Barriers to Accessing and Engaging in HIV Preventive Care and Pre-Exposure Prophylaxis Experienced by Transgender Women in Florida.

BACKGROUND: PrEP, a biomedical HIV prevention option, continues to be underutilized among transgender women who could benefit from sustained use, especially women of color and those who identify as Latina and/or reside in the southeastern US. OBJECTIVE: We explored the barriers and facilitators experienced by transgender women who live in Florida regarding accessing, using, and/or staying on PrEP. METHODS: In-depth interviews and focus groups were conducted in either Spanish or English with adult transgender women living in Florida (N = 22). The interviews were audio-recorded, transcribed, and coded in ATLAS.ti using thematic analyses. RESULTS: The mean age of the participants was 42.2 years. Among the participants, 73% were Hispanic/Latina, 59% were foreign-born, and approximately one-third were living with HIV (but had past experience with PrEP). Transgender women cited the following barriers to accessing or considering PrEP: (1) costs and benefits of PrEP use; (2) under-representation in clinical trials resulting in unknown or misinformation regarding PrEP side effects; (3) chronic poverty; and (4) trauma and discrimination. Other stressors, such as behavioral healthcare needs, were identified. CONCLUSIONS: Our analysis revealed interlocking systems of oppression like transphobia, discrimination, and misgendering, which were common barriers experienced by our participants. These synergistically epidemic (i.e., syndemic) barriers contributed to their feelings of being systematically excluded in social spaces, research, public health planning and policies, laws, and social programs related to PrEP. These structural barriers are impediments to HIV preventive care but also act as a source of stress that contributes to mental health problems, financial vulnerability, substance abuse, and other deleterious health outcomes.

Impact of Channels Aspect Ratio on the Heat Transfer in Finned Heat Sinks with Tip Clearance.

A 3D numerical study is used to analyze the flow topology and performance, in terms of heat transfer efficiency and required pumping power, of heat sink devices with different channel aspect-ratio in the presence of tip-clearance. Seven different channel aspect ratios AR, from 0.25 to 1.75, were analyzed. The flow Reynolds numbers Re, based on the average velocity evaluated in the device channels region, were in the range of 200 to 1000. Two different behaviors of the global Nusselt were obtained depending on the flow Reynolds number: for Re<600, the heat transfer increased with the channels aspect ratio, e.g., for Re=400, the global Nusselt number increased by 14% for configuration AR=1.75 when compared to configuration AR=0.25. For Re>600, the maximum Nusselt is obtained for the squared-channel configuration, and, for some configurations, flow destabilization to a unsteady regime appeared. For Re=700, Nusselt number reduced when compared with the squared-channel device, 11% and 2% for configurations with AR=0.25 and 1.75, respectively. Dimensionless pressure drop decreased with the aspect ratio for all cases. In the context of micro-devices, where the Reynolds number is small, these results indicate that the use of channels with high aspect-ratios is more beneficial, both in terms of thermal and dynamic efficiency.

Evaluation of Spanish Health System during the COVID-19 Pandemic: Accountability and Wellbeing Results.

The COVID-19 pandemic poses a challenge for health systems. For this reason, it is essential to evaluate the management of health systems in the face of the pandemic, identifying the factors that may contribute to its failure or success. This management is more difficult in decentralized countries, since in them, health competencies are distributed among different levels of government. This is the case in Spain, one of the countries most affected by the pandemic. Therefore, the aim of this article is to evaluate how the Spanish health system has managed the COVID-19 pandemic. Four factors related to health management are analyzed: transparency, communication, reputation and well-being generated. For this purpose, a quantitative analysis is used with the contrast of secondary sources, such as the Merco rankings or survey data from the Centro de Investigaciones Sociológicas (Sociological Research Center). The results show that although the flow of communication about the health system increases considerably, such information comes mainly from the media, with a deficit in the transparency of health management. Likewise, although the reputation of the health system increases at the beginning of the pandemic, as it progresses, there is a deterioration in citizen satisfaction with the healthcare management and the services provided, as well as in the well-being generated by them. This study may have implications for decision making by public authorities regarding the different factors of health management.

Microcanonical ensemble simulation method applied to discrete potential fluids.

In this work we extend the applicability of the microcanonical ensemble simulation method, originally proposed to study the Ising model [A. Hüller and M. Pleimling, Int. J. Mod. Phys. C 13, 947 (2002)0129-183110.1142/S0129183102003693], to the case of simple fluids. An algorithm is developed by measuring the transition rates probabilities between macroscopic states, that has as advantage with respect to conventional Monte Carlo NVT (MC-NVT) simulations that a continuous range of temperatures are covered in a single run. For a given density, this new algorithm provides the inverse temperature, that can be parametrized as a function of the internal energy, and the isochoric heat capacity is then evaluated through a numerical derivative. As an illustrative example we consider a fluid composed of particles interacting via a square-well (SW) pair potential of variable range. Equilibrium internal energies and isochoric heat capacities are obtained with very high accuracy compared with data obtained from MC-NVT simulations. These results are important in the context of the application of the Hüller-Pleimling method to discrete-potential systems, that are based on a generalization of the SW and square-shoulder fluids properties.

