Vulnerable Young Women Research Articles

The Inter-ministerial National Structural Intervention trial (INSTRUCT): protocol for a parallel group cluster randomised controlled trial of a structural intervention to reduce HIV infection among young women in Botswana

BackgroundWide recognition that structural factors are important in the HIV epidemic has not generated much evidence of impact of structural interventions. Few randomised controlled trials of structural interventions for HIV prevention have an HIV endpoint, and most of those did not show a significant impact. It has proved difficult to prevent new HIV infections in Botswana, especially among young women, many of whom are unable to act on HIV preventive choices. Proposed by a government think tank in Botswana, the Inter-ministerial National Structural Intervention trial (INSTRUCT) tests whether addressing social and economic factors, including gender inequality, gender violence, poverty, and poor access to education, can lower HIV infection rates among young women. Focussed on increasing access by marginalised young women to government support programs, the intervention seeks to change their structural position, reducing their vulnerability to transactional sex, and thus to HIV infection.MethodsThis parallel group cluster randomised controlled trial compares HIV rates among young women in districts with and without the structural interventions. The 30 administrative districts in the country, stratified by HIV prevalence and development status, will be randomly assigned to 5-district implementation waves. The intervention in the first-wave districts will include: (i) recruiting and preparing vulnerable young women to apply to government support programs, (ii) making the support programs more accessible to young women by engaging local program officers and young women in co-evaluation of programs and co-design of solutions; and (iii) generating an enabling environment for change in communities through an audio-drama edutainment program. In year five, an impact survey will measure HIV rates among vulnerable young women (15–29 years) in a random sample of communities in the five intervention districts and in the five second-wave (control) districts. Fieldworkers will undertake rapid HIV screening and interview young women and young men, collecting information on secondary outcomes of attitudes and behaviours.DiscussionThis is the first step in a planned stepped-wedge design that will roll out the intervention, modified as necessary, to all districts. Strong government commitment provides an important opportunity to reduce new HIV cases in Botswana, and guide prevention efforts in other countries.Trial registrationRegistration number: ISRCTN 54878784. Registry: ISRCTN. Date of registration: 11 June 2013.

Race Rescue

Abstract This paper examines Methodist missionary discourse in Papua at the turn of the nineteenth century, locating two themes: what I call a pathology of desire, to be found in the polemical missionary discourses directed at sexuality, immorality and licentiousness, and a pathology of culture, to be found in their polemical discourses against abortion, infanticide and child-rearing practices. Together, these pathologies were seen as the main causes of population decline. The two discourses, constantly at play, produce a doubled image of Papuan women – the fallen woman and the bad mother – which, it was considered, necessitated the intervention of “a civilising mission.” This involved race rescue – the isolation of those thought vulnerable (children and young women) on the mission station, away from the dangers of the villages, at the same time instilling in them their own notions of sexual morality, and above all the training of Papuan women in European models of motherhood and domesticity, so they would become good wives and mothers.

Reaching young women who sell sex: Methods and results of social mapping to describe and identify young women for DREAMS impact evaluation in Zimbabwe.

Young women (aged 15–24) who exchange sex for money or other support are among the highest risk groups for HIV acquisition, particularly in high prevalence settings. To prepare for introduction and evaluation of the DREAMS programme in Zimbabwe, which provides biomedical and social interventions to reduce adolescent girls’ and young women’s HIV vulnerability, we conducted a rapid needs assessment in 6 towns using a “social mapping” approach. In each site, we talked to adult sex workers and other key informants to identify locations where young women sell sex, followed by direct observation, group discussions and interviews. We collected data on socio-demographic characteristics of young women who sell sex, the structure and organisation of their sexual exchanges, interactions with each other and adult sex workers, and engagement with health services. Over a two-week period, we developed a “social map” for each study site, identifying similarities and differences across contexts and their implications for programming and research. Similarities include the concentration of younger women in street-based venues in town centres, their conflict with older sex workers due to competition for clients and acceptance of lower payments, and reluctance to attend existing services. Key differences were found in the 4 university towns included in our sample, where female students participate in diverse forms of sexual exchange but do not identify themselves as selling sex. In smaller towns where illegal gold panning or trucking routes were found, young women migrated in from surrounding rural areas specifically to sell sex. Young women who sell sex are different from each other, and do not work with or attend the same services as adult sex workers. Our findings are being used to inform appropriate intervention activities targeting these vulnerable young women, and to identify effective strategies for recruiting them into the DREAMS process and impact evaluations.

