Anna Mia Ekström
Biographic Data
| ID | 165218 |
|---|---|
| NAME | Anna Mia Ekström |
| GIVEN NAMES | Anna Mia |
| FAMILY NAME | Ekström |
| SIGNATURE | EKSTRÖM A M |
| AFFILIATIONS | Karolinska Institutet |
| ORCID | 0000-0002-3912-1171 |
| VERIFIED | Yes |
| TOTAL WORKS | 67 |
| TOTAL CITATIONS | 15 |
| AUTHOR COUNT | 67 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2005 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 3 |
“Even with one Man, but with many women, you can get cervical cancer”
Cervical cancer is a leading cause of cancer-related morbidity and mortality among women in low-resource settings, with Uganda being disproportionately affected. Despite the availability of screening services in Uganda, uptake remains unacceptably low, yet population-level data on women’s perceptions and experienced barriers to screening remain limited. This hinders the development of targeted community-based interventions for cervical cancer scr…
From shock to resilience in GBV and SRH services
box Abrupt US Agency for International Development funding cuts led to the collapse of Zambia’s Stamping Out and Preventing Gender-Based Violence programme, with police data showing rising reports of sexual violence
Attitudes, perceived knowledge, and experiences regarding condom use, STIs, transactional sex, and healthcare utilization among young male forced migrants in Stockholm, Sweden
BACKGROUND: The experience of forced migration, along with post-migration stressors, can elevate the risk of poor sexual health outcomes among young people. Despite this, little evidence is available on the sexual health needs, behaviors, and healthcare utilization of young male forced migrants in Sweden and elsewhere. OBJECTIVE: This study aims to explore the attitudes, perceived knowledge, experiences, and needs of young Eritrean, Afghan, and S…
Needle and syringe coverage per injection and factors associated with needle sharing among clients of the Stockholm Needle and Syringe Program, 2013–2023
BACKGROUND: Needle and Syringe Programs (NSP) are a cornerstone of harm reduction, yet evidence on whether they adequately meet injection-related needs and reduce needle sharing in real-world settings, particularly where NSP were introduced late, remains limited. We examined needles to injection coverage and predictors of needle sharing among clients of the Stockholm NSP between 2013 and 2023. METHODS: Using data from a national clinical monitori…
A qualitative study of peer education experiences and oral pre-exposure prophylaxis use among adolescent girls and young women at high risk of HIV acquisition in Kampala, Uganda
Introduction: Oral pre-exposure prophylaxis (PrEP) use remains low among adolescent girls and young women (AGYW) at high HIV risk in Eastern and Southern Africa. Most peer-led interventions involve brief interaction, however peer education offering extended engagement may foster peer learning. This study explored experiences of a peer education intervention among AGYW who engaged in sex work (young FSWs) in Kampala, Uganda and examined how it inf…
Prevalence and associated factors of selling sex among men who have sex with men (MSM) in Latin America
INTRODUCTION: Selling sex has been associated with negative social and health outcomes, but most studies have been limited geographically and have not distinguished between selling and buying sex. This study assesses prevalence and factors associated with selling sex in the last 12 months among men who have sex with men (MSM) in 18 Latin American countries. METHODS: Data were collected in 2018 through the Latin American MSM Internet Survey, a cro…
Social determinants of hazardous alcohol use in a Ugandan population cohort
BACKGROUND: There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries. OBJECTIVES: To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences. METHODS: This cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communiti…
Empowering women
BACKGROUND: While the adverse effects of intimate partner violence (IPV) on sexual and reproductive health are globally recognized, research in low- and middle-income countries, particularly Uganda, remains limited. OBJECTIVE: This study aims to assess the association between past-year IPV and HIV, contraceptive use, and unintended pregnancies among Ugandan women. METHODS: Data from the Africa Medical and Behavioural Sciences Organization collect…
Operationalizing African self-reliance in vaccine manufacturing
The COVID-19 pandemic underscored Africa's urgent need for vaccine security and self-reliance. In response, the African Union and Africa Centers for Disease Control and Prevention (CDC) established the Framework for Action (FFA) through the Platform for Harmonized African Health Products Manufacturing (PHAHM), with a goal of 60% local vaccine production by 2040. During 2024, Africa CDC, Karolinska Institutet, and Charité Universitätsmedizin Berli…
