Browsing by Author "Wagman, Jennifer"

Now showing 1 - 7 of 7
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    Alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities of Lake Victoria, Uganda
    (BMC public health, 2021) Ojiambo Wandera, Stephen; Mbona Tumwesigye, Nazarius; Walakira, Eddy J.; Kisaakye, Peter; Wagman, Jennifer
    Few studies have investigated the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities from eastern and central Uganda. Therefore, we aimed to determine the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in the fishing communities on the shores of Lake Victoria, in Uganda. Methods: We conducted multivariable logistic regression analyses of HIV risk behavior using cross-sectional data from 501 young people from Mukono (Katosi landing site) and Namayingo districts (Lugala landing site). Results: Almost all (97%) respondents reported at least one HIV risk behavior; more than half (54%) reported engagement in three or more HIV risk behaviors. Results from the adjusted model indicate that alcohol use, working for cash or kind, being married, and having multiple sexual partners increased the odds of HIV risk behavior. IPV was not associated with HIV risk behavior. Conclusion: Interventions to promote consistent condom use and fewer sexual partnerships are critical for young people in the fishing communities in Uganda.
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    Coercive sex in rural Uganda: Prevalence and associated risk factors
    (Social Science & Medicine, 2004) Koenig, Michael A.; Lutalo, Tom; Zhao, Feng; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Wagman, Jennifer; Serwadda, David; Wawer, Maria; Gray, Ronald
    Despite growing recognition of the problem, relatively little is known about the issue of coercive sex in developing countries. This study presents findings from a community-based survey of 4279 reproductive-aged women in current partnerships in the Rakai District of Uganda carried out in 1998–99. One in four women in our study report having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. In a regression analysis of risk factors for coercive sex, conventional socio-demographic characteristics emerged as largely unpredictive of the risk of coercive sex. Behavioral risk factors—most notably, younger age of women at first intercourse and alcohol consumption before sex by the male partner—were strongly and positively related to the risk of coercive sex. Coercive sex was also strongly related to perceptions of the male partner’s HIV risk, with women who perceived their partner to be at highest risk experiencing almost three times the risk of coercive sex relative to low risk partnerships. Supplemental analysis of 1-year longitudinal data provides additional support for the hypothesis that coercive sex may frequently be a consequence of women’s perceptions of increased HIV risk for their male partner. The findings of this study are discussed in terms of the need for sexual violence prevention programs more generally in settings such as Uganda, and in terms of the possible importance of incorporating issues of sexual and physical violence within current HIV prevention programs.
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    Contextual Barriers and Motivators to Adult Male Medical Circumcision in Rakai, Uganda
    (Qualitative health research, 2013) Ssekubugu, Robert; Leontsini, Elli; Wawer, Maria J.; Serwadda, David; Kigozi, Godfrey; Kennedy, Caitlin E.; Nalugoda, Fred; Sekamwa, Richard; Wagman, Jennifer; Gray, Ronald H.
    Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical efficacy, waiting time before resumption of sex, and religion were identified as obstacles to MMC acceptance. Prevention and healing of sexually transmitted infections (STIs), access to HIV and other ancillary care, penile hygiene, and peer influence were key motivators. Voluntary counseling and testing for HIV, partner influence, and sexual potency were both barriers and motivators. Individual and societal factors, such as pain and religion, might slow MMC scale up. Health benefits, such as HIV/STI prevention and penile hygiene, are essential in motivating men to accept MMC.
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    Domestic violence in rural Uganda: evidence from a community-based study
    (Bulletin of the world health organization, 2003) Koenig, Michael A.; Lutalo, Tom; Zhao, Feng; Nalugoda, Fred; Wabwire-Mangen, Fred; Kiwanuka, Noah; Wagman, Jennifer; Serwadda, David; Wawer, Maria; Gray, Ronald
    Although domestic violence is an increasing public health concern in developing countries, evidence from representative, community-based studies is limited. In a survey of 5109 women of reproductive age in the Rakai District of Uganda, 30% of women had experienced physical threats or physical abuse from their current partner—20% during the year before the survey. Three of five women who reported recent physical threats or abuse reported three or more specific acts of violence during the preceding year, and just under a half reported injuries as a result. Analysis of risk factors highlights the pivotal roles of the male partner’s alcohol consumption and his perceived human immunodeficiency virus (HIV) risk in increasing the risk of male against female domestic violence. Most respondents —70% of men and 90% of women—viewed beating of the wife or female partner as justifiable in some circumstances, posing a central challenge to preventing violence in such settings.
