Newsletter September 2016
| ICRH Global Newsletter
23rd of September, 2016
|Academic Network on Sexual Health and Rights Policy (ANSER)
On 30 November, ANSER will be officially launched in Gent. This event will be followed immediately by an international conference on 1 and 2 December.
|Call for abstracts
Within the context of the ANSER conference (see above) we are inviting colleagues and students from universities and organisations worldwide to present their research on sexual and reproductive health and rights.
|Visualisation of methylation patterns
ICRH Belgium received an Industrial Research StarTT Valorisation grant for the project entitled ‘Methylation in situ hybridization: visualization of methylation patterns using UPSAS (uniprobe signal amplification system)’.
|Prevalence of FGM in Europe
On May 26th 2016 ICRH obtained a no-cost extension for the project Towards a better estimation of prevalence of female genital mutilation in the European Union (FGM-PREV).
|Staff motivation and contraception stock-outs
The report of the project ‘Enhancing motivation of family planning service providers as a lever to avoid stock-outs and increase quality of service’ has been published.
Adolescents and youth taking control of their HIV treatment issues in Mombasa, Kenya
The Boresha project, testing the feasibility of venue-based HIV prevention interventions targeting male and female sex workers, and their clients, in Mombasa, Kenya, is now at full speed.
|Posters presented at the 21th International AIDS Conference:
THPEC152 ”Not what we agreed: examining male sex workers´ experiences of physical and sexual violence from their clients in Mombasa, Kenya" J.E. Mantell, T.B. Masvaure, J.U. Tocco, T. Sandfort, S.V. Chabeda, A. Restar, P. Gichangi, Y. Lafort
THPED290 "Perceptions of sexual and gender-based violence by female sex workers and male clients in Mombasa, Kenya" S.V. Chabeda, P. Gichangi, A. Restar, J.U. Tocco, T.B. Masvaure, T. Sandfort,
WEPED390 ""Yes, I would like to use them, because sex is my work": awareness of and willingness to use PrEP and PEP among female and male sex workers in Mombasa, Kenya" A. Restar, Y. Lafort, J. Tocco, P. Gichangi, T. Masvawure, J. Mantell, S. Chabeda, T. Sandort
THPED357 “Who dunnit?: Intentional and unintentional condom breakage in sexual interactions between female and male sex workers and their clients in Mombasa, Kenya” T.B. Masvawure, J. Mantell, J. Tocco, P. Gichangi, A. Restar, S. Chabeda, Y. Lafort, T. Sandfort
Testing mobile sexual and reproductive health messages for adolescents in Kenya
The ICRHK project ‘Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcomes’ (ARMADILLO).
Message development committee
|ICRH Mozambique annual meetings
On 15 September, the institutional meetings of ICRH Mozambique took place in Maputo
|Global Early Adolescent Study (GEAS) results presented at Young Lives Conference in Oxford
On 8th and 9th September 2016 ICRH researcher Sara De Meyer presented qualitative results of GEAS at the ‘Adolescence, Youth and Gender Conference’.
National Adolescent Sexual and Reproductive Health Policy Launch in Kenya
ICRHK in partnership with UNFPA supported the launch of the national Adolescent Sexual and Reproductive Health Policy in Kilifi and Mombasa Counties of the Kenyan Coast.
picture: peer educators during the launch of the ASRH policy in Kilifi County
Kenyatta University MPH students’ visits
As part of mentorship programs, ICRHK receives students from local universities in Kenya.
Kenyatta University MPH students attending a session at the ICRHK boardroom
Jin-Lin came to ICRH Belgium as a visiting PhD scholar from Xi’an Jiaotong University in China
|Patrick Li, Hon-chung
Patrick has joined ICRH Belgium since August 2016 as a research assistant of the INPAC project.
|ICRH Activity Report 2015
The 2015 Activity Report of ICRH Belgium is available and can be downloaded from the website.
The report contains among others a full overview of projects and publications of 2015. A PDF version can be downloaded HERE
|Connecting the dots
Network data and models in HIV epidemiology
Effective HIV prevention requires knowledge of the structure and dynamics of the social networks across which infections are transmitted. These networks most commonly comprise chains of sexual relationships, but in some subpopulations, sharing of contaminated needles is also an important, or even the main mechanism that connects people in the network. Whereas network data have long been collected during survey interviews, new data sources have become increasingly common in recent years, because of advances in molecular biology and the use of partner notification services in
HIV prevention and treatment programmes. This study reviews current and emerging methods for collecting HIV-related network data, as well as modelling frameworks commonly used to infer network parameters and map potential HIV transmission pathways within the network. The authors discuss the relative strengths and weaknesses of existing methods and models, and propose a research agenda for advancing network analysis in HIV epidemiology. They make the case for a combination approach that integrates multiple data sources into a coherent statistical framework.
Wim Delva, Gabriel E. Leventhal and Stephane Helleringer. Connecting the dots: network data and models in HIV epidemiology. AIDS. 2016 Aug 24;30(13):2009-20
|New WHO publications on stillbirths and neonatal deaths
The World Health Organization has launched 3 publications to help countries improve their data on stillbirths and maternal and neonatal deaths.
The first publication, the ‘WHO Application of the International Classification of Disease-10 to deaths during the perinatal period’ (ICD-PM), is a standardized system for classifying stillbirths and neonatal deaths.
The second publication, ‘Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths’, is a guide to help countries review and investigate individual deaths so they can recommend and implement solutions to prevent similar ones in the future. It also incorporates ICD-PM classification in order to help countries complete at least a basic death review, which is an in-depth investigation into causes and circumstances surrounding the death.
