RESUMO
The 2017 expanded Mexico City Policy prohibits non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. We study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President's Emergency Plan for AIDS Relief (PEPFAR) via a primary survey in all recipient countries and key-informant interviews in South Africa and the Kingdom of Eswatini (May-November 2018). Survey results showed that 28 percent (56 of 198) of organizations reported stopping or reducing at least one service in response to the policy. Reported service reductions included reducing the delivery of information about sexual and reproductive health, pregnancy counseling, contraception provision, and HIV testing and counseling. Interview data highlighted how these reductions were often a result of decreased patient flows or implementation of the expanded policy beyond what is required. Reductions disproportionately harmed pregnant women, youth, and key populations such as sex workers and men who have sex with men. Reduced delivery of sexual and reproductive health services has the potential to negatively affect many intended beneficiaries of PEPFAR funding, especially in areas with high HIV prevalence. Policy makers must respond to disruptions in service delivery and end any implementation that undermines US investment in high-quality HIV and sexual and reproductive health services.
Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Adolescente , Feminino , Saúde Global , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Serviços de Saúde , Homossexualidade Masculina , Humanos , Cooperação Internacional , Masculino , México , Gravidez , África do SulRESUMO
Colombia has an extensive policy framework to address violence against women. In this qualitative study the authors address the health system and policy response to sexual violence in Bogotá. Interviews were conducted with doctors, nurses, and social workers (n = 46) in emergency departments at public hospitals in Bogotá in 2015, and were analyzed for thematic content. Key findings were compared with district and national policies and 2013 WHO clinical and policy guidelines. Most providers exhibited sensitivity towards victims, but reported inadequate capacity building, undermining policy implementation. Our participants' eagerness to provide quality care suggests that health system strengthening may be timely and effective.
Assuntos
Atitude do Pessoal de Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Política de Saúde , Delitos Sexuais/psicologia , Adulto , Colômbia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
BACKGROUND: Female sex workers (FSWs) experience high rates of violence from their sexual partners. Although violence is associated with HIV risk behaviors among FSWs, there is limited evidence on the association between violence and HIV treatment outcomes. METHODS: We analyzed data from a socio-behavioral survey with a cohort of FSWs living with HIV in the Dominican Republic (n = 268) to describe the burden of violence from a sexual partner in the last 6 months. We assessed the relationship between violence and HIV treatment outcomes, comparing findings across 2 types of sexual partners: intimate partners and clients. RESULTS: Nearly one-fifth of women (18.3%) experienced violence in the last 6 months. More women experienced violence from an intimate partner (12.3%) than a client (8.3%), with some (2.6%) reporting both. Although violence from an intimate partner was significantly associated with not currently being on antiretroviral treatment [ART; adjusted odds ratio (AOR): 4.05, 95% confidence interval (CI): 1.00 to 16.36] and missing an ART dose in the last 4 days (AOR: 5.26, 95% CI: 1.91 to 14.53), violence from a client was associated with never having received HIV care (AOR: 2.85, 95% CI: 1.03 to 7.92) and ever interrupting ART (AOR: 5.45, 95% CI: 1.50 to 19.75). CONCLUSIONS: Violence from a sexual partner is associated with poor HIV treatment outcomes among FSWs. Different patterns by type of partner reflect how relationship dynamics may influence these associations. Violence prevention and support services should be tailored based on type of partner. Violence screening and referrals should be integrated into HIV care services for FSWs to improve their health and reduce ongoing transmission.
Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Profissionais do Sexo , Parceiros Sexuais , Violência , Adolescente , Adulto , Estudos de Coortes , República Dominicana , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. METHODS: We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. RESULTS: Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. DISCUSSION: A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings.
Assuntos
Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Poder Psicológico , Características de Residência/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adulto , Terapia Antirretroviral de Alta Atividade , Comportamento , Brasil/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Quênia/epidemiologia , Tailândia/epidemiologia , Ucrânia/epidemiologiaAssuntos
Preservativos/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Fatores Etários , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos , Feminino , Humanos , Nicarágua , Assunção de Riscos , Trabalho Sexual/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Violência/estatística & dados numéricosRESUMO
PURPOSE: To assess the prevalence and different types of violence experienced by women prisoners in Brazil and the effects of violence on women's depression and illicit drug use. METHODS: Participants (N=377) were incarcerated women from a state prison in a northeastern city of Brazil. Multivariate logistic regression models (adjusted for age, education, partner status, prison history, drug related offense, and sentencing status) were used to assess associations between each type of violence (physical abuse, sexual abuse, and life threats) and each outcome variable: recent depression and illicit drug use. RESULTS: The majority of participants (87%) reported experiencing some type of violence in their lifetime, including physical violence (83%), sexual victimization (36%), and threats on their life (29%.) Sexual violence was significantly related to both recent depression (Odds Ratio (OR)=2.8; 95% Confidence Interval (CI)=1.4-5.3) and recent substance use (OR=2.7; 95% CI=1.6-4.4) in adjusted models. Experiences of life threats were also significantly associated with illicit drug use (OR=2.2; 95% CI: 1.3-3.7), as was physical violence (OR=2.4; 95% CI: 1.2-4.9); however, neither of these latter two violence variables were significantly associated with depression. CONCLUSION: Reports of lifetime violence victimization among this incarcerated sample of women were extremely prevalent and relevant to women's depression and illicit drug use. Prison efforts to address women's depression and illicit drug use may be most effective by incorporating aspects related to women's history of victimization, especially given the high rates of violence experienced by women in this sample.