The social and cultural consequences of infertility in rural and periurban

Relatively little is known about infertility experiences among women in rural Malawi and the impact of infertility on women's marital and family relations. This article examines the perspectives of women and health care providers regarding women's concepts of reproductive health and attitudes toward infertility. The paper explores the supports and barriers to managing infertility at the individual, household, and community levels. The data presented was drawn from semi-structured interviews with health care providers and patients within a prevention of mother to child transmission program and focus group discussions with community men and women in four communities in Southern Malawi. Seventy-eight patients, 12 health care providers, and 32 community leaders participated in the study. The findings suggest that gender inequities and kinship relations intersect to produce infertility related stigma which exacerbates the social and cultural consequences of being infertile in these study communities. Social support from other women experiencing infertility is one strategy to help women manage the social and cultural burden of infertility in these study communities. These results shed light on the meaning of motherhood to women living in rural and periurban Sub-Saharan African communities and call for an expansion of infertility services, social services, and mental health services for both women and men who experience infertility. (Afr J Reprod Health 2022; 26[7]: 112-126).

Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study

Background: Few data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult. Aim: This study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa.Setting: Tanzania, East Africa. Methods: Outreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated. Results: In the sample of 300 participants, 17.0% of participants were identified as 'transsexual or transgender' (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms 'transsexual and transgender' or their explanation in Swahili, reported by interviewers. Conclusion: In this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers.

A structured approach to effective mentoring of women health researchers in Africa

Objectives: To formatively evaluate the HIGHER Women consortium's Mentor Protégée Program (MPP) and derive lessons for successful African women scientist mentorship. Design: Desk review of program documents and cross-sectional surveys of mentors and protégées. Setting: All 10 regions of Cameroon Participants: Women working in health research participating in the MPP. Interventions: Building health research skills and providing support for women to cope within the African psychosocial environment using a holistic approach. Main outcome measures: Formed mentor-protégés duos applying the MPP with measurable accomplishments. Results: The consortium counted 121 members with 103 protégées and 18 mentors. Of 103 protégées, 35 responded to the 2018 survey, while 77 responded to the 2022 survey. Mentioned benefits of the program included an increase in scientific peer-reviewed journal publications and presentations at national and international conferences. In the 2022 survey, a Pearson correlation showed an r of 0.41, which, although not statistically significant (p = .592), suggests a positive correlation between the increased number of peer-reviewed articles and increased number of years as HIGHER Women protégées. Conclusions: Mentorship programs can help over time to bridge the gender gaps within Africa as well as the gaps between African-led research and the rest of the world while making a meaningful contribution to enhancing the quality, diversity, and productivity of researchers. A mentoring program such as the HIGHER Women MPP can be improved by leveraging local and international partners to foster the mentoring program's sustainability, scalability, and expanded reach.

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos, Nigeria

Background: Gender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities. Objective: To examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown. Method: This cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling. Results: The mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents. Conclusion: The fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.

The impact of an inclusive education intervention on learning outcomes for girls with disabilities within a resource-poor setting

Background: Despite a global commitment to the right to education for persons with disabilities, little is known about how to achieve inclusive education in practice, particularly in low- and middle-income countries (LMICs), where the majority of the world's people with disabilities reside. Moreover, although exclusion from education is magnified by intersecting gender and socioeconomic inequalities, there is especially little knowledge regarding what approaches to inclusive education are effective amongst girls with disabilities living in resource-poor settings. Objectives: The objective of this article was to assess the impact of an inclusive education intervention led by a non-governmental organisation (NGO) on the educational attainment of girls with disabilities in the resource-poor Lakes region of Kenya. Method: A quasi-experimental design was employed, where the literacy and numeracy educational attainment of the intervention and control groups was compared over two time points a year apart (Time 1 and Time 2; total matched N = 353). During this period, activities pertaining to six core components of a holistic inclusive education model were implemented. Results: Relative to the control group, girls with disabilities in the intervention group reported a greater increase in literacy and numeracy attainment, adjusted for grade and level of functional difficulty. Conclusion: Findings suggest that the intervention was successful in engendering additional improvements in the educational attainment of girls with disabilities from the resource-poor Lakes region of Kenya. Results highlight both the applicability of NGO-led interventions in settings, where national implementation of inclusive education is constrained, and the potential of taking such interventions to scale

Les différences liées au genre dans les accidents vasculaires cérébraux

L'impact dévastateur des accidents vasculaires cérébraux sur la qualité de vie des sujets a motivé à conduire cette étude. Le but est d'identifie lesdifférences entre les genres dans la perspective d'optimiser la prise en charge surtout sur facteurs se révélant péjoratives individuellement pour chaque groupe MéthodesIl s'agit d'une étude prospective analytique d'une durée de neuf (9) mois allant de juillet 2019 à mars 2020 aux urgences médicales de l'Hôpital National de Niamey. Etait éligible, tout patient consentant ayant développé un AVC avec une lésion objectivée au scanner cérébral.Résultats : L'étude avait inclus au total 100 sujets dont 59 ayant présenté un infarctus cérébral et les 41 autres un AVC hémorragique. Le sex-ratio était de 1. Au niveau de l'âge il n'y a pas eu de différence entre les genres (p=0,547). Les non-instruits ont été retrouvés plus chez les femmes (p=0,001). Des pressions artérielles systoliques (p=0,014) et diastoliques p=0,014) et diastoliques (p=0,02) au stade 3 de l'OMS ont concernées plus les hommes que les femmes. Les femmes ont été les plus intéressées par l'infarctus cérébral et inversement les hommes par l'AVC hémorragique (p=0,025). Le genre n'a pas eu de lien statistique avec le décès (p˃0,05).Conclusion : L'étude a seulement objectivé une rela-tion entre le genre, le niveau d'instruction, la pression artérielle et le type d'accident vasculaire

Gender disparity in risk factors for chronic kidney disease in a rural community in Southern Nigeria

Background: The evidence for gender disparity in prevalence of CKD is conflicting; while some studies report male preponderance, others have report female preponderance or no difference. Reasons for gender disparities in CKD prevalence may be related to differences in the occurrence of risk factors across the gender, amongst other factors. This study was to determine gender disparities in the risk factors for CKD. Method: This study is based on data from a community based cross-sectional study carried out in Ogbona, a rural community in Southern Nigeria. The WHO STEPS for surveillance of chronic diseases risk factors and chronic disease-specific morbidity and mortality questionnaire was adapted for this study. Four hundred and seventy-six participants were selected from 142 housing units in the community using multi-stage cluster sampling. Clinical examinations and laboratory investigations including serum creatinine, and urinalysis were performed. Results: Majority of participants were females (66.2%). CKD was commoner in females compared to males (14.3% vs. 12.7%, P= 0.06). More females than males had high body fat percentages (65.7% vs. 40.9%, P=<0.0001), high waist-hip ratio (99.7% vs 73.3%, P=<0.0001) and central obesity (43.1% and 4.3% P=<0.0001). More males compared to females used alcohol (56% vs. 9.2%, P=<0.0001), were overweight (42.2% vs 28.9%, P=0.004), and had proteinuria (6.2% vs 2.5%, P=0.054). The odds of females having central obesity are 16.7 times the odds of males having central obesity; similarly, the odds of females having high BF are 2.7 times the odds of males having high BF. Females had 122-fold the odds of men having high WHR. The odds of drinking alcohol are 92% less compared to males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications). No female smoked cigarettes. Conclusion: This study shows that there is no statistically significant gender difference as regards prevalence of CKD, however several risk factors of CKD show gender disparity. The odds for central obesity, high WHR, high body fat percentages are significantly greater in females; while smoking, alcohol use, and over weightness, are commoner in males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications)

Gender perspectives and health literacy proficiencies of In-school adolescents in Osun State, Nigeria

Health literacy proficiency has been linked with positive adolescent health outcomes. Strategies aimed towards improving health literacy have been suggested as a major way of achieving adolescent health and wellbeing. Previous research has identified a nexus between socio-demographics, education and health literacy proficiency. This study therefore, explores existing relationships between gender, socio-economic class and the health literacy proficiency levels of in-school adolescents in Osun State.Mixed method involving questionnaire survey and Focus group discussion were used to obtain data from 1,200 randomly selected in-school adolescents from 12 high schools in Osun State, Nigeria. The survey instrument was an adaptation of the electronic health literacy scale (eHEALS). Results show only 1,186 (98.8%) questionnaire were found analysable. Mean age of respondents was 15 + 0.6 with 616(51.1%) being female. Overall health literacy proficiency was low with only 447(37.7%) having a high level of health literacy proficiency. Quantitative survey shows that both gender and socio-economic background have negative statistically significant relationship with health literacy proficiency. Similarly, FGD revealed that females generally have lower health literacy proficiency when compared with males. The study concludes that gender based interventions for female adolescents could reduce health and educational disparities which will contribute to the achievement of Sustainable Development Goals 3, 4 and 5.

