Exploring the prevalence of abortion and its characteristics in Perú.

OBJECTIVES: Our paper presents the analysis of a nationwide survey that explored induced abortion among women using a ballot-box technique. Our objective was to determine the prevalence of abortion and the main characteristics of the procedure. STUDY DESIGN: We conducted surveys in households with 2400 women aged 18-49 from urban areas nationwide, between October 15 and 29, 2018. Data collection was overseen by the Instituto de Opinión Pública de la Universidad Católica del Perú. We performed a probabilistic, multistage, and socioeconomic level-stratified sampling. Our study used the "ballot-box technique" to ensure anonymity and reduce the risk of social desirability. RESULTS: We visited 15,433 houses nationwide. Among those households where surveys could not be conducted, it was due to abandoned or inaccessible property, unwilling to participate, absent members, out of quota, or inconclusive survey. On average, 19.0% of Peruvian women at all socioeconomic levels reported having had at least one abortion in their lifetime. Induced abortion is reported at all socioeconomic levels and reported age of the abortion is concentrated between 19 and 29 years old. In 57.7% of cases, women sought healthcare personnel for their last induced abortion. Among them, procedure abortion (45.3%) stands out over medical abortions (34.0%). Thirty-three percent of women who reported having had at least one induced abortion in their lifetime were admitted to a hospital after their last abortion. CONCLUSIONS: The illegality of abortion has not prevented its occurrence in Peru. Our results suggest that, in Peru, legal restrictions on induced abortion create an unfavorable context for women's health, exposing them to services whose safety is not guaranteed. Efforts should be made to increase awareness and education about contraception and family planning methods to prevent unwanted pregnancies and reduce the need for abortion. IMPLICATIONS: These findings should be considered in public policy discussions regarding abortion, since they might have a great impact for better decision making. They demonstrate that legal restrictions have not prevented the occurrence of abortion but has only created unsafe conditions around it.

Violence Experiences in Childhood and Adolescence Among Gay Men and Transgender Women Living in Perú: A Qualitative Exploration.

The overall goal of this study was to qualitatively explore the different types of violence experienced by gay men (GM) and transgender women (TW) living in Peru during childhood and adolescence, as well as their potential consequences and sources of protection. Participants were selected using purposive sampling. Recruitment took place in a community-based organization in Lima, Peru. In all, 32 GM and 23 TW participated in a total of four Focus Group Discussions (FGD) and 25 in-depth interviews (IDI). Qualitative data collection was conducted between July and October 2016. Four FGD took place with GM (n = 21) and one with TW (n = 9). In addition, 11 IDI with GM and 14 with TW were conducted. Data were analyzed using descriptive inductive analysis. Three main types of violence were experienced in childhood and adolescence: (a) violence occurring in the home or otherwise perpetrated by family members, (b) school-based violence, and (c) sexual violence. Both GM and TW experience violence within and outside school and home. School systems should make teachers and parents aware of the impact of homophobic and transphobic bullying and violence. Certain modifications in schools, such as having all-gender bathrooms and promoting activities that are not grounded in gender roles, could be very effective at reducing homophobic and transphobic violence. Schools should also address sexual violence more actively, among both male and female students. Parents' attitudes toward homosexuality and gender diversity need to be addressed by future interventions.

Community Perspectives on Zika Virus Disease Prevention in Guatemala: A Qualitative Study.

Zika virus, which is transmitted by Aedes aegypti mosquitoes and through sexual transmission, disproportionally affects the human fetus. Guatemala experienced a surge of Zika cases beginning in 2016. We conducted a qualitative study of community perceptions of the seriousness of Zika, as well as the effectiveness, feasibility, and collective efficacy of Zika prevention actions. Free listing elicited the preventive actions salient for 68 participants comprising pregnant women, men with a pregnant partner, and women likely to become pregnant; 12 focus group discussions in a highland and a lowland town explored other concepts through rank orderings of prevention practices depicted on cards. Participants' initial concern about Zika, based on recent experience with chikungunya and high media coverage, diminished because of its mild symptoms and reduced media coverage. Participants identified more than 32 salient preventive actions, many of which are considered effective by programs. Participants ranked water storage container cleaning and regular unspecified cleaning of the house and its surroundings as highly effective, feasible, and of high collective efficacy; however, the actions lacked the specificity needed to effectively destroy mosquito eggs. Community-level removal of tires and discarded containers had lower collective efficacy than household-level implementation because of the municipal and community cooperation needed. Condom use, although salient for Zika prevention, was hindered by gender roles. The findings indicate space for increasing self-efficacy for condom use among fathers-to-be, abandoning nonspecific terms such as "cleaning" and "standing water," increasing people's skills in using bleach as an ovicide, and promoting antenatal care and family planning counseling.

'It all dials back to safety': A qualitative study of social and economic vulnerabilities among transgender women participating in HIV research in the USA.

