Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors.Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between June and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis. Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19­5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28­8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47­32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services. Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.

Barriers to adolescents' access and utilisation of reproductive health services in a community in north-western Nigeria: a qualitative exploratory study in primary care

Background: There is a dearth of qualitative studies exploring in-depth barriers that adolescents face in accessing and utilising reproductive health services (RHS) in Nigerian primary healthcare centres. Aim: This study explored the barriers hindering adolescents' access to and utilisation of RHS in primary healthcare centres. Setting: This study was conducted in three primary healthcare centres in Kaduna North Local government area, Nigeria. Methods: This study used an exploratory descriptive qualitative design. Fourteen adolescents and three RHS providers were selected and interviewed. The data collection methods included individual in-depth interviews with adolescents and key informant interviews with service providers. Interviews were conducted between January 2017 and April 2017. Thematic content analysis was used to analyse the data. Results: This study identified three thematic barriers to adolescent's utilisation of RHS. These included individual, social and health system barriers. Individual factors included the following: inadequate knowledge about RHS and poor attitudes of adolescents towards RHS; social factors such as parental influence, community and religious norms, financial constraints and stigma; and health system factors such as poor attitudes of service providers and inconvenient health facility opening hours hindered adolescents from utilising RHS. Most prominent was the strong influence of the social factors that affected adolescents to the extent that they felt constrained to freely utilise RHS out of a sense of commitment to religious values. Conclusion: The findings highlight the need for the development of programmes that would foster collective responsibility for supportive environments within communities and health facilities for positive adolescent RHS experiences

Reaching the youngest moms and dads: a socio-ecological view of actors and factors influencing first-time young parents' use of sexual and reproductive health services in Madagascar

Globally, few programs consider the needs of first-time young parents (FTYPs), who face disproportionate negative health consequences during pregnancy and childbirth. Scant evidence exists on FTYPs' broader health needs. Formative research in two regions of Madagascar used a socio-ecological lens to explore, via 44 interviews and 32 focus group discussions, the influences on FTYPs at the individual, couple, family, community, and system levels. We spoke with FTYPs who had, and who had not, used sexual and reproductive health (SRH) services, their parents/kin and influential adults, and community health workers and facility health providers. Data analysis, guided by a codebook, used Atlas.ti. Age, social position, and implicit power dynamics operating within and across socio-ecological levels affected FTYPs' service-seeking behaviors. The nature and extent of influence varied by health service type. Cross-cutting social factors affecting service use/non-use included gender dynamics, pressures from mothers, in-laws, and family tradition, and adolescent stigmatization for too-early pregnancy. Structural and economic factors included limited awareness of and lack of trust in available services, unfriendliness of services, and FTYPs' limited financial resources. A socio-ecological program perspective can inform tailoring of activities to address broader SRH issues, including how relationships, gender, power, and intergenerational dynamics influence service use

Challenges of women refugees in utilising reproductive health services in public health institutions in Durban, KwaZulu-Natal, South Africa

Background: Reproductive health services are essential for everyone worldwide. In South Africa, the available literature does not address reproductive health as a full package for women refugees and their experiences. This study addressed women refugees in relation to reproductive healthcare services they receive from public healthcare facilities. Aim: The aim of the study was to document the day-to-day experiences of women refugees and uncover their challenges regarding utilisation of reproductive health services in public institutions of Durban, KwaZulu-Natal. Setting: The study was conducted in eThekwini district, Durban, KwaZulu-Natal, and did not consider participants who are located beyond the above-mentioned city's borders. Methods: A qualitative, descriptive design was used. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews with eight women refugees. Thematic content analysis guided the study. Results: Two major themes emerged: negative experiences or challenges, and positive experiences. The most dominant negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural hegemony, and the shortage of health personnel and overcrowding of public hospitals. The positive experiences included positive treatment and care and social support. Conclusion: The findings revealed that women refugees in Durban, KwaZulu-Natal, face many challenges such as medical xenophobia and discrimination in their attempt to seek reproductive health services in public healthcare facilities, making them even more vulnerable. Assisting women refugees with their reproductive health needs will remediate the challenges they face

