Browsing by Author "Daskilewicz, Kristen"

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    Open Access
    Experience of and factors associated with violence against sexual and gender minorities in nine African countries: a cross-sectional study
    (2021-02-15) Müller, Alex; Daskilewicz, Kristen; Kabwe, Mc L; Mmolai-Chalmers, Anna; Morroni, Chelsea; Muparamoto, Nelson; Muula, Adamson S; Odira, Vincent; Zimba, Martin
    Objective The objective of this research was to assess physical and sexual violence experienced by sexual and gender minorities in nine African countries, and to examine factors associated with violence. Methods We conducted an exploratory multi-country cross-sectional study among self-identifying sexual and gender minorities, using a survey tool available in paper and online. Participants were sampled through venue-based and web-based convenience sampling. We analysed data using descriptive statistics and logistic regression, with Stata15. Findings Of 3798 participants, 23% were gender minorities, 20% were living with HIV, and 18% had been coerced into marriage. Fifty-six per cent of all participants had experienced physical or sexual violence in their lifetime, and 29% in the past year. Gender minorities had experienced significantly higher levels of violence compared to cisgender (sexual minority) participants. The variable most strongly associated with having experienced violence was being coerced into marriage (AOR, 3.02), followed by people living nearby knowing about one’s sexual orientation and/or gender identity (AOR, 1.90) and living with HIV (AOR, 1.47). Conclusion Sexual and gender minorities in Eastern and Southern Africa experience high levels of violence. Sexual orientation and gender identity need to be recognised as risk factors for violence in national and regional law and policy frameworks. States should follow the African Commission Resolution 275 and provide protection against violence based on real or perceived sexual orientation or gender identity.
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    Lesbian, gay, bisexual, transgender and intersex human rights in Southern Africa: A contemporary literature review
    (HIVOS, 2017-06-01) Meer, Talia; Lunau, Marie; Oberth, Gemma; Daskilewicz, Kristen; Muller, Alex
    Individuals engaging in same-sex acts, individuals identifying as lesbian, gay, bisexual, transgender, and/ or intersex (LGBTI), and individuals who do not conform to heteronormative ideals of gender and sexuality experience structural, institutional and individual discrimination and exclusion across the world. This is no different in Southern African countries. While LGBTI individuals are heterogeneous and face very specific challenges based on their sexual orientation, gender identity, race, class, ethnicity and other factors, they share experiences of structural, institutional and individual discrimination and marginalisation based on their sexual orientation and gender identity (SOGI). In most Southern African countries, same-sex activity remains criminalised, which further marginalises LGBTI individuals, and acts as an additional barrier to accessing public services and realising full civil and political rights. This contemporary literature review focuses on the state of LGBTI human rights in 10 Southern African countries: Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The purpose of this review is to contribute towards a strong evidence base and scientific foundation for informed programming in the region.
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    Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis
    (Public Library of Science, 2015) Ciaranello, Andrea L; Myer, Landon; Kelly, Kathleen; Christensen, Sarah; Daskilewicz, Kristen; Doherty, Katie; Bekker, Linda-Gail; Hou, Taige; Wood, Robin; Francke, Jordan A
    BACKGROUND: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. METHODS: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO " Option A "): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). RESULTS: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory , POC improved clinical outcomes and reduced healthcare costs. CONCLUSIONS: In antenatal clinics implementing Option A , the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.
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    The no-go zone: a qualitative study of access to sexual and reproductive health services for sexual and gender minority adolescents in Southern Africa
    (BioMed Central, 2018-01-25) Müller, Alex; Spencer, Sarah; Meer, Talia; Daskilewicz, Kristen
    Abstract Background Adolescents have significant sexual and reproductive health needs. However, complex legal frameworks, and social attitudes about adolescent sexuality, including the values of healthcare providers, govern adolescent access to sexual and reproductive health services. These laws and social attitudes are often antipathetic to sexual and gender minorities. Existing literature assumes that adolescents identify as heterosexual, and exclusively engage in (heteronormative) sexual activity with partners of the opposite sex/gender, so little is known about if and how the needs of sexual and gender minority adolescents are met. Methods In this article, we have analysed data from fifty in-depth qualitative interviews with representatives of organisations working with adolescents, sexual and gender minorities, and/or sexual and reproductive health and rights in Malawi, Mozambique, Namibia, Zambia and Zimbabwe. Results Sexual and gender minority adolescents in these countries experience double-marginalisation in pursuit of sexual and reproductive health services: as adolescents, they experience barriers to accessing LGBT organisations, who fear being painted as “homosexuality recruiters,” whilst they are simultaneously excluded from heteronormative adolescent sexual and reproductive health services. Such barriers to services are equally attributable to the real and perceived criminalisation of consensual sexual behaviours between partners of the same sex/gender, regardless of their age. Discussion/ conclusion The combination of laws which criminalise consensual same sex/gender activity and the social stigma towards sexual and gender minorities work to negate legal sexual and reproductive health services that may be provided. This is further compounded by age-related stigma regarding sexual activity amongst adolescents, effectively leaving sexual and gender minority adolescents without access to necessary information about their sexuality and sexual and reproductive health, and sexual and reproductive health services.
