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1.
AIDS Care ; 35(12): 1971-1981, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-36919583

RESUMO

Background: Breastfeeding is not recommended for women living with HIV (WLWH) in Canada. We described the prevalence of breastfeeding and explored experiences of care, support, and stigma related to infant feeding. Setting: Quebec, Ontario, and British Columbia (Canada). Methods: Data were obtained from the HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) surveys, conducted between 2013 and 2018. Results: Breastfeeding was reported by 73.5% of the 786 women who delivered before HIV diagnosis and 7.3% of the 289 women who delivered after HIV diagnosis. Among them, earlier year of delivery, delivery outside of Canada, and African, Caribbean, Black ethnicity were independently associated with increased odds of breastfeeding. Among WLWH who had a live birth during the last year, 77% (40/52) felt that they had received support regarding infant feeding practices, and 77% (23/30) were concerned that not breastfeeding could lead to them being identified as WLWH. Among 71 women within one year postpartum at any one of the study waves, 89% reported having an undetectable viral load. Conclusion: Breastfeeding experiences were common among WLWH, most often prior to HIV diagnosis. Fear of unintentional HIV status disclosure when not breastfeeding and challenges to maintain an undetectable HIV viral load are important issues to address during postpartum care.


Assuntos
Infecções por HIV , Feminino , Lactente , Humanos , Estudos de Coortes , Infecções por HIV/epidemiologia , Canadá/epidemiologia , Saúde da Mulher , Ontário/epidemiologia , Aleitamento Materno , Período Pós-Parto
2.
AIDS Behav ; 24(1): 95-113, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30900043

RESUMO

In 2012, the Supreme Court of Canada ruled that people with HIV are legally obligated to disclose their serostatus before sex with a "realistic possibility" of HIV transmission, suggesting a legal obligation to disclose unless they use condoms and have a low HIV viral load (< 1500 copies/mL). We measured prevalence and correlates of ruling awareness among 1230 women with HIV enrolled in a community-based cohort study (2015-2017). While 899 (73%) participants had ruling awareness, only 37% were both aware of and understood ruling components. Among 899 aware participants, 34% had never discussed disclosure and the law with healthcare providers, despite only 5% being unwilling to do this. Detectable/unknown HIV viral load, lack of awareness of prevention benefits of antiretroviral therapy, education ≤ high-school and high HIV-related stigma were negatively associated with ruling awareness. Discussions around disclosure and the law in community and healthcare settings are warranted to support women with HIV.


Assuntos
Comportamento Criminoso , Infecções por HIV/diagnóstico , Pessoal de Saúde/psicologia , Parceiros Sexuais/psicologia , Revelação da Verdade , Canadá , Estudos de Coortes , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Legislação como Assunto
3.
AIDS Care ; 31(11): 1427-1434, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30822106

RESUMO

Previous maternity experiences may influence subsequent reproductive intentions and motherhood experiences. We used latent class analysis to identify patterns of early motherhood experience reported for the most recent live birth of 905 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Four indicators were used: difficulties getting pregnant, feelings when finding out pregnancy, feelings during pregnancy, and feelings during the first year postpartum. Most (70.8%) pregnancies analyzed occurred before HIV diagnosis. A four-class maternity experience model was selected: "overall positive experience" (40%); "positive experience with postpartum challenges" (23%); "overall mixed experience" (14%); and "overall negative experience" (23%). Women represented in the "overall negative experience" class were more likely to be younger at delivery, to not know the HIV status of their pregnancy partner, and to report previous pregnancy termination. Women represented in the "positive experience with postpartum challenges" class were more likely to report previous miscarriage, stillbirth or ectopic pregnancy. We found no associations between timing of HIV diagnosis (before, during or after pregnancy) and experience patterns. Recognition of the different patterns of experiences can help providers offer a more adapted approach to reproductive counseling of women with HIV.


