Medicine and Health Sciences Commons^™

Chronic Pain: The Extra Burden On Canadian Women, Marta Meana, Robert Cho, Marie Desmeules

Psychology Faculty Research

Health Issue

Chronic pain is a major health problem associated with significant costs to both afflicted individuals and society as a whole. These costs seem to be disproportionately borne by women, who generally have higher prevalence rates for chronic pain than do men.

Key findings

Data obtained from 125,574 respondents to the Canadian Community Health Survey (2000–2001) indicated that 18% of Canadian women suffered from chronic pain, compared to 14% of men. This gender discrepancy, however, seemed to be linked primarily to differences in age, income, and education between adult men and women in this large sample. Age, income, depression …

Medicalization Of Female Genital Cutting Among The Abagusii In Nyanza Province, Kenya, Carolyne Njue, Ian Askew

Reproductive Health

This study sought to understand the role that health providers play in the medicalization of female genital cutting (FGC) among the Abagusii community in western Kenya, among whom the practice continues to be almost universal. Interviews with service providers and their clients revealed an overwhelming belief that FGC fulfills a traditional cultural obligation among the Abagusii, and that it limits a woman’s sexual desire and confers respect on girls. New approaches are needed within this community to present FGC as violating human rights and national laws, as well as threatening girls’ and women’s health. The study recommends measures such as …

Strengthening Sti Treatment And Hiv/Aids Prevention Services In Carletonville, South Africa, Lewis Ndhlovu, Catherine Searle, Johannes Van Dam

HIV and AIDS

Although knowledge about HIV/AIDS is widespread in South Africa, adult HIV prevalence is high, indicating high levels of risky sexual behavior. Understanding the gap between knowledge and behavior requires an examination of the social context in which the epidemic occurs. The Horizons Program conducted an intervention study in the Carletonville area to study the social determinants of the HIV epidemic and to assess the impact of a targeted program of HIV and STI prevention and service delivery. In 1998, the Mothusimpilo (“Working together for health”) Intervention Project (MIP) was launched to reduce community prevalence of HIV and other STIs and …

Equitable Access To Hiv Counseling And Testing For Youth In Developing Countries: A Review Of Current Practice, Ann P. Mccauley

HIV and AIDS

While many people get HIV-related counseling and testing, only those who receive pre- and post-test counseling, and test voluntarily, are participating in voluntary counseling and testing (VCT). The high rates of HIV infection among youth make it crucial to find programs to prevent infection. Because there is evidence that many adults benefit from VCT, there is increasing interest in extending these services to young people. VCT counseling helps adolescents evaluate their own behavior and its consequences. A negative test result offers the opportunity to recognize vulnerabilities and develop risk-reduction plans to adopt safe behaviors. Young people who test HIV-positive can …

Promoting Young People's Sexual And Reproductive Health: Stigma, Discrimination And Human Rights, Kate Wood, Peter Aggleton

Reproductive Health

Sponsored jointly by the DFID-supported Safe Passages to Adulthood program, John Snow International, YouthNet/Family Health International, and the Population Council, the international knowledge synthesis meeting on Promoting Young People’s Sexual and Reproductive Health: Stigma, Discrimination and Human Rights took place in Brighton, England, June 5–7, 2003. Participants from a wide variety of countries were invited to describe their experiences of working to challenge stigma and discrimination and promote human rights as they relate to young people’s sexual and reproductive health. The meeting brought together program leaders from a variety of countries to discuss stigma, discrimination, and human rights in relation …

Determining An Effective And Replicable Communication-Based Mechanisms For Improving Young Couples' Access To And Use Of Reproductive Health Information And Services In Nepal—An Operations Research Study, Center For Research On Environment Health And Population Activities (Crehpa)

Reproductive Health

This operations research study sought to determine an effective communication-based model for increasing the involvement of community-based groups in improving access to and use of reproductive health services and information by young married couples. The study employed a quasi-experimental design with two experimental and two nonequivalent control groups in the Udaypur district of Nepal. As stated in this report, this OR study clearly demonstrates the effectiveness of communication-based models such as the formation and reactivation of Youth Communication Action Groups and Mother’s groups, basic and refresher training, group interaction and mobilization, and social events in creating an enabling environment for …

Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Dale Huntington, Mary Philip Sebastian, Barbara Mensch, Wesley H. Clark, Aditya Narain Singh, Sohini Roychowdhury, M.E. Khan, Nirmala Selvam, Bella C. Patel, Sandhya Barge, Y.P. Gupta, Lovleen Johri, Gita Biswas, Manohar Shenoy

Reproductive Health

The Population Council’s Frontiers in Reproductive Health (FRONTIERS) program and Policy Research Division, in collaboration with CARE India, conducted an operations research study in Allahabad, Uttar Pradesh to examine the feasibility and impact of adding livelihood counseling and training, savings formation activities, and follow-up support to an ongoing reproductive health program for adolescents. The short-term objective of the study was to foster development of alternative socialization processes for adolescent girls that encourage positive sexual and reproductive health behaviors. The study also aimed to produce a replicable model for CARE and other agencies to use in adding livelihood activities to adolescent …

A World Apart: The Disadvantage And Social Isolation Of Married Adolescent Girls, Nicole Haberland, Erica Chong, Hillary J. Bracken

Poverty, Gender, and Youth

This brief is based on a paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents, held in Geneva, Switzerland, December 9–12, 2003. The consultation brought together experts from the United Nations, donors, and nongovernmental agencies to consider the evidence regarding married adolescent girls’ reproductive health, vulnerability to HIV infection, social and economic disadvantage, and rights. The relationships to major policy initiatives—including safe motherhood, HIV, adolescent sexual and reproductive health, and reproductive rights—were explored, and emerging findings from the still relatively rare programs that are directed at this population were discussed. Despite the program attention and funding that have …

Socioeconomic Disadvantage And Unsafe Sexual Behaviors Among Young Women And Men In South Africa, Kelly Hallman

Poverty, Gender, and Youth

This study investigates how relative socioeconomic status influences the sexual behaviors of young women and men aged 14–24 years in KwaZulu-Natal Province, South Africa—an environment characterized by high HIV prevalence and high rates of poverty and inequality. Relative economic disadvantage is found to significantly increase the likelihood of a variety of unsafe sexual behaviors and experiences. Poorer young people, especially females, also have significantly lower access to media sources for family planning information. Without sufficient attention in the design and placement of HIV prevention programs to the economic and social conditions in which individuals live, the potential effectiveness of the …

Forced Sexual Relations Among Married Young Women In Developing Countries, Deepika Ganju, William Finger, Shireen J. Jejeebhoy, Vijaya Nidadavolu, K.G. Santhya, Iqbal Shah, Shyam Thapa, Ina Warriner

Poverty, Gender, and Youth

Recent research in developing countries suggests that a considerable number of young women may experience forced sex within marriage, but most women may be inhibited from reporting these experiences due to shame, fear of reprisal, or deep-rooted unequal gender norms. In September 2003, a global consultative meeting on nonconsensual sex among young people in developing countries was held in New Delhi, India. The meeting was organized by the Population Council in collaboration with World Health Organization/Department of Reproductive Health and Research, and Family Health International/YouthNet. Participants included researchers, legal analysts, representatives from community-based NGOs, policy-makers, and young people themselves. Papers …

Including Married Adolescents In Adolescent Reproductive Health And Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

The majority of sexually active girls aged 15–19 in developing countries are married, and married adolescent girls tend to have higher rates of HIV infection than their sexually active, unmarried peers. Married adolescent girls represent a sizable fraction of adolescents at risk and experience some of the highest rates of HIV prevalence of any group. Nonetheless, married adolescents have been marginal in adolescent HIV/AIDS policies and programs and have not been the central subjects for programs aimed at adult married women. This paper offers a partial explanation for why married adolescents have so often been overlooked, the reasons why marriage …

Adherence To Antiretroviral Therapy In Adults: A Guide For Trainers, Horizons Program, International Centre For Reproductive Health, Mombasa Coast Province General Hospital

HIV and AIDS

Over the last five years, there has been a rapid change in treatment strategies for HIV infection. With the advent of newer antiretrovirals, treatment has moved from mono-therapy and bi-therapy to triple drug therapy or Highly Active Antiretroviral Therapy. One of the foremost concerns of ARV programs is the ability of people living with HIV/AIDS to maintain near perfect adherence over the long term. To achieve the goal of antiretroviral therapy (ART), undetectable levels of the virus in the blood, patients are required to maintain more than 90–95% adherence. Adherence is defined as a patient’s ability to follow a treatment …