Reproductive agency and the acceptability of divorce, abortion, and homosexuality among migrants from the Middle East and Africa living in Sweden–a cross-sectional analysis
Our study found that migrants from MENA and SSA expressed a high degree of reproductive agency. Migrants had low values of a combined measure of the acceptability of divorce, abortion and homosexuality; however, acceptance increased with time spent in Sweden. Understanding factors associated with migrants' sense of reproductive agency and their values and how these change over time in Sweden provides a foundation for working towards equitable sex…
Is reproductive agency associated with subjective well-being? A population-based cross-sectional study among men and women in four sub-Saharan African countries using the World Values Survey
We investigated the association between reproductive agency (RA) and subjective well-being (SWB) in Ethiopia, Kenya, Nigeria, and Zimbabwe using cross-sectional research design. We used nationally representative data from the World Values Survey from 2017 to 2021 (N = 4948). SWB used four items on perceived: (i) life satisfaction (range 1-10), overall life agency (range 1-10), health status (range 1-5), and happiness (range 1-4). RA used one item…
Opioid overdose and mortality among people who use or inject drugs in Myanmar
Opioid overdose is common and disproportionately affects people outside existing programs. Expanding peer‐led and mobile outreach, tailoring referral pathways for migrants, broadening community naloxone distribution, and securing sustained domestic financing are urgent priorities
Growing up in the shadow of HIV
Despite growing understanding and acceptance of the concept of Undetectable = Untransmittable (U = U) among gay men, HIV stigma remains a burden for people living with HIV. This study explored perceptions of HIV among HIV seronegative gay men in Sweden in this new context. Using snowball sampling, 15 gay men born between 1980 and 2000 were recruited to the study. Semi-structured interviews were conducted and data were subjected to reflexive thema…
Preference for novel biomedical HIV pre-exposure prophylaxis methods among adolescent girls and young women in Kampala, Uganda
Background Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW’s preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14–24-years-old AG…
Prevalence and associated factors for poor mental health among young migrants in Sweden
BACKGROUND: Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. OBJECTIVE: To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15-25) in Sweden. METHODS: = 6449). Among these, 990 participants aged 15-25 were eligible for the study. Mental health was measured using the Refugee Healt…
Use of mobile phones to collect data on Covid-19
During the COVID-19 pandemic lockdown, we deployed a rapid, mobile phone-based survey to assess access and participation rates when using mobile phones to collect data on COVID-19 in Rakai, south-central Uganda. We sampled prior Rakai Community Cohort Study (RCCS) participants based on HIV status using mobile phone contacts. We administered a 30-minute phone-based interview to consenting participants to assess their knowledge about different aspe…
Knowledge gaps related to HIV and condom use for preventing pregnancy
We found significant knowledge gaps on HIV and condom use for preventing pregnancy among migrants in Sweden. Comprehensive sexual health education in language schools, along with information to newly arrived migrants from diverse regional backgrounds and targeted sexual health services to younger individuals, women, and those who lack sexual health education, are needed to address these information gaps and provide crucial SRHR education and info…
Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden – a nationwide study
The most dominating stigma feature was anticipation of stigma. Female gender, shorter time since HIV diagnosis, feelings of hopelessness, non-sharing HIV status, and lack of available emotional HIV-related support constituted potential vulnerability factors of the four HIV-related stigma manifestations. Our findings highlight the vital necessity to support people living with HIV to increase their resilience to stigma in its different forms. Explo…
Assessing the Nepalese health system’s readiness to manage gender-based violence and deliver psychosocial counselling
Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors’ physical, sexual and mental health care needs. However, there is a notable lac…
Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria
Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected …
Prevalence and predictors of use of long-term and short-acting reversible contraceptives among women of reproductive age in Wakiso and Hoima districts, Uganda
