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1.
PLoS One ; 19(1): e0296806, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38236914

RESUMO

Traditional gender and social norms reinforce asymmetrical power relations, increase the risk of experiencing gender-based violence and mediate poor engagement with sexual and reproductive health services. This study explored gender norms and expectations amongst cisgender adolescents in rural KwaZulu-Natal, South Africa. A purposive sample of 29 adolescents aged 16-19 years old were enrolled as part of a longitudinal qualitative study. The current analysis reports on the first round of in-depth interviews, which focused on the role of men and women in their community. A theoretically informed thematic analysis identified three broad themes: 1) Adolescent interpretation and understanding of gender identity, 2) Gendered essentialism and Gender roles (two sub-themes: Young men: Power through providing, and Young women: The domestication process which highlighted that gender roles were defined by being the provider for men, and the successful fulfilment of traditional domestic behaviours amongst women), 3) Gender and fertility highlighted how participants highly valued fertility as affirming of manhood/womanhood. These norms reinforce gender roles that maintain asymmetrical power relations, carrying them over into adulthood. The subtle social pressure to prove fertility could have unintended consequences for driving teenage pregnancy. Structural, gender-based interventions emphasising positive gender-role development in early childhood are needed.


Assuntos
Papel de Gênero , Gravidez na Adolescência , Pré-Escolar , Gravidez , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Identidade de Gênero , África do Sul , Comportamento Sexual
2.
PLoS One ; 18(11): e0294285, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37948399

RESUMO

BACKGROUND: South Africa is among the countries with the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71 000 Treponema pallidum infections among South African men and women of reproductive age. METHODS: We evaluated STI prevalence and incidence and associated risk factors in 162 women aged 18-33 years old, residing in eThekwini and Tshwane, South Africa who were part of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. Women were randomised to use depot medroxyprogesterone acetate (n = 53), copper intrauterine device (n = 51), or levonorgestrel (n = 58) implant. Lateral vaginal wall swab samples were collected prior to contraceptive initiation and at months one and three following contraceptive initiation for STI testing. RESULTS: There were no significant differences in STI incidence and prevalence across contraceptive groups. At baseline, 40% had active STIs (CT, NG, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) or herpes simplex virus-2 shedding across all age groups- 18-21 years (46%), 22-25 years (42%) and 26-33 years (29%). The incidence of STIs during follow-up was exceptionally high (107.9/100 women-years [wy]), with younger women (18-21 years) more likely to acquire CT (75.9/100 wy) compared to 26-33 year olds (17.4/100 wy; p = 0.049). TV incidence was higher in the 26-33 year old group (82.7/100 wy) compared to the 18-21 year olds (8.4/100 wy; p = 0.01). CONCLUSIONS: Although the study participants received extensive counselling on the importance of condom use, this study highlights the high prevalence and incidence of STIs in South African women, especially amongst young women, emphasising the need for better STI screening and management strategies.


Assuntos
Infecções por Chlamydia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Trichomonas vaginalis , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , África do Sul/epidemiologia , Anticoncepcionais , Prevalência , Incidência , Infecções Sexualmente Transmissíveis/prevenção & controle , Chlamydia trachomatis , Neisseria gonorrhoeae , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico
3.
Am J Reprod Immunol ; 88(2): e13542, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35394678

RESUMO

PROBLEM: Data on the effects of contraceptives on female genital tract (FGT) immune mediators are inconsistent, possibly in part due to pre-existing conditions that influence immune mediator changes in response to contraceptive initiation. METHODS: This study included 161 South African women randomised to injectable depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (IUD), or levonorgestrel (LNG) implant in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. We measured thirteen cytokines and antimicrobial peptides previously associated with HIV acquisition in vaginal swabs using Luminex and ELISA, before, and at 1 and 3 months after contraceptive initiation. Women were grouped according to an overall baseline inflammatory profile. We evaluated modification of the relationships between contraceptives and immune mediators by baseline inflammation, demographic, and clinical factors. RESULTS: Overall, LNG implant and copper IUD initiation were associated with increases in inflammatory cytokines, while no changes were observed following DMPA-IM initiation. However, when stratifying by baseline inflammatory profile, women with low baseline inflammation in all groups experienced significant increases in inflammatory cytokines, while those with a high baseline inflammatory profile experienced no change or decreases in inflammatory cytokines. CONCLUSION: We conclude that pre-contraceptive initiation immune profile modifies the effect of contraceptives on the FGT innate immune response.


Assuntos
Anticoncepcionais Femininos , Infecções por HIV , Anticoncepcionais Femininos/efeitos adversos , Anticoncepcionais Femininos/farmacologia , Citocinas , Feminino , Genitália , Infecções por HIV/epidemiologia , Humanos , Imunidade Inata , Inflamação , Dispositivos Intrauterinos de Cobre/efeitos adversos , Levanogestrel/efeitos adversos , Levanogestrel/farmacologia , Acetato de Medroxiprogesterona/efeitos adversos , Acetato de Medroxiprogesterona/farmacologia
4.
Glob Public Health ; 17(9): 2054-2069, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34488554

RESUMO

Understanding the sexual relationships of young women is critical for preventing HIV infections. This study aimed to describe the sexual behaviour of partners, comparing the accuracy of sexual health knowledge between partners. The study took place in 2017 in KwaZulu-Natal, South Africa. Purposive sampling was used to select 18-27-year-old sexually active women. Consenting female participants completed a structured and semi-structured interview, while consenting male sexual partners identified through the female participant completed a structured questionnaire on sexual health information. Using a reflexive inductive approach and thematic analysis, we identified key discrepancies in the assumptions partners make about each other's sexual health information. Twenty-three sexual dyads were identified and four key discrepancies were identified: Age: partners either over or underestimated the age of their partners, HIV status: where partners were unaware of, or incorrectly assumed their partner's status, Lack of awareness of partner's concurrent relationships and more general knowledge of the partner's sexual health behaviours. Discussions about sexual health are mediated by relationship length, type of partner, power and perceived fidelity. While it is possible to undertake dyadic level research, ethical tensions remain. Sex-positive and egalitarian sexual health interventions that target the individual, as well as the sexual relationship, are needed.


Assuntos
Infecções por HIV , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Medição de Risco , Comportamento Sexual , Parceiros Sexuais , África do Sul/epidemiologia , Adulto Jovem
5.
Cult Health Sex ; 21(1): 95-107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29658830

RESUMO

The use of vaginal products may increase the risk of HIV infection by affecting the vaginal biome. Understanding what vaginal products young women are using, and why, is key to assessing the complexity of sexual health and risk. This study reports on findings from research with adolescent and young women in rural KwaZulu-Natal about the vaginal products they use and motivations for using them. The study identified over 26 products that young women used to enhance their sexual experience and found some young women spent time preparing and sourcing vaginal products in order to pleasure and retain partners. Opinions differed about vaginal product use. While some women perceived that vaginal products could provide a means of out-performing other women, retaining a partner and providing sexual autonomy, there was a stigma attached to using them. Study findings highlight the social value of using vaginal products, especially in settings where partner retention is linked to economic survival. Expanding our understanding of what products are used and the reasons young women use them warrants continued investigation.


Assuntos
Atitude Frente a Saúde/etnologia , Características Culturais , Infecções por HIV/psicologia , Comportamento Sexual/etnologia , Ducha Vaginal/estatística & dados numéricos , Administração Intravaginal , Adolescente , Adulto , Feminino , Infecções por HIV/etiologia , Humanos , Motivação , Medição de Risco , Comportamento Sexual/psicologia , Estigma Social , África do Sul , Ducha Vaginal/efeitos adversos , Adulto Jovem
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