La transmission hétérosexuelle de HIV de l’homme vers la femme est le principal mode de contamination dans le monde. Il implique la mise en contact du sperme infecté avec la muqueuse génitale féminine saine, puis le passage du virus libre ou associé aux cellules à travers la muqueuse. Les mécanismes impliqués dans la transmission de HIV de l’homme vers la femme ainsi que l’impact du plasma séminal sur la transmission sélective des virus à tropisme R5 sont encore mal connus. Au cours de mon séjour doctoral nous avons visualisé le passage du virus associé aux cellules ainsi que du virus libre à travers la muqueuse génitale endocervicale. Dans un premier temps l’étude s’est focalisée sur la transmigration de cellules immunitaires infectées par HIV à travers un modèle in vitro de muqueuse endocervicale reconstruite, ainsi que sur le rôle du plasma séminal dans la transmission de HIV et la sélection des virus à tropisme R5. Par la suite, un virus chimérique fluorescent, réplicatif et infectieux, permettant sa détection par microscopie confocale sur plusieurs cycles de réplication, a été développé. Après mise en contact de ce virus chimérique, à tropisme X4 ou R5, avec la muqueuse endocervicale, nous avons visualisé par microscopie confocale l’infection des cellules épithéliales endocervicales et la transmission de HIV à des cellules immunitaires disposées au pôle basal. L’utilisation d’un modèle mathématique nous a permis de standardiser et quantifier la détection de cellules infectées dans la muqueuse. Mes travaux de thèse décrivent dans un premier temps l’importance du passage de HIV associé aux cellules dans la transmission hétérosexuelle, ainsi que l’implication du plasma séminal dans la sélection des virus à tropisme R5. De plus, le modèle virologique développé permet de visualiser directement la transmission hétérosexuelle de HIV à travers la muqueuse génitale féminine. J’ai ainsi démontré qu’il est possible de visualiser directement, de localiser et de quantifier la présence du virus au sein de la muqueuse. Cet outil virologique permettra d’approfondir les connaissances et la compréhension des mécanismes impliqués dans la transmission hétérosexuelle de HIV et dans la sélection des virus à tropisme R5 / Heterosexual transmission of HIV from men to women is the main route of contamination by this agent worldwide. This mode of transmission involves the contact between infected semen and healthy female genital mucosa, and then the crossing of cell-free or cell-associated viruses through the mucosa. The mechanisms involved in HIV transmission from men to women as well as the role of seminal plasma in selective transmission of R5-tropic viruses stay partially unknown. During the course of my PhD we visualized the crossing of cell-associated and cell-free virus through the endocervical genital mucosa. Initially, the study focused on the transmigration of infected immune cells through an in vitro model of endocervical mucosa, as well as on the role of seminal plasma in HIV transmission and selection of R5-tropic strains. Afterwards, we developed a fluorescent, replicative competent, infectious chimeric virus allowing its detection by confocal microscopy after several replication cycles. After contact of the endocervical mucosa with X4- or R5-tropic chimeric viruses, we visualized by confocal microscopy the infection of endocervical epithelial cells and the transmission of HIV to immune cells placed in the basal compartment. The use of a mathematical model allowed standardizing and quantifying the detection of infected cells in the mucosa. My PhD work describes as a first step the importance of the crossing of cell-associated HIV particles in the heterosexual transmission, as well as the involvement of seminal plasma in the selection of R5-tropic strains. Moreover, the virological model developed herein allows the direct visualization of HIV transmission through the female genital mucosa. I have thus demonstrated that it is possible to localize and quantify viral particles within the mucosa. This virological tool help to better understand the mechanisms involved in HIV heterosexual transmission and the selection of R5-tropic strains

The practice of female genital cutting/s (FGC) has been under national scrutiny in Sweden for decades. Besides strong laws and policies enforced by the Swedish government, civil society organisations have played an important role in addressing the subject of FGC in Sweden. The purpose of this research is to examine what roles and functions civil society organisations assume as they tackle the practice of FGC. Based on semi-structured interviews conducted with employees and volunteers from civil society organisations that address the practice on a daily basis, this study sheds light on the possibilities and challenges civil society organisations face when they approach the question of FGC in Sweden. This research finds that civil society organisations carry a lot of responsibility in terms of tackling FGC in Sweden, as governmental efforts are perceived to be insufficient. Criticism against the Swedish government is first and foremost directed to the lack of knowledge and understanding on FGC within authorities and to the lack of grassroot efforts together with diaspora communities. Thus, this examination shows how civil society organisations engage and provide complementary efforts. First, civil society organisations raise awareness and shed light on the complexity on the practice of FGC within several authorities to secure that knowledge about the practice is maintained. Second, civil society organisations strive to involve, engage and empower individuals on grassroot levels by creating safe and familiar spaces to talk about FGC. Finally, local efforts provided by civil society organisations aim to empower people affected by the practice of FGC to make their voices heard and to represent themselves. In conclusion, this research demonstrates that civil society organisations hold vital complementary roles in relation to the Swedish state in terms of addressing the practice of FGC in Sweden.