Assuntos
Infecções por HIV/psicologia , Análise de Classes Latentes , Complicações Infecciosas na Gravidez/psicologia , Adulto , Canadá , Estudos de Coortes , Serviços de Planejamento Familiar , Feminino , Infecções por HIV/complicações , Humanos , Gravidez , Saúde da Mulher
4.
Arch Sex Behav ; 48(4): 1015-1040, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30891711

RESUMO

Love remains hidden in HIV research in favor of a focus on risk. Among 1424 women living with HIV in Canada, we explored (1) whether eight facets of sex and intimacy (marital status, sexual activity, physical intimacy, emotional closeness, power equity, sexual exclusivity, relationship duration, and couple HIV serostatus) may coalesce into distinct relationship types, and (2) how these relationship types may be linked to love as well as various social, psychological, and structural factors. Five latent classes were identified: no relationship (46.5%), relationships without sex (8.6%), and three types of sexual relationships-short term (15.4%), long term/unhappy (6.4%), and long term/happy (23.2%, characterized by equitable power, high levels of physical and emotional closeness, and mainly HIV-negative partners). While women in long-term/happy relationships were most likely to report feeling love for and wanted by someone "all of the time," love was not exclusive to sexual or romantic partners and a sizeable proportion of women reported affection across latent classes. Factors independently associated with latent class membership included age, children living at home, sexism/genderism, income, sex work, violence, trauma, depression, HIV treatment, awareness of treatment's prevention benefits, and HIV-related stigma. Findings reveal the diversity of women's experiences with respect to love, sex, and relationships and draw attention to the sociostructural factors shaping intimate partnering in the context of HIV. A nuanced focus on promoting healthy relationships and supportive social environments may offer a more comprehensive approach to supporting women's overall sexual health and well-being than programs focused solely on sexual risk reduction.


Assuntos
Infecções por HIV/epidemiologia , Relações Interpessoais , Análise de Classes Latentes , Parceiros Sexuais/psicologia , Adolescente , Adulto , Canadá , Feminino , Humanos , Amor , Pessoa de Meia-Idade , Comportamento Sexual/psicologia , Adulto Jovem
5.
Cult Health Sex ; 21(10): 1087-1102, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30624133

RESUMO

The Women, ART and the Criminalization of HIV Study is a qualitative, arts-based research study focusing on the impact of the HIV non-disclosure law on women living with HIV in Canada. The federal law requires people living with HIV to disclose their HIV-positive status to sexual partners before engaging in sexual activities that pose what the Supreme Court of Canada called a 'realistic possibility of transmission'. Drawing on findings from seven education and discussion sessions with 48 women living with HIV regarding HIV non-disclosure laws in Canada, this paper highlights the ways in which women living with HIV respond to learning about the criminalisation of HIV non-disclosure. The most common emergent themes included: the way the law reproduces social and legal injustices; gendered experiences of intimate injustice; and the relationship between disclosure and violence against women living with HIV. These discussions illuminate the troubling consequences inherent in a law that is antithetical to the science of HIV transmission risk, and that fails to acknowledge the multiple barriers to HIV disclosure that women living with HIV experience. Women's experiences also highlight the various ways the law contributes to their experiences of sexism, racism and other forms of marginalisation in society.


Assuntos
Revelação/legislação & jurisprudência , Infecções por HIV , Sexismo , Parceiros Sexuais , Canadá , Feminino , Infecções por HIV/etnologia , Infecções por HIV/transmissão , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa
6.
Harm Reduct J ; 16(1): 47, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319894

RESUMO

BACKGROUND: A community-based research (CBR) approach is critical to redressing the exclusion of women-particularly, traditionally marginalized women including those who use substances-from HIV research participation and benefit. However, few studies have articulated their process of involving and engaging peers, particularly within large-scale cohort studies of women living with HIV where gender, cultural and linguistic diversity, HIV stigma, substance use experience, and power inequities must be navigated. METHODS: Through our work on the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), Canada's largest community-collaborative longitudinal cohort of women living with HIV (n = 1422), we developed a comprehensive, regionally tailored approach for hiring, training, and supporting women living with HIV as Peer Research Associates (PRAs). To reflect the diversity of women with HIV in Canada, we initially hired 37 PRAs from British Columbia, Ontario, and Quebec, prioritizing women historically under-represented in research, including women who use or have used illicit drugs, and women living with HIV of other social identities including Indigenous, racialized, LGBTQ2S, and sex work communities, noting important points of intersection between these groups. RESULTS: Building on PRAs' lived experience, research capacity was supported through a comprehensive, multi-phase, and evidence-based experiential training curriculum, with mentorship and support opportunities provided at various stages of the study. Challenges included the following: being responsive to PRAs' diversity; ensuring PRAs' health, well-being, safety, and confidentiality; supporting PRAs to navigate shifting roles in their community; and ensuring sufficient time and resources for the translation of materials between English and French. Opportunities included the following: mutual capacity building of PRAs and researchers; community-informed approaches to study the processes and challenges; enhanced recruitment of harder-to-reach populations; and stronger community partnerships facilitating advocacy and action on findings. CONCLUSIONS: Community-collaborative studies are key to increasing the relevance and impact potential of research. For women living with HIV to participate in and benefit from HIV research, studies must foster inclusive, flexible, safe, and reciprocal approaches to PRA engagement, employment, and training tailored to regional contexts and women's lives. Recommendations for best practice are offered.


