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There is limited information about how the mental health of people has changed over time during the COVID-19 pandemic in low- and middle-income countries. In a cross-sectional study, we identified factors associated with psychological distress at two periods immediately after two peaks of the COVID-19 pandemic in Russia. Data were collected via online surveys. In May–June 2020, we surveyed 373 respondents across Russia. In January-February 2021, we surveyed 743 people, using the same approach for survey distribution. With Kessler-10 as a measure of psychological distress, we used regression analysis to determine factors associated with higher psychological distress among Russians. Levels of psychological distress were high in both time periods and did not significantly change between the surveys. Having had COVID-19, losing one's job, experiencing problems accessing healthcare, and changing drinking behaviour during the pandemic were associated with higher psychological distress. Apart from getting sick or worrying about the virus, psychological distress is affected by restrictions and the consequences of the pandemic situation. As the COVID-19 pandemic continues, actions are needed to address the mental well-being of the population in Russia. [ABSTRACT FROM AUTHOR]

There is a dearth of lesbian gay, bisexual, transgender, and queer (LGBTQ+) mental health research in Southeast Europe. Our study aimed to explore Macedonian LGBTQ+ people's mental health and their experiences with mental health services. We conducted a qualitative study with 71 LGBTQ persons in N. Macedonia in the summer of 2017. Diverse sexual orientations, gender identities, and geography were represented among participants. We used content, thematic, and narrative analyses to understand LGBTQ+ people's mental health and experiences with mental health services. LGBTQ+ participants described living a 'double-life' and explained that minority stressors challenge their mental health and ability to access mental health services. Participants extensively shared unethical experiences with mental health services. Transgender participants and LGBTQ+ persons living in smaller towns described additional stigmatisation that harmed their mental health and hampered use of services. While, safe and affirming mental health services exist, they are not the norm nor readily accessible to all LGBTQ+ persons. Macedonian LGBTQ+ people experience mental health burdens because of societal stigmatisation. Institutional discrimination, lack of accessibility, and poor quality of services challenge LGBTQ+ people's ability to address mental health needs. Structural and community-level interventions are needed to support Macedonian LGBTQ people's mental health. [ABSTRACT FROM AUTHOR]

The HIV burden is high among female sex workers (FSW) in Ethiopia, yet HIV testing coverage is suboptimal. We conducted a cross-sectional survey among 137 FSW in Addis Ababa. We examined factors related to recent HIV testing and self-reported HIV serostatus using logistic regression. HIV prevalence was 10%; and among HIV-negative participants, 63% reported recent HIV testing. Involvement in sex work for ≥5 years (aOR 3.25; 95% CI 1.22, 8.69; p-value 0.02) and hormonal contraceptive use (aOR 3.37; 95% CI 1.09, 10.41; p-value 0.03) were significantly associated with recent HIV testing. Involvement in sex work for ≥5 years (aOR 13.13, 95% CI 1.31 132.01, p-value 0.03), drug use (aOR 8.02; 95% CI 1.36, 47.31; p-value 0.02), and having a job other than sex work (aOR 122.05, 95% CI 2.97 > 999.99, p-value 0.01) were significantly associated with self-reported HIV-positive serostatus. These results identify areas to target future HIV risk-reduction interventions for FSW in Ethiopia. [ABSTRACT FROM AUTHOR]

Russia is host to one of the largest populations of labour migrants, who primarily come from Central Asia. There remains a dearth of information about the health of this population, in particular Central Asian women. We conducted a qualitative, exploratory study on the health concerns and healthcare utilisation among Central Asian female labour migrants in Russia. We conducted in-depth interviews with service providers and female labour migrants between June and November, 2017. We used thematic analysis to identify the following themes: there is a range of health concerns, including sexual and reproductive health issues; economic vulnerability and racial/ethnic discrimination influence health and utilisation of services, and constrain making health a priority; access to information is lacking; issues of trust, language and cultural norms influence healthcare service utilisation; and, social support is important to consider. Our findings reflect how religion, gender, ethnicity, and socio-economic position intersect to influence health and utilisation of services. These findings have implications for public health programming and interventions among this largely neglected population, as well as make an important contribution to the existing global health literature on women, migration, and health. [ABSTRACT FROM AUTHOR]

Decision-making regarding the outcome of a pregnancy may include participation of the woman herself, her sexual partner, parents, family, and/or community. This paper examines who had the most say in the outcome of young Ghanaian women's last pregnancy and whether this correlated with her level of reproductive autonomy (RA). We analysed cross-sectional data from 380 previously pregnant young women in urban Ghana. We measured communication and decision-making RA using modified scales ranging from 3 (low RA) to 12 (high RA). We tested unadjusted associations between the RA sub-scales and who made the pregnancy decision (self, partner, both together, or someone else) and used multinomial regression models to understand these associations when controlling for sociodemographic, reproductive history, and social context variables. In final models, a one-point increase in decision-making RA was associated with an adjusted relative risk ratio of 0.79 (95% CI: 0.66–0.93; p = 0.006) of partner having the most say as compared to the woman having the most say. The communication RA scale was not associated. Programmes that increase RA may be effective in increasing women's rights to execute decisions about reproductive health and outcomes. Future research should explore this notion and the role of pregnancy disclosure in this relationship. [ABSTRACT FROM AUTHOR]

