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CONTEXT: Vaginal rings are available forcontraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS: Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS: Twenty-sixarticles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method--often related to insertion and removal, cleanliness and discomfort with touching their vagina--that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS: Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use. Contexto: Los anillos vaginales estan disponibles para la anticoncepcion y el reemplazo hormonal, y se estan desarrollando como tecnologias de prevencion del VIH/ETS o de propositos multiples. Se necesita con urgencia una comprension integral de las expectativas y experiencias de las mujeres con los anillos para fundamentar el desarrollo del producto y optimizar el uso del anillo. Metodos: Entre enero de 1996 y noviembre de 2017, se realizaron busquedas en tres bases de datos (PubMed, Global Health y CINAHL) sobre articulos en idioma ingles sometidos a revision por pares, que aportaron datos cualitativos sobre barreras y facilitadores del uso de metodos anticonceptivos controlados por mujeres. Los datos sobre los metodos de estudio, hallazgos y conclusiones relacionados con los anillos anticonceptivos se extrajeron, organizaron y analizaron. Resultados: Veintiseis articulos, todos publicados desde 2008, cumplieron con los criterios de inclusion en el analisis. Siete estudios se centraron en gran medida o completamente en los anillos (e involucraron usuarias actuales, anteriores o potenciales), mientras que los otros estudios se centraron en otros metodos anticonceptivos, pero incluyeron datos especificos sobre el anillo. La familiaridad con el anillo era baja y las mujeres generalmente expresaron preocupaciones iniciales sobre el metodo--muchas veces en relacion con la insercion y extraccion, la limpieza y la incomodidad al tocar su vagina--que tipicamente se superaban con el tiempo. Otros temas importantes fueron aspectos relacionados con el uso y la interrupcion del uso del anillo, la importancia de las propiedades y caracteristicas relacionadas con el anillo y consideraciones relacionadas con parejas sexuales y proveedores de servicios medicos. Conclusion: Los datos cualitativos tienen potencial para fundamentar el diseno y la promocion de los anillos vaginales. Las investigaciones futuras deben explorar mas a fondo las expectativas y experiencias de las mujeres con respecto al anillo, el valor de involucrar a los companeros masculinos en la evaluacion del anillo y la evaluacion de las intervenciones para mejorar la comunicacion entre paciente y proveedor con respecto a la eleccion y el uso del anillo. Contexte: L'anneau vaginal, deja propose a des fins de contraception et de traitement hormonal de substitution, fait aujourd'hui l'objet d'une mise au point parmi les technologies de prevention du VIH/sida ou polyvalente. Il est imperatif de bien comprendre les attentes et le vecu des utilisatrices pour eclairer la mise au point du produit et en optimiser l'usage. Methodes: Trois bases de donnees (PubMed, Global Health et CINAHL) ont ete consultees a la recherche d'articles en langue anglaise evalues par les pairs et publies entre janvier 1996 et novembre 2017, faisant etat de donnees qualitatives sur les obstacles et les facteurs propices a l'usage des methodes contraceptives controlees par les femmes. Les donnees relatives aux methodes d'etude, aux observations et aux conclusions pertinentes a l'anneau contraceptif en ont ete extraites, puis organisees et analysees. Resultats: Vingt-six articles publies, tous depuis 2018, ont repondu aux criteres d'inclusion. Sept etudes concernaient largement ou exclusivement l'anneau (avec participation des utilisatrices actuelles, passees ou potentielles); les autres examinaient d'autres methodes contraceptives mais presentaient des donnees specifiques a l'anneau. Vanneau n'etait guere familier aux femmes, dont les preoccupations initiales a l'egard de la methode--souvent liees aux questions d'insertion et de retrait, d'hygiene et de gene au contact du vagin--se dissipaient toutefois au fil du temps. Les autres grands themes touchaient a l'utilisation de l'anneau et a l'arret de la methode, a l'importance de ses proprietes et caracteristiques et a des considerations relatives aux partenaires sexuels et aux prestataires de soins de sante. Conclusion: Les donnees qualitatives offrent un potentiel utile a la conception et a la promotion de l'anneau. La recherche future devra examiner davantage les attentes et le vecu des femmes a son egard, l'importance de la participation des partenaires masculins a son evaluation et l'evaluation des interventions entreprises pour ameliorer la communication entre patientes et prestataires quant au choix et a l'utilisation de la methode., Women are disproportionately affected by negative sexual and reproductive health outcomes, including unintended pregnancy and STDs. (1) It is critically important that women have access to effective and acceptable products [...]