Bottlenecks and Red Tape Reduce Access to Government Support Programs by Botswana’s Most Vulnerable Young Women

Bottlenecks and Red Tape Reduce Access to Government Support Programs by Botswana’s Most Vulnerable Young Women

Family formation: A positive outcome for vulnerable young women?

While marriage and childbirth are generally considered positive adult outcomes, it is not clear that this holds true among low income young women. Beyond adolescent parenting, little empirical data exists on various types of family formation in this population. The aims of this study were twofold: (1) to understand predictors of type of family formation (e.g., none, childrearing, marriage, or both) among 4385 young women with childhood histories of poverty and/or maltreatment; and (2) to explore whether family formation patterns were associated with negative adult behavioral and health outcomes. Results of the AIM 1 multinomial regression analysis of family formation indicated that the likelihood of childrearing with or without marriage increased with an increase in the number of adolescent risk behaviors after controlling for the maltreatment and/or poverty histories. Among women with maltreatment histories, early onset maltreatment was associated with childrearing or marriage compared to no family. Among previously maltreated women, predictors of family formation varied according to prior poverty history. AIM 2 Cox regression results indicated that having children with or without marriage was associated with a higher risk of negative outcomes after controlling for maltreatment and adolescent risk factors. Bivariate analyses suggested that most of the increased risk was associated with having at least two children. Findings underscore the importance of preventing adolescent risk behaviors among low income and maltreated girls as well as early and unplanned births among vulnerable young adult women.

Understanding the importance of collecting qualitative data creatively.

Understanding the importance of collecting qualitative data creatively.

Using storyboards in participatory research.

To draw on the authors' experience of research conducted with vulnerable young women to argue for the use of storyboards in focus groups. Creative methods are used increasingly in qualitative research to generate richer data and promote more meaningful participation. This paper discusses the authors' experiences of using storyboards in participatory research. This approach has a number of advantages such as promoting participation and engagement, empowering participants and enabling them to take more control over the research process. Using creative techniques with more traditional qualitative approaches may create additional, in-depth data as well as increased participation. Such approaches could be of value in nursing research in which patients, clients and service user perspectives are often vitally important. Using creative methods in qualitative research promotes participation.

“Having a Baby Changes Everything” Reflective Functioning in Pregnant Adolescents

Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy. This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7+1.5years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes. These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners. Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.

Evaluation of “Jumat Pintar” Program in Reducing the Incidence of Anemia in Young Women in Sukoharjo, Indonesia

Background : Anemia is iron deficiency in the body which gives a negative impact. Anemia in the short term can lead to vulnerable young women experience a decline in achievement of learning at school. While long-term, sustained anemia from adolescence until the pregnant can lead to complications of bleeding to death and in Sukoharjo, Jumat Pintar implementation prevents the incidence anemia especially in young women. The activity encouraged from this policy is the giving of Fe tablet. The evaluation was conducted to assess the performance of the implementation of the policy of running and achievements obtained in accordance with the original purpose. This study was aimed to evaluate the implementation of Jumat Pintar program in lowering the incidence of anemia of young women. Subject and Methods : This was a qualitative study, was conducted in September-October 2016 in Sukoharjo. A total of 20 samples were selected by using purposive sampling technique. The data was collected using in depth interviews, observation and study of documentation. The data were analyzed using the interactive analysis techniques to compare the data obtained with data triangulation. Results : The execution of Jumat Pintar at stages of planning activities, the determination of the amount of goals and services granting Fe tablet was in adherence with the standard procedures of implementation. The stage of the expansion of the network of independent outlets and stages of monitoring and oversight have not run optimally. The scope of consumption of Fe tablet is not can be traced and decrease in the numbers of Genesis anemia in teenagers does not represent the entire area. The main constraints implementation comes from the absence of a legal umbrella agreement work, lack of financial support from various parties, the low commitment of the education sector, and low awareness of the goal. Conclusion : The implementation of Jumat Pintar is running optimally. The formation of independent outlets have yet to be implemented at each high school in Sukoharjo Regency, the absence of funding sources and still low level of involvement of target. Keywords : anemia, the movement of young women, the evaluation of the implementation of Jumat Pintar program. Correspondence: Ayudhia Pratiwi. School of Public Health, Sebelas Maret University, Surakarta. Journal of Maternal and Child Health (2016), 1(1): 25-33 https://doi.org/10.26911/thejmch.2016.01.01.05

