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Complex inequalities have shaped the trajectory of the HIV epidemic in South Africa. These include factors related to gender disempowerment, poverty, family disruption and violence – all of which have intensified the risk of HIV infection among the majority of South Africans, contributing to one of the most severe country-level HIV epidemics globally. Neo-liberal economic policies adopted in the post-apartheid period failed to address poverty and burgeoning urban migration – both of which were key factors exacerbating vulnerability to HIV. While there was, ostensibly, a strong commitment to addressing the HIV epidemic by the post-apartheid government, HIV prevalence among pregnant women quadrupled from 7.6% in 1994 to 30.2% in 2005. Contributing to this rise, was a series of missteps by the national Department of Health in the late 1990s, which constrained HIV prevention efforts and stifled HIV treatment. The mid-2000s saw a reprioritisation of the response to the epidemic, with international guidelines supported by biomedical and social research underpinning a rights- and evidence-based response. Multisectoral HIV prevention activities were complemented by high levels of investment in implementing prevention of mother to child HIV transmission and expanding access to antiretroviral therapy (ART) for HIV through the public sector. While these efforts contributed to stabilising the epidemic, stark inequalities in vulnerability and susceptibility to HIV infection continued – in particular, among youth. In this chapter, we draw on a review of the research literature to describe concerns and explore opportunities for a response.

The purpose of this study was to develop pre-exposure prophylaxis (PrEP) education materials that directly address the needs of trans women. PrEP medication is an effective HIV prevention strategy, but some groups at high risk of HIV, such as transgender (trans) women, have suboptimal uptake and adherence. Most PrEP marketing has been aimed fat men who have sex with men (MSM) and include trans women as part of that audience, but this strategy ignores important differences in perceptions of and barriers to PrEP.

This study used a social marketing approach grounded in exchange theory to systematically develop and pretest PrEP messaging and communication materials for trans women through qualitative (focus groups: n = 5, 34 participants) and quantitative (surveys: n = 128) methods in Philadelphia and the San Francisco Bay area. Segmentation analysis, perceptual mapping and vector message modeling techniques were used to create three-dimensional visualizations of PrEP perceptions to identify highly targeted messaging. Working with trans artists, the authors developed prototype materials using the targeted messaging and pretested these (n = 11) in both locations for feedback on content, look and insight on appropriate intervention strategies.

Using segmentation and perceptual mapping, this study identified key PrEP messaging across different subgroups, including by demographic and psychographic variables. Differences by group were determined to not be significant and overall messages that would resonate with all groups were built into the materials. Pretesting sessions indicated high acceptability of the messaging and trans women-centered approach to increase PrEP uptake.

To the best of the authors’ knowledge, this is the first study to use a social marketing framework to create targeted PrEP communication materials for trans women in partnership with trans women.

Women involved in the carceral system (CS) experience several conditions that increase their risk for HIV (e.g. high rates of substance use, psychiatric disorders, histories of victimization). The purpose of this study is to explore perspectives on potential strategies to connect women in the CS to pre-exposure prophylaxis (PrEP) services.

This study conducted in-depth interviews with 27 women involved in the CS eligible for PrEP. Using vignettes, interviews explored attitudes, barriers and facilitators toward PrEP screening, referral and linkage facilitated via a CS stakeholder, an mHealth application or providing PrEP service referrals during detention via a navigator.

Most women were, on average, 41.3 years, from racial and ethnic minority groups (56% black/African American; 19% Latinx). Inductive thematic analysis revealed CS involved women expressed mostly positive attitudes toward CS-based PrEP implementation. Younger women were more accepting of and interested in mHealth interventions. Implementation facilitators included leveraging relationships with trusted allies (e.g. “peers”) and existing systems collaborations. Recommended implementation strategies included providing HIV and PrEP-specific education and training for system stakeholders and addressing issues related to privacy, system mistrust and stigma.

Results provide a critical foundation for the implementation of interventions to improve PrEP access for women involved in the CS and have important implications for implementation strategies for all adults involved in the CS. Improving access to PrEP among this population may also support progress toward addressing national disparities in PrEP uptake, where women, black and Latinx populations have substantial unmet need.

