Presentation led by Dr. Katherine Andrinopoulos, an Assistant Professor at Tulane University, John Hembling, M&E Specialist, and Tory M. Taylor, also an M&E Specialist.
Il s'agit d'une fiche technique sur la prévention du VIH parmi les trans.
Non datée, elle est le fruit du travail de Rita Melendez, de la San Francisco State University, Valerie Spencer de la Charles R. Drew University, et David Whittier, du Centers for Disease Control and Prevention.
The document discusses barriers to HIV prevention and care for gay and bisexual African American males aged 18-24 in Sacramento County. It notes that this group has disproportionately high rates of HIV infection locally and nationally. Some key barriers include poverty, lack of health insurance, discrimination, homophobia, and lack of access to healthcare. The proposed "PrEP for Love" program aims to address this issue by providing HIV/STI education, access to pre-exposure prophylaxis medication, and linkage to culturally competent healthcare providers to reduce new HIV infections in this high-risk population. It seeks to replicate the success of a similar program in San Francisco that reported zero new HIV cases during its operation.
Transgender Health : Findings From Two Needs Assessment Studies In PhiladelphiaSanté des trans
Transgender Health: Findings from Two Needs Assessment Studies in Philadelphia.
Il s'agit d'un article de Gretchen P. Kenagy, paru dans la revue Health and Social Work (volume: 30. Issue: 1) en 2005.
Il présente les résultats de deux enquêtes de recueil des besoins des trans en matière de santé à Philadelphie.
HIV/AIDS affects persons from Sub-Saharan Africa and men who have sex with men (MSM) in a disproportionate way. This article analyzes the evidence and the plausibility of anogenital anatomical factors which may contribute to the HIV/AIDS pandemic in the key populations for sexual transmission. The etiology of the pandemic is discussed. Direct and indirect evidence for narrow anogenital anatomy is presented. Two semi-theoretical arguments for anatomical factors are put forward. Anogenital anatomy is analyzed in view of Hill's criteria for causation. I describe how randomized controlled trials and other confirmatory studies could be designed and discuss the consequences of the hypothesis. While many contributing factors for the HIV/AIDS pandemic are well established, direct and indirect empirical evidence, as well as semi-theoretical arguments, militates for an additional role of macroscopic anogenital anatomy in HIV key populations. This factor fulfills Hill's criteria.
This research proposal aims to study factors that lead to higher rates of HIV/AIDS diagnoses among African American men ages 18-24 compared to other groups. The researcher will conduct surveys and interviews with at least 100 men who have sex with men, including those of various races and socioeconomic backgrounds. Key research questions include examining differences in access to healthcare, levels of risk behavior, and how cultural and educational factors may influence HIV transmission patterns between racial groups. The goal is to better understand disparities and empower communities through more effective education and prevention strategies.
This document assesses four vulnerability indicators used to identify at-risk neighborhoods for prioritizing pandemic interventions. It finds low concordance rates between indicators, meaning they identify different tracts as vulnerable. It also finds substantial differences in the racial composition and proportion of minority neighborhoods included between indicators. Specifically, an indicator based on pre-existing health conditions performs best at including African American populations and neighborhoods. The choice of indicator thus has significant implications for which groups and places receive priority support.
The document discusses findings from the National Survey of American Life (NSAL) regarding mental health differences among racial and ethnic groups in the United States. It finds that while race is an important factor, there are also differences between ethnic groups like African Americans, Afro-Caribbeans, and whites. Immigrant status and ancestry were found to impact mental health outcomes for Afro-Caribbeans. The study also looked at multigenerational families and found mental health disparities are influenced by multiple social and biological factors over the life course, not any single cause.
This document summarizes research on child sexual abuse across cultures. It begins by reviewing prevalence studies from around the world that show rates of child sexual abuse ranging from 7-36% for females and 3-29% for males. A few exceptions outside these ranges are noted from studies among Native Canadians, South Africans, and Malaysians. The document then provides a more detailed review of recent prevalence studies and report data on child sexual abuse in various world regions, including the Americas, Western Europe, Central and South America, Africa, Asia, the Middle East, and the Pacific. The goal is to broaden understanding of child sexual abuse beyond Western cultures and address this issue inclusively across all societies.
Il s'agit d'une fiche technique sur la prévention du VIH parmi les trans.
Non datée, elle est le fruit du travail de Rita Melendez, de la San Francisco State University, Valerie Spencer de la Charles R. Drew University, et David Whittier, du Centers for Disease Control and Prevention.
The document discusses barriers to HIV prevention and care for gay and bisexual African American males aged 18-24 in Sacramento County. It notes that this group has disproportionately high rates of HIV infection locally and nationally. Some key barriers include poverty, lack of health insurance, discrimination, homophobia, and lack of access to healthcare. The proposed "PrEP for Love" program aims to address this issue by providing HIV/STI education, access to pre-exposure prophylaxis medication, and linkage to culturally competent healthcare providers to reduce new HIV infections in this high-risk population. It seeks to replicate the success of a similar program in San Francisco that reported zero new HIV cases during its operation.
Transgender Health : Findings From Two Needs Assessment Studies In PhiladelphiaSanté des trans
Transgender Health: Findings from Two Needs Assessment Studies in Philadelphia.
Il s'agit d'un article de Gretchen P. Kenagy, paru dans la revue Health and Social Work (volume: 30. Issue: 1) en 2005.
Il présente les résultats de deux enquêtes de recueil des besoins des trans en matière de santé à Philadelphie.
HIV/AIDS affects persons from Sub-Saharan Africa and men who have sex with men (MSM) in a disproportionate way. This article analyzes the evidence and the plausibility of anogenital anatomical factors which may contribute to the HIV/AIDS pandemic in the key populations for sexual transmission. The etiology of the pandemic is discussed. Direct and indirect evidence for narrow anogenital anatomy is presented. Two semi-theoretical arguments for anatomical factors are put forward. Anogenital anatomy is analyzed in view of Hill's criteria for causation. I describe how randomized controlled trials and other confirmatory studies could be designed and discuss the consequences of the hypothesis. While many contributing factors for the HIV/AIDS pandemic are well established, direct and indirect empirical evidence, as well as semi-theoretical arguments, militates for an additional role of macroscopic anogenital anatomy in HIV key populations. This factor fulfills Hill's criteria.
This research proposal aims to study factors that lead to higher rates of HIV/AIDS diagnoses among African American men ages 18-24 compared to other groups. The researcher will conduct surveys and interviews with at least 100 men who have sex with men, including those of various races and socioeconomic backgrounds. Key research questions include examining differences in access to healthcare, levels of risk behavior, and how cultural and educational factors may influence HIV transmission patterns between racial groups. The goal is to better understand disparities and empower communities through more effective education and prevention strategies.
This document assesses four vulnerability indicators used to identify at-risk neighborhoods for prioritizing pandemic interventions. It finds low concordance rates between indicators, meaning they identify different tracts as vulnerable. It also finds substantial differences in the racial composition and proportion of minority neighborhoods included between indicators. Specifically, an indicator based on pre-existing health conditions performs best at including African American populations and neighborhoods. The choice of indicator thus has significant implications for which groups and places receive priority support.
The document discusses findings from the National Survey of American Life (NSAL) regarding mental health differences among racial and ethnic groups in the United States. It finds that while race is an important factor, there are also differences between ethnic groups like African Americans, Afro-Caribbeans, and whites. Immigrant status and ancestry were found to impact mental health outcomes for Afro-Caribbeans. The study also looked at multigenerational families and found mental health disparities are influenced by multiple social and biological factors over the life course, not any single cause.
This document summarizes research on child sexual abuse across cultures. It begins by reviewing prevalence studies from around the world that show rates of child sexual abuse ranging from 7-36% for females and 3-29% for males. A few exceptions outside these ranges are noted from studies among Native Canadians, South Africans, and Malaysians. The document then provides a more detailed review of recent prevalence studies and report data on child sexual abuse in various world regions, including the Americas, Western Europe, Central and South America, Africa, Asia, the Middle East, and the Pacific. The goal is to broaden understanding of child sexual abuse beyond Western cultures and address this issue inclusively across all societies.
- The document discusses a research project examining factors that influence poverty rates in America, specifically looking at incarceration, health, income, and race.
- The researchers hypothesized that ethnic minorities with low incomes who are incarcerated are more likely to experience poverty due to barriers to employment and healthcare access after prison.
- Analysis of 2012 GSS survey data found those with criminal records were more likely to come from low-income backgrounds, supporting the hypothesis. However, relationships between other variables like health were less clear. Overall, the findings confirm race and income influence recidivism and perpetuation of poverty.
The survey aimed to understand the risk factors threatening the sexual health of lesbians and women who have sex with women (WSW) in Durban, South Africa. It interviewed 60 lesbians and WSW aged 15-35, with 75% Black African and 25% Indian/Asian. Many respondents had come out to friends and siblings but not parents. Reasons for not coming out varied and included fear of rejection. Health issues found included alcohol use by over 68% and drug use like marijuana. Rates of STIs and violence in relationships were low but underreporting was an issue. Access to sexual healthcare faced challenges like stigma and lack of lesbian-friendly services.
Transgender Clients : We Need Effective Care Too!Santé des trans
Il s'agit d'une présentation powerpoint de la Directrice du Center of excellence for transgender HIV prevention de l'UCSF, qui passe en revue l'ensemble des enjeux liés à l'épidémie de sida parmi les trans, ainsi que les déterminants de santé globaux. Date inconnue.
Plan de l'intervention
Getting on the Same Page:
Establishing a Common Language
What Are the Facts?
What is the HIV Prevalence among Trans People in the US?
Effects of Stigma & Discrimination on Trans Communities
What are the Barriers and Challenges?
What Are We Going To Do?
Addressing Transphobia
Action Steps & Recommendations
Where do we go for help?
Transgender Female Youth And Sex Work HIV Risk And A Comparison Of Life Facto...Santé des trans
This study examined factors associated with engagement in sex work among 151 transgender female youth ages 15-24 in Los Angeles and Chicago. The researchers found that 67% had engaged in sex work and 19% self-reported being HIV positive. Lower education, homelessness, street drug use, and lower perceived social support were significantly associated with sex work when controlling for other factors. The findings suggest a need for research on sex work initiation and HIV prevention programs that address the complex individual, social, and community challenges faced by transgender female youth.
The document discusses how HIV/AIDS has disproportionately impacted African Americans in urban areas. Some key points:
- African Americans represent 13% of the US population but around half of new HIV diagnoses. Rates are much higher than for whites and Hispanics.