SAMMANFATTNING Bakgrund Kvinnlig könsstympning (Female Genital Mutilation, FGM) är en uråldrig tradition med starka band till kulturell och etnisk identitet. Mer än 200 miljoner kvinnor och flickor beräknas vara könsstympade och årligen riskerar cirka 3,9 miljoner ytterligare flickor att utsättas. Andelen kvinnor från länder där FGM är vanligt förekommande och som föder barn i Sverige har ökat i och med ökad invandring från dessa länder. FGM är internationellt betraktat som en kränkning av de mänskliga rättigheterna samt ett brott mot kvinnor och barns rättigheter. Syfte Att jämföra förekomsten och risken för perinatala komplikationer hos kvinnor med en diagnos av FGM med kvinnor utan denna diagnos som fött barn i Sverige mellan åren 2007 - 2017. Metod En populationsbaserad kohortstudie. Resultat Det huvudsakliga resultatet i denna studie är att barn födda av kvinnor med en FGM diagnos har en signifikant ökad risk för låg Apgar, födas lätta för tiden (SGA), drabbas av kramper, perinatal död inklusive intrauterin fosterdöd samt att födas överburna. Slutsats FGM är förknippat med ett flertal allvarliga perinatala komplikationer. Störst risk kunde ses mellan FGM och att födas lätt för tiden, födas överburen och intrauterin fosterdöd. Dessa samband var robusta oavsett vilket land kvinnan är född. Det går att dra slutsatsen att kvinnor med en FGM-diagnos och deras nyfödda barn tillhör en riskgrupp. Det är av stor vikt att arbeta preventivt för att skydda dessa kvinnor och barns hälsa. / ABSTRACT Background Female Genital Mutilation (FGM) is an ancient tradition with strong ties to cultural and ethnic identity. More than 200 million women and girls are estimated to be exposed, and about 3.9 million more girls are at risk each year. The proportion of women from countries where female genital mutilation is common, and which gives birth to children in Sweden has increased with an increased immigration. Female genital mutilation is internationally considered as a violation of human rights and a violation of women's and children's rights. Aim To compare the incidence and risk of perinatal complications among women with a diagnosis of FGM with women without this diagnosis who has given birth to a child in Sweden during the years 2007 - 2017. Method A population-based cohort study. Results The main result of this study is that children born of women with an FGM-diagnosis have a significantly increased risk of low apgar scores, being born Small for Gestational Age, convulsions, perinatal death and prolonged pregnancy could be observed. Conclusion FGM is associated with a number of serious perinatal complications. The greatest risk was seen between female genital mutilation and being born Small for Gestational Age, prolonged pregnancy and intrauterine fetal death. These relationships were robust regardless of which country the woman was born. It can be concluded that women with an FGM diagnosis and their newborn children belong to a risk group. It is very important to work preventively to protect these women and children's health.