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    Which methods of dissemination do women in Cape Town, South Africa prefer when searching for safe abortion providers?
    (2018) Blackburn, Kayla M; Harries, Jane; Daskilewicz, Kristen
    Background: The Choice on Termination of Pregnancy Act of 1996 makes provision for access to safe abortion, free of charge in government facilities in South Africa. Despite liberal abortion legislation, unsafe abortion persists in South Africa. Increasing access to information about safe and legal abortion providers through methods such as online databases, community health workers, and telephone hotlines will most likely decrease the number of women using illegal/unsafe abortion providers. This study aims to: determine how women prefer to access information on safe abortion providers and services in Cape Town, South Africa; determine which avenues of obtaining information are most accessible for women; and determine if there is a preferential difference in accessing information based on age, education and socioeconomic status. The purpose of this research is to provide knowledge on how to increase the accessibility of safe abortion providers and services through preferential information dissemination. Methods: Participants were recruited from Marie Stopes International South Africa, a non-profit organization (NGO) that provides sexual and reproductive health services in Cape Town, South Africa. Recruitment of participants took place between September and November 2017. Eligibility criteria included that participants be between 18 to 49 years of age and presenting for an abortion. Data was collected through a self-administered paper-based questionnaire. There were four sections of the questionnaire: Socio-Demographics, Reproductive History, Interactions with Sources of Health Information, and Preferred Method to Access Information. Results: Ninety-eight women completed the self-administered questionnaire. Over 59 % of women preferred to use the internet to access information about safe abortion providers. Participants had access to the internet via their mobile phones, computers, laptops, and tablets. Internet access was more accessible for women who had completed secondary school and/or acquired a post-secondary degree, was employed, and/or earned more than USD 258 a month. Participants also preferred to use health care providers (29%), and community health workers (20%) for accessing information about safe and legal abortion services. Conclusions: This study identified the most preferred and acceptable methods to access information about safe abortion providers by women at an NGO clinic in Cape Town. Community health workers, the internet and health care providers and hotlines should be used to formulate dissemination methods that are tailored to women in South Africa. Information about government facilities, their current abortion provision status, and the type of abortion services they provide should be compiled, continually updated, and made available to women in dissemination methods that are most preferred, accessible and acceptable to women. Options for socioeconomically disadvantaged women should be developed in conjunction with Internet-based options for accessing information about safe abortion providers and services.
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    Women’s experiences seeking informal sector abortion services in Cape Town, South Africa: a descriptive study
    (BioMed Central, 2017-10-02) Gerdts, Caitlin; Raifman, Sarah; Daskilewicz, Kristen; Momberg, Mariette; Roberts, Sarah; Harries, Jane
    Background: In settings where abortion is legally restricted, or permitted but not widely accessible, women face significant barriers to abortion access, sometimes leading them to seek services outside legal facilities. The advent of medication abortion has further increased the prevalence of informal sector abortion. This study investigates the reasons for attempting self-induction, methods used, complications, and sources of information about informal sector abortion, and tests a specific recruitment method which could lead to improved estimates of informal sector abortion prevalence among an at-risk population. Methods: We recruited women who have sought informal sector abortion services in Cape Town, South Africa using respondent driven sampling (RDS). An initial seed recruiter was responsible for initiating recruitment using a structured coupon system. Participants completed face-to-face questionnaires, which included information about demographics, informal sector abortion seeking, and safe abortion access needs. Results: We enrolled 42 women, nearly one-third of whom reported they were sex workers. Thirty-four women (81%) reported having had one informal sector abortion within the past 5 years, 14% reported having had two, and 5% reported having had three. These women consumed home remedies, herbal mixtures from traditional healers, or tablets from an unregistered provider. Twelve sought additional care for potential warning signs of complications. Privacy and fear of mistreatment at public sector facilities were among the main reported reasons for attempting informal sector abortion. Most women (67%) cited other community members as their source of information about informal sector abortion; posted signs and fliers in public spaces also served as an important source of information. Conclusions: Women are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities. Some were unaware how or where to seek formal sector services, or believed the cost was too high. Many informal methods are ineffective and unsafe, leading to potential warning signs of complications and continued pregnancy. Sex workers may be at particular risk of unsafe abortion. Based on these results, it is essential that future studies sample women outside of the formal health sector. The use of innovative sampling methods would greatly improve our knowledge about informal sector abortion in South Africa.