexual and reproductive health, which limits girls' agency and exposes them to unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Continued pregnancy after an abortion attempt is a likely outcome in countries where unsafe abortions prevail. Yet there is a paucity of literature on the consequences and implications of failed abortions. This study explored young women's abortion decision-making, their experiences of failed abortion and its consequences in South-Western Nigeria. It presents findings from semi-structured interviews conducted with 14 women who had become unintentionally pregnant as unmarried teenagers, desired abortions, yet became mothers. Whilst the fear of the stigma associated with young unmarried motherhood gave rise to participants' desire for abortion, restrictive abortion laws influenced their experiences and abortion decision-making. Participants who attempted an abortion failed and were forced to carry their unwanted pregnancies to term. They then experienced continued discrimination, forced motherhood, and a rejection of maternalism. Their experiences are analysed as responses to the complex interplay between social norms, abortion restrictions, stigma and forced motherhood. The paper makes a case for improving women's reproductive autonomy in decision-making, – highlighting the social and mental health consequences of restricted access to abortion, and reinforce the importance of taking a holistic approach to addressing the sexual health of young women, by focusing not only on physical health but also on ensuring wellbeing. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas. [ABSTRACT FROM AUTHOR]

This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in – and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software. Aspirations of AGYW's were categorised as short and long-term. Short-term aspirations were associated with the social status derived from obtaining trendy items such as nice clothing, or smart phones. Long-term aspirations included completing secondary education, having a professional job, being respected, getting married and having children. Aspirations were influenced by aspects of the social context, such as peers and structural factors that dictated what was acceptable for respectable AGYW. AGYW lacked the independent capabilities to meet long-term aspirations such as completing education. In pursuit of their short – and long-term aspirations, AGYW engaged in higher risk sexual behaviours such as transactional sex, age-disparate sex and condomless sex. AGYW's aspirations were important in determining their sexual decision making. Interventions should capitalise on AGYW's aspirations when addressing their SRH risks by finding innovative ways of engaging them based on their circumstances and aspirations. [ABSTRACT FROM AUTHOR]

The use of participatory visual methods and integration of cellphone technology is expanding in global public health research. Cellphilm method capitalises on these trends by inviting participants to use mobile devices to create short videos about health topics. This paper presents the quilted cellphilm method, which supports the participation of stigmatised populations to engage in research. We present the method with reference to the Celling Sex project, which worked with young women who have transactional sex experience. Four key steps in our unique model are discussed: (a) individual cellphilm-making; (b) participatory analysis; (c) creating a composite video; (d) publicly screening the work. We consider how working individually with participants in the cellphilm-making process built trust. We unpack how offering participants opportunities to engage in either group or one-on-one activities promoted participation in collaborative analysis. We outline how creating a composite video of the cellphilms and organising screenings facilitated knowledge translation and exchange. Overall, the quilted cellphilm method created a supportive community for vulnerable participants to generate products that challenged social stigma. Increased reliance on mobile media, especially during the COVID-19 pandemic, makes the quilted cellphilm method an opportune, exciting and accessible approach for participatory public health research. [ABSTRACT FROM AUTHOR]

Detention and removal of unauthorised immigrants by United States (U.S.) Immigration and Customs Enforcement (ICE) has steadily increased despite declining rates of unauthorised migration. ICE detainees are held in overcrowded detention centres, often without due process and deprived of adequate food, sanitation, and medical care. Conditions of ICE detention contribute to malnutrition and increase the likelihood of infectious disease exposure, including tuberculosis (TB). TB infection interacts with Type 2 Diabetes (DM2), disproportionately affecting individuals who are routinely targeted by federal immigration practices. When two diseases interact and exacerbate one another within a larger structural context, thereby amplifying multiple disease interactions, this is called a syndemic. In this paper, we examine malnutrition in ICE detention as a pathway of bidirectional risks for and interactions between TB and DM2 among ICE detainees. Drawing from literature on detention conditions, TB, and DM2 rates along the U.S.-Mexico border, we propose an ICE-TB-DM2 syndemic model. We present a map displaying our proposed syndemic model to demonstrate the spatial application of syndemic theory in the context of ICE detention, strengthening the growing scholarship on syndemics of incarceration and removal. [ABSTRACT FROM AUTHOR]