Modern contraceptive use has increased globally, but unmet needs persist in low- and middle-income countries. This study in Uganda aimed to examine the prevalence and factors influencing the use of short-acting reversible contraceptives (SARC) like pills and long-term methods such as intrauterine devices. Limited evidence exists on the use of SARC and long-term methods in Uganda. Data from the Africa Medical and Behavioural Sciences Organization …
Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and …
Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be long…
Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan
Although policy makers and health providers in Pakistan saw a clear need to scale-up and integrate anal cancer screening for key populations, the feasibility of this is dependent on political will, financing, anti-stigma and discrimination interventions and health system efficiency
Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden
We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR
The impact of a community health worker intervention on uptake of antenatal care
The provision of high-quality antenatal care (ANC) is important for preventing maternal and newborn mortality and morbidity, but only around half of pregnant women in Tanzania attended four or more ANC visits in 2019. Although there is emerging evidence on the benefit of community health worker (CHW) interventions on ANC uptake, few large-scale pragmatic trials have been conducted. This pragmatic cluster-randomized trial, implemented directly thr…
Taking Care of Business
In this article we examine the dynamics of social relationships in which alcohol use and risky sexual behaviors cooccur. As part of a larger biological and behavioral HIV surveillance survey, 20 men who lived in an urban, informal settlement on the outskirts of Cape Town, South Africa participated in in-depth interviews. Interview transcripts were analyzed according to a latent content analysis. Findings highlight the latent association between a…
Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria
Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected …
Opt-out HIV testing during antenatal care
Two years after the introduction of provider-initiated, opt-out HIV counselling and testing during antenatal care (ANC) in Uganda, HIV testing uptake is still low. This study was carried out to explore pregnant women's experiences of, and views on, the policies for opt-out, and couple HIV testing, and to understand how the policy implementation could be improved in order to increase access to prevention of mother-to-child-transmission (PMTCT) ser…
Young Males' Gendered Sexuality in the Era of HIV and Aids in Limpopo Province, South Africa
This article is focused on young males' sexual identity and behaviors in rural South Africa. The study comprised 19 focus group discussions with adolescents aged 12 to 14 years. The informants depict male sexuality as biologically predetermined, where physical needs and practices such as circumcision legitimize early sexual debut. Furthermore, the construction of male sexual identity and power imbalances in relationships are already evident at an…
Growing up in the shadow of HIV
Despite growing understanding and acceptance of the concept of Undetectable = Untransmittable (U = U) among gay men, HIV stigma remains a burden for people living with HIV. This study explored perceptions of HIV among HIV seronegative gay men in Sweden in this new context. Using snowball sampling, 15 gay men born between 1980 and 2000 were recruited to the study. Semi-structured interviews were conducted and data were subjected to reflexive thema…
Social Determinants of HIV Among Men Who Have Sex with Men in Cape Town
The Social Construction and Context of Domestic Violence in Wakiso District, Uganda
This study explored community perceptions of factors associated with domestic violence, with an emphasis on events occurring during pregnancy. Ten focus group discussions, 14 key-informant interviews and four case vignettes were conducted in Wakiso district, Uganda between August and December 2003. Data were analysed using thematic content analysis. Perceived motives and meanings, triggering as well as associated factors, perceived coping mechani…
Socioeconomic determinants of infant mortality
Background: To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. Aim: To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at coun…
Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya
The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Médecins Sans Frontièrs (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative semi-structured interviews were conducted with 26 patients, 9 men and 17 women. Six main reasons emerged for not accepting ART: a) fear of taking medication on an empty stomach due to lack of food; b) fear tha…
Relative Response
