Profamilia

ABSTRACT Despite increased Latinx representation in higher education, first-generation students, particularly Latinas, face unique challenges impacting their success and retention. Using testimonio, three first-generation Latina doctoral students in social work reflect on their experiences as fellows of the Council on Social Work Education’s Minority Fellowship Program (MFP). They highlight the program’s critical role in offering cultural and financial support, building networks, and fostering peer connection. Their testimonios emphasize the importance of “finding your people” and how the MFP contributed to their persistence and belonging. The study calls for broader institutional support for first-generation and BIPOC graduate students, emphasizing that programs like the MFP should complement, not replace, systemic efforts to create more inclusive and equitable academic environments.

Introducción: la sexualidad y la salud sexual de las personas adultas mayores es una dimensión invisible en la prestación de los servicios de salud. Debido a esto, es importante conocer las percepciones y dificultades del personal de salud para brindar esta atención. Objetivo: identificar diferencias y similitudes en la percepción que tienen los proveedores de servicios de salud en Colombia sobre la sexualidad y la salud sexual en el adulto mayor. Metodología: se realizaron 5 grupos focales en Bogotá, Barranquilla, Cali y Medellín donde participaron 19 profesionales de la salud de una institución prestadora de servicios de salud sexual y reproductiva. Resultados: los profesionales de la salud reconocen la sexualidad como un aspecto importante en la prestación de los servicios de salud en las personas mayores, a pesar de la invisibilidad actual del tema en la atención médica. Reconocen la complejidad de hablar sobre sexualidad en la interacción médico-paciente, en parte por la falta de entrenamiento de los profesionales de la salud y por las propias inhibiciones de los pacientes. Discusión: persisten obstáculos sociales y teóricos para abordar los temas de sexualidad en consulta, al igual que diferencias de género para el tratamiento de temas de sexualidad y salud sexual. Conclusiones: los prestadores de servicios de salud son claves para remover barreras a la atención, acompañamiento y comprensión de la salud sexual y la sexualidad de las personas mayores.

Multipurpose prevention technologies (MPTs), which prevent sexually transmitted infection(s) and unintended pregnancy, are highly desirable to women. In this randomized, placebo-controlled, phase I study, women used a placebo or tenofovir (TFV) and levonorgestrel (LNG) intravaginal ring (IVR), either continuously or cyclically (three, 28-day cycles with a 3 day interruption in between each cycle), for 90 days. Sixty-eight women were screened; 47 were randomized to 4 arms: TFV/LNG or placebo IVRs used continuously or cyclically (4:4:1:1). Safety was assessed by adverse events and changes from baseline in mucosal histology and immune mediators. TFV concentrations were evaluated in multiple compartments. LNG concentration was determined in serum. Modeled TFV pharmacodynamic antiviral activity was evaluated in vaginal and rectal fluids and cervicovaginal tissue ex vivo. LNG pharmacodynamics was assessed with cervical mucus quality and anovulation. All IVRs were safe with no serious adverse events nor significant changes in genital tract histology, immune cell density or secreted soluble proteins from baseline. Median vaginal fluid TFV concentrations were >500 ng/mg throughout 90d. TFV-diphosphate tissue concentrations exceeded 1,000 fmol/mg within 72hrs of IVR insertion. Mean serum LNG concentrations exceeded 200 pg/mL within 2h of TFV/LNG use, decreasing quickly after IVR removal. Vaginal fluid of women using TFV-containing IVRs had significantly greater inhibitory activity (87-98% versus 10% at baseline; p<0.01) against HIV replication in vitro. There was a >10-fold reduction in HIV p24 antigen production from ectocervical tissues after TFV/LNG exposure. TFV/LNG IVR users had significantly higher rates of anovulation, lower Insler scores and poorer/abnormal cervical mucus sperm penetration. Most TFV/LNG IVR users reported no change in menstrual cycles or fewer days of and/or lighter bleeding. All IVRs were safe. Active rings delivered high TFV concentrations locally. LNG caused changes in cervical mucus, sperm penetration, and ovulation compatible with contraceptive efficacy. Trial registration: ClinicalTrials.gov #NCT03279120.

