Articles de revues sur le sujet « Sexually transmitted diseases Social aspects Africa »

With political, economical and social changes in Lithuania following the break-up of the Soviet Union, the health-care system has changed. The old Soviet system has been abandoned and it has taken time to re-establish a system under the new government. Resources are limited in most aspects of health care, including sexually transmitted infections (STIs). This has, also limited the development of education packages on STIs which are so important when trying to combat the spread of HIV infection. Notifications of syphilis, in Lithuania, have increased 52 fold between 1990 and 1996 although, since then, the incidence has started to decrease. Syphilis has been more reliably notified than other STIs and serves as the most reliable indicator of STI trends.

Illness representations have been shown to differ across cultures. The aim of the study was to study disease terminology and lay prototypes among a Northern Sotho community in South Africa. The sample for a free listing of disease terms included 41 (55%) women and 34 (45%) men, with a mean age of 36 years (SD=5.6, range 18 to 75 years). The sample for pile sorting of disease terms included 80 Northern Sotho-speaking third-year students from the University of Limpopo; 44 women, 36 men, mean age, 23.4 years (SD=3.4). From free listing of disease terms 50 were selected for pile sorting. Using hierarchical cluster analysis the following clusters could be identified: (1) respiratory problems, (2) internal body problems and sexually transmitted diseases, (3) chronic diseases and head diseases, (4) child diseases and mental problems, (5) child diseases and cancer, (6) feet problems, (7) gastrointestinal diseases. There was homogeneity of features within cluster and difference between clusters.

Adolescents worldwide are at high risk for adverse consequences of sexual activity, including HIV, other sexually transmitted diseases, and unintended pregnancy. Effective intervention strategies are needed to address this risk. This article discusses the advantages of the reasoned action approach for developing such strategies, including the ability to integrate population-specific qualitative information with the approach to develop an intervention that is both theoretically grounded and culturally appropriate. It also describes an application of the approach in developing “Let Us Protect Our Future,” a culturally appropriate HIV risk-reduction intervention for adolescents in South Africa, where sexually transmitted HIV infections are having an especially devastating impact. The results of a randomized controlled trial revealed that grade 6 students in schools that received the intervention were less likely to report having sexual intercourse, unprotected sexual intercourse, and multiple sexual partners during the 12-month follow-up period than their counterparts in control schools.

Background: Sexually Transmitted Infections (STIs) are a public health concern worldwide. Awareness campaigns have been conducted worldwide, educating communities on their manifestations, prevention, and steps to be taken once infected. Objective: This study aimed to determine childbearing women’s knowledge, attitudes, and beliefs about STIs. Methods: A cross-sectional study was conducted at a district hospital near Pretoria in South Africa. The population comprised 190 childbearing women registered at the family planning clinic of the hospital. The sample size of 130 participants was computed at a confidence level of 95% with an error margin of 5%. Participants were selected using a table of random numbers, and data collection by means of a researcher-administered questionnaire. The SPSS software (version 22) was used for data analysis. Statistical significance was set at p < 0.05. Results: Of the 130 participants, 123(94.6%) knew that STIs can be acquired through sex, and 41(31.5%) did not know that STIs can be asymptomatic. The most known STI was HIV by 117(90%) participants, the most known transmission route was sexual intercourse by 126 (96.9%) participants, and the most known symptom was penile/vaginal discharge by 108(83%) participants. Seventy-four (57.3%) regarded STIs as not dangerous, based on their belief that STIs are curable. There was generally a poor association between knowledge on STIs and alcohol consumption (p > 0.05). Conclusion: The childbearing age women knew most aspects of STIs, but had gaps of knowledge. They believed that STIs are curable, which influenced their attitudes towards STIs. Health care professionals are challenged to educate patients on STIs on an ongoing basis.

Background: Premature sexual activity has become a norm in South African society, often resulting in teenage pregnancy and sexually transmitted diseases (STD). Occurrence of premature sexual activity is related to insufficient education, gender inequal- ities, household poverty and place of residence. The Stepping Stones project uses a 10-session programme to educate learners about relationships, HIV-prevention and teenage pregnancy. The purpose was to measure and describe learners’ sexual knowl- edge and activities in a rural technical secondary school in North-west Province, South Africa.
 Methods: A cross-sectional survey. Questionnaires were distributed to learners in grade 8 to 12. Descriptive statistics was used in analysis.
 Results: Seventy-nine questionnaires were analysed. Despite a young sample, 26.6% were sexually active and 24.1% engaged in sexual activity. The mean age for first-time sexual intercourse was 15.2±2.3 years. The use of contraceptives was low (41.2%) and participants reported difficulty in talking to partners about condom use (54.8%). Almost half (45.5%) of the participants had never heard of STDs. Participants expressed a need to use social media as a sex education tool (12.3%). The primary source of information was from school-based programmes (58.0%).
 Conclusion: Findings point to unsafe sexual practice of learners at a school in rural South Africa, even from an early age. This concern is accompanied by the occurrence of low levels of sexually-related knowledge. The learners would benefit from contin- ued implementation of the Stepping Stones programme. Implementation could be improved by incorporating social media and emphasising gender equality and negotiation skills in sexually vulnerable situations.
 Keywords: Sexual knowledge; adolescent learners; South Africa.

Reproductive health is a state of complete physical, mental and social well-being not only free from disease or disability in all aspects related to the reproductive system, its functions and processes. Reproductive health includes: reproductive organs, adolescent sexual behavior, pregnancy, risky sexual behavior of adolescents, sexually transmitted diseases (STDs).Objective: Knowing the image of young women's knowledge about reproductive health class X SMAN 1 Lalan Musi Banyuasin.Method: Descriptive quantitative by using Cross Sectional design done with interview technique with questioner to 60 respondents with purposive sampling technique.Results: Knowledge of reproduction tools, 34 respondents (56.7%) had enough knowledge and 11 respondents (18.3%) had good knowledge. Knowledge of adolescent sexual behavior, 25 respondents (41,6) have enough knowledge and 16 respondents (26,7%) have good knowledge. Knowledge of pregnancy, 33 respondents (55%) have enough knowledge and 5 respondents (8.3%) have good knowledge. Knowledge about risky sexual behavior, 25 respondents (42%) have less knowledge and 13 respondents (21.6%) have good knowledge. Knowledge of sexually transmitted diseases (STDs), 35 respondents (58.3%) had less knowledge and 7 respondents (11.7%) had good knowledge. Improving adolescent knowledge should be carried out for health counseling to schools, as well as providing additional materials on reproductive health and using UKS facilities to the maximum extent possible.

Until recently in Russia the general methodology for the prevention of sexually transmitted infections (STIs) including HIV-infection and blood-borne infections (BBI) has not been developed and targeted preventive interventions aimed at vulnerable populations have not been applied. As a rule, domestic researchers have been confined to detailed analysis of epidemiological data on the prevalence of STIs and other socially significant diseases in general population and their clinical features without offering social prevention technologies. Meanwhile, a large number of scientific researches aimed at improving the prevention strategies for STI/BBI and comprehensive preventive programs combining biomedical and behavioral components are being carried out all over the world. Unfortunately, preventive programs developed abroad cannot be mechanically introduced into the practice of Russian health care system. The programs should be adapted and implemented in the context of the socioeconomic and cultural uniqueness of Russia. The current epidemic situation necessitates switching from secondary and tertiary STI/BBI prevention and traditional biomedical approach to primary prevention and multidisciplinary approach. The multidisciplinary approach to healthy life style promotion and prevention of self-destructive behaviors including alcohol and drug use and risky sexual practices is a new branch of medicine. The presented article is aimed to analyze theoretical, methodological and practical aspects of the development, implementation and effectiveness evaluation of behavioral preventive interventions focused on socially significant infections.

Abstract The current study presents some aspects of syphilis in the Balkan Peninsula from the 19th century until the Interwar. Ever since the birth of modern Balkan States (Greece, Bulgaria, Turkey and Serbia), urbanization, poverty and the frequent wars have been considered the major factors conducive to the spread of syphilis. The measures against sex work and sexually transmitted diseases (STDs) were taken in two aspects, one medical and the other legislative. In this period, numerous hospitals for venereal diseases were established in the Balkan countries. In line with the international diagnostic approach and therapeutic standards, laboratory examinations in these Balkan hospitals included spirochete examination, Wassermann reaction, precipitation reaction and cerebrospinal fluid examination. Despite the strict legislation and the adoption of relevant laws against illegal sex work, public health services were unable to curb the spread of syphilis. Medical and social factors such as poverty, citizen’s ignorance of STDs, misguided medical perceptions, lack of sanitary control of prostitution and epidemiological studies, are highlighted in this study. These factors were the major causes that helped syphilis spread in the Balkan countries during the 19th and early 20th century. The value of these aspects as a historic paradigm is diachronic. Failure to comply with the laws and the dysfunction of public services during periods of war or socioeconomic crises are both factors facilitating the spread of STDs.

