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1.
Orv Hetil ; 161(2): 56-66, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31902233

RESUMO

Introduction: The stigmatization of mental patients is a priority topic in both domestic and international research. In addition to social prejudices, people living with mental illness must also struggle with the stigmatizing attitude of health professionals. Aim: It was a survey of attitudes of nursing health care professionals towards psychiatric patients and mental illnesses. We also aimed to assess mental health knowledge among the nursing staff. In the light of the results, our aim was to make proposals for the reform of nursing education. Method: We performed the survey among members of the Hungarian Chamber of Health Care Professionals, in 4 sections (paramedics, emergency nurses, psychiatric nurses and adult nurses). We analyzed the results of the online quantitative survey with multiple variables descriptively. Results: 495 of the completed questionnaires were evaluable (n = 495). Psychiatric nurses are characterized by a less stigmatizing attitude towards rescue and emergency carers and other adult nurses. Less stigmatizing attitudes are characterized by BSc and MSc graduates than those who have secondary education. Almost half of all nurses (47%) in the study feel they have a lack of preparedness about mental illnesses. The rate is 49% for rescue and emergency workers, and 55% for members of the adult care section. There is also a relatively high proportion (28%) of psychiatric nurses, who consider their skills to be inadequate. At the same time, of course, this group replied in the highest proportion (37%) that his knowledge is adequate. Conclusion: Psychiatric education should be made more effective at all levels of nursing training. It would also be important to incorporate sensitizing and anti-stigma methods and to develope empathy. Orv Hetil. 2020; 161(2): 56-66.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Transtornos Mentais/psicologia , Estigma Social , Adulto , Humanos
2.
Psychiatr Prax ; 47(1): 35-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910459

RESUMO

OBJECTIVE: Borderline Personality Disorder (BPD) appears to be the most stigmatized diagnosis among personality disorders. This study aims to assess attitudes of psychiatric nurses towards patients with BPD compared to patients with depressive disorder. METHOD: 37 psychiatric nurses were randomized to an experimental between-subject design, in form of two questionnaires with different vignettes. The vignettes examined main outcomes such as negative attitudes, social distance and emotional reactions. RESULTS: Significant moderate to large differences in terms of social distance (p = 0.033, d = -0.736) and single emotional reactions towards patients with BPD (p = 0.017, d = 0.82), e. g. "I have compassion with her" were found. CONCLUSION: Patients with BPD have a substantial need for support. Quality and standards of inpatient care of patients with a BPS disorder can only guaranteed by giving adequate information about the causes of the disorder and professional treatment of the patients. Personnel must be trained to be able to cope with the specifics of the symptoms in BPD patients.


Assuntos
Transtorno da Personalidade Borderline , Enfermagem Psiquiátrica , Estigma Social , Transtorno da Personalidade Borderline/psicologia , Feminino , Alemanha , Hospitalização , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
4.
J Homosex ; 67(1): 79-103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30307800

RESUMO

Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.


Assuntos
Afro-Americanos/psicologia , Homossexualidade Masculina/psicologia , Minorias Sexuais e de Gênero/psicologia , Mídias Sociais , Espiritualidade , Adolescente , Adulto , Grupos Focais , Infecções por HIV/psicologia , Humanos , Masculino , Estigma Social , Tennessee , Adulto Jovem
5.
Epidemiol Psychiatr Sci ; 29: e82, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839013

