Dissertation research articulating how macro-level gender norms that limit female sexualagency and choice in heterosexual negotiations are enacted or resisted at the micro-level of an individual woman or sexual interaction, using mixed methods to theorize female sexualagency and investigate its
Notional acceptability of vaginal microbicide gels for HIV/STI prevention was high among both women and men in this study. Microbicide acceptability was per- ceived within a broad reproductive health framework i.e. that use would promote a ‘healthy womb’ or help ‘pre- vent sickness or pregnancy’ , in addition to preventing HIV. This perception was held by women and men and is in contrast to advice provided by the research team. Conversely, one female respondent was concerned that gel could ‘block’ menstrual flow and cause sickness in the womb. Many women and men thought that microbi- cides would best be used by sex workers and considered use between ‘trusted partners’ unnecessary. Most women were confident that they would be able to negotiate gel use with their sexual partners in future and many were prepared to use microbicides covertly should their part- ner refuse. Other women were concerned that increased vaginal ‘wetness’ would make truly covert use difficult and could expose them to increased risk of physical or sexual violence. There were mixed views on the potential of microbicide gels to modify sexual pleasure for women and their male partners. Some women reported that their partners preferred ‘their vagina dry’ and that men would ‘ask women to clean it [out]’ should they use gel; one woman reported that increased vaginal lubrication would make sex more pleasurable for women. Women were confident that they could use a product similar to the surrogate microbicide in future but some were con- cerned that initial use might be problematic without ap- propriate counseling and support from health workers. These findings clearly have implications for future microbicides research and for the introduction of safe and effective vaginal microbicides for HIVprevention in PNG.
Dissatisfaction that stemmed from masculine ideologies characterized by receiving satisfying sexual performance or frequent sex could potentially be addressed by com- municating openly about necessary changes in the quality and quantity of sex, and could be resolved through targeted communication interventions. Nevertheless, other causes of dissatisfaction were harder to deal with; for example, the belief that men have an innate natural overpowering lust for sex with different sexual partners. The dissatisfaction resulting from these factors may be much harder to resolve in the confines of a couple because these are a product of beliefs operating at a society level. Hence these beliefs may be addressed through community education as the HIV epidemic has been a driver for reconsideration of risky gendered behaviors and attitudes. 39
Increasing urbanisation, inadequate infrastructure and inadequate social and legal systems to protect the interests of the poor mean there is much corruption. These newer systems also embody sites of power from older cultural and religious systems. Thus men dominate. There are only three women in the national parliament of a total of 111 Members of Parliament, few women leading at Provincial government level and very few women run formal businesses or hold significant government leadership positions. Women participate in the emerging economic markets in informal ways by selling and exchanging agricultural products, home-made, small scale products and informal domestic and child care services. Some women in urban areas with limited or no opportunity to engage in the formal cash economy do so by selling sex, a high-risk high-reward way of obtaining cash. Low status, limited options and limited power to negotiate means women who participate in this type of economic activity are also at risk for acquisition of HIV, other STIs and physical violence (Kelly, Kupul et al. 2011). So when one goes into a community and asks about male circumcision, what is happening and what should happen, responses should be examined in light of these co-existing and often competing world views.
A study conducted by World Health Organization and  titled New Data on Male Circumcision and HIVPrevention: Policy and Programme Implications concluded that male circumcision reduces sexual transmission of HIV both from infected male to female and infected male to female. The research further showed male circumcision as a practice in itself can cause HIV transmission. Professionally conducted male circumcision reduces HIV transmission by up to 60%. The study recommended that male circumcision should be recognized as an efficacious intervention for HIVprevention and that the practice should be recognized as an additional strategy for prevention of heterosexually acquired HIV infection in males. However, the study outlined that male circumcision only provide partial protection from HIV infection. It is therefore important that there is effective communication to sensitize the communities on the importance and limitations of male circumcision as a strategy of reducing HIV infection. This study recommended that further studies should be conducted to clarify the risks and benefits of male circumcision as a strategy or reducing HIV transmission from HIV male to females and to recommend how safer male circumcision can reach rural areas.