In South Africa, adolescents and young adults (ages 15–24) are at risk of HIV, sexually transmitted infections, and unintended pregnancies. Recently, the Department of Basic Education has revised its sexuality education content and teaching strategies (using scripted lessons plans) as part of its life orientation curriculum. This paper presents the methodology and baseline results from the evaluation of the scripted lesson plans and supporting activities. A rigorous cluster-level randomized design with random assignment of schools as clusters is used for the evaluation. Baseline results from grade 8 female and male learners and grade 10 female learners demonstrate that learners are at risk of HIV and early and unintended pregnancies. Multivariable analyses demonstrate that household-level food insecurity and living with an HIV-positive person are associated with sexual experience and pregnancy experience. Implications are discussed for strengthening the current life orientation program for future scale-up by the government of South Africa.

AIDS interventions typically fail to address the disjuncture between private behaviors and the social determinants of HIV infection. Data from a telephone survey of manufacturing companies and a postal survey of occupational health nurses in the Western Cape, South Africa, were used to explore the possible role of occupational health services in prevention and control of AIDS. The author found limited evidence of worker involvement in AIDS programs, particularly in companies with occupational health professionals. The management of sexually transmitted diseases was incomplete. Mandatory pre-employment testing of workers for HIV was not widespread. Respondents' opinions on priorities for AIDS prevention and control reflected a preoccupation with knowledge transfer. To ensure their effectiveness, workplace AIDS programs must improve worker participation and integrate AIDS prevention in general workplace health and safety programs. In addition, education programs must develop objectives within a critical theoretical understanding of the behavioral issues relevant to AIDS prevention, and must emphasize the empowerment of women in the workplace. In the context of the present restructuring of health services in South Africa, occupational health services, using the strategies outlined, can make a major contribution to national AIDS prevention and control.

Researchers from the Universities of Oxford, Nairobi, and Manitoba are collaborating on a project to develop an HIV vaccine based on the immunological protection mechanisms found in commercial sex workers from the Majengo slum in Nairobi. This group consists of educationally and economically disadvantaged women who resort to commercial sex work for a living. A clinic was established in the slum to study sexually transmitted diseases, which now includes HIV/AIDS. The clinic serves as a research facility for the collaborating researchers who have been using the women's blood, cervical, vaginal, and saliva samples for the ongoing studies. The clinic runs two HIV-integrated activities: HIV research and HIV care and treatment. For HIV negative participants, samples are collected and used for research and care after they give informed consent.

Background: Sexual and Reproductive Health (SRH) issues often get less priority than other aspects of humanitarian health response in emergencies and disasters. We aimed to explore the men’s perceptions of Sexually Transmitted Infections (STIs), men’s involvement, and barriers to STIs prevention among men in the affected area by Merapi eruption 2010. Methods: The study used qualitative content analysis. Data were collected through face-to-face in-depth interviews with 2 participants living with STIs and focus on group discussions with 22 participants who witnessed Merapi eruption 2010 from December 2016 to March 2017 in Sleman District, the Special Region of Yogyakarta Province, Indonesia, including academicians, community leaders and community health workers. Results: Participants from the disaster site were mostly senior high school graduates aged between 33 and 46 years. Four themes developed from fourteen categories that represented the men’s perceptions of STIs, men’s involvement, and barriers to the STIs prevention among men in the affected area by Merapi eruption 2010, were revealed from the investigation. Conclusion: Low participation of men in STIs prevention has led to poor SRH outcomes among women. Nurses have a main role in Disaster Risk Reduction (DRR) to enhance the awareness and understanding of people in preparedness for future disasters. Thus, it is necessary for nurses and other health professionals involved in DRR to optimize coordination with community leaders, community health volunteers (health cadres), and other stakeholders to prevent the transmission of communicable diseases in the community.

In this paper we provide an account of our multi-dimensional evaluation of a community led HIV-prevention program in the southern African mining community of Carletonville. The Mothusimpilo Project has three pillars: peer education and condom distribution, syndromic management of sexually transmitted diseases (STDs), and stakeholder mobilisation. Substantial efforts are being made to evaluate the impact of the intervention and in this paper we outline the theoretical rationale, research design and some preliminary results of the evaluation. The first section provides the setting for the evaluation work, viz an intervention which seeks to contextualise traditional biomedical and behavioural approaches to HIV-transmission within their broader community and social contexts. In the second section we outline the theoretical assumptions underlying the evaluation (which has both 'outcome evaluation' and 'process evaluation' components). In particular, we discuss the way in which the concepts of identity, empowerment and social capital are used to understand the processes involved in health-enhancing behaviour change. In the third section we describe our multi-disciplinary evaluation methodology and present some preliminary findings from our on-going evaluation study. One important goal of our evaluation research is to demonstrate the extent to which community level factors serve to assist or hinder the project in achieving its goals. In this way we hope to contribute to understandings of the role of community participation in influencing the outcomes of community-based health promotional projects.

Design: Health issues throughout the sustainable development goals have also been integrated into one ultimate goal, which helps to ensure a healthy lifestyle as well as enhances well-being for any and all human beings of all social level. Meanwhile, regarding the clime change, we may take urgent action to its impacts. Purpose: Nowadays, climate change makes it much more difficult to control the pattern of diseases transmitted and sometimes hard to prevent. In line with this, Centres for Disease Control (CDC) Taiwan grouped the spread of disease through its source in the first six main groups. Those are food or waterborne, airborne or droplet, vector-borne, sexually transmitted or blood-borne, contact transmission, and miscellaneous. According to this, academics, government, and the private sector should work together and collaborate to maintain the health issue. This article examines and connects the climate and communicable aspects towards Penta-Helix in Taiwan. Finding: In summary, we have been addressing the knowledge center on the number of private companies throughout the health care sector, the number of healthcare facilities, and the education institutions widely recognized as Penta Helix. In addition, we used hierarchical likelihood structural equation modeling (HSEMs). All the relationship variables among climate, communicable disease, and Penta Helix can be interpreted through the latent variables with GoF 79.24%.

Background: The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as lack of awareness, social myths, reluctance to vaccine acceptance and stigma with sexually transmitted diseases. Here, we formulate strategies to implement intervention programs against HPV infections and other risk factors for cervical cancer in these countries. Methods: We searched PubMed, Web of Science, and African Journals Online for this review. The current status of anti-HPV vaccination and precancerous screening programs in Mali and Senegal has been assessed by onsite visits. Collaborators from Mali and Senegal collected data and information concerning HPV vaccination and screening programs in these countries. Findings: We found that anti-HPV vaccination and cervical cancer screening have been conducted sporadically mainly in urban areas of Mali and Senegal. No known population-based programs are in progress in either of the two countries. We highlighted the advantages and drawbacks of currently available screening tests and proposed that screening by visual inspection with acetic acid (VIA) accompanied by self-sampling is the most cost-effective, culturally acceptable and most feasible strategy to implement in primary care settings. In addition, HPV DNA testing would be affordable, if local laboratory facilities could be established. We found that many of the factors that increase HPV acquisition and promote the oncogenic effect of the virus are largely widespread in both Senegal and Mali. These include infections with HIV and other sexually transmitted infections (STIs), immunosuppression, polygamous marriages, high parity, early sexual activities, early pregnancies, and multiple sexual partners. Interpretation: Neither vaccines nor screening tests are within the reach of the population in Mali and Senegal because of the high cost. The effective intervention measure would be to integrate anti-HPV vaccines into the Extended Program for Immunization (EPI), which has saved 3 million young lives per year in Africa with the support of GAVI, to implement cost control mechanisms for HPV vaccinations via price negotiations with manufacturing companies, as has recently been done by Rwanda. The collective efforts by local governments, researchers, private sector, and donors may lead to the introduction of affordable screening tests. A robust awareness campaign coupled with sustained and regular engagement of local communities about the prevention and risk factors is extremely important. The projected solutions may be well applicable to other Sub-Saharan countries that face similar challenges containing cervical cancer.

