The Ethics of Nurse Poaching From the Developing World

Recruiting nurses from other countries is a long-standing practice. In recent years many countries in the developed world have more frequently recruited nurses from the developing world, causing an imbalance in the health services in often already impoverished countries. Despite guidelines and promises by developed countries that the practice should cease, it has largely failed to do so. A consortium of authors from countries that have experienced significant nurse poaching consider the ethical aspects behind this continuing practice

Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort.

OBJECTIVE: To investigate whether the incidence of HIV infection is higher among sexually active women using depot medroxyprogesterone acetate (DMPA) or noresthisterone enanthate (NET-EN) injections for contraception than among women using nonhormonal or no contraception. METHODS: Five hundred and fifty-one initially HIV-negative women were followed up for a total of 491 person-years. Participants were interviewed, counselled, examined, tested for HIV and other STIs, and treated, at three monthly intervals for 1 year. RESULTS: There was no significant association between progestin contraceptive use and HIV infection (rate ratio 1.1, 95% CI 0.5 to 2.8; log-rank test, p=.73). In proportional hazards regression, the only significant hazard ratios for HIV acquisition were prevalent Neisseria gonorrhoea (5.2; 95% CI 1.1 to 23.7, p=.035) and Trichomonas vaginalis (4.8; 95% CI 1.0 to 22.8, p=.049); bacterial vaginosis was marginally significant (2.8; 95% CI 1.0 to 8.3, p=.057). The adjusted hazard ratios for NET-EN and DMPA were 1.76 (95% CI 0.64 to 4.84) and 0.46 (95% CI 0.06 to 3.79), respectively, relative to nonuse. Five hundred and twelve of 551 women had one or more confirmed STIs during the study. CONCLUSIONS: There is no evidence of an association between HIV infection and injectable contraceptives. Due to the limited power of this study and because similar studies have not included young women using NET-EN, we recommend that further research be carried out to focus on the use of NET-EN and HIV acquisition in high risk groups

Assessment of Service Availability and Health Care Workers' Opinions about Young Women's Sexual and Reproductive Health in Soweto, South Africa

Young women in South Africa experience high HIV and unintended pregnancy rates. Health care workers' (HCWs') opinions about sexual and reproductive health (SRH) issues impact young women's ability to access SRH services. We explored HCW opinions through interviews with a purposive sample of 29 HCWs in three primary health clinics in Soweto, South Africa and examined service availability through facility assessments. Most HCWs believed young women should not have sex before marriage and thought that young women ignore information they receive about HIV and pregnancy prevention. HCWs acknowledged outside factors influencing young women's ability to protect themselves. Most thought injectables were the most appropriate contraception for young women; all recognized the importance of condoms for dual protection. Some services were only reported to be provided to those over 18 years. HCWs may benefit from workshops providing technical and policy information and values clarification exercises highlighting the impact of opinions on service provision (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).Les jeunes femmes en Afrique du Sud connaissent de taux élevés du VIH et de grossesse non voulues. Les opinions des membres du personnel soignant (MPS) sur les problèmes de la santé sexuelle et de reproduction (SSR) influencent la capacité des jeunes femmes d'avoir accès aux services de la SSR. Nous avons exploré les opinions des MPS à travers les interviews en profondeur avec un échantillon calculé de 29 MPS dans trois cliniques de santé primaire à Soweto, Afrique du Sud et nous avons examiné la disponibilité des services à travers les évaluations des établissements. La plupart des MPS ont cru que les jeunes ne devraient pas avoir des rapports sexuels avant le mariage et ont cru que les jeunes femmes ignorent les informations concernant le VIH et la prévention de la grossesse. Les MPS ont reconnu les facteurs extérieurs qui influent sur la capacité des jeunes femmes de se protéger. La plupart croyaient que les injectables constituaient la contraception la plus appropriée pour les jeunes femmes ; toutes les femmes reconnaissaient l'importance des préservatifs pour une double protection. Certains services ont été rendus aux femmes qui avaient plus de 18 ans. Les MPS peuvent profiter des ateliers qui donnent des informations sur les techniques et la politique ainsi que les exercices sur la clarification de valeurs qui ne mettent pas en lumière les influences des opinions sur l'assurance des services (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).)