Objetivo: Describir los métodos anticonceptivos reportados por las usuarias de servicios de interrupción voluntaria del embarazo (ive), antes y posterior a la consulta, y explorar la asociación entre las características sociodemográficas y los antecedentes ginecológicos con la elección de anticonceptivos de alta eficacia posterior a la ive, con gestaciones menores de 15 semanas, en el departamento de Antioquia, Colombia, en la institución Profamilia, entre el 2015 y el 2020. Metodología: Estudio de corte transversal. Se analizaron los 13 067 registros de consultas de ive realizadas en Profamilia de la regional Antioquia, del 2015 al 2020. Las variables cualitativas se midieron con frecuencias y porcentajes, y las cuantitativas, con la media y la desviación estándar. Se implementaron modelos de regresión logística para establecer la asociación de las variables independientes con la variable de interés. Resultados: La consulta de ive contribuyó al incremento del uso de métodos anticonceptivos de alta eficacia. Antes de la ive, el 53 % de las mujeres no usaban ningún método. Posterior a la interrupción, el 97 % empezó a utilizar métodos de alta eficacia. Además del uso de métodos poco eficaces o el uso de preservativo, obtuvieron una posibilidad 13 veces más alta de elegir un método de alta eficacia. Conclusiones: La educación en métodos anticonceptivos posterior a una ive es fundamental para promover el uso de opciones muy efectivas, con el fin de disminuir la aparición de nuevos embarazos no deseados que puedan llevar a una ive recurrente.

SummaryBackgroundSayana Press® is a 3-monthly contraceptive injection approved by regulatory agencies in more than 40 countries worldwide. Existing effectiveness and pharmacokinetics (PK) data suggest that high contraceptive efficacy may be maintained if the reinjection interval of Sayana Press is extended from 3 to 4 months.MethodsWe conducted a phase 3 trial at three sites in the Dominican Republic, Brazil, and Chile from September 2017 through April 2020. We enrolled 750 women at risk of pregnancy who agreed to use Sayana Press off-label every 4 months (3 treatment cycles) for 12 months. The effectiveness cohort included 710 participants randomized equally to receive injections in the abdomen or thigh. Forty additional participants received injections in the back of the upper arm for comparative PK analyses. The primary outcome was pregnancy, defined by a positive urine pregnancy test confirmed by ultrasound and/or serum human chorionic gonadotropin. Secondary outcomes included PK, safety, and acceptability. Laboratory and trial Sponsor staff were blind to injection site. This study is registered with ClinicalTrials.gov, number NCT03154125.FindingsThere were no pregnancies during follow-up; the Pearl Index during 629.3 woman-years (WY) of follow-up in the primary effectiveness analysis was 0.00 (95% CI 0.00, 0.59). Pharmacokinetic profiles differed by injection site, with higher geometric mean (GM) medroxyprogesterone acetate concentrations for the abdomen than the thigh and arm. At month 8, significantly higher GM concentrations were observed in the abdomen and the thigh as compared to the arm, as well as at month 12 in the abdomen as compared to the arm. Injection site reactions were reported by 10.7% of participants.InterpretationBoth pregnancy and PK results confirm that Sayana Press is a highly effective contraceptive method when administered every 4 months. These findings may inform modification of the dosing schedule, or duration of the grace period for reinjection, or both, to reduce overall drug exposure while maintaining contraceptive efficacy.FundingThis work is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), provided to FHI 360 through Cooperative Agreement AID-OAA-A-15–00,045, and a grant from the Gates Foundation. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID, the United States Government, or the Gates Foundation, nor does any mention of trade names, commercial products, or organizations imply endorsement by FHI 360, USAID, the United States Government, or the Gates Foundation.