The prevalence of HIV infection in Africa is substantially higher among young women than it is among young men. Biological explanations of this difference have been presented but there has been little exploration of social factors. In this paper we use data from Carletonville, South Africa to explore various social explanations for greater female infection rates. This paper reports on data from a random sample of 507 people between 13 and 24 years old. Subjects were tested for HIV, as well as other sexually transmitted infections (STIs), and answered a behavioural questionnaire. The age-prevalence of HIV infection differs between men and women with considerably higher rates of increase with age among young women. The age of sexual debut did not differ significantly between men and women (15.9 and 16.3 years, respectively) and below the age of 20 years there was no difference in the number or distribution of the number of sexual partners reported by men or women. The risk of infection per partnership was substantially higher among women than among men. Women have sexual partners who are, on average, about five years older than they are with some variation with age. Scaling the age-prevalence curve for men by the age of their sexual partners gives a curve whose shape is indistinguishable from that for women but is about 30% lower for men than for women. In terms of social explanations for HIV rates among women, the data indicates that this difference can be explained by the relative age of sexual partners, but not by other factors explored. In addressing the epidemic among young women it will be essential to deal with the social factors that lead young women to select their partners from older-age cohorts and that shape their sexual networking patterns.

The aim: to analyze the cases of mycobacteriosis in the population of people living with HIV, identified in the infectious diseases hospital in Saint-Petersburg over the past decade.Materials and methods. 90 cases of patients with HIV and mycobacteriosis, who were treated at the clinical infectious diseases hospital named after S.P.Botkin in the period from 2005 to 2017 were analyzed. Distribution of cases by year and etiology was performed. The inclusion criteria were the presence of HIV, culturally confirmed diagnosis of mycobacteriosis. Exclusion criteria: detection of non-tuberculosis mycobacteria without species identification. Two groups were distinguished: mycobacteriosis caused by mycobacterium avium (83 patients) and mycobacteriosis caused by other non-tuberculosis mycobacteria (7 cases). The distribution of patients by sex, age, aspects of epidemiological anamnesis was performed, the main clinical forms were characterized. Sources of bacterial excretion in mycobacteriosis in patients with HIV infection were recorded.Results. Since 2012, there has been an increase in the frequency of mycobacteriosis detection in patients with HIV: the growth of nosology over the past five years, on average, was 57% per year. Group Mycobacterium avium complex was characterized mainly by sexual path of HIV transmission (68,7%), the average age was 35 years, one third of patients were employed at the time of detection of the disease (35%). 11 persons (13,3 per cent) reported a history of being in prison, only four (4,8 per cent) were active drug users. In the group of patients with mycobacteriosis caused by other non-tuberculosis mycobacteria, the hemocontact pathway of HIV transmission prevailed (57,1%), the penitentiary history was 28,6%. In more than half of the cases, the leading source of bacterial excretion was the material of the upper respiratory tract.Conclusion. There is a steady increase in mycobacteriosis in the structure of secondary infections in patients with HIV. The leading etiological agent was mycobacterium avium, patients with this pathology has preserved social status, sexually transmitted infection. Mainly developed generalized forms of the process, the most frequent source of bacterial excretion according to this sample was the material of the respiratory tract.

Abstract Different names are used when referring to sex education, as well as there are different ways to teach the subject. Yet, it remains an essential part of the school curriculum. Using different curricula may yield various results. The content of sex education classes is dependent on various cultural and social aspects, specific to the certain country. In Poland, sex education-related topics are brought up during classes of Introduction to Family Planning, as it is called in Polish. The Ministry of Education is responsible for shaping sex education policies. The curriculum mostly focuses on STI-related diseases (including HIV/AIDS), contraceptive methods and teen pregnancy issues. Unfortunately, psychological aspects of sex or sexual assault subjects are rarely discussed upon. As a result, sexual initiation often results in unwanted pregnancies or infections. Shame is a huge obstacle to effective communication on these topics between teens ant their parents. This shows the need for organizing educational meetings for parents or carers to help them start a conversation on this delicate subject with their kids. Sex education should be focused on presenting upright knowledge with medical accuracy, which will be an addition to the content provided by parents. Well-prepared teachers can have impact over lowering the rate of sexually transmitted infections and teenage pregnancies. Sex education has also a significant influence over promoting responsible sex and increasing teens’ awareness.

The paper presents the methodological and technical aspects of a research project that set out to explore the relationship between sexuality and drugs addiction, with the twofold aim of a better focusing of the phenomenon which is hidden and difficult to read and at preparing appropriate strategies for the prevention of sexually transmitted diseases. The survey was carried out in the border area between the Italian regions Marche and Abruzzo, which is identified as the “pole of sex” [Ricci S., 1998:23] and where there are high rates of drug addiction. The survey involved the population of prostitutes, transvestites and transsexual who regularly attend the road called “Bonifica del Tronto”, between the provinces of Ascoli Piceno and Teramo and who are regular users of drugs (heroin, cocaine and others). It is a marginal population with various ethnic backgrounds, coming from Eastern Europe, Africa and Latin America, which now has a quite stable settlement in this area and is perceived almost as a “subculture of sex”. The majority of the subjects recruited for the research are users of the local Services for drugs addiction. This made the initial contact and recruitment less difficult as it was done through the mediation of the Service operators. The research adopted a qualitative methodological approach and has been carried out through individual interviews – mostly in the headquarters of the Services.

Objectives: Human papillomavirus (HPV) is known as one of the sexually transmitted diseases and the main cause of cervical cancer with its own significant psychological problems. Considering the hidden social aspects associated with these behaviors and since no qualitative research has focused on this issue in Iran, the present study sought to explain women’s experiences of infection with HPV. Materials and Methods: This qualitative research was conducted based on conventional content analysis. To this end, in-depth and semi-structured interviews were fulfilled with 20 individuals (13 women with HPV and 7 key informants) after obtaining participants’ consent. Data analysis was also carried out simultaneously with data collection. Results: Following the code extraction, participants’ experiences in the face of HPV symptoms were grouped into two main categories of psychological responses (i.e., concern, fear and panic, unbelievable acceptance, unpleasant feelings, individual’s response to the disease, as well as reactions by people, family, and husband in the face of the disease) and physical experiences of the disease (i.e., clinical symptoms and long incubation period of the virus). Each subcategory also contained a code that was demonstrated with statements provided by study participants. Conclusions: The results of this study highlighted the importance of understanding the risk of HPV. It was further recommended to provide preventive counseling in community health centers, as well as advising and guiding patients in therapy clinics.

The aim of this project is about valuing these themes, not only in order to increase physiological genres knowledge or the responsible use of contraceptives, but is mainly about growing sexual psychosocial features awareness. Treating these themes in a psychoeducational intervention means: minimize sexually-transmitted diseases, prevent psychotic patients from quitting psychopharmacological treatment and favour the birth and the development of intimate relationships that may help patients leaving an unhelpful isolation condition.Increase the awareness of different sexual and affection aspects: physiological, anatomic and reproductive, relational and communicative, emotional, social and cultural, playful and pleasant ones.The 18 meetings interventions were done using a psychoeducational model; an active leading group manner (role plays and simulations) was used in order to ease the exchange of views between patients and the group leader.We did a first round of meetings with ten patients who participated actively; we also submitted to them a questionnaire – before and after the intervention – in which we collected knowledge and opinions about different themes (contraceptives, risk awareness, affective relationships etc.).From a qualitative analysis of the results we saw a knowledge-improvement about the dealt themes, and also, in some cases, we identified a modification in some problematic behaviours. The sample it's still too small for statistical analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Semi-structured interviews were conducted with 40 mine workers on a Johannesburg gold mine, focusing on workers' perceptions of health, HIV/AIDS and sexuality. The paper seeks to highlight a range of factors which might predispose mine workers to high-risk sexual behaviour, despite the fact that they had all attended HIV-education programmes. These factors are presented within a framework that views the process of sexual decision making as a debating process - in which competing facts and beliefs are weighed up against one another - within the context of a range of normative and social parameters. Firstly, attention is given to a number of pre-existing perceptions and doubts which may blunt the force of the facts that HIV educational messages seek to impart to this particular group of people. These include a lack of perceived urgency regarding the treatment of sexually transmitted diseases (STD's), a commitment to ‘flesh-to-flesh’ sex, a dislike of condoms, and faith in the ability of traditional healers to cure a range of STD's and possibly also HIV/AIDS. Secondly, attention is given to the normative context of sexuality, and in particular the way in which norms of masculinity predispose people to high-risk sexual behaviour. Finally, the paper focuses on some aspects of social and occupational life on the mines as the context within which sexual relationships are conducted. These include the phenomenon of single sex hostels, an acceptance of high levels of disease and accidents as the norm, and the use of alcohol. The paper concludes with a discussion of the challenges these findngs pose for a peer education programme which is shortly to be implemented in the mining context.

