Women and divorce: financial coping from midlife to older age.

Divorce is a life-changing event with financial implications for women. Although large-scale studies have examined the factors associated with financial coping after divorce, little attention has been paid to the lived experience of women over time. In this study, we used mixed methods to examine the financial well-being of divorced women over 20 years from 1996 to 2016. Using data from the Australian Longitudinal Study on Women's Health [ALSWH], we analyzed women's ratings of their ability to manage on available income, and their narrative comments about financial coping over eight waves, beginning in midlife (ages 46-51). The ratings improved over time, particularly as women reached peak career in their 50s or 60s or entered retirement. Despite this upward trajectory, financial strain persisted for ~40% of the cohort who faced poor health or diminishing job prospects. We conclude that, although financial hardship often eases over time, women's early ratings of financial coping predict levels of income security in older age.

Ricky and Lucy: gender stereotyping among young Black men who have sex with men in the US Deep South and the implications for HIV risk in a severely affected population.

HIV disproportionately affects young Black men who have sex with men in the USA, with especially high rates in the Deep South. In this Alabama study, we interviewed 24 pairs of young Black men who have sex with men aged 19-24 and their close friends (n = 48) about sexual scripts, dating men and condom use. Three main themes emerged from the study: the power dynamics of 'top' and 'bottom' sexual positions for condom use; gender stereotyping in the iconic style of the 'I Love Lucy' show of the 1950s; and the sexual dominance of 'trade' men. Gender stereotyping was attributed to the cultural mores of Black families in the South, to the preferences of 'trade' men who exerted sexual and financial control and to internalised stigma relating to being Black, gay and marginalised. The findings suggest that HIV prevention education for young Black men who have sex with men is misguided if gendered power dynamics are ignored, and that funded access to self-protective strategies such as pre-exposure prophylaxis and post-exposure prophylaxis could reduce HIV risk for this severely affected population.

HIV-Related Stigma Among Healthcare Providers in the Deep South.

Stigma towards people living with HIV (PLWH) in healthcare settings is a barrier to optimal treatment. However, our understanding of attitudes towards PLWH from healthcare providers' perspective in the United States is limited and out-of-date. We assessed HIV-related stigma among healthcare staff in Alabama and Mississippi, using online questionnaires. Participants included 651 health workers (60 % White race; 83 % female). Multivariate regression suggests that several factors independently predict stigmatizing attitudes: Protestant compared to other religions (ß = 0.129, p ≤ 0.05), White race compared to other races (ß = 0.162, p ≤ 0.001), type of clinic (HIV/STI clinic: ß = 0.112, p ≤ 0.01), availability of post-exposure prophylaxis (yes: ß = -0.107, p ≤ 0.05), and perceptions of policy enforcement (policies not enforced: ß = 0.058, p = p ≤ 0.05). These findings may assist providers wishing to improve the quality care for PLWH. Enforcement of policies prohibiting discrimination may be a useful strategy for reducing HIV-related stigma among healthcare workers.

Losing Ground: Racial Disparities in Medical Debt and Home Foreclosure in the Deep South.

Medical debt is a persistent problem in the United States. This study examined the role of medical debt in relation to home foreclosure in a Deep South county with high rates of poverty, health disparities, and a racial gap in homeownership. Statistical analysis and geographic information systems mapping of municipal court records for 890 foreclosees indicated disproportionately high rates of medical debt among African Americans who lived in racially distinct neighborhoods. Both nonmedical and medical debt judgments were more numerous among African Americans than among whites; foreclosees in both groups had a higher medical debt burden compared with nonforeclosees. These results help to explain medical debt as a driver of foreclosure and racial disparities in homeownership.

The PRO-TEST Program: HIV and Hepatitis C Services at the Parole Office.

This article describes an on-site program for HIV and hepatitis C (hep-C) services at a parole office in an impoverished U.S. state. Both officers and their supervisees participated in the program. The officers attended workshops on the biology of HIV, and hep-C, and workplace safety, and collaborated in development and implementation of the services. The supervisees received HIV and hep-C education, voluntary testing, and referral for treatment after a positive diagnosis. Test results showed that few supervisees were positive for HIV and 16% of White individuals were diagnosed with hep-C. These findings support the need for on-site services for supervisees in community corrections.

