Inuit women's stories of strength: informing Inuit community-based HIV and STI prevention and sexual health promotion programming.

BACKGROUND: There is a dearth of literature to guide the development of community-based HIV and sexually transmitted infection (STI) prevention and sexual health promotion programs within Inuit communities. OBJECTIVE: The aim of this study was to create a dialogue with Inuit women to address the lack of information available to inform programming to improve the sexual health of Inuit women, their families, and their communities in the Canadian Arctic. DESIGN: This study used Indigenous methodologies and methods by drawing from Inuit Qaujimajatuqangit and postcolonial research theory in a framework of Two-Eyed Seeing, and using storytelling sessions to gather data. Community-based participatory research principles informed the design of the study, ensuring participants were involved in all stages of the project. Nine storytelling sessions took place with 21 Inuit women aged 18-61 years. Storytelling sessions were audio recorded and transcribed verbatim, and Atlas.ti aided in the organization of the data for collaborative thematic analysis within three participatory analysis sessions with 13 of the participating women. RESULTS: From the storytelling and analysis sessions, five major themes emerged: (a) the way it used to be, (b) change, (c) family, (d) intimate relationships and (e) holistic strategies. Participating women emphasized that HIV and STI prevention and sexual health promotion programming needs to take a holistic, community-wide, family-focused and youth-centred approach within their communities. CONCLUSION: Participants identified several important determinants of sexual health and shared ideas for innovative approaches they believe will work as prevention efforts within their communities. This article specifically focuses on key characteristics of programming aimed at STI and HIV prevention and sexual health promotion that were identified throughout participants' stories. This study has provided a narrative to complement the epidemiological data that highlight the urgent need for prevention programming.

Sexually transmitted infections and their diagnoses: Bapedi experience.

BACKGROUND: The global burden of sexually transmitted infections (STIs) is a major concern to the World Health Organization (WHO). OBJECTIVE: To document STIs treated by Bapedi traditional healers and their methods of diagnoses in the Limpopo Province, South Africa. METHODS: A semi-structured questionnaire with closed and open-ended questions was used to collect data from 34 traditional healers, during a face-to-face interview. RESULTS: Five seemingly dissimilar STIs; gonorrhoea, chlamydia, HIV/AIDS, nta (Bapedi-terminology) and syphilis were identified as being treated by Bapedi traditional healers. With the exclusion of HIV/AIDS, all STIs are known by healers via their vernacular names. Not all of the recorded STIs are treated by all the questioned traditional healers. Generally, diagnosis of these infections was based primarily on the presentation of symptoms and certain behavioural traits; mostly unprotected sexual intercourse with multiple partners. CONCLUSION: The current study concludes that Bapedi traditional healers play an important role in the treatment STIs in the Limpopo Province. Of concern is their diagnosis which is based primarily on the presentation of symptoms and behavioural traits, which are not always accurate indicators. Thus, to make their contribution to the treatment and management of STIs beneficial, they have to receive elementary training in diagnostic methods particularly for HIV/AIDS.

Local public health systems and the incidence of sexually transmitted diseases.

OBJECTIVES: We examined the associations of local public health system organization and local health department resources with county-level sexually transmitted disease (STD) incidence rates in large US health jurisdictions. METHODS: We linked annual county STD incidence data (2005-2008) to local health department director responses (n = 211) to the 2006 wave of the National Longitudinal Study of Local Public Health Systems, the 2005 national Local Health Department Profile Survey, and the Area Resource File. We used nested mixed effects regression models to assess the relative contribution of local public health system organization, local health department financial and resource factors, and sociodemographic factors known to be associated with STD incidence to county-level (n = 307) STD incidence. RESULTS: Jurisdictions with local governing boards had significantly lower county-level STD incidence. Local public health systems with comprehensive services where local health departments shoulder much of the effort had higher county-level STD rates than did conventional systems. CONCLUSIONS: More integration of system partners in local public health system activities, through governance and interorganizational arrangements, may reduce the incidence and burden of STDs.

Making a difference: the construction of ethnicity in HIV and STI epidemiological research by the Dutch National Institute for Public Health and the Environment.

