Public health initiatives in Zambia encourage the uptake of early infant male circumcision (EIMC) as an HIV prevention strategy. This study assessed EIMC parental decision-making during perinatal care in Lusaka, Zambia, focusing on the influence of sociodemographic factors, family, and friends. A longitudinal pilot perinatal intervention, Like Father Like Son (LFLS), was implemented among 300 couples attending antenatal clinics in four urban community health centers. Participants were assessed postpartum regarding subsequent EIMC decisions. Partners, religion, and marital status were associated with the EIMC decision-making. Large scale EIMC promotion interventions that target both parents during perinatal care should be explored.
Kaylin M Yudice, Violeta J Rodriguez, Deborah L Jones et al.
OBJECTIVE: In high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country. DESIGN: A cross-sectional study. SETTING: This study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals. PARTICIPANTS: 1119 persons receiving HIV services in 2020. METHODS: We conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time. RESULTS: The mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p<0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p<0.001) and those living in the Western region (US$2.88 higher, p<0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III. CONCLUSIONS: Costs and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities.
Elizabeth Ekirapa, Monica Jordan, Thuong Nong et al.
INTRODUCTION: Prior research demonstrates that emergency department (ED) patients with suicidal ideation (SI), substance use (SUD), and/or intimate partner violence (IPV) have disproportionate adverse outcomes for both women and infants. The 2013 Hague Protocol suggested that children with caregivers with the above characteristics are also more likely to suffer from child maltreatment. Of all pregnancies in this group, as many as 90% are unintended. We hypothesized that women with SI/SUD/IPV have gaps in care access, high levels of unscheduled care use, and reduced ED contraceptive inquiry, which if addressed could potentially improve outcomes. METHODS: We conducted a chart review of 62,284 ED visits from 2018-2021 from a suburban four-hospital system in the Southern United States. We compared women of reproductive age (15-44) with SI/SUD/IPV (4,776) against controls (57,508). The exposures were defined as women with SI, SUD, and/or IPV. We analyzed results using the chi-square test (χ2) with Bonferroni adjustment to test for independence and logistic regression. RESULTS: Women suffering from SI/SUD/IPV who present to the ED have contraceptive status less frequently documented compared to controls without these factors (39.5 vs 51.7%, RR 0.77, CI, 0.74-0.79, P < .001). They also have reduced access to care, with higher rates of uninsurance (32.7 vs 26.1%, P < .001), more care in the acute care environment, longer ED length of stay (LOS) (mean was 10.38 vs 3.87 hours, P < .001), higher hospitalization rates (61.0 vs 8.7%, P < .001), and higher 30-day ED revisits (11.8 vs 8.8%, P < .001), even after adjusting for the Social Vulnerability Index, acuity, age, and obesity (adjusted odds ratio 1.52 95% CI 1.36-1.70 P < .001). CONCLUSION: Despite significant morbidity coupled with reduced access to ambulatory care and disproportionately increased ED use, little ED contraceptive documentation exists. This practice contributes to inequity, given the increased number of unintended pregnancies and greater need of contraceptives in women with suicidal ideation/substance use disorder/intimate partner violence.
Alison Ruch, Adam Henderson, Ania Izabela Rynarzewska et al.
INTRODUCTION: Intimate partner violence (IPV) is a universal problem that exists in most countries of the world. Worldwide, one third of women will experience physical or sexual violence in their lifetime, mainly by intimate partner. IPV can affected on reproductive health and lead to serious injury and death of mother and baby. Current systematic review was conducted with the aim of determining the relationship between intimate partner violence, reproductive health and pregnancy outcome. MATERIAL AND METHODS: Study performed based on "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) by PICO components. The literature review was conducted using the electronic medical databases were searched using the equivalent keywords without starting time limit, up to January 2024. Medical subject headings with Boolean operators, and the proportionate keywords as follows: (fertility OR pregnancy OR child bearing) AND (intimate partner violence OR domestic violence) in title, abstract and keywords of articles were used. Inclusion criteria were published observational studies and clinical trials in English language. Studies participants considered women with a history of IPV and fertility as an outcome. Data extracted according to a predefined checklist. Two investigators independently examined title, abstract, and full-text screening. The study selection, quality assess, and extraction of data were independently by two researchers. Inconsistencies resolved by a third researcher. FINDINGS: A total of 1834 documents were retrieved that finally; 39 articles were reviewed. About 50% of the articles were related to the last five years. Relationship between IPV and intention to have children through "unwanted and unintended pregnancy", "contraception use", "contraception use and types of IPV and unmet need for contraception use" has a contradictory effect. Additionally, relationship between IPV and pregnancy outcomes through "maternal health", "pregnancy", "number of children and childbirth intervals" and "fetal outcomes" has a contradictory effect in different ways. According to the results, women subjected to violence may face an increased risk of pregnancy complications, abortion, stillbirth and infant death. Also, intimate partner violence may increase the incidence of induced abortion among women experiencing violence. CONCLUSION: According to this review study, intimate partner violence can affect the reproductive health, and pregnancy outcome. Therefore, violence against women by the husband should be given more attention and solutions should be considered at the social and individual level for improve the reproductive health and pregnancy outcome.
Malikeh Amel Barez, Fatemeh Goudarzi, Nader Sharifi et al.