Quantification of progesterone and 17-β estradiol in mouse serum by liquid chromatography-tandem mass spectrometry Authors: Benjamin Kennard, Allison Cobble, Amy Gravitte, Keleigh Galloway, Jen Kintner, Jennifer Hall, Stacy Brown Introduction: In the United States, Chlamydia trachomatis is a commonly appearing sexually transmitted infection1. It affects the U.S. healthcare system to a tune of about $500 million dollars annually2. In women, it generally appears asymptomatic and can lead to severe secondary complications such as pelvic inflammatory diseases or infertility1. Female sex hormones, estrogen and progesterone, are being identified to have a role in chlamydial infection. Specifically, this study aims to create quantification methods to detect levels of estrogen and progesterone in mice, infected with Chlamydia muridarum, plasma samples. Methods: Progesterone samples were prepared using solid-liquid extraction (SLE+) cartridges with ethyl acetate as the elution solvent. Estradiol samples were prepared using liquid-liquid extraction (LLE) with methyl tert-butyl ether and subsequent derivatization with DMIS. Following sample preparation, hormones were quantified in samples using LC-MS/MS with a gradient elution of 1 mM ammonium fluoride in water and acetonitrile. The separation was achieved using a UCT C18 column (100 x 21.mm, 1.8 μm particle size) maintained at 50oC. The mass spectrometer was set up to isolate molecular ions for progesterone (m/z 315.0910) and derivatized estradiol (m/z 431.1835). Quantification was facilitated by the use of deuterium-labeled internal standards and their corresponding molecular ions in the mass spectrometer (d9-progesterone; m/z 324.1230 and d5-estradiol; m/z 436.2922). Results: Several aspects of the assay presented have been optimized for maximum analyte recovery and analytical sensitivity, including column choice, mobile phase, derivatizing agents for estradiol, and extraction protocols for progesterone. The LC-MS/MS method was investigated for precision and accuracy over three separate days. The dynamic range of the progesterone assay was 5 – 100 ng/mL, with a limit of detection of 1 ng/mL. Likewise, the estradiol assay was linear in the range of 5 – 100 ng/mL, with a limit of detection of 0.5 ng/mL. The average precision, represented by % RSD was 0.74 – 8.5% and 6.3 – 13.4% for progesterone and estradiol, respectively. The accuracy of the method, represented by % error was 1.6 – 14.4% and 4.0 – 10.5% for progesterone and estradiol, respectively. Successful validation was defined as < 15% RSD and error (< 20% at the limit of quantification), per current FDA Guidelines. Conclusions: The developed LC-MS/MS method is specific for progesterone and estradiol, and the extraction is suitable for preparation of mouse serum samples. This assay could be successfully applied to hormone quantification in mouse samples to support the investigation of the link between chlamydia infection and hormone levels in female animals. References 1. Chlamydia - 2017 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats17/chlamydia.htm. Accessed October 23, 2018. 2. Owusu-Edusei K, Chesson HW, Gift TL, et al. The Estimated Direct Medical Cost of Selected Sexually Transmitted Infections in the United States, 2008. Sex Transm Dis. 2013;40(3):197-201. doi:10.1097/OLQ.0b013e318285c6d2

Female genital cutting is a problem that has taken several dimensions and continues to be practiced despite enormous efforts and resources invested by governments,non-governmental organizations (NGOs) and other stakeholders to ensure that the practice is discontinued worldwide. This study was conducted with the primary objective of assessing the views and perceptions of NGOs on the practice of female genital cutting in Nigeria. The study also examines efforts by civil society and the Nigerian government towards combating and eliminating the practice of FMC in Nigeria. Aside from the systematic literature review, a case study of ten NGOs were interviewed on the telephone. Findings indicate that girls being kept pure as virgins, protection of girls' reproductive potential, increase in fertility, aiding marriageability, traditional practice, and keeping with lineage practice are responsibile for the practice in Nigeria. Few theories were reviewed, and research questions were designed in line with the theories. The approaches include the Functionalist theory, cultural relativism, social theory and Feminism.

Despite many international and local attempts to end the practice of FGM/C, this practice continues to flourish in Nigeria and thus has a negative impact on the lives of girls and women on a daily basis. Furthermore, female genital mutilation is a serious form of violence against girls, women, and children that must be abolished worldwide. This study primarily sought to understand the sociocultural factors that influence the mothers' attitudes towards the continuation of FGM/C in Nigeria. The study used the theory of planned behaviour developed by Ajzen which proposes three distinct constructs as drivers of intention. This theory was deemed to be suitable for the study since sociocultural factors that contribute to the continuation of FGM in relation to mothers’ attitudes toward the practice can be interpreted or linked to the determinants of intention. In addition, this study used secondary data analysis and relied largely on reliable secondary sources.