From "Coffin Dodger" to "Boomer Remover": Outbreaks of Ageism in Three Countries With Divergent Approaches to Coronavirus Control.

OBJECTIVES: This article compares responses to coronavirus control in Australia, the United Kingdom, and the United States, 3 countries in which public ageism erupted over the social and economic costs of protecting older adults from Covid-19. METHODS: Thirty-five (35) newspapers, media websites, and current affairs magazines were sourced for the study: 8 for Australia, 12 for the United Kingdom, and 15 for the United States. Searches were conducted daily from April to June 2020, using key words to identify age-related themes on pandemic control. RESULTS: Despite divergent policies in the 3 countries, ageism took similar forms. Public responses to lockdowns and other measures cast older adults as a problem to be ignored or solved through segregation. Name-calling, blame, and "so-be-it" reactions toward age vulnerability were commonplace. Policies banning visits to aged care homes angered many relatives and older adults. Indefinite isolation for older adults was widely accepted, especially as a vehicle to end public lockdowns and economic crises. DISCUSSION: Older adults have and will continue to bear the brunt of Covid-19 in terms of social burdens and body counts as the pandemic continues to affect people around the globe. The rhetoric of disposability underscores age discrimination on a broader scale, with blame toward an age cohort considered to have lived past its usefulness for society and to have enriched itself at the expense of future generations.

The Gold Standard and the Pyrite Principle: Toward a Supplemental Frame of Reference.

In medicine and social sciences, the phrase "gold standard" is often used to characterize an object or procedure described as unequivocally the best in its genre, against which all others should be compared. Examples of this usage are readily available in rigorously peer-reviewed publications, touted by test publishers, and appear in descriptions of methodologies by social science researchers. The phrase does not accurately describe commonly accepted measures, tests, and instruments. Instead, the descriptor can be ambiguous and misleading. This paper presents an overview of the history of the gold standard and its current applications to medicine and the social sciences. We question the use of the phrase "the gold standard" and suggest the additional operational use of a "pyrite principle" as a less presumptuous frame of reference. In thinking about validity and standards, the pyrite principle permits an understanding of standards as authoritative rather than fixed constructs in behavioral and health sciences.

Partnership concurrency status and condom use among women diagnosed with Trichomonas vaginalis.

INTRODUCTION AND BACKGROUND: Partner concurrency increases the risk of sexually transmitted infections (STIs) such as Trichomonas vaginalis. Women diagnosed with T. vaginalis have a 2- to 3-fold higher risk of acquiring the human immunodeficiency virus and developing the acquired immunodeficiency syndrome. GOALS: We sought to describe partnership concurrency (multiple sexual partners during the same time period) and condom use among women diagnosed with T. vaginalis, and to compare reports of concurrency between matched female and male dyads. METHODS: A baseline interview on partnership status and condom use was administered to women diagnosed with T. vaginalis at a public sexually transmitted infections (STI) clinic. A male partner substudy was also conducted. Seventy-three dyads were matched by unique identifier and female and male responses were compared. RESULTS: The participants were 319 African American women and 10 white women aged 15-40 years (N = 329). Almost three fourths (72.3%) had only 1 partner over a 3-month period, compared with more than one fourth (27.7%) with > or =2 partners. Regular condom use was low (16.4%), especially with regular partners (9.1%). In the matched substudy, men reported significantly higher rates of concurrency than women (47.3% vs. 23.0%; p < or = .002). Men who practiced concurrency were not significantly more likely than other men to use condoms with regular partners. CONCLUSIONS: Women seldom used condoms with their regular male partners and these partners had significantly higher rates of concurrency and low rates of condom use. Women may underestimate the risk of acquiring STI from regular partners. Counseling strategies should include the risk of being infected with STDs such as trichomonas by regular partners as well as by casual partners in the absence of condom use.

Sharecropper's Tuberculosis: Pathologies of Power in a Fatal Outbreak.

Tuberculosis Bacilli (TB) is a global scourge that affects poor people and regions. Drawing on Farmer's (2003) pathologies of power, and a case study approach, we examine the sociostructural landscape of a fatal outbreak of Sharecropper's TB among African Americans in rural Alabama. In a mixed-method qualitative approach involving oral history, surveys, interviews and documentary analysis, we identified three pathologies that contribute to TB susceptibility: corporate power, land wealth, and structural racism. While medicine can cure non-resistant forms of TB, control of future outbreaks will depend upon a social "cure" such as addressing structural inequality and building community trust in the health system.

Health Risks of American Long-Distance Truckers: Results From a Multisite Assessment.

OBJECTIVE: The aim of this study was to assess the general and sexual health of long-haul truck drivers in the United States. METHODS: Drivers were recruited from company sites and truck stops in North Carolina, Tennessee, and Mississippi. A sample of 266 drivers was assessed for lifestyle activities; body mass index and blood pressure were measured, and biologic samples were taken for cholesterol, diabetes, and sexually transmitted infection (STI)/HIV testing. RESULTS: The drivers in this study had higher levels of cholesterol and higher rates of smoking, obesity, and diabetes than the U.S average. STI/HIV infection rates were lower than the U.S. average. CONCLUSION: Long-haul truck driving is a stressful occupation with few opportunities for healthy living. Stress reduction, wellness programs, and better food and exercise options at truck stops should be adopted for the benefit of truckers and the safety of the driving public.

Illicit drug use and the social context of HIV/AIDS in Alabama's Black Belt.

CONTEXT: The rural Black Belt of Alabama is among the poorest areas of the nation. Poverty, lack of health infrastructure, and health disparities involving HIV/AIDS and other diseases reflect the lower life expectancy of people in the region. The Black Belt region has the highest HIV rates in rural America. PURPOSE: Using Alabama as a case example, the paper describes the role of illicit drug use in pathways to HIV transmission in the Black Belt and examines the relationship between drug use and social context with respect to HIV/AIDS disparities in the region. METHODS: Published research and national and state data were triangulated for information on interactions between illicit drug use, social context, and HIV/AIDS. FINDINGS: Illicit drug use is implicated in HIV risk in Alabama's Black Belt, but less so than in other parts of the nation. Published research suggests that the impetus for drug use involves status seeking in the context of heterosexual contact and economic disparities. HIV transmission in Alabama's Black Belt speaks to the tyranny of small places; that is, the risk of HIV/AIDS occurs in geographically bounded areas with a history of racial homogeneity, historically high rates of sexually transmitted infections, and clustered sexual networks in this isolated region. CONCLUSIONS: Social context is an important correlate of HIV risk in the Black Belt. The role of drug use in HIV risk is secondary to social-contextual factors involving rural isolation, racial homogeneity, and the racial disparities of the region.

Two vignettes of adolescent sexual disclosure: guidance for HIV clinical practice.

HIV-positive adolescents are required by law to notify sexual partners, but can find it difficult to achieve this goal. This article offers practice guidance for counselling HIV-positive adolescents about sexual disclosure in clinical settings and for building confidence in managing sexual lives with HIV. We use two vignettes to illustrate key differences between perinatally and sexually infected adolescents in terms of readiness to disclose, and include a set of strategies for both groups that can be tailored to individual circumstances and contexts. The toolbox of strategies we describe include pre-counselling, focused counselling, social support groups and technical support. Pre-counselling helps to identify barriers and motivations to sexual disclosure and is followed by counselling sessions in which the focus is on role playing and sexual scripts for disclosure. Peer-led support groups are designed to boost adolescent confidence, and pre-paid cell phones, text messaging, ready-dial phone numbers and a private Facebook page provide back-up support and out-of-hours contact. Since sexual disclosure can be a risky proposition, safety plans, such as having an emergency contact person, should always be in place. These strategies are designed to empower vulnerable adolescents, foster trust between patient and provider, and reduce HIV transmission to sexual partners.

Domestic violence in barriers to health care for HIV-positive women.