Objective: Until recently, HIV prevalence has been based on estimates from antenatal sentinel surveys which have been found to overestimate HIV prevalence among the general population. Multiple studies have shown women to be disproportionately affected by HIV and AIDS epidemic. Design: Data for this study were based on the first Nigerian population household-based HIV biomarker survey of 2007, which used a multi-stage probability sampling technique. Methods: Respondents were selected through probability sampling (male age 15 - 64 years and female 15 - 49 years). This paper, therefore, examined the correlates of marital status and HIV prevalence among women in Nigeria. Results: A descriptive analysis of the data showed that HIV prevalence of women that were formerly married: divorced, sepa- rated or widowed were more than double that of those who were currently married/cohabiting with a sexual partner; and more than three times those that were never married. Bivariate and multivariate levels of analysis were explored in this paper. At bivariate level, findings showed a significant difference in HIV prevalence among women according to their marital status (p < 0.0001), educational attainment (p = 0.004) and geo-political zones (p = 0.003). Respondents that were formerly married were 5.6 times as likely to be infected with HIV compared with those who had never married (OR = 5.6, p < 0.0001) while HIV prevalence increased with higher educational attainment. Conclusion: In view of these findings, HIV programmers should design interventions that will improve economic empowerment as well as so- cial security for women that were formerly married. In addition, gender mainstreaming in the ongoing HIV and AIDS preventive efforts should be strengthened and scaled-up.
Economic disempowerment within the dominant HIV/AIDS discourse is presented as a factor pushing women to practice unsafe sex in the form of multiple partners without the protection of condoms. Furthermore, lack of formal education is operationalised as denying women access to skills and information, and as a determinant of poverty (ILO/UNAIDS/UNESCO, February, 2011). Gender inequality and poverty are said to influence a woman's inability to negotiate condom use and HIV testing (NMSF II, 2008-2012). Because of these shortcomings, women are said to lack power as they cannot refuse unprotected sex that is dangerous to their health, leave a relationship, or influence their partner's decision to have multiple partners or use a condom (Michau, Naker, & Swalehe, 2002; Philemon & Kessy, 2008). This is to suggest that women become infected by their partners, have little or no role in the transmission of HIV, and no agency to protect themselves. In Chapter 5, I examined the interplay of social positionalities and identities (resulting from the intersection of educational attainment, employment, marital status, income/wealth, gender roles, and expectations associated with sexuality) and how, within the participants' discourses, they influenced the potential for PEW to engage in multiple sexual partnerships. This chapter seeks to expand
There were no significant differences among focus group participants in regards to awareness, concerns, and recommendations of PrEP. There were several differences around willingness to use PrEP and perceptions of PrEP among participants. Eleven participants were not willing to start using PrEP for HIVprevention; however, the remaining 16 participants were willing to use PrEP, with many stating that they were eager to start taking PrEP immediately if it was available and covered by insurance. Participants who described themselves as low-risk individuals and reported low-risk behavior, had a high willingness to use PrEP. The high willingness to use PrEP could be reflective of their need to engage in continued safer sexual practices (e.g., consistent condom use) or engaging in very little sexual activity. However, not reflective of their current approach to sexual activity, these participants, along with the other participants reported they would be less likely to use a condom if on PrEP — demonstrating that even women who practice safe and responsible sex can feel a sense of invincibility on PrEP. It is imperative that potential PrEP users receive a proper and thorough education of PrEP and how it works most effectively with condom use prior to uptake.
