Leyla Ismayilova

Integrating Children's Savings Accounts in the Care and Support of Orphaned Adolescents in Rural Uganda.

This study examines an economic empowerment model of care and support for orphaned adolescents in rural Uganda. Under this model, 277 AIDS‐orphaned youths (ages 11–17) from 15 comparable schools were randomly assigned to either the usual care, which involves provision of counseling and education‐related supplies, or the experimental condition, in which participants also received matched‐savings accounts. The analyses indicate that poor families in rural Uganda can and do save for their youths if provided with support and incentives. Analyses also locate statistically significant differences between youths in the experimental and control groups on attitudes toward saving, academic performance, educational aspirations, and health‐related behaviors. The results suggest that savings‐related interventions have a place in the care and support of orphaned youths in poor sub‐Saharan Africa, where the number of such youths is steadily increasing.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

PURPOSE This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda.

PURPOSE By adversely affecting family functioning and stability, poverty constitutes an important risk factor for childrens poor mental health functioning. This study examines the impact of a comprehensive microfinance intervention, designed to reduce the risk of poverty, on depression among AIDS-orphaned youth. METHODS Children from 15 comparable primary schools in Rakai District of Uganda, one of those hardest hit by HIV/AIDS in the country, were randomly assigned to control (n = 148) or treatment (n = 138) conditions. Children in the treatment condition received a comprehensive microfinance intervention comprising matched savings accounts, financial management workshops, and mentorship. This was in addition to traditional services provided for all school-going orphaned adolescents (counseling and school supplies). Data were collected at wave 1 (baseline), wave 2 (10 months after intervention), and wave 3 (20 months after intervention). We used multilevel growth models to examine the trajectory of depression in treatment and control conditions, measured using Childrens Depression Inventory (Kovacs). RESULTS Children in the treatment group exhibited a significant decrease in depression, whereas their control group counterparts showed no change in depression. CONCLUSIONS The findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa, incorporating poverty alleviation-focused approaches, such as this comprehensive microfinance intervention, has the potential to improve psychosocial functioning of these children.

Effects of a couple-based intervention to reduce risks for HIV HCV and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial.

Objective:Project Renaissance is a randomized controlled trial of an HIV/hepatitis C virus (HCV)/sexually transmitted infection (STI) prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, STIs, rates of unprotected sex, and unsafe injection over the 12-month follow-up period compared with those assigned to an attention control arm. Design:A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to 1 of 2 arms: (1) a 5-session HIV/HCV/STI prevention intervention (risk reduction: RR) or (2) a 5-session Wellness Promotion (WP) intervention. Results:Over the 12-month follow-up period, assignment to RR compared with WP significantly lowered the incidence of HCV infection by 69% [incidence rate ratios (IRR) = 0.31, 95% (CI) confidence interval: 0.10 to 0.90, P = 0.031]. Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR = 0.49, 95% CI: 0.16 to 1.48, P = 0.204) and any STI by 37% (IRR = 0.63, 95% CI: 0.21 to 1.93, P = 0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR = 0.58, 95% CI: 0.36 to 0.93, P = 0.024) and more consistent condom use (odds ratios = 2.30, 95% CI: 1.33 to 4.00, P = 0.003) over the entire follow-up period compared with WP participants. Conclusions:Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia.

Objectives We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex). Methods We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics. Results Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants. Conclusion Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.

Spousal Violence in 5 Transitional Countries: A Population-Based Multilevel Analysis of Individual and Contextual Factors

OBJECTIVES I examined the individual- and community-level factors associated with spousal violence in post-Soviet countries. METHODS I used population-based data from the Demographic and Health Survey conducted between 2005 and 2012. My sample included currently married women of reproductive age (n = 3932 in Azerbaijan, n = 4053 in Moldova, n = 1932 in Ukraine, n = 4361 in Kyrgyzstan, and n = 4093 in Tajikistan). I selected respondents using stratified multistage cluster sampling. Because of the nested structure of the data, multilevel logistic regressions for survey data were fitted to examine factors associated with spousal violence in the last 12 months. RESULTS Partners problem drinking was the strongest risk factor associated with spousal violence in all 5 countries. In Moldova, Ukraine, and Kyrgyzstan, women with greater financial power than their spouses were more likely to experience violence. Effects of community economic deprivation and of empowerment status of women in the community on spousal violence differed across countries. Women living in communities with a high tolerance of violence faced a higher risk of spousal violence in Moldova and Ukraine. In more traditional countries (Azerbaijan, Kyrgyzstan, and Tajikistan), spousal violence was lower in conservative communities with patriarchal gender beliefs or higher financial dependency on husbands. CONCLUSIONS My findings underscore the importance of examining individual risk factors in the context of community-level factors and developing individual- and community-level interventions.