The aim of this article is to support efforts to hold governments accountable for their commitments to respond to HIV and AIDS. It describes a new approach to ranking countries' responses in order to facilitate cross-country comparisons. The method uses the United Nations General/Assembly Speecial Session on HIV/AIDS (UNGASS) Declaration of Commitment as its point of departure and was designed to rank countries in terms of their efforts to fight …
Young Males' Gendered Sexuality in the Era of HIV and Aids in Limpopo Province, South Africa
This article is focused on young males' sexual identity and behaviors in rural South Africa. The study comprised 19 focus group discussions with adolescents aged 12 to 14 years. The informants depict male sexuality as biologically predetermined, where physical needs and practices such as circumcision legitimize early sexual debut. Furthermore, the construction of male sexual identity and power imbalances in relationships are already evident at an…
Voices on adherence to ART in Ethiopia and Uganda
This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system…
Social networks and concurrent sexual relationships – a qualitative study among men in an urban South African community
The aim was to explore and describe characteristics of males' social and sexual networks in a South African peri-urban community. Twenty in-depth interviews were conducted with men participating in a larger quantitative study where the median age of the men was 28.7 years and almost 56% had some high-school education, 17.2% were unemployed and 94.7% were not married. A Thematic Question Guide with open-ended questions was used for the interviews.…
The construction of an idealised urban masculinity among men with concurrent sexual partners in a South African township
BACKGROUND: The perspectives of heterosexual males who have large sexual networks comprising concurrent sexual partners and who engage in high-risk sexual behaviours are scarcely documented. Yet these perspectives are crucial to understanding the high HIV prevalence in South Africa where domestic violence, sexual assault and rape are alarmingly high, suggesting problematic gender dynamics. OBJECTIVE: To explore the construction of masculinities a…
My partner wants a child
The gender of the positive partner affects the factors associated with a desire for children. Interventions targeting sero-discordant couples should explore contraceptive choices, the cultural importance of children, and partner communication
Mistrust in marriage-Reasons why men do not accept couple HIV testing during antenatal care- a qualitative study in eastern Uganda
In summary, pursuing couple HIV testing as a main avenue for making men more willing to test and support PMTCT for their wives, does not seem to work in its current form in this region. HIV services must be better adapted to local gender systems taking into account that incentives, health-seeking behavior and health system barriers differ between men and women
The influence of traditional medicine and religion on discontinuation of ART in an urban informal settlement in Nairobi, Kenya
OBJECTIVE: The objective of this study was to explore the influence of traditional medicine and religion on discontinuation of antiretroviral therapy (ART) in one of Africa's largest informal urban settlement, Kibera, in Nairobi, Kenya. METHODS: Semi-structured face-to-face interviews were conducted with 20 patients discontinuing the African Medical and Research Foundation (AMREF) ART program in Kibera due to issues related to traditional medicin…
Sexual risk-reduction strategies among HIV-infected men receiving ART in Kibera, Nairobi
This paper explores motivational factors and barriers to sexual behaviour change among men receiving antiretroviral treatment (ART). Twenty in-depth interviews were undertaken with male patients enrolled at the African Medical and Research Foundation clinic in Africa's largest urban informal settlement, Kibera in Nairobi, Kenya. All participants experienced prolonged and severe illness prior to the initiation of ART. Fear of symptom relapse was t…
Keeping healthy in the backseat’
Although there is a large body of literature related to the experiences of motherhood and aspects of the change that it brings about, how the experience of motherhood affects the healthcare of women with chronic illness is less documented. This study explores how motherhood in newly delivered HIV-infected mothers in Kenya interrupted their antiretroviral treatment (ART). Qualitative interviews were performed with 26 mothers on ART in a rural or u…
Is 'Opt-Out HIV Testing' a real option among pregnant women in rural districts in Kenya
High coverage of HIV testing appears to be achieved at the cost of pregnant women not understanding that testing is optional. Good quality HIV pre-test information is central to ensure that pregnant women understand and accept the reasons for testing and will thus come back to collect their test results, an important prerequisite for completing PMTCT for those who test HIV-positive
Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study
Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. More than 80% adherence may be sufficient to maintain virologic suppression on NNRTI-based regimens in the short-te…
Reasoning and deciding PMTCT-adherence during pregnancy among women living with HIV in Kenya
This study explores type identities among rural and urban slum women on antiretroviral therapies who become pregnant. Narrative structuring was chosen to develop type narratives that illustrate how rural and urban women handle their HIV-infection and how they reason and decide about PMTCT-adherence during pregnancy and childbirth. Women in rural areas described their lives as 'secure and family controlled'. This gave the women security and predic…
Taking Care of Business
In this article we examine the dynamics of social relationships in which alcohol use and risky sexual behaviors cooccur. As part of a larger biological and behavioral HIV surveillance survey, 20 men who lived in an urban, informal settlement on the outskirts of Cape Town, South Africa participated in in-depth interviews. Interview transcripts were analyzed according to a latent content analysis. Findings highlight the latent association between a…
Opt-out HIV testing during antenatal care
Two years after the introduction of provider-initiated, opt-out HIV counselling and testing during antenatal care (ANC) in Uganda, HIV testing uptake is still low. This study was carried out to explore pregnant women's experiences of, and views on, the policies for opt-out, and couple HIV testing, and to understand how the policy implementation could be improved in order to increase access to prevention of mother-to-child-transmission (PMTCT) ser…
“Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa
BACKGROUND: Transactional sex is believed to be a significant driver of the HIV epidemic among young women in South Africa. This sexual risk behaviour is commonly associated with age mixing, concurrency and unsafe sex. It is often described as a survival- or consumption-driven behaviour. South Africa's history of political oppression as well as the globalization-related economic policies adopted post-apartheid, are suggested as the underlying con…
Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health
Reasons for postnatal failure to adhere by mothers put on ART for life during pregnancy included lack of motivation to continue ART after weaning the child, poverty and stigma. Projects that simultaneously address stigma, poverty and women's lack of empowerment may be necessary for PMTCT and ART to reach their full potential. Our results indicate that the new WHO proposal to start all HIV-infected pregnant women on lifelong ART regardless of CD4 …
Vital need to engage the community in HIV control in South Africa
According to the latest 2014 UNAIDS report, which was based on the 2012 South African National HIV Prevalence, Incidence & Behavior Survey, there were between 6.3 and 6.4 million HIV infected people in South Africa. Although the number of new infections appears to have declined in the past 5 years, 370,000 new infections were still estimated to occur in 2013. Young, black women were most at risk with a very high incidence of 4.5%. Of the infected…
Prevention of mother-to-child transmission of HIV in rural Uganda
BACKGROUND: The reported coverage of any antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission (PMTCT) has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is subject to overestimations since it only considers enrolment and not completion of the PMTCT programme. The PMTCT programme is complex as it builds on a cascade of sequential interventions that should t…
Antiretroviral treatment coverage in a rural district in Tanzania – a modeling study using empirical data
ART coverage in the Rufiji district is unevenly distributed and far from the universal coverage target of 80%, in particular among young men. The findings in 2010 are close to the most recent estimates of ART coverage in 2013. To strive for universal coverage, both the recruitment of new eligible individuals to pre-ART and ART and the successful retention of those already on ART in the program need to be prioritized
Influence of socioeconomic position and gender on current cigarette smoking among people living with HIV in sub-Saharan Africa
Gender, education and socioeconomic context are independently associated with current cigarette smoking among people living with HIV in sub-Saharan Africa
Social Determinants of HIV Among Men Who Have Sex with Men in Cape Town
Medicine (53 works) · HIV/AIDS Research and Interventions (35 works) · Environmental health (33 works) · Adolescent Sexual and Reproductive Health (26 works) · Family medicine (26 works) · Psychology (26 works) · Demography (25 works) · Population (24 works) · Sociology (23 works) · Public health (22 works)