- Cities examined like Detroit, New York, Baltimore, and DC have large African American populations and high rates of HIV among this group.
- Factors contributing to higher rates include poverty, lack of access to healthcare and education, high-risk behaviors, and stigma preventing awareness and treatment.
- Efforts are being made through organizations, campaigns, testing and healthcare to address the epidemic in these communities.
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
This research project aims to examine the family burden of people living with AIDS receiving treatment at BPKIHS. It will use an exploratory research design and survey 30 primary caregiver family members using interviews and assessments of family burden. The study hypothesizes that there will be no association between family burden and caregiver characteristics or social stigma. It seeks to understand the demographic profiles of PLWAs and their families, problems faced by caregivers, and the relationship between family burden and demographics. The results could help develop strategies to better support patients and reduce caregiver burden through education and policy changes.
AIDSTAR-One Prevention of Alcohol-Related HIV Risk BehaviorsAIDSTAROne
A growing body of research suggests that alcohol consumption is associated with the sexual behaviors that put people at risk for HIV. In developing countries battling severe HIV epidemics, addressing harmful drinking in conjunction with interventions to reduce sexual risk behavior may reduce HIV transmission more quickly than conventional HIV prevention interventions alone. Developed for program planners and implementers, this technical brief reviews the evidence on new and innovative programs in this emerging area. The brief catalogs what is known about the relationship between harmful alcohol use and HIV sexual risk behavior and offers a critical analysis of interventions to address the issue.
www.aidstar-one.com/focus_areas/prevention/resources/technical_briefs/prevention_alcohol_related_risk_behavior
This report summarizes findings on HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM) in Canada. Key findings include: rates of HIV are highest among MSM, who represent over 40% of new HIV infections; factors like homophobia, lack of social support, and barriers to healthcare contribute to higher vulnerability; and more research is needed on resilience, subpopulations of MSM, and culturally-competent healthcare services. The report aims to inform future research, policy, and programming to address HIV/AIDS in these communities.
Transgender Identity And HIV : Resilience In The Face Of StigmaSanté des trans
Il s'agit d'un article de Walter Bockting, publié en 2008 dans Focus, une publication du AIDS Health Project, affilié à l'University of California, San Francisco.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
This document discusses variables related to the male and female prison populations in the United States. It provides statistics on ethnic populations, age, gender, sentences, security levels, offenses, and mental health of inmates. A survey was also conducted of students in a sociology class about these topics. The survey results showed that students were most accurate in their responses about the total US inmate population, the average inmate age, the percentage of the population that is male inmates, and the percentage of female prison officers.
This document discusses a research study that aimed to determine if countries with higher literacy rates and involvement in higher level economic sectors (industry/services rather than agriculture) had lower rates of reported sexual violence. The study analyzed data on literacy rates, economic sectors, and reported sexual crimes for 58 countries. No correlation was found between literacy rates and sexual crimes. The economic sector data could not be adequately analyzed due to lack of available data from many developing countries. The conclusion was that developed countries have better infrastructure and data collection abilities than developing countries.
Latin@ Lives and the Next Generation of HIV Prevention: Policies, Politics a...CHAMP Network
The document summarizes key points about Latinx communities and HIV/AIDS prevention including:
- Latinx people represent 15.3% of the US population but account for 24.8% of HIV diagnoses due to undercounting of Puerto Ricans.
- Substance use, mental illness, and HIV/AIDS are interlinked and increasing one risk can increase the others.
- Injection drug use and sex with injection drug users were major causes of AIDS cases among Hispanic women in the late 1990s.
- Harm reduction strategies like syringe exchange programs are effective in preventing HIV transmission and should be supported.
The document summarizes an analysis of a sexual risk reduction (HIV/AIDS) intervention program for African American women led by Ralph DiClemente. The randomized controlled trial aimed to increase consistent condom use through skills training based on social cognitive theory and the theory of gender and power. Results found women in the intervention had 2.1-4.1 higher odds of consistent condom use and improved communication compared to the control group. However, the study had limitations like not measuring long-term condom use and a p-value above 0.05, indicating no significant association between treatment and other factors.
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
Violence contre les Femmes et Filles en Haiti dfid report 2013Stanley Lucas
There are various cultural, political and economic drivers of violence against women and girls in Haiti. They include the following. Gender stereotypes and discrimination against women: Researchers stress that the incidence of violence in the post-earthquake period should be understood in the context of the longer-term social exclusion, and cultural and legal discrimination against women. Women’s economic dependency: There is some evidence that women who are economically dependent on men are more vulnerable to sexual exploitation. Poverty, displacement and poor conditions in internally displaced persons’ (IDP) camps: Studies indicate significant correlations between limited access to adequate food, water and sanitation, and women and girls’ vulnerability to sexual violence in IDP camps. Legacy of state-led violence: Politically motivated violence has been used by some regimes in Haiti. Culture of impunity and weak capacity in the state justice system: An acute lack of resources and capacity in the Haitian justice system makes it difficult for the state to prosecute and punish perpetrators, and deters victims from seeking redress.
- African American men account for 70% of new HIV/AIDS cases in Los Angeles County, though they represent only 12-14% of the population. The majority of cases are in men ages 20-49.
- Poverty, lack of health insurance, and high incarceration rates negatively impact access to healthcare for African American men with HIV/AIDS in Los Angeles. However, community organizations provide support and work to increase access.
- HIV/AIDS has disproportionate effects in the African American community in Los Angeles County. Efforts are being made to increase testing, prevention, and treatment through programs tailored for at-risk groups.
Structural Racism: a “Cause of Causes”lauren442438
This document discusses structural racism and its relationship to health outcomes in the United States. It defines structural racism as racial inequities perpetuated by intentionally or unintentionally discriminatory policies that compound over time. Examples of racist policies throughout US history are provided, showing how they disadvantaged racial minorities in areas like education, housing, employment, and criminal justice. The document also discusses pathways by which structural racism can negatively impact health, such as differential exposure to environmental stressors and resources, as well as differential treatment in systems like healthcare. Nursing is called to address structural racism as a root cause of health inequities.
Interoperability & Crowdsourcing: Can these improve the management of ANC pro...MEASURE Evaluation
The document discusses how the MomConnect program in South Africa is using interoperability and crowdsourcing to improve access to and quality of antenatal care (ANC). MomConnect allows pregnant women to register for services via cell phone, collecting registration data that is integrated with other health information systems. It also uses crowdsourcing by sending surveys to women to provide feedback on clinic services. This feedback has helped identify issues and improve clinics. The program aims to register all pregnancies early and provide targeted health messages and feedback mechanisms to support maternal health. Over 500,000 women registered in the first year.
RHINO Forum: How can RHIS improve the delivery of HIV/AIDS services?MEASURE Evaluation
This document discusses how routine health information systems (RHIS) can be improved to better monitor linkages between HIV/AIDS services and other health services. Integrating separate vertical program reporting systems into a single national RHIS could facilitate client referrals, continuity of care, and achievement of program goals. However, challenges include harmonizing different recording forms and integrating programs not designed to be combined. The discussion forum explores issues around monitoring individual clients versus aggregates, defining linkage indicators, and ensuring data quality when integrating systems.
- The document discusses a research project examining factors that influence poverty rates in America, specifically looking at incarceration, health, income, and race.
- The researchers hypothesized that ethnic minorities with low incomes who are incarcerated are more likely to experience poverty due to barriers to employment and healthcare access after prison.
- Analysis of 2012 GSS survey data found those with criminal records were more likely to come from low-income backgrounds, supporting the hypothesis. However, relationships between other variables like health were less clear. Overall, the findings confirm race and income influence recidivism and perpetuation of poverty.
The survey aimed to understand the risk factors threatening the sexual health of lesbians and women who have sex with women (WSW) in Durban, South Africa. It interviewed 60 lesbians and WSW aged 15-35, with 75% Black African and 25% Indian/Asian. Many respondents had come out to friends and siblings but not parents. Reasons for not coming out varied and included fear of rejection. Health issues found included alcohol use by over 68% and drug use like marijuana. Rates of STIs and violence in relationships were low but underreporting was an issue. Access to sexual healthcare faced challenges like stigma and lack of lesbian-friendly services.
Transgender Clients : We Need Effective Care Too!Santé des trans
Il s'agit d'une présentation powerpoint de la Directrice du Center of excellence for transgender HIV prevention de l'UCSF, qui passe en revue l'ensemble des enjeux liés à l'épidémie de sida parmi les trans, ainsi que les déterminants de santé globaux. Date inconnue.
Plan de l'intervention
Getting on the Same Page:
Establishing a Common Language
What Are the Facts?
What is the HIV Prevalence among Trans People in the US?
Effects of Stigma & Discrimination on Trans Communities
What are the Barriers and Challenges?
What Are We Going To Do?
Addressing Transphobia
Action Steps & Recommendations
Where do we go for help?
Transgender Female Youth And Sex Work HIV Risk And A Comparison Of Life Facto...Santé des trans
This study examined factors associated with engagement in sex work among 151 transgender female youth ages 15-24 in Los Angeles and Chicago. The researchers found that 67% had engaged in sex work and 19% self-reported being HIV positive. Lower education, homelessness, street drug use, and lower perceived social support were significantly associated with sex work when controlling for other factors. The findings suggest a need for research on sex work initiation and HIV prevention programs that address the complex individual, social, and community challenges faced by transgender female youth.
The document discusses how HIV/AIDS has disproportionately impacted African Americans in urban areas. Some key points:
- African Americans represent 13% of the US population but around half of new HIV diagnoses. Rates are much higher than for whites and Hispanics.
- Cities examined like Detroit, New York, Baltimore, and DC have large African American populations and high rates of HIV among this group.
- Factors contributing to higher rates include poverty, lack of access to healthcare and education, high-risk behaviors, and stigma preventing awareness and treatment.
- Efforts are being made through organizations, campaigns, testing and healthcare to address the epidemic in these communities.
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
This research project aims to examine the family burden of people living with AIDS receiving treatment at BPKIHS. It will use an exploratory research design and survey 30 primary caregiver family members using interviews and assessments of family burden. The study hypothesizes that there will be no association between family burden and caregiver characteristics or social stigma. It seeks to understand the demographic profiles of PLWAs and their families, problems faced by caregivers, and the relationship between family burden and demographics. The results could help develop strategies to better support patients and reduce caregiver burden through education and policy changes.
AIDSTAR-One Prevention of Alcohol-Related HIV Risk BehaviorsAIDSTAROne
A growing body of research suggests that alcohol consumption is associated with the sexual behaviors that put people at risk for HIV. In developing countries battling severe HIV epidemics, addressing harmful drinking in conjunction with interventions to reduce sexual risk behavior may reduce HIV transmission more quickly than conventional HIV prevention interventions alone. Developed for program planners and implementers, this technical brief reviews the evidence on new and innovative programs in this emerging area. The brief catalogs what is known about the relationship between harmful alcohol use and HIV sexual risk behavior and offers a critical analysis of interventions to address the issue.
www.aidstar-one.com/focus_areas/prevention/resources/technical_briefs/prevention_alcohol_related_risk_behavior
This report summarizes findings on HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM) in Canada. Key findings include: rates of HIV are highest among MSM, who represent over 40% of new HIV infections; factors like homophobia, lack of social support, and barriers to healthcare contribute to higher vulnerability; and more research is needed on resilience, subpopulations of MSM, and culturally-competent healthcare services. The report aims to inform future research, policy, and programming to address HIV/AIDS in these communities.
Transgender Identity And HIV : Resilience In The Face Of StigmaSanté des trans
Il s'agit d'un article de Walter Bockting, publié en 2008 dans Focus, une publication du AIDS Health Project, affilié à l'University of California, San Francisco.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
This document discusses variables related to the male and female prison populations in the United States. It provides statistics on ethnic populations, age, gender, sentences, security levels, offenses, and mental health of inmates. A survey was also conducted of students in a sociology class about these topics. The survey results showed that students were most accurate in their responses about the total US inmate population, the average inmate age, the percentage of the population that is male inmates, and the percentage of female prison officers.
This document discusses a research study that aimed to determine if countries with higher literacy rates and involvement in higher level economic sectors (industry/services rather than agriculture) had lower rates of reported sexual violence. The study analyzed data on literacy rates, economic sectors, and reported sexual crimes for 58 countries. No correlation was found between literacy rates and sexual crimes. The economic sector data could not be adequately analyzed due to lack of available data from many developing countries. The conclusion was that developed countries have better infrastructure and data collection abilities than developing countries.
Latin@ Lives and the Next Generation of HIV Prevention: Policies, Politics a...CHAMP Network
The document summarizes key points about Latinx communities and HIV/AIDS prevention including:
- Latinx people represent 15.3% of the US population but account for 24.8% of HIV diagnoses due to undercounting of Puerto Ricans.
- Substance use, mental illness, and HIV/AIDS are interlinked and increasing one risk can increase the others.
- Injection drug use and sex with injection drug users were major causes of AIDS cases among Hispanic women in the late 1990s.
- Harm reduction strategies like syringe exchange programs are effective in preventing HIV transmission and should be supported.
The document summarizes an analysis of a sexual risk reduction (HIV/AIDS) intervention program for African American women led by Ralph DiClemente. The randomized controlled trial aimed to increase consistent condom use through skills training based on social cognitive theory and the theory of gender and power. Results found women in the intervention had 2.1-4.1 higher odds of consistent condom use and improved communication compared to the control group. However, the study had limitations like not measuring long-term condom use and a p-value above 0.05, indicating no significant association between treatment and other factors.
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
Violence contre les Femmes et Filles en Haiti dfid report 2013Stanley Lucas
There are various cultural, political and economic drivers of violence against women and girls in Haiti. They include the following. Gender stereotypes and discrimination against women: Researchers stress that the incidence of violence in the post-earthquake period should be understood in the context of the longer-term social exclusion, and cultural and legal discrimination against women. Women’s economic dependency: There is some evidence that women who are economically dependent on men are more vulnerable to sexual exploitation. Poverty, displacement and poor conditions in internally displaced persons’ (IDP) camps: Studies indicate significant correlations between limited access to adequate food, water and sanitation, and women and girls’ vulnerability to sexual violence in IDP camps. Legacy of state-led violence: Politically motivated violence has been used by some regimes in Haiti. Culture of impunity and weak capacity in the state justice system: An acute lack of resources and capacity in the Haitian justice system makes it difficult for the state to prosecute and punish perpetrators, and deters victims from seeking redress.
- African American men account for 70% of new HIV/AIDS cases in Los Angeles County, though they represent only 12-14% of the population. The majority of cases are in men ages 20-49.
- Poverty, lack of health insurance, and high incarceration rates negatively impact access to healthcare for African American men with HIV/AIDS in Los Angeles. However, community organizations provide support and work to increase access.
- HIV/AIDS has disproportionate effects in the African American community in Los Angeles County. Efforts are being made to increase testing, prevention, and treatment through programs tailored for at-risk groups.
Structural Racism: a “Cause of Causes”lauren442438
This document discusses structural racism and its relationship to health outcomes in the United States. It defines structural racism as racial inequities perpetuated by intentionally or unintentionally discriminatory policies that compound over time. Examples of racist policies throughout US history are provided, showing how they disadvantaged racial minorities in areas like education, housing, employment, and criminal justice. The document also discusses pathways by which structural racism can negatively impact health, such as differential exposure to environmental stressors and resources, as well as differential treatment in systems like healthcare. Nursing is called to address structural racism as a root cause of health inequities.
Interoperability & Crowdsourcing: Can these improve the management of ANC pro...MEASURE Evaluation
The document discusses how the MomConnect program in South Africa is using interoperability and crowdsourcing to improve access to and quality of antenatal care (ANC). MomConnect allows pregnant women to register for services via cell phone, collecting registration data that is integrated with other health information systems. It also uses crowdsourcing by sending surveys to women to provide feedback on clinic services. This feedback has helped identify issues and improve clinics. The program aims to register all pregnancies early and provide targeted health messages and feedback mechanisms to support maternal health. Over 500,000 women registered in the first year.
RHINO Forum: How can RHIS improve the delivery of HIV/AIDS services?MEASURE Evaluation
This document discusses how routine health information systems (RHIS) can be improved to better monitor linkages between HIV/AIDS services and other health services. Integrating separate vertical program reporting systems into a single national RHIS could facilitate client referrals, continuity of care, and achievement of program goals. However, challenges include harmonizing different recording forms and integrating programs not designed to be combined. The discussion forum explores issues around monitoring individual clients versus aggregates, defining linkage indicators, and ensuring data quality when integrating systems.
Assessing HIV Service: Use and Information Systems for Key Populations in Nam...MEASURE Evaluation
The document summarizes the plans to assess HIV service use and information systems for key populations in Namibia. The original proposal was to assess a case management approach using program data, but challenges with data quality and lack of a population size estimate led to a new plan. The new plan includes estimating the size of key populations, enrolling HIV-positive and HIV-negative individuals in separate cohorts to analyze linkage to care, retention, viral suppression, and seroconversion rates over 12-18 months. The assessment will leverage opportunities to measure the HIV cascade for key populations and facilitate prevention data planning.
This document summarizes Dawne Walker's presentation on building M&E capacity for community-based programs in Tanzania. Some key points include:
1) Community-based programs are expected to produce comparable data to facility-based programs but without the same infrastructure and resources.
2) Data quality issues exist at multiple levels from data collection to analysis and use.
3) MEASURE Evaluation developed a Community Trace and Verify (CTV) methodology and participatory M&E approaches to better meet the needs of community-based programs.
4) Participatory M&E fosters community ownership of information and priority setting.
Monitoring Scale-up of Health Practices and InterventionsMEASURE Evaluation
This guide provides information to help monitor the scale-up of health practices and interventions. It introduces the guide and its objectives, which are to provide background on monitoring scale-up initiatives. The guide includes a rationale for monitoring scale-up, a readiness assessment, 10 considerations for monitoring scale-up such as defining objectives and selecting indicators, and appendices with case studies and frameworks for scaling up health interventions. The goal is to create a practical resource that can help effectively monitor and evaluate the scale-up process.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Including AIDS-affected young people in OVC research: Challenges and opportu...MEASURE Evaluation
A Child Status Network webinar discussing how to involve young people (especially HIV-positive young people) in research about orphans and other vulnerable children. Dr. Lucie Cluver from the Young Carers Project and Oxford University led the November 2012 webinar.
"The Prevalence, Experience and Management of Pain: Secondary Analysis of the Care & Support PHE" webinar presentation by Dr. Richard Harding, King's College London.
Led by Dr. Sharon Weir, MEASURE Evaluation, and Professor Peter Figueroa, University of the West Indies, Jamaica.
Presentation on the PLACE method and how it has been used for HIV/STI surveillance, behavioral surveillance, program monitoring, size estimation of most-at-risk populations, and program planning.
Addressing Complexity in the Impact Evaluation of the Cross-Border Health Int...MEASURE Evaluation
This document discusses evaluating the Cross-Border Health Integrated Partnership Project (CB-HIPP) in East Africa. CB-HIPP aims to improve access to quality health services and outcomes in cross-border areas. The evaluation will measure health outcomes in intervention and comparison sites at baseline and over time to quantify CB-HIPP's impact. Addressing the evaluation's complexity involves collecting data from multiple sources, measuring a broad range of outcomes, and using an appropriate analytic method like difference-in-differences to account for background trends.
Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Se...MEASURE Evaluation
This document provides guidelines for monitoring and evaluating HIV programs for sex workers, men who have sex with men, and transgender people at the national, sub-national, and service delivery levels. It outlines an 8-step public health model approach involving understanding the epidemic, determinants of transmission, developing combination prevention programs, and evaluating impact. Key concepts covered include causal pathways, indicators, and emphasizing quality and involvement of key populations. The guidelines are meant to be adapted to local contexts.
Kickoff webinar slides from the Spring 2016 RHINO forum on health worker information systems, presented by Carl Leitner and Amanda Puckett BenDor from Intrahealth
Enhancing FP/RH Decision Making through GIS Data LinkingMEASURE Evaluation
This document discusses using geographic information systems (GIS) to link multi-sectoral data in order to enhance decision making for family planning and reproductive health programs in Rwanda. It provides an overview of a case study conducted in Rwanda that explored linking key data sources such as demographic health surveys, commodity distribution data, and poverty and agriculture data using common geographic identifiers. The case study found that free and open source GIS software like Excel to Google Earth, Quantum GIS, and OpenGeoDa could effectively link and visualize the data. Lessons learned included the importance of stakeholder engagement to access sensitive data, using accurate population data when normalizing indicators, and how GIS data linking can provide insights and incentives to improve health programs.
Assessment of Constraints to Data Use is a rapid assessment tool designed to identify barriers and constraints that inhibit effective practices in data use.
http://www.cpc.unc.edu/measure/publications/ms-11-46-a
Monitoring Referrals to Strengthen Service IntegrationMEASURE Evaluation
Presented by Dr. Cristina de la Torre for a November 2013 webinar.
Access the webinar recording at https://universityofnc.adobeconnect.com/p23708adzuz/
Evaluating Impact of OVC Programs: Standardizing our methodsMEASURE Evaluation
Jen Chapman presents on the Orphans and Vulnerable Children Program Evaluation Tool Kit, which supports PEPFAR-funded programs and helps fulfill the aims presented in the USAID Evaluation Policy.
This webinar discusses developing monitoring and evaluation (M&E) frameworks for social service systems. It outlines a 3-phase process: reviewing literature and stakeholder inputs, suggesting core indicators, and developing a final M&E framework. Two examples of functioning social service systems are provided. Key system components that could be evaluated are also identified, including leadership, workforce capacity, financing, information management, coordination, and service delivery. The purpose of the M&E framework is to guide and monitor social service system strengthening efforts.
Evaluations of Gender-Integrated Reproductive Health Interventions: A Review ...MEASURE Evaluation
This document summarizes a review of gender-integrated reproductive health intervention evaluations. The review examined 23 studies and found that most were conducted in sub-Saharan Africa and South Asia, using quantitative methods. Few studies explicitly discussed a theory of change or included power calculations in their sampling. Most collected data from only one sex and few used validated gender scales. Common gender-related outcomes examined attitudes towards gender roles and decision-making. The conclusion calls for more mixed methods studies that integrate gender considerations throughout design, sampling, and measurement.
This document provides an overview of the epidemiology of transgender populations including estimates of prevalence, challenges with data collection, and HIV risk factors. Key points include:
- There are no reliable estimates of the transgender population due to lack of data collection and social stigma. Estimates range from 1 in 30,000 to 1 in 1,000 for MTF individuals and 1 in 100,000 to 1 in 33,800 for FTM individuals.
- HIV prevalence among transgender women averages 28% according to a meta-analysis, with the highest rates among African American transgender women. Risk factors driving transmission include social stigma, gender identity validation through sex, and survival sex work.
- Very little data exists on transgender
COMMENTARYMinority Group Status and Healthful AgingSociLynellBull52
COMMENTARY
Minority Group Status and Healthful Aging:
Social Structure Still Matters
During the last 4 decades,
a rapid increase has oc-
curred in the number of sur-
vey-based and epidemio-
logical studies of the health
profiles of adults in general
and of the causes of dispar-
ities between majority and
minority Americans in par-
ticular. According to these
studies, healthful aging con-
sists of the absence of dis-
ease, or at least of the most
serious preventable diseases
and their consequences, and
findings consistently reveal
serious African American
and Hispanic disadvantages
in terms of healthful aging.
We (1) briefly review con-
ceptual and operational def-
initions of race and Hispanic
ethnicity, (2) summarize how
ethnicity-based differentials
in health are related to social
structures, and (3) empha-
size the importance of atten-
tion to the economic, politi-
cal, and institutional factors
that perpetuate poverty and
undermine healthful aging
among certain groups. {Am
J Public Health. 2006;96:
1152-1159. doi:10.2105/AJPH.
2006.085530)
Jacqueline L Angel, PhD, and Ronald J. Angel. PhD
ALTHOUGH THE SUPREME
Courl outlawed the principle of
sepajate but equal in 1954 with
its famous Brown versus Bom-d
of Education decision, many mi-
nority y^mericans luul that they
are still separate and unequal.
Despite a century of impressive
innovations in medical science
and improvements in public
health, poverty continues to un-
dermine the pliysical and emo-
tional health of a large number
of Americans, and serious ra-
cial/ethnic health disparities
persist'"^ Low-income families
have inadequate healtli care
coverage,"'^ and individuals who
lack adequate insurance are
more likely to die from cancer
and other serious diseases be-
cause of late diagnoses and defi-
cient care.^"" Perhaps the most
basic question is wliether health
disadvantages among minority
Americans are the direct and
almost complete resuit of pov-
erty and its correlates. Well-
documented correlates include
low educationai levels, labor
force disadvantages, and resi-
dential segregation iii ghettos
and barrios, where individuals
are exposed to environmental
and social health risks such as
drugs. \'io!ence. and fainily
disruption.'"^" ̂ ''
Radal/ethnic disparities in mor-
bidity and mortality are so glaring
that the federal govemment has
been forced to respond, and a
large body of research has exam-
ined tlie role socioeconomic status
(SES) and ailture play in these
disparities.'̂ The ultimate goal Ls
to identiiy the sodal stuictural
causes of inequities in health so
that genera] population health can
be impn)ved. We will present ap-
proaches to studying radal/etlinic
health disparities hy (1) reviewing
operational definitions of race and
ethnicity and tlie research tools
tliat estimate difierential disease
burdens and health au'e use,
(2) assessing jast how far the field
has come in understanding healtli.
and (3) |iro]X)sing a future re-
search agenda that examines the
soda ...
This document discusses appropriate services for sexual minority youth. It begins by defining terms used to describe various sexual orientations and gender identities. It then estimates that between 2-5% of youth identify as a sexual minority. The document discusses factors that make this group less visible and reluctant to self-identify in more conservative communities. It outlines several risks faced by sexual minority youth, such as homelessness, bullying, substance abuse, and elevated suicide rates. The document stresses the importance of providing non-discriminatory, welcoming, and person-first services to sexual minority youth.
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
Running Head: COMMUNITY ANALYSIS 1
Community Analysis
The most prevalent risk factors among racial and ethnic minorities are unprotected vaginal or anal sex, inadequate sex education, improving access to prevention and care services and drug use. Jackson, MS has a population of 173,212, with median household income of $32,250. Poverty is one of the major contributing factors to the risky behaviors and the rise of HIV infections within racial/ethnic minority youths. The residents with incomes below the poverty level in Jackson, MS by 2015 was 39.9%, and those with income below 50% of the poverty level was 19.2%, the breakdown is between ages 13 to 19 years of poor residents in Jackson, MS and the percentage is below half of poverty level of 20%. The most common race or ethnicity living below the poverty line in Jackson, MS is Black or African American, followed by White and Hispanic or Latino. The state of homelessness is on the rise and many of these shelters in Jackson, MS now have waiting lists with majority of its occupants are racial/ethnic minority. Even with the waiting lists, those that need to be sheltered will have to call ahead to confirm (City Data, 2015).
Mississippi is one of the most rustic states in the United States and its population is perhaps the poorest. According to the 2010 Census, Mississippi has a population of 2,967,297 people, with a racial distribution of 59% white, 37% black, 3% Hispanic, and 2% other. Mississippi ranks second in the nation (after the District of Columbia) for the highest proportion of African Americans. Through U.S. Census Bureau 2011 American Community Surveys, Mississippi levels the first in the country for the number of people living in poverty (22.6% of the total population) and the lowest middle household revenue ($36,919) (United State Census Bureau, 2011). According to the 2011 National HIV Surveillance Report, Mississippi had the 4th highest rate of HIV infection in the United States. The state’s capital city, Jackson, had the third highest rate of HIV diagnoses within aged 13 to 19 years and the eighth highest AIDS diagnosis by metropolitan statistical area (MSA) in 2011. For the past twenty years, numbers of peoples living with HIV in Mississippi has risen yearly. By the end of December 31, 2013, there was approximately 10,473 Mississippians living with HIV (National HIV Surveillance Report, 2013).
Secondary data
Jackson, MS the state’s capital city and with the most new HIV disease cases are identified in the West Central Public Health District V, which includes the metropolitan Jackson Hinds area, where 47% of all persons with HIV disease in Mississippi reside presently (Mississippi State Department of Health, 2015). According to data for states and metropolitan areas, it’s shown that racial and ethnic minority youths aged between 13 to 19 years rank 4th in the diagnose of HIV at 44.7%. The education b ...
Material Hardship and Self-Rated Mental Healthamong Older Bl.docxalfredacavx97
Material Hardship and Self-Rated Mental Health
among Older Black Americans in the National
Survey of American Life
Gillian L. Marshall, Roland J. Thorpe Jr., and Sarah L. Szanton
This article examines the association between material hardships and self-rated mental
health (SRMH) among older black Americans and determines whether the effect varies by
race and ethnicity. Using data from the National Survey of American Life, multiple logistic
regression models were specified on a sample of older white Americans (n = 289), African
Americans (n = 1,135), and black Caribbean Americans (n = 377). Material hardship was
measured as an index of seven items that occurred within the past year. Material hardship
(odds ratio = 0.48; 95 percent confidence interval = 0.29–0.79) was associated with SRMH
for both groups. None of the interactions were significant. The study concludes that mater-
ial hardship may contribute to poorer SRMH among older African Americans and black
Caribbean Americans. Future studies should examine these associations by using longitu-
dinal designs, which may be better designed to confirm these results.
KEY WORDS: African Americans; black Caribbean Americans; material hardship; mental health
Although federal agencies such as theNational Institutes of Health [NIH], theNational Academy of Medicine [NAM]
(formerly the Institute of Medicine), and the Admin-
istration on Aging (AoA) have goals of reducing or
eliminating mental health disparities across the life
course (AoA, 2001; U.S. Department of Health and
Human Services [HHS], AoA, 2008), significant
racial, ethnic, and economic disparities in mental
health persist. This is particularly true among older
adults (AoA, 2001). One of the goals set out by NIH
and NAM has been to better understand and reduce
socioeconomic and racial health disparities.
Earlier work suggests that socioeconomic status
(SES), in part, is one mechanism by which health dis-
parities exist (Williams & Collins, 1995; Williams, Yu,
Jackson, & Anderson, 1997). The impact of SES as a
risk factor resulting in poor health outcomes has been
well documented (Braveman, Cubbin, Egerter, Wil-
liams, & Pamuk, 2010; Farmer & Ferraro, 2005; Lantz,
House, Mero, & Williams, 2005). Although the con-
tribution of SES is important in that it has been a ma-
jor source for understanding health disparities, it still
does not fully explain the gap in health that remains or
the pathway by which low income affects health
(Whitfield, Thorpe, & Szanton, 2011). SES indicators
other than education, income, and occupation may
be worth exploring. Some evidence suggests that
the differences in the relationship between low SES
and poor health outcomes may be attributed to eco-
nomic hardships (Kahn & Pearlin, 2006; Krause, 1987;
Szanton et al., 2008; Szanton, Thorpe, & Whitfield,
2010; Thorpe, Szanton, Bell, & Whitfield, 2013).
Material hardship, for example, complements mea-
sures of SES in an attempt to capture hardships ex-
perienced r.
HIV Prevention And Health Service Needs Of The Transgender Community In San F...Santé des trans
This document summarizes the findings of focus groups conducted with 100 transgender individuals in San Francisco to understand their HIV risk behaviors and access to prevention and health services. Key findings include:
1) Sex work was commonly discussed and seen as necessary due to discrimination, though it increased HIV risk. Unprotected sex was also common due to low self-esteem and desire for validation.
2) Participants reported barriers like insensitivity of providers and fear of discrimination prevented access to services.
3) Recommendations included hiring transgender staff and training providers to be more sensitive.
A psychological autopsy of an intellectually gifted student with attention de...KarinaBorges32
This document presents a psychological autopsy of an 18-year-old male who was intellectually gifted but also had attention deficit disorder. The autopsy uses theories of suicide and research on gifted students to analyze his life and death by suicide. It finds that he exhibited traits common to other gifted students who died by suicide, like intense emotions, polarized thinking, and discussions of suicide with peers. Schools need resources to support students with dual exceptionalities to prevent future deaths. Understanding the unique experiences of gifted students can help identify those at risk and promote their well-being.
This document discusses racial micro-aggressions, which are brief everyday exchanges that send denigrating messages to people of color. The session will discuss research finding micro-aggressions in healthcare, academic, and other settings and how they negatively impact sense of belonging. Examples of micro-aggressions are provided. Continued racial micro-aggressions can cause psychological distress in individuals. Strategies for improving organizational climate and culture will also be discussed.
This document provides a summary of recent research related to racism. It begins with an introduction from Dr. Zarrin Siddiqui, the president of ECCWA Research, stating the organization's goal of promoting multiculturalism. The document then summarizes six research articles on topics related to racism, including how exposure to racism affects birth outcomes for African American women, the relationship between structural racism and risk of heart attacks among black Americans, and discourses of denial around racism in local anti-racism efforts in Australia. The introduction notes that ECCWA Research Briefs are intended to keep abreast of recent research important for ethnic communities and provide overviews of key issues.
The document summarizes a study on LGBTQ youth and internet use which surveyed over 5,500 teenagers recruited through an online polling panel and GLSEN. Key points:
- 22% identified as gay, lesbian, or queer while 67% identified as straight
- 3% identified as transgender or another gender
- The study aimed to understand challenges in surveying LGBTQ youth due to small population sizes
Running Head:
JUVENILE RECIDIVISM
1 1 JUVENILE RECIDIVISM
4
2 Juvenile Recidivism Annotated Bibliography
Ronald S. Dixon Keiser University Dr. Carolyn Dennis MACJ513 October 1, 2017 ANNOTATED BIBLIOGRAPHY Aalsma, M.
2 C., White, L.
M., Lau, K.
L., Perkins, A., Monahan, P., & Grisso, T.
(2015).
2 Behavioral Health Care Needs, Detention-Based Care, and Criminal Recidivism at Community Reentry from Juvenile Detention:
A Multisite Survival Curve Analysis.
American Journal of Public Health, 105(7), 1372-1378.
3 doi:10.2105/AJPH.2014.302529
The authors of the article are researcher-practitioners in contribution to the field of criminology especially in relevance to juvenile delinquency. Matthew Aalsma, Laura White, and Katherine L Lau work with the Division of Pediatrics, Indiana University School of Medicine, and Indianapolis.
2 Anthony Perkins works with Precision Statistical Consulting, LLC, Indianapolis, IN.
Patrick Monahan is with the Division of Biostatistics, Indiana University School of Medicine.
Thomas Grisso collaborates with the Division of Psychiatry, University of Massachusetts Medical School, and Worcester.
The examination was chiefly routed to fulfill the discoveries of past comparative looks into to the Indiana Criminal Justice Institute and the US Division of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Curriculum. The exploration question in the examination looks to address the effect of behavioral wellbeing administrations to adolescents on recidivism. Particularly the exploration inspected the effect of policy on the young people of the province of Indiana. The approach included two key components. Information about behavioral prosperity needs, behavioral well-being treatment got, and recidivism was found inside a year after release for 8363 adolescents (developed 12-18 years; 79.4% male). After the investigation, the examination group watched that discoveries reinforce past research showing that restorative behavioral issues are related to recidivism and that Black teenagers are unnecessarily rearrested after containment.
Barrett, D.
2 E., & Katsiyannis, A.
(2015).
2 Juvenile Delinquency Recidivism:
Are Black and White Youth Vulnerable to the Same Risk Factors?
Behavioral Disorders, 40(3), 184-195.
The article is a research study carried out by using archived data from the state of South Carolina's juvenile justice agency in contribution to examining the risk level associated with both blacks and white teens in the state of Carolina, in the USA. The research addresses the judicial system of South Carolina as well as future researchers and practitioners in the field of juvenile delinquency. The authors have proficient knowledge in education studies and other specialties. David Barrett is a licensed psychologist and has previously worked in the National Institute of mental health's laboratory of development phycology. He has extensive knowledge ...
ORIGINAL ARTICLE Curretit health c&e delivery sites’ Ii,’.docxjacksnathalie
ORIGINAL ARTICLE
Curretit health c&e delivery sites’: Ii,’
are examined, and recommenda- ’
tions are given for improvement
of both practitioner skills and
health care programs targeting
these youth. J Pediatr Health
Care. (1997). 11, 266-274.
Psychosocial Issues in
Primary Care of
Lesbian, Gay,
Bisexual, and
Pansgender Youth
Jennifer L. Kreiss, MN, RN, and
Diana L. Patterson, DSN
T he passage through puberty, peer group acceptance, and
the establishment of a personal identity are all developmental
tasks of the adolescent years. For the youth who is lesbian, gay,
bisexual, or transgender, self-acceptance and identity forma-
tion in the face of a heterosexist society are difficult tasks asso-
ciated with many risks to physical, emotional, and social
health. Gay and bisexual males are at particularly high risk for
acquiring sexually transmitted diseases, including human
Jennifer L. Kreiss is a Pediatric Nurse Practitioner at Children’s Hospital & Medical Center in Seattle,
Washington.
Diana L. Patterson is an Assistant Professor in Family and Child Nursing at the University of Washington and is
Nursing Discipline Head at Adolescent Clinic at the University of Washington in Seattle, Washington.
Reprint requests: Jennifer Kreiss, MN, RN, Children’s Hospital Medical Center, 4800 Sand Point Way NE, P.O.
Box 5371, Seattle, WA 98105-0371.
Copyright 0 1997 by the National Association of Pediatric Nurse Associates & Practitioners.
0891.5245/97/$5.00 + 0 25/l/79212
266 November/December 1997
Kreiss & Patterson
immunodeficiency virus and ac-
quired immunodeficiency syn-
drome (Zenilman, 1988). Lesbian,
gay, bisexual, and transgender
youth are also at increased risk for
low self-esteem, depression, sui-
cide (Remafedi, Farrow, & De&her,
1991), substance abuse, school
problems, family rejection and dis-
cord, running away, homelessness,
and prostitution (Kruks, 1991;
Remafedi, 1990; Savin-Williams,
1994). The psychosocial health con-
cerns faced by sexual minority
youth are primarily the result of
societal stigma, hatred, hostility,
isolation, and alienation (American
Academy of Pediatrics Committee
on Adolescence, 1993). One of the
roles of the primary health care
provider is to recognize adoles-
cents who are struggling with sex-
ual orientation issues and support
a healthy passage through the spe-
cial challenges of the teen years.
In recent years homosexuality
has become increasingly main-
stream. Images of lesbians and gay
men are visible in every venue of
popular culture, from television
shows and films to famous sports
stars and musicians. Presidential
speeches and national debates
occur on questions of gays in the
military, gay marriage and parent-
ing, domestic partnerships, and the
acquired immunodeficiency syn-
drome epidemic. The heightened
public awareness makes it easier
for adolescents to recognize the
meaning of same-sex attractions
and to self-.
1) The document discusses gaps in post-sexual assault healthcare among homeless young adults. It reports on a study of 1,405 young adults aged 18-26 across 7 US cities.
2) The study found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received post-assault medical care.
3) Latinx young adults were more likely than other groups to receive post-assault care. Participants frequently did not seek care because they did not want to involve the legal system and did not think it was important.
Using ethnography to generate culturally based interventions_schensul_5.3.12CORE Group
The document describes how ethnography was used to inform culturally-based interventions in India. It summarizes how ethnographic research identified key cultural concepts in local communities, such as "gupt rog" among men and "safed pani" among women, which were used as entry points for public health programs. Focusing on these emic perspectives allowed the design of interventions that were salient, engaged community participation, and had potential for sustainability.
Gaps in Sexual Assault Health Care Among Homeless Young Adults.pdfsdfghj21
This document summarizes a study examining gaps in sexual assault health care among homeless young adults in the United States. The study surveyed 1,405 homeless young adults aged 18-26 across 7 cities. It found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received a post-sexual assault medical examination. The study aims to identify barriers and facilitators to receiving post-assault care in order to improve prevention and healthcare services for this at-risk population.
This study compared racial preferences in mate choice between individuals raised in multicultural communities versus monocultural communities. A survey was administered to individuals from both types of communities. Results showed that individuals from multicultural communities demonstrated a preference for disassortative mating at a higher rate (57.4%) than those from monocultural communities (25.7%), who showed a preference for assortative mating (69.2%). A chi-squared test revealed a statistically significant difference between the groups. The findings suggest that evolutionary factors like increasing genetic homogeneity influence stronger assortative mating preferences in monocultural environments.
This document discusses how racism and racial inequalities impact health. It finds that racial disparities in health persist even after accounting for socioeconomic status. Black Americans have higher rates of disease, worse health outcomes, and shorter life expectancies than white Americans. Discrimination operates through multiple pathways like restricting socioeconomic attainment, segregating communities, and directly impacting stress levels. Both chronic everyday discrimination and acute major discriminatory experiences are associated with worse health. Place and environment also matter - segregated communities tend to be more disadvantaged and have worse health outcomes. Discrimination within the medical system also negatively impacts health. Overall, racism appears to be a major driver of the significant and persistent racial inequalities seen in health.
Similar to Measuring Ethnic and Sexual Identities: Lessons from Two Studies in Central America (20)
Managing missing values in routinely reported data: One approach from the Dem...MEASURE Evaluation
This Data for Impact webinar was held in December 2020. Access the recording and learn more at https://www.data4impactproject.org/resources/webinars/managing-missing-values-in-routinely-reported-data-one-approach-from-the-democratic-republic-of-the-congo/
This Data for Impact webinar took place October 29, 2020. Learn more at https://www.data4impactproject.org/resources/webinars/use-of-routine-data-for-economic-evaluations/
Data for Impact hosted a one-hour webinar sharing guidance for using routine data in evaluations. More: https://www.data4impactproject.org/resources/webinars/routine-data-use-in-evaluation-practical-guidance/
Tuberculosis/HIV Mobility Study: Objectives and BackgroundMEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Understanding Referral Networks for Adolescent Girls and Young WomenMEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Data for Impact: Lessons Learned in Using the Ripple Effects Mapping MethodMEASURE Evaluation
The document summarizes experiences using the Ripple Effects Mapping (REM) method to evaluate development programs in Tanzania and Botswana. REM is a participatory method that engages stakeholders to visually map the different effects of a program. The summaries describe:
1) How REM was used to evaluate a governance program in Tanzania, including training facilitators, conducting interviews and group mapping sessions, and analyzing results.
2) Tailoring REM for evaluating a youth program in Botswana, such as adjusting questions for younger participants and capturing complex outcomes.
3) Lessons learned about facilitating REM, including the need for extensive training, tailoring the method to the population, and allowing time for discussion to fully explore outcomes
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Development and Validation of a Reproductive Empowerment ScaleMEASURE Evaluation
This document describes a study that developed and validated a Reproductive Empowerment Scale for use in Nigeria. Researchers created items to measure women's agency regarding their reproductive health and tested the scale's psychometric properties. The results supported the scale as a valid and reliable measure of reproductive empowerment for women in Nigeria.
Sustaining the Impact: MEASURE Evaluation Conversation on Maternal and Child ...MEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like depression and anxiety.
Using Most Significant Change in a Mixed-Methods Evaluation in UgandaMEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Lessons Learned In Using the Most Significant Change Technique in EvaluationMEASURE Evaluation
This document summarizes lessons learned from using the Most Significant Change (MSC) technique in evaluations conducted in five countries. The MSC technique involves collecting stories from participants about significant changes resulting from an intervention, analyzing the stories to identify themes, and sharing the stories with stakeholders. The document discusses strengths and limitations of MSC, provides examples of its application in different programs and countries, and identifies lessons learned. Key lessons are that MSC generates rich qualitative data but requires careful facilitation and training, and follow-up interviews can further strengthen learning from the approach.
Malaria Data Quality and Use in Selected Centers of Excellence in Madagascar:...MEASURE Evaluation
This document summarizes the results of a cross-sectional baseline survey assessing malaria data quality and use in health centers in Madagascar that were selected as Centers of Excellence to improve data practices. The survey found that while reporting completeness and timeliness were high, data accuracy remained an issue. Baseline performance on data quality indicators was similar between the intervention sites that would implement Centers of Excellence and control sites. The implementation of Centers of Excellence aims to drive improvements in data quality, analysis, and use for decision-making in Madagascar.
Evaluating National Malaria Programs’ Impact in Moderate- and Low-Transmissio...MEASURE Evaluation
The framework highlights the importance of routine surveillance data and confirmed malaria incidence for evaluating national malaria programs in low- and moderate-transmission settings. Process evaluations assess program performance and coverage to determine when impact evaluations are needed. Impact evaluations then measure reductions in malaria burden using methods like interrupted time series and constructed controls while accounting for other factors. Key challenges include defining intervention maturity and coverage thresholds needed to achieve measurable impact. The framework emphasizes continuous evaluation along the implementation and impact pathways to guide program decisions.
Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation ...MEASURE Evaluation
MEASURE Evaluation's support between 2015-2018 likely contributed to significant improvements in Madagascar's malaria surveillance system. Key improvements included: 1) availability of guiding documents, 2) increased completeness and timeliness of facility and community reporting, and 3) establishment of a culture of data dissemination and use. Data quality, reporting rates, and staff capacity all significantly increased over this period according to the assessment. Continued support is needed as Madagascar works towards malaria elimination.
Lessons learned in using process tracing for evaluationMEASURE Evaluation
Access the recording for this Data for Impact (D4I) webinar at https://www.data4impactproject.org/lessons-learned-in-using-process-tracing-for-evaluation/
Use of Qualitative Comparative Analysis in the Assessment of the Actionable D...MEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help regulate emotions and stress levels.
Sustaining the Impact: MEASURE Evaluation Conversation on Health InformaticsMEASURE Evaluation
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
District Residency Programme (DRP) for PGs in India.pptx
Measuring Ethnic and Sexual Identities: Lessons from Two Studies in Central America
1. Measuring Ethnic and
Sexual Identities
Lessons from two studies in Central America
2. Session Objectives
After the presentations, participants will be able to:
Give examples of ethnic and sexual identity-related
questions from two recent studies
Relate how these constructs were central to the
research questions
Highlight implications for the studies‟ findings
Apply lessons learned to other research efforts
3. Ethnicity and HIV Risk Factors
in Guatemala:
Measuring indigenous identity and its effects
4. Study Overview
Indigenous Guatemalans are highly
disadvantaged on many measures of
health and well-being – are they also
at higher risk for HIV?
Secondary analysis of the ENSMI
(DHS) women‟s and men‟s datasets
from 2008-09
Multivariate logistic regression for
different ethnic groups on 5 factors
(early sexual debut, lifetime sexual
partners, HIV knowledge, HIV
testing, sex worker patronage)
http://www.cpc.unc.edu/measure/publications/tr-12-86
5. Ethnicity in Guatemala
The government of Guatemala recognizes four pueblos:
Ladino, Maya, Xinca and Garífuna
Around 60% of the population is ladino; the other three
groups are officially designated as indigenous
Mayans constitute 99% of the indigenous population
Twenty-three linguistically distinct Mayan subgroups are
centered in the country‟s rural western highlands
6. Who is indigenous, who is ladino?
Ethnicity is mutable and multidimensional, but most
surveys use a single categorical variable to measure it
ENSMI and the national census have long histories of
obtaining data on ethnicity via „interviewer‟s observation‟
In 2008-09, an ethnic self-identity question was added:
“Do you consider yourself to be indigenous, ladino, or
some other ethnicity?”
7. Ethnicity in the 2008-09 ENSMI
Men Women
4% 3%
37%
44%
44%
47%
8% 13%
Indigenous Cross-Identified* Ladino Other/No Response
*Respondents who self-identified as indigenous but were identified by the interviewer as ladino
8. Long histories and broad ramifications
In 1950, census enumerators classified 4% of locally-
identified indigenous Guatemalans as ladino; in 1964,
16% were cross-classified (Early, 1974)
A 1998 study in Brazil concluded that previous studies
had underestimated the country‟s racial inequality,
because they relied on self-classification (Telles & Lim)
Cause of death affects coroners‟ classification of US
decedents‟ race in 1993: “non-racial characteristics thus
shape official statistics” (Noymer et. al, 2011)
9. Why does it matter how we measure
ethnicity in Guatemala?
Different dimensions of ethnic identity might have different
effects on HIV risk and other outcomes there
The validity and reliability of ethnicity questions, including
the two in current use, may vary
Conclusions about the size and vulnerability of different
groups can affect program and policy decisions
The Government of Guatemala officially supports ethnic
self-determination
10. “A dispute over ethnicity marked census-taking day in Bolivia as
the landlocked Andean nation's population submitted
Wednesday to its first national head count in 11 years.”
Text: Carlos Valdez for the Associated Press, 2012. Photos: Página Siete, La Razon
11. “After more than a century, the Census Bureau is
dropping its use of the word „Negro‟ to describe black
Americans in surveys”
Source: Jason Howerton for the Associated Press, 2013
12. Ethnicity in our analysis
Should cross-identified respondents in Guatemala be
considered indigenous or ladino? What matters more:
ethnic self-identity or the interviewer‟s observation?
Regardless of how its members were identified, the
indigenous group had lower adjusted odds of sexual risk,
comprehensive knowledge and HIV testing
But these results obscured the profile of cross-identified
respondents, a group with unique potential to explain
possible measurement effects
13. Three categories instead of two
Self- Interviewer
Categories identification Observation
Indigenous Indigenous Indigenous
Cross-identified Indigenous Ladino
Ladino Ladino Ladino
14. Illustrative Adjusted Odds Ratios of HIV risk by Ethnicity
WOMEN MEN
Adjusted OR Adjusted OR
Ever tested for HIV
Indigenous Reference Reference
Cross-identified 2.46 (1.93-3.13)*** 1.18 (0.64-2.16)
Ladino 2.25 (1.98-3.03)*** 1.57 (0.95-2.59)*
Comprehensive HIV Knowledge
Indigenous Reference Reference
Cross-identified 1.17 (0.95-1.43) 1.46 (0.97-2.22)*
Ladino 1.63 (1.40-1.89)*** 1.58 (1.27-1.97)***
*p<0.10; **p<0.05; ***p<0.001
^Adjusted for age, education, marital status, household wealth
quintile, urban/rural residence, geographic region of residence
15. “The strength of relationship between
ethnicity and health outcomes
appears influenced by „acculturation,‟
the extent to which members of an
ethnic group have adopted the beliefs
and practices of another group.”
(Ford and Kelly, 2005)
16. Conclusions
Guatemalans construct ethnic self-identities that aren‟t
reliably predicted by the “interviewer‟s observation,” but
both may reflect useful concepts for health research
Using an ethnic self-identity measure could increase the
estimated size of the indigenous population in Guatemala
by as much as 13%
Ethnic self-identification has clear potential to increase
estimates of HIV risk in the indigenous population,
because of acculturation among the cross-identified
17. Conclusions (cont.)
The choice of measure could also have profound
implications for analyses gauging ethnic disparities on
other health outcomes
If the cross-identified population grows, these
measurement effects would be even more substantial
Researchers should consider investing in formative
research for question design, and engage indigenous
communities in these efforts
18. Next Steps
Guatemala‟s Presidential Commission against Indigenous
Racism and Discrimination is holding high-level meetings
to discuss the findings of the study and implications for
measuring ethnicity in national studies
Both categorical ethnicity measures as well as ethnic
markers (language, traditional dress), will likely be
included in the 2013 ENSMI
Analysis of these data could identify the questions or
question sets with the highest construct validity, and that
best distinguish population groups on health outcomes
19. Health Service Utilization among
Men Who Have Sex with Men and
Transgender Women
in El Salvador:
Using gender identity and
sexual orientation as distinct constructs
20. Evolution of Public Health Approach
to Sexual Minorities
Homosexuality classified as a mental disorder in the DSM until
1973.
Specific health needs of sexual minorities largely unexplored
until the HIV epidemic in mid-1980s.
Increased vulnerability to HIV led to a focus on gay men as a
“risk group,” increasing stigma, both for these groups and
people living with HIV.
Movement to focus on behavior that increased transmission
risk for HIV, i.e. “MSM - men who have sex with men.”
21. Diversity among Sexual Minorities
MSM
MSM is a population that has emerged from HIV research
and practice (1992)1
Defines the population based on a high-risk sexual behavior vs.
sexual orientation (homosexual, gay, bisexual, heterosexual)
Allows for inclusion of men who do not identify as
gay/homosexual and have sex with other men.
Examples include: gay-identified men, heterosexual men who
have sex with other men, bisexual men, male sex workers
(regardless of their sexual orientation)
22. Diversity among Sexual Minorities
Transgender
A transgender (trans) person is someone whose gender identity
differs from their biological sex (assigned to them at birth)
Gender: What society believes about the appropriate roles, duties,
rights, responsibilities, accepted behaviors, opportunities and status
of men and women, in relation to one another
Gender-identity is a personal sense of being a man, woman or
something different, regardless of their sexual orientation
Transgender women is a common term for people born biologically
male with female identification or expression
23. Study Overview
USAID‟s Central American
Regional HIV Program
requested that MEASURE
conduct a study of health
service utilization among
MSM in San Salvador to
inform HIV prevention
programming
24. Challenge
Do we include or exclude
TW from our study?
Local TW groups strongly
advocated to not be
considered as MSM, but they
wanted data about their
population
Did not have sufficient funding
for a TW-specific study
25. How to include MSM and TW as part of
the study population?
Representation in the Measuring constructs
study population: accurately:
Outreach to/input from TW Outreach to/input from TW
organizations, field team organizations, field team
Inclusive eligibility criteria Separate gender identity
and questions and sexual orientation
TW as part of interviewer measures
team
Inclusion of TW seed
26. Reframing study eligibility criteria
2008 Biological and behavioral surveillance
study
A man who had anal sex with another man in the last
12 months
2011 Health Service Utilization study
A man or transgender woman who had anal sex
(receptive or penetrative) with another man or
transgender woman in the last 12 months
27. Questions inclusive of TW
EXAMPLES:
The last time you had an HIV test, did the provider
have sufficient knowledge about the health needs of
men who have sex with men or transgender women?
Approximately how many people know that you form
sexual relationships with men or transgender
women?
28. Gender Identity: Sexual
Orientation
Personal sense of
being a man or a
woman or
something different
≠ One‟s erotic and
emotional attraction
to another
• Man • Gay/Homosexual
• Woman • Bisexual
• Trans Woman • Heterosexual
• Trans Man • Others
• Others
29. EL SALVADOR Biological and Behavioral
Surveillance Study 2008
Sexually, how do you identify yourself?
1 = Heterosexual
2 = Bisexual Sexual Orientation
3 = Gay/Homosexual
4 = Transvestite
5 = Transsexual
Gender Identity
6 = Transgender
7 = Other
30. Separating Sexual Orientation and
Gender Identity
Sexual Orientation Gender identity
In terms of your sexual What is your gender
orientation, how do you identify? (read responses)
identify? Man
Gay / homosexual Woman
Bisexual Transgender woman
Heterosexual Other ________________
Other _______________
31. Representation of TW in 2008 BBSS
compared to 2011 HSU study
2008 BBSS 2011 HSU study
91.0%
81.5%
18.5%
9.1%
Percent of sample population Percent of sample population
TW, n=67 MSM, n=508 TW, n=164 MSM, n=506
32. Sexual orientation by gender identity
MSM TW
Gay/homosexual Bisexual Heterosexual Gay/homosexual Bisexual Heterosexual
52.0%
81.1%
43.2%
4.7% 11.1% 7.8%
Sexual orientation Sexual orientation
33. Medical insurance and regular health
care provider, by gender identity
MSM (n=506)
25% 27%
Trans women
(n=164)
14%
10%
Medical insurance Regular health care provider
34. Experiences of discrimination by a health
care provider for being MSM or a trans
woman (n=669)
71% 76% 74% 69%
52% 56% 55% 55%
Treated with less Received poorer Refused services ** Needed to act more
respect** quality of services** masculine*
MSM Trans women
35. Social vulnerability by gender identity
53.4%
28.6% 24.9% 29.0%
15.6%
12.5%
Homelessness** Incarceration* Sex work**
MSM TW
36. Abuse and maltreatment due to sexual
orientation
Maltreatment and
abuse was defined
as, hitting, punching, k
icking, threats, scoldin
g or humiliations
21% 21%
MSM (n=506)
TW (n=164)
Victim of abuse of maltreatment due to sexual orientation
37. Conclusions
Framing of eligibility criteria, composition of field
team, and diversity in seeds for RDS, can achieve a
larger proportion of TW as part of MSM studies
Distinguishing between gender identity and sexual
orientation as separate constructs is a more accurate
measurement technique, and allowed for a more
nuanced understanding of the needs of each
subgroup.
38. Works cited
1. Beyrer, C. Baral, S. van Griensve, F. et al. (2012). Global epidemiology
of HIV infection in men who have sex with men. Lancet. Vol. 380: 367-
377.
2. Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C.
Worldwide burden of HIV in transgender women: a systematic review and
meta-analysis. Lancet Infect Dis 2013,13:214-222.
3. Minesterio de Salud Pulica y Asistencia Social, Universidad de Valle, y
Centros para la Prevencion y Control de Enfermedades. Encuesta
Centroamericana de Vigilancia de Compartamiento Sexual y Prevalencia
de VIH/ITS en Poblaciones Vulnerables, El Salvador. In; 2009.
4. Joing United Nations Programme on HIV/AIDS; Country Fact Sheet, El
Salvador, 2009.
39. Special thanks to USAID Guatemala and the
USAID Central America Regional HIV/AIDS
Program for providing the support that made
this work possible!
MEASURE Evaluation is a MEASURE project funded by the U.S. Agency
for International Development and implemented by the Carolina Population
Center at the University of North Carolina at Chapel Hill in partnership with
Futures Group International, ICF Macro, John Snow, Inc., Management
Sciences for Health, and Tulane University. Views expressed in this
presentation do not necessarily reflect the views of USAID or the U.S.
Government. MEASURE Evaluation is the USAID Global Health Bureau's
primary vehicle for supporting improvements in monitoring and evaluation
in population, health and nutrition worldwide.
Visit us online at http://www.cpc.unc.edu/measure.
41. Increased Risk for HIV among MSM & TW
Disproportionate burden of HIV among men who have sex
with men (MSM) and transgender women (TW) in both
generalized and concentrated epidemic settings.
Globally, the prevalence of HIV among MSM is estimated to
be between 14-18%1 , and 19.1% among TW2.
In San Salvador HIV prevalence among MSM is estimated at
10.8% among MSM and 9.7%% among TW3, but is only 0.8%
for general population of El Salvador5.
42. NICARAGUA Biological and Behavioral
Surveillance Study 2009-2010
Among men who have sex with men there are those who self-
identify as gay, bisexual, heterosexual, transvestite,
transsexual, transgender. How do you self-identify?
1 = Heterosexual
2 = Bisexual
Sexual Orientation
3 = Gay
4 = Homosexual
5 = Transvestite
6 = Transsexual Gender Identity
7 = Transgender
8 = Other
43. Respondent-Driven Sampling10
A variant of chain referral sampling, wherein peers
recruit peers.
Designed to reach “hidden” populations that are socially
networked.
A coupon system is used to link recruits/recruiters, and
secondary incentives.
Initiated by purposively selected members of the target
population, “seeds.”
Reduces biases associated with chain-referral methods
by limiting the number of coupons per participant, and
achieving long recruitment chains that allows the sample
to reach “equilibrium.”
45. Gender Identity & Sexual Orientation
% (IC 95%)
Gender Identity
Male 81.5 (76.9-85.7)
Trans female/Female 18.5 (14.3-23.1)
Sexual Orientation
Man - Gay / Homosexual 37.9 (32.1-43.4)
Man - Bisexual / Heterosexual 43.7 (38.0-50.7)
Trans woman - Heterosexual 14.3 (10.5-18.1)
Trans woman - Gay / Bisexual 4.1 (2.0-6.0)
Editor's Notes
Measuring ethnicity, especially indigenousness, but not race is common in Latin America. At least one country, Ecuador, has also included both the interviewer’s observation and respondent’s self-identity in censuses (Hall and Patrinos, ed., 2006)Bolivia in 2001 characterized respondents as indigenous or not using a matrix of language and self-identity variables (Comisión Económica para América Latina y el Caribe, CEPAL, 2005)
84% of women and 88% of men in the 2008-09 survey identified themselves the same way the interviewer did, as either indigenous or ladino13% of women and 8% of men self-identified as indigenous, but were identified by the interviewer as ladinoCross-identification in the other direction was rare (around2%), and the remaining cases had ‘other’ or no response on one or both ethnicity variables
Lots of other countries, including the US, have grappled for decades with differences between these two measures, and with deciding which one is “right” or best for a certain research or policy context.
Why can’t we just choose the measure that’s easiest or cheapest to implement?Newer DHS data using self-identity aren’t directly comparable with results from previous years, the main reason official reports continue to present the interviewer’s observation alone.
Some political and implementation issues that have arisen elsewhere:In 2012 Bolivia’s census recorded respondents’ identification with any one of 40 indigenous groups or Afro-Bolivian, but did not include “mestizo.” Critics suggested that the decision was “calculated to protect Evo Morales' presidency” and fears of expropriation reportedly led people to underreport their assets.
Why do you think the US Census Bureau would risk offending people by keeping the term “Negro” in its questionnaire?Before 1960, census-takers filled out the form and chose the category for each person they counted. Self-identification was fully in place by 1970.