Background Determine attitude of young people to reproductive health issues can somewhat predict their behavior in this area. This helps us in planning future on reproductive health. The aim of this study was to determine the attitude of reproductive health and related factors among Iranian students in public universities in Iran. Method A cross-sectional study was carried out. The tool was developed based on a literature review to find out about reproductive health attitudes and sociodemographic factors associated. The face and content validity of the questionnaire was performed using expert judgment. Cronbach’s coefficient and test–retest were used to determine the reliability. Data were analyzed using the Statistical Package for Social Sciences software by independent t test, ANOVA, and multiple linear regression. Results Out of 461 respondents, the majority of students were nonmedical sciences (81.1%). The main sources of information for reproductive health awareness were the media (40%); 54.9% disagreed with having premarital sex in both sexes, while only 36% agreed to postpone sexual activity until marriage in order to prevent sexually transmitted diseases. Moreover, 64% believed that contraception would cause infertility in the future. The majority found the need for reproductive health services and education essential for single youth. Multiple regression showed a poor reproductive health attitude in nonmedical students, families who did not talk about boy–girl relationships, as well as in satellite users and hookah consumers. Conclusion The students’ level of attitude on reproductive health was not satisfactory. Intervention programs related to reproductive health taking into account the cultural aspects of Iranian society can protect young people from risky behaviors and unwanted pregnancies by creating a positive attitude.

The article analyzes the general and special international legal acts in the field of regulation of the right to the highest standard of living (right to health) of minors deprived of liberty, in particular: Declaration of the Rights of the Child, 1924, United Nations Declaration of the Rights of the Child, 1959, International Covenant on Economic, Social and Cultural Rights, 1966, Convention on the Rights of the Child, 1989, United Nations Minimum Standard Rules on the Administration of Juvenile Justice (Beijing Rules), 1985, United Nations Guidelines for the Prevention of Juvenile Delinquency (The Riyadh Guidelines), 1990, UN General Assembly special resolutions on the protection of the rights of the child, including children deprived of their liberty, etc. The emphasis is placed on key problematic aspects of the protection of the right to health of minors deprived of their liberty, in particular: the use of torture and other cruel, inhuman or degrading treatment or punishment; harm to the mental and physical health of children in all situations of imprisonment; the spread of sexually transmitted infections. The article focuses on the special needs of children with disabilities. Given the existing problems of drug use, which contribute to the spread of infectious diseases among the categories of prisoners, cause significant harm to the health of minors, attention is focused on the characteristics of special rules in this area. Given the fact that the emergence and spread of the COVID-19 pandemic has become a modern threat and a challenge to health of population in general, including persons deprived of their liberty, attention is paid to international acts, which set out recommendations to protect this category of persons during the pandemic. Relevant conclusions and recommendations have been made to improve the status of minors deprived of their liberty.

AIDS has become the leading cause of death among people under age 45 in many major cities throughout the United States and Western Europe, and the projected mortality rate for those infected with HIV is virtually 100%. As of July 5, 1996, the World Health Organization (WHO) Global Programme on AIDS reported a cumulative 1,393,649 AIDS cases from 193 countries (WHO 1996). This represented a 19% increase in actual cases reported a year earlier. However, the WHO estimates that allowing for incomplete reporting and under-diagnosis, there were probably some 7.7 million cumulative AIDS cases by mid-1996. In terms of HIV, the WHO estimates that there has been a cumulative distribution of almost 30 million HIV-infected individuals as of mid-1996 (WHO 1996). The joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that some 20.1 million adults were living with HIV infection or AIDS at the close of 1995. By the year 2000, UNAIDS estimates project that 30 to 40 million people will have been infected with HIV worldwide (UNAIDS 1996). With more than 19 million HIV-infected adults, Sub-Saharan Africa remains the most affected region of the world (WHO 1996). The predominant mode of transmission since the beginning of the epidemic has been through heterosexual contact. The reuse of unsterilized hypodermic needles in transfusions and inoculations is also relatively common in many African nations. In a number of countries in that part of the world, furthermore, HIV infection has been spread through population movements due to situations of conflict or poverty (Decosas et al. 1995). The lower status of women in a number of African nations has also contributed to the rapid spread of the epidemic (UNAIDS 1996). HIV infections in African women outnumber men by a ratio of 6 to 5. More than 6 million women of childbearing age have been affected, and UNAIDS believes that as many as I million children may already have been infected either prior to or during birth, or during breast feeding (UNAIDS 1996). Another contributing factor has been the full range of sexually transmitted diseases, which increase the risk of HIV infection if left untreated (UNAIDS 1996).

ABSTRACTObjective: to identify the influence of religiosity in the adoption of safer sexual behaviors related to prevention of STD/ HIV/AIDS, from the knowledge of the activities in the church and can be inserted in the course of nursing as a social network of support, but also will promote educational activities with young people from the biblical knowledge about the prevention of these diseases. Methods: this is about a qualitative study, focused on the Paulo Freire’s methodology. The subjects are adolescents who participate in meetings of young assiduously promoted by the Catholic church in the municipality of Tianguá-CE to accept and participate in the study. To assist in the collection and analysis of data used: semi-structured interview, a field diary, observation and free of crop circles as Freirian method. The analysis will be made from the sort of stories and discussion according to the sequence of circles together with the results more significant. It will be observed the ethical aspects of research in Human Beings accordance with Resolution 196/96. Descriptors: nursing; health education; sexually transmitted diseases; acquired immunodeficiency syndrome. RESUMOObjetivo: identificar a influência da religiosidade na adoção de comportamentos sexuais seguros relacionados à prevenção das DST/HIV/AIDS, a partir das atividades realizadas na igreja que podem ser inseridas no exercício da enfermagem como rede social de apoio, e promover ações educativas com os adolescentes acerca da prevenção destes agravos. Métodos: será realizado estudo qualitativo voltado à metodologia de Paulo Freire. Os sujeitos serão adolescentes que participem assiduamente de encontros de jovens promovidos pela igreja católica do município de Tianguá-CE e que aceitem participar do estudo. Para a coleta e análise dos dados será utilizado entrevista semi-estruturada, diário de campo, observação livre e círculos de cultura conforme o método Freiriano. A análise será a partir da ordenação das narrações e discussão de acordo com a seqüência dos círculos e com os resultados mais significativos. Serão observados os aspectos éticos da pesquisa em Seres Humanos de acordo com a Resolução 196/96. Descritores: enfermagem; educação em saúde; doenças sexualmente transmissíveis; síndrome de imunodeficiência adquirida. RESUMEN Objetivos: identificar la influencia de la religiosidad en la adopción de comportamientos sexuales seguros relacionados con la prevención de las DST/HIV/SIDA, a partir de las actividades realizadas en la Iglesia que pueden ser inseridas en le ejercicio de la enfermería como red social de apoyo y promover acciones educativas con los adolecentes a cerca de la prevención de estos agravantes. Métodos: será realizado un estudio cualitativo tornado hacia la metodología de Paulo Freire. Los sujetos seron adolecentes que participen asiduamente de reuniones de jóvenes promovidas por la Iglesia Católica del Municipio de Tianguá-CE e que acepten participar del estudio. Para la colección y análisis de los datos será utilizada entrevista semi-estructurada, prontuario de campo, observación libre y círculos de cultura conforme el método de Freire. El análisis será a partir de la orden de narrativas y discusión de acuerdo con la secuencia de los círculos y con los resultados más significativos. Serán observados los aspectos éticos de la pesquisa en Seres Humanos en la conformidad con la Resolución 196/96. Descriptores: enfermería; educación en salud; enfermedades de transmisión sexual; síndrome de inmunodeficiencia adquirida.