Teenage pregnancies in Mozambique: the experience of "Servicios Amigos dos Adolescentes" clinics in Beira

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10­14; 15­19; 20­24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15­19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4­5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10­14 year old girls; 8% amongst 15­19 year olds; 10% amongst 20­24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique

Assessing the importance of gender roles in couples' home-based sexual health services in Malawi

To more effectively address individuals' and couples' sexual and reproductive health needs, innovative service delivery strategies are being explored. These strategies are logistically and ethically complicated, considering prevailing gender inequalities in many contexts. We conducted an exploratory study to assess the acceptability of couples' home-based sexual health services in Malawi. We collected qualitative data from six focus group discussions and 10 husband-wife indepth interviews to gain a more thorough understanding of how gender norms influence acceptability of couples' sexual health services. Findings reveal that women are expected to defer to their husbands and may avoid conflict through covert contraceptive use and non-disclosure of HIV status. Many men felt that accessing sexual health services is stigmatizing, causing some to avoid services or to rely on informal information sources. Gender norms and attitudes toward existing services differentially impact men and women in this setting, influencing the perceived benefits of couples' sexual health services (Afr J Reprod Health 2010; 14[4]: 63-73)

Linkage between VCT and Reproductive Health Services (FP; ANC and delivery) in two Public Facilities of Rural Ethiopia

Background: Linking of related health services or delivering services in an integrated setup is an indispensable undertaking to optimize utilization of scarce resources in developing countries like Ethiopia. However; very related services such as HIV/AIDS and reproductive health are mostly delivered not in an integrated setup and a lot of missedopportunities are observed. Method: A cross-sectional study was conducted to describe the linkage between VCT and reproductive health services in two public health facilities of rural Ethiopia. A total of 405 women who were attending family planning (FP); antenatal and delivery care services were interviewed with structured questionnaire. Moreover; using qualitative technique; service provider interview and direct service delivery observation were conducted. Results: It was found that almost half of the women coming to attend ANC; delivery and family planning services have sufficient knowledge about VCT. Overall; 80have favorable attitude towards VCT. Family planning (FP) clients have less favorable attitude and less knowledge compared to ANC and delivery care attendees. Only 46.9of women reported that they were informed about VCT during their current visit. About 32.4of FP; 62.8of ANC were informed by providers about VCT (P0.001). Similarly; 22.4of FP; 57.9of ANC attendees were advised to get tested by the providers (P0.001). Majority of ANC attendees were referred to the VCT sites as compared to FP clients which were found to be due to the existence of formal referral between the ANC and VCT clinics for PMTCT services. Use of IE/BCC materials to disseminate messages in different service delivery sites was very limited. FP counse- ling and contraceptives are not provided at the VCT sites and there is no referral to FP clinics for those who may need the services. Conclusion: The study revealed weak linkage between VCT and FP which was mainly due to shortage of trained manpower; lack of time to counsel clients; negligence; absence of clear guidelines and referral system and lack of follow up and supervision. Therefore; orientation of providers; development of clear referral guideline and supportive supervision are recommended to minimize such missed opportunities

Breaking the Cycle of Unsafe Abortion in Africa

Globally; nearly half of all maternal deaths from unsafe abortion occur in Africa. Abortion-related deaths and injuries are especially tragic; because when properly performed; abortion is one of the safest of all medical procedures. Factors contributing to this neglected public health crisis include inadequate health care resources and infrastructure; restrictive laws and policies; stigma; and women's lack of empowerment. Actions needed include making high quality abortion care more available and accessible; especially at the primary care level and to the full extent permitted by law. Others include removing medically unnecessary policy and legal restrictions on abortion; and better informing health care professionals; women and communities about the impact of unsafe abortion and the circumstances under which abortion can be legally obtained

Promoting Sexual and Reproductive Health and Rights in Nigeria through Change in Medical School Curriculum

