| 1. |
- Agardh, Charlotte, et al.
(författare)
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Using pharmacists and drugstore workers as sexual healthcare givers : A qualitative study of men who have sex with men in Dar es Salaam, Tanzania
- 2017
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown that men who have sex with men (MSM) avoid formal healthcare services because of the fear of discrimination as homosexuality is illegal and stigmatized in Tanzania. Instead, self-treatment by medications obtained directly from pharmacies or drugstores may be common when MSM experience symptoms of suspected sexually transmitted infections (STIs) related to sexual activity with men. Objective: To explore MSM’s perceptions and experiences of seeking treatment and advice from pharmacists and drugstore workers in Dar es Salaam, Tanzania, with regards to their sexual health and STI-related problems. Materials and Methods: 15 in-depth interviews were conducted with MSM with experience of seeking assistance relating to their sexual health at pharmacies and drugstores in Dar es Salaam in 2016. A qualitative manifest and latent content analysis was applied to the collected data. Results: Four themes related to different aspects of MSM’s perceptions and experiences of pharmacy care emerged from the analysis: (1) Balancing threats against need for treatment reflected informants’ struggles concerning risks and benefits of seeking assistance at pharmacies and drugstores; (2) Identifying strategies to access required services described ways of approaching a pharmacist when experiencing a sexual health problem; (3) Seeing pharmacists as a first choice of care focused on informants’ reasons for preferring contact with pharmacies/drugstores rather than formal healthcare services; and (4) Lacking reliable services at pharmacies indicated what challenges existed related to pharmacy care. Conclusions: MSM perceived the barriers for accessing assistance for STI and sexual health problems at pharmacies and drugstores as low, thereby facilitating their access to potential treatment. However, the results further revealed that MSM at times received inadequate drugs and consequently inadequate treatment. Multi-facetted approaches are needed, both among MSM and drugstore, pharmacy, and healthcare workers, to improve knowledge of MSM sexual health, STI treatment, and risks of antibiotic resistance.
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| 2. |
- Krischer, Jeffrey P, et al.
(författare)
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Predicting Islet Cell Autoimmunity and Type 1 Diabetes : An 8-Year TEDDY Study Progress Report
- 2019
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 42:6, s. 1051-1060
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Assessment of the predictive power of The Environmental Determinants of Diabetes in the Young (TEDDY)-identified risk factors for islet autoimmunity (IA), the type of autoantibody appearing first, and type 1 diabetes (T1D).RESEARCH DESIGN AND METHODS: A total of 7,777 children were followed from birth to a median of 9.1 years of age for the development of islet autoantibodies and progression to T1D. Time-dependent sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to provide estimates of their individual and collective ability to predict IA and T1D.RESULTS: HLA genotype (DR3/4 vs. others) was the best predictor for IA (Youden's index J = 0.117) and single nucleotide polymorphism rs2476601, in PTPN22, was the best predictor for insulin autoantibodies (IAA) appearing first (IAA-first) (J = 0.123). For GAD autoantibodies (GADA)-first, weight at 1 year was the best predictor (J = 0.114). In a multivariate model, the area under the ROC curve (AUC) was 0.678 (95% CI 0.655, 0.701), 0.707 (95% CI 0.676, 0.739), and 0.686 (95% CI 0.651, 0.722) for IA, IAA-first, and GADA-first, respectively, at 6 years. The AUC of the prediction model for T1D at 3 years after the appearance of multiple autoantibodies reached 0.706 (95% CI 0.649, 0.762).CONCLUSIONS: Prediction modeling statistics are valuable tools, when applied in a time-until-event setting, to evaluate the ability of risk factors to discriminate between those who will and those who will not get disease. Although significantly associated with IA and T1D, the TEDDY risk factors individually contribute little to prediction. However, in combination, these factors increased IA and T1D prediction substantially.
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| 3. |
- Abebe, Hirut, et al.
