Videos by Caroline Allen
Indicators of the impact of climate change on health and of health-related adaptation and mitigat... more Indicators of the impact of climate change on health and of health-related adaptation and mitigation measures can enable evidence-based policy and initiatives. This presentation, to the Caribbean Public Health Agency (CARPHA) Online Scientific Conference 2021, presents research with stakeholders in Caribbean and Pacific Small Island Developing States to identify priority areas for research and action in these highly vulnerable regions. The research was conducted for The Lancet Countdown, a collaboration of research institutions and UN agencies that tracks progress on indicators in health and climate change, based at University College London. 52 views
Reports by Caroline Allen
Characteristics of Caribbean small island developing states make them vulnerable to climate chang... more Characteristics of Caribbean small island developing states make them vulnerable to climate change, such as their small land area and human resource base, remote location, dependence on marine resources, and concentrations of populations and infrastructure near coastlines. These factors also affect health, for example through their impact on the availability of human resources for health; access to medical supplies, water and healthy food; and the vulnerability of key infrastructure, livelihoods and nutrition to the oceanic and meteorological outcomes of climate change, such as sea level rise, ocean acidification, rising temperatures, precipitation extremes and more frequent and severe hurricanes.
This report is an agenda for research and action which synthesizes the evidence on climate change and health (CCH) associations in the Caribbean, and on measures taken to address these links. An online conference in 2021 brought together over a thousand experts and advocates, including 162 presenters, from 80 countries, to share information relevant to health vulnerabilities to climate change in the Caribbean. The report analyses evidence presented at the conference and from additional literature review, including research and surveillance data and gaps and evaluation of actions taken to address the CCH challenges identified. It includes chapters presenting the evidence and recommended actions for eighteen priority areas under four main headings:
1. Climate change health impacts, exposures and vulnerability
2. Adaptation, planning and resilience for health;
3. Mitigation actions and health co-benefits;
4. Resources and engagement for climate change and health action.
The agenda is the most comprehensive information resource to date for the movement to forge resilience against the impact of climate change on health in the Caribbean.
My essay, "The Caribbean: a view from the frontline" in this essay collection by Green Alliance, ... more My essay, "The Caribbean: a view from the frontline" in this essay collection by Green Alliance, UK shows some of the devastating effects of climate change on health in the small island developing states of the region.
Climate Change and Health in Small Island Developing States, 2022
This report identifies challenges and priorities for Small Island Developing States (SIDS) regard... more This report identifies challenges and priorities for Small Island Developing States (SIDS) regarding health and climate change. Based on a consultative process with experts from Caribbean and Pacific (SIDS), the report identifies areas for the development of indicators for monitoring progress in addressing the considerable health vulnerabilities of people in SIDS arising from climate change. It was commissioned and written with The Lancet Countdown: Tracking Progress on Health and Climate Change, an international, multidisciplinary collaboration that exists to monitor the links between public health and climate change. The Lancet Countdown brings together 38 academic institutions and UN agencies from every continent, drawing on the expertise of climate scientists, engineers, economists, political scientists, public health professionals and doctors. Each year, the Lancet Countdown publishes an annual assessment of the state of climate change and human health, seeking to provide decision-makers with access to high-quality evidence-based policy guidance.
Caribbean Public Health Agency, 2018
The countries of the Caribbean are small in population and geographical size, and highly vulnerab... more The countries of the Caribbean are small in population and geographical size, and highly vulnerable to external man-made and environmental shocks. This Report describes a major threat to the health of Caribbean people and the communities where they live, learn, work and play; that of climate change. The examination of climate change is framed within a more general description of links between climate and health. Actions that have been taken to address the links are presented, along with examples of good practice and suggestions for the future. Among the connections examined are those between climate and environmental determinants of health such as food and water security and quality, wastewater, air quality, heat stress and storm damage. Impacts on infectious disease, vector borne disease, non-communicable diseases and mental health are presented. Evidence for these connections in the Caribbean are shown and strategies suggested to strengthen the evidence base. The challenges for Caribbean health systems are explored and analysed, looking at building blocks of health systems: leadership and governance; the health workforce; health information systems; medical products and technology; service delivery, and financing.
