| ICRH Global Newsletter |
13th of June, 2014
ICRH Conference ‘Sexual and reproductive health and rights today and tomorrow’
On the occasion of its 20th anniversary, ICRH organises a two-day conference on 4 and 5 December 2014 in Ghent, Belgium.
The conference will focus on the state of the art and remaining challenges in sexual and reproductive health worldwide. Within the framework of the conference, distinct symposia will take place on the following topics:
-Adolescent sexual and reproductive health and well-being
-HPV, related diseases and vaccination
-Harmful cultural practices with focus on female genital mutilation and forced marriages
-Maternal health, with focus on family planning and quality of maternal and newborn care.
-Behavioural change interventions, a cross-cutting element in most of ICRH’s research projects.
At the end of the second conference day, there will be a celebration event for 20 years ICRH.
A call for abstracts for posters will be launched. For more details and preliminary program of the conference, please go to http://icrhb.org/icrh-conference-2014
or contact us at email@example.com.
CERCA – final conference on adolescent sexual and reproductive health
In February 2014, the CERCA project consortium organized an international conference in Cuenca, Ecuador, on ‘promoting sexual and reproductive health of adolescents’.
The conference targeted health-care professionals, researchers, students, educators, adolescents, parents and members of the communities interested in the subject. The conference included lectures, forums and round tables.
In plenary sessions, forums and round tables, 45 speakers (26 Ecuadorian and 19 international experts) presented diverse aspects of adolescent sexual and reproductive health (ASRH): determinants of ASRH, sexual health promoting strategies, health policies, and adolescents’ access to SRH services, adolescent sexuality, sexuality education, and adolescents’ SRH rights. Results and outputs from the CERCA research in the three countries were presented and discussed.
Over the three days, more than 800 people attended the conference.
The event gathered experts from different countries, including representatives of ALAPE (Latin American Association of Paediatrics, Adolescence Unit), CODAJIC (Confederation of Adolescence and Youth of Latin America and The Caribbean), UNFPA, WHO, Ministries of Health of Ecuador and Nicaragua.
Following the final CERCA conference in Ecuador, the declaration of Cuenca and online petition “Improve Sexual and Reproductive Health of Adolescents in Latin America” (http://chn.ge/1fobtSN) has been launched the 14th of March 2014. Over 500 supporters from all corners in world including scientists, field workers, medical staff, and authorities signed the petition.
The congress programme and further information is available online at: www.proyectocerca.com.
More information: Sara De Meyer (firstname.lastname@example.org) and Peter Decat (email@example.com)
Antenatal care in Mozambique
ICRH-Mozambique and the Mozambican Ministry of Health are conducting a research project aiming to increase the use of evidence-based practices during antenatal care (ANC).
The project is supported by Embassy of Belgium – Delegation of Flanders (formerly FICA), with technical support from WHO. The Ministry of Health uses a model for ANC that recommends women should attend at least four visits and receive various evidence-based interventions. However, full use of these interventions is limited at health facilities. For this reason, Mozambique was selected to carry out a demonstration project to implement evidence-based ANC through a cluster randomized controlled trial. The study aims to assess whether a kit-based system of medicines and materials and a closer monitoring of their use would ensure permanent availability of these products thereby enabling the nurses to improve the quality of the antenatal consultations.
The research intervention includes the provision of kits with all necessary medicines and laboratory supplies for ANC (medical and non-medical equipment) and training sessions for the health providers. Control clinics will provide services as usual, through regular supply channels and procedures.
The results of the study will support the development of strategies to increase the quality of ANC not only in Mozambique, also in other countries experiencing service delivery challenges related to supply-chain malfunctions.
The intervention will be rolled out sequentially to 10 selected health centres across the country, starting a new facility every two months. The intervention was launched in the first health centre (Anchilo in Nampula province) on June 2nd and will end in December 2015.
More information: Sally Griffin, firstname.lastname@example.org
Gender norms and sexual wellbeing
The Flemish Minister for Innovation supports ICRH research on gender and sexual wellbeing of adolescents.
The ages 10-14 years are among the most critical for human development, yet one of the most poorly understood stages. While the biological processes that adolescents go through are universal, the social contexts within which they occur vary considerably. During the transition from child to adult, young people are expected to assume socially defined gender roles that determine their sexual and reproductive health future.