This study conﬁ rms that married Rwandan men and women differ in their reporting of sexual behaviors, condom use, reproductive desires, and pregnancy-related issues. Fur- thermore, it conﬁ rms that the methodological approach of couples-level data collection and analysis (versus individual- level only) is vital to understanding relationship dynamics necessary for the prevention of HIV within couples. Though agreement within couples was high regarding key character- istics of the partnership (type of marriage and relationship), agreement was generally low regarding condom use in the couple, sexual behavior outside the couple, and fertility- related issues. These are all critical to understanding HIVprevention for the largest HIV risk group in Africa. Without conﬁ dent understanding of couple-level agreement on such relationship and sexual behavior issues, risk reduction pro- grams that target either the individual or the couple may be misguided and unsuccessful in changing the behavior nec- essary for the prevention of HIV transmission. To untangle the partnership dynamics of individual- and couple-related factors impacting the sexual dyad’s risk for HIV, investi- gating couples’ agreement regarding HIV-related risk and prevention factors is crucial 7,18,32 and primary to risk reduc-
Few studies have investigated the potential protective influence of economic resources on safer sexual practices among young women. While several studies have demonstrated the gradient of sexual risk-taking among households with lower socioeconomic status [6, 28-31], young women's individual economic measures such as income, employment, debt, or financial control have not been well studied in the context of HIVprevention . This is despite the potential of individual economic resources to have greater influence on young women's sexual decision-making than household measures of wealth, such as familial assets and educational levels [6, 32, 33]. In addition, studies investigating factors associated with sexually protective behaviors among youth have largely focused on non-economic influences, such as knowledge, parental or family communication, religious or moral injunctions, education, social connectedness, and community norms [1, 21, 34-36]. According to asset theory, individuals with increased assets in the present may be more likely to engage in positive future planning to protect those assets (or resources) in the future [29, 35, 37, 38]. This could mean that young women with greater economic resources today may more deliberately adopt behaviors to protect themselves, including avoidance of HIV [29, 39, 40]. However, the extent to which individual economic resources relate to sexually protective behaviors remains unclear among sub-Saharan African young women. The few studies to-date that have examined this relationship have shown mixed results [29, 32, 41-43]. In some settings, increased economic resources have been associated with less sexual vulnerability, such as fewer reports of forced, coercive, or survival sex  and changes in attitudes towards sexual risk-taking [29, 32]. In other cases, increased economic resources have been associated with no change in young women's sexual behaviors or sexual control  or resulted in higher sexual risk-taking due to delayed marriage, expanded travel, and greater access to sexual partners [41-43]. As such, both measures of poverty and wealth have been associated with sexual behaviors that protect against or increase risk of HIV infection [11, 12, 44].
The Center uses a variety of advocacy methods in its work, from press releases to research reports, websites to legal challenges. Examples of activities which it has contributed to include support to the PATHWAY Act, US legislation that would require the President’s Emergency Plan for AIDS Relief to develop a comprehensive and integrated HIVprevention strategy that addresses the specific vulnerabilities of girls and women. This would include links to sexual violence, coercion, early marriage and ensuring access to necessary information, methods and services.
Abstract: Early sexual debut has been recognized to play a seminal role in the heterosexual HIV transmission among adolescents and young adults in sub-Saharan Africa. A cross-sectional analysis of the relationship between initiation of sexual activity before age 15 and HIV sero- status, among men and women aged 15-24 years, was conducted using Demographic and Health Surveys data of four central African countries with different levels of HIV seroprevalence, namely Cameroon, Gabon, Democratic Republic of Congo, and Congo. The median age at sexual debut varied between 15 and 16 years in all countries. After adjusting for sociodemographic, economic, behavioral, and most recent partner’s characteristics, as well as HIVprevention knowledge, early sexual debut was significantly associated with a positive HIV test among women in Cameroon (OR, 2.52; 95% CI, 1.57-4.01; p=.0001) and Democratic Republic of Congo (OR, 3.92; 95%CI, 1.71-9.48; p=.002). No association was found statistically significant among men. Among female Cameroonians, an age between 20-24 years (OR, 1.88; 95% CI, 1.13-3.22; p=.02) and a lifetime number of sexual partners greater than one (OR, 3.05; 95%CI, 1.77-5.61; p=.0001) remained significantly associated with HIV, whereas a negative association was found between a low economic status and HIV infection among women in Democratic Republic of Congo (OR, 0.16; 95%CI, 0.04-0.5; p=.004), in the multivariate analyses. Early sexual debut is associated with HIV infection among young women in some central African countries, independently of the level of HIV seroprevalence of the country. Sex-education strategies for the youth in central Africa, particularly for women, should emphasize the necessity of delaying first sexual intercourse and avoiding other risky sexual behaviors.