Family planning (FP) services through the lens of human rights are not well known in Nepal. This study aims to assess Family Planning 2020: Rights and Empowerment Principles for Family Planning and identify factors affecting contraceptive use among HIV-infected women living in rural Far Western Nepal.

This study conducted a cross-sectional survey using self-designed proforma. To assess the association between contraceptive use and independent variables, this study calculated adjusted odd ratio (AOR) with 95% confidence interval (CI) using statistical package for social sciences (SPSS) V.20.

Only 37.8% of participants had access to full range of contraceptive methods, and only 57.5% of participants received proper counseling. Agency/autonomy, transparency/accountability and voice/participation were practiced by 43.7%, 23.4% and 19.7% of participants, respectively. Husband’s support (AOR = 4.263; 95% CI: 1.640–11.086), availability of FP services in their locality (AOR = 2.497; 95% CI: 1.311–4.754), employment (AOR = 3.499; 95% CI: 1.186–10.328) and postpartum period (AOR = 0.103; 95% CI: 0.023–0.475) were significantly associated with contraceptive use.

Health-care providers’ and program managers’ perspectives were not examined.

Findings of this study will be useful for making strategic plan on human rights-based approach to FP.

Expanding access to contraceptive information and services and strengthening autonomy, accountability and participation are key to human rights-based approach to FP.

This study identified that inadequate counselling, nonavailability of full range of contraceptive methods, low level of autonomy, accountability and participation were key bottlenecks in fulfilling human rights-based approach to FP.

The aim of this study was to address the unmet information needs of Malawian informal carers. We report on a three-year project which we co-created with informal carers, medical doctors and NGOs with the view to disseminate health advisory messages.

This study was developed on the principles of co-production. The impact of our health advisory messaging approach was assessed through observations and questionnaire-based surveys for quality, clarity and usefulness.

The messages were disseminated beyond the local support groups and reached a much wider community via word of mouth. The messages also led to short and medium term benefits for informal carers and their loved ones.

Our findings highlight the importance of understanding the contextual conditions of informal caring and that of co-producing interventions with the people these aim to benefit.

Stigma remains to be a major barrier to addressing the sustained rise of human immunodeficiency virus (HIV) infections in the Philippines. Gay, bisexual, and other men who have sex with other men (MSMs) (G/B/MSM) living with HIV experience compounded stigma due to their sexual identity and HIV seropositive status. The family has been identified as one of the main sources of homonegativity and HIV-related discrimination. Drawing from the family life histories of 31 Filipino MSMs living with HIV, the authors demonstrate the concept of compounding stigma, which posits that the extent and nature of gender- and sexuality-based stigma experienced in early life may potentiate or mitigate the experience of HIV stigma in later life in the context of the family. Narrative analysis of the family life histories reveals a central factor that shaped the sexual development and stigma experiences of MSMs living with HIV: sexual identity visibility in the family (SIVF) – the family’s extent of knowledge and/or acceptance of their sexuality. Three core narratives emerged from the data that categorize informants based on the type of SIVF present in their family life viz. full, partial, and invisible. Results also trace the resultant life trajectories for each core narrative and reveal three forms of compounding stigma: low compounding stigma or compounding acceptance, compounding enacted stigma, and compounding internalized stigma.

The purpose of this paper is to explore the experiences of black Sub-Saharan African (BSSA) migrants from war-torn zones in accessing health services in the West Midlands region of the UK. This may help to inform on factors influencing the uptake of health services for new migrant communities.

This study explored the experiences of BSSA migrants from war-torn zones in accessing health services in the West Midlands using an explorative qualitative approach. Ten focus groups made up of seven participants each were followed up with three in-depth one-to-one interviews from each focus group using a conversational approach where research participants were encouraged to direct and shape the discussion in accordance with their own experiences, views and particular concerns (Kvale, 1996) as opposed to responding to a pre-determined agenda.

Following transcription, coding and analysis of the focus group discussions and follow-up interviews, this study found that perceptions and attitudes of BSSA communities in accessing health services included difficulties in navigating the health system, intrusive and embarrassing questions from clinicians, stigmatisation through offering an HIV test, culturally unfriendly counselling support, unconfidently services and episodes of trauma flashbacks.

