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Objectives: In Nepal, where increasing numbers of married couples live apart due tomigration, progress in reducing unmet need for family planning (UMN) is stagnant. This study aims to identify spatial patterns of UMN of married women and spousal separation in Nepal and explore associations between UMN and spousal separation at individual- and district-levels. Methods: We used 2016 Nepal Demographic and Health Surveys data to conduct spatial and multilevel logistic analyses. Results: This study shows evidence of similar geographical patterns in UMN of married women and spousal separation. At the individual level, women living with their spouses had 88% (aOR = 0.12, 95% CI 0.11-0.13) decreased odds of experiencing UMN compared to those living apart from their spouses. While not statistically significant, increasing odds of UMN were observed with higher prevalence of spousal separation at the district level. Conclusion: This study contributes to the existing literature by showing similar geographical patterns of UMN and spousal separation across Nepal and demonstrating both individual and contextual effects of spousal separation on UMN among married women. Theoretical and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07–1.80; p <.05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14–2.32; p <.01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence. [ABSTRACT FROM AUTHOR]

Communicating about actions to address climate change is critical to mobilize collective actions, and enact policies for climate change mitigation (prevention) and adaptation to climate change. The current study assessed factors associated with climate change action (CCA) communications in the US. Respondents were recruited through Prolific, an online survey research platform. The sample was restricted to the 599 respondents who reported that the issue of climate change was extremely or very important to them. Key outcome variables included (1) talking to family/friends about CCA, (2) texting/emailing family/friends about CCA, and (3) posting or sharing a post on social media about CCA. Multinomial logistic regression models examined correlates of CCA communications. Descriptive and injunctive social norms, barriers to CCA, and climate change distress were consistently significantly associated with engaging in the three CCA communication modalities in the prior month compared to never. This study's results suggest that talking with peers is the most common form of CCA communication, and is associated with social norms and distinct barriers to CCA. Organizations that address climate change should consider utilizing dialogical approaches to shift social norms related to CCA, and foster CCA communications and address barriers to CCA. [ABSTRACT FROM AUTHOR]

The 2014–2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men's engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when 'navigating' the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services – even when lacking direct financial control. Essentialist descriptions of men as 'providers' and women as 'navigators', therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men's engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays. [ABSTRACT FROM AUTHOR]

Decreasing the consumption of meat and dairy has been identified as an effective strategy for protecting the health of humans and the planet. More specifically, transitioning to diets that are lower in animal-source foods and higher in fruits, vegetables, legumes, and whole grains offers a promising opportunity to better align consumer behaviors with contemporary nutritional and ecological goals. However, given the limited understanding of how these changes in dietary behaviors can be best promoted, there is a need to explore the merits of community-based approaches to meat reduction and their capacity to advance more sustainable practices of eating at the individual, household, and community levels. To address this gap in the literature, we surveyed more than 100 American households participating in a communitywide, 12-week-long Meatless Monday challenge and tracked the changes in their knowledge, attitudes, beliefs, and food choices over a nine-month period. The case study provided herein highlights a number of key findings from our evaluation. Most notably, our results demonstrate the value of community-based efforts in initiating and maintaining dietary behavior change and provide preliminary insights into the unique roles of multilevel interventions and diverse stakeholder engagement in promoting healthier, more sustainable diets. [ABSTRACT FROM AUTHOR]

Couple communication and joint decision-making are widely recommended in the family planning and reproductive health literature as vital aspects of fertility management. Yet, most studies continue to rely on women's reports to measure couple concordance. Moreover, the association between communication and decision-making is often assumed and very rarely studied. Arguably, associations between dyadic communication and shared decision-making constitute a missing link in our understanding of how communication affects fertility-related practices. Informed by Carey's notions of transmission and ritual communication, this study sought to address those gaps with two complementary studies in Nepal: a qualitative study of married men and women and a quantitative study of 737 couples. To assess spousal concordance on matters of family planning-related communication and decision-making in the quantitative study, responses from the couple were compared for each question of interest and matched responses were classified as concordant. Quantitative results found that more than one-third of couples reported spousal communication on all measured family planning-related topics. Nearly, 87% of couples reported joint decision-making on both family planning use and method type. Partner communication was significantly and positively associated with concordant family planning decision-making in both bivariate and multivariate models. Couples communicating about three family planning topics had more than twice the odds of concordant family planning decision-making than did those not reporting such communication. The qualitative findings provided insights into discordant as well as concordant interactions, revealing that decision-making, even when concordant, is not necessarily linear and is often complex. [ABSTRACT FROM AUTHOR]

