Spiritual Health and the COVID-19 Pandemic: Impacts on Orthodox Christianity Devotion Practices, Rituals, and Religious Pilgrimages.

The impact of the COVID-19 pandemic on multiple aspects of physical and social health, including spiritual and religious dimensions, has been discussed not only by numerous theologians, scientists, and politicians, but also by millions of believers of all faiths worldwide. The pandemic seems to have exerted a significant impact on religious practices. Massive gatherings of devoted and faithful people have been strongly discouraged and even openly banned. Prominent religious festivals and pilgrimages that have been conflated by the media with other "mega-spreader events" are incessantly canceled to mitigate the pandemic and alleviate the burden of COVID-19 on the healthcare system. The impact of the pandemic on Catholic or Muslim religious tourism has been extensively described in peer-reviewed and gray literature. However, observant members of the Orthodox Christianity faith have also experienced the constrictive prohibitions for gathering at and worshiping in shrines, churches, and monasteries. Among the manifestations of devotion that the pandemic has interfered with are the attendance to public worship spaces for the celebration of rites and ceremonies, like the celebration of Orthodox Easter. Expressions of reverent devotion including the kissing of crosses and icons as well as the sacrament of Holy Communion may have also been considered a motive of concern as these holy objects and the spoon used might act as fomites in the dissemination of the virus. Visitation of holy places has been also hampered by the pandemic. The most important centers of pilgrimage for Orthodox Christianity are Mount Athos and Jerusalem, as well as the Shrine of Panagia Evangelistria in the Island of Tinos, Greece. Authorities have halted almost completely the arrival of visitors to these sites. This paper aims at elaborating on the impact that the COVID-19 pandemic has had on social manifestations of religiosity and therefore taking a toll on the spiritual health of believers who have deeply rooted religious convictions and are strongly attached to Church tradition. This analysis closes with the provision of specific suggestions for the care, support, and healing of the impacted or splintered spiritual health of the believers who cannot participate in expressions of devotion, such as pilgrimages and religious tourism because of personal and public health concern, such as the COVID-19 pandemic.

Rethinking 'Bacha Bazi', a culture of child sexual abuse in Afghanistan.

The global pandemic appears to be a never ending challenge. With the authorities' reach shrinking, we can assume that Bacha Bazi is celebrated more than before. Perpetrators not only harass individuals but also put public health in peril by organizing gathering and parties. With both individual and public health and rights at stake, this pandemic could also be a chance to contain Bacha Bazi practices. It may be early to say this and we definitely need to collect more information before we reach any conclusion, but most importantly, we, from healthcare workers and youth workers to policymakers, need to take action. Awareness is the spark of our mobilization. As citizens we can be more critical towards traditions involving any kind of abuse. As healthcare workers, we can be alert when treating boys, adolescents and young adults. We can probably spot a hidden case of abuse and refer the victim accordingly. As citizens we can support policymakers who are committed to take action against harassment of this, and any other, kind and this can also be a crucial chance to address the shadows haunting our societies once and for all.

HIV prevention among transgender women in Latin America: implementation, gaps and challenges.

INTRODUCTION: Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America. METHODS: We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations. RESULTS AND DISCUSSION: Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws. CONCLUSIONS: Transgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance.

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.

Hepatitis C in key populations in Latin America and the Caribbean: systematic review and meta-analysis.

OBJECTIVES: Summarize hepatitis C virus (HCV) prevalence in injecting (IDU) and non-injecting drug users (NIDU), men who have sex with men (MSM), sex workers, and prison inmates in Latin America and the Caribbean (LAC). METHODS: Systematic review on HCV prevalence in sub-populations in LAC. Databases searched from 1-1-2000 to 10-30-2013. INCLUSION CRITERIA: prevalence studies in sub-populations in LAC. HCV-antibody was marker for prevalence of current/past HCV infection and HCV-RNA for prevalence of HCV current infection. RESULTS: IDU HCV current/past infection presented highest prevalence, from 1.7 % in Colombia to over 95 % in Ciudad Juarez and Tijuana, Mexico and pooled regional anti-HCV prevalence was 49 % (CI 95 % 22.6-76.3 %). NIDU, MSM and sex workers anti-HCV prevalence was below 10 %, and pooled regional prevalence of 4 % (CI 95 % 2.6-4.5 %), 3 % (CI 95 % 1.7-4.5 %) and 2 % (CI 95 % 1.0-3.4 %), respectively. Prison inmates presented higher values, but prevalence decreased over the 15-year time span (p < 0.001). Current HCV infection from three countries showed prevalence under 10 % in prison inmates and 1-46 % among drug users. CONCLUSIONS: Disease burden is high and surveillance, prevention and treatment should target these groups in LAC.

Preventing transfusion-transmitted HIV infection in Latin America and the Caribbean: issues associated with blood donor interviews and sex between men.

BACKGROUND: Blood-borne transmission is the most efficient route for acquiring HIV infection, particularly through transfusion. Availability of noninfectious blood units for hemotherapy is a necessary condition for efficient functioning of health services. They have the obligation to ensure that the blood supply is safe, which includes interviewing potential donors to ascertain whether they might be at risk of being HIV infected. The interview procedures demand that blood services staff inquire potential blood donors about sexual practices associated to HIV transmission. Assumptions and misconceptions may unnecessary exclude adequate donors. METHODS: Review of published and unpublished country reports in Latin America regarding blood safety and deferral criteria related to same sexual behavior among males. RESULTS: An analysis of criteria for deferral of potential blood donors shows inconsistencies that may impact the necessary safe blood supply. CONCLUSIONS: The blood donor deferral criteria should be revised according to relevant epidemiological evidence and social legitimacy. Personnel in blood banks and hemotherapy services should be educated to conduct appropriate interviews for accepting or deferring potential donors. Potential donors and the public should be knowledgeable for them to understand the reasons why some individuals may be deferred. Health authorities should work to reduce the stigma associated with HIV, prioritize building strong and meaningful partnerships with civil society, and engage diverse sectors in the national AIDS response.

