The precarity of mobile loan debt and repayment among female sex workers in Nairobi, Kenya: Implications for sexual health.

Financial technology tools have been utilised to create readily available mobile loan platforms for urban-based, daily-wage earners in Kenya. From a financial lending perspective, this development signals greater inclusion and equality in formal bank financing systems. In this paper, however, we examine mobile loans and their repayment from the perspective of women who sell sex in Nairobi, drawing upon the qualitative findings of two community-based studies conducted in close collaboration with sex worker-led organisations serving the sexual health needs of their peers. Our findings suggest that mobile loans may undermine the financial security strategies and economic independence of sex workers, leaving these women in more precarious economic circumstances, which have been shown in other instances to have effects on sexual risk taking and vulnerability to HIV infection.

Actions needed to promote health equity and the mental health of Canada's Black refugees.

OBJECTIVES: The overall goal was to synthesize knowledge on actions that need to be taken to promote health equity and the mental health of Black refugees in Canada. DESIGN: Group concept mapping systems were applied to generate and organize action-oriented statements related to the different social determinants of health. A total of 174 participants from the cities of Calgary and Edmonton with experience working with Black Canadians participated in four focus groups: (a) 2 focus groups that engaged 123 participants in brainstorming 84 statements guided by the following focus prompt: 'A specific action that would improve the mental health equity of Black refugees living in Canada is … ' and (b) 2 focus groups of 51 participants who sorted the generated statements and rated them by order of 'importance' and 'ideas seen in action.' Data was further computed and analysed by the research team and a select advisory group from the participants. RESULTS: A 10-cluster map generated included the following clusters: (1) promoting cultural identity, (2) promoting ways of knowing, (3) addressing discrimination and racism, (4) addressing the criminalization of Black Canadians, (5) investing in employment for equity, (6) promoting equity in housing, (7) facilitating self-determination, (8) improving (public) services, (9) promoting appropriate and culturally relevant mental health services, and (10) working with and addressing faith and belief related issues. Clusters 4 and 9 ranked as the most important clusters in promoting health equity and the mental health of Black Canadians. CONCLUSIONS: Addressing the criminalization of Black Canadians through a range of rehumanizing interventions at institutional levels will provide a platform from which they can participate and engage others in developing appropriate and culturally relevant mental health services.

Supporting front-line practitioners' professional development and job satisfaction in mental health and addiction.

Substantial organizational change in many health institutions has eliminated profession-based departments and replaced them with program management structures. This article aims to explore practitioners' perceptions of their professional work in a large urban centre for addiction and mental health that has undergone such change. Seventy-six practitioners from six professions participated in focus groups that were transcribed and analyzed. Practitioners' perceptions about their professional competence, performance, development, and job satisfaction were affected by three interrelated factors: available supervision from experts who validate practitioners' subjective work experiences and provide population-specific knowledge for effective interventions; teams that provide a home base and support through positive interpersonal relations, collaboration and informal feedback; and organizations and managers who provide assistance and training while expecting quality performance and productivity. Effective clinical and organizational leaders manage tensions between providing supportive environments and expecting accountability throughout the workplace.