Assessment of Service Availability and Health Care Workers' Opinions about Young Women's Sexual and Reproductive Health in Soweto, South Africa

Young women in South Africa experience high HIV and unintended pregnancy rates. Health care workers' (HCWs') opinions about sexual and reproductive health (SRH) issues impact young women's ability to access SRH services. We explored HCW opinions through interviews with a purposive sample of 29 HCWs in three primary health clinics in Soweto, South Africa and examined service availability through facility assessments. Most HCWs believed young women should not have sex before marriage and thought that young women ignore information they receive about HIV and pregnancy prevention. HCWs acknowledged outside factors influencing young women's ability to protect themselves. Most thought injectables were the most appropriate contraception for young women; all recognized the importance of condoms for dual protection. Some services were only reported to be provided to those over 18 years. HCWs may benefit from workshops providing technical and policy information and values clarification exercises highlighting the impact of opinions on service provision (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).Les jeunes femmes en Afrique du Sud connaissent de taux élevés du VIH et de grossesse non voulues. Les opinions des membres du personnel soignant (MPS) sur les problèmes de la santé sexuelle et de reproduction (SSR) influencent la capacité des jeunes femmes d'avoir accès aux services de la SSR. Nous avons exploré les opinions des MPS à travers les interviews en profondeur avec un échantillon calculé de 29 MPS dans trois cliniques de santé primaire à Soweto, Afrique du Sud et nous avons examiné la disponibilité des services à travers les évaluations des établissements. La plupart des MPS ont cru que les jeunes ne devraient pas avoir des rapports sexuels avant le mariage et ont cru que les jeunes femmes ignorent les informations concernant le VIH et la prévention de la grossesse. Les MPS ont reconnu les facteurs extérieurs qui influent sur la capacité des jeunes femmes de se protéger. La plupart croyaient que les injectables constituaient la contraception la plus appropriée pour les jeunes femmes ; toutes les femmes reconnaissaient l'importance des préservatifs pour une double protection. Certains services ont été rendus aux femmes qui avaient plus de 18 ans. Les MPS peuvent profiter des ateliers qui donnent des informations sur les techniques et la politique ainsi que les exercices sur la clarification de valeurs qui ne mettent pas en lumière les influences des opinions sur l'assurance des services (Afr J Reprod Health 2012 (Special Edition); 16[2]: 283-293).)

Establishing a continuum of care between HIV prevention trials and public healthcare systems: The MIRA Standard of Care program

Background The ability of researchers to provide sustainable care to individuals who acquire HIV during participation in HIV prevention trials has rapidly expanded along with national treatment options. The Methods for Improving Reproductive Health in Africa (MIRA) trial (2003—2006), a phase III multi-site randomized controlled trial, measured the effectiveness of the diaphragm used with Replens ® lubricant gel in preventing heterosexual acquisition of HIV among women in Zimbabwe and South Africa. The MIRA Standard of Care program, which started towards the end of the trial period and continued for 5 months after trial closeout, enabled women who acquired HIV during the trial to receive additional counseling and clinical care and facilitated links to long-term HIV-related care and treatment from public health facilities. Purpose To describe eligible participants’ uptake of these optional services and evaluate the program’s strengths and limitations. Methods All women who acquired HIV during their MIRA participation were re-contacted and invited to return to the study clinics for additional care and referrals. Sites reported monthly statistics of uptake of services. Results From start to end, 185 of 323 (57%) HIV-positive participants accepted additional care; 81 (25%) could not be relocated. 142 (44%) women received referrals to government healthcare facilities and 90 (28%) enrolled in wellness/ treatment programs. Fifty-seven (18%) declined further care, but reasons for doing so were not recorded systematically. Limitations The program began after most participants had exited from the MIRA trial and required re-contacting women, resulting in difficulty in locating some participants. Conclusions In the future, care for participants who seroconvert should be offered at the trial onset and fully integrated into clinical trials to avoid losing these participants for further care. More research is needed to identify and understand perceived barriers to establishing a continuum of care between clinical trials and public sector health facilities. Clinical Trials 2010; 7: 256—264. http:// ctj.sagepub.com </jats:p

Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming

Sexual self-efficacy (SSE) – one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents’ HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14–19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16–17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.BBAHS was funded by the Canadian Institutes of Health Research (CIHR), Institute for Human Development, Child and Youth Health (230513). Initial seed funding was provided by Simon Fraser University through a President Research Award to CLM. The funders of this project did not have any role in the study design, collection interpretation of the data, in the writing of the report or the decision to submit the article for publication.FacultyReviewe

Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa

Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one’s confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14–19, median age = 18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0–6) with ‘high-SSE’ = score > 3 (study alpha = 0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p < 0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p = 0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR = 3.51, 95%CI = 1.86–6.64), but not women (aOR = 1.43, 95%CI = 0.74–2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.BBAHS was funded by the Canadian Institutes of Health Research (CIHR), Institute for Human Development, Child and Youth Health (230513). Initial seed funding was provided by Simon Fraser University through a President Research Award to CLM.FacultyReviewe