Sex Differences in HIV Testing among Older Adults in Sub-Saharan Africa: A Systematic Review.

BACKGROUND: Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. METHODS: A systematic search of four databases, namely, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Global Health, was conducted from 2000 to January 2020. The primary outcome of interest for this study was gender differences in HTC among older adults in SSA. Observational studies including cross-sectional, retrospective, and prospective cohort studies were included. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. RESULTS: From the database search, 4143 articles were identified. Five studies were ultimately included in the final review. Of the 1189 participants, 606 (51.1%) and 580 (48.9%) were female and male, respectively. The review findings suggested that both men and women preferred HTC providers that are the same sex as them with women additionally preferring a provider who is also of a similar age. Men and women differed in their pathways to getting tested for HIV. The review documented mixed results with regard to the associations between sex of older adults and uptake of HTC. Older adult HTC uptake data are limited in scope and coverage in sub-Saharan Africa. CONCLUSION: This review revealed shortage of evidence to evaluate optimum HTC utilization among older adults. Few studies examined sex differences in HIV testing among older adults in the region. There is a need for stakeholders working in the area of HIV prevention and treatment to focus on older adult health utilization evidence organization, disaggregated by age and sex. Hence, high-quality research designs are needed on the topic in order to generate good quality evidence for targeted interventions to improve HTC among older adults in sub-Saharan Africa.

Stopping exploitation: Properly remunerating healthcare workers for risk in the COVID-19 pandemic.

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID-19 patients-and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, assuming healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement.

Health Risk Behaviors and Resilience Among Low-Income, Black Primary Care Patients: Qualitative Findings From a Trauma-Informed Primary Care Intervention Study.

This study describes an intervention with low-income, Black primary care patients and their experience in changing a health risk behavior. Participant themes, including behavioral coping, personal values, accomplishments and strengths, barriers and strategies, and social support, are understood in relationship to health behavior theories. Two structured interviews were conducted 1 month apart. Content analysis was used to analyze responses from 40 participants. Participants were well equipped with resilience-based coping, self-efficacies, and informal social networks despite economic and social disadvantages. Findings from this study have the potential to improve behavioral health coping and reduce racial inequities in health prevalent for this population.

Not the doctor's business: Privacy, personal responsibility and data rights in medical settings.

This paper argues that assessing personal responsibility in healthcare settings for the allocation of medical resources would be too privacy-invasive to be morally justifiable. In addition to being an inappropriate and moralizing intrusion into the private lives of patients, it would put patients' sensitive data at risk, making data subjects vulnerable to a variety of privacy-related harms. Even though we allow privacy-invasive investigations to take place in legal trials, the justice and healthcare systems are not analogous. The duty of doctors and healthcare professionals is to help patients as best they can-not to judge them. Patients should not be forced into giving up any more personal information than what is strictly necessary to receive an adequate treatment, and their medical data should only be used for appropriate purposes. Medical ethics codes should reflect these data rights. When a doctor asks personal questions that are irrelevant to diagnose or treat a patient, the appropriate response from the patient is: 'none of your business'.

Conductas sexuales de riesgo asociadas a las infecciones de transmisión sexual en adolescentes de una comunidad / Risky sexual behaviors associated to sexually transmitted infections among adolescents in a community

Introducción:Las infecciones de transmisión sexual constituyen un grupo heterogéneo de enfermedades de extrema importancia para la salud pública mundial dada su magnitud, trascendencia y repercusión para el paciente, la familia y la sociedad. Afectan con mayor frecuencia a los adolescentes. Objetivo: Identificar conductas de riesgo asociadas a las ITS en la adolescencia. Material y métodos: Se realizó un estudio analítico de casos de estudio y control para evaluar conductas de riesgos asociadas a las ITS en adolescentes del policlínico California. Se aplicó un cuestionario semiestructurado y anónimo, para la recogida de información, los resultados fueron representados en tablas, calculándose pruebas de significación estadísticas. Resultados: El mayor número estudiado fue entre 18 y 19 años (47.0 por ciento); 50.5 por ciento presentaban cambios frecuentes de parejas; 48 por ciento mantenían relaciones sexuales desprotegidas; la percepción de riesgos de adquirir una ITS, tanto en el grupo de estudio y control fue de 23,2 por ciento y 40,3 por ciento respectivamente. Conclusiones: Las relaciones sexuales no protegidas y los cambios frecuentes de parejas constituyeron conductas sexuales de riesgos relacionadas con las Infecciones de Transmisión Sexual(AU)

Introduction: Sexually transmitted infections constitute a heterogeneous group of diseases of extreme importance for the world public health due to their magnitude, consequence, and repercussion for the patient, the family, and the society. Adolescents are more highly affected by them. Objective: To identify risky behaviors associated to STI in the adolescence. Material and Methods: An analytical case-control study was conducted to evaluate risky behaviors associated to STI in adolescents in California Polyclinic. A semi-structured and anonymous questionnaire was used to attain information, and the results were represented in charts in which significant statistics were calculated. Results: The greatest number studied was the one of 18 and 19 years of age (47.0 percent); 50.5 percent presented frequent changes in their couples; 48 percent maintained unprotected sexual relations; the risk perception of acquiring a STI both in the study and the control group was 23,2 percent and 40,3 percent, respectively. Conclusions: Unprotected sexual relations and frequent changes in couples were the risky sexual behaviors related to Sexually Transmitted Infections.