Search

BackgroundYoung people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents. ObjectiveTumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial. MethodsDuring the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview–based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game’s appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel. ResultsAdolescent participants’ survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability. ConclusionsThis study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents. Trial RegistrationClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW)

BackgroundThere is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. ObjectiveTo pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. MethodsTumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. ResultsIntervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P

Objective: mHealth interventions often favour individual-level effects. This is particularly problematic in contexts where social support and shifts in social norms are critical to sustained behaviour change. Mobile digital games represent a promising health education strategy for youth, including in low-resource settings. We sought to better understand the interpersonal and social interactions that can be elicited by digital games for health. Design: We piloted "Tumaini," a smartphone game rooted in interactive narrative designed to prevent HIV among young Africans (aged 11-14), in a randomised controlled feasibility study and analysed reports of the household dynamics surrounding gameplay. Following a 16-day intervention period, phone gameplay log files were downloaded, and intervention arm participants (n = 30) completed a gameplay experience survey; eight focus group discussions were held, four with intervention arm participants (n = 27) and four with their parents (n = 22). Setting: This study took place in Kisumu, Kenya, in Spring 2017. Method: Descriptive statistics were computed from survey responses and log files. Focus group transcripts were labelled, analysed thematically and compared demographically using MAXQDA software. Results: Data from log files, surveys and focus groups indicate that the game generated considerable interaction and dialogue with parents, siblings and friends and served as a catalyst for children to act as advocates for healthful decisions about sex, both within the family and beyond. The game showed a high level of acceptability with parents. Conclusion: Serious digital games using a smartphone platform can generate considerable household interaction. Games can model and facilitate these exchanges, maximising multi-level effects. An additional app for parents could reinforce these effects.

Objectives: The past decade has seen changes in US HIV policy in sub-Saharan Africa in response to a new Administration and far-reaching technical, scientific and programmatic developments. These include dramatically increased access to life-saving anti-retroviral therapy (ART) and related services, the roll-out of voluntary medical male circumcision and growing sensitivity to gender-based violence, including child sexual abuse, and to its role in increasing vulnerability to HIV. The "Families Matter! Program" (FMP) is an intervention for parents and caregivers of 9- to 12-year-olds that promotes effective parent-child communication about sexuality and sexual risk reduction. FMP was adapted from a US evidence-based intervention in 2003-2004 and is now implemented in eight African countries. In 2012-2013, the FMP curriculum was updated and enhanced to respond to new US Government priorities. Methods: Enhancements to the curriculum drew on the results of Violence Against Children surveys, on a review of existing literature, on feedback from the field on the existing curriculum and on stories written by young people across Africa for scriptwriting competitions. Methods: Enhancements to the curriculum drew on the results of Violence Against Children surveys, on a review of existing literature, on feedback from the field on the existing curriculum and on stories written by young people across Africa for scriptwriting competitions. Results: We updated FMP with scientific content and stronger linkages to services. We also intensified our focus on structural determinants of risk. This contextualisation of sexual risk-taking within structural constraints led us to place greater emphasis on gendered vulnerability and the diverse pressures children face and to intensify our situation-based pedagogical approach, drawing on the authentic youth-authored narratives. Conclusion: We describe these changes as an illustration of and source of insight into much-needed programmatic adaptation in response to evolving HIV policy.

A study of 50 narratives (16 male-authored, 34 female-authored, ages 13-16) contributed to a scriptwriting competition by Mexican youth from Oaxaca State was undertaken to understand youth social representations of hegemonic masculinity. Representations of masculinity manifested within three domains: substance use, companionate or abusive relationships, and economic roles. Positively portrayed male characters maintained companionate relationships and economically provided for loved ones. Rejection of abusive rural male characters who misuse financial resources occurred via condemnatory language and tragic outcomes. The young authors highlight financial control as a key element of Mexican masculinity, but this control goes unchallenged if dependents benefit. The rejection of a macho hegemonic masculinity in favor of a companionate relationship model mirrors historic trends in Mexico regarding migration, gender, class, and modernity. Keywords: companionate relationships, hegemonic masculinity, Mexico, narrative analysis, social representations, youth, In Latin America, research on gender and masculinities has been conducted over the past several decades across contexts of social, political, and economic transformation, including the influence of feminist movements [...]

Background: Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. Objective: The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. Methods: Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. Results: Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. Conclusions: This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. [ABSTRACT FROM AUTHOR]

'Der Sturm' (Storm), a periodical started by Herwarth Walden in 1910, was the propagator of Walden's work and of Expressionism. It focused on visual art, poetry, literature and artistic theory. Walden's championing of the German internationalism found full expression in the contents of 'Sturm'. The dialectical relation between art and politics in 'Der Sturm', especially during the war period, 1914-1919 is examined.

Sexual transaction, or any exchange of financial or material goods for sex, contributes to the disproportionate HIV burden among young women aged 15-24 years in sub-Saharan Africa. We analysed representations of sexual transactions in a sample of 363 narratives about HIV written by young Africans. The narratives were written at 4 time points (1997, 2005, 2008, 2014) by authors aged 10-24 years in urban and rural areas of Senegal, Burkina Faso, South-east Nigeria, Kenya and Eswatini, formerly Swaziland. We combined three analytical approaches: descriptive statistics of quantifiable characteristics of the narratives, thematic data analysis and a narrative-based approach. Representations reflect sexual transaction as a spectrum, with commercial sex work and sexual transactions that include romance at opposite ends. Narratives represent female characters increasingly motivated by a desire for social status symbols and by romantic love over time. Condemnation and stigmatisation of sexual transactions motivated by materialism remain similar across countries. In order to mitigate young women's disproportionate risk of HIV there is a need to combine efforts to address the economic marginalisation and gender inequality that drive sexual transactions with activities to promote skills and reflection and influence harmful norms, potentially drawing on companionate ideologies. [ABSTRACT FROM AUTHOR]

Nearly 32% of women report experiencing physical violence from an intimate partner and more than 8% report being raped by a significant other in their lifetime. Young people's perceptions that their peers perpetrate relationship violence have been shown to increase the odds of self-reported perpetration. Yet, limited research has been conducted on this relationship as individuals begin to age out of adolescence. The present study sought to examine the link between the perception of peer perpetration of intimate partner violence (IPV) and self-reported IPV perpetration among a sample of predominately young adult (21-35 years) males. This study also explored the discordance between the perception of peer IPV behavior and self-reported perpetration. Data from 101 male peer dyads (n = 202) were taken from a study on the effects of alcohol and bystander intervention in Atlanta, Georgia. Thirty-six percent (n = 73) of men reported perpetrating physical IPV and 67% (n = 135) reported perpetrating sexual IPV in the past 12 months. Nearly 35% (n = 55) of the sample reported that none of their peers had perpetrated physical IPV, which contradicted their friend's self-report of physical IPV perpetration. Similarly, 68% (n = 115) of the men perceived none of their peers to have perpetrated sexual IPV, which contradicted their friend's self-report of sexual IPV perpetration. Discordance variables were significantly associated with self-reported perpetration for both physical (χ2 = 152.7, p <.01) and sexual (χ2 = 164.4, p <.01) IPV. These results point to an underestimation of peer IPV perpetration among young adult males. Findings suggest a traditional social norms approach to IPV prevention, which seeks to persuade individuals that negative behaviors are less common than perceived, may not be the best approach given a significant number of men believed their friends were nonviolent when they had perpetrated violence. [ABSTRACT FROM AUTHOR]