Limited attention has been given to the effects of labour migration on the reproductive lives of women 'left behind' as their partners travel for work. Drawing on two rounds of qualitative interviews with 20 women in the central hill region of Nepal, this paper examines how global economic processes that lead Nepali men to travel for work also affect women's reproductive work, including childrearing and reproductive decision-making. Women understood their husband's migration to engage in the wage economy as a response to both immediate and long-term goals for their children and family. As a result, such productive work was intrinsically linked to reproductive work. Men's migration patterns played a pivotal role in reinforcing women's immediate childrearing roles and affecting whether and when women used a contraceptive method and what methods they considered. During periods of spousal migration, women's reproductive lives became targets of gossip and rumours as their intimate and reproductive practices and use of remittances were socially monitored. This complex understanding of women's lived experiences at the nexus of (re)productive work and labour migration can be practically applied to address the reproductive health needs of women with migrant spouses in Nepal. [ABSTRACT FROM AUTHOR]

Responses to the death of a spouse vary; although some are at increased risk of poorer physical and mental health outcomes, others have more resilient responses. In light of the limited scope of research on widows’ experiences in Nepal, a setting where widows are often marginalized, we explore themes of resilience in Nepali widows’ lives. Drawing from a larger qualitative study of grief and widowhood, a thematic narrative analysis was performed on narratives from four widows that reflected resilient outcomes. Individual assets and social resources contributed to these widows’ resilient outcomes. Forgetting, acceptance, and moving forward were complemented by confidence and strength. Social support and social participation were key to widows’ resilient outcomes. These four narratives reflect the sociocultural context that shape widows’ resilient outcomes in Nepal. Future studies on the emergent themes from this exploratory study will help identify how best to encourage resilient outcomes among widows. [ABSTRACT FROM AUTHOR]

Female sex workers (FSW) are highly mobile, which may result in reduced access to and use of health services and increased risk for poor health outcomes, particularly for those living with HIV. Mobility includes spatial, temporal, and social elements that are not fully captured by quantitative measures. We conducted two rounds of in-depth interviews with FSW living with HIV in Iringa, Tanzania (n = 20), and Santo Domingo, Dominican Republic (n = 20), to describe mobility experiences and compare mobility narratives across settings. We integrated a thematic analysis of all interviews with a narrative analysis of a subset of 10 information-rich interviews (five in each country) with women who had recently traveled, for sex work or another reason, outside of their hometown. Across narratives, FSW living with HIV traveled locally or to seasonal destinations, for short and long periods. Social factors influencing mobility included economic drivers; risk of arrest, harassment, or violence; anonymity and/or familiarity; social relationships; and clients' mobility. Spatial, temporal, and social factors intersected in unique ways in FSW's mobility experiences, yet distinct mobility typologies were evident across settings and destinations. Together, mobility narratives of FSW living with HIV can inform quantitative research on mobility typologies in Tanzania, the Dominican Republic, and elsewhere. With the potential for economic circumstances, climate change, and other emergencies to increase people's mobility around the world, researchers and practitioners can learn from the lived experiences of FSW to inform whether and how to tailor and improve the accessibility of HIV care and treatment interventions based on spatial, temporal, and social characteristics of mobility., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hendrickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Historically, men in sub-Saharan Africa have worse outcomes along the HIV care continuum than women. Brothers for Life (BFL) is a community-based behavior change intervention for men, adapted for Côte d'Ivoire, involving group discussions that address salient gender norms and promote HIV prevention, testing, and linkage to care with support from peer navigators. The goal of this study was to describe the BFL program as implemented in Côte d'Ivoire, evaluate program implementation, and report uptake of HIV testing and treatment among BFL participants., Setting: Three urban and periurban sites in Côte d'Ivoire., Methods: The implementation evaluation assessed the fidelity and acceptability of the BFL program and the reach of program completion, testing and peer navigation using qualitative and quantitative approaches., Results: BFL facilitation fidelity and content fidelity were high. Semistructured interviews with BFL participants indicated that men appreciated the format and content and that the BFL program helped some participants overcome their fears and adopt more positive attitudes and behaviors around testing and treatment. Assessments of reach showed that, of the 7187 BFL participants, 81% tested for HIV as part of BFL and 2.3% (135) tested HIV-positive. Of those, 76% (102) accepted peer navigator support, and 97% (131) initiated treatment. After 6 months, 100% of the 131 men who initiated treatment remained in care., Conclusion: The implementation of BFL in Côte d'Ivoire successfully achieved the goals of engaging participants in discussions around HIV prevention, encouraging HIV testing, and achieving linkage to care, treatment initiation, and retention.

