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PROBLEM STATEMENT: Globally, 70% of more than three million new curable sexually transmitted infections (STI) are among 15-24 year olds, with young people in developing countries bearing the highest burden. Chlamydia Trachomatis prevalence, for example, is 15.4% and 20.5% in young women and men attending STD clinics in the U.S. However, Caribbean STI data for young men are particularly scarce and inconsistent and cases are under-reported due to poor health seeking behavior. In Guyana, 42% of the STI cases from 2010 -2014 occurred in young people, aged 15- 24. Moreover, few programs and policies focus specifically on the sexual and reproductive health (SRH) needs of young men. This dissertation explores the contextual and behavioral factors that cause young men’s vulnerability to STI and proposes recommendations for the national response in Guyana. METHODS: Research methods included: 9 focus group discussions (FGDs) with young men, aged 15-18, mothers and fathers and 25 in-depth interviews with representatives from government, community, faith-based and donor organizations. Interviews and FGDs were audiotaped, transcribed, and analyzed for major themes among and across each stakeholder group. Analysis was guided by a socio-ecologic framework and resulted in program and policy recommendations to address vulnerability to STI and augment protective factors against STI in young men in Guyana. RESULTS: Salient overarching themes include: Poverty and Disenfranchisement “Yes, this is a Man”: Early Sex, Fast Money, and Risk”, “The Empty Room: Young Men without Male Roles Models”, “Sex in a violent society”, “Stigma, Discrimination, and Shame: Road blocks to young men’s sexual health” and Young men’s Sexual and Reproductive Health: Young men’s Sexual and Reproductive Health: It all depends on family, religion, education, music and media (or not). Participants highlighted a lack of SRH awareness and health care seeking resulting from insufficient male SRH promotion and services. Parental engagement, school attendance, supportive peers, religious commitment and internet use for SRH information were described as protective factors. CONTRIBUTION: A socio-ecological model helped to comprehensively identify and organize broad social determinants of SRH and high risk sexual behaviors for young men. The resulting program and policy recommendations are proposed for implementation in Georgetown, Guyana. / 2018-11-08T00:00:00Z

Ongoing global health inequities have been amplified since the 2020 COVID-19 pandemic and subsequent social movements. Such inequities have resulted in increased literature critiquing the historical roots and current practices in global health. From this literature, questions have emerged about the future of global health and Canada’s role in this future. However, there is little research consolidating existing critiques and, based on these critiques, exploring adolescent sexual and reproductive health (ASRH) research and the role of Canadian funding for ASRH. The aim of this dissertation is to consolidate contemporary critiques of global health to develop a conceptual framework for one potential imagined future for global health. It then explores the conceptual framework for an imagined future through an example of global health research, policy, and practice, as it relates to ASRH in Eastern sub-Saharan Africa, to consider the opportunities and challenges of achieving this new potential vision. In this dissertation, I present four unique contributions. The first article presents the conceptual framework for an imagined future that will be used to explore ASRH research, policy, and practice. The second article presents findings from a scoping review on adolescent engagement in ASRH research. The third article presents a review of Canada’s Feminist International Assistance Policy (FIAP) and examines the development of the policy in relation to an imagined future. The fourth article presents a qualitative description of stakeholder perspectives who are implementing ASRH projects with Canadian funding and discusses these perspectives in relation to an imagined future. Conclusions suggest that language to support changes towards an imagined future in global health exists although there is continued opportunity to operationalize the changes. Further research is encouraged to engage local actors and consider practical ways to shift towards equity and justice in Canadian funding for ASRH. / Dissertation / Doctor of Philosophy (PhD) / There is growing controversy in the field of global health and it is not yet clear how the field will respond and evolve. As the number of critiques grow, responding with new ideas for the future of global health becomes more urgent and yet more difficult. This thesis aimed to address this challenge by examining what an imagined future for global health research, policy, and practice might be, and how it might be achieved. This research focuses on the future of global health and Canada’s role in it, particularly regarding adolescent sexual and reproductive health (ASRH) in Eastern sub-Saharan Africa. By reviewing documents and conducting qualitative interviews, this study explores adolescent involvement in ASRH research, Canada’s Feminist International Assistance Policy (FIAP) and stakeholder experiences implementing ASRH projects with Canadian funding. Findings emphasize the need for concrete actions to implement the changes proposed by scholars. Further research is encouraged to engage local actors and consider practical ways forward for shifts towards equity and justice in Canadian funding.