Changes in pre- to post-immigration HIV risk behaviors among recent Latino immigrants.

This prospective longitudinal study examined pre- to post-immigration HIV risk behavior trajectories among recent Latino immigrants in Miami-Dade County (Florida). We identified socio-demographic factors associated with these trajectories and collected retrospective pre-immigration HIV risk behavior data at baseline from a sample of 527 Caribbean, South American, and Central American Latinos ages 18-34 who immigrated to the U.S. less than one year prior. Two follow-up assessments (12 months apart) reported on participants' post-immigration HIV risk behaviors. Results indicated overall decreases in pre- to post-immigration condom use. In the sample, recent Latino immigrants with lower education, younger age, and higher incomes had steeper decreases in pre- to post-immigration condom use. We also found differences in the risk behavior trajectories of males and females. Latino women reported significant increases in the number of sexual partners post immigration, while men reported decreases in the number of sexual partners after immigrating to the U.S.

Condom use preferences among Latinos in Miami-Dade: emerging themes concerning men's and women's culturally-ascribed attitudes and behaviours.

Among Latinos, cultural values such as machismo and marianismo may promote inconsistent condom use representing a significant risk factor for HIV infection. Yet there continues to be a need for additional research to explore the influence these cultural values have on Latino men and women's condom use attitudes and behaviours given increasing HIV rates of HIV infection among Latinos. The purpose of this study was to explore further Latino traditional culturally-ascribed attitudes and behaviour for emerging themes toward condom use among a diverse group of adult Latino men and women living in Miami-Dade County, Florida, USA. The study used a qualitative study-design and collected data from 16 focus groups with a total of 67 Latino men and women. Findings from the focus groups described attitudes and behaviours that counter traditional gender roles towards sex and expected sexual behaviours informed by machismo and marianismo. Common attitudes noted in the study include men's classification of women as dirty-clean to determine condom use and women's assertiveness during sexual encounters negotiating condom use--in favour and against it. As the findings of this study suggest, the process differ greatly between Latino men and women, having an impact on the risk behaviours in which each engage.

Dating, marriage, and parenthood for HIV-positive heterosexual Puerto Rican men: normalizing perspectives on everyday life with HIV.

HIV-positive men are living long and healthier lives while managing HIV as a chronic illness. Although research has extensively documented the experiences of illness of people living with HIV, dating, marriage, and fatherhood among heterosexual Latino men has not been examined. To address this gap, this study used a qualitative study design to examine patterns and strategies for dating, marriage, and parenthood among 24 HIV-positive heterosexual Puerto Rican men living in Boston. The findings in our study indicate that an HIV diagnosis does not necessarily deter men from having an active sexual life, marrying, or having children. In fact, for some of the men, engaging in these social and life-changing events is part of moving on and normalizing life with HIV; these men planned for, achieved, and interpreted these events in the context of establishing normalcy with HIV. Although the HIV diagnosis discouraged some men from engaging in sexual relations, getting married, or having children, others fulfilled these desires with strategies aimed to reconciling their HIV status in their personal life, including dating or marrying HIV-positive women only. Additional important themes identified in this study include the decision to disclose HIV status to new sexual partners as well as the decision to accept the risk of HIV transmission to a child or partner in order to fulfill desires of fatherhood. Understanding the personal struggles, decision-making patterns, and needs of HIV-positive heterosexual men can aid in designing interventions that support healthy living with HIV.

Critical phenomena in the majority voter model on two-dimensional regular lattices.

In this work we studied the critical behavior of the critical point as a function of the number of nearest neighbors on two-dimensional regular lattices. We performed numerical simulations on triangular, hexagonal, and bilayer square lattices. Using standard finite-size scaling theory we found that all cases fall in the two-dimensional Ising model universality class, but that the critical point value for the bilayer lattice does not follow the regular tendency that the Ising model shows.

Pre- to postimmigration alcohol use trajectories among recent Latino immigrants.

The escalation of alcohol use among some Latino immigrant groups as their time in the United States increases has been well documented. Yet, little is known about the alcohol use behaviors of Latino immigrants before immigration. This prospective longitudinal study examines pre- to postimmigration alcohol use trajectories among a cohort of recent Latino immigrants. Retrospective preimmigration data were collected at baseline from a sample of 455 Cuban, South American, and Central American Latinos ages 18-34 who immigrated to the United States less than 1 year prior. Two follow-up assessments (12 months apart) reported on their postimmigration alcohol use in the past 90 days. We hypothesized (a) overall declines in pre- to postimmigration alcohol among recent Latino immigrants and (b) gender/documentation specific effects, with higher rates of alcohol use among males and undocumented participants compared to their female and documented counterparts. Growth curve analyses revealed males had higher levels of preimmigration alcohol use with steeper declines in postimmigration alcohol use compared to females. Declines in alcohol use frequency were observed for documented, but not undocumented males. No changes in pre- to postimmigration alcohol use were found for documented or undocumented females. This study contributes to the limited knowledge of pre- to postimmigration alcohol use patterns among Latinos in the United States. Future research is needed to identify social determinants associated with the alcohol use trajectories of recent Latino immigrants, as it may inform prediction, prevention, and treatment of problem-drinking behaviors among the largest and fastest growing ethnic minority in the United States.