In my postgraduate formation during the last years of the 80’s, we had close to thirty hospital beds in a pavilion called “sépticas” (1). In Colombia, where abortion was completely penalized, the pavilion was mostly filled with women with insecure, complicated abortions. The focus we received was technical: management of intensive care; performance of hysterectomies, colostomies, bowel resection, etc. In those times, some nurses were nuns and limited themselves to interrogating the patients to get them to “confess” what they had done to themselves in order to abort. It always disturbed me that the women who left alive, left without any advice or contraceptive method. Having asked a professor of mine, he responded with disdain: “This is a third level hospital, those things are done by nurses of the first level”.
 Seeing so much pain and death, I decided to talk to patients, and I began to understand their decision. I still remember so many deaths with sadness, but one case in particular pains me: it was a woman close to being fifty who arrived with a uterine perforation in a state of advanced sepsis. Despite the surgery and the intensive care, she passed away. I had talked to her, and she told me she was a widow, had two adult kids and had aborted because of “embarrassment towards them” because they were going to find out that she had an active sexual life. A few days after her passing, the pathology professor called me, surprised, to tell me that the uterus we had sent for pathological examination showed no pregnancy. She was a woman in a perimenopausal state with a pregnancy exam that gave a false positive due to the high levels of FSH/LH typical of her age. SHE WAS NOT PREGNANT!!! She didn’t have menstruation because she was premenopausal and a false positive led her to an unsafe abortion. Of course, the injuries caused in the attempted abortion caused the fatal conclusion, but the real underlying cause was the social taboo in respect to sexuality.
 I had to watch many adolescents and young women leave the hospital alive, but without a uterus, sometime without ovaries and with colostomies, to be looked down on by a society that blamed them for deciding to not be mothers. I had to see situation of women that arrived with their intestines protruding from their vaginas because of unsafe abortions. I saw women, who in their despair, self-inflicted injuries attempting to abort with elements such as stick, branches, onion wedges, alum bars and clothing hooks among others. Among so many deaths, it was hard not having at least one woman per day in the morgue due to an unsafe abortion.
 During those time, healthcare was not handled from the biopsychosocial, but only from the technical (2); nonetheless, in the academic evaluations that were performed, when asked about the definition of health, we had to recite the text from the International Organization of Health that included these three aspects. How contradictory!
 To give response to the health need of women and guarantee their right when I was already a professor, I began an obstetric contraceptive service in that third level hospital. There was resistance from the directors, but fortunately I was able to acquire international donations for the institution, which facilitated its acceptance. I decided to undertake a teaching career with the hope of being able to sensitize health professionals towards an integral focus of health and illness.
 When the International Conference of Population and Development (ICPD) was held in Cairo in 1994, I had already spent various years in teaching, and when I read their Action Program, I found a name for what I was working on: Sexual and Reproductive Rights. I began to incorporate the tools given by this document into my professional and teaching life. I was able to sensitize people at my countries Health Ministry, and we worked together moving it to an approach of human rights in areas of sexual and reproductive health (SRH). This new viewpoint, in addition to being integral, sought to give answers to old problems like maternal mortality, adolescent pregnancy, low contraceptive prevalence, unplanned or unwanted pregnancy or violence against women. With other sensitized people, we began with these SRH issues to permeate the Colombian Society of Obstetrics and Gynecology, some universities, and university hospitals. We are still fighting in a country that despite many difficulties has improved its indicators of SRH.
 With the experience of having labored in all sphere of these topics, we manage to create, with a handful of colleagues and friend at the Universidad El Bosque, a Master’s Program in Sexual and Reproductive Health, open to all professions, in which we broke several paradigms. A program was initiated in which the qualitative and quantitative investigation had the same weight, and some alumni of the program are now in positions of leadership in governmental and international institutions, replicating integral models. In the Latin American Federation of Obstetrics and Gynecology (FLASOG, English acronym) and in the International Federation of Obstetrics and Gynecology (FIGO), I was able to apply my experience for many years in the SRH committees of these association to benefit women and girls in the regional and global environments.
 When I think of who has inspired me in these fights, I should highlight the great feminist who have taught me and been with me in so many fights. I cannot mention them all, but I have admired the story of the life of Margaret Sanger with her persistence and visionary outlook. She fought throughout her whole life to help the women of the 20th century to be able to obtain the right to decide when and whether or not they wanted to have children (3). Of current feminist, I have had the privilege of sharing experiences with Carmen Barroso, Giselle Carino, Debora Diniz and Alejandra Meglioli, leaders of the International Planned Parenthood Federation – Western Hemisphere Region (IPPF-RHO). From my country, I want to mention my countrywoman Florence Thomas, psychologist, columnist, writer and Colombo-French feminist. She is one of the most influential and important voices in the movement for women rights in Colombia and the region. She arrived from France in the 1960’s, in the years of counterculture, the Beatles, hippies, Simone de Beauvoir, and Jean-Paul Sartre, a time in which capitalism and consumer culture began to be criticized (4). It was then when they began to talk about the female body, female sexuality and when the contraceptive pill arrived like a total revolution for women. Upon its arrival in 1967, she experimented a shock because she had just assisted in a revolution and only found a country of mothers, not women (5). That was the only destiny for a woman, to be quiet and submissive. Then she realized that this could not continue, speaking of “revolutionary vanguards” in such a patriarchal environment.
 In 1986 with the North American and European feminism waves and with her academic team, they created the group “Mujer y Sociedad de la Universidad Nacional de Colombia”, incubator of great initiatives and achievements for the country (6). She has led great changes with her courage, the strength of her arguments, and a simultaneously passionate and agreeable discourse. Among her multiple books, I highlight “Conversaciones con Violeta” (7), motivated by the disdain towards feminism of some young women. She writes it as a dialogue with an imaginary daughter in which, in an intimate manner, she reconstructs the history of women throughout the centuries and gives new light of the fundamental role of feminism in the life of modern women. Another book that shows her bravery is “Había que decirlo” (8), in which she narrates the experience of her own abortion at age twenty-two in sixty’s France.
 My work experience in the IPPF-RHO has allowed me to meet leaders of all ages in diverse countries of the region, who with great mysticism and dedication, voluntarily, work to achieve a more equal and just society. I have been particularly impressed by the appropriation of the concept of sexual and reproductive rights by young people, and this has given me great hope for the future of the planet. We continue to have an incomplete agenda of the action plan of the ICPD of Cairo but seeing how the youth bravely confront the challenges motivates me to continue ahead and give my years of experience in an intergenerational work.
 In their policies and programs, the IPPF-RHO evidences great commitment for the rights and the SRH of adolescent, that are consistent with what the organization promotes, for example, 20% of the places for decision making are in hands of the young. Member organizations, that base their labor on volunteers, are true incubators of youth that will make that unassailable and necessary change of generations. In contrast to what many of us experienced, working in this complicated agenda of sexual and reproductive health without theoretical bases, today we see committed people with a solid formation to replace us. In the college of medicine at the Universidad Nacional de Colombia and the College of Nursing at the Universidad El Bosque, the new generations are more motivated and empowered, with great desire to change the strict underlying structures.
 Our great worry is the onslaught of the ultra-right, a lot of times better organized than us who do support rights, that supports anti-rights group and are truly pro-life (9). Faced with this scenario, we should organize ourselves better, giving battle to guarantee the rights of women in the local, regional, and global level, aggregating the efforts of all pro-right organizations. We are now committed to the Objectives of Sustainable Development (10), understood as those that satisfy the necessities of the current generation without jeopardizing the capacity of future generations to satisfy their own necessities. This new agenda is based on:
 - The unfinished work of the Millennium Development Goals
 - Pending commitments (international environmental conventions)
 - The emergent topics of the three dimensions of sustainable development: social, economic, and environmental.
 We now have 17 objectives of sustainable development and 169 goals (11). These goals mention “universal access to reproductive health” many times. In objective 3 of this list is included guaranteeing, before the year 2030, “universal access to sexual and reproductive health services, including those of family planning, information, and education.” Likewise, objective 5, “obtain gender equality and empower all women and girls”, establishes the goal of “assuring the universal access to sexual and reproductive health and reproductive rights in conformity with the action program of the International Conference on Population and Development, the Action Platform of Beijing”. It cannot be forgotten that the term universal access to sexual and reproductive health includes universal access to abortion and contraception.
 Currently, 830 women die every day through preventable maternal causes; of these deaths, 99% occur in developing countries, more than half in fragile environments and in humanitarian contexts (12). 216 million women cannot access modern contraception methods and the majority live in the nine poorest countries in the world and in a cultural environment proper to the decades of the seventies (13). This number only includes women from 15 to 49 years in any marital state, that is to say, the number that takes all women into account is much greater. Achieving the proposed objectives would entail preventing 67 million unwanted pregnancies and reducing maternal deaths by two thirds. We currently have a high, unsatisfied demand for modern contraceptives, with extremely low use of reversible, long term methods (intrauterine devices and subdermal implants) which are the most effect ones with best adherence (14).
 There is not a single objective among the 17 Objectives of Sustainable Development where contraception does not have a prominent role: from the first one that refers to ending poverty, going through the fifth one about gender equality, the tenth of inequality reduction among countries and within the same country, until the sixteenth related with peace and justice. If we want to change the world, we should procure universal access to contraception without myths or barriers. We have the moral obligation of achieving the irradiation of extreme poverty and advancing the construction of more equal, just, and happy societies.
 In emergency contraception (EC), we are very far from reaching expectations. If in reversible, long-term methods we have low prevalence, in EC the situation gets worse. Not all faculties in the region look at this topic, and where it is looked at, there is no homogeneity in content, not even within the same country. There are still myths about their real action mechanisms. There are countries, like Honduras, where it is prohibited and there is no specific medicine, the same case as in Haiti. Where it is available, access is dismal, particularly among girls, adolescents, youth, migrants, afro-descendent, and indigenous. The multiple barriers for the effective use of emergency contraceptives must be knocked down, and to work toward that we have to destroy myths and erroneous perceptions, taboos and cultural norms; achieve changes in laws and restrictive rules within countries, achieve access without barriers to the EC; work in union with other sectors; train health personnel and the community. It is necessary to transform the attitude of health personal to a service above personal opinion.
 Reflecting on what has occurred after the ICPD in Cairo, their Action Program changed how we look at the dynamics of population from an emphasis on demographics to a focus on the people and human rights. The governments agreed that, in this new focus, success was the empowerment of women and the possibility of choice through expanded access to education, health, services, and employment among others. Nonetheless, there have been unequal advances and inequality persists in our region, all the goals were not met, the sexual and reproductive goals continue beyond the reach of many women (15). There is a long road ahead until women and girls of the world can claim their rights and liberty of deciding. Globally, maternal deaths have been reduced, there is more qualified assistance of births, more contraception prevalence, integral sexuality education, and access to SRH services for adolescents are now recognized rights with great advances, and additionally there have been concrete gains in terms of more favorable legal frameworks, particularly in our region; nonetheless, although it’s true that the access condition have improved, the restrictive laws of the region expose the most vulnerable women to insecure abortions.
 There are great challenges for governments to recognize SRH and the DSR as integral parts of health systems, there is an ample agenda against women. In that sense, access to SRH is threatened and oppressed, it requires multi-sector mobilization and litigation strategies, investigation and support for the support of women’s rights as a multi-sector agenda.
 Looking forward, we must make an effort to work more with youth to advance not only the Action Program of the ICPD, but also all social movements. They are one of the most vulnerable groups, and the biggest catalyzers for change. The young population still faces many challenges, especially women and girls; young girls are in particularly high risk due to lack of friendly and confidential services related with sexual and reproductive health, gender violence, and lack of access to services. In addition, access to abortion must be improved; it is the responsibility of states to guarantee the quality and security of this access. In our region there still exist countries with completely restrictive frameworks.
 New technologies facilitate self-care (16), which will allow expansion of universal access, but governments cannot detach themselves from their responsibility. Self-care is expanding in the world and can be strategic for reaching the most vulnerable populations. There are new challenges for the same problems, that require a re-interpretation of the measures necessary to guaranty the DSR of all people, in particular women, girls, and in general, marginalized and vulnerable populations. It is necessary to take into account migrations, climate change, the impact of digital media, the resurgence of hate discourse, oppression, violence, xenophobia, homo/transphobia, and other emergent problems, as SRH should be seen within a framework of justice, not isolated.
 We should demand accountability of the 179 governments that participate in the ICPD 25 years ago and the 193 countries that signed the Sustainable Development Objectives. They should reaffirm their commitments and expand their agenda to topics not considered at that time. Our region has given the world an example with the Agreement of Montevideo, that becomes a blueprint for achieving the action plan of the CIPD and we should not allow retreat. This agreement puts people at the center, especially women, and includes the topic of abortion, inviting the state to consider the possibility of legalizing it, which opens the doors for all governments of the world to recognize that women have the right to choose on maternity. This agreement is much more inclusive:
 Considering that the gaps in health continue to abound in the region and the average statistics hide the high levels of maternal mortality, of sexually transmitted diseases, of infection by HIV/AIDS, and the unsatisfied demand for contraception in the population that lives in poverty and rural areas, among indigenous communities, and afro-descendants and groups in conditions of vulnerability like women, adolescents and incapacitated people, it is agreed: 
 33- To promote, protect, and guarantee the health and the sexual and reproductive rights that contribute to the complete fulfillment of people and social justice in a society free of any form of discrimination and violence.
 37- Guarantee universal access to quality sexual and reproductive health services, taking into consideration the specific needs of men and women, adolescents and young, LGBT people, older people and people with incapacity, paying particular attention to people in a condition of vulnerability and people who live in rural and remote zone, promoting citizen participation in the completing of these commitments.
 42- To guarantee, in cases in which abortion is legal or decriminalized in the national legislation, the existence of safe and quality abortion for non-desired or non-accepted pregnancies and instigate the other States to consider the possibility of modifying public laws, norms, strategies, and public policy on the voluntary interruption of pregnancy to save the life and health of pregnant adolescent women, improving their quality of life and decreasing the number of abortions (17).