Climate change came to the forefront of public health concerns in the Caribbean in 2017 following... more Climate change came to the forefront of public health concerns in the Caribbean in 2017 following the devastation to several countries wrought by Hurricanes Irma and Maria. Yet the links between climate and health are not generally understood in the region. This State of Public Health Report uses conceptual frameworks developed to understand climate and health globally, and adapts and applies them to evidence from the Caribbean. The report presents evidence from Caribbean studies of how environmental determinants of health, such as heat, water and food quality, food security and disease vectors, are affected by climate change and variability. New areas of enquiry, such as links between climate and non-communicable diseases, are also explored. The report includes a case study of the impact of Hurricane Maria on Dominica, based on primary data collection, and presents surveillance data to examine the health impact of Hurricanes Irma and Maria on affected countries. The work of Caribbean and global agencies to adapt to and mitigate climate impacts on health is presented. The concluding chapter examines climate action in the Caribbean according to the World Health Organisation's framework of elements in building climate-resilient health systems.
Caribbean Public Health Agency, 2020
The years of later life are often referred to as the “golden years”, signifying a hope that they ... more The years of later life are often referred to as the “golden years”, signifying a hope that they will be filled with serenity and happiness. Ideally, older persons should be able to continue pursuing their goals and aspirations, including (among other things) spiritual pursuits and contemplation of lifetime achievements; enjoyment of mastery over skills acquired earlier in life; participation in family and community life, and sharing of accumulated wisdom, cultural values and skills. However, to attain these requires conditions conducive to health along the life course. If circumstances of life and earlier behaviours result in non-communicable diseases (NCDs) and other disabling conditions,
opportunities to enjoy the “golden years” will be restricted, as will the potential social and economic benefits of a vigorous, active and productive older population. This State of Public Health Report (SPHR), from the Caribbean Public Health Agency (CARPHA) provides information on the health situation and response to ageing in the Caribbean region. The information provided aims to facilitate
1) Development of rights-based approaches to health of older persons;
2) Strengthening of initiatives to promote health along the life course to ensure a healthy older population while reducing potential costs associated with population ageing.
World Health Organization and United Nations Framework Convention on Climate Change Small Island Developing States Initiative, 2020
In October 2018, Ministers of Health gathered in Grenada to develop a Caribbean Action Plan to ou... more In October 2018, Ministers of Health gathered in Grenada to develop a Caribbean Action Plan to outline the implementation of the WHO Special Initiative on Climate Change and Health in Small Island Developing States (SIDS) locally and to identify national and regional indicators of progress. As part of the regional action plan, small island nations have committed to developing a WHO UNFCCC health and climate change country profile to present evidence and monitor progress on health and climate change. This WHO UNFCCC health and climate change country profile for Antigua and Barbuda provides a summary of available evidence on climate hazards, health vulnerabilities, health impacts and progress to date in health sector efforts to realize a climate-resilient health system.
World Health Organization and United Nations Framework Convention on Climate Change Small Island Developing States Initiative, 2020
In October 2018, Ministers of Health gathered in Grenada to develop a Caribbean Action Plan to ou... more In October 2018, Ministers of Health gathered in Grenada to develop a Caribbean Action Plan to outline the implementation of the WHO Special Initiative on Climate Change and Health in Small Island Developing States (SIDS) locally and to identify national and regional indicators of progress. As part of the regional action plan, small island nations have committed to developing a WHO UNFCCC health and climate change country profile to present evidence and monitor progress on health and climate change. This WHO UNFCCC health and climate change country profile for Dominica provides a summary of available evidence on climate hazards, health vulnerabilities, health impacts and progress to date in health sector efforts to realize a climate-resilient health system.
Caribbean Public Health Agency, 2017
The International Labour Office welcomes such applications.
Report from the Gender Assessment of Barbados, funded by the Caribbean Development Bank. The repo... more Report from the Gender Assessment of Barbados, funded by the Caribbean Development Bank. The report is intended as a tool for those pursuing gender equity and economic efficiency in Barbados.