Economically vulnerable women engaged in sex work (WESW) comprise one of the key populations with higher prevalence of HIV globally. In Uganda, HIV prevalence among WESW is estimated at 37% and accounts for 18% of all new infections in the country. This paper describes the strategies by which we have engaged community stakeholders in a randomised clinical trial aimed at evaluating the efficacy of adding economic empowerment components to traditional HIV risk reduction to reduce the incidence of STIs and HIV among WESW in Uganda. We demonstrate that stakeholder engagement, including the engagement of WESW themselves, plays a critical role in the adaptation, implementation, uptake, and potential sustainability of evidence-based interventions. To our knowledge, this is the first study to utilise stakeholder engagement involving WESW in Uganda. Researchers working with hard-to-reach populations, such as WESW, are encouraged to invest time and resources to engage key stakeholders through a full range of collaborative activities; and ensure that research is culturally appropriate and meets the needs of all stakeholders involved. ClinicalTrials.gov identifier: NCT03583541. [ABSTRACT FROM AUTHOR]

This paper examines the decline of the AIDS Programme in Brazil, the Latin American country most affected by the epidemic, with emphasis in the second decade of the twenty-first century. For many years, Brazil served as a model in Global Health due to a comprehensive preventive policy, a partnership between the government and health activists and the support of life-saving drugs as public goods rather than commodities. The regression of AIDS policies in Brazil interacted with developments in the United States as well as with multilateral agencies like UNAIDS that emphasised biomedicalisation in the response to the disease where broad human-rights programmes and alliance with activists were not priorities. International programmes like the 'Ending AIDS' campaign indirectly undermined the exceptional status AIDS enjoyed since the late 1980s. The backlash in Brazilian policies to fight AIDS was a result of the fragmentation of the left and the empowerment of radical conservative authoritarian and religious forces. The result was the breakdown of the long-held belief that successful anti-AIDS disease programmes could simultaneously help control the disease and build better healthcare systems and ultimately prompted the end of the special place AIDS' policy had in Brazil. [ABSTRACT FROM AUTHOR]

HIV and emotional distress often co-occur and interact in syndemic clusters with social, political, and economic factors that amplify the 'syndemic suffering' of individuals. In this paper, I describe how HIV+ women seeking antiretroviral therapy (ART) at a hospital in northern Tanzania engaged with plural methods of healing to ease suffering and address the multiple dimensions of illness. I explain the case of a famous faith healer at the time of research from 2011–12, 'Babu wa Loliondo,' from whom a third of the women interviewed – 25 of 75 – sought care in addition to their ART. These women experienced significantly fewer symptoms of emotional distress compared with those women who did not, suggesting that either those who sought his care were already healthier, or one strategy for coping – engagement with medical pluralism – played a role in buffering against syndemic HIV and emotional distress. [ABSTRACT FROM AUTHOR]

This paper explores the dynamics of access under the state-funded universal health insurance scheme in Chhattisgarh, India, and specifically the relationship between choice, affordability and acceptability. A qualitative case study of patients from the slums of Raipur City incurring significant heath expenditure despite using insurance, was conducted, examining the way patients and their families sought to navigate and negotiate hospitalisation under the scheme. Eight purposefully selected ('revelatory') instances of patients (and their families) utilising private hospitals are presented. Patients and their family exercised their agency to the extent that they could. Negotiations on payments took place at every stage, from admission to post-hospitalisation. Once admitted, however, families rapidly lost the initiative, and faced mounting costs, and increasingly harsh interactions with providers. The paper analyses how these outcomes were produced by a combination of failures of key regulatory mechanisms (notably the 'smart card'), dominant norms of care as a market transaction (rather than a right), and wider cultural acceptance of illegal informal healthcare payments. The unfavourable normative and cultural context of (especially) private sector provisioning in India needs to be recognised by policy makers seeking to ensure financial risk protection through publicly financed health insurance. [ABSTRACT FROM AUTHOR]

Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants' understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects' motives for participation, and to creating space for studies of empirical ethics. [ABSTRACT FROM AUTHOR]

