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1.
Sex Health ; 212024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38769681

RESUMO

Sexually diverse Muslim men (SDMM) are seen to present later and with more advanced symptoms of HIV and other sexually transmitted infections (STIs). The limited access to sexual healthcare services is attributed to the stigma associated with their multiple intersecting identities. We conducted a scoping review to synthesise research on barriers impeding SDMM's access to sexual health care. We used Arksey and O'Malley's five-stage framework as the methodology for the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews, was used as a guide for the presentation of the results. Searches conducted in EBSCOhost, Scopus, MEDLINE, Embase, CINAHL, Global Health, and Google Scholar yielded 1382 results, of which 18 studies were deemed eligible for this review. Bronfenbrenner's socioecological model was employed as a framework to analyse the studies. Through analysing the eligible studies, we identified factors operating at three different levels that can impede SDMM's access to sexual health care. Limited awareness and low-perceived risk of HIV/STIs, coupled with the fear of sexual identity disclosure might act as individual-level barriers to sexually diverse Muslim men's access to sexual health care. The experiences of discrimination within clinical settings were presented as a healthcare system-related issue discouraging SDMM from revisiting those services. Heteronormative and religious ideologies, homophobic government programs, and poverty might manifest in the more intimate domains of healthcare delivery, creating hostile spaces for SDMM. Intensive research and advocacy efforts are required to improve SDMM's access to sexual health care, which can reduce their risk of HIV/STIs.


Assuntos
Acessibilidade aos Serviços de Saúde , Islamismo , Saúde Sexual , Infecções Sexualmente Transmissíveis , Humanos , Islamismo/psicologia , Masculino , Infecções Sexualmente Transmissíveis/prevenção & controle , Estigma Social , Infecções por HIV , Minorias Sexuais e de Gênero/psicologia
2.
BMC Public Health ; 23(1): 2438, 2023 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-38057784

RESUMO

BACKGROUND: To develop effective public health policies, programs, and services tailored to the unique sexual health needs of migrant populations, it is essential to understand the myriad socio-ecological factors that influence their sexual health. This qualitative community-based participatory study aimed to explore factors influencing migrants' sexual health at different socio-ecological levels in a Canadian setting. METHODS: Participants (n = 34) from African, Caribbean, Black; Latin American; South Asian; Middle Eastern, as well as East and Southeast Asian communities were recruited across Manitoba using printed flyers, community organizations, and social media. Individual interviews, conducted in English, French, Mandarin, Cantonese, Tagalog, Arabic, Swahili, and Tigrinya languages, explored questions relating to sexual health and experiences with service providers. Data were analyzed using reflexive thematic analysis and socio-ecological systems theory. RESULTS: The study uncovered a range of individual, interpersonal, institutional, and socio-structural factors that affect the sexual health of migrants in Manitoba. Individual factors such as sexual health knowledge and testing practices, interpersonal factors like the type of sexual partnerships, institutional factors such as sexual health information needs, language, and service access barriers, and structural-level factors like gender norms and HIV stigma exerted a significant influence on the sexual health practices of study respondents. Sexual health awareness was influenced by various factors including length of time in Canada and involvement in community-based services. Study respondents identified issues related to access to HIV testing and sexual health information, as well as language barriers, racism in healthcare, and HIV stigma. Gender and social norms played a significant role in discouraging communication about sex and safer sex practices. CONCLUSIONS: The study highlights the complex interplay of factors that influence the sexual health of migrants, and the need for targeted sexual health awareness campaigns and provision of sexual health information in languages spoken by migrants. Public health interventions focused on improving the sexual health outcomes for migrants should consider the socio-ecological elements identified in this study. These findings can inform public health campaigns to increase access to services and address sexual health inequities among migrant communities in Canada.


