International Public Health Commons^™

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services—Appendixes, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. Included in this document are the Appendixes to “The Reference Guides for Health Care Organizations Seeking Accreditation for High-Quality, Gender-Sensitive Reproductive Health Services,” which provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures …

Improving The Quality Of Family Planning And Reproductive Tract Infection Services For Urban Slum Populations: Demand-Based Reproductive Health Commodity Project, Md. Noorunnabi Talukder, Ubaidur Rob, Md. Mafizur Rahman

Reproductive Health

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. …

Mainstreaming Emergency Contraception In Kenya: Final Project Report, Jill Keesbury, Wilson Liambila, Francis Obare, Paul Kuria

Reproductive Health

For more than a decade, advocates have sought to improve access to emergency contraception (EC) around the world. These efforts have been highly successful in Europe and North America, have generated much debate in Latin America, and are beginning to take hold in Asia. In Africa, however, the success of EC programs remains limited. Even in countries where the regulatory environment is favorable, resource constraints within the public sector limit the ability to provide consistent and quality EC services at low cost. In a growing number of African countries, the private sector has emerged to fill these gaps, increasing access …

Being (Becoming Empowered In Nursing Growth): Training Guide For Nursing Students On Sexuality And Gender, Maryann Washington

Reproductive Health

This training guide was produced as part of a Health and Population Innovation Fellowship administered by the Population Council, India, and aims to help the faculty of nursing students to deliver comprehensive sexuality education effectively and efficiently, to help trainee nurses see the whole picture of sexuality in its matrix of safety, pleasure, reproduction, illness, and health. The package is called ‘BEING’ (acronym for Becoming Empowered in Nursing Growth) as it is assumed that, if delivered well, it could empower nurses’ growth to address these issues.

The Copperbelt Model Of Integrated Care For Survivors Of Rape And Defilement: Testing The Feasibility Of Police Provision Of Emergency Contraceptive Pills, Jill Keesbury, Mary Zama, Sudha Shreeniwas

Reproductive Health

The Zambian Ministry of Home Affairs (Police Service), Ministry of Health (MOH) and the Population Council collaborated on an operations research study designed to improve services for survivors of gender-based violence (GBV). Specifically, the study tested the feasibility of police provision of emergency contraception (EC). It also hypothesized that the intervention could strengthen GBV services at both police and health facilities through an increased emphasis on multisectoral collaboration. Based on the study’s findings, national scale-up of this program has been widely endorsed. The following recommendations are offered to guide such scale-up: ensure that a dedicated EC pill is available through …

The Refentse Model For Post-Rape Care: Strengthening Sexual Assault Care And Hiv Post-Exposure Prophylaxis In A District Hospital In Rural South Africa, Julia C. Kim, Ian Askew, Lufuno Muvhango, Ntabozuko Dwane, Tanya Abramsky, Stephen Jan, Ennica Ntlemo, Jane Chege, Charlotte Watts

Reproductive Health

The Refentse study aimed to develop a nurse-driven, post-rape care model that could be integrated into existing reproductive health/HIV services within a rural South African hospital, and to evaluate the impact of this model on the quality of care delivered. Following the intervention, there were significant improvements in the quality of clinical history and examination, and the provision of pregnancy testing, emergency contraception, STI treatment, HIV counseling and testing, post-exposure prophylaxis (PEP), trauma counseling, and referrals. The report concludes that it is possible to improve sexual assault services including PEP within a rural South African hospital at modest cost, using …

Translating Medical Evidence Into Practice: Working With Communities And Providers To Promote Active Management Of The Third Stage Of Labour, B. Subha Sri

Reproductive Health

Although postpartum hemorrhage is a leading cause of death in India, and despite the fact that active management of the third stage of labor (AMTSL) has been established as a best practice, efforts to promote it have been limited. This paper documents the experiences of a project that aimed to enable the translation of available evidence regarding AMTSL into practice through two strategies, at community and provider levels respectively. Community-level activities included efforts to build awareness regarding safe delivery practices, sensitize individuals regarding the rights perspective and their entitlement to safe services, and facilitate the translation of this awareness into …

