Abstract Background Transactional sex, which includes exchanging sex for material goods, services, or money, is a key HIV risk factor. Risk patterns associated with transactional sex among men who have sex with men (MSM) in Sweden, where buying sexual services is illegal, have not been examined earlier. This study aims to assess whether transactional sex (both buying and selling), country of birth, and migration-related factors (described by country of origin) are associated with self-reported HIV status among MSM in Sweden. Methods We analyzed secondary data from the 2017 European MSM Internet Survey (EMIS-2017), including participants reporting to live in Sweden (n = 4443). Using multivariate logistic regression analysis, we aimed to understand factors related to involvement in transactional sex and risk of HIV acquisition. Results Among the respondents, 5.4% reported living with HIV, with 8.8% of foreign-born MSM and 4.8% of Swedish-born MSM. The multivariable analysis showed that both selling and buying sex in the past five years increased the odds of reporting a positive HIV serostatus among all participants. Stratifying by transactional sex exposure and country of birth showed an HIV prevalence increase for all groups. Foreign-born selling or buying sex ever in the last five years had the highest prevalence of all groups (ranging from 17.8 to 19.1%). Other factors associated with a positive HIV status were age, outness, sex with a woman in the past twelve months, and condom use. Conclusions The relatively high reported HIV prevalence supports the need for HIV prevention, including the scale-up of access to pre-exposure prophylaxis to foreign-born MSM. A transparent discussion about risk factors and socioeconomic structures contributing to risk behaviors, including transactional sex, is needed. Key messages • Engaging in transactional sex increases the HIV risk among MSM in Sweden, particularly among foreign-born MSM. • HIV prevention needs to address the socioeconomic factors contributing to risky behaviors, such as transactional sex.

Abstract The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic—among others—call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of ‘systemic risk’, there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures.

ABSTRACT 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 Data were drawn from a cross-sectional survey conducted with migrants aged 15–65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15–25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. Results Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18–2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17–3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25–3.17), and to live alone (AOR:1.95, 95% CI:1.25–3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37–4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33–0.88), Asia (AOR:0.44, 95% CI:0.22–0.86), Europe (AOR:0.30, 95% CI:0.14–0.61) and Africa (AOR 0.37, 95% CI: 0.23–0.60) had lower odds of poor mental health than those arriving from Syria. Conclusion The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.

Abstract:In order to address the research gaps on climate finance dynamics in developing countries, especially those with low governance scores, this study assesses the 2016–2020 bilateral climate finance to these countries. The total disbursed bilateral climate finance was US$1.3 billion (92 percent for mitigation, 7 percent for adaptation, and 1 percent for mitigation and adaptation simultaneously). Development-focused loans were the prevailing financial instrument cumulatively, and grants were the prevailing instrument on a per-country level. Japan was the biggest provider of bilateral climate finance (US$1 billion) to fund Uzbekistan's natural gas-fired electric power plants. All major bilateral climate finance providers ranked high on governance scores compared to the ten examined countries. Countries examined in this study will need to receive higher amounts of bilateral climate change finance in order to improve their readiness to address this issue and reduce their vulnerability to climate change impacts.

Göran Tomson and colleagues argue that our ability to control pandemics requires global action to counter inequalities from demographic, environmental, technological, and other megatrends

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018–2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated growing political commitment to HHSDGs, with augmentation of multisectoral institutional arrangements, strengthening of monitoring systems and engagement of development partners. On the other hand, there has been limited involvement of civic society representatives and academia, relatively few capacity development initiatives were in place, a well-crafted communication strategy was missing, and there is limited evidence of additional domestic financing for implementing HHSDGs. While the momentum towards universal health coverage is notable, explicit linkages with non-health SDGs and integrated multisectoral implementation strategies are lacking. The study offers messages to LMICs that would allow for a full decade of accelerated implementation of HHSDGs, and points to the need for more implementation research in each domain and for testing interventions that are likely to work before scale-up.

To deliver on the 2030 Agenda and the seventeen development goals, while facing complex health challenges, we need research and education that extend across multiple scientific fields. This will enable researchers from a variety of disciplines to meet, identify research issues, apply for funding, and conduct interdisciplinary research. In addition, student involvement is key in achieving the 2030 Agenda’s global goals – and beyond. Challenges include, climate change and child health, non-peaceful societies, gender inequalities and health. The Swedish Institute for Global Health Transformation (SIGHT) was founded in 2017 at the Royal Swedish Academy of Sciences with the support of the Bill & Melinda Gates Foundation. SIGHT’s mission is to promote an interdisciplinary approach in research and education in the field of global health. In order to deliver on the commitment to global health among researchers and students in various scientific fields and at universities and colleges across Sweden, SIGHT has established SIGHT Fellows, a mentoring programme for academic researchers. In collaboration with universities, established research institutions, and other stakeholders, SIGHT Student Network holds dynamic meetings for students from a variety of disciplines and universities to contribute to delivering the UN’s sustainability goals.

Background Better understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed. Objectives Explore the barriers and facilitators to the integration of health services for refugees; the processes involved and the different stakeholders engaged in levaraging intersectoral approaches to protect refugees’ right to health on resettlement. Design Scoping review. Methods A search of articles from 2000 onward was done in MEDLINE, Web of Science, Global Health and PsycINFO, Embase. Two frameworks were applied in our analysis, the ‘framework for analysing integration of targeted health interventions in systems’ and ‘Health in All Policies’ framework for country action. A comprehensive description of the methods is included in our published protocol. Results 6117 papers were identified, only 18 studies met the inclusion criteria. Facilitators in implementation included: training for providers, colocation of services, transportation services to enhance access, clear role definitions and appropriate budget allocation and financing. Barriers included: lack of a participatory approach, insufficient resources for providers, absence of financing, unclear roles and insufficient coordination of interprofessional teams; low availability and use of data, and turf wars across governance stakeholders. Successful strategies to address refugee health included: networks of service delivery combining existing public and private services; system navigators; host community engagement to reduce stigma; translation services; legislative support and alternative models of care for women and children. Conclusion Limited evidence was found overall. Further research on intersectoral approaches is needed. Key policy insights gained from barriers and facilitators reported in available studies include: improving coordination between existing programmes; supporting colocation of services; establishing formal system navigator roles that connect relevant programmes; establishing formal translation services to improve access and establishing training and resources for providers.