Intervenciones Comunitarias Y Política Gubernamental Reducen El Riesgo Del Vih En La República Dominicana, Deanna Kerrigan, Luis Moreno, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

Programas efectivos para evitar nuevas infecciones del VIH entre trabajadoras sexuales y sus parejas, y por lo tanto la población en general, son componentes críticos de estrategias nacionales de prevención del VIH. Generalmente los esfuerzos de prevención se han concentrado en intervenciones que alcanzan a los miembros de estos grupos vulnerables al nivel individual, tal como promoción de condones y manejo de ITS. Actualmente, muchos investigadores y gerentes de programas se encuentran dirigiéndose a intervenciones “ambientales-estructurales” que toman en cuenta los contextos físicos, sociales y políticos en que el comportamiento individual ocurre. Un estudio reciente realizado por Horizons, en conjunto …

Challenges Faced By Households In Caring For Orphans And Vulnerable Children, Population Council

HIV and AIDS

South Africa has seen a rapid increase in HIV prevalence among the general population over the past ten years, from less than 1 percent in 1990 to 20 percent in 2001. As the HIV/AIDS epidemic increases, so do the number of orphans and vulnerable children (OVC). In 2002, an estimated five million people were living with HIV/AIDS. Because of the average 10-year period between infection and death, even if HIV prevalence declined rapidly, South Africa would still experience an increasing orphan burden for many years to come. By 2010, 16 percent of all children in South Africa will be orphans …

The Role Of Incentives In Encouraging Workplace Hiv/Aids Policies And Programs, Simon Baker, Srisuman Sartsara, Patchara Rumakom, Philip Guest, Katie D. Schenk, Anthony Pramualratana, Suparat Suksakulwat, Surachai Panakitsuwan, Sikarat Moonmeung

HIV and AIDS

This brief examines the role of incentives in encouraging companies in Thailand to adopt workplace policies and programs that address AIDS-related stigma and discrimination and respond to the needs of workers for information and services. The research was a collaboration between the Horizons Program, American International Assurance (AIA), the Thailand Business Coalition on AIDS (TBCA), and AusAID. After the initiative was launched (known as the AIDS-response Standard Organization), TBCA staff built relationships with company managers to explain and promote the advantages of joining. Companies agreeing to implement at least three HIV/AIDS workplace policies would receive a reduction of 5–10 percent …

Attracting Youth To Voluntary Counseling And Testing Services In Uganda, Ann P. Mccauley, Milka Juma, Edward Kirumira, Nelson Kakande, Scott Geibel, C. Hitimana-Lukanika, Daniel Lukenge, Edith Mukisa

HIV and AIDS

Little is known about the use of voluntary counseling and testing (VCT) by youth, a group that comprises more than half of those newly infected with HIV. An exploratory study conducted in Nairobi, Kenya, and Kampala and Masaka in Uganda revealed that young people want information, confidentiality, low-cost HIV testing, and friendly, professional counseling. Two facilities in Kampala, the AIDS Information Center (AIC) and Naguru Teenage Information and Health Center (NTIHC), implemented new youth-oriented strategies to increase VCT utilization and satisfaction with services among young people. In 2001, AIC established a youth corner behind the regular adult clinic with a …

Youth Behavioral Risks And Psychosocial Resources In Peru's Alternative-Development Zones, Federico R. Leon, Mary L. Claux

Reproductive Health

Alternative-development programs are being offered to the population of seven regions of central-eastern Peru involved in coca cropping. The youth of these regions are above the national average in risk of pregnancy and sexually transmitted infections, use of alcohol and drugs, and violence against women. This study sought to identify and describe protective factors expected to function as counterforces to such risks; develop reliable indicators and provide a baseline concerning the risk behaviors and protective factors; compare youth by gender, developmental stage, urbanization, and geography to determine whether segmented interventions are required; and recommend specific intervention strategies. The results of …

Ishraq: Safe Spaces To Learn, Play And Grow: Expansion Of Recreational Sports Program For Adolescent Rural Girls In Egypt, Nadia Zibani

Poverty, Gender, and Youth

Over the past three years, the Ishraq program in the villages of northern El-Minya, Egypt, grew from a novel idea into a vibrant reality. In the process, approximately 300 rural girls have participated in a life-transforming chance to learn, play, and grow into productive members of their local communities. Currently other villages—and soon other governorates—are joining the Ishraq network. Ishraq is a mixture of literacy, life-skills training, and—for girls who have been sheltered in domestic situations of poverty and isolation—a chance to play sports and games with other girls their age and develop a sense of self-worth and mastery; the …