The Global Early Adolescent Study (GEAS) aims to understand the factors in early adolescence that predispose young people to subsequent sexual health risks and conversely that contribute to healthy sexuality so as to provide the information needed to improve sexual and reproductive health outcomes. GEAS is led by Johns Hopkins School of Public Health (Baltimore, USA) and the Department of Reproductive Health and Research of the World Health Organisation. It will take place in ten cities around the world. A cross-country comparison offers a unique perspective on the commonalities and differences of the role of parents, peers as well as media in shaping young people’s sexuality and the role of gender norms in that development across diverse cultural settings.
Financial support of the Flemish Minister for Innovation, will make it possible for ICRH to participate in the first phase of this prestigious research project together with its long-term partner, the University of the Western Cape, South Africa.
More information: Sara De Meyer, email@example.com
Staff motivation and contraception stock-outs
ICRH obtained an Innovation Grant from the Reproductive Health Supplies Coalition to investigate how contraception stock-outs can be avoided by enhancing the motivation of health centre staff.
Exploring and influencing the human factor in preventing stock-outs is an important building block to create a service provision environment that fosters high quality service delivery. The impact of different types of interventions on staff motivation will be tested, and the relation between the level of staff motivation on one hand, and the occurrence of stock outs and quality of service on the other will be assessed. The research will take place in 15 health centres in Manhiça and Marracuene districts in Maputo Province, Mozambique. This project, which will be conducted in collaboration with ICRH Mozambique, will run for 18 months and is expected to yield important insight and know-how to inform future programmes aimed at ensuring contraceptive security and choice.
More information: firstname.lastname@example.org
|SEHIB steering committee|
In May, the SEHIB-HPV surveillance project Steering Committee met at ICRH offices in Ghent.
SEHIB is a study aiming to do surveillance on the effects of human papillomavirus vaccination and cervical cancer in Belgium. The meeting gathered representatives of the different partners: Geraldine Dominiak-Felden, Patrick Dhont and François Simondon (SANOFI), Marc Arbyn (WIV-ISP), Stéphanie Gofflot (UG Liège), Steven Weyers (UZ Gent), Davy Vanden Broeck and Aurore Guieu (ICRH).
The objective of the meeting was to discuss the current status of the study – with more than 6.600 cervical samples collected since 2011 - and the next steps in the coming months. SEHIB will come to an end in the course of Autumn 2014.
More information: email@example.com and firstname.lastname@example.org
|Summer School Network-Statistics in Health Research|
From 18-22 August, a summer school of Network Statistics in Health Research will take place at Ghent University, Belgium
Participants of this one-week summer school will be introduced to the field of statistical analysis of network data, with an emphasis of model applications in health research.
This summer school is primarily aimed at PhD and Master’s students from Flemish Universities, but applications from other (post-doctoral) researchers, as well as applicants from non-Flemish institu-tions are welcome too. The deadline for registration is June 30 2014. There are only 25 spaces available.
More information and registration: http://www.networkstatisticsinhealth.ugent.be/
|ICRH researcher Sara De Meyer wins Young Scientist Award|
On May 31st, Sara De Meyer, researcher at ICRH, won the Young Scientist Award at the 13th congress of the European Society of Contraception and Reproductive Health.
With the presentation of the research “Positive attitudes towards gender equality go hand in hand with a safe and happy sex life among adolescents: results from a cross-sectional study in Bolivia and Ecuador”, Sara was one of the two winning young scientists. The research that Sara presented is based on data from the CERCA-project, an intervention study on community-embedded reproductive health care for adolescents in Latin America. This European funded project ran from 2010 until 2014 and was coordinated by ICRH. For more information:http://www.escrh.eu/about-esc/news/award-winners-honoured, SaraA.email@example.com
At the end of May, dr. Peter Decat left ICRH to combine a job as general practitioner with an appointment at the Ghent university department of family medicine.
Peter Decat joined ICRH in 2009 after having worked for 20 year as a physician in Bolivia and Belgium. He worked on several research projects and was team leader of ICRH’s the priority populations team. In the last four years, peter coordinated CERCA (community-embedded reproductive care for adolescents in Latin America), a multicentre intervention research project in Bolivia, Nicaragua and Ecuador. Peter’s specific field of interest is the integration of reproductive health services in primary health care. A people centered approach, combining person centeredness and community participation, is key in this issue.