(författare)
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Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus : a cross-sectional study using demographic and health survey data
- 2023
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Ingår i: BMC Infectious Diseases. - 1471-2334. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia. Method: Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15–49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables. Results: Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25–49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged le 24 years. Conclusion: Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.
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| 4. |
- Agardh, Anette
(författare)
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Between love and fear - determinants of sexual behavior among Ugandan university students
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: More than half of all new HIV infections in sub-Saharan African countries, including Uganda, occur among young people between the ages of 15 and 24, the most sexually active period of their lives. Understanding the contextual determinants of sexual behavior in this group is crucial in combating the pandemic. Aim: The overall aim of this study was to assess the impact of demographic, religious, social capital, mental health, and sexual coercion factors on risky sexual behavior among a student population in Uganda in order to gain a deeper understanding of the forces that shape sexual behavior of young people with the purpose of contributing to policy formulation and implementation of more effective interventions to prevent the spread of HIV/AIDS. Method: In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic, social capital, and religious factors, as well as alcohol use, mental health, experience of sexual coercion, age of sexual debut, number of sexual partners, and condom use. Mental health was assessed using items from the Hopkins Symptoms Checklist-25(HSCL-25) and the Symptom Checklist-90 (SCL-90). Logistic regression analysis was applied as the main analytical tool, and synergistic effects between some of the main determinants were investigated. Results: Thirty-seven percent of the male and 49% of the female students had not previously had sexual intercourse. Of the male and female students with sexual experience, 46% of the males and 23% of the females had had three or more lifetime sexual partners, and 32% of the males and 38% of the females did not consistently use condoms with a new partner. Minor importance of religion in one’s family while growing up was correlated to a statistically significant degree with early sexual debut and having many sexual partners (OR 1.7, 95% CI: 1.2–2.4 and OR 1.6, 95% CI: 1.1–2.3, respectively). Being of Protestant faith interacted with gender among those who had debuted sexually. Protestant female students were more likely to have had three or more sexual partners; the opposite was true for Protestant male students. Non-dominant bridging trust among male students was associated with a higher risk for having had many sexual partners (OR 1.8, 95% CI: 1.2–2.9). Low trust in others was associated with a greater likelihood of sexual debut in men, while the opposite was true in women. A similar pattern was seen regarding a high number of lifetime sexual partners in individuals who were raised in families where religion played a major role. After controlling for potential confounding factors, high scores on depression and a high number of sexual partners were significantly associated among both males (OR 2.0, 95% CI: 1.2–3.3) and females (OR 3.3, 95% CI: 1.3–8.6). Elevated anxiety scores among men were associated with a high number of sexual partners (OR 1.9, 95% CI: 1.1–3.3) and inconsistent condom use (OR 1.9, 95% CI: 1.1–3.6). Experience of sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI: 1.1−2.3), early sexual debut (OR 2.4, 95% CI: 1.5−3.7), as well as with having had a high number of sexual partners (OR 1.9, 95% CI: 1.2−3.0), but not with inconsistent condom use. Good mental health scores, reporting high trust in others, or stating that religion played a major role in one’s family of origin seemed to buffer the effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: Religion, social capital, mental health, and sexual coercion appear to be important determinants of sexual behavior among Ugandan university students. Using such knowledge, one may design and implement more effective programs to prevent the spread of HIV/AIDS. Policy makers would benefit from involving young people in the planning of interventions against HIV/AIDS, and in the formulation and implementation of youth-friendly policies to better understand how strategies should be tailored in relation to the needs of the target group. It would also be desirable to introduce coordinated youth-friendly health services to address both the psychological as well as the sexual and reproductive health-related concerns of young people.
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| 5. |
- Agardh, Anette, et al.