Sexual Coercion: Young Men's Experiences As Victims And Perpetrators, Deepika Ganju, William Finger, Shireen J. Jejeebhoy, Vijaya Nidadavolu, K.G. Santhya, Iqbal Shah, Shyam Thapa, Ina Warriner

Poverty, Gender, and Youth

Available evidence suggests that a considerable number of young people experience nonconsensual sex across the world, however research has mainly concentrated on the experiences of young girls and their perspectives of perpetrators of violence. Little is known about coercion among young males as victims or perpetrators. Case studies presented at an international consultative meeting in September 2003 in New Delhi, India, challenged the common assumption that only women are victims of violence, and shed light on the experiences of young males as victims of sexual coercion. These case studies also discussed the perspectives of young males as perpetrators of violence …

The Tostan Program: Evaluation Of A Community Based Education Program In Senegal, Nafissatou J. Diop, Modou Mbacke Faye, Amadou Moreau, Jacqueline Cabral, Helene Benga, Fatou Cisse, Babacar Mane, Inge Baumgarten, Molly Melching

Reproductive Health

This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a nongovernmental organization based at Thiès, Senegal. The basic education program consisted of four modules: hygiene, problem-solving, women’s health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyze their own situation more effectively and thus find the best solutions for themselves. The GTZ Supra Regional Project for the Elimination of Female Genital Cutting funded implementation of the program in 90 villages in Kolda Region, and the Population Council’s Frontiers in Reproductive Health …

Married Adolescents: An Overview, Nicole Haberland, Erica Chong, Hillary J. Bracken

Poverty, Gender, and Youth

The nascent work reviewed in this compendium indicates that married girls experience significant social isolation and limited autonomy. Across the studies examined, on indicators of mobility, exposure to media, and social networks, married girls are consistently disadvantaged compared to their unmarried peers. Similarly, across studies, on most of the domains explored here (mobility, decision-making, control over economic resources, and possibly gender-based violence), married girls tend to be less empowered and more isolated than slightly older married females. There may also be health issues associated with marriage during adolescence. Married girls are frequently at a disadvantage in terms of reproductive health …

Culturally Appropriate Information, Education And Communication Strategies For Improving Adolescent Reproductive Health In Cusco, Peru, Marco Florez-Arestegui Cornejo, Rosalinda Barreto Silva

Reproductive Health

The project Culturally Appropriate Information, Education and Communication Strategies for Improving Adolescent Reproductive Health in Cusco, Peru was designed in response to the evident lack of information and education on adolescent reproductive health in the country and, in particular, in the rural areas of the department of Cusco. Research revealed that a great need for sexual and reproductive health information still exists among indigenous adolescents in the rural areas of the region and that sexual education programs have to be sustainable. This report recommends that the Ministry of Education train more teachers in sexual and reproductive health topics, taking into …

Experience From A Community-Based Education Program In Burkina Faso: The Tostan Program, Djingri Ouoba, Zakari Congo, Nafissatou J. Diop, Molly Melching, Baya Banza, Georges Guiella, Inge Baumgarten

Reproductive Health

This study describes a project that tested the feasibility and effectiveness of replicating the village empowerment program (VEP) developed by the Senegalese NGO, TOSTAN, in Burkina Faso. Although originally developed for empowering women, the program implemented in Burkina Faso also involved men because of their key role in such decisions. Frontiers in Reproductive Health, with funding from USAID and the GTZ Supra Regional Project for the Elimination of FGC, supported the adaptation, implementation, and evaluation of the VEP model in 23 villages in the province of Bazega/Zoundwéogo. In the existing social climate among the Burkinabé, where there is widespread awareness …

Paving The Path: Preparing For Microbicide Introduction—Report Of A Qualitative Study In South Africa, Julie Becker, Rasha Dabash, C. Elizabeth Mcgrory, Diane Cooper, Jane Harries, Margaret Hoffman, Jennifer Moodley, Phyllis Orner, Hillary J. Bracken

HIV and AIDS

With recently accelerated support for the development of microbicides to prevent HIV transmission and the urgency of the global AIDS epidemic, it is important to begin to identify strategies for introducing a microbicide once it is proven safe and effective and is approved for use. This report presents results from a qualitative study that explored a range of issues likely to influence microbicide introduction—positively or negatively—at three levels: community, health service, and policy. The study, which identified critical issues to be addressed in building support for microbicides and facilitating a smooth introduction, was conducted between September 2002 and September 2003 …