Introduction: Despite healthcare providers' growing awareness of pre-exposure prophylaxis (PrEP), prescription rates remain low. PrEP is an efficacious HIV prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of PrEP on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for PrEP access, we examined how medical students' willingness to prescribe PrEP varied by patients' condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with PrEP. Methods: An online survey was distributed to 854 medical students in the Northeastern US in 2015. Participants (n = 111) were surveyed about their willingness to prescribe PrEP for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with PrEP) and partnering practices (single male partner with untreated HIV or multiple male partners of unknown HIV status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception. Results: Willingness to prescribe PrEP was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe PrEP--93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse.The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%). Conclusion: Medical students' clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal HIV prevention services. Keywords: HIV; pre-exposure prophylaxis; healthcare disparities; prescriptions; health personnel; sexual minorities, 1 | INTRODUCTION Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy [1]. US clinical guidelines cite condomless sex as a key indicator of HIV risk and PrEP candidacy [2]. [...]

Background: Previous research has suggested that orphaned children and adolescents might have elevated risk for HIV infection. We examined the state of evidence regarding the association between orphan status and HIV risk in studies of youth aged 24 years and younger. Methods: Using systematic review methodology, we identified 10 studies reporting data from 12 countries comparing orphaned and non‐orphaned youth on HIV‐related risk indicators, including HIV serostatus, other sexually transmitted infections, pregnancy and sexual behaviours. We meta‐analyzed data from six studies reporting prevalence data on the association between orphan status and HIV serostatus, and we qualitatively summarized data from all studies on behavioural risk factors for HIV among orphaned youth. Results: Meta‐analysis of HIV testing data from 19,140 participants indicated significantly greater HIV seroprevalence among orphaned (10.8%) compared with non‐orphaned youth (5.9%) (odds ratio = 1.97; 95% confidence interval = 1.41‐2.75). Trends across studies showed evidence for greater sexual risk behaviour in orphaned youth. Conclusions: Studies on HIV risk in orphaned populations, which mostly include samples from sub‐Saharan Africa, show nearly two‐fold greater odds of HIV infection among orphaned youth and higher levels of sexual risk behaviour than among their non‐orphaned peers. Interventions to reduce risk for HIV transmission in orphaned youth are needed to address the sequelae of parental illness and death that might contribute to sexual risk and HIV infection., Background One of the many consequences of the global HIV epidemic is the impact of adult parental AIDS illness and death on children [1,2]. Orphans are defined as children under [...]

ABSTRACT Background Abstinence-plus (comprehensive) interventions promote sexual abstinence as the best means of preventing HIV, but also encourage condom use and other safer-sex practices. Some critics of abstinence-plus programs have [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.childyouth.2006.03.002 Byline: Paul Montgomery, Charles Donkoh, Kristen Underhill Keywords: Young people; Independent living programs; Public care; Foster care; Life skills Abstract: A substantial body of evidence suggests that young people leaving public care systems are at increased risk for low educational attainment, unemployment, homelessness, physical and mental health difficulties, dependency on public assistance, and involvement with the criminal justice system. Independent living programs (ILPs), which incorporate life skills and personal development, are one strategy frequently used to improve outcomes for young people leaving care. However, the effectiveness of ILPs remains unknown. This paper systematically reviews the current evidence for ILPs, summarizing all controlled comparisons designed to evaluate their effectiveness. Reviewers were unable to find any randomized controlled trial evaluating ILPs, but the results of eight non-randomized controlled studies suggest that some ILPs may have protective effects for youth leaving the public care system. These trends were observed for outcomes related to educational attainment, employment, housing, health, and other life skills; nevertheless, the weak methodological quality of the evidence tempers the validity and generalizability of these conclusions. Further research utilizing random assignment of participants is imperative in order to draw reliable conclusions for policy and practice. Author Affiliation: Centre for Evidence-Based Intervention, Department of Social Policy and Social Work, Oxford University, UK Article History: Received 27 January 2006; Revised 7 March 2006; Accepted 22 March 2006