Experience of Workplace Violence among Intensive Care Unit Nurses

Purpose: The purpose of this study was to explore the experience of workplace violence among intensive care unit nurses. Methods: The participants of this research were twelve registered nurses who work in the intensive care units (ICU) at the hospitals in Seoul and Gyunggido. Data were collected by individual in-depth interviews and analyzed using the phenomenological methodology by Colaizzi. Results: From significant statements, five theme clusters emerged as follow; 1) vulnerable young women to violence, 2) my own reflection was bruised and exhausted, 3) a hopeless everyday, 4) seeking a solution in relation, 5) establishing one’s status as a professional nurse. Conclusion: This study provides a profound understanding on the experiences of workplace violence among ICU nurses. The hospitals are suggested to provide a safe environment by developing programs and policies to prevent and cope with hospital workplace violence for ICU nurses.

Inclusion of adolescent girls in HIV prevention research – an imperative for an AIDS‐free generation

Recent scientific advances centred on the use of anti-retrovirals (ARVs) – both prophylactically to prevent HIV acquisition (pre-exposure prophylaxis, or PrEP) and for treatment to minimize onward transmission (treatment as prevention, or TasP) – have led to a new-found optimism for control of the HIV/AIDS epidemic and the possibility of creating an “AIDS-free generation”. In order to translate this optimism into reality, large and sustained reductions in incident HIV infections are required. Several models have projected that with substantial programmatic scale-up of the new prevention agenda, such requirements can be satisfied. However, these models typically assume a uniform efficiency for interventions in reducing incident infections across populations, and neglect to consider their current unavailability to a key population driving the epidemic at its epicentre: adolescent girls. (Published: 8 March 2014) Citation: Abdool Karim Q and Dellar R. Journal of the International AIDS Society 2014, 17 :19075 http://www.jiasociety.org/index.php/jias/article/view/19075 | http://dx.doi.org/10.7448/IAS.17.1.19075

Why vulnerable young women at risk of HIV should be prioritized for access to preexposure prophylaxis

Why vulnerable young women at risk of HIV should be prioritized for access to preexposure prophylaxis

O09.3 A Successful Model in Reaching Out Mobile Population to Control the Spread of STI/HIV/AIDS: Experience from Link Worker Scheme Implemented in 200 Villages Mostly Inhibited by Mobile Population in West Bengal, India

The fact is that over 57% of the 2.9 million HIV positive people in India live in rural areas. India still has a rural base with 69% of its population...

P2.162 Health-Related Quality of Life and Biological Test Results as Predictors of Adverse Adolescent Pelvic Inflammatory Disease Outcomes

BackgroundAdolescents who experience pelvic inflammatory disease (PID) are highly likely to experience adverse reproductive health outcomes. Some adolescents might benefit from intensive clinical services to prevent recurrent disease and/or associated...

Persistence and partnerships: School nurses, inequalities and the HPV vaccination programme

This study examines the role of school nurses in the delivery of the HPV immunisation programme. A qualitative study, including 80 semi-structured interviews, was conducted with health professionals (primarily school nurses) from across the four UK nations. Interviews explored the role of the school nurse in the HPV programme and efforts to address health inequalities. Many school nurses were persistent and flexible when targeting vulnerable young women and addressing health inequalities. In addition, understanding why parents and girls rejected the vaccine and working in partnerships were central to addressing health inequalities in the HPV vaccination programme. School nurses are a valuable part of the workforce tackling health inequalities in young people. Persistence and partnerships improved school nurses’ ability to address health inequalities. Future vaccination programmes can benefit from better understanding how differences in the delivery of an immunisation programme affects uptake and health inequalities.