Assuntos
Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Direito Penal/legislação & jurisprudência , Overdose de Drogas/reabilitação , Estudos Epidemiológicos , Infecções por HIV , Grupo Associado , Pesquisa/educação , Canadá , Competência Clínica/legislação & jurisprudência , Estudos de Coortes , Feminino , Humanos , Capacitação em Serviço/legislação & jurisprudência , Estudos Longitudinais , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Seleção de Pessoal/legislação & jurisprudência , Projetos de Pesquisa , Fatores Sexuais , Marginalização Social
7.
BMC Public Health ; 18(1): 644, 2018 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-29783965

RESUMO

BACKGROUND: Basic needs (e.g., food security and stable housing) are important determinants of health and well-being, yet their impact on health-related quality of life (HRQoL) in the context of HIV and aging has not been systematically investigated. METHODS: Multiple linear regression models examined the relationship between unmet basic needs, and physical and mental HRQoL by age strata (20-34, 35-49 and 50+) in a cross-sectional sample of 496 people living with HIV in Ontario, Canada. RESULTS: An overwhelming majority of participants (87%) reported unmet needs related to food, clothing or housing. The prevalence of unmet basic needs in the two older groups appeared to be lower than among younger participants, but the difference did not reach statistical significance. The presence of unmet basic needs predicted substantially lower mean physical health and mental health summary scores in the two oldest groups. Notably, age moderated the influence of unmet basic needs on HRQoL. CONCLUSIONS: The availability and accessibility of food security, appropriate clothing and stable housing for people living with HIV who are aging need to become a higher priority for program planners and decision makers.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Habitação/estatística & dados numéricos , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Adulto Jovem
8.
AIDS Care ; 29(2): 137-144, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27449254

RESUMO

HIV-related stigma is associated with many psychological challenges; however, minimal research has explored how perceived HIV-related stigma intersects with psychosocial issues that mothers living with HIV may experience including depression, perceived stress and social isolation. The present study aims to describe the correlates and predictors of HIV-related stigma in a cohort of women living with HIV (WLWH) from across Ontario, Canada during pregnancy and early postpartum. From March 2011 to December 2012, WLWH ≥ 18 years (n = 77) completed a study instrument measuring independent variables including sociodemographic characteristics, perceived stress, depression symptoms, social isolation, social support and perceived racism in the third trimester and 3, 6 and 12 months postpartum. Multivariable linear regression was employed to explore the relationship between HIV-related stigma and multiple independent variables. HIV-related stigma generally increased from pregnancy to postpartum; however, there were no significant differences in HIV-related stigma across all study time points. In multivariable regression, depression symptoms and perceived racism were significant predictors of overall HIV-related stigma from pregnancy to postpartum. The present analysis contributes to our understanding of HIV-related stigma throughout the pregnancy-motherhood trajectory for WLWH including the interactional relationship between HIV-related stigma and other psychosocial variables, most notably, depression and racism.


Assuntos
Infecções por HIV/psicologia , Mães/psicologia , Complicações Infecciosas na Gravidez/psicologia , Racismo/psicologia , Estigma Social , Adulto , Depressão/etiologia , Feminino , Humanos , Ontário , Período Pós-Parto , Gravidez , Terceiro Trimestre da Gravidez , Apoio Social , Estresse Psicológico/etiologia , Inquéritos e Questionários
9.
Qual Health Res ; 27(14): 2088-2099, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28814159

RESUMO

Pregnant women and mothers living with HIV are under surveillance of service providers, family members, and the community at large. Surveillance occurs throughout the medical management of their HIV during pregnancy, preventing HIV transmission to their baby, infant feeding practices, and as part of assessments related to their ability to mother. Enacted and anticipatory HIV-related stigma can exacerbate the negative impact that being under surveillance has on mothers living with HIV as they move through their pregnancy, birthing, and mothering experiences. In response, women living with HIV find ways to manage their experiences of surveillance through engaging in acts of distancing, planning, and resisting at different points in time, and sometimes enacting all three practices at once. Positioning the narratives of pregnant women and mothers living with HIV in relation to their experiences of surveillance illuminates the relationship between the surveillance of mothers living with HIV and HIV-related stigma.