Injury is a major public health crisis contributing to more than 4.48 million deaths annually. Trauma registries have proven highly effective in reducing injury morbidity and mortality rates in high income countries. They are a critical source of information for injury prevention, benchmarking care, quality improvement, and resource allocation. Historically, low and middle income countries (LMICs) have largely been excluded from trauma registry development due to limited resources. Recently, this has begun to change with low-resource hospitals adopting innovative strategies to implement trauma registries. Nonetheless, dissemination of these strategies remains fragmented. Hospitals looking to develop their own trauma registries have no current, comprehensive resource that summarises the implementation decisions of other registries in similar contexts. This scoping review aims to identify where trauma registries are located in LMICs, bringing up to date previous estimates, and to identify the most common approaches to registry implementation and operation in these settings. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study on social norms and child marriage in rural Cameroon, a country with high prevalence of child marriage but largely ignored in the literature. Study participants (n = 80) were men and women from four different ethnic groups living in four rural villages (two in the Far-North, two in the East). With the assistance of four local interviewers, we conducted 16 semi-structured focus groups to understand how existing social norms contributed to child marriage in participants' communities. We found great variety in the influence of social norms on people's health-related practices: across these four communities, social norms made compliance with the child marriage practice (respectively) possible, tolerated, appropriate, and obligatory. Effective health promotion interventions should be grounded within sound theoretical understandings of the varying influence of social norms. Using data on child marriage, this paper offers a case study of how that understanding can be developed. [ABSTRACT FROM AUTHOR]

Non-state actors, including humanitarian agencies, play a prominent role in providing health care in low- and middle-income countries. Between 2007 and 2009, Musina, a South African municipality bordering Zimbabwe, became the site of several interventions by non-state organisations as an unprecedented number of Zimbabweans crossed the border, putting strain on already burdened local systems. After the initial need for humanitarian relief dissipated, organisations started to implement projects that were more developmental in nature. For example, Médecins sans Frontières developed a mobile clinic programme to improve health care access for migrant farm workers, a programme that was subsequently integrated into the Department of Health. Since the handover of the programme, it has faced multiple challenges. Using qualitative methodology and a case study approach, this paper traces the development of the programme, exploring the changing relationship between MSF and the state during this time. This research raises questions about the implications of short-term 'innovative' interventions targeting the access that migrants have to care, within a context in which policy and programmatic responses to health are not migration aware. Furthermore, it highlights the ways in which the energies and resources of local DoH employees were redirected by MSF's involvement in the area. [ABSTRACT FROM AUTHOR]

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement's primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue's contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America's epistemological innovations and social movement action in the domain of public health are especially warranted. [ABSTRACT FROM AUTHOR]

This paper discusses the complexity of contemporary struggles for collective health in Colombia, by analysing the efforts of different actors to inscribe abortion as a matter of public health and as a human right. In 2006 the Colombian Constitutional Court (Sentence C 355 of 2006) partially decriminalised abortion in specific circumstances. Such a change in regulation was the result of the strategic coordination of international organisations, researchers and women's social movements. These groups produced a powerful network of international regulation and epidemiological data about abortion's mortality and burden of disease in order to move the discussion from the moral field to public health and international law. Despite the significance of the sentence in terms of civil rights, ten years after the regulation there is no clarity about its impact. Conservative sectors within the government have limited the operation of the regulation, through eliciting convoluted rules for hospitals and care providers. On the other hand, data about safe abortions are weak and precarious. Recently groups opposed of abortion have exploited such weakness to undermine the impact of the decriminalisation and to criticise the justification of legalising abortion as a matter of public health. [ABSTRACT FROM AUTHOR]

This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context. Recognition of difference between Latin America and the global economic core regions was a key impetus for seeking 'national solutions to national problems' in countries like Argentina and Chile, even as integration into these networks provided progressive doctors, scientists, and other intellectuals important international support for local political reforms. [ABSTRACT FROM AUTHOR]

