"I would prefer to be dead than to live this way": Lived experiences of stigma and discrimination against khwaja sira in Swat, Pakistan.

Due to their identification as third gender people, khwaja sira have historically been subjected to experiences of social marginalization. However, the extant literature has not fully explored the lived experiences of stigma and discrimination against khwaja sira in the Swat Valley of Khyber Pakhtunkhwa, Pakistan. To address this gap, we conducted 45 interviews with khwaja sira in Mingora, Swat, Khyber Pakhtunkhwa to better understand their experiences of gender-nonconformity stigma and discrimination in various social contexts, including within their families, in accessing health care, and within education and work contexts. Applying Minority Stress Theory and utilizing thematic content analysis, the present study identified three dimensions of gender-nonconformity stigma: (1) internalized stigma, namely feelings of shame and embarrassment; (2) perceived stigma, namely opinions others had of khwaja sira regarding lack of employability or engagement in sex work; and (3) enacted stigma, namely exclusion from families, in educational settings, in religious spaces, and in healthcare settings. Findings should inform future social intervention and community practice engagements with khwaja sira communities in Pakistan.

Labor Pains: Work-Related Barriers to Access to Health Care for People Living with HIV in Hyderabad, India.

To explore themes regarding work-related barriers to access to health care, we conducted 32 interviews, 16 with third gender people and 16 with cisgender women, all of whom were all living with HIV in Hyderabad, India. Most respondents were members of Dalit castes and had been living with HIV for several years at the time of the interview. Using thematic content analysis, interviews were coded by two researchers using a social determinants of health conceptual framework. Themes highlighted in this study include the burden of taking time off from work, the loss of pay associated with missing work, and the interruption of gendered care work responsibilities that respondents faced when seeking treatment. Findings from this study support the claim that equitable work policies and practices for marginalized laborers can increase access to medical care for people living with HIV.

Predictors of Food Insecurity and Childhood Hunger in the Bronx During the COVID-19 Pandemic.

Using a community-based participatory research approach, we conducted a survey of 218 food pantry recipients in the south Bronx to determine predictors of food insecurity and childhood hunger. In adjusted multiple regression models, statistically significant risk factors for food insecurity included: having one or more children and not having health insurance. Statistically significant protectors against childhood hunger were: having a graduate degree, having health insurance and Spanish being spoken at home. Experiencing depression symptoms was positively associated with both food insecurity and childhood hunger. Frequency of food pantry use was not significantly associated with either food insecurity nor childhood hunger. This study suggests that targeting families with multiple children and without insurance will best help to promote food security among residents of the south Bronx. Social policy implications related to food security and benefit provision through the COVID-19 pandemic are also provided.

COVID-19 stigma and depression across race, ethnicity and residence.

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.

"Having a guru is like having a licence": analysing financial relationships between khwaja sira gurus and chelas in Swat, Pakistan.

The focus of this study was on identifying themes regarding the financial relationships between gurus (leaders) and chelas (disciples) in khwaja sira communities in Khyber Pakhtunkwa, Pakistan. We interviewed 45 khwaja sira in Mingora, Swat on their experiences of guru-chela culture. All interviews were digitally audio recorded, then translated and transcribed directly from Pashto into English. Transcripts of the interviews were analysed using thematic content analysis in a manner informed by both social reproduction theory and notions of Islamic capital. We identified four major themes related to relationships within guru-chela culture: (1) financial relationships are highly structured; (2) financial exchanges can be mutually beneficial; (3) systems of payment and debt can be exploitative; and (4) financial ties to gurus continue throughout the life course of khwaja sira. Findings show how financial interactions within guru-chela relationships are reflective of larger social forces, reproducing kinship structures, systems of Islamic gift-giving, and capitalist processes occurring within Pakhtun society.

Race, masks, residency and concern regarding COVID-19 transmission.

To explore sociodemographic predictors for concern regarding COVID-19 transmission and how these factors interact with the identities of others, we conducted a web-based survey where we asked 568 respondents in the United States to indicate their level of COVID-19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID-19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID-19. Individuals who self-reported themselves to be at high risk for COVID-19 were more likely to be concerned about COVID-19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID-19 concern.

Associations between HIV stigma, gender, and depression among people living with HIV in Hyderabad, India.

The goal of this study was to explore the association between HIV stigma and depression and whether gender moderated this relationship. The theoretical framework for the study combined an adapted version of Goffman's conceptualization of stigma with gender role theory. We surveyed 150 individuals living with HIV in Hyderabad, India (51 cisgender women, 49 cisgender men, and 50 third gender people) on their experiences with HIV stigma. While third gender people had statistically higher scores for HIV stigma over their cisgender counterparts, the association between each of three different forms of stigma (internalized stigma, perceived stigma, and experienced stigma) on depression was negatively moderated by third gender status. This demonstrates that third gender research participants who experienced certain forms of HIV stigma were less likely to be depressed than cisgender participants. These findings indicate resilience amongst third gender people living with HIV and can be used to better tailor social policies and gender-affirming HIV care programs in south India.