This study examines how development phases such as education, economy and living in urban or rural areas have an impact on the phenomenon female genital mutilation. A comparative study was made on the three African countries Sudan, Somalia and Sierra Leone. The study is written with information from sociological theories, surveys from the database MICS and established research in order to make an analysis. The purpose of this study is to make a contribution to the already made research on the topic of female genital mutilation. The question of the issue of the study is to analyse and describe how development can have an impact both positive and negative on the phenomenon of female genital mutilation. Furthermore, we want to investigate and understand to what extent living in urban and rural areas make a difference in female genital mutilation. How much of a difference does having a better education make whether mothers mutilate their daughters or not? Is having a better economy a difference or not? Using a quantitative method consisting of data collected from the database MICS we made Binary logistic regressions in order to answer the question of the study. The data consisted of already made surveys on the subject female genital mutilation in the countries Sudan, Somalia and Sierra Leone. The result from the analysis was that in the countries Somalia and Sierra Leone having a higher education makes a difference in whether a woman has heard of female genital mutilation or not. It also showed in these two countries that actually having a higher education increased the risk for women to be mutilated. In Sudan it showed that a having lower education also increased the risk of female genital mutilation. With the economy it showed that in all three countries having a higher economy increases the chances of being mutilated. The analyse also showed that if a family lives in urban areas the changes of the daughter being exposed to female genital mutilation decreases. The conclusion of the study is that the urbanisation that is happening in Africa today will make a big difference in the attitudes and the continuation of female genital mutilation. And having the chance of gaining a better education will also change the attitudes and the continuation of the phenomenon. Having a better economy will develop the family and especially the women to chance their belief of female genital mutilation.

ABSTRACT Female genital mutilation and circumcision (FGM/C) is an expression that describes social and traditional actions performed for the removal of the clitoris and inner lips; labia minora as well as part of the outer lips; labia majora. The research has addressed the effects of this action on women in Ejagham community of the Southwest region of Cameroon. The study focuses on effects revealed during the research, including voices of the women who had undergone FGM/C, excisors recount, violence against women physical, psychological, social, and sexual effects.  In traditional African societies, cultural values should be upheld with dignity to humankind. Our traditional practices too, need to give honour to our bodies. Therefore, opinions from different groups within the Ejagham community are revealed in the discussion. More so, the study also found out that FGM/C was a practice performed on the girls and women on the cultural and traditional beliefs that the process signifies a rite of passage from girl to womanhood.  The process caused pain and violated the right of the young girls. The findings revealed that there are divided opinions on FGM/C within the community. Custodians of the Ejagham tradition that are in favour of the practice are conflicting with those who are against the practice on medical and human right justifications.  These different platforms play a prominent role in the various perceptions held by the people. A significant segment of the Ejagham community, together with some representatives of the international community, NGOs and the government of Cameroon are involved in efforts to bring about change in the community by eliminating the tradition through community-based awareness programs. These programs that are accessible by everybody has empowered people in the community with knowledge on the subject and provided the necessary resources that will help in eliminating the practice. The efforts have initiated a changing climate in the community; however, this does not yet mean that the tradition has been abolished. The paper shall also discuss the traditional and cultural reasons for the practice of FGM in Cameroon. The author will state International instruments, Conventions, the National laws, Action plan that is to eliminate or lead to the abandonment of FGM practices in Cameroon.  The paper will conclude with suitable suggestions to eradicate the practice of FGM/C, which is against Human Rights. Keywords: Female Genital Mutilation/Cutting, Human Rights, Ejagham, Community, Cameroon / <p>Comments from the Examiner have been included in the thesis</p> / Master in Peace and Development WorkABSTRACT Female genital mutilation and circumcision (FGM/C) is an expression that describes social and traditional actions performed for the removal of the clitoris and inner lips; labia minora as well as part of the outer lips; labia majora. The research has addressed the effects of this action on women in Ejagham community of the Southwest region of Cameroon. The study focuses on effects revealed during the research, including voices of the women who had undergone FGM/C, excisors recount, violence against women physical, psychological, social, and sexual effects. In traditional African societies, cultural values should be upheld with dignity to humankind. Our traditional practices too, need to give honour to our bodies. Therefore, opinions from different groups