Dance4life is an internationally-recognised behavioural intervention delivered in schools and com... more Dance4life is an internationally-recognised behavioural intervention delivered in schools and communities to promote health and prevent HIV among young people. Barbados is currently the only Caribbean country where it has been implemented.
This evaluation takes stock of the status, achievements and remaining gaps in the work of dance4life Barbados.
Dance4life responds positively to gaps in sexual and reproductive health education and is unique in Barbados in its highly youth-oriented pedagogic methods to promote sexual and reproductive health. Participating students emphasised that their life options had expanded, as well as their knowledge and safer sexual behaviour, as a result of interacting with the dance4life team. However, the potential of dance4life is constrained, principally by human resource limitations.
Strengthening the Evidence Base on Youth Sexual and Reproductive Health and Rights in the Eastern... more Strengthening the Evidence Base on Youth Sexual and Reproductive Health and Rights in the Eastern Caribbean Population Fund Sub-Regional Office for the Caribbean. Unless otherwise attributed, the findings, interpretations and conclusions expressed herein are solely those of the consultant who prepared the work and do not necessarily reflect the views of UNFPA. References included in this document to other publications, reports, studies, websites should not be interpreted as an endorsement of the content by UNFPA.
At the beginning of the twenty-first century, the adolescent and youth population 1 is the larges... more At the beginning of the twenty-first century, the adolescent and youth population 1 is the largest cohort in the history of the Caribbean region, representing 26.6% of the total population. They are living in a world undergoing demographic transition, globalization, environmental changes, and a growing reliance on new communication technologies. The disproportionate impact of these issues on low-income, poorly educated, indigenous, migrant, cross-border, and ethnic minority adolescents and youth is of special concern and requires a targeted response.
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Videos by Caroline Allen
Reports by Caroline Allen
This report is an agenda for research and action which synthesizes the evidence on climate change and health (CCH) associations in the Caribbean, and on measures taken to address these links. An online conference in 2021 brought together over a thousand experts and advocates, including 162 presenters, from 80 countries, to share information relevant to health vulnerabilities to climate change in the Caribbean. The report analyses evidence presented at the conference and from additional literature review, including research and surveillance data and gaps and evaluation of actions taken to address the CCH challenges identified. It includes chapters presenting the evidence and recommended actions for eighteen priority areas under four main headings:
1. Climate change health impacts, exposures and vulnerability
2. Adaptation, planning and resilience for health;
3. Mitigation actions and health co-benefits;
4. Resources and engagement for climate change and health action.
The agenda is the most comprehensive information resource to date for the movement to forge resilience against the impact of climate change on health in the Caribbean.
opportunities to enjoy the “golden years” will be restricted, as will the potential social and economic benefits of a vigorous, active and productive older population. This State of Public Health Report (SPHR), from the Caribbean Public Health Agency (CARPHA) provides information on the health situation and response to ageing in the Caribbean region. The information provided aims to facilitate
1) Development of rights-based approaches to health of older persons;
2) Strengthening of initiatives to promote health along the life course to ensure a healthy older population while reducing potential costs associated with population ageing.
This evaluation takes stock of the status, achievements and remaining gaps in the work of dance4life Barbados.
Dance4life responds positively to gaps in sexual and reproductive health education and is unique in Barbados in its highly youth-oriented pedagogic methods to promote sexual and reproductive health. Participating students emphasised that their life options had expanded, as well as their knowledge and safer sexual behaviour, as a result of interacting with the dance4life team. However, the potential of dance4life is constrained, principally by human resource limitations.