RESUMO

AIMS: This review aims to understand the scope of the literature regarding mental health-related microaggressions towards people affected by mental health problems. METHODS: A scoping review was conducted to explore this question. Four electronic health-oriented databases were searched alongside Google Scholar. As per scoping review principles, the inclusion criteria were developed iteratively. The results of included studies were synthesised using a basic narrative synthesis approach, utilising principles of thematic analysis and thematic synthesis where appropriate. RESULTS: A total of 1196 records were identified, of which 17 met inclusion criteria. Of these, 12 were peer-reviewed journal articles, three were research degree theses and two were book chapters. Six included empirical studies were qualitative, four were quantitative and two employed a mixed-methods design. Within these, five qualitative studies aimed to describe the nature of mental health microaggressions experienced by people with mental health problems. Themes identified in a thematic synthesis of these five studies included stereotypes about mental illness, invalidating peoples' experience and blaming people with mental illness for their condition. The included publications informed on the perpetration of mental health microaggressions by family, friends, health professionals and social workers. In addition, two studies created scales, which were then used in cross-sectional surveys of the general public and community members to assess characteristics, such as right-wing political views, associated with endorsement of mental health microaggressions. A consensus definition of microaggressions emerged from the included studies: microaggressions are brief, everyday slights, snubs or insults, that may be subtle or ambiguous, but communicate a negative message to a target person based on their membership of a marginalised group, in this case, people affected by mental illness. CONCLUSIONS: The study of mental health microaggressions is an emerging, heterogeneous field, embedded in the wider stigma and discrimination literature. It has been influenced by earlier work on racial microaggressions. Both can be ambiguous and contradictory, which creates difficulty defining the boundaries of the concept, but also underpins the key theoretical basis for the negative impact of microaggressions. Mental illness is a more concealable potential type of identity, so it follows that the reported perpetrators of microaggressions are largely friends, family and professionals. This has implications for intervening to reduce the impact of microaggressions. There are several challenges facing research in this area, and further work is needed to understand the impact of mental health microaggressions on people affected by mental health problems.


Assuntos
Agressão/psicologia , Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes/psicologia , Preconceito/psicologia , Discriminação Social , Estigma Social , Grupos de Populações Continentais/psicologia , Humanos , Saúde Mental , Estereotipagem
6.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864297

RESUMO

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Assuntos
Aconselhamento/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estigma Social , Fatores Socioeconômicos , Adulto Jovem
7.
Praxis (Bern 1994) ; 108(15): 971-976, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31771494

RESUMO

HIV in Sub-Saharan Africa: Where Are We Today? Abstract. In sub-Saharan Africa the HIV epidemic has changed remarkedly due to expanded testing and easier access to antiretroviral medication. The rate of new infections has decreased substantially since 2005, the life expectancy of people living with HIV has increased and the mortality rate has declined. Yet still a lot needs to be achieved to stop the ongoing epidemic. Women are still at a higher risk to get infected and stigma and discrimination are a hindrance to further reduce the incidence. Challenges like the lack of technical capacities, especially to perform viral load and resistance testing, refusal of testing or condom use and increasing drug resistance to first-line therapies jeopardize the goal of 90-90-90: 90 % of people tested, 90 % of positives under care and 90 % of treated persons virologically controlled. New testing strategies and medication with higher efficacies which, when taken regularly, stop the transmission completely, provide hope in the fight against HIV.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , África ao Sul do Saara , Feminino , Humanos , Incidência , Estigma Social
9.
N Engl J Med ; 381(21): 2067-2069, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31747732
10.
Indian J Med Ethics ; 4(3): 253-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727604

RESUMO

I was a student of the Government Medical College (GMC), Nagpur, from 1970 to1975. Based on my own experiences, I agree completely with Anurag Bhargava's comments regarding casteism at GMC Nagpur (1). Caste stigma gets attached to you early in life and stays with you till you reach the grave. I am still afraid to visit my so-called alma mater and I will explain why in this letter.


Assuntos
Governo , Universidades , Humanos , Índia , Estigma Social
11.
Psychiatr Prax ; 46(8): 439-444, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31683334

RESUMO

OBJECTIVE: The investigation of mediating effects of empowerment and stigmatization on the association between depressive symptoms and subjective quality of life in patients with affective disorders. METHOD: Depressive Symptoms (BDI-II), internalized and perceived stigmatization (ISMI; PDDQ), empowerment (EPAS) and subjective quality of life (WHOQOL-BREF) were assessed in 37 patients with affective disorders (F31 - F33; ICD-10), age 18+ in inpatient, day hospital or outpatient psychiatric treatment. Data analyses were conducted by means of path-analysis. RESULTS: Empowerment and in low proportion internalized and perceived stigma turned out to be mediating variables between the severity of depression and subjective quality of life. 57 % of the variance of the subjective quality of life could be explained by the path model. CONCLUSION: Empowerment has meaningful influence mediating between depression and subjective quality of life. In order to improve the quality of life of patients with an affective disorder, strategies for increasing empowerment are to be integrated into treatment.


