Identifying barriers to ART initiation and adherence: An exploratory qualitative study on PMTCT in Zambia

Background Though antiretroviral therapy (ART) is widely available, HIV positive pregnant women in Zambia are less likely to start and remain on therapy throughout pregnancy and after delivery. This study sought to understand readiness to start ART among HIV pregnant women from the perspectives of both women and men in order to suggest more holistic programs to support women to continue life-long ART after delivery. Methods We conducted a qualitative study with HIV positive pregnant women before and after ART initiation, and men with female partners, to understand readiness to start lifelong ART. We conducted 28 in-depth interviews among women and 2 focus group discussions among male partners. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes from the data were organized using the social ecological framework. Results Men thought of their female partners as young and needing their supervision to initiate and stay on ART. Women agreed that disclosure and partner support were necessary preconditions to ART initiation and adherence and, expressed fear of divorce as a prominent barrier to disclosure. Maternal love and desire to look after one’s children instilled a sense of responsibility among women which motivated them to overcome individual, interpersonal and health system level barriers to initiation and adherence. Women preferred adherence strategies that were discrete, the effectiveness of which, depended on women’s intrinsic motivation. Conclusion The results support current policies in Zambia to encourage male engagement in ART care. To appeal to male partners, messaging on ART should be centered on emphasizing the importance of male involvement to ensure women remain engaged in ART care. Programs aimed at supporting postpartum ART adherence should design messages that appeal to both men’s role in couples’ joint decision-making and women’s maternal love as motivators for adherence.

Inter-Relationship between Women and Nature: A Critical Study of the Fictions of Anita Desai

The inward or inner agony, pressure and any other issues of women life are reflected in a peculiar way through the Nature or its natural objects of as we can clearly point out in the novels of Anita Desai. The female protagonists of the novels of Anita Desai could not express their inner feelings before their male partners or anybody as they express themselves properly and smoothly through Nature and its different Natural objects. In other words, we can say that life of the women protagonists in the novels of Anita Desai and Nature are closely connected with each other. As Nature and women both have the power of nurturing and sustenance, which means both of them carry maximum similar feminine qualities. So to maintain peace and equality in the society, we should have to understand the inward feelings of both women and Nature.

Semen parameters in male partners of sub-fertile couples.

Objective: To evaluate the frequency of semen parameters in male partners of in sub-fertile couples. Study Design: Cross-sectional study. Setting: Department of Gynaecology, Bakhtawar Ameen Hospital, Multan. Period: July 2019 to July 2020. Material & Methods: Infertile couples from at least 12 months were selected for study. A team of Gynaecologist, andrologist and endocrinologist assessed the couples. In male partner, general physical examination, endocrine factor, genetic assessment, accessory gland infection and testicular dysfunction were evaluated. Semen sample was sent to laboratory for semen analysis. Results: In a total of 169 sub-fertile couples, the mean age of male and female partner were 37.98±4.54 years and 32.51±3.78 years respectively. Mean duration since marriage was 5.17±4.51 years. Abnormal semen parameters such as azoospermia, oilgo-azoospermia, asthenozoospermia, teratozoospermia and aspermia were noted 21 (12.4%), 26 (15.4%), 48 (28.4%), 18 (10.7%) and 10 (5.9%) subjects respectively. There were 46 (27.2%) subjects with normal semen parameters. Conclusion: Most of the male sub-fertile subjects had asthenozoospermia. More than one fourth of the subjects had normal semen parameters.

Money, Power, and Relationships: Economic Vulnerability in Girls’ Lives and Risk for Partner Violence Among Girls in Ibadan, Nigeria

This study explored the experience of economic vulnerability and its effect on girls’ future aspirations, relationships, and financial reliance on male partners, as well as risk for intimate partner violence (IPV) and related health consequences. Thirteen Focus Group Discussions (FGDs) were conducted among 122 female adolescents aged 15–19 years. Participants reported that lack of economic resources limits girls’ ability to be economically independent by reducing opportunities to receive education or enter into a trade. Economic vulnerability decreases girls’ ability to become economically independent, increasing financial reliance on male partners, and in turn, increasing risk for IPV, sexually transmitted infections, and unintended pregnancy.