Assuntos
Infecções por HIV , Saúde Sexual , Migrantes , Humanos , Manitoba , Canadá , Acessibilidade aos Serviços de Saúde
3.
BMC Public Health ; 23(1): 2054, 2023 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-37858070

RESUMO

BACKGROUND: HIV programming in Ukraine largely targets "key population" groups. Men who purchase sex are not directly reached. The aim of our study was to explore the prevalence of sexually transmitted and blood-borne infections (STBBIs) among men who purchase sex from female sex workers. METHODS: Following geographic mapping and population size estimation at each "hotspot", we conducted a cross-sectional bio-behavioural survey with men who purchase sex between September 2017 and March 2018 in Dnipro, Ukraine. Eligibility criteria included purchasing sex services at a "hotspot" and being ≥ 18 years. Participants completed a structured questionnaire, followed by HIV/HCV rapid testing and a dried blood spot (DBS) sample collection for confirmatory serology. RESULTS: The study enrolled 370 participants. The median age was 32 (interquartile range [IQR] = 27-38) and the median age of first purchase of sexual services was 22 (IQR = 19-27). Over half (56%) of participants reported ever testing for HIV; four participants (2%, N = 206) reported having tested positive for HIV, with three out of the four reporting being on ART. Forty percent of participants had ever tested for HCV, with three (2%, N = 142) having ever tested positive for HCV. In DBS testing, nine participants (2.4%) tested positive for HIV and 24 (6.5%) tested positive for ever having an HCV infection. CONCLUSION: Prevalence of HIV and HCV in this population was high. Given high rates of study enrolment and testing, efforts should be made to reach men who purchase sex with expanded STBBI programming.


Assuntos
Infecções por HIV , Hepatite C , Profissionais do Sexo , Masculino , Humanos , Feminino , Adulto , Infecções por HIV/epidemiologia , Estudos Transversais , Prevalência , Ucrânia/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia
4.
Cult Health Sex ; 25(8): 976-990, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36052988

RESUMO

Based on a diary writing exercise, this paper illuminates the complex ways in which sex workers in Ukraine actively work through and manage stigma in their daily lives. Pushing beyond the notion of stigma as a static and fixed psychosocial designation that can be readily measured, we argue that stigma is actively confronted by sex workers through various forms of gendered emotional and physical labour that enable them to recuperate a sense of moral personhood. This notion of moral personhood is often tied to wider gender-specific values pertaining to caregiving and motherhood.


Assuntos
Profissionais do Sexo , Humanos , Profissionais do Sexo/psicologia , Trabalho Sexual , Pessoalidade , Ucrânia , Princípios Morais
5.
Curr HIV/AIDS Rep ; 19(1): 76-85, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34822064

RESUMO

PURPOSE OF REVIEW: To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. RECENT FINDINGS: Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.


Assuntos
COVID-19 , Infecções por HIV , Profissionais do Sexo , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Países em Desenvolvimento , Infecções por HIV/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Fatores Socioeconômicos
6.
BMC Public Health ; 22(1): 559, 2022 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-35313838

RESUMO

BACKGROUND: HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations. METHODS: We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was "unreached" by the program, who then each identified three respondents, resulting with data on 290 individuals. RESULTS: Findings illustrate the interconnectedness of community-based organization (CBO) members and non-members. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST. CONCLUSION: Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV , Homossexualidade Masculina , Humanos , Quênia , Masculino , Autoteste
7.
BMC Public Health ; 22(1): 754, 2022 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-35421967

RESUMO

BACKGROUND: We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya. METHODS: Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset. RESULTS: EFA produced a two-factor scale of perceived and enacted stigma. The CFA model fit to the two-factor scale was improved after removing three cross-loaded items and adding correlated errors (chi-squared = 26.5, df 17, p = 0.07). Perceived stigma was associated with depressive symptoms (beta = 0.34, 95% CI 0.24, 0.45), alcohol use (beta = 0.14, 95% CI 0.03, 0.25) and other substance use (beta = 0.19, 95% CI 0.07, 0.31), while enacted stigma was associated with alcohol use (beta = 0.17, 95% CI 0.06, 0.27). CONCLUSIONS: Our findings suggest enacted and perceived sexual stigma are distinct yet closely related constructs among GBMSM in Kenya and are associated with poor mental health and substance use.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Homossexualidade Masculina , Humanos , Quênia/epidemiologia , Masculino , Reprodutibilidade dos Testes , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
8.
BMC Psychiatry ; 21(1): 25, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430838

