Narratives on Reproductive Justice Among Black Adolescent Girls in Clinical Research in the US.

Narratives reflecting on a longitudinal study of sexual and reproductive health during the adolescent years of young, low-income, Black women in the US show that participants felt cared for, supported, and recognized during the study in ways counter to dominant modes of structural, medical, and obstetric racism and stratified reproduction. Black women's narratives illuminate how research tools offered access to alternative, unanticipated, and improvised sources of Black feminist care and social networks that have much to teach us about how to transform adolescent care in the face of reproductive injustices in the US.

Barriers to Patients' Acceptance of Social Care Interventions in Clinic Settings.

INTRODUCTION: Despite efforts to identify and address the social needs of patients in U.S. healthcare settings, researchers consistently find high rates of patients who decline social interventions after reporting that they have unmet social needs. It is an open question as to why people who screen positive for social risks decline assistance. This question was qualitatively explored in a community health center in Rhode Island. METHODS: From 2020 to 2021, a total of 26 patients with a positive screen for social risks were telephonically interviewed. Zoom focus groups with clinic staff and Community Advisory Board members were also conducted. Interviews were audio recorded and transcribed. Transcripts were read and analyzed by 4 investigators using an open-coding framework to identify themes emerging from the data and across interviews. RESULTS: A total of 6 dominant themes related to why patients decline social assistance emerged from the data and were identified across interviews and study populations. Participants explained that the wording of screening questions, along with voluminous paperwork and time constraints of the clinic sometimes resulted in inaccurate reporting. Patients' knowledge of limited resources from previous experiences of requesting social support but not receiving help was a theme. Shame/pride, stigma/discrimination, beliefs and lack of understanding, and fear/mistrust were also described. CONCLUSIONS: Barriers to patients' acceptance of services to support social needs were influenced by multiple factors, both internal and external to the health center. These findings can inform best practices related to and the reliability of social risk screening processes in clinic settings to promote social justice and ensure health equity.

The cultural politics of secrecy during HIV home counselling and testing campaigns in Kenya.

How do the local cultural politics of secrecy intersect with biomedical and institutionalised global health knowledge and management of HIV? This question was ethnographically researched during a home counselling and testing programme as it was initiated twice in a Kenyan community. The programme was informed by worldwide efforts to organise and control HIV so as to 'end AIDS'. We focused critical attention on the relationship between HIV testing and counselling and contend that local expertise in speaking about (or silencing) sexuality, intimacy and HIV intersected with the home counselling and testing campaign as an instrument in the co-production of local gender dynamics and power arrangements. We demonstrate how the home counselling and testing programme was put to use for local cultural projects aimed at (re)negotiating gender, sexuality, social roles, intimacy and power dynamics and, in consequence, produced uneven experiences with testing, treatment and AIDS-related health outcomes during a period of major social change.

A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV.

Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018-2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants' health enhanced retention but were offset by perceived lack of value in PMTCT services following infants' immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV.

Bewitching sex workers, blaming wives: HIV/AIDS, stigma, and the gender politics of panic in western Kenya.

Since access to HIV testing, counselling, and drug therapy has improved so dramatically, scholars have investigated ways this 'scale-up' has interacted with HIV/AIDS-related stigma in sub-Saharan Africa. Drawing on data collected during ethnographic research in a trading centre in western Kenya, this paper critically analyses two violent and localised case studies of panic over the ill health of particular community residents as a nuanced lens through which to explore the dynamic interplay of gender politics and processes of HIV/AIDS-related stigma in the aftershocks of the AIDS crisis. Gaining theoretical momentum from literatures focusing on stigma, gender, witchcraft, gossip, and accusation, we argue that the cases highlight collective anxieties, as well as local critiques of shifting gender roles and the strain of globalisation and legacies of uneven development on myriad forms of relationships. We further contend that these heightened moments of panic and accusation were deployments of power that ultimately sharpened local gender politics and conflicts on the ground in ways that complicated the social solidarity necessary to tackle social and health inequalities. The paper highlights one community's challenge to eradicate the stigma associated with HIV/AIDS during a period of increased access to HIV services.