Significant developments have occurred in the field of sexual and reproductive health and rights (SRHR) globally in the last decade. However; this is yet to translate into improved status of SRHR in developing countries. One of the strategies recognised worldwide for addressing the poor status of SRHR is human capacity building at all levels. A pilot work conducted in two federal university medical schools identified a major gap in knowledge among medical students on issues related to SRHR. This called for a review of the curriculum to enable the incorporation of relevant and topical issues. This article describes the processes leading to the adoption of the Nigerian medical schools' sexual and reproductive health and rights curriculum. The exercise culminated in the identification of internal and external stakeholders and needs of the Nigerian medical schools in teaching reproductive health. The participation of lecturers (bottom-up approach) brought about a sense of ownership of the document and promoted the broad consultation and participation of all participants. It also identified capacity building and the need for evaluation as a basis for further review

Community Leaders' Perception of Reproductive Health Issues and Programmes in Northeastern Nigeria

Context: A faith-based NGO wanted to expand its reproductive health programmes to Northeastern Nigeria in view of its poor reproductive health indices compared to the other parts of the country. In order to make the programme more acceptable; accessible and successful; a rapid needs assessment was conducted. Objective: To assess the perception and acceptability of the various components of reproductive health among community and religious leaders in northeast Nigeria. Study Design. Setting and Subjects: A community-based qualitative study. One community leader and one Islamic religious leader each were interviewed in Ganjuwa; Dass and Shira local government areas of Bauchi state. Similarly; a community leader and a religious leader each were interviewed in Maiduguri; Konduga and Gwoza local government areas of Borno state. In Yobe state; one religious and one community leader were interviewed. Results: The community/religious leaders perceived reproductive health problems as prevalent and contributing to maternal morbidity and mortality. They believe women should seek healthcare services for preventive and curative care preferably from female providers. They suspect reproductive health programmes as Western agenda for population control. They have very strong feelings against the provision of elective abortion services. The only acceptable indications for elective abortion include death of the fetus in utero; gross congenital anomaly incompatible with life and serious maternal health risk. A committee of trusted; and preferably Muslim; Godfearing; doctors should assess and confirm these indications. They accept that women with complications of spontaneous abortion should seek care. The provision of contraceptive services to adolescents or married couples is not acceptable. In case of married couples; the only acceptable indication is on serious maternal health grounds. Even then; only harmless methods of contraception may be used specifically coitus interruptus or calendar method with prior spousal consent. The use and promotion of condoms as a barrier method or for the prevention of STIs is not acceptable. The prevention and care of those with HIV/AIDS is acceptable with emphasis on pre-marital abstinence and faithfulness among couples. Conclusion: The varied perceptions; cultural and religious barriers to reproductive health services need to be articulated in order to structure appropriate strategies that will inform and sensitize people about reproductive health programmes and services. Advocacy; monitoring and involvement in programme planning; implementation and social mobilization are useful strategies for addressing this issue

Integrating HIV voluntary counselling and testing services into reproductive health settings

This guide aims to provide sexual and reproductive health (SRH) programme planners; managers; and providers with the information necessary to integrate voluntary counselling and testing (VCT) for HIV/AIDS within their services. VCT has been shown to be an effective strategy to facilitate behaviour change for HIV prevention. It offers an entry point for early care and support for those infected with HIV and prevention of mother to child transmission. VCT also plays a role in reducing stigma and discrimination. The cost of establishing VCT services within existing SRH settings is lower than establishing them in freestanding sites. In particular; the guide considers integration within the context of family planning (FP) service provision. FP and VCT service provision have similar aims of reaching sexually active people and promoting safe and healthy sexuality; including the prevention of HIV; sexually transmitted infections (STIs); and unwanted pregnancy. FP settings offer specific opportunities for reaching women with VCT. (excerpt)

Fertility; Family Planning; HIV/AIDS and reproductive health: with emphasis on the Third world

This publication constitutes an up-to-date comprehensive textbook in the fields of fertility; family planning; HIV/AIDS and reproductive health. It is divided into three sections related to (1) From fertility control to reproductive health; (2) Providing reproductive health services and (3) Issues in the 21st century; which provide informations about fertility behavior; trends of fertility in all nations; international family planning; integration of family planning; HIV/AIDS and reproductive health