“It was like climbing a mountain and not reaching the top”: Experiences of South African youth living with HIV who became parents during COVID-19 lockdowns

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Disclosure of HIV Status to Youth With Perinatally-Acquired HIV: The Dilemma, Risks, and Responsibilities

Kenya’s Community Health Strategy (CHS) focuses on health actions for improved health at level one (community-based level). Poor health indicators have been reported among young people over the years; hence TICH, in its design for the Get Up Speak Out (GUSO) program, adopted the community-based approach (Community Health Strategy) by training and engaging 29 Community Health Volunteers as the SRHR youth group mentors for the GUSO program. Thereafter, the mentors were assigned roles with the aim of improving young people’s SRHR in their respective communities. The study was conducted among mentors to assess their knowledge and practice towards youth-friendly service, as well as the challenges they experience in mentoring the young people in the community. The survey was a full-coverage survey (target participants included all the 29 youth mentors engaged in the GUSO program). The study engaged an e-platform for questionnaire administration in adherence to the Covid-19 preventive guidelines from the Ministry of Health. The study found that most males are the most concerned with mentoring young people compared to women mentors with key support that mentors provide to young people during the mentorship process are attending young people meetings and providing training to young people. This study highlights the importance of CHVs when trained as mentors in supporting young people’s SRHR information and service access. The study emphasises the integration of tasks in line with young people’s SRHR alongside the CHVs normal tasks as a working strategy for improving young people’s SRHR situations in the community. However, the study highlights the gap in CHVs capacity to handle the hard-to-reach young people with SRHR information and services.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

ObjectivesYoung people on the verge of, or in, secure state care or incarceration have reduced general and sexual health. The promoting of sexual health among young people in secure state care is therefore a responsibility for both the state-run agency responsible for this care and for the professionals who work there.MethodsThis position paper discusses sexual and reproductive health and rights (SRHR) for young people in secure state care in Sweden. Four previous studies on sexual health of young people in secure state care are revisited, and governmental policy documents are examined.ResultsYoung people in secure state care face many threats to their sexual and reproductive health and rights. Some of these threats originate with the institutional placement itself and the lack of knowledge among the staff. Clashes on various levels between the subjectively desired (young people seeking pleasure from sex, alcohol, or other drugs) and the societally desired (sexual health, minimal alcohol use, and no drug use among young people) are described. In addition, clashes are seen between young people who want to be like everyone else in their social context and the staff with a mission (i.e. job description) to readjust young people into adopting socially accepted behaviour.ConclusionI argue that young people in secure state care have sexual experiences that are marginalized and placed on the outskirts of the charmed (sexual) circle of societally accepted sexual behaviour. In addition, their experiences are surrounded by silence, a silence sustained by both young people and professionals. The readiness of professionals to handle SRHR for young people in secure state care in a knowledge-based and non-judgemental fashion is crucial. Future research should focus on this readiness and have the needs and wishes of young people as its departing point. Although the article involves a local context, it may be of interest to a wider audience, as the placement of young people in secure state care and other forms of incarceration occurs worldwide.

It is broadly agreed that sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are intimately linked. UHC has been described as a pragmatic means for advancing SRHR, and SRHR is considered an essential component of UHC. SRHR is universally recognized as a fundamental dimension of health and well-being and a human right. Ensuring SRHR requires a comprehensive, intersectional, and life-course approach, recognizing the layers of privilege or vulnerability that may influence one’s sexual and reproductive health needs and opportunities to fulfill one’s sexual and reproductive rights, as well as the shifting needs of individuals across the life course. UHC, on the other hand, implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative, and palliative essential health services. UHC also entails access to quality medicines and vaccines while ensuring that the use of these services does not expose the users to financial hardship. In 2019, the Political Declaration on UHC stipulated that access to SRH services as a key aspect of UHC was to be achieved by 2030. The declaration also reaffirmed commitments to the International Conference on Population and Development Programme of Action and Beijing Platform for Action. While SRHR is integral to the UHC agenda, and the delivery of both SRH services and UHC relies on functioning and quality primary health care systems, there are limitations of the UHC agenda for advancing SRHR. The aspiration of UHC and to what extent it has integrated SRHR under its ambit and advanced it from a gender and rights perspective can be revealed by a set of cases reflecting the experiences of people in vulnerable situations, which illustrate different shortcomings in the current UHC framework and its translation on the ground. These shortcomings include systematic exclusions and discrimination of persons currently belonging to marginalized groups, inadequate investment in and respect for women health workers, violations of autonomy and dignity, lack of accountability, and power of politics. These shortcomings, which limit access to and experience of quality health services, cannot be removed by narrowly focusing on addressing the “ability to pay” or reducing the financial barriers alone. Therefore, the current framing of UHC is insufficient to progressively realize SRHR and thus demands a reconceptualization and/or extension of current framing and design. To address the shortcomings, an intersectional feminist approach to UHC is proposed. Shifting mindsets and including gender and power analysis in UHC design, operationalization, and measurement of UHC outcomes will allow for achieving the UHC objectives of financial protection, equity in access, and service quality. Taking an intersectional feminist approach to UHC would improve not only SRHR outcomes but also health outcomes at large. It will furthermore offer a pathway to truly deliver on the objectives of UHC—equitable health care for all.

This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child's difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring.

In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders. Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. A rural Area Health Service in NSW. Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders. Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided.

This article explores the background to the creation of the Victims and Witnesses Action Group in Leicester. It lays out the aims of this group and how researchers sought to help meet them by carrying out research amongst the communities and agencies of Leicester. The findings highlighted gaps in service provision and led to calls for more multi‐agency working. This article goes on to set out proposals to tackling these gaps in provision through the idea of a federation. This brings together agencies working with victims and witnesses of crime, with a view to offering appropriate and accessible services within Leicester.