Background: A significant amount of research has previously been conducted in developing countries such as India, to improve women’s sexual and reproductive health. However, women living in North Indian slums still have poor access to proper sexual and reproductive healthcare. The aim of this thesis is to investigate the published literature to create a consolidated understanding of the key barriers faced by women in slum populations when accessing sexual and reproductive health services in Northern India. Methods: A scoping review was carried out following the five stages outlined in Arksey and O’Malley’s framework. Five online databases (MEDLINE, Global Health, Ovid Emcare, Embase, and Web of Science) were searched. An interpretive thematic analysis was conducted to extract meaningful themes from the data using the Conceptual Framework for Reproductive Empowerment developed by the International Center for Research on Women Results: In total, 28 articles were identified to be incorporated into the scoping review. The results of this study were grouped according to the CFFRE to understand how they compared in regard to women’s reproductive empowerment. This scoping review found reproductive empowerment was significantly hindered by women lacking a proper education and understanding of SRH services, lack of employment and financial resources. Additionally, women’s husbands and mothers-in-laws were barriers to contraceptive use. Finally, poor interactions with healthcare providers and the healthcare system, and systemic factors such as behaviours in treatment seeking, son preference and religion were barriers to accessing SRH services. Conclusion: This scoping review investigated the barriers faced by women living in slum populations in Northern India to accessing SRH services. The results of this study contribute to the literature by identifying areas that require improvement to SRH services for women living in slums, and will be integral to implementing strategies and interventions to allow better access to SRH services in the future. / Thesis / Master of Science (MSc) / A significant amount of research has previously been conducted in India, to improve women’s sexual and reproductive health. However, women living in North Indian slums still have poor access to proper sexual and reproductive healthcare. Therefore, this study investigated the key barriers faced by women in slum populations when accessing sexual and reproductive health services in Northern India. A review of previous studies was conducted by searching five electronic databases and a total 28 articles were included into the review. This study found that women lacking a proper education and understanding of SRH services, lack of employment and financial resources, and women’s husbands and mothers-in-laws were barriers to SRH services. Finally, poor interactions with healthcare providers and the healthcare system, and systemic factors such as behaviours in treatment seeking, son preference, and religion were also barriers to accessing SRH services.

The purpose of the study was to explore and describe young people’s perceptions of access to sexual and reproductive health (SRH) services in Swaziland. The study provided insights into the SRH services currently available to the young people of Swaziland and reveals the opportunities that can be used to improve accessibility and utilisation of the current reproductive health services. The findings will inform policy-making and appropriate future interventions for young people’s sexual and reproductive needs and services. Data were collected through a descriptive exploratory study design. Colaizzi’s seven steps of data analysis were used. The study provides ample evidence that young people face sexual health risks that justify their need to access and utilise SRH services. The findings revealed that access to service is an important but complex element of quality care, as it determines whether a client gets to the service provider. / Health Studies / M.A. (Health Studies)