RESUMO

BACKGROUND: It is argued that Indian gender minorities displayed differential mental health problems and suicide attempts. Hence, the study was intended to understand the prevalence of anxiety, depression and suicidality among this group, specifically those living in a metropolitan city in South India. METHODS: The data was generated from a cross-sectional study that employed a structured questionnaire to collect information about experiences of anxiety, depression and suicidal behavior among gender-diverse individuals in Bangalore, the capital city of Karnataka state. The study used stratified simple random sampling of eligible individuals who were 18 years of age and older and who were enrolled in an HIV prevention program implemented for gender-diverse individuals run by the Karnataka Health Promotion Trust and the University of Manitoba at the time of the study (2012). Bivariate and multivariate analyses were used to assess the relative contribution of various factors that affect suicide ideation or actual attempts among the gender diverse participants. RESULTS: Results showed that 62% whose main source of income was Basti (socially sanctioned practice of begging), 52% of Hijras, 56% who lived with their Gurus, 58% who were not happy with their physical appearance, 55% who consumed alcohol daily, and 63% who experienced high depression had ever thought of or attempted suicide in the month prior to the survey. However, multivariate analysis showed that respondents who were not happy with their physical appearance and thought of changing it had significantly higher odds (AOR = 2.861; CI 1.468,5.576; p = 0.002) of either having thoughts that it was better being dead or wished they died. Similarly, those who experienced high depression, their odds of either having had thoughts of or having attempted suicide increased by three times (AOR = 3.997; CI 1.976, 8.071; p < 0.000). CONCLUSIONS: It is observed that a high percentage of gender minorities had attempted suicide or thought of suicide during the month preceding the data collection. The findings bring new insights on the proximate determinant of physical appearance on the suicidality of gender minorities assigned male at birth and appropriate to account for this while addressing the mental health issues.


Assuntos
Minorias Sexuais e de Gênero , Suicídio , Adolescente , Adulto , Estudos Transversais , Humanos , Índia/epidemiologia , Masculino , Prevalência , Fatores de Risco , Ideação Suicida , Tentativa de Suicídio
9.
Cult Health Sex ; 23(9): 1255-1269, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32672518

RESUMO

Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis' (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the project. Although the project proved immensely successful in terms of retention and adherence, to explain these findings we point towards Ashodaya's history of collectivisation around sexual health-a history of community action that has given rise to new spaces of belonging and accumulated knowledges that became instrumental in the formulation of strategies to confront anticipated challenges during the project. These strategies included: (1) the participation of community leaders as the first participants to take PrEP, followed by the sharing of their experiences through testimonials to their peers; (2) the endorsement of PrEP among community leaders living with HIV, to avoid social divisions around HIV status; and (3) ongoing community-level support from outreach workers that went beyond administering PrEP to address the various needs of the community. These community-led approaches demonstrate that communities hold key insights into the delivery of clinically-oriented interventions, suggesting the vital role they continue to play in planning and implementing new prevention technologies.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Profissionais do Sexo , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Índia
10.
Sex Health ; 18(1): 31-40, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33632382

RESUMO

Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Profissionais do Sexo , Minorias Sexuais e de Gênero , Fármacos Anti-HIV/uso terapêutico , Ásia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino
11.
Cult Health Sex ; 22(12): 1333-1348, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31661667

RESUMO

This qualitative study highlights the complex interplay between the social and structural conditions in Chengdu, China that shape the possibilities and vulnerabilities of money boys' sexual health. Within the context of China's liberalised market economy, we explore (1) how money boys' enter the sex trade market and navigate their sexual networks; (2) how their lives are enmeshed in fields of sexual desire, stigma and coercion; and (3) how the illicit and stigmatising nature of their work poses barriers to health service access. Findings reveal how the sex trade market and clinic are precarious spaces in which entrepreneurial ethics of the self and stigma-related coercive relations simultaneously enable and constrain money boys' sexual freedom and safer sex practices. By understanding this entrepreneurial precarity through the co-articulation of clinical and organisational work spaces, public health and social service providers can have a stronger sense of how various vulnerabilities configure to affect safer sex practices.


