Search Results (337)

HIV disproportionately affects key populations (MSM, transgender people, sex workers and psychoactive substance users), who face greater social vulnerability and limited healthcare access. This study aimed at analyzing sexual orientation and gender identity and their association with sexual practices, sexually transmitted infections and psychoactive substance use among PrEP users. Method: A cross-sectional study was conducted between January 2018 and June 2021 with 736 Brazilian PrEP users from a health service in São Paulo. Sociodemographic data, sexual behaviors, STI history (past 3 months) and psychoactive substances use (past 3 months) were extracted from clinical records. The associations were analyzed using binomial logistic regression (p < 0.05). Results: Most of the participants were cisgender men (93.4%) and homosexual (84.8%), with a mean age of 34.9 years old. Condomless sex was reported by 98.5%, and 18.4% had some recent sexually transmitted infection, mainly syphilis. Psychoactive substance use was reported by 55.4%, especially marijuana, club drugs, erectile stimulants and poppers. Transgender and cisgender women were more likely to report sex work and crack use. Homosexual and bisexual participants had higher odds of using erectile stimulants. Conclusions: The study reveals key links between gender, sexual orientation and risk behaviors, highlighting the need for inclusive, targeted prevention. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

Background/Objectives: Human immunodeficiency virus (HIV) has evolved from a fatal disease to a manageable chronic condition. However, stigma persists, affecting the lives and sexuality of HIV-positive people, particularly in the gay population. Research on their sexuality is limited, highlighting the need for studies that address their experiences and needs. The aim of the study is to explore the individuals’ experiences of sexuality in serodiscordant gay couples. Methods: A descriptive study was conducted using thematic content analysis. Data collection was carried out through in-depth interviews. Six gay men who have been and/or are in a serodiscordant relationship for at least one year participated in the research. Results: Five sub-themes were identified grouped into two main themes as follows: sexuality: a complex concept accentuated by HIV and the impact of serodiscordance on partners. Conclusions: It is essential to promote accurate information and health services tailored to the needs of people living with HIV while fostering gender equity and combating stigma related to HIV and the gay community. Experiencing sexuality in this context is not only possible but can be full and satisfying when adequate resources are available. Full article

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure—the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)—to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. Methods: A total of 124 women (M[age] = 38.18; SD = 5.49; range 21–45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. Results: A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. Conclusions: The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication—supporting psychological well-being, informed decision-making, and long-term survivorship care. Full article

The adolescent years are pivotal in reproductive and sexual development and maturation, yet the experience of migration can severely disrupt this period, inhibiting young immigrants’ knowledge, access, and engagement with sexual and reproductive health (SRH) services. Further, young immigrants and minority populations often face persistent intersectional barriers, including language difficulties, cultural stigma, and systemic exclusion, that result in adverse SRH outcomes. Recent advances in SRH care, particularly in digital health and community-based interventions, show promise in improving access to culturally appropriate SRH services and information. Co-designing SRH programs with families and young immigrants to adequately acknowledge the unique cultural norms and barriers in SRH is essential in ensuring a high outreach of interventions. Shifts in traditional health policies are needed to ensure that immigrant and minority adolescents are not overlooked and that SRH programs incorporate culturally relevant content that is easily and widely accessible. Despite positive shifts, several barriers remain: limited disaggregated data on diverse populations, inadequate policy attention, and the insufficient scalability and funding of promising interventions. Future research and promotional efforts must prioritise the co-creation of SRH interventions with stakeholders and affected communities, ensuring that services are sustainable, culturally appropriate, and accessible to all adolescents. Full article

This article presents a structured review of literature published between 2015 and 2025 on the experiences of rural LGBTQIA+ youth. Using targeted search terms—including “LGBT*,” “rural,” “country,” “young people,” “sexual and gender minority (SGM),” “small town,” “youth,” and “students”—a research team identified 26 peer-reviewed articles that met inclusion criteria. Through team-based thematic analysis, six core themes emerged: (1) gaps in intersectional analysis, (2) mental health outcomes, (3) culturally responsive services and resources, (4) community climate and context, (5) experiences of victimization, and (6) policy. Across these themes, the review highlights the resilience, agency, and strength of LGBTQIA+ youth navigating rural environments. The literature consistently demonstrates how experiences of victimization are closely linked to mental health outcomes, while access to social support—particularly from affirming adults in systems (such as schools)—can mitigate harm and foster well-being. Implications for social work research, practice, and policy are discussed, with an emphasis on supporting LGBTQIA+ youth in U.S. Southern rural settings. Full article