As práticas contraceptivas na adolescência apresentam dinâmica própria, em que as decisões acerca do uso de algum método variam em função de uma série de elementos, como o conhecimento sobre anticoncepção, a experiência sexual e o relacionamento vigente. Por conta de serem essencialmente solteiros, os adolescentes alternam os métodos de acordo com o tipo de relacionamento, seja ocasional ou estável, bem como ao longo deste. É justamente nos momentos de alternâncias e descontinuidades no uso de métodos que a anticoncepção de emergência pode surgir como opção para a prevenção da gravidez não planejada. Mesmo que já esteja disponível em alguns serviços da rede pública de saúde no país, pouco se sabe sobre o seu conhecimento e uso. Assim, este estudo teve como objetivo analisar o nível do conhecimento e o uso da anticoncepção de emergência entre adolescentes estudantes do ensino médio. Para isto, foi conduzido um estudo quantitativo do tipo transversal. A população de estudo constou de estudantes solteiros de 15 a 19 anos de idade que estavam matriculados em escolas públicas e privadas do município de Arujá, São Paulo. Os estudantes foram selecionados considerando a amostragem probabilística por conglomerado, realizado em duas etapas (estratificação por escola e sistemática por turma) (n=669). Os dados foram coletados por meio de um questionário autoaplicado, no qual as variáveis dependentes foram o conhecimento sobre a anticoncepção de emergência (incluindo apenas aqueles que a conheciam) e o uso da anticoncepção de emergência (incluindo apenas aqueles que iniciaram a vida sexual). As variáveis independentes dizem respeito às características sociodemográficas e ao comportamento sexual e contraceptivo. A análise de regressão linear múltipla identificou como variáveis associadas ao nível do conhecimento da anticoncepção de emergência o tipo de escola, o ano escolar, o sexo, a relação sexual e conhecer alguém que já usou o método. Por sua vez, a análise de regressão logística múltipla identificou como variáveis associadas ao uso da anticoncepção de emergência a religião, o namoro atual e conhecer alguém que já usou o método. Os resultados obtidos demonstraram que os adolescentes de ambos os tipos de escola sabem pouco sobre a anticoncepção de emergência, apesar de uma parcela significativa ter usado este método. Demonstraram, também, que o nível de conhecimento da anticoncepção de emergência não afetou o uso deste método. / Contraceptive practices in adolescence present specific dynamics, in which decisions about the use of a method vary upon contraception knowledge, sexual experience and dating. As adolescents are mostly single, they alternate the use of contraceptive methods according to their relationships, whether occasional or permanent, as well as along it. Whenever there are alternations and discontinuities in the use of regular methods, emergency contraception may emerge as an option to prevent an unplanned pregnancy. Even though it is already available in some primary health services, little is known about adolescents knowledge and use. This study aimed to analyze the level of knowledge and use of emergency contraception among high school adolescent students. So we conducted a cross-sectional quantitative study. The study population was single students from 15 to 19 years of age enrolled in public and private high schools in the city of Arujá, São Paulo, Brazil. Students were selected based on a cluster sampling, conducted in two stages (stratificatied sampling by school and systematic sampling by class) (n = 669). Data were collected through a self-administered questionnaire, in which the dependent variables were knowledge about emergency contraception and the use of emergency contraception (considering only those who reported sexual initiation). Independent variables were sociodemographic characteristics and sexual and contraceptive behavior. From multiple logistic regression analysis, data showed that associated variables to the level of knowledge of emergency contraception were school type, school year, sex/gender, sexual intercourse and knowledge of someone who has used the method. On the other hand, variables associated with the use of emergency contraception were religion, current dating and knowledge of someone who has used the method. Results showed that adolescents from both schools know little about emergency contraception, although more than a half have used this method. Level of knowledge of emergency contraception did not affect the use of this method.

