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BackgroundSexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. ObjectiveThe aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). MethodsThis protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. ResultsPhase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. ConclusionsThis feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers. International Registered Report Identifier (IRRID)DERR1-10.2196/15569

: Introduction: The World Health Organization (WHO) is guided by its global programme of work and the goal that a billion more people have universal health coverage (UHC). To achieve UHC, access for those most vulnerable must be guaranteed and prioritized. WHO is committed to developing evidence‐based guidance to work towards UHC for trans and gender diverse (TGD) people. This commentary describes WHO's work related to TGD people over the last decade. Discussion: In 2011, WHO developed guidelines for the prevention and treatment of HIV and sexually transmitted infections (STIs) in men who have sex with men and TGD people. In 2013, the “HIV civil society reference group” called on WHO to provide specific guidance for TGD people. Values and preferences of TGD people were considered by WHO for the first time, which informed the development of the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. The 2014 Guidelines included a comprehensive package of HIV‐related health and enabling interventions with specific considerations for TGD people, as well as a specific policy brief in 2015. Regional WHO offices developed and/or supported the development of blueprints on transgender health and HIV in 2014 and 2016. A 2015 WHO report on sexual health, human rights and the law elucidated the harmful impacts of discriminatory laws on the basis of sexual orientation and gender identity. In 2019, the 11th edition of the international classification of diseases saw the removal of “transsexualism” as a mental and behavioural disorder. WHO's first guideline on self‐care interventions, updated in 2021, included key considerations concerning TGD people. In 2022, WHO's updated key populations guidelines include a prioritized package of not just HIV, but also viral hepatitis and STI health interventions for TGD people. Still, a broader and more specific health approach and a greater focus on social issues are needed to better serve the health needs of TGD people. Conclusions: WHO's understanding and commitment to TGD people's health has evolved and improved over the past decade. Together with professional and community trans health organizations, WHO should now start developing evidence‐informed global guidance on TGD health as part of its remit to support UHC to all., INTRODUCTION The Thirteenth General Programme of Work defines the World Health Organization's (WHO's) strategy for 2019–2023. It focuses on triple billion targets to achieve measurable impacts on people's health at [...]

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 [...]

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 [...]

Background Although men who have sex with men (MSM) are considered at high risk for transmission of sexually transmitted infections, including HIV, there are few studies estimating the population size of MSM in Europe. We used network data from a survey of MSM in four cities to perform successive sampling–population size estimations (SS-PSE) to estimate MSM population sizes. Methods Data were collected in 2013–14 in Bratislava, Bucharest, Verona and Vilnius using respondent-driven sampling (RDS). SS-PSE uses a Bayesian framework to approximate the RDS sampling structure via a successive sampling model and uses the selection order of the sample to provide information about the distribution of network sizes over the population members of MSM. Results We estimate roughly 4600 MSM in Bratislava, 25 300 MSM in Bucharest, 7200 in Verona and 2900 in Vilnius. This represents 2.9% of the estimated adult male population in Bratislava, 2.3% in Bucharest, 2.7% in Verona and 1.5% in Vilnius. The number of MSM living with HIV would roughly be 200 in Bratislava, 4554 in Bucharest, 690 in Verona and 100 in Vilnius. Conclusions Benefits of this method are that no additional information from an RDS survey needs to be collected, that the sizes can be calculated ex post facto a survey and that there is a software programme that can run the SS-PSE models. However, this method relies on having reliable priors. Although many countries are estimating the sizes of their vulnerable populations, European countries have yet to incorporate similar and novel methods. [ABSTRACT FROM AUTHOR]

Background: Infertility affects 48.5 million couples worldwide with a prevalence estimated at 3.5-16.7% in low- and middle-income countries (LMIC), and as high as 30-40% in Sub-Saharan Africa. ART services are not accessible to the majority of these infertile couples due to the high cost of treatments in addition to cultural, religious and legal barriers. Infertility and childlessness, particularly in LMIC, have devastating consequences, which has resulted in considerable interest in developing affordable IVF procedures. However, there is a paucity of evidence on the safety, efficiency and ability to replicate techniques under different field conditions, and how to integrate more affordable ART options into existing infrastructures.Objective and Rationale: This review was performed to investigate the current availability of IVF in LMIC and which other ART options are under development. This work will unfold the landscape of available and potential ART services in LMIC and is a key element in positioning infertility more broadly in the Global Public Health Agenda.Search Methods: A systematic literature search was performed of articles and gray literature on IVF and other ART options in LMIC published between January 2010 and January 2020. We selected studies on IVF and other ART treatments for infertile couples of reproductive age (18-44 years) from LMIC. The review was limited to articles published after 2010, based on the recent evolution in the field of ART practices in LMIC over the last decade. Citations from high-income countries, including data prior to 2010 and focusing on specialized ART procedures, were excluded. The literature search included PubMed, Popline, CINHAL, EMBASE and Global Index Medicus. No restrictions were applied with regard to study design or language. Two reviewers independently screened the titles and abstracts, and extracted data. A search for gray literature was performed using the 'Google' search engine and specific databases (worldcat.org, greylit.org). In addition, the reference lists of included studies were assessed.Outcomes: The search of the electronic databases yielded 3769 citations. After review of the titles and abstracts, 283 studies were included. The full texts were reviewed and a further 199 articles were excluded. The gray literature search yielded 586 citations, most of which were excluded after screening the title, and the remaining documents were excluded after full-text assessment due to duplicate entries, not from LMIC, not relevant or no access to the full document. Eighty-four citations were included as part of the review and separated into regions. The majority of the studies were observational and qualitative studies. In general, ART services are available and described in several LMIC, ranging from advanced techniques in China to basic introduction of IVF in some African countries. Efforts to provide affordable ART treatments are described in feasibility studies and efficacy studies; however, most citations were of low to very low quality. We found no studies from LMIC reporting the implementation of low-cost ART that is effective, accessible and affordable to most of those in need of the services.Wider Implications: The World Health Organization is in a unique position to provide much needed guidance for infertility management in LMIC. This review provides insight into the landscape of ART in LMIC in various regions worldwide, which will guide efforts to improve the availability, quality, accessibility and acceptability of biomedical infertility care, including ART in these countries. [ABSTRACT FROM AUTHOR]

Objective: To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations.Methods: A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains.Findings: A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%-7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99).Conclusions: Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission.Prospero Registration Number: CRD42018102934. [ABSTRACT FROM AUTHOR]