Premarital Sexual Behaviour Among Unmarried College Students Of Gujarat, India, Rachna Sujay

Reproductive Health

The aim of this report is to explore experiences of sexual relations and factors (including, for example, those at the individual, parental, peer, and college levels) associated with premarital sex, safe and otherwise, among college-going male and female students in Gujarat, India. Findings suggest that awareness of sexual and reproductive matters was relatively limited, attitudes to premarital sex typically gendered, and fewer than half of all students had been exposed to sexuality education in school or college. Romantic partnerships and physical intimacy were reported by considerable proportions of male and female students; premarital sex among notable minorities; and unsafe sex, …

Medical Response To Male Same-Sex Sexuality In Western India: An Exploration Of 'Conversion Treatments' For Homosexuality, Ketki Ranade

Reproductive Health

This report aims to explore the use of conversion therapy by healthcare providers in Western India to treat homosexuals, the criteria used for selecting clients for conversion therapy, the types of therapies employed, and perceived outcomes of such therapies. In contrast to most international guidelines for treatment of homosexuality, conversion therapy still seems to be practiced by many healthcare providers in India. Findings suggest that providers’ attitudes, understanding, and assumptions regarding normative and non-normative sexuality, homosexuality, marriage, procreation, and change or cure of homosexual sexual orientation makes up a complex belief system that has not incorporated some of the latest …

Exploring The Lives Of Youth In The Bpo Sector: Findings From A Study In Gurgaon, Monisha Vaid

Reproductive Health

This report seeks to fill gaps in information on the lives of unmarried youth in the business process outsourcing (BPO) sector in India. Specifically, it documents young people’s self-efficacy and their connections with their family and peers, as well as their sexual experiences and substance use practices. The findings presented in this report reiterate the fact that BPO employment not only provides young adults with a profitable and challenging work environment, but also has other positive outcomes: many young BPO employees associated their increased independence and self-efficacy to their employment in this sector, many reported close peer networks, and many …

An Assessment Of Sexual And Gender Based Violence In Wajir District, North Eastern Kenya, Gladys K. Mwangi, Guyo W. Jaldesa

Reproductive Health

A 2006 baseline survey conducted by CARE Kenya indicated that sexual and gender-based violence (SGBV) is widespread throughout Kenya’s North Eastern Province. Other findings revealed that high levels of stigma and gender imbalances are associated with sexual violence and female genital mutilation (FGM) and that a coordinated approach to responding to the service needs of survivors is missing. As noted in this report, there is limited awareness of the legal mechanisms available to survivors. The Population Council’s study in Wajir District ascertained the need for and possible components of an integrated and comprehensive services model that could meet the needs …

Assessment Of Risk Factors For Hiv Infection Among Men Who Have Sex With Men In The Metropolitan Area Of Campinas City, Brazil, Using Respondent-Driven Sampling, Maeve De Mello, Adriana De Araujo Pinho, Magda Chinaglia, Waimar Tun, Aristides Barbosa Junior, Maria Cristina, F.J. Ilario, Paulo Reis, Regina C.S. Salles, Suzanne Westman, Juan Diaz

HIV and AIDS

The Population Council, in collaboration with the Brazil Ministry of Health, the Municipal Program of STD/AIDS of Campinas, and the US Centers for Disease Control and Prevention/Global AIDS Program/Brazil, conducted a study to characterize the sociodemographic, behavioral, and environmental factors associated with subgroups of MSM who are most at risk for HIV infection. This research is the first Brazilian study to provide population-based estimates for HIV, syphilis, and HIV-related risk behaviors using an innovative sampling technique to reach members of the target population. Our data suggest the importance for HIV prevention programs to address not only sexual risk reduction, but …

Is It Feasible To Integrate Alcohol-Related Risk Reduction Counseling Into Vct Services? Findings From Kenya, Caroline Mackenzie, Karusa Kiragu, George Odingo, Rukia Yassin, Peter Shikuku, Patrick Angala, Nduku Kilonzo, William Sinkele, Melania Akinyi