Embora o dispositivo intrauterino (DIU) seja pouco usado no Brasil, ele é o método contraceptivo reversível mais usado no mundo. Trata-se de um método seguro, altamente eficaz e com resultados positivos na saúde das populações. Por meio da prevenção de gestações não planejadas, atua na redução da morbidade e mortalidade materna, mortalidade infantil e abortos inseguros. Pesquisas recentes, contudo, mostram que o acesso ao DIU nos serviços de Atenção Básica à Saúde nem sempre é facilitado, sendo permeado por barreiras organizacionais que contribuem para sua subutilização. Tais barreiras podem restringir o pleno exercício dos direitos sexuais e reprodutivos das mulheres brasileiras. Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde e elaborar, como produto desta dissertação, uma síntese destas barreiras, destinada aos gestores de saúde, com suas implicações e recomendações. Método: Estudo quantitativo, descritivo. A coleta de dados foi realizada por meio do preenchimento de um instrumento estruturado, online, pelos 79 profissionais responsáveis pela área técnica de Saúde da Mulher. O cenário do estudo foi a macrorregião Sul de Minas Gerais. A análise dos dados foi realizada por meio do software Stata, versão 14.0, e descrita por meio de número absoluto e proporções. Resultados: A maioria dos municípios possui protocolo de atenção à saúde da mulher (55,7%). Destes, 77,3% elaboraram seu próprio protocolo, mas 29,6% não treinaram a equipe de saúde para usá-lo. Dentre todos os municípios participantes, 15,2% não disponibilizam DIU, sendo que alguns também não referenciam a mulher para outros serviços (8,3%). Dentre aqueles que disponibilizam o DIU, a grande maioria não possui protocolo específico (68,7%); uma parcela não adota a gravidez como condição impossibilitante da inserção do DIU (10,5%) e, por outro lado, adotam condições menos relevantes como infecção vaginal (80,6%). Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos. Como exames necessários, foi citado o Papanicolaou (94,7%), teste de gravidez (63,2%) e exame de sangue (29,8%). Quanto ao local de disponibilização, 83,7% não o disponibilizam nas Unidades Básicas de Saúde. Como profissional que insere o DIU, 97,0% referiram médico e nenhum citou o enfermeiro. Quanto aos grupos de planejamento reprodutivo, 43,0% dos municípios não os realizam. Por fim, 86,1% dos trabalhadores reportaram não haver dificuldades para obtenção do DIU. Conclusão: Foram identificadas barreiras organizacionais que dizem respeito ao uso de protocolos, também barreiras relacionadas à disponibilização e inserção do DIU, e barreiras relativas aos grupos de planejamento reprodutivo. / Introduction: Although the intrauterine device (IUD) is little used in Brazil, it is the most used reversible contraceptive method in the world. It is about a safe method, highly effective and with positive results in the health of populations. By means of preventing unplanned pregnancies, it works to reduce maternal morbidity and mortality, infant mortality and unsafe abortions. Recent research, however, show that access to IUD in Primary Health Attention services is not always facilitated, being permeated by organizational barriers that contribute to their underutilization. Such barriers may restrict the full exercise of sexual and reproductive rights of Brazilian women. Objective: To identify organizational barriers for providing IUD in the Primary Health Attention services and elaborate, as a product of this dissertation, a summary of these barriers, which is intended for health managers, with their implications and recommendations. Method: Qualitative, descriptive study. Data collection was performed by completing, online, a structured instrument, by 79 professionals responsible for the technical field of Womens Health. The study setting was the macro-region in the southern of Minas Gerais. Data analysis was performed using Stata software, version 14.0, and described by absolute number and proportions. Results: Most municipalities have attention protocol to womens health (55.7%). Of these, 77.3% developed its own protocol, but 29.6% did not train health staff to use it. Among all participating municipalities, 15.2% do not offer IUD, and some did not refer women to other services (8.3%). Among those, which provide the IUD, the vast majority do not have specific protocol (68.7%); a portion does not adopt pregnancy as an impeditive condition of insertion of the IUD (10.5%) and, on the other hand, adopt less relevant conditions such as vaginal infection (80.6%). As a criterion for accessing the IUD, 86.5% reported prescription, 71.6% exams, 44.6% aged over 18 years old and 24.4% participation in groups. As required exams, it was quoted the Pap smear (94.7%), pregnancy test (63,2%) and blood tests (29,8%). As a place of availability, 83.7% do not provide in the Basic Health Units. As a professional to insert the IUD, 97.0% reported the doctor and none cited the nurse. Municipalities do not realize reproductive planning group at 43.0%. Finally, 86.1% of workers reported not having difficulties in obtaining the IUD. Conclusion: Organizational barriers were identified concerning the use of protocols, also barriers related to the availability and IUD insertion, and barriers related to the reproductive planning groups.