(författare)
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Experience of sexual coercion and risky sexual behavior among Ugandan university students
- 2011
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Growing worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people and is associated with risky sexual behavior thereafter. The causal mechanisms behind this are unclear but may be dependent on specific contextual determinants. Little is known about factors that could buffer the negative effects of coercion. The aim of this study was to assess the association between the experience of sexual coercion and risky sexual behavior among university students of both sexes in Uganda. Methods: In 2005, 980 (80%) out of a total of 1,220 students enrolled in Mbarara University of Science and Technology in Uganda participated in a self-administered questionnaire covering socio-demographic and religious factors, social capital, mental health, alcohol use, and sexual behavior. A validated scale of six items was used to assess the experience of sexual coercion. Logistic regression analyses were applied to control for confounders. Potential buffering factors were analyzed by testing for effect modification. Results: Fifty-nine percent of those who responded had previously had sexual intercourse. Among the male students 29.0%, and among the female students 33.1% reported having had some experience of sexual coercion. After controlling for age, gender, and educational level of household of origin, role of religion and trust in others sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI; 1.1-2.3), early sexual debut (OR 2.4, 95% CI; 1.5-3.7), as well as with having had a great number of sexual partners (OR 1.9, 95% CI; 1.2-3.0), but not with inconsistent condom use. Scoring low on an assessment of mental health problems, reporting high trust in others, or stating that religion played a major role in one's family of origin seemed to buffer the negative effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: The findings of this study suggest that the experience of sexual coercion is common among youth/young adults in Uganda and is subsequently associated with risky sexual behavior in both sexes. The existence of individual and contextual factors that buffer the effects mentioned was also demonstrated. In the Ugandan context, this has implications for policy formulation and the implementation of preventive strategies for combating HIV/AIDS.
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| 6. |
- Agardh, Anette, et al.
(författare)
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Health Risks in Same-Sex Attracted Ugandan University Students : Evidence from Two Cross-Sectional Studies
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.
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| 7. |
- Agardh, Anette, et al.
(författare)
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Social capital and sexual behavior among Ugandan university students
- 2010
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Ingår i: Global health action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- In general, social capital was associated with less risky sexual behavior in our sample. However, gender and role of religion modified the effect so that we can not assume that risky sexual behavior is automatically reduced by increasing social capital in a highly religious society. The findings indicate the importance of understanding the interplay between social capital, religious influence, and gender issues in HIV/AIDS preventive strategies in Uganda.
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| 8. |
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| 9. |
- Agardh, Anette, et al.
(författare)
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The Impact of Socio-Demographic and Religious Factors upon Sexual Behavior among Ugandan University Students.
- 2011
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:8
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: More knowledge is needed about structural factors in society that affect risky sexual behaviors. Educational institutions such as universities provide an opportune arena for interventions among young people. The aim of this study was to investigate the relationship between sociodemographic and religious factors and their impact on sexual behavior among university students in Uganda. METHODS: In 2005, 980 university students (response rate 80%) were assessed by a self-administered questionnaire. Validated instruments were used to assess socio-demographic and religious factors and sexual behavior. Logistic regression analyses were applied. RESULTS: Our findings indicated that 37% of the male and 49% of the female students had not previously had sex. Of those with sexual experience, 46% of the males and 23% of the females had had three or more sexual partners, and 32% of the males and 38% of the females did not consistently use condoms. For those who rated religion as less important in their family, the probability of early sexual activity and having had a high number of lifetime partners increased by a statistically significant amount (OR = 1.7; 95% CI: 1.2-2.4 and OR = 1.6; 95% CI: 1.1-2.3, respectively). However, the role of religion seemed to have no impact on condom use. Being of Protestant faith interacted with gender: among those who had debuted sexually, Protestant female students were more likely to have had three or more lifetime partners; the opposite was true for Protestant male students. CONCLUSION: Religion emerged as an important determinant of sexual behavior among Ugandan university students. Our findings correlate with the increasing number of conservative religious injunctions against premarital sex directed at young people in many countries with a high burden. of HIV/AIDS. Such influence of religion must be taken into account in order to gain a deeper understanding of the forces that shape sexual behavior in Uganda.
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| 10. |
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