Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma.

BACKGROUND: Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS: During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS: Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION: PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.

[Responding to the sexual and reproductive health needs of Venezuelan migrant women in LimaResposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima]. / Respondiendo a las necesidades de salud sexual y reproductiva de las migrantes venezolanas en Lima.

Objectives: To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods: Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results: Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion: This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.

Objetivo: Apresentar e analisar a resposta do sistema de saúde peruano às necessidades de saúde sexual e reprodutiva de mulheres venezuelanas radicadas em Lima, Peru, e identificar algumas explicações para essa resposta. Métodos: Entrevistas telefônicas semiestruturadas detalhadas com 30 mulheres venezuelanas, 10 profissionais de saúde e 2 funcionários do Ministério da Saúde. Resultados: Com base nas experiências das mulheres venezuelanas que recorreram a esses serviços no período de 2019 a 2020 e nas perspectivas de profissionais e autoridades de saúde, apresentamos uma análise da capacidade e das limitações dos serviços de saúde pública para atender às necessidades de saúde sexual e reprodutiva dessa população. Os relatos das mulheres migrantes indicam uma experiência positiva com um sistema de saúde, que, apesar das deficiências, responde às necessidades mais comuns de saúde sexual e reprodutiva. Isso está em conformidade com os relatos dos profissionais de saúde e das autoridades, que enfatizam a existência de políticas prioritárias de atenção à saúde sexual e reprodutiva. Conclusão: Este estudo mostra de que maneira um âmbito de prioridade nacional (reduzir a mortalidade materna) e mecanismos operacionais de proteção social (como o Seguro Integral de Saúde) se convertem em instrumentos complementares, afetando positivamente e estendendo benefícios à população migrante, embora essa população não tenha sido levada em consideração quando da elaboração dessas políticas.

Perceived Negative Political Climate Among Hispanic/Latino Adolescents Before and After the 2020 U.S. Presidential Election: Associations with Internalizing Symptoms and Substance Use.

The political climate often changes following the installment of a new president. This volatility presents opportunities for examining how elections might affect vulnerable subgroups such as Hispanic/Latino (HL) adolescents. The present study explored the perception of negative political climate among HL adolescents before and after the 2020 U.S. presidential election and its association with internalizing symptoms and substance use. We conducted the study in Los Angeles and Miami between 2020-2021, with a sample of 304 HL adolescents (Females = 60.8%), aged 15.3 years on average. Participants completed measures of negative political climate (pre- post-election) and measures of depressive symptoms, anxiety, substance misuse, and substance use intentions after the election. We used paired tests and linear mixed-effects modeling to explore changes in perceived negative climate before and after the election. Structural equation modeling was used to determine predictors of negative political climate and its associations with internalizing symptoms and substance use. Results indicated that following the election negative political climate increased significantly in Miami and among Cuban-origin adolescents but not in Los Angeles or among Mexican-origin adolescents. Pre-election perceived negative political climate was significantly predicted by gender, study site, and mother's nativity. Pre-election negative political climate predicted post-election internalizing symptoms and substance use intentions indirectly through post-election negative political climate. HL youth's perceived political climate is a complex construct that might vary across different sociopolitical contexts and populational sub-groups. Exploring variations in politically-based cultural stressors and their role as mental health and substance use risk factors is crucial to addressing HL disparities. KEY WORDS: Adolescence, Hispanic/Latino, political climate, presidential election, internalizing symptoms, substance use.

Cultural stress, daily well-being, and internalizing and externalizing symptoms among Hispanic college students.

The present study was designed to examine the extent to which, in a sample of 873 Hispanic college students, daily levels of, and variability in, well-being would mediate the predictive effects of culturally related stressors (discrimination, negative context of reception, and bicultural stress) on internalizing and externalizing symptoms 11 days later. A 12-day daily diary design was utilized, where reports of cultural stressors were gathered on Day 1, daily well-being reports were gathered on Days 2-11, and outcomes were measured on Day 12 (with controls for Day 1 levels of these same outcomes). Structural equation modeling results indicated that daily means of, and variability in, well-being significantly mediated the predictive effect of Day 1 ethnic/racial discrimination, negative context of reception, and bicultural stress on Day 12 symptoms of anxiety and depression. No effects emerged for externalizing symptoms. When we decomposed the latent well-being variability construct into its component indicators (self-esteem, life satisfaction, psychological well-being/self-acceptance, and eudaimonic well-being), daily variability in life satisfaction and self-acceptance appeared to be primarily responsible for the mediated predictive effects we observed. These results are discussed in terms of implications for further research, for counseling practice, and for the development of more inclusive university practices and policies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A validation of the Perceived Negative Context of Reception Scale with recently-arrived Venezuelan immigrants in Colombia and the United States.

