Circumcision: its nature and practice among some ethnic groups in southern Nigeria

A questionnaire survey carried out in five rural communities in mid-southern Nigeria documents the degree and range of male and female circumcision practices among Bini, Esan, Etsako, Ijaw and Ukwuani ethnic groups. Two hundred and eighty adults (154 males and 126 females) reported on themselves and their 1417 children (757 sons and 660 daughters). Circumcision of both sexes remains widely practised, though the timing of the event and extent of surgery show wide variations among, and sometimes, within ethnic groups. The commonest reason for the practice is a strong desire to continue ethnic traditions. Altered sexual urge for women, increased sexual performance for men, protection of baby's health, as well as general reproductive and aesthetic consideration are also important reasons. Traditional surgeons usually perform the operation and few complications were reported to be associated with the procedure in either sex. Female circumcision in this area is not as destructive or mutilating as in some Arabic and East African cultures. Because of the relatively low rate of complications a major campaign against circumcision in these areas does not at present seem warranted.     

Assessment of health services for treatment of sexually transmitted infections among Nigerian adolescents

BACKGROUND: The available evidence indicates that Nigerian adolescents use various health practitioners for the treatment of sexually transmitted diseases (STDs). However, the quality of the STD treatment used by adolescents has not been investigated previously. GOAL OF THIS STUDY: To investigate the quality of services provided by health practitioners for the treatment and prevention of STDs among adolescents in Benin City, Nigeria. STUDY DESIGN: In-depth interviews were conducted with 48 formal and informal sector health practitioners who were identified by key informants as being the main providers of STD treatment in the city. Their facilities were visited to evaluate the quality of services they provide for STD treatment. RESULTS: Health providers in the informal sector showed inadequate knowledge of the appropriate treatment methods for STDs. Although providers in the formal sector had better knowledge, they lacked appropriate management guidelines and were poorly oriented to the problems of STDs in adolescents. There was consensus among the health providers that adolescents most frequently use informal treatment for STDs. Nevertheless, among all providers, there was evidence of inadequate counseling of adolescents, a poor attitude toward the promotion of condom use, and inadequate use of referral opportunities. CONCLUSIONS: Comprehensive public health measures are needed to address these problems in Nigeria. These include the provision of reproductive health education for adolescents, the retraining of health providers, and the consolidation of services for the prevention and treatment of STDs.     

Sexual Debut Among Heterosexual Men of African and Caribbean Descent: Are the Youth Initiating Sex Earlier than the Older Generation?

Although age at first sex is considered a measure of sexual risk and vulnerability for HIV infection, there is a dearth of literature on age at sexual debut in the Canadian context. This study examined time variations to first sex among heterosexual African, Caribbean, and Black (ACB) men in four Ontarian cities. A population-based retrospective survey (n?=?879) on timing to first sexual intercourse was conducted between 2018 and 2019 among self-identified heterosexual ACB men 16 years or older and residing in London, Ottawa, Toronto or Windsor. We used the lognormal survival analysis technique to examine variations in time to first sexual intercourse among age cohorts and between cities. The findings showed a generational shift in the pattern of sexual initiation, with younger heterosexual ACB men initiating sexual intercourse earlier compared with those currently older than 50 years. We observed those between 16 and 19 years, 20 and 29 years, and 30 and 39 years of age to have significantly higher risk ratios of TR?=?0.852, TR?=?0.869, and TR?=?0.855, respectively. At city level, the results show marked spatial variations, with youth in cities of Toronto, Ottawa, and London at the highest risk of early sexual debut relative to those in Windsor. Early initiation of first sexual intercourse among heterosexual ACB youth was observed with those in the larger cities being at a relatively higher risk. There is the need for programs aimed at delaying sexual debut among youth in general. It is, however, important to recognize the relative risk of those in the larger cities.

     

The socio-cultural context of health behaviour among Esan communities, Edo State, Nigeria

This paper reports on health beliefs and their influence on treatment decisions and behaviour among the Esan people of mid-west Nigeria. The sources for the study are my own experience of growing up in Esan society, anthropological field work, and focus groups. The research revealed a transitional society where both traditional and modern medicine are employed and where the choice between them is determined by belief systems which are themselves in the process of change, as well as by distance and costs. The traditional health-belief system was one which placed most responsibility and blame upon women, and a system of social control over the adult female population. Changing health beliefs are less the result of the introduction of a new health philosophy than of the retreat, under the impact of Christianity, of traditional religion which embodied the older health philosophy.     

Advancing research for HIV prevention among African,Caribbean and Black men: Protocol for a multisite cross-sectional study in Ontario (weSpeak study)

In Ontario, African, Caribbean, and Black (ACB) men account for almost 60% of the estimated number of HIV-positive people (through heterosexual contact), although they constitute less than 5% of the province''s population. However, current HIV research, programming and policy in Ontario are not aligned with heterosexual ACB men''s healthcare needs and interests, and fail to engage them in community responses to HIV.weSpeak is a multisite (Ottawa, Toronto, London, and Windsor) project that is aims to:

• 1.assess the sociocultural and socio-political conditions that contribute to HIV related health disparities among ACB men,
• 2.examine social and behavioral vulnerabilities to HIV among ACB men, including their social identities related to race, class, gender and sexualities,
• 3.community engagement and mobilization part of the project, and
• 4.generate, appraise and share new knowledge, and support its translation into intervention and practice.