Assuntos
Acessibilidade aos Serviços de Saúde , Homossexualidade Masculina/psicologia , Trabalho Sexual/psicologia , Estereotipagem , Adulto , China , Humanos , Masculino , Pesquisa Qualitativa , Assunção de Riscos , Sexo sem Proteção , Adulto Jovem
12.
Cult Health Sex ; 22(10): 1177-1190, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31549914

RESUMO

Persisting inequities in maternal health pose a particular burden for marginalised populations such as sex workers. However, current literature on pregnancy and sex work is limited to mostly quantitative studies focusing on contraception use, unplanned and/or undesired pregnancies and unsafe abortions. Additionally, emphasis has been placed on the prevention, treatment and care of STIs and HIV with less attention accorded to women's pregnancy desires and implications to work. In this paper, we explore sex workers' conflicted experiences surrounding pregnancy, parenthood, and work. Forty-six women participated in in-depth interviews as part of a qualitative exploratory study conducted in close collaboration with a sex worker collective in the city of Mysore (South India). Our analysis focuses on women's pragmatic responses to pregnancy desires, workplace challenges during and after pregnancy, strategies for managing risk and approaches to managing work and childcare. We show that women confront various intersecting challenges with respect to pregnancy and sex work. Women's complex decision-making balances multiple considerations while highlighting the temporal dimension of pragmatism as women respond not only to the immediacy of an encounter but also in anticipation of a better future.


Assuntos
Negociação/psicologia , Poder Familiar/psicologia , Profissionais do Sexo/psicologia , Adulto , Cuidado da Criança , Pré-Escolar , Feminino , Humanos , Índia , Lactente , Entrevistas como Assunto , Gravidez
13.
Med Anthropol Q ; 34(3): 398-419, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32521087

RESUMO

In Kenya, globally circulating HIV surveillance techniques are implicated in an emergent experimental terrain that merges scientific interest with health administration agendas. Sex worker activists reroute and repurpose this technocratic knowledge to more precisely pinpoint and defy the undemocratic imperatives of an encroaching experimental order that aims to govern the health of key populations. Reconstructing the conditions of emergence of these evidentiary politics reveals growing interdependencies between sex workers and scientific and technical experts as they are brought into increasing interaction with each other.


Assuntos
Vigilância em Saúde Pública , Opinião Pública , Profissionais do Sexo , Antropologia Médica , Pesquisa Biomédica , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Quênia , Masculino , Política
14.
Sex Transm Dis ; 46(8): 556-562, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31295225

RESUMO

Ashodaya Samithi, an organization run by and for female, male, and transgender sex workers in Mysore, India, has worked since 2004 to prevent sexually transmitted infection (STI)/human immunodeficiency virus (HIV) transmission and improve HIV cascade outcomes. We reviewed published and programmatic data, including measures of coverage, uptake, utilization and retention, and relate STI/HIV outcomes to evolving phases of community mobilization. Early interventions designed "for" sex workers mapped areas of sex work and reached half the sex workers in Mysore with condoms and STI services. By late 2005, when Ashodaya Samithi registered as a community-based organization, interventions were implemented "with" sex workers as active partners. Microplanning was introduced to enable peer educators to better organize and monitor their outreach work to reach full coverage. By 2008, programs were run "by" sex workers, with active community decision making. Program data show complete coverage of community outreach and greater than 90% clinic attendance for quarterly checkups by 2010. Reported condom use with last occasional client increased from 65% to 90%. Surveys documented halving of HIV and syphilis prevalence between 2004 and 2009, while gonorrhoea declined by 80%. Between 2005 and 2013, clinic checkups tripled, whereas the number of STIs requiring treatment declined by 99%. New HIV infections also declined, and Ashodaya achieved strong cascade outcomes for HIV testing, antiretroviral treatment linkage, and retention. Program performance dropped markedly during several periods of interrupted funding, then rebounded when restored. Ashodaya appear to have achieved rapid STI/HIV control with community-led approaches including microplanning. Available data support near elimination of curable STIs and optimal cascade outcomes.


