Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems.

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.

Ethnic inequalities in mental health and socioeconomic status among older women living with HIV: results from the PRIME Study.

OBJECTIVES: Women living with HIV in the UK are an ethnically diverse group with significant psychosocial challenges. Increasing numbers are reaching older age. We describe psychological and socioeconomic factors among women with HIV in England aged 45-60 and explore associations with ethnicity. METHODS: Analysis of cross-sectional data on 724 women recruited to the PRIME Study. Psychological symptoms were measured using the Patient Health Questionnaire 4 and social isolation with a modified Duke-UNC Functional Social Support Scale. RESULTS: Black African (BA) women were more likely than Black Caribbean or White British (WB) women to have a university education (48.3%, 27.0%, 25.7%, respectively, p<0.001), but were not more likely to be employed (68.4%, 61.4%, 65.2%, p=0.56) and were less likely to have enough money to meet their basic needs (56.4%, 63.0%, 82.9%, p<0.001). BA women were less likely to report being diagnosed with depression than WB women (adjusted odds ratio (aOR) 0.40, p<0.001) but more likely to report current psychological distress (aOR 3.34, p<0.05). CONCLUSIONS: We report high levels of poverty, psychological distress and social isolation in this ethnically diverse group of midlife women with HIV, especially among those who were BA. Despite being more likely to experience psychological distress, BA women were less likely to have been diagnosed with depression suggesting a possible inequity in access to mental health services. Holistic HIV care requires awareness of the psychosocial needs of older women living with HIV, which may be more pronounced in racially minoritised communities, and prompt referral for support including psychology, peer support and advice about benefits.

A national survey of facilities for complainants of sexual assault.

In 2006, a national survey demonstrated wide disparities in services offered to sexual assault complainants in the UK, most marked between sexual assault referral centres and non-sexual assault referral centres (police victim examination suites). With national standards introduced in 2009 and the expansion of sexual assault referral centres, we aimed to evaluate the current situation. A questionnaire based on the original 2006 survey, collecting data on population covered, access, funding, personnel, medical care and clinical governance was sent to all 44 UK sexual assault referral centres open in 2012. No non-sexual assault referral centres were identified. Data were collected over six months from December 2012. Twenty-three sexual assault referral centres from England and Scotland responded (response rate 52%), but not all answered every question. All (20/20) had 24 h access for acute referrals, although one sexual assault referral centre reported 24 h opening was not always possible due to recruitment issues. Thirteen of 20 (65%) had a separate rota for under 16 s, but this was often not 24 h/day. All services (20/20) offered facilities for non-police referrals and for provision of anonymous intelligence. All sexual assault referral centres employed female examiners, 11/17 (65%) male examiners and half (10/20) forensic nurse practitioners. All (21/21) offered pregnancy testing and emergency contraception, 19/21 (90%) HIV post-exposure prophylaxis , 12/21 (57%) hepatitis B virus vaccine and 11/21 (52%) medical care for injuries on site. For follow-up care, 12/21 (57%) provided in house counselling, 10/21 (48%) sexually transmitted infection screening, 12/21 (57%) hepatitis B virus vaccination and 14/21 (67%) HIV post-exposure prophylaxis . Our survey shows improvement in services for complainants of sexual assault since 2006 with better access to forensic examinations, medical and psychological care. However, as the response rate was low and without data from non-sexual assault referral centre services, we cannot give a comprehensive national picture. Our results also show that there has been little improvement in providing sexual health screening on site or by referral and this should be addressed by sexual assault referral centres.