Gail Webber

The Impact of Migration on HIV Prevention for Women: Constructing a Conceptual Framework

There are an estimated 40.5 million people currently living with HIV globally, 17.5 million of whom are women, according to the AIDS Epidemic update: December 2005, conducted by UNAIDS and the World Health Organization (WHO) 2005. Women are vulnerable to HIV for biologic as well as social reasons. In the past, the HIV prevention theorists have not considered the context of womens lives: factors at the individual, relationship, and community levels, as well as structural factors (both policy and cultural) impact on HIV prevention for women. This is particularly true for migrant women, who may be especially vulnerable to HIV infection during their time of transition. Throughout this article I explore the international literature for both the historical context of HIV prevention for women and the impact of migration on HIV risk for women. The literature review provides a basis for the development of a conceptual framework of the socioecologic factors affecting HIV prevention for migrant women. I call for consideration of the broad context of womens experience when developing interventions for this population.

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

BackgroundThe purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011.MethodsFocus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities.ResultsSeveral common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends.The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites.ConclusionsRecommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.

Women's Health in Women's Hands: A Pilot Study Assessing the Feasibility of Providing Women With Medications to Reduce Postpartum Hemorrhage and Sepsis in Rural Tanzania

In rural Africa, deaths from childbirth are common and access to health care facilities with skilled providers is very limited. Leading causes of death for women are bleeding and infection. In this pilot study, we establish the feasibility of distributing oral medications to women in rural Tanzania to self-administer after delivery to reduce bleeding and infection. Of the 642 women provided with medications, 90% of the women took them appropriately, while the remaining 10% did not require them. We conclude that is it feasible to distribute oral medications to rural women to self-administer after delivery.

Sexual and reproductive health issues facing Southeast Asian beer promoters: a qualitative pilot study

BackgroundIn Southeast Asia, hundreds of thousands of young rural women migrate from their villages to the larger cities in search of work. Many find employment with beer companies or in the clubs where beer is sold, promoting the sale of beer. Previous research suggests these young migrants are in a highly vulnerable position. This paper will describe the findings of an October 2009 meeting to develop a research agenda on the sexual and reproductive health of beer promoters and a subsequent pilot study of focus groups with beer promoters to review this agenda.MethodsParticipants of the research meeting representing beer promoters, academics, non-governmental organizations (NGOs), government and the beer industry from Cambodia, Thailand, Laos, and Vietnam collaborated in the development of three key research themes. The themes were verified in focus group discussions with beer promoters organized by local research partners in all four countries. The focus group participants were asked what they felt were the key sexual and reproductive health issues facing them in a non-directive and unstructured manner, and then asked to comment more specifically on the research priorities developed at the meeting. The focus groups were recorded digitally, transcribed, and translated into English. The data were analyzed by coding for common themes and then developing matrices to compare themes between groups.ResultsThe participants of the meeting identified three key research themes: occupational health (including harassment and violence, working conditions, and fair pay), gender and social norms (focusing on the impact of power relations between the genders on womens health), and reproductive health (knowledge and access to reproductive health care services). The participants in the focus groups in all four countries agreed that these were key priorities for them, though the emphasis on the most important issues varied between groups of women. Sexual harassment in the workplace and challenges in accessing reproductive health care services because of the barriers of cost, shyness, and stigmatizing attitudes of health care providers were common problems for many of the women.ConclusionsThere is a need for regional research and programming for beer promotion women in Southeast Asia focusing on the three research themes of occupational health, gender norms and reproductive health. Such research and programs could provide important benefits for many beer promotion women who currently face significant risks to their sexual and reproductive health.

Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers

Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.

âÂÂPlease Do Not Forget Usâ - Views of Women, Nurses, and TraditionalBirth Attendants on Community Distribution of Medications to PreventPostpartum Hemorrhage and Sepsis: A Qualitative Pilot Study in RuralTanzania

Background: Postpartum hemorrhage and sepsis are the most common causes of death for women in childbirth globally. In rural Tanzania where about one woman dies every hour from childbirth, over sixty percent of women deliveroutside of health care institutions and therefore lack access to medications to prevent bleeding and infection. In thisstudy, women delivering in rural Rorya District in northern Tanzania were provided with 600 micrograms of misoprostoland 500 mg of erythromycin to take immediately after delivery to prevent postpartum hemorrhage and sepsis. Thepurpose of the study was to assess the feasibility of distributing these medications. Methods: Selected women, dispensary nurses and traditional birth attendants who were involved in deliveries where the two study medications were taken were interviewed by research assistants in the local language of Kiswahiliabout their views on community distribution of these two medications. The interviews were taped with digital recordersand the recordings were transcribed and translated into English. The English transcripts were independently coded bytwo researchers using a qualitative software analysis program, assessing for common and diverging themes betweenand within the three groups of interviewees. Results: A total of 32 women, 17 dispensary nurses, and 13 traditional birth attendants were interviewed. Therewas strong support for community distribution of medications to prevent bleeding and infection after delivery amongst the participants. Other common themes from the research included family involvement in the decision of the women to take the medications, safe storage of the medications by the women, and minimal side effects of the medications.A variety of people administered the medications. Several participants observed that provision of the medications by dispensary nurses improved women’s access to the dispensaries. Views differed on whether traditional birth attendants should be permitted to distribute the medications. Conclusions: There is strong support from rural women, dispensary nurses, and traditional birth attendants fora community distribution program of medications to prevent postpartum hemorrhage and sepsis. Future research willfocus on the distribution of misoprostol in clean delivery kits directly to rural women by local health providers, as thereis insufficient evidence for prevention of sepsis by inclusion of a single dose of antibiotics.

A survey of Cambodian health-care providers' HIV knowledge, attitudes and intentions to take a sexual history

Cambodia has one of the highest prevalence rates of HIV in Asia and is scaling up HIV testing. We conducted a cross-sectional survey with 358 health care providers in Phnom Penh, Cambodia to assess readiness for voluntary testing and counselling for HIV. We measured HIV knowledge and attitudes, and predictors of intentions to take a sexual history using the Theory of Planned Behaviour. Over 90% of health care providers correctly answered knowledge questions about HIV transmission, but their attitudes were often not positive towards people living with HIV. The Theory of Planned Behaviour constructs explained 56% of the variance in intention to take a sexual history: the control providers perceive they have over taking a sexual history was the strongest contributor (51%), while social pressure explained a further 3%. Attitudes about taking a sexual history did not contribute to intention. Interventions with Cambodian health care providers should focus on improving skills in sexual history-taking.

Community member and policy maker priorities in improving maternal health in rural Tanzania

To determine community member and policy maker priorities in improving maternal health in rural Tanzania.

Promoting respectful maternity care in rural Tanzania: nurses’ experiences of the “Health Workers for Change” program

BackgroundDisrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women’s access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women’s needs based on the “Health Workers for Change” curriculum.MethodsSix series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes.ResultsThe participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women’s experiences in the future.ConclusionsThe qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.