within the Ejagham community are revealed in the discussion. More so, the study also found out that FGM/C was a practice performed on the girls and women on the cultural and traditional beliefs that the process signifies a rite of passage from girl to womanhood. The process caused pain and violated the right of the young girls. The findings revealed that there are divided opinions on FGM/C within the community. Custodians of the Ejagham tradition that are in favour of the practice are conflicting with those who are against the practice on medical and human right justifications. These different platforms play a prominent role in the various perceptions held by the people. A significant segment of the Ejagham community, together with some representatives of the international community, NGOs and the government of Cameroon are involved in efforts to bring about change in the community by eliminating the tradition through community-based awareness programs. These programs that are accessible by everybody has empowered people in the community with knowledge on the subject and provided the necessary resources that will help in eliminating the practice. The efforts have initiated a changing climate in the community; however, this does not yet mean that the tradition has been abolished. The paper shall also discuss the traditional and cultural reasons for the practice of FGM in Cameroon. The author will state International instruments, Conventions, the National laws, Action plan that is to eliminate or lead to the abandonment of FGM practices in Cameroon. The paper will conclude with suitable suggestions to eradicate the practice of FGM/C, which is against Human Rights. Keywords: Female Genital Mutilation/Cutting, Human Rights, Ejagham, Community, Cameroon

Bakgrund: Kvinnlig könsstympning är ett kirurgiskt ingrepp i de kvinnliga genitalierna som av tradition utövas idag i flera delar av världen. Traditionen är vanlig i flera delar av Afrika, Asien och Mellanöstern och på grund av migration är det allt fler könsstympade kvinnor som bor i västvärlden. Kvinnlig könsstympning strider mot de mänskliga rättigheterna och den svensk lagstiftningen mot kvinnlig könsstympning. Könsstympning har inget medicinskt syfte och medför hälsorisker såväl som kortvariga och långvariga hälsoproblem som exempelvis förblödning, infektioner, menstruations- och miktionsproblematik. Problemformulering: För att kunna ge ett gott bemötande och en god omvårdnad till dessa kvinnor behöver sjuksköterskor i Sverige ha en djupare förståelse och större kunskap om detta fenomen. Syfte: Att belysa kvinnors upplevelser efter könsstympning. Metod: En litteraturöversikt som bygger på tio kvalitativa artiklar, söktes i databaserna Cinahl Complete, Medline och Pubmed. Datan analyserades med inspiration från Fribergs (2017) kvalitativ innehållsanalysmetod. Resultat: Insamlat data analyserades utifrån fyra teman. (1) Fysiska och psykiska följder (2) Att uthärda lidande och skam (3) Att upprätthålla familjens heder (4) Upplevelser vid mötet av vårdpersonal. Slutsats: Kvinnlig könsstympning konstateras vara ett folkhälsoproblem i Sverige. Traditionen utövas runt om i världen och medför stora hälsoproblem. Kunskapsbristen har en stor påverkan på kvinnornas vårdprocess och väg till välbefinnande. Detta beror till stor del på vårdpersonalens bristande kompetens och förståelse av fenomenet. Som resultat har kvinnor svårigheter med att kommunicera och dela med sig av sina problem, vilket har präglat och påverkat deras vardagliga liv negativt. Vårdpersonalen kan undvika detta genom att erhålla relevant information och kunskap om ingreppet och kulturen runt kvinnlig könsstympning, då det är ett vanligt förekommande och ett väsentligt ämne. / Background: Female genital mutilation is a traditional procedure concerning the female genitalia that is practiced today in several parts of the world. The tradition is common in several parts of Africa, Asia and the Middle East and due to migration, an increasing number of women with genital mutilation are living in the western world. Female genital mutilation is in opposition to human rights and the Swedish law against female genital mutilation (SFS 1982:316). Genital mutilation has no medical reasons and imposes health risks such as short and long-term health problems, for example: bleeding, infections, menstrual and urinary problems. Problem formulation: In order to be able to encounter and treat women affected by female genital mutilation properly, nurses in Sweden need to have a deeper understanding and knowledge of this phenomenon. Purpose: To illuminate women's experiences of problems after genital mutilation. Method: A literature study based on ten qualitative articles. (Keywords: Female genital mutilation, experiences and health/health problems) were used to search on the following databases Cinahl Complete, Medline and Pubmed. The analysis was inspired by Friberg's (2017) description of qualitative content analysis. Results: Four themes emerged from the analysis. (1) Physical and mental consequences (2) To endure suffering and shame (3) Maintaining the family honor (4) Experiences when meeting healthcare professionals. Conclusion: Female genital mutilation is found to be a public health problem in Sweden. The tradition is practiced around the world and can cause serious health problems. The lack of knowledge has a major impact on the women's care process and path to well-being as the healthcare professional’s care competence and understanding of female genital mutilation was found to be minimal. This has resulted in women's difficulty communicating and sharing their problems that affected their daily lives. Healthcare professionals can avoid this by obtaining relevant information and knowledge about the procedure as female genital mutilation is an essential subject.