Influences on cultural, social, economic and political life of the Bhaca as well as their Interaction with other cultures from within South Africa and other parts of the world have led to the erosion of older traditions and customs resulting in a replacement of values that have promoted immorality, crime and an increase in sexually transmitted diseases among others. Consequently, these forces have resulted in change in the structure of mamtiseni and nkciyo female initiation ceremonies, thereby influencing the musical arts embedded in them. This article examines the educational content of the songs and dances and the role these musical arts play within mamtiseni and nkciyo celebrations expressed by the Bhaca of the Eastern Cape Province of South Africa. The article reveals that despite the influences on mamtiseni and nkciyo female initiation ceremonies it is evident that certain elements have continued to a large extent as they used to be in the pre-colonial times, while others have undergone change to suit the current lifestyle of the people in South Africa. The songs have undergone changes especially in their texts, which have shifted focus from menstruation and marriage to include topical issues of a social nature and wellbeing, and as such the repertoire reduced.

Sexually transmitted diseases (STD) are defined as a group of communicable diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually transmitted include some 20 pathogens. Some of these agents (such as Chlamydia trachomatis, herpes simplex virus, human papilloma virus, hepatitis B. virus, human immunodeficiency virus) tend to replace the classical "venereal diseases" both in importance and frequency as these agents are often more difficult to detect, treat, and control. Sexually transmitted diseases are a major public health problem in most African countries on account of their frequency, their associated morbidity and mortality, their impact on maternal and infant health, as well as their economic costs in terms of health expenditure and lost productivity, and, last but not least, because of their social consequences. Recent epidemiological studies using sophisticated diagnostic technologies greatly extend our knowledge on the true spectrum of complications and sequelae associated with these infections. Nongonococcal urethritis - caused to 40% by Chlamydia trachomatis - and gonococcal infections are together the most frequent sexually transmitted diseases. The increasing importance of chlamydial infections, in contrast to a gradual decrease of gonococcal infections, is related to the fact that these infections Sexually transmitted diseases (STD) are defined as a group of communica- ble diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually trans- mitted include some 20 pathogens. Some of these agents (such as Chlamydia trachomatis, herpes simplex virus, human papilloma virus, hepatitis Br virus, human immunodeficiency virus) tend to replace the classical "vene- real diseases" both in importance and frequency as these agents are often more difficult to detect, treat, and control. Sexually transmitted diseases are a major public health problem in most African countries on account of their frequency, their associated morbidity and mortality, their impact on maternal and infant health, as well as their economic costs in terms of health expenditure and lost productivity, and, last but not least, because of their social consequences. Recent epidemio- logical studies using sophisticated diagnostic technologies greatly extend our knowledge on the true spectrum of complications and sequelae asso- ciated with these infections. Nongonococcal urethritis - caused to 40% by Chlamydia trachomatis - and gonococcal infections are together the most frequent sexually transmitted diseases. The increasing importance of chlamydial infections, in contrast to a gradual decrease of gonococcal infections, is related to thefact that these infections frequently cause asymptomatic or mild disease and do not motivate patients to seek medical care, resulting in an extended period of infectivity and high risk of developing complications. Untreated gonorrhoea and chlamydial infections are the most common causes of epididymitis in males under the age of 35 years and may lead to decreased fertility. In some parts of sub-saharan Africa where urethritis often goes untreated, epididymitis is the leading course of male infertility. Also urethral strictures still from a large part of urogenital practice in some African countries. An estimated 8-16% of women with untreated endocervical gonococcal or chlamydial infections will develop acute salpingitis following an ascending spread of these pathogens. After one episode of acute salpingitis approximately 10% of women may become infertile due to complete tubal occlusion. Similarly, the risk for women to develop an ectopic pregnancy after salpingitis is 6-10 times greater than in controls. Ectopic pregnancies in areas with insufficient health services carry a high mortality risk. Maternal infections with STD may not only have adverse effects on pregnancy outcome but may cause serious morbidity and mortality in the newborn (e.g. congenital syphilis, ophthalmia neonatorum, herpes simplex virus infection of the neonate, chlamydial pneumonia, congenital HIV infection). AIDS is an example "par excellence" of a sexually transmitted disease of public health importance requiring extensive clinical services and posing enormous financial and social problems for the individual and the society at large. AIDS and the other viral STD have greatly increased the interest in primary prevention strategies such as health education and behavioral modification, for the control of sexually transmitted diseases.KEYWORDS: chancroid, chlamydia, gonorrhoea, HIV, infertility, sexually transmitted diseases, surveillance