This report is an agenda for research and action which synthesizes the evidence on climate change and health (CCH) associations in the Caribbean, and on measures taken to address these links. An online conference in 2021 brought together over a thousand experts and advocates, including 162 presenters, from 80 countries, to share information relevant to health vulnerabilities to climate change in the Caribbean. The report analyses evidence presented at the conference and from additional literature review, including research and surveillance data and gaps and evaluation of actions taken to address the CCH challenges identified. It includes chapters presenting the evidence and recommended actions for eighteen priority areas under four main headings:
1. Climate change health impacts, exposures and vulnerability
2. Adaptation, planning and resilience for health;
3. Mitigation actions and health co-benefits;
4. Resources and engagement for climate change and health action.
The agenda is the most comprehensive information resource to date for the movement to forge resilience against the impact of climate change on health in the Caribbean.
opportunities to enjoy the “golden years” will be restricted, as will the potential social and economic benefits of a vigorous, active and productive older population. This State of Public Health Report (SPHR), from the Caribbean Public Health Agency (CARPHA) provides information on the health situation and response to ageing in the Caribbean region. The information provided aims to facilitate
1) Development of rights-based approaches to health of older persons;
2) Strengthening of initiatives to promote health along the life course to ensure a healthy older population while reducing potential costs associated with population ageing.
This evaluation takes stock of the status, achievements and remaining gaps in the work of dance4life Barbados.
Dance4life responds positively to gaps in sexual and reproductive health education and is unique in Barbados in its highly youth-oriented pedagogic methods to promote sexual and reproductive health. Participating students emphasised that their life options had expanded, as well as their knowledge and safer sexual behaviour, as a result of interacting with the dance4life team. However, the potential of dance4life is constrained, principally by human resource limitations.
Design and methods: A review of sexual behaviour surveys with youth aged 15–24 years was conducted as part of the Pan American Health Organization (PAHO) HIV Caribbean Office’s Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritized. Studies were sought via database searches and contact with researchers and National AIDS Programmes.
Results: Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study age groups and indicators. Data were sufficient to identify the following among 15–24-year olds:
More males than females report sexual intercourse before the age of 15 years.
More than half of sexually active youth report sex before age 16 years.
First sexual encounter is usually with someone older, with age differences larger for females.
More males than females report multiple partnerships, with 20%–76% of males reporting this in the past year.
Condom use varies widely, with no clear pattern by gender.
Conclusion: There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, partner reduction and consistent condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardization of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence.
evidence of links, while quantitative studies are methodologically limited. Service providers generally focused either on VAW or HIV. There is a need to address HIV at the level of gender norms and to develop mechanisms to integrate VAW and HIV services.
Design and Methods: A cross-sectional survey was conducted with people living with HIV (PLHIV) who receive services from non-governmental organisations affiliated to the Caribbean Regional
Network of People Living with HIV/AIDS (CRN+) in Antigua and Barbuda, Grenada and Trinidad and Tobago. PLHIV, from CRN+, traced potential participants, administered informed consent procedures and carried out structured interviews. The main outcome measure was 95% to 100% adherence over the previous seven days. Multiple logistic regression was conducted to identify associations with demographic characteristics, psychological status, health and support service use, sexual behaviour and
substance abuse.
Results: Of 394 respondents, 69.5% were currently taking ART. Of these, 70.1% took 95% to 100% of their prescribed pills. One in 20 took more pills than prescribed, all of whom were prescribed fewer or equal to the median pill number. Factors independently associated with adherence were use of a counselling service (OR 3.20; 95% CI 1.55, 6.61), revelation of HIV status without consent (OR 2.31; 95% CI 1.13, 4.74), alcohol consumption (OR 0.47; 95% CI 0.23, 0.96) and side effects (OR 0.32; 95% CI 0.15, 0.68). Drug resistance to ART was reported by 6% of users.
Conclusion: Improvements in ART adherence may be achieved by counselling, focussed attention to alcohol users and developing drugs with reduced side effects. Such measures are critical to maintain PLHIV quality of life gains and prevent the proliferation of drug resistant HIV strains.
Network of People Living with HIV/AIDS, or CRN+).
Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews.
Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for ‘‘enough’’ income 5.06; 95% CI: 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI: 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI :1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV negative partner and 9% were married.
Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for
protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.
To outline the development process of National Clinical and Policy Guidelines on Intimate Partner Violence (IPV) and Sexual Violence (SV) in Trinidad and Tobago (T&T). The Guidelines aim to support implementation of quality standards for IPV and SV survivors.