No cenário da educação relativo à saúde, as questões sexuais são responsáveis por uma série de fatores que podem tanto contribuir com a promoção da saúde sexual e reprodutiva quanto a levar os indivíduos a transtornos severos. Caso não exista uma política de abertura para lidar com esses problemas, principalmente na adolescência, de forma dialogada, sincera e honesta, cabe ao enfermeiro compreender que a sexualidade e seus diversos desdobramentos dependem de uma série de condições econômicas, ambientais, socioculturais propícias, entre outros, como condicionantes e/ou determinantes da condição de saúde. Objetivo: Identificar o significado de sexualidade, violência sexual e educação sexual junto aos professores atuantes no ensino fundamental de uma escola pública do Estado do Paraná, procurando desenvolver conjuntamente com eles, um programa educativo visando instrumentalizá-los para a ação educativa neste sentido. Metodologia: Pesquisa qualitativa, mediatizada pela pesquisa-ação, que permite levantar problemas e, propor posteriormente ações educativas. Para a coleta de dados utilizamos a entrevista, com a aplicação de questionário e a observação participante com o uso do diário de campo. A amostra foi constituída por 23 professores do ensino fundamental de uma cidade do interior paranaense. Adotamos como critérios de inclusão: ser professor efetivo, atuar no ensino fundamental e aceitar participar, voluntariamente, do estudo. Análise dos dados: esses foram levantados, através das respostas emanadas pelos participantes da pesquisa. Foram trabalhados qualitativamente e, portanto, por categorização, permitindo o agrupamento de todos os elementos convergentes e/ou divergentes, apropriados e/ou ajustados às reflexões, de acordo com a discussão, associados aos dados obtidos no estudo. Resultados: Depreendemos que a maioria dos professores pesquisados relacionou o conceito de sexualidade ao ato sexual. Destacaram que os pais ainda possuem dificuldades em discutir o assunto no contexto familiar. Reconheceram a existência de inúmeras dificuldades em discutir a temática na escola. Os professores percebem que na sociedade contemporânea há uma intensa valorização do ato sexual, contribuindo para a vivência de uma sexualidade narcisista, imediatista e individualista. Demonstraram vasta consciência social sobre a influência das estruturas sociais na disseminação da violência sexual. Apontaram que a principal dificuldade na abordagem sobre sexualidade em sala de aula relaciona-se ao seu despreparo e falta de conhecimento sobre o assunto. Reconheceram que não há um programa específico sobre a temática sexual, além da ênfase na importância da interação da família na elaboração e implementação da educação sexual no espaço escolar. Portanto consideramos que a enfermagem enquanto prática social deve ocupar efetivamente o espaço escolar contribuindo para o preparo dos professores no enfrentamento desse grande desafio que é a educação sexual, pois mesmo com os diversos dispositivos legais esta prática não tem sido efetiva e ainda perpetua-se a visão biologicista em detrimento de uma educação libertadora, dialógica, crítica e transformadora. / In the educational scenario, relating to health, the sexual matters are responsible for a succession of factors which can head individuals to severe perturbation. If there is no political discussion to deal with those problems, mainly in the adolescence, in a dialogued way, sincere and honest, it is the nurse who is in charge of understanding that the sexuality and its several unfolding depend on a series of financial, environmental, socio-cultural conditions, among others, as conditioning and/or determinant of the health condition. Aim: Identify the meaning of sexuality, sexual violence and sexual education in a partnership with the teachers from the elementary school of a public school in the state of Paraná, developing with them an educational program aiming for give them tools enough to work in this sense with educational actions. Methods: Qualitative researching, under the actionsearching, which allow us surveying some problems and then suggest some educational actions. We used the interview, with a questionnaire, to survey the data, and also the observation of the participant, using the diary fields. The sample was constituted by 23 teachers of the elementary school from a town in the countryside of Paraná. We adopted as inclusion criteria: being teacher currently, working in the elementary school and accepting being part of the study, voluntarily. Data Analysis: these were surveyed through the answers given by the participants of the searching. They were analyzed qualitively and, therefore, by categorization, allowing the grouping of all converging and/or diverging elements, proper and/or adjusted to the reflections, according to the discussion, associated by the obtained data from the study. Results: We inferred that the majority of the interviewed teachers understand the concept of sexuality as the sex act itself. They highlighted that the parents still have some difficulties discussing this matter in the familiar context. They recognized that there are countless difficulties discussing this issue at school. Teachers noticed that, nowadays, in the society there is a strong valuation of the sex act, contributing to the existing of a narcissist, imediatist and individualist sexuality. They showed a wide social consciousness about the influence of the social structures in the spreading of the sexual violence. They also pointed the main difficult approaching about the sexuality in the classroom, their own lack of preparation and knowledge about this matter. They acknowledged that there is no specified program about sexuality, but the emphasis in the importance of the family interaction in the developing and application of the sexual education inside the school environment. Therefore, we consider that nursing, as a social activity, must, effectively, take part in the school environment contributing for the teachers preparation to face this huge challenge, the sexual education, because even with several legal mechanisms, this practice has not been effective and it still remains the biologistic view to the detriment of a liberating, dialogical, critical and a transforming education.

