Joelle Mak

The Global Prevalence of Intimate Partner Violence Against Women

Data from 81 countries was used to estimate global prevalence of intimate partner violence against women. Violence against women is a phenomenon that persists in all countries (1). Since the 1993 World Conference on Human Rights and the Declaration on the Elimination of Violence against Women, the international community has acknowledged that violence against women is an important public health, social policy, and human rights concern. However, documenting the magnitude of violence against women and producing reliable comparative data to guide policy and monitor progress has been difficult.

Intimate partner violence victimization and alcohol consumption in women: a systematic review and meta-analysis

AIMS To examine the evidence of association between intimate partner physical or sexual violence (IPV) victimization and alcohol consumption in women. METHODS We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies released before 6 June 2013. Studies providing an estimate of association between violence and alcohol consumption or alcohol use disorders were eligible for inclusion. Quality was assessed and random effects meta-analyses used to generate pooled odds ratios (OR) where appropriate. Higgins I(2) where P<0.10 was taken to indicate heterogeneity. RESULTS Fifty-five studies providing 102 estimates of association met the inclusion criteria. Most estimates were not controlled for partner alcohol use and other key confounders. Seven longitudinal studies provided 12 estimates of the association between alcohol and subsequent IPV; nine of 12 estimates showed a direction of increased odds of subsequent IPV, pooled OR=1.27 [95% confidence interval (CI)=1.07-1.52], I(2) =0%, P=0.437. Nine longitudinal studies provided 15 estimates of association between IPV and subsequent alcohol use; 14 of 15 estimates showed a direction of increased odds of subsequent alcohol use, pooled OR=1.25 (95% CI 1.02-1.52), I(2)=0%, P=0.751. Cross-sectional studies showed an association between IPV and alcohol use, pooled OR=1.80, 95% CI 1.58-2.06, but with substantial heterogeneity, I(2)=60.8%, P<0.0001. Definition of alcohol use partly accounted for heterogeneity in cross-sectional estimates. CONCLUSIONS There is a clear positive association between alcohol use and intimate partner physical or sexual violence victimization among women, suggesting a need for programming and research that addresses this link. However, the temporal direction of the association remains unclear. Longitudinal studies with multiple waves of data collection are needed.

Childhood Sexual Abuse and Suicidal Behavior: A Meta-analysis

BACKGROUND AND OBJECTIVE: Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with childhood sexual abuse (CSA) exposure can help inform prevention strategies. We aimed to quantify to what extent CSA was associated with incident suicide attempts in men and women. METHODS: We searched 20 health and social science databases from first record until February 2009 and updated the search in Medline from February 2009 to February 1, 2013. Longitudinal studies and cotwin analyses from twin studies in any population from any year were eligible for inclusion. Of 22 235 abstracts screened as part of a series of reviews, 9 studies met the inclusion criteria for this review. Characteristics, effect estimates, and quality data were extracted. Random-effects meta-analysis was used to generate pooled odds ratios (ORs). RESULTS: Seven longitudinal and 2 twin studies with 8733 participants met the inclusion criteria. The overall pooled estimate for longitudinal studies was OR = 2.43 (95% confidence interval: 1.94–3.05), I2 = 87.5%, P < .0001. The pooled OR from cotwin analysis was 2.65 (95% confidence interval: 0.82–4.49, I2 = 0%, P = .867). Studies adjusted for a range of confounders, but baseline suicidal behavior was not well-controlled. Too few studies met the inclusion criteria to quantitatively examine sources of heterogeneity. CONCLUSIONS: CSA exposure is associated with suicide attempts when a range of different confounders are controlled for, but the temporality of the association is not well established, and the association is highly heterogeneous.

Need demand and missed opportunities for integrated reproductive health–HIV care in Kenya and Swaziland: evidence from household surveys.