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    Experiences of Sexual Coercion Among Adolescent Women: Qualitative Findings From Rakai District, Uganda
    (Journal of interpersonal violence, 2008) Wagman, Jennifer; Baumgartner, Joy Noel; Geary, Cindy Waszak; Nakyanjo, Neema; Ddaaki, William George; Serwadda, David; Gray, Ron; Nalugoda, Fred Kakaire; Wawer, Maria J.
    Limited data from low-income countries are available on the continuum of coercive experiences, the contexts in which they occur, and how adolescent women perceive and respond to coercion. This article presents results from focus group discussions and in-depth interviews with pregnant and never pregnant sexually active female adolescents, aged 15 to 17, residing in Rakai District, Uganda, to examine sexual coercion, its context, and the links between coercion and adolescent reproductive health outcomes, including early sexual debut and pregnancy. Informants described multiple forms of sexual coercion, including coerced or forced intercourse, unwanted sexual touching, verbal harassment, and transactional sex. Sexual coercion was perceived to be a normal part of intimate relationships; in particular, informants felt that a woman’s lack of decision-making authority, including choices on sexual encounters, was implicit to marriage. This information may help violence prevention programs develop a range of strategies for addressing sexual coercion among adolescents.
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    Personal and community benefits and harms of research: views from Rakai, Uganda
    (Aids, 2007) Thiessena, Carrie; Ssekubugu, Robert; Wagman, Jennifer; Kiddugavu, Mohammed; Wawer, Maria J.; Emanuel, Ezekiel; Gray, Ronald; Serwadda, David; Grady, Christine
    To assess what individuals in low-income countries perceive as benefits and harms of population-based HIV/STD research. Design: A total of 811 research participants, research decliners, and community opinion leaders in the Rakai District, Uganda were surveyed. Types of personal and community benefits and harms, as well as rates of reporting great personal and community benefit were assessed. Methods: Using logistic regression, demographic characteristics, participant and opinion leader status, use of Rakai Health Sciences Program (RHSP) services, and perceived research effects were entered as predictors of reported great personal and great community benefit. Results: Most respondents thought that RHSP research was of great personal (85%) and community (88%) benefit. The perception that the RHSP was a great personal benefit was correlated with female sex, post-secondary education, frequent use of RHSPsponsored medical services, health knowledge gains, and increased hope for future health improvements. Persons of non-Baganda ethnicity and 30–39 year-olds were less likely to believe research was personally beneficial. Regarding research as a great community benefit was associated with reported health knowledge gains, greater hope for Rakai residents’ future health, and local economic benefit. Decliners were the most likely to report a personal harm, while community opinion leaders identified community harms at the highest rates. Conclusions: The majority of Rakai residents report that HIV/STD research has enhanced their own and their communities’ welfare. Different factors were associated with the belief that research is a personal versus community benefit. Variations in participant, decliner, and community opinion leader perceptions highlight inadequacies of current community consultation mechanisms.
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    Research Benefits for Hypothetical HIV Vaccine Trials: The Views of Ugandans in the Rakai
    (Ethics & Human Research, 2008) Grady, Christine; Wagman, Jennifer; Ssekubugu, Robert; Wawer, Maria J.; Serwadda, David; Kiddugavu, Mohammed; Nalugoda, Fred; Gray, Ronald H.; Wendler, David; Dong, Qian; Dixon, Dennis O.; Townsend, Bryan; Wahl, Elizabeth; Emanuel, Ezekiel J.
    Collaborative, multinational clinical research is complicated by thorny ethical issues, especially when sponsored by developed world entities and conducted in the developing world. An overarching ethical concern in all research is the possible exploitation of vulnerable individuals or populations. Exploitation, often understood as an unfair distribution of benefits,' may be more of a challenge in international research because of background disparities in health, health resources, and power between developed and developing countries.- Codes and guidelines have recommended pro- vision of benefits to participants or the host community as one means of minimizing exploitation in inter- national research.3 Ensuing debates on the type and level of benefit that should be provided have focused on issues such as compensation to individual research participants and post trial access to products proven effective.4 Although research participants are often reimbursed or compensated with money or other goods, researchers and members of research ethics boards sometimes disagree about what kind of reimbursement or compensation-and how much-is appropriate. International guidelines note that participants may be reimbursed or compensated for time, travel, and inconvenience with money or free medical care in acceptable amounts approved by local research ethics boards, as long as amounts are "not so large or the medical services so extensive as to induce prospective subjects to consent to participate in the research against their better judgment."6 Previous studies have shown that financial incentives may impact individuals' willingness to participate in HIV vaccine trials, but few studies have directly assessed respondents' opinions about whether research participants should be financially compensated.