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Background Despite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking. Methods Using Noblit and Hare’s meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass’ notion of first-, second-, and third-order constructs. Results The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. Conclusions Improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA.

Background In Nigeria, many young girls are engaged in commercial sex work as a means of livelihood and support of dependent relatives. Although studies have documented some of the violence related issues among commercial sex workers, the plight of adolescent and young sex workers particularly in urban slums may be different in context and depth. Objective This study explored the lived experiences of violence and health related harm among vulnerable young female sex workers in urban slums in Ibadan and Lagos, Southwest Nigeria. It also analyzed their coping strategies and survival mechanisms. Design The study is cross-sectional and applied an interpretive phenomenological approach to this qualitative study through in-depth interviews. Participants Young female sex workers ages (15–24 years) who reported having experienced violence were recruited for the study. Twelve participants completed the interviews out the 20 initially contacted. Data collection and analysis Primary data were collected using in-depth interviews (IDIs). Data were transcribed using a phenomenological framework analysis. Participants’ reports based on life experiences were identified: lived experience “daily brothel life experience”; sources of violence such as law enforcement agents’ intermittent raids; violence experience with clients who often demanded sexual acts beyond the agreed scope; and coping strategies employed to mitigate the challenges. Settings The study was conducted in brothels of two selected slum areas in Ibadan and Lagos, Southwest Nigeria. Results The results showed that the major motivation for engaging in commercial sex work was for economic reasons. However, there are inherent risks involved particularly for the vulnerable young people. Stigmatization from the community, clients’ uncontrolled-aggressive behavior and harassment from law enforcement agents are some of the frequent violence experiences reported. Self-help coping strategies are usually employed to prevent or mitigate the challenges. Conclusion The plight of this young people required policy and program attention towards alternative economic empowerment to rehabilitate those willing to leave the profession. Also the need to develop arm reduction interventions towards protection of young sex workers against violence.

Wild edible fruits from the forest have often been regarded as poverty food; however, there has been a notable shift in recent years as these wild edible fruits have gained increasing recognition for their significance in global food security, especially in agricultural societies such as Senegal. This paper contributes to the debate on how the forest plays a role in diets and nutrition security using the example of wild fruit (Baobab) found in the Boundou Region in Senegal. The livelihood strategies of people in this region have been subject to external influences, such as climate shock and restrictions enforced as the area became a protected area in 2009. These external influences have resulted in the loss of pasture use and the prohibition of hunting. Restriction of access to these previous commons (pasture, wildlife) diminishes the resilience of the local population. However, a new alternative of seasonal usage of wild fruit, specifically baobab, for commercial purposes has emerged as everybody in the community has unrestricted access to collecting these wild edible fruits within the protected area, which is uncommon in other protected areas. The commodification and commercialization of these wild fruits bring essential cash income to many households, thereby improving food security.

Background Over the past decade, awareness and use of emergency contraceptive pills (ECPs) among young women has rapidly increased in Ghana; however, the rate of unintended pregnancy among this group remains high. We conducted a qualitative study to better understand the context and patterns of ECP use among young unmarried women in Ghana. Methods We conducted in-depth interviews with unmarried sexually active women aged 18–24 in Accra, Ghana to explore their perceptions, experiences, and opinions regarding sexual relationships and contraceptive methods, and to examine the factors that influence choice of ECPs. A total of 32 young women participated in the study. Results Most participants had used ECPs at least once. Participants described being unable to plan for sexual encounters, and as a result preferred ECPs as a convenient post-coital method. Despite being widely and repeatedly used, women feared the disruptive effects of ECPs on the menstrual cycle and were concerned about long-term side-effects. ECPs were sometimes used as a back-up in cases of perceived failure of traditional methods like withdrawal. Misinformation about which drugs were ECPs, correct dosage, and safe usage were prevalent, and sometimes spread by pharmacists. Myths about pregnancy prevention techniques such as urinating or washing after sex were commonly believed, even among women who regularly used ECPs, and coincided with a misunderstanding about how hormonal contraception works. Conclusions ECPs appear to be a popular contraceptive choice among young urban women in Ghana, yet misinformation about their correct usage and safety is widespread. While more research on ECP use among young people is needed, these initial results point to the need to incorporate information about ECPs into adolescent comprehensive sexuality education and youth-friendly services and programmes.

ObjectiveIn the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP.DesignLongitudinal study.SettingA community-based approach was used to investigate FP use in the North and South-Kivu regions.ParticipantsOverall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up.Primary and secondary outcomesFP use and intention to use FP.ResultsThe mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=−0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052).ConclusionTPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.