OBJECTIVES: Millions of Venezuelans have left their country in search of safety and stability in the United States (U.S.) and Colombia, two countries where recent increases in anti-immigrant rhetoric and sentiment have occurred. The Perceived Negative Context of Reception Scale captures the degree to which immigrants report feeling that people from their country are unwanted/marginalized within their new receiving context. In the present study, we examine the psychometric properties of the Perceived Negative Context of Reception Scale with recent Venezuelan immigrant adolescents and adults in the U.S. and Colombia. METHOD: We conducted confirmatory factor analysis using data from the Colombia and Miami's Newest Arrivals (CAMINAR) Study, which collected data from Venezuelan adults in Bogotá, Colombia, and South Florida in October-November 2017, and the Venezolanos en Nuevos Entornos (VENE) Youth Project which surveyed Venezuelan youth living in Florida between November 2018 and July 2019. RESULTS: We found that the negative context of reception evidenced strong psychometric properties among immigrants in both the U.S. and in Colombia, among adolescents and adults, and among male and female respondents. We also found that negative context of reception scores was associated with elevated scores on criterion-related factors-that is, perceived discrimination and depressive symptoms-in ways that are theoretically coherent and support measure validity. CONCLUSION: We provide new evidence that the Perceived Negative Context of Reception scale is reliable and valid for use with Venezuelan immigrants in the U.S. and Colombia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The family crisis migration stress framework: A framework to understand the mental health effects of crisis migration on children and families caused by disasters.

Crisis migration refers to displacement of large numbers of individuals and families from their home countries due to wars, dictatorial governments, and other critical hazards (e.g., hurricanes). Although crisis migration can adversely influence direct and indirect effects on the mental health of adults and their children collectively as families, there is a deficiency in theory that addresses family level processes in this crisis migration context. We propose the Family Crisis Migration Stress Framework, which consolidates what is known about the multiple factors affecting mental health outcomes of crisis migrants into one cohesive model. In our article, we synthesize relevant theories and models of disaster, migration, and family resilience in order to create a framework in which to organize the complex processes that occur within families as a result of migration and that affect the mental health of children. We include examples from various national settings to illustrate the tenets of our framework. Future policy and intervention for crisis migrant should focus on the family as a unit, instead of parents and children as individual entities.

Baseline prevalence and correlates of HIV and HCV infection among people who inject drugs accessing a syringe services program; Miami, FL.

BACKGROUND: Blood-borne viral infections, such as HIV and hepatitis C (HCV), are common infections among people who inject drugs (PWID). This study aims to determine the prevalence of HIV and HCV infection among PWID accessing the first legal syringe services program (SSP) in the state of Florida, along with examining baseline correlates of HIV and HCV infection. METHODS: Baseline behavioral enrollment assessments of 837 participants accessing an SSP for the first time were analyzed. Patients self-reporting or testing HIV or HCV positive at the enrollment visit were included. Socio-demographic, drug use, and injection-related risk behaviors in the last 30 days were compared across groups defined by all combinations of HIV and HCV serostatus. Bivariate and multivariable logistic regression models were used to assess correlates of baseline HCV and HIV infection independently. RESULTS: Overall prevalence for HCV and HIV infection were 44.4% and 10.2%, respectively. After adjusting for confounders, the most significant correlates of baseline HCV infection were age (aOR = 1.01), lower education level (aOR = 1.13), currently homeless (aOR = 1.16), injecting more than seven times a day (aOR = 1.14), reusing syringes (aOR = 1.18), and sharing injection equipment (aOR = 1.13). The most significant predictors of baseline HIV infection were age (aOR = 1.01), non-Hispanic Black race (aOR = 1.28), Hispanic ethnicity (aOR = 1.12), gay or bisexual orientation (aOR = 1.22), and methamphetamine injection (aOR = 1.22). In addition, heroin injection (aOR = 0.92) was significantly associated with a lower odds of HIV infection. DISCUSSION/CONCLUSION: Baseline behavioral predictors differed between HIV infection and HCV infection among participants accessing syringe services. Understanding the risk factors associated with each infection should be considered when developing additional harm reduction interventions tailored for diverse PWID populations served at SSPs.