Assuntos
Infecções por HIV/psicologia , Mães/psicologia , Complicações Infecciosas na Gravidez/psicologia , Gestantes/psicologia , Vigilância em Saúde Pública , Adulto , Parto Obstétrico/psicologia , Feminino , Infecções por HIV/terapia , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Ontário , Gravidez , Complicações Infecciosas na Gravidez/terapia , Isolamento Social/psicologia , Estigma Social , Fatores Socioeconômicos , Adulto Jovem
10.
BMC Med Res Methodol ; 16(1): 101, 2016 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-27543135

RESUMO

BACKGROUND: Community-based research has gained increasing recognition in health research over the last two decades. Such participatory research approaches are lauded for their ability to anchor research in lived experiences, ensuring cultural appropriateness, accessing local knowledge, reaching marginalized communities, building capacity, and facilitating research-to-action. While having these positive attributes, the community-based health research literature is predominantly composed of small projects, using qualitative methods, and set within geographically limited communities. Its use in larger health studies, including clinical trials and cohorts, is limited. We present the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a large-scale, multi-site, national, longitudinal quantitative study that has operationalized community-based research in all steps of the research process. Successes, challenges and further considerations are offered. DISCUSSION: Through the integration of community-based research principles, we have been successful in: facilitating a two-year long formative phase for this study; developing a novel survey instrument with national involvement; training 39 Peer Research Associates (PRAs); offering ongoing comprehensive support to PRAs; and engaging in an ongoing iterative community-based research process. Our community-based research approach within CHIWOS demanded that we be cognizant of challenges managing a large national team, inherent power imbalances and challenges with communication, compensation and volunteering considerations, and extensive delays in institutional processes. It is important to consider the iterative nature of community-based research and to work through tensions that emerge given the diverse perspectives of numerous team members. CONCLUSIONS: Community-based research, as an approach to large-scale quantitative health research projects, is an increasingly viable methodological option. Community-based research has several advantages that go hand-in-hand with its obstacles. We offer guidance on implementing this approach, such that the process can be better planned and result in success.


Assuntos
Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Infecções por HIV/fisiopatologia , Saúde Reprodutiva/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , Canadá/epidemiologia , Estudos de Coortes , Pesquisa Participativa Baseada na Comunidade/métodos , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e Questionários
11.
Arch Womens Ment Health ; 19(5): 809-23, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26961003

RESUMO

We measured stress, depression and post-traumatic stress disorder (PTSD) levels of urban Indigenous women living with and without HIV in Ontario, Canada, and identified correlates of depression. We recruited 30 Indigenous women living with HIV and 60 without HIV aged 18 years or older who completed socio-demographic and health questionnaires and validated scales assessing stress, depression and PTSD. Descriptive statistics were conducted to summarize variables and linear regression to identify correlates of depression. 85.6 % of Indigenous women self-identified as First Nation. Co-morbidities other than HIV were self-reported by 82.2 % (n = 74) of the sample. High levels of perceived stress were reported by 57.8 % (n = 52) of the sample and 84.2 % (n = 75) had moderate to high levels of urban stress. High median levels of race-related (51/88, IQR 42-68.5) and parental-related stress (40.5/90, IQR 35-49) scores were reported. 82.2 % (n = 74) reported severe depressive symptoms and 83.2 % (n = 74) severe PTSD. High levels of perceived stress was correlated with high depressive symptoms (estimate 1.28 (95 % CI 0.97-1.58), p < 0.001). Indigenous women living with and without HIV reported elevated levels of stress and physical and mental health concerns. Interventions cutting across diverse health care settings are required for improving and preventing adverse health outcomes.


Assuntos
Saúde Mental , Grupos Populacionais , Estresse Psicológico/psicologia , População Urbana , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Ontário , Análise de Regressão , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos , Inquéritos e Questionários
12.
Soc Work Health Care ; 55(2): 161-79, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26684355

RESUMO

Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/psicologia , Mães/psicologia , Gestantes/psicologia , Adulto , Canadá , Feminino , Humanos , Narração , Pesquisa Qualitativa , Estigma Social
13.
AIDS Care ; 27(9): 1183-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25964996

RESUMO

Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = -2.1, CI = -3.9,-0.3); (ES = -3.5, CI = -6.1,-1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.


