Jaya Earnest

A Systematic Review of Factors Influencing Fertility Desires and Intentions Among People Living with HIV/AIDS: Implications for Policy and Service Delivery

With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.

Stressors, Coping, and Social Support Among Women in Papua New Guinea

In this study we used an interpretive, ethnographic, qualitative approach to examine Papua New Guinean women’s narratives and perceptions about their health and the ways in which these were linked to coping with personal adversity. Women used a variety of strategies to cope with psychosocial stressors and challenging life circumstances, including both reliance on their own agency and active efforts and the seeking of social and spiritual support. We observed that limited access to social and economic resources, combined with gender constraints, made women socially and culturally vulnerable to social strain that affected their physical and emotional health. A number of women used avoidance strategies that were related to lower levels of self-esteem and life satisfaction and displayed high levels of anxiety. We propose the need to understand the context in which coping takes place and to enhance resilience strategies used by women in developing countries such as Papua New Guinea to manage the multiple stressors associated with confronting life’s challenges.

Youth empowerment for the most vulnerable: A model based on the pedagogy of Freire and experiences in the field

Purpose – This paper aims to review global adolescent empowerment programmes and develops and proposes a model that can be used with vulnerable adolescents. The model reflects theory and experience drawn from the literature.Design/methodology/approach – The review is a synthesis of articles on empowerment theory, models and programme evaluations. Literature is selected and critiqued that reflects aspects of empowerment as described by Freire or relating to empowering models that could be generalised and related specifically to vulnerable adolescent programmes. Vulnerable adolescents within the context of this paper have been identified as those experiencing social, economic, cultural or physical disadvantage.Findings – The findings document that empowerment programmes do not fully integrate the theory or pedagogy of empowerment as described by Freire. In most cases the goals of empowerment programmes, when stated, do not reflect the transformative or social action aspects of empowerment theory. Neverthele...

The involvement of men in maternal health care: cross-sectional, pilot case studies from Maligita and Kibibi, Uganda

BackgroundThe International Conference on Population Development held in Cairo in 1994 identified the importance of male involvement in reproductive health programs. Since then, there has been an increase in reproductive health initiatives that target both men and women in an attempt to fulfill the 5th Millenium Development Goal. Yet, while the benefits of male involvement have been acknowledged, there continues to be a challenge in creating a space for and engaging men in maternal health. This is problematic due to the role of men as the head of the household in many countries, especially developing countries, which suffer from higher rates of maternal mortality. Furthermore, men are important as partners, fathers and health care professionals and as such it is important to involve and engage with men in maternal health education, and antenatal care.MethodsThe purpose of this study undertaken in two rural villages in southeastern Uganda, was twofold: firstly to understand men’s current participation in antenatal, pregnancy care and childbirth and secondly to gain insight into both men and women’s attitudes toward increased male involvement. Focus group discussions and semi-structured questionnaires were used to collect information from 35 men and women. The women were either pregnant or had been involved in a birth experience in the past 3 years and the men had wives who were pregnant or had given birth recently.ResultsMen interviewed in the two villages believed that issues related to pregnancy and childbirth were the domain of women. Involvement tended to be confined (to removed) strictly to traditional gender roles, with men’s main responsibility being provision of funds. The women, on the other hand, were interested in receiving more support from their husband through planning, attendance to antenatal care and physical presence in the vicinity of where the birth was taking place.ConclusionThis cross-sectional study has highlighted the space for increased male involvement and participation in maternal health, proposed recommendations and the need for community health education directed at men that engages them in this important area.

Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.

Factors Associated With Perceived Stigma Among People Living With HIV/AIDS in Post-Conflict Northern Uganda

HIV-related stigma continues to persist in several African countries including Uganda. This study quantified the burden of stigma and examined factors associated with stigma among 476 people living with HIV (PLHTV) in Gulu, northern Uganda. Data were collected between February and May 2009 using the HIV/AIDS Stigma Instrument-PLWA. Females more than males, respondents aged above 30 years, and those who had been on antiretroviral therapy for a longer time experienced higher levels of stigma. Verbal abuse and negative self-perception were more common forms of stigma. The association between antiretroviral therapy and stigma suggested that organizational aspects of antiretroviral delivery may lead to stigmatization of PLHIV. Interventions such as counseling of PLHIV, education of health workers and the community would lead to reductions in negative self-perception and verbal abuse and in turn improve the quality of life for PLHIV in northern Uganda.

Youth empowerment for the most vulnerable

Purpose – This paper aims to review global adolescent empowerment programmes and develops and proposes a model that can be used with vulnerable adolescents. The model reflects theory and experience drawn from the literature.Design/methodology/approach – The review is a synthesis of articles on empowerment theory, models and programme evaluations. Literature is selected and critiqued that reflects aspects of empowerment as described by Freire or relating to empowering models that could be generalised and related specifically to vulnerable adolescent programmes. Vulnerable adolescents within the context of this paper have been identified as those experiencing social, economic, cultural or physical disadvantage.Findings – The findings document that empowerment programmes do not fully integrate the theory or pedagogy of empowerment as described by Freire. In most cases the goals of empowerment programmes, when stated, do not reflect the transformative or social action aspects of empowerment theory. Neverthele...

Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda

HIV‐related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV‐related stigma among PLHIV in post‐conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future.

A Cross-Generational Study of Contraception and Reproductive Health Among Sudanese and Eritrean Women in Brisbane, Australia

This study conducted in Brisbane, Australia, was undertaken with a cross-section of Sudanese and Eritrean mothers and daughters. We explored and documented the womens intergenerational experiences and knowledge of reproductive health and contraception. Underpinned by a qualitative approach, focus group discussions were undertaken along with key informant interviews with health and multicultural sector professionals. Through examination of knowledge shared, the analysis distilled key aspects of intergenerational fears, cultural safety, and health. Participants proposed recommendations on how refugee and migrant women in Australia and resettled countries globally can more effectively and holistically exercise their sexual and reproductive health rights.

Resettlement experiences and resilience in refugee youth in Perth, Western Australia.

BackgroundIn Australia, the two major pathways of refugee entry are the United Nations High Commissioner for Refugees resettlement programme and irregular maritime arrivals (IMAs) seeking asylum. The Australian Government’s policies towards IMAs since July 2013 are controversial, uncompromising and consistently harsh, with asylum seekers held in detention centres for prolonged periods. Refugees and asylum seekers have distinct and unique stressors that make resettlement difficult.MethodsThis exploratory study examines resettlement experiences for refugee youth in Western Australia using the psychosocial conceptual framework and qualitative methods. Focus group discussions and key informant interviews were undertaken with verbatim transcripts analysed using thematic analysis to identify themes.ResultsThemes documented that language and its impact, and experience with education, health, and social activities, support structures provided to youth and supporting future aspirations as critical to successful resettlement. This exploratory study contributes to developing a broader understanding of the resettlement experiences of refugee youth, drawing on their current and past experiences, cultural differences and mechanisms for coping.ConclusionFluency in English language, especially spoken, was a facilitator of successful resettlement. Our results align with previous studies documenting that support programs are vital for successful resettlement. Although faced with immense difficulties refugee youth are resilient, want to succeed and have aspirations for the future. Strategies and recommendations suggested by refugee youth themselves could be used for developing interventions to assist successful resettlement.