Overeating and binge eating among immigrants in the United States: new terrain for the healthy immigrant hypothesis.

BACKGROUND: Prior research indicates that, compared to individuals born in the United States (US), immigrants are less likely to experience mental health and inhibitory control problems. However, our understanding of overeating and binge eating-both related to mental health and inhibitory control-among immigrants in the US remains limited. Drawing from a large national study, we report the prevalence of overeating and binge eating among immigrants vis-à-vis the US-born. METHODS: The data source used for the present study is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, 2012-2013), a nationally representative survey of 36,309 civilian, non-institutionalized adults ages 18 and older in the US. Logistic regression was employed to examine the relationship between immigrant status and key outcomes. RESULTS: The prevalence of any (immigrants = 7.8%, US-born = 17.0%) and recurrent overeating (immigrants = 2.9%, US-born = 5.3%) was lower among immigrants than US-born individuals. Among those reporting recurrent overeating, the prevalence of binge eating with loss of control was comparable among immigrant (37.2%) and US-born participants (39.9%), in general. However, stratified analyses revealed that risk of binge eating with loss of control was lower among immigrant women compared to US-born women (AOR 0.54, 95% CI 0.29-0.98). CONCLUSIONS: Findings from the present study provide clear results that immigrants are substantially less likely to overeat as compared to US-born individuals and that, among women but not men, immigrant status is associated with lower risk of binge eating with loss of control.

I am Lifted Above the World: utilizing VR for stress reduction among perinatal women of color.

Background: Perinatal mental health conditions affect 800,000 individuals annually in the United States and are a leading cause of complications in pregnancy and childbirth. However, the impact of these conditions varies across racial and ethnic groups. Portable digital solutions, such as mobile apps, have been developed for maternal mental health, but they often do not adequately cater to the needs of women of color. To ensure the effectiveness and equity of these interventions, it is crucial to consider the unique experiences of perinatal women from diverse racial backgrounds. This qualitative study aims to explore the complex aspects of motherhood, maternal mental well-being, and resilience among perinatal women of color. It also investigates the factors that either hinder or facilitate the use of Virtual Reality (VR) for stress management in this specific demographic. Methods: This research involves two focus groups comprising perinatal women, primarily identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. Additionally, feedback is collected from five different participants. The study assesses Nurture VR™, a VR-based program integrating mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and postpartum. Results: Qualitative analysis uncovers five primary themes and 19 sub-themes, addressing the complexities of motherhood, maternal mental health, attitudes towards VR therapy, postpartum care, and the perception of resilience. Participants share challenges related to household management, caregiving, financial stress, breastfeeding, relaxation, sleep, and the significance of social support. Their preferences and reservations regarding VR therapy are also expressed. Conclusion: This study sheds light on the diverse struggles and obstacles faced by women of color during and after pregnancy, with potential repercussions for their mental and sleep health. It underscores the need for mental health screening and analysis of maternal stress-related sleep issues, in addition to the facilitation of social support in maternal health programs. Additionally, it highlights the promise of culturally responsive behavioral treatments, including VR interventions, in offering timely and tailored mental health support to perinatal women, taking into account their intersectional identities.

Measuring Anxiety Among Latino Immigrant Populations: Within-Country and Between-Country Comparisons.

Anxiety is the most prevalent mental health disorder among adults worldwide. Given its increased prevalence among migrants due to their marginalized position in the societies where they reside, psychometric evaluations of anxiety measures such as the Generalized Anxiety Disorder-7 (GAD-7) are needed for use with migrants. The present study is the first attempt to compare the structure of GAD-7 scores for (a) different Latino groups in the same country and (b) the same Latino group in two different countries. Using three samples of Mexican and Venezuelan migrants (total N = 933), we provide reliability and validity evidence of the GAD-7 for use with adult Latino migrants. Utilizing confirmatory factor analysis and item response theory, we demonstrate that the GAD-7 is internally consistent, possesses a strong single-factor structure, and generates scores with equivalent psychometric properties. GAD-7 is appropriate for use with Mexican and Venezuelan migrants across differing gender groups and education levels.

Perceived discrimination and posttraumatic stress disorder among Venezuelan migrants in Colombia and the United States: The moderating effect of gender.