The CAPRISA 004 trial is supported by the Centre for the AIDS Programme of Research in South Africa (CAPRISA), the United States Agency for International Development (USAID), FHI (co operative agreement # GPO-A- 00-05-00022-00, contract # 132119), and LIFElab, now TIA (Technology Innovation Agency) a biotechnology centre of the South African Department of Science and Technology. Support from CONRAD for the product manufacturing and packaging as well as support from Gilead Sciences for the Tenofovir used in the production of gel is gratefully acknowledged. We acknowledge the Columbia University-Southern African Fogarty AIDS International Training and Research Programme (CU-SA AITRP), funded by the Fogarty International Center, National Institutes of Health (grant# D43TW00231), for supporting the training of clinical trial staff. This study would not have been possible without the support of the women participating in this trial and their contributions and commitment is acknowledged with deep appreciation. Special thanks to members of the CAPRISA Research Support Group members at the CAPRISA Vulindlela and eThekwini Clinical Research Sites. We acknowledge the dedication and commitment of staff at the CAPRISA eThekwini and Vulindlela Clinical Research Sites in implementing this trial; the CAPRISA Research Laboratory staff for undertaking the laboratory testing and archiving of samples; CAPRISA Data Management and Statistics staff for management and quality assurance of case report forms. The funding agencies played no role in the design and conduct of the trial, analysis and interpretation of the data or decision to publish.
Abstract: There is a renewed interest in delivering pharmaceutical products via intravaginal rings (IVRs). IVRs are flexible torus-shaped drug delivery systems that can be easily inserted and removed by the woman and that provide both sustained and controlled drug release, last- ing for several weeks to several months. In terms of women’s health care products, it has been established that IVRs effectively deliver contraceptive steroids and steroids for the treatment of postmenopausal vaginal atrophy. A novel application for IVRs is the delivery of antiretroviral drugs for the prevention of human immunodeficiency virus (HIV) genital infection. Microbi- cides are antiviral drugs delivered topically for HIVprevention. Recent reviews of microbicide IVRs have focused on technologies in development and optimizing ring design. IVRs have several advantages, including the ability to deliver sustained drug doses for long periods of time while bypassing first pass metabolism in the gut. IVRs are discreet, woman-controlled, and do not require a trained provider for placement or fitting. Previous data support that women and their male sexual partners find IVRs highly acceptable. Multipurpose prevention technology (MPT) products provide protection against unintended/mistimed pregnancy and reproductive tract infections, including HIV. Several MPT IVRs are currently in development. Early clinical testing of new microbicide and MPT IVRs will require a focus on safety, pharmacokinetics and pharmacodynamics. Specifically, IVRs will have to deliver tissue concentrations of drugs that are pharmacodynamically active, do not cause mucosal alterations or inflammation, and do not change the resident microbiota. The emergence of resistance to antiretrovirals will need to be investigated. IVRs should not disrupt intercourse or have high rates of expulsion. Herein, we reviewed the microbicide and MPT IVRs currently in development, with a focus on the clinical aspects of IVR assessment and the challenges facing microbicide and MPT IVR product development, clinical testing, and implementation. The information in this review was drawn from PubMed searches and a recent microbicide/MPT product development workshop organized by CONRAD.
Although AGYW perceived HIV risk to be higher in older men, they still had unprotected sex with them suggesting that economic incentives outweighed HIV risk. Moreover, some respondents reported sexual relationships with men they thought or knew had high HIV risk due to economic reasons. These findings not only highlight AGYW’s vulnerability but also the fact that economically empowering this group of women should indeed be prioritized as part of the HIV combination prevention package . Evident in most accounts was the persistent lack of empowerment in condom negotiation among AGYW–despite many years of program- ming for condoms. Over and above intensifying interventions to engender risk perception among AGYW, initiatives need to expand access to and promote female-controlled HIV pre- vention efforts such as vaginal microbicide ring  and pre-exposure prophylaxis .