Biomedical and public health researchers and practitioners routinely record and comment on ethnicity: however, the use of this category is often vague and without explicit statement on what ethnicity is or how it correlates to health disparities. Presented here is an inquiry into the case of ethnicity in HIV/STI research in the Netherlands. This paper considers the construction and operationalization of the concept ethnicity in HIV/STI epidemiological research in the Netherlands. The concept ethnicity is followed as it is defined, measured, categorized, communicated and constructed in the annual national HIV/STI surveillance report of the Dutch National Institute for Public Health and the Environment (RIVM) and as this construction co-evolves in society through the Dutch media, politics and prevention practice. The epidemiological work of the RIVM on HIV/STI in The Netherlands has resulted in the materialization of a distinct ethnic construction, the high risk sexual ethnic other, presumed, not only to be at heightened risk for HIV, but also to spread HIV in the Netherlands through promiscuity and absent safe sex practices. This construct is shown to be perpetually self-validating as it informs methodological choices, such that, behavioural studies almost always establish ethnic behavioural differences. The construct and related ethnic rhetoric also allow for the extrapolation of "findings" within a specific ethnic group regarding a specific STI to all groups considered ethnic minorities and so a categorical ethnic minority problem group is constructed within Dutch society. This imagery is disseminated through newspaper articles and dialogue in the Dutch House of Representative and HIV/STI prevention practice, through which the construct is reaffirmed and ascribed scientific and social validity. Knowledge of ethnic minorities' high-risk status and their sexual practices that lead to this become common, and so the construct is further operationalized in government budget planning and subsequent research programmes.

Self-reported sexually transmitted disease symptoms and treatment-seeking behaviors in China.

In recent decades, sexually transmitted diseases (STDs) have reemerged and spread as a major public health problem in China. However, little effort has been made on promoting appropriate health-seeking behaviors among people living with STDs. A randomly selected sample of market vendors in Fuzhou (N = 4510) was recruited and assessed from 2003 to 2004 to examine their choice of pharmacy versus hospital, and folk remedy versus Western medicine when having STD symptoms. Approximately 11.3% of the sample (4.0% of men and 17.8% of women) reported having had abnormal genital discharge or genital ulcer during the past 6 months. More (over 60%) people chose Chinese folk remedy to treat symptoms or prevent transmission when they had genital discharge and/or genital ulcer. Approximately 30% of study participants with reported STD symptoms visited pharmacies only to seek treatment, and 17% visited neither hospital nor pharmacies. Visiting a pharmacy only for STD treatment was marginally significantly associated with being female (prevalence ratio [PR] = 1.665, confidence interval [CI] = 0.980, 2.831) and never married (PR = 1.984, CI = 1.098, 3.594) after controlling for other potential confounders. Education about appropriate health-seeking behaviors to obtain effective treatment of STD must be a top priority to control the rapid spread of STDs in China.

"Born again is a sexual term": demons, STDs, and God's healing sperm.

In this article I examine the intersection between sexuality and spirit-filled bodies in American Evangelicalism. I am interested in investigating two issues: the sexual body as a site of spiritual battle and the use of popular science, especially the domain of genetics, as material evidence for this spiritual warfare. Specifically, I trace the increasingly spiritualized framing of marital intercourse in evangelical literature. To follow this trajectory, I highlight the spiritualized dangers of transgressive sexuality as well as the sexualizing of spirituality in evangelical sex manuals and deliverance manuals. This article centers around one text, Holy Sex: God's Purpose and Plan for Our Sexuality, whose authors' contend that sexually transmitted diseases are, in fact, demons lodged in genetic material that can be transferred through body fluids and bloodlines. The assertions about biology and demonic affliction made throughout the book are extreme and would be rejected by most readers of mainstream evangelical sex manuals. I argue that this book, though marginal, is not an irrelevant text. It reflects deep-seated anxieties about sexual bodies, spiritual concerns, and disease. Idiosyncratic though it may seem, Holy Sex taps into wider uncertainties about the spiritual vulnerability of the physical body found in contemporary evangelical literature.