The third publication, ‘Time to respond: a report on the global implementation of maternal death surveillance and response’, helps countries strengthen their maternal mortality review process in hospitals and clinics.
All publications can be downloaded from the WHO website.
For more information, please contact Christian Lindmeier (email@example.com) or Kimberly Chriscaden (firstname.lastname@example.org).
|Barriers to HIV and sexual and reproductive health care for female sex workers
Results from a cross-sectional survey and focus group discussions in Tete, Mozambique
In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis. In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care.
The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies.
The authors conclude that the use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic.
Lafort Y, Lessitala F, Candrinho B, Greener L, Greener R, Beksinska M, Smit JA, Chersich M, Delva W. Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions. BMC Public Health. 2016 Jul 20;16:608. doi: 10.1186/s12889-016-3305-5.
|HIV and reproductive health services for female sex workers
Results of a policy and situational analysis in Tete, Mozambique.
In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs.
Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users.
There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations-and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices.
There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality.
Lafort Y, Jocitala O, Candrinho B, Greener L, Beksinska M, Smit JA, Chersich M, Delva W. Are HIV and reproductive health services adapted to the needs of female sex workers? Results of a policy and situational analysis in Tete, Mozambique. BMC Health Serv Res. 2016 Jul 26;16:301. doi: 10.1186/s12913-016-1551-y.
|HIV prevention and care-seeking behaviour among female sex workers
A baseline cross-sectional survey in four cities in India, Kenya, Mozambique and South Africa.
The aim of the study was to identify gaps in the use of HIV prevention and care services and commodities for female sex workers. It was conducted in the context of an implementation research project aiming to improve use of sexual and reproductive health services.
Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison.
Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P < 0.05) after adjusting for differences in FSWs' socio-demographic characteristics.
The authors conclude that the use of HIV prevention and care by FSWs is often insufficient and differed greatly between cities. Differences could not be explained by variations in socio-demographic sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used.
Lafort Y, Greener R, Roy A, Greener L, Ombidi W, Lessitala F, Haghparast-Bidgoli H, Beksinska M, Gichangi P, Reza-Paul S, Smit JA, Chersich M, Delva W. HIV prevention and care-seeking behaviour among female sex workers in four cities in India, Kenya, Mozambique and South Africa. Trop Med Int Health. 2016 Aug 1. doi: 10.1111/tmi.12761. [Epub ahead of print]
|Where do female sex workers seek HIV and reproductive health care?
A survey in 4 cities in India, Kenya, Mozambique and South Africa on HIV and reproductive health care seeking behaviour of female sex workers.
A baseline cross-sectional survey among female sex workers (FSWs) was conducted in four cities within the context of an implementation research project aiming to improve FSWs' access to HIV, and sexual and reproductive health (SRH) services. The survey measured where FSWs seek HIV/SRH care
Using respondent-driven sampling (RDS), FWSs were recruited in Durban, South Africa (n = 400), Tete, Mozambique (n = 308), Mombasa, Kenya (n = 400) and Mysore, India (n = 458) and interviewed. RDS-adjusted proportions were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests.
Across cities, FSWs most commonly sought care for the majority of HIV/SRH services at public health facilities, most especially in Durban (ranging from 65% for condoms to 97% for HIV care). Services specifically targeting FSWs only had a high coverage in Mysore for STI care (89%) and HIV testing (79%). Private-for-profit clinics were important providers in Mombasa (ranging from 17% for STI care and HIV testing to 43% for HIV care), but not in the other cities. The most important reason for the choice of care provider in Durban and Mombasa was proximity, in Tete 'where they always go', and in Mysore cost of care. Where available, clinics specifically targeting FSWs were more often chosen because of shorter waiting times, perceived higher quality of care, more privacy and friendlier personnel.
The authors conclude that the place where care is sought for HIV/SRH services differs substantially between cities. Targeted services have limited coverage in the African cities compared to Mysore. Convenience appears more important for choosing the place of care than aspects of quality of care. The best model to improve access, linking targeted interventions with general health services, will need to be tailored to the specific context of each city.
Lafort Y, Greener R, Roy A, Greener L, Ombidi W, Lessitala F, Haghparast-Bidgoli H, Beksinska M, Gichangi P, Reza-Paul S, Smit JA, Chersich M, Delva W. Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa. PLoS One. 2016 Aug 5;11(8):e0160730. doi: 10.1371/journal.pone.0160730. eCollection 2016.
|Maternal health care delivery for migrants
A review of the existing evidence on the reduction of inequalities in accessibility and quality of maternal health care delivery for migrants in the WHO European Region.
The number of female migrants of childbearing age is rapidly increasing, which entails specific needs for maternal health services. Through a systematic review of the academic literature and a critical interpretive synthesis of policy frameworks, the authors of this review aimed to assess interventions and policies that improve the accessibility and quality of maternal health care for migrants in the WHO European Region.
The review demonstrated that most migrant women have poorer maternal health outcomes than other women throughout the WHO European Region. Identified risk factors are linked not only to pregnancy, childbirth and the postpartum period but also to events before conception. Restricted entitlement and problems with familiarity, knowledgeability, acceptability, availability and affordability jeopardize migrant women’s access to maternal health care. Ensuring universal access to care and providing culturally sensitive care will enhance access to and the quality of maternal health care and eventually improve migrant maternal health.
Ines Keygnaert, Olena Ivanova, Aurore Guieu, An-Sofie Van Parys, Els Leye and Kristien Roelens. What is the evidence on the reduction of inequalities in accessibility and quality of maternal health care delivery for migrants? A review of the existing evidence in the WHO European Region (2016). Health Evidence Network synthesis report 45. ISBN 978 92 890 5157 6.