Kamndaya M.,University of Witwatersrand |
Thomas L.,Gender and Health Unit |
Vearey J.,University of Witwatersrand |
Sartorius B.,University of KwaZulu - Natal |
Kazembe L.,University of Namibia
Journal of Urban Health | Year: 2014
Young people in urban slums adopt HIV risk behaviors influenced by their neighborhood factors. Three critical factors in urban slums of Southern and Eastern Africa - the region most affected by the HIV epidemic in the world - are unmet needs of housing, food, and health care, which are associated with HIV sexual risks. Yet, there has been limited attention on how the combination of unmet needs of housing, food, and health care - i.e., material deprivation - relates to sexual risk behavior among young people in urban slums. Cross-sectional data were extracted from the LoveLife survey in South African four provinces - KwaZulu Natal, Mpumalanga, Eastern Cape, and Gauteng, to examine the association between material deprivation and sexual risk behavior among young people aged 18-23 years (263 males, 267 females) in urban slums. Adjusted logistic regression models showed that material deprivation was significantly associated with increased odds of high sexual risk taking for young men (adjusted OR∈=∈1.20; 95 % CI∈=∈1.10, 5.58) and young women (adjusted OR∈=∈1.43; 95 % CI∈=∈1.35, 3.28). Financial difficulty - a proxy for other deprivations - was the most salient influence on young women's high sexual risk taking (adjusted OR∈=∈2.11; 95 % CI∈=∈1.66, 2.70). Localized behavioral HIV prevention interventions should target young people in deprived households. © 2014 The New York Academy of Medicine.
Gibbs A.,University of KwaZulu - Natal |
Jewkes R.,Gender and Health Unit |
Mbatha N.,Room E304 Diakonia Conference Center |
Washington L.,Room E304 Diakonia Conference Center |
Willan S.,University of KwaZulu - Natal
African Journal of AIDS Research | Year: 2014
This paper seeks to refocus debates on structural interventions away from assessing their effectiveness towards understanding processes around how such interventions are implemented. Implementation Science is focused on understanding potential challenges of translating interventions from highly controlled conditions into real life settings. Using the case study of Stepping Stones and Creating Futures a structural and behavioural intervention to reduce intimate partner violence and HIV risk behaviours amongst young women and men in urban informal settlements, we explore the challenges of implementing such an approach. We move beyond simply describing challenges of implementing, to understand how these challenges had an impact on the safe social space the intervention seeks to create as its underlying theory of change. We identify four major challenges of implementation: taxi fares, food provided during the intervention, young peoples ongoing need to work and journals provided during the intervention. We suggest that, in different ways, these factors all impinged on the emergence of a safe social space. Understanding the challenges of implementing the intervention is critical for reflecting on scaling up interventions. Central to this is the need to work with participants to help them negotiate the challenges of participating in interventions. © 2014 NISC (Pty) Ltd.
Shamu S.,University of the Western Cape |
Abrahams N.,Gender and Health Unit |
Temmerman M.,Ghent University |
Musekiwa A.,Biostatistics Unit |
Zarowsky C.,University of the Western Cape
PLoS ONE | Year: 2011
Background: Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women. Methods: A key-word defined search of various electronic databases, specific journals and reference lists on IPV prevalence and risk factors during pregnancy resulted in 19 peer-reviewed journal articles which matched our inclusion criteria. Quantitative articles about pregnant women from Africa published in English between 2000 and 2010 were reviewed. At least two reviewers assessed each paper for quality and content. We conducted meta-analysis of prevalence data and reported odds ratios of risk factors. Results: The prevalence of IPV during pregnancy ranges from 2% to 57% (n = 13 studies) with meta-analysis yielding an overall prevalence of 15.23% (95% CI: 14.38 to 16.08%). After adjustment for known confounders, five studies retained significant associations between HIV and IPV during pregnancy (OR1.48-3.10). Five studies demonstrated strong evidence that a history of violence is significantly associated with IPV in pregnancy and alcohol abuse by a partner also increases a woman's chances of being abused during pregnancy (OR 2.89-11.60). Other risk factors include risky sexual behaviours, low socioeconomic status and young age. Conclusion: The prevalence of IPV among pregnant women in Africa is one of the highest reported globally. The major risk factors included HIV infection, history of violence and alcohol and drug use. This evidence points to the importance of further research to both better understand IPV during pregnancy and feed into interventions in reproductive health services to prevent and minimize the impact of such violence. © 2011 Shamu et al.
McDermott S.,Public Health Agency of Canada |
Desmeules M.,Public Health Agency of Canada |
Lewis R.,Public Health Agency of Canada |
Gold J.,Public Health Agency of Canada |
And 9 more authors.
Journal of Immigrant and Minority Health | Year: 2011
Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin. © 2010 Her Majesty the Queen in Rights of Canada.
Doull M.,University of Ottawa |
Runnels V.E.,University of Ottawa |
Tudiver S.,Gender and Health Unit
Journal of Women's Health | Year: 2010
Objective: To examine the use of sex- and gender-based analysis (SGBA) in systematic reviews of cardiovascular health in order to strengthen the evidence base for clinical practice and policy. Methods: To determine the current status of SGBA in systematic reviews, an appraisal tool was developed by the research team and applied by an independent reviewer to a random sample of 38 Cochrane systematic reviews. The sample was drawn from reviews addressing interventions for cardiovascular diseases (CVD). A random sample of Cochrane reviews in cardiovascular health was selected from the Cochrane Library, Issue 3, 2001, to Issue 3, 2007. The main outcome measure was the number of reviews that included analysis of sex or gender or both. Results: Our findings showed that SGBA was generally absent in the sampled reviews. Data were rarely disaggregated by sex; only 2 of 38 reviews reported any sex or gender research gaps. Only one quarter of the reviews included a rationale as to why any subgroup analyses by sex were or were not completed. None of the 38 reviews met all of the appraisal tool criteria. As well, we found that where sex or gender was mentioned, the terms were used interchangeably. Conclusions: Despite increasing evidence over the past decade documenting that sex and gender frequently matter in CVD, this study demonstrated that SGBA was rarely considered in systematic reviews. We suggest this omission has important implications for assuring the quality of research and of evidence-based policy and practice and for achieving equitable health outcomes for women and men. To build a robust evidence base for future work in cardiovascular health, we propose that the methodologies of systematic reviews and of SGBA be refined and synchronized to enhance the collection, synthesis, and analysis of evidence for decision making. © 2010, Mary Ann Liebert, Inc.