HIV and AIDS

In Kenya, an estimated 30 percent of men report to be alcohol users which may be fueling the HIV pandemic, due to its association with high-risk sexual behavior and reduced inhibitions. The Population Council’s Horizons program collaborated on a study to improve screening of clients for alcohol use, provision of feedback of screening results, and referrals to care and support during voluntary testing and counseling (VCT) for HIV. Overall, the results indicate that it is feasible to integrate alcohol risk reduction counseling into VCT, and that it is generally accepted by providers and clients alike. This study therefore supports the …

Promoting Gender Equity As A Strategy To Reduce Hiv Risk And Gender-Based Violence Among Young Men In India, Ravi K. Verma, Julie Pulerwitz, Vaishali Sharma Mahendra, Sujata Khandekar, A.K. Singh, S.S. Das, Sunil Mehra, Anita Nura, Gary Barker

HIV and AIDS

The Horizons Program, CORO for Literacy, MAMTA, and Instituto Promundo developed, piloted, and scaled-up a behavior-change intervention in India to examine the effectiveness of interventions to improve young men’s attitudes toward gender roles and sexual relationships, and to reduce HIV risk behaviors and partner violence. The results of this study suggest that young men became less supportive of inequitable gender norms after participating in the interventions. Similarly, there were significant improvements among intervention participants in key outcome indicators, including condom use, partner communication, partner violence, and attitudes toward PLHIV. To maximize the chances of long-term sustainability of these positive changes, …

Catalyzing Personal And Social Change Around Gender, Sexuality, And Hiv: Impact Evaluation Of Puntos De Encuentro´S Communication Strategy In Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Propiciando Cambio Personal Y Social Alrededor Del Género, Sexualidad Y Vih: Evaluación De Impacto De La Estrategia De Comunicación De Puntos De Encuentro En Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Caring For Caregivers: An Hiv/Aids Workplace Intervention For Hospital Staff In Zambia—Evaluation Results, Karusa Kiragu, Mutinta Nyumbu, Thabale J. Ngulube, Panganani Njobvu, Chilufya Mwaba, Arthur Kalimbwe, Spike Bradford

HIV and AIDS

The Horizons Program collaborated on a Caring for Caregivers initiative in Zambia whose objective was to develop and test a risk-reduction workplace program for hospital staff. This was motivated by the recognition that hospital workers are often overlooked in HIV programming, and yet many are infected or affected by HIV. It was also motivated by the fact that hospital staff are heterogeneous, with both clinical and non-clinical staff having varying levels of understanding regarding HIV transmission. Caring for Caregivers was a peer education program targeted at hospital staff and implemented in two hospitals in Zambia, with a combined staff of …

Repositioning Postnatal Care In A High Hiv Environment: Swaziland, Charlotte E. Warren, Rachel Shongwe, Allen Waligo, Mohammed Mahdi, Goldy Mazia, Indira Narayanan

HIV and AIDS

This Horizons report from the Swaziland Ministry of Health and Social Welfare discusses findings from an intervention which aimed to reposition postnatal care within the context of a high HIV prevalence environment. The objectives were to determine if changes to the sexual and reproductive health guidelines on postnatal care would result in the timely and quality provision of key components of essential maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirms that the introduction …

Improving Hospital-Based Quality Of Care In Vietnam By Reducing Hiv-Related Stigma And Discrimination, Khuat Thi Hai Oanh, Kim Ashburn, Julie Pulerwitz, Jessica Ogden, Laura Nyblade

HIV and AIDS

To address HIV-related stigma and discrimination, and improve the quality of care in the healthcare setting in Vietnam, the Institute for Social and Development Studies, the International Center for Research on Women, and the Horizons Program conducted intervention research in four hospitals. The study team conceptualized two fundamental causes of HIV-related stigma: 1) fear of casual transmission; and 2) negative values/social judgments and associations between HIV and certain behaviors and groups, such as sex workers and injecting drug users. Both intervention strategies successfully reduced stigma and discrimination toward HIV-positive patients in these healthcare settings. The findings show that addressing stigma …