Objective:Little is known about the need and demand for integrated reproductive health and HIV services at the population level. Design:Descriptive data analysis of household surveys collected by the Integra Initiative. Methods:Household surveys were conducted among 18–49-year-olds in Kenya (N = 1752) and Swaziland (N = 779) in 2009. Data on fertility intentions, contraceptive use, sexual behaviours and HIV testing were used to determine unmet needs. Demand for integrated services was defined as wanting reproductive health services with HIV/sexually transmitted infection (STI) services within one visit. Results:At the population level, family planning needs (90%) were higher than HIV/STI prevention needs: 53% (women) and 75% (men). Fewer had unmet family planning needs through non-use of contraceptives: 17% (women) and 27% (men); versus unmet HIV/STI prevention needs through inconsistent condom use: 48 and 26% of women; 51 and 32% of men in Kenya and Swaziland, respectively. Dual need was higher for men: 64% (Kenya) and 73% (Swaziland) versus women (48%) with more unmet in Kenya (43%) compared to Swaziland (25%). Missed opportunities for integrated service provision were high among women: 49 and 57% with unmet family planning needs; and 55 and 32% with unmet HIV/STI prevention needs in Kenya and Swaziland, respectively, used services, but did not receive the needed service. Most men with unmet needs were non-service users. Approximately a quarter of women wanted and received integrated reproductive health–HIV/STI services in both countries. Conclusions:Demand creation at the community level and provider-initiated integrated service provision are needed, using different strategies for men and women, to address substantial family planning and HIV/STI prevention needs.

What is the prevalence of and associations with forced labour experiences among male migrants from Dolakha, Nepal? Findings from a cross-sectional study of returnee migrants

Objectives Growing numbers of people are migrating outside their country for work, and many experience precarious conditions, which have been linked to poor physical and mental health. While international dialogue on human trafficking, forced labour and slavery increases, prevalence data of such experiences remain limited. Methods Men from Dolakha, Nepal, who had ever migrated outside of Nepal for work were interviewed on their experiences, from predeparture to return (n=194). Forced labour was assessed among those who returned within the past 10 years (n=140) using the International Labour Organizations forced labour dimensions: (1) unfree recruitment; (2) work and life under duress; and (3) impossibility to leave employer. Forced labour is positive if any one of the dimensions is positive. Results Participants had worked in India (34%), Malaysia (34%) and the Gulf Cooperation Council countries (29%), working in factories (29%), as labourers/porters (15%) or in skilled employment (12%). Among more recent returnees (n=140), 44% experienced unfree recruitment, 71% work and life under duress and 14% impossibility to leave employer. Overall, 73% experienced forced labour during their most recent labour migration. Forced labour was more prevalent among those who had taken loans for their migration (PR 1.23) and slightly less prevalent among those who had migrated more than once (PR 0.87); however the proportion of those who experienced forced labour was still high (67%). Age, destination and duration of stay were associated with only certain dimensions of forced labour. Conclusion Forced labour experiences were common during recruitment and at destination. Migrant workers need better advice on assessing agencies and brokers, and on accessing services at destinations. As labour migration from Nepal is not likely to reduce in the near future, interventions and policies at both source and destinations need to better address the challenges migrants face so they can achieve safer outcomes.

Men's use of sexual health and HIV services in Swaziland: a mixed methods study.

BACKGROUND Over one-quarter of the adult population in Swaziland is estimated to be HIV positive. Mens use of sexual health (SH) services has significant implications for HIV prevention. This study aimed to understand Swazi mens health-seeking behaviours in relation to SH and HIV services. METHODS A household survey was conducted in Manzini (n=503), complemented by 23 semi-structured interviews and two focus group discussions (with a total of 10 participants). RESULTS One-third of male survey participants used SH services in the past year, most commonly HIV testing (28%). Service users were more likely to be sexually active (aOR 3.21, 95% CI: 1.81-5.68 for those with one partner; and aOR 2.35, 95% CI: 1.25-4.41 for those with multiple partners) compared with service non-users. Service users were less likely to prefer HIV services to be separated from other healthcare services (aOR 0.50, 95% CI: 0.35-0.71), or to agree with travelling further for their HIV test (aOR 0.52, 95% CI: 0.33-0.82) compared with non-users, after controlling for age-group and education. Men avoided SH services because they feared being stigmatised by STI/HIV testing, are uncomfortable disclosing SH problems to female healthcare providers, and avoided HIV testing by relying on their wifes results as a proxy for their own status. Informal providers, such as traditional healers, were often preferred because practitioners were more often male, physical exams were not required and appointments and payment options were flexible. CONCLUSION To improve mens uptake of SH services, providers and services need to be more sensitive to mens privacy concerns, time restrictions and the potential stigma associated with STI/HIV testing.