Showing 21 - 33 of 33 Results for "violence"

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Efforts are needed to further research and repeal laws that criminalize HIV non-disclosure, exposure or transmission — including vertical transmission of HIV—, which can discourage people from testing for HIV, and undermine the relationship between patients and physicians and other service providers. Because women are more likely to be tested, legal mandates to disclose HIV-positive serostatus may discourage women from accessing needed services and may lead to increased risk of abandonment and violence (see sections on VAW, HTC, etc).
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Women, especially married women, ongoing education about the role of condoms in preventing HIV acquisition and transmission, along with condom negotiation skills. A study found that women did not believe that condoms reduce the risk of HIV transmission. Another study found that married women of alcoholic men are aware of risks of contracting HIV from their husbands but reported difficulty in negotiating condom use as well as violence.
Male and Female Condom Use
1 study
Further interventions are needed to reduce barriers to HIV testing. Studies found that fear of partner notification, risk of domestic violence, the unreliability of rapid HIV tests, test availability, long waiting times at the clinic, costs for transport, lack of childcare and the need for partner consent were barriers to HIV testing. The impact of rapid testing during labor and delivery for HIV-positive women has yet to be assessed and HIV test results were not provided prior to delivery.
Antenatal Care - Testing and Counseling
1 study
Changing the gender norms that can lead to increased risks of HIV such as those dictating multiple sexual partners, the use of violence, or drinking heavily for men and sexual ignorance, submissiveness and dependency for women and girls is a current challenge. Further well-evaluated interventions are needed and existing interventions need to be scaled up. Studies found that women were aware of being at risk for HIV yet felt they had no power to negotiate the terms of sex or to demand condom use. Studies found that both men and women thought multiple sexual partners for men to be an accepted norm in many countries. Media reinforced these gender stereotypes.
Transforming Gender Norms
1 study
Interventions are needed for adolescents to reduce acceptance of gender-based violence and stigma against people living with HIV. A study found high rates of stigma among adolescent girls. A nationally representative survey of youth in Tanzania found high rates of acceptance for a husband to beat his wife if she goes out without telling him; argues with him; burns food; or refuses to have sex with him. In 35% of countries with data available, more than 50% of women and men report discriminatory attitudes toward people living with HIV (UNAIDS, 2015e).
Mitigating Risk
1 study
Additional evidence- and rights-based interventions are needed for couples counseling in sero-discordant relationships; counseling that clearly explains serodiscordance and can identify women at risk of violence and make appropriate links to other services. While WHO issued recommendations on couples testing and counseling (WHO, 2012g), more evidence-based interventions are needed for counseling for couples in sero-discordant relationships. These interventions may need to differ by sex, as in one study, women living with HIV were likely to report an HIV-negative or unknown serostatus partner and men living with HIV were more likely to report multiple sexual partners.
Staying Healthy and Reducing Transmission
1 study
Interventions for pregnant women and their partners to stay HIV-negative or reduce HIV transmission are needed. [See also %{c:11} and %{c:13}] Pregnancy is a time of high risk for HIV acquisition. Home-based partner education for couples with no reports of interpersonal violence may be more effective than clinic based interventions, especially when women can opt-out of disclosing their sero-status. A systematic review found that incident infection (i.e. recently acquired during pregnancy) resulted in up to a 15-fold higher risk of vertical transmission.
Antenatal Care - Treatment
1 study
Programs for male circumcision need to provide women, as well as men, with detailed factual knowledge of the benefits and risks of voluntary medical male circumcision. Surveys found that women lacked detailed factual knowledge of the benefits and risks of voluntary medical male circumcision and believed that if their male partner was circumcised (whether medically or traditionally) that condom use was unnecessary to protect them from acquiring HIV. Both women and men needed knowledge that abstinence is necessary during wound-healing. Women also need to know that female genital cutting does NOT protect against HIV acquisition or transmission. Women reported that circumcised men adopted risky sexual behaviors. Women feared that medical male circumcision would reduce their ability to negotiate for safer sex and would increase violence. A study of women who acquired HIV found that a large proportion of women reported not knowing whether their partner was circumcised.