OBJECTIVES: The primary aim of this study was to examine the association between perceived discrimination and posttraumatic stress disorder (PTSD) outcomes among recently arrived Venezuelan parents in Florida and Colombia. The secondary aim was to determine whether, given the existence of an association between perceived discrimination and PTSD, this association may have been moderated by gender or by country of relocation. This is the first study to examine perceived discrimination and PTSD in Venezuelan migrants. METHOD: In October 2017, 647 Venezuelan migrant parents (62% female, average age 33) participated in an online survey in the United States (primarily Florida) and Colombia (Bogotá). The survey was cross-sectional and assessed mental health outcomes, perceived discrimination, and participant demographics. RESULTS: There was a significant positive association between discrimination and PTSD outcomes when controlling for age, college completion, marital status, and recency of arrival (ß = .25, p < .001). Further, this relationship was moderated by gender, with the relationships of discrimination with PTSD symptom severity (ß = .26, p < .001) and likelihood of a positive PTSD screen (OR = 1.07, 95% confidence interval [1.04, 1.09], p < .001) both reaching significance for women but not for men. CONCLUSIONS: Perceived discrimination is an important factor when considering mental health outcomes among Venezuelans in the United States and in Colombia. Further, our findings suggest the presence of gender differences in the relationship between discrimination and PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hurricane stress, cultural stress, and mental health among hurricane Maria migrants in the U.S. mainland.

Hurricane Maria (2017) caused great damage to Puerto Rico, undermining people's quality of life and forcing thousands to migrate to the U.S. mainland. Identifying individuals at elevated risk of suffering mental health problems as a function of being exposed to hurricane and cultural stress is crucial to reducing the burden of such health outcomes. The present study was conducted in 2020-2021 (3-4 years postdisaster) with 319 adult Hurricane Maria survivors on the U.S. mainland. We aimed to (a) identify latent stress subgroups, as defined by hurricane stress and cultural stress, and (b) map these latent stress subgroups or classes onto sociodemographic characteristics and mental health indicators (i.e., symptoms of posttraumatic stress disorder, depression, and anxiety). We used latent profile analysis and multinomial regression modeling to accomplish the study aims. We extracted four latent classes: (a) low hurricane stress/low cultural stress (44.7%), (b) low hurricane stress/moderate cultural stress (38.7%), (c) high hurricane stress/moderate cultural stress (6.3%), and (d) moderate hurricane stress/high cultural stress (10.4%). Individuals in the low hurricane stress/low cultural stress class reported the highest household incomes and levels of English-language proficiency. The moderate hurricane stress/high cultural stress class reported the worst mental health outcomes. While postmigration cultural stress, as a chronic stressor, emerged as the most important predictor of poor mental health, hurricane stress, as an acute stressor that occurred several years earlier, emerged as less influential. Our findings might be used to inform mental health prevention experts who work with natural disaster survivors forced to migrate. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

What is well-being? A scoping review of the conceptual and operational definitions of occupational well-being.

Well-being is a multifaceted construct that is used across disciplines to portray a state of wellness, health, and happiness. While aspects of well-being seem universal, how it is depicted in the literature has substantial variation. The aim of this scoping review was to identify conceptual and operational definitions of well-being within the field of occupational health. Broad search terms were used related to well-being and scale/assessment. Inclusion criteria were (1) peer-reviewed articles, (2) published in English, (3) included a measure of well-being in the methods and results section of the article, and (4) empirical paper. The searches resulted in 4394 articles, 3733 articles were excluded by reading the abstract, 661 articles received a full review, and 273 articles were excluded after a full review, leaving 388 articles that met our inclusion criteria and were used to extract well-being assessment information. Many studies did not define well-being or link their conceptual definition to the operational assessment tool being used. There were 158 assessments of well-being represented across studies. Results highlight the lack of a consistent definitions of well-being and standardized measurements.

Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents.

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

After Hurricane Maria: Effects of disaster trauma on Puerto Rican survivors on the U.S. mainland.