Genre et attitudes de stigmatisation à l'égard des Personnes vivant avec le VIH (PVVIH) au Bénin

Contexte : Les attitudes de rejet des PVVIH constituent un frein à l'accès universel et à leurs droits essentiels. Cet article vise à apporter un éclairage sur les disparités de genre en matière de stigmatisation des PVVIH.Méthodologie : Analyse secondaire des données de l'EDSB 2011-2012. Un indicateur de niveau de stigmatisation a été créé pour faire des analyses multi-variées de régression logistique sur un échantillon de 4813 hommes et 14849 femmes.Résultats : Pour les deux sexes, avoir un niveau élevé d'instruction, être exposé fréquemment aux médias, être chrétien et appartenir au groupe ethnique Adja déterminent l'attitude bienveillante envers les PVVIH. Il en est de même pour les femmes qui sont en union conjugale, celles qui vivent en milieu rural, celles vivant dans des ménages riches ou celles n'ayant aucune activité économique.Conclusion: Développer des stratégies de protection des PVVIH en s'appuyant sur les attitudes bienveillantes observées

Gendered childcare norms ­ evidence from rural Swaziland to inform innovative structural HIV prevention approaches for young women

Addressing discriminatory gender norms is a prerequisite for preventing HIV in women, including young women. However, the gendered expectation that women will perform unpaid childcare-related labour is rarely conceptualised as influencing their HIV risk. Our aim was to learn from members of a rural Swazi community about how gendered childcare norms. We performed sequential, interpretive analysis of focus group discussion and demographic survey data, generated through participatory action research. The results showed that gendered childcare norms were firmly entrenched and intertwined with discriminatory norms regarding sexual behaviour. Participants perceived that caring for children constrained young women's educational opportunities and providing for children's material needs increased their economic requirements. Some young women were perceived to engage in "transactional sex" and depend financially on men, including "sugar daddies", to provide basic necessities like food for the children they cared for. Our results suggested that men were no longer fulfilling their traditional role of caring for children's material needs, despite women's traditional role of caring for their physical and emotional needs remaining firmly entrenched. The results indicate that innovative approaches to prevent HIV in young women should incorporate structural approaches that aim to transform gendered norms, economically empower women and implement policies guaranteeing women equal rights

Love grows with sex: teenagers negotiating sex and gender in the context of HIV and the implications for sex education

How do teenagers located in the KwaZulu-Natal province of South Africa, the epicentre of the HIV pandemic, give meaning to sexuality? This paper examines teenage black Africans investments in sex and sexuality and the gendered dynamics through which sexuality is articulated. Whilst unequal gender relations of power continue to feature prominently within relationship dynamics fuelling the gendering of HIV, attention to the micro-processes through which relationships are forged remain significant in illustrating the complex connections between love, sex and gender. Drawing on empirical findings with teenagers between the ages of 16 and 17 years old, the paper shows how relationships are conceptualised based on discourses of love. Love is inextricably bound up with sex and when teenagers talk about love and sex they also talk about condom use, multiple sexual partners and gender inequalities. What teenagers were interested in for their sexual relationships was not raised in sex education programmes at school. Implications for addressing teenage constructions of sexuality are discussed in the conclusion

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation

Intimate partner violence in early adolescence:the role of gender; socioeconomic factors and the school

BACKGROUND:Intimate partner violence (IPV) among adolescents is common worldwide; but our understanding of perpetration; gender differences and the role of social-ecological factors remains limited.OBJECTIVES:To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender; and associated risk and protective factors.METHODS:Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA); participating in the PREPARE study; completed a self-administered questionnaire. RESULTS:The participants' mean age was 13.65 years (standard deviation 1.01); with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) reporting perpetrating IPV. Girls were less likely to report being a victim/survivor of physical IPV (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.57 - 0.92) and less likely to be a perpetrator of sexual IPV than boys (OR 0.33; 95% CI 0.21 - 0.52). Factors associated with perpetration of physical and sexual IPV were similar and included being a victim/survivor (physical IPV: OR 12.42; 95% CI 8.89 - 17.36; sexual IPV: OR 20.76; 95% CI 11.67 - 36.93); being older (physical IPV: OR 1.26; 95% CI 1.08 - 1.47; sexual IPV: OR 1.36; 95% CI 1.14 - 1.62 ); having lower scores on school connectedness (physical IPV: OR 0.59; 95% CI 0.46 - 0.75; sexual IPV: OR 0.56; 95% CI 0.42 - 0.76) and scoring lower on feelings of school safety (physical IPV: OR 0.66; 95% CI 0.57 - 0.77; sexual IPV: OR 0.50; 95% CI 0.40 - 0.62).CONCLUSIONS:Physical and sexual IPV was commonly reported among young adolescents in SA. Further qualitative exploration of the role of reciprocal violence by gender is needed; and the role of 'school climate'-related factors should be taken into account when developing preventive interventions

