War and HIV: Sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District,Northern Uganda

Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15–29 years old in Gulu District. Biological specimens were collected for rapid and confirmatory HIV testing. Separate multivariable logistic regression models by sex identified risk factors for HIV infection. HIV prevalence was 15.6% (95% confidence interval [CI]: 10.8%, 21.6%) among females and 9.9% (95% CI: 6.1%, 15.0%) among males. The strongest correlate of HIV infection among men was a non-consensual sexual debut (adjusted odds ratio [AOR] 3.24; 95% CI: 1.37–7.67), and having practiced dry sex (AOR 7.62; 95% CI: 1.56–16.95) was the strongest correlate among women. Conflict-affected men and women experience vulnerability to HIV infection in different ways than may have originally been understood. Post-conflict programme planners must therefore design and implement contextualised, evidence-based responses to HIV that are sensitive to gender and cultural issues.     

Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda

Abstract

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one′s body and future. Women′s experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women’s sexual and reproductive health needs and protect their rights. Enabling young women’s agency through access to safe abortion and contraception is paramount.     

不同性别务工青少年生殖健康状况分析

目的 了解15～24岁不同性别进城务工青少年的性与生殖健康知信行状况及影响因素。方法 采用自编结构式匿名问卷对山东省济南市1075名15～24岁进城务工青少年进行自填式问卷调查。结果 男性与女性进城务工青少年的性与生殖健康知识水平均较低,尤其流产相关知识,男性得分中位数仅25.0分;35.0%的男性认为只要双方愿意就可以发生婚前性行为,高于女性的16.1%;面对恋人性要求,男性坚持不发生性行为的比例(18.1%)远低于女性(53.1%),差异有统计学意义(χ²=141.704,P<0.001);30.7%的调查对象自我报告发生过性行为,其中男性为40.1%,女性为23.7%,差异有统计学意义(χ²=29.385,P<0.001);不同性别进城务工青少年发生婚前性行为的共同影响因素为年龄、文化程度、对避孕的态度;女性还与对婚前性行为的看法、对恋人性要求的处理方式有关。结论 为进城务工青少年提供性与生殖健康教育及服务时应考虑性别差异。     

Hard boys, attractive girls: expressions of gender in young people's conversations on smoking in Northern Ireland

Health behaviour and attitudes among young people can be interpreted within the context of personal and social identity. This paper explores ways in which 10- to 11-year-olds in Northern Ireland expressed perceptions of gender ideology while discussing the topic of smoking. The data were gathered by means of in-depth interviews (n=85). Although few had tried smoking, the positive quality of their own gender appeared to be expressed through negative assessment of smokers of the opposite gender, and on different ideas of perceived gender dimensions in adult smoking. In order to deliver successful health promotion interventions, it is crucial to understand and address differences based on gender as it may partly explain differences in smoking experimentation and prevalence.     

Critical regionalities and the study of gender and sexual diversity in South East and East Asia

This paper argues the case for critical regional enquiries in East and South East Asia into the study of gender and sexual diversity. The concept of 'regions' is here seen as a partial and provisional way of describing both the various ways in which an area of the world is imagined as being separate and distinct, and of describing the flows of people, goods and ideas through which a particular region or world area is made. Further, it is suggested that the idea of regions is a theoretically and politically necessary fiction. On the one hand, a critical regional perspective provides a vantage point from which to problematize naive and uncritical writing on globalization, including the 'globalization' of gender and sexual identities. On the other hand, it enables us to think about the wider networks of material and symbolic relations within, and through which, gender and sexuality are made and experienced in particular locales.     