Objective: This research is interested in the social transformations in francophone Africa, in particular urbanization and the communication revolution, and their influence on the lifestyles of young adolescents in Ouagadougou (Burkina Faso) and Kinshasa (Democratic Republic of the Congo). The objective is to examine the opportunities, challenges, and risks associated with these societal changes and related perceptions according to the gender of adolescents., Method: This qualitative study, conducted in 2015, uses data collected through semi-structured interviews with 64 adolescents from 10 to 14 years and their parents/guardians in Ouagadougou and Kinshasa. The analysis followed a deductive and inductive process to identify how societal changes offer new possibilities that are associated with risks for adolescent girls and boys., Results: According to participants, adolescence is accompanied by more opportunities today than in the past. Autonomy/freedom of movement, access to formal education, and access to information bring with them increased risks that differ by gender. Girls are exposed to an increase in sexual risks, boys to violence and consumption of alcohol., Conclusion: These results illustrate the ways in which societal transformations in francophone Africa influence the gendered socialization of young adolescents. The lifestyle changes and risks associated with them call for programs adapted for girls and to boys that exploit new communication tools to increase their access to information.

Objective: This research is interested in the social transformations in francophone Africa, in particular urbanization and the communication revolution, and their influence on the lifestyles of young adolescents in Ouagadougou (Burkina Faso) and Kinshasa (Democratic Republic of the Congo). The objective is to examine the opportunities, challenges, and risks associated with these societal changes and related perceptions according to the gender of adolescents., Method: This qualitative study, conducted in 2015, uses data collected through semi-structured interviews with 64 adolescents from 10 to 14 years and their parents/guardians in Ouagadougou and Kinshasa. The analysis followed a deductive and inductive process to identify how societal changes offer new possibilities that are associated with risks for adolescent girls and boys., Results: According to participants, adolescence is accompanied by more opportunities today than in the past. Autonomy/freedom of movement, access to formal education, and access to information bring with them increased risks that differ by gender. Girls are exposed to an increase in sexual risks, boys to violence and consumption of alcohol., Conclusion: These results illustrate the ways in which societal transformations in francophone Africa influence the gendered socialization of young adolescents. The lifestyle changes and risks associated with them call for programs adapted for girls and to boys that exploit new communication tools to increase their access to information.

Addressing community-level factors (CLFs) is integral to the ongoing effort to design multilevel, effective, and sustainable interventions to address each element of the HIV/AIDS treatment cascade. This review, the first critical review of this topic, identified 100 articles that (1) assessed CLFs in relation to the HIV/AIDS treatment cascade, (2) had been peer-reviewed, and (3) were based on studies conducted in low- or middle-income countries. Social support and social networks, cultural norms, gender norms, and stigma were the key CLFs associated with treatment and care. This extensive review found only 5 evaluations of interventions designed to affect CLFs, reflecting a major gap in the literature. All were communication interventions designed to create a more positive environment for HIV testing and access to treatment and care, thus pointing to some of the potential extraindividual effects of communication interventions. The qualitative data are rich and vital for understanding the context; yet, more quantitative analysis to provide evidence regarding the distribution of these factors is essential, as only 19 of the studies were quantitative. There is a pressing need to (1) collect community-level data, (2) validate social and gender norm scales, and (3) better use available data regarding social norms, gender norms, and other CLFs. These data could be aggregated at the cluster, neighborhood, or community levels and incorporated into multilevel analysis to help clarify the pathways to enhanced outcomes across the treatment cascade and thereby mitigate HIV sequelae.