Assuntos
Infecções por HIV/psicologia , Habitação/estatística & dados numéricos , Desnutrição , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Ontário , Pobreza
14.
Health Care Women Int ; 36(8): 883-901, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24527767

RESUMO

Infant feeding raises unique concerns for mothers living with HIV in Canada, where they are recommended to avoid breastfeeding yet live in a social context of "breast is best." In narrative interviews with HIV-positive mothers from Ontario, Canada, a range of feelings regarding not breastfeeding was expressed, balancing feelings of loss and self-blame with the view of responsibility and "good mothering" under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed that their choices were influenced by variations in social and cultural norms, messaging, and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.


Assuntos
Aleitamento Materno , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mães/psicologia , Adulto , Canadá , Comportamento de Escolha , Feminino , Infecções por HIV/transmissão , Humanos , Lactente , Entrevistas como Assunto , Narração , Ontário , Gravidez , Complicações Infecciosas na Gravidez/psicologia , Pesquisa Qualitativa , Estigma Social
15.
Health Care Women Int ; 36(8): 936-64, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25256222

RESUMO

The meaningful involvement of women living with HIV/AIDS (MIWA) is a key feature of women-centred HIV care, yet little is known about transforming MIWA from principle to practice. Drawing on focus group data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), we explored HIV-positive women's meaningful involvement in the design and delivery of HIV/AIDS services in British Columbia, Canada. In this article, we highlight the benefits and tensions that emerge as women traverse multiple roles as service users and service providers within their care communities, and the impact this has on their access to care and overall health.


Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/terapia , Serviços de Saúde Comunitária/organização & administração , Atenção à Saúde/métodos , Serviços de Saúde da Mulher , Síndrome da Imunodeficiência Adquirida/psicologia , Adolescente , Adulto , Canadá , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Participação do Paciente , Adulto Jovem
16.
PLoS One ; 19(5): e0303168, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38758960

RESUMO

INTRODUCTION: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. OBJECTIVES: To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. METHODS: We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. ETHICS AND DISSEMINATION: Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.


Assuntos
Saúde Materna , Humanos , Feminino , Haiti , Gravidez , Adolescente , Adulto Jovem , Near Miss , Pesquisa Participativa Baseada na Comunidade , População Rural , Fotografação , Pesquisa Qualitativa , Adulto
17.
Can J Public Health ; 115(1): 8-14, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38087186

RESUMO

The criminalization of HIV non-disclosure represents a significant issue of concern among people living with HIV, those working across the HIV sector, public health practitioners, and health and human rights advocates around the world. Recently, the government of Canada began a review of the criminal law regarding HIV non-disclosure and invited feedback from the public about potential reforms to the Criminal Code. In light of this public consultation, this commentary examines social science research from Canadian scholars that documents the intersecting damaging effects of HIV criminalization. Canadian social scientists and other researchers have shown that HIV criminalization is applied in uneven and discriminatory ways, impedes HIV prevention efforts, perpetuates HIV stigma, and has a damaging impact on the daily lives of people living with HIV. We argue that there is an urgent need for reforms that will significantly restrict how the criminal law is applied to HIV non-disclosure.


RéSUMé: La criminalisation de la non-divulgation du VIH est une question très préoccupante pour les personnes vivant avec le VIH, celles qui travaillent dans le secteur du VIH, les praticiens et praticiennes de la santé publique et les porte-parole de la santé et des droits de la personne du monde entier. Récemment, le gouvernement du Canada a amorcé un examen du droit criminel portant sur la non-divulgation du VIH et a invité le public à commenter d'éventuelles réformes du Code criminel. À la lumière de cette consultation publique, notre commentaire porte sur les études en sciences sociales menées au Canada qui font état des effets croisés préjudiciables de la criminalisation du VIH. Des spécialistes des sciences sociales et d'autres chercheuses et chercheurs canadiens ont montré que la criminalisation du VIH est appliquée de façon inégale et discriminatoire, qu'elle nuit aux efforts de prévention du VIH, qu'elle perpétue la stigmatisation liée au VIH et qu'elle a des effets dommageables sur la vie quotidienne des personnes vivant avec le VIH. Nous soutenons qu'il existe un besoin urgent de réformes pour restreindre de façon appréciable l'application du droit criminel à la non-divulgation du VIH.