More information: firstname.lastname@example.org
Is an AIDS-Free Generation Possible?
Southern Africa, home to about 20 % of the global burden of infection continues to experience high rates of new HIV infection despite substantial programmatic scale-up of treatment and prevention interventions.
While several countries in the region have had substantial reductions in HIV infection, almost half a million new infections occurred in this region in 2012. Sexual transmission remains the dominant
mode of transmission. A recent national household survey in Swaziland revealed an HIV prevalence of 14.3 % among 18–19 year old girls, compared to 0.8 % among their male peers. Expanded ART programmes in Southern Africa have resulted in dramatically decreased HIV incidence and HIV mor-tality rates. In South Africa alone, it is estimated that more than 2.1 million of the 6.1 million HIV-positive people were receiving ART by the end of 2012, and that this resulted in more than 2.7 mil-lion life-years saved, and hundreds of thousands of HIV infections averted. Biological, behavioural and structural factors all contribute to the ongoing high rates of new HIV infection; however, as the epidemic matures and mortality is reduced from increased ART coverage, epidemiological trends become hard to quantify. What is clear is that a key driver of the Southern African epidemic is the high incidence rate of infection in young women, a vulnerable population with limited prevention options. Moreover, whilst ongoing trials of combination prevention, microbicides and behavioural economics hold promise for further epidemic control, an AIDS-free generation will not be realised unless incident infections in key populations are reduced.
Wim Delva & Quarraisha Abdool Karim. The HIV Epidemic in Southern Africa – Is an AIDS-Free Generation Possible? Curr HIV/AIDS Rep (2014) 11:99–108 DOI 10.1007/s11904-014-0205-0.
Sexual violence and sub-Saharan migrants in Morocco:
A study aimed at investigating the nature of violence that sub-Saharan migrants experience around and in Morocco, assessing which determinants they perceive as decisive, and formulating prevention recommendations.
The European Union contracted Morocco to regulate migration from so-called “transit migrants” from Morocco to Europe via the European Neighbourhood Policy. Yet, international organisations signal that human, asylum and refugee rights are not upheld in Morocco and that many sub-Saharan migrants suffer from ill-health and violence.
Applying Community-Based Participatory Research, the researchers trained twelve sub-Saharan migrants as Community Researchers to conduct in-depth interviews with peers, using Respondent Driven Sampling. They interpreted results with Community Researchers and the Community Advisory Board and commonly formulated prevention recommendations.
Among the 154 (60 F-94 M) sub-Saharan migrants interviewed, 90% reported cases of multiple victi-mizations, 45% of which was sexual, predominantly gang rape. Seventy-nine respondents were personally victimized, 41 were forced to witness how relatives or co-migrants were victimized and 18 others knew of peer victimisation. Severe long lasting ill-health consequences were reported while sub-Saharan victims are not granted access to the official health care system. Perpetrators were mostly Moroccan or Algerian officials and sub-Saharan gang leaders who function as unofficial yet rigorous migration professionals at migration ‘hubs’. They seem to proceed in impunity. Respondents
link risk factors mainly to their undocumented and unprotected status and suggest that migrant communities set-up awareness raising campaigns on risks while legal and policy changes enforcing human rights, legal protection and human treatment of migrants along with severe punishment of perpetrators are politically lobbied for.
The authors conclude that Sub-Saharan migrants are at high risk of sexual victimization and subse-quent ill-health in and around Morocco. Comprehensive cross-border and multi-level prevention actions are urgently called for. Given the European Neighbourhood Policy, it is deemed paramount that the European Union politically cares for these migrants’ lives and health, takes up its responsibility, drastically changes migration regulation into one that upholds human rights beyond survival and enforces all authorities involved to restore migrants’ lives worthy to be lived again.
Ines Keygnaert, Abdessamad Dialmy, Altay Manço, Jeroen Keygnaert, Nicole Vettenburg, Kristien Roelens and Marleen Temmerman. Sexual violence and sub-Saharan migrants in Morocco: a com-munity-based participatory assessment using respondent driven sampling. Keygnaert et al. Globalization and Health 2014, 10:32. http://www.globalizationandhealth.com/content/10/1/32
Cervical cancer screening and use of diagnostic and therapeutic procedures
This study aimed to assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.