A truly resilient public health system is one that incorporates the public as a key stakeholder in this preparation [16–18]. [...]engaging the public in EP involves educating communities, promoting a culture of preparedness. Trust facilitates the positive reception of accurate information and the negative reception of mis/disinformation, which undermines emergency response efforts [17,19,20]. [...]by involving local communities in the planning process of EP, authorities can harness local knowledge and insights, which are valuable for the creation of locally relevant EP measures [21–23]. [...]the advancements highlighted within these pages serve as a foundation for future work. 6.HsuY-CChenY-LWeiH-NYangY-WChenY-H.Risk and Outbreak Communication: Lessons From Taiwan’s Experiences in the Post-SARS Era.Health Security(2017)15(2):165–9.10.1089/hs.2016.0111 7.AttademoG.International Efforts Against the Infodemic: Some Bioethical Reflections.Medicina e Morale(2022)71(1):69–78.10.4081/mem.2022.1200 8.SpitaleGBiller-AndornoNGermaniF.Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach.J Med Internet Res(2022)24(2):e34385.10.2196/34385 9.GrandeDMitraNLuna MartiXMerchantRAschDDolanAConsumer Views on Using Digital Data for COVID-19 Control in the United States.JAMA Netw Open(2021)4:e2110918.10.1001/jamanetworkopen.2021.10918 10.FagherazziGGoetzingerCRashidMAAguayoGAHuiartL.Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers.J Med Internet Res(2020)22(6):e19284.10.2196/19284 11.WilhelmEBallalaiIBelangerM-EBenjaminPBertrand-FerrandisCBezbaruahSMeasuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference.JMIR Infodemiology(2023)3(1):e44207.10.2196/44207 12.WillaertTVan EeckePBeulsKSteelsL.Building Social Media Observatories for Monitoring Online Opinion Dynamics.Social Media Soc(2020)6.10.1177/2056305119898778 13.SpitaleGGermaniFBiller-AndornoN.The PHERCC Matrix.

ObjectiveThe aim of this study is to improve the understanding of the characteristics of health system resilience in Myanmar’s response to Cyclone Nargis and to explore ways to improve resilience at the system level.Design and settingThis is an explanatory qualitative study exploring the institutional capacity of resilience in Myanmar’s health system. Analysis proceeded using a data-driven thematic analysis closely following the framework method. This process enabled comparisons and contrasts of key emergent themes between the participants, which later generated key results describing the foundational assets, barriers and opportunities for achieving resilience in Myanmar.ParticipantsThe study comprised of 12 in-depth interviews conducted with representatives from international organisations and non-governmental organisations (NGOs). The inclusion criteria to recruiting the participants were that they had directly been a part of the Cyclone Nargis response at the time. There was a balanced distribution of participants across UN, bilateral and NGOs, and most of them were either Myanmar citizens or expatriates with extensive working experience based in Myanmar.ResultsKey findings elucidate the characteristics of resilience that have been salient or absent in Myanmar’s response to Cyclone Nargis. Strong social capital and motivation propelled by its deep-rooted culture and religion served as Myanmar’s greatest assets that filled major gaps in the system. Meanwhile, its postcolonial and military legacy posed barriers towards investing in building its long-term foundations towards resilience.ConclusionsThis study revealed that resilience in the health system can be built through strategic investments towards building the foundations of resilience to better prepare for future shocks. In the case of Myanmar, social capital and motivation, which surfaced as its foundational assets, can be channelled into opportunities that can help achieve its long-term health goals, accelerating its journey towards resilience in the health system.

This paper examines changes in formal and informal land access rules for women in the Kafue Flats of southern Zambia and identifies alternatives to land privatization. In rural African communities dependent on subsistence production, access to common pool resources (CPRs) such as fisheries, wildlife or wild fruits made an important contribution to household food and nutritional security. In the pre-colonial period, the use of agricultural land and associated CPRs was governed by local institutions of common property, characterized by more-than-human relationships embedded in the local animistic ontology. To examine how women’s pre-colonial access rights were increasingly disregarded in the wake of new statutory laws, we analyzed qualitative ethnographic data on livelihoods and food security from three time periods between 2002 and 2018. The findings show how customary law land tenure has remained important, despite being complemented by statutory law designed to also protect women’s property rights. We conclude that women’s customary access rights to land and CPRs must be taken into account in the drafting of formal legislation, as suggested by successful examples of bottom-up institution building in other regions.

Background In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men’s sensitization on gender equity and women’s empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level. Objective This study assessed how involving men in gender equity affects women’s health and socio-economic outcomes, including food security. Methods A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run. Results Results showed that the household income improved with intervention (coefficient = 0.327; p  = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p  = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p  = 0.135), or family planning use (coefficient = 0.216; p  = 0.435) nor women’s participation in the decision-making (coefficient = 0.033; p  = 0.227) nor on couple’s cohesion (coefficient = 0.024; p  = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area. Conclusion Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women’s participation in decision-making and social cohesion.

Background Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia. Method A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10–19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables. Results The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29–2.70)], being in school [AOR = 2.38(CI: 1.05–5.41), better family income [AOR = 10.92 (CI; 7.10–16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35–16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02–3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake. Conclusion Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. “Gender-culture-context-appropriate” interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.