Assuntos
Infecções por HIV/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Saúde Pública/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/prevenção & controle , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Índia/epidemiologia , Masculino , Prevalência , Saúde Pública/economia , Saúde Pública/normas , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia
15.
BMC Public Health ; 19(1): 986, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337368

RESUMO

BACKGROUND: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in what contexts the delivery of HIVST to MSM could increase awareness of HIV status and lead to early linkage to HIV treatment and prevention. METHODS: The study will be embedded within existing MSM-focused community-based HIV prevention and treatment programmes in 3 counties in Kenya (Kisumu, Mombasa, Kiambu). The study is designed to assess three HIV testing outcomes among MSM, namely a) coverage b) frequency of testing and c) early uptake of testing. The study will adopt a mixed methods programme science approach to the implementation and evaluation of HIVST strategies via: (i) a baseline and endline bio-behavioural survey with 1400 MSM; (ii) a socio-sexual network study with 351 MSM; (iii) a longitudinal qualitative cohort study with 72 MSM; (iv) routine programme monitoring in three sites; (v) a programme-specific costing exercise; and (vi) mathematical modelling. This protocol evaluates the impact of community-based implementation of HIV self-testing delivery strategies among MSM in Kenya on reducing the undiagnosed MSM population, and time for linkage to prevention, treatment and care following HIV self-testing. Baseline data collection started in April 2019 and the endline data collection will start in July 2020. DISCUSSION: This study is one of the first programme science studies in Sub-Saharan Africa exploring the effectiveness of integrating HIVST interventions within already existing HIV prevention and treatment programmes for MSM in Kenya at scale. Findings from this study will inform national best approaches to scale up HIVST among MSM in Kenya.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Programas de Rastreamento/métodos , Autocuidado , Adolescente , Adulto , Estudos de Coortes , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Quênia , Estudos Longitudinais , Masculino , Programas de Rastreamento/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Projetos de Pesquisa , Adulto Jovem
16.
Cult Health Sex ; 21(11): 1240-1256, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30632909

RESUMO

Newly proposed legislation that aims to protect the well-being of transgender people in India offers hope of greater recognition of human rights and improved access to entitlements for these marginalised groups. However, social welfare and health institutions have a long way to go in translating proposed legislation into policies that can concretely address the social suffering of transgender people. Drawing on ethnographic field research in northern Karnataka among a highly understudied transgender group known as the jogappas, we describe the effects of overlapping forms of structural violence surrounding education, subsistence, family life and attempts to access social and health services. Findings reveal how social inequities are implicated in the emergence of transgender subjectivities along the road to becoming a jogappa. Our findings alert policy makers to the diverse needs of transgender people in India, which continually evolve while rooted in moral histories of religiosity.


Assuntos
Direitos Humanos , Pessoas Transgênero/psicologia , Violência , Adulto , Antropologia Cultural , Feminino , Direitos Humanos/legislação & jurisprudência , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Pobreza
17.
BMC Public Health ; 17(1): 469, 2017 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-28521748

RESUMO

BACKGROUND: The HIV epidemic among men who have sex with men (MSM) continues to expand globally. The addition of an efficacious, prophylactic vaccine to combination prevention offers immense hope, particularly in low- and middle- income countries which bear the greatest global impact. However, in these settings, there is a paucity of vaccine preparedness studies that specifically pertain to MSM. Our study is the first vaccine preparedness study among MSM and female sex workers (FSWs) in Kenya. In this paper, we explore willingness of Kenyan MSM to participate in HIV vaccine efficacy trials. In addition to individual and socio-cultural motivators and barriers that influence willingness to participate (WTP), we explore the associations or linkages that participants draw between their experiences with or knowledge of medical research both generally and within the context of HIV/AIDS, their perceptions of a future HIV vaccine and their willingness to participate in HIV vaccine trials. METHODS: Using a social network-based approach, we employed snowball sampling to recruit MSM into the study from Kisumu, Mombasa, and Nairobi. A field team consisting of seven community researchers conducted in-depth interviews with a total of 70 study participants. A coding scheme for transcribed and translated data was developed and the data was then analysed thematically. RESULTS: Most participants felt that an HIV vaccine would bring a number of benefits to self, as well as to MSM communities, including quelling personal fears related to HIV acquisition and reducing/eliminating stigma and discrimination shouldered by their community. Willingness to participate in HIV vaccine efficacy trials was highly motivated by various forms of altruism. Specific researcher responsibilities centred on safe-guarding the rights and well-being of participants were also found to govern WTP, as were reflections on the acceptability of a future preventive HIV vaccine. CONCLUSION: Strategies for engagement of communities and recruitment of trial volunteers for HIV vaccine efficacy trials should not only be grounded in and informed by investigations into individual and socio-cultural factors that impact WTP, but also by explorations of participants' existing experiences with or knowledge of medical research as well as attitudes and acceptance towards a future HIV vaccine.