Effectively engaging the private sector through vouchers and contracting – A case for analysing health governance and context

Lebanon’s healthcare system has demonstrated remarkable resilience amidst ongoing political and economic turbulence. Yet, the critical domain of Sexual and Reproductive Health and Rights (SRHR) remains underserved. This commentary analyses the systemic barriers, policy deficiencies, and urgent needs that shape SRHR within Lebanon's healthcare landscape. Despite the country’s commitments to international frameworks like the ICPD and CEDAW, SRHR policies are hindered by political fragmentation, societal conservatism, and insufficient prioritisation. These challenges translate into inadequate and inconsistent family planning services, a lack of comprehensive sexuality education, inadequate maternal healthcare, and significant obstacles in accessing essential services, especially for marginalised communities such as refugees, women, and youth. Lebanon’s "Vision 2030" health strategy, while ambitious in scope, offers only limited engagement with SRHR, which leaves systemic inequities unaddressed. Renewed episodes of violence and displacement further strain the healthcare system and deepen the disparities faced by vulnerable groups. The reliance on temporary, NGO-led initiatives to fill gaps in service provision underscores a broader policy paralysis and inconsistent resource allocation, which together prevent the sustainable integration of SRHR into national health frameworks. This commentary calls for a gender-sensitive, inclusive healthcare policy that positions SRHR as a foundational pillar of public health, gender justice, and social equity. Achieving this requires concerted efforts among government agencies, NGOs, and international partners to overhaul existing frameworks and address structural barriers.

This study describes the adoption of an action learning (AL) approach to (i) identify challenges that primary healthcare workers face in delivering gender-transformative sexual and reproductive health and rights (SRHR) services to young people, and (ii) recommend feasible solutions to resolve these challenges. This study implemented in Ebonyi State, Nigeria, included three AL structured sessions with healthcare workers, community members, and researchers. AL participants formed six groups, each representing one of the six selected local government areas. Data on potential challenges in providing youth-friendly gender-equitable and inclusive SRHR services and strategies for addressing them were synthesized through consultations with the stakeholders using the modified Delphi technique. The key challenges that health workers faced were: (i) provider-related issues such as personal values and beliefs regarding providing contraceptives to young unmarried people; (ii) community/client-related issues such as lack of male, parents/guardians, and community support; and (iii) negative perceptions regarding health seeking for SRHR services. Proposed strategies include reaching young men and boys with SRHR services outside Primary Health Care settings; facilitating dialogue to support female partners; and promoting community advocacy. AL has shown promise in understanding young people's SRHR challenges and in developing strategies to advance gender-transformative youth-friendly SRHR services in Nigeria.

The good practice case study was undertaken in 2015 and mostly focussed on out of school youth with regard to adolescent sexual reproductive health and rights and HIV and Aids prevention. This study used a mixed method where both the quantitative as well as the qualitative research method were utilised and where the latter was the dominant method. The research focus on the target beneficiaries between the ages 15-24 and the services they received from Partners in Sexual Health (PSH). The findings indicate that this group are very early sexual active. The research has further established that when it comes to Sexual Reproductive Health and Rights (SRHR) there is a huge need for youth friendly services and cognisance need to be taken of the needs of young people, which is not being identified and addressed fully. While the exact impact on beneficiaries of the Out of School Project has not been measured, there is considerable evidence of a positive impact on beneficiaries as reflected by the respondent’s comments. According to observations made by the key informants the uptake of the Out of School Project was excellent. The study concluded by presenting a list of recommendations.

Young people with substance use problems often have an early sexual debut, an increased risk of sexually transmitted infections and unplanned pregnancies, and a high risk of experiencing sexual violence. At the same time, according to the national action plan on sexual and reproductive health and rights (SRHR), the social services in Sweden have an important role in addressing sexual health in various contexts, such as in child welfare investigations. Therefore, this study has investigated how Swedish child welfare workers understand and relate to sexual health issues in child welfare investigations regarding young people with substance use problems. Following a strategic sampling, 15 child welfare workers were interviewed. The interviews were examined with a thematic content analysis with results showing that sexual health issues represented an area where knowledge was lacking. This was largely connected to that the child welfare workers had not been taught about SRHR in their bachelor’s degree nor in their continued education within the child welfare system. As a result of this, they often developed their own individual, professional approach for assessing sexual health matters, guided by the principle of “not investigating more than necessary”. When addressing sexual health in their assessment work, the child welfare workers primarily focused on risk, vulnerability and exposure. Not assessing young peoples’ sexual health was seen as protecting the right to confidentiality and privacy. In summary, this meant that young people with a problematic substance use were seldom given opportunities to talk about their sexual health, and especially not about positive sexual experiences related to their substance use.

This paper studies the effect of bride price on the realisation of the sexual and reproductive health rights of women in South Africa and Nigeria. It adopts the doctrinal research method by reviewing the nature and form of bride price in South Africa and Nigeria. The paper also considers the legal framework for sexual and reproductive health rights of women in South Africa and Nigeria and the consequential effects of bride price on the sexual and reproductive health rights of women in the two countries. It argues that the payment of bride price inhibits the realisation of the sexual and reproductive health rights of women entrenched in various international instruments which both South Africa and Nigeria are signatories and their respective domestic laws. The paper submits that men in the society should be educated that the payment of bride price does not translate to buying their wives but as a mere token to show their gratitude in anticipation for the gift of a wife. Payment of bride price should be seen as a mere cultural observation without the ulterior motive of subjugating the woman. Keywords: Bride Price, Women, Sexual Rights, Reproductive Rights, Nigeria, South Africa DOI: 10.7176/JLPG/96-04 Publication date: April 30 th 2020