Immigrants experience an elevated risk of intimate partner violence (IPV), but little is known about how cultural competencies within a couple are protective against IPV. Using the Dyadic Cultural Competence and Balance model, we tested hypotheses involving cultural competencies and IPV risk among U.S. immigrant dyads in the Future of Families and Child Wellbeing Study (N = 188). The longitudinal data revealed that high dyadic bicultural competence predicted reduced risk of IPV over time. Financial strain exacerbated low dyadic bicultural competence predicting more IPV. In summary, dyadic bicultural competence appears protective against IPV among immigrants.
Quinn E Hendershot, Hayley C Fivecoat, Matthew D Johnson
Violence against children is a global public health issue that can lead to long-lasting negative consequences for child outcomes. The Irie Homes Toolbox (IHT) is an early childhood, violence prevention, parenting program designed for integration into early childhood educational services in Jamaica. We have previously shown that the program is effective in reducing child maltreatment when implemented by the research team. For wide-scale dissemination, the IHT needs to be delivered by preschool staff as part of their routine duties. We adapted the IHT using results from our previous evaluations, and we are conducting a mixed-method feasibility trial of the IHT fully integrated into preschool provision. Twenty-four basic schools in Kingston and St. Andrew, Jamaica, have been randomly assigned to intervention (n = 12) or wait-list control (n = 12) with 10 caregivers per school participating in the study (240 caregivers, 120/group). The intervention is delivered through 12 weekly, 1-hr sessions by a preschool teacher with groups of 10 caregivers of children aged 2-6 years. An ongoing process evaluation includes quantitative measures of caregiver attendance, teacher compliance, and fidelity of intervention implementation and qualitative measures of enablers and barriers to implementation and suggestions for improvement. In the impact evaluation, the primary outcome is the frequency of caregivers' use of violence against their child. Secondary outcomes are caregiver attitudes to violence, preferences for harsh punishment, involvement with their child, and child conduct problems. All outcomes are measured through caregiver report. The results of the study will be used to inform revisions of the IHT for implementation at scale. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Taja Francis, Marsha Bowers, Helen Baker-Henningham
A limited qualitative literature explores children's lived experiences of violence; boys' relationships with perpetrator fathers remain largely unexplored. Drawing on interviews with 31 boys, this paper explores the accounts of their relationships with their perpetrator fathers, focusing particularly on the implications of boys' understanding of these relationships for their sense of burgeoning masculinity. Three themes are considered: in (a) relational ambiguity; (b) performing masculinities, managing violence; and (c) envisioning alternative futures and re-visioning the past. Our findings highlight the importance of interventions for boys that facilitate the expression of their often complex and ambivalent feelings and fears about their father's violence, and what it means for them and their future.
Jane E M Callaghan, Lisa C Fellin, Stavroula Mavrou et al.
BACKGROUND: It is unclear whether having both prior violence experiences and HIV interacts on mental health (MH) among adolescent girls and young women (AGYW). METHODS: We used 2018/2019 Violence Against Children and Youth Survey data on 7593 AGYW who ever had sex and had a known HIV status from 5 sub-Saharan African countries. We assessed the interactions between HIV status and violence exposures-childhood physical violence, childhood emotional violence, childhood sexual violence (SV), lifetime SV, lifetime physical violence/SV, and age at first SV experienced on 4 MH outcomes, adjusting for the sociodemographic covariates. We applied the Benjamini-Hochberg procedure to address multiple comparisons and presented adjusted odds ratio with 95% confidence intervals stratified by HIV status. RESULTS: Of the total AGYW sample, 2.08% were HIV positive, 37.06% had moderate psychological distress (PD), 10.03% had severe PD, 10.64% had substance misuse, and 13.53% had suicidality history. Two models had significant interactions between HIV and violence. The likelihood of severe PD among AGYW with childhood SV experiences was significantly higher if they were diagnosed with HIV (aOR: 83.89, 95% CI: 18.26 to 385.36) versus those without HIV diagnoses (aOR: 2.86, 95% CI: 1.91 to 4.29). Similarly, the adjusted odds ratio for the association of lifetime SV and severe PD was 12.95 times higher among AGYW with HIV (aOR: 31.85, 95% CI: 7.62 to 133.11) versus those without HIV (aOR: 2.46, 95% CI: 1.54 to 3.92). CONCLUSIONS: Our results emphasize the need for trauma-informed HIV care with integrated violence and MH services, particularly for AGYW who have HIV and prior SV experiences.
Sushma Dahal, Joseph Logan, Udhayashankar Kanagasabai et al.
In heterosexual relationships, intimate partner violence (IPV) affects both men and women. However, women are more likely than men to seek help. This study used a qualitative approach to describe community perceptions on the coping and help-seeking behavior of male victims of female-perpetrated IPV. Love for their children and wives, and fear of shame, losing property and breaking the law makes men stay in abusive marriages. Avoidance, silence, submission, finding another partner, and being religious are some of the coping strategies employed. Both formal and informal reporting avenues are utilized but the latter seemed preferable. Internal and external barriers to male IPV reporting and help-seeking were underscored. Help-seeking by male IPV victims seems a taboo in a society that expects exaggerated masculinity inadvertently hindering reporting. Our findings reveal that both men and women appreciate the need for a gender-inclusive response to IPV. Despite reported shortcomings, leveraging existing easily accessible support systems such as family, community leadership, local administration, and religious institutions could be an ideal approach to start conversations about male IPV recognition and mitigation.
Jacinta Mukulu Waila, Olaf Horstick, Domnick Onyango Mitiro et al.