PURPOSE: In September 2017, Hurricane Maria devastated Puerto Rico. Houses were destroyed, millions of people lost power and access to clean water, and many roads were flooded and blocked. In the years following the storm, hundreds of thousands of people have left Puerto Rico and settled on the U.S. mainland. The purpose of this study is to examine the impact of disaster trauma among Puerto Rican adults who moved to the U.S. mainland after Hurricane Maria. METHOD: Participants were 319 adult Puerto Rican Hurricane Maria survivors on the U.S. mainland. Women comprised 71.2% of the sample. Data were collected between August 2020 and October 2021. Participants completed Spanish-language measures of hurricane-related trauma, perceived ethnic discrimination and negative context of reception on the U.S. mainland, language stress, depressive symptoms, anxiety, optimism, life satisfaction, and problem drinking. RESULTS: We estimated a structural equation model where hurricane trauma predicted cultural stress, which in turn predicted internalizing symptoms, optimism, and life satisfaction. Internalizing symptoms, optimism, and life satisfaction were specified as predictors of problem drinking. Results indicated that hurricane trauma predicted cultural stress. Cultural stress predicted internalizing symptoms, optimism, and life satisfaction. Internalizing symptoms predicted problem drinking. Hurricane trauma indirectly predicted internalizing symptoms through cultural stress and indirectly predicted problem drinking through cultural stress and internalizing symptoms. CONCLUSIONS: Traumatic experiences from the storm may predispose Puerto Rican Hurricane Maria survivors to perceive cultural stress on the U.S. mainland. In turn, cultural stressors may be associated with internalizing symptoms and alcohol problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Mental Health Impact of Hurricane Maria on Puerto Ricans in Puerto Rico and Florida.

OBJECTIVES: The aim of this study was to compare the effect of Hurricane Maria on internalizing and posttraumatic stress disorders (PTSD) among Puerto Ricans who moved to Florida after the storm versus those who stayed on the island. METHODS: In March through April 2018 (6 months after Hurricane Maria), an online survey was used to assess the effects of the storm on mental health. A sample of 213 displaced Puerto Ricans living in urban and rural/suburban areas in Florida, as well as urban and rural areas of Puerto Rico, participated in the study. RESULTS: Rates of PTSD were high in both sites (Florida, 65.7%; Puerto Rico, 43.6%); however, participants in Florida were far more likely than those in Puerto Rico to meet diagnostic criteria for PTSD (OR, 2.94; 95% CI, 1.67-5.26). Among participants in both Florida and Puerto Rico, those living in urban areas were more likely than those in rural/suburban areas to meet criteria for PTSD and generalized anxiety disorder. CONCLUSIONS: Results suggest that post-Hurricane Maria adjustment and adaptation may have been more psychologically taxing for Puerto Ricans who moved to Florida than it was for those who remained on the island, and more difficult for those in urban areas than it was for those in suburban or rural areas. (Disaster Med Public Health Preparedness. 2019;13:24-27).

Respondiendo a las necesidades de salud sexual y reproductiva de las migrantes venezolanas en Lima / Responding to the sexual and reproductive health needs of Venezuelan migrant women in Lima / Resposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima

RESUMEN Objetivo. Presentar y analizar la respuesta que el sistema de salud peruano viene dando a las necesidades en salud sexual y reproductiva de las mujeres venezolanas que radican en la ciudad de Lima, Perú e identificar algunas de las razones que nos permite entender esta respuesta. Métodos. La información se recogió mediante entrevistas a profundidad semiestructuradas por vía telefónica a 30 mujeres venezolanas, 10 trabajadores de salud y 2 funcionarios del Ministerio de Salud. Resultados. A partir de las experiencias de mujeres venezolanas que acudieron a estos servicios durante el 2019-2020 y de las perspectivas del personal y autoridades de salud presentamos un análisis de la capacidad y limitaciones que los servicios de salud públicos tienen para atender las necesidades de salud sexual y reproductiva de esta población. Los testimonios de las mujeres migrantes reportan una experiencia positiva con un sistema de salud que, a pesar de las deficiencias, responde a las necesidades de salud sexual y reproductiva más comunes. Estas coinciden con los testimonios del personal de salud y con las de las autoridades quienes enfatizan la existencia de políticas prioritarias para la atención de la Salud Sexual y Reproductiva. Conclusión. Este estudio muestra cómo un marco de prioridad nacional (disminuir la mortalidad materna), acompañado de mecanismos operativos de protección social (como el Seguro Integral de Salud), se convierten en instrumentos complementarios, que repercute de manera positiva y extiende beneficios para las y los migrantes, a pesar de no haber considerado a esta población durante el diseño de estas políticas.

ABSTRACT Objectives. To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods. Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results. Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion. This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.