Objetivo: Explorar los conocimientos y las percepciones de algunas niñas, niños y adolescentes respecto a la sexualidad, el ejercicio de los derechos sexuales y reproductivos, y la educación sexual. Metodología: se realizó un estudio cualitativo, a partir de 25 entrevistas semiestructuradas a personas de entre 9 y 14 años, en 8 municipios priorizados de Colombia. Resultados: En todos los municipios se encontró un desconocimiento generalizado de los temas abordados, así como significados reducidos y percepciones en extremo negativas sobre la sexualidad, la educación sexual, los derechos sexuales y reproductivos, y la salud sexual, a lo que se suman fuertes estereotipos de género. Conclusiones: Los conocimientos y las connotaciones negativas asignadas a los conceptos por los que se preguntó dan cuenta de la limitada y precaria educación sexual que han recibido niñas, niños y adolescentes de estos municipios, lo que significa que aunque en el país existe un marco legal propicio y unas metas relacionadas con el abordaje integral de la sexualidad desde la primera infancia, estos no se están cumpliendo.

Bu çalışmada, Horasandan itibaren daha tasavvufi bir görünüm ve mahiyet kazanan fütüvvet ahlak ve düşüncesinin idealize ettiği ve kavramsallaştırdığı “ideal insan” anlayışı ortaya konmaya çalışılacaktır. Pek çok çalışmada fütüvvet idealinin ve fetalık değerlerinin yatay eksende insanın kendisini kuşatan maddi gerçeklik ve beşeri çevresi arsındaki kurmuş olduğu ilişki ekseni hakkındaki genel ahlaki ilkeler üzerinden çözümleme yapıldığını görmekteyiz. Bu çalışmada göstermeye çalışacağımız temel nokta, yatay eksende gerçekleşen tüm insan eylemlerinin, davranış kodlarının ve ahlaki prensiplerin fütüvvet geleneğinin Horasanda özellikle melamet ehli dava tasavvufi bir mahiyet kazandığı Horasan döneminden itibaren “ideal insan” kavramsallaştırmasıyla tamamen farklı bir mahiyet kazandığını göstermeye çalışmaktır. Bu yüzden, bu çalışmada ehli fütüvvetin ideal insan kavramsallaştırması ortaya konmaya çalışılacak ve bu ideal insan anlayışının Sufi geleneğinin büyük üstatlarının ortaya koyduğu ve formülize ettiği ideal insan anlayışla olan benzerlikleri ve farklılıkları gösterilmeye çalışılacaktır. Bu çalışmanın temel tezi, Horasan Melametiliğinin etkisiyle birlikte kabilevi bir özellik gösteren “feta” (delikanlı) anlayışının ve feta kavramına yüklenen anlamın tamamen değiştiği ve ideal insan kavramının büyük ölçüde kişinin dikey eksende müteal ve aşkın varlık olan Allah ile kurduğu ilişki düzeyine ve bu dikey eksende kurulan ilişkinin, ilişkinin mahiyetinin insanın yatay düzlemdeki her türlü ilişkisini kuşattığı ve belirleyici olduğunu göstermeye çalışmaktır. Pek çok çalışmada, fütüvvetin dikey eksene ilişkin göndermelerinin görmezden gelindiği ya da genel olarak İslam benlik tasavvurundaki etkisinin göz ardı edildiğini söyleyebiliriz. Fütüvvet idealinin ve değerlerinin daha çok yatay düzlemdeki izdüşümleri üzerine durulduğu ya da ahlaki ilkelere gönderme yapıldığını ancak hiçbir şekilde fütüvvet ehlinin gündelik eylemlerinin arka planında yer alan saikin –ki bu saik büyük ölçüde kişinin dikey eksende aşkın varlıkla kurmuş olduğu ilişki düzeyi ile yakından alakalıdır.