Willingness to Disclose Sexually Transmitted Infection Status to Sex Partners Among College-Aged Men in the United States.

Disclosure of sexually transmitted infections (STIs) to sexual partners is critical to the prevention, treatment, and control of STIs. We examine personal intra and interpersonal influences on willingness to disclose STI status among college-aged men. Participants (n = 1064) were aged 17 to 24 years and recruited from a variety of university and community venues. Using independent-samples t test, Pearson χ test, and binary logistic regression, we examined the relationship between willingness to disclose an STI and intrapersonal and interpersonal factors, including age, masculinity values, interpersonal violence, partner cell phone monitoring, alcohol and/or drug use, condom use, number and characteristics of sex partners, and previous STI. Results reveal that among college-aged men, type of sex partner and masculinity values are significant variables in predicting whether or not an individual is willing to disclose. These data can inform STI control programs to more effectively address the complex issues associated with STI disclosure to sex partners.

"That's nasty" to curiosity: early adolescent cognitions about sexual abstinence.

PURPOSE: Effective sex education for early adolescents should make use of age-appropriate cultural models about sexual abstinence. However, little is known about how early adolescents view this topic. We describe developmental differences in cognitions about sexual abstinence among high-risk early adolescents. METHODS: After institutional review board approval and informed consent, we interviewed 22 11-14-year-olds, using a qualitative, two-stage interview. Participants were first asked a series of open-ended questions about sexual abstinence, and then asked to explain their answers. Interviews were transcribed, organized by age, and read in their entirety. Codes were developed from the literature, field notes, and transcripts. Key concepts were identified and models were developed with a focus on developmental change. RESULTS: We observed three distinct views of sexual abstinence, "That's Nasty," "Curious," and Normative. All viewed abstinence as a starting point and sex as a transition to adulthood. "That's Nasty" participants identified sex as distasteful, displayed limited understanding of sex, and viewed abstinence as appropriate for kids like themselves. Curious participants expressed a desire for information about sex, and a sense of missing something important. Normative participants viewed the transition from abstinence to sexual experience as part of a normal, albeit challenging, transition to adulthood. CONCLUSIONS: Participants demonstrated differences in cognitions about sexual abstinence, related to age and development. The transition from viewing sex as distasteful to curiosity appears to be a time of both vulnerability and openness, and may provide an opportunity for intervention.

Perceptions of sexual abstinence among high-risk early and middle adolescents.

PURPOSE: Sexual abstinence has become the primary response to adolescent pregnancy and sexually transmitted infection (STI) prevention. However, most abstinence programs are based on adult ideas of abstinence, and little is known about how adolescents themselves conceptualize sexual abstinence. METHODS: In this qualitative study, we conducted semi-structured exploratory interviews with 42 adolescents aged 11-17 years recruited from primary care clinics. RESULTS: We observed marked confusion over the term "abstinence." However, the concept of abstinence, or choosing not to have sex, was clear and relevant. Participants viewed sexual abstinence as part of a normal developmental continuum. All adolescents were abstinent for a period of time, and then transitioned to sexual activity when they were ready. Readiness was determined by (1) individual factors, such as age, life events, physical maturity and social maturity, (2) relationship factors such as being with the "right" person, or having a committed relationship, (3) moral and religious beliefs, and (4) the balance of health, social, and family risks and benefits. Sex was considered something powerful, and the transition to first sex a rite of passage in which adolescents took on what they perceived to be adult roles. We observed differences by age, gender, and sexual experience in how adolescents determined readiness. CONCLUSIONS: Adolescents conceptualize sexual abstinence differently than adults, with differences by age, gender and sexual experience. Rather than a simple behavioral decision, our participants viewed abstinence as a broader part of normal development and viewed the transition to sex as an important rite of passage to adulthood.