Mitzy Gafos
Biographic Data
| ID | 6330986 |
|---|---|
| NAME | Mitzy Gafos |
| GIVEN NAMES | Mitzy |
| FAMILY NAME | Gafos |
| SIGNATURE | GAFOS M |
| AFFILIATIONS | London School of Hygiene & Tropical Medicine |
| ORCID | 0000-0002-7894-1498 |
| VERIFIED | Yes |
| TOTAL WORKS | 34 |
| TOTAL CITATIONS | 1 |
| AUTHOR COUNT | 34 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2010 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
Longitudinal assessment of changes in hair cortisol levels and associations with violence, poor mental health and harmful substance use among female sex workers in Nairobi, Kenya
Female sex workers (FSWs) in sub-Saharan Africa commonly experience violence, mental health problems, and harmful substance use. Stressful life events can harm the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, serving as a pathway to increased poor health, including HIV susceptibility through cortisol levels. In this paper, we examine changes in hair cortisol concentration (HCC) levels and associations with experiences of violence…
Crises and complexity
The end of the COVID-19 global health emergency presents an opportunity to reflect on actions needed to enhance the effectiveness of responses to any future shocks. We highlight critical areas requiring attention from researchers and research commissioners to enhance the identification and adoption of ‘good value’ interventions, and we discuss the complexities of evidence-informed decision-making across multiple sectors, the evolving role of mode…
“Going into the black box”
Background: The World Health Organization (WHO) plays a crucial role in producing global guidelines. In response to previous criticism, WHO has made efforts to enhance the process of guideline development, aiming for greater systematicity and transparency. However, it remains unclear whether these changes have effectively addressed these earlier critiques. This paper examines the policy process employed by WHO to inform guideline recommendations,…
Factors Associated with Usage of Oral-PrEP among Female Sex Workers in Nairobi, Kenya, Assessed by Self-Report and a Point-of-Care Urine Tenofovir Immunoassay
Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. We aimed to estimate usage of oral-PrEP, and factors associated with adherence among female sex workers (FSWs) in Nairobi, Kenya, using a novel point-of-care urine tenofovir lateral flow assay (LFA). The Maisha Fiti study randomly selected FSWs from Sex Worker Outreach Program clinics in Nairobi. Data were collected from 1003 FSWs from June-October 2019, including su…
Needs & networks
Our proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals' unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care
Boys’ perspectives on girls’ marriage and school dropout
Girls' education has for many decades been central to the global development agenda, due to its positive impact on girls' health and wellbeing. In this paper, the authors revisit boys' attitudes, behaviours and norms related to girls' education, following the Samata intervention to prevent girls' school dropouts in Northern-Karnataka, South India. Data were collected from 20 boys in intervention villages before and after the intervention, and ana…
Exploring practices to enhance benefits and reduce risks of chemsex among gay, bisexual, and other men who have sex with men
BACKGROUND: Chemsex is the intentional combining of specific drugs with sex, primarily by gay, bisexual, and other men who have sex with men (GBMSM), to enhance intimacy, pleasure, and prolong sexual sessions. Practices vary across geographic and social settings. Participants report benefits and risks of chemsex. Studies have previously reviewed chemsex practices and harm reduction interventions separately. This review aims to examine both togeth…
Alcohol use and associated risk factors among female sex workers in low- and middle-income countries
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review a…
Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru
We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify healt…
Psychological and Behavioural Within-participant Predictors of Adherence to Oral HIV Pre-Exposure Prophylaxis (PrEP)
Oral PrEP's effectiveness relies on adequate adherence during periods of substantial HIV risk. Since most PrEP users will miss doses, understanding predictors within participants can help to explain adherence. We used a cross-sectional, within-participant design with 67 gay, bisexual, and other men who have sex with men taking PrEP daily. Using a questionnaire, informed by the Information Motivation Behavioral Skills Model, participants were aske…
Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya
Our study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence
Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self‐Testing Public Health Intervention) randomized controlled t…
SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003 )
Health and wellbeing needs and priorities in mining host communities in South Africa
We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 tar…
Mental health challenges and perceived risks among female sex workers in Nairobi, Kenya
There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy
Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for intervi…
I have the confidence to ask’
Gender norms serve to normalise gender inequalities and constrain girls’ agency. This paper examines how girls’ agency, along a continuum, is influenced by the interplay between constraining and enabling influences in the girls’ environments. We analyse data from a qualitative study nested within a cluster randomised evaluation of Samata, a multi-layered programme supporting adolescent girls to stay in school and delay marriage in Karnataka, Sout…
Pre-exposure prophylaxis (PrEP) uptake and adherence experiences of gay and bisexual men who engage in chemsex
In this study, the majority of GBM who engaged in chemsex, initiated PrEP in recognition of their potential risk of HIV acquisition and reported high levels of PrEP adherence. They used multiple strategies to support effective PrEP access and adherence. These findings support a growing body of evidence that PrEP is a viable prevention tool for GBM who engage in chemsex, and that chemsex does not negatively impact PrEP adherence
Adolescent Girls and Their Family Members’ Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India
Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between inter…
Capitalising on aspirations of adolescent girls and young women to reduce their sexual health risks
This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in - and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software.…
The dapivirine vaginal ring from the perspective of married men in Uganda
Background : Men play a key role in influencing uptake of women's health products, such as female condoms and vaginal microbicides used for family planning and HIV prevention. Method : We explored men's perceptions of the dapivirine vaginal ring (DVR), a vaginal microbicide, in Kalungu District, rural south-western Uganda. In June/July 2018, we conducted in-depth interviews with 10 partners of women participating in the DREAM study, a phase 3B op…
Exploring Mechanisms of Action
SELPHI involves two interventions: (A) It provides one HIV self-testing (HIVST) kit; (B) It offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the pathways to impa…
The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls
BACKGROUND: Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girl…
Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial
ClinicalTrials.gov identifier: NCT02065986 . Registered 19 February 2014 (retrospectively registered)
Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants
These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk
Chemsex behaviours among men who have sex with men
Adolescent Girls and Their Family Members’ Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India
Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between inter…
Re-framing microbicide acceptability
Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic ('insider') perspective or attempt to…
Intravaginal insertion in KwaZulu-Natal
Intravaginal insertion is often associated with the concept of 'dry' sex. All HIV-prevention microbicides tested to date have been vaginally applied lubricant-based gels. In this paper, we examine whether the use of intravaginal insertions could be in conflict with the introduction of vaginal microbicide gels. The Africa Centre site was part of the Microbicides Development Programme evaluating PRO2000/5 microbicide gel. We conducted in-depth-inte…
How effective is effective enough? Opinions of potential end-users of microbicides from a rural South African community
To assess the views of potential end-users of a microbicide in KwaZulu-Natal regarding the characteristics that would justify further development, three focus group discussions were conducted in 2009 with 23 local staff members working on a microbicide clinical trial, 20 former trial participants and 14 Community Advisory Board members not enrolled in the trial, in an area with high HIV incidence and low consistent condom use. All participants ag…
The Implications of Post-coital Intravaginal Cleansing for the Introduction of Vaginal Microbicides in South Africa
Post-coital intravaginal cleansing (IVC) could counteract the protective effect of a vaginal microbicide. IVC less than 1 h after sex is discouraged in most microbicide trials. During a microbicide trial in KwaZulu-Natal, we collected quantitative data on post-coital IVC. We discussed IVC during in-depth-interviews (IDIs) and focus-group discussions (FGDs) with women enrolled in the trial, and during FGDs with community members. Nearly one-third …
Communication About Microbicide Use Between Couples in KwaZulu-Natal, South Africa
The ways in which couples communicate about microbicides is likely to influence microbicide uptake and usage. We collected quantitative data about whether women in a microbicide trial discussed microbicides with their partners and explored communication about microbicides during 79 in-depth-interviews with women enrolled in the trial and 17 focus-group discussions with community members. After 4 weeks in the trial, 60 % of 1092 women had discusse…
Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD)
BACKGROUND: Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. METHODS: PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex…
Alcohol Availability, Marketing, and Sexual Health Risk Amongst Urban and Rural Youth in South Africa
South Africa has high rates of HIV prevalence and incidence and very high binge drinking rates amongst youth. GIS mapping of alcohol outlets and participatory research methods were used to explore and understand youth's perception of alcohol availability and marketing, and their associated risks for HIV and sexual violence. Twenty seven youth 18-24 years from an urban and rural area participated in the study. There was high density of alcohol out…
The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour
There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrE…
Response to the Hammoud et al paper on ‘the new MTV generation’
The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls
BACKGROUND: Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girl…
Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial
ClinicalTrials.gov identifier: NCT02065986 . Registered 19 February 2014 (retrospectively registered)
Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants
These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk
Chemsex behaviours among men who have sex with men
Exploring Mechanisms of Action
SELPHI involves two interventions: (A) It provides one HIV self-testing (HIVST) kit; (B) It offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the pathways to impa…
Capitalising on aspirations of adolescent girls and young women to reduce their sexual health risks
This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in - and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software.…
The dapivirine vaginal ring from the perspective of married men in Uganda
Background : Men play a key role in influencing uptake of women's health products, such as female condoms and vaginal microbicides used for family planning and HIV prevention. Method : We explored men's perceptions of the dapivirine vaginal ring (DVR), a vaginal microbicide, in Kalungu District, rural south-western Uganda. In June/July 2018, we conducted in-depth interviews with 10 partners of women participating in the DREAM study, a phase 3B op…
Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya
Our study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence
Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self‐Testing Public Health Intervention) randomized controlled t…
SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003 )
Health and wellbeing needs and priorities in mining host communities in South Africa
We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 tar…
Mental health challenges and perceived risks among female sex workers in Nairobi, Kenya
There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy
Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for intervi…
I have the confidence to ask’
Gender norms serve to normalise gender inequalities and constrain girls’ agency. This paper examines how girls’ agency, along a continuum, is influenced by the interplay between constraining and enabling influences in the girls’ environments. We analyse data from a qualitative study nested within a cluster randomised evaluation of Samata, a multi-layered programme supporting adolescent girls to stay in school and delay marriage in Karnataka, Sout…
Pre-exposure prophylaxis (PrEP) uptake and adherence experiences of gay and bisexual men who engage in chemsex
In this study, the majority of GBM who engaged in chemsex, initiated PrEP in recognition of their potential risk of HIV acquisition and reported high levels of PrEP adherence. They used multiple strategies to support effective PrEP access and adherence. These findings support a growing body of evidence that PrEP is a viable prevention tool for GBM who engage in chemsex, and that chemsex does not negatively impact PrEP adherence
Adolescent Girls and Their Family Members’ Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India
Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between inter…
Alcohol use and associated risk factors among female sex workers in low- and middle-income countries
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review a…
Medicine (28 works) · HIV/AIDS Research and Interventions (20 works) · Environmental health (18 works) · Family medicine (17 works) · Psychology (16 works) · HIV, Drug Use, Sexual Risk (15 works) · Adolescent Sexual and Reproductive Health (13 works) · Human immunodeficiency virus (HIV (12 works) · Men who have sex with men (12 works) · Population (12 works)