Editorial: Inequities and Disparities in Reproductive Health: HIV and STIs

Mat Lowe^1*Ruth Oladele^2*Choolwe Jacobs³

• ¹Society for the Study of Women's Health, Banjul, Gambia
• ²Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ³University of Zambia, Lusaka, Zambia

Reproductive health affects everyone; however, there are still massive disparities in outcomes and access to care. This editorial contains papers on a research topic titled, ‘Inequities and disparities in reproductive health: STIs and HIV’. These papers bring together research findings on some of the most important inequity issues across the reproductive health field, including gender, HIV, drug inequity, intervention mapping, determinants of contraceptive usage, and associated factors and predictors of loss to follow-up in HIV programs in various country contexts.A total of thirteen (13) submissions were received for the research topic, with nine accepted and four rejected. The published papers encompass both original research and papers involving secondary data analysis, as well as a perspective paper. Three papers from Ethiopia focused on risky sexual practices and associated factors among attendees of antiretroviral therapy (ART) and also examined geospatial variations and determinants of contraceptive utilization among married reproductive-aged women, as well as the incidence and predictors of loss to follow-up among pregnant and lactating women in the Option B+ Prevention of Mother-to-Child Transmission (PMTCT) program. Salato et al.’s study among 398 adults living with HIV in South Ethiopia and who were undergoing ART revealed a high prevalence (43.7%) of high-risk sexual practices in the past six months. The results indicated that not disclosing HIV status, alcohol consumption, and poor social support were significantly associated with these risky behaviors. The other paper by Terefe et al. aimed to identify geospatial variations in and determinants of contraceptive utilization among married women of reproductive age in Ethiopia, revealing comparatively low contraceptive usage with considerable regional variation. The study by Azanaw et al. on the incidence and predictors of loss to follow-up among pregnant and lactating women in the Option B+ PMTCT program showed a low incidence of loss to follow-up, which was lower than that reported in most African countries but slightly higher than the World Health Organization (WHO) target. A different paper by Gedefie et al. utilized multi-level analysis to assess the prevalence and determinants of HIV among reproductive-age women (15–49 years) in Africa from 2010 to 2019. This study discovered that the highest percentage of HIV was found in Lesotho (23.98%), followed by South Africa (19.12%) and Mozambique (14.67%), emphasizing the; need for targeted public health intervention strategies to prevent HIV transmission in these groups. A systematic review by Zhan et al. (2024) examined the prevalence of mental disorders among young people living with HIV (YLWH) found a heightened risk of mental health issues (24.6% had depression and 17.0% had anxiety) in this population, underscoring the necessity for targeted interventions to promote the mental health and wellbeing of YLWH. Other papers on the research topic included a qualitative study on understanding inequalities in the coverage of adolescent sexual and reproductive health services in selected regions of Zambia. This paper from Zambia by Munakampe et al. found that, while adolescents were aware of and had access to common services and commodities like male condoms, health education, and HIV counseling and testing, availability was hindered by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. Accessibility was further restricted during the COVID-19 pandemic lockdown, compounded by low acceptability of sexual and reproductive health (SRH) services among adolescents, which led to the use of alternatives such as herbal medicine and the perpetuation of myths and misconceptions. Another paper by Torres-Cortés et al. sought to promote equity in adolescent health in Latin America through an exploratory sequential mixed-method study, which involved literature reviews, focus groups, individual interviews, and intervention mapping to inform the design of a comprehensive sex education program. The results of this paper indicated a statistically significant increase in protective skills related to sexuality among all participants following the intervention. Finally, two papers from the United States (Chory and Bond; Hammond et al.) discussed access to PrEP (pre-exposure prophylaxis) and other sexual health services for cisgender women, as well as leveraging PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief) to promote equity in HIV drug access.