Assuntos
Transtornos do Humor/psicologia , Qualidade de Vida , Estigma Social , Alemanha , Humanos , Participação do Paciente , Índice de Gravidade de Doença
12.
Metas enferm ; 22(9): 16-26, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185038

RESUMO

Objetivo: describir la percepción que tienen los estudiantes de Ciencias de la Salud acerca de las personas con problemas de salud mental e identificar los factores que se relacionan con dichas atribuciones. Método: estudio descriptivo transversal llevado a cabo en 2018. La muestra estaba formada por estudiantes de Enfermería y Fisioterapia del Centro Universitario de Ciencias de la Salud San Rafael-Nebrija de Madrid (España). Se recopilaron variables identi- ficativas del sujeto de estudio y se utilizó el cuestionario de Atribución AQ-27, que consta de 27 ítems y nueve factores que informan sobre responsabilidad, piedad, ira, peligrosidad, miedo, ayuda, coacción, segregación y evitación. Se realizaron análisis uni y bivariantes. Resultados: participaron 262 estudiantes de Ciencias de la Salud, 67,8% (n= 177) del Grado de Enfermería y 32,2% (n= 84) del Grado de Fisioterapia. El 77,4% (n= 202) era mujer. La edad osciló entre 18-45 años. El 9,3% tenía formación en salud mental, el 9,9% experiencia laboral en el área, el 23,3% presentó antecedentes familiares en trastornos de salud mentaly el 7% antecedentes personales. Los valores medios (desviación estándar) más altos los presentaron en los factores "ayuda" 7,66 (1,37), "coacción" 6,56 (1,62) y "piedad" 6,51 (1,36). Los más bajos en "ira" 3,41 (1,79) y "responsabilidad" 2,50 (1,35). Se encontraron diferencias estadísticamente significativas (p< 0,05) en ira y ayuda respecto al título de Grado; en segregación respecto a la formación previa en salud mental; y en peligrosidad, miedo, ayuda, segregación y evitación respecto a antecedentes personales en salud mental. Conclusiones: los estudiantes de Ciencias de la Salud destacan en las dimensiones de ayuda, piedad y coacción; y obtienen valores más bajos en ira y responsabilidad. La formación previa en salud mental influye sobre el factor segregación. La presencia de antecedentes personales en salud mental influye sobre los factores miedo, peligrosidad, ayuda, segregación y evitación


Objective: to describe the perception by Health Sciences students of persons with mental health problems, and to identify the factors associated with said attributions. Method: a descriptive cross-sectional study conducted on 2018. The sample included Nursing and Physical Therapy students from the Centro Universitario de Ciencias de la Salud San Rafael-Nebrija from Madrid (Spain). Identification variables of the study subject were collected, and the AQ-27 Attribution Questionnaire was used, which consists of 27 items and nine factors informing about Blame, Anger, Pity, Dangerousness, Fear, Help, Segregation, Coercion and Avoidance. Univariate and bivariate analyses were carried out. Results: the study included the participation of 262 Health Sciences students: 67.8% (n= 177) from Nursing and 32.2% (n= 84) from Physical Therapy; 77.4% (n= 202) were female. There was an 18-to-45-year-old age range; 9.3% had mental health training, 9.9% had working experience in the area, 23.3% presented a family background with mental health disorders, and 7% had a personal background. The highest mean values (standard deviation) were present in the following factors: "help" with 7.66 (1.37), "coercion" with 6.56 (1.62), and "pity" with 6.51 (1.36). The lowest values (p≤ 0.05) were found in "anger" with 3.41 (1.79) and "blame" with 2.50 (1.35). Statistically significant differences were found in Anger and Help in terms of the type of degree; in Segregation in terms of previous training in Mental Health; and in Dangerousness, Fear, Help, Segregation and Avoidance in terms of personal mental health background. Conclusions: Health Sciences students stood out in the Help, Pity and Coercion dimensions, and obtained lower values in Anger and Blame. Previous training in mental health had impact on the Segregation factor. The presence of personal background in mental health had impact on these factors: Fear, Dangerousness, Help, Segregation and Avoidance