A growing knowledge base highlights the importance of accounting for a variety of social and structural determinants of health (SDOH) when understanding mental and behavioral health among adolescents and young adults. The objective of the current study is to examine patterns of self-reported SDOH deficits and characterize participant health indicators and social identity across classes. Data is from a cross-sectional national study of young people who were recruited through study advertisements on social media and surveyed online. Data were collected between June 2022 and October 2023. Eligibility included (1) ages 13–22 years, (2) living in the United States, and (3) proficient in English. Health indicators included suicide attempts, suicidal ideation, drug overdose, perceived likelihood of living to age 35, non-suicidal self-injury, recent alcohol use, and depression. Five classes of SDOH deficits were identified: (1) Economic Instability, (2) Low Overall SDOH Deficits, (3) High Social SDOH Deficits (adversity and discrimination), (4) High Economic SDOH Deficits, and (5) High Overall SDOH Deficits. Differences across class by health indicators and marginalized identity were found, with high proportions of gender minority and sexual minority youth in both the High Overall SDOH Deficit group and the High Social SDOH Deficit classes. Black youth were more likely to be part of the High Economic SDOH Deficits class. The findings encourage a public health approach that recognizes that improving the health of today’s young people must be connected to policies that reduce poverty, improve neighborhoods, and increase access to basic goods, services, and healthcare. Full article

Cervical cancer remains one of the main causes of female mortality, especially in middle- and low-income countries, despite efforts towards the implementation of global vaccination against human papillomavirus (HPV). The aim of this study was to review and compare the most recently published international guidelines providing recommendations on cervical cancer screening strategies among average and high-risk women. Thus, a comparative review of guidelines by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), the World Health Organization (WHO), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cancer Council Australia (CCA), and the European Guidelines (EG) was conducted. There is an overall agreement regarding the suggestions made for women younger than 21 and those older than 65, with all guidelines stating against routine screening, with the exceptions of CTFPHC and CCA that expand the age group to up to 70 and 75 years, respectively. Continuation of screening in older women is also suggested in those with a history of a precancerous lesion and those with inadequate screening. Most guidelines recommend routine screening at 30–65 years, while the WHO advises that screening should be prioritized at 30–49 years. HPV DNA testing is the method of choice recommended by most guidelines, followed by cytology as an alternative, except for CTFPHC, which refers to cytology only, with self-sampling being an acceptable method by most medical societies. Agreements exist regarding recommendations for specific groups, such as women with a history of total hysterectomy for benign reasons, women with a complete vaccination against HPV, individuals from the lesbian, gay, bisexual, transgender, and queer communities and women with multiple sexual partners or early initiation of sexual activity. On the other hand, the age group of 21–29 is addressed differently by the reviewed guidelines, while differentiations also occur in the screening strategies in cases of abnormal screening results, in women with immunodeficiency, those with in utero exposure to diethylstilbestrole and pregnant women. The development of consistent practice protocols for the most appropriate cervical cancer screening programs seems to be of major importance to reduce mortality rates and safely guide everyday clinical practice. Full article

Background: Sexual violence against adolescents and young people (AYP) remains a public health concern. This study explores patterns of sexual violence and help-seeking behaviour as well as their associated risk/protective factors with guidance of a technical package (INSPIRE) designed to reduce sexual violence in low-resource settings. Methods: The 2019 Violence Against Children Survey (VACS) dataset comprises 788 males and 1344 females. After describing the prevalence and patterns of sexual violence and help-seeking behaviour (informal disclosure, knowledge of where to seek formal help, seeking formal help, and receipt of formal help) among 13- to 24-year-old AYP, logistic regression models were then fitted to predict past-year sexual violence and informal disclosure among adolescent girls and young women (AGYW). Results: More young women than young men informally disclosed sexual violence experience (46% versus 23%). Gender inequitable attitudes [AOR 3.07 (1.10–8.56); p = 0.03], experiencing emotional violence at home [AOR 2.11 (1.17–3.81); p = 0.01] and cyberbullying [AOR 5.90 (2.83–12.29); p = 0.00] were identified as risk factors for sexual violence among AGYW. Life skills training [AOR 0.22 (0.07–0.73); p = 0.01] and positive parental monitoring [AOR 0.31 (0.10–0.99); p = 0.05] were found to be protective against sexual violence among AGYW. Positive parental monitoring [AOR 3.85 (1.56–9.46); p = 0.00] was associated with an increased likelihood of informal disclosure among AGYW. Conclusions: As Kenya intensifies efforts towards sexual violence prevention, this study underscores the need to develop and strengthen policies and programs on life skills training, cultural norms, and positive parenting, as well as improve awareness and access to post-violence response and support services. Full article