Introdução: O uso de métodos anticonceptivos modernos pela maior parte das mulheres brasileiras não diminuiu, conforme esperado, assim como a ocorrência de gestações não desejadas, abortamentos e, consequentemente, mortes maternas, o que revela uso com perfil irregular e descontínuo. No Brasil, há pouca informação sobre os padrões e os determinantes da ocorrência dessas descontinuidades contraceptivas. Devido às inconsistências no uso de métodos serem relativamente comuns, é necessário mensurar o quanto as mulheres interrompem seu uso a despeito de não desejarem engravidar e/ou os alternam inúmeras vezes, nem sempre com opção por um método mais eficaz. Objetivo: Analisar os padrões e os determinantes das descontinuidades contraceptivas no uso da pílula oral, do hormonal injetável e do preservativo masculino. Método: Estudo longitudinal retrospectivo, conduzido com amostra probabilística de 1.551 mulheres de 18 a 49 anos de idade, usuárias de 57 Unidades Básicas de Saúde da cidade de São Paulo/SP (2015) e Aracaju/SE (2016). Os dados foram coletados por entrevista face a face usando o calendário contraceptivo. No Stata 14.2, as análises das taxas de descontinuidade contraceptiva no período de doze meses foram realizadas pelo método de Kaplan-Meier e dos fatores associados por meio dos Modelos de Riscos Proporcionais de Cox, ambos para descontinuidade total, abandono, troca para método menos eficaz e troca para método mais eficaz. Resultados: A taxa de descontinuidade total no uso de métodos foi 41,9% aos doze meses, sendo maior entre usuárias do preservativo masculino (48,1%), seguida de hormonal injetável (39,0%) e pílula oral (38,6%). Entre as usuárias de pílula oral, a taxa de abandono foi a maior; entre as usuárias do hormonal injetável, foi a troca para um método menos eficaz; e, entre as usuárias do preservativo masculino, foi a troca para um método mais eficaz. Os aspectos associados às descontinuidades variam segundo o tipo de método. A descontinuidade no uso da pílula oral foi associada à idade (18-24 anos), vivência de abortamento, incerteza quanto à intenção reprodutiva e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do hormonal injetável foi associada ao maior número de parceiros sexuais, à vivência de abortamento e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do preservativo masculino foi associada à idade (25-34 e 35-49 anos), à união conjugal, ao menor poder aquisitivo (classe econômica D/E) e ao maior número de filhos vivos. Conclusões: Foram observadas altas taxas de descontinuidades no uso de métodos contraceptivos, que variaram conforme o tipo de método. Chama a atenção o papel dos efeitos colaterais na determinação da ocorrência de descontinuidade no uso dos métodos hormonais. Por sua vez, a troca por método mais eficaz foi pouco frequente, com exceção das usuárias de preservativo masculino. Sugere-se ampliar o acesso aos métodos contraceptivos mais eficazes e de longa duração e melhorar a assistência em contracepção nos serviços do Sistema Único de Saúde, de forma a contemplar as necessidades de saúde das mulheres e seus direitos sexuais e reprodutivos. / Introduction: Use of modern contraceptive methods by the majority of Brazilian women did not reduce the occurrence of unintended pregnancies, abortions or maternal deaths as expected, which means that it might be an irregular and discontinuous use. In Brazil, there is a little information on the patterns and determinants of the occurrence of these contraceptive discontinuations. Because inconsistencies in the use of methods are relatively common, it is necessary to measure how much women discontinue their use despite they are willing to get pregnant and/or switching them countless times, not always with the option of a more efficient method. Objective: Our purpose is to investigate patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injection and condom. Method: We conducted a retrospective longitudinal study with probabilistic sample of 1,551 women among 18-49 year old who are primary users of 57 health care facilities, both in Sao Paulo (2015) city and Aracaju city (2016). Data were collected by face-to-face interview in line with contraceptive