Suchergebnisse

Globally, over 200 million women have been cut and are living with FGM/C-related consequences. In Africa, an estimated 27 million, 24 million, and 20 million girls/women have undergone FGM/C in Egypt, Ethiopia, and Nigeria respectively, the countries with the highest prevalence of FGM/C on the continent. In Nigeria, although the practice is considered widespread, national surveys suggest a gradual decline of FGM/C prevalence among women aged 15–49 years from 30 percent in 2008 to 20 percent in 2018. While these statistics suggest progress, the prevalence is still as high as 67 percent in some states. Nigeria's National Strategic Health Development Plan Framework highlighted the need to strengthen the health system to cater to an increasing population served by scarce skilled health professionals. Findings from this study show that the level of readiness of the health facilities to handle FGM/C-related complications is low as evidenced by poor infrastructure, lack of equipment, and limited human capacity. Improving the health system response in the prevention and management of FGM/C complications requires focused funding, political leadership, and better stakeholder coordination.

In Africa, it is estimated that 27 million, 24 million, and 20 million girls and women have undergone FGM/C in Egypt, Ethiopia, and Nigeria, respectively, making them the countries with the highest absolute numbers of women and girls living with FGM/C in the continent. Despite the existence of laws, policies, and plans of action that should drive the health system's response, the practice persists at a substantial level in Nigeria. The goal of the study, detailed in this working paper, was to contribute to a reduction in the prevalence and ultimately the abandonment of FGM/C through a diagnostic assessment of the health sector's response to FGM/C management and prevention in Nigeria and the identification of possible solutions for strengthening the existing response. The study explored how the health system implements the national policy and plan of action for FGM/C, and how the health-care sector supports the prevention and management of FGM/C-related complications to identify possible solutions for system strengthening. Findings suggest that improving the health system response in the prevention and management of FGM/C complications requires government ownership at all tiers.

Primary health care (PHC) is the first contact in a healthcare system and, at its core, includes access to basic interventions that address health needs at the community level. These basic interventions are provided by key frontline health workers—nurses, midwives, and community health extension workers—critical for facilitating immediate access to maternal, newborn, and child health services at PHC facilities. Despite the critical roles of these healthworker cadres, their distribution is uneven and skewed—geographic and within levels of care and governments, in addition to poor distribution of skills—compounded by high attrition due to poor human resources for health (HRH) management and development. The aim of this study is to examine the HRH hiring, deployment, and retention procedures and practices in Cross River and Bauchi states in Nigeria, to generate evidence to support the development of improved and gender-sensitive hiring and deployment guidelines. The study also provides recommendations for improved HRH planning and management for better service delivery.

AbstractIntroductionHIV self‐testing (HIVST) offers an alternative to facility‐based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment.MethodsA cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick® HIV antibody test) distribution to eligible MSM followed by a 3‐month follow‐up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits.ResultsThe median age of the participants was 25 years, 88.7% were literate and 17.9% were first‐time testers. Of the 257 participants (80.7% retention) who completed the three‐month follow‐up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self‐reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three‐month survey.ConclusionsHIVST distribution through KOLs was feasible and oral self‐testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self‐testing, this study showed that linkage to treatment can be achieved with active follow‐up and access to a trusted MSM‐friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

AbstractIntroductionTransgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria.MethodsIn‐depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services.Results and discussionThree main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender‐inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender‐inclusive and gender‐affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender‐inclusive CSO clinics.ConclusionsThis study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender‐inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender‐affirming HIV services.

As researchers have begun to adapt to the continuing presence of COVID-19, they have also begun to reflect more deeply on fundamental research issues and assumptions. Researchers around the world have responded in diverse, thoughtful and creative ways – from adapting data collection methods to fostering researcher and community resilience, while also attending to often urgent needs for care. This book, part of a series of three Rapid Responses, connects themes of care and resilience, addressing their common concern with wellbeing. It has three parts: addressing researchers' wellbeing, considering participants' wellbeing, and exploring care and resilience as a shared and mutually entangled concern. The other two books focus on Response and Reassessment, and Creativity and Ethics. Together they help academic, applied and practitioner-researchers worldwide adapt to the new challenges COVID-19 brings