Yvette Cuca

Gender differences in the timing of first intercourse: data from 14 countries.

Data from the most recent nationally representative surveys of reproductive behavior in 14 countries throughout the world were used to assess regional variations in young peoples sexual behavior. Analyses focus on 15-19 year olds but also use data from 20-24 year olds to provide a more complete picture of gender differences in behavior during adolescence. In most countries roughly one-third or more of teenage women have had intercourse; in four countries (Ghana Mali Jamaica and Great Britain) about 3 in 5 are sexually experienced. Between about one-half and three-quarters of adolescent males in seven countries have ever had intercourse but the proportion is one-third or less in Ghana Zimbabwe the Philippines and Thailand. In most countries sexual intercourse during the teenage years occurs predominantly outside marriage among men but largely within marriage among women. Never married young people are considerably less likely to be currently sexually active than to be sexually experienced. For example in Ghana 49% of never-married adolescent women have had intercourse but only 23% have done so within the past month. In most of these countries a high proportion of adolescents is potentially at risk for a range of poor reproductive health outcomes. Program planners must find ways to help sexually active adolescents consistently use effective means of protection against both pregnancy and sexually transmitted diseases. (authors)

Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: A longitudinal study

BACKGROUND Descriptive literature exists on the effects of HIV-related stigma on the lives of people living with HIV infection but few empirical studies have measured perceived HIV stigma nor explored its potential relationship to quality of life (QoL) over time in people living with HIV infection. AIM A cohort study of a purposive convenient sample of 1457 HIV-positive persons was followed for one year in a longitudinal design that examined the effects of stigma and the life satisfaction dimension of the HIV/AIDS Targeted Quality of Life Instrument (HAT-QOL) over time, as well as the influence of other demographic and assessed social variables. Data were collected three times about six months apart from December 2005 to March 2007. RESULTS The average age in this sample was 36.8 years (SD=8.78, n=1454) and 72.7% (n=1056) were female. The initial sample of participants was balanced among the five countries: Lesotho, Malawi, South Africa, Swaziland, and Tanzania. An attrition analysis demonstrated few demographic differences between those who remained in the study 12 months later compared with those at baseline. However, those who completed the study and who answered the QoL questions had significantly higher life satisfaction scores at baseline than those who left the study. There was a general increase in the report of life satisfaction QoL in all countries over the one-year period. However, as stigma scores increased over time there was a significant decrease in life satisfaction with differing rates of change by country. Certain factors had a positive influence on life satisfaction QoL: positive HIV media reports, taking antiretrovirals, reduced symptom intensity, and disclosure to a friend. CONCLUSION This cohort study is the first to document empirically in a longitudinal sample, that perceived HIV stigma has a significantly negative and constant impact upon life satisfaction QoL for people with HIV infection. In the absence of any intervention to address and reduce stigmatization, individuals will continue to report poorer life satisfaction evidenced by reduced living enjoyment, loss of control in life, decreased social interactivity, and decreased perceived health status.

Measuring family planning service quality through client satisfaction exit interviews.

A model client exit interview developed by the International Planned Parenthood Federation Western Hemisphere Region was used to measure levels of client dissatisfaction with various components of quality. During 1993-96 89 surveys of more than 15000 clients were conducted in eight Latin American and Caribbean countries. The areas of quality that most often received more than 5% negative response from clients (termed negative response cases) were waiting time (mentioned in 70% of surveys) with a mean dissatisfaction level of 20%) ease of reaching the clinic (in 54% with an average dissatisfaction level of 12%) and price of services (47% and 10% respectively). Using the survey results participating family planning associations made changes to improve quality in these areas ranging from improving appointment systems to relocating to implementing sliding fee scales. Results from 16 subsequent follow-up surveys showed a decline in each country in the number of negative response cases as well as in the mean level of dissatisfaction. For example in Brazil the mean number of negative response cases per survey declined from 2.7 to 2.2 and the mean level of dissatisfaction among them fell from 19% to 11%. Well-known problems of measuring client satisfaction may be addressed by focusing on a low threshold of dissatisfaction as a way to uncover shortcomings in service quality. Although declines in dissatisfaction cannot be attributed entirely to the changes made as a result of the use of the questionnaires client surveys can provide a quick and inexpensive way of determining areas of service where quality could be improved. These kinds of improvements will be necessary if service providers hope to become more sustainable and if they are to help clients meet their reproductive health needs. (authors)

Evaluation of a Health Setting-Based Stigma Intervention in Five African Countries