Assessment Of Risk Factors For Hiv Infection In Female Sex Workers And Men Who Have Sex With Men In Ciudad Del Este, Paraguay, Magda Chinaglia, Waimar Tun, Maeve Mello, Magdalena Insfran, Juan Diaz

HIV and AIDS

Research conducted by the Population Council/Brazil, supported by the USAID-funded Horizons Project, documents findings from a study in Paraguay among men who have sex with men and female sex workers to estimate HIV and syphilis prevalence; examine knowledge, attitudes, and risk behaviors related to HIV and STIs; and describe the contextual and behavioral factors influencing HIV and STI transmission. Findings provide guidance to the development of HIV and STI prevention and care interventions and further operations research to test strategies and interventions to reduce the spread of HIV and STIs in these groups.

School As A Workplace In Kenya: Evaluation Of The Teachers Matter Hiv/Aids Project, Karusa Kiragu, Caroline Mackenzie, Jennifer Weiss, Murungaru Kimani, Debbie Gachuhi

HIV and AIDS

The Horizons program of the Population Council embarked on an operations research initiative in Kenya to test the feasibility of implementing a teacher-centered workplace program based in schools. The study was conducted in partnership with the Ministry of Education, the Kenya Institute of Education, the Teachers Service Commission, and UNICEF. Called Teachers Matter, the project’s main audience was primary and secondary school teachers. The purpose of the research was to assess whether such a program would improve teachers’ HIV-related knowledge, attitudes, and behaviors; increase the proportion of teachers seeking voluntary testing and counseling; and enhance their ability to cope with …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Andhra Pradesh 2007-08, Niranjan Saggurti, Anrudh K. Jain, Saumya Ramarao, Hanimi Reddy Modugu, Ajay Kumar Singh, Suvakanta N. Swain, Ravi K. Verma

HIV and AIDS

The Population Council, in collaboration with TNS India Pvt. Ltd., undertook a study in Andhra Pradesh, India, to examine the patterns of male migration and its links with HIV risk. The goal was to provide evidence to inform the design and implementation of HIV interventions for male migrant workers. The study documented the volume and patterns of mobility, including the social dynamics within the contract system that employs these men as laborers, and the sexual risk behaviors and addictive behaviors of male migrants. The results suggest a predominance of interdistrict movements of men within Andhra Pradesh with a strong positive …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Karnataka 2007-08, Shiva S. Halli, Raluca Buzdugan, Niranjan Saggurti, Ravi K. Verma, Stephen Moses, James Blanchard, Anrudh K. Jain, Saumya Ramarao, Ajay Kumar Singh, Suvakanta N. Swain

HIV and AIDS

The present study was undertaken by the Population Council and the Karnataka Health Promotion Trust to study the patterns and factors driving migration among men and the extent to which they engage in high-risk activities associated with HIV. The specific objectives of the study were: to understand the patterns and factors driving the migration of men seeking work in the state of Karnataka; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men, with an emphasis on their mobility as one possible factor. Results suggest …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Maharashtra 2007-08, K. Anil Kumar, Shalini Bharat, Niranjan Saggurti, Ravi K. Verma, Anrudh K. Jain, Saumya Ramarao, Kanchan Mukherjee, Ajay Kumar Singh, Suvakanta N. Swain

HIV and AIDS

HIV prevalence in Maharashtra is one of the highest among Indian states. The specific objectives of this study were: to understand the patterns and drivers of migration/mobility of men who migrate for the purpose of work in the state of Maharashtra; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men with particular emphasis on the role of mobility in determining the sexual risk behavior. The present study clearly demonstrates that these male migrants, married or otherwise, retain strong connectivity to their native villages, but …

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Andhra Pradesh 2007-08, Niranjan Saggurti, Ravi K. Verma, Hanimi Reddy Modugu, Saumya Ramarao, Ajay Kumar Singh, Vaishali Sharma Mahendra, Anrudh K. Jain