Linking Reproductive Health To Social Power: Community Health Workers In Belize And Pakistan, Susana Galdos, Lucella Campbell, Patricia Mohammed, Debbie Rogow, Saumya Ramarao, Ali M. Mir, Nicole Haberland

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité focuses on two traditional family planning programs that undertook projects to help women enlarge their zone of influence in both the private and public spheres. The first case study focuses on the Belize Family Life Association (BFLA), a nongovernmental organization in a small Caribbean country. The second case study recounts the experience of the Pakistani government, which has an enormous, but entrenched, target-oriented family planning program. Both programs began by recognizing that women’s lack of social power is a major obstacle to their being able to protect their own health. Both trained village workers to regard …

Community Approaches And Government Policy Reduce Hiv Risk In The Dominican Republic, Deanna Kerrigan, Luis Moreno, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

Effective programs that avert new HIV infections among sex workers and their partners, and hence the general population, are critical components of national HIV-prevention strategies. Prevention efforts have frequently relied on interventions that reach members of these vulnerable groups as individuals, such as condom promotion and STI management. Now, many researchers and program implementers are increasingly turning to “environmental-structural” interventions that address the physical, social, and political contexts in which individual behavior takes place. A recent Horizons study conducted jointly with two Dominican NGOs—Centro de Orientación e Investigación Integral and Centro de Promoción e Solidaridad Humana—and the National Program for …

Vulnerability And Intervention Opportunities: Research Findings On Youth And Hiv/Aids In South Africa, Population Council

HIV and AIDS

The Nelson Mandela Children’s Fund (NMCF) seeks comprehensive local solutions to address the negative effects of HIV/AIDS on children, adolescents, households, and communities. To this end, NMCF initiated the Goelama Project, which uses a community mobilization strategy to catalyze action by local organizations and government bodies to prevent HIV infection and mitigate the socioeconomic impacts of the disease, particularly as they affect orphans and vulnerable children (OVC). This brief highlights key findings from an assessment of reproductive and sexual health knowledge and behaviors among nearly 5,000 youth from eight districts in three provinces in South Africa where the Goelama Project …

Combining Community Approaches And Government Policy To Reduce Hiv Risk In The Dominican Republic, Deanna Kerrigan, Luis Moreno, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

A recent Horizons study conducted jointly with two Dominican NGOs assessed the impact of two environmental-structural models in reducing HIV-related risk among female sex workers in the Dominican Republic and compared their cost-effectiveness. In the two cities studied, there were improvements from pre- to post-intervention in the key outcome variables, however the type and level of these changes varied by intervention approach. Based on our findings, program planners and policymakers involved in the study in the Dominican Republic agree that the integrated solidarity and policy model in conjunction with ongoing peer education and community mobilization activities is an appropriate, cost-effective, …

Opiniones Y Respuestas: Resultados De Una Encuesta De Opinión A Médicos Mexicanos Sobre El Aborto, Diana K. Lara, Lisa Goldman, Michelle Firestone

Reproductive Health

En México es incuestionable el papel crucial que los médicos juegan en la oferta de servicios seguros de aborto legal y en la atención a las mujeres con abortos en evolución, espontáneos o inducidos, y abortos complicados. Sin embargo, ningún estudio dirigido a personal de salud, y específicamente a médicos, se había realizado con una muestra representativa a nivel nacional. Una brecha de ese tipo en la literatura científica justificó la realización, entre julio y agosto de 2002, de una encuesta nacional en la cual se recopiló información sobre los conocimientos y las opiniones de médicos gíneco-obstetras, médicos familiares y …

Married Adolescents: A Review Of Programmes, Auralice Graft, Nicole Haberland, Rachel E. Goldberg

Poverty, Gender, and Youth

Historically, major adolescent and reproductive health initiatives have failed to explicitly consider the needs of married adolescents. This paper provides insight into what is being done—or not being done—to support married adolescent girls and boys, how these populations’ needs are being conceptualized, and the extent to which social context is factored into program design. Some early work with adolescent mothers (married and unmarried) is considered. The degree to which selected adolescent programs have been able to reach married girls with their activities is briefly examined. A few basic parameters of potential interventions for married adolescents are presented, including an inventory …