Center for Health and Gender Equity

Intimate partner violence (IPV) is a significant barrier to HIV prevention service utilization, yet little is known about its impact on pre-exposure prophylaxis (PrEP) adherence among gay, bisexual, and other men who have sex with men (GBMSM). This study examines the association between IPV victimization and PrEP adherence using data from an online survey of 937 current PrEP users in Ukraine, conducted in early 2022, a few days before Russia's invasion. Participants reported on six types of IPV experienced in the past six months, physical, sexual, emotional, and financial abuse as well as partners' monitoring and controlling behaviors. Further, they self-reported their PrEP adherence and were asked to describe the reasons for missing PrEP medications through an open-ended question. Nearly 40% of respondents experienced at least one form of IPV, with sexual and emotional IPV being most common. Only 35.4% reported excellent or very good adherence to PrEP medication. Self-reported reasons for missed doses included COVID-19 restrictions, changes in sexual behavior, use of alternative HIV prevention methods, and health or psychological factors. In multivariable models adjusting for sociodemographic and behavioral factors, sexual IPV, monitoring, and controlling IPV were associated with higher PrEP adherence. The positive association may suggest that IPV survivors increase their PrEP adherence as a protective strategy against HIV infection. These findings highlight the importance of integrating trauma-informed IPV screening and support within PrEP programs and adopting flexible service models to sustain adherence, especially during social and political crises. Future longitudinal research should explore mechanisms linking IPV and PrEP adherence and develop structural interventions to better support this vulnerable population.

There is limited data on forced marriages in the context of India. This study involved validation of new measures of women’s marital choice in terms of partner selection and timing of marriage as indicators of women’s marital agency in rural India. We conducted a cross-sectional analysis of survey data from N = 1192 married women aged 18–30 who participated in the Counseling Husbands and wives to Achieve Reproductive health and Marital equity (CHARM2) trial in rural Maharashtra, India. We included two novel items on women’s decision-making regarding who the married and when they married. We evaluated the construct validity of these measures by testing their associations with other traditionally gender normative practices related to marriage including girl child marriage, purdah, and dowry using Fisher’s exact test. We then conducted crude and adjusted regression models to determine associations between our marital choice variables and indicators of current marital agency, specifically recent intimate partner violence, marital quality, and contraceptive self-efficacy. 15.5% of women reported they were the primary decision-maker on marital partner selection and 9.4% reported they were the primary decision-maker on marital timing. Both measures were highly corelated to each other (r = 0.8) and with reports of arranged marriage (with partner choice r = 0.9; with marriage timing r = 0.6). Having choice over marriage partner and timing were equally inversely correlated with child marriage (r = -0.3, respectively) and equally and positively correlated with not receiving a dowry (r = 0.4, respectively). Both choice variables were negatively correlated with the practice of purdah (r = -0.3 and − 0.1). Our marital choice variables were not associated with any agency in marriage dependent variables, except for choice of partner and marital quality (adjusted odds ratio = 1.5; 95% confidence interval: 1.0, 2.1), but all outcomes trended in the expected direction. The findings indicate that our marital choice measures show partial construct validity, linked to normative practices restricting women and girls’ agency at marital entry, and may be a useful indicator of non-forced marriage, but measures of agency at marriage largely do not correlate with agency in marriage.

Background Medicaid dental programs face potential challenges with anticipated federal funding cuts. Traditional fee-for-service models have struggled to serve all Medicaid populations effectively.Case Description This case study examines two successful dental practice models serving Medicaid populations: Equity Dental in Oregon operating under capitation-based care for 65,000 enrollees across 15 counties, and Montshire Pediatric Dentistry serving 28,000 children across Northern New England, 59% of whom are Medicaid enrollees. Both practices provide minimally invasive dentistry and medical management of dental caries as core strategies.

