Suchergebnisse

Community-based participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerged related to: Negotiating power imbalances between APs and the CAC; CAC members' shifting roles as part of the CAC and wider community; and anticipated challenges in decision making about sustainability. Factors contributing to ethical dilemmas included low access to education, scarcity of financial resources, and the shortage of HIV-related services despite high prevalence.

In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision‐making in the context of high rates of poverty and human immunodeficiency virus (HIV). Semi‐structured interviews were conducted with 34 adolescents. One‐third (13) reported religious coping related to economic stress, HIV, or sexual decision‐making; the majority (29) reported religious coping with these or other stressors. Adolescents reported praying to God to partner with them to engage in positive behaviors, praying for strength to resist unwanted behaviors, and passive strategies characterized by waiting for God to provide resources or protection from HIV. Adolescents in sub‐Saharan Africa may benefit from HIV prevention interventions that integrate and build upon their use of religious coping.

Armed conflict and forced migration are associated with an increase in intimate partner violence (IPV) against women. Yet as risks of IPV intensify, familiar options for seeking help dissipate as families and communities disperse and seek refuge in a foreign country. The reconfiguration of family and community systems, coupled with the presence of local and international humanitarian actors, introduces significant changes to IPV response pathways. Drawing from intensive fieldwork, this article examines response options available to women seeking help for IPV in refugee camps against the backdrop of efforts to localize humanitarian assistance. This study employed a qualitative approach to study responses to IPV in three refugee camps: Ajuong Thok (South Sudan), Dadaab (Kenya), and Domiz (Iraqi Kurdistan). In each location, data collection activities were conducted with women survivors of IPV, members of the general refugee community, refugee leaders, and service providers. The sample included 284 individuals. Employing visual mapping techniques, analysis of data from these varied sources described help seeking and response pathways in the three camps, and the ways in which women engaged with various systems. The analysis revealed distinct pathways for seeking help in the camps, with several similarities across contexts. Women in all three locations often "persevered" in an abusive partnership for extended periods before seeking help. When women did seek help, it was predominantly with family members initially, and then community-based mechanisms. Across camps, participants typically viewed engaging formal IPV responses as a last resort. Differences between camp settings highlighted the importance of understanding complex informal systems, and the availability of organizational responses, which influenced the sequence and speed with which formal systems were engaged. The findings indicate that key factors in bridging formal and community-based systems in responding to IPV in refugee camps include listening to women and understanding their priorities, recognizing the importance of women in camps maintaining life-sustaining connections with their families and communities, engaging communities in transformative change, and shifting power and resources to local women-led organizations.

Abstract
Purpose
Physically harsh discipline is associated with poor developmental outcomes among children. These practices are more prevalent in areas experiencing poverty and resource scarcity, including in low- and middle-income countries. Designed to limit social desirability bias, this cross-sectional study in rural Uganda estimated caregiver preferences for physically harsh discipline; differences by caregiver sex, child sex, and setting; and associations with indicators of household economic stress and insecurity.

Method
Three-hundred-fifty adult caregivers were shown six hypothetical pictographic scenarios depicting children whining, spilling a drink, and kicking a caregiver. Girls and boys were depicted engaging in each of the three behaviors. Approximately half of the participants were shown scenes from a market setting and half were shown scenes from a household setting. For each scenario, caregivers reported the discipline strategy they would use (time out, beating, discussing, yelling, ignoring, slapping).

Results
Two thirds of the participants selected a physically harsh discipline strategy (beating, slapping) at least once. Women selected more physically harsh discipline strategies than men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54). Participants shown scenes from the market selected fewer physically harsh discipline strategies than participants shown scenes from the household (b = -0.51; 95% CI, -0.69 to -0.33). Finally, caregivers selected more physically harsh discipline strategies in response to boys than girls. Indicators of economic insecurity were inconsistently associated with preferences for physically harsh discipline.

Conclusions
The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline.