{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:55:32Z","timestamp":1794333332950,"version":"4.9.0"},"reference-count":62,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Weill Cornell Medicine Department of Medicine","award":["Fund for the Future Award (Award Number N\/A)"],"award-info":[{"award-number":["Fund for the Future Award (Award Number N\/A)"]}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["ES\/P010873\/1"],"award-info":[{"award-number":["ES\/P010873\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01TW012435"],"award-info":[{"award-number":["K01TW012435"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,6,9]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Women who have been forcibly displaced in complex humanitarian settings suffer from poor sexual health, though the association with violence and war trauma is poorly characterised. We investigated sexual health outcomes and their relationship to violence and trauma among women living in a protracted forced displacement setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted in an urban refugee camp in Beirut, Lebanon. Participants were Syrian women who are refugees aged 18\u201349 years. Community health workers conducted door-to-door recruitment and administered a survey to assess violence and trauma. Capillary blood and vaginal swabs were collected for sexually transmitted infection (STI) testing. Sexual health outcomes included gynaecologic symptoms, self-reported lifetime STI history and current STIs. The relationship of sexual health outcomes with violence, trauma and other factors was assessed using Bayesian Gaussian copula models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Recruitment and data collection were conducted from February to September 2023. Of 305 eligible participants, 250 (82.0%) consented for study participation. The mean age was 30.3 (SD\u00b16.9) years. Over 80% of women disclosed experiencing gender-based violence. Participants experienced a median of 12 (IQR 7) traumatic war events; 197 (78.8%) met criteria for post-traumatic stress disorder (PTSD) and 125 (50.0%) had severe food insecurity. Among a subset (n=216), current gynaecologic symptoms (80.1%) and lifetime STI history (63.4%) were common. We detected one case of\n                      <jats:italic>Trichomonas vaginalis<\/jats:italic>\n                      . By graphical models, gynaecologic symptoms and STI history were significantly associated with sexual violence, which clustered with physical and emotional violence, war trauma, PTSD and severe food insecurity (posterior edge inclusion probability &gt;0.5).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Lebanon, the sexual health of Syrian women who are refugees is closely linked to a syndemic of violence, war trauma, poor mental health and food insecurity. A syndemics-informed approach is urgently needed to address the needs of forcibly displaced women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002561","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T09:40:15Z","timestamp":1751708415000},"page":"e002561","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Sexual health of Syrian women in protracted forced displacement: the syndemic interplay of violence, war trauma, poor mental health and food insecurity"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0265-2582","authenticated-orcid":false,"given":"Sasha","family":"Fahme","sequence":"first","affiliation":[{"name":"Center for Global Health, Weill Cornell Medical College, New York, USA"},{"name":"Epidemiology and Population Health Department, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-4702","authenticated-orcid":false,"given":"Ghina R","family":"Mumtaz","sequence":"additional","affiliation":[{"name":"Epidemiology and Population Health Department, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut Faculty of Medicine, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0996-9654","authenticated-orcid":false,"given":"Maia","family":"Sieverding","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Community Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Chehab","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Community Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"El Nakib","sequence":"additional","affiliation":[{"name":"National AIDS Control Program, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0790-0506","authenticated-orcid":false,"given":"Laith","family":"Abu-Raddad","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medical College, New York, USA"},{"name":"Infectious Disease Epidemiology Group, Weill Cornell Medicine, Doha, Qatar"},{"name":"World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV\/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Downs","sequence":"additional","affiliation":[{"name":"Center for Global Health, Weill Cornell Medical College, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Global Health, Weill Cornell Medical College, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"DeJong","sequence":"additional","affiliation":[{"name":"Epidemiology and Population Health Department, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Center for Global Health, Weill Cornell Medical College, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"2026010703053038000_3.2.e002561.1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/wmh3.231","article-title":"Syrian Refugee Women\u2019s Health in Lebanon, Turkey, and Jordan and Recommendations for Improved Practice","volume":"9","author":"Samari","year":"2017","journal-title":"World Med Health Policy"},{"key":"2026010703053038000_3.2.e002561.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15081583","article-title":"A Systematic Review of Sexual and Reproductive Health Knowledge, Experiences and Access to Services among Refugee, Migrant and Displaced Girls and Young Women in Africa","volume":"15","author":"Ivanova","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2026010703053038000_3.2.e002561.3","doi-asserted-by":"publisher","DOI":"10.1001\/2012.jama.10161"},{"key":"2026010703053038000_3.2.e002561.4","unstructured":"UNHCR policy on refugee protection and solutions in urban areas. 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