OBJECTIVES: Transgender women (TW) are highly burdened by HIV infection in the USA. Research is needed into drivers of the HIV epidemic for TW, including longitudinal studies to identify risks for incident HIV infection and optimal intervention targets. This formative research sought to understand TW's experiences with, perceptions of and barriers and facilitators to HIV research participation to inform future research implementation. DESIGN: Between August 2017 and January 2018, five online synchronous computer-mediated focus groups were conducted in English and two in Spanish. Recruitment used a mixed format of technology, such as geotargeted social media, and non-technology infused methods, such as peer referrals. Maximum variation sampling was used to enrol participants across a wide range of characteristics. Qualitative codes were iteratively developed and applied to focus group discussion transcripts by independent analysts. SETTING: Participants were recruited from Atlanta, Baltimore, Boston, Miami, New York City and Washington D.C. PARTICIPANTS: Participants identified as TW≥18 years and resided in one of the six metropolitan areas or outlying regions. 33 participants elected to partake in English focus groups and eight participated in Spanish-led groups. RESULTS: The geographically diverse sample had a mean age of 41.1 years (SD=13.6), and 34% identified as Black African American and 29% as Hispanic/Latina. Social and economic factors were found to shape HIV research participation for TW. Barriers to HIV research participation included limited research opportunities, mistrust, fear of mistreatment, safety and confidentiality, competing priorities and HIV stigma. Facilitators to HIV research participation were peer involvement and engagement, monetary and non-monetary incentives, flexibility and choices, multiple modalities and methods, and transcenteredness. CONCLUSION: It is critical to address the social and economic vulnerabilities surrounding HIV research participation for TW. Results from this study can inform the design and implementation of gender-affirming and culturally tailored approaches to HIV research with TW.

Conocimientos respecto a la identificación y manejo del trastorno depresivo mayor en internos y residentes de medicina de la Universidad Peruana Cayetano Heredia en el año 2011 / Knowledge about identification and management of major depressive disorder in interns and medical residents of the Universidad Peruana Cayetano Heredia in the year 2011

Objetivos: Explorar los conocimientos de los internos de medicina y residentes de especialidades médicas de la Universidad Peruana Cayetano Heredia acerca del diagnóstico y tratamiento del trastorno depresivo mayor. Metodología: Se realizó un estudio transversal durante enero y febrero de 2011. Se elaboró un cuestionario para evaluar conocimientos acerca del diagnóstico y manejo de depresión mayor, el cual fue validado mediante revisión de jueces y luego se hizo un piloto con ex-alumnos de medicina egresados el año 2010. Posteriormente se aplicaron los cuestionarios a 36 médicos residentes de medicina y 82 internos. Resultados: El 91,5% de los participantes realizó una correcta impresión diagnóstica de depresión mayor, el 97% consideró que sí debía darse tratamiento farmacológico, pero sólo el 48,8% de internos y 33,3% de residentes prescribió una terapéutica correcta. Los antidepresivos mencionados como primera línea fueron los inhibidores selectivos de la recaptación de serotonina(91,2%), siendo el de mayor preferencia, la sertralina (65,4%), seguida de la fluoxetina (24%). Más del 90% de los participantes sugirió adicionar un tratamiento no farmacológico y una interconsulta a otro servicio. En relación al conocimiento sobre cómo elegir el antidepresivo, vemos que el promedio de respuestas acertadas por los internos fue de 3,8 (DE=1,99) mientras que entre los residentes, el promedio de respuestas correctas fue de 3,08(DE=1,56). Conclusiones: No hay mayor dificultad para realizar un correcto diagnóstico de depresión mayor, tanto en internos como en residentes, sin embargo hay deficiencias para la prescripción de un tratamiento completo adecuado.

Objectives: To explore the knowledge of the interns and medical residents of the Universidad Peruana Cayetano Heredia about the diagnosis and treatment of major depressive disorder. Methods: A cross-sectional study was made on January and February 2011. A questionnaire was developed to evaluate the knowledge about the diagnosis and treatment of major depression; this was validated by means of experts revision and then, a pilot was fulfilled by former interns. After this process was completed, the questionnaire was taken by 36 medical residents and 82 interns. Results: A total of 91.5% of participants made a correct diagnosis of major depression, 97% considered necessary to give pharmacologic treatment, but only 48.8% of interns and 33.3% of residents gave an adequate prescription. The antidepressants given as a first line treatment were selective serotonin reuptake inhibitors, being the most prescribed sertraline (65.4%) followed by fluoxetine (24%). Over 90% of participants added a nonpharmacologictreatment and a consultation to another service. About the knowledge on how to choose an antidepressant, we found that the average of right answers among the interns was 3.8 (SD=1.99) while among the residents was 3.08 (SD=1.56). Conclusions: There is no difficulty in making an adequate diagnosis of a majordepression case, neither in interns nor residents, but there is a lack of knowledge about the right treatment.