| 1. |
- Agardh, Anette, et al.
(author)
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Health Risks in Same-Sex Attracted Ugandan University Students : Evidence from Two Cross-Sectional Studies
- 2016
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 11:3
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Journal article (peer-reviewed)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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| 2. |
- Agardh, Anette, et al.
(author)
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The Impact of Socio-Demographic and Religious Factors upon Sexual Behavior among Ugandan University Students.
- 2011
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:8
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Journal article (peer-reviewed)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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| 3. |
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| 4. |
- Larsson, Markus, et al.
(author)
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Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience
- 2016
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In: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 9
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Journal article (peer-reviewed)abstract
- Background: Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited.Objective: To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality.Design: In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about,or sexually engaged with someone of the same sex.Results: Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.75.7; OR 2.0, 95% CI: 1.33.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI:2.14.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.73.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.95.8), and number of sexual partners (OR 1.9, 95% CI: 1.043.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.18.5; AOR 2.8, 95% CI: 1.35.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.67.1; AOR 2.7, 95% CI:1.45.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking.Conclusions: These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental health and trauma response are critical to meet the health needs of this population.
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| 5. |
- Tumwine, Gilbert, et al.
(author)
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Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners’ attitudes and practices in low-income countries
- 2023
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In: Global Health Action. - 1654-9716. ; 16:1
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Journal article (peer-reviewed)abstract
- Introduction: In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners’ knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners’ knowledge, attitudes and practices concerning SRHR in low-income countries. Objectives: 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners’ SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees’ characteristics, their SRHR work environment and transfer of training. Methods: A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees’ pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees’ baseline characteristics and post-training attitudes and practices. Results: Trainees’ self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. Conclusion: The findings indicate that the ITP was effective in improving trainees’ self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.
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| 6. |
- Tumwine, Gilbert
(author)
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Capacity Development for Healthcare Systems in Low- and Middle-Income Countries. Assessing the effectiveness of an advanced international training programme in sexual and reproductive health and rights in Africa and Asia.
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Background: The 2030 agenda for sustainable development calls upon all nations to make critical investments in their health systems to deliver universal access to Sexual and Reproductive Health and Rights (SRHR). Capacity development is listed among the strategies for achieving sustainable development goals. Although capacity development has been a major component of international development for decades, its effectiveness has limited evidence. This thesis aims at evaluating the effectiveness of an International Training Programme (ITP) in sexual and reproductive health and rights (SRHR) and to understand the role of different actors and contextual factors in capacity development for health systems in low-and middle-income countries. Religion and culture were hypothesised to be significant determinants for changing healthcare practitioners’ SRHR attitudes and practices. Methods: The study population was healthcare practitioners (HCPs) enrolled in the ITP from 13 countries in Africa and Asia. In study I, in-depth interviews with 28 HCPs were conducted and analysed using qualitative content analysis. Studies II and III were based on quantitative data from a sample of 115 healthcare practitioners and analysis was done using multivariate linear regression. Study IV utilised data from an instrument designed for evaluating the ITP change projects. Data analysis was done using logistic regression and 99 change projects were included in the final analysis.Results: Findings from study I indicate that local context, personal values, and social norms influence healthcare practitioners’ SRHR attitudes and practices. In study II, high level of self-rated SRHR knowledge, normative SRHR attitudes and active knowledge seeking behaviour were significant predictors of normative SRHR practices before the ITP intervention. Study III indicates that the ITP intervention was effective in improving the participants’ SRHR knowledge, attitudes, knowledge seeking behaviour and SRHR practices. Improvement in active knowledge seeking behaviour was a significant predictor of changing SRHR practices. Study IV, indicates that improved team capacity resulted in significant improvement in organisational effectiveness and support from partner organisations increased awareness of and demand for SRHR services. Conclusion: The findings suggest that the ITP approach for improving the capacity of healthcare practitioners (as change agents) was associated with improved organisational effectiveness. Other factors that positively contributed to organizational effectiveness were support from partner organizations and involvement of the media. Support from partner organization was also critical in increasing access to, and demand for, SRHR services. The use of new SRHR approaches seemed to negatively influence the effectiveness of organizations. Additionally, the findings suggest that although healthcare practitioners understand the importance of rights in SRH, they did not conform to the principle that rights apply to all components of SRHR and all persons in all settings. Howver, contrary to the evaluation hypothesis, religion and culture did not have a significant influence on changing SRHR practices. Instead, it was the improvements in participants’ knowledge seeking behavior that significantly predicted positive changes in SRHR practices at the end of the intervention.These findings highlight the potential of training interventions in contributing to the capacity development of healthcare systems in low-and middle-income countries.
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| 7. |
- Tumwine, Gilbert, et al.
(author)
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Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia
- 2022
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In: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 15:1
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Journal article (peer-reviewed)abstract
- Background: The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence. Objective: The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries. Methods: The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders. Results: Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services. Conclusions: Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.
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| 8. |
- Tumwine, Gilbert, et al.
(author)
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'One-size doesn't fit all' : Understanding healthcare practitioners' perceptions, attitudes and behaviours towards sexual and reproductive health and rights in low resource settings: An exploratory qualitative study
- 2020
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:6, s. 0234658-0234658
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Journal article (peer-reviewed)abstract
- Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, "one-size doesn't fit all' in SRHR" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, "aligning a pathway to service delivery", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, "health practitioners acting as gatekeepers", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.
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| 9. |
- Tumwine, Gilbert, et al.
(author)
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Predictors of health care practitioners’ normative attitudes and practices towards sexual and reproductive health and rights : a cross-sectional study of participants from low-income countries enrolled in a capacity-building program
- 2020
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In: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 13:1
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Journal article (peer-reviewed)abstract
- Background: Sexual and Reproductive Health and Rights (SRHR) is a concept of human rights applied to sexuality and reproduction. Suboptimal access to SRHR services in many low-income countries results in poor health outcomes. Sustainable development goals (3.7 and 5.6) give a new impetus to the aspiration of universal access to high-quality SRHR services. Indispensable stakeholders in this process are healthcare practitioners who, through their actions or inactions, determine a population’s health choices. Often times, healthcare practitioners’ SRHR decisions are rooted in religious and cultural influences. We seek to understand whether religious and cultural influences differ significantly according to individuals’ characteristics and work environment. Objective: The purpose of this study was to examine the role of healthcare practitioners’ individual characteristics and their work environment in predicting normative SRHR attitudes and behaviours (practices). We hypothesized that religion and culture could be significant predictors of SRHR attitudes and practices. Methods: A quantitative cross-sectional study of 115 participants from ten low-income countries attending a capacity-building programme at Lund University Sweden was conducted. Linear regression models were used to assess for the predictive values of different individual characteristics and workplace environment factors for normative SRHR attitudes and SRHR practices. Results: Self-rated SRHR knowledge was the strongest predictor for both normative SRHR attitudes and normative SRHR practices. However, when adjusted for other individual characteristics, self-rated knowledge lost its significant association with SRHR practices, instead normative SRHR attitudes and active knowledge-seeking behaviour independently predicted normative SRHR practices. Contrary to our hypothesis, importance of religion or culture in an individual’s life was not correlated with the measured SRHR attitudes and practices. Conclusion: Healthcare practitioners’ cultural and religious beliefs, which are often depicted as barriers for implementing full coverage of SRHR services, seem to be modified by active knowledge-seeking behaviour and accumulated working experience with SRHR over time.
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