Assuntos
Vacinas contra a AIDS/administração & dosagem , Pesquisa Biomédica/métodos , Infecções por HIV/prevenção & controle , Voluntários Saudáveis/psicologia , Homossexualidade Masculina/psicologia , Profissionais do Sexo/psicologia , Adolescente , Adulto , Altruísmo , Feminino , Humanos , Quênia , Masculino , Motivação , Seleção de Pacientes , Estigma Social , Adulto Jovem
18.
AIDS Care ; 27(10): 1241-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26295360

RESUMO

This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers (SWs); and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of SWs and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by SWs. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44-9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03-24.16]) or both equally (AOR = 3.18[1.39-7.80]) (versus by the SWs herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for SWs in the context of their relationships with NPPs.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Sexo Seguro/estatística & dados numéricos , Profissionais do Sexo/psicologia , Parceiros Sexuais , Adolescente , Estudos Transversais , Feminino , Fertilidade , Humanos , Índia , Relações Interpessoais , Masculino , Profissionais do Sexo/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Saúde da Mulher , Adulto Jovem
19.
Cult Health Sex ; 16(2): 149-63, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24236895

RESUMO

Evidence suggests that in India, the early stages of a woman's career as a sex worker may be an important period to target for HIV and sexually transmitted infection prevention. Before such an intervention is designed and implemented, it is necessary to first understand the life circumstances of women at the start of their sex work careers. We performed a review to bring together available literature pertaining to entry into sex work in India and to highlight knowledge gaps. We found that historical traditions of dedication into sex work, financial insecurity, family discord, violence and coercion, and desire for financial independence are commonly reported reasons for entering into sex work. We also found that families and the broader sex worker community play an important role in the early stages of a woman's sex work career. We suggest that HIV-prevention programmes in India would substantially benefit from a deeper understanding of the life circumstances of new and young women sex workers. Further research should be conducted focusing on family and community involvement in women's entry into sex work, and on the important period of time after a woman's first commercial sex encounter, but before self-identification as a sex worker.


Assuntos
Conflito Familiar , Pobreza , Trabalho Sexual , Violência , Mulheres , Coerção , Feminino , Infecções por HIV/prevenção & controle , Tráfico de Pessoas , Humanos , Índia , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/prevenção & controle
20.
BMJ Open ; 14(2): e077955, 2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326243

RESUMO

INTRODUCTION: Sexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men's access to sexual healthcare. METHODS AND ANALYSIS: To conduct this scoping review, we will follow the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews. To classify the barriers to sexual healthcare, we will employ Bronfenbrenner's socioecological model as a conceptual framework. We will conduct a literature search via Medline, Embase and Global Health (OVID); Scopus; CINAHL on EBSCOhost along with several other EBSCOhost databases (Academic Search Complete, Canadian Reference Centre, Alternative Press Index, Family & Society Studies Worldwide, Social Work Abstracts) and Google Scholar, published until November 2023. Journal articles, published in the English language, describing quantitative and qualitative research on sexual healthcare access barriers for sexually diverse Muslim men will be included in the review. Commentaries and correspondences, along with grey literature including research reports and conference abstracts, as well as studies that do not include men with the Muslim faith, will be considered ineligible. Following screening of titles and abstracts, we will conduct a full-text screening to determine the final number of studies to be included in the review. A Microsoft Excel spreadsheet will be used to extract study characteristics, and information on sexual healthcare access barriers will be classified according to the socioecological model's core concepts. ETHICS AND DISSEMINATION: Our review does not require ethics approval. We will disseminate the review findings through peer-reviewed academic journals, seminars and conference presentations.


Assuntos
Atenção à Saúde , Islamismo , Humanos , Masculino , Canadá , Atenção à Saúde/métodos , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
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