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Estigma Social , Transtornos Mentais/epidemiologia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Estudos Transversais , Inquéritos e Questionários , Saúde Mental
13.
Rev. bioét. derecho ; (47): 93-107, nov. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184868

RESUMO

Este artículo tiene como propósito reflexionar sobre la situación de estigma y discriminación que afecta a personas con VIH/SIDA. Esto constituye una vulneración a los derechos fundamentales de estas personas y una barrera en el avance hacia la eliminación de la enfermedad. Ya que estudios realizados en diferentes países dan cuenta que las personas en esta condición se sienten discriminadas por la sociedad, y por los profesionales de la salud. Este es uno de los aspectos que ha dificultado el acceso al tratamiento, su adhesión, y educación para el cambio de conducta en los grupos de riesgo


Aquest article té com a propòsit reflexionar sobre la situació d'estigma i discriminació que afecta a persones amb VIH/SIDA. Això constitueix una vulneració dels drets fonamentals d'aquestes persones i una barrera en l'avanç cap a l'eliminació de la malaltia. Estudis realitzats en diferents països exposen que les persones en aquesta condició se senten discriminades per la societat i pels professionals de la salut. Aquest és un dels aspectes que ha dificultat l'accés al tractament, l'adhesió al mateix, i educació per al canvi de conducta en el grups de risc


This article aims to reflect on the situation of stigma and discrimination affecting people with HIV/AIDS. This constitutes a violation of the fundamental rights of these people and a barrier to progress towards the elimination of the disease. Studies carried out in different countries show that people in this condition feel discriminated against by society and by health professionals. This is one of the aspects that has hindered access to treatment, adherence, and behaviour change education in at-risk groups


Assuntos
Humanos , Ageismo/ética , Sexismo , Discriminação Social , Estigma Social , Grupos de Risco , Relações Profissional-Paciente/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Pessoal de Saúde/ética , Síndrome de Imunodeficiência Adquirida/epidemiologia , Soroprevalência de HIV , Acesso aos Serviços de Saúde/ética , Direitos Humanos
14.
BMC Health Serv Res ; 19(1): 746, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651300

RESUMO

BACKGROUND: Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services. METHODS: Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically. RESULTS: The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours. CONCLUSION: This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs' engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adulto , Atitude Frente a Saúde , Utilização de Instalações e Serviços , Feminino , Grupos Focais , Infecções por HIV/prevenção & controle , Pessoal de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Organizações/estatística & dados numéricos , Defesa do Paciente , Papel Profissional , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Estigma Social , África do Sul , Adulto Jovem
16.
BMC Public Health ; 19(1): 1382, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660947

RESUMO

BACKGROUND: Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi. METHODS: We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach. RESULTS: Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships. CONCLUSION: The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Instalações Privadas/estatística & dados numéricos , Adulto , Revelação , Medo , Feminino , Infecções por HIV/psicologia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estigma Social , Adulto Jovem
17.
J Couns Psychol ; 66(5): 564-576, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31580125

RESUMO

Sexual minorities high in attachment avoidance (i.e., discomfort with closeness) and attachment anxiety (i.e., fear of abandonment) tend to report greater internalized heterosexism. Yet, the causes of this link have not been fully explored. Some propose that insecure attachment schemas may make it difficult to form the types of social connections that can help alleviate internalized stigma (and vice versa: internalized heterosexism might make one avoid the types of relationships that would foster secure attachment). This study used structural equation modeling to test whether reduced connection to the LGBTQ+ community could help explain the link between insecure attachment and internalized heterosexism. Study 1 (n = 480) explored links between attachment avoidance, attachment anxiety, community connectedness and internalized heterosexism. Higher avoidance predicted lower connection which, in turn, predicted higher internalized heterosexism. Attachment avoidance's association with internalized heterosexism was fully explained by an indirect effect through connectedness. Conversely, attachment anxiety did not predict connectedness or internalized heterosexism. Study 2 (n = 447) replicated these findings. These results suggest low connectedness might help explain the association between attachment insecurity and internalized heterosexism, though this path might be specific to attachment avoidance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aprendizagem da Esquiva , Heterossexualidade/psicologia , Relações Interpessoais , Modelos Psicológicos , Apego ao Objeto , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Mecanismos de Defesa , Medo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estigma Social , Adulto Jovem
18.
AIDS Behav ; 23(Suppl 3): 276-286, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31586283