RESUMO Objetivo. Apresentar e analisar a resposta do sistema de saúde peruano às necessidades de saúde sexual e reprodutiva de mulheres venezuelanas radicadas em Lima, Peru, e identificar algumas explicações para essa resposta. Métodos. Entrevistas telefônicas semiestruturadas detalhadas com 30 mulheres venezuelanas, 10 profissionais de saúde e 2 funcionários do Ministério da Saúde. Resultados. Com base nas experiências das mulheres venezuelanas que recorreram a esses serviços no período de 2019 a 2020 e nas perspectivas de profissionais e autoridades de saúde, apresentamos uma análise da capacidade e das limitações dos serviços de saúde pública para atender às necessidades de saúde sexual e reprodutiva dessa população. Os relatos das mulheres migrantes indicam uma experiência positiva com um sistema de saúde, que, apesar das deficiências, responde às necessidades mais comuns de saúde sexual e reprodutiva. Isso está em conformidade com os relatos dos profissionais de saúde e das autoridades, que enfatizam a existência de políticas prioritárias de atenção à saúde sexual e reprodutiva. Conclusão. Este estudo mostra de que maneira um âmbito de prioridade nacional (reduzir a mortalidade materna) e mecanismos operacionais de proteção social (como o Seguro Integral de Saúde) se convertem em instrumentos complementares, afetando positivamente e estendendo benefícios à população migrante, embora essa população não tenha sido levada em consideração quando da elaboração dessas políticas.

Respondiendo a las necesidades de salud sexual y reproductiva de las migrantes venezolanas en Lima

[RESUMEN]. Objetivo. Presentar y analizar la respuesta que el sistema de salud peruano viene dando a las necesidades en salud sexual y reproductiva de las mujeres venezolanas que radican en la ciudad de Lima, Perú e identificar algunas de las razones que nos permite entender esta respuesta. Métodos. La información se recogió mediante entrevistas a profundidad semiestructuradas por vía telefónica a 30 mujeres venezolanas, 10 trabajadores de salud y 2 funcionarios del Ministerio de Salud. Resultados. A partir de las experiencias de mujeres venezolanas que acudieron a estos servicios durante el 2019-2020 y de las perspectivas del personal y autoridades de salud presentamos un análisis de la capacidad y limitaciones que los servicios de salud públicos tienen para atender las necesidades de salud sexual y reproductiva de esta población. Los testimonios de las mujeres migrantes reportan una experiencia positiva con un sistema de salud que, a pesar de las deficiencias, responde a las necesidades de salud sexual y reproductiva más comunes. Estas coinciden con los testimonios del personal de salud y con las de las autoridades quienes enfatizan la existencia de políticas prioritarias para la atención de la Salud Sexual y Reproductiva. Conclusión. Este estudio muestra cómo un marco de prioridad nacional (disminuir la mortalidad materna), acompañado de mecanismos operativos de protección social (como el Seguro Integral de Salud), se convierten en instrumentos complementarios, que repercute de manera positiva y extiende beneficios para las y los migrantes, a pesar de no haber considerado a esta población durante el diseño de estas políticas.

[ABSTRACT]. Objectives. To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons under- lying this response. Methods. Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results. Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion. This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.

[RESUMO]. Objetivo. Apresentar e analisar a resposta do sistema de saúde peruano às necessidades de saúde sexual e reprodutiva de mulheres venezuelanas radicadas em Lima, Peru, e identificar algumas explicações para essa resposta. Métodos. Entrevistas telefônicas semiestruturadas detalhadas com 30 mulheres venezuelanas, 10 profissionais de saúde e 2 funcionários do Ministério da Saúde. Resultados. Com base nas experiências das mulheres venezuelanas que recorreram a esses serviços no período de 2019 a 2020 e nas perspectivas de profissionais e autoridades de saúde, apresentamos uma análise da capacidade e das limitações dos serviços de saúde pública para atender às necessidades de saúde sexual e reprodutiva dessa população. Os relatos das mulheres migrantes indicam uma experiência positiva com um sistema de saúde, que, apesar das deficiências, responde às necessidades mais comuns de saúde sexual e reprodutiva. Isso está em conformidade com os relatos dos profissionais de saúde e das autoridades, que enfatizam a existência de políticas prioritárias de atenção à saúde sexual e reprodutiva. Conclusão. Este estudo mostra de que maneira um âmbito de prioridade nacional (reduzir a mortalidade materna) e mecanismos operacionais de proteção social (como o Seguro Integral de Saúde) se convertem em instrumentos complementares, afetando positivamente e estendendo benefícios à população migrante, embora essa população não tenha sido levada em consideração quando da elaboração dessas políticas.