Few studies have addressed the issue of domestic violence and health care for HIV-positive women. However, such women are at increased risk of clinical progression when domestic violence prevents access to health care or their ability to take HIV medicines on a consistent basis. To address this issue, 3 focus groups and 50 in-depth interviews were conducted at a public health clinic with HIV-positive women clients who had experienced domestic violence. The results are illustrated in 4 case studies of how domestic violence diminishes women's ability to obtain regular health care. Abused women were reluctant to keep appointments if they were afraid of their partners, if they were depressed, feeling ill or "too worn down," or if they were ashamed of being abused. Abusive partners were sometimes reported to sabotage women's efforts to seek care, keep appointments or take medications. The study concluded that domestic violence is an underrecognized barrier to women's ability to obtain regular medical care for HIV/AIDS. Effective HIV treatment is dependent on consistent HIV care, and domestic violence is a crucial barrier for some women. More research is needed to determine the most effective interventions for domestic violence in relation to HIV-positive women.

A partnership approach to providing on-site HIV services for probationers and parolees: a pilot study from Alabama, USA.

INTRODUCTION: HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, particularly among African Americans. In the Deep South state of Alabama, a policy directive to reduce prison overcrowding has diverted large numbers of convicted felons to community supervision. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. This study sought to implement on-site HIV services for probationers and parolees through an intersectoral programme involving law enforcement, university and HIV agency employees. The three main objectives were to (1) involve probation/parole officers in planning, execution and assessment of the programme, (2) provide HIV education to the officers and (3) offer voluntary pretest HIV counselling and testing to probationers and parolees. METHODS: The partnered programme was conducted between October and December 2015. Offenders who were recently sentenced to probation ("new offenders"), received HIV education during orientation. Offenders already under supervision prior to the programme ("current offenders") learned about the on-site services during scheduled office visits. Outcomes were measured through officer assessments, informal feedback and uptake of HIV services among offenders. RESULTS: A total of 86 new and 249 current offenders reported during the programme (N=335). Almost one-third (31.4%) of new offenders sought HIV testing, while only 3.2% of current offenders were screened for HIV. Refusals among current offenders invoked monogamy, time pressures, being tested in prison, fear of positive test results and concerns about being labelled as gay or unfaithful to women partners. Officers rated the programme as worthwhile and feasible to implement at other offices. CONCLUSIONS: The partnership approach ensured support from law enforcement and intersectoral cooperation throughout the programme. HIV training for officers reduced discomfort over HIV and fostered their willingness to be active agents for referral to HIV services. Voluntary testing was enhanced by the HIV employee's educational role, particularly during orientation sessions for new offenders. The almost one-third success rate in HIV testing among new offenders suggests that future efforts should concentrate on this group in order to maximize participation at the probation and parole office.

Domestic violence, sexual ownership, and HIV risk in women in the American deep south.

Domestic violence and sexual abuse are important correlates of HIV risk in women. This paper examines the links between HIV risk and domestic violence in women in a region with the highest HIV/AIDS rates in the United States. The theoretical framework incorporates Butler's (1993) and (1990) concept of performative gender and Collins' (2000) "controlling images" of African American women as a context for domestic violence in the Deep South. Two focus groups were convened to develop a definition of domestic violence as HIV risk; 50 in-depth individual interviews of HIV-positive women were subsequently conducted for specific information on the topic. A final focus group was conducted for verification and feedback. The interview data revealed that controlling images of women as sexualized bodies were enacted through rape, sexual coercion, and name-calling in intimate relationships. The main finding was that the women lacked the ability to control sexual activities (including condom use) in abusive relationships with HIV-positive men. The women used various strategies to escape abusive partners and to obtain treatment for HIV/AIDS. The study concludes that the links between gender inequity, domestic violence, and HIV transmission should appear in prevention materials to encourage domestic violence screening in health settings, and to provide abused women with information on the not-so-obvious risks of being infected in abusive relationships.

Partner notification methods for African American men being treated for trichomoniasis: a consideration of main men, Second Hitters, and Third Players.

This pilot study sought information on African American men's preferences for partner notification methods for a common sexually transmitted infection called trichomoniasis. Two focus groups of African American men were convened at a public STI clinic where they were being treated for trichomoniasis. The groups identified a sexual hierarchy in men's preferences for methods of partner notification. The hierarchy consisted of main men (Cake Daddies), second men (Second Hitters), and third or fourth men (Third Players), with placement depending on age, income, and social status. Health department employees affirmed the existence of a sexual hierarchy in a separate focus group. Sexual and economic bartering formed the basis of the hierarchy, and the secrecy involved in such arrangements presented a considerable challenge for STI control. Disease intervention specialists who were responsible for contact tracing spoke of cat-and-mouse methods in contacting the men without understanding fully exactly how the hierarchy influenced men's responses to partner notification. The findings suggest that STI control efforts must take the sexual hierarchy and its privacy implications into account if partner notification methods are to be acceptable to African American men.

Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty.

Sexually transmitted infections (STI) occur at high rates in the US compared to other Western nations. Sociocultural indicators such as race and ethnicity, lower socioeconomic status and historically higher rates of certain diseases, such as syphilis, are correlated factors but do not explain fully why STI rates are particularly high in the American Deep South. One salient factor is the stigma associated with STI and its effect on screening and treatment. This paper presents the results of six focus group interviews that were conducted among mainly African-American health workers, patients and students in Alabama, USA. The results showed that STI-related stigma directly and indirectly affected willingness to be treated for STI at public health clinics. Four dimensions of stigma emerged: (1) Religious ideation affected how health workers felt about 'promiscuous' patients (especially women), (2) privacy fears discouraged male patients from seeking treatment at local clinics, (3) racial attitudes affected willingness to be treated for STI and (4) Stigma transference (being "scarlet lettered") emerged as a potent disincentive to treatment. Partner notification was more likely if patients felt betrayed by a sexual partner. Further research is needed to clarify these stigma-related dimensions and the impact on screening, treatment and partner services.

Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support.

This study used Olshansky's (1962) concept of chronic sorrow to examine social support needs of 21 human immunodeficiency virus (HIV)-positive men and women in a southern U.S. city. The methods of inquiry consisted of narrative interviews and a quantitative assessment of depression (the Center of Epidemiological Studies on Depression [CES-D] Scale). This combined approach indicated that chronic sorrow in HIV-positive persons is related to illness, fear of death, poverty, and social isolation, especially for women with children. More than half of the subjects scored as depressed, with African American women scoring significantly higher than Caucasian men or women. Social isolation often resulted from the effects of stigma, as framed in Erving Goffman's theory of discredited identity. The women were likely to be stigmatized because of their association with "dirty sex," contagion, and moral threat in heterosexual communities. Most of the men had been protected from the worst effects of stigma because of their ties to the gay community and associated health networks. Based on these preliminary findings, stigma should be considered a marker of chronic depression in the HIV-positive, and support services should take account of the stigmatizing contexts of HIV-positive persons.

Giving birth, going home: influences on when low-income women leave hospital.

The US Newborns' and Mothers' Health Protection Act of 1996 ('The Two-Day Law') mandates insurance coverage for women who have just given birth to remain in hospital for two days post-partum. However, many women are being discharged from hospital after 24 hours. To assess why early discharge is still occurring, a study of 406 new mothers was conducted at an urban metropolitan hospital in the USA. The women were aware of the new law (95%) but decision making was often relinquished to hospital authorities. Patients who stayed longer tended to be more assertive in decision making, and used the Two-Day Law as leverage in discussions about going home. The study concluded that the nurses were authoritative and often influential agents in the decision-making process, and that patients were likely to interpret specific interactions with hospital staff as a signal to leave.

"Notify your partners--it's the law": HIV providers and mandatory disclosure.

HIV care providers in the United States must counsel clients about disclosure to sexual partners and report anyone who is suspected of noncompliance. This study compared provider attitudes and practices in relation to counseling clients about mandatory disclosure in North Carolina and Alabama, the 2 states with similar HIV epidemiology but different laws for HIV control. Personal interviews were conducted with 20 providers in each state (n = 40). The results were analyzed in a qualitative, cross-comparison method to identify patterns of convergence or difference. Providers in both states believed that clients often failed to notify sexual partners and were secretive if questioned about disclosure. Differences in counseling styles and procedures for each state were noteworthy. Compared to Alabama, North Carolina had harsher penalties for nondisclosure, stricter and more standardized procedures for counseling, and providers expressed greater support for HIV criminalization. Although most North Carolina providers viewed the stricter standards as beneficial for HIV care and control, Alabama providers were likely to view such standards as a barrier to patient care. These results indicated a direct relation between state HIV law, provider attitudes, and counseling procedures for mandatory disclosure.