Gender and sexual vulnerability of young women in Africa: experiences of young girls in secondary schools in Uganda

Sexuality is part and parcel of students' experiences of schooling manifested in personal friendships, relations and social interaction. These encounters constitute sites within which sexual identities are developed, practiced and actively produced through processes of negotiation. Drawing on qualitative research conducted in 14 selected secondary schools in Central and Western Uganda, the study illuminates gendered sexual vulnerability within patterns of social interaction and young girls gendered experiences and negotiation of their sexuality. The study reveals that through social and discursive practices, students construct complex gendered relations of domination and subordination that position boys and girls differently, often creating gender inequalities and sexual vulnerability for those gendered as girls. Girls' vulnerability is characterised by confusing and traumatic experiences fraught with double standards and silences. Typical of these experiences are complex tensions and contradictions surrounding constructions of sexuality that are predicated upon unequal power and gender relations characterised by homophobia, misogyny, control of female sexuality and sexual abuse and exploitation, all which work against girls' expression of sexuality. Gender sensitive sexuality education is identified as a valuable site of intervention to address such vulnerabilities and promote gender equality and equity in society.     

Young people, gender and smoking in the United Kingdom

Over the last decade, gender has emerged as a significant differentiatorof smoking prevalence among young people in developed countries.Some attention has also been given to gender difference.s inmotives for taking up smoking. Compared to recent work on adultsmoking, the literature on smoking among young people has failedto take up the challenge of the analysis of gender differencesto highlight an interpretation of young people's smoking asa rational response to material and social pressures. This paperdraws mainly on questionnaire data from an ongoing UK studyof Adolescent Health and Parenting to outline an alternativeto the usual health education approach to young people's smoking.in this alternative model, the main factors associated withyoung people's smoking are material circumstances, life satisfactionand stress, including dissatisfaction with parental relationships,and peer sociability. Smoking is associated with poor reportedhealth status. The relationship between social factors and smokingin young men and women shows some significant differences, withyoung women being significantly more likely to smoke for stress-relatedreasons. Qualitative materialfrom a follow-up interview studyis indicative of the processes underlying the statistical associationsfound in the questionnaire     

Designing sexual health services for young people: a methodology for capturing the user voice

The aim of the study was to assess the suitability of the Thurstone paired comparison method for capturing the user voice, through a survey of young people's views on the most salient priorities for a sexual health service. A convenience sample of 161 12–24 year olds was used. A psychometrically robust questionnaire was developed from a review of the relevant literature and from the information provided by three focus groups. The data derived from both stages were distilled into seven themes, and adapted to a Thurstone paired comparison format, in which each theme was paired with every other theme, with an 8-point scale between each pairing (21 pairings in total). Respondents were required to indicate their preference for one theme over the other in each pairing. The questionnaire was completed by 161 young people between April and July 2007, and the results were analysed using the Kendall coefficient of concordance to establish the degree of within-group agreement. The results suggested that there was significant agreement as to the essential desirable features of a sexual health service, both within the whole sample as well as within sub-samples (i.e. gender, age group and previous sexual health service use). The priorities were privacy, and a dedicated service close to home, with a drop-in facility and male and female staff being next most important, and an informal service and young staff being lowest priorities. The feedback from the pilot study, the 40% return and absence of spoiled questionnaires together indicated that the respondents found the method acceptable, while the actual findings corroborated those from other studies. Taken together, these results suggest that the Thurstone method offers a quick and simple method of capturing the user voice, with the results having sufficient validity to inform the planning of a local sexual health service.     

The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania

This paper explores the structural role of the family and parenting in young people's sexual and reproductive health. The study involved eight weeks of participant observation, 26 in-depth interviews, and 11 group discussions with young people aged 14–24 years, and 20 in-depth interviews and 6 group discussions with parents/carers of children in this age group. At an individual level, parenting and family structure were found to affect young people's sexual behaviour by influencing children's self-confidence and interactional competence, limiting discussion of sexual health and shaping economic provision for children, which in turn affected parental authority and daughters' engagement in risky sexual behaviour. Sexual norms are reproduced both through parents' explicit prohibitions and their own behaviours. Girls are socialised to accept men's superiority, which shapes their negotiation of sexual relationships. Interventions to improve young people's sexual and reproductive health should recognise the structural effects of parenting, both in terms of direct influences on children and the dynamics by which structural barriers such as gendered power relations and cultural norms around sexuality are transmitted across generations.     