Improving the health status of Caribbean people: recommendations from the Triangulating on Health Equity summit.

In 2011, Morehouse School of Medicine convened a summit in San Juan, Puerto Rico, to discuss issues related to the health status of people and communities in the Caribbean region. The summit provided a forum for transparent dialog among researchers, policymakers, and advocates from the Caribbean region and the United States. The summit's theme-improving the region's health outcomes through the adoption of effective practices linking health promotion and primary care, within the context of social and cultural determinants-called for a comprehensive and integrative model or a triangulation of methodologies to improve health outcomes. This article summarizes the recommendations of two workgroup sessions examining the challenges to improving health outcomes in the region and the opportunities to meet those challenges. The recommendations seek to develop action-oriented agendas that integrate research, practice, and policy. Outcomes of the summit highlight the importance of (a) community participation in planning interventions, (b) policymakers' commitment to prioritizing health, and (c) Caribbean governments' commitment to addressing the underlying social factors responsible for poor health outcomes.

Alcohol use among recent Latino immigrants before and after immigration to the United States.

BACKGROUND: US-born Latinos have higher rates of alcohol use than Latinos who have immigrated to the United States. However, little is known about the pre-immigration drinking patterns of Latino immigrants or about the changes in their drinking behaviors in the 2 years post-immigration. OBJECTIVES: This article reports findings of a longitudinal study that compared rates of regular, binge, and heavy drinking among a cohort of recent Latino immigrants, ages 18-34, prior to immigration to the United States and in the 2 years post-immigration. METHODS: Baseline data were collected on the drinking patterns of 405 Latino immigrants living in the United States for 12 months or less. A follow-up assessment occurred during their second year in the United States. RESULTS: Findings indicate that number of days of drinking declined significantly post-immigration. Binge alcohol use (five or more drinks on the same occasion during the past 90 days) significantly declined during the post-immigration period. Heavy alcohol use (five or more drinks on the same occasion on five or more days during the past 90 days) also significantly decreased. CONCLUSIONS: Results suggest a need for continued exploration of pre-immigration drinking patterns and research to uncover underlying factors associated with declines in rates of problematic alcohol use among recent Latino immigrants. SCIENTIFIC SIGNIFICANCE: The results of this study can aid in furthering our understanding of the alcohol use of Latino immigrants ages 18-34 prior to and post immigration to the United States to guide future research and the development of culturally tailored clinical interventions.

Alcohol misuse among recent Latino immigrants: the protective role of preimmigration familismo.

Familismo in the Latino culture is a value hallmarked by close relations with nuclear and extended family members throughout the life span, with pronounced levels of loyalty, reciprocity, and solidarity. Familismo is posited as health protective against alcohol misuse among Latinos in the United States. This study examines the relative influence of pre- and postimmigration familismo on alcohol use behaviors among recent Latino immigrants while accounting for myriad sociocultural factors (gender, age, documentation status, education, income, marital status, presence of family members in the United States, primary language used in the community, English language proficiency, and time in the United States). Participants included 405 young adults, aged 18 to 34 years, who were primarily of Cuban (50%), Columbian (19%), and Central American (15%) descent. Retrospective assessment of preimmigration familismo occurred during participants' first 12 months in the United States. Follow-up assessment of alcohol use behaviors occurred during participants' second year in the United States. Multiple Indicators Multiple Causes (MIMIC) path modeling was used to test study hypotheses. Inverse associations were determined between preimmigration familismo and alcohol use quantity and harmful/hazardous alcohol use. Men and participants who reported more proficiency in English, and those living in neighborhoods where English is predominantly spoken, indicated more alcohol use quantity and harmful/hazardous alcohol use. By considering both pre- and postimmigration determinants of alcohol use, findings offer a fuller contextual understanding of the lives of Latino young adult immigrants. Results support the importance of lifelong familismo as a buffer against alcohol misuse in young adulthood.

Critical phenomena of the majority voter model in a three-dimensional cubic lattice.

In this work we investigate the critical behavior of the three-dimensional simple-cubic majority voter model. Using numerical simulations and a combination of two different cumulants, we evaluated the critical point with a higher accuracy than the previous numerical result found by Yang, Kim, and Kwak [Phys. Rev. E 77, 051122 (2008)]. Using standard finite-size scaling theory and scaling corrections, we find that the critical exponents ν,γ, and ß are the same as those of the three-dimensional Ising model.

Nominal thermodynamic temperature in nonequilibrium kinetic Ising models.

We show that a nominal temperature can be consistently and uniquely defined everywhere in the phase diagram of large classes of nonequilibrium kinetic Ising spin models. In addition, we confirm that, at critical points, the large-time "fluctuation-dissipation ratio" X( infinity ) is a universal amplitude ratio, and find in particular X( infinity ) approximately 0.33(1) and X( infinity )=1 / 2 for the magnetization in, respectively, the two-dimensional Ising and voter universality classes.