Who, What, Where: Female Genital Mutilation

This is the first in a series of Who, What, Where: A Series on Global Health Issues. We hope to introduce public health issues across the world and educate readers about their history. 

Let’s talk about Female Genital Mutilation. 

What exactly is FGM? According to the World Health Organization, it is the practice of removing the external female genitalia for non-medical purposes, often resulting in injury due to improper surgical techniques, non-sterilized equipment/environments, and inexperienced practitioners. A large percentage of these procedures causes life-long health complications such as cysts, recurrent bladder infections, and even infertility. 

Who is affected by FGM? As the name suggests, this issue is one that plagues individuals assigned female at birth —primarily African and Middle Eastern women. Some cultures view FGM as a rite of passage girls undergo before transitioning into womanhood while others believe it suppresses a woman’s sexual desire, allowing her virginity to stay intact when the time for marriage comes. The latter has fostered an environment where FGM became the norm as mothers are expected to ensure the next generation kept the traditions alive. Certain communities also believe it enhances the sexual pleasure for their husbands. 

Where is FGM most likely practiced? There are about 200 million women and girls who are currently living with the consequences. Somalia is believed to have the highest prevalence with a whopping 98%, followed by Guinea at 97%, Djibouti with 93%, etc. Although the practice is a concern in European, Asian, and South American countries alike, cases in African countries continue to soar. Preventative measures are being taken to combat FGM through educating women on the complications, advocating for fathers and men to speak against the practice, and compelling religious leaders to denounce it. The key factor is educating mothers, as the cultural expectations are deeply ingrained into their upbringing. Young girls are more likely to follow along if their mothers are uneducated about the health issues brought on by the practice.  

While International Day of Zero Tolerance for Female Genital Mutilation falls annually on February 6th as a joint effort to combat FGM on a global level, the COVID-19 pandemic has set back the goal of stamping out the practice completely by the end of 2030. The global lockdown has brought forth high rates of domestic violence incidents, has made many educational programs wholly unable to function, and families have had easier access participating in the procedure without being cornered. Despite the unforeseeable circumstances brought by the pandemic, the fight to dismantle FGM practices continues to rage on. 

Moving in the right direction: India court legalizes gay sex in landmark ruling

There currently are no official demographics for the LGBT population in India. However according to unofficial estimates submitted by the government of India to the Supreme Court, there were about 2.5 million gay people in 2012. Lesbian, gay, bisexual, transgender (LGBT) people in India face many difficulties, both social and legal. Reports of killings, attacks, torture, and beatings are not uncommon. LGBT people in India also face discrimination in the community and rejection from their families. Continue reading “Moving in the right direction: India court legalizes gay sex in landmark ruling”

Challenges Accessing PrEP for HIV Prevention in England

The successful integration of HIV prevention programs that increase testing and offer early treatment for infected individuals is contributing to reductions in new HIV infections. By 2016, the 5,164 HIV diagnoses in gay and bisexual men living in England represented an 18% decline compared to the 6,286 diagnosis in 2015.  Secure integration of pre-exposure prophylaxis (PrEP) will continue to reduce infections. HIV prevention programs need to address persistent barriers and doubts however, including limited access of PrEP in England. Continue reading “Challenges Accessing PrEP for HIV Prevention in England”

Improving LGBT Health Education in South Africa: Addressing the Gap

I first became interested in the topic of lesbian, gay, bisexual, and transgender (LGBT) health care and health education while working as a country lead for the Presidential Emergency Plan for AIDS Relief (PEPFAR). During my time there I had the opportunity to travel to South Africa and understand their community and health care system a bit better, with an emphasis on their HIV/AIDS epidemic. This post focuses on the LGBT history in South Africa, recent developments, addressing that there is a gap between homophobia and non-judgmental care, and the importance of health care workers understanding LGBT health education.

More and more countries around the world are opening their arms to welcome and embrace LGBT pride. South Africa has one of the world’s more progressive constitutions which legally protects LGBT people from discrimination, although current research indicates that they continue to face discrimination and homophobia in many different facets of life. The most recent milestone occurred in 2006 when the country passed a law to recognize same-sex marriages. Nevertheless, LGBT South Africans particularly those outside of the major cities, continue to face some challenges including conservative attitudes, violence, and high rates of disease. As the country continues to grow there seems to be an increase in LGBT representation (with approximately 4,900,000 people identifying as LGBT) whether it is through activism, tourism, the media and society or support from religious groups. So, what about LGBT health education? Continue reading “Improving LGBT Health Education in South Africa: Addressing the Gap”

Addendum: What does health reform have to do with IH?

While I am sure that most of you have been riveted by my recaps of APHA’s Mid-Year Meeting on health reform, many readers are probably asking what the heck I, your friendly neighborhood Communications Chair, was doing there, and why the IH section was asked to send a representative to this meeting. The whole purpose of inviting section representatives and state affiliate leaders was to stimulate discussion about health care reform as it related to each section or affiliate’s work, and how the sections and affiliates could get more involved in the effort. Upon discovering this, my mind drew a blank.

How does health reform relate to the work of our members?

After some thought, I can see two major areas in which our membership would be interested in health reform. The first is in border health: despite the increased coverage that came with the new law, it does not cover undocumented immigrants and even some classes of migrant workers with temporary work visas (for example, those who come to work during the harvest season).

The other area is in sharing information. Our health reform battle has received much global attention, and the international health community is interested in the way the new health legislation will finally take shape and how individual communities will implement it. Also, a lot of the population health and wellness challenges that are being targeted by the Public Health and Prevention Fund grants (e.g. obesity, diabetes, tobacco use) are receiving increasing amounts of attention in developing nations as professionals are realizing that these countries share a disproportionate burden of chronic conditions. IH members who work in communities outside the U.S. may be interested in seeing how communities here address these issues, and they could apply some successful programs to their own communities facing similar issues.

The section representatives and affiliate leaders attended a luncheon that served as a breakout session to discuss these very issues. We were divided into geographic regions by table (which did not seem to make a lot of sense for section members, but it was productive nonetheless) and hashed out our impressions from the meeting and how the sessions related to the work of the sections and/or affiliates. APHA plans to use the notes from these discussions to compile a report for the sections and affiliates to use in their work as it relates to the mid-year meeting.