This will be a mixed method study comprising focus groups, in-depth interviews, and a survey to meet the data objectives. All data collection activities will take place at the same time in 4 cities in 3 sequential phases:

• 1.focus groups,
• 2.in-depth interviews, and
• 3.a questionnaire survey.

Service providers will participate in the concept mapping exercise to review the research findings and develop program, policy, and community-based initiatives to promote resilience and meaningfully engage heterosexual ACB men in community responses to HIV survey.This study will provide evidence on:

• 1.heterosexual ACB men''s experience of structural disadvantage and psychological factors is associated with HIV vulnerability.
• 2.heterosexual ACB men with greater internal resilience and social resources show greater risky behaviors, and
• 3.a conceptual Model of HIV vulnerability linking the potential internal and external factors that interact to influence HIV vulnerability.

This study will lead to better understanding of the structural determinants and the psychosocial risk factors of HIV transmission among ACB men in Ontario which will aid in designing evidence-based intervention programs, and thereby reduce their higher vulnerability to HIV and its associated consequences.     

HIV vulnerability and sexual risk among African youth in Windsor, Canada

This paper reports on an exploratory study of the sexual behaviour of young Africans living in Windsor, Canada. Twenty-five face-to-face interviews were conducted with thirteen men and twelve women aged 18 to 25 years. Data analysis enabled the identification of four main themes: awareness and concerns about STIs/HIV; partner's influence on negotiating sex or discussing sexual matters; effects of migration and availability of healthcare on perceptions of own risk and assumptions about HIV prevalence in Canada; and discomfort talking about sex. Findings highlight the influence of gender power in determining the nature of sexual activities and outcomes, as well as risky sexual behaviours. Future actions to decrease HIV transmission in Canada should address these issues in ways that are culturally sensitive and culturally inclusive.     

What Do Medical Students Do for Self-Care? A Student-Centered Approach to Well-Being

Phenomenon: Despite the promotion of medical student health and wellness through recent program and curricular changes, research continues to show that medical education is associated with decreased well-being in medical students. Although many institutions have sought to more effectively assess and improve self-care in medical students, no self-care initiatives have been designed using the explicit perspectives of students themselves. Approach: Using concept mapping methodology, the research team created a student-generated taxonomy of self-care behaviors taken from a national sample of medical students in response to a brainstorming prompt. The research team examined how students’ conceptualizations of self-care may be organized into a framework suitable for use in programming and curricular change in medical education. Findings: Ten clusters of self-care activities were identified: nourishment, hygiene, intellectual and creative health, physical activity, spiritual care, balance and relaxation, time for loved ones, big picture goals, pleasure and outside activities, and hobbies. Using results of the two-dimensional scaling analysis, students’ individual self-care behaviors were organized within two orthogonal dimensions of self-care activities. Insights: This concept map of student-identified self-care activities provides a starting point for better understanding and ultimately improving medical student self-care. Students’ brainstormed responses fit within a framework of varying levels of social engagement and physical-psychological health that included a wide range of solitary, social, physical, and mental health behaviors. As students’ preferred self-care practices did not often include programmatic activities, medical educators may benefit from consulting this map as they plan new approaches to student self-care and in counseling individual students searching for more effective ways to ease the burdens of medical school.     

What does a decolonizing/decentralizing methodology in examining sexual lives entail?

This paper is based on an international study, HIV Prevention for Rural Youth (HP4RY) 2008-2012, designed to examine the state of, and teach about, sexual health and HIV/AIDS in Edo State, Nigeria. The paper focuses on the mixed methods used in this study, paying attention to the meaning of collaboration and participation in research in a cross-continental setting. Additionally, the paper considers the complexities of engaging in decolonizing and respectful methodological approaches in these settings. Drawing on specifics from the mixed methods and details from the relevant literature, this paper demonstrates the continued need for cross-continental decolonization and decentralized engagements, specifically when dealing with sensitive topics like sexuality and HIV/AIDS. .     

The use of National Youth Service Corp members to build AIDS competent communities in rural Edo State Nigeria

This paper focuses on the community component of a larger action research project on HIV Prevention for Rural Youth (HP4RY), funded by the Global Health Research Initiative (Canada). It began with ethnographic research in 10 communities selected using geographic representative sampling and random assignment to one of three research arms. Using the AIDS Competent Community (ACC) model developed by Catherine Campbell, the ethnographic research identified factors in six domains that contributed to youth vulnerability to HIV infection. This was followed by recruitment, training and deployment of three overlapping cohorts of young adults (n = 40) serving in Nigeria's National Youth Service Corp (NYSC), to mobilize youth and adults in the communities to increase communities' AIDS competence over a nearly 2 year period. Monthly reports of these Corpers, observations of a Field Coordinator, and community feedback supported the conclusion that communities moved towards greater AIDS competence and reduction in youth vulnerability to HIV infection.