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City.

BACKGROUND: We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women. METHODS: A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test. RESULTS: Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test. CONCLUSION: The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.

A Systematic Review of Intimate Partner Violence Interventions Impacting South Asian Women in the United States.

This systematic review is the first published attempt to synthesize literature pertaining to intimate partner violence (IPV) interventions impacting South Asian women in the United States. Applying the conceptual framework of intersectionality, the goals of this review are to (1) understand current trends, intervention modalities, and areas of focus within IPV interventions targeting South Asian communities in the United States and (2) to identify gaps in the address of IPV among these communities. Using the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 35 databases and identified 12 research studies. Our study included a collective sample of 318 South Asian IPV survivors and 25 organizations. Findings underscore that there are minimal IPV interventions available to South Asian women living in the United States. Most interventions have not been systematically evaluated, making their efficacy questionable. Those that reported outcome evaluation, namely recurrence of IPV, demonstrated limited efficacy. IPV research on South Asian women often dismisses financial concerns in light of cultural dimensions impacting IPV. Given that financial dependence is a major driver of violence against South Asian women, scholars must question the efficacy of available interventions that cannot foster the social and economic security of IPV survivors. Without sufficient attention to the intersecting social, cultural, and economic challenges that South Asian women face in abusive relationships, the efficacy of IPV interventions will remain limited.

Secret lives and gender fluidity of people living with HIV in Hyderabad, India.

This mixed-methods study sought to explore gender fluidity among people living with human immunodeficiency virus (HIV) in Hyderabad, India, almost all of whom did not identify as hijra. Sixteen gender-nonconforming people living with HIV completed both surveys and in-depth interviews, exploring their experiences with HIV and gender nonconformity stigma. Interviews were conducted in Hindi and Telugu, digitally audio-recorded, then subsequently translated and analyzed in English, using interpretative phenomenological analysis. Our study highlighted three categories of gender expression: (1) "We have to maintain secrecy about our hijra life": Living secret lives; (2) "What happens if my neighbor sees me here?": Contextual disclosure; (3) "Twenty-four hours a day I will wear a sari": Being fully out. Analysis revealed that many gender-nonconforming people reported identifying with two distinct gender identities: one in the daylight, where they identified as men and fulfilled a role of husband and father with their family, and another at night where they identified otherwise-as women, as third gender, as kothis, hijra, transgender. Themes reinforce a phenomenological interpretation of gender identity and expression in the south Indian context, which is grounded in practices regarding identity's embodiment in clothing, vocal intonation, makeup, and context.

Barriers and Facilitators to Participation in Long-Acting Injectable PrEP Research Trials for MSM, Transgender Women, and Gender-Nonconforming People of Color.

We collected 216 responses from sexually active MSM, transgender women, and gender-nonconforming (GNC) people of color through a web-based survey to understand the facilitators and barriers to research participation in a hypothetical LAI PrEP trial. In adjusted models, these items were found to be significantly associated with research participation likelihood: ever participated in HIV research study; comfort with taking daily pill; comfort with providing urine sample; and concerns over potential side effects of shot. Asian participants were more concerned about others knowing they were being recruited than were Black and Latinx respondents F(2, 216) = 3.98; p < .05. Asian respondents were also less comfortable with being recruited at organizations serving communities of color than Black and Latinx respondents, F(2, 216) = 5.10; p < .05. Cisgender respondents were more comfortable with being recruited by a friend or colleague than were transgender/GNC respondents, F(1, 215) = 4.8; p < .05.

Asian in the Time of COVID-19: Creating a Social Work Agenda for Asian American and Pacific Islander Communities.

The health of Asian American and Pacific Islander (AAPI) communities remains an understudied area of racial/ethnic minority research in the United States, and even more so in the field of social work. The COVID-19 pandemic has highlighted how AAPI health and social welfare issues have not received adequate attention in social policy, social work practice, and research. Contrary to model minority myths, AAPIs are subject to racialized attitudes and discrimination, which have been associated with adverse physical and mental health outcomes, including increased anxiety, depression, and suicidality. Drawing from the theoretical framework of AsianCrit, which is grounded in critical race theory, authors analyze health disparities among AAPI communities as reflected in COVID-19 hospitalizations and fatalities, as well as increases in acts of anti-Asian racism and xenophobia. Better understanding health disparities of AAPI communities needs to be a key research issue for social workers in future years. The authors conclude by offering a short set of recommendations to improve social policy, social work practice, and research to more aptly address contemporary social issues impacting AAPI communities.

Navigating Intersectional Stigma: Strategies for Coping Among Cisgender Women of Color.

Intersectionality is a critical tool for understanding how socially constructed categories shape multiple dimensions of lived experience. In this study, we apply an intersectional lens to explore how women of color from two different contexts, Hyderabad, India and Chicago, Illinois, manage gendered forms of stigma and oppression as they converge with other devalued statuses, namely living with HIV or having a history of drug use or incarceration. Applying intersectional stigma as our conceptual framework, and drawing from transnational feminist perspectives, we identified two overarching themes. Women in both contexts combat stigma by employing strategies of concealment within their romantic and familial systems. Moreover, women's roles as mothers were critical sources for managing their complex illnesses and for accessing support. Using these experiences of stigma against women of color as our analytic lens, we offer an intersectional framework for qualitative health research involving marginalized cisgender women of color in transnational contexts.

Are skin color and body mass index associated with social network structure? Findings from a male sex market study.

Objectives: There is a growing burden of HIV and sex-related diseases in South Asia and India. Sociological research illustrates that key axes of social stratification, such as race and ethnicity, affect social network structure which, in turn, impacts sexual health and wellbeing. Research on networks has increasingly begun to examine the ways in which networks drive or harness sexual behaviors, but has largely neglected the influence of culture and cultural markers in this continuum. Furthermore, much of the existing scholarship has been conducted in the U.S. or in Western contexts.Design: As part of an exploratory effort, we examined how skin color and body mass index (BMI) affected networks among 206 men who have with men (MSM) frequenting sex markets in Hyderabad, India. A novel phone-based network generation method of respondent-driven sampling was used for recruitment. In assessing how skin color and BMI drive these structures, we also compared how these factors contribute to networks relative to two more commonly referenced markers of social difference among Indians, caste and religion.Results: Our findings suggest that skin color and BMI contribute significantly more to network structure than do caste and religion.Conclusions: These findings tentatively illuminate the importance of individual-level heterogeneity in bodily attributes, factors which are seldom considered in conventional approaches to researching how social stratification and health inequalities are animated during the formation of networks.

"They Kept Away": Social Isolation of Cisgender Women Living with HIV in Hyderabad, India.

Social isolation of cisgender women living with HIV has been recognized as a barrier to early detection of the virus, disclosure of HIV status to partners, and access to healthcare and social work services. The goal of this study is to explore how social isolation and depression affect cisgender women living with HIV in Hyderabad, India. Sixteen cisgender women living with HIV were asked to complete in-depth interviews regarding their experiences with HIV stigma and depression. All interviews were digitally audio-recorded in Hindi or Telugu, then translated, transcribed, and analyzed using thematic content analysis by two to three coders. Three main themes emerged from the qualitative interviews among these cisgender women living with HIV: (1) "They kept away": Experiences with social isolation; (2) "I thought people would think badly about me": Perceived experiences of discrimination; and (3) "I will live till I die": Suicidality, resilience, and gaining hope. Our findings reinforce the need for emphasis on culturally appropriate interventions for depression for cisgender women living with HIV in India, including greater access to mental health resources, greater availability of trained counselors that share the same gender and are native speakers of Hindi or Telugu, and increased family and community support for socially isolated individuals.

Women Connected to at Risk Indian Men Who Have Sex with Men: An Unexplored Network.

Little is known about the women connected to Indian MSM and their impact on HIV risk. We surveyed 240 Indian MSM, who identified their social networks (n = 7,092). Women (n = 1,321) comprised 16.7 % of the network, with 94.7 % representing non-sexual connections. MSM were classified as having low, moderate, or high female network proportion. MSM with moderate female network proportion (8-24 % total network) had significantly lowered odds of HIV seropositivity (AOR = 0.24, 95 % CI = 0.1-0.6). This suggests moderate proportions of female connections could mediate HIV risk. HIV prevention interventions in India could consider the greater involvement of women among their target audiences. Se sabe poco sobre las mujeres conectadas a HSH en India y su impacto en el riesgo de VIH. Se encuestó a 240 HSH indios, quienes identificaron sus redes sociales (n = 7,092). Las mujeres (n = 1,321) formaron al 16.7 % de la red, del cual el 94.7 % representa conexiones no sexuales. Los HSH se clasificaron como baja, moderada o alta proporción de red femenina. HSH con proporción moderada de red femenina (8-24 % del red total) tuvieron un riesgo significativamente reducido de seropositividad de VIH (AOR = 0,24; IC 95 % = 0,1-0,6). Esto sugiere que tener una proporción moderada de contactos femeninos podría atenuar el riesgo de VIH. Las intervenciones de prevención del VIH en India podrían considerar una mayor participación de las mujeres en su público objetivo.