Assuntos
Criminosos , Infecções por HIV , Humanos , Canadá/epidemiologia , Infecções por HIV/prevenção & controle , Saúde Pública , Direito Penal
18.
AIDS Care ; 25(3): 337-46, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22774876

RESUMO

Research has established a link between perceived social support and health-related quality of life (HRQOL) among persons living with HIV/AIDS. However, little is known about the ways through which social support influences HRQOL. This study examined the direct and indirect effects of perceived social support on physical and mental HRQOL in a sample of 602 adults living with HIV in Ontario, Canada. Participants completed the Medical Outcomes Study-HIV (MOS-HIV) health survey, the MOS-HIV Social Support Scale (MOS-HIV-SSS), and the Center for Epidemiological Studies Depression-Revised scale. Data on demographic and clinical characteristics were also collected. The direct and indirect effects of social support on the two MOS-HIV HRQOL summary measures, that is, physical health summary (PHS) and mental health summary (MHS), were estimated in multiple linear regression analyses. Perceived social support had significant direct effects on PHS (B=0.04, p<0.01) and MHS (B=0.05, p<0.01). It also had significant indirect effect on both PHS (B=0.04, p<0.01) and MHS (B=0.11, p<0.01), mediated by depressive symptoms. Interventions that enhance social support have the potential to contribute to better HRQOL either directly or indirectly by decreasing the deleterious effect of depressive symptoms on HRQOL.


Assuntos
Infecções por HIV/psicologia , Nível de Saúde , Qualidade de Vida/psicologia , Apoio Social , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Idoso , Depressão/etiologia , Feminino , Sobreviventes de Longo Prazo ao HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Avaliação de Resultados em Cuidados de Saúde , Adulto Jovem
19.
J Glob Health ; 13: 04168, 2023 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-38146820

RESUMO

Background: Evidence on the effectiveness of youth-led interventions for improving maternal-neonatal health and well-being of women and gender diverse childbearing people in low-income and middle-income countries (LMICs) is incomplete. We aimed to summarise the evidence on whether community level youth-led interventions can improve maternal and neonatal outcomes in LMICs. Methods: We included experimental studies of youth-led interventions versus no intervention, standard care, or another intervention. Participants were women and gender diverse childbearing people during antepartum, intrapartum, and postpartum periods. MEDLINE, Embase, CINAHL, Global Health, Web of Science, and Cochrane Library, and grey literature were searched to January 2023. All interventions addressing and targeting maternal-neonatal health and well-being that were youth-led and community level were included. Primary outcomes of interest were maternal death and neonatal death. We excluded based on population, intervention, comparison, and outcome (PICO) and design. Two reviewers independently extracted key information from each included study and assessed risk of bias. Random-effects meta-analysis was performed where there were sufficient data. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A narrative synthesis was done for results that could not be pooled. Results: Of the 8054 records retrieved, four trials (21 813 enrolled participants) met the inclusion criteria. The Cooperative for Assistance and Relieve Everywhere, Inc. (CARE) Community Score Card intervention compared to standard reproductive health services control did not significantly improve Antenatal Care coverage (difference-in-differences estimate ß = 0.04; 95% confidence interval (CI) = -0.11, 0.18, P = 0.610; one study, low certainty of evidence). The multi-component social mobilisation interventions compared to standard of care had no effect on adolescent/youth pregnancy (adjusted odds ratio estimate = 1.08; 95% CI = 0.87, 1.33; three studies; low certainty of evidence). Conclusions: Youth-led interventions in LMICs did not show a significant improvement in maternal outcomes. More studies are required to make more precise conclusions. Registration: PROSPERO: CRD42021288798.


Assuntos
Países em Desenvolvimento , Morte Perinatal , Recém-Nascido , Feminino , Gravidez , Adolescente , Humanos , Masculino , Cuidado Pré-Natal , Período Pós-Parto , Família , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
AIDS Behav ; 16(8): 2361-73, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22903401

RESUMO

Although lack of housing is linked with adverse health outcomes, little is known about the impacts of the qualitative aspects of housing on health. This study examined the association between structural elements of housing, housing affordability, housing satisfaction and health-related quality of life over a 1-year period. Participants were 509 individuals living with HIV in Ontario, Canada. Regression analyses were conducted to examine relationships between housing variables and physical and mental health-related quality of life. We found significant cross-sectional associations between housing and neighborhood variables-including place of residence, housing affordability, housing stability, and satisfaction with material, meaningful and spatial dimensions of housing-and both physical and mental health-related quality of life. Our analyses also revealed longitudinal associations between housing and neighborhood variables and health-related quality of life. Interventions that enhance housing affordability and housing satisfaction may help improve health-related quality of life of people living with HIV.


Assuntos
Infecções por HIV/psicologia , Nível de Saúde , Habitação , Qualidade de Vida , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Ontário , Satisfação Pessoal , Análise de Regressão , Características de Residência , Autorrelato , Fatores Socioeconômicos , Inquéritos e Questionários
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