This special issue of Global Public Health presents a collection of articles that analyse power and its mechanisms in health systems and health policy processes. Researchers have long noted that the influence of power is implicated throughout the global health field, yet theories and methods for examining power—its sources, workings, and effects—are rarely applied in health policy and systems research. By engaging with the social sciences and humanities, contributors to this collection aim to analytically sharpen and thematically broaden the study of power and politics in global health. Contributors analyse the exercise of power by actors typically considered powerful on the global stage as well as actors across the health system who may be powerful in national or local contexts. Additionally, the papers draw attention to actors, interest groups, and practices not usually viewed as politically salient in health policy and systems research in low- and middle-income countries. The papers not only analyse power but also identify ways to counteract it, such as by using human rights-based frameworks to investigate and challenge power asymmetries. Collectively, they show how researchers working on global health issues can theorise power and deepen political analysis of health policy and systems. [ABSTRACT FROM AUTHOR]

Since 2000, the eight Millennium Development Goals (MDGs) provided the framework for global development efforts transforming the field now known as global health. The MDGs both reflected and contributed to shaping a normative global health agenda. In the field of global health, the role of the state is largely considered to have diminished; however, this paper reasserts states as actors in the conceptualisation and institutionalisation of the MDGs, and illustrates how states exerted power and engaged in the MDG process. States not only sanctioned the MDGs through their heads of states endorsing the Millennium Declaration, but also acted more subtly behind the scenes supporting, enabling, and/or leveraging other actors, institutions and processes to conceptualise and legitimize the MDGs. Appreciating the MDGs' role in the conceptualisation of global health is particularly relevant as the world transitions to the MDGs' successor, the Sustainable Development Goals (SDGs). The SDGs' influence, impact and importance remains to be seen; however, to understand the future of global health and how actors, particularly states, can engage to shape the field, a deeper sense of the MDGs' legacy and how actors engaged in the past is helpful. [ABSTRACT FROM AUTHOR]

This paper explores intra-regional South-South cross-border patient travel within the context of Southern Africa. South Africa, in particular, has been widely touted as one of the emerging destinations of high-end patients from the Global North alongside other destinations such as Brazil, India, Costa Rica and Thailand. Using South Africa as a case study, the paper demonstrates that South-South cross-border patient travel is far more significant than North-South patient travel both in numerical and financial terms. Every year, thousands of patients from neighbouring countries travel to South Africa in search of medical treatment for procedures that are not offered in their own countries. Despite its size and importance, the South-South flow of patients in Southern Africa is not fully understood and requires further scholarly research. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has placed strain on healthcare systems across the world; however, countries experiencing overlapping crises such as economic or political unrest face immense pressure in ensuring routine healthcare services can continue to operate. Despite being less likely suffer severe disease or die from COVID-19, data suggest women have experienced poorer mental health, higher rates of unemployment, and more social isolation during the pandemic. In general, we know women and girls experience multiple forms of disadvantage in disaster contexts including being more likely to become homeless, work as an unpaid carer, and to experience poverty. Research from previous disaster contexts has demonstrated that women's healthcare services tend to be deprioritised in the emergency response, and reports suggest this has been the case during the COVID-19 pandemic. This paper highlights key priorities for safeguarding women's and girls' health in disaster contexts, especially during the COVID-19 pandemic, by drawing on learning from the multiple crises facing Beirut, including responding to the pandemic, economic collapse, and the Beirut Port Explosion in 2020. [ABSTRACT FROM AUTHOR]

While mobile phones promise to be an important tool for bridging the healthcare gaps in resource-poor areas in developing countries, scalability and sustainability of mobile phones for health (mhealth) interventions still remain a major challenge. Meanwhile, health workers are already using their own mobile phones (referred to as 'informal mhealth') to facilitate healthcare delivery in diverse ways. Therefore, this paper explores some strategies for integrating 'informal mHealth' in the healthcare delivery of Ghana, by highlighting some opportunities and challenges. The study mainly employed a combination of literature review, focus group discussions and key informant interviews with community health nurses (CHNs) and other stakeholders, who were purposively selected from the three ecological zones in Ghana. The study found that, while scale-up of 'formal mhealth' remains challenging in Ghana, almost all CHNs in our study are using their personal mobile phones 'informally' to bridge healthcare gaps, thereby promoting universal health coverage. This provides opportunities for promoting (or formalising) 'informal' mhealth in Ghana, in spite of some practical challenges in the use of personal mobile phones that need to be addressed to ensure sustainable healthcare delivery in the country. [ABSTRACT FROM AUTHOR]

