"I'm Getting Life from the Treatment": Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa.

The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.

A Social-ecological Perspective on Understanding Facilitators to Access Primary Health Care Services among Ethiopian Immigrant Women in the United States.

Using a social-ecological model (SEM), this qualitative study explored the facilitators of access to primary health care (PHC) among Ethiopian immigrant women in the U.S. Data were collected through in-depth interviews (N=21, ≥18 years) and analyzed thematically using Nvivo12. At the individual level, stable employment, insurance, immigration status, proactivity, education, communication skills, and internet usage were identified as facilitators of PHC access. Interpersonal support from family and friends was highlighted as a key facilitator. Institutional facilitators included interpretation services and the sociocultural background of health care providers. On the community level, support from community organizations and residing in certain locations were recognized as facilitators of PHC access. No policy-level facilitators were identified. The findings underscore the importance of strengthening individual and interpersonal capacities, including job opportunities, social support, legal assistance for immigration status, and education and communication skills. Further research is needed to analyze policy gaps and suggest viable solutions.

"We Want to See Youth That Would Be Better People Than Us": A Case Report on Addressing Adolescent Substance Use in Rural South Africa.

Research suggests that substance use, particularly among adolescents may lead to increased illegal activities as well as physical and social health consequences. Around the world, communities, overburdened with adolescent and youth substance use, are finding ways to address this public health threat. Using a case study based on a focus group discussion with nine founding members, this paper reports on the case of Sibanye-a rural community coalition whose mission is to reduce the burden of adolescent substance use on families in rural South Africa. The focus group discussions were audio-recorded, transcribed verbatim, and analyzed using Nvivo 12. This work highlights the power of an engaged collective effort in addressing key community issues, even in rural areas of emerging economies where health and community infrastructure may be limited. The Sibanye coalition taps into its collective wealth of community knowledge to provide social contributions and aesthetics to help adolescents abstain from substance use and sexual risk behaviors. These activities offer adolescents safe places to meet each other, health education, and the ability to structure their free time meaningfully. Engaging community residents, particularly disadvantaged groups, should be central to any local and national strategies for promoting health and well-being.

How Midwestern College students protected their families in the first year of COVID-19.

Introduction: College students routinely visit their families due to geographic proximity and their financial dependence. Consequently, the potential of transmitting COVID-19 from campus to their families' homes is consequential. Family members are key sources of support for one another in nearly all matters but there is little research uncovering the mechanisms by which families have protected each other in the pandemic. Methods: Through an exploratory qualitative study, we examined the perspectives of a diverse, randomly sampled, group of students from a Midwestern University (pseudonym), in a college town, to identify COVID-19 prevention practices with their family members. We interviewed 33 students between the end of December 2020 and mid-April 2021 and conducted a thematic analysis through an iterative process. Results: Students navigated major differences in opinions and undertook significant actions in attempts to protect their family members from COVID-19 exposure. Students' actions were rooted in the greater good of public health; prosocial behavior was on display. Discussion: Larger public health initiatives could target the broader population by involving students as messengers.

Similarities in COVID-19 Mortality Between Canadian Provinces and American States Before Vaccines Were Available.

Canada and the USA are often compared for their markedly different approaches to health care despite cultural similarities and sharing the world's longest international boundary. The period between the onset of the COVID-19 pandemic in January 2020 and the availability of a vaccine in December 2020 offers an ideal opportunity to compare subnational Canadian and American pandemic mortality. Preventing the spread of COVID-19 was through compliance with health orders and best practices; treatment was only available to those admitted to hospitals and whose lives were at risk. Using publicly available data from the Johns Hopkins University 2019 Novel Coronavirus Visual Dashboard, we seek to uncover if there were any similarities in Canadian provinces' and American states' monthly COVID-19 mortality per 100,000 people, building on a broader scientific push towards understanding the successes and failures of different health systems in the pandemic. The similar province and state cumulative COVID-19 mortality rate trajectories identified in our analyses do not amount to intuitive comparative jurisdictions which suggests the importance of identifying localized pandemic responses.

En dépit de leur proximité culturelle et de leur frontière commune, la plus longue au monde, les États-Unis et le Canada font souvent l'objet de comparaisons quant à leurs approches très différentes en matière de soins de santé. La période comprise entre le début de la pandémie de COVID-19 en janvier 2020 et la disponibilité d'un vaccin en décembre de la même année nous offre une occasion idéale de comparer la mortalité pandémique à l'échelle infranationale dans les deux pays. Au cours de cette période, la lutte contre la propagation de la COVID-19 s'est articulée autour du respect des ordonnances de santé et des pratiques exemplaires, les traitements n'étant réservés qu'aux personnes admises dans les hôpitaux dans un état critique. En utilisant les données du tableau de bord de la COVID-19 proposé par l'université John Hopkins, et en nous fondant sur une tendance scientifique plus large visant à comprendre les réussites et les échecs des différents systèmes de santé au cours de la pandémie, nous avons tenté de déceler des similitudes entre les provinces canadiennes et les états américains relativement au nombre de décès mensuel de la COVID-19 pour 100 000 habitants. Les trajectoires similaires des taux de mortalité cumulés liés à la COVID-19 dans les provinces et les états, observées dans nos analyses, ne constituent en aucun cas une comparaison intuitive entre les deux pays, ce qui souligne l'importance d'identifier les réponses locales à la pandémie.

COVID-19 and Higher Education: A Qualitative Study on Academic Experiences of African International Students in the Midwest.

COVID-19 pandemic has harshly impacted university students since the outbreak was declared in March 2020. A population impacted the most was international college students due to limited social networks, restrictive employment opportunities, and travel limitations. Despite the increased vulnerability, there has been limited research on the experiences of African-born international students during the pandemic. Using an exploratory qualitative design, this study interviewed 15 African-born international students to understand their experiences during the pandemic. Thematic analysis revealed that the COVID-19 pandemic influenced participants' academic life directly via an abrupt shift to online learning and indirectly through disruptions in an academic work routine, opportunities for networking, and career advancement, resulting in lower academic performance and productivity. These experiences were worsened by other social and regulatory barriers associated with their non-immigrant status. The study findings suggest an increased need for institutional and community support for international students as vulnerable populations during a crisis to promote sustained academic success.

"COVID Is Another Layer of Problematic Things": Change, Vulnerability, and COVID-19 among University Students.

The COVID-19 pandemic not only had detrimental effects on physical health but also had adverse effects on college students' mental health. This paper begins to fill a gap in knowledge related to the contextual factors that impacted college students' mental health during COVID. Using in-depth interviews with a diverse sample of 33 college students at a Midwestern university, during Spring 2021, we highlight the pandemic's role in shaping college students' mental health and their outlook of the future. Thematic analysis revealed student reports of mental health decline during the pandemic attributed to campus closures and social distancing policies implemented by the institution to reduce the spread of COVID-19. Students shared that the pandemic created uncertainties about their future opportunities for education, career fulfillment, and employment. However, the interviews also suggested a general sense of adaptation to the pandemic's impact which was students achieved via a combination of active and passive coping strategies. Expanding institution-based mental health services to include a variety of modalities and off-line toolkits for students can help students cope with mental health challenges, whether in 'normal times' or during national crises. Future research should focus on identifying strategies for promoting mental wellness among college students and exploring post-pandemic mental health wellbeing.

From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment.

OBJECTIVE: As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. METHODS: Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. FINDINGS: Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). DISCUSSION: Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.