Old ideals and new realities: the changing context of young people's partnerships in Cebu,Philippines

The Philippines has experienced rapid sociodemographic changes in recent years, with implications for young people. This study combines quantitative and qualitative data from Metro Cebu to assess the timing and predictors of young people's partnerships, as well as the context in which these partnerships are occurring. The majority of young people (54%) had premarital sex, though this pattern varied by gender. Wealthier, urban young men, and women with less education and lower reported religiosity, were more likely to have premarital sex. Engagement in risk behaviours was predictive of premarital sex for both males and females. The qualitative data contextualise the circumstances under which young people engage in sex and form partnerships and illustrate how sociocultural norms contribute to gender differences in partnership patterns. Given the ‘new’ realities of young Filipinos' lives, targeted efforts to support the transition to adulthood are needed to avert potentially adverse life events.     

Nae job,nae future: young people and health in a context of unemployment*

There is increasing concern about the health, particularly mental health, of young people and the factors that affect it. Drawing on data from the West of Scotland Twenty-07 Study: Health in the Community, this paper describes the pattern of health in a cohort of about 1000 young people between the ages of 15 and 21, within a context of their experience and expectations of unemployment. Contrary to assumptions of healthiness, high levels of poor physical and mental health were found, with a third of males and two-fifths of females exhibiting evidence of psychological morbidity at age 18. Poorer mental health was strongly linked to the experience of unemployment and being at home, the latter predominantly involving females. This effect was confirmed in multivariate analysis, which controlled for prior health. In addition, an expectation of being unemployed in the future was associated with poorer mental health. For many young people entering the labour market, the prospects of limited employment opportunities and associated risks to health are a major public health concern. In setting their needs firmly on the policy agenda, and planning appropriate services, these broader social issues should not be forgotten.     

Ideologies of sexuality,menstruation and risk: girls' experiences of puberty and schooling in northern Tanzania

This paper examines girls' voiced experiences of menstruation, puberty and schooling in northern Tanzania. The study was conducted in Moshi and Rombo Districts of Kilimanjaro, a predominantly Chagga region with historically strong support for girls' education. The major question explored was how the onset of menses and puberty may be impacting on girls' school participation, given societal implications of pubertal onset and potentially gender discriminatory school environments. The methodology included a comparative case study using in‐depth interviews and participatory research with young women living in urban and rural Kilimanjaro. Along with important findings about how menstrual onset creates challenges for girls attending school emerged findings about the significant gaps in girls' knowledge about body changes, sexual health and HIV/AIDS. These findings underline the importance of identifying new girl‐centred approaches to guidance on bodily development and HIV prevention.     

Making choices about medical interventions: the experience of disabled young people with degenerative conditions

Background Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children’s role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents’ perspectives. Objective To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision‐making processes. Design and methods Findings from a longitudinal qualitative study of 10 young people (13–22 years) with degenerative conditions are reported. Individual semi‐structured interviews were conducted with participants over 3 years (2007–2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Results Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Discussion Young people’s experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as ‘irreversible’ and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working.     

Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK

This article considers the relevance of the notion of ontological security – a sense of order, stability, routine and predictability to life – to contemporary conceptualisations of wellbeing. Drawing on in‐depth interviews with unaccompanied young people seeking asylum in the UK, it demonstrates how a positive sense of self and being able to visualise a place and role in the world into the future were integral to their notion of wellbeing, offering an important counter to the pervasive sense of living in limbo. The article argues that this fundamental need for a projected self is largely neglected in contemporary discussions on wellbeing. To date the idea of security as a determinant of wellbeing has been primarily constructed around the notion of protection from harm and the provision of the requirements for physical, emotional, economic and social wellbeing in the here and now. Findings from this research suggest that those providing services and support to young people who have experienced trauma need to consider how they might best nurture in them a sense of place, belonging and security into the future. Equally, they have implications for how we conceptualise and operationalise wellbeing more generally.     

Young people, HIV/AIDS and the promotion of sexual health

In the lay and professional literatures on HIV and AIDS, youngpeople are frequently characterized as being at high risk ofinfection. Their social immaturity, their spontaneity, theiremotional volatility and their propensity to risk-take is saidto render them specially vulnerable. This paper questions theappropriateness of such a view and argues for a more sociallydifferentiated understanding of young people and their HIV/AIDShealth promotion needs. It reviews aspects of relevant Europeanepidemiology, describes dominant ideologies of youth and adolescenceand their impact upon HIV/AIDS work, and identifies key implicationsfor policy and practice.     