Design and Methods:
The process included a review of relevant national legislation, policy, and practices, Pan American Health Organization/ World Health Organization (PAHO/ WHO) and other guidance documents on healthcare for women subjected to violence. Evidence-based practices from these documents were included in consultations on their appropriateness in the T&T context. Multidisciplinary teams of frontline health workers from each of the five Regional Health Authorities were consulted in groups of 6-13 participants, with individual follow-up discussions about scale up needs (November 2020 – March 2021). Interviews were held with 6 senior stakeholders from the Ministry of Health, Office of the Prime Minister-Gender Affairs, National HIV/ AIDS Coordinating Committee and 4 civil society agencies. A multidisciplinary team of health policy practitioners and PAHO/ WHO oversaw the process and revisions to the Guidelines based on stakeholder feedback.
Results:
Participants provided recommendations to integrate quality standards into routine clinical practice. These were incorporated into National Clinical and Policy Guidelines on IPV and SV, consistent with national policy and evidence-based guidance. The Guidelines incorporate human rights principles and pathways of care including the identification of violence, clinical and psychosocial care, safety planning, referrals, prevention and care during public health emergencies. They were approved by the Ministry of Health on 15 August 2022.
Conclusions:
The methods outlined provide a systematic approach to facilitate implementation of evidence-based practices. They underscore the importance of government leadership, consensus building, collaboration and feedback from professionals across health, social service and civil society sectors in addressing violence as a public health issue. Training of trainers has been undertaken to ensure implementation.
Design and Methods: Health outcomes for countries where Hurricanes Irma and Maria made landfall in 2017 while at Category 4 or 5 strength on the Saffir-Simpson scale were compared with other Caribbean countries and previous years, using weekly syndromic surveillance reports on gastroenteritis, fever and numbers of confirmed cases of dengue, chikungunya and Zika. For Dominica, comparisons were made between health outcomes in 2015 (Tropical Storm Erika), 2017 (Hurricane Maria) and six-year averages.
Results: Gastroenteritis cases, but not fever cases, increased more rapidly in countries struck by the hurricanes at Category 4 or 5 strength than in those that were not. Total confirmed cases of chikungunya, dengue and Zika were lower in both sets of countries in 2017 than in the 2014-’16 period. Within two weeks of both Tropical Storm Erika and Hurricane Maria in Dominica the number of gastroenteritis cases increased then exceeded the six-year average until the end of the year.
Conclusion: In 2017, Category 4 or 5 hurricanes led to additional health impact in reported gastroenteritis, but not in fevers or mosquito-borne diseases. Data are consistent with mosquito-borne diseases being in an inter-epidemic period. Commonality of weather conditions in the tropical wet season and regional public health action may help explain lack of differences in most health outcomes. Simple statistical comparisons and graphic representations of health with weather data can orient action to address climate and health links.
Design and Methods: As part of research for CARPHA’s State of Public Health Report 2017-18 on climate and health, a case study of Dominica was undertaken. The research protocol was reviewed and approved by the Dominica Ministry of Health and an Oversight Committee of regional and international experts. 22 key informants were interviewed in Dominica. Documents and statistics were collected. Analysis was guided by a framework linking environmental determinants, health system building blocks and health outcomes.
Results: Hurricane damage rendered more than half of health facilities non-functional. There was a 43% reduction in beds available at the hospital. Housing damage was 38% of all hurricane costs, creating loss of access to utilities and personal security. Delays in the removal of 1.5 million m2 of debris resulted from centralisation of disposal vehicles and road damage. Above-ground water and power lines, wastewater treatment facilities, sewerage systems, agriculture and food supply were widely damaged.
Immediate action included: implementation of a Water, Sanitation and Hygiene (WASH) strategy with international partners; recording environmental pollution, and inspection of food establishments. Longer-term strategies include: re-building infrastructure to climate resilient standards, decentralisation and community involvement in solid waste management. Surveillance data reveal an increase in gastro-enteritis cases but not in fever or vector-borne disease cases following Hurricane Maria.