Bakgrund Kvinnlig könsstympning innebär att hela eller delar av könsorganen avlägsnas. I världen uppskattas 100-140 miljoner kvinnor genomgått ingreppet. Kvinnlig könsstympning är främst förekommande i de västra och östra delarna av Afrika samt i Egypten. Ingreppet är inte en religiös plikt utan har sedan 2000 år tillbaka utförts som en kulturell sed. En kartläggning av faktorer som påverkar fortsatt utövande av kvinnlig könsstympning behövs för att få svar på vilka resurser i det förebyggande arbetet som har störst påverkan i avskaffningen av kvinnlig könsstympning. Kartläggningen kan ge vårdpersonal en riktning om vilka resurser som är viktiga i det förebyggande arbetet och möjlighet att influera berörda kvinnor till avskaffning av ingreppet. Syfte Syftet var att kartlägga faktorer som påverkar utövande av kvinnlig könsstympning. Metod Litteraturstudie baserad på vetenskapliga artiklar valdes som metod för att granska och sammanställa litteraturen och få en översikt över kunskapsläget av det valda ämnet kvinnlig könsstympning. Totalt hittades 19 relevanta artiklar genom databassökning i Pubmed och CINAHL samt manuell sökning. Resultat Utövandet av kvinnlig könsstympning var främst relaterat till tradition och anpassning i samhället. Kvinnor som motsatte sig ingreppet erhöll medieinnehåll och hade grundläggande kunskaper om medicinska komplikationer, religiösa förbud och utbildningsinterventioner. Attityder gentemot utövande av kvinnlig könsstympning har ett samband mellan kön, ålder, utbildningsnivå och bostadsområde. Låg avsikt att utöva ingreppet på sina döttrar var associerat med manligt kön, hög ålder samt hög utbildningsnivå av modern. Utvärderandet av lagförbudet i Egypten visade inga skillnader i mönstret av spridning av kvinnlig könsstympning före och efter lagförbudet. Lagförbudet sågs inte som en lösning utan som ett sätt att skapa konfrontation mellan regeringen och samhället. Olika utbildningsprogram/interventioner visade sig ha en påverkan på attitydförändring gentemot kvinnlig könsstympning. Slutsats Faktorer som påverkade utövandet av kvinnlig könsstympning är utbildning, kunskap, ålder, kön och geografi. Utbildningsinterventioner har en attitydpåverkan både direkt och indirekt. Detta samt hälsoutbildningar, personliga erfarenheter och interaktion med familj och vänner är de främsta källorna till kunskap om könsstympning. Lagstiftning mot ingreppet är inte tillräckligt. Det behövs åtgärder på kommunalnivå där hälso- och sjukvårdspersonal kan informera, ge stöd och påverka attityd till att stoppa denna sedvänja. Nyckelord: Litteraturstudie, kvinnlig könsstympning, kvinnlig omskärelse, förebyggande arbete, prevention, attityder, resurs.