Sexually transmitted infection (STI) testing among young oil and gas workers: the need for innovative, place-based approaches to STI control.

BACKGROUND: Northeastern British Columbia is undergoing rapid in-migration of young, primarily male workers in response to the "boom" in the oil/gas industries. Accompanying the boom is a rise in Chlamydia rates among youth, which exceed the provincial average by 22%. STI testing reduces the disease burden, contributing to STI prevention. OBJECTIVES: 1) To document youths' perceptions regarding the socio-cultural and structural forces that affect young oil/gas workers' access to STI testing; 2) to gather service providers' perspectives on sexual health service delivery for workers; and 3) to develop recommendations to improve the accessibility of STI testing. METHODS: We conducted ethnographic fieldwork (8 weeks) in a remote oil/gas community, including in-depth interviews with 25 young people (ages 15-25) and 14 health and social service providers. RESULTS: Participants identified limited opportunities to access testing, geographic isolation, and 'rigger' culture as three key categories inhibiting STI testing among oil/gas Workers. DISCUSSION: These results suggest the need for place-based approaches to STI control. Innovative outreach strategies are suggested to address oil/gas workers' needs, including a locally tailored STI awareness campaign, condom distribution, expanded clinic hours, and onsite STI testing.

Eban health promotion intervention: conceptual basis and procedures.

OBJECTIVE: This article concerns the health promotion intervention that served as the comparison condition in Project Eban, the NIMH Multisite HIV/STD Prevention Trial for African American Couples. Considerable research has documented the high rates of chronic diseases, including heart disease, cancer, stroke, and diabetes, among African Americans. Many of these diseases are tied to behavioral risk factors-the things that people do or do not do, their diet, the amount of exercise they get, and their substance use practices. DESIGN: The Eban Health Promotion Intervention was designed to increase healthful behaviors, including physical activity, healthful dietary practices, ceasing cigarette smoking and alcohol abuse, practicing early detection and screening behaviors, and improving medication adherence. As a comparison condition, the Eban Health Promotion Intervention was designed to be structurally similar to the Eban HIV/STD Risk Reduction Intervention. METHODS: This article describes the intervention and how it was developed, integrating social cognitive theory with information collected in formative research to ensure that the intervention was appropriate for African Americans affected by HIV. CONCLUSION: Project Eban not only tests the efficacy of an HIV/STD risk reduction intervention for African American serodiscordant couples, but also tests the efficacy of an intervention addressing many of the other health problems common in this population.

Social construction and cultural meanings of STI/HIV-related terminology among Nguni-speaking inmates and warders in four South African correctional facilities.

Cultural sensitivity is increasingly recognized as a means to enhance the effectiveness of health promotion programmes all over the world. Sociocultural meanings and terminology of diseases are important in understanding how different groups perceive and interpret illness. This study was conducted as part of the process of developing and adapting a sexually transmitted infection (STI)/HIV peer led health education intervention for soon-to-be-released inmates who were predominantly Nguni speakers in South Africa. Two focus group discussions (FGDs) were conducted with prison inmates in each of four facilities. Additionally, one FGD was conducted in each prison with non-health trained (custodial) personnel who were Nguni speakers from the same community (n = 27). The data revealed unique terminology and meanings attached to several biomedically defined STIs. These sociocultural constructions were not limited to inmates as findings from warders' discussions showed a similar pattern. Moreover, we found the existence of a number of traditional 'folk' STIs and culture-specific prevention methods. These conceptualizations influence reported health-care-seeking behaviour, where dual consultation of traditional healers and biomedical remedies is widely practiced. The research has biopsychological as well as cultural implications for the development and adaptation of contextually relevant health promotion interventions.

Indigenous healers' beliefs and practices concerning sexually transmitted diseases.