Conclusion: Disaster preparedness, response and recovery should include management systems for environmental determinants, which affect health systems, mental health, NCDs and communicable diseases.
Evidence-based HIV programming and policy in the Caribbean is hampered by limited access to research information. Barbados’ National HIV Research Agenda (2012) identified weaknesses including lack of research infrastructure in the National AIDS Programme, and gaps in communication between stakeholders and with the public.
Methods
The HIV Gateway was conceived as a repository of publications and reports on HIV in the Caribbean searchable via a website accessible to the public (www.hivgateway.com). Searches for items for inclusion were conducted on bibliographic databases such as PubMed and Scopus using the words “HIV” and “Caribbean” or Caribbean country names. Individuals and institutions involved in HIV research were approached to recommend items. Abstracts and web addresses (URLs) or PDFs providing access to original publications have been included.
Results
HIV Gateway contains over 5,000 journal publications, reports, conference abstracts, posters and slide presentations on HIV in the Caribbean. It is equipped with infographic tools facilitating searches by author and keyword. Seventy percent of visitors who enter the site continue viewing other pages within it, average time on the site is 5 minutes, and over 30% of users return to the site.
Conclusion
HIV Gateway provides opportunities for researchers and practitioners to build evidence-based approaches and develop collaborations based on knowledge of who is working on issues and topics. Healthcare professionals are invited to contribute articles or reports to continually expand and update the database and make this the website of choice for anyone wanting to find out about HIV in the Caribbean.
Randomised control trials of adult male circumcision (MC) have shown reductions in female to male HIV transmission of around 60%. This presentation considers:
1. Evidence of effectiveness of MC in preventing HIV
2. The Caribbean epidemiological context
3. Questions and controversies about MC and their applicability in the Caribbean
Methods
• A review was conducted of research papers and international guidelines. Peer-reviewed scientific literature on bibliographic databases was obtained via Scopus and Medline. Another key source was the Clearinghouse on Male Circumcision for HIV prevention; a website initiated by WHO, UNAIDS and other partners.
• The review of the epidemiological situation in the Caribbean was conducted using surveillance reports and research by the Ministries of Health, UNAIDS and others
• Key questions and areas of controversy considered included:
o Should a MC for HIV prevention strategy focus on circumcising infants or adults, or both?
o Does MC affect sexual pleasure?
o Safety of the procedure
o Acceptability/ demand
o Will it lead to an increase in sexual risk-taking (risk compensation)?
o Target populations
o Does it protect men who have sex with men?
o Does it protect women?
Results
• Circumcising adults and neonates would maximise short and long term impact on the epidemic. However, there are ethical concerns about circumcising infants. On the other hand, availability of adult MC is severely limited and it is generally unavailable for HIV prevention purposes in the Caribbean
• Research on the impact on sexual pleasure is ongoing. Follow up with participants in MC trials show that sexual pleasure has not been negatively affected and in one trial most men reported improvements.
• MC can be provided safely in low-resource settings when it is performed by providers who are well-trained and have the proper equipment and supplies.
• In studies in Jamaica and the Dominican Republic (where most males are not circumcised), research shows about one-third of men surveyed are willing to be circumcised, with this number jumping to two-thirds after medical personnel had explained the procedure and its benefits in preventing HIV.
• High levels of “risk compensation” would be necessary to offset the benefits of MC
• Offering voluntary medical male circumcision (VMMC) to heterosexual men at high risk will probably be the most effective MC HIV prevention strategy in the context of a mixed, medium level epidemic
• Among men who have sex with men, studies have shown significant or marginal reductions in risk for the insertive partner but not the receptive partner in anal intercourse. Given high HIV prevalence among MSM, health education should focus on risks associated with sex acts rather than sexual orientation alone
• Women benefit indirectly from expansion in MC through reduction in chance of meeting an infected partner. Counselling and complementary condom promotion are needed given that MC does not provide 100% protection and HIV risk is higher in the “healing period.”