calendar. In Stata 14.2 analyzes of 12-month contraceptive discontinuation rates were performed using the Kaplan-Meier Survival Estimates method and associated factors using the Cox Proportional Hazards Models, both for total discontinuation, abandonment, and switching to a less efficient method and switching to more efficient method. Results: The discontinuation rate in the use of methods was 41.9% at 12 months, being higher among male condom users (48.1%), followed by hormonal injection (39.0%) and oral pill (38.6%). Among oral pill users, the abandon rate was the highest; among users of hormonal injections, was the switching to a less efficient method; and among male condom users, it was the switching to a more efficient method. The aspects associated to the discontinuations varied according to the type of method. Discontinuation of oral pill users was associated with age (18-24 years old), experience of abortion, uncertainty about reproductive intention and side effects/health concern. Discontinuation in the use of hormonal injections was associated with a greater number of sexual partners, the experience of abortion, and the side effects/health concern. Discontinuation of condom users was associated with age (25-34 and 35-49 years old), marital union, lower income and the highest number of live children. Conclusion: High discontinuation rates were observed in the use of contraceptive methods, which varied according to the type of method. The role of side effects/health concern in determining the occurrence of discontinuation in the use of hormonal methods is noteworthy. On the other hand, switching to more efficient method was infrequent, except for the male condoms users. It is suggested to amplify access to the more effective methods as well as long active also improving care in contraception in the all health care facilities services, in order to take into account both women health needs and their sexual and reproductive rights.

Made available in DSpace on 2016-08-10T10:55:13Z (GMT). No. of bitstreams: 1 Norma Esther Negrete Calpineiro.pdf: 855798 bytes, checksum: 8be9050fd34abcc423e6020e780fe4c0 (MD5) Previous issue date: 2007-02-28 / O estudo traça o perfil de mulheres vivendo com HIV/Aids em tratamento no Hospital de Doenças Tropicais de Goiânia por meio de dados coletados dos prontuários e da Ficha da Mulher daquelas que realizaram a primeira consulta no Ambulatório de Ginecologia da Unidade e de gestantes que participaram dos cursos no Grupo de Adesão do Hospital. Os dados coletados evidenciaram que a maioria das mulheres encontra-se na idade reprodutiva, a maioria absoluta é parda ou negra, tem pouca escolaridade, considera-se do lar, declarou-se casada sendo que as outras afirmaram serem viúvas, solteiras ou terem parceiro fixo. A exposição sexual ao HIV prevaleceu em quase a totalidade das mulheres, tendo recebido o diagnóstico fora do ciclo gravídico-puerperal, a maioria tinha até quatro filhos, não usava preservativos nas relações sexuais e tinha realizado esterilização cirúrgica. Uma porcentagem significativa afirmou estar em abstinência sexual, sendo que majoritariamente as mulheres estavam na condição de doentes pela Síndrome de Imunodeficiência Adquirida. A elevada prevalência de outras doenças de transmissão sexual, de lesões pré-malignas e malignas do colo uterino condiz com a realidade das pacientes no que se refere à abordagem integral e facilidade de acesso aos Serviços de Saúde. Os dados das gestantes com HIV/Aids revelam que a maioria tinha sido diagnosticada durante o pré-natal, destacando-se aquelas que receberam o diagnóstico após o parto sem a devida profilaxia para evitar a transmissão materno-fetal. A associação destas variáveis demonstra que as mulheres que vivem com HIV/Aids em tratamento no HDT encontram-se vulneráveis à tríplice discriminação argüida por alguns, pelo fato de serem negras pobres e por serem mulheres, este perfil coincide com a denominada feminização negrófila e com a pauperização do HIV/Aids. É necessária a abordagem multidisciplinar dessas mulheres para diminuir os agravos à saúde inerentes à situação e contribuir para a superação da exclusão no sentido amplo do termo.