A Grounded Theory study has been used, based on its Theory of Symbolic Interactionism, to explore indigenous healers' beliefs and practices concerning sexually transmitted diseases amongst the Vhavenda. Initial data collection has been done, using purposive sampling and when categories started emerging, theoretical sampling was then used. Data were analysed by using three basic types of coding namely, open coding, axial coding and selective coding. The findings of the study revealed a variety of terms used to identify STDs. It then also became evident that there are similarities between gonorrhoea, syphilis and condylomata as shown in the orthodox sexually transmitted diseases posters used in orthodox medicine with some of the STDs that the indigenous healers are familiar with. In accordance with the Grounded Theory, the description of types of diseases, disease patterns as well as signs and symptoms culminated in the emergence of the Dirt Theory. Based on the above findings, it was recommended that guidelines for designing a module for teaching health professionals be formulated to assist nurses in understanding the beliefs and practices of the people they serve.

Risk behaviors among Asian women who work at massage parlors in San Francisco: perspectives from masseuses and owners/managers.

This study investigates cognitive, cultural, and contextual factors that influence HIV-related risk behaviors among Asian women who engage in sex work at massage parlors in San Francisco. Focus groups and qualitative interviews were conducted for Vietnamese and Thai masseuses and massage parlor owners/managers. Economic pressure as well as subjective evaluation of customers for the risk of HIV/STD infection increase unprotected sexual behaviors among Asian masseuses. Massage parlor owners/managers do not establish a clear policy for condom use at their parlors. Consequently, male customers often manipulate their intention not to use a condom while negotiating with masseuses. HIV/STD prevention intervention programs should address specific risks and needs for Asian masseuses, owners/managers, and male customers in order to promote health and well being among Asian masseuses who have been neglected by public health and social services.

Empowering health promotion: a holistic approach in preventing sexually transmitted infections among first nations and inuit adolescents in Canada.

Sexually transmitted infections (STIs) such as gonorrhea and chlamydia, among others, are significant health concerns for Canadian aboriginal (i.e., First Nations, Inuit) adolescents. This is further compounded by ineffective prevention and promotion strategies that were designed to lessen the incidence of STIs in this population. Structure and content of health service programs are crucial considerations in STI prevention because even well-constructed and carefully implemented programs may have very little impact on aboriginal youth if these programs are not culturally sensitive and specific to individual adolescent's needs. Furthermore, because components of sexual and reproductive health are inextricably linked to empowerment and equality between the sexes, holistic health nurses need to develop strategies that increase self-esteem, self-advocacy, and healthy choices among aboriginal adolescents.

Social factors related to risk for violence and sexually transmitted infections/HIV among Asian massage parlor workers in San Francisco.

Asian women who work at massage parlors in San Francisco have high levels of risk for sexually transmitted infections (STIs), including HIV, and being victims of violence, which jeopardizes their health and wellbeing. On the basis of mapping, the targeted districts in San Francisco where massage parlors were located, 23 massage parlors were identified where commercial sex activity took place. Using snowball-sampling methods, 43 Asian female massage parlor workers were recruited for focus groups; 21 participants were Vietnamese and 22 were Thai. Qualitative analyses revealed frequent exposure to violence including verbal or physical abuse from customers and gang members, as well as persistent HIV risk behaviors associated with multiple daily sex partners, inconsistent condom use with customers, and forced sex. Social factors related to gender, immigration status, and socioeconomic status appeared to be closely tied to the health and wellbeing of Asian masseuses. Study findings suggest that individualized as well as community-level interventions are necessary to improve these women's health and decrease their prolonged exposure to risks for STIs and violence.

Contextual influences on reproductive wellness in northern India.

OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.

Risk behaviors of Filipino methamphetamine users in San Francisco: implications for prevention and treatment of drug use and HIV.

OBJECTIVE: This study describes the demographics, HIV risk and drug use behaviors, and psychosocial status of Filipino American methamphetamine users in the San Francisco Bay area. METHODS: Individual interviews were conducted with 83 Filipino American methamphetamine users, recruited through snowball sampling methods. A structured survey questionnaire included measures of drug use behaviors, HIV-related sexual behaviors, psychosocial factors, and demographics. RESULTS: Filipino methamphetamine users tended to be male, to have low levels of perceived personal control in their lives, and to report low levels of shame about their drug use. Methamphetamine use was strongly associated with HIV-related risk behaviors. Frequent methamphetamine users tended to engage in drug use before or during sex and to use condoms infrequently. Commercial sex activity was associated with frequency of methamphetamine use. About one-third of the study participants had never been tested for HIV. CONCLUSION: HIV/STD and drug abuse prevention programs that target Filipino Americans are needed. These programs should be tailored to meet clients' needs on the basis of gender, employment status, acculturation, and psychosocial variables that affect drug use and sexual behaviors.