HIV and AIDS

This report presents the findings from the female sex workers study in Andhra Pradesh, India implemented by TNS India Private Limited and the Population Council in New Delhi. Specifically the study was undertaken to assess the volume and patterns of mobility of female sex workers; to describe the characteristics of mobile female sex workers; and too examine the determinants of HIV risk among female sex workers, with particular emphasis on mobility-related characteristics. The report concludes that targeting such highly mobile female sex workers in intervention programs requires a comprehensive understanding of their places of solicitation and sex. Female sex workers …

Patterns Of Migration/Mobility And Hiv Risk Among Female Sex Workers: Maharashtra 2007-08, Niranjan Saggurti, Vaishali Sharma Mahendra, Rajendra Singh, Saumya Ramarao, Suvakanta N. Swain, Ajay Kumar Singh, Anrudh K. Jain, Ravi K. Verma

HIV and AIDS

According to recent estimates, Maharashtra, India recorded high HIV prevalence among female sex workers, however there is a dearth of research documenting the migration patterns of sex workers and the linkages between their mobility and vulnerability to HIV. This Population Council study attempts to answer some of the questions on mobility and migration of female sex workers in Maharashtra as they relate to the HIV epidemic. Findings show an association between degree of mobility and the indicators of HIV risk such as consistent condom use with different types of partners, STI symptoms reported, sexual violence, and self-perception of risk for …

Informed Consent In Hiv Prevention Trials: Highlights From An International Workshop, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Consentement Éclairé Dans Les Essais De Prévention Du Vih: Points Saillants D'Un Atelier International, Population Council

HIV and AIDS

Résumé adapté du rapport de l'atelier co-organisé par le Population Council et Family Health International en mai 2005. Le résumé se concentre spécifiquement sur les outils et stratégies présentés lors de l'atelier qui sont utilisés dans les essais de prévention du VIH pour faciliter le consentement éclairé, expliquer concepts difficiles et évaluer la compréhension parmi les participants à l'essai. Des exemples illustratifs d'essais achevés et en cours sont mis en évidence. Ce résumé sera utile à un public de chercheurs locaux, d'avocats et de membres du personnel des essais cliniques.

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Brief adapted from the report of a workshop co-hosted …

Training Youth Caregivers To Provide Hiv Education And Support To Orphans And Vulnerable Children In South Africa, Tobey C. Nelson, Eka Esu-Williams, Lungile Mchunu, Pinkie Nyamakazi, S'Fiso Mnguni, Katie D. Schenk, Catherine Searle, Jennifer Redner

HIV and AIDS

In KwaZulu Natal, South Africa, in Durban’s peri-urban community of Valley of 1000 Hills, Horizons partnered with Valley Trust to implement and evaluate a program to provide education and support to orphans and vulnerable children. The study utilized a pre-post test design to assess the feasibility and impact of building the capacity of youth aged 18–24 years to provide HIV education and support to in-school orphans and vulnerable children in their communities. The Valley Trust Youth Caregiver Program trained older youth to provide HIV education, homework assistance, and psychosocial support to orphans and vulnerable children aged 11–15 years. The program …

Engaging Communities In Supporting Hiv Prevention And Adherence To Antiretroviral Therapy In Zambia, Fiona Samuels, Joseph Simbaya, Avina Sarna, Scott Geibel, Phillimon Ndubani, Jolly Kamwanga

HIV and AIDS

In Zambia, the prevalence of HIV is estimated at 16 percent among 15–49-year-olds. This brief presents findings from an operations research study to access the outcomes of the Antiretroviral Community Education and Referral (ACER) project in two urban areas in Zambia—Lusaka and Ndola. The ACER project was implemented by the International HIV/AIDS Alliance, based in England, and the Alliance’s Zambia office, in conjunction with local Zambian partners. Launched in mid-2004, the two-year project built on previous formative research that examined knowledge and attitudes about prevention and treatment. The research was conducted by the Institute of Eco­nomic and Social Research in …