Gender inequality dynamics in the prevention of a heterosexual HIV epidemic in Sub-Saharan Africa

This paper critiques the approach to the elimination of gender inequality as an HIV prevention strategy in the just ended era of the Millennium Development Goals; with the aim of contributing to the formulation of policy guidelines for sub-Saharan Africa in the Sustainable Development Goals. The aim is to underscore the mutual responsibility of women and men in achieving a sustainable HIV response and ending the epidemic. While taking into account the real vulnerability of women; prevention programmes can reflect gender dynamics more accurately so that attention is given to the role of both sexes in propagating - or stemming - a predominantly heterosexual HIV epidemic. More emphasis could be given to the harm caused to both men and women by certain norms related to masculinity and sexuality; and the subsequent need for combined efforts in reducing intimate partner violence and concurrency. The empowerment and engagement of both women and men as agents of change would need to be dealt with more creatively

Neglected Older Women and Men: Exploring Age and Gender as Structural Drivers of HIV among People Aged over 60 in Uganda

This study explored how women's and men's gendered experiences from childhood to old age have shaped their vulnerability in relation to HIV both in terms of their individual risk of HIV and their access to and experiences of HIV services. It was a small scale-scale study conducted in urban and rural sites in Uganda between October 2011 and March 2012. The study used qualitative methods: in-depth interviews (with 31 participants) and focus group discussions (FGDs) with older women (2) and men (2) in urban and rural sites and 7 key informant interviews (KIIs) with stakeholders from government and non-government agencies working on HIV issues. Women's position; the cultural management of sex and gender and contextual stigma related to HIV and to old age inter-relate to produce particular areas of vulnerability to the HIV epidemic among older women and men. Women report the compounding factor of gender-based violence marking many of their sexual relationships throughout their lives; including in older age. Both women and men report extremely fragile livelihoods in their old age. Older people are exposed to HIV through multiple and intersecting drivers of risk and represent an often neglected population within health systems. Research and interventions need to go beyond only conceptualising older people as 'carers' to better address their gendered vulnerabilities to HIV in relation to all aspects of policy and programming

If the Doctors see that they don't know how to Cure the Disease; they say it's AIDS': How Older Women in Rural South Africa Make Sense of the HIV/AIDS Epidemic

South Africa; like other sub-Saharan African countries; is in the midst of the AIDS epidemic. Older women; here defined as aged 60 years and older; while at lower risk of infection than those aged 20-50; are amongst those deeply 'affected' by the epidemic. In rural areas; older women; who have always played central roles in social reproduction in South African households and families; bear the brunt of care giving for the sick and dying. For this reason; it is important to explore how these women understand the epidemic. In South Africa; the prominence of traditional healers and medicine alongside biomedicine has led to multiple ways of perceiving; explaining and treating illness. This paper explores the various discourses older women in rural South Africa employ to make sense of the HIV/ AIDS epidemic in their daily lives. The aim is to better understand how these women construct the epidemic and how this knowledge can be used to benefit education and treatment endeavours in similar contexts. This paper draws on interview data collected as part of the Gogo Project conducted in the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit. Sixty women between the ages of 60 and 75 years living in the rural Agincourt sub-district participated in three in-depth; semi-structured interviews. The respondents in this study relied on a variety of discourses to make sense of the HIV/AIDS epidemic. They displayed a high level of knowledge based on biomedical education; however; they expressed ideas; often simultaneously; that seemed to contradict this education. Their ability to employ seemingly contradictory discourses represents the need to place the epidemic within familiar 'explanatory models' that are based on these women's life experiences and local knowledge.

Developing and implementing global gender policy to reduce HIV and AIDS in low- and middle-income countries: policy makers' perspectives

Gender inequalities have been recognised as central to the HIV epidemic for many years. In response; a range of gender policies have been developed in attempts to mitigate the impact and transform gender relations. However; the effects of these policies have been less than successful. In March 2010 the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Agenda for accelerated country level action on women; girls; gender equality and HIV (the Agenda); an operational plan on how to integrate women; girls and gender equality into the HIV response. This paper explores the perspectives of those involved in developing and implementing the Agenda to understand its strengths and limitations. In-depth one-on-one interviews were conducted with 16 individuals involved in the development and implementation of the Agenda. The data were analysed using thematic network analysis. Facilitators of the Agenda centred on the Agenda's ability to create political space for women and girls within the global HIV/AIDS response and the collaborative process of developing the Agenda. Barriers to the implementation and development of the Agenda include the limited financial and non-financial resources; the top-down nature of the Agenda's development and implementation and a lack of political will from within UNAIDS to implement it. We suggest that the Agenda achieved many goals; but its effect was constrained by a wide range of factors