The experiences of young people with obesity in secondary school: some implications for the healthy school agenda

In 1995, the World Health Organisation launched a Global School Health Initiative to reduce health risks among young people. In the UK, the National Healthy School Programme (HSP) developed as part of a wider government commitment to promoting social inclusion. One of the key issues to be tackled by the programme is childhood obesity, for obesity is widely argued to be a public health problem for which a solution needs to be found. However, the assumption that obesity is necessarily problematic and that a higher body weight leads to health problems and social exclusion, is not without challenge. Critics of anti-obesity campaigns question the significance of weight per se and highlight the potential implications of discrediting not only fatness, but also the people who are seen as fat. This paper therefore explores the experiences of young people with obesity within the secondary school environment in relation to areas of concern prioritised by the HSP. The paper draws upon data from a qualitative research study involving 18 children and young people, between the ages of 10 and 17. Data were generated in focus group discussions and individual interview with participants of a community-based obesity intervention programme in South Yorkshire, UK. Data collection took place in 2005, and thematic analysis of the data was undertaken. Findings suggest that the issues prioritised in the HSP, particularly physical exercise and healthy eating, present challenges to young people with obesity and can reinforce their vulnerability to bullying in schools and contribute to their social exclusion. It concludes that social exclusion is a process experienced by, and pertinent to, children and young people, which has meaning for their experiences of, and during, childhood and youth. The whole-school approach of the HSP may fail to adequately address the experiences of marginalised and vulnerable groups of young people within schools, challenging and undermining the social inclusion agenda in which the programme is grounded and contributing to the construction of undesirable, fat, young bodies.     

A qualitative study exploring the benefits of involving young people in mental health research

Introduction

It is increasingly accepted that young people need to be centrally involved in research on issues that affect them. The aim of this study was to explore young people's perceptions of the benefits for them of being involved in mental health research and the processes that enabled these benefits.

Methods

Qualitative interviews were conducted by co-researchers (young people with lived experience and/or interest in mental health) with 13 young people (aged 13–24 years) who had experience of being involved in mental health research when they were between 11 and 16 years of age. Reflective thematic analysis was used to identify important aspects of young people's experiences.

Results

Four main themes were identified: (1) opportunity to have a meaningful impact, (2) opportunity to be part of a supportive community, (3) opportunity to learn and grow and (4) increasing opportunities for young people.

Conclusion

This study highlights young people's experiences of being involved in mental health research and identifies ways in which researchers can ensure that involvement opportunities bring benefits to both the young people and the research.

Patient or Public Contribution

This research was a response to issues raised by young people involved in research. The project was supported by co-researchers throughout, including design, data collection, analysis and write-up.     

Lessons learned from engaging men in sexual and reproductive health as clients,partners and advocates of change in the Hoima district of Uganda

This study examined the impact of a three-year intervention project conducted in the Hoima district of Uganda, which sought to engage men in sexual and reproductive health as clients, equal partners and advocates of change. Structured surveys with 164 self-reported heterosexual men aged 18–54 years were used to assess knowledge and attitudes towards sexual and reproductive health. Data from these were analysed using Stata and SPSS. Additionally, five focus groups were conducted with the female partners and male beneficiaries of the project and with project peer educators. Four interviews were conducted with project staff and male beneficiaries. Data from these and the focus groups were analysed using a thematic approach. Following the intervention, a significantly greater number of men accessed, and supported their partners in accessing sexual health services services, had gained sexual and reproductive health awareness, reported sharing domestic duties and contraceptive decision-making, and displayed a decreased tolerance for domestic violence. It was more difficult to assess men's involvement and behaviours as advocates of change, which sheds light on the complexities of a gender transformative project and the importance of evaluating such projects from both men's and their partners' perspectives and at different levels of the male involvement model in sexual and reproductive health.