The Osun State Government, in collaboration with the Global HIV/AIDS Initiative Nigeria, established the anti- retroviral (ART) centre at the State Specialist Hospital, Osogbo to provide comprehensive HIV/AIDS care for HIV positive patients, and receive referral of HIV posi- tive clients from all health care facilities in Osun and other neighbouring states. The centre opens daily from 8:00 a.m. to 4:00 p.m. while emergency services are pro- vided on 24 hour basis. It provides highly active anti- retroviral therapy (HAART) to eligible clients living with HIV/AIDS every Monday and Wednesday. The centre is headed by the ART coordinator with the support of other health care workers .
participant knowledge and preference for this method of HIVprevention. A randomized control group was not used, and as a result, it was not possible to be certain that the interven- tion caused the outcome. The reason why this study did not include a control arm was that this study was funded as a pilot. However, this study has generated the need to plan for a larger study that will include a control arm. The sample size of this pilot study prevented subanalyses by ethnicity or sexual preference; future research should be conducted with larger samples and control groups to address these issues. In addition, follow-up assessment was only done immediately postintervention; preferences for method may change over time or with additional consideration. Finally, it is possible that responses to hypothetical scenarios may be a poor proxy for future patient preferences.
Abstract: There are ~900,000 new HIV infections among women every year, representing nearly half of all new HIV infections globally. In the US, nearly one-fifth of all new HIV infec- tions occur among women, and women from racial and ethnic minority communities experience disproportionately high rates of new HIV infections. Thus, there is a need to develop and implement effective HIVprevention strategies for women in the US and internationally, with a specific need to advance strategies in minority communities. Previous studies have demon- strated that oral HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral medications by HIV-uninfected persons to prevent HIV acquisition, can reduce HIV incidence among women who are adherent to PrEP. However, to date, awareness and uptake of PrEP among women have been very limited, suggesting a need for innovative strategies to increase the knowledge of and access to PrEP among women in diverse settings. This narrative review summarizes the efficacy and safety data of PrEP in women, discusses considerations related to medication adherence for women who use PrEP, and highlights behavioral, social, and structural barriers to maximize the effectiveness of PrEP in women. It also reviews novel modalities for PrEP in women which are being developed and tested, including topical formulations and long-acting injectable agents that may offer advantages as compared to oral PrEP and proposes a community-oriented, social networking framework to increase awareness of PrEP among women. If women are provided with access to PrEP and support to overcome social and structural barriers to adhere to PrEP, this prevention strategy holds great promise to impact the HIV epidemic among women in the US and globally.
Sexual and marital relationships change during preg- nancy due to multiple physical and psychological changes. Factors including physiological and anatomical changes of a pregnant woman may affect sexual function in preg- nancy. Some factors including abandoning sexual activity and feeling of guilt regarding sexual relations during preg- nancy, altered body image, reduced sense of charm for the spouse, fear of injury to the fetus, fear of abortion, and early childbirth can affect woman sexual response and ul- timately the couple ’ s relationship, leading to anxiety and lack of self-confidence in couples and eventually disrupt- ing the mental health of the family . Bayrami et al. showed that 66.3%, 50.7%, and 69.2% of women suffered from sexual dysfunction in the first, second, and third trimesters of pregnancy respectively, and sexual desire dis- order will be the most commonly reported sexual dysfunc- tion in each trimester of pregnancy . Mother receives less attention and care during the postpartum period com- pared to the pregnancy period, and most deaths and dis- abilities occur during this period .
Autonomy to save money was uniformly limited, only 6 % young women reported having a bank account (5 % independently, without a spouse or parent or other rela- tives; data not shown). Both married and unmarried women were highly restricted in their mobility outside the village and ability to visit doctors alone (Table 5); married participants were also significantly more re- stricted in their mobility within the village, when com- pared with unmarried participants (visiting a friend inside village: 25 vs 46 %, p = 0.001; visiting a shop inside village: 25 vs 52 %, p = 0.001). Both married and unmar- ried young women reported limited self-efficacy in ex- pressing their own opinions, discussing SRH issues and helping a friend to choose a trained abortion provider. Table 4 Knowledge of sex/pregnancy, contraception and abortion among married and unmarried young women in Jharkhand, 2012