Factors that Influence Modern Contraceptive use Among Women Aged 35 - 49 Years and their Male Partners in Gomoa West District, Ghana: A Qualitative Study

Background: The use of contraception among women aged 35 to 49 years is imperative due to the risk of unplanned pregnancy and poor obstetric outcomes. However, the use of contraceptives in this age group has been reported to be low. In Ghana, studies are limited that determine factors influencing contraception among women in this age group, in particular the influence of husbands. This study aims to ascertain factors that influence contraception among women aged 35 to 49 years and their male partners. Objectives: The objective of the study was to describe factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in the Gomoa West District of Ghana. Methods: A total of 44 informants participated in the study. In-depth interviews were conducted remotely for 22 women, 15 male partners of women interviewed, and seven family planning service providers. Twenty-one informants participated in four focus group discussions organized. A simple thematic analysis was undertaken. Results: Factors that influenced the use of modern contraceptives were achieved desired family size, counselling by health professionals, health reasons, and influence of male partner. Barriers to using modern contraceptives included religious or socio-cultural reasons, experience or fear of side effects, rumors or misconceptions, and the belief that contraceptive use is a matter for women. Conclusions: This study described factors that influence contraception among women 35 to 49 years and their male partners. All informants used some form of contraception, although traditional contraceptive method users (TCMUs) did not consider traditional contraceptive methods (TCMs) as a form of contraception. Education on effective TCMs as an alternative for non-users of modern contraceptive methods (MCMs) is needed. Strengthening male involvement in family planning and health educational activities could alleviate fear and reduce misconceptions about using modern contraceptives.

Relationship Between Smoker Male Partner and Intrauterine Insemination Success in Kasih Ibu General Hospital Denpasar

Background : Assisted reproductive technology, one of which is intrauterine insemination (IUI) allows infertile couples to get pregnant. The pregnancy success of IUI procedure varies among individuals. Objective: The study aim is to determine whether there is a relationship between smoker male partners and IUI success. Methods: This research is an analytic study with cross-sectional approach conducted at Kasih Ibu General Hospital Denpasar with purposive sampling technique. There are 35 male couples aged 25-50 years who underwent the IUI procedure selected as samples. The research data was gathered from patient's medical records and statistically analyzed using the Chi-Square test. Results: The study found that of the 35 samples, 13 (37.1%) were smokers, whereas 22 (62.9%) male partners were non-smokers. There were 6 (17.1%) samples’ partners who were pregnant after undergoing the IUI procedure, and 29 (82.9%) samples’ partners were not pregnant. It was found that there was no significant relationship between male partner smokers and the success of IUI at Kasih Ibu General Hospital Denpasar (p=0.832). However, in descriptive analysis and relative risk calculation, smoker male partner is less likely to achieve pregnancy than non-smoker’s male partner (RR=0.85). Conclusion: Smoker male partners may not contribute to IUI success. Further studies should be done with a higher number of samples, multicenter, and more controlled risk factors to make it more accurate in determining the relationship.

Psychosocial characteristics pattern correlated with HIV-related risky sexual behavior among HIV-negative men who have sex with men: a latent profile analysis.

Background Men who have sex with men (MSM) have become a high-risky population of HIV infection due to their risk sexual behaviors. The psychosocial characteristics play an important effect on HIV-related risky behaviors. This current study aimed to explore the relationship between HIV-related risky behaviors and the latent pattern of psychosocial characteristics among HIV-negative MSM. Method Participants were recruited from Wuhan, Nanchang, and Changsha city from September 2017 to January 2018. The basic socio-demographic characteristics, psychosocial characteristics and HIV-related risky behaviors were collected by self-administered questionnaire and standardize scales. Latent profile analysis (LPA) was used to create the latent classes using variables associated with HIV-related risky behaviors, including social support, reliance, sexual minority stigma, identity concealment, adverse childhood experience and depression. Results Three psychosocial characteristic patterns were revealed by the LPA. “identity concealment group” (IC group) and “ACE group” represented the highest risk profile with highest score of identity concealment and adverse childhood experience (ACE), respectively. “IC group” have a higher likelihood of one-night male partners (AOR=2.74, 95%CI=1.54, 4.90), both fixed and one-night male partners (AOR=2.01, 95%CI=1.34-3.01) and HIV-unsure male partner (AOR=2.12, 95%CI=1.44-3.13) compared with “social support and resilience group” (SR group). ACE group were more likely having inconsistent condom use (AOR=2.58, 95%CI=1.41-4.73), and having sex with HIV-positive male partner (AOR=4.90, 95%CI=1.95-12.30) with comparison of SR group. Interesting, ACE group had a higher ratio (90.0%) of inconsistent condom use among MSM whose male partners were HIV-positive. Conclusions Six important psychosocial factors were divided into three latent pattern classes. Compared with “social support and reliance group”, “identity concealment group” and “ACE group” were more likely to engage in HIV-related risky sexual behaviors. Besides mental health guidance, promoting serological disclosure of sexual partners and consistent condom use behavior is critical for MSM with higher level of identity concealment or ACE.