Voluntary Medical Male Circumcision
1 study
Interventions are needed to provide women and their partners with a better understanding of the risk of acquiring HIV through sexual practices as well as through injecting drug use (IOM, 2007). Studies found low rates of condom use despite sexual relationships with IDUs, lack of knowledge by IDUs on sexual and reproductive health and lack of access to clean needles. A study also found that many MSM and male intravenous drug users avoid disclosure of their sexual and drug risk behavior along with their HIV status due to stigma and gender norms and that most wives reported violence and little or no condom use. HIV-positive male IDUs want help with disclosure to their wives. Most wives of IDUs reported only a single lifetime sexual partner and only a tiny proportion reported injecting drug use.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Interventions are needed to reduce barriers to treatment adherence and to understand how these differ by sex. Increased research is needed to understand the most effective strategies to increase adherence. Studies found that a number of barriers that impact treatment adherence, such as violence, stigma, transport costs, childcare, forced migration, the need for food, the need to hide their medication from their male partners and changes in body image. Screening and treatment for depression may improve adherence, although some studies have shown mixed results. A review found that adherence differs by sex, but with little disaggregation for which factors affect women. Data collection should be more nuanced and not assume that women fall into static groups. A study of people living with HIV who disengaged from ART found that harsh and disrespectful treatment by providers, as well as competing work and livelihood demands, lack of funds for transport, etc. made attendance at ART clinics challenging.
Adherence and Support
1 study
Interventions are needed for male involvement that do not such reinforce harmful gender norms or increase risk for violence, stigma or discrimination. “Evidence for effectiveness of male involvement in PMTCT programs is scant” (Beckham et al., 2015: 67). One study only evaluated male involvement as accompanying their pregnant partner to ANC care with no HIV related outcomes listed and tasking the woman to require her male partner to come to ANC (Nyondo et al., 2015). Most approaches only reach men through their pregnant spouse, with no services for men beyond HIV testing and use men as an instrument solely to increase access to services by women. Men have been denied involvement in antenatal care, birth and delivery even if the couple so chooses.
Antenatal Care - Treatment
1 study
Interventions, policies and budgets are needed to reduce sexual coercion and rape of both boys and girls, create awareness in communities that violence against children is unacceptable, strengthen child statutory protection systems, and conceptualize and implement appropriate child protection services in developing countries. Access to post-exposure prophylaxis in case of rape when the perpetrator is HIV-positive is also needed. [See also %{c:21}] In most countries of Eastern and Southern Africa, the age of consent for sex is 16. Despite these restrictions, more than 10% of girls have had sexual debut before age 15. A study found that in a sample of more than 1,000 males and more than 1,000 females, large numbers had experienced high rates of physical punishment, emotional abuse and touching of sexual organs when not wanted or sex due to force or coercion prior to age 18 and that incident HIV infections were more common in women who suffered emotional abuse, sexual abuse and physical punishment. Sexual abuse in men was associated with alcohol abuse and depression. Other studies found high rates of sexual coercion and high-risk behaviors among street children. “Few children disclose abuse, fewer still seek services and report to authorities, virtually no children actually receive services and perpetrators rarely suffer consequences” (Sommarin et al., 2014: S213). Most research does not provide adolescent-specific data on violence, instead listing results for ages 15 to 49. Reviews have not found evidence that preventive responses have had an impact on rates of sexual abuse. Effective programs in the US and Canada have not been assessed for adaptation in other countries.
Mitigating Risk
1 study
Adolescents living with HIV need information and services through adolescent-friendly HIV services on a number of topics, including disclosure, safer sex, contraception, safe motherhood and gender-based violence. Studies found that health providers were unprepared to discuss HIV and contraception with adolescents who acquired HIV through perinatal transmission, despite the fact that significant numbers of these adolescents were already sexually active. Another study found that these adolescents need skills to disclose their serostatus to sexual partner. WHO recommends that perinatally infected adolescents be advised of their positive serostatus by age 6 (WHO, 2013) but there is little guidance on disclosure for adolescents. Facilitated disclosure by parents and providers to adolescents living with HIV may lead to higher retention in HIV care (Arrive et al., 2012). Parents living with HIV whose adolescents may be living with HIV also need assistance to disclose to their adolescents, as parents fear rejection from their children. Positive health dignity and prevention interventions can help people living with HIV lead healthy lives and reduce HIV transmission, but tailored interventions for adolescents and their parents have not been evaluated for effectiveness, although a trial is currently ongoing (Cunningham, 2015; Mofeson and Cotton, 2013). One study found that 29% of young women aged 16 to 24 living with HIV reported being forced to have sex. No validated curriculum that was shown to be effective for reducing unsafe sex among adolescents living with HIV was found, although some manuals have been developed (Parker et al., 2013c; UNESCO and GNP+, 2012).
Increasing Access to Services
1 study