While sexual and gender minorities (SGM)-based discrimination and poor mental health is well established in the literature within Western contexts, there is a significant gap in our understanding in other regions, specifically Southeastern Europe. Additionally, limited information exists on self-concealment's role in these pathways. We explored the relationship between self-concealment, discrimination and mental health in Macedonia, a country rife with sociopolitical oppression towards the population. We utilised regression and structural equation models to identify the effects of self-concealment on the relationship between discrimination and rumination and social interaction anxiety from a cross-sectional survey of 18–30 year olds (n = 396). Self-concealment was a significant mediator between discrimination and psychosocial outcomes; accounting for 29% of the effect from discrimination to social anxiety, and 57% of the effect from discrimination to rumination (p <.001). Results reveal that by actively managing their identity, SGM in Macedonia experience elevated distress beyond the impact of discrimination. The results discern salient information on how to disrupt the adverse role of discrimination of SGM on mental health outcomes. This provides a crucial template for the global public health community when developing mental health programmes and advocating for policies, to begin reversing the mental health inequities created within the country. [ABSTRACT FROM AUTHOR]

There is a dearth of information about the factors influencing postpartum engagement in HIV treatment and care in Russia, a country with an expanding HIV epidemic and poor treatment coverage. The goal of our community-based study was to identify and explore the factors influencing engagement in care after pregnancy. We conducted in-depth interviews with 50 women living with HIV who had recently given birth, and with 20 health care and social service providers in two locations: a large metropolitan city (St. Petersburg) and a semi-urban town near the Ural Mountains. Thematic analysis led us to identify the following themes in regard to factors influencing postpartum engagement in care: feeling overwhelmed with caring for an infant; sense of responsibility for child's health and well-being; misinformation and AIDS denialism; HIV-related stigma and fear; benefits versus side-effects of ART; professional and personal support; drug and alcohol use; and structural factors. Structural factors include poverty, continued provision of ART after pregnancy, dosage, obtaining necessary documents, and distance to clinic. These findings are important to consider in developing much-needed interventions to promote women's longer-term engagement in HIV care and treatment in Russia. [ABSTRACT FROM AUTHOR]

Faith-based organisations (FBOs) have long been part of the fight against HIV and AIDS. International bodies continue to collaborate with FBOs to implement HIV-prevention programmes with mixed success. Zambia has been a target of such programmes in part due to its high HIV prevalence. The Trusted Messenger approach to provide religious leader networks with biomedical, science-focused education about HIV and AIDS was piloted in 2006, but participant experiences of the intervention have not been explored qualitatively. In 2016, in-depth interviews were conducted of 34 randomly chosen individuals who attended Trusted Messenger workshops between 2006 and 2016 in Livingstone, Lusaka, and the Copperbelt region. Findings indicate that the religious leader attendees gained scientific insights about HIV which motivated their action in personal, social, and religious contexts. Participants found the science comprehensible and empowering and identified workshop frequency and language as challenging. Utilising science-focused education within contextual settings of religious leader networks can combat the spread of HIV and the mistreatment of people living with HIV and AIDS. [ABSTRACT FROM AUTHOR]

Female sex workers are particularly susceptible to HIV-infection in Russia. However, a dearth of information exists on their utilisation of HIV services. A mixed-methods, cross-sectional study was conducted to examine motivators and barriers to HIV testing among street-based sex workers in St. Petersburg, Russia. The health belief model was the theoretical framework for the study. Twenty-nine sex workers participated in in-depth interviews, and 139 sex workers completed interviewer-administered surveys between February and September 2009. Barriers to getting an HIV test were fear of learning the results, worrying that other people would think they were sick, and the distance needed to travel to obtain services. Motivators for getting tested were protecting others from infection, wanting to know one's status and getting treatment if diagnosed. Logistic regression analysis demonstrated that knowing people living with HIV [aOR = 6.75, 95% CI (1.11, 41.10)] and length of time since start of injection drug use [aOR = 0.30, 95% CI (0.09, 0.97)] were significantly associated with recently getting tested. These results are important to consider when developing public health interventions to help female sex workers in Russia learn their HIV status and get linked to care and treatment services if needed. [ABSTRACT FROM PUBLISHER]

Ethical and human rights concerns have been expressed regarding the global shift in policies on HIV testing of pregnant women. The main purpose of this research was to conduct a policy analysis using a human rights-based approach of national policies for HIV testing of pregnant women. We collected HIV testing policies from 19 countries including: Cambodia, China, Guyana, Haiti, India, Jamaica, Kenya, Moldova, Papua New Guinea, Russian Federation, South Africa, Sudan, Swaziland, Tanzania, Ukraine, United States, Uzbekistan, Zambia and Zimbabwe. We analysed the HIV testing policies using a standardised framework that focused on government obligations to respect, protect and fulfil. Our results highlight the need for more attention to issues of pregnant women's autonomy in consenting to HIV testing, confidentiality in antenatal care settings and provision of counselling and care services. We conclude with a discussion about potential implications of the current testing policies and provide recommendations for ways that HIV testing policies can more effectively uphold the human rights of pregnant women.