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

BACKGROUND Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. METHODS This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. RESULTS The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). CONCLUSION Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.

Prevalence and Correlates of Intimate Partner Violence by Type and Severity Population-Based Studies in Azerbaijan, Moldova, and Ukraine

The article estimates the prevalence and sociodemographic correlates of intimate partner violence (IPV) by type and severity in population-based samples from three countries of the former Soviet Union (fSU). The article utilized nationally representative data from the Demographic and Health Surveys (DHS) conducted in Azerbaijan (2006), Moldova (2005), and Ukraine (2007). Respondents were selected using stratified multistage cluster sampling. The sample included ever-married (or cohabitating) females of reproductive age (15-49 years old); weighted sample n = 3,847 in Azerbaijan, n = 4,321 in Moldova, and n = 2,355 in Ukraine. The analysis used multinomial survey logistic regression adjusting for the sampling design and sampling weights. Ten percent of ever-partnered women in Azerbaijan and Ukraine and 20% in Moldova ever experienced physical IPV (without sexual) from their most recent husband or cohabitating partner; 3% of women in Azerbaijan and Ukraine and 5% in Moldova experienced sexual IPV (with or without physical), and 2% of women in Azerbaijan, 3% in Ukraine, and 6% in Moldova experienced violence resulting in severe physical injuries from their most recent partner. In all three countries physical, sexual, and injurious IPV was higher among formerly married women. Compared to women with above secondary education, women with secondary education or below demonstrated higher risk for physical IPV (in Moldova and Ukraine), sexual IPV in Moldova, and injurious IPV in all three countries. Poor socioeconomic status—as indicated by low household wealth status in Azerbaijan and partner’s unemployment in Moldova and Ukraine—was significantly associated with higher risk for physical and injurious IPV. In Moldova and Ukraine partners’ low level of education was associated with higher risk for sexual IPV. The article demonstrates that experiences and factors associated with IPV are diverse and context specific. The findings may be helpful in targeting interventions to sociodemographic groups disproportionately affected by IPV in these three transitional countries.

Maltreatment and Mental Health Outcomes among Ultra-Poor Children in Burkina Faso: A Latent Class Analysis

Objectives Research about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso. Methods This paper utilizes baseline data collected from 360 children ages 10–15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages. Results About 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, p<0.05) and lower symptoms of trauma (b = -3.90, SE = 1.52, p<0.05). Conclusions This study offers insight into the psychological well-being of children in the context of ultra-poverty in Burkina Faso and associated context-specific adverse childhood experiences. Identifying specific sub-groups of children with increased exposure to life stressors has implications for program developers. Study findings indicate a further need to explore the mental health consequences of traumatic experiences within the context of ultra-poverty and to develop integrated economic and psychosocial interventions that prevent or mitigate childhood adversities linked with the family-level poverty and violence in the family.

Intimate Partner Physical and Sexual Violence and Outcomes of Unintended Pregnancy Among National Samples of Women From Three Former Soviet Union Countries

The article examines the relationship between intimate partner violence (IPV) and unintended pregnancy among nationally representative samples of women in three former Soviet Union countries. Women who experienced physical and/or sexual IPV from their current or most recent husband or living together partner demonstrated higher risks of unintended last pregnancy, either terminated through abortion (in Azerbaijan, Moldova, and Ukraine) or resulting in unintended live birth (in Ukraine). IPV prevention components should be integrated into reproductive health programs to reduce the risk of unintended births and abortions among women living with abusive partners in these former Soviet Union countries.