The high prevalence and associated negative consequences of intimate partner violence (IPV) (23–49%) against girls has been well-documented in Nigeria. This study evaluated Girls Invest, an app-based economic empowerment intervention, to address social and economic factors associated with IPV among girls ages 15–19 in low-income communities in Ibadan, Nigeria. Satisfaction, acceptability, and feasibility of the intervention were also assessed. We conducted a 2-armed randomized-controlled trial (16 schools, 8 schools per arm) among girls ages 15–19 (n = 258) to compare the Girls Invest intervention to a wait-list control condition on social and economic risk factors associated with IPV. Quantitative analyses compared survey data at baseline and 6 months follow-up using a difference-in-differences approach. Five focus groups were also conducted among a subset of participants (n = 62) after completing the intervention; focus group data were analyzed and independently coded by two researchers for themes related to participants’ satisfaction, acceptability, and impact on economic and social factors associated with IPV. Participants averaged 16 years old, were predominantly from the Yoruba tribe, and most reported Islam as their religion. Participants reported high levels of acceptability and satisfaction with the app-based intervention. Survey findings indicate statistically significant improvements in gender equitable attitudes (p = 0.02) and non-significant trends toward reduced endorsement of traditional gender roles (p = 0.07) and decreased perception of economic vulnerability (p = 0.20) among Girls Invest participants relative to the waitlist control group. These survey findings were further substantiated by focus group findings with the following themes reported: 1) satisfaction with the app-based platform and financial incentives, 2) greater awareness of issues regarding gender equity and women’s rights, 3) increased awareness of healthy versus unhealthy relationship behaviors, 4) increased knowledge and confidence regarding financial decision-making, and 5) improved expectations for the future regarding vocational opportunities. Notably, participants reported discussing topics they learned with friends and siblings. While a full-scale trial is needed, our findings suggest that Girls Invest holds promise in mitigating social and economic factors associated with IPV. Given the increasing use of smartphones in Nigeria and globally, mobile technology may be a useful platform to support scalability and is lower in cost compared to traditional in-person approaches. Clinical trials unique ID: NCT06942481 (Retrospective registration: 4/9/2025). Data available upon request; study ongoing.

Abstract Environmental action, including that which addresses climate change and takes care of the environment more broadly, could be strengthened by making collaboration across silos more imaginable. In this technical article, we describe a “systems of care” tool that facilitates a broad range of participants to express the local and everyday relations that underpin care for their places and communities. Researchers and practitioners who aim to bring together participants from different sectors can implement the tool, using drawings and narrations of these systems of stewardship and care, to find connections and disconnections between participants. Reflexive questions can be tailored to fit the participants, but aim to identify important relations in the system and actions to strengthen them. We show the use of the tool in two case studies: one as part of a community workshop on climate adaptation in New York City and another in a digital workshop with artists and urban greening practitioners across the world as part of The Nature of Cities Virtual Festival. Through this tool, we can see, in real time, how hyper‐local actions and relations can thread into wider networks of environmental stewardship and community care. In particular, the tool unveils aspects of environmental stewardship often uncaptured by other research methods, such as the non‐environmental organizations and relations that sustain caretakers. It also allows participants from different contexts to dialogue, finding both common and different elements across their practice and strengthening relationships between them. Finally, it can expand the conceptual and geographic lens at which stewardship is understood by bringing attention to how relations across thematic silos and large physical distances can support local environmental actions. By starting with the relations, actions, and places that already exist, the tool promotes a relational understanding of people‐place‐organization connections and disconnections that can strengthen the overall system of care while working to repair relationships in environmental governance.

Non-Partner Sexual Violence (NPSV) is under reported in many low-income countries including Nigeria. This study was conducted to assess the prevalence and factors associated with NPSV experience among in-school adolescent girls in low-income communities of Ibadan, Southwestern Nigeria. A cross-sectional survey was conducted among 376 in-school adolescent girls in Ibadan, Nigeria. Multistage sampling technique was used to select respondents from senior secondary schools in two Local Government Areas with largest number of low-income communities. Respondents were assessed on experience of lifetime NPSV. Data were analysed using bivariate and multivariable logistic regression. Level of significance was set at 5%. Mean age of the respondents was 16.2 (SD 1.0) years. Majority of respondents were Muslims (57.7%) and only 29.3% had ever been in a relationship. The prevalence of lifetime NPSV among the respondents was 16.5%. The most frequently reported form of NPSV was being threatened or pressured to have sex (13.3%) and made to do something sexually when girl didn’t want to (2.9%). Reported perpetrators who were known vs. unknown was 56.5% vs. 21%. Significant predictors of experience of NPSV were, age 18 to 19 years (AOR = 2.60, 95% CI: 1.06–6.4) and witnessing violence in childhood (AOR = 2.33, 95% CI:1.27–4.28). Non-partner sexual violence is prevalent among adolescent girls in low-income communities of Ibadan, Nigeria, with most girls reporting that perpetrators were known to them. These findings underscore the urgent need for preventive efforts, particularly those that consider perpetration as occurring in girls’ immediate social and familial environments. Non-Partner Sexual Violence (NPSV) is defined as a sexual act that is committed or attempted by someone (stranger, acquaintance, friend and other family member) other than husband or partner, without the consent of the victim or against someone who is unable to consent or refuse. NPSV is a traumatic experience with serious lifelong impact on the health and wellbeing of girls including physical, psychological health such as anxiety, depression, and suicidal ideation. Adverse sexual and reproductive health outcomes have also been associated with NPSV, including unwanted pregnancy, unsafe abortion, high risk sexual behaviour, sexually transmitted diseases, including HIV and death. Social consequences have also been reported which include school absenteeism, school drop-out, and engaging in high-risk behaviours such as alcohol and substance use. NPSV is under reported in many low-income countries including Nigeria. This study was conducted to assess the prevalence and factors associated with non-partner sexual violence experience among in-school adolescent girls in Ibadan, Southwestern Nigeria. We found that NPSV is common among the adolescent girls. The perpetrators of the act were males known to the girls who pressure them into unwanted sex. Most notably, the experience of NPSV was positively associated with having been in a relationship with male partner and witnessing violence in childhood.