In preliminary work using a dichotomous ethnicity variable, we tested effect sizes both ways.Although our answer to the question “Is the indigenous group at higher risk?” didn’t change, ethnicity did show stronger effects on HIV risk factors using the interviewer’s observation (e.g. differences between the two groups were more pronounced)
We added a third category to the independent variable, comparing odds for ladinos and the cross-identified group separately to those for indigenous respondents.
On nearly every outcome, the ladino and cross-identified groups were comparably (and significantly) different from indigenous respondents.In these examples for the odds for ever having had an HIV test were 2.25 times higher for ladino women compared to indigenous women, and 2.46 times higher for cross-identified women compared to indigenous women. The odds of having comprehensive HIV knowledge were 1.58 times higher for ladino men compared to indigenous men and there was a marginal difference between cross identified men and indigenous men.
From “Conceptualizing and Categorizing Race and Ethnicity in Health Services Research,” 2005.Our results echo this conclusion. The indigenous population becomes ‘ladinoized’ if self-identification is used to determine group membership, lessening demographic and risk factor distinctions between the groups. Other studies have opted to measure acculturation directly using validated scales.
Another example: American Indianpopulationgrew 255% between 1960 and 1996, largely through changing patterns of racial self-identification. (Passel, 1996)
COSIDRA has disseminated the findings of the study nationally.High-level meetings with the National Statistics Institute, Ministries, donors and civil society to discuss the implications of our findings and of measuring ethnicity on the upcoming census.
-Delinking of behavior from lived experience, social context, to focus on individual behavior.-largely focused on sexual behavior, rather than overall health and well-beingDSM = “Diagnostic and Statistical Manual of Mental Disorders”After last bullet – while the inclusiveness of this term has increased diversity with this group, there may be a loss nuance. For example, transgender women, who are often included in this group, have different life experiences and vulnerabilities to HIV.
MSM is a population that has emerged from HIV research and practice-it’s a way to define a group based on a high-risk behavior vs. sexual orientation. You may have men who self-identify as heterosexual, be married to a woman and have sex with another man and you would be leaving them out of your study. May be harder to reach group b/c not necessarily at Gay venues, etc.-sexual orientation refers to who you are attracted to sexually, someone of the same or different biological sex
Transgender women have often been included as sub-group of MSM in much HIV research and surveillanceCoined in the 1970s, transgender referred to people who lived full-time in the gender opposite to their sex (generally) assigned at birth, but did not seek gender reassignment surgery.In the 1990s, transgender evolved to be an umbrella term to describe the identities and experiences of individuals who transgress traditional categories of sex and gender. As a personal identity, transgender is used by people who “feel a need to express a gender identity different from the one society associates with their genitals” It is an umbrella term encompassing many identities including transsexuals, cross-dressers, transvestites, intersexuals othersThe boundaries of identity for transgender people remains nebulous. Sex is generally thought of as biologically based, with the physical body, hormones and chormosomes indicating sex. Sex is usually designated soley on the physical appearance of genitalia. Categories of female and male are putatively seen as exhaustive, mutually exclusive and immutable. Some believe that sex, like gender, is also socially constructed. Gender is traditionally been viewed as a natural and essential counterpart to sex. It is an ascribed status which designates the psychological, social and cultural aspects of maleness and femaleness. Gender, gender roles and gender presentation are susceptible to cultural definitions and can change over time. Gender identity is the internal, private experience of one’s gender, it is a self-attribution of genderGender roles are social, public, with implied expectations, obligations and privileges associated with each gender.Femininity and masculinity are ideological constructions whose manifestations (women, men, girls and boys) are recreated in each generation according to the intermeshing requirements of social, cultural, econoic and biological necessities.
It is in this context that USAID’s Central American Regional HIV Program requested that MEASURE conduct a health service utilization study among MSM in San Salvador, El SalvadorThe HIV epidemic in El Salvador is concentrated among MSM, TW and Sex WorkersWe know from a 2008 HIV Prevalence and Behavior Study that HIV prevalence was 10.8% among MSM, a figure that included TW.
We faced a serious challenge when initiating the study. After El Salvador’s 2008 HIV prevalence study, TW groups were strong advocates that demanded TW specific data. They did not want to be considered a sub-group of MSM that could not be disaggregated in the results. They wanted to be able to say something about their community/population for advocacy, programming, funding, etc. We didn’t have enough money to do two separate surveys… We spent a lot of time deciding whether to include TW in the sample or exclude. As you can tell from the image of the report cover, we included them.We made this decision based on several factors: We wanted did not want to exclude such a highly vulnerable group from the studyFrom previous studies we knew that TW were highly socially connected to MSM in San Salvador and would be collected in an RDS sampleWhile we didn’t know if we would have enough TW in the study to be able to disaggregate, we coordinated with USAID’s AIDSTAR ONE Project, which was going to implement a mixed methods health services study among TW at the same time we were in the field.
What did we do? We designed a study that aimed to:Describe past-year health service utilization, including general health and HIV/STI services.Identify factors that may influence health service utilization.Determine the extent of experienced discrimination from healthcare providers We made efforts to ensure that we were explicitly acknowledging TW in our study population, byReaching out and gathering input from TW organzations and our own field teamDeveloping eligibility criteria and survey questions that were inclusive of TWIncluding a TW as part of the interviewer teamIncluding a TW as a seed in implementation of respondent driving samplingWe also made efforts to measure the related constructs accurately. Again we reached out to TW organizations, sharing our tools and gating inputImportantly, we measured gender identity and sexual orientation separately, and we will take about this in a few slides.-We anticipated getting about 10% of our sample as TW, which consistent with the 2008 BBSS and other studies in El Salvador and the region.-If we excluded TW, we would have no data on that population.-Concern about getting a small percentage, from which populations would be eager to First issue we had to confront was about representing each population in the study The second issue, was about measuring constructs appropriately in the study, so as not to generalize experiences of one group with the other (wrongly attributing findings to both groups), or to miss findings important within each group.
For bothstudies:18 years of age or olderA man or transgender woman who had anal sex (receptive or penetrative) with another man or transgender woman in the last 12 monthsLived, worked, or studied in San Salvador for at least 3 months prior to the interviewIn possession of an RDS coupon given to them by someone they know who participated in the study (exception for seeds)
Examples of how we framed quesitons to be inclusive:READ QUESTIONS
We also asked separate questions to measure gender identity and sexual orientationIn many HIV studies in concentrated epidemics, transgender women have been included as a sub-group of the MSM population. In Central America and other regions, the constructs of gender identity and sexual orientation has been conflated and generally asked a single question. As a reminder, Gender identity is defined as one’s personal sense of gender, of being a man or a woman or something different Sexual orientation is one’s erotic and emotional attraction to another. Our classification of sexual orientation is generally assumed to be based on biological sex.
Here we have an example of how the question was asked in the 2008 El Salvador Biological and Behavioral Surveillance Study. READ QUESTIONThis form of the question makes the selection of one’s gender identity and sexual orientation mutually exclusive. If you identify as a transgender, you cannot choose a sexual orientation.
In the 2011 MEASURE study, we asked two separate questions. First we asked the respondents to identify their sexual orientation.In a separate question we asked them to indicate their gender identity.
The 2011 MEASURE study had nearly twice as many TW in the study compared to the 2008 biological and behavioral surveillance study. Our study found 18.5% of the sample to be TW compared to 9.1 of the 2008 study.It is possible that there are more transgender women in our study because of the explicit inclusion of TW in the eligibility criteria.It is also possible that there appears to be more TW in our study because we measured gender identity separate from sexual orientation, while in the other study TW had to choose between sexual orientation and gender identity.2008 BBSS, only data from San Salvador is represented in this slide – pie chart?-In SM an additional 26 TW and 166 MSM participated; weighted percent in SM of TW was 12.1%; 93 TW total
There is a possibility that if a transgender woman had to choose between identifying as being heterosexual or as transgender we would have inflated the percentage of MSM considered to be heterosexual.Why important? Heterosexual MSM are considered to be hardest to reach and bridge population.
Wewerealsoabletoseedifferences in characteristics of thestudypopulationbygenderidentity.For example more MSM had medical insurance and a regular healthcareprovidercomparedtotransgenderwomen.Menos de un cuarto (menos de 25%) reportaron tener un seguro medico o proveedor regular de salud.Mas HSH tienen seguro medico y un proveedor regular que MTNota: Definición de proveedor regular – Usted tiene un médico u otro profesional de salud a quien acude normalmente cuando está enfermo o necesita cuidado médico
As anotherexampletransgenderwomenwere more likelytoreportexperiencingdiscrimanationfrom a healthcareprovidercomparedto MSM.For example 74% of TW reportedbeingrefusedhealthservicesbecause of genderidentityor sexual orientationcomparedto 55% of MSM Lamayoria de los HSH y mujeres trans experimentaron discriminación de parte de un proveedor de salud. Por ejemplo 55% fueron tratado con menos respeto por un proveedor alguna vez.59% recibio peor calidad de servicios por ser HSH/mujer transLe negaron servicios a 58% Y 58% sintio que era necesario decirle al proveedor que era heterosexual.54.4% reporto altos niveles de discriminación por parte del proveedorMT reportan MAS discriminacion por parte de un proveedor de salud HSH
We also see differences in social vulnerability between the two groups. MSM were more likely to report having been homeless in the 6 months prior to the study compared to TWWhereas, TW were more likely to report having been incarcerated or to have engaged in sex work than MSM
Surprisingly there was no difference between MSM and TW in the percentage who reported experiencing abuse or maltreatment in the past 12 months.We hypothesized that more TW women would have reported experiencing maltreatment or abuse because their stigma is generally more visible. These results may indicate that stigma takes many forms and can be equally detrimental to both groups.Nota – no hay unadiferencia entre experincias de abuso y maltrato en los ultimos 12 meses entre HSH y mujeres trans)
Increased risk due to transmission probability and contact rate.-generalized epidemic – national prevalence is above 1%-concentrated, national prevalence is below 1% but above 5% in higher risk populations-low level, mixed above 1%, but not too high, and above 5% in higher risk groups (Caribbean)
Similarly, the
-Developed as a mechanism to obtain population-based generalizable estimates of surveillance for HIV/STI
Median network size – 10 (1-350)
La mayoria se identifico como hombre, pero casi 20% se auto-identifico como mujer transgenero.En cuanto a orientacion sexual, 38% son hombres gay u homosexual. 44% son Hombres bisexuales o heterosexuales. 14% son mujeres trans que se identifican como heterosexual y 4% son mujeres trans que se identifican como gay o bisexual.Casi 69% tienen una pareja hombre o una pareja trans