HIV risk and the internet: results of the Men's INTernet Sex (MINTS) Study.

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with > or =1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.

Misrepresentation on the Internet and in real life about sex and HIV: a study of Latino men who have sex with men.

Experiences of men who have internet sex with men were studied to determine the level of misrepresentation in real life and on the Internet of physical, relationship, sexual interests, and HIV status. An internet-based questionnaire in English and Spanish ($20 compensation) recruited 1,026 Latino MISM over 3 weeks. Four 'fib' scales were created to measure misrepresentation by the respondent and to the respondent on the Internet and IRL. Overall, respondents rated being misrepresented to on the Internet significantly highest, followed by being misrepresented to IRL and misrepresenting themselves to others on the Internet, and misrepresenting themselves to others IRL lowest. For HIV status there were no differences between Internet and IRL misrepresentation by others and Internet and IRL misrepresentation by self, but a significant difference between HIV status misrepresentation by self and others. Misrepresenters were more likely to have had cybersex before meeting their last partner and to prefer cybersex, to be more sexually compulsive, and to speak and think more in Spanish. Social desirability considerations account for the higher misrepresentation on physical characteristics and sexual interests by others, and higher misrepresentation on the Internet. However, misrepresentation of HIV status was the lowest category and while it was misrepresented more often by others than self, there were no internet/IRL differences. Data suggest that HIV misrepresentation occurred for 20% of men and was lower than other forms of misrepresentation. Implications for HIV prevention are discussed, along with the concept of levels of accuracy in internet communications.

[Maternal syphilis and congenital syphilis in Latin America: big problem, simple solution]. / Sífilis materna y sífilis congénita en América Latina: un problema grave de solución sencilla.

From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1% and to range from 1.00% in Peru to 6.21% in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1000 live births in El Salvador to 12.0 per 1000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5% to 15%. Factors that determine the persistence of congenital syphilis as public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care, and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination.

Sífilis materna y sífilis congénita en América Latina: un problema grave de solución sencilla / Maternal syphilis and congenital syphilis in Latin America: big problem, simple solution

From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1 percent and to range from 1.00 percent in Peru to 6.21 percent in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1 000 live births in El Salvador to 12.0 per 1 000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5 percent to 15 percent. Factors that determine the persistence of congenital syphilis as a public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination.

Bloodborne and sexually transmitted infections in drug abusers in the United States, Latin America, the Caribbean, and Spain.

In the United States, approximately 1 million Americans are infected with human immunodeficiency virus (HIV), and several thousand new infections are reported each year. More than one-third of cases of acquired immunodeficiency syndrome (AIDS) are associated with injection drug use. An estimated 1.8 million adults and children are currently living with HIV in Latin America and the Caribbean, and injection drug abuse remains a major factor in initial exposures to HIV in these parts of the world. Although only 3 cases of AIDS related to drug abuse have been reported in Bolivia, a country with a nascent epidemic, >19,000 cases of AIDS have been reported in Argentina and >22,000 in Brazil, with a significant number associated with injection drug use. Extensive epidemiological and clinical research has been conducted in the United States and elsewhere to determine the extent and nature of the problem and to design and develop interventions (prevention and treatment) for drug abusers infected with HIV. The articles in this supplement present a current view of the nature and extent of the bloodborne and sexually transmitted infections in drug abusers and their partners in the Western Hemisphere.

Access to antiretroviral treatment in Latin American countries and the Caribbean.

OBJECTIVES: To assess the access to antiretroviral therapy in the Latin America and Caribbean region and the main issues involved. METHODS: A review of National AIDS Programmes reports, published studies on HIV access to antiretroviral drugs, and personal communications from National AIDS Programmes in the region. RESULTS: Most countries have, or are in the process of developing, laws and regulations to ensure better access to antiretroviral drugs for people in need. However, there are still many countries that either have not implemented policies or do not have policies. There has been an important decrease in the cost of drugs, but prices are still too high for all countries to afford them. The benefits in decreased mortality and hospitalizations in the countries with high coverage are significant. The number of people receiving antiretroviral therapy has been estimated to be close to 170,000 individuals; however, this figure only represents a fraction of the people in need in the region. Some different strategies will have to be implemented in order to increase coverage. CONCLUSION: Renewed efforts are needed from both governments and international community organizations to strengthen the health services and increase access to antiretroviral drugs.

Ya se dispone de antirretroviricos contra el VIH y el sida: es necesaria ahora la prevencion? / Antiretroviral agents against HIV and AIDS are now available: is prevention still necessary?

New antiretroviral agents have radically changed the treatment of HIV infection and AIDS. In many patients, this treatment has produced substantial improvement, as well as marked reductions in circulating viral particles. Furthermore, there has been a decrease in mortality from AIDS complications resulting from the use of very active retroviral therapy (VART). A source of concern, however, is the current perception that the disease, though not yet curable, can be successfully treated with this new therapy, since this notion could be changing the public's attitude toward the continued need for preventive measures