| 1. |
- Ugarte Guevara, William J., 1979-
(författare)
-
Averting HIV and AIDS epidemic in Nicaragua : Studies of prevalence, knowledge, attitudes, and behavior
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV).The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common.This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.
|
|
| 2. |
- Valladares, Eliette, et al.
(författare)
-
HIV community prevalence and testing practices in León, Nicaragua
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Our objective was to determine the HIV prevalence, testing practices, and HIV-related behaviors in a general population sample in the municipality of Leon, Nicaragua. We performed a cross-sectional community-based study of 2,204 males and females ages 18 to 69, from a health and demographic surveillance system. A behavior survey and blood sampling for HIV were also carried out. Seven of 1,960 individuals who provided biological samples (0.35%; CI 0.18–0.67) were HIV positive. The predicted prevalence of HIV among non-participants was about 11% higher than the observed prevalence but it was not significantly different. The major obstacle to HIV testing seemed to be the fear of being diagnosed HIV positive. This is the first study to determine HIV prevalence among the general population in Nicaragua. Our findings confirmed that this population has a low prevalence but high risk for HIV infection. Prevention strategies are essential to maintain this figure.
|
|
| 3. |
- Ugarte, William J., 1979-, et al.
(författare)
-
Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua : Results from a community-based study
- 2013
-
Ingår i: AIDS Education and Prevention. - : Guilford Publications. - 0899-9546 .- 1943-2755. ; 25:2, s. 164-178
-
Tidskriftsartikel (refereegranskat)abstract
- Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach’s alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest Community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV.
|
|
| 4. |
- Larsson, Frida M., et al.
(författare)
-
Exploring sexual awareness and Decision-making among adolescent girls and boys in rural Nicaragua : A socio-ecological approach
- 2022
-
Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 31
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how individual, relational, and social contexts influence adolescents' sexual awareness and decision-making in rural Nicaragua.METHODS: Eighteen semi-structured interviews were conducted with adolescent boys and girls aged 15 to 19 years. Thematic analysis identified patterns of meaning applying a socio-ecological approach. A thematic map illustrates how the themes are organized according to the socio-ecological model and suggests their interactions.RESULTS: Six main themes emerged as (1) Adolescence - a period of life changes, (2) Fears as a pathway to awareness and decision-making, (3) Awareness about protective measures, (4) Relational influences on adolescents' sexual health, (5) Service provision and institutional influences on awareness and decision-making and (6) Sociocultural determinants on adolescent sexual health. Informants of both genders expressed concern in several issues of their sexuality. They identified fear of pregnancy, STIs, and their impact on future goals, family communication, and school-based sexual education as protective factors for their sexual decision-making. Adolescents of both genders are challenging social and cultural norms by developing sexual agency.CONCLUSION: These findings imply that personal and societal factors in rural Nicaragua produce a multi-dimensional effect on adolescent sexual self-efficacy. Our study is relevant for a wider discussion about sexual awareness to promote positive development and health outcomes particularly among adolescents' girls and boys living in rural settings.
|
|
| 5. |
- Ellsberg, Mary, et al.
(författare)
-
Pathways to change: Three decades of feminist research and activism to end violence against women in Nicaragua
- 2022
-
Ingår i: Global Public Health. - : Informa UK Limited. - 1744-1692 .- 1744-1706. ; 17:11, s. 3142-3159
-
Tidskriftsartikel (refereegranskat)abstract
- This paper presents the results of nearly three decades of partnershipbetween feminist researchers and activists to prevent violence againstwomen and girls (VAWG) in Nicaragua. A household survey conductedin 1995 in León, the country’s second-largest city, revealed that 55 percent of women had experienced lifetime physical intimate partnerviolence (IPV), and 27 per cent had experienced IPV in the last 12months. The study results were instrumental in changing domesticviolence laws in Nicaragua. A follow-up study in 2016 found a decreaseof 63 per cent in lifetime physical IPV and 70 per cent in 12-monthphysical IPV. This paper examines possible explanations for thereduction, including the policy reforms resulting from feministadvocacy. We compare risk and protective factors for physical IPV, suchas changes in women’s attitudes towards violence, their use of services,and knowledge of laws, using data from both the 1995 and 2016surveys, as well as three waves of Demographic and Health Surveys. Weconclude that the decline in IPV can be partially attributed to the effortsof the Nicaraguan women’s movements to reform laws, provide servicesfor survivors, transform gender norms, and increase women’sknowledge of their human rights.
|
|
| 6. |
- Safon, Cara, et al.