The experiences of BSSA migrants who sought health services in the West Midlands in the UK demonstrated important implications for future practice and informed service delivery. There is a need to consider cultural education for both BSSA migrants and health professionals to enhance understanding and trust between the groups. Basic professional training for health professionals should also encompass the needs of the growing ethnic populations in the UK.

A consensus in the literature is that anti-gay prejudice has a negative impact on HIV programming for men who have sex with men (MSM). This paper aims to analyse the prevalence and predictors of anti-gay prejudice in Barbados, an island in the Caribbean, and possible impacts on the full recognition of the right to health care.

The study used nationally representative data obtained from the Caribbean Development Research Services capturing anti-gay prejudice in Barbados in 2004, 2013 and 2019. The data were analysed using logit models and ordinary least squares regression.

The share of persons who expressed feelings of hatred towards gays and lesbians did not change significantly over the period. Social distance attitudes improved between 2004 and 2013 but have not changed since. Men generally expressed more prejudice than women and male sexual prejudice could be localised to three groups – men without tertiary education, men under 51 and members of non-Christian religions. Meanwhile, there was little consistency in the predictors of women’s attitudes over the period.

This study provides insights into the trends in attitudes towards sexual minorities in a developing country. The main conclusion is that although health care is provided as a universal right to all Barbadians, a strictly medical approach to HIV prevention among MSM in countries with high levels of anti-gay prejudice is insufficient.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to end the acquired immunodeficiency syndrome (AIDS) epidemic as a public health threat by 2030 emphasises the importance of leaving no one behind. To determine progress towards the elimination goal in Ghana, an in-depth understanding of human immunodeficiency virus (HIV) care from the perspective of vulnerable populations such as persons living with HIV in incarceration is necessary. This study aims to explore the experiences of incarcerated individuals living with HIV (ILHIV) and on antiretroviral therapy (ART) in selected Ghanaian prisons to help inform policy.

The study adopted a qualitative approach involving in-depth interviews with 16 purposively selected ILHIV on ART from purposively selected prisons. Interviews were conducted between October and December 2022. Thematic analysis was performed using the ATLAS.Ti software.

Three themes were generated from the analysis: waking up to a positive HIV status; living with HIV a day at a time; and being my brother’s keeper: preventing HIV transmission. All participants underwent HIV screening at the various prisons. ILHIV also had access to ART although those on remand had challenges with refills. Stigma perpetuated by incarcerated individuals against those with HIV existed, and experiences of inadequate nutrition among incarcerated individuals on ART were reported. Opportunities to improve the experiences of the ILHIV are required to improve care and reduce morbidity and mortality.

Through first-hand experiences from ILHIV in prisons, this study provides the perception of incarcerated individuals on HIV care in prisons. The insights gained from this study can contribute to the development of targeted interventions and strategies to improve HIV care and support for incarcerated individuals.

Sexually transmitted infections (STIs) can be transferred from one person to another through sexual contact. STIs lead to substantial morbidity and mortality and affect many different aspects of human life, including quality of life, sexual health, reproductive health and even the health of newborns and children. Despite of high rates of STIs in prisons, there are not sufficient screening, prevention and treatment programs to control STIs transmission among prisoners in Iran. This study aims to evaluate the prevalence of STIs among incarcerated women in Iran for the first time, using the active case finding strategy.

This is a cross-sectional study conducted on 438 incarcerated women in a prison in Tehran, Iran, from 2017 to 2018. A total of 438 prisoners were screened by active case findings for STI symptoms, then evaluated by complete genital and anal examination, followed by molecular testing.

A total of 189 (43.2%) prisoners announced vaginal discharge, while 194 (44.3%) individuals had vaginal discharge in the genital examination. In the cervical examination, 137 individuals (31.3%) had abnormal findings, of which 83 (18.9%) individuals had cervicitis, 40 (9.1%) individuals had cervical erosion, 38 (8.7%) individuals had cervical prolapse and 17 (3.9%) individuals had bleeding originated from the cervix.

This study showed that it is possible to set up a system in which the diagnosis, follow-up and treatment of prisoners with STIs can be actively performed. Educating prisoners about signs and symptoms, risk behaviors and prevention routes of STIs, as much as regular screening of prisoners, and adequate treatment can help control the STIs prevalence among prisoners and in the general population.