The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years.
Cervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively.
The screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.
Arbyn M, Fabri V, Temmerman M, Simoens C (2014) Attendance at Cervical Cancer Screening and Use of Diagnostic and Therapeutic Procedures on the Uterine Cervix Assessed from Individual Health Insurance Data (Belgium, 2002-2006). PLoS ONE 9(4): e92615. doi:10.1371/journal.pone.0092615.
HPV vaccines to prevent cervical cancer and genital warts: an update
This review describes the immunology of natural HPV infections and the immune response evoked through vaccination.
Cervical cancer is an important public health problem worldwide, and especially in developing coun-tries. The link between cervical cancer and oncogenic human papillomavirus (HPV) infection has been clearly established. Furthermore, non-oncogenic HPV are responsible for the majority of genital warts. Two prophylactic HPV vaccines are available, which have the potential of considerably reducing HPV-related morbidity and mortality. Both vaccines are based on virus-like particles of the L1 capsid protein, and are highly efficacious and immunogenic if given before exposure to HPV, i.e. to adolescent girls between 9 and 13 years of age in a three-dose schedule. The current duration of protection is 8.4 years with the bivalent vaccine (HPV16/18) and 5 years with the quadrivalent vac-cine (HPV6/11/16/18). Research is on-going to evaluate the efficacy of the current vaccines in a two-dose schedule, as compared to the recommended three-dose schedule. To increase the protection, the development and testing of a nine-valent prophylactic HPV vaccine (HPV6/11/16/18/31/33/45/52/58) is being undertaken. Research is also directed towards therapeu-tic vaccines and the development of a prophylactic L2 vaccine.
Carine Dochez, Johannes J. Bogers, Rita Verhelst, Helen Rees, HPV vaccines to prevent cervical cancer and genital warts: an update, Vaccine, Volume 32, Issue 14, 20 March 2014, Pages 1595-1601, ISSN 0264-410X, http://dx.doi.org/10.1016/j.vaccine.2013.10.081.
Sexual and gender-based violence in the European asylum and reception sector: a perpetuum mobile?
This paper explores the nature of SGBV occurring in this sector and discusses determinants for ‘Desirable Prevention’.
Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV.. Applying community-based participatory research, an SGBV knowledge, attitude and practice survey was conducted with residents and professionals in eight European countries. Of the 562 respondents, 58.3% reported cases of direct (23.3%) or peer (76.6%) victimization. Results indicate that when men were involved, it most likely concerned sexual perpetration and physical victimization, compared with females, who then rather perpetrated emotional violence and underwent sexual victimization. Compared with others, asylum seekers appeared more likely to perpetrate physical and endure socio-economic violence, whereas professionals rather bore emotional and perpetrated socio-economic violence. When group perpetration or victimization occurred, it most likely concerned socio-economic violence. The authors conclude that within the European asylum reception sector, residents and professionals of both sexes experience SGBV victimization and perpetration. Given the lack of prevention policies, the findings call for urgent desirable prevention programmes addressing determinants socio-ecologically.
Ines Keygnaert; Sonia F. Dias; Olivier Degomme; Walter Deville; Patricia Kennedy; Andras Kovats; Sara De Meyer; Nicole Vettenburg; Kristien Roelens; Marleen Temmerman. Sexual and gender-based violence in the European asylum and reception sector: a perpetuum mobile?
The European Journal of Public Health 2014; doi: 10.1093/eurpub/cku066. http://eurpub.oxfordjournals.org/cgi/reprint/cku066?
|Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour|
The aim of this cohort study of Kenyan female sex workers was to investigate putative links be-tween alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.
A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression.
Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4.1-fold higher sexual and 8.4 higher odds of physical violence, while hazardous drinkers had 3.1-fold higher physical violence. No association was detected between AUDIT category and pregnancy, or infection with Syphilis or Trichomonas vaginalis. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers.
This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence. Experimental evidence is required demonstrating that interventions to reduce alcohol use can avert unsafe sex.
Chersich M, Bosire W, King’ola N, Temmerman M, Luchters S. Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers. BMC Globalization and Health. 2014 Apr 3;10:22