Sexually transmitted diseases are an important problem in family medicine and sexology. Women who already have an infection (particularly one that causes genital lesions) are more likely to get or transmit another STI, including HIV. Some aspects of the prevention of sexually transmitted infections in the context of sex education and promotion of healthy behaviors were discussed. Promoting mechanical contraceptives, consulting with sexual health specialists, and providing professional healthcare are effective tools in combating sexually transmitted diseases. It is impossible to overestimate the role of family doctors or primary care physicians in providing reliable information on prevention, diagnosis and treatment of sexually transmitted diseases. Sexually transmitted diseases belong to infectious diseases for which the incidence rate has grown steadily in recent years. They are a significant problem not only for family medicine or sexology, but they are a global social problem. The role of family doctors, i.e. general practitioners, in providing reliable information on prevention, diagnosis and treatment of STD should not be overestimated.

This paper was initiated as an effort to improve our understanding of health-seeking behaviour in individuals with sexually transmitted infections. It quickly became apparent that the social, cultural, economic, biological and political issues that influence health-seeking behaviour in individuals with sexually transmitted infections greatly differed from those who have or had other diseases. Through a critique of the most current model describing sexually transmitted infection health-seeking behaviour developed by Aral and Wasserheit (1999), this paper presents a focused argument for an anthropology of sexually transmitted infections. The Aral and Wasserheit (1999) model fails to significantly describe the health-seeking behaviour of individuals infected with more than one sexually transmitted infection simultaneously. By examining aspects of pathocenosis and epidemiological synergy, it was found that the complex interactions between syphilis and HIV/AIDS changes the way we should study health-seeking behaviour for individuals with sexually transmitted infections in general. Therefore, while examining the syphilis/HIV paradigm, it became clear that an anthropology of sexually transmitted infections is in fact necessary.

Hanne Overgaard Mogensen: A Social
 Response to the Epidemics of Urbanization.
 AIDS Information in Southern
 Zambia
 In Southern Zambia, Tonga people associate
 AIDS with a locally defined disease called
 kahungo which is said to be caused by
 contact with symbolically polluted biood.
 Before the arrival of AIDS, kahungo was
 associated with TB and sexually transmitted
 diseases. In Africa, epidemics of TB and
 STDs were often related to colonization and
 urbanization. Similar to AIDS, they spread
 more rapidly than what was known in
 Europe, and the colonial administration tried
 to explain this with “problems of behaviour”,
 thereby ignoring the miserable
 conditions under which people lived. The
 Tongas’ association of these diseases with
 kahungo should be seen as a social response
 to new epidemics. While the Europeans
 talked about individual problems of adaptation
 to modem life, kahungo concems the
 collective responsibility to maintain order.
 Kahungo, a disease of disorderly biood, has
 become the symbol of the disorder of
 urbanization and modemization.

Due to the scarcity of official data on sexually transmitted diseases in the Middle East and North Africa region (MENA), it becomes important to seek alternative indications on the online information interests and possible spread of such diseases. This paper uses news stories from 10 Arabic media outlets, Wikipedia views, and data from Google Trends as well as social media on the HIV-AIDS epidemic. In order to investigate whether Internet searches are driven or influenced by media coverage, the correlation between media coverage and Internet searches is examined. The results indicate that there are very weak to moderate correlations between the two as media coverage of HIV-AIDS is not a good indicator of public attention. Data sources that are more accessible, like Google and Wikipedia searches and social media, can provide a better understanding of public information interests. Also, data retrieved from Google Trends in relation to the search terms “AIDS treatment” and “AIDS symptoms” provide important indicators on the top cities from which searches often originate. The findings of the study can aid health practitioners in identifying interest in and awareness of HIV-AIDS in the MENA region.

Background: Unplanned pregnancies amongst students at higher education institutions are a major concern worldwide, including South Africa. Apart from various social and psychological challenges, unplanned pregnancies affect students’ objectives of achieving academic success. Research undertaken in the United States of America (USA) indicates that around 80% of female students in institutions of higher education between ages 18 and 24 are sexually active.Objectives: To assess and describe the use of contraceptives by undergraduate female students in a selected higher educational institution in Gauteng.Method: A cross-sectional, descriptive, quantitative design was used. A total of 400 female undergraduate students were requested to respond to a self-administered questionnaire. Stratified random sampling was used to select the participants. They were selected systematically from two campuses. Data were entered using an excel sheet at the Department of Statistics, and analysed using the Statistical Analysis Software programme, (SAS version 9.3), of the Department of Statistics’ higher educational institutions.Results: A total of 74%females indicated they were sexually active, 79%of whom reported using contraceptives. The most common used methods were oral contraceptives at 38%, and 25% for male condoms. The most commonly known methods were condoms at 84%, and the oral contraceptive at 68%. The knowledge of condom use to prevent sexually transmitted diseases was high at 91%.Conclusion: Inadequate knowledge and awareness on some contraceptive methods was found. Thus, educational programmes to increase students’ knowledge on the use of all contraceptive methods are urgently needed

Background: Approximately 3 million adolescents and young adults (AYA), between the ages of 15 years and 24 years, are living with HIV in sub-Saharan Africa. The use of pre-exposure prophylaxis (PrEP) may be a promising HIV prevention tool to bridge the high-risk years of AYA between sexual debut and adulthood.Objectives: Concerns have been raised that the use of PrEP could lead to an increase in sexual risk behaviour and sexually transmitted infections in general and less condom use in particular among adolescents.Methods: This study assesses condom use among South African adolescents enrolled on a demonstration PrEP study, called Pluspills, being conducted in Cape Town and Soweto. A questionnaire on sexual risk behaviour was administered at baseline and after 4, 8 and 12 weeks. Three different questions on condom use were asked at each visit. Unless all answers indicated condom use at all times, a participant was scored ‘at risk’. McNemar’s tests and a Cochran’s Q test were used to investigate changes in condom use over time.Results: We interviewed 148 adolescents (66% female) at baseline. Eighty-nine participants completed all visits. In this group, an increase in condom use was observed over the period of 12 weeks. Most participants who reported behavioural changes mentioned an increase in condom use.Conclusion: There was no sign of sexual risk compensation in the 12 weeks of the study. Observed increase in condom use can be explained by an increased awareness of personal HIV risk or by social desirability or recall biases. In future research, additional data including other biomarkers of unprotected sex and longer follow-up time would be useful to help understand the relationship between PrEP use, sexual risk perception and consequent behaviours, especially in adolescents.

AbstractObjectivesIt is widely accepted that sexual and reproductive health in adolescents are among the health priorities in the world that affects health aspects and the formation of beliefs and socioeconomic development in the community. However, achieving goals related to sexual and reproductive health is not possible without awareness and participation of the adolescents. On the other hand, proper knowledge about such issues can prevent many problems in this regard.MethodsThis qualitative study was carried out for one month in schools of Alborz University of Medical Sciences using content analysis. Data were collected from semi-structured, individual and in-depth interviews with female students. In addition, data analysis was performed using guided qualitative content analysis (theory-based).ResultsAnalysis of the data led to the extraction of 11 primary codes classified in six categories of protection motivation constructs (perceived sensitivity, perceived severity, response efficiency, response cost, self-efficacy, and internal rewards) and two additional categories (communications and social contexts).ConclusionAll interviewees found themselves exposed to sexually transmitted diseases and emphasized sexual self-care even though the majority of these individuals had inadequate self-efficacy.