Conclusion
MC is one of the most effective HIV prevention methods and should be given active consideration by Caribbean National AIDS Programmes as a component of “combined prevention” of HIV."
To provide baseline data and generate new knowledge to inform the development of programmes to support adolescent and youth sexual and reproductive health and rights in Dominica, Grenada, St. Lucia and St. Vincent and the Grenadines.
Design and methods
A literature review was conducted of existing research relating to teenage pregnancy, HIV and STI among 10-24 year olds in the four countries. Seventeen single-sex focus group discussions (FGDs) were conducted with 100 people aged 15-17. Informed consent was obtained from parents and young people provided assent before participation. Research methods were approved by Ethics Review Committees in the four countries and at St. George’s University, Grenada.
Results
The literature review showed a majority of youth report having sex before the legal age of consent. There is evidence of low condom use, inter-generational and transactional sex and child abuse, alongside the concentration of poverty among children and youth. Young people in FGDs thought that schools and parents provided factual information but youth still lack necessary sexual and reproductive health skills. They requested interactive and experiential learning methods to empower them in the face of multiple sources of sexual imagery and information via their peers, popular culture and internet-based technologies.
Conclusion
A new paradigm of sexual and reproductive health education for youth is required, emphasising interaction, participation and critical analysis to achieve health literacy, defined as skills that determine the ability of people to gain access to, understand and use information in ways which promote and maintain good health."
To develop a Caribbean regional profile of youth sexual behaviour associated with risk of HIV.
Design and methods
A review of sexual behaviour surveys with youth aged 15-24 was conducted as part of the PAHO HIV Caribbean Office’s Review and Gender Analysis of Caribbean HIV Behavioural and Seroprevalence Studies. Studies with internationally recommended indicators were prioritised. Studies were sought via database searches and contact with researchers and National AIDS Programmes.
Results
Inter-country comparisons and longitudinal analyses were limited by lack of uniformity in study indicators. Data was sufficient to identify the following among 15-24 year olds:
• More males than females report sex before the age of 15.
• More than half of sexually active youth report sex before 16, the legal age of consent.
• First sex is usually with someone older, with age differences larger for females.
• More males than females report multiple partnerships, with 20%-76% of males reporting this in the past year.
• Condom use varies widely, with no clear pattern by gender.
Conclusion
There are substantial levels of early sexual initiation, intergenerational sex among females and multiple partnerships among males, while condom use is inconsistent. Efforts to promote delay in sexual initiation, reduction in the number of sex partners and condom use should be supplemented with initiatives against harmful gender norms, child abuse and transactional sex and skills to negotiate safe sex. Standardisation of survey methods to facilitate cross-study comparisons should continue and encompass additional risk factors such as transactional sex, gender-based violence, drug use and HIV treatment adherence."
others.
Following literature review, the thesis examines the historical process of the formation of health promotion as a hegemonic discourse within the West. A worldsystem approach is then used to situate health promotion in a transnational structure, and to analyse health data from Trinidad and Tobago regarding the relevance of health promotion in the Third World. Fieldwork among non-governmental organisations (NG0s) in Trinidad examines interpretations of health promotion, drawing attention to areas of difference from hegemonic discourse and the symbolic identities invoked.
Health problems in Trinidad and Tobago were found to be related to patterns and fluctuations in capital accumulation on a transnational scale, with problems usually associated with "modernisation" coexisting with diseases associated with
"poverty". Health promotion strategies need to take account of how both production and consumption are structured globally.
In their health promotion work, most NGOs blended elements of non-Western understandings, particularly in the area of spirituality, with hegemonic concepts grounded in biomedical science. The postcolonial concept of hybridity is used to analyse responses and resistance to Western discourse. Respondents maintained that spirituality enabled people to transcend racism and to enhance
subjective well-being and control over health.
The results highlight that to devise appropriate health promotion strategies means to respect difference, not by adopting a position of cultural relativism but by understanding how transnational relationships of power pervade relationships between cultures and affect health. Strategies should nurture the creative expression
of local views, contesting the centralisation of knowledge and material resources for health within the West.