This study investigates the influence of social norms on male caregiving in Uganda and considers the implications for tailoring and scaling the REAL Fathers mentoring program across six regions. By identifying key norms and reference groups, the findings inform strategies to enhance father engagement in early childhood development within culturally and socially relevant frameworks. This study employed an exploratory Participatory Learning and Action (PLA) approach, integrating in-depth interviews, focus group discussions, and community validation workshops to identify and prioritize social and gender norms across the study regions. We found that norms influence male engagement in care giving directly, by setting expectations for how men should behave with their wives and children. Norms also have a strong indirect influence through social expectations about what is appropriate for men and women related to power, decision-making and gender roles. Data shows that the norms and the reference groups that sustain them are consistent across cultural regions and the social sanctions that enforce the norms are largely intangible. We also found some exceptions to the norms. For norm shifting interventions to be effective, practitioners should be intentional in engaging reference groups and take advantage of exceptions to norms as leverage points for behavior change. Also, the different norm shifting strategies adopted should be able to address the complexity and interconnectedness of the norms.

Veterans identifying as lesbian, gay, bisexual, additional orientations, or not sure (LGB+) may have unique health-related social needs. By addressing social needs, health systems can take steps to alleviate persistent health disparities in this population. To evaluate associations between sexual orientation and need for support for social needs among primary care patients served by the Veterans Health Administration (VHA). This cross-sectional study used data from a national sample of VHA primary care patients seen in January or February 2023 who were invited to participate in a survey online or by mail. Data collection occurred from March 2 through May 9, 2023. Self-reported sexual orientation (straight or LGB+). Unadjusted prevalence ratios (PRs) and adjusted PRs (APRs) of need for support across 13 health-related social domains. Of 38 759 veterans invited to participate in the survey, 7095 (18.3%) responded and 6296 (16.2%) with complete data were included. Weighted responses represented 903 714 veterans. The unweighted number (weighted percentage) identifying as straight was 5874 (94.2%) and as LGB+ was 422 (5.8%); 3585 (89.1%) were male. In unadjusted comparisons, LGB+ veterans had a higher prevalence of need for support for feeling socially isolated (PR, 1.40; 95% CI, 1.04-1.87), feeling lonely (PR, 1.59; 95% CI, 1.20-2.09), finding or keeping work (PR, 1.71; 95% CI, 1.07-2.75), paying for food (PR, 1.71; 95% CI, 1.19-2.46), paying for basics such as housing, medical care, and heating (PR, 1.89; 95% CI, 1.29-2.75), managing experiences of discrimination (PR, 2.31; 95% CI, 1.54-3.48), and getting or maintaining housing (PR, 2.41; 95% CI, 1.40-4.15). After adjusting for age and for a combined race, ethnicity, and sex variable, LGB+ veterans had higher prevalence of need for support for managing experiences of discrimination (APR, 1.79; 95% CI, 1.21-2.64) and getting or maintaining housing (APR, 1.91; 95% CI, 1.10-3.34). This cross-sectional study found that LGB+ veterans reported a higher prevalence of social needs related to managing experiences of discrimination and housing instability compared with their straight counterparts. Expansion of support systems to address social needs in general and to ensure that systems are tailored for groups that more often experience certain needs should be considered.