RESUMO

We characterized the potential benefits and risks of participating in a microenterprise program targeting low-income women living with HIV (WLWH) in Alabama; and described potential mechanisms through which microenterprise programs could influence sexual risk behaviors and engagement in HIV care. Fourteen stakeholders and 46 WLWH (89% African American) participated in the qualitative study. Data were collected using in-depth interviews (stakeholders) and focus group discussions (WLWH). NVivo qualitative software was used for the management and analysis of the data. The data revealed four main mechanisms through which microenterprise programs could potentially improve health outcomes: (1) social support and encouragement from other women, (2) improvement in self-esteem, (3) creating structure in the women's lives, and (4) financial strengthening. Potential risks included unwanted disclosure of HV status, stigma and loss of insurance benefits. Microenterprise programs have the potential to be acceptable and may contribute to improved health and social outcomes among low-income WLWH in Alabama.


Assuntos
Infecções por HIV/psicologia , Motivação , Autoimagem , Empresa de Pequeno Porte/organização & administração , Adulto , Alabama/epidemiologia , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Pobreza , Pesquisa Qualitativa , Assunção de Riscos , Comportamento Sexual , Estigma Social
19.
Lancet ; 394(10210): 1750-1763, 2019 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-31604660

RESUMO

BACKGROUND: Women across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries. METHODS: We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment. FINDINGS: 2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15-19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6-8·0) and younger women with some education (OR 1·6, 1·1-2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity. INTERPRETATION: More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context. FUNDING: United States Agency for International Development and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.


Assuntos
Trabalho de Parto/psicologia , Parto/psicologia , Violência/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Gana , Guiné , Acesso aos Serviços de Saúde , Humanos , Mianmar , Nigéria , Gravidez , Estudos Prospectivos , Estigma Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
20.
Nonlinear Dynamics Psychol Life Sci ; 23(4): 491-515, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31586499

RESUMO

The number of people living with HIV (PLWH) increases rapidly with advancement in antiretroviral therapy. Suicide prevention is challenging, particularly for PLWH because of the negative impact of HIV-related stigma and social capital reduction. However, only a small proportion of the variance in suicide risk can be explained by these variables if a linear paradigm is used as guidance. In this study, we tested a nonlinear cusp catastrophe modeling. Participants (N = 523) were PLWH selected through a risk venue-based method in Wuhan, a provincial capital city in China. Suicidal ideation post HIV+ diagnosis and in the past 30 days and suicide plan and attempt were assessed. Data were collected using self-report questionnaire and were analyzed using both the direct and multivariate stochastic cusp catastrophe modeling methods with social capital as asymmetry variable and HIV-related stigma as bifurcation variable. The analysis was executed using R, including nls() function for the direct method and 'cusp' package for the stochastic modeling. Results from stochastic cusp modeling analysis indicated that social capital was significantly associated with risk of suicide after controlling for key covariates; the association was significantly bifurcated by HIV-related stigma. The data fit the cusp model better than the alternative linear model (R2 =.483 vs. .127). Findings of this study indicate suicide behaviors among Chinese PLWH follow a nonlinear dynamic system. In addition to enhancing our understanding of suicide risk, findings of this study underscore the significance in social capital enhancement and stigma reduction for suicide prevention among PLWH in China.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Estigma Social , Suicídio/psicologia , Suicídio/estatística & dados numéricos , China/epidemiologia , Humanos , Ideação Suicida
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