(författare)
-
Determinants of perceived insufficient milk among new mothers in León, Nicaragua
- 2016
-
Ingår i: Maternal and Child Nutrition. - : John Wiley & Sons. - 1740-8695 .- 1740-8709. ; 13:3
-
Tidskriftsartikel (refereegranskat)abstract
- Breastfeeding has been shown to improve maternal and child health. In Nicaragua, the primary risk of death and disability-adjusted life years among children under 5 years of age is suboptimal breastfeeding. Although the Nicaraguan Ministry of Health promotes exclusive breastfeeding from within the first half hour through the first 6 months of life, less than a third of children in the country under 6 months of age are exclusively breastfed. As part of a larger, mixed-methods study, 21 semi-structured, in-depth interviews were conducted with new mothers recruited from three primary health centers between June and August 2015 in order to identify the social, cultural, and structural factors that contribute to infant feeding practices and the discrepancy between recommendations and practices among mothers who delivered at an urban public hospital in León, Nicaragua. Audio recordings were transcribed verbatim, and interview transcripts were coded and analyzed by a three-member team using a grounded theory approach. Findings highlight a widespread perception of insufficient milk among mothers that influenced early cessation of exclusive breastfeeding and other infant feeding practices. This perception stemmed from anxiety about meeting infant nutritional needs and infant satiety, anxiety about maternal nutrition, advice from and role modeling of family members about mixed feeding, and perceived infant feeding norms. Results suggest that support modeled after the 10 steps of the Baby-friendly Hospital Initiative as well as strengthened policy-level support are needed. Community interventions that address cultural and structural barriers to improve breastfeedingpractices may also help to increase breastfeeding rates
|
|
| 7. |
- Ellsberg, Mary, et al.
(författare)
-
Long-term change in the prevalence of intimate partner violence : a 20-year follow-up study in León, Nicaragua, 1995-2016
- 2020
-
Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 5:4
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Although intimate partner violence (IPV) affects an estimated one out of three women globally, evidence on violence prevention is still scarce. No studies have measured long-term change in larger populations over a prolonged period.Methods The aim of this study was to measure changes in the prevalence of IPV in León, Nicaragua, between 1995 and 2016. The 2016 study interviewed 846 ever-partnered women aged 15 to 49 regarding experiences of physical, sexual and emotional IPV. These findings were analysed together with comparable data collected from 354 women in 1995. Multivariate logistic regression modelling was carried out on a pooled data set to identify differences between the two studies while controlling for potential confounding factors.Results Lifetime physical IPV decreased from 54.8 to 27.6 per cent (adjusted OR (AOR) 0.37; 95% CI 0.28 to 0.49) and 12-month prevalence of physical IPV decreased from 28.2 to 8.3 per cent (AOR 0.29; 95% CI 0.20 to 0.42), respectively. Similar decreases were found in lifetime and 12-month emotional IPV. No significant difference was found in the prevalence of lifetime sexual violence between the two time periods.Conclusions The results suggest that the reduction in IPV was not due to demographic shifts, such as increased education or age, but reflects a true decrease in the prevalence of IPV. The decrease is not likely to have occurred on its own, and may be attributable to multisectoral efforts by the Nicaraguan government, international donors and the Nicaraguan women’s movement to increase women’s knowledge of their rights, as well as access to justice and services for survivors during this time period.
|
|
| 8. |
- Brenner, Cecilia, et al.
(författare)
-
Men's reproductive coercion of women : prevalence, experiences, and coping strategies-a mixed method study in urban health facilities in León, Nicaragua
- 2021
-
Ingår i: BMC Women's Health. - : BioMed Central (BMC). - 1472-6874. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women's reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC.METHODS: A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18-35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis.RESULTS: Ever RC prevalence was 17.4% (95% CI, 13.8-21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4-16.3) or ever experiencing CS (11.8%, 95% CI 8.7-15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2-16.0) than above. Twelve months PP (7.4%, 95% CI 5.0-10.5) and CS (8.7%, 95% CI 6.1-12.0) were also similar. Women's higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women's long-term fertility autonomy.CONCLUSIONS: Our facility-based study showed that men's RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women's reproductive autonomy.
|
|
| 9. |
- Bergström, Anna, 1983-, et al.
(författare)
-
Knowledge about Sexual and Reproductive Health among School Enrolled Adolescents in Tololar, Nicaragua, A Cross-Sectional Study
- 2018
-
Ingår i: Journal of Public Health International. - : Open Access Pub. - 2641-4538. ; 1:2, s. 27-38
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua.Methods: A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value <0.05 was considered significant.Results: The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value < 0.01) and knowledge increased significantly with age (p-value < 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic.Conclusions: Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.
|
|
