Avni Amin

A Systematic Review of the Correlates of Violence Against Sex Workers

We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally. We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks. This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.

Addressing violence against women: a call to action

Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.

Creating an Enabling Environment for Adolescent Sexual and Reproductive Health: A Framework and Promising Approaches

This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered.

Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review

Background Early adolescence (ages 10–14) is a period of increased expectations for boys and girls to adhere to socially constructed and often stereotypical norms that perpetuate gender inequalities. The endorsement of such gender norms is closely linked to poor adolescent sexual and reproductive and other health-related outcomes yet little is known about the factors that influence young adolescents’ personal gender attitudes. Objectives To explore factors that shape gender attitudes in early adolescence across different cultural settings globally. Methods A mixed-methods systematic review was conducted of the peer-reviewed literature in 12 databases from 1984–2014. Four reviewers screened the titles and abstracts of articles and reviewed full text articles in duplicate. Data extraction and quality assessments were conducted using standardized templates by study design. Thematic analysis was used to synthesize quantitative and qualitative data organized by the social-ecological framework (individual, interpersonal and community/societal-level factors influencing gender attitudes). Results Eighty-two studies (46 quantitative, 31 qualitative, 5 mixed-methods) spanning 29 countries were included. Ninety percent of studies were from North America or Western Europe. The review findings indicate that young adolescents, across cultural settings, commonly express stereotypical or inequitable gender attitudes, and such attitudes appear to vary by individual sociodemographic characteristics (sex, race/ethnicity and immigration, social class, and age). Findings highlight that interpersonal influences (family and peers) are central influences on young adolescents’ construction of gender attitudes, and these gender socialization processes differ for boys and girls. The role of community factors (e.g. media) is less clear though there is some evidence that schools may reinforce stereotypical gender attitudes among young adolescents. Conclusions The findings from this review suggest that young adolescents in different cultural settings commonly endorse norms that perpetuate gender inequalities, and that parents and peers are especially central in shaping such attitudes. Programs to promote equitable gender attitudes thus need to move beyond a focus on individuals to target their interpersonal relationships and wider social environments. Such programs need to start early and be tailored to the unique needs of sub-populations of boys and girls. Longitudinal studies, particularly from low-and middle-income countries, are needed to better understand how gender attitudes unfold in adolescence and to identify the key points for intervention.

Safer disclosure of HIV serostatus for women living with HIV who experience or fear violence: a systematic review

Globally 56% of all married women are using a modern method of contraception up from less than 10% in 1960. In sub-Saharan Africa however only 19% of married women are using a modern method of contraception. Since nearly all family planning services require assistance from a health worker access to health workers is a principal supply-side determinant of family planning service use. This technical brief presents findings from a study that explored if and how health workforce measures differ between eastern and western Africa in an effort to identify factors that may have helped some countries to achieve important gains in contraceptive prevalence while other countries have not. The findings raise questions about whether government commitment and certain policy choices vis-a-vis health workforce distribution and qualifications—even when absolute levels of health worker density are low—could make a difference in the provision of family planning services in resource-constrained countries.Supporting individuals as they disclose their HIV serostatus may lead to a variety of individual and public health benefits. However, many women living with HIV are hesitant to disclose their HIV status due to fear of negative outcomes such as violence, abandonment, relationship dissolution and stigma.

Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of womens vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV.

Implications of the Global Early Adolescent Study's Formative Research Findings for Action and for Research

Implications of the Global Early Adolescent Study’s Formative Research Findings for Action and for Research Venkatraman Chandra-Mouli, M.B.B.S., M.Sc. *, Marina Plesons, M.P.H. , Emmanuel Adebayo, Ph.D., M.P.H. , Avni Amin, Ph.D., M.Sc. , Michal Avni, M.P.H. , Joan Marie Kraft, Ph.D. , Catherine Lane, M.P.H. , Clarissa Lord Brundage, M.P.H. , Tamara Kreinin, M.H.S.A , Emily Bosworth, M.P.H. , Claudia Garcia-Moreno, M.Sc. , and Shawn Malarcher, M.P.H. b Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland United States Agency for International Development, Washington, D.C. Bill and Melinda Gates Foundation, Seattle, Washington David and Lucile Packard Foundation, Los Altos, California

Sexually transmitted infections and women's sexual and reproductive health

Sexually transmitted infections (STIs) are widespread globally and result in a large burden of sexual and reproductive health consequences that disproportionately affect women, including pregnancy complications, cancer, infertility, and enhanced HIV transmission. A new WHO publication, available online, outlines key points of action and new and future technologies for global STI prevention and control. Highlights from the WHO publication are described in the present article.

Food insecurity, sexual risk behavior, and adherence to antiretroviral therapy among women living with HIV: A systematic review

ABSTRACT Gender inequalities shape the experience of food insecurity among women living with HIV (WLHIV). We systematically reviewed the impact of food insecurity on sexual risk behaviors and antiretroviral therapy (ART) adherence among WLHIV. We included qualitative or quantitative peer-reviewed articles, extracted data in duplicate, and assessed rigor. Seven studies, from sub-Saharan Africa, North America, and Europe, met inclusion criteria. Food insecurity was associated with increased sexual risk through transactional sex and inability to negotiate safer sex. Hunger and food insecurity were barriers to ART initiation/adherence. Multidimensional programming and policies should simultaneously address poverty, gender inequality, food insecurity, and HIV.

A pressing need to respond to the needs and sexual and reproductive health problems of adolescent girls living with HIV in low- and middle-income countries

This commentary provides the rationale and makes a call for greater investment and effort to meet the sexual and reproductive health (SRH) problems of adolescent girls living with HIV in low‐ and middle‐income countries (LMIC).