The COVID-19 health crisis has so far involved enormous consequences in human pain, suffering and death. While biomedical science responded early, its response has been marked by several controversies between what appeared to be mainstream perspectives, and diverse alternative views; far from leading to productive debate, controversies often preceded polarisation and, allegedly, exclusion and even censorship of alternative views, followed by the pretense of scientific consensus. This paper describes and discusses the main controversies in the production of COVID biomedical knowledge and derived control measures, to establish if alternative positions are also legitimate from a 'normal science' perspective (rather than comparing them for superiority); explores potential non-scientific explanations of the alleged exclusion of certain views; and analyzes ethical issues implied. The operation of non-scientific factors in scientific and regulatory processes (e.g. various forms of subtle corruption) has been documented in the past; the intervention of such influences in the mishandling of controversies (i.e. on early management, non-pharmacological prevention and vaccination) cannot be ruled out and deserves further investigation. Some of these controversies, increasingly visible in the public domain, also involve ethical challenges that need urgent attention. Polarisation, censorship and dogma are foreign to true science and must be left behind. [ABSTRACT FROM AUTHOR]

Lockdowns and other COVID-19 containment measures enforced to kerb the pandemic have had a massive impact on the overall growth of the world. Income-generating activities have been reduced, but the impact is more consequential among the low- and middle-income countries. The disproportionate access to vaccines between wealthy and poor countries has resulted in 'vaccine apartheid.' An 'every-country-for-itself' approach or 'vaccine nationalism' coupled with 'vaccine hesitancy' has contributed to disproportionate access to and uptake of the COVID-19 vaccines. This paper argues that it is time for the decision-makers to adopt a Universal Vaccine Access Strategy (UVAS). The authors argue that sharing resources by establishing local production of vaccines wherever possible, timely donation of unused COVID-19 vaccines to developing countries and addressing vaccine hesitancy have become imperative to interrupt the emergence of new variants. [ABSTRACT FROM AUTHOR]

Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula—and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health. [ABSTRACT FROM AUTHOR]

Traditional approaches to development programming with fixed targets and outcomes do not fit complex problems where the pathway to achieve results differs in each context and evolves constantly. Adaptive programming improves responses to complex problems by identifying which solutions bring change. This paper reviews the theory behind adaptive programming approaches and introduces the 'Pathways of Change' tool for achieving sustainability results, developed for the multi-country Women's Integrated Sexual Health programme. Qualitative data, using semi-structured interviews and group discussions from teams in over 17 countries in Africa and South Asia, are presented which examine the application of the Pathways of Change (PoC) tool focusing on successes and challenges across different intervention areas. The PoC responds to the need for a more practical adaptive programming tool that can be tailored to support flexibility in global health programme implementation while meeting donor requirements. Findings suggest that the PoC tool provides a flexible yet robust alternative to traditional monitoring frameworks and is able to facilitate adaptive, contextualised planning and monitoring for multi-country programmes. The PoC tool offers a solution to realise the ambitions of implementing adaptive programming within global health programmes and potentially beyond. [ABSTRACT FROM AUTHOR]

The proliferation of international and regional organisations in the last decades led to increasing overlap of memberships and mandates in social policy areas. Whereas the literature has explored the benefits and perils of institutional overlap though neglecting the social policy dimension of such processes, studies on regionalism have focused on single cases of regional organisations. This paper breaks new ground by examining the effects of the overlap in membership, health mandates and institutional mechanisms between the Common Market of the South (MERCOSUR) and the Union of South American Nations (UNASUR) between 2008 and 2018. It focuses on two cases of access to medicines: the creation of the medicine price bank and the price negotiation of high-cost medicines. Our argument is that the overlap was positive, leading to an incipient trend towards cooperation. This was facilitated by the membership structure, the expertise already accumulated in the region and the relations and networks among those involved in health regional cooperation. Overall, the article deepens our understanding of the conditions under which regional organisations, even in the context of institutional overlap, can contribute to adequately respond to transnational challenges, which, as global health, are not only persistent, but also profoundly affect our societies. [ABSTRACT FROM AUTHOR]

The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although healthcare equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS -offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health. [ABSTRACT FROM AUTHOR]