Health seeking and sexual behaviour in patients with sexually transmitted infections: the importance of traditional healers in Thyolo, Malawi.

OBJECTIVES: To describe health seeking and sexual behaviour including condom use among patients presenting with sexually transmitted infections (STIs) and, to identify sociodemographic and behavioural risk factors associated with "no condom use" during the symptomatic period. METHODS: A cross sectional study of consecutive new STI cases presenting at the district STI clinic in Thyolo, Malawi. They were interviewed by STI counsellors after obtaining informed consent. All patients were treated according to national guidelines. RESULTS: Out of 498 new STI clients, 53% had taken some form of medication before coming to the STI clinic, the most frequent alternative source being the traditional healer (37%). 46% of all clients reported sex during the symptomatic period (median 14 days), the majority (74%) not using condoms. 90% of all those who had not used condoms resided in villages and had seen only the traditional healer. Significant risk factors associated with "no condom use" included visiting a traditional healer, being female, having less than 8 years of school education, and being resident in villages. Genital ulcer disease (GUD) was the most common STI in males (49%) while in females this comprised 27% of STIs. CONCLUSIONS: These findings, and especially the extremely high GUD prevalence is of particular concern, considering the high national HIV prevalence in Malawi (9%) and the implications for STI and HIV transmission. There is an urgent need to integrate traditional healers in control activities, encourage their role in promoting safer sexual behaviour, and to reorient or even change existing strategies on condom promotion and STI control.

Petrol sniffing in a pregnant Aboriginal population: a review of maternal and neonatal outcomes.

The study's aim was to determine if petrol sniffing during pregnancy is associated with adverse maternal and neonatal outcomes at the Alice Springs Hospital. The study design was a retrospective case note review. The subjects were Aboriginal women who delivered at the Alice Springs Hospital between July 1991 and September 1999 where petrol sniffing was identified on the discharge coding; 14 women with 21 pregnancies were identified. One hundred and eleven nulliparous Aboriginal women who delivered at hospital between July 1998 and June 1999, with singleton gestation in cephalic presentation, were identified from the birth register and used as the control group. We found that women identified as petrol sniffers during pregnancy presented later for antenatal care, had fewer antenatal visits, lower booking haemoglobin and weighed less at booking when compared with non-petrol-sniffing women. Women who sniffed petrol during pregnancy were more likely to have one or more sexually transmitted diseases identified during the pregnancy; to use other substances during pregnancy; to be colonised with group B Streptococcus; to have meconium stained liquor prior to delivery; and to have a still-birth. Infants born to petrol-sniffing mothers were more likely to have birthweight less than 2,500 g; to have Apgar scores of less than 7 at 5 minutes; to require admission to the neonatal unit; and to be placed in foster care or for adoption. We concluded that the pregnancy complicated by petrol sniffing should be recognised as one at increased risk of adverse outcome, necessitating increased antenatal surveillance. However, as with other substances abused, it is extremely difficult to determine the role played by the substance per se, and that of the lifestyle associated with the abuse behaviour.

The meaning of RTI in Vietnam--a qualitative study of illness representation: collaboration or self-regulation?

In collaboration with the National Committee for Population and Family Planning, a study was conducted in a rural and urban commune of northern Vietnam to provide community-level information about women's reproductive health and behaviors. Ethnographic and structured interviews were conducted with 32 women. A psychosocial model of health behavior, the Dual Process Model, was applied to provide a theoretical framework for understanding women's interpretations of, and strategies for, coping with symptoms of reproductive tract infections (RTIs). Women were found to interpret and manage RTI symptoms collaboratively with other women. Therefore, women's approach to care seeking was influenced heavily by their peer network and not driven by their method of family planning.