Health perceptions among victims in post-accord Colombia: Focus groups in a province affected by the armed conflict.

The peace agreement with the Colombian guerrilla group Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo represented an opportunity for peacebuilding and victims' reparation, rather than the end of the internal armed conflict. In this context, this study aimed to uncover the consequences of conflict on victims' health and on health service provision, and their perceived health status during the post-accord stage in the Meta region, located in the country's eastern plains. Historically, this region has been one of the territories most affected by the presence of conflict-related groups and armed confrontations. Through focus groups, this research explored the health perceptions and experiences of victims of armed conflict. Ten focus groups were conducted with men and women, victims of the armed-conflict, in four municipalities with different degrees of armed conflict intensity. The focus group transcripts were coded using NVivo. The results show that the way women have experienced conflict and the effects of conflict on mental health in general for men, women, and children were recurrent themes in the dialogue of victims. Likewise, it highlights the need to understand the barriers that the current health model imposes on the right to health itself. From the victim's perspective, they experience stigmatization, discrimination, and revictimization when accessing health services. These barriers co-occur along with structural limitations of the health system that affect the general population.

[Social determinants and the Sustainable Development Goals' tuberculosis target in the AmericasDeterminantes sociais e a meta para a tuberculose dos Objetivos de Desenvolvimento Sustentável nas Américas]. / Determinantes sociales y meta de tuberculosis en los Objetivos de Desarrollo Sostenible en las Américas.

OBJECTIVE: Determine patterns of tuberculosis (TB) incidence indicators and number of deaths from TB within the framework of target 3.3 of the Sustainable Development Goals (SDGs) and their correlation with social determinants. METHODS: Ecological study methodology was used, in which the population is the unit of analysis. Social determinants were analyzed using a negative binomial regression model and strength of association. RESULTS: In the Americas, there was an average annual reduction in the TB incidence rate of 0.3% from 2009 to 2018; however, from 2015 to 2018, the rate increased, from 27.6 to 28.8 per 100,000 population. With regard to social determinants, the groups of countries with the lowest human development index (HDI) and gross domestic product (GDP) have a higher incidence of TB. TB risk in the country with the lowest HDI is six times that of the country with the highest HDI. CONCLUSIONS: At the current rate of reduction in the incidence rate and number of deaths from TB, the Region of the Americas will not meet the targets in the SDGs and in the End TB Strategy. Rapid implementation and expansion of interventions for TB prevention and control are required to attain the targets. This involves, among other actions, reducing access barriers to diagnosis and treatment and strengthening initiatives to address social determinants.

OBJETIVO: Determinar o comportamento dos indicadores de incidência da tuberculose (TB) e o número de mortes por TB no quadro da meta 3.3 dos Objetivos de Desenvolvimento Sustentável (ODS) e sua correlação com os determinantes sociais. MÉTODOS: Utilizamos uma metodologia de estudo ecológico, na qual a unidade de análise é a população. Para a análise dos determinantes sociais, utilizamos o modelo de regressão binomial negativo e a avaliamos a força das associações. RESULTADOS: Nas Américas, observou-se uma redução anual média na taxa de incidência de TB de 0,3% entre 2009 e 2018; entretanto, de 2015 a 2018 houve um aumento, de 27,6 para 28,8 por 100.000 habitantes. Com relação aos determinantes sociais, os grupos de países com índice de desenvolvimento humano (IDH) e produto interno bruto (PIB) mais baixos apresentam uma maior incidência de TB. O risco de TB no país com o menor IDH é seis vezes maior que no país com o maior IDH. CONCLUSÕES: Se mantido o ritmo atual de redução na taxa de incidência e no número de mortes por TB, a Região das Américas não alcançará as metas propostas nos ODS e na Estratégia pelo Fim da Tuberculose. É necessária uma implementação e expansão mais rápida das intervenções de prevenção e controle da TB para alcançar este objetivo. Isto implica, entre outras ações, reduzir as barreiras de acesso ao diagnóstico e tratamento e fortalecer as iniciativas que abordam os determinantes sociais.