Barriers to help-seeking behaviors in transgender populations in non-Western contexts are both understudied and poorly understood. Using a quantitative cross-sectional design, this study examined the psychological help-seeking attitudes of 109 transgender persons from Pakistan in relation to their psychological distress and attitudes toward sexuality. This research further identified which components of distress (stress, anxiety, or depression) were stronger predictors and assessed the role of particular demographic/behavioral factors in help-seeking attitudes. Participants completed three validated assessment tools translated into Urdu: Beliefs about Psychological Services Scale, the Depression, Anxiety, and Stress Scale (DASS-21), and the Sexual Attitude Scale. The results indicated that psychological distress predicted expertness and intent but not stigma tolerance. Post hoc analysis using DASS-21 subscales revealed that stress and anxiety were the stronger predictors of attitudes related to expertness and intent. The Sexual Attitude Scale marginally predicted stigma tolerance directly and also moderated the relationship between psychological distress and help-seeking attitudes for stigma tolerance. Finally, a role for demographic/behavioral factors—possibly serving as a proxy for mental health literacy—was identified for stigma tolerance. These findings reiterate the importance of tailored mental health awareness initiatives within the transgender community in non-Western settings and highlight the need for qualitative research to further understand the dynamics of psychological distress along with other linked factors. Full article

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article

Background: Madagascar is one of the lowest-income countries in Africa, and it has a poorly developed healthcare system. Malagasy women face limited access to sexual and reproductive health services, which is a serious risk factor facilitating the spread of sexually transmitted infections (STIs). The aim of the present study was to assess the prevalence of STIs (Trichomonas vaginalis, Neisseria gonorrhoeae, Treponema pallidum, and HIV-1/HIV-2) and urogenital schistosomiasis, as well as to evaluate hematological parameters and nutritional status, in a group of women from northern Madagascar. Methods: The study was conducted in April 2024 at the Clinique Médicale Beyzym in Manerinerina, Ambatoboeny District. Samples, which included overnight urine, venous blood, and vaginal swabs, were collected from 159 women aged 15–80 years. The urine samples were examined for the presence of Schistosoma haematobium eggs by light microscopy, the vaginal swabs were tested for the presence of Trichomonas vaginalis and Neisseria gonorrhoeae infections (by light microscopy), and venous blood samples were collected into VACUTAINER SEC collection tubes without anticoagulant and were tested for HIV-1/HIV-2 and Treponema pallidum infections using test cassettes. Results: The prevalence of STIs in the study group was found to be 31.5%, while S. haematobium infections were found in 17.6% of the tested women. Cases of gonorrhea (20.1%), trichomoniasis (8.8%), syphilis (7.6%), and one case of HIV infection were identified. Conclusions: The study found a high prevalence of STIs and S. haematobium cases in Tsimihety women. In order to improve the quality of healthcare in Madagascar, it is necessary to improve accessibility to maternal, sexual, and reproductive health services. Full article

Human trafficking for forced labour or sexual exploitation often takes the form of forced migration. It is the third-largest crime industry in the world and has severe consequences on the women survivors. Trafficking violates the safety, welfare, and human rights of the victims and forces physical and psychological imprisonment on them. Despite the significant number of women being trafficked, little is known about the best ways to address their needs. This article highlights the understanding developed by social service providers in South Africa regarding the consequences of human trafficking on women survivors. Being aware of the complex challenges faced by women survivors of human trafficking enables social service providers to respond to their needs effectively through appropriate interventions and services. Data for this qualitative study were collected through one-on-one interviews and analysed using thematic analysis. Social service providers understand the following to be related to women survivors of trafficking: involvement in drugs and sex work, dependency on the perpetrator, lack of self-esteem, self-blame and shame, being disoriented, psychological challenges, lack of financial support, health issues, isolation, and loneliness. To be relevant and effective, services should be packaged in a manner that addresses all the challenges faced by women survivors of human trafficking. Full article

Key affected populations (KAPs), including women who use drugs, engage in sex work, or live with HIV, are disproportionately affected by HIV, gender-based violence, substance use, and mental health. In Kazakhstan, they face significantly higher rates of intimate partner violence (IPV), with prevalence ranging from 45% to 75% compared to the national average of 27%, alongside barriers to accessing IPV services. This community-level implementation trial with a waitlist control group evaluated the effectiveness, safety, and acceptability of a self-paced mobile health intervention (UMAI-WINGS) for women from KAPs in Kazakhstan. The study enrolled 508 women, with 306 in Almaty City (intervention) and 200 in Almaty Oblast (waitlist control). IPV rates (physical, sexual, and psychological) were assessed at baseline and 6-months post-intervention. Participants in the intervention community were significantly less likely to report psychological (−23.0%), sexual (−27.0%), and physical IPV (−29.0%) at the 6-month follow-up compared to the control group. These results demonstrate the potential of digital, community-driven interventions to reduce IPV among marginalized women and offer a scalable, evidence-based model for implementation. The success of the UMAI-WINGS underscores the value of community-based, mobile health approaches for advancing trauma-informed, survivor-centered care and closing critical service gaps for underserved populations. Full article