Background: School participation and educational attainment among adolescents have been rising rapidly in the developing world. Thus, to attain Millennium Development Goal 6 (Combat HIV and/or AIDs, malaria and other diseases), it is crucial to seize the opportunity to educate and encourage teenagers about healthy choices and proper social behaviours that will continue into adulthood.Aim: This study aimed to assess the exposure of rural secondary school learners to health education and promotion at schools in the Limpopo Province of South Africa.Setting: This study was carried out at 10 secondary schools in Vhumbedzi educational circuit.Methodology: The study adopted a cross-sectional quantitative approach. Data were collected from 338 randomly selected learners from 10 secondary schools that make up a rural Vhumbedzi circuit in the Limpopo province. A self-administered questionnaire was used to collect data.Results: The findings showed that, 102 (66.07%) male and 121 (67.60%) female learners reported that they were taught about physical changes that occur during adolescence. In the same vein, most of the participants (n = 128, 84.39%) and (n = 152, 85.39%) males and females respectively claimed to have been taught about sexually transmitted diseases.Conclusion: In this study the secondary schools in the Limpopo Province of South Africa are making efforts to uphold and expose their learners to health education and promotion at school.Keyword: Health education and promotion, adolescents, school, learners

: Coronavirus (COVID-19) outbreak was first reported from China in December 2019, and World Health Organization declared the outbreak as a pandemic on 11 March 2020. The number of confirmed cases is rising alarmingly in most countries across all continents over the past few months. The current COVID-19 pandemic has an immense impact on Sexual and reproductive health and rights (SRHR) with disruptions in regular provision of Sexual and reproductive health (SRH) services such as maternal care, safe abortion services, contraception, prevention and treatment of HIV/AIDS and other sexually transmitted diseases. Other aspects that merit attention include probable increase in domestic violence, sexual abuse, and effects of stigma associated with coronavirus infection on SRH clients and health care providers. Furthermore, as the coronavirus infection is relatively new, only minimal data is available to understand the impact of this disease on SRH, including coronavirus infection complicating pregnancies, and in people with STI/HIV-related immunosuppression. There is a serious necessity for the medical fraternity to generate psycho-social and clinico-epidemiological correlations between coronavirus disease and SRHR outcomes. The article reviews the hidden impact of coronavirus pandemic on sexual and reproductive health and rights of women, particularly in India

Abstract Background With growth of genomics research in Africa, concern has arisen about comprehension and adequacy of informed consent given the highly technical terms used in this field. We therefore decided to study whether there are linguistic and cultural concepts used to communicate heritability of characters, traits and diseases in an indigenous African population. Methods We conducted Focus Group Discussions among 115 participants stratified by sex, age and socio-economic status and Key Informant Interviews among 25 stakeholders and Key Opinion Leaders among Yoruba living in Ibadan, Nigeria. We used Atlas-ti v.8.3.17 software to analyze the data, using thematic approach. Results The study participants identified several linguistic and cultural concepts including words, proverbs, and aphorisms that are used to describe heritable characters, traits and diseases in their local dialect. These included words that can be appropriated to describe dominant and recessive traits, variations in penetrance and dilution of strength of heritable characteristics by time and inter-marriage. They also suggested that these traits are transmitted by “blood”, and specific partner’s blood may be stronger than the other regardless of sex. Conclusions Indigenous Yoruba populations have words and linguistic concepts that describe the heritability of characters, traits and diseases which can be appropriated to improve comprehension and adequacy of informed consent in genomics research. Our methods are openly available and can be used by genomic researchers in other African communities.

Purpose Identifying the health-related needs in transgender (TG) people can help to formulate strategies for providing appropriate and accessible health services and promoting health and social justice, as well as human rights in these populations. This systematic review aims to determine health-related needs, problems and barriers, as well as ways to solve them in TG people from the viewpoint of TG individuals and health policymakers. Design/methodology/approach All international electronic databases such as PubMed (Medline), Embase, CINAHL, Scopus, Web of Sciences, Cochrane, PsycInfo and Google Scholar (Gray Literature) were searched from December 1990 to December 2019. After the search, the articles were screened based on their title, abstract and full text. The quality of articles was assessed using the Strengthening the reporting of observational studies in epidemiology (STROBE), Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Qualitative Research (SRQR) checklists. The search strategy, data extraction and quality evaluation of articles were independently performed by two researchers. Findings The general health-related needs identified in TG individuals from the viewpoint of themselves included access to legal hormone therapy, psychological and psychiatric counseling, privacy, health and hygiene needs, equality and freedom of expression. General health-related needs in TG individuals from the viewpoint of health policymakers included screening tests to detect sexually transmitted diseases, especially HIV, cancers and other diseases, as well as training service providers (physicians, nurses, health workers, etc.). Research limitations/implications One of the limitations of this study was nonreporting of health-related needs in initial articles by different TG groups because these groups have had different needs and different barriers to accessing health-care services. In this study, health-related needs and barriers to satisfy them were categorized from the viewpoint of TG populations and health policymakers around the world, which may influence future decisions to provide services to TG populations. The results of this systematic review can help to develop different strategies by considering all TGs from individual, family and social aspects to better provide services for this group. However, given the dynamics and changes in the existing communities and the limited studies on gender minorities in developing countries, further research is required to comprehensively address the subject. Originality/value The findings can be used as an incentive to improve existing conditions and to address problems and shortcomings. The results of this systematic review formulate strategies for providing appropriate and accessible health services and better lives for TGs, planning for more effective participation of these individuals in local communities, improving their physical problems and mental health through counseling, as well as promoting health and social justice, and human rights for these populations.

Antimicrobial resistance is one of the most complex global health challenges today. The world has long ignored warnings that antibiotics and other medicines are losing their effectiveness after decades of overuse and misuse in human medicine, animal health and agriculture. Common illnesses like pneumonia, postoperative infections, diarrhoeal and sexually transmitted diseases, as well as the world’s largest infectious disease killers – tuberculosis (TB), HIV and malaria – are increasingly becoming untreatable because of the emergence and spread of drug resistance. Worsening antimicrobial resistance could have serious public health, economic and social implications. The threat of antimicrobial resistance is also becoming a key consideration for programmes addressing maternal and child health, sexual and reproductive health, foodborne diseases, water and sanitation, and infection prevention and control. Although the 21st century is being shaped by technology and innovation, humans could soon find themselves in an era where simple infections once again kill millions every year. The past three years have seen unprecedented global political momentum to address antimicrobial resistance: in 2015, governments adopted a global action plan at the World Health Assembly and in 2016 passed a political declaration at the United Nations General Assembly. Antimicrobial resistance has made it onto the agendas of the G7 and G20 groups and is a core component of the Global Health Security Agenda. WHO is working closely with the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health in leading global efforts against antimicrobial resistance and ensuring that the necessary momentum is consolidated and sustained. These efforts are guided by an ad-hoc interagency coordination group established in 2017. A global development and stewardship framework to combat antimicrobial resistance is being drafted to support the development of new antimicrobial medicines, diagnostics, vaccines and other tools. One of the gravest global concerns about antimicrobial resistance currently is that antibiotic resistance has emerged in so many pathogens, including TB. In 2016, at the high-level meeting of the UN General Assembly on antimicrobial resistance, Heads of State directed an unprecedented level of attention to curbing the spread of infections that are resistant to antimicrobial medicines. They reaffirmed their commitment to stopping the misuse of antimicrobial medicines in human health, animal health and agriculture, and recognized the need for stronger systems to monitor drug-resistant infections and the amounts of antimicrobials used in humans and animals. In the wake of the increasing global awareness of the need for new antibiotics, Member States highlighted market failures, and called for new incentives for investment in research and development of new, effective and affordable medicines, rapid diagnostic tests, and other important therapies to replace those that are losing their effectiveness. In response to this and in line with the Global Action Plan on Antimicrobial Resistance to support the identification of pathogens of greatest concern, WHO developed a priority list of antibiotic resistant bacteria to underpin renewed efforts for the research and development of new antibiotics. The only possible defence against the threat of antimicrobial resistance and the (very real) possibility of a post-antibiotic era is a global and coordinated effort by all stakeholders to support other important therapies such as the Oxygen-Ozone (O2O3) therapy. As a result, the scope and focus of the work underlying this dissertation was to study the application of O2O3 therapy towards several resistant bacteria. Moreover, we evaluated three different framework for gut bacteria, skin and soft tissue infections and mucosal infections.