The study aim is to explore the results of an HIV stigma intervention in five African health care settings. A case study approach was used. The intervention consisted of bringing together a team of approximately 10 nurses and 10 people living with HIV or AIDS (PLHA) in each setting and facilitating a process in which they planned and implemented a stigma reduction intervention, involving both information giving and empowerment. Nurses (n = 134) completed a demographic questionnaire, the HIV/AIDS Stigma Instrument-Nurses (HASI-N), a self-efficacy scale, and a self-esteem scale, both before and after the intervention, and the team completed a similar set of instruments before and after the intervention, with the PLHA completing the HIV/AIDS Stigma Instrument for PLHA (HASI-P). The intervention as implemented in all five countries was inclusive, action-oriented, and well received. It led to understanding and mutual support between nurses and PLHA and created some momentum in all the settings for continued activity. PLHA involved in the intervention teams reported less stigma and increased self-esteem. Nurses in the intervention teams and those in the settings reported no reduction in stigma or increases in self- esteem and self-efficacy, but their HIV testing behavior increased significantly. This pilot study indicates that the stigma experience of PLHA can be decreased, but that the stigma experiences of nurses are less easy to change. Further evaluation research with control groups and larger samples and measuring change over longer periods of time is indicated.

Does "Asymptomatic" Mean Without Symptoms for Those Living with HIV Infection?

Abstract Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as “asymptomatic” by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003–2005 and 2005–2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.

The development and validation of the HIV/AIDS Stigma Instrument – Nurse (HASI-N)

Abstract Illness-related stigma remains a serious problem in the management of HIV disease in Africa. This article describes a series of study phases conducted to develop and validate an instrument to measure HIV/AIDS-related stigma as perpetrated and experienced by nurses. Data were collected in Lesotho, Malawi, South Africa, Swaziland and Tanzania, from 2004–2006. The first phase was a qualitative study with focus group participants (n=251) to gather emic and etic descriptions of HIV/AIDS-related stigma in the five countries. Based on the qualitative data, a 46-item instrument was developed and tested during a second phase in the same five countries (n=244). The result of this phase was a 33-item, three-factor instrument with an average Cronbach alpha of 0.85. A third phase tested the instrument in 1474 nurses. The result was a final 19-item instrument, the HIV/AIDS Stigma Instrument – Nurse (HASI-N), comprised of two factors (Nurses Stigmatizing Patients and Nurses Being Stigmatized) with a Cronbach alpha of 0.90. Concurrent validity was tested by comparing the level of stigma with job satisfaction and quality of life. A significant negative correlation was found between stigma and job satisfaction. The HASI-N is the first inductively derived instrument measuring stigma experienced and enacted by nurses. It has the potential to be used not only to measure stigma, but also to develop stigma-reduction interventions.

HIV Stigma and Nurse Job Satisfaction in Five African Countries

&NA; This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross‐sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries.

From Treatment to Healing: The Promise of Trauma-Informed Primary Care

Author(s): Machtinger, Edward L; Cuca, Yvette P; Khanna, Naina; Rose, Carol Dawson; Kimberg, Leigh S

Measuring HIV Stigma for PLHAs and Nurses over Time in Five African Countries

The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association.

Integrating systematic screening for gender‐based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region

KEY LESSONS LEARNED: Ongoing marketing is key to the success of youth hotlines. Radio campaigns proved especially fruitful for PROFAMILIA in Colombia. Developing strategic alliances with other organizations can help disseminate information about the service to youth. Participating in a nationwide youth meeting helped PROFAMILIA develop ties with youth-serving agencies who in turn promoted the hotline to their clients. Logistical problems can frustrate callers and affect demand for services. Marketing and promotion campaigns should be strategically timed and potential logistical delays in the service should be anticipated. Because it can be difficult for youth to discuss issues related to their sexuality handling these calls often requires more time and patience than when dealing with adults and adequate staffing is required. Hotline staff must have access to up-to-date information on available services for youth. This is especially important when the hotline service is offered nationwide and youth are to be referred to services in multiple sites. Hotline staff should receive comprehensive training covering a broad range of topics such as adolescent development sexual and reproductive health drug and alcohol abuse sexual harassment and gender-based violence and making referrals to other organizations. Since hotlines are often a free service project sustainability can become an issue if donor funding is not forthcoming. Consider cross-subsidization from clinical services as a possible strategy for sustainability. (excerpt)Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender‐based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution‐wide changes are needed to provide services effectively and to address needs of women experiencing violence.