Doenças sexualmente transmissíveis em mulheres que sofrem crimes sexuais

Sexual violence can be associated with physical trauma, lethality, sexual disorders, unwanted pregnancy, psychological consequences and sexually transmitted diseases (STD). The STD feature high prevalence and incidence in women who suffer sexual violence. Its occurrence depends on the type and frequency of sexual exposures, injuries concomitant genital, age and the victim's susceptibility, condition of himenal membrane, presence of inflammatory STD or pelvic ulcer, and serological or viral load status of the perpetrator. Sex crimes reach particularly vulnerable young women, with damages for reproductive health including increased risk of infertility and anogenital cancer. This article presents the narrative literature review, with current aspects on the incidence and prevalence of different etiological agents of the STD, repercussions for reproductive health, and measures of drug prophylaxis after sexual exposure is consummated.

Researcher tales and research ethics: the spaces in which we find ourselves

The tales we tell here focus on the ethical issues arising from our research practice with vulnerable young participants and those for whom research has been inextricably linked with European imperialism and colonialism. The importance of relational obligations, temporality and potential for a continuing narrative approach to ethical research cannot be underestimated, and accordingly we recount our experiences in order to highlight these obligations as well as ethical tensions that we encountered. Importantly, our tales and the underpinning theorization suggest that Human Research Ethics Committees (HRECs) ‘perform’ their duties and make decisions to a pre‐ordained set of prescriptive standards that do not necessarily take into account the agency of vulnerable young people or Indigenous women.

Feasibility and potential acceptability of three cervical barriers among vulnerable young women in Zimbabwe

BackgroundWe explored the potential acceptability of three cervical barriers (CB) (Ortho All-Flex® diaphragm, SILCS® diaphragm, FemCapTM cervical cap) among sexually experienced Zimbabwean young women.MethodsForty-five young women (aged 16–21 years) received...

Young Women, Local Authority Care and Selling Sex: Findings from Research

Summary Researchers, practitioners and policy makers have noted the disproportionate number of young women with backgrounds of local authority care who are involved in commercial sex. However, the lack of knowledge about why this occurs means that there is little evidence with which to develop interventions. This article describes research that explored young women’s routes into the sex industry from local authority care using a feminist participatory action approach. The women’s life-story narratives demonstrate that the psycho-social legacies of their care experiences—how they defined themselves and placed themselves in the world—were instrumental in their entry into selling sex. From these themes, a framework for understanding young women’s involvement in commercial sex is drawn that traces young women’s paths from living in/leaving care to selling sex. The article includes discussion of the implications for social work practice with vulnerable young women and recommendations for interventions.

Red in the desert

<h3>Background</h3> Adolescents who experience pelvic inflammatory disease (PID) are highly likely to experience adverse reproductive health outcomes. Some adolescents might benefit from intensive clinical services to prevent recurrent disease and/or associated sequelae such as chronic pelvic pain (CPP). The objective of this study is to explore the relationship between health-related quality of life (HRQL) and baseline biological outcomes with subsequent reproductive health outcomes. <h3>Methods</h3> We conducted secondary analysis of longitudinal data from the 386 young women ≤ 21 years of age enrolled in the Pelvic Inflammatory Disease Clinical Evaluation and Health (PEACH) Trial. Demographic and reproductive health histories, SF-12 HRQL assessments, and biological samples for sexually transmitted infection (STI) testing (Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC)) were provided at baseline and follow-up research visits. Stepwise linear regression analyses were conducted to assess differences in HRQL over time, baseline HRQL and reproductive health outcomes, and baseline STI status and 32-month HRQL outcomes. <h3>Results</h3> There were significant improvements in mean physical health (PH) and mental health (MH) HRQL scores from 5-days to 32 months (PH: 61.7 vs. 79.4, MH: 58.3 vs. 68.6, p &lt; 0. 001). While the 5-day HRQL was not predictive of CPP at 32 months, women who had recurrent STI/PID over 32 months had lower 5-day mental health composite and physical functioning subscale scores. Women with non-GC/CT PID at baseline had lower 32-month HRQL composite scores for physical and mental functioning than those with GC/CT positivity at baseline. <h3>Conclusions</h3> Lower baseline HRQL scores are associated with recurrent STI/PID and non-GC/CT PID is associated with lower HRQL at 32 months. Additional work exploring the potential use of baseline biological